Tag Archives: human rights

Addressing the Afghanistan humanitarian crisis

By Justina Wong February 16, 2022

In August 2021, Americans who were already dealing with the upheaval and roller coaster of emotions caused by the ongoing COVID-19 pandemic faced another frustration when the U.S. military suddenly withdrew from Afghanistan. The humanitarian crisis in Afghanistan has caused many mixed emotions for individuals who identify with the military community. And for most Afghan refugees, the struggle is not over.

According to the United Nations High Commissioner for Refugees (UNHCR), nearly 6 million Afghans have been forcibly displaced from their homes, with over 3.5 million people currently displaced within Afghanistan and 2.6 million living in other countries. As of Jan. 2022, more than 76,000 Afghans have been brought to the United States.

What counselors should know

Relocating to another country can be a traumatizing experience. In the United States, Afghan refugees often spend weeks in cramped quarters on military bases not knowing when they will be able to leave and start their lives in America. Once they do leave the base, they face a new set of obstacles in the host country.

Affordable housing is a significant challenge for many refugees, who often flee with only the shirts on their back. They do not have any money or belongings, and this issue can be exacerbated for refugees who resettle in areas with exponentially high costs of living such as Los Angeles and New York City. The refugees who are approved to leave the military base typical stay in a room at a motel, hotel or Airbnb or in the house of a host family. Their housing is paid for by nonprofit organizations or private donors. Finding a sustainable way of providing long-term housing is another concern. They usually do not have a place to call their own.

Other obstacles include language barriers, employment, financial insecurities, transportation, food insecurities and other basic necessities for daily living. Most of them are still trying to process the trauma they experienced fleeing their home country, living on military bases and being relocated somewhere else. A lot of these refugees left their families or extended family members behind in Afghanistan.

It is important for counselors to understand the experiences that Afghan refugees went through to come to the United States. Their courage, bravery and perseverance are closely intertwined with fear, despair and trauma. Counselors should refrain from making the following assumptions:

  • All Afghan refugees want to live in the United States.
  • Mental health services are easily accessible for Afghan refugees.
  • Afghan refugees should be grateful that they are living in the United States.
  • Afghan refugees are taking away jobs from American citizens.
  • All Afghan refugees want to adapt to American culture, including customs, societal norms and foods.

Instead, counselors should be knowledgeable about specific concerns that Afghan refugees face, which include the following:

  • Refugees experience a high level of racism if they live in communities different from their own. One of the reasons they are being placed in California and New York is because these states already have established Afghan communities.
  • Acculturation can be a struggle because of cultural differences in language, customs, social norms and foods.
  • Refugees are less likely to access mental health services because of barriers and mental health stigmas. Some might not understand what mental health means or what mental health services have to offer them because in their home country, these services are not available or mental health is not often discussed.
  • Mental health services and insurance are expensive and viewed as luxuries instead of necessities. With little financial assistance from the U.S. government, most families cannot afford insurance copays or services. Their main focus is providing food and shelter.
  • There are few counselors that are competent in providing mental health services to refugees in their native language.
  • Afghan culture teaches individuals to face the trauma they have experienced, keep their heads down and keep going on with their lives. In doing so, this creates generational trauma.

Being aware of refugees’ struggles and challenges will equip counselors when advocating for Afghan refugees as well as help them build a stronger therapeutic alliance with any potential future refugee clients.

How counselors can help Afghan refugees

Some counselors might think they are not well equipped to support Afghan refugees because of language barriers or lack of knowledge about Afghan culture. However, counselors can support them using basic counseling skills. Instead of focusing on how they are different from refugees, counselors should concentrate on the ways they are similar.

To illustrate this point, consider the following case vignette:

Hamid is a 42-year-old man who left Afghanistan with his wife Zeia and their three sons (ages 5, 3, and 6 months) and relocated to Los Angeles. Hamid and his family are temporarily staying in a building behind the main house of a host family. He expresses frustration regarding being unable to afford food for his family, so the host family refers him to see a Hispanic, female counselor named Theresa, who works at a nonprofit organization that provides wraparound services for refugees.

In their initial session, Theresa has a hard time understanding Hamid because of his limited proficiency in English. After reading his intake paperwork, Theresa believes Hamid could use therapy to discuss his past trauma of escaping Afghanistan and receiving constant death threats for helping the U.S. military as an interpreter, but Hamid is more concerned about having food for his family. They are both frustrated with their inability to understand each other.

Theresa decides to use her love of art to create a visual aid for Hamid, so she can understand his needs better. During their second session, Theresa presents the visual aid — a pyramid of Maslow’s hierarchy of needs she created using pictures — to Hamid, who enthusiastically nods his head and smiles in approval. Hamid immediately points to the picture of food and water and then to the picture of a family. Theresa points to the picture of food and asks if Hamid needs food for his family. Hamid nods.

Theresa then creates a checklist of all of Hamid’s needs using the visual aid. At the end of their session, Theresa concludes that food is Hamid’s main concern. Theresa gestures for Hamid to follow her, and she brings him to one of her coworkers who is a licensed social worker. Theresa asks her coworker to help Hamid fill out an application for CalFresh, a Supplemental Nutrition Assistance Program that provides monthly food benefits to people with low income, so he can receive an electronic benefits transfer (EBT) card to buy food for his family.

While not all counselors are proficient in speaking Pashto or Dari (the two mostly widely spoken languages in Afghanistan), they should be proficient in understanding Maslow’s hierarchy of needs and the use of nonverbal cues and body language in counseling sessions. By asking her coworker to help Hamid fill out an application for CalFresh, Theresa has addressed Hamid’s physiological and safety needs. In doing so, she has built a strong therapeutic alliance with Hamid, and he is more likely to come back to see her and discuss his past trauma in future sessions. She has presented herself as someone Hamid can go to if he needs anything.

How counselors can help military veterans

Afghan refugees are not the only ones struggling with the humanitarian crisis in Afghanistan: Military veterans have been significantly affected too. Veterans might be experiencing feelings of guilt, betrayal, shame, anger, hopelessness, worthlessness or resentment. The U.S. withdrawal from Afghanistan has also caused many veterans to struggle with moral injury, which the U.S. Department of Veterans Affairs defines as the distressing psychological, behavioral, social and sometimes spiritual aftermath of being exposed to events that damages or goes against one’s own moral compass.

Ben (a pseudonym) is a former Marine and personal friend of mine, and for the past 15 years, he has worked as a military contractor in Afghanistan. When I asked him how he felt about the U.S. withdrawal from Afghanistan, he expressed feelings of anger, hopelessness and worthlessness regarding the situation. He was angry and frustrated that he could not go to Afghanistan to help the Afghan interpreters with whom he had previously worked. In his mind, he left his “brothers” behind and that was unacceptable. The thought of abandoning those who risked their lives serving as interpreters haunted him.

Leonid Altman/Shutterstock.com

He felt guilty that many of these interpreters were promised safe passage and a special immigration visa (SIV) to enter the United States for their work as U.S. military interpreters only to discover they were later denied entry. Ben has known some interpreters who have been waiting for as long as 11 years for their SIV paperwork to be approved. The more interpreters reached out to him for help with getting their SIVs approved, the more hopeless and worthless he felt.

He also believes the loss of the war makes it seem like all the sacrifices he and his fellow veterans made were for nothing.

Counselors who work with military veterans should know that moral injury is different than having posttraumatic stress disorder (PTSD). Moral injury can be equally if not more traumatizing because it is focused on feelings of guilt, shame and betrayal. And in my work with military veterans, I’ve found that more of them engage in self-destructive behaviors because of moral injury than from a diagnosis of PTSD.

Here are a few questions counselors can ask clients to better understand a veteran’s wounded sense of morality:

  • What are you feeling? Do you feel guilt, shame, betrayal, anger, resentment, regret, hopeless or worthlessness?
  • What happened to make you feel this way?
  • What did you witness that made you feel this way?
  • Do you feel like you failed to prevent certain events or acts that conflict with your own values, beliefs and principles?
  • Have you found yourself ruminating on things since the event occurred?
  • How would you change the outcome if you had a second chance?
  • Have there been other incidents in your past when you have experienced moral injury?
  • How do you view yourself? Sometimes moral injury comes with a sense of self-loathing and feelings of worthlessness.
  • How do you manage your wounded sense of morality (e.g., substance use, anger outbursts, self-harm or self-destructive behaviors, deep breathing or meditation, volunteering with organizations that help veterans, working with fellow veterans)?
  • What do you need to feel a sense of peace and that you did all you could do with what you had?

How counselors can be advocates

As counselors, we owe it to our clients to advocate for not only their mental health but also their human rights. S. Kent Butler’s vision for his ACA presidential year is to #ShakeItUp and #TapSomeoneIn. These two hashtags represent action. Counselors cannot sit back during this humanitarian crisis and simply sympathize or empathize with military veterans or Afghan refugees. They must advocate and take action.

Licensed counselors could provide pro bono counseling services, process groups specifically focused on trauma or moral injury, or psychoeducational groups on parenting, goal setting or stress management. They could also cofacilitate support groups with Afghan refugees to research the needs of the community. Unlicensed counselors and counselors-in-training can provide similar services with clinical supervision.

Counselors can also volunteer to help Afghans as they rebuild their lives in the United States; this could involve teaching them English or about their basic human rights or helping them figure out where to buy groceries or diapers or how to apply for an identification card. And counselors can facilitate support groups or retreats for veterans struggling with moral injury so they know they are not alone.

There is room for everyone. My challenge to you is to fulfill Butler’s vision to #ShakeItUp and #TapSomeoneIn.

 

*****

 

Justina Wong

Justina Wong is a new professional currently earning hours towards licensure at a group private practice in California. She serves on the Military and Government Counseling Association’s board of directors and as a graduate assistant to the president of the Association for Multicultural Counseling and Development. Justina is also a member of the American Counseling Association’s Human Rights Committee.

She wrote this article on behalf of the Human Rights Committee.

***** 

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.

Restoring relationships with survivors of human trafficking

By Lindsey Phillips August 4, 2021

Jenna Hershberger, a licensed associate professional counselor, was working on a crisis response team for a regional human service center in North Dakota when she received a call from a young woman reporting physical abuse. The woman was forthcoming about her medical complaints but not the state of her mental and emotional health. Hershberger could tell there was more to the woman’s story, so she asked to meet her in real life to discuss things further. The woman agreed.

During their in-person meeting, Hershberger, a therapist at the Village Family Service Center in Fargo, North Dakota, noted signs of potential sex trafficking. “Her presentation was really concerning. She was very tearful,” Hershberger recalls. The woman also kept mentioning how her “friends” had forced her to do things while she was under the influence of substances. The more the woman shared, the more convinced Hershberger grew that the people being referenced were human traffickers, not friends. When Hershberger asked where the woman was staying, she revealed that she was currently homeless.

After talking for a while, the woman finally acknowledged that she had been forced into sex trafficking and wanted to get out. She was scared and didn’t know what to do. Fortunately, Hershberger did. She found the woman a safe shelter for the night and helped her locate mental and physical health services.

“I’m in North Dakota … [where] prevalence rates [of human trafficking] are lower, yet it’s still happening,” says Hershberger, a member of the American Counseling Association. “The tragedy where I am and in Midwestern, rural areas is that people just seem to say, ‘Well, this doesn’t happen here.’”

Jared Rose, a licensed professional clinical counselor and supervisor with a private practice, Moose Counseling and Consulting LLC, in Toledo, Ohio, has also encountered a “that doesn’t happen in my community” mentality when it comes to human trafficking. He began working in anti-trafficking about 15 years ago when someone involved in an anti-trafficking organization in Toledo approached him because of his work with the LGBTQ+ community and with people infected with, affected by or at risk for contracting HIV, both of which often intersect with trafficking. When conducting trainings in rural Ohio counties, Rose has heard law enforcement say, “That’s not happening here.” This statement makes Rose cringe because he knows firsthand from his work with individuals who have been trafficked that it is happening.

Human trafficking, in fact, is more common than we think. The International Labour Organization reported that approximately 40.3 million people were in modern slavery globally in 2016. Sometimes people incorrectly assume that human trafficking is a problem only in developing countries, but the National Human Trafficking Hotline identified 63,380 survivors of human trafficking in the United States from 2007 to 2019.

Rose, an ACA member who wrote an ACA fact sheet on human trafficking awareness for school counselors in 2019, finds that too many counselor clinicians also remain unaware of the definition and signs of trafficking. “You could have the epitome case sitting in front of you,” Rose says. “And if you don’t even know what trafficking is, you’re going to miss it.”

Recognizing the Signs

The U.S. Department of Homeland Security defines human trafficking as the use of force, fraud or coercion to obtain some type of labor or commercial sex act. Rose, an assistant professor of counseling at Bowling Green State University, advises counselors to stay alert to signs of force, fraud or coercion with clients. “Take note of who they are with and where the power and control lie,” he says. For example, is someone else benefiting — often financially — from the client’s actions? Does someone else seem to be in charge or making all the client’s decisions for them?

Hershberger, a doctoral candidate in the counselor education and supervision program at North Dakota State University, also looks for visual signs such as bruising, scarring or branding. Individuals who are being or have been trafficked are often branded with “ownership” tattoos with the name of their trafficker or with symbols such as a star or cowboy hat. Because sex acts place a lot of strain on the body, survivors often discuss medical complaints such as dental issues, migraines or urinary tract infections, she adds.

Clients who have been trafficked “may appear overly compliant and submissive, or they might appear really abrasive and abrupt,” Hershberger points out. Counselors must recognize “that those strategies were adaptive at one time but they’re not right now.”

As it relates to falling victim to trafficking, Rose notes that the No. 1 risk factor for children is being unhoused. He prefers the term unhoused to runaway, he explains, because children are often abandoned or “thrown out” by their families. “Within a matter of two to three days of being out of the home, kids are approached [by traffickers], and one-third of those [unhoused] kids are going to get trafficked,” he says. “So, that piece of being unhoused — couch surfing, staying at a shelter, living on the street or whatever the case may be — puts them at significantly higher risk.” Children who are already vulnerable may easily fall prey to an adult who shows them attention or what they initially perceive as support, he adds.

Other risk factors include lower socioeconomic status, past trauma (sexual, physical, emotional, verbal or spiritual), being differently abled, substance use, and belonging to a racial or sexual minority group, Hershberger says. Given the complex trauma that these individuals experience, they often present with comorbid disorders such as substance use, bipolar and severe depression, she notes.

Counselors may overlook or miss signs of trafficking when they take the client’s circumstances or presenting issues at face value, notes Paige Dunlap, an associate professor of counseling at North Carolina Agricultural and Technical State University. For example, if a client is homeless or doesn’t have any identification, counselors may start to talk about the emotions, behaviors and social systems surrounding the client’s chronic homelessness and help them come up with a plan to find a more stable environment. But in doing this, clinicians may miss the larger picture, stresses Dunlap, a licensed clinical mental health counselor with a private practice in Greensboro, North Carolina. Perhaps the client was forced into sex trafficking after being taken from their home or fleeing an unsafe environment.

“There’s a lot of different risk factors. There’s a lot of different things to look for. There’s a number of populations that we are particularly concerned about, but at end of day, it all boils down to vulnerability,” Rose says. For that reason, he stresses that counselors need to be cognizant of that vulnerability piece in connection with their clients.

Sometimes counselor practitioners worry that they won’t be able to recognize the signs that someone has been trafficked, Rose says, but he reassures them they know how to read interpersonal reactions. They know when someone is looking to another person for answers. They notice when people’s stories do not match up.

Counselors also need to consider what a trafficking survivor might look like in their particular clinical setting, Hershberger says. For example, if a counselor is doing crisis work, they might have someone who is in denial about being trafficked or confront a situation that appears to be domestic violence.

The office setting may determine the likelihood of a practitioner encountering an individual who is currently being trafficked or who has gotten out. Counselors who work in public health settings or hospitals are more likely to see individuals who are currently being victimized when these individuals come in for a medical issue such as testing for a sexually transmitted disease or injury from abuse, Rose notes. Counselors working in private practice or at a community agency will typically see these clients after they have been extricated, he says.

Establishing trust and safety

People who have been trafficked may find it difficult to trust others. Before thinking about clinical treatment plans, counselors need to establish a sense of safety and a healthy therapeutic rapport with these clients, Hershberger stresses. These individuals have experienced “complex trauma in the sense that it’s repeated for long duration and often comes from people who should be caregivers,” she explains, “so it makes it really hard for survivors of trafficking to trust us. We need to be really authentic because survivors will pick up on it if [we’re] not.”

Hershberger, president of the North Dakota Association for Counselor Education and Supervision, advises clinicians to maintain an open-door policy with survivors of human trafficking, especially when they are working on engagement with the client. People who are dealing with significant trauma may be more prone to canceling sessions, so adhering to a policy of termination after two missed sessions will not help build engagement and rapport with these clients, she cautions.

Counselors’ innate desire to help clients heal can sometimes be an impediment to build-ing this relationship. Rose sees counselors who want to dive right into the trauma work before first building strong therapeutic and strategic foundations, which can take a long time. “The minute we try to push too much — even if our best intentions are there — is when someone can have [a negative] reaction” and feel that the counselor is forcing them to do something they don’t want or are not yet ready to do, he says.

Rose has also witnessed the inverse: clients who get frustrated when counselors don’t jump straight into the trauma work. When this happens, he explains to clients that although they may feel ready, their whole system may not be. To further illustrate the point, he compares trauma work to a physical wound: “If I start poking around at a wound and you don’t trust me yet or your entire system isn’t ready to allow that yet, you’ll immediately pull back and you’re not going to want me to go near it,” he tells clients. “And the same [thing] is happening cognitively and emotionally with trauma. If we start poking around and you’re not ready, then it’s going to fall apart on us.”

The need for clinical trauma care

Rose asserts that counselors are in a prime position to provide clinical psychotherapy and trauma-focused work. Rose is an executive member of the Lucas County Human Trafficking Coalition, and he was awarded the Social Justice Leader Award from the Human Trafficking and Social Justice Institute in 2017.

Mental health services geared toward survivors of trafficking are great at managing clients’ symptoms through art or expressive therapy or group work, but Rose finds this is often where their treatment ends. “It has to be more. It has to be evidence-based trauma work,” he stresses. “We can’t just treat symptoms. We have to treat the whole person, and we have to treat the trauma.”

“Folx that have been labor trafficked have all sorts of layers of trauma damage. … Sex traffic victims have all of the symptoms of domestic violence, emotional abuse, physical abuse, sexual abuse — all rolled into one very unpleasant package,” he continues. “And expressive therapy is not going to treat that trauma; it’s going to treat the symptoms. If we really want to help folx, we have to go deeper, and that’s where counselors really need to come into play.”

Rose, a certified therapist in eye movement desensitization and reprocessing (EMDR), recommends that counselors use an evidence-based trauma treatment that follows a triphasic approach that a) establishes a foundation, b) reprocesses and works through the trauma and c) plans for the future. Rose often uses EMDR when he’s working with this population because he finds it helpful to treat the root cause of the trauma. He also recommends trauma-focused cognitive behavior therapy, especially when working with children and adolescents.

Take the relational approach

Hershberger points out that traffickers differ from other sexual offenders (who are often described as socially awkward and desire a sense of belonging) in that they are often socially intelligent, charismatic and good at forming relationships. They gain the trust of vulnerable individuals by initially fulfilling their need for love, connection and belonging, she explains. For example, the trafficker could be the first person in the individual’s life to recognize and celebrate their birthday or give them special attention, such as taking them to get a manicure.

These acts can cause some survivors to form bonds with and defend their traffickers — a condition often referred to as Stockholm syndrome. Hershberger and Dunlap point out that something similar sometimes happens with individuals who experience domestic violence. “Survivors will often defend their trafficker because they didn’t have that sense of belonging or that family growing up. So, this is the first time they’re experiencing that — along with horrible kinds of trauma — but it’s hard for them to differentiate that,” Hershberger explains.

According to Hershberger, these trauma bonds illustrate survivors’ desire for human connection. Traffickers thwart this connection by exploiting this desire for their own gain.

“Human sex trafficking is the ultimate anti-relationship,” argues Hershberger, who recently presented on this topic at ACA’s Virtual Conference Experience. Survivors of sex trafficking have been forced “to exist in a world absent of authentic, growth-fostering relationships,” she explains. Thus, she recommends that counselors use a relational-cultural approach with this client population to foster an authentic growth-fostering connection.

To explain this approach, Hershberger presents Marie, a fictional client: When she was 14 years old, Marie lived in an abusive home where her mother’s boyfriend molested her. So, Marie was excited when Jake, a 24-year-old man, approached her and promised a better life as his “girlfriend.” He bought her nice things and told her she was “amazing in bed.” One day, he told Marie some money hadn’t come through at work and asked if she would help him by having sex with a few guys. When she resisted, he beat her until she complied. He forced her into sex trafficking, and she was having sex with as many as 10-15 men a night. (See Hershberger’s 2020 article, “A relational-cultural theory approach to work with survivors of sex trafficking,” published in the Journal of Creativity in Mental Health, for a more detailed discussion of this case study.)

Following a relational-cultural framework, Marie’s counselor first establishes a sense of safety and trust, and they are authentic, empathetic and consistent in their interpersonal interactions, Hershberger says. So, if the counselor makes a mistake by showing up late for session, they own that mistake, apologize and ask Marie how they can make up for it.

Marie may have internalized negative beliefs or self-blame such as “I’m only good for my body and others’ use” or “I’m not worthy of being loved.” The counselor can help Marie first identify and name these beliefs, and then they can work together to challenge these negative beliefs. The therapeutic relationship further challenges Marie’s distorted thinking about herself and relationships, Hershberger notes, and models what a healthy relationship entails.

To challenge Marie’s belief, the counselor could use self-disclosure and tell Marie, “I experience you as a creative, confident individual who is worthy of being loved.” Hershberger recommends that counselors use the client’s own words when reflecting positive attributes to help the client identify and own their strengths.

As Hershberger points out, traffickers try to keep victims in a constant state of uncertainty about their environment, safety or identity. So, the counselor’s role is to identify moments or thoughts that are unclear, such as Marie’s negative perception of her self-worth, and help her add clarity to them.

Hershberger names bibliotherapy and narrative therapy as useful approaches for empowering survivors of trafficking and helping them find their own voice. For example, the counselor could ask Marie what name her trafficker gave her and the name she wants to use moving forward. Then, Marie could journal about this new identity and the qualities associated with it.

The counselor could also add in creative techniques such as collage or relational imagery. For example, Hershberger once had a client who identified with the image of a wounded deer because they too had been hurt and abandoned. The wounding paralleled their own trauma around the physical abuse they had experienced while being trafficked. Later, Hershberger used this image to help the client think about what they wanted their future identity to be and to create a collage of their strengths.

The therapeutic relationship becomes a healthy relationship — one that is safe, dependable and empowering and that counters the disconnection and uncertainty survivors experienced when they were trafficked, Hershberger says.

Preparing to work with this population

The best way to understand what is going on with human trafficking in a specific area is to get involved and volunteer in the community, Rose says. One place to start is joining or attending meetings of local, regional or state trafficking coalitions and task forces. “You can learn more about what agencies are providing services for this population,” he says. “They need to know where mental health providers are, and you need to know where additional services are for survivors.”

Rose advises counselors to approach these partnerships with an attitude of wanting to learn and help. Communities don’t respond well to people who think they know what is best or have all the right answers, he says. Instead, inform these organizations of the crucial skills they may be missing. Counselors have “the clinical piece that a lot of these places need and strive for,” Rose notes. “There’s a lot of social workers, nurses and different helping professionals, but clinical mental health treatment may not be what they have.”

In addition to attending monthly meetings of North Dakota’s trafficking task force, Hershberger prepared to work with this population by reading case examples and familiarizing herself with these tough stories. She also reached out to other clinicians in the field to hear about their experiences. As she points out, “It’s one thing to hear terminology, but it’s another thing to hear somebody’s story.”

Rose and Dunlap recommend that counselors limit their caseloads (if they have that option) when working with this population. “You can’t hear the thing of nightmares for three, four or eight hours a day and expect to be OK by 6 or 7 o’clock at night,” Rose says. Both he and Dunlap, an ACA member who researches and works with youth with disabilities, survivors of human trafficking and criminal populations, have had to learn how to balance their clinical schedules better. They intentionally leave time between these difficult sessions so they can reflect, reenergize and regroup before seeing their next client.

Counselors must also remember that not every client-counselor relationship is the right fit, Rose says. For example, someone may refer a female survivor of sex trafficking to him because of his expertise in EMDR, but if she has been abused by men her entire life, she may not want to work with Rose regardless of his qualifications and reputation as a counselor.

“These clients have had people treat them really poorly their entire lives,” he points out. “Part of that therapeutic relationship is recognizing maybe I’m not the best counselor for every person I want to help, and that’s OK. Just giving [clients] that freedom and autonomy will help them along in their journey. They don’t have to work with me to fix the problem.”

Rose reminds counselors there are other ways to help serve this population without working directly with clients. Counselors can get involved in local agencies that work on human trafficking, provide education and trainings, or work on prevention, he says.

Hershberger understands how difficult it can be when counselors must refer a client. Because she was part of a crisis response team when she met the woman who was a survivor of human trafficking, she wasn’t able to continue working with her. The woman was referred to another clinician who worked for the human service center. “That was hard,” she recalls. “I couldn’t stay with her, and having that continuity of care would have been nice.”

Hershberger did have a chance to meet with the woman a few months later. With the help of her new counselors, she was making progress toward creating healthier relationships.

fizkes/Shutterstock.com

****

Working with perpetrators of human trafficking

Paige Dunlap, a licensed clinical mental health counselor in Greensboro, North Carolina, once worked with an agency in Detroit that assisted individuals who no longer wanted to be engaged in gang activity. In sharing their stories, some of the group members disclosed that they had been directly or indirectly involved in trafficking other individuals. After recovering from the initial shock of hearing that, Dunlap started to think and educate herself about ways counselors could help perpetrators of trafficking.

“We as counselors don’t really talk about this hidden population” of perpetrators, she says. “We don’t know too much about them.”

Often people’s biases can cloud their judgment about these individuals. The more Jenna Hershberger, a licensed associate professional counselor in Fargo, North Dakota, researched and worked with cases of sex trafficking, the more she discovered the dichotomous thinking attached to it: People consider traffickers to be “bad” and survivors to be “good.” But it’s more complicated than that, she says.

“In the literature, we see that traffickers and survivors experience the same kinds of childhood traumas, such as sexual, emotional, physical and spiritual abuse,” she explains. But for individuals who become traffickers, “there is a distortion that happens in the way that they respond to the trauma.” Hershberger, a doctoral candidate in the counselor education and supervision program at North Dakota State University, acknowledges this is an area of research that mental health professionals do not fully understand yet. But initial clinical findings, as well as Hershberger’s own professional experience, indicate that traffickers often seem to have empathy deficits and endorse trafficking myths such as “people like this way of life.”

Dunlap, an associate professor of counseling at North Carolina Agricultural and Technical State University, says that traffickers and victims of trafficking often get enmeshed in that world for similar reasons. “There is a need for belonging in all of these individuals,” she says. Both groups often lack support systems, have limited work opportunities and are tempted by the promise of a “better” life, she explains.

Once individuals get involved in trafficking, it becomes difficult for them to leave, Dunlap points out. “It becomes almost an institutionalization for them too. … They don’t know how to function outside of that.”

“Getting those individuals into your office to do this hard work is really going to be tough,” she admits. “If you’re a counselor and you do happen to have these clients, the last thing they need is for your own biases to be stopping them from getting help, because they’re doing good just to be there.”

Hershberger hopes counselors continue to research ways to better help both the survivors and perpetrators of human trafficking. In doing so, she encourages counselors to consider a larger question: How as a society are we creating spaces in which people don’t know what a healthy relationship looks like so that they’re seeking out this subculture for a sense of belonging?

 

****

Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

****

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

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.

 

*****

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.

*****

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.

 

****

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

 

*****

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.

 

****

 

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.

 

****

 

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.