Tag Archives: immigration

Fostering immigrant communities of healing

By Lindsey Phillips January 28, 2020

During the months surrounding the 2016 presidential election, the rhetoric around immigration was so charged that Daniel Gutierrez, a licensed professional counselor (LPC) and American Counseling Association member, noticed a substantial uptick in panic disorders at a free clinic in Charlotte, North Carolina. One therapist even told Gutierrez about a client who was having panic attacks every time that a political ad played on television.

Four years later, Gutierrez, an assistant professor in the counselor education program at William & Mary and coordinator of the addictions emphasis for the university’s clinical mental health counseling program, says he still encounters immigrants who are terrified and no longer understand the immigration process in the United States. Many worry about family members back in the countries they left. Some worry that if they visit these family members, they may not be able to easily return to the United States themselves. Some are confronted by people screaming “Go back home!” as they shop for groceries or walk down the street. Fear, guilt and worry are constant emotions for many immigrants, notes Gutierrez, who is also faculty director of the New Leaf Clinic at William & Mary in Williamsburg, Virginia.

In fact, Gutierrez says that providing counseling services to immigrant populations can sometimes feel like working in a hospital emergency room. “We’re just trying to stop the bleeding for a minute, and sometimes we don’t have time to look at some of the other concerns,” he says. “You don’t even know where to start. There’s so much trauma and anxiety.”

“They have such a history of past trauma that it overshadows everything,” Gutierrez continues. “They’ll have this experience on the border crossing or in their home country, and when they get here, that [experience] influences every relationship.” Gutierrez has seen cases in which a mother has difficulty connecting with her partner and children because of the guilt she feels about a trauma that happened while the family was crossing into the United States. For this reason, counselors often have to deal with larger presenting issues — trauma, anxiety, depression — before they can work on other concerns such as relationship issues, he explains.

Immigrants also face myriad stressors after migrating to a new country, and these stressors take a toll on their mental health. In fact, researchers have identified an immigrant paradox in which recent immigrants often outperform more established immigrants in areas of health, education, conduct and criminal justice.

This paradox illustrates how damaging acculturative stressors such as financial concerns, insufficient living conditions or food, cultural misunderstandings, an inability to communicate or speak a new language, lack of employment, and isolation can be to immigrants. Lotes Nelson, a clinical faculty member at Southern New Hampshire University who often presents on this topic, points out that these stressors can result in symptoms of anxiety, depression, posttraumatic stress disorder (PTSD), conduct disorders (especially for children) or substance abuse issues.

Isolation and the lack of a support system can cause immigrants to turn inward and internalize their symptoms, says Nelson, who lives in St. Augustine, Florida, and, as an LPC and approved clinical supervisor in North Carolina, offers distance counseling services. Her clients who are immigrants often report feeling that something isn’t right — their heart is racing all the time or they constantly feel sad, for example — but they can’t pinpoint what it is or why they feel this way. In addition, they frequently lack people they trust to talk to about their concerns.

One problem is that accessibility to counseling services is limited for immigrant populations. Gutierrez, author of the chapter “Counseling Latinx Immigrant Couples and Families in the USA” in the forthcoming book Intercultural Perspectives on Family Counseling, says that immigrants are less likely to receive mental health services, and when they do, the services are often lower quality than what the majority culture receives. “The counselors who are offering the care [to immigrant populations] are overwhelmed with large caseloads. They are about to hit burnout. … The immigrant stories of journeying over are [also] really difficult,” he explains.

In addition, Gutierrez finds that the counseling profession doesn’t have enough practitioners who understand the cultural implications and nuances of working with immigrants.

Nelson, a national certified counselor and a minority doctoral fellow of the National Board for Certified Counselors, also points out that immigrants may not voluntarily seek counseling because many have not been exposed to mental health care until reaching the United States. So, at least initially, she says, they may not consider counseling to be an acceptable service or treatment. When someone is not familiar with the mental health care process or if they question the validity of therapy, then they are not going to easily share their thoughts, concerns and fears in counseling, explains Nelson, a member of ACA.

Gutierrez and Nelson agree that to overcome some of the barriers that immigrants face in receiving mental health care, work must be done on the part of counselors to cultivate personal relationships and build trust with them. Counselors need to understand where each individual client is from and what that person’s transition to living in the United States has been like. Gutierrez also stresses that if they truly want to make a difference, counselors must enter into partnerships with immigrant populations and the communities that serve them.

Overcoming language barriers

Language is often a barrier when working with immigrant populations, and finding bilingual counselors can be a problem, according to Gutierrez. In 2009, when Gutierrez lived in Orlando, Florida, he sought his own mental health counselor but found only five who were Latinx and spoke both Spanish and English.

Gutierrez, co-founder of the annual Latinx Mental Health Summit, also points out that native Spanish speakers will sometimes use physiological terms to talk about psychological illness, which results in diagnoses being missed or lost in translation. For example, in some Latinx cultures, people may say, “My heart hurts” or “I have pain in my heart” to describe sadness.

Nelson has observed that immigrants who are experiencing anxiety also commonly describe their symptoms physiologically, such as having abdominal pains. Some clients may believe that a stomachache is purely physical and not related to mental health, she points out.

Counselors can overcome some language barriers by working with interpreters. Because of the complexity of translating mental health terms and concepts, Nelson cautions counselors to make sure they are working with qualified interpreters, not just individuals who happen to speak the language. With some clients, certain mental health terms or symptoms may not exist in their cultures, so their language may not even have a word to describe it, she adds.

Nelson invites interpreters to ask her questions to clarify and help them make sense of what they are translating. She also requests that they translate her words verbatim to the client to avoid potential misinterpretations.

Finding qualified interpreters can also be a challenge, Gutierrez points out. Nelson and Gutierrez have used interpreting agencies, hospitals and university language departments to find interpreters. Once counselors do find someone qualified, they then need to ensure that the translator will keep clients’ information confidential, Gutierrez adds. He recommends that counselors have interpreters sign confidentiality agreements. For him, the best-case scenario is working with interpreters in the helping fields (e.g., case management, nursing, health education) because they already understand the importance of client confidentiality.

There is also a danger of misinterpreting body language when working with clients from different cultures, Nelson notes. For example, whereas nodding in U.S. culture typically denotes comprehension, some clients raised in Asian cultures may nod because they are embarrassed about not fully understanding what is being communicated or don’t want to make the therapist feel bad that they don’t understand, Nelson explains.

Nelson has also had clients bring in their children to translate for them in session. When this happens, she explains to the client that even though the children may be capable of translating, the conversation may be beyond the child’s developmental age, so she would prefer working with a translator. However, some clients resist working with a translator and feel safe only when having someone inside their family unit translate their personal information. When this happens, Nelson respects the client’s preference but carefully explains the potential consequences of choosing that option.

Prioritizing family

Many immigrant populations place a high value on family, and this means that counselors should make it a priority too. “If a client has to choose between their child and being seen by [a therapist] … they always prioritize family. They always prioritize children,” Gutierrez says. “So, family cohesion is a stronger predictor of whether [immigrants] engage in services or benefit from services than [it is with] the majority culture.”

Gutierrez says counselors will be more successful engaging with immigrant populations if they offer family services, provide some form of child care, or help clients connect how their own well-being and mental health influence their children’s well-being.

Nelson agrees that counselors must find ways to incorporate the family if they are to be successful in reaching out to immigrant populations. Because child care can be a challenge for many of these clients, she suggests that counselors consider providing clients’ children with a separate room where they can color, watch movies or engage in other developmentally appropriate activities while their parents are in session. However, she acknowledges that this setup is not always possible, so counselors may have to find other ways to accommodate families.

Clients often come to see Sara Stanizai, a licensed marriage and family therapist and owner of Prospect Therapy in Long Beach, California, because they are navigating two conflicting messages: the individualist mindset widely embraced in the United States and the collectivist mindset often emphasized in their homes. Family was so central to one of Stanizai’s adult clients that the client’s mother had to speak with Stanizai before the client could work with her.

If clients come in discussing problems with their family and the therapist’s advice is to set better boundaries, this could work against the clients’ mental health and well-being because being with their family is a priority for them, Stanizai says.

Instead, she works with clients to reframe the issue with their families to find common ground. Rather than focusing on why a client is at odds with his or her parents, she helps the client think about the underlying motivations and values that they all agree on. For example, the client may agree with the parents’ desire for them to have more opportunities and to be successful, even if the client doesn’t fully agree with the parents’ high expectations or demands to get straight A’s.

Because of the stigma that often surrounds mental health within immigrant communities, some clients may not feel able to talk openly with their families about counseling. This is strange for them because they have such strong family units, Gutierrez points out. An inability to turn to their families can prevent these clients from going to counseling because they fear getting “caught,” he adds.

Thus, confidentiality becomes particularly important when working with immigrants whose communities may stigmatize counseling or whose experiences or undocumented status could prevent them from freely sharing their stories. For example, if an individual’s pastor refers the client to Nelson, she will make a point to say, “I know you came here because your pastor recommended counseling, but this does not mean that what you share here goes back to your pastor. This meeting is for you, and anything you say here will stay within this room.”

When working with clients who are immigrants, counselors should consider the individual’s overall support system, which can include family, friends, faith leaders, community elders, local organizations, medical doctors and other professional service providers, Nelson says. She reminds her clients that she is just one part of their support system. For example, if spirituality is important to a client, then she will say, “It sounds like you have great respect for your worship leader. I want you to continue to go to them while you are also coming to counseling. You have a whole host of support around you.”

“If you as a counselor [have] … tunnel vision — ‘this is me and my client’ — when working with immigrants, then it’s more than likely not going to be successful,” Nelson says. “Because if you only look at one of those resources, such as friends, [clients] are going to get a fraction of the treatment that they need.”

Partnering with the community

Gutierrez learned the value of community and partnerships when he worked as a counseling professor at the University of North Carolina at Charlotte (UNCC). Mark DeHaven, a distinguished professor in public health sciences at UNCC, taught Gutierrez about community work and connected him with Wendy Pascual, the former director of Camino Community Center, a local free clinic.

Through his partnership with Pascual, Gutierrez learned that the clinic had 85 people on a waiting list to receive mental health services. He also discovered that primary care was often a starting point for immigrants to receive services. The majority of people at the clinic had mental health issues related to depression, anxiety, stress or trauma, and these issues were often a significant driver of their physiological complaints (e.g., diabetes, high blood pressure). The physical illness was often just a symptom of a mental health concern — one that was going untreated because of a lack of qualified counselors and services.

Gutierrez worked with Pascual and a team of academics, including DeHaven, to fulfill this need and reduce mental health disparity within the immigrant Latinx community in Charlotte. Graduate counseling students at UNCC agreed to provide counseling services for the clinic, so the services remained free for the immigrant population and operated as part of the students’ counseling training.

Gutierrez notes that counselors need to enter into partnerships if they want to make a difference in immigrant communities. He stresses the word partnership. “There’s a difference between partnership and collaboration,” Gutierrez notes. “Collaborating with people in a community is OK; you do your stuff and then you go back home. But partnership [involves] … joining with people in the community and … adopting their mission and vision.”

Partnerships allow counselors to reach immigrant communities and better understand clients’ cultural values. For clients who are immigrants, it is often about the personal relationship and building confianza, or trust, Gutierrez says. But he notes that in Spanish, the word confianza goes further than just trust. “It’s confidence. It’s connection. It’s partnership. It’s someone who invites you in to break bread,” he explains.

Gutierrez cautions counselors not to assume that immigrant clients are going to come to them. Instead, he advises counselors to work within the communities they want to serve. He also recommends attending community events such as church celebrations or local festivals as a first step toward building these partnerships. By attending the annual Puerto Rican festival in Charlotte, he was able to foster relationships with individuals and learn more about what work was already being done to help immigrant communities.

Counselors should “just follow the crowd backward,” he advises. For example, they can look for people organizing food and backpack drives or voter registration efforts and connect with them because these people are the ones who are already doing great work in the community.

Partnerships have also assisted immigrants in finding Nelson, who notes that most of her clients come to see her because of referrals from religious leaders, resettlement agencies or other clients. She also agrees that immigrant families value seeing counselors out and about in their communities, including at events, festivals, fairs, their places of worship and so on.

Even so, counselors must remember to uphold their ethical obligations, such as protecting client confidentiality, during such community interactions, she notes. When a client brings Nelson a flyer for an upcoming event, she carefully weighs her ethical obligations with the needs of the client: Will attending the event harm or benefit her relationship with the client? Could it in any way interfere with the client’s treatment or the progress the client is making?

She also has conversations with the client about boundaries. They discuss how the client wants to handle this dual relationship and talk through scenarios concerning what could happen as a result of Nelson attending the event. Will the client acknowledge her (and vice versa) when they see each other? How does the client want to explain their relationship to family members and friends who may be at the event?

For Gutierrez, the faith-based community has been the biggest asset in working with immigrant populations. In churches and other spiritual communities, immigrants can typically use their own language, connect with others like them, and feel safe and heard, he explains. For this reason, Gutierrez advises counselors to work with pastors and other spiritual leaders to educate them about the benefits of professional counseling. Often, that is all practitioners need to do to increase the number of immigrants who seek counseling, he says.

Gutierrez tested the power of spirituality for immigrant communities by holding identical educational counseling courses (with the same curriculum and instructor) in a clinic and in a church. Whereas only 20-30% of immigrants completed the course at the clinic, 90% of those attending the class at the church stayed because they said they felt the class was closer to God and more aligned with their beliefs, Gutierrez says.

If clients value spirituality, counselors can integrate that into their sessions and adapt interventions to include spirituality (adhering to the competencies developed by the Association for Spiritual, Ethical and Religious Values in Counseling), Gutierrez says. For example, counselors might ask clients how they understand a situation from their own religious or spiritual perspective, or they could discuss the use and function of meditation and prayer, as appropriate, he explains.

Nelson has had immigrant clients with symptoms of depression or anxiety report that “I’m possessed by the devil because I feel this way.” Other clients have told her that in their home country, they would have been taken to church and prayed over for days or weeks for having such feelings. When this happens, she relates mental health needs to medical ones because the concept of medical health is often familiar to these clients, even if mental health is not. She asks them where they went when they had physical pain. When they respond that they went to see a doctor or a healer in their village, she compares that process to seeking a mental health professional to figure out why they feel sad or feel like something is not right with them emotionally, psychologically or socially.

Diagnosing the person, not the culture

“We’ve treated culture in counseling sometimes likes it’s a diagnosis,” Gutierrez asserts. He explains that practitioners sometimes try to adapt counseling approaches to fit specific cultures — for example, using cognitive behavior therapy (CBT) with all Latinx clients. But this method ignores the differences within cultures, he says. CBT may work well for one Latinx client, but another Latinx client may prefer psychoanalysis.

“Good cultural accommodation or adapting culturally responsive care starts with a good conversation about what the client needs and the services you provide,” Gutierrez says.

“There’s still a human being in that chair. … It’s less about the strategies you use and more about the person you’re working with … because they’re dealing with multiple layers of stress, challenges and stigmas. So, find out what their story is before making some assumptions,” he advises.

Being culturally responsive may mean adjusting the length of counseling sessions, Gutierrez notes. Even though a 50-minute clinical session is standard practice in the United States, shorter sessions may work better for some immigrants, he says.

Likewise, Nelson says it is dangerous for counselors to quickly settle on a diagnosis without knowing the client’s overall picture. On the surface, it may look like an immigrant client is dealing with anxiety over moving to a new country, but counselors should consider everything the person has experienced in their life before, during and after migration, she explains. Past and ongoing traumas and adverse childhood experiences can shape a person’s development and can potentially lead to disruptive behaviors, PTSD, depression and anxiety, she adds.

To learn about clients’ immigration experiences, Nelson often says, “Tell me what you went through physically and mentally. What was the living situation when you were migrating, and what is it now? What kind of threats did you experience?”

Often, clients will resist answering these questions because they are not yet willing to focus on the traumatic experiences they went through, Nelson says. Many clients respond along the lines of “I don’t think about that. That’s over now. I want to focus on the here and now” or “That’s just what I had to do to get here and to get a better life.”

When clients dismiss their past experiences, Nelson respects where they’re at emotionally and cognitively and doesn’t push them to share more of their story in that moment. She admits that it is easy as a counselor to develop an unspoken agenda with clients, so she continually reminds herself that counseling is about allowing clients to tell their stories when and how they need to.

Both Gutierrez and Stanizai stress the importance of counselors educating themselves about different cultures and not placing the burden of this education on clients who are immigrants. Although multicultural training courses can be helpful, it is often equally (if not more) beneficial to learn from the community itself, Stanizai says. Gutierrez agrees that immersion is the best teacher, so he advises counselors to put themselves in settings where they are surrounded by people different from themselves.

Stanizai, who specializes in working with first-generation/bicultural Americans and runs an Adult Children of Tiger Moms support group, advises counselors to spend time reading books and watching media written for and by people in the culture they are working with. “Find a local news source, a radio station, novels or nonfiction that can educate you on not only specific topics but also cultural values and beliefs,” Stanizai says.

Cultural awareness helps counselors learn about privilege, avoid making assumptions or buying into stereotypes about groups of people, and better understand how being an immigrant within mainstream American culture can affect clients’ beliefs and mental health, Stanizai says. Most immigrants will not care whether counselors are familiar with every cultural custom, such as marriage contracts, but they will care, she says, if counselors have a surprised reaction — e.g., “What is that? That’s so different!” — to something they share about their culture.

No matter how much counselors educate themselves, they can never learn about all of their clients’ different experiences and cultures. Gutierrez finds that sometimes counselors are scared to talk about race and ethnicity out of concern about potentially making a mistake. This fear can turn into overcorrection and cause counselors not to ask important questions, he notes.

It is OK, Gutierrez says, for counselors to directly address the issue of a client’s race or ethnicity differing from that of the counselor. For example, a counselor could broach the topic by saying, “My family is Latinx. My parents came here from Cuba. You are Asian. I wonder how you feel about getting help from someone whose background is different from yours?”

Gutierrez and Stanizai also advise counselors to take a tutorial stance when working with immigrant clients by asking questions about their unique experiences. Counselors could ask, “What was it like to grow up in your family? How much did culture play a part in your childhood? How is your family different from your best friend’s family? How is it the same?”

Counselors’ hubris can also be a barrier to working effectively with clients who are immigrants, Gutierrez warns. If counselors feel like they are going to be savior figures and fix all of the immigrant’s problems, then that mindset undercuts the progress of the client, he explains.

Stanizai agrees. “It’s easy for very well-meaning therapists to get caught up in trying to prove to their clients that they are good people,” she says. “You want to make sure that you’re not processing [clients’ stories] for your own benefit. … That’s really off-putting, and people can sense it a mile away.”

Clearing the way for immigrants

Counselors only have to sit and hear one immigrant’s story or journey to realize how resilient they are, Gutierrez notes. “I don’t give them solutions. They find them,” he says. “They’ve pulled themselves through all these difficulties and challenges, so there’s this amazing resilience in them.”

Often, the pressures and demands of life, of having to concoct strategies to get to work and home, weigh on them, so Gutierrez says he simply provides them with a safe, secure space where they don’t have to feel all of that extra pressure. “Usually I’m just clearing the way for them,” he says.

Providing this space can take many forms. One therapist Gutierrez knows often has clients sing old hymns or folk songs as a symbolic way of allowing them to recapture a piece of their soul that they may have lost during their journey. In this safe space, clients can grieve what they have lost or what worries them in their own way, Gutierrez explains.

Counselors might also consider simply sharing a cup of coffee with their clients. Gutierrez recalls one immigrant client from early in his counseling career who demonstrated his resourcefulness and taught him how to “break the rules.” The client brought Gutierrez a bag of coffee as a thank you, but Gutierrez explained that he couldn’t accept the client’s gift for ethical reasons. The client said, “Oh, so you can’t take it from me?” So, the client opened the bag, walked to the coffee machine and made two cups of coffee. The client then said, “Well, I’m going to drink a cup. We can share it together.”

This moment was a turning point for Gutierrez. Now, he often enjoys a cup of coffee with clients while they talk in session. This small gesture counters some of the hostility and challenges that immigrants face, especially in today’s environment. As Gutierrez points out, it also creates a comfortable counseling atmosphere that will help immigrant clients find peace and lets them know that “there’s room for [them] here.”

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RELATED READING: See the online exclusive article “Straddling two worlds,” which explores the complex and critical issue of identity development among immigrant populations.

Also, check out Counseling Today‘s 2016 Q+A with Gutierrez, “Counseling interns get firsthand exposure to immigrant experience.”

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

Letters to the editor: ct@counseling.org

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

Straddling two worlds

By Lindsey Phillips January 23, 2020

Because immigrants often feel like they are straddling two worlds — their origin country and their new one — identity development is complex and critical for this population. Immigrant clients often tell Sara Stanizai, a licensed marriage and family therapist and owner of Prospect Therapy in Long Beach, California, that they have one foot in each culture and don’t fully fit into either one.

When people feel like they don’t fully belong to any one community and are constantly hiding one or more aspects of themselves to try to fit in, they question their identity and choices, Stanizai explains. She finds this is especially true for emerging adults who are figuring out their careers. Immigrants may be successful at their jobs, but they often feel like they are failing because they are hiding or ignoring a part of their identity in the process, she says.

Daniel Gutierrez, an assistant professor in the counselor education program and coordinator of the addictions emphasis for the clinical mental health counseling program at William & Mary, points out that straddling two worlds involves code switching between language and cultures: People alter their behavior and speech to accommodate different cultural norms. They may act and speak one way at home and another way when they are at school or work or out with friends. “You can’t be who you are naturally. You have to switch depending on the social context or you have to abandon your home culture to succeed, and then you feel guilty all the time,” says Gutierrez, who is also faculty director of the New Leaf Clinic at William & Mary.

Gutierrez finds that many immigrants question their identity (for example, “Am I Korean enough? Am I white enough?”). Immigrants may feel that they need to reject their home culture to fit in with their new one, so Gutierrez recommends asking clients, “How do you identify? Whom do you connect with? What does your social network look like now? How do you make sense of what’s home?”

Immigration can also cause intergenerational conflict because family members acclimate to the new country and culture at different rates. The expectation that even after immigrating, children will continue to behave as they did in their origin country can lead to conflict, says Lotes Nelson, a clinical faculty member at Southern New Hampshire University. She often hears clients say that their children are “behaving like Americans” because they are being disrespectful to them or dressing and behaving in a way that is embarrassing to the family. These clients often ask her, “What do I need to do to make sure our children follow our culture and behaviors?”

Nelson, a licensed professional counselor and approved clinical supervisor in North Carolina, acknowledges that this isn’t an easy conversation to have, but she invites families to talk through their feelings. One framework that she finds helpful is the ABCDE model (which is part of rational emotive behavior therapy) because it helps clients reflect and reframe their thinking about a certain situation or emotion.

Nelson, a member of the American Counseling Association, briefly illustrates how this model works: Take a 13-year-old child who is no longer interested in going to church (the “A” or activating event). The parents may interpret this change as a sign that coming to the United States was a mistake (the “B” or belief), Nelson says. They may feel responsible for their child no longer practicing their spiritual values, and these emotions may manifest as anger at the child (yelling or physically punishing the child; the “C” or consequence).

To help parents challenge their interpretations of the event and their emotional response to it (the “D” or disputing), Nelson may say, “Let’s explore your impression about what has occurred for your child. Tell me more about this belief that coming to America might have been a mistake for you and your family. I wonder how else you might view this new experience.”

Closely examining the situation with a new perspective often helps clients navigate their emotions and thoughts more effectively and helps them find a way to move forward, she explains. In this example, the parents may realize how living in the United States has exposed their child to different beliefs and how their child now has friends who don’t go to church. So, the parents make a new plan: They will continue discussing the significance that religion plays in their culture in the hope that the child’s rejection of church is not permanent (the “E” or effects).

Younger generations of immigrants may also feel indebted to their parents for their sacrifices, such as moving to a new country to provide them with better opportunities or paying for their education. As a result, they may choose a career path — one they don’t want — just to honor their parent’s wishes, says Gutierrez, a licensed professional counselor in North Carolina and Virginia and an ACA member.

He recalls working with a family who possessed conflicting notions of academic success and happiness. The mother thought her children were not doing well in school, but the kids said they were doing fine. Success for the mother meant her children getting straight A’s and becoming successful medical doctors. Her children resented the added pressure because they didn’t value straight A’s in the same way.

Gutierrez says his role as a counselor is not to wave his finger at family members but to teach them how to communicate with one another. In a sense, he operates as a referee, making sure each person pauses and clearly states back what they heard the other person say.

With this particular family, Gutierrez asked the son, “What do you think your mom is going to say this week?”

The son said, “She’ll scream at me about not finishing my homework or about getting a B on my last math test.”

Gutierrez asked, “What do you think she wants from you? What do you think she means by always bringing up school and grades?”

The son replied, “She only cares about grades and about me becoming a doctor. She doesn’t care about what I want out of life.”

The mother was in the room and heard her son’s perspective. Later in the session, she had the chance to share her side of the story. She expressed how yelling over her son’s grades was the way she expressed her love for him because she didn’t want him to struggle the way she had. This exchange caused the mother and son to become emotional because they both gained a deeper understanding of the other’s feelings and the underlying motivations of the mother’s actions, Gutierrez shares.

Stanizai finds that immigrants are often used to having external validation or external measures of success, so in therapy, she helps clients move to internal ones. For example, a client might be getting pressure from their family to get straight A’s and become a lawyer or doctor, and this pressure is affecting the client’s mental health. Stanizai would help the client identify the internal qualities and strengths that they possess that are not dependent on the expectations or circumstances of others. For example, she might help the client realize that they will succeed in whatever career they choose — even if it’s a different career from what the family wants — because they possess a good work ethic.

“A lot of anxiety comes from feeling overwhelmed and feeling responsible for so many people other than [themselves],” Stanizai says. “If people feel they have no other choice than to cut people or cultures out of their life, then that can make people feel disconnected and depressed.” Feeling “othered” or isolated can exacerbate symptoms of mental health issues such as depression and anxiety, she adds.

Because it is so isolating to not fully fit into any one group, Stanizai started an Adult Children of Tiger Moms support group to give immigrant children a safe space to talk about these issues and find others who have similar experiences. She has noticed that the group, which has people from various types of cultures, has become its own culture — one that is validating and healing to its members.

Groups are often more accessible for people who may not be able to commit to weekly individual counseling sessions. In addition, they tend to help people overcome any stigmas they have about therapy because when participating in a group, individuals often feel like they are taking a class, not going to counseling, she adds.

Stanizai has noticed that a common thread often emerges in her group sessions: No matter how successful the participants are, they all feel like they are letting their families down. Many group members report feeling unhappy at their jobs, yet they feel that they have to stay because of family expectations. They also note feeling guilty because their parents often assume they will move back home — either to their hometown or into their parents’ house — after they graduate.

Stanizai had one client who graduated and found a job in a city that was far away from her parents. The client felt so guilty that she went back to visit them every weekend. Stanizai asked the client, “Why do you think your parents want you to move back home? Why is that so important to them?” The client said, “My parents worry about me, and they want to stay connected.”

Stanizai worked with the client to brainstorm ways that she could connect with her parents without having to go home every weekend, such as using a video chatting app or inviting them to her apartment for dinner. The client decided to email her parents more often, and she found that doing this actually helped her and her father grow closer, Stanizai says. They would exchange long emails, and in writing each other, they were sharing more details about their lives than they did when the client went home and sat quietly watching TV with her father.

“Parents really want [their children] to be successful and happy, Stanizai says. “The framework for what that looks like might be different from [the client’s], but they can respect and honor that and also open their [parents’] eyes to what is important to them without completely turning their backs on [their family] so they can both coexist.”

This intergenerational conflict serves as a microcosm of the constant struggle between identities that immigrants often face. With counseling, these clients can come to terms with these identities and finally find their footing.

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For more on working with clients who are immigrants, read the in-depth feature article “Fostering immigrant communities of healing” in the February issue of Counseling Today.

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

Letters to the editor: ct@counseling.org

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

Should we talk about politics? What we are missing in counseling sessions

By Cebrail Karayigit and Donna M. Nesbitt April 8, 2019

The 21st century has become a period of widespread refugee crisis. The Department of Homeland Security defines refugee as “a person outside his or her country of nationality who is unable or unwilling to return to his or her country of nationality because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.”

According to The Guardian, in 2017, the number of people forced to flee their homes rose to a record high of 16.2 million. In recent years, individuals migrating from authoritarian countries has mainly been motivated by political instability. These countries are often structured in ways that allow the government to hold a majority of the power, while their citizens have restricted political freedoms.

Although there are many such countries, the failed coup attempt on July 15, 2016, in Turkey illustrates a worrisome example of deteriorating stability in a country that just a few years prior was being promoted as a model of democracy. The failed coup resulted in many academics, doctors, teachers and journalists becoming targets of persecution in their home country. Many of them fled to survive or to seek better lives, and in the process, they experienced extremely stressful events — e.g., losing their jobs, lost socioeconomic status — because of political oppression.

It is important to acknowledge the deep need these individuals have for freedom of thought and speech, especially knowing that they come out of a culture of silence and fear. As professional counselors, however, we have a natural tendency to avoid talking about political issues in our practices. We need to become aware that refugees who discuss these issues are not often looking to engage in a political debate; rather, they want to have their words and thoughts validated in a safe space.

Given that the lives of many refugees are complicated by the political turmoil in their home countries, avoiding political conversation with them in counseling would not seem to be genuine or authentic practice. In fact, allowing them to discuss how they have been affected by those political factors can offer a deeper understanding of their presenting problems.

As Elie Wiesel, the Romanian-born Jewish writer who eventually became a U.S. citizen, once stated, “Wherever men and women are persecuted because of their race, religion or political views, that place must — at that moment — become the center of the universe.” Thus, as counselors, we should understand that these struggles are a significant part of refugees’ lives and should be given the attention and respect they deserve.

Why this topic matters to Cebrail

While completing my internship at one of the largest public universities in the eastern part of Turkey, I encountered a client of Kurdish descent. In our first session, this client identified her issues with experiencing political oppression on campus and with being Kurdish in Turkey, especially given the oppressive political climate that continues even today.

My internship supervisor advised me to discontinue our session when this topic was broached, because at that time, it was considered unwise to discuss such political matters with a client in such an environment where some tension has always been apparent regarding Kurdish issues. Reflecting on this now, I realize that my supervisor was only trying to protect me. However, this was also the first time I began questioning the idea that discussing politics in session should be taboo.

As a counselor educator, I am now in a unique position to witness the power of practicing freedom of speech on campus here in the United States. As a professional counselor and educator who comes from Turkey, I am often invited to speak on topics such as diversity and counseling in Turkey, either through panel discussions or in classes.

Not so long ago, a colleague at Pittsburg State University in Kansas requested that I speak to a class about the political climate and turmoil in Turkey, in hopes that it would raise awareness about what has been occurring there. Once again, I was faced with the tension of engaging in a political discussion, but this time with future professionals. This created some inner conflict for me. Many academics in Turkey were dismissed from their jobs for injudicious reasons, such as suspicion of involvement in the coup, suspicion of association with a particular organization, or for being outspoken in criticizing the government. Yet, here I was, about to discuss these very matters in an academic setting.

As Elif Shafak, a Turkish-British novelist, once stated, “You do not have the luxury of being apolitical if you are from wobbly or wounded democracies.” Although I usually discuss such political issues privately, I have come to realize how difficult it is not to share these matters with peers and students in academic settings. In my experiences, many Turkish refugees are very occupied with wanting to discuss previous and current political issues in their home country because of their deep and unmet need for freedom of thought and speech. This suggests to me that our counseling clients who have already experienced many stressful events because of political oppression need to be given a real opportunity to tell their stories in full without being judged.

In recent years, one of the main reasons that Turkish refugees have been coming to the U.S. is because of the political instability in Turkey. As I have been helping some of them personally and professionally, it has become evident to me that political factors are always the center of discussions. Because most of their presenting problems are a result of their stressful experiences with political oppression back home, it made me question once again whether counseling can provide that safe space for them to practice free speech, express their struggles and have their unique stories validated. How can discussing political issues be taboo when most of their problems come from political oppression?

Why this topic matters to Donna

As a graduate student in the clinical psychology program at Pittsburg State University, I have been taught on several occasions to avoid discussing political or religious beliefs in session when possible because this can lead to issues of bias and an inability to remain objective. However, in my class on diversity that is required by the program, I experienced another perspective. We were taught that if you are working with a client who is seeking services due to political or religious persecution, you need to be ready and willing to see from the client’s viewpoint. This is especially true in the case of immigrants and refugees.

I was fortunate to be present for the class mentioned by Dr. Karayigit, and I learned a great deal from what he described in his discussion. It opened my eyes further to the possibility that clients I counsel may be experiencing similar distress, and I want to be as prepared as possible for those sessions.

In my current position as a case manager, I work with a diverse population. This often requires me to consider political or religious beliefs in terms of the reason the treatment has been sought and what I work on with a client. I have encountered political and religious beliefs both similar to and opposite from my own. This has not limited my ability to engage in discussions about either with my client, nor has it discouraged me from doing so. Rather, I consider it an opportunity to truly learn about my clients’ stories and how these topics have impacted their lives.

I think the persecution and conflict that clients have experienced due to their political or religious beliefs should be factored in to treatment because these events are a significant part of their stories. It is important to recognize that our clients are human beings, which means that we have to be willing to explore the topics that matter most to them — regardless of our own beliefs.

Why this subject is especially relevant

In today’s world, counseling requires an increasingly greater focus on immigrant populations. With refugees constituting an important part of this population, it is important to understand that their distress is often a result of their experiences with political oppression and a lack of freedom of expression.

Working as professional counselors in any capacity, we follow the ACA Code of Ethics, and we are expected to provide the best possible service to our clients. While we have an ethical responsibility to not impose our personal beliefs and values on our clients, we also need to create a safe atmosphere in which our clients can practice free speech and expression of their own beliefs and values. In that case, wouldn’t dismissing the subject of politics in session — especially if it is a significant part of the client’s story — be more harmful? Is it not exacerbating the hardship the client is already experiencing if the client is an immigrant or refugee?

That’s why we believe that allowing clients to express their feelings and thoughts about political factors in a safe, judgment-free space is crucial to remaining authentic and genuine in the service we provide as counselors. To work with this population more effectively, it is important to understand that discussing political issues with these clients can have a positive impact in their lives.

Strategies and implications for professional counselors

Although the counseling profession puts a strong emphasis on multicultural awareness and competence, political factors are not typically discussed in counseling sessions. This might be because clients are unsure about the appropriateness of discussing political factors, especially if they are coming from a culture of silence and fear. That’s why, when working with such clients, it is essential to understand their experiences with oppression.

Another barrier to the discussion of political factors is the counselor’s lack of understanding and knowledge regarding the political stance in the client’s home country. When counselors do not have enough information and understanding of different political structures as a whole, it will prevent them from entering the world of the client openly. Having or acquiring this basic understanding is a very important step in communicating with clients whose primary issues stem from a country’s political state. If counselors can provide an atmosphere for clients to openly discuss their experiences, clients will be able to practice freedom of thought and expression. Having such an open dialogue will reinforce these clients’ abilities to engage in freedom of expression.

Following is a composite of suggestions to work more effectively with refugees who have experienced political oppression:

Learn as much as you can about the basic political structure (e.g., totalitarian, authoritarian, democratic) of clients’ home countries.
Become knowledgeable about the history of oppression in both your own country and your client’s country. Where does your client fit within the political power structure? How is the client affected by his or her country’s history of oppression?
Recognize and acknowledge the negative impact of political oppression on individuals (e.g., lost socioeconomic status).
Recognize your own political biases to manage any countertransference (e.g., What is your political hot button? How do you feel about refugees coming to your country?).
Be a role model by encouraging your clients to practice freedom of thought and expression (e.g., clinically relevant self-disclosure).
Challenge your clients’ speech codes, especially if they hold faulty beliefs about political oppression. For instance, a client might say that if academics were dismissed from their jobs, then the government must have had a valid reason. It is important to challenge clients’ faulty beliefs by asking such questions as, “By what criteria have they dismissed people from their jobs? What is the measure here?”

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Cebrail Karayigit is an assistant professor in the Department of Psychology and Counseling at Pittsburg State University. He is currently teaching graduate and undergraduate psychology and counseling courses, and supervising practicum/internship students in the school counseling program. Contact him at ckarayigit@pittstate.edu.

Donna M. Nesbitt is a graduate student in the clinical psychology program at Pittsburg State University. She is currently working as a clinical case manager.

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

Self-care for the activist counselor

By Shekila Melchior and Dannette Gomez Beane June 4, 2018

An activist is a person who campaigns and takes action for social change. Counselors are often activists for their clients and for their profession by nature of being in a helping field.

The issue of self-care looms for both counselor practitioners and counselor educators as we face difficult client issues, large caseloads and demanding work environments. The need for self-care only intensifies when societal issues grow more divisive and combative, as we have experienced over the past year or more. Contentious social movements and issues such as #BlackLivesMatter and immigration can have an impact on the climate of care we provide as counselors for our clients and for the communities in which we live.

A tale of two doctoral students

Being a doctoral counseling student is stressful. Being a doctoral counseling student whose research is directly affected by the social movements and climate of the nation is even more stressful.

Shekila’s journey

When I (Shekila Melchior) chose my dissertation topic, “The Social Justice Identity Development of School Counselors Who Advocate for Undocumented Students,” in spring 2016, I had no idea what lay ahead. At the time of my data collection, a heated and divisive presidential election was unfolding in which the issue of undocumented immigration had turned into a political platform. The United States was inundated with xenophobic remarks, anti-immigrant rhetoric and the proposition of erecting physical structures to prevent individuals from entering the country.

On Election Day, concern turned to fear for many people who were confronted with the harsh reality of an unstable future — namely, that their ability to continue residing in the United States was in peril. After the election of President Donald Trump, I questioned whether anyone would participate in my research interviews regarding undocumented students. The climate in our country had changed, but my timeline for defending my research had not.

As an advocate, I was flooded with messages about protest marches and prompting me to write to Congress and participate in meetings to educate others. As a friend, I listened to the concerns of those closest to me who were fearful of deportation and of the possible termination of the Deferred Action for Childhood Arrivals (DACA) program, implemented by the Obama administration to provide temporary protections to undocumented immigrants who arrived in the United States as children. As a researcher, I encountered participants who were concerned for their students and eager for their voices — and the voices of their students — to be heard.

Dannette’s journey

When I (Dannette Gomez Beane) chose my dissertation topic, “Virginia Counselors’ Engagement With Social Issues Advocacy for Black/African American Clients/Students” in spring 2017, I never could have predicted what would occur that fall. During the time that I was engaged in my data collection, the white supremacist rallies that ended in violence and death in Charlottesville, Virginia, transpired. The topic of race relations was suddenly on everyone’s mind, but especially mine as my dissertation clock ticked.

I had difficulty telling people about my research. People didn’t understand why we were always talking about race. People found it even more bizarre that, as a Latina, I had chosen a topic that concerned African Americans. My reasons for picking the topic had everything to do with the revolving door of students in my office who could not attend class, turn in assignments or even talk to their friends because they felt so debilitated from what was going on around them. I just kept thinking, “What can I do to help? What are counselors in my state doing to help these students?”

Responses and critical incidents

We (Shekila and Dannette) processed our own personal reactions to these events. The issues that arose during the writing of our dissertations served as motivation to complete our research. Although both of us feared the worst, we hoped for the best as our research progressed. Our fear was that what was occurring nationally and regionally would silence the participation of counselors, causing them to retreat to neutrality out of a concern of responding in a socially undesirable way. Our hope was that counselors would rise to the occasion and speak on behalf of those marginalized populations that needed advocacy. Ultimately, both of us were successful in our data collection, and the respondents to our studies commented with expressions of concern for themselves and their clients/students.

One counselor who responded to Dannette’s study said, “I work in a rural county in the South and have about 20 percent of my population that is African American. I also work in a system very close to Charlottesville. We always have race issues.”

A participant in Shekila’s study shared the frustrations of their students. The participant recalled a time when one of their students wore a T-shirt that said “Relax Trump, I’m Legal.” Another participant who was a DACA recipient was concerned that he might no longer be able to work with his students if DACA were repealed.

The “critical incident” experienced by the advocate begins a process of cognitive dissonance, a “waking up.” According to Leon Festinger’s theory, when individuals experience cognitive dissonance, it changes the core of what they believe, leading them to wrestle with new information in light of things they have previously understood (for more, see Paul C. Gorski’s article “Cognitive dissonance as a strategy in social justice training” in the Fall 2009 issue of Multicultural Education). Thus, advocates begin to recognize the shift within themselves as it relates to a social issue.

Encountering an undocumented student as a high school counselor served as my (Shekila’s) critical incident. In that moment, I felt helpless and uninformed, but through that critical incident, I began my research, which later propelled me to a place of advocacy.

One of my research participants made a statement about how activist counselors develop: “I think that over time, because of my being sensitive to some of their [undocumented students’] struggles and just seeing the human side to their stories … there’s stuff that you don’t learn being in the counseling program. It’s like baptism by fire with that. It’s not something that I can teach. You can’t teach people to be empathetic like that. You can certainly tell them this is how you go about it, but you either have that or you don’t have that. You may be able to awaken something in someone with it, but if it’s not there, it’s not there.”

Dannette’s research is informed by racial identity development theory, with “encounter” being a stage in which a person is faced with the realization that race matters. Counselors who experience these “critical” or “encounter” moments are undeterred from participating with and advocating for others. On the other hand, counselors who have not experienced such a profound incident may not be as moved to engage in social issues advocacy.

As one of Dannette’s study respondents shared, “During an incident that occurred last year at my school when a black/African American student was suspended, I was told by my admin to stay out of it. I felt strongly that the way it was handled was discrimination, and [I] was very disturbed. I was able to discuss the incident with the parent in private and give [her] tools to help advocate for her son. She was also upset because of the way it was managed. I was not able to get into it too deeply with the parent because I felt my job was in jeopardy. However, I was able to encourage her to take it further and add insight into the best way to do so.”

The adversity we face in our work, school and personal lives for participating in social issues advocacy is heightened when incidents occur that feed the political divisiveness. The emotional toil that advocating takes on the activist counselor can be daunting. The work is ever-changing and never-ending. The activist counselor strives to always be informed and to inform others. The greater the degree of political divisiveness, the more strain it can take on the activist counselor. Compassion fatigue can set in, which brings us to self-care.

Avoid, engage, deflect

How can we seek and find comfort, understanding and care when we make our living and have developed our identities as activist counselors? Speaking as the authors of this article, we rely on peer support, faculty advisers, family members, friends and faith communities. At times, however, these normal sources of support and encouragement do not align with the activist mentality; in fact, they sometimes choose to remain neutral or even work against the advocacy. In such cases, activist counselors are left to do one of the following: avoid, engage or deflect.

Note: We (the authors) avoid going to social media for support because we find that causes another layer of stress that will not be addressed in this article.

Avoidance

Our identity as activist counselors is hard to shut off. Some would argue that it never shuts off. Avoiding times when our “buttons are pushed” is a skill that takes practice. The benefit to avoiding adversarial opinions is that of self-preservation. We sometimes “pick our battles” when engaging in dialogue and try to focus on the outcome of peace if avoidance is the best decision. The risk is that we miss a teachable moment or fail to use our place of privilege to educate others.

Engagement

As activist counselors, we are good at compartmentalizing our needs and views for the well-being of others, but when it comes to standing up for what we believe in outside of the therapeutic relationship, we typically take the opportunity to engage.

We often encourage our clients to engage with conflict because it is a practice that almost always results in growth and stretching. Engaging with conflict is natural for counselors who help others to face their fears, practice change and reframe ideologies. The benefit of engaging with adversarial views is that dialogue can emerge, allowing opportunities to increase understanding of and empathy for the other’s view. The risk of this engagement is that the dialogue might turn into an argument, with one-sided views and the shutting down of a topic or, worse, a relationship. As counselors, we are trained to de-escalate these types of heated situations, finding ways to redirect or, in some instances, deflect.

Deflection

Here it comes. You have no time to avoid or engage. A person in your life just dropped a statement that goes against your activist counselor mindset and identity. You know what this sounds like. It is a statement such as “I don’t see _____. All people are the same in my eyes” or “Those people need to ______.” You are left to react without warning.

One approach, especially when caught off guard, is to deflect. The risk in deflecting is that we may seem like we are not paying attention to what the person is saying because we choose to change the topic. This could cause suspicion or hurt if the person is hoping for our engagement in this topic. The benefit is that we do not engage in what could be a relationship-ending conversation depending on the situation.

Recharging the activist self

Avoidance, engagement and deflection are just three examples of ways to approach our daily walk as activist counselors. Counselors regularly encounter situations that must be navigated carefully, and there is no judgment in using any of these three approaches.

As activist counselors, we are hard-wired to serve. But we cannot continue to serve well unless we are diligent in practicing self-care. In this context, self-care does not mean going to the local spa (although we all need that kind of treatment every once in a while). Self-care means filling our cups back up when we are feeling low. Here are some strategies that we have found helpful in recharging our activist selves.

1) Reflect often: We must ask ourselves, why do we do what we do? Reflection is a key component to self-actualization and bringing meaning to our work. Through reflection, we can be in a constant state of improvement. We become more aware, become more open-minded, more readily recognize our own biases and work toward personal growth and change. Reflection enables counselors to grow in both empathy and connection to others.

2) Remain informed: Activist counselors must stay informed of real stories and real facts so they can remain rooted in the truths of people’s experiences rather than getting caught up in the media spin. Counselors must also stay up-to-date with evolving issues as they become more complex. It is imperative for counselors to see events from all angles and to seek out the voices that have been silenced.

3) Give voice to the voiceless: That brings us to using our power for good. As counselors, we hold a position of authority with the clients and students we serve. In addition, our education provides us with privilege that can be used to give voice to those who have been silenced, including individuals who are struggling to enjoy basic freedoms in this country. Our voices are needed. Our voices should be heard.

As counselors, we are always to remember beneficence — to do good and to promote the well-being of others. This is our strength in the counseling relationship. As activist counselors, we must also recognize when rest is needed and when we need to ask for help. Remember that we advocate together to eradicate the systemic oppression that impacts our clients and our students — and even us — every day.

Together, we are change agents. The foundation of what we do and why we do it can be summed up in a quote from Mohandas Gandhi: “The best way to find yourself is to lose yourself in the service of others.”

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Shekila Melchior is an assistant professor and program coordinator of school counseling at the University of Tennessee at Chattanooga. Contact her at shekila-melchior@utc.edu.

Dannette Gomez Beane is the director of recruitment and operations of undergraduate admissions at Virginia Tech. She adjunct teaches for the counselor education programs at Virginia Tech and Buena Vista University. Contact her at gomezds@vt.edu.

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

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

Applying the MCC in a divisive sociopolitical climate

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

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

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

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

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

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

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

c) The pervasiveness of White supremacy and White privilege

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

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

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

The MCC framework

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

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

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

a) We are all multicultural individuals.

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

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

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

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

Current realities

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

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

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

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

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

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

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

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

Legislation and policy affecting human rights

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

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

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

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

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

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

Awareness and guidance from the MCC, MSJCC

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Letters to the editor: ct@counseling.org

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