Tag Archives: Counselors Audience

Counselors Audience

Hey, Siri: Did you break confidentiality, or did I?

By Nicole M. Arcuri Sanders January 14, 2020

Did you know that your tech devices have the potential to break your clients’ confidentiality just by being in the counseling setting with you? Imagine that you have worked a full day seeing an array of clients for the various concerns they are facing. Then, at the end of the day, you snuggle up on the couch and scroll through your phone’s applications. You notice numerous ads and suggestions that relate to the topics clients have shared. For instance, imagine a client sharing about a traumatic event that happened in the Catskills, and now you have Airbnb suggestions for that area, along with resources for dealing with sexual abuse.

You may be wondering, “How did that happen? Was my phone listening to our session?” The answer might be yes.

In other cases, you might not be made aware that your phone was listening, but it is important to know that it has that capability. The reason for this is the voice assistant technology on your devices. While on, these devices are constantly listening. For instance, Apple iPhone is listening for the word “Siri”; anything said after that is considered a command. The same is true with Amazon’s voice assistant Alexa and with Google Assistant. Each of these devices is waiting for its name to be called so that it can follow up with whatever assistance the person using it desires.

However, it has been found that the devices sometimes mistake certain words and are activated unintentionally.

This past July, The Guardian newspaper shared shocking reports from an Apple contractor. This whistleblower reported that Apple contractors “regularly hear confidential medical information, drug deals, and recordings of couples having sex, as part of [Apple contractors’] job providing quality control.” These workers are tasked with listening to grade the responses of the company’s Siri voice assistant. For example, the workers will grade if the response from Siri was accidental or deliberate and if Siri’s response was appropriate.

But what does this mean for professional counselors? Just think invasion of privacy and breach of confidentiality concerns.

Voice assistant concerns in the counseling setting

This next section is going to present a hypothetical counseling office to address some of the confidentiality concerns that surround the counseling experience with technological voice assistants. Consider whether you address these concerns in your informed consent with clients. Would these occurrences align with Health Insurance Portability and Accountability Act (HIPAA) regulations?

Waiting room: Counselors strive to create a warm and inviting setting to foster a comfortable feeling for clients because they are in a vulnerable situation. Perhaps some relaxing music is playing in the waiting room. Consider Alexa being programed to shuffle through various playlists of calming songs throughout the day.

As clients await their sessions or end their sessions, they may need to discuss billing with the front-desk assistant or call their insurance companies. Clients may even take a call during this time for other purposes. Alexa hears all of these conversations throughout the day. Therefore, the potential is there for the entrance to this “safe place” for clients to instead become a place where personal information is leaked to Alexa and to those who monitor Alexa or have access to Alexa’s recordings.

Additionally, clients may not even realize that while they are in your office discussing billing, diagnosis, and plans moving forward, their smartphone’s voice assistant can be eavesdropping as well. The same goes for all of the other smartphones located in the waiting room, including those being used by personnel working the front desk.

In session: When clients and counselors meet in an office, safety is a concern. Therefore, counselors may choose to keep their phones in their pocket or nearby in case they need to call for help. Some sites may even have a policy requesting that counselors have their cellphones on them at all times. However, now these phones’ voice assistants can have access to the dialogue that occurs within the room. This also means that whoever is monitoring the voice assistants have access. What was intended to be a safe place for clients to navigate and process concerns is now compromised.

Can you imagine if you, as the counselor, were facilitating a group and each client had a smartphone with a voice assistant? Consider also if you take notes on an iPad that has voice assistant technology. As counselors, we understand there are some limits to confidentiality. However, these voice assistant technologies have the capability to leak what clients and counselors once believed to be confidential information.

 

Disconnect: Don’t be considered liable

A number of considerations need to be taken into account by both the counselor and the client regarding confidentiality of sessions when voice assistant technologies are present. First and foremost, this issue should be addressed. Now that you are aware of the implications for your practice, you are ethically responsible for addressing these possibilities with your clients.

According to the 2014 ACA Code of Ethics, clients have the right to confidentiality and an explanation of it limits (Standard A.2.b.). Understanding these limits, clients have the right to make an informed decision regarding whether they would like to participate in counseling services with you (Standard A.2.a.).

Therefore, if you choose to utilize voice assistant technologies, you need to inform clients of the benefits and risks prior to them beginning counseling services. This explanation is not limited only to the counselor using these technologies but also acknowledging whether the counseling site allows its staff or clients to use them. If your site chooses not to utilize voice assistant technologies, you will need to address what your protocol is concerning this matter. For instance, will all cellphones be turned off? How will this be regulated?

What if your site requires cellphones for safety concerns or if clients are not willing to turn their phones off? How can you still protect client confidentiality and be in alignment with HIPAA regulations? The simple answer is to turn off your voice assistant technologies. You might consider noting the confidentiality risks in your informed consent and then sharing some of the directions noted below for how to disable these technologies.

 

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For iPhones and iPads, to turn off Siri, complete the following directions:

1) Open your settings.

2) Click Siri and Search.

3) Toggle OFF, listen for “Hey Siri.”

4) Toggle OFF, Press Home (or side button) for Siri.

5) Toggle OFF, allow Siri when locked.

 

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To turn off “Hey/OK Google,” complete the following directions:

1) Open your settings.

2) Under Google Assistant, tap Settings again.

3) Under Devices, tap Phone.

4) Turn OFF Access with Voice Match/Assistant.

 

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To turn off Amazon Alexa, complete the following directions:

1) Open your settings.

2) Select Alexa Privacy.

3) Tap Manage How Your Data Improves Alexa.

4) Turn “Help Improve Amazon Services and Develop New Features” OFF by tapping the switch.

5) Confirm your decision.

 

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These steps can provide clients with a choice while also informing them of the risks of their choices. In group counseling, however, as a safeguard to clients’ confidentiality, I would recommend not allowing any client to keep their cellphones, iPads or any other voice assistant technologies on.

Because these devices may travel with us basically everywhere we go, our conversations are being monitored for product improvements, but in the process, our confidentiality is being breached. Currently, with some simple options for turning off these technologies, clients can continue to maintain the level of confidentiality to which they originally thought they were agreeing.

As counselors, we take many safeguards to protect our clients’ confidentiality. I encourage you to toggle off your voice assistant technology options to keep your devices from being the reason you are held liable for breaking confidentiality. Moving forward, as technologies continue to transform, we as counselors need to be ready to address implications in the counseling setting.

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Nicole M. Arcuri Sanders is a licensed professional counselor, national certified counselors, approved clinical supervisor, and core faculty at Capella University within the School of Counseling and Human Services. Contact her at Nicole.ArcuriSanders@capella.edu.

 

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

Grieved: A firsthand account of enduring a client grievance as a counselor

By Jessica Smith January 7, 2020

I learned in graduate school that most counselors will experience three things in their careers: a client who dies by suicide, a client who overdoses, and a client who files a grievance. I remember hoping that I would be the exception to the rule. Throughout my career, I tried to do everything in my power to avoid that grad school prophecy. But fate had other plans: Last year, one of my clients filed a grievance against me.

Shame breeds in secrecy. In my experience, being the subject of a client grievance is one of the most shaming — and isolating — events a counselor can encounter. Those who choose to speak openly and honestly about the grievance process are often met with judgment and criticism. In an effort to help combat the silence and stigma, I’m sharing my story with the hope that it will provide guidance and support to other counselors who are going through this difficult and trying process. I want to remind others that they are not alone on this journey while also offering a road map for a way through. It will be OK.

One of the things that helped me get through the grievance process was conceptualizing it in terms of Elisabeth Kubler-Ross’ grief cycle. I tell my clients that the stages are the road map for grief. If I had a road map, then I had a direction to go, and I was not stuck or lost. I did not know when I would reach acceptance, but I knew that it was on the horizon if I just kept moving forward.

 

Denial and shock

Early last year, while checking my email in a Target parking lot, I saw a message from the Department of Regulatory Agencies (DORA) sitting in my inbox. In Colorado, DORA is the governing body that issues licenses to providers while also handling consumer grievances. My heart began beating quickly. I felt dizzy and nauseous. I walked into the store to return an item at the customer service counter, and I had to will my legs to move forward and my mouth to speak. I felt like everyone around me could see a massive letter “G” tattooed across my forehead. My hands began to shake as I drove home so that I could read the email at my desktop computer. As I read through the entire message from DORA, I started to cry.

A few weeks prior, I had taken on a new client at my practice. Interestingly, my intuition immediately suggested that this client would be challenging. The second session reinforced my sense that building a therapeutic relationship with this client was going to be a rough road. The third session didn’t happen — the client was a no-show, no-call. When I reached out to the client through a text message, she said that she did not want to schedule a future session with me, so I discharged her from therapy that afternoon. I had a feeling this would not be the last time that I heard from this client. My intuition was correct.

I received an email from the client that night, criticizing me for the way I had handled the interaction. She thanked me for helping her but asked me to explain my “side of the story.” Because I had already discharged her from therapy and felt that any potential future counselor-client relationship would be negatively impacted by the exchange, I told her that I no longer felt comfortable working with her. Again, I had a feeling this would not be the last time I heard from this particular client. My intuition was right again.

 

Bargaining

DORA was citing me for poor communication and abandonment. I immediately reached out to a friend and former colleague who had worked with an organization that completed assessments for DORA. I knew she had also been through the client grievance process a few years prior. As I prepared for our discussion, I looked up everything I could find on the internet about the grievance process, client abandonment, HIPAA, and mental health statutes. Nothing was clear, and most of the information seemed contradictory.

On the phone, I laid out the facts of the case before my friend. Like many others I would talk to along the way, she thought it likely the case would be dropped. Thankfully, the grievance was not based on a verbal exchange; resolving the case would not depend on pitting my word against the client’s. My friend advised me that I might need to seek legal counsel, and we discussed my official response to the complaint, which I typed up immediately and sat on over the weekend.

The following Monday, I gathered the client’s file and submitted it to DORA, along with my response to the grievance. I also reached out to my insurance carrier to let it know about the grievance. All the while, I was hoping the case would be dismissed so that this nightmare would end. Due to the benign nature of my case and the cost, I chose to hold off on hiring legal counsel at the beginning, but my insurance provider encouraged me to reach out to a lawyer if the case continued any further.

 

Depression

The grievance was all I could think about. It consumed me. I would fall asleep ruminating about it and wake up the next morning to a continuation of my thoughts from the night before. Or, just as often, I would wake up in the middle of the night, my anxiety quickly rising as I remembered that this was not a dream — it was really happening to me. I prayed for it all to go away. I wanted to return to a sense of normalcy. I began second-guessing myself and the image I was presenting to my clients at work. I felt on edge and afraid that something else would happen. I feared that this grievance process would not be the end of it.

I had been in the field for seven years and had never experienced an issue like this previously. I had provided services in challenging and demanding settings, including detoxes, residential treatment facilities, and jails, and I had never before had a client complain to a supervisor or another colleague about my work.

Because the personal is professional and the professional is personal in our work, it can be hard to separate the two. This makes it difficult to prevent internalization during the grievance process. I felt like a bad counselor and, thus, a bad person. At the same time, I felt confused because I had other clients telling me that I was an incredible therapist who had helped them change their lives for the better and become the best versions of themselves. I tried to hold space for all of these experiences and live in the gray, but it was tiresome and tough to do.

Fearing judgment and criticism, I was mindful of who I shared my troubles with. I was in a vulnerable place and was already attacking and beating myself up enough without someone else adding to the punishment and suffering. Like most therapists, I am attuned to nonverbal cues and underlying speech tones and was always looking for them when I told my story to fellow counselors. For the most part, I chose to keep the experience to myself and a few confidants, but I knew that wasn’t enough. I also needed the perspective and guidance of other professionals during this demanding time, so I shared with people in my therapist support groups. The majority of the people I told were empathetic, nonjudgmental and supportive, but there were a few whose faces dropped once I told them. There were still others who tried to use my story as their own personal case study, which was disappointing and disheartening.

I felt like I was in a dream, observing this entire experience happening to me from a distance. I believe that, at the time, this was a necessary coping strategy. I had to compartmentalize the experience so that I could go to work each day and meet with clients at my private practice. I likened it to being sued by your company and continuing to show up for work every day, knowing what is happening around you and within you.

I questioned myself constantly and considered what I could have done differently. I read through the mental health statutes and searched HIPAA forums, but nothing was transparent and straightforward. I tried to look up articles, podcasts and research on the grievance process but could find only one research article from the 1990s on the impact of the grievance experience on psychologists. It helped to know that my experience of the process was normal and valid, but it did not ease my fears.

 

Anger

I have two licenses in Colorado, which is advantageous in my work — except for when I going through the grievance process. My double licenses made it doubly difficult because my case had to go before both boards. The two licensing bodies can have differing opinions and sanctions, but I learned early on that once one board reaches a verdict, the other board often follows suit. I received an email informing me that the Colorado State Board of Licensed Professional Counselor Examiners would be the first to review my case, in May. I had submitted my paperwork in February, so it would be months before I would know the resolution of my case. I was learning that the grievance process is a prolonged waiting game.

Meanwhile, I was expanding my practice and interviewing contract therapists. Then, in April, I received an email from the Colorado State Board of Addiction Counselor Examiners informing me that my case had gone before its board first, without my knowledge. I was blindsided. I was in the middle of doing interviews but, thankfully, had a break, so I drove home. I made it about halfway before pulling over to the side of the road to read the rest of the email. My mind was blown. I felt like my sense of reality was crumbling.

The Board of Addiction Counselor Examiners had found me “guilty” of the allegations and was moving the case forward to Colorado’s Office of Expedited Settlement. I found a lawyer online and emailed him from the side of the road. I felt powerless and out of control and needed to find a way to regain my sense of self-agency. I knew that taking action was the way for me to do that. I didn’t want to have any regrets about what I could have or should have done, so I was finally ready to get legal assistance for this fight.

I met with the lawyers the following week and learned that they were receiving three to five grievance cases per day. In the past, they said, they had received only three to five grievance cases per month. After our meeting, I looked up the list of therapists involved in disciplinary actions through DORA’s website, and the numbers were staggering. There are approximately 26,000 counselors in Colorado, and more than 11,000 have received disciplinary action.

I was angry — with myself, with the system, with the profession, and with the client. I felt so much anger pulsating through me that I wanted to scream and to run away, both at the same time. I thought about walking away from it all — leaving the counseling profession, giving up my licenses, and moving on to a different, safer, easier path.

Mainly I thought, “Why me?” I felt myself moving into a victim mentality as I had done in the past when going through trying experiences. Because I have been victimized in my past, this is an easy role for me to assume when I am experiencing pain and suffering. I blame others and shut down.

Anger is an uncomfortable emotion, but I knew I was meant to have it in this moment because it would lead to motivation, change and movement. I could harness it or let it eat me alive. It was my choice alone.

 

Acceptance

Like many grieving people, I remained stuck for some time in the anger phase. Anger feels powerful and motivating, unlike sadness, which is exhausting and debilitating. However, I always go back to the saying that “anger is like taking a cyanide pill and hoping it will kill your enemy.” It only ends up hurting you in the end. My anger toward myself, the client, the system and the profession would not serve me. It would end up eating me alive if I allowed it to.

I was walking home from work one day when suddenly it began to rain. Completely unprepared, I had nothing to keep me dry. It was only a mild shower, however, so I said out loud, “If it keeps raining like this, then I’ll be OK.” It started raining harder. Undaunted, I said again, “If it keeps raining like this, then I’ll be OK.”

And then it began to pour. I was halfway home, caught in a storm without a raincoat. All I could do was surrender. I was broken open. The armor of anger I had been parading around in fell away as I began to cry. “I surrender,” I said aloud. “I get it. I’ll always be OK.” I started to smile as tears mingled with the raindrops running down my face. Nature has a way of asking us to let go of our resistance and surrender.

I released my anger in that moment, realizing that I’d been aiming most of it at myself. I began the slow process of forgiving myself and coming back home to the idea that we are all doing the best we can. I never meant to hurt the client, and I had no malicious intent in my actions. I had done the best I could in that moment and with the situation.

I moved into acceptance by making meaning of the experience and discovering that it was meant to realign me with my soul’s calling and purpose. I realized that I cannot veer far off my course in life before the universe pushes me back into my lane.

 

Lessons learned: Seek support, ask for help, find allies

It is difficult to share with others what it’s like to go through the grievance process, but it is also incredibly necessary. As is the case with any grief process, we need sources of support to call on to ground us and anchor us when we feel like we are floating away or losing sight of our true selves. As professional counselors, we may make mistakes, but that does not make us bad people. We need to be reminded of our goodness and wholeness.

It is essential to surround ourselves with genuine and unconditional love and to have a safe place to cry and yell without fear of judgment or criticism. When all we want is to lie on the ground and give up, our support systems can lift us up and keep us moving forward. And, finally, we need to be reminded that counseling is extremely difficult work.

My only regret about the whole process is that I did not seek legal counsel sooner. I wonder what might have happened if I had not been deterred by the nature of my case and the cost. Although I now realize that I needed to go through this process to realign my priorities and path both personally and professionally, I sometimes question whether things would have turned out differently if I had sought the assistance of a lawyer in formulating my response to the grievance originally.

Retaining attorneys earlier in the grievance process might not have helped me avoid the verdict of “guilty,” but it likely would have provided me more peace of mind. In fact, once I sought legal counsel and spoke with my lawyers, I felt a sense of ease and relief. As I mentioned, I was restless and waking up frequently during the nights, but after that initial afternoon meeting with my lawyers, I got my first full night’s sleep in two months. I am aware of how vital regaining the ability to rest was to enduring the trauma of the grievance process. Sleep heals.

Later on in the process, I connected with the Colorado Counseling Association (CCA). I remember saying to myself, “DORA protects the consumers, but who protects the counselors?” This was my answer. I went to an event sponsored by CCA and learned more about the advocacy work it does to support and help counselors. Specifically, it is fighting to change the vague and subjective language of the clause in the mental health statute of “best practices” that was cited in my case and many other cases as a catch-all category for disciplinary actions. Here were even more people on my side who were passionate about advocating for counselors and changing the system.

During the grievance process, someone had said to me that the tower I had built with all I had believed to be true was crumbling and falling, leaving behind a pile of rubble and debris. My beliefs about my career had been built on shaky and rocky ground to begin with, so it was inevitable that they would all come tumbling down eventually. Now that the collapse had ended, I had to decide what to do with the debris. I could choose to walk away from the bricks and stones in the rubble, or I could use them to build a new tower on stronger ground.

I am still in the process of rebuilding, and I know that it will be a slow and methodical project. I am fulfilling the stipulations from DORA and considering the future. I am not sure if I will ultimately want to maintain both of my licenses. For now, however, I have chosen to keep them. But I know that the choice is mine — no one else’s. I now have a solid foundation on which to build my tower.

With each placement of brick and stone, I feel stronger and more powerful than I was before this experience. My battles scars and wounds will influence how I build my tower, but they will not halt or control the construction. As Carl Jung said, “I am not what happened to me; I am what I choose to become.”

 

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Jessica Smith is a licensed professional counselor and licensed addiction counselor with a private practice, Radiance Counseling (radiancecounseling.com), in Colorado. Contact her at jsmith@radiancecounseling.com.

 

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

 

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

Digesting the connection between food and mood

By Lindsey Phillips December 31, 2019

For most of her life, the woman would not let herself eat cake. She feared that if she started, she would never be able to stop. The presence of cake at every birthday party she attended tormented her. She grew so preoccupied with thoughts of cake that she had food fantasies about eating it.

The woman’s unhealthy relationship with food eventually led her to Michele Smith, a licensed professional counselor who operates a private practice called The Runaway Fork in Westfield, New Jersey. With Smith’s guidance, the woman decided to conquer her fear by eating a sheet cake while she was alone.

The client took her first bite, but it wasn’t the experience she had fantasized about. It tasted artificial and waxy. She thought perhaps it was only the frosting that she didn’t like, so she took another bite, this time focusing more on the cake itself. It only confirmed the horrible taste from her first impression. The woman ended up throwing out the entire cake.

The client’s craving for cake had caused her years of suffering, yet when she finally ate it mindfully, she discovered that she didn’t even like it, says Smith, who is also a licensed mental health counselor in New York.

“There’s all this unnecessary suffering around food, weight and body,” Smith continues. At the same time, “there seems to be a lack of services available for everyday people who do not have eating disorders [but] who want to discuss and heal their relationship with food, body and weight.”

For this reason, Smith, a certified mind-body eating coach and a member of the American Counseling Association, created her private practice to help people who struggle in their relationship with food. She doesn’t have a precise phrase to explain this special niche she has carved out with her counseling practice, but she says it differs from nutritional counseling, which focuses on helping clients figure out what to eat. Instead, Smith attends to who clients are as “eaters.” This includes connecting their relationship with food to other life domains and psychosocial factors — such as anxiety, depression and trauma — that professional clinical counselors work with every day.

Researchers are not completely sure how food fits into the overall mental health equation, but recent studies suggest a strong connection. In general, food can promote wellness in three ways: 1) by providing the brain with nutrients it needs to grow and generate new connections, 2) by tamping down inflammation and 3) by promoting gut health.

In 2017, the world’s first study of dietary intervention for clinical depression, called the SMILES trial, found that a modified Mediterranean-style diet (which encourages whole grains, fruits, vegetables, legumes, low-fat/unsweetened dairy, raw unsalted nuts, lean red meat, chicken, fish, eggs and olive oil, while discouraging sweets, refined cereals, fried foods, fast foods and processed meat) resulted in a significant reduction in depression symptoms when compared with the typical modern diet loaded with fast food, processed foods and refined carbohydrates.

A randomized controlled trial published last year in PLOS ONE supports the findings of the SMILES trial. Researchers found that adults who followed a Mediterranean-style pattern of eating for three weeks reported lower levels of anxiety and stress and a significant decrease in their depression symptoms.

These and other findings suggest that counselors should no longer think of mental health in isolation but rather as part of a complex system that includes what people eat.

A missing piece of the mental health puzzle

Lisa Schmidt, a licensed associate counselor, certified whole foods dietitian nutritionist, and instructor in the School of Social Work at Arizona State University, points out that people seldom think about what they eat. “The act of eating is considered a nuisance. It’s something people don’t have time for until they’re just so hungry, they have to eat something, and when you get to that point, you often make very poor nutritional choices,” she says.

For instance, people may grab fast food and eat it in the car on the way to their next meeting or to pick up their kids. Then, when they have trouble sleeping later that evening, they assume it is related to their feelings of anxiety, thus overlooking any possible connection to food, Schmidt adds. 

“Most people don’t know that the kind of foods we choose [to eat] can help us regulate our nervous system and perhaps is the missing link in mental health care,” Schmidt notes.

Schmidt, an ACA member in private practice in Scottsdale, Arizona, says that mood-related disorders often have a food component to them because nutrition-poor diets affect mood. The standard American diet, often aptly referred to by its acronym SAD, frequently leads to people being hungry and tired and having dysregulated moods, she continues. People often alternate between periods of escalation, during which they fuel themselves with caffeine, processed sugar and refined carbs, and periods of starvation. This unhealthy pattern leads to dysregulated moods, Schmidt explains.

In addition, stress (which is common in fast-paced, disrupted lifestyles) dysregulates people’s nervous system responses. When people are stressed and in fight-or-flight mode, their bodies secrete glucose into the bloodstream, fueling them to run away from real or imagined danger. Then the pancreas secretes insulin as it tries to regulate blood sugar levels, Schmidt explains. These swings in blood sugar levels affect mood and can lead people to become “hangry” — hungry and angry, she adds.

Two researchers at the University of North Carolina at Chapel Hill recently set out to study the underlying mechanism behind the complicated “hangry” reaction, and their results challenge the theory that hanger is the result only of low blood sugar. They found that hunger-induced feelings can lead to tantrums and anger when people are in stressful situations and are unaware of their bodily state. In other words, hunger pangs might turn into other negative emotions in certain contexts.

This suggests that people should slow down and pay attention to both their physical and their emotional cues. Smith advises her clients to carefully set the scene before eating, telling them that eating should be stress free, relaxing and pleasant. To achieve this, they might consider using a candle or playing calming music. They shouldn’t be using their phones, watching television or walking around, she says. And although some families use dinner as a time to reprimand their children, there shouldn’t be any arguing while eating, Smith adds.

Because the quickest way to relax the body and mind is through breathing, Smith instructs clients to take as many deep breaths as they need to calm down before they begin eating. She also recommends that clients put their forks down between bites or use their nondominant hand to help them slow down and fully experience their food.

Mindful eating also involves approaching the meal with all of the senses, Smith says. She often illustrates this type of eating in session by having clients — especially those prone to eating quickly or eating distractedly as they work or stare at a screen — engage their senses while eating a Girl Scout Thin Mint cookie. During this activity, Smith asks clients to forget about their ingrained diet rules, negative self-talk, or whatever else might be in their heads and focus on their bodily experience of eating.

First, she has clients look at the cookie so the brain will register that food is present. Next, she has them touch the cookie and notice its texture. Then Smith asks them to smell the Thin Mint because scent affects our pleasure or displeasure with food. Once clients put the cookie in their mouths, they slowly roll it on all parts of their tongues without biting into it. When they finally bite the cookie, they listen to the sound it makes and notice how it tastes and when the taste starts to diminish. At the end of the exercise, Smith asks clients to rate their experience as pleasant, unpleasant or neutral. 

This simple exercise is an eye-opening experiment for most of Smith’s clients, who often admit they would normally just throw the cookie in their mouths and not think twice about it. When people learn to slow down and eat mindfully, they become better at noticing when they are full or if they are no longer tasting their food. Smith says one of her clients discovered through the exercise that she actually didn’t like Thin Mint cookies, even though she had eaten them all of her life.

It’s one thing to tell clients what mindful eating is; it’s another thing for them to experience and feel it for themselves, Smith says. “Mindful eating as a practice can be helpful at reawakening [our] appreciation for food,” notes Schmidt, author of Sustainable Living & Mindful Eating. “As we wake up to how we feel and what we experience, we have the possibility of change.”

The emotional toll of restrictive eating

“Every diet is some form of food restriction,” Smith asserts. “When you eliminate certain foods or when you deem certain foods bad or forbidden, you’re actually going to create the overeating through that sense of deprivation.” For example, the night before someone starts a no-carb diet, he or she might binge on bread as a “farewell” (often referred to as “Last Supper” eating). People on diets never reach habituation, so when they are exposed to restricted foods, they may overeat them, which only reinforces the idea that they can’t be trusted around a particular food, Smith adds.

Licensed clinical professional counselor Heather Shannon wrote a book chapter on nutritional stress management strategies for volume one of the book Stress in the Modern World: Understanding Science and Society. She says the all-or-nothing, judgmental thinking that is common with most diets often creeps over into character judgment: “I’m bad because I ate that carb” or “I feel horrible that I cheated on my diet by eating that cupcake,” for example.

Shannon, who offers coaching and teletherapy as a psychotherapist at Lotus Center in Chicago, had one client who was fit and healthy but fixated on losing three pounds. One morning, the client woke up feeling great, but the second she stepped on her scale and saw she had gained one pound, her mood changed. She went from feeling wonderful to feeling horrible in two seconds.

Fixating on an outcome, such as the number on the scale or the number of times a person has gone to the gym that week, is a big part of anxiety, Shannon says, and it opens up the possibility of good and bad labeling (e.g., “I’m bad because I went to the gym only once this week”). Instead, she helps clients focus more on their habits and which habits make them feel good, healthy and connected to their bodies. “If you’re treating your body really well, then whatever the results are is how your body is supposed to be,” she says.

Smith, a certified intuitive eating counselor, helps clients let go of the dieting mentality and reawaken their intuitive eater. In the intuitive eating model, there are no “good” and “bad” foods. Smith describes it as “a non-diet, flexible style of eating where you follow your internal sensations of hunger and satiety to gauge what, when and how much you eat.”

Smith points out that not every client will automatically be ready to put all foods back on the table. Under those circumstances, counselors can instead help raise awareness around dieting and how it may be interfering in clients’ lives. For instance, counselors might ask: How has your diet affected or changed your relationships with others? How much time and money have you spent on diets? How has it affected your social life and mental health? What in your life has changed because of dieting?

Schmidt also tries to help clients adjust their mindset around food. “Nourishment is not determined by one episode,” she says. “It’s an eating pattern over time.” For this reason, she advises clients to follow the 80-20 rule, in which 80% of the time people make choices that are whole foods (mostly plant-based), and then they don’t need to worry about the 20% of the time that they have a treat or indulge.

“We eat for reasons that are other than just to feed our bodies,” Schmidt says. “We eat as part of celebrations, and food is pleasurable. So, adopting a very restrictive, Spartan way of eating” — particularly one that demonizes any particular food group — “… can become disordered eating and cause problems for some people. … And research shows eating this way will fail 95% of the time.”

Instead of adopting the latest diet fad, people should find a way to eat that they can follow for the rest of their lives and that simultaneously supports their health and mood, Schmidt says.

Using foods to cope with moods 

If clients understand biological hunger and still reach for food without feeling hungry, then they are often engaging in emotional eating, Smith says. This may mean that a client eats because of unresolved trauma or grief. Maybe the client has perfectionist tendencies and uses food to manage his or her anxiety. Or perhaps food is the way a client copes with being in a marriage or job that makes them unhappy.

Smith works with clients to figure out what they are feeling — such as anxious or lonely, for example — when they experience emotional hunger. “This is where the mental health piece comes in,” she says. “You’re talking about eating, but the root cause of the eating is really psychological issues. … They’re people pleasing. They need boundaries. They need to be assertive. They need to say no to people and they can’t, so they use food to cope.”

Shannon, author of the ACA blog posts “Nutrition for Mental Health” and “How Does What You Eat Affect How You Feel?” finds the internal family systems approach effective for uncovering underlying issues associated with emotional eating, especially if clients have a playful side. She first helps clients identify the part of themselves that is overeating by asking what this eating part of them feels like in their bodies. One client might feel it in their stomach, whereas another client might sense it as a coach whispering in their ear.

Shannon also instructs clients to personify the part of them that is overeating by naming it (for example, the Snacking Part, Cake, or even a human name such as Maria). Then, both she and the client can easily address and reference this personified part.

Shannon might ask the part, “What is going on when you overeat?”

And the part almost always provides an answer. For example, “Well, I feel like I work too hard, and I need this because it’s my pressure release valve” or “I feel like I can’t count on people, so I’m counting on food.”

Smith and Shannon both caution against having clients keep a food journal that tracks food intake or weight. They say that activity takes clients out of themselves rather than tuning inward. In addition, they warn, it can promote obsessiveness. But they agree that clients can benefit from journaling about their emotions and feelings associated with food. For example, a client could write down what he or she feels right after overeating as a way of identifying what emotions are associated with the behavior. 

Schmidt has clients keep a food and mood journal, but not to track food intake or to promote weight loss. Instead, the goal is to help clients build an awareness of when they’re eating and how they feel before and after eating. This ultimately gives them a better understanding of how food affects their mood and how mood can affect their eating habits.

She provides an extreme but not unusual example: While journaling, a client noticed that they did not eat anything until 2 p.m. They felt terrible but only had 10 minutes to eat, so they ingested a protein bar and soda. Immediately afterward, they felt good, but an hour later, the client was starving, mad and stressed again.

“Most people … spend less than two minutes a day thinking about what they’re going to eat. They just react,” Schmidt says. “So, building awareness of all our habits, including our fueling habits, is really important.” 

In addition, if people are not fueling their bodies in a healthful way, it will create difficulties for them, Schmidt says. Chronic pain, substance abuse, anxiety and depression are all issues for which food is a huge component, she asserts. Schmidt had a client who would eat seven to nine bowls of Froot Loops for breakfast while in recovery from drug use. People recovering from substance use may often transfer their addiction to food, especially highly processed, sugary types of foods, she says.

Smith encourages her clients to approach their relationship to food with a compassionate curiosity. Clients can view nutritional changes as an experiment to figure out how their bodies react or what works best for them, she explains. Also, if clients haven’t fully mastered their new coping skills and continue to engage in emotional eating, then Smith advises them to be compassionate with themselves and say, “I’m reaching for food, and I know I’m not hungry. I look forward to the day when I can cope with my emotions without using food.”

Staying within scope

Smith has noticed that many counselors shy away from discussing any issue related to food with clients, reasoning that it falls outside their scope of practice and because becoming a certified eating disorder specialist or nutritionist requires specialized training. But she encourages counselors to rethink this mindset. “It’s not out of [counselors’] scope of practice to talk about people’s relationship with food. It’s such a critical part of everybody’s day. So, to not look at it is missing a big part,” Smith says.

“You don’t have to talk about the grams of protein per se, which is out of our scope … to really help somebody,” she continues. “Because [clients are] dying to talk about it, and they need that space. And it’s connected to so many other life domains [e.g., trauma, grief, anxiety, depression, stress] which counselors are more than equipped to talk about.” 

As a certified health coach, Shannon says she would never prescribe foods for clients or tell them what they should or shouldn’t eat, but that doesn’t prevent her from talking about food in session. In fact, on her intake form, she screens for potential issues with food by including general questions such as: What do you generally eat for breakfast, lunch and dinner? Do you snack or skip meals? Do you overeat or under eat? Then, in her first session with clients, she discusses this information and asks follow-up questions to gain a better understanding of clients’ relationship with food and the way this could be affecting their mental health.

“Even if you’re not a nutrition expert, we all know some basic stuff. We all know whole foods are better than processed foods. We all know excess sugar is not helpful,” Shannon says. For this reason, she recommends that counselors screen for basic nutritional information to see if food might be a piece of the client’s mental health puzzle. 

Rather than telling clients what to eat, Shannon takes a behavioral approach and asks, “What are you eating, and how is that working for you? What do you think might work better?” Sometimes, she will also provide clients with helpful resources and advise them to talk to their doctor or a nutritionist about other options they could pursue.

Schmidt finds that discussing alcohol use with clients can serve as a great segue into talking about their diet in general. In her experience, alcohol often comes up with clients who have mood disorders, and because alcohol is a nervous system depressant, it is not advised for these clients. While discussing their alcohol use, Schmidt will ask other questions about their diet, such as if they eat breakfast consistently or if they eat lots of processed, high-sugar foods. From there, she might suggest that clients try to limit the amount of food with added sugars that they eat and experiment with eating fresh fruit as a snack or dessert most days of the week. Schmidt will also use the Healthy Eating Plate (created by Harvard Health Publications and nutrition experts at the Harvard School of Public Health) as a way to help clients visualize how to build meals that support balanced moods.

Schmidt recommends that counselors interested in the food-mood connection experiment with their own eating habits to see how this affects their mood. “It is particularly difficult for a counselor who has a poor diet to talk about the food-mood connection with a client,” she says. Similar to how counselors practice meditation themselves before teaching it to clients, Schmidt believes counselors should first reorganize their own way of eating to include mostly foods derived from plants, to limit caffeine, and to limit or eliminate alcohol.

After counselors have experimented on their own with the food-mood connection, Schmidt says, then they can ask clients to do a chain analysis. For example, if a client is having panic attacks, the counselor might ask, “What do you remember doing just before the panic attack? Did you have anything to eat or drink? If so, what did you eat or drink?” Maybe the client will say that he or she remembers drinking coffee or alcohol before the panic attack happened. The counselor could follow up and ask whether the client noticed any change in how he or she felt after drinking three cups of coffee or drinking alcohol to excess before having a panic attack. This technique will help clients connect their dietary choices, which are ultimately under their control, to the way their mood is affected, Schmidt says.

Smith acknowledges that counselors’ scope of practice does limit just how far they can go in addressing food issues with clients. For instance, counselors cannot provide nutritional advice to clients. “That creates this barrier that is hard to get around,” she says. “So, then, you do have to reach out to other professionals like nutritionists and dietitians and really work as a team.” She says counselors can either work with a nutritionist to determine what nutritional treatments and approaches are best for the client, or work with clients to ensure they are advocating for their own dietary preferences (such as using plans that focus on well-being instead of weight loss) with the nutritionist or speaking up when they feel a certain nutritional approach is harming or not helping them.

But at what point should counselors refer to a nutritionist? Counselors have referred clients to Schmidt, in her role as a nutritionist, because they suspected their clients had an eating disorder or were binging on foods. Schmidt thinks it is a good idea to also refer to an eating specialist if clients talk about food or their bodies frequently in counseling, are extremely overweight or underweight and the condition is disruptive for them, or have suddenly lost a significant amount of weight.

When finding referral sources, Schmidt recommends that counselors look for professionals trained in the Health at Every Size approach, which promotes size acceptance and serves as an alternative to the weight-centered approach.

Smith agrees that “the focus always has to be on wellness, not weight loss.” She advises counselors against referring clients to dietitians, nutritionists or doctors who track calories, encourage weigh-ins, or engage in fat shaming. Instead, she suggests looking for health professionals who teach intuitive eating and operate from a weight-neutral model.

Adding in the nutritional piece

People routinely look for mental shortcuts or a magic bullet to solve their problems, and this tendency extends to food consumption. From research, we know that people will tend to eat 30% more of a food that they deem “healthy,” Schmidt notes. Researchers even have a name for this tendency to overestimate the overall healthfulness of an item based on a single claim such as being low calorie or low in fat: the health halo effect. This halo effect appears to encourage people to eat more than they otherwise would because they feel less guilty about consuming the food.

Clients often come to see Smith because they are confused and don’t know what to do. They have dieted for years with little or no success, and they are confounded by all the conflicting nutritional advice. For Smith, it comes down to a core question: “How does this [food] feel in your body?”

“You’re making peace with food,” she says. “This is your journey of one, and only you can know whether pizza feels good or depleting and when and under what circumstances.” Counseling can help clients tune in to their own unique nutritional needs and preferences and connect this piece to how their mood is affected, Smith says.

Schmidt advises counselors to focus on the big picture and not get caught up in one particular approach to eating. Instead, it is about helping clients make their own connections between what they are eating and how it affects their moods.

Also, because everyone is unique, the nutritional advice that has benefited a counselor personally may not help the counselor’s clients. However, the majority of clients (and all people) need to eat more fruits and vegetables, so if counselors encourage them to do that, it could have a huge impact on clients’ health and mood, Schmidt asserts.

“Having a personal connection to food and its life-giving properties is one of the most amazing gifts we can give ourselves, as well as elevating the status of food and eating for our clients,” Schmidt says. “Helping clients understand that the process of food and feeding is a central part of their recovery is a message that’s independent of what they should be eating.”

“Nutrition is always a piece of the puzzle,” Shannon adds. “So, by understanding the nutrition …
even a little bit, you’re going to be potentially twice as effective working with your clients.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

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

Multicultural encounters

Compiled by Bethany Bray November 21, 2019

The 2014 ACA Code of Ethics calls counseling professionals to “gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population.”

At face value, this is easy enough to understand. But when it comes to multicultural competence, what does it look like to put this “head” knowledge into practical action?

For Letitia Browne-James, a licensed mental health counselor (LMHC) who owns a counseling practice in the Orlando, Florida, area, this endeavor once involved bringing a client’s family into session to better understand how his cultural background, and its views on the role of family, were affecting his mental health.

The client was from a collectivist, Caribbean culture that placed greater importance on the family unit than on its individual members. Family approval was paramount to this client, she explains.

Browne-James also has Caribbean roots, but “I come from a culture where individualism is encouraged and celebrated,” she says. Connecting with this client — and fully understanding his cultural perspective — came via openness, flexibility and creativity on the part of Browne-James, who has a doctorate in counselor education and supervision with a specialization in counseling and social change.

“I invited the client to bring in his family for a few sessions so I could learn more about the family’s views and assess how I could help him individually by helping the entire family system understand mental illness and how to treat it with familial support successfully,” says Browne-James, a core faculty member in the Adler Graduate School’s online program. “We learned that [involving family] was the fastest and most effective way to help the client achieve his counseling goals and live a healthier and productive life in society.”

Browne-James encourages counselors to fully explore each client’s culture, whether that involves doing research, consulting with colleagues, or meeting with a client’s family. It is also helpful to invite clients to speak in sessions about what their cultural identity means to them, how they apply that identity to their life, and how they’d like it to inform their goals and work in counseling.

“I encourage professional counselors to think of multicultural competence as the basics of being a professional and ethical counselor — [to] view their help-seeking behaviors to expand their cultural knowledge as a professional strength rather than a weakness,” says Browne-James, president-elect of the Florida Counseling Association and treasurer of the Association for Multicultural Counseling and Development (AMCD). “I would also encourage them to be patient with themselves, with colleagues and with clients who are at different stages in their cultural journey, while remembering that cultural competence cannot be separated from ethical practice.”

Striving toward multicultural competence

Counseling Today recently reached out to American Counseling Association members of varied backgrounds and practice settings and asked them to share some of their case examples and insights regarding multicultural counseling.

We encourage readers to add their own thoughts to this discussion by posting comments at the bottom of this article, below.

 

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Multicultural competence is a never-ending journey that involves risk, adventure and discovery. Culturally competent counselors strive to enhance their awareness, knowledge and skills to work with others who are culturally different from themselves in meaningful ways. This includes deconstructing long-held assumptions, values, beliefs and biases that do not foster cross-cultural sensitivity. Furthermore, multicultural competence includes the ability to recover from cultural errors and to tolerate, manage and resolve intercultural conflict, no matter the setting.

Every cross-cultural interaction creates learning opportunities for counselors and counselor educators to enhance their awareness, knowledge and skills in multicultural counseling. One way clinicians can create opportunities to gain cultural awareness is by focusing on an art form (e.g., music, film, painting, photography) that interests the client. Counselors can use this information as a pathway to identify the constellation of values and assumptions that impact and inform their client’s worldview.

I remember working with an adolescent client who was in the midst of working through her cultural identity development. The client was born in Nicaragua and adopted at 6 months old by a white upper-middle-class family. She struggled with her racial and ethnic identity since she did not feel tied to her Nicaraguan roots and she did not identify as white. Initially, she was not very expressive, but I was able to reduce the cultural distance between the two of us by focusing on her interest in music.

Even though our identities (age, race, ethnicity, socioeconomic status) and developmental stages were completely different, I used music as a window into her worldview. In one of our first sessions together, the client mentioned that a popular rock band (Twenty One Pilots) was her favorite music artist. I had never heard of that [band] before, but I used this information to spark a conversation about her identity-formation process. I asked the client, “What’s your favorite song [from this band]?” She responded, and I asked her for permission to listen to the song and discuss the lyrics during the session. She agreed, and we dissected the lyrics line by line.

This activity created an environment that allowed the client to feel safe and supported as she opened up about her struggles with her racial and ethnic identity, low self-esteem, and desire to engage in self-harm behaviors. The underlying message in the song also gave me additional information regarding the client’s presenting concerns that she had not previously disclosed.

Fortunately, this cross-cultural encounter facilitated a strong working alliance that led to therapeutic change. I took a risk that proved to be beneficial for the client and created an opportunity to enhance my multicultural competence.

— Whitney McLaughlin is a licensed professional counselor (LPC) and a doctoral candidate at North Carolina State University.

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The term multicultural competence can feel vast or intangible. I do my best to embody multicultural competence by remembering that life and counseling are centered around people interacting with people, existing within a system. Every person is different, and understanding that these differences are central to our human experiences is essential.

Beginning with self-exploration of who I am and my worldview is imperative. Models such as Pamela Hays’ approach from her book Addressing Cultural Complexities in Practice: Assessment, Diagnosis, and Therapy can be helpful in the process of understanding who and what I represent within counseling and society. Additionally, every identity I hold and the intersection of my many identities have different meaning in different contexts.

For example, when working with an adolescent [client] who self-identified as black, cisgender and queer, I asked myself, “What may I represent within the context of this counseling relationship?” To the client, my identities as black and cisgender may place me as an insider or safe to speak with, but my identity as heterosexual may place me as an outsider or an oppressor. I had to consider the spectrum of my humanity, the intersections of my various identities, the meaning that can be derived from who I am and what I may represent to my client, and intentionally make space for it all within the counseling relationship.

Then, all the same considerations needed to be made for my client’s identities while also accounting for systemic factors. For example, considering how systemic white privilege, racism, homophobia and heterosexism affected my client’s lived experiences as a black queer male assisted in understanding my client’s needs. Urie Bronfenbrenner’s model can be helpful in conceptualizing the levels and roles of systems (see Counseling Today’s April 2013 cover article “Building a more complete client picture” for additional information).

I recognize this sounds like a lot (and it is), but this can be accomplished through intentionality.

1) Do your homework: This refers to doing your personal work, such as understanding who you are and what you represent. I participate in my own therapy and have frequent conversations with trusted, critical thinkers to stay grounded and aware.

2) Work for your client: This refers to being receptive to understanding your client’s experiences while not requiring that they educate you on every aspect of their identities. For example, when working with the client mentioned above, I made sure I knew how queer was defined broadly while also allowing the client to express what being queer meant to him and his experiences.

3) Have an open dialogue: This refers to not shying away from discussing our identities and the effects of the systems we exist in. This also means not putting the responsibility on our client to broach the topic. With my client, acknowledging the interplay of his many identities across the multiple systems he existed within allowed us to examine the depth and variety of his lived experiences.

— Tyce Nadrich is an LMHC, supervisor and assistant professor of clinical mental health counseling at Molloy College. He also has a private practice in Huntington, New York, where he supervises counseling trainees and works predominantly with adolescents and young adults of color.

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There are two things that I impress upon all counselors I train. The first is that Caucasians are not devoid of culture, and the comparative practice of juxtaposing the lived experiences of nonwhite persons to their white counterparts is oppressive. Second, to be a culturally competent counselor, one must first have a deep understanding of [one’s self] as a cultural being.

I specialize in African American mental health, and this has required a great deal of study in black and liberation psychologies, culturally responsive psychotherapies, and culturally congruent treatments and frameworks. This also means always being willing to critique and ask questions about the worldviews and assumptions embedded in the many trainings and presentations I attend each year, to better understand their utility or lack thereof to the populations I serve.

Multiculturalism is a central tenet of my clinical work as well as my work as a counselor educator. As an African American woman being trained in predominantly white settings, most of my clients [when I was] a trainee and in my early career were racially/ethnically and culturally different from me. But the client who stands out most was an African American woman in her mid-40s [who was] accessing care through a hospital-based trauma treatment program for abused and suicidal African American women. She had an extensive trauma history, which included a long history of sexual abuse and intimate partner violence. While she had extensive contact with health care providers in the past, she’d never had a health care provider who looked like her. Despite being racially, ethnically and even culturally similar [to me, her counselor], she expressed a desire and preference for a white-identified counselor.

Oftentimes, we limit our understanding of multiculturalism and cultural competence to working with those who are dissimilar. What this client highlighted for me was how people of color, race, culture, ethnicity and other social locations exist in a complicated relationship to the systemic oppressive forces of racism, sexism, classism, ableism, etc., experienced in the day-to-day lives of people of color. And sometimes you can’t disentangle them, and they create additional barriers to accessing care.

Fast-forward nearly a decade, and though the majority of my clients identify as African American, I am always intentional about exploring the racial and cultural similarities and differences [between myself and] all clients.

— Delishia Pittman is an LPC and a licensed psychologist in Washington, D.C., and director of the clinical mental health counseling program at George Washington University.

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I work at one of the largest community colleges in the United States. We currently have about 65,000 students, and I work at one of the largest campuses. Our students are permitted to walk in for “counseling,” which is academic-based and similar to school counseling rather than mental health therapy. Our students are diverse in age, ability, learning, experience, race, nationality, language, citizenship and gender, just to name a few.

A simple request from a student to change their major puts my multicultural counseling and social justice skills [into] action. Very rarely is changing a major merely transactional, which is why it’s not a task that can be done by the student themselves. It requires coming in to meet with an adviser or counselor. [When this occurs], I want to have a conversation with the student about how they arrived at their program of study. As an immigrant, first-generation college student, and marginalized counselor, I’m aware of the environmental influences [that affected my choice of] my first major and how that evolved to my current career.

Most students at my college, but not all, are also first-generation college students, fully Pell [Grant] eligible (low socioeconomic status), immigrants, or first-generation Americans, which impacts their decision on what they should study. I ask what assessments they used, what they have learned about their major/career of choice, and what influences they have in their life to help them decide.

Since my students are so diverse and have so many intersecting identities, I never want to assume that they are also coming from a marginalized background. Some of my students are coming from a place of greater privilege than I had as a student or [have] even now as a professional.

Students sometimes confide that they are studying a major that does not interest them, and we investigate what is pressuring them to study that major, usually in science, technology, engineering or mathematics. I assess if the student has the privilege to change their major to their preferred major. This is important to understand, as not all students are in a place to choose. We assess if we can find additional resources, find integrative programs of study or minors to sneak into their curriculum, and I even offer my support to help advocate to their stakeholders about the possibility of changing their major. Regardless of whether they change majors or not, we come up with an academic plan.

I think it’s important for our profession to understand that in all types of counseling, even in school, career and vocational, where the work seems more transactional, there is an opportunity to implement our multicultural and social justice competencies. We must understand that our clients or students are diverse and have intersecting identities. They are influenced by family, culture, environment, media, peers and even our systems. We need to take all that into consideration to give them the best possible service.

— Margarita Martinez is an academic success counselor and curriculum chair for student development at Northern Virginia Community College. In addition, she serves as vice president for Latinx concerns for AMCD, as secretary for the Virginia Counselors Association, and as co-chair of the strategic plan committee for the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC).

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As a black woman in a suburb of Georgia, I have had numerous clients contact me simply because I am black. Georgia is one of those states that is known for having been a part of the Confederacy and having many small cities that are still dangerous for people of color.

I live and work in what is statistically the most diverse city in Georgia. My county is considered one of the most diverse counties in the nation. I am learning more, now than ever, the differences between myself and those with whom I work. I’ve been in academia for about five years without seeing clients and assumed that when I [returned to counseling and] joined a group practice, I would be seeing the “worried well.” But issues surrounding racial trauma and perception are not as commonly addressed as some other daily worries.

I recall one client, a darker-skinned African American male in his early 60s. He’d lived through the civil rights movement in Georgia, retired from one career, and raised all of his children. However, he was experiencing distress because of the way people viewed him as a “large, black, heavy-voiced man.” He felt that whenever he wasn’t whispering, others would assume that he was mad and say that he was yelling.

He also felt that this view of him was useful in his previous career as a prison guard, but once he completed his degree and attempted to start his next career as an elementary school teacher, his colleagues (mostly white women) reported that he was “aggressive, loud and scary,” and his contract wasn’t renewed. This man had struggled to get out of poverty and earn a degree, and in the year 2019, [he] was still experiencing discrimination based on others’ unfair perception of intent. He also felt like his family was telling him to change who he was rather than understanding his predicament.

I understand that my African American experience does not necessarily mirror [that of] other African Americans. Essentially, the only things that my client and I had in common were that we were African American, heterosexual and Georgia residents. He was almost twice my age; I am not a first-generation college student and have not experienced living in poverty. Even with these cultural differences, I know what it is like to be unfairly described as aggressive.

In relation to multicultural competence, there is a lot of attention given to race, ethnicity, sexual orientation and identity. [Yet] there are so many other things that we must consider. The best course of action is to allow our clients to express which aspects of their culture they believe most affect their day-to-day lives. Never assume that [just] because you have one or two things in common, that you’re adequately prepared to address your client’s issues.

— Asha Dickerson is an LPC in Lilburn, Georgia, and a professor at Adler Graduate School. She also serves as AMCD’s Southern Region representative and as president-elect of ACA of Georgia.

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Sharpening our multicultural competence requires that counselors enter the experience and suffering of those who are different from us. When we allow the other person to lead us into their unique reality, we may confront fear and anxiety. There is a chance that we may begin questioning our own values and worldview.

An example that comes to mind was an invitation made by a co-worker to join an initiation ritual from the religious tradition of Santeria [a religion brought to Cuba by slaves from western Africa and eventually to the United States by Cuban immigrants]. In this ceremony, my co-worker’s adolescent daughter was being inducted as a priestess. The ceremony was characterized by constant drumming, humming, walking in a circle, and minimal dialogue. Initially, I did not feel comfortable, as the ceremony was very different from my own religious tradition. In addition, I grew up listening to negative comments about santeros within my own culture.

After recognizing my fear of the unknown, I chose to gain knowledge about Santeria. This is a religion that helps its members gain balance and unity of the body, mind and spirit. The priest, or santero, invokes all sources of intelligence (conscious and unconscious, physical and metaphysical, individual and collective) in addressing [a person’s] suffering.

I rejoiced that my initial fear did not stop me from becoming better informed about this person’s religious beliefs [and the religion’s] ancient, holistic healing practices. By studying the ancestral beliefs of Santeria, I found much commonality between this African-based spirituality and modern counseling. Both traditions would like to empower clients in living with meaning and purpose. As [psychologist] Alberto Villoldo said, “Reclaim the courage of our ancestors, and bring that forward into the future.”

Multicultural competence is necessary when interacting with every client, not just clients of color. All clients are multifaceted and deserve that we honor their multiple dimensions of identity and how they shape their mental health and coping skills.

Multicultural competence is fundamental in establishing an effective relationship with our clients. It also invigorates and empowers us in developing a genuine relationship with our clients. It allows us to go beyond surface impressions and helps us discover the client’s deepest values, past and current sources of oppression/survival, and their hidden strengths so that they can creatively manage life’s challenges and opportunities.

— Maria del Carmen Rodriguez is an assistant professor in the Department of Counselor Education in the Nathan Weiss Graduate College at Kean University in New Jersey and president-elect-elect of the New Jersey Counseling Association.

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In 1992, I moved from the Midwest and became a professor at Appalachian State University in Boone, North Carolina. Shortly after moving to the Appalachian Mountains, I became a volunteer counselor at the local health department and served in that role for 25 years. My clientele primarily consisted of women who had little opportunity for jobs or education and who experienced barriers of poverty such as [lack of] transportation. My typical clients were women who came from traditional Appalachian mountain culture and were raising children in single-parent families. Therefore, from the onset, my counseling was inherently a multicultural practice because it involved numerous cultural differences between me and my clients — educational, economic, spiritual, etc.

I needed to remember that the therapeutic alliance was critical and consider their cultural beliefs and values. Generally, I focused on welcoming clients and inviting hope. For example, at times I would ask when they had last eaten and made sure I offered them food and beverage before we started the counseling session. Specifically, through readings and professional consultations, I learned the following Appalachian values:

  • Egalitarianism: Be an authority without being authoritarian.
  • Personalism: Use simple, direct, honest, straightforward and respectful speech. Be accessible.
  • Familism: Remember that blood is thicker than water and family structure is resilient.
  • Religious worldview: Explore religion as a possible resource.
  • Sense of place: Explore how clients view being economically deprived [and their view of] the importance of land.
  • Avoidance of conflict: Be respectful toward clients.

However, I also needed to examine each client’s unique pattern of values. For example, one client explicitly stated that I could counsel her for depression, but I could never discuss her Christian religion with her because I was not a religious leader. We agreed to this limit and, over one year, successfully resolved her depression.

I found that multicultural competence is not a result of “magic formulas” or the use of “politically correct terms.” [Rather, it] requires adapting recommended standards to the individual client. Such adaptation within Appalachian culture included:

  • Listening to their story. Explore “Who are they?” Be in their story, and reserve judgment.
  • Being aware of client tendencies to be “street smart,” be dependent on systems due to poverty, and value survival at all costs.
  • Using subtle techniques such as stages of change to understand context, motivational interviewing to invite dialogue, and solution-focused brief therapy to provide practical solutions.
  • Introducing concepts long term. Revisit important concepts repeatedly.

Finally, I found I needed to be brave, risk making mistakes, and learn how to recover from mistakes. I needed to be cautious of being so politically correct that counseling stopped us from being human and real with each other and instead turned the process into an assembly line.

My clients needed me to always remain human, real and compassionate with them so they felt safe and cared for, thereby inviting a genuine, healing dialogue.

— Geri Miller is an LPC, supervisor, licensed psychologist and licensed clinical addictions specialist. She is a professor in the Human Development and Psychological Counseling Department (clinical mental health counseling track) at Appalachian State University.

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As an Asian counselor and counselor educator who specializes in play therapy, working with clients who are from a culturally different background than my own happens regularly. Though this difference felt like a burden at first, now I appreciate the lens that I developed because of the intersectionality and complexity of each client’s cultural identity. This lens helps me cultivate my cultural humility, which embraces an interpersonal stance that is other-oriented and open to the other in relation to aspects of cultural identity.

I recall when I was at the beginning of my graduate program training in Texas and still in the beginning stage of my racial and cultural identity development, I experienced unsettling emotional reactions when child clients in play therapy bluntly commented on my appearance or accent such as “You talk funny”; “Are you from China?” [and] “You have black hair!” Because of the great supervision I received, in which I felt safe enough to explore my cultural identity, those reactions gradually dissipated, and I was able to be more fully present with children even when they made some cultural remarks.

I believe working with clients from various cultural backgrounds requires a counselor to have continued openness, self-refection, growth and development over time. Therefore, it requires absolute lifelong commitment from a counselor.

Recently, I began a project in collaboration with immigration lawyers to provide play therapy to unaccompanied and undocumented minors who are in the process of applying for asylum [in the United States]. Although I have extensive experience in providing play therapy to children with trauma and adverse experiences, I realized that I possessed limited knowledge on the historical and political context of some of the countries from which those clients came, particularly in the Northern Triangle of Central America, and on the ever-shifting immigration policies in the U.S. The actions that I am partaking in to educate myself to gain more knowledge in those areas are reading, taking webinars/workshops on immigration policies, joining a state-level immigration emergency action group, and consulting immigration lawyers and paralegals in this project.

I work for a university which is a Hispanic-serving institution and where the majority of the students hold a minority status. I love dedicating my time to conversations with my graduate students from those [Central American] countries and being educated by them about their cultures. Those conversations have helped me be a more culturally informed counselor and counselor educator.

In addition, I have been fortunate in learning from professionals outside of the counseling field who are also providing services to clients with diverse backgrounds. This provides me with a more holistic sense of my clients’ strengths and struggles. I hope collaborative work beyond the boundaries of separate professions becomes more common.

— Yumiko Ogawa is an LPC, counselor supervisor, play therapist supervisor, and associate professor at New Jersey City University.

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As many before have said, multicultural competence is an ongoing endeavor. Much of the work
is subtle and nuanced. Many counselors are eager to try out their newly learned advocacy skills. When counselors who hold dominant identities work with minoritized populations, advocacy without self-awareness can cause harm. Actions should not replace deep personal, introspective, multicultural work.

Often, counselors are not aware when clients or students do not regard them as a safe or affirming person. Clients or students may not pursue a counselor’s services if they hear from members of their own cultural groups and communities that the counselor has been unaffirming or has avoided discussing important aspects of a client’s or student’s race, culture or identity. Clients or students may come increasingly late to sessions, cancel, or terminate early without giving a reason. Counselors can brush [this] off or identify an alternative explanation for these occurrences, but these situations may indicate that counselors need more work on developing their own multicultural competence.

Counselors should also consider which clients they tend to have an easier rapport with and which they do not and reflect upon the reasons. We need to move away from intellectual understandings of racism, sexism, classism, ableism, transphobia, etc., and move toward considering how these injustices show up in our lives. For instance, cisgender counselors might ask themselves, “How might I be making my transgender client/student feel invisible by subtly avoiding discussing their trans identity, or am I focusing too much on their trans identity and not listening to their presenting concerns?”

Excelling at wielding social justice language is not a substitute for making authentic connections and fostering ongoing relationships with individuals who hold different identities and life experiences. These relationships outside the office can help counselors connect better with their clients and students.

— Rafe McCullough is an LPC, a licensed professional school counselor, and an assistant professor at Lewis & Clark College in Portland, Oregon. He was a member of the AMCD committee that developed the Multicultural and Social Justice Counseling Competencies endorsed by ACA.

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As a visibly identifiable Muslim woman, cultural differences in religious and spiritual practice come into my work in different ways. While some practitioners might choose not to disclose and broach their faith, my hijab serves as an indicator of my religious practice. What this often means is that clients make assumptions about who I am, what I believe, my level of religiosity, and how I practice based on their expectations of who I might be as a Muslim counselor and what society has taught them about my religion.

I can remember a time when I picked up a client assigned to my caseload from the waiting area. I introduced myself briefly in the main lobby and walked her to my private counseling office. As soon as we sat down, before I had a chance to say anything, she looked at me and said, “This isn’t going to work. I’m a very Christian lady, and I’m not going to work with a Muslim.” Because of the personal awareness work that I do as a clinician, I was able to notice and acknowledge my personal reactions and respond appropriately. For example, a few of those immediate reactions and assumptions were:

  • “This client has no idea who I am or how I practice.”
  • “I’m so tired of having to defend my faith and undo the unjust and vilifying narratives of Muslims in the media.”
  • “People who look like her have oppressed people who look like me. I wonder if I’m safe in this room.”
  • “She might feel unsafe in this room because of who she believes I might be.”

Through my personal work and practice of multicultural concepts of awareness, I was able to ground myself and attend to the client. [I reminded] myself that although such an incident may trigger some of my own trauma experiences as a black Muslim woman in a society that attempts to diminish people who look like me, my role in this counseling space was to prioritize the wellness of my client — and to do so with compassion and unconditional empathy and regard. I reminded myself that although she had made some assumptions about me, I had made assumptions about her based on my worldview as well.

Multicultural competence doesn’t just happen naturally. It isn’t something I just choose to have in a moment because it seems relevant. It’s a constant practice and requires deep reflection, critical insight, and a willingness to engage in developing my personal awareness and taking the needed actions to make sure that when I’m in the privileged role of counselor, my clients are valued, honored and respected. That was a very difficult process early on as a beginning counselor with many marginalized identities and experiences that can be triggered by some of the beliefs that my clients hold about me. It’s hard work.

But because of that continuous process of reflection and my own personal work, I was able to hear this client say that she couldn’t work with me because of my faith, and respond by compassionately broaching differences in our cultural identities and allowing her space to share her worldview.

I have had many clients see my hijab and tell me that they can’t work with me because of it, but they all decide to continue working with me after spending our first hour together. I came to realize over time that being a counselor with a cultural identity different than the majority culture was a subtle but powerful form of advocacy. I have been able to build deep, trusting relationships with individuals who had never had a personal interaction with someone who identifies as Muslim. [I] challenged their biases about who Muslims are simply by doing my job and putting in the time and effort to develop my awareness as a clinician.

My visible indicator of religion has also come up many times in various other ways with clients. For example, I have learned that clients who similarly identify as Muslim may also have hesitations about working with me because my hijab serves as an indicator of some form of religiosity that has negatively impacted them in some way. I learned, for instance, the importance of intentionally broaching when working with clients with LGBTQ+ identities because of my knowledge of the oppression and trauma they may have faced specific to religion and the intersection of their cultural identities. For one of my past clients, for example, seeing my hijab for the first time at intake served as a trigger for the trauma [the individual had] experienced in their religious community, and it made them hesitant to work with me. I wouldn’t have known that if I hadn’t taken the time to broach with them.

While some counselors may choose not to broach their religious identities, my practice of wearing a hijab changes that. My role as a competent counselor is to make sure that my clients are empowered and affirmed in their identities when working with me, and that can’t happen if I’m not willing to put the knowledge and awareness that I have into action. I’ve had to recognize how my intersectional privileged and marginalized identities influence the counseling process and take the steps needed to do justice to my clients.

— Zobaida Laota is an LPC associate in North Carolina who recently completed a doctorate in counseling and counselor education at the University of North Carolina at Greensboro.

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I think there is value in reading and studying about various cultures, but I think it is more effective when supplemented by building relationships, exploring new insights with colleagues, and engaging in cultural immersion experiences. Learning through relationships and engaging directly in a new culture provide a more authentic experience [for] gaining awareness, sensitivity, knowledge and appreciation.

One specific example from my own journey as a school counselor [who is white] involved seeking out a colleague from Iran to help me understand more about the culture of a student who had just moved to the United States from her country of origin [also in the Middle East]. Being aware that I needed more information about my student’s background (religion, country of origin) and [was] out of my comfort zone, my colleague provided new insights about her [own] faith, life experiences, and the impact of world events/discrimination that provided me a glimpse into her worldview. Although this student’s experience was not identical to my colleague’s, [my colleague’s] knowledge of common experiences, values and cultural strengths provided me needed insights to support this student in a culturally sensitive way.

Other ways that I gain knowledge, awareness and skills include attending counseling conference sessions focused on multicultural counseling topics. Having the opportunity to learn from other colleagues, reflect on my own biases, and explore multiple perspectives has been invaluable in my own development as a counselor. There is also tremendous value in participating in advocacy and social justice efforts with those directly impacted by discrimination, racism and injustice.

Multicultural competence is a lifelong journey. Staying aware of how we are feeling in uncomfortable moments and identifying new blind spots that highlight our personal biases are necessary in our work as counselors. If we begin to adopt a mindset that we are “experts” and have achieved multicultural competence, I fear we will overestimate our competence and not strive for new understanding, which is a disservice to our clients.

I think we have to work diligently and intentionally to seek out supervision, consultation and mentoring from colleagues of various cultural backgrounds. There is value in surrounding yourself with colleagues who can provide different perspectives and identify, as well as challenge, blind spots. I think we sometimes underestimate the value of having a network of diverse colleagues who can keep us honest and challenge us when needed.

— Kimberlee Ratliff is an LMHC and certified school counselor in Washington state, a professor in the American Public University System, and an adjunct faculty member at the University of Puget Sound and the City University of Seattle.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the
following select resources offered by the American Counseling Association:

ACA Code of Ethics (counseling.org/knowledge-center/ethics)

ACA-endorsed competencies (counseling.org/knowledge-center/competencies)

  • Multicultural and Social Justice Counseling Competencies
  • Competencies for Counseling the Multiracial Population
  • ALGBTIC Competencies for Counseling LGBQIQA Individuals
  • ALGBTIC Competencies for Counseling Transgender Clients
  • American Rehabilitation Counseling Association Disability-Related Counseling Competencies

Books (counseling.org/publications/bookstore)

  • Multicultural Issues in Counseling: New Approaches to Diversity, Fifth Edition, edited by Courtland C. Lee
  • Counseling for Multiculturalism and Social Justice by Manivong J. Ratts and Paul B. Pedersen
  • Understanding People in Context: The Ecological Perspective in Counseling edited by Ellen P. Cook
  • Experiential Activities for Teaching Multicultural Competence in Counseling edited by Mark Pope, Joseph S. Pangelinan and Angela D. Coker
  • Counseling for Social Justice, Third Edition, edited by Courtland C. Lee

Counseling Today (ct.counseling.org)

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org

 

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

Human Rights 101: Implications for counselors and the counseling profession

By Michael P. Chaney, Carman Gill and John Super November 19, 2019

On April 30, an on-campus shooting at the University of North Carolina at Charlotte left two people dead and four others injured.

On January 6, Dana Martin, a 31-year-old, transgender woman of color was found in her vehicle—which had crashed into a ditch—with a fatal gunshot wound to the head, in Hope Hull, Alabama.

In 2017, two doctors and a clinic manager in the Detroit area were accused of performing or facilitating female genital mutilation (FGM) on nine girls—at least two of whom were only 7 years old.

Since 2017, the Chinese government has been detaining at least one million and perhaps as many as three million Uighur and other ethnic Muslims in internment camps in the Xinjiang region.  The camps are a part of a years-long effort to wipe out the ethnic and religious traditions of the Uighur and other Muslim ethnic groups. Former prisoners describe torture and constant political indoctrination designed to force detainees to give up their religious beliefs, language and ethnic identity.

At first glance, these incidents seem to have little in common with each other; however, the link that bonds them together is that they are all human rights violations. A next logical question some might ask is what do these issues have to do with counselors and the counseling profession? Many professional counselors do not think human rights issues are related to or comfortably fit within the counseling profession and/or are outside of the traditional job description of counselors. This is partially due to the difficulty of separating human rights issues from political issues, which may create values conflicts for some counselors. Second, many counselors may not have a clear understanding of what human rights are beyond the rights that people know about, particularly if the rights directly impact them. Thus, values conflicts and lack of understanding often lead to professional counselors’ cautious involvement with human rights.

 

We are past and current members of the American Counseling Association’s Human Rights Committee (HRC) whose stated mission is to bring awareness to human rights and social issues that impact the counseling profession and to address barriers that impede human rights. We believe that human rights issues are inextricably linked to both the practice of counseling and the overall profession. We’ve developed this two part series, consisting of two separate articles that explores why human rights issues are important to counselors and counselors-in-training. This first article provides a general background of human rights issues and its relevance to practitioners, whereas the second article is solely focused on human rights issues and counseling students and counselor training.

We start with a question: What are human rights?

The concept of human rights entered the international realm with the founding of the United Nations (UN) in 1945. The term “human rights” was mentioned seven times in the UN’s founding charter, establishing that the promotion and protection of human rights is a key purpose and guiding principle of the organization. In 1948 the UN issued a document drafted by representatives from all regions of the world — The Universal Declaration of Human Rights — which for the first time set out fundamental human rights recognizing the inherent dignity and equal and inalienable rights of all humans regardless of race, gender, nationality, religion, language, social status, place of birth or other factors (such as sexual orientation, which is not specifically mentioned in the declaration). Human rights may include civil, political and cultural rights. Simply, human rights are freedoms and liberties that are due to people solely based on their status as human beings. The foundation of human rights is built upon respect for the individual, which aligns with counselors’ primary ethical responsibility to respect the dignity of our clients and students. According to the UN, everyone is entitled to basic human rights.

Although it is impossible to list all human rights issues in this series, there are defined categories. The first category pertains to the right to personal and physical safety, which includes freedom from slavery or unwilling servitude; torture; and inhuman, cruel or degrading treatment or punishment. From a counseling perspective, issues that may fall under this category include but are not limited to mental health consequences associated with interpersonal and domestic violence, gender-based harassment, human trafficking, and community gun violence. The second category includes political rights and civil liberties such as the right to express one’s ideas and beliefs freely and to fair treatment in the judicial system. For counselors, examples of this dimension include addressing mental health consequences associated with racial disparities in incarceration rates and forced treatment of mentally ill offenders. The third category of human rights centers on social and economic rights, which include the right to quality education, gainful employment, housing, health and an adequate standard of living. This dimension has implications for counselors who provide services to clients or students who live in poverty, are unemployed, struggle with health concerns or experience psychological distress as a result of systemic oppression. These examples demonstrate that human rights issues can potentially affect anyone. Therefore, human rights have a seat at the counseling table.

Human rights in the helping professions

Because human rights violations impact mental wellbeing, several of the member organizations affiliated with helping professionals specifically name human rights in their mission or vision statements. For example, one of the five general ethical principles included in the American Psychological Association’s code of ethics is respect for peoples’ rights and dignity. The Society for the Psychological Study of Social Issues describes itself as an organization that promotes research and education on psychological aspects of critical social issues and brings science and evidence to human problems. The statement of ethical principles created by the International Federation of Social Workers–the global body for the social work profession– states that members and the profession as a whole strive for social justice, human rights, and inclusive, sustainable social development.

Although the American Counseling Association (ACA) is in a unique position to be a leader at the intersection of counseling and human rights, presently, it does not name human rights in its vision and mission statements. However, ACA’s recently developed strategic plan includes social justice and empowerment as a core value, whose guiding principles can be summarized with the catch phrase: Human rights are right.

Because counselors are often on the front lines treating the mental health consequences of human rights violations in the lives of clients and students, we should have a clear understanding of our professional responsibilities as it pertains to human rights issues. First, we have a responsibility not to violate the human rights of other people including our clients and students. Second, we should work to build a culture where human rights are respected.

Why human rights are relevant to counselors and the counseling profession

As counselors, we must recognize the crucial role human rights play in mental health and wellness. Human rights violations often result in serious emotional consequences for individuals, families and communities. We began this article by giving recent examples of brutal human rights violations. Unfortunately, these incidents are just a snapshot — a mere fraction of the violations that entire groups targeted for their ethnicity, religion or political beliefs and individuals in marginalized populations experience daily. Many clients encounter multiple forms of harassment, bullying, restriction of freedoms, verbal abuse, threats of violence and life-threatening events.

The long-lasting physical and emotional consequences of exposure to these conditions cannot be understated. As a result of these violations, clients may experience a range of detrimental mental health consequences including but are not limited to — increased loss of dignity, ongoing stress, anxiety, sleep disturbances, physical distress, spiritual distress, increased substance use, decreased productivity, emotional dysregulation, severe depressive symptoms and suicidality. In addition to the impact on holistic wellness, individuals often experience post-trauma stress symptoms and are at risk of developing post-traumatic stress disorder (PTSD). Whether clients experience a single incident or have been subjected to chronic, ongoing human rights violations, their lives are impacted, as are the lives of loved ones, families, and communities. Collectively, we are all diminished as a result.

As counselors, it is incumbent upon us to identify human rights concerns and their impact, to uphold individual human rights and address the negative consequences associated with violating these rights.

The ACA Code of Ethics can serve as a guide to protecting and upholding human rights. In fact, the ethical principles defined in the code’s preamble to directly relate to human rights advocacy. Consider, for instance, the principle of autonomy, which states that counselors have a responsibility to foster an individual’s right to control their life. Control of one’s life pertains not only to the counseling setting, but extends to every life aspect and to all three of the human rights categories listed earlier in this article. Therefore, counselors should be cognizant not to intentionally or unintentionally violate the human rights of clients. This is consistent with an additional ethical principle, beneficence.

As counselors we have a responsibility to treat our clients with justice, equity and fairness. This responsibility incorporates human rights issues as well, as every human being has the right to basic freedoms, human decency and respect. Justice includes advocating on behalf of marginalized populations and treating clients and students fairly. Honoring others and keeping our commitments to those we serve and to the greater social community embodies the principle of fidelity and is in keeping with human rights principles. In doing so, we build trusting relationships with those around us, allowing for positive interactions and improved wellness, building healthier communities. Veracity, the last ethical principle listed in the preamble, bids counselors to deal truthfully with those they encounter professionally. Speaking the truth by identifying and exposing human rights violations creates awareness that can lead to change. Taken as a whole, these principles form a roadmap not just for the counseling-client relationship, but also for respecting the human rights of people not just in our communities but in society as a whole, which can help foster a healthier world.

Global human rights initiatives and mental health

As stated above, the UN’s Universal Declaration of Human Rights (UDHR) was originally adopted in 1948 and reinforces the ideals behind bettering our communities through endorsing fundamental human rights, understanding the mental health consequences of violating these rights and advocating. Consistent with ACA’s ethical principles, this declaration includes language such as autonomy, freedom and justice. This document heavily endorses the ideas of personhood, dignity and freedom for every human being, which complements the core values of the counseling profession.

Key to any discussion on human rights is the UN’s Commission on Human Rights (UNHRC) and its relationship to mental health and counseling. Established in 1946 for the purpose of incorporating legal responses into human rights problems globally, the UNHRC included 53 member states, whose delegates met at annual sessions in Geneva. The commission reviewed reports on specific human rights issues, adopted resolutions, issued statements and made decisions regarding human rights issues. It also provided a forum for countries, non-governmental organizations (NGOs) and human rights advocates to voice their concerns.

The UNHRC established the committee that drafted the UDHR and was tasked with upholding it until 2006 when the Human Rights Council replaced the commission. Currently, the council promotes and protects human rights worldwide. Consisting of 47 members, including the United States, the Human Rights Council meets three times per year in Geneva, but may also hold a special session as needed to address urgent human rights violations. The council focuses much of its work on pervasive issues such as cultural rights, adequate housing, the rights of indigenous people, the rights of people with disabilities, racism, slavery, human trafficking and violence against women.

Addressing human rights violations in counseling

Understanding the professional and clinical importance of human rights issues is valuable to the counseling profession in general and in clinicians specifically. Knowing how to assess and treat the negative effects of human rights violations is paramount to treating [client] symptoms in sessions. A counselor’s primary role is to help clients address the issues that brought them to counseling and to advocate on their behalf. In fact, the ACA Code of Ethics encourages us to advocate at individual, group, institutional and societal levels to address potential barriers and obstacles that inhibit access necessary to the growth and development of clients. For clinicians to effectively advocate on behalf of clients’ human rights, understanding how and why the issue affects clients, society, and the counseling relationship is a must.

For many counselors, human rights violations assessment was not likely taught in their respective counseling programs. Therefore, it is crucial that counselors hone their assessment skills by understanding how violations of human rights may manifest in clients. Identifying the words and behaviors hinting at trauma that may stem from human rights violations can help the counselor to further assess the client. Just as counselors should assess for histories of abuse, substance use and suicidal or homicidal ideation, gathering information about experiences of human rights violations is essential.

At the onset of clinical work with clients who have experienced trauma associated with human rights violations, we recommend four guiding principles with which to frame the therapeutic relationship. First, create a safe environment in which trauma symptoms can be stabilized and explored. Second, counselors would serve their clients well by asking direct, open-ended questions about potential human rights violations and exploring issues that help uncover related trauma. Third, do not discriminate, remain nonjudgmental and avoid victim-blaming as clients share their violation experiences. Fourth—and last—assist clients in empowering themselves. Once these fundamental principles are in place, the following counseling strategies may be effective in treating trauma symptoms associated with human rights violations.

  • Manage the level of emotional stimulation and expression in sessions. While avoiding overstimulation is beneficial, clients who limit their emotional expression may be resisting stepping outside of their comfort zone, which could prevent adequate processing and growth. In contrast, clients who are highly expressive emotionally may become overstimulated, which could cause trauma symptoms to get worse.
  • Mindfulness of emotions helps clients develop a level of awareness of their feelings and teaches clients how to examine the emotions they experience without judging whether or not they are “good” or “bad.”
  • Teach clients coping strategies for intense human rights violations, trauma symptoms and feelings. Techniques such as relaxation training, cognitive disputation and stress reduction can be helpful.
  • Educate clients on normal reactions to trauma. This includes validating and normalizing clients’ affective reactions to human rights violations.
  • Grounding techniques that make use of all the senses help clients to stay focused and in the present when processing distressful human rights violations. Three effective techniques include having the client listen to the counselor’s voice, have the client feel bare feet on the ground, and allow client to name 5 things they see, 4 things they feel, 3 things they hear, 2 things they smell, 1 thing they taste (5-4-3-2-1).
  • Eye movement desensitization and reprocessing (EMDR) has been shown to be effective for many clients to alleviate symptoms of trauma and distress such as those connected to human rights violations.
  • Group therapy for trauma survivors may be an effective complement to individual therapy.

The strategies mentioned above are by no means an exhaustive list of all potentially effective interventions at a counselor’s disposal for treating the mental health consequences of human rights violations. We encourage readers to consult professional literature for additional interventions.

ACA has done a phenomenal job of addressing the intersection of mental health and human rights — yet more can be done. As the counseling profession evolves and ACA continues to grow, we offer three recommendations that we believe would place it at the forefront of counseling and human rights issues. These recommendations stem from the World Health Organization, and we adapted them for the counseling profession.

ACA and the counseling profession should:

  1. Continue to raise awareness and advocate for change by educating clients and advocating for targets of human rights violations.
  2. Develop and support mental health policies and laws that promote human rights.
  3. Train stakeholders on the human rights of people with mental health issues. Stakeholders include anyone who has an impact on people with mental health issues, including but not limited to counselors, law enforcement, schools and the judicial system.

 

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Michael P. Chaney is a licensed professional counselor, an approved clinical supervisor and an associate professor in the Department of Counseling at Oakland University in Rochester, Michigan. He is the immediate past co-chair of ACA’s Human Rights Committee and currently serves as the editor-in-chief of the Journal of LGBT Issues in Counseling. Contact him at chaney@oakland.edu.

Carman S. Gill is a licensed professional counselor, a national certified counselor and an approved clinical supervisor. She is also a professor and the doctoral program coordinator at Florida Atlantic University in Boca Raton, Florida. She is the immediate past co-chair of ACA’s Human Rights Committee and a past president of the Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC). Contact her at carmangill@gmail.com

John T. Super is a faculty member in the University of Central Florida’s counselor education program. After receiving his master’s degree in marriage, couples and family counseling, he worked in and developed a clinical private practice with a focus on helping LGBTQ+ couples with relational issues. He is a national certified counselor and is also a licensed marriage and family therapist in the state of Florida. Contact him at jsuper@ucf.edu

 

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