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Human rights 101, Part 2: Implications for graduate students and counselor education programs

By Clark D. Ausloos and Taylor Nelson December 2, 2019

Part one of our two-part series provided a foundation of the importance of human rights, the relevance to professional counseling, and practical strategies to use when working with clients who have experienced human rights violations. Part two focuses on human rights, social justice and advocacy related to counseling graduate students and counselor education programs.

Many people enter the counseling profession because they have a desire to help people. They have a knack for listening and possess a genuine curiosity for the human condition. Many students have a passion for mending, repairing and supporting others towards self-actualization. In many introductory graduate classes, students explore the foundations of the counseling profession, learning about psychotherapy pioneers such as Sigmund Freud, Carl Jung, Alfred Adler, Frank Parsons, and Carl Rogers, and learn necessary basic skills in order to best help clients.

However, graduate students are not often given clear direction on how to execute one essential ethical mandate dictated in the ACA Code of Ethics: to “advocate at individual, group, institutional, and societal levels to address barriers and obstacles that inhibit access and/or the growth and development of clients” (A.7.a). Advocacy can seem confusing and challenging to graduate students – some might even think: I didn’t become a counselor to engage in advocacy. Many graduate students are unclear as to the multifaceted roles that counselors have, including the component of advocacy as it relates to human rights issues. This lack of clarity is not unfounded  –  professional counselors often lack consensus on how best to advocate for and on behalf of their clients’ human rights.

Multiculturalism, social justice and human rights

Counseling is a young profession and has seen many developments throughout the years. Starting in the late 1980s, professional counselors saw a need for attention to diversity in clinical and educational settings. Increasingly, counselors were diagnosing and treating individuals who differed culturally from themselves. Therefore, the needs of the profession shifted, however slowly, to meet the needs of consumers. At that time, scholarship focused on racial and ethnic identities in counseling, and mainly examined the relationship between a professional counselor’s ethnocultural identity and that of the client. In the 1990s, Garry Walz and colleagues identified significant trends that should inform future counseling, including developing skills in counseling older adults, counseling family systems, a commitment to multiculturalism, and most salient to this article, the development of advocacy skills.

In 1992, ACA’s first Multicultural Counseling Competencies (MCC) were developed for professional counseling. Becoming competent in multicultural counseling would require counselors to not only understand and honor the diverse customs of different cultures but to recognize the additional barriers many client groups faced. Meeting the needs of disadvantaged clients would require not just knowledge, but action. In 1998, the American Counseling Association (ACA) formed a new division — Counselors for Social Justice (CSJ)— to implement social action strategies aimed at the empowerment of clients and oppressed individuals and groups. With the increasing awareness that social justice concerns must take a prominent role in the profession, the need for individual counselors to gain competency became clear. Because social justice and multicultural issues are inherently linked, the competencies were incorporated into an adapted version of the MCC in 2015, creating the Multicultural and Social Justice Counseling Competencies (MSJCC). At the same time awareness of the importance of advocacy—both for the profession itself and for counselors’ work with clients—was growing and became a focus for ACA leaders. A task force was created to develop advocacy competencies. The ACA Advocacy Competencies were completed in 2003 to provide guidance for counselor advocacy at the micro (e.g., clients, students), meso (e.g., communities, organizations), and macro (e.g. to reflect the profession’s growing understanding of the use of advocacy with clients and their communities and were updated in 2018.

Still, with all of this information, graduate students may be left wondering, “what exactly does this mean for me?”

As mentioned in part one of our series, human rights are civil, political and/or cultural rights that are afforded to humans regardless of our intersecting identities. When these rights of our clients are violated, there are tremendous mental health repercussions. Counselors-in-training need to understand the complexities of human rights issues, when and how these rights are violated, and the ways they can engage in advocacy around these issues.

There is a clear connection between social justice, advocacy and human rights. At times, social justice can be combined with advocacy, creating social justice advocacy, which can be described as organized efforts aimed at influencing sociopolitical outcomes, often with or on behalf of vulnerable, marginalized populations. Whether direct system intervention or collaborative advocacy with clients or client groups, counselors-in-training and practicing counselors need to be able to conceptualize and execute advocacy and social justice strategies to mitigate health disparities caused by human rights violations.

The impact of human rights on graduate students

Beginning counseling students are asked to reflect upon their own worldviews and to begin to form a framework from which they will work with clients – a theoretical orientation. It is likely that human rights issues have, in some way, affected students’ lives prior to entering graduate school.

Tracy, for example, is a graduate student who has encountered societal barriers due to their non-binary gender identity (non-binary denotes a gender identity that is not defined in terms of the traditional binary of male or female). Tracy has faced discrimination in schools, was forced to use a bathroom that was not congruent with their identity and has encountered challenges with changing their gender marker on legal documents. This pattern of harassment and obstruction has not only impeded Tracy’s pursuit of their right to a quality education—it has threatened their personal safety. As a counselor in training, Tracy’s worldview and the way they approach counseling will be directly affected by these violations of their human rights.

In contrast, Anthony is a counseling graduate student with numerous identities. As a White, heterosexual, cisgender male, Anthony has experienced very few human rights violations. Yet human rights issues have already had an effect on Anthony’s worldview and theoretical orientation. Because Anthony has not experienced discrimination due to gender identity or sexual orientation, has not experienced poverty, harsh criminal sentencing and does not face obstacles related to legal documents or using public restrooms, his understanding of the relationship between human rights and counseling will be markedly different than Tracy’s.

These two examples demonstrate that when students begin their counselor training, their views on human rights issues have already been shaped by their experiences. A student who has not experienced violations has potentially started to develop a worldview that may not include an understanding of human rights issues. In contrast, a student who has experienced violations not only has an understanding of human rights issues but has been shaped by the difficulties they faced. These divergent experiences will affect the students’ training and may have a significant influence on their work as professional counselors. Thus, it is essential to intentionally address these issues in graduate school.

Learning the effectiveness of clinical interventions in counseling sessions is an established and vital part of graduate students’ training. However, it is equally imperative that counselors-in-training learn how effective—and necessary—it is to work with clients in varying groups and levels, such as families, groups, and at the community or other systemic level. Using a social justice and advocacy approach allows counselors to empower marginalized clients while also working to change the existing external environments for the clients.

For example, as a counselor-in-training, Anthony may work with a 14-year old bisexual, transgender person of color who has experienced time in the criminal justice system. To provide effective counseling, Anthony not only needs to know information about the current justice system, youth under the law, gender, sexuality and racial and ethnic identities and how this impacts his clients health, but also ways to systemically advocate with and on behalf of this client, as an essential part of ethical treatment and attention to social justice.

Anthony can get this critical information by using resources such as Human Rights Watch, an international organization which investigates and reports on human rights-related violations around the world lists several current human rights concerns on their website: Harsh criminal sentencing, racial disparities, drug policy and policing, children in the criminal justice systems, hate crimes, rights of non-citizens, sexual orientation and gender identity, women’ and girls’ rights, and national security, among others.

Human rights and counselor education programs

In many counselor education programs, human rights issues are often introduced in multicultural and diversity courses, as well as in courses that teach about ethical and legal issues within counseling. However, this is not enough. Additional training is needed but is unlikely to be available to students because most education programs do not offer elective courses in human rights issues. It is often the responsibility of course instructors to take the lead by incorporating human rights issues throughout coursework.

Sufficiently educating students on human rights issues will require curricula and systemic change and will also require counselor educators to self-reflect and understand how human rights issues shaped their own worldview, which will, in turn, affect their work with students. If instructors model silence surrounding these issues, students may graduate from counselor education programs lacking the human rights knowledge that is critical to their work as professional counselors. Counselor educators need to teach students that any reflection on the factors that have shaped their worldview is incomplete without examining human rights issues. The extent of the effect of human rights issues on individuals is evident by examining the significant difference in the lived experiences of Anthony and Tracy.

Although scholarly research plays a part in any graduate program, the expectations for master’s level counseling students are different than those in doctoral programs. Some master’s programs may not assign regular research projects to students. In contrast, doctoral students undertake rigorous research into clinical counseling practices and improvement in counselor education and training. Because human rights issues play an important role in these topics, students are likely to encounter clear examples of violations. For example, research examining the counseling experiences of single mothers of color in poverty might explore systemic barriers and oppression these people face, which are direct violations of human rights.

By not giving students significant exposure to research, counselor education programs are missing an opportunity for counselor trainees to be exposed to human rights issues. The old adage “meet clients where they are at” provides a helpful framework for understanding the need to integrate human rights issues into counseling programs. As part of their training, counseling students provide services to a client base that includes members of society who regularly experience human rights violations. Without an understanding of the myriad forms human rights violations can take (see part one of this series for examples) and an awareness of which populations regularly experience issues—and the physical and mental health damage caused—counselors-in-training will be ill-equipped to meet the needs of their clients.

When counselor education programs minimize or outright ignore human rights concepts in students’ training, they could potentially be causing potential harm to future clients. Nonmaleficence — avoiding actions that cause harm — is one of the fundamental ethical principles of counseling set out in the ACA Code of Ethics preamble. Intentionally infusing social justice advocacy and human rights components into the array of coursework will benefit graduate students’ self-efficacy, their clients, and, ultimately, society at large.

 

In the following section, we provide several strategies for graduate students, counselor educators, and counselor education programs to attend to human rights issues and incorporate advocacy and social justice strategies into the classroom:

For graduate students:

  • Mitigate imposter syndrome related to advocacy by managing self-talk, reflecting on accomplishments, normalizing with other graduate students, and practicing self-grace and compassion.
  • Call, text, email, or write to local, state and national legislative representatives on issues that directly impact human rights issues.
  • Engage in continuous self-assessment related to your own advocacy and social justice competency, by using advocacy competency self-assessment tools and surveys.
  • Conduct research that relates to human rights issues and propose/present it at local, regional, and national counseling conferences.
  • Develop and update a list of local, regional, state, and national resources for clients who experience human rights violations.

For counselor education programs and educators:

  • Foster intentional discussions about current human rights issues throughout all areas of counselor training, in addition to diversity, lifespan, and legal/ethical courses.
  • Integrate human rights issues into case studies and clinical examples so graduate students can experience “real world” examples of clients in training programs, prior to practicum and internship experiences.
  • Co-construct specific advocacy and social justice plans as part of coursework that allows graduate students an opportunity to actively participate in these strategies outside of their practicum or internship counseling sessions.
  • Structure clinical experiences that allow students to work with diverse clients and settings. One way to do this might be to work with the program’s clinical coordinator to ensure practicum and internship sites are varied and, if possible, host a variety of clients with a variety of presenting issues.
  • Teach human rights violation assessment as part of a comprehensive biopsychosocial diagnostic evaluation.
  • Allow guest speakers who have experienced human rights violations in the classroom. The personal stories of people who have lived through human rights violations provide a more vivid and compelling understanding than a lecture containing abstract examples. Mentor and model students in research that relates to human rights issues and empower them to propose/present it at local, regional and national counseling conferences.

 

Counselor education programs can also expand outside awareness of human rights issues in a variety of ways:

  • Create statements (with university permission) of support or resolutions that can increase the visibility of and address barriers to human rights issues.
  • Host “days of awareness,” with various human rights topics addressed on different days through flyers, posters or with guest speakers via workshops or panels.
  • Partner with other departments, when possible, in order to cast a wider net of influence and awareness of human rights issues.

 

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Clark D. Ausloos is a doctoral candidate at the University of Toledo. He is a licensed school counselor and currently practices as a licensed professional counselor in a private practice setting in Northwest Ohio. Contact him at clark.ausloos@utoledo.edu.

Ausloos was a member of the American Counseling Association’s Human Rights Committee, as were the authors of the first article in this series.

Taylor M. Nelson is a second-year doctoral student at the University of Toledo. She is a licensed professional counselor in Ohio, working in an inpatient psychiatric hospital setting. Contact her at Taylor.Nelson2@rockets.utoledo.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.

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.

Applying the MCC in a divisive sociopolitical climate

By Patricia Arredondo and Rebecca L. Toporek May 9, 2018

We are living through a historic era that many people describe as divisive, polarizing and disheartening. The world of social media never sleeps, and we are bombarded with images of pain and strife. The visible presence of neo-Nazi groups marching, the increase in arrests and deportations of immigrants from sanctuary sites, the killing of unarmed Black boys and men, the senseless deaths from domestic terrorism in Las Vegas and Orlando, the increased incidence of school shootings and the devastation of natural disasters in Houston, Florida and Puerto Rico have led many of our students and clients to wonder aloud: What is going on? Will access to guns continue to bring violence into our schools? Will North Korea bomb the United States? Will we have a new civil war in our country? Will our access to health care be compromised because of tax breaks to wealthy corporations? No counselor is immune to this sociopolitical climate of tension and uncertainty.

Though not always verbalized, these questions are on the minds of many individuals, creating both cognitive and emotional dissonance, much as similar events did 25-30 years ago. In 1991, we witnessed the brutal beating of Rodney King, a Black man, by Los Angeles police officers. In 1989, the Berlin Wall was opened and eventually taken down. Also during this time period, following the CIA’s involvement in Central America, refugees who had been forced to flee from El Salvador, Nicaragua and Honduras were denied asylum in the United States. Today we witness the disruption of families through deportation and the incarceration of children, separated from their parents and often left to languish indefinitely.

Today, three essential living documents continue to call the counseling profession to action. The Multicultural Counseling Competencies (MCC, 1992), the operationalization of those competencies (1996) and the Multicultural and Social Justice Counseling Competencies (MSJCC, 2015) help counselors, educators and supervisors navigate our tumultuous times and provide guidance for ethical and effective practice — clinical, educational and advocacy. These guides prove useful and applicable for contemporary challenges.

The MCC, developed by Derald Wing Sue, Patricia Arredondo (one of the authors of this article) and Roderick J. McDavis, were the impetus for change in the counseling profession and continue to hold relevance in today’s national discourse. Then and now, we see:

a) Increasing racial and ethnic diversification of the country, with the U.S. becoming a majority/ethnic minority country

b) Legislation being promoted to oppress persons of color, people with disabilities, Indigenous peoples, immigrants, LGBTQ individuals and other underrepresented groups

c) The pervasiveness of White supremacy and White privilege

d) Eurocentric models in counselor training that ignore intersecting identities and the sociopolitical context that introduces barriers and oppression

e) Ethical issues resulting from the failure to consider cultural differences and variabilities, particularly in practice and supervision

In this article, our intention is to call attention to stressors in U.S. society and to discuss how the MCC can continue to be catalysts for inclusion and social justice advocacy.

The MCC framework

During the past 25 years, the needle has not moved with respect to the composition of counselors-in-training and counseling faculty. We are still a predominantly White profession, although our clients are increasingly diverse and with intersecting identities.

Now more than ever, the MCC and the Dimensions of Personal Identity (DPI) model provide guidance for understanding ourselves and our clients through an examination of cultural worldviews in a sociopolitical environment. They invite us to examine privileges and unconscious biases that may be detrimental to teaching and counseling. They also point out the harm of neglecting the environmental conditions that benefit or adversely affect individuals.

The DPI model presents an intersectional approach to identity and includes numerous dimensions, such as predetermined characteristics that serve as a profile (e.g., age, ethnicity); our experiences and opportunities (e.g., educational background, income); and a contextual dimension that shapes our experience (e.g., historical and sociopolitical events). This model communicates several premises:

a) We are all multicultural individuals.

b) We all possess a personal, political and historical culture and biases.

c) We are affected by sociocultural, political, environmental and historical events.

d) Multiculturalism also intersects with multiple factors of individual diversity.

The MCC and subsequent MSJCC are about change, requiring counseling professionals and graduate students alike to reflect on their own lenses and those of their clients/students, the role of power and privilege, and how the MCC can support respectful responses and engagement in times of political divisiveness. National incidents during the past few years remind us of the need to know facts, engage in perspective-taking and examine our personal beliefs and feelings to engage in ethical and effective counseling.

Current realities

When former President Barack Obama was elected, many people and organizations stated that we were moving into a post-racial era. However, even following his election, assertions about the president’s birthplace persisted (including allegations perpetuated by our current president, Donald Trump). This action propagated doubts about Obama’s legitimacy and arguably subjected him to more scrutiny than previous presidents faced.

Following Obama’s 2008 election, there was an astounding increase in hate groups in the country, accompanied by a rise in hate crimes. For example, hate crimes against Muslim Americans rose 67 percent in 2015. During the national election campaign season and subsequent election of Donald Trump in 2016, the number of hate crimes increased again dramatically. In October 2017, 25.9 percent more hate crimes were reported than in October 2015. According to the Southern Poverty Law Center, there are now 954 hate groups operating in the United States. In addition, 623 “patriot” organizations were classified as active, extreme anti-government groups in 2016.

The White nationalist march that sparked violent conflict and led to the death of one counterprotester this past August in Charlottesville, Virginia, provides a high-profile example of the increased visibility of hate groups. This event is a vivid reminder that hate thrives in many sectors of our society, including among neighbors, friends and family. Trump’s comment that there was fault on both sides minimized the killing of Heather Heyer, a peaceful demonstrator.

Another example of great divisiveness and misunderstanding from 2016 involved the controversy surrounding athletes “taking a knee” during the playing of the national anthem before NFL games. Colin Kaepernick, then a quarterback for the San Francisco 49ers, initiated this action to call attention to racial biases among police forces, the killing of young Black men and the subsequent acquittal of White police officers. As the movement grew, so did the hostility verbalized by the current presidential administration and a segment of the public. A failure to dialogue, inflammatory assertions and the blaming of athletes only exacerbated a national divide. We wonder why these peaceful protests could not be tolerated. Framing this as a “patriotism” issue and a Black-White divide rather than a human-rights and freedom-of-speech issue further polarized the public. As counselors, we may see clients with a range of opinions and perspectives on this and other issues, and we too have to examine our beliefs on these divisive issues.

The #MeToo movement cannot be overlooked in this discourse. Thankfully, the voices of privileged women brought this center stage, yet it was Tarana Burke, an African American woman, who coined the term and brought issues of oppression among working-class women in the South to light. Women across the life span, but particularly girls, women of color, older adult women and economically disadvantaged women, continue to be victimized in a heteropatriarchal society. Although the majority of counseling professionals and counselors-in-training are women, we must be intentional about addressing sexism in the classroom, therapy room and institutions in which we work. We are privileged, but many of our students and clients may not know how to negotiate spaces of harassment and sexual assault.

There is no time for complacency if we, as counselors, consider ourselves to be ethical and multicultural and social justice advocates. The impact of a dissonant national climate and visible expressions of hate on clients and communities must inform our work.

Counselors possess critical competencies to facilitate and support clients, peers and family members who require advocacy. To this end, we must use critical thinking, seek accurate information and develop understanding of sociopolitical contexts. Collective responses and calls to action for justice have been framed politically within the context of a racialized history. For example, assertions that the Black Lives Matter movement is parallel to White supremacy groups misconstrue the purpose of the organization. Black Lives Matter is a collective response of peaceful marches that began in response to the killings of Trayvon Martin and other young Black men, whereas, White supremacy is a movement based on the belief that the White “race” is superior. These are very different premises and have very different purposes.

The “March for Our Lives” and “March Across America” were spearheaded by high school students in response to deadly school shootings. These young people raised their voices to challenge legislators and school officials to make schools safe. These marches were visible nationally and brought the issue of gun control to the forefront. School counselors and educators nationally supported the power of these voices. Within the framework of the MCC, we can critically understand the racialized context in which these voices are heard. In the process, many have recognized that youth of color have been raising the issue for some time.

Legislation and policy affecting human rights

There are a number of examples of policy and legislation that endanger human rights and, thus, the well-being of clients and communities.

The website I Am an Immigrant (iamanimmigrant.com) posts empowering messages detailing personal stories of perseverance and success from immigrants from various countries. Contrast this with scenes of individuals being taken from their homes by U.S. Immigration and Customs Enforcement — families torn apart, children witnessing their parents being handcuffed, individuals and communities living with new fears and trauma. Hate-based trauma is a critical clinical issue and one that is directly connected to current sociopolitical events and policies.

The MCC guide us to examine our attitudes about immigrants, documented and undocumented alike. If we subscribe to, or neglect to refute, statements that all Latino men are “rapists and drug dealers,” as stated by the president, or that immigrants in low-paying jobs are taking opportunities away from American citizens, then counseling and teaching relationships will be harmed. We must become knowledgeable about the facts concerning immigrants’ historical and current contributions to U.S. society and recognize the shadow of illegitimacy that is cast with harmful rhetoric.

Legislation proposing to ban transgender individuals from the military, limit the access of transgender persons to school bathrooms and remove protections for LGBTQ individuals in the workplace have also reemerged as contentious human-rights issues. These issues should encourage us as counselors to take a moment for self-examination to ensure that we understand our responsibilities. The MCC acknowledge that we all have biases and assumptions based on personal values, but in our professional role, we are expected to uphold the ACA Code of Ethics, including the requirement to pursue nondiscrimination.

With the spate of 2017 hurricanes — including Harvey, Irma and Maria — we witnessed people’s resilience despite the extensive loss of homes, lives and livelihood. What was equally striking was the differential response of federal agencies to the victims of Hurricane Maria on the island of Puerto Rico. The damages were anticipated, but the slow engagement by the U.S. government was inadequate on many accounts. Many months later, a lack of safe drinking water, electricity to fuel hospital generators and internet access to check on loved ones are among the persistent examples of neglect. There were also many blame-the-victim taunts by the U.S. president. These were noted by many Puerto Ricans, human-rights advocates and others as indications of double standards, raising questions about the role of biases in federal response to disasters.

As counselors informed by the MCC, we must ask ourselves about this differential treatment of U.S. citizens and the lack of basic historical knowledge concerning Puerto Ricans as U.S. citizens. This example of marginalization cannot be overlooked.

Awareness and guidance from the MCC, MSJCC

In addition to providing guidance regarding multicultural counseling interactions, the MCC, its operationalizing document and the MSJCC give guidance that is useful in contextualizing and responding to the impact of these traumatic and life-ending events — for clients, for communities and for counselors themselves. We will provide just a few examples but encourage readers to invest in a more thorough examination.

One overarching dimension, implicit in the MCC and explicit in the MSJCC, is that of privilege and marginalization. This dimension calls on counselors to examine their position and power within institutions and society in relation to clients. For example, the current U.S. presidential administration and economic power structures reflect White, Christian, male, heterosexual norms, and numerous legislative and judicial decisions are reinforcing values associated with beliefs about the superiority of those identities. The position of the counselor in relation to those decisions and identities is relevant in terms of beliefs and socialization, as well as what the counselor might represent to the client. Are we seen as trustworthy or “handmaidens of the status quo” (Sue et al, 1992).

In any constellation of the counseling relationship (i.e., whether the counselor is of a similar background to the power brokers and the client is similar to communities being targeted for oppression, whether those roles are switched or whether the counselor and the client are of similar identities), the DPI model highlights the ways in which these identities may be relevant. The dimension of privilege and marginalization should be considered in each of the three arenas of MCC: counselor awareness of own values and biases, client worldview, and culturally appropriate interventions and advocacy.

Counselor awareness of own cultural values and biases: As a critical component of multicultural counseling, current political, social and global events present opportunities for examining counselors’ perspectives and how those perspectives contribute to the counseling environment. These beliefs may support clients experiencing marginalization or they may interfere with best practices and the amelioration of systemic oppression.

Differences based on political or economic views, unexamined racial bias, beliefs about immigration or other stimuli may promote assumptions about clients, their choices and the epistemology of their concerns. Furthermore, divisiveness in communities, the media and families can contribute to conflict that is not easily resolved. There are some who see student advocacy for school safety as opposite to Second Amendment rights. These are intrinsically related issues.

One example of an observable indicator of cultural self-awareness (as quoted from the 1996 MCC operationalization document): “Can identify specific social and cultural factors and events in their history that influence their view and use of social belonging, interpretations of behavior, motivation, problem-solving and decision methods, thoughts and behaviors (including subconscious) in relation to authority and other institutions and can contrast these with the perspectives of others.” In the current political climate, in which legislation limits the rights of entire segments of the population (e.g., members of the LGBTQ community, women, Muslims, immigrants, refugees), this statement suggests the importance of counselors examining their own history in relationship to authority, institutions and beliefs.

Counselor awareness of client worldview: Many current events require us to reflect in terms of the sociopolitical climate and biases. Power differentials between clients and counselors are always present. Differences in the counseling dyad based on a client’s underrepresented identity status require the counselor to attend even more intently.

For example, in counseling, college students who were protected under the Deferred Action for Childhood Arrivals (DACA) program may now be preoccupied with concerns about remaining in the U.S., the possible deportation of loved ones and harassment by others who consider them to be undocumented immigrants. Trust issues may also inhibit these clients from fully disclosing out of fear that the counselor might break confidentiality because of the student’s status.

Understanding clients’ worldviews includes understanding the sociopolitical reality in which they live, their fears, the reality of the bias they may face and the impact of immigration policies and practices on their families and communities. Regardless of immigration status, or beliefs about immigration, when the current presidential administration makes broad statements disparaging immigrants and connecting that to cultural identity markers such as ethnicity, it affects entire communities. In the example involving DACA, it is important to understand the policies, rights and resources available to students and to understand the climate of their peers and institutions.

Moving beyond DACA, since the 2016 presidential election, expressions of hate against immigrants, Muslims, Black students and others have increased. Multicultural practice requires an understanding of that climate and how it affects clients. As counselor educators, it is our responsibility to check in with our students to support and hear them out. This is a small gesture of advocacy.

Culturally appropriate intervention strategies: Culturally appropriate counseling interventions include work with clients and on behalf of clients. The MCC advise counselors to consider the cultural contexts of clients and counseling approaches that are congruent for clients’ developmental level, familial and cultural beliefs, and acculturation. Understanding the client’s cultural and sociopolitical context should help determine culturally appropriate interventions and support systems. In the MSJCC, the Advocacy Competencies are also integrated as interventions. The ACA Advocacy Competencies provide valuable guidance for advocating with clients and on behalf of clients to address many of the difficult issues affecting their well-being.

In the DACA example, counselors could advocate through individual interventions, organizational interventions and policy or legislative actions. Individually, counselors could provide students with campus resources to assist with documents that need to be submitted and with identifying DACA-informed immigration attorneys.
DACA clients may also be facing hostility either from fellow students or, in some cases, from staff or faculty. Counselors, as charged by the ACA Code of Ethics, are responsible for bringing discrimination to the attention of their employers and for acting in the best interests of clients. This is an example of an intersection between advocacy and ethical imperatives and would represent organization-level advocacy.

 

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Patricia Arredondo is president of the Arredondo Advisory Group and faculty fellow at Fielding Graduate University. She has published extensively on multicultural competencies and guidelines, Latinx mental health and immigrant identity challenges. She is a past president of the American Counseling Association. Contact her at parredondo@arredondoadvisorygroup.com.

Rebecca L. Toporek is a professor in the Department of Counseling at San Francisco State University. She has written extensively on multicultural counseling, social justice, engaged empowerment of communities and advocacy. Her counseling specialties are focused
on career and college counseling.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go
to ct.counseling.org/feedback.

 

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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.

Counseling survivors of human trafficking

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

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

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

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

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

 

Risk and protective factors

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

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

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

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

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

 

Human trafficking business model and counseling implications

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

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

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

1) The supplier recruits the victim.

2) The manufacturer grooms the victim.

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

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

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

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

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

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

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

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

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

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

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

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

 

Case example         

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

 

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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.

 

Homelessness: A counselor’s role in alleviating a complex systemic issue

By Zach Bruns and Cody Andrews July 10, 2017

How would you know if your client is homeless or at risk of becoming homeless? For counselors working in school or community settings, this seems like a simple question to answer. In reality, homelessness is a complex status that may be layered with shame, guilt, addiction, trauma, family strife, legal pitfalls, economic and employment barriers, and inadequate physical and mental health treatment.

As professional counselors, we are challenged with trying to meet the psychological and emotional needs of our clients. How do we properly treat individuals with mental health symptoms whose needs are so intricately interwoven into personal and environmental factors, especially housing instability? The professional research correlating homelessness and mental health counseling is surprisingly minimal (although not nonexistent), whereas the efficacy of current popular psychotherapy techniques (e.g., cognitive behavior therapy, dialectical behavior therapy, motivational interviewing) has been repeatedly demonstrated throughout research literature. Therefore, it is reasonable to ask: Is psychotherapy alone enough to adequately help individuals living in homelessness or without permanent housing? We will attempt to answer that question in this article while emphasizing the importance of instilling hope in the lives of our clients.

As an American Counseling Association member and a licensed professional counselor and substance abuse counselor in Wisconsin, I (Zach Bruns) have the privilege of working as a mental health clinician on a multidisciplinary team that serves individuals who are homeless or at risk of becoming homeless in Milwaukee County. Our nonprofit agency, Outreach Community Health Centers, receives funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to run a Projects for Assistance in Transition from Homelessness (PATH) program (see bit.ly/2hcldEg). We do not have all the answers and resources to solve the systemic societal issues of homelessness, but I would like to share my insights on practical ways to help individuals who are living in homelessness or at risk of homelessness.

Let’s start with the basic concepts of homelessness. Each community in the United States has different access to resources for people experiencing homelessness. Smaller rural communities may rely heavily on faith-based organizations to assist individuals experiencing homelessness or economic hardship. Larger urban communities such as Milwaukee often have emergency shelters, open year-round or seasonally, that cater to specific populations (e.g., survivors of domestic violence, single women, women with children, families, single men). Depending on a shelter’s funding source — i.e., private or governmental — shelters may enforce their own rules or be required to abide by certain rules and regulations that dictate who can and cannot be admitted into their shelter, how long residents can stay and what services are offered to individuals or families during their shelter stay. The Department of Housing and Urban Development (HUD) also organizes collaborative countywide Continuum of Care programs throughout the United States. These programs seek to provide services to those who are homeless, including helping individuals, unaccompanied youth and families transition into housing (see bit.ly/27ioSpd).

Emergency shelters that receive funding through HUD are expected to track the types of services they provide to individuals and the dates of shelter stays. HUD also funds permanent housing programs such as the Rapid Re-housing (see bit.ly/1MtqB19) and Housing First (see bit.ly/1HGeOsl) initiatives, which are required to provide documentation of a client’s homeless status before enrolling an individual or family in services. HUD created criteria for classifying homelessness into four categories (see bit.ly/1Ir9R9v): literally homeless, imminent risk of homelessness, homeless under other federal statutes and fleeing domestic violence. Individuals are placed into housing programs based on their category of homelessness, the length of time they have been homeless (e.g., 12 months or more in the past three years) and their documented disability status.

With this general background of homelessness in mind, how can counselors provide hope and encouragement and help our clients who are struggling with housing instability?

Primary health care. Help your clients get connected to a primary care doctor. This is vitally important because many (but not all) individuals who are homeless or at risk of homelessness have not had a recent physical exam or have unaddressed medical issues. You may be able to make an internal referral if you are affiliated with a medical clinic. Otherwise, you may need to help these clients research clinics that accept their insurance (if insured) or clinics that accept uninsured clients or work on a sliding fee scale. 

Psychiatry services. Not all clients’ mental health symptoms rise to a level requiring medication management just because they are homeless or at risk of being homeless. However, many individuals can benefit from the therapeutic effects of psychotropic medications as prescribed by a psychiatrist, advanced practice nurse prescriber or other credentialed prescriber. Depending on where you practice as a counselor, psychiatric services may be difficult to access or feature long wait lists. A primary care physician may be an alternative option, depending on your client’s mental health needs. A primary care doctor may be able to prescribe psychotropic medications for common mental health diagnoses such as mild to moderate mood disorders. Consider asking your clients to sign a release of information so that you can communicate with their doctor and coordinate appropriate services for them.    

Public benefits. If your clients are living in poverty and struggling to secure consistent employment and stable housing, they may benefit from public benefits. Help your clients enroll in and utilize benefit programs such as Medicaid or state-based health insurance, the Supplemental Nutrition Assistance Program (SNAP) and unemployment insurance. If you are not the right person to assist clients with these tasks, refer them to an agency in your area that helps with public benefits. Also consider researching additional special benefits that may be available in your area. For example, SAMHSA’s SOAR program helps individuals who are homeless and living with a mental illness apply for and increase their chances of successfully obtaining Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits (see bit.ly/2eM4YPr).

Emergency shelter. If your community has a coordinated entry system for shelter, you may need to help clients make calls for shelter services, especially if this is their first time experiencing homelessness and they are feeling scared, ashamed or hesitant to ask for help. In Milwaukee County, most shelter bed openings are currently coordinated through IMPACT 2-1-1, which can be accessed via phone or online chat. Private shelters follow different rules and often accept individuals who present to a shelter in person. We recommend that you call the shelter in advance to check for current bed openings.

Disability documentation. Unless it’s your initial intake session with your client, you likely have already completed a formal intake process, including using relevant evidence-based screening tools, so you now have a sense of the mental health needs and issues that affect your client’s quality of life. The next step to helping your client is to vouch for your client in writing. Many supportive housing programs require documentation from a medical or mental health professional noting the individual’s current medical or mental health diagnosis. Work with your client to obtain housing application paperwork, and offer to write the client a letter on your agency’s letterhead documenting any disabilities that you are qualified to diagnose.

Food and clothing (and maybe a sleeping bag). As counselors, sometimes we forget about the physiological and safety needs at the bottom of Abraham Maslow’s hierarchy of needs pyramid. Consider obtaining or creating a list of local community resources, including food pantries, free meal sites and clothing banks, to share with your clients. Many secondhand clothing stores, such as Goodwill and St. Vincent de Paul, offer voucher programs for people in need of clothing and furniture. Consider reaching out to local churches, temples, mosques, synagogues or other nonprofits to request donations of material goods that your clients may need, such as personal hygiene supplies, coats or jackets, boots, blankets or even sleeping bags. 

Transportation. Transportation can be a major barrier to a client obtaining and keeping employment and attending regular appointments such as counseling sessions, supervised visits with children and apartment showings. In Wisconsin, individuals with Medicaid can qualify for assistance with transportation for medical-related services, usually via public transportation (if available) or contracted transportation services. Some cities also offer discounted public transportation for seniors, individuals with Medicare or persons with qualifying disabilities. In Milwaukee, our PATH team helps qualifying individuals apply for a GO Pass, a discounted bus pass for county residents older than 65 or for younger residents who receive SSI or SSDI, or who have a veterans disability designation and also have Medicaid or SNAP benefits.

Cell phone. A cell phone is a simple everyday device that most of us take for granted. However, if your client is living on the streets, under a bridge, in his or her car or even “couch surfing” with friends or family, a phone can be that client’s lifeline to the outside world. If your client is enrolled in public benefits, he or she likely qualifies for a free government-issued phone. You can help clients apply for a cell phone online through programs such as SafeLink Wireless (see bit.ly/1ISUYOD) or in person at local cell phone retail stores (call first to check availability).   

Long-term case management. We all have worked with difficult clients — individuals with complex mental and physical health needs whose level of care may extend beyond the scope of outpatient counseling treatment. To better support these clients, consider submitting a referral to a long-term case management program in your county. In Milwaukee County, the Milwaukee County Behavioral Health Division contracts with community agencies to offer three different types of case management programs for people whose primary diagnosis is related to mental health (see bit.ly/2q1uGSl). For individuals whose main diagnosis relates to physical health, there are additional agencies and case management programs, such as Family Care programs (see bit.ly/2hKeRg8), that offer services.      

In conclusion, psychotherapy is not enough to treat all the mental, social, emotional and environmental aspects surrounding individuals or families who are experiencing homelessness. By stepping outside the traditional boundaries of a counselor’s role, you can greatly benefit and encourage your clients as they progress along their recovery journeys. By using your person-centered counseling skills, you will encourage and build up hope in your clients, especially if they are struggling with issues surrounding homelessness. Remember the beloved Carl Rogers, who urged us all to treat our clients with genuineness, empathy and unconditional positive regard.

 

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Zach Bruns, a licensed professional counselor and substance abuse counselor, has been practicing community-based clinical counseling since 2013. He serves as the mental health clinician for the multidisciplinary Projects for Assistance in Transition from Homelessness team at Outreach Community Health Centers in Milwaukee. He also works through Dungarvin Inc. and the Milwaukee County Behavioral Health Division’s Community Consultation Team to provide mobile crisis services to individuals diagnosed with intellectual/developmental disabilities and mental illnesses, their providers and loved ones. Contact him at zacharyb@
orchc-milw.org
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Cody Andrews has served as the lead service provider for the Street Outreach Team at Outreach Community Health Centers since June 2015. He is starting graduate school this fall to obtain a master’s degree in social work and from there hopes to pursue a doctoral degree in social welfare. His research interests include housing interventions, social support systems of people experiencing homelessness and homeless outreach. Contact him at codya@orchc-milw.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.