Tag Archives: Social Justice

Social Justice

Stepping across the poverty line

By Laurie Meyers May 26, 2016

According to a study by the U.S. Census Bureau, there were 46.7 million Americans living in poverty in 2014, or a poverty rate of 14.8 percent. The picture was even bleaker for many ethnic and racial minorities. The same study found that 26.2 percent of African Americans (10.8 million people) and 23.6 percent of Hispanic Americans (13.1 million people) lived in poverty. Children were also particularly vulnerable. The study reported that 21.1 percent of Americans under the age of 18 lived in poverty.

What qualifies as living in poverty? The answer is not simple. A number of factors are involved in calculating income, and the Census Bureau has created 48 possible poverty thresholds. Broadly, however, any single individual younger than 65 with an income of less than $12,316 or any single individual 65 or older with an income of less than $11,354 is considered to be living in Branding-Images_povertypoverty. The poverty threshold for two people under the age of 65 living together is $15,934, and the threshold for two people over the age of 65 living together is $14,326. For a family of three — one child and two adults — the threshold is $19,055. For a family of three with one adult and two children, the threshold is $18 higher at $19,073.

The thresholds are derived using the Orshansky Poverty Thresholds, a formula originally developed in the 1960s by Mollie Orshansky, an economist working for the Social Security Administration. The formula compares pretax cash income against a level set at three times the cost of a minimum food diet in 1963 in today’s prices (updated annually for inflation using the Consumer Price Index).

However, these numbers can’t truly capture the reality of daily life for those living under the strain of poverty, say counselors who regularly work with client populations that are economically disadvantaged. Imagine taking multiple buses and dedicating up to two hours of travel time to get someplace that someone who owns a car can reach in 20 minutes. Imagine having to choose between buying groceries or paying the electric bill. Imagine managing a chronic illness while living on the streets.

Counselors are trained in diversity and multiculturalism, but does this awareness of discrimination and alternative worldviews necessarily include those living poverty? Not often enough, asserts Pam Semmler, a licensed professional counselor (LPC) and private practitioner in Denver. “I’ve been to a lot of diversity trainings, and none of them covered socioeconomic barriers,” she says.

The average counselor doesn’t have adequate training or even a good frame of reference when it comes to clients living in poverty, says Semmler, who spent more than nine years counseling clients at the Colorado AIDS Project. The project is part of the Colorado Health Network, a statewide organization that provides health services, case management, substance abuse counseling, housing assistance, transportation, nutrition services and financial assistance to people with HIV and those at risk. Semmler has also provided training to staff at the Colorado Coalition for the Homeless on diversity issues specifically related to working with those in poverty.

Of course, people living in poverty are not one monolithic culture, Semmler stresses. However, they do share something deeply significant: a lack of money and limited access to the resources that money typically makes available.

“Poverty is actually a lack of multiple resources,” Semmler says. Financial resources are the most obvious, but those living in poverty also often lack health, housing, social, family, emotional and sometimes even spiritual resources, she continues.

To help clients living in poverty, counselors first need to understand the barriers that these individuals face in their everyday lives, say Semmler and other experts.

A different world

“We tend not to talk about a ‘culture of poverty’ as in years past,” says Louisa Foss-Kelly, a professor in the Counseling and School Psychology Department at Southern Connecticut State University whose research interests include counseling people who are economically disadvantaged. “However, people living in poverty often share perspectives and engage in similar survival-related activities. They do whatever it takes to meet their needs or those of the family’s.”

“For example,” she continues, “a client may sell belongings on the street to make some quick cash, barter services with neighbors and find other creative ways to pay bills that might not be understood by people in the middle or upper class.”

Because counselors often come from middle-class backgrounds, the practice of counseling often reflects those experiences and values, but practitioners should take care not to judge clients through this lens, says Foss-Kelly, an American Counseling Association member and LPC who has worked in community counseling settings with clients living in poverty.

“Unfortunately, many counselors have never been challenged to explore their own biases about poverty,” she says. “They may not understand the impact of their own socioeconomic history on the process of counseling.”

Counselors simply aren’t trained in the realities of living in poverty as part of their counseling education, says Victoria Kress, an ACA member and past president of the Ohio Counseling Association whose research interests include working with client populations that are economically disadvantaged. “For example, I was trained as a counselor in the early 1990s, and my training was based on middle-class values and assumptions,” she says. “It was assumed that my future clients would come in for counseling of their own volition; they would have food in their bellies; they’d be safe; they’d be verbal and forthcoming; they’d have transportation; they’d be invested in growing and living up to their optimal potential. As I began to see clients, it became increasingly clear that none of these assumptions was accurate.”

“People living in poverty engage in a constant financial battle,” Foss-Kelly adds. “They may have to work two or three jobs, find food banks and navigate the maze of social services organizations. They may struggle with children in emotional distress because of frequent moves or other family disruptions. These clients may arrive to counseling tired, hungry or late. A judgmental counselor might say that [these clients aren’t] serious about changing or that they’re too disorganized or lazy to take care of themselves.”

Chelsey Zoldan, an LPC, currently works as a counselor at the Medication Assisted Treatment Department at Meridian HealthCare in Youngstown, Ohio. But she has also counseled those in the rural Appalachian section of the state and says that time issues — mainly clients not having enough of it and being late to appointments — were among the most common obstacles.

Many clients living in poverty have unreliable transportation or no transportation at all, Zoldan points out. In some states, public agencies may provide transportation to community clinics and other services for those living at or below the poverty line, but there is no guarantee that transportation will be timely, she continues. Some clients rely on rides from friends and family, but the person doing the driving sets the schedule, which may not fit with the client’s needs. In other instances, friends and family members may not be reliable when it comes to promises to drive or offer other assistance, she says. Public transportation may not be readily available or may require multiple transfers on a sporadic schedule.

Zoldan, an ACA member, points out that it may take clients relying on area bus service two hours to get somewhere that it would take her 20 minutes to drive to in her car. She adds that the bus schedule is inscrutable to her and her colleagues, but that clients who are struggling to get by financially routinely navigate the inconsistent routes and take multiple buses to get where they need to go. Unfortunately, as a result, they are often late or even miss appointments altogether. “Some counselors might interpret this as meaning that they [the clients] don’t care or aren’t committed to the process,” Zoldan says, acknowledging that she had to shift her own perspective regarding timeliness when she first started working with clients who were economically disadvantaged.

Some health care and other service providers may not be willing to accommodate these scheduling challenges, and that is a problem, Zoldan says, because these clients still need to be seen. And if a provider turns them away after they are late in arriving, they may not come back at all, she points out.

Clients who are economically disadvantaged may also have limited work flexibility or lack child care, adds Kress, who is the community counseling clinic director, clinical mental health counseling program coordinator and addiction counseling program coordinator at Youngstown State University in Ohio. Counselors need to be sensitive to the logistical problems that these clients face, she says.

When possible, Kress says, practitioners should consider providing in-home counseling and flexible or drop-in scheduling. In addition, clinics or practices that have the resources might consider offering day care and transportation assistance, which could involve providing the actual transportation or giving out public transportation vouchers, Kress says.

Meeting basic needs

As Kress began her counseling career, she realized that many of her clients living near the poverty line were struggling simply to survive. This reality often required her to be more “active” in these clients’ lives than her training had prepared her for.

“One of my first clients — a teenage mother — came [to counseling] in crisis because her electricity had been turned off,” Kress remembers. “In that situation, what she needed from me was to help her figure out how to get it turned back on. Having never had my electricity turned off, I had no idea where to begin. And my counseling textbooks didn’t talk about how to get one’s electricity turned back on. I had to put aside my expectations, be flexible and roll with helping her problem-solve her electricity situation.”

Before counselors can begin to effectively address traditional counseling concerns, they must make sure that their clients’ basic survival needs — including food, shelter and clothing — are being met, say the professionals interviewed for this article.

In doing so, counselors working with clients in poverty may find themselves playing many different roles, says Zoldan, who is also a doctoral student in the counseling program at the University of Akron. “You might have to be care coordinator, do case management, perform vocational counseling,” she says. “You might also … help with county health funds, student loans, transportation.” Counselors might also serve as de facto mental health educators for their clients, their clients’ families and even the community at large, particularly in rural settings, Zoldan adds.

Some might think that many of these services are the purview of social workers, not counselors. But Kress has a message for those who protest this expanded vision of meeting the needs of clients.

“I’d say this: How can a person work on higher order counseling goals if they are worried about where their next meal is coming from or how they will get their electricity turned back on?” Kress says. “Effective counselors are flexible and meet their clients where they are at.”

Foss-Kelly agrees. “Counselors treat the whole person in context,” she emphasizes. “So we have to acknowledge and respond to the crises our clients face when they leave the counseling room, even if those crises are financial in nature. Counselors are well-trained to provide referrals and work alongside social workers. In addition, we have to integrate the client’s basic needs into case conceptualization, treatment and treatment planning.”

Kress adds that she believes it is “old-school thinking” to state that counselors shouldn’t also help clients with their basic needs. In fact, she says, in the area of community mental health, the days of clients being assigned to a case manager who was a social worker and then to a separate counselor are long gone. “Now what we see is clients being assigned one mental health professional who provides counseling and case management. The system has had to adapt to the needs of consumers.”

Although counselors in community clinics or facilities affiliated with local social services might more commonly work with individuals living in poverty, Kress and others interviewed for this article say that most practitioners will encounter clients who are economically disadvantaged at some point.

Zoldan urges counselors to be deliberate about ensuring that these clients feel empowered in their own treatment. Taking an authoritative approach as the counselor and neglecting or diminishing the client’s input is potentially detrimental, she points out. The counselor might very well be unaware of the individual’s basic needs that are going unmet, she says, and the client may not trust the practitioner at first because he or she is viewed as an outsider. “The goal is to collaborate with your client on everything,” Zoldan says. “People in poverty are used to feeling oppressed in different ways.”

“Many people who live in poverty perceive that existing institutions do not serve their interests and needs, and counselors need to recognize that they are part of the system, whether they like it or not,” Kress adds. “Counselors must be flexible and sensitive to clients’ needs.”

Because counselors are part of the system, they should work it to their clients’ advantage, say Zoldan and Kress. It can be important for counselors to align with agencies, clinics or charities that offer assistance with food, housing, health care and other needs, Zoldan points out. She urges counselors to build relationships with these organizations and to also make contacts with officials in local service agencies such as job and family services so that clients’ needs can be better met.

Seeking solutions

In addition to the challenges related to basic survival, those living in poverty face many other barriers, Kress says. Common issues among this population include substance abuse, chronic mental or physical illnesses, teenage pregnancy and unsafe living environments that might involve intimate partner violence, she explains.

“In my experience, clients need to have counselors acknowledge and validate their experiences,” she says. “Many times, clients may not even connect the dots that these experiences are having a significant impact on their lives. In many ways, these experiences have been such a part of the landscape of their lives that they don’t recognize the impacts they have on them.”

Semmler agrees, saying that many of her clients have never had anyone explain to them how poverty has affected the entire trajectory of their lives.

Those in poverty are often blamed for their circumstances and stereotyped as lazy or incapable of saving money, Zoldan says. The reality is that many of these individuals are working two or even three jobs just to scrape by and aren’t saving money because they don’t have any to spare, she says.

“Each day may start with managing different crises — trying to find food or a place to sleep or meeting other basic needs of the family,” Foss-Kelly observes. “This survival focus inevitably impacts both the content and process of any counseling session. A person-centered approach is a critical foundation for counseling, but it may move at a pace that’s too slow for addressing crises of survival.”

Adds Kress, “When working with these populations, counselors need to be active, involved and focused on concrete and present solutions.”

Several of the counselors we spoke to emphasized the need to help these clients recognize and build on the strengths they have already developed to survive under the strain of poverty. As with any client, counselors should take into account the worldview and individual context of a person living in poverty, says Zoldan, who likes to use strength-based counseling, particularly for those coming from generations of poverty.

Contrary to the stereotype of lazy people just looking for a handout, living in poverty actually requires a significant amount of self-sufficiency, Zoldan points out. These clients typically must navigate public transportation and assistance systems and may juggle multiple jobs with child care and other family responsibilities, all of which requires a great deal of planning, she notes. Zoldan recalls a former client who had a backup plan for any major eventuality, including what to do if she couldn’t pay her rent, couldn’t afford food, lost her primary means of transportation and so on.

Kress notes that those affected by poverty may also acquire skills and strengths — including the ability to accept and handle difficult situations and live in the moment as needed — that aren’t readily apparent to most casual observers. “Identification and expansion of client and client-system strengths help to provide hope and support clients’ well-being,” she says.

In general, people who live in poverty also strongly value relationships, Zoldan says. This can oftentimes be very positive. For example, friends and family members can provide the person both emotional and practical support in the form of child care, meal sharing, housing and so on.

However, in some cases, it can also erect another barrier, Zoldan says. “Relationships are valued above all else,” she observes, meaning that counselors need to be aware that getting these clients to set boundaries or remove themselves from unhealthy living situations can be a complicated proposition.

Simply telling a client to cut off a relationship is not culturally appropriate, Zoldan says, so counselors may need to encourage other alternatives. For instance, if a client is struggling with substance abuse and her mother and sister are still using in their homes, a counselor might suggest that, rather than cutting off all contact, the client and her relatives talk only by phone or meet in public instead of in the relatives’ homes.

Ending or limiting these relationships with family and friends represents a significant loss of connection for clients. So Zoldan and her colleagues encourage these clients to get involved in 12-step programs in which they can get support and build a family of sorts within the recovery group. Zoldan’s agency also encourages group therapy, which can offer another source of connection and support for clients living in poverty.

Semmler is an attachment-focused therapist, so she always circles back to relationships. “When people attach in order to survive, the relationships are not always the most healthy,” she observes. Becoming psychologically healthy may require clients to break some of those ties, so Semmler, during her time with the AIDS project, would encourage clients to make healthy attachments to service providers and other participants in the program.

Helping the youngest living in poverty

Children living in poverty face many challenges that make it difficult for them to get an education, says Christi Jones, an ACA member who is an elementary school counselor in rural Alabama. The board of education for her school district is trying to remove one significant barrier by matching students who are in need of psychological assistance with mental health counselors. Part of Jones’ job is to help facilitate this process.

“At my school, mental health services are provided one day a week,” Jones says. “As a school counselor with approximately 600 students, collaboration with our local mental health agency assists in meeting student needs. At the beginning of each school year, I introduce the mental health counselor to teachers and staff members and assist in developing a schedule. When coming from the outside to work in a school, it is essential to have an understanding of the school culture.”

“I work with the mental health counselor to build relationships with key staff members who can assist in success in the school setting,” she continues. “The mental health counselor in turn ensures I understand what is required for students to qualify to receive services in the school setting. I can then share information about the program with both teachers and parents.”

Jones explains that students in the rural area where she works often need help beyond what she can give them as a school counselor. Transportation is an issue for many of the children’s families, so having an in-house mental health counselor at the school eliminates that barrier and also provides a source of long-term support for children and their families.

Jones sometimes continues to collaborate with the mental health counselor to address a student’s difficulties. In addition, because the mental health counselor is at the school only one day per week, Jones sometimes sees students who need additional support.

Another equally important part of her role as a school counselor is to advocate for students’ overall well-being, which sometimes means helping to meet basic needs such as food and clothing, Jones asserts. “My mentor counselor told me during my first year as a school counselor that basic needs must be met before you can work on issues,” she says. “I provide counseling to my students, but I also believe that social justice is an important part of my role as a school counselor. I work to connect my students and their families to resources.”

It is hard for children to focus on learning if they are hungry or worried about where the next meal is coming from, Jones says, so she worked with church and community leaders to create a weekend backpack program. “Local churches come each Friday and provide backpacks of food from our local food bank for students to take home,” she explains. During the winter and spring school breaks, families are also given enough food to last until school starts again.

Jones also maintains a clothing closet stocked with various seasonal clothes for students in need. She doesn’t wait for these students to approach her before offering assistance.

“If you take the time to get to know your students, it is not hard to find out who is in need,” Jones says. “If they see you on a regular basis and you talk to them, they will share their struggles and successes with you. Also, I see things just by observing students in the halls or in their classrooms. Students will sometimes come to school in flip-flops in cold weather, or you can tell their shoes or clothes are too small. Teachers also provide information about student needs.”

“As the school counselor, I have had the opportunity to help many of the families in my community,” Jones says. “Where I work, it is small enough that you get to watch your students grow up. You know all the families, and you care about your students long after they leave your building. Beyond data, I measure success in graduation invitations and students coming back to tell me they are going to college. [They are] often the first in their family to do so. There are many challenges to working with students living in a rural, high-poverty area, but there are opportunities to make a difference that make it the most rewarding profession.”

Embracing counseling’s core values

The counselors interviewed for this story emphasize that clients living in poverty want help and want to be heard. “The most important advice I can give [to counselors]: Be authentic and be understanding,” Zoldan says.

To build a therapeutic relationship with clients dealing with impoverishment — or any client, for that matter — practitioners must fall back on the core values of counseling, says Almeta McCannon, an ACA member who co-led a roundtable session at the 2016 ACA Conference & Expo in Montréal on counseling people affected by poverty. “I would advise clinicians to go back to the cornerstones of our profession: empathy, compassion, unconditional positive regard,” she says. “These are what allow us to relate to people who have experienced things we could never imagine and still be able to help them through a difficult time or situation. Assuming is the enemy here. I would encourage [counselors to ask] questions about the things that they do not understand and to really listen to the responses to those questions.”

Foss-Kelly believes counselors also need to take the next step and advocate for those living in poverty. “Counselors can play a key role in advocating for the marginalized, including those in poverty,” she says. “Of course, this advocacy begins with individual clients and communities, but it should also include spreading awareness in professional circles and among power brokers. People living in poverty come to counseling in a vulnerable state. We as counselors must fight to help other counselors understand their unique needs.”

 

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To contact the people interviewed for this article, email:

 

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Additional resources

To learn more about the topics addressed in this article, see the following resources offered by the American Counseling Association.

Books (counseling.org/bookstore)

  • ACA Advocacy Competencies: A Social Justice Framework for Counselors edited by Manivong J. Ratts, Rebecca L. Toporek & Judith A. Lewis
  • Counseling for Multiculturalism and Social Justice: Integration, Theory and Application, fourth edition, by Manivong J. Ratts & Paul B. Pedersen
  • Multicultural Issues in Counseling: New Approaches to Diversity, fourth edition, by Courtland C. Lee

Webinars (counseling.org/continuing-education/webinars)

  • “Why Does Culture Matter? Isn’t Counseling Just Counseling Regardless?” with Courtland C. Lee

Podcasts (counseling.org/continuing-education/podcasts)

  • “Hunger, Hope and Healing” with Sarahjoy Marsh
  • “Multiculturalism and Diversity. What Is the Difference? Is Not Counseling … Counseling? Why Does It Matter?” With Courtland C. Lee

VISTAS Online articles (counseling.org/knowledge-center/vistas)

  • “Counselor Training and Poverty-Related Competencies: Implications and Recommendations for Counselor Training Programs” by Courtney East, Dixie Powers, Tristen Hyatt, Steven Wright & Viola May
  • “Preparing Counseling Students to Use Community Resources for a Diverse Client Population: Factors for Counselor Educators to Consider” by Sarah Kit-Yee Lam
  • “Professional Counseling in Rural Settings: Raising Awareness Through Discussion and Self-Study With Implications for Training and Support” by Dorothy Breen & Deborah L. Drew

In addition, counselors who would like to get involved in issues of diversity and social justice may be interested in joining Counselors for Social Justice, a division of ACA. Founded in 2000, CSJ’s mission is to work to promote social justice in society through confronting oppressive systems of power and privilege that affect professional counselors and their clients and to assist in the positive change in society through the professional development of counselors. Visit CSJ’s website at counseling-csj.org.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

Multicultural and Social Justice Counseling Competencies: Practical applications in counseling

By Manivong J. Ratts, Anneliese A. Singh, S. Kent Butler, Sylvia Nassar-McMillan and Julian Rafferty McCullough January 27, 2016

During the past three decades, counseling scholars and practitioners have argued that multicultural competence is a central concern to working effectively with diverse clients and to providing culturally responsive counseling environments. Counselors and clients both bring to the therapeutic relationship a constellation of identities, privileged and marginalized statuses, and cultural values, beliefs and biases to which counselors need to attend. Furthermore, clients increasingly bring to counseling issues of inequity that lead to unhealthy risk factors.

The Multicultural and Social Justice Counseling Competencies (MSJCC), developed by a committee consisting of Manivong J. Ratts, Anneliese A. Singh, Sylvia Nassar-McMillan, S. Kent Butler and Julian Rafferty McCullough in 2015, seek to address these issues. Carlos Hipolito-Delgado commissioned the committee during his tenure as president of the Association for Multicultural Counseling and Development (AMCD), a division of the American Counseling Association. Both Branding-Images_justiceAMCD and ACA have endorsed the competencies, which can be found at counseling.org/knowledge-center/competencies. Their endorsement signifies the need to integrate multicultural and social justice competencies into all aspects of the counseling profession.

Built upon the original Multicultural Counseling Competencies (MCC) developed by Derald Wing Sue, Patricia Arredondo and Roderick J. McDavis in 1992, the MSJCC represent emerging multicultural and social justice factors within our global society. The original MCC focused on attitudes, knowledge and skills as the foundation of multicultural competence and were geared toward “majority” counselors working with “minority” clients.

Nearly 25 years later, however, it is clear that the range of diversity, particularly considering the salience of intersectional identities, is truly endless. For example, it is not uncommon for marginalized counselors to work with privileged clients in today’s world. The MSJCC provide a framework for addressing the constellation of identities that clients and counselors bring to the therapeutic relationship. The MSJCC also set the expectation that counselors address issues of power, privilege and oppression that impact clients. Moreover, the MSJCC require counseling professionals to see client issues from a culturally contextual framework and recommend interventions that take place at both individual and systems levels.

In this article, we are highlighting the practical application of the MSJCC in counseling and share how they may be used in conjunction with other ACA-oriented multicultural and social justice competencies. We also emphasize implications for the use of the MSJCC. The January issue of the Journal of Multicultural Counseling and Development (JMCD) provides a more detailed description of the theoretical underpinnings of the MSJCC.

Conceptual framework

The conceptual framework of the MSJCC illustrates the major concepts related to developing multicultural and social justice competence. At the core is the belief that multiculturalism and social justice should be at the center of all counseling. This conceptual framework also introduces new terminology with which it is important for counselors to familiarize themselves: quadrants, domains and competencies.

MulitculturalPraxis_fit

Quadrants: Quadrants reflect the complex identities and the privileged and marginalized statuses that counselors and clients bring to the counseling relationship. Clients and counselors are both members of various racial, ethnic, gender, sexual orientation, economic, disability and religious groups, to list a few. These identities are categorized into privileged and marginalized statuses. A client or counselor may hold either status or both statuses simultaneously. These statuses are prevalent depending on how each individual is experiencing the current interaction.

Being attentive of these statuses highlights how issues of power, privilege and oppression play out between counselors and clients. The interactions are categorized into four quadrants:

  • Quadrant I: Privileged Counselor–Marginalized Client
  • Quadrant II: Privileged Counselor–Privileged Client
  • Quadrant III: Marginalized Counselor–Privileged Client
  • Quadrant IV: Marginalized Counselor–Marginalized Client

Conceptually, client and counselor interactions may fit into the quadrants in numerous ways. They reflect the fluidity of identities and how the dynamics of power, privilege and oppression impact the counseling relationship.

For example, a gay male counselor of color and a heterosexual female client of color may experience their interaction through various lenses. They both may perceive their interaction to stem from Quadrant IV because of shared racial identities — a common experience with respect to issues of racism. Alternatively, the client may consider their interaction from a Quadrant I perspective because of gender differences. The client may feel displaced and at a disadvantage because of the counselor’s male privilege. Another possibility is that the counselor might identify with Quadrant III because of their differences in sexual orientation. In such a scenario, the counselor may be placed at a disadvantage because of the client’s heterosexual privileges.

Domains: Domains are intended to be developmental in nature, and they focus on progressive levels of multicultural and social justice competence. The domains are:

1) Counselor self-awareness

2) Client worldview

3) Counseling relationship

4) Counseling and advocacy interventions

Counselor self-awareness is important for identifying one’s cultural values, beliefs and biases. This insight assists in identifying one’s worldview and hot-button issues that may interfere with helping clients. Second, being cognizant of a client’s cultural values, beliefs and biases may help counselors understand clients’ worldviews and identity development. Next, being aware of the extent to which shared and unshared identities; privileged and marginalized statuses; values, beliefs and biases; and culture influence the counseling relationship may be important in determining appropriate evidence-based treatment interventions. When counselors possess self-awareness, are attuned to clients’ worldviews and are cognizant of how this shapes the counseling relationship, they are better equipped to respond to client needs.

To respond effectively, the MSJCC set the expectation that counselors understand the sociocultural systems that are affecting their clients’ sense of well-being and address the corresponding issues appropriately. To this end, the socioecological model is embedded within the counseling and advocacy interventions domain to provide a framework for interventions and strategies at the interpersonal, intrapersonal, institutional, community, public policy and international/global levels. Moreover, the levels allow counselors to see client issues more contextually and aid in determining whether targets for health promotions need to occur individually or systemwide.

At the intrapersonal level, counselors who are multicultural and social justice competent discuss their own cultures and identities, inquire about their clients and provide open conversations related to how, collectively, privileged and marginalized identities might work to enhance or barricade the counseling relationship. It is essential that counselors are willing to authentically bring this discussion into the room. Such discussions can help counselors gain rich insight into their clients’ cultural backgrounds. Clients and counselors who engage positively in this dynamic may increase mutual trust and enrich the therapeutic alliance.

An important factor at the intrapersonal level is the exploration of client experiences with microaggressions and discrimination. Counselors can help clients develop critical consciousness around experiences with racism, sexism, ableism, classism, religious oppression, homophobia or transphobia and so on. This, in turn, helps clients externalize their oppression. Using culturally appropriate, empowerment-based frameworks and techniques to help clients express powerful feelings of anger or despair resulting from frequent experiences with discrimination and oppression is crucial to improving one’s mental wellness.

At the interpersonal level, counselors who are multicultural and social justice competent take initiative to explore client relationships with family, friends, co-workers and their communities. This work may occur inside or outside of “the office.” For example, counselors may step out of the comfort of their office settings to talk directly with individuals in their clients’ lives (with client permission). This approach may help to identify individuals who support or obstruct client progress.

Relatedly, it is critical to help clients develop networks with caring individuals who share a similar privileged or marginalized identity and with whom they identify. Examples include helping an African American client to connect with an African American student group such as a sorority or fraternity. White clients might find it beneficial to be in an organization in which other White individuals are doing anti-racism work. This exploration process may be enhanced when counselors take the time to attend these meetings with clients. Stepping outside the office setting and working alongside clients will likely create discomfort for counselors who are traditionally trained.

At the institutional level, multicultural and social justice counselors focus their efforts on institutional rather than individual change. Counselors may initially inquire about the climate within a client’s workplace, community organizations or school. For example, a counselor can ask a client, “What is it like being the only Latina woman in a predominately White workplace?” or “How is it to navigate your workplace as a person with a disability?” Counselors could take it a step further by conducting needs assessments of their clients’ workplaces or schools to determine the extent to which these organizations are supportive of the clients. This strategy involves collaborating with clients and their workplaces or schools to conduct a climate survey.

Counselors may also advocate for clients by connecting them to supportive people within institutions who may be instrumental in helping to reduce inequities that clients experience. As change agents, counselors can work to improve climates within agencies, schools or organizations that inhibit client growth and feelings of well-being. For example, a professional school counselor might advocate with, and on behalf of, students who miss valuable instruction time because they use wheelchairs and cannot get to class on time due to overcrowded hallways and a lack of automatic doors. Similarly, a clinical mental health counselor might attend a meeting as an ally at the client’s place of employment to discuss equity issues affecting the client’s work environment.

At the community level, multicultural and social justice counselors focus their attention on the norms and values in society and the influence of these factors on clients’ well-being. It is important for counselors to discuss how clients believe that others perceive them and if they think that society holds negative stereotypes or attitudes about their membership in a privileged or marginalized group.

For instance, a counselor might explore, through societal lenses, the difficulties that a nontraditional female student faces when she doesn’t feel that her mostly male cohort takes her seriously as a medical student. The counselor could explore with the client the societal perceptions of women in science and math fields and the added pressure of having to prove herself repeatedly to male classmates. Creating informative websites may be another positive way to bring the issue to public awareness. Counselors may also use broader social advocacy strategies to vocalize support for women in general or back their participation in male-dominated careers, thus transforming public perception of their strengths and capabilities. Lastly, counselors can conduct research that identifies societal perceptions of particular women groups, explore the impact of these discernments and investigate how to mediate negative attitudes toward them.

At the public policy level, multicultural and social justice counselors focus on the rules, laws and policies that impact clients and other members of their group. This work may involve altering oppressive laws and policies or helping to create more-inclusive policies. An example could include focusing on issues faced by a female transgender client who is forced by city or state laws to either use the public restroom of the gender recorded on their birth certificate or face legal consequences. The counselor might advocate with, or on behalf of, the client by using the counselor’s cisgender (person who is not transgender) privilege to work with city officials to alter policies and practices that are oppressive toward transgender people. Furthermore, counselors, along with their local counseling organizations and legislators, may help to create policies and laws that do not discriminate against the transgender population and other sexual and gender minorities who constantly feel the brunt of stigmatization.

At the international/global level, multicultural and social justice counselors stay current and understand the impact that international activities may have on clients. For instance, the November terrorist incident in Paris involving the Islamic State may create toxic conditions in which Middle Eastern clients in the United States experience a significant increase in discrimination. In addition to discussing the impacts on clients, it would be essential for counselors to increase their knowledge and seek professional development that furthers their understanding of the political and historical contexts surrounding such occurrences. This knowledge may in turn equip counselors with the ability to work with other community leaders to create programs that ward off potential hate crimes.

Competencies: Counselors who are multicultural and social justice competent are in a constant state of developing attitudes and beliefs, knowledge, skills and action (AKSA) that allow them to effectively work with clients from a multicultural and social justice framework. The AKSA competencies are embedded within the counselor self-awareness, client worldview and counseling relationship domains described above.

Attitudes and beliefs refer to possessing awareness of the values, beliefs and biases that counselors possess about themselves and their clients. Knowledge denotes counselors being well-informed on the complexities surrounding counselor and client identity development, worldviews, the nuances of culture and the positive and negative effects of privileged and marginalized statuses. Skills refer to counselors’ abilities to tailor interventions that align with the cultural worldview of clients. Action refers to counselors taking steps to operationalize attitudes and beliefs, knowledge and skills with clients. The action component, also endorsed by Allen Ivey, Mary Ivey and Carlos Zalaquett, is based on the belief that possessing attitudes and beliefs, knowledge and skills is not enough if these competencies are not operationalized.

Using the MSJCC in tandem with other competencies 

Counselors can use the MSJCC alongside other ACA competencies to provide culturally responsive counseling and contextually appropriate interventions. The ACA Advocacy Competencies, which emerged out of Counselors for Social Justice, another division of ACA, were developed to describe how counselors might advocate with clients or on behalf of clients. These competencies further delineate the micro (e.g., student, client), meso (e.g., school, community) and macro (e.g., public arena, public policy) levels of advocacy that counselors may use.

As discussed earlier, the MSJCC embed action within counseling competence, with the expectation that counselor awareness, knowledge and skills are linked to counselor action in addressing issues of privilege and oppression when working with a wide variety of social identities espoused by clients. Therefore, in essence, the MSJCC extend the advocacy competencies to a more comprehensive approach that works with clients and continues outside of the duration of counseling. However, the advocacy competencies still have value, and counselors can consult these competencies together with the MSJCC to identify the most effective levels of action intervention. Interventions should be in collaboration with clients (e.g., developing self-advocacy skills) or on behalf of clients (e.g., advocating for gender-inclusive bathrooms for transgender people).

The Association for Specialists in Group Work (ASGW), another ACA division, developed the Multicultural and Social Justice Principles of Group Work to revise an earlier document titled “Principles for Diversity-Competent Group Workers.” Similar to the need to revise the AMCD multicultural competencies, ASGW was supportive of efforts to integrate multicultural and social justice principles into one document guiding the development of competence in leading group work. Counselors may use the MSJCC to guide both individual and group work with clients, using the MSJCC model to identify social identities of similarity and difference with clients, while also using the three domains of the ASGW Multicultural and Social Justice Principles of Group Work to explore the specific development of multicultural and social justice competence when facilitating group modalities. The three domains of these principles include the awareness of self and group members, strategies and skills (with two sub-domains: group worker planning and group worker processing), and social justice advocacy.

The MSJCC focus specifically on awareness, knowledge, skills and action that counselors should develop in multicultural and social justice competence. Meanwhile, the ACA Competencies for Counseling With Transgender Clients and the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling Competencies for Counseling LGBQQIA Individuals explore this competence within CACREP training domains (e.g., social and cultural foundations, assessment) when working with transgender and lesbian, gay, bisexual, queer, questioning, intersex and ally (LGBQQIA) clients. Counselors may therefore use the MSJCC model to identify the privilege and oppression identities of counselor and client, while using the transgender and LGBQQIA competencies to examine these identities specifically within sexual orientation and gender identity.

Other ACA division competencies also exist (see counseling.org/knowledge-center/competencies). The extent to which these competencies specifically address or embed multicultural and social justice competencies varies. When using these competencies, the MSJCC will help counselors specifically give attention to the multiple issues of privilege and oppression that influence counselor awareness, knowledge and action competence.

Summary

The MSJCC provide:

  • A comprehensive framework for viewing one’s attitudes about newly emergent populations
  • A fresh start for looking at the worldviews of populations with whom one may come in contact and provide counseling services for daily
  • An opportunity to examine the impacts of these internalized attitudes and, taken together with client worldview, delve into the influences those dual dynamics have on the counseling relationship, both in traditional and broader senses

Thus, the aspirational quality of the MSJCC is critical in every single counseling encounter. In mental health and school settings, we may continue to serve clients from marginalized groups, and they may continue to overrepresent traditionally beleaguered populations. However, the way oppression is manifest in today’s world is ever-changing. For example, recent immigrants, whether documented or undocumented, face daily persecution. Others might belong to refugee groups that have been oppressed in their countries of origin and come to the United States only to face new subjugations.

Moreover, the expansion of the counseling role, beyond the actual traditional relationship and into a role of advocacy and social action as an expectation of the profession, creates room for stretching and growth on the part of counselors and their delivery models and systems. For example, should a counselor note an inherent bias within the agency structure, a learning curve might exist in terms of figuring out whom to talk to or what actions to take to create change. Consequently, some personal risk to one’s job security may be present in taking such action.

Regarding community action, this role involves a new set of activities on the part of counselors to identify and network with community leaders and become involved with community action networks. Finally, the policy level is often intimidating and overwhelming for counselors in terms of understanding policymaking players and processes. However, consider what could happen if counselors were to become activists in changing managed care, for example, through lobbying and other large-scale education efforts. Not only would clients be better served if that were to happen, but counselors could also avoid becoming caught up in their own webs of helplessness or hopelessness that often lead to professional burnout. Additionally, training gaps often exist between newly trained and veteran counselors who have served in the field for longer periods of time. With the benefit of renewed multicultural competence training, successes and changes may inadvertently serve to engage experienced counselors at new levels, inspiring them to continue striving for multicultural and social justice competence.

 

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Manivong J. Ratts, Anneliese A. Singh, S. Kent Butler, Sylvia Nassar-McMillan and Julian Rafferty McCullough served on the committee that developed the Multicultural and Social Justice Counseling Competencies.

Letters to the editorct@counseling.org

Revisiting Ferguson

By Holly Wagner, Christina Thaier and Brian Hutchison November 17, 2015

[Editor’s note: Roughly one year ago, CT Online wrote an article about the initiatives the counseling department at the University of Missouri – St. Louis (UMSL) was engaging in as protests and turmoil rocked the city of Ferguson after Michael Brown, an unarmed black teenager, was fatally shot by a white Ferguson police officer, Darren Wilson.

This fall, we’ve asked some of those counselors to reflect on what they have experienced and learned since serving as witnesses to history and trying to help others find their voices as “storytellers.”

Brian Hutchison is a licensed professional counselor (LPC) and associate professor at UMSL; Holly Wagner is an LPC and assistant professors at UMSL; and Christina Thaier is a provisional licensed professional counselor (PLPC) working on a doctorate in counselor education and supervision at UMSL. They are all American Counseling Association members.]

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As a St. Louisan, I [Christina] have started to mark time — or perhaps how I recognize myself or my city — as before, during and after Ferguson. Post-Ferguson, one of the things I’ve come to understand is the power of the storyteller. I’d heard many times in history classrooms (which were not my favorite) that history is determined by the one who is telling the story. I believed it then, I’m sure, but I’ve come to understand it differently post-Ferguson, in a know-it-in-your-bones sort of way.

And so, as the three of us do our best to honor this opportunity to serve as storytellers about our experience of Ferguson, we do so recognizing the weight of such a privilege, knowing there are voices more worthy than ours to do so, and hoping to honor the young man (Michael Brown), our fellow St. Louisans and the city the story truly belongs to.

From Holly Wagner: A time to respond, a place to be heard and a space where crisis and growth convened

Timing can mean a lot in life. When someone is asked why a certain decision was made or a sequence of events occurred, the response is often about timing. For example, we often hear folks say, “It’s time for a change” or “It’s about time” or “It just wasn’t the right time.”

As I reflect on the events that led up to the crisis in Ferguson in August 2014, as well as the community responses following Michael Brown’s death, the concept of timing and time seem significant. For the people of Ferguson and the surrounding North City of Saint Louis, it was “past time for a change.” The time had come for their voices to be heard. In our own small, unique way, the faculty and students at UMSL showed up to listen.

August 2014 was my first semester as a faculty member in the UMSL Department of Counseling and Family Therapy. I had literally just arrived on the UMSL scene when it was time to respond. It was time to act, to do something helpful, and there was no time to be hesitant about it. I remember feeling overwhelmed by the energy and intention that surrounded me as my new colleagues and students leapt into action, driven by a desire to be helpful, yet unobtrusive. We talked about how to show up in ways that would truly benefit the people who were hurting. The idea of the sand tray naturally emerged as a potential medium for expressions to come forth during the crisis.

Through previous experiences with sand tray work with both children and adults, I felt innately that it could be the conduit needed for peoples’ voices to be heard. We were intentional in framing our work as an expressive technique to facilitate storytelling rather than sand tray therapy. We approached the events simply with sand and figurines, as well as open ears and hearts. What transpired made it evident that this simple approach was truly all that was needed at that time.

I have often heard that the Chinese symbol for “crisis” also contains aspects of the word “opportunity.” At the time of the Ferguson crisis, it seemed difficult to hold those two words or truths together. It was hard to imagine something good coming from the pain and struggle that was so palpable at the time. As counselors, however, we understand that healing is a process that takes time and space during which meaning can be made. Over time, if we are given the space to create insight and meaning, we can adapt and grow in response to the trauma or crisis we experienced. Thus, this was our intention as we showed up to the various events surrounding the Ferguson crisis. We witnessed the immediate effects of freely expressed emotions, meaning making and insight, and relief and validation related to a story being told.

While it is more difficult to ascertain any long-term effects that our engagement may have had on our community members, it has truly been amazing to hear the accounts of the impact this participation has had on our own students’ growth, awareness and counselor development. For many students involved, working with a sand tray or responding to a community crisis had been solely discussed theoretically up until that time. Responding to our community’s needs allowed students an opportunity to experientially engage in ways that they found meaningful to their development as persons and [as] counselors, while igniting a passion for social justice work. It was a time we will never forget.

 

From Christina Thaier: Showing up

On a sleepy, snowy afternoon when I was 18 years old, I was complaining to a friend’s mom about how I didn’t want to get dressed up for a family member’s wedding that evening. She looked at me gravely, in that “I’m about to say something really important” sort of way, and offered some unrequested advice. As if it were an absolute truth, she declared, “You honor the people you care about by showing up” — she was talking about weddings, funerals, birthday parties, dinner parties and probably even church — “and you should take the time to look nice. It tells them that their celebration matters to you.”

In other words, go put on a dress and a smile, and act like you know better than to think you are the center of the universe.

Though I’m stubborn, and it took me longer than it should have to understand the wisdom of her words, they eventually became part of who I am and what I do. In August of 2014, when our city was in a state of crisis, when we had no idea what was going to happen next, what was the right thing to do or how to go about it, her words offered a familiar solace — you show up, where you are invited, if someone matters to you.

As school was opening, many of us were asking the same questions: As counselors-in-training, what is our role? What do we do? How can we be helpful? Dr. Brian Hutchison and Dr. Holly Wagner offered us an answer. They asked our chapter of Chi Sigma Iota, of which I was currently serving as president, to consider showing up with them.

They taught us how to build a mobile outreach unit made up of sand trays, story stones, paint and symbolic figurines. They told us there was no manual, no evidence-based protocol, no textbook or peer-reviewed article with the answers we needed. They were willing to let us see that they didn’t really know what healing tents at a protest might look like — but they went anyway.

I remember being afraid as I drove to the first protest with a car full of sand and figurines. Were we crazy? Was it safe? Did I have anything to offer? Would I say the wrong thing? Did I know what I was getting myself in to?

Viktor Frankl said that despair is suffering without meaning. We had hoped to offer others, in our own small way, an opportunity to discover something meaningful for themselves during this crisis. The truth is, we might have been the ones most moved by the experience.

It turned out that the few hours I spent with my colleagues, holding a space for strangers to tell their stories, was one of the most meaningful experiences of my life. We laughed and cried and mourned and hoped and, most of all, we witnessed human beings seeing and hearing each other as we truly were during Ferguson. To say it was beautiful is not enough.

 

From Brian Hutchison: Who am I?

I remember the last time I was called a racist. It was approximately 11 years ago. I believe at the time that this fact was no longer true, but it shook me deeply because I knew that at one time, early in my life and into my late teens, it was. At that time, I had never known a person of color, nor had I read the works of Baldwin or Biko or Douglas or Coates or any of the myriad authors who have shaped my worldview over the past 25 years.

Having been asked to reflect on my personal experience while working with residents and protestors in Ferguson, Missouri, following Michael Brown Jr’s death, my thoughts go back to that moment when I was last called a racist. I had already decided that much of my work would focus on issues of social class, urban poverty and black people, yet that wound — inflicted by the social experience of my youth and not the person who called me a racist — throbs with raw pain still today. And I am a person who is able to set that acute pain aside, who can deflect by focusing on the power of choice and mastery I feel in my life. In essence, I am a person who is male and white and straight and educated living in the United States in the early 21st century.

Who am I to be asked to be helpful to the mostly black community of Ferguson? Who am I to be asked to be helpful to the mostly black community of protestors? Who am I to be asked to help the mostly young, black community of organizers? More than anything else, being asked to reflect on my personal experience of being asked to help in Ferguson makes me think, “Who am I?”

My answer does not feel elegant enough to put to the page, yet I am compelled. I am a person who did not ask to be male, white, straight, able-bodied, and to have an opportunity to be this educated. The choices I have been given were not mine to decide when the seeds of their possibility were first planted. These choices are my privilege, but the choices for most whom I have met in the schools, community centers, tents and streets of the St. Louis community do not look like mine. They are not made with an ingrained sense of mastery and power. They are choices made despite the circumstances of their lived experience.

What I did choose was to say yes. I did choose to ask if I could be helpful versus demanding to help (from my privileged worldview in my privileged way). I did choose to show up as often as I could when asked but never to ask if I could show up. I did choose to do what was asked instead of what I wanted to do. These choices were simple, yet did not come to me easily because of my 44 years of accrued habits lived within my bubble of privilege.

The gifts I received were the knowledge that I can step outside of myself and be led by others, do have the capacity to work through my own history of guilt to be helpful and that there is something to be gained by counselors — all types of people who are counselors — if we simply say yes, be humble and show up when asked.

 

UMSL_1

(Clockwise, left to right) UMSL students Jeremy Kane, Korey Lowery, Emily Muertz, Christina Thaier, UMSL assistant professor Holly Wagner and Gabrielle Fowler create story stones during a protest in downtown St. Louis in October 2014. The group used story stones, sand trays and other therapeutic tools with protesters.

UMSL_2

 

As you can probably tell, the three of us can be taken back to during Ferguson quite easily. We look back at that time of crisis in our city and shudder at images we can’t unsee — violence and grief and so many raw emotions on every television, computer screen and headline. We see breaking news and front pages that paint a portrait of St. Louis as divided and conquered. All of that was part of the story, yes. But somewhere in the wreckage and loss, the black and white, the debate and the protest, mourners came together and explored what it meant to be a St. Louisan during, and then after, Ferguson.

In the last year, in post-Ferguson St. Louis, what have we learned? We know that history-making happens in the present. We know that art and connection have the potential to be transcendent. We know that words like “race” and “privilege” are easier to say with practice but not nearly as important as words like “value,” “worth” and “dignity.” We know that holding a space for someone else is a gift for both parties. We know that people will surprise us — for the good and the bad. We know that our city needs more change and that we love her despite her imperfections. We know that we want to continue being part of that change. We know we don’t really know what that looks like, and we can’t find the answers in our textbooks or journals or empirical truths. But we think it might start by showing up. And listening.

 

The UMSL sand tray team (left to right), Brian Hutchison, Katy Leigh, Brianne Overton, Jennifer Culver, Susan Kashubeck-West and Holly Wagner, pictured at a wellness night event organized soon after the 2014 protests began. Leigh, Overton and Culver are UMSL doctoral students; Hutchison, Kashubeck-West and Wagner are UMSL faculty. The wellness night was sponsored by the Organization for Black Struggle and the Hands Up Coalition to provide those who had been sleeping out at night for days a place to rest, eat, get a massage and do some sand tray storytelling, says Hutchison.

The UMSL sand tray team (left to right), Brian Hutchison, Katy Leigh, Brianne Overton, Jennifer Culver, Susan Kashubeck-West and Holly Wagner, pictured at a wellness night event organized soon after the 2014 protests began. Leigh, Overton and Culver are UMSL doctoral students; Hutchison, Kashubeck-West and Wagner are UMSL faculty. The wellness night was sponsored by the Organization for Black Struggle and the Hands Up Coalition to provide those who had been sleeping out at night for days a place to rest, eat, get a massage and do some sand tray storytelling, says Hutchison.

 

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See Counseling Today’s article from one year ago, “Storytelling and hope in Ferguson” at wp.me/p2BxKN-3L6

 

 

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

Fulfilling a counselor’s obligation to social justice work

By Robin J. Landwehr June 4, 2015

One of my favorite things about graduate school was doing literature reviews. I enjoyed finding the perfect articles to support my positions, gaining really useful insights and simply being amazed at some of the things that we have learned about being human.

A thought frequently ran through my mind as I was doing literature reviews: I wish more of this very important information would find its way into the awareness of the general public. The truth is, some SocialJustice1academics do a really great job of passing very useful information back and forth to one another, but I am not sure that the public always benefits from what we are learning.

I decided I would try to do something about that in my own practice as a counselor. I started a personal blog with the intention of writing about social justice issues through the lens of a counselor. I wanted to write in a style that was easy to understand, despite much of the information being based on research literature.

I firmly believed then, as I do now, that if people became more aware and educated about social justice issues, then they would feel compelled to act on these issues.

Shortly after starting my blog, I also became a contributing writer for the online magazine Everyday Feminism. This platform has permitted me to write several articles pertaining to mental health and social justice work that have been shared thousands of times on social media sites such as Facebook and Twitter by people all over the world.

We have some extraordinarily intelligent people around us, but not all of them are counselors, social scientists or researchers who have the time to pore over hundreds of articles to get accurate information about the many social justice issues that are out there. And I think that it is partly our responsibility as counselors to offer this information.

So, I encourage individual counselors to be actively looking for ways to get involved, in a very public way, with social justice work.

I think that taking up this position helps the counseling profession in many ways. For one thing, I think that it is a great way to earn public trust. It certainly isn’t a secret that people have a real distrust of mental health professionals. And they may not have a clue that social justice work is even something that we are supposed to be doing.

Why would they? The only image of us is the traditional counselor sitting in the office counseling a client who is relaxing on a psychoanalysis couch.

If we make an effort to get more involved with social justice issues, then hopefully the people for whom we advocate and provide our expertise can see that we are interested in helping to improve social conditions for them. I can’t think of a better way to increase the public confidence in our profession.

Every week I read the comments that Everyday Feminism, various mental health blogs and other sources receive on their social media sites regarding various social justice issues. It seems to me that people really want solid information. But in the absence of accurate information, myths abound.

While I give praise to the American Counseling Association and other mental health organizations for taking very public stands on critical social justice issues, I don’t think that individual counselors should be satisfied with leaving social justice work up to our professional organizations alone. There are simply too many things out there that we can play an instrumental role in improving if we look for more opportunities.

I serve on the board of directors for the nonprofit organization Lesbian Health Initiative (LHI) in Houston. The mission is to help eliminate health disparities in the LGBTQ communities — a clearly marginalized group. I have used my experiences in behavioral health in medical settings, writing articles and nonprofit work to do what I can to help with this social justice endeavor.

Counselors possess a unique purpose and specialized training that make us perfect for serving in social justice movements. The issues that we help people with in the counseling setting are often the result of the issues that play out in our society. Unequal treatment, violence, trauma and poverty are just a few of the issues we know our clients are dealing with. Many of us are survivors ourselves.

Ultimately, if we really want our clients’ lives to improve, then we must change the circumstances that aid in their psychological distress. And it makes sense that some of the best-equipped people to help make these changes are the individuals who study these issues.

From a purely selfish perspective, I know that a better society benefits me too. I will never really know all of the ways that social justice advocates throughout history have created opportunities for me. What I do know is that I want part of their legacy to be mine — that when my time has passed, someone can say that I left opportunities behind for others.

My heart becomes full when I read about counselors who are not only responding to change and crisis but who also station themselves right in the middle while it is occurring around them. They are right there to influence things for the better.

For example, the University of Missouri – St. Louis (UMSL) counseling department staff and students have been very involved in the highly volatile situation that erupted in Ferguson, Missouri, after the shooting of Michael Brown. Those counselors and students realized that their community was hurting and headed right toward it. Their efforts were highlighted in a CT Online article.

They did not just offer crisis counseling and support, although that may have been good enough. They also spoke out about the long history of racial inequality in that community and recognized that it was a major reason why the people of Ferguson began their movement.

The students and staff of UMSL made an effort to understand the issue. They have comforted the hurting and have been beside them while they demand social justice.

That is exactly where we belong.

I should probably point out that social justice work takes a certain amount of courage. Not everyone wants social justice, believe it or not. There are some people who benefit from the status quo. Putting yourself out there as a person who does social justice work means that you may not always receive a warm welcome. I have certainly been on the receiving end of some not-so-friendly tweets.

When this happens, we have to trust the information that we have gathered. We have to believe in ourselves and our cause. We have to remind ourselves that we don’t stand alone; rather, there are thousands of us.

SocialJustice2The next thing I plan to do is become a member of the Counselors for Social Justice, a division of ACA. I will continue to look for social justice opportunities in my own community and beyond.

I believe that all counselors should be looking for their social justice niche and make their voices heard on behalf of the clients they serve.

The keyboard is one medium that I use to promote social justice. I get to combine my love of writing and hunting down information and use it for a good purpose.

What will you do?

 

 

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Robin J. Landwehr is a licensed professional counselor in North Dakota and a licensed mental health counselor in Florida. She is also a national certified counselor. Contact her through her blog at thehippieinmeblog.com.

Advocacy in action

By Laurie Meyers April 23, 2014

ProtestAdvocacy is a concept that can evoke visions of protesters and picket lines, phone banks and information booths, and maybe even knocking on doors and accosting strangers on the street.

But at its most basic level, advocacy means to help or assist, and isn’t that the essence of counseling?

“I feel that the basic principles of advocacy — helping people to be their best — have always been a part of the profession in some ways,” says Courtland Lee, a past president of the American Counseling Association and a pioneer in multiculturalism and social justice work. “But it’s evolved over time. People really started to use the word advocate in the real sense [in the] 1960s as the major social justice movements — the struggle for civil rights, the anti-Vietnam War movement and the call for women’s equality — began to transform society.”

Counselors, like the rest of society, were affected by these movements, Lee says. “It started as more of a philosophy that counselors need to be agents of social change. As it evolved, advocacy became part of the multicultural and social justice movements,” says Lee, a professor of counselling at the University of Malta and editor of the ACA books Multicultural Issues in Counseling and Counseling for Social Justice.

Counselors began realizing that working with the client one on one wasn’t always enough, Lee says. Making lasting differences in clients’ lives often required challenging the prevailing environment and working to change it.

Rita Chi-Ying Chung, an international expert on multicultural and cross-cultural counseling, discovered that truth at the beginning of her career when she began working with refugees, a population forced to navigate many cultural barriers when arriving in a new county.

“I felt that we were creating kind of a revolving door where we would see clients, they would feel better, and then leave and go back in their world and get exposed to whatever issues or injustices that were happening to them, and their pain and difficulties would just come back,” says Chung, an ACA member and professor in the counseling and development program at George Mason University (GMU) in Fairfax, Va. “As counselors, I just think a critical part of our counseling is advocacy — not just on an individual level but on a community as well as a systemic level.”

The need for advocacy isn’t limited to large societal movements or even large groups of people, however. The need is present in every counselor’s office, school or classroom.

“Advocacy is not an adjunct piece; it’s a core, fundamental piece of any counseling we do with anybody,” says Fred Bemak, Chung’s research partner, frequent collaborator and spouse.

Lee offers the example of a famous case in Maryland in which a mother struggling to make it paycheck to paycheck and who couldn’t afford health insurance was unable to take her son to the dentist when he got a toothache. Tragically, the tooth became infected, the infection spread to the boy’s brain and he died.

“So, imagine this mom coming in for grief counseling,” Lee says. “It’s one thing to help her process grief, but at the same time, she is stuck in a dead-end job [and] another son has never been to the dentist, so the same thing could happen to him. Grief counseling on its own is not sufficient.”

But how would a counselor advocate for the client? By addressing the circumstances that led to the tragedy, Lee says. For instance, he suggests, the mother needs a better job, so perhaps the counselor could find a program that would help her upgrade her skills. The counselor could make a simple phone call to the state’s social services department to see what assistance the client might be eligible for, such as help with energy bills, emergency cash that could go toward paying rent or food stamps. The counselor could assist in securing dental care for the other child by checking with the dental community to find a dentist or clinic willing to provide low-cost or pro bono work.

Many of today’s counselors are actively advocating for clients, causes, social change and even the profession itself. In this article, we share a few of their stories.

Stopping traffic

Since 2012, Rita Chi-Ying Chung has received both the Gilbert and Kathleen Wrenn Award for a Humanitarian and Caring Person and the Kitty Cole Human Rights Award from ACA. Much of her work focuses on social justice and human rights. But Chung, who is also a consultant, researcher and faculty member at GMU’s Diversity Research and Action Center, didn’t start her career looking to become an advocate. Instead, advocacy found her.

“I was trained in a more traditional way of counseling, and advocacy wasn’t a real part of it,” says Chung, who was born, raised and educated in New Zealand, where she received her master’s and doctoral degrees in psychology at Victoria University of Wellington. But then the so-called “boat people” — Southeast Asian refugees who fled by sea on makeshift rafts and boats — started arriving in New Zealand in the 1980s. These were the “second wave” of Southeast Asian refugees from Vietnam, Cambodia and Laos who were fleeing the postwar chaos that still lingered nearly a decade after the fall of Saigon and the end of the Vietnam War.

Chung was working in community mental health centers as the refugees poured in. Her superiors thought she was uniquely qualified to work with this emerging client population because she was the only Asian counselor in Queensland and perhaps in all of New Zealand at that time.

“I was bilingual in Chinese — not any other Asian languages, just Chinese — but many of the refugees were Chinese-speaking Vietnamese, so we were able to communicate,” Chung recalls. “Because of that, I think some of the social services staff thought, ‘OK, she’s Asian. She’s talking to some of them, so therefore, she must be able to speak to all of them.’’’

The hugely uninformed assumption that one Asian person could somehow communicate with all other Asian people made Chung consider that the mental health community was likely oblivious to other cultures and their specific psychosocial needs as well. After all, if professionals didn’t even know what language the refugees spoke, how could they begin to understand and help them cope with their trauma?

Chung has published numerous articles and books on advocacy, multiculturalism and social justice. Today, she continues to advocate for and work with refugees, immigrants, minorities and other at-risk groups. An international conference on at-risk children led Chung to her current primary focus: child sex trafficking, particularly of Asian girls. She spent approximately three years traveling to Burma (Myanmar) with the nongovernmental organization (NGO) Save the Children UK to work with trafficked children and study possible ways to stop child trafficking.

The issues surrounding child trafficking are complex, Chung says. Girls are often sold to traffickers by their parents, which most counselors (and most other people in the Western World, for that matter) find extremely difficult to understand. But these are areas that are extremely impoverished, Chung explains, and sometimes the choice boils down to taking money from the traffickers for one child or watching one or more of your children starve to death.

“If it’s a difference between someone in your family’s going to die if you don’t put food on the table or you may be trafficked to another country, what are you going to do?” asks Chung. “You also need to understand Asian culture. In general, there is this concept of filial piety. The obligation for any child is to take care of their parents, which includes not only taking care financially, but to obey and respect and sacrifice anything for the greater good of the family.”

Even when the police raid a brothel and the trafficked girls are “freed,” they may choose not to go home, Chung says. “It’s not because they love what they’re doing. In all my years studying the trafficking industry, I’ve never met anyone who said, ‘Yeah, I volunteered.’ The Asian girls don’t leave because they feel that leaving is letting their family down,” she says.

“At the same time, they can’t leave because there is nowhere to go,” she continues. “In this culture, there is such stigma about rape and abuse. There’s such shame and loss of face, which doesn’t just apply to the girl but to the whole family.”

“It’s difficult,” Chung says. “I suddenly realized that in such an economically depressed situation, we’re not going to stop trafficking. It took me awhile to just accept the fact because I came into it thinking I was going to help prevent it.”

What Chung does do is ease community reentry for girls who have the option of coming back, in part by helping communities develop realistic alternatives for making money.

Easing reentry also involves education, Chung says. Part of that is sitting down as a community and collectively talking about how the group can heal, she says. Sometimes the healing involves listening to the girls’ stories.

“Sometime we’ll do role-play where the girls play out what it is like to be trafficked, telling their stories in an indirect way,” explains Chung. “Survivors will take on different trafficking roles. One person will be a trafficked individual, one person will be the madam in the house, etc. During this kind of simplistic playing out of roles, you can look around the community, and people are just crying. They’ve never truly thought about what the girls’ experiences were like. Once we get those tears out, the healing begins.”

Even so, the process is never simple. In some cases, Chung says, the family won’t take the girl back, especially if she is pregnant. However, others in the community may step forward and offer her a place to stay. Sometimes girls who were trafficked will band together and find a facility where they can live as a group.

Regardless, it remains essential to provide the girls with ways other than sex work to make money. Sometimes, however, the suggestions aren’t practical.

“We’ve got to give girls education and skills, but there are these programs out there that want to teach girls to be hairdressers and then send [them] back to their villages. What’s the point?” Chung exclaims. “Because, quite frankly, if I’m poor and I’m having trouble putting food on the table, I’m not going to pay someone to wash my hair.”

“I say [instead], what are the local resources? In one area, they have all these grasses they can weave with, and people use natural products to make dyes,” she explains. “So we thought, why not make lots of baskets and dye them different colors? Maybe we can find someone to take them once or twice a week to local markets and sell them, and that’s a way of sustainable living.”

For those who are still being trafficked, Chung and others have tried to provide a few safeguards. “We set up toll-free numbers in countries so that if there’s been some coercion, fraud, some threat, there’s someplace they can call,” she says. “Sometimes girls don’t even realize they are being trafficked into the sex industry. They have been told that they are going to be a maid or waitress or nanny somewhere, earning a lot of money, and before [they] know it, they are in a situation where their passports have been taken and they’ve been told that they owe a lot of money.”

Any attempt to stop or reduce trafficking must also address the demand side, emphasizes Chung, who was invited in 2008 to give a presentation on the cultural issues surrounding child trafficking at the United Nations. “White European men will go to different countries in Europe or Asia to have sex with children, but they don’t classify themselves as pedophiles. In the trafficking world, we call them ‘casual pedophiles,’” she says.

Most people are also unaware of how much sex trafficking goes on in the United States, Chung says. People would be shocked to discover that sex trafficking can take place anywhere, in anybody’s neighborhood, she says. The victims are not only women and children brought in from other countries but, in some cases, underage American girls. According to an FBI report from 2011, more than 290,000 U.S. youth were considered to be at risk for becoming trafficking victims. Although most victims of trafficking come from impoverished backgrounds, traffickers also target girls from more affluent families who are vulnerable for a variety of reasons, such as a history of sexual abuse, drug addiction, extreme low-self esteem, a desire to fit in or even promises of a glamorous lifestyle. Chung points out that in Northern Virginia, where she lives, there have been recent cases of high school girls being pulled into the sex industry.

“Human trafficking goes way back in civilization — back to the days of the Roman Empire — and it’s big business,” concludes Chung.

Counseling and advocacy: Two parts of a whole

For Fred Bemak, the academic program coordinator for counseling and development at GMU, advocacy and counseling are fundamentally intertwined. He was an advocate even before he became a counselor, and that experience shaped how he viewed his training and the counseling profession.

While in college, Bemak served as a summer counselor in the Upward Bound program, which works with youth from diverse backgrounds, including those who are economically disadvantaged, to give them a jump start toward college. Bemak continued working with Upward Bound throughout his counseling training, and the juxtaposition created significant cognitive dissonance for him.

“I realized pretty quickly that helping people accommodate to those social conditions was not a good way to do counseling,” explains Bemak, the founder and director of GMU’s Diversity Research and Action Center. “The traditional counseling field said, ‘Let me help somebody feel better about themselves even though they’re poor and they’re hungry and they don’t have a job and people are discriminating against them, and let me help them adapt to all that so that they can manage their lives.’ … From my Upward Bound experiences, I learned that’s not quite enough. Because we’re helping people to adapt to oppressive situations and the conditions of their lives don’t change, we’re just trying to change their mental status to say [in essence], ‘I’m poor and I’m happy,’ and that’s ridiculous.”

Bemak trained in what was considered to be one of the more progressive programs of its time, but as he describes it, it was still based on European-American concepts that didn’t fit the circumstances he was seeing at all.

“In the morning, I’d have been in the African American community with parents who were frustrated and angry and upset about life, trying to figure out how to manage without food. And then,” he says, “I’d go to these counseling classes, and it would be like two different planets.

“There was my training, and then there was working with vulnerable people in difficult circumstances. I had to craft together … how do I take this training and capitalize on it for the purpose of meeting the needs of people who are in marginalized circumstances?”

Those dual, clashing experiences spurred Bemak to get his doctorate so he could qualify for positions through which he could influence policy and bring social justice, multiculturalism and advocacy to organizations across the United States and then abroad.

His international work began when one of Bemak’s friends, a Yale University psychiatrist, received a general call for assistance from community service providers to assist with the needs of incoming Southeast Asian refugees. “He said, ‘Call Fred. He knows about working with children,’” Bemak recounts. “I said, ‘But I haven’t even been to Vietnam or Cambodia!’ They said, ‘You’ve been to Asia, and that’s as close as we can get.’”

Bemak learned by doing. “I didn’t know much about that population and what was going on,” he says. “But very quickly, because there were very few people in the United States doing this work, I became an ‘expert.’ I didn’t know enough to deserve the title, but there was basically no one else, so I was getting calls from all over the country to do training and consulting, and everywhere I went, I learned more.”

Bemak’s work has since expanded to include refugee populations from around the world. He has helped provide services in 55 different countries. He says his experiences continually remind him of the importance of advocacy and how much more he still needs to learn and do.

“One of the things I’ve been doing recently that has been very, very intense is working with postwar/conflict youth. Working with child soldiers, working with abductees, working with orphans, working with people infected with HIV/AIDS as a result of war. I’ve been doing that in Uganda most recently and looking at some other projects in Liberia,” says Bemak, who consults for the NGO Invisible Children.

“It’s incredibly intense and painful work,” he continues. “Many times in these counseling sessions, I’ll have been the first person to hear these stories because people have not been able to tell them because they have not found the conditions in which they feel they can.”

All of Bemak’s advocacy counseling work revolves around helping diverse people and communities in need, but after Hurricane Katrina, he felt compelled to create a kind of urgent care counseling unit that would respond in the wake of disasters. Bemak was at a national counselor educators’ meeting when, roughly six weeks after the devastating storm, someone asked who among the attendees had been to the Gulf Coast and seen the horrible devastation. Only a few hands went up. Worse yet, in Bemak’s opinion, the counselors who had visited the region had assisted primarily by helping to clean up, not by putting their desperately needed counseling skills to good use with the affected population. Worst of all, he says, when he looked into relief efforts, he found that small, diverse communities in Mississippi were not getting the services they needed. He notes that most of the focus was on New Orleans, but even there, the need was so great that there weren’t enough mental health providers to go around. Bemak was afraid that smaller affected communities in Mississippi were getting lost in the shuffle.

“So, I created Counselors Without Borders in my head, right there,” he says. In addition to its work in Mississippi after Hurricane Katrina, Counselors Without Borders has also provided culturally sensitive services to migrant communities and on American Indian reservations when wildfires scorched Southern California in 2007, as well as in Haiti in the wake of the 2010 earthquake.

The organization only deploys where it is needed. “I only want to go to places where needs are not being already met,” Bemak says. “Counselors Without Borders is a backup organization to come in and do culturally responsive work where it’s not being done.”

The thread that runs throughout all of Bemak’s work is social justice — how to address human rights and help achieve equity in counseling. The answer, for him, is advocacy.

“In the work we’re doing [as counselors], I think we’re really contributing to problems by not addressing advocacy and by not incorporating that as a core part of our jobs,” he asserts. “I think we’re contributing to the social problems and the inequities and the social conditions that oppress and hurt people.”

The battle for mental health

Keith Myers, a licensed professional counselor in Atlanta, has always been interested in the military. It’s a bit of a family tradition. His father was in the Navy during World War II, and both of his brothers have also served.

Myers chose to take a different route. The ACA member has been a practicing counselor for approximately 11 years and has worked in a variety of clinical settings. One of those settings turned his interest in the military into a focus for advocacy.

Myers has been a private practitioner for almost a year now, but before that he spent about two and a half years working with and advocating for veterans and active-duty service members at the Shepherd Center in Atlanta, a private rehabilitation center that specializes in brain and spinal cord injuries. As he would learn, working with this population required an approach based on an understanding of the military’s unique culture.

Specifically, Myers worked in the SHARE (Shaping Hope and Recovery Excellence) Military Initiative, an intensive outpatient program for veterans and active-duty members who had sustained a traumatic brain injury (TBI). Although SHARE received referrals from the military, it was a privately funded initiative that provided something military services did not offer — a chance to receive physical rehabilitation and mental health treatment simultaneously, Myers says.

“Patients could receive treatment for both their TBI and PTSD [posttraumatic stress disorder], which is a great advantage because it can sometimes be difficult to tease out what is [caused by] TBI and what is PTSD since their symptoms often overlap,” says Myers, a member of both the ACA Veterans Interest Network and the ACA Traumatology Interest Network.

The treatment was comprehensive. Patients had access to physical therapists, occupational therapists, speech therapists, physiatrists and mental health treatment, including individual, group and, in some cases, family therapy, Myers explains.

To even begin the process, however, Myers had to earn the clients’ trust — to advocate through understanding. “Military clients can be a difficult population to establish trust with just because they have a general mistrust of anyone outside the military. … There are exceptions, but they are pretty distrustful of civilians in general,” he says.

That distrust extends particularly to mental health practitioners of any kind. In the military, a strong stigma is attached to mental health problems and treatment, Myers explains. And if a service member does get help within the military system, there is virtually no confidentiality, unlike in the private or public mental health sectors. Military mental health practitioners report to higher-ranking officers and must disclose any potential problems that come up in sessions, he says.

“In fact, among military personnel, the mental health professionals are known as ‘wizards’ because they can make you disappear from your unit,” Myers says ruefully.

So, with each of his clients, Myers began by explaining that confidentiality worked differently at the Shepherd Center. He would not be revealing their conversations to anyone. Although he was required to give general reports on progress, the details of what was said in the therapy room would stay in the therapy room.

Myers also used his background to start to connect. “I was a little looser with my professional and personal disclosures. I could see there was clinical value in disclosing that I came from a military family and sharing some of my experience,” he says.

Just having knowledge of military culture and knowing the differences between branches was a big help. “Always know your branches,” he advises. “Never call a Marine a soldier — that’s an Army designation. Don’t call someone a sailor unless they are in the Navy.”

It may sound like a small thing, he says, but the military and its branches have their own unique culture, and taking a multicultural approach and getting to know and understand this population’s customs is essential to establishing trust and counseling effectively.

“It’s a slow process in the beginning,” Myers says, “but once rapport is established, the sense of trust becomes an almost unbreakable bond.”

Now back in private practice while earning his doctoral degree, Myers’ desire to help military members has led to significant advocacy work, both at the individual and community levels. Myers currently sees several military clients and advocates for them by helping them fill out disability paperwork with the Department of Veterans Affairs. He also accompanies certain clients on visits to their physicians. The visits started when several clients confided to Myers that they didn’t really know what they wanted or needed from their doctors.

“We would sit down before the physician’s appointment, and the client and I would talk about the visit and what their needs were,” Myers explains. “Then we would kind of do a role-play of what I [as the client] might say to the physician, and sometimes the client would say, ‘What you said is better than how I would say it, so would you mind coming to my appointment?’”

The clients felt better having someone to help articulate all of their needs, and Myers liked being there to make sure his clients felt their needs were being addressed.

Myers is also advocating by educating other mental health and health professionals about the unique needs of the military population. He has presented at multiple health facilities in the Atlanta area, including an audience of 80 at an area psychiatric center. Myers also presents on the topic to faculty and students at Mercer University, where he is earning his doctorate.

Myers’ presentations educate audiences about the extreme physical and mental stressors that military clients experience. “The heat is extreme — often well over 100 degrees — and military members have to endure it, often while dressed in body armor,” he points out. “Missions require a high degree of vigilance and are sometimes ambiguous. They may be peacekeeping or diplomatic [missions], but there is always the threat of IEDs [improvised explosive devices] and the possibility of ambush or military fire.”

Those in combat also have to face things such as conflict within the unit, the loss of fellow unit members, general fear and horror, and the possibility of death or being maimed. And even when they return home, Myers says, they still must deal with the memories and the myriad emotions those memories engender.

Myers has been pleased with the feedback he receives, particularly from audience members who come up after his presentations to tell him they have always been interested in treating military members but haven’t known how or where to begin. He helps interested counselors and other mental health professionals to get started, whether it is through professional connections or simply working with nonprofit advocacy organizations such as the Wounded Warrior Project.

Myers says he will continue to present, and once he has finished his doctorate, he hopes to teach counselor trainees not just about military culture, but also combat and trauma.

“One of the most rewarding aspects of working with this population is being able to serve those who served,” he says.

The accidental advocate

When ACA member Kevin Feisthamel began his job at the Cleveland Clinic Foundation’s Melon Center for multiple sclerosis (MS), he knew little about the disease. He had just finished a counseling internship that focused on health psychology and had developed a strong interest in neuropsychology. So when a neuropsychological technician position opened up in the MS clinic, he jumped at the chance, despite not knowing anything about the symptoms, prognosis or treatment options for MS. At first, he simply focused on administering the personality and intelligence tests. After all, he reasoned, that was what he was there for.

But it didn’t take long for Feisthamel to recognize the devastation that MS can cause and to realize that the clinic patients needed more than just test administration — they needed empathy and knowledge.

After their initial baseline tests, patients would return about three months later to be retested. Feisthamel would score the tests, and the clinic neurologist and psychiatrist would evaluate the results, looking for decline or changes in cognition.

“Suddenly,” Feisthamel says, “I was seeing these highly intelligent people whose mental function was markedly decreasing over time. I would also see people — kids, really — who were 18 or 19 and in wheelchairs, and I was amazed at how debilitating this disease could be. I just couldn’t imagine what they were going through, and I tried to put myself in their shoes but realized that I didn’t even know enough to do that. That’s what got me started. I felt educating myself was crucial not only for myself but for the clients I was seeing.”

Although Feisthamel wasn’t addressing the decline and associated symptoms directly with the patients, he felt he needed to know more to better understand the bad news he sometimes had to deliver. He also wanted to help on a systemic level by participating in research that could uncover more about the effects of MS — in particular depression and fatigue, which were symptoms he witnessed so often.

Eventually, Feisthamel began sitting in with the neurologist and taking part in the discussions with patients. He also was invited to start taking part in presentations on the research the Cleveland Clinic was doing related to MS. He was involved in several studies, including one that focused on depression in MS patients. For that study, Feisthamel looked at the personality assessment data the clinic had collected and tried to identify specific personality characteristics that might help individuals cope with their depression.

Feisthamel eventually left the Cleveland Clinic to pursue his doctorate, but he retained his passion for research and advocacy. He no longer devoted so much time to MS, although he did write a meta-analysis of research on pharmacological and counseling interventions for MS patients with depression for his psychopharmacology class. The article was later published in a peer-reviewed journal in 2009.

Today, Feisthamel teaches at Walden University and is also director of the health center at Hiram College. He is still an enthusiastic advocate, but his current focus is on the science of happiness and positive psychology. He established a Hiram chapter of Active Minds, an organization that empowers students to speak openly about mental health to encourage help-seeking behaviors, and recently completed a week of education on suicide prevention. Feisthamel sees clients daily but says about 80 percent of his job at Hiram revolves around getting out and educating people about where and how to get help and what kinds of things they can do for themselves.

“I don’t worry a lot about the people I do see,” he says. “I worry about the ones I don’t. That’s why I have to get out of my office to talk about counseling services and to give presentations on campus to students and faculty.”

Feisthamel is also encouraging advocacy among future counselors. Walden’s counseling program is focused on social change, he says, and he regularly asks his students to think about what social change is and how they can use it to advocate for their clients.

“We can have a huge impact, not just at the national level, but at the community level,” he emphasizes.

Defending counselors everywhere

John Yasenchak, an ACA member from the Bangor, Maine, area, never really considered himself much of an advocate. He’d participated in a few things to help raise awareness around counselor identity, but mostly he was focused on his practice and the classes he taught at Husson University.

Then came the fight around MaineCare, the state’s Medicaid program. The state Legislature has been trying to cut the program’s funding for years, according to Yasenchak, and in 2013, lawmakers decided MaineCare should stop reimbursing licensed clinical professional counselors (LCPCs) for patients who had “dual eligibility,” meaning they were eligible for both MaineCare and Medicare.

“The justification was based on Medicare’s refusal to include counselors as legitimate mental health providers who deserve to be reimbursed,” he explains. “The state pointed to this regulation and asked why it should reimburse counselors if the national Medicare system wasn’t.”

The prospect of being locked out of MaineCare sent shock waves through the state’s counseling community, Yasenchak says, because it would put counselors’ income or positions in jeopardy and many clients wouldn’t be able to continue receiving care from their chosen LCPC providers. “I had students coming in asking me if they should continue in the counselor education program. Was there an actual future in counseling? Would they even be able to find jobs, or should they switch to another helping profession?” Yasenchak recounts.

The situation served as a real wake-up call about the need for Maine counselors to start lobbying for recognition as legitimate mental health providers, not just at the state level but at the national level too, Yasenchak says. They did lobby the state Legislature, but the Maine Counseling Association (MeCA), a branch of ACA, and the Maine Mental Health Counselors Association realized that counselors could never be secure professionally until the Medicare problem was addressed.

Yasenchak, then serving as president of MeCA, and others started reaching out to contacts who had connections to Susan Collins, one of Maine’s U.S. senators. In the meantime, the state lobbying effort was gathering support from consumers and the CEOs of federally backed medical centers and furiously raising awareness. This activity and the many written testimonials it garnered were part of the background information presented to Collins. Her office responded positively but wanted more information, even asking Yasenchak and others to do research in the Federal Register.

The legwork paid off. By the time Yasenchak and several of his colleagues met with Collins, she had agreed to help sponsor the Seniors Mental Health Access Improvement Act of 2013 in the U.S. Senate. The bill is currently being reviewed by the Senate Finance Committee. A companion bill that includes Medicare reimbursement for LPCs has also been introduced in the House of Representatives.

Yasenchak and colleagues Deb Drew and Jeri Stevens are sticking with the process. Despite the dedicated lobbying at the state level, the Maine Legislature passed legislation denying reimbursement to LCPCs for dually eligibl clients. This is a targeted exclusion that does not apply to any other mental health professionals, Yasenchak points outs. Clients who had previously seen an LCPC had to transfer care to other providers unless they pursued a special waver.

Yasenchak knows that counselors’ livelihoods and clients’ treatment will continue to be threatened — and, in some cases, eliminated — until the fight for Medicare reimbursement is won.

Looking back, moving forward

As the counseling profession moves forward, all counselors need to learn how to advocate for their clients, Lee says. Advocating for all clients means that counselors will help not just by talking about their clients’ presenting issues, but by ensuring that they have access to the resources necessary to meet their needs, he explains. This shift toward advocacy is reflected in the increasing number of counseling programs that train students in working for social change.

As calls for counselor advocacy grow, so does the need for strategies to carry out advocacy work. Rebecca Toporek helped provide counselors with practical steps for implementing advocacy efforts when she, Judy Lewis, Mary Smith Arnold and Reese House developed the ACA Advocacy Competencies as part of a task force. The ACA Governing Council endorsed the Advocacy Competencies in 2003.

“The Advocacy Competencies were created to provide counselors with definitions, strategies and guidance to facilitate the process of working with clients and client communities to identify the most appropriate action and strategize appropriate actions,” Toporek says.

The competencies define six domains of appropriate advocacy for counselors:

  • Client/student empowerment
  • Client/student advocacy
  • Community collaboration
  • Systems advocacy
  • Public information
  • Social/political advocacy

For more information on the Advocacy Competencies, go to counseling.org/docs/competencies/advocacy_competencies.pdf?sfvrsn=3.

For Bemak, the issue is fairly simple. “If we’re not advocating for our clients,” he says, “we’re not doing our jobs.”

 

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KCA advocates for its next generation

At the Kentucky Counseling Association (KCA), advocacy has taken the form of nurturing and supporting the next generation of counselors.

KCAOver the past few years, KCA, a branch of the American Counseling Association, has launched a series of initiatives focused on counselors entering the profession. Those initiatives range from creating a special tab with graduate student resources on its website to increasing its educational offerings for entry-level counselors at its annual conference.

The effort has been “a win-win,” says KCA Associate Director Bill Braden. The entry-level counselors have brought fresh ideas and a new voice to KCA, while the association’s more experienced counselors have been able to mentor and network with the profession’s next generation.

Attendance at KCA’s annual conference has doubled, which KCA Executive Director Karen Cook attributes to the association’s recent focus on graduate students. KCA has expanded conference offerings for graduate students and new professionals, such as Q&A sessions on licensure, mock job interviews and the creation of a special lounge at the conference venue where graduate students can meet up and network.

The new programs and initiatives were created to focus on a challenging and critical time that can exist postgraduation for new counselors. Upon finishing graduate school, many budding counselors confront the pressures of finding a job and establishing themselves in the profession, all while burdened with student loan debt, Braden points out.

Cook and Braden say that KCA’s leadership team came to the realization that the association needed some type of outreach or mentorship initiative to connect new graduates with the state’s experienced counselors. A small task force, formed in 2012, developed a survey to identify graduate student needs and how KCA could help meet those needs. The survey was circulated at the annual conference and throughout the state. The task force then evolved into a student leadership team that includes representatives from universities throughout Kentucky.

“When we talked with our peers, [we] felt like students were missing out on how they fit into the bigger picture,” says Shana Goggins, a member of the original KCA task force who graduated from the master’s program at Eastern Kentucky University (EKU) in May 2013. “We felt like [we could do] more … to show students how much easier it is to get involved with a professional organization as a student, rather than waiting until you’ve graduated, you’re in the field and you’re trying to navigate work and just getting yourself oriented. We wanted to do something to show students that they were a viable part of the association.”

Goggins and her colleagues helped create a graduate student academy at KCA’s 2013 conference with a lineup of offerings tailored to new counselors, including the Q&A on licensure and sessions on self-care, public speaking, professional networking and other helpful topics.

“We want [new counselors] to understand how important it is to be proud of their profession and the importance of what we do,” Cook says. “We want to continue to listen to their voice and connect them with counselors in the field. We don’t want them to feel like they have to go it alone. … We love to see the interaction that goes on now between the grad students and the [experienced] counselors.”

KCA has also expanded its long-standing graduate school scholarship program. Each university in Kentucky now receives one scholarship for a counseling student to attend a summer class. The scholarship recipient, in turn, is invited to be involved with KCA’s annual conference in the fall, Cook says.

Panagiotis “Panos” Markopoulos, a classmate of Goggins’ at EKU who is now a doctoral student at the University of New Orleans, said KCA supports its members like a family. “It’s not just a one-way street, most definitely,” he says.

Markopoulos and Goggins were both involved in the 2012 task force and were instrumental in launching KCA’s focus on entry-level counselors, Braden says.

“As much as we’ve helped KCA, KCA has helped us,” says Goggins, a prelicensed counselor who is still involved with KCA. “I like to think that they’ve definitely helped us a lot more than we’ve helped them. But they would probably say the opposite. It’s a win-win, on everybody’s end.”

 

— Bethany Bray

 

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To contact individuals interviewed for this article, email:

Courtland Lee at courtland.c.lee@um.edu.mt

Rita Chi-Ying Chung at rchung@gmu.edu

Keith Myers at doc355@yahoo.com

Kevin Feisthamel at FeisthamelKP@hiram.edu

John Yasenchak at yasenchakj@husson.edu

Rebecca Toporek at rtoporek@sfsu.edu

 

 

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Social justice advocate and visionary Judy Lewis passed away as this article on counselor advocacy was being written. See page 48 of Counseling Today‘s May issue for an “In Memoriam” article on her life and legacy.

 

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Laurie Meyers is a staff writer for Counseling Today. Contact her at LMeyers@counseling.org

Letters to the editor: ct@counseling.org