Counseling Today, Cover Stories

Counseling beyond U.S. borders

By Lynne Shallcross December 15, 2009

Deborah Pinkston moved to Venezuela in 1985 after her husband was stationed there with a church organization. She went as a missionary to work with orphanages and at-risk children but realized she needed additional training in counseling. So, during their furloughs back to the United States, Multiracial Teen Couple Holding Globe MapPinkston earned her master’s degree in psychology and counseling and, in 2001, began counseling in the South American nation. She founded a counseling center in 2002 and continued to work with two orphanages she had previously helped to establish until moving back to the United States earlier this year.

Whether it’s a spouse’s job, a personal desire to counsel abroad or any number of other circumstances that take U.S. counselors overseas, most find out quickly that counseling is practiced in different ways and means different things the world over. Counseling Today spoke with five American Counseling Association members who have firsthand experience counseling internationally. In sharing their stories, they suggest that many of the lessons they have learned while providing counseling in other countries can readily be applied to effective practice here in the United States.

Andrea Al-Adwani, Kuwait

Andrea Al-Adwani says the issues she deals with as a counselor in Kuwait would be familiar to most U.S. counselors — only the issues come with a unique twist. Take, for example, identity development. “Arab youth who have always attended private American or British school struggle with their developing identity versus the identity their parents want them to have,” says Al-Adwani, who has been a counselor at the American University of Kuwait in Safat for five years and has worked at a local clinic for two years.

In public schools in Kuwait, Al-Adwani says, children complete tasks by memorization. But many Kuwaitis send their children to private schools with a British or American curriculum, where they are exposed to Western influence, including an emphasis on critical thinking skills. This often leads to an unexpected consequence for the parents, who find that their children no longer believe something just because they are told it is so. For these kids, identity confusion looms large, Al-Adwani says. “If their English skills are stronger than their Arabic skills and they compare their religious teachings with historical context to interpret their faith on their own instead of following without questioning, then what does it mean to be Kuwaiti, to be Muslim? Can I still be Kuwaiti without thinking like my tribe? Can I still be a good Muslim if I talk to the opposite sex on the phone?”

Couples counseling also brings a mix of familiar and new issues to the table, she says. For example, in Kuwaiti and many Arab societies, it’s legally and socially acceptable to marry a first cousin. Some families insist on marrying within the family so the inherited wealth will be protected. And, Al-Adwani says, because a woman can only marry with the consent of her father, her choices are limited if her father expects her to marry within the family. “This is difficult if she does not like any of her cousins and even more difficult for the Kuwaiti lady who has attended Western schools and been exposed to other ways of life,” says Al-Adwani, who earned her degree from Regent University but moved to Kuwait so her half-American, half-Kuwaiti husband could manage the family business.

“Divorce is still seen as a scandalous tragedy (in Kuwait), even though the divorce rate among young people has risen substantially over the past decade,” Al-Adwani says. While a divorced man may find another wife, a divorced woman is seen as “damaged goods,” Al-Adwani continues, because she is no longer a virgin. The situation is compounded when the divorced couple is from the same family. “When cousins divorce, it can create an explosion within the tribe, with brothers and sisters blaming one another for their son’s or daughter’s poor behavior in the marriage and bringing shame on the family,” she says.

About 70 percent of the students at the American University of Kuwait are Kuwaiti, Al-Adwani says, with the rest being Egyptian, Jordanian, Syrian, Palestinian or a blend of Arab nationalities. In her work at the clinic, Al-Adwani sees clients 12 years and older from a variety of backgrounds — Arab nationalities, clients who are a blend of Eastern and Western ethnicities, women who are married to Kuwaiti men and “third-culture” Western families who move from country to country every few years. While Al-Adwani treats problems such as grief, depression and anxiety, she also handles a host of issues foreign to most U.S. counselors — including what to do when a husband or father takes a second wife, whether to wear a hijab (head scarf), the adjustment and challenges of wearing a hijab and the consequences of removing it. Lesbian-gay-bisexual-transgender issues also have a different slant in Kuwait, she says. “Members of the LGBT community face many challenges, but for many here, it is not an option for them to come out to their close friends or family members. This brings a new layer of challenges for this population as they pass through adolescence, face forced marriages and grow into adulthood.”

Second-generation trauma is another issue Al-Adwani sees quite frequently. Several Arab countries have experienced war in the past 20 years, she explains. “Kuwait’s landscape has been repaired since the Gulf War, but the people still carry the residual effects of witnessing death and destruction. Students who were small children and remember little or nothing about the war now wonder why their parents are short-tempered, judgmental, easily angered, irritable and unable to teach their children effective coping skills.” The kids take it personally, Al-Adwani says, so she tries to help them see that these responses are not about them but about the extreme situations their parents experienced. “After gaining a broader perspective, the students are often able to talk to parents calmly to work through disagreements, compromises, confrontations and boundaries and develop a much healthier self-esteem.”

When Al-Adwani arrived in Kuwait, she was amazed at the apparent lack of resources. It took her years of networking and using word of mouth to piece together a group of counselors, doctors, psychologists and a psychiatrist with whom she is comfortable working so she can give her clients the comprehensive care they need. In Kuwait, there are no mental health laws, and local laws are not always strong enough to protect victims, Al-Adwani says. “In fact, many sexual assault victims feel they cannot report the crime for fear they will not be able to get married or that the family will punish the victim for bringing shame to the household. Instead of a typical referral process used in the U.S., it is helpful for counselors in Kuwait to know when to facilitate an alliance with the strongest female family member to form an effective intervention for younger clients, especially in cases of domestic violence.”

Counselors in Kuwait need to be comfortable discussing religion, Al-Adwani says, because it is very closely tied with culture in Arab countries. In terms of techniques, Al-Adwani has made a couple of tweaks. “I have adapted my family systems framework to include drawing respectful connections between religions and using the clients’ own religious rituals as part of the process. I have increased my use of storytelling and analogies in this oral-based society, as well as helping clients reclaim their musical and dance heritage as methods of self-expression during a time when the conservative society bans public concerts and performance arts are often seen as a lower-class activity.”

Al-Adwani has also learned that it isn’t worth staking out positions she feels are “right” on certain issues if it offends the client or discredits the profession. “I may consider it perfectly fine to wear red nail polish, a sleeveless shirt or a knee-length skirt, but if I am working with a conservative Arab family, they will not even consider my help if I am dressed in a way they deem scandalous,” she says. And while Al-Adwani might otherwise feel comfortable going to work with little or no makeup, in Kuwaiti society, that signals a woman isn’t taking care of herself and, therefore, probably isn’t taking care of her family or her work. That woman would be seen as low class, Al-Adwani says. “In a classist society, people do not want to associate with someone who obviously appears to be from a lower class and will not consider them as a professional. ‘Dress for success’ means something very different in Kuwait.”

Kuwait is, in many ways, a shame-based society, Al-Adwani says. Individuals will give up autonomy rather than endure the possible shame of ruining the reputation of the family or causing younger siblings to be unable to find a good spouse, she says. “The good of the family is considered more important than the good of the individual because, in ancient times, it was the strength of the tribe that was able to protect the families and individuals. In modern times, people still do not want to be perceived as being weak or crazy, so many families choose to take their loved ones to Europe for treatment instead of risking someone in Kuwait finding out there is a problem and ‘ruining’ the family name.”

For other international counselors and even U.S. counselors with clients from an Arab culture, Al-Adwani offers a word of advice: Proceed with caution when your bias is very different from the client’s way of life. “If the client feels they are being judged by the counselor or that the counselor has a preference in the decision that the client makes, then the client may be influenced to make a decision that makes the counselor happy instead of the decision that works best for them in their culture. Clients will also terminate therapy if they make a decision that they believe will disappoint the counselor. Some clients would rather avoid contact than risk hearing or seeing shameful judgment from an authority figure, especially in a shame-based society.”

Reflecting on her five years of counseling practice in Kuwait, Al-Adwani says she’s learned not to compare cultures. “We are tempted to compare every new thing with the world we know. I have found that if I constantly compare life in Kuwait with life in the U.S., then I will always be frustrated, even angered.” The Arab mentality is quite different from Western thought, Al-Adwani says, but instead of picking one or the other, she has adopted both cultures separately. “I tell Americans who move to Kuwait that they must create a new ‘bubble’ in their head and put all the new culture in that new compartment because it simply will not fit into the same compartment as the information they bring with them from home. In my head there is both the Kuwaiti world and the U.S. world, and I can flow in and out of each of them while still maintaining the core beliefs that are important to me.”

That’s a difficult challenge and a tough mind-set to maintain, Al-Adwani admits, but she says it is crucial. “If I am tired, I can easily revert to my home culture and declare everything around me as ‘ridiculous,’ at which point I am very little help to my clients, my family or myself.”

Alemka Berliner, Uzbekistan

Wearing a backpack in the United States doesn’t usually signal that a person has a problem. But across oceans and lines of culture, perceptions can change. Being open to those different perspectives is crucial, says Alemka Berliner, a counselor and executive director of the Tashkent International Medical Clinic in Uzbekistan. Berliner remembers hearing sincere concerns from the sister of one of her Central Asian clients who had begun wearing a backpack. “(She) was concerned because there is ‘nothing he really needs in this bag’ and he is probably taking it everywhere he goes ‘just to be different,'” Berliner recalls. “She asked me if this is normal. I offered a very simplified response and shared that, in my culture, as long as the behavior does not cause harm to self or others or if the behavior doesn’t prevent the individual from functioning in society, it is not likely to be considered a disorder.” The client’s sister insisted she was still worried that her brother was not normal, even within Berliner’s definition. She told Berliner that wearing the backpack would hurt her brother because he would not be taken seriously and people would think he was strange. Because of the backpack, the sister said, her brother was not making friends, and she feared he would lose his job.

It might be hard to imagine that kind of concern in the United States, admits Berliner, who has also worked as a counselor in Croatia and Belgium. “I found that the origin, process and manifestation of many disorders are often similar across cultures, but at the same time, even the concept and understanding of what is to be considered a disorder or deviant behavior is not an agreed upon and accepted concept across cultures.” What Berliner does see as a commonality across all the cultures in which she has counseled is a search for meaning and purpose. “How we go about this search and how we see ourselves in this search clearly differ because our human experiences are different. Yet I found that the drive to make sense of one’s life, to take control of one’s life within the cultural boundaries, and a need to make reasonable explanations for one’s experiences are common to all my clients.”

Uzbekistan is a multiethnic country, with Uzbeks, Tajiks, Russians, Tatars and Koreans being just a sampling of the cultures represented among the Central Asian nation’s 28 million residents, according to Berliner. The Tashkent International Medical Clinic focuses on providing health care to foreign nationals, so Berliner’s clients hail from a multitude of cultural and ethnic backgrounds and vary in age, gender and religion. The topics Berliner addresses with clients include marital and relationship problems, work and stress-related concerns, substance abuse, grief, depression and anxiety. “Each and every presenting problem is related at least in some way or affected by the transitions or contact and experience with other cultures,” says Berliner, who earned her counseling degree from the University of Maryland University College Europe.

Counseling as a profession is not something many people are familiar with outside of the United States, Berliner says. Translating the word counselor is so difficult in some languages that psychologist is used instead. The trouble with that, Berliner says, is that the idea of psychiatry or psychology sometimes carries the stigma of a professional who works with the mentally ill or the “abnormal.”

In working abroad, Berliner has also noticed that the local law often doesn’t regulate counseling practice. “Guidance or requirements on issues involving minors and mandatory reporting may not be available,” she says. “Often there are no regulations, or they don’t apply to foreigners, and sometimes there are limited or no social services and support available for referral and consultation.”

Most of the courses on counseling culturally diverse clients as it relates to race, culture and ethnicity focus on counseling within the United States, says Berliner, who moves to a new international location every few years with her husband, a U.S. diplomat. But international counselors’ experiences with clients often involve the reverse — an individual’s cultural adjustment not to the United States but to a different country, such as Uzbekistan, after living for several years in America or elsewhere in the West, Berliner says. “I don’t speak all the native languages of the clients I see, nor can I claim full familiarity with their cultures. In the absence of that, the openness to accept and understand different realities, value systems, customs, spoken and unspoken expectations, social hierarchies (and) different ways of understanding self and others are the first steps in effective counseling in an international environment. The way of accessing this information also varies from client to client, so even assessment strategies may need to be reconsidered.”

Berliner has found that some treatment strategies, including cognitive behavioral, solution-focused and generally directive techniques, work better than others with culturally diverse and well-educated clients. But some of her Western clients seem to respond better and are more receptive to a person-centered approach, she says. “So again, no one approach fits all. In a multicultural environment such as Uzbekistan, all assumptions about human interactions are challenged, so counseling needs to take on a new dimension of sensitivity in all its aspects, from intake interview and treatment planning to counseling intervention.”

When Berliner thinks about what it means to counsel internationally, she looks at the ACA membership certificate hanging on a wall in her office. “There are words on the certificate that I believe best summarize my experience of counseling outside the U.S. — ‘uniqueness of each individual.’ I believe that working overseas requires a continuous search for and understanding of that uniqueness. I learned to guard my counseling from any attempts to fit my clients in any familiar, previously formed concept of who they may be based on their country of origin, their ethnic background, gender, age or presented life experience.”

Counselors in the United States would benefit from taking the same approach, Berliner says. “Counselors do well when they work on their awareness of their own cultural makeup and experiences, continuously work on expanding knowledge relevant to different cultural groups we work with — but making sure that we don’t try to fit our clients into what we learned about their particular culture — and strive to learn new skills and therapeutic techniques that could improve the effectiveness of our counseling intervention.”

Carly Henderson, Tanzania and Czech Republic

Knowing where you come from and taking the time to realize what that means to you and others was the most important lesson Carly Henderson learned during the six years she spent abroad working as a professional school counselor in international schools. Henderson counseled children age 3 years through fifth grade, as well as their families, in Dar es Salaam, Tanzania, from 2002 to 2005. From 2005 to 2007, she was a middle school counselor in Prague, Czech Republic. “The cultural piece is very, very important,” says Henderson, now working as a behavior consultant in a school district outside Portland, Ore. “And by this I mean my culture — all that I bring to the counseling setting. My assumptions and biases, my internalized view of others, my worldview toward politics and human rights, my racial identity development, my knowledge of and sense of self as an American overseas.” Henderson says being aware of your own culture and making the effort to understand its significance is likewise the most important thing in counseling relationships at home in the United States. “I need to know my own biases before I can ethically meet you at the table as my client.”

The majority of Henderson’s work overseas was with children of expatriates. Between the two posts, Henderson worked with children and families from Tanzania and the Czech Republic as well as Holland, South Africa, the United States, Great Britain, Romania, Russia and Japan, among others. Because few native English-speaking counselors or psychologists were present in either location, Henderson says she did more family counseling than school counselors typically do. “In some ways, my job mirrored that of a school counselor working in the U.S. However, there were several unique aspects to the job — namely, the transitory nature of the community and how that affects lifestyle and personal identity, cross-cultural factors and multiculturalism, third-culture kids, social and economic status in the home and guest countries, and access to resources and networking.”

The issue of third-culture kids, described by Henderson as children who have lived a significant part of their developmental years outside their parents’ culture, is one that she encountered quite frequently in the two international schools. “Third-culture kids build relationships to all of ‘their’ cultures, while not having full ownership in any. It’s different than an expatriate adult lifestyle in that it takes place during the developmental years, leading to a defined profile of strengths and challenges, which are shared among third-culture kids, even though their individual geographical histories vary.”

Henderson offers the example of a child who grows up in India but identifies herself as Canadian because either she was born in Canada or because one or both of her parents are Canadian. “When she lives in New Delhi as a 14-year-old, she is clearly not Indian. But when she returns to Canada for summer holidays after spending several years abroad, she is clearly not ‘Canadian’ either.”

In addition to the third-culture kids, Henderson did group and individual work with children who stayed put at the same international school from kindergarten through high school while friends and peers regularly came and went. “The effects are often overlooked. The concept of friendship and permanence of relationship changes in this setting. Children — and adults — either become quick to befriend, skipping the first few stages of bonding and getting right to the heart of it, or avoid it altogether, creating isolation and difficulty attaching to others.” International school settings often lack a full team of experts, Henderson says. In the absence of professionals who specialized in school psychology, special education, speech language pathology and occupational therapy, Henderson was called on to provide additional services, including counseling families. In addition, she made efforts to build relationships with the embassies and corporations that employed her students’ parents to ensure child safety. “For the expatriates in our school communities, there were less options or mandates for things like child protective services or wrap-around mental health services for families in need of intervention. Sometimes, the only recourse I had when faced with a situation of child abuse was to work with my school administrators and the family’s embassy or employer. The employer or embassy would put pressure on the family or return them to their home country.”

Looking back, Henderson, who found her first post through International School Services and her second through Search Associates and the European Council of International Schools, wishes she had known more about how other cultures view counseling before heading overseas. “With that said, the best way to learn this was to ask a lot of questions once I got there. There was a lot more initial work to be done in establishing the counseling relationship, including some ‘fishing’ to learn how I was viewed by my families and what they saw as my role.” Henderson even made an effort to get the word out to the teachers, who hailed from all parts of the world, about her role and what she could offer.

Henderson also reiterates the vital importance of culture. For the most part, she says, the books she read about other cultures before going abroad stereotyped groups, were overgeneralized and were written from a U.S. perspective. “African Americans, Asian Americans, Native Americans — I met few of these people overseas. However, I did work with many people from African and Asian countries. They are big and diverse places, and my bringing stereotypes to the table did me little good. I had to listen to teacher colleagues and parents and kids to understand where they were coming from and how to interpret situations from their perspectives.”

Henderson concedes she also had to learn what her own culture represented on a superficial level to those from other cultures. “(I discovered) that being an American meant things to others, and when I walked into the room as the counselor, I didn’t walk in tabula rasa.” While working in Tanzania, Henderson became a leader in the Seeking Educational Equity and Diversity program, housed at Wellesley College, but still she admits she had a lot to learn about being White. “Even in Tanzania, being White meant unearned power and knowledge. How I allowed space for others to tell their stories and assume leadership was something I needed to learn and reflect on constantly.” To counselors in the United States, Henderson says learning about themselves and reaching out to others can make a big difference. “It’s not enough not to make assumptions. As counselors, we need to actively investigate ourselves — all that we have learned and absorbed in our lives as ‘U.S.-ians.'” Also remember that the world is large and full of intelligent people, she says. “We can learn so much from others that will help us in our work and personal lives. Our national dialogue too often is about ‘What can we do for Africans?’ or insert another group who needs our money and our compassion. But forming relationships with people from other places can help us in so many ways.”

Christopher Kozlowski, Ireland

I found you when I needed you
At the end of a telephone
I had no one else to turn to
I was feeling so alone
And you listened
And you listened
And you listened
As my problems I poured out.

Those are the first lines of a poem written for Christopher Kozlowski by one of his first clients in Ireland. Kozlowski, who earned his degree in community counseling from Southern Illinois University, has been working as a counselor in Ireland’s National Counseling Service (NCS) for the past four years. NCS was founded to help people who experienced institutional abuse in Ireland’s government-funded industrial schools and orphanages (the country’s prime minister issued a formal apology for the systemic pattern of abuse in 1999). “Our service works from a counseling perspective, looking at the individual as an individual rather than a diagnosis,” says Kozlowski, who worked as an outpatient manager with the Union County Counseling Service in Anna, Ill., before moving to Ireland. Kozlowski’s clients are adults who experienced abuse, whether emotional, physical, sexual or neglect, before the age of 18. Kozlowski and his colleagues work exclusively with trauma; NCS clients either meet the criteria for post-traumatic stress disorder or exhibit significant symptoms. The duration of sessions varies widely. Kozlowski has seen clients for as few as six sessions and for as long as four years. “As a consequence of their early experiences, most if not all of my clients tend to be caretakers (but) find it extremely challenging to care for themselves or ask for help.”

One of the most powerful parts of the clients’ experience at NCS, Kozlowski says, is the respect paid to their needs. The simplest example of that, he says, is how clients are given tea or coffee and biscuits while they wait for their appointments. “This simple act has often been mentioned to me by clients and how they are made to feel at home, safe and cared for when attending services.”

One of the biggest differences Kozlowski has noticed between counseling in the United States and Ireland is the degree to which health care administration and financial reimbursement steer the course of counseling. “My experience in the U.S. was that managed care often dictated the most ‘appropriate’ service or means of engagement. Whereas here, I find counselors practicing as psychoanalytical therapists, with Gestalt, cognitive behavioral therapy and person-centered techniques, and client needs take a front seat to financial concerns.” Although Kozlowski says concise documentation is a key part of his work in Ireland, the paperwork is limited to notes about progress. His experience in the United States was that insurance companies had a great deal of influence on the number of counseling sessions and relied heavily on the diagnosis. In Ireland, however, the number of sessions is dependent on the client’s needs, and a diagnosis isn’t necessary to proceed with counseling work. “The emphasis in Ireland would be more about the well-being of the client and the client’s specific needs as opposed to the external restraints placed on counselors in the U.S. by third-party payers,” he says.

Counseling is a young profession in Ireland. Most work is done by clinical psychologists who are part of teams led by psychiatrists within a medical model, Kozlowski says. Although that means counseling opportunities are limited, he feels optimistic about the future. “Irish counseling organizations are working to establish professional standards and qualifications of practitioners while simultaneously lobbying policy makers to recognize the counselors and expand their (area of practice).”

Initially, Kozlowski was a little nervous about connecting with his clients because the Irish tend to be “fiercely nationalistic and proud of their heritage,” he says. Being a foreigner to the country and culture, Kozlowski worried that his clients wouldn’t trust him fully and would fail to benefit from the therapeutic process. “Fortunately, what I have found is that we all struggle with the same basic challenges of humanity. These common challenges link us as humans regardless of where we come from and make mutual understanding possible.”

Beyond the commonalities, Kozlowski finds being genuine of the utmost importance. “I find clients want me to be who I am. That means that I do not try and be Irish or (act like) someone with the answers to all their concerns. Instead, (it’s about) being an American who practices in Ireland and who, although a trained professional, is human, makes mistakes and sometimes needs clarification on things which may seem obvious to a client.”

While he says his clients are the ones to be congratulated for their successes or improvements, it’s clear Kozlowski’s clients think he plays a role in their healing, too. His client’s poem concludes:

It could have all been so different
I may not have made it through
But thanks to you and all your helpful staff
My mind is now renewed

Deborah Pinkston, Venezuela

During her eight years of counseling in Venezuela, Deborah Pinkston learned that, sometimes, the best thing a counselor can do is listen. One client in particular stands out in Pinkston’s mind. A young woman who was born in China but whose family immigrated to Venezuela when she was an adolescent came to Pinkston because she was struggling with the pull between Chinese tradition and her new life in another country. The client had quickly adapted to the Latin culture and fallen in love with a Venezuelan man. The client’s parents, however, had picked out a Chinese man for her to marry, leaving her feeling torn between her family’s wishes and the life she wanted to lead.

“There are no easy answers in situations such as these,” says Pinkston, who lived in Venezuela for 24 years before moving back to Arkansas in June, where she is now interning at Northwest Counseling Inc. while working to obtain counselor licensure from the state. “I sat with her as she struggled with this issue, as she poured out her pain and anguish. Joining the client and walking beside (him or her) through the process is sometimes the most valuable thing the counselor can do. It would have been easy for me as an American to say, ‘Just do what your heart tells you.’ But she was from another culture, another family, another world, and that line of reasoning wouldn’t have been of any value to her.”

During her time in Venezuela, Pinkston provided counseling services through a church, for two local orphanages and for a private hospital in the city of Valencia. She counseled people of all ages, socioeconomic levels and cultural backgrounds. Valencia is an international city, Pinkston says, so her client base included a range of different nationalities.

Many of the young adults Pinkston counseled struggled with issues of family and self. “They felt that they had a duty to their family but also had ideas about what they wanted to do with their lives that was in opposition to what their family expected or needed. Again, for a North American, the answer is easy: ‘Do what you want to do! They’ll get over it!’ In counseling language, ‘What is it that you want to do?’ It’s not that easy for a young person who is born into a collective culture.”

In Venezuela, the “client” is often the entire family, sometimes spanning three generations, Pinkston says. “With clients from ethnic backgrounds different from our own, we must be prepared to find that the client approaches the counseling session with a completely different expectation or mental picture of what counseling is all about.”

For example, she explains, Hispanic culture is a collective rather than an individual-based culture, so the well-being of the group is given priority. “It seems that Hispanic families are a perfect example of systems theory — what affects one affects everyone else, and all the relationships and dynamics are interrelated,” says Pinkston, who had as many as eight family members in a single counseling session. “The actual counseling session with a complete family can be very interesting and challenging as Grandma goes to sleep, the teen pouts and the toddlers run around the room while Dad is trying to talk.”

Although challenging, counseling the entire family at once is a fun version of group therapy, Pinkston says, and there’s never a dull moment. “It gives the counselor a unique opportunity to observe how the family interacts and all the issues that are affecting the well-being of the family and its individual members. Communication exercises can be practiced in the counseling session, and no one is left out or in the dark about what is happening in counseling.” She says it was actually refreshing to work with entire families — something that isn’t always easy to arrange with Caucasian families. “So much can be done with several individuals at once when they are all present in the counseling session. Although it may feel overwhelming at the beginning — I certainly felt overwhelmed the first time I counseled a family of three generations together — it can also be very effective in bringing about positive changes in family dynamics and relationships.”

Looking back, Pinkston wishes she had grasped from the start just how much she could learn from her clients. “I’m ashamed to say it, but at the beginning, I went in thinking I had the answers. I found out that much of what I thought I knew didn’t work for some clients because of their ethnic background.” Pinkston says counselors must put aside their biases and open their minds in order to learn. “We must be students of the individuals we are serving and students of their culture if we are to guide them through a healing process that is effective for them. Even when we feel that we are familiar with a particular culture, we must not assume that all individuals from that particular ethnic group are the same and share the same culture. There are subcultures within each culture, so the learning process never ends.”

As for counseling within U.S. borders, the advice Pinkston brings back from Venezuela is to embrace multicultural counseling. “The more relationships the counselor can build with individuals from diverse cultures and the more the counselor can travel, read and inform himself about various cultures that he may be called upon to counsel, the more prepared the counselor will be to understand the issues that may affect the counseling process and outcomes.”

When seeing clients from other cultures here in the United States, Pinkston says it’s important for counselors to keep in mind that many of the issues will be related to loss — loss of home, family, jobs or a familiar way of life — when individuals leave their home country. “We often assume that everyone who comes to the U.S. is gaining everything — a ‘step up’ for immigrants — but sometimes the opposite is true. Many individuals have left nice homes, successful careers, and they have left many of their family members behind when they come from countries that are torn by war and conflict. Others are leaving a dictatorship where the country they once loved has become a living hell.”

Parents might also be grieving the fact that their children will not fully experience the customs and traditions of their home culture, assimilating into American culture to a certain degree instead. “I raised my children in Venezuela and, at times, I grieved that they weren’t in the U.S. for Thanksgiving, Christmas, Easter and the Fourth of July,” Pinkston says. “We tried to celebrate these holidays and traditions the best we could, but it wasn’t the same as being in our home country at those special times.”

The most important thing a counselor can do is simply be there for clients and try to understand what they are going through, Pinkston says. “So much loss has occurred for many individuals, and they are dealing with these losses while at the same time trying to survive in a new culture. Adjustment issues are huge, and a caring counselor can go a long way in showing the support and guidance that our clients need.”




Letters to the editor:


  1. Julia Overlin

    Hi Ms. Shallcross,

    I just read your article with Counseling Today (2009) on practicing counseling outside U.S. borders and about the counseling experience in Venezuela particularly. My husband and I are considering a move to Ensenada for its ability to afford us a quality of life not easily found inside U.S., the dollar going so much farther there.

    I have 10 mos to complete my master’s degree and am at this point just considering the logistics. I wondered if you could direct me as to how one goes about practicing in somewhere like Ensenada. I will be nationally certified (NCC) and LPCC’d by the time we are moving there, I will be licensed in California. Is it just a matter of taking my U.S. licensures to the Government center and transfer licensure or do they have their own exam? I’ve researched “counseling in Ensenada” but am only provided Yelp reviews of existing counseling sites there, no real insight on how to live and work there as a professional counselor.

    Any insight you could provide would be appreciated. It won’t be for awhile if we go but am just researching possibilities of what would be involved.

    Ultimately we would likely gravitate back-and-forth between San Diego and Ensenada as fishing seasons require, husband a professional fisherman chartering our sport fishing boat we also live aboard. I have aspirations of having a live/work loft in San Diego as a second home that I would counsel out of.

    Telehealth I intend to be a part of what I offer in my counseling services, another aspect of counseling I am researching the possibility of doing from Ensenada. I will be licensed in California to Telehealth counsel clients who are in California, but is anything special needed re licensure/certification for counseling professionally in Ensenada or surrounding areas?



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