Tag Archives: outreach

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.

Key considerations for counselor community engagement

By Matt Glowiak, Nicole A. Stargell and Devon E. Romero November 5, 2018

If you are reading this article, it is likely because you have a strong interest in counseling. We might even be able to go a step further in saying that you probably love counseling, right? As members of the Chi Sigma Iota (CSI) Counselor Community Engagement Committee, we agree — we love counseling. We also love using components of our professional skills to directly serve the community in ways that go beyond traditional counseling.

We invite you to take a moment to close your eyes and think back: What was it that influenced your choice to become a counseling professional? Was it your love and compassion for humanity? Was it due to a struggle experienced by someone you love or care about? Was it due to some great injustice that you couldn’t stand any longer? Or was it a talent with which you were born and were fortunate enough to harness through the progression of your life? If you answered “yes” to any or all of these questions, we are in a similar situation.

People who come to this field do so because they want to be that change they wish to see in the world. Counselors embody the foundational qualities of empathy, congruence and unconditional positive regard in their everyday lives. Counselors engage with the community in positive ways on a daily basis. Other times, counselors channel more intentional counseling skills in the community when they want to make a difference, and they are willing to make sacrifices if necessary. As individuals who have taken the initiative to earn professional degrees, it is apparent that we possess a desire to make the world a better place. Why else would we spend countless hours and make significant sacrifices to get into a better position to help others?

At its core, the role of a counselor is as a helper. That is, our mission is to create a better society, person by person, population by population. As professional counselors, we join with our clients in a relationship to support them toward their mental health and wellness goals.

Although we spend the majority of our working hours in session with clients, our professional identities transcend the professional setting. The way we show up in the community is a representation of the counseling profession. We can use our unique skills to support the community in ways that extend beyond the core role of counselor. These roles might include, but are not limited to, advocate, author, community member, educator, gatekeeper, philanthropist, public speaker, researcher and student. The opportunities we have to make the world a better place are seemingly limitless.

Those familiar with CSI may be aware of our mission “to promote scholarship, research, professionalism, leadership, advocacy and excellence in counseling, and to recognize high attainment in the pursuit of academic and clinical excellence in the profession of counseling” (csi-net.org).

To fulfill a portion of this mission, the CSI Counselor Community Engagement (CCE) Committee uses the “Ten Key Considerations for Chapter CCE” to intentionally “plan and implement activities that are collaborative, have measurable goals, advocate for a specific need, make a quantifiable difference in the community and are intentionally evaluated. Many CCE activities include elements of fundraising, professional development and/or advocacy; however, CCE incorporates a unique practical application component in collaboration with a community partner.”

As individuals who love professional counseling, we spend time showing the world how professional counselors make a positive difference in the professional and community settings.

Why is counselor community engagement important?

Sometimes it can be difficult to remain optimistic when we live in a world where tragedy occurs daily. With our eyes and ears open, we cannot hide from it. From one side of the world to the other, people are negatively affected by racial oppression, sexual inequality, homophobia, homicide, genocide, school shootings, suicide, war, civil unrest, political divide, poverty, homelessness, starvation, slavery, human trafficking, drug trafficking, natural disasters, human-caused disasters and personal relationship difficulties.

As we think back on our lives, each of us can recall situations in which we, or someone close to us, were personally affected by incidents that really struck a chord with us — incidents that seemed not right, unfair or downright horrific. But what can be done?

As Mahatma Gandhi said, “You must be the change you wish to see in the world.”

The decision to respond or not to respond is one that involves several considerations. After all, as counselors, we spend our working hours helping others, and we do need some time off from work. However, people often choose not to respond because they think they cannot possibly make a difference. “How can I, as one person, stop racial oppression?” Sometimes, the decision to not respond comes from a lack of resources. “I don’t have the time.” “I don’t have the money.” “I don’t have the education or skills.” Sometimes, we don’t respond because we worry what others will think of us. “If I speak out on behalf of the LGBTQ population, will other people think that I’m gay?” Other times, the decision is in line with the phenomenon of the bystander effect. “Other people are already there who will help.” Sometimes, it comes down to us not seeing something as being our personal responsibility or business. “Well, nothing bad is happening in my neighborhood, but if it did, I would certainly intervene then.” Although the reasons not to respond are many, a lack of response always leads to the same result: continued injustice.

Then there are those who, for whatever reason, choose to respond. Whether personally affected, vicariously impacted or just wanting to do what is right for humankind, these individuals intervene to help in whatever way possible, regardless of how big or small. If you can find a small amount of energy to devote to something you view as important, you will make the world a better place.

As William Faulkner said, “Never be afraid to raise your voice for honesty and truth and compassion against injustice and lying and greed. If people all over the world … would do this, it would change the earth.”

As professional counselors, it is our ethical duty and obligation to respond to the American Counseling Association’s call in the Advocacy Competencies (2003) in the areas of client/student empowerment, client/student advocacy, community collaboration, systems advocacy, public information and social/political advocacy.

Accordingly, it is the purpose of counselor community engagement to serve those populations that need our help, even if that help extends beyond the core role of professional counselors and into those additional roles as advocates, educators, fundraisers and public speakers. After all, we possess the transferable skills, resources and desire to help. So, we should do just that when we can.

How to engage

The question is where do we begin? We start with an idea. But what use is a great idea if it remains unpursued? The truth is that it is of no use. Sometimes, a fair idea with solid implementation is what can make all the difference in the world. The difference, then, is in the execution.

As David Bornstein explains in How to Change the World: Social Entrepreneurs and the Power of New Ideas, “An idea is like a play. It needs a good producer and a good promoter even if it is a masterpiece. Otherwise the play may never open; or it may open but, for a lack of an audience, close after a week. Similarly, an idea will not move from the fringes to the mainstream simply because it is good; it must be skillfully marketed before it will actually shift people’s perceptions and behavior.”

After an idea is conceived, professional counselors should move on to complete a more intentional needs assessment surrounding the idea. As described on CSI-net.org, “Connecting with the community of interest, particularly leaders and stakeholders, necessitates a needs assessment both in formal (e.g., instruments, surveys, interviews) and informal methods. Once the needs are identified, [organizations] can begin creating an action plan to focus on steps to address each need specifically. Implementing the action plan provides direct service to the community. After the CCE activity is complete, [organizations] will benefit from an evaluation process. This evaluation connects with the community by taking their input through a variety of assessment tools (e.g., interviews, surveys) and identifies new needs to build upon for future endeavors.”

With this general progression of needs assessment, action plan, direct service, evaluation process and identification of new needs, CSI has devised a 10-step method to counselor community engagement that any organization can easily follow.

 

1) Working together: How can I or my organization work with others to promote meaningful counselor community engagement?

Counselors intentionally approach community engagement of all forms in the spirit of cooperation and service. Counselors assume a servant leadership role when out in the community and especially when engaging in a specific community engagement activity.

Working together is a crucial element of community engagement activities, and it is important to mention on its own as a foundational attitude for the other considerations. Cooperation and collaboration provide a foundation for conducting initial needs assessments and promoting change within communities. We can work with others by leading, partnering or joining. Simply by reaching out, we may receive the assistance we need to take what was once an idea and turn it into something successful.

2) Level of counselor community engagement outreach: At what level of outreach should I or my organization engage our community?

On the organizational level, it is quite natural to get stuck thinking on the microsystem level: “What can we do to help this organization?” With that logic, all thoughts and actions focus only on what the organization and its members can do within the organization to sustain it. However, by moving beyond the microsystem and working with and for others, much more work can be done than was ever thought possible. Levels of counselor community engagement outreach might include local programs, national outreach and international outreach.

Reaching out is much easier than one might think. A simple email or phone call or attendance at a meeting might create the spark for a meaningful networking opportunity. Even in terms of national and international outreach, opportunities are much less intimidating and more practical than they may at first seem. At these levels, emails and phone calls still work, but taking the time to attend a larger national or international conference allows for face-to-face, personal connection.

3) Issue areas: What community areas or issues should I or my organization focus on?

Every community is different. Each community is composed of varied demographics in varied locations with varied needs. The bottom line is that every community, regardless of how functional, has some type of need. To maximize the benefits that your organization can offer, it is important to first match your organization’s output to the needs of the community. Therefore, it is critical to begin with some type of needs assessment. This might include asking:

  • What does our community need?
  • Is there a certain social injustice I have noticed?
  • What issues are a concern to our community and larger world?
  • How do we benefit the most people?

Considerations such as these are important for beginning any type of effort. As we look around us — watching the news on TV, reading updates online, listening to the radio — we will see more and more need for our assistance.

4) Populations served: With whom should I or my organization engage?

This question varies significantly from one organization to the next. Those you engage will depend on the need you are attempting to fulfill, the population you intend to serve and the resources you have available, among other factors.

Within our communities are numerous individuals and groups we wish to serve through a variety of activities. These individuals and groups may include:

  • After-school programs
  • Boys & Girls Clubs
  • Foster children and agencies
  • Individuals who are homeless
  • Homeless shelters
  • Nonprofit agencies
  • Individuals who are oppressed
  • Populations experiencing poverty
  • Populations who have experienced a natural disaster
  • Sober homes/halfway houses
  • Vocational programs for youth and adults

Many people could benefit from the caring efforts of a citizen who also happens to be a professional counselor. Think outside the box and remember that every individual experiences his or her own unique struggles. Anyone who is open to help might benefit from counselor community engagement.

5) Community partners: Who else might be an important partner in my or my organization’s counselor community engagement efforts?

A partner may be defined as “a person who takes part in an undertaking with another or others.” A partnership can be something that is either temporary or long term. Collaborating with various organizations can maximize the effectiveness of counselor community engagement efforts. Those of you who attended the American Counseling Association Conference & Expo in Montréal in 2016 witnessed a partnership between ACA and the Canadian Counselling and Psychotherapy Association. Through this partnership, the two associations were able to merge the talents of counselors from multiple countries to further strengthen the diversity and quality of presentations, networking opportunities and other efforts.

Within our communities are numerous individuals and groups with which we might work to promote meaningful counselor community engagement. These individuals and groups may include:

  • Businesses (local and national)
  • Community boards
  • Elected officials
  • Government officials
  • Hospitals
  • Media outlets (traditional and online)
  • Mental health professionals
  • Organization members
  • Organization leaders
  • Other helping professionals
  • Primary and secondary schools
  • Professional associations
  • Registered charities
  • Religious organizations
  • Universities and colleges

Each of these entities alone or in combination may provide the necessary resources to assist in your counselor community engagement endeavor or
may significantly benefit from that endeavor themselves.

Forming partnerships is much simpler than you might think, but it always requires the first action step of reaching out. At this point, readers have likely noticed a similar theme among several of the key considerations for counselor community engagement: working with others to foster positive community change. Many individuals wish to make the world a better place. So, take a step back, think about the bigger picture, and connect with people who might wish to promote a similar mission.

6) Activities: What kinds of activities could I or my organization take part in to engage our community?

To this point, we have discussed the importance of needs assessments and collaborating with others. Depending on what is needed and who and what we have to work with, there are any number of activities in which we may engage. The main activity categories include:

  • Charitable donations and fundraising
  • Counseling and related services
  • Education
  • Other volunteer activities

These activities may include providing or organizing presentations, workshops, keynotes, continuing education, exam preparation, donations, fundraisers, sporting events, benefits, food drives, blood drives, scholarships, awareness events, conferences, free or low-cost counseling, group counseling, psychoeducational groups, awareness presentations, advocacy events, grant writing, tutoring or mentorship. Other engagement activities could involve planting trees, picking up waste, making meals, working at a food bank and so on.

Counselor community engagement activities come in all sizes and shapes. The benefits of producing one giant event will not necessarily outweigh the benefits of holding multiple smaller events throughout the year. It is important to consider the weight that “meaning” carries with every event in which your organization engages. Meaning will differ from one organization to the next. Whereas one organization might find raising $500 a relatively modest accomplishment, it could hold significant meaning for another organization. For example, it might represent the first major fundraiser the organization has ever undertaken and successfully accomplished. Or perhaps meaning is not based on the amount of money raised at all but rather on the purpose for which it was raised. In this respect, meaning might be tied strongly to a sense of accomplishment, advocacy, an increase of awareness, the building of morale, the strengthening of membership or some other factor.

7) Advocacy: What might it mean for me or my organization to advocate?

Counselors might wish to promote the welfare of an individual or group by explaining to others why the issue is important and how others can help. Counselors advocate for themselves, for the profession and for others. Advocacy can be performed at three levels:

  • Client- or population-specific advocacy
  • General community advocacy
  • Professional advocacy

Advocacy can be used to promote observable change, and it might be used to raise awareness that systematically influences decisions and circumstances across time. It is important to ask the questions, “What might it mean for my organization to advocate? How can we use our power as counselors and our privilege as citizens to speak up for what is right?”

8) Frequency: How often should I or my organization take part in counselor community engagement activities?

Although the knee-jerk response is to say the more, the merrier, it is important to consider what is practical. As we all know, an activity that is well thought out is much more productive and meaningful than something that is put together haphazardly. Determining how often you or your organization take part in community engagement should depend on
the following:

  • Needs of the community or organization
  • Availability of time
  • Funding
  • Availability of personnel
  • Availability of location (e.g., brick-and-mortar, online)
  • Motivation of stakeholders

As with any other key consideration, it is important to be strategic when planning the frequency of counselor community engagement activities. For example, an organization might consider hosting a one-time service event to raise money for families affected by the tragedy of a school shooting. Another organization might consider organizing ongoing counselor community engagement events to educate the public on topics such as bullying, gun laws, screening and peaceful intervention. In either case, the effort expended would be significant, so organizations are encouraged to take strategic action toward engagement activities that they believe will be most purposeful.

9) Action planning/program development: How might I or my organization plan and develop counselor community engagement activities?

Adequate planning and preparation will include meeting with stakeholders and setting goals with measurable objectives. For instance, multiple hurricanes tend to impact various regions of the United States each year. Action planning entails first reaching out to impacted areas and seeing how we may assist. Once needs are assessed, we can then meet with those stakeholders to develop an action plan around the goals we hope to accomplish. These goals might include performing community outreach, donating time, fundraising and so on.

10) Evaluation: How did the counselor community engagement activity impact the community and those who engaged in the project?

To answer this question, some type of evaluation must be conducted. This may be done using a simple survey, soliciting feedback, asking questions or via other means. What are the benefits of a comprehensive evaluation? According to Kieron Kirkland, former development research manager at Nominet Trust, which is a grant maker in the field of socially motivated technology, performing an evaluation helps organizations to:

  • Know whether an activity or project is working
  • Know how things are working
  • Understand why things are working
  • Be more adaptable
  • Be aware of unintended outcomes
  • Better communicate the value of their work
  • Focus their work
  • Help look after the people with whom they are working
  • Build organizational resilience

Many factors contribute to the success or failure of a counselor community engagement activity. Without investigating the various components of the activity, it is difficult to gauge whether it is worth conducting again or whether improvements are needed. To increase efficacy, there needs to be some indication of what works. Otherwise, organizations may continue spending resources on something that is fruitless or even harmful. Therefore, it is essential to always conduct some type of evaluation after each counselor community engagement activity.

 

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It is our hope that you have found this article helpful for planning, implementing, maintaining and evaluating your counselor community engagement activities. With a bit of effort and intention, we can achieve much more together, thus fulfilling the mission of ACA, CSI and the counseling profession as a whole. Now it is time for you to help change the world.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Matt Glowiak is core clinical faculty at Southern New Hampshire University as well as co-clinical director and co-founder of counseling speaks in Chicago, Park Ridge and Lake Forest, Illinois. He currently chairs the Chi Sigma Iota (CSI) International Counselor Community Engagement Committee. Contact him at m.glowiak@snhu.edu.

Nicole A. Stargell is an assistant professor in the Department of Counseling at the University of North Carolina at Pembroke, where she serves as the clinical mental health counseling field placement coordinator and the counseling programs testing coordinator. She is also the chapter faculty adviser of the Phi Sigma Chapter of CSI. Contact her at nastargell@gmail.com.

Devon E. Romero is an assistant professor in the Department of Counseling at the University of Texas at San Antonio. Contact her at devon.romero@utsa.edu.

 

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.

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

By Zach Bruns and Cody Andrews July 10, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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Zach Bruns, a licensed professional counselor and substance abuse counselor, has been practicing community-based clinical counseling since 2013. He serves as the mental health clinician for the multidisciplinary Projects for Assistance in Transition from Homelessness team at Outreach Community Health Centers in Milwaukee. He also works through Dungarvin Inc. and the Milwaukee County Behavioral Health Division’s Community Consultation Team to provide mobile crisis services to individuals diagnosed with intellectual/developmental disabilities and mental illnesses, their providers and loved ones. Contact him at zacharyb@
orchc-milw.org
.

Cody Andrews has served as the lead service provider for the Street Outreach Team at Outreach Community Health Centers since June 2015. He is starting graduate school this fall to obtain a master’s degree in social work and from there hopes to pursue a doctoral degree in social welfare. His research interests include housing interventions, social support systems of people experiencing homelessness and homeless outreach. Contact him at codya@orchc-milw.org.

 

Letters to the editor: ct@counseling.org

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

 

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

Stepping across the poverty line

By Laurie Meyers May 26, 2016

According to a study by the U.S. Census Bureau, there were 46.7 million Americans living in poverty in 2014, or a poverty rate of 14.8 percent. The picture was even bleaker for many ethnic and racial minorities. The same study found that 26.2 percent of African Americans (10.8 million people) and 23.6 percent of Hispanic Americans (13.1 million people) lived in poverty. Children were also particularly vulnerable. The study reported that 21.1 percent of Americans under the age of 18 lived in poverty.

What qualifies as living in poverty? The answer is not simple. A number of factors are involved in calculating income, and the Census Bureau has created 48 possible poverty thresholds. Broadly, however, any single individual younger than 65 with an income of less than $12,316 or any single individual 65 or older with an income of less than $11,354 is considered to be living in Branding-Images_povertypoverty. The poverty threshold for two people under the age of 65 living together is $15,934, and the threshold for two people over the age of 65 living together is $14,326. For a family of three — one child and two adults — the threshold is $19,055. For a family of three with one adult and two children, the threshold is $18 higher at $19,073.

The thresholds are derived using the Orshansky Poverty Thresholds, a formula originally developed in the 1960s by Mollie Orshansky, an economist working for the Social Security Administration. The formula compares pretax cash income against a level set at three times the cost of a minimum food diet in 1963 in today’s prices (updated annually for inflation using the Consumer Price Index).

However, these numbers can’t truly capture the reality of daily life for those living under the strain of poverty, say counselors who regularly work with client populations that are economically disadvantaged. Imagine taking multiple buses and dedicating up to two hours of travel time to get someplace that someone who owns a car can reach in 20 minutes. Imagine having to choose between buying groceries or paying the electric bill. Imagine managing a chronic illness while living on the streets.

Counselors are trained in diversity and multiculturalism, but does this awareness of discrimination and alternative worldviews necessarily include those living poverty? Not often enough, asserts Pam Semmler, a licensed professional counselor (LPC) and private practitioner in Denver. “I’ve been to a lot of diversity trainings, and none of them covered socioeconomic barriers,” she says.

The average counselor doesn’t have adequate training or even a good frame of reference when it comes to clients living in poverty, says Semmler, who spent more than nine years counseling clients at the Colorado AIDS Project. The project is part of the Colorado Health Network, a statewide organization that provides health services, case management, substance abuse counseling, housing assistance, transportation, nutrition services and financial assistance to people with HIV and those at risk. Semmler has also provided training to staff at the Colorado Coalition for the Homeless on diversity issues specifically related to working with those in poverty.

Of course, people living in poverty are not one monolithic culture, Semmler stresses. However, they do share something deeply significant: a lack of money and limited access to the resources that money typically makes available.

“Poverty is actually a lack of multiple resources,” Semmler says. Financial resources are the most obvious, but those living in poverty also often lack health, housing, social, family, emotional and sometimes even spiritual resources, she continues.

To help clients living in poverty, counselors first need to understand the barriers that these individuals face in their everyday lives, say Semmler and other experts.

A different world

“We tend not to talk about a ‘culture of poverty’ as in years past,” says Louisa Foss-Kelly, a professor in the Counseling and School Psychology Department at Southern Connecticut State University whose research interests include counseling people who are economically disadvantaged. “However, people living in poverty often share perspectives and engage in similar survival-related activities. They do whatever it takes to meet their needs or those of the family’s.”

“For example,” she continues, “a client may sell belongings on the street to make some quick cash, barter services with neighbors and find other creative ways to pay bills that might not be understood by people in the middle or upper class.”

Because counselors often come from middle-class backgrounds, the practice of counseling often reflects those experiences and values, but practitioners should take care not to judge clients through this lens, says Foss-Kelly, an American Counseling Association member and LPC who has worked in community counseling settings with clients living in poverty.

“Unfortunately, many counselors have never been challenged to explore their own biases about poverty,” she says. “They may not understand the impact of their own socioeconomic history on the process of counseling.”

Counselors simply aren’t trained in the realities of living in poverty as part of their counseling education, says Victoria Kress, an ACA member and past president of the Ohio Counseling Association whose research interests include working with client populations that are economically disadvantaged. “For example, I was trained as a counselor in the early 1990s, and my training was based on middle-class values and assumptions,” she says. “It was assumed that my future clients would come in for counseling of their own volition; they would have food in their bellies; they’d be safe; they’d be verbal and forthcoming; they’d have transportation; they’d be invested in growing and living up to their optimal potential. As I began to see clients, it became increasingly clear that none of these assumptions was accurate.”

“People living in poverty engage in a constant financial battle,” Foss-Kelly adds. “They may have to work two or three jobs, find food banks and navigate the maze of social services organizations. They may struggle with children in emotional distress because of frequent moves or other family disruptions. These clients may arrive to counseling tired, hungry or late. A judgmental counselor might say that [these clients aren’t] serious about changing or that they’re too disorganized or lazy to take care of themselves.”

Chelsey Zoldan, an LPC, currently works as a counselor at the Medication Assisted Treatment Department at Meridian HealthCare in Youngstown, Ohio. But she has also counseled those in the rural Appalachian section of the state and says that time issues — mainly clients not having enough of it and being late to appointments — were among the most common obstacles.

Many clients living in poverty have unreliable transportation or no transportation at all, Zoldan points out. In some states, public agencies may provide transportation to community clinics and other services for those living at or below the poverty line, but there is no guarantee that transportation will be timely, she continues. Some clients rely on rides from friends and family, but the person doing the driving sets the schedule, which may not fit with the client’s needs. In other instances, friends and family members may not be reliable when it comes to promises to drive or offer other assistance, she says. Public transportation may not be readily available or may require multiple transfers on a sporadic schedule.

Zoldan, an ACA member, points out that it may take clients relying on area bus service two hours to get somewhere that it would take her 20 minutes to drive to in her car. She adds that the bus schedule is inscrutable to her and her colleagues, but that clients who are struggling to get by financially routinely navigate the inconsistent routes and take multiple buses to get where they need to go. Unfortunately, as a result, they are often late or even miss appointments altogether. “Some counselors might interpret this as meaning that they [the clients] don’t care or aren’t committed to the process,” Zoldan says, acknowledging that she had to shift her own perspective regarding timeliness when she first started working with clients who were economically disadvantaged.

Some health care and other service providers may not be willing to accommodate these scheduling challenges, and that is a problem, Zoldan says, because these clients still need to be seen. And if a provider turns them away after they are late in arriving, they may not come back at all, she points out.

Clients who are economically disadvantaged may also have limited work flexibility or lack child care, adds Kress, who is the community counseling clinic director, clinical mental health counseling program coordinator and addiction counseling program coordinator at Youngstown State University in Ohio. Counselors need to be sensitive to the logistical problems that these clients face, she says.

When possible, Kress says, practitioners should consider providing in-home counseling and flexible or drop-in scheduling. In addition, clinics or practices that have the resources might consider offering day care and transportation assistance, which could involve providing the actual transportation or giving out public transportation vouchers, Kress says.

Meeting basic needs

As Kress began her counseling career, she realized that many of her clients living near the poverty line were struggling simply to survive. This reality often required her to be more “active” in these clients’ lives than her training had prepared her for.

“One of my first clients — a teenage mother — came [to counseling] in crisis because her electricity had been turned off,” Kress remembers. “In that situation, what she needed from me was to help her figure out how to get it turned back on. Having never had my electricity turned off, I had no idea where to begin. And my counseling textbooks didn’t talk about how to get one’s electricity turned back on. I had to put aside my expectations, be flexible and roll with helping her problem-solve her electricity situation.”

Before counselors can begin to effectively address traditional counseling concerns, they must make sure that their clients’ basic survival needs — including food, shelter and clothing — are being met, say the professionals interviewed for this article.

In doing so, counselors working with clients in poverty may find themselves playing many different roles, says Zoldan, who is also a doctoral student in the counseling program at the University of Akron. “You might have to be care coordinator, do case management, perform vocational counseling,” she says. “You might also … help with county health funds, student loans, transportation.” Counselors might also serve as de facto mental health educators for their clients, their clients’ families and even the community at large, particularly in rural settings, Zoldan adds.

Some might think that many of these services are the purview of social workers, not counselors. But Kress has a message for those who protest this expanded vision of meeting the needs of clients.

“I’d say this: How can a person work on higher order counseling goals if they are worried about where their next meal is coming from or how they will get their electricity turned back on?” Kress says. “Effective counselors are flexible and meet their clients where they are at.”

Foss-Kelly agrees. “Counselors treat the whole person in context,” she emphasizes. “So we have to acknowledge and respond to the crises our clients face when they leave the counseling room, even if those crises are financial in nature. Counselors are well-trained to provide referrals and work alongside social workers. In addition, we have to integrate the client’s basic needs into case conceptualization, treatment and treatment planning.”

Kress adds that she believes it is “old-school thinking” to state that counselors shouldn’t also help clients with their basic needs. In fact, she says, in the area of community mental health, the days of clients being assigned to a case manager who was a social worker and then to a separate counselor are long gone. “Now what we see is clients being assigned one mental health professional who provides counseling and case management. The system has had to adapt to the needs of consumers.”

Although counselors in community clinics or facilities affiliated with local social services might more commonly work with individuals living in poverty, Kress and others interviewed for this article say that most practitioners will encounter clients who are economically disadvantaged at some point.

Zoldan urges counselors to be deliberate about ensuring that these clients feel empowered in their own treatment. Taking an authoritative approach as the counselor and neglecting or diminishing the client’s input is potentially detrimental, she points out. The counselor might very well be unaware of the individual’s basic needs that are going unmet, she says, and the client may not trust the practitioner at first because he or she is viewed as an outsider. “The goal is to collaborate with your client on everything,” Zoldan says. “People in poverty are used to feeling oppressed in different ways.”

“Many people who live in poverty perceive that existing institutions do not serve their interests and needs, and counselors need to recognize that they are part of the system, whether they like it or not,” Kress adds. “Counselors must be flexible and sensitive to clients’ needs.”

Because counselors are part of the system, they should work it to their clients’ advantage, say Zoldan and Kress. It can be important for counselors to align with agencies, clinics or charities that offer assistance with food, housing, health care and other needs, Zoldan points out. She urges counselors to build relationships with these organizations and to also make contacts with officials in local service agencies such as job and family services so that clients’ needs can be better met.

Seeking solutions

In addition to the challenges related to basic survival, those living in poverty face many other barriers, Kress says. Common issues among this population include substance abuse, chronic mental or physical illnesses, teenage pregnancy and unsafe living environments that might involve intimate partner violence, she explains.

“In my experience, clients need to have counselors acknowledge and validate their experiences,” she says. “Many times, clients may not even connect the dots that these experiences are having a significant impact on their lives. In many ways, these experiences have been such a part of the landscape of their lives that they don’t recognize the impacts they have on them.”

Semmler agrees, saying that many of her clients have never had anyone explain to them how poverty has affected the entire trajectory of their lives.

Those in poverty are often blamed for their circumstances and stereotyped as lazy or incapable of saving money, Zoldan says. The reality is that many of these individuals are working two or even three jobs just to scrape by and aren’t saving money because they don’t have any to spare, she says.

“Each day may start with managing different crises — trying to find food or a place to sleep or meeting other basic needs of the family,” Foss-Kelly observes. “This survival focus inevitably impacts both the content and process of any counseling session. A person-centered approach is a critical foundation for counseling, but it may move at a pace that’s too slow for addressing crises of survival.”

Adds Kress, “When working with these populations, counselors need to be active, involved and focused on concrete and present solutions.”

Several of the counselors we spoke to emphasized the need to help these clients recognize and build on the strengths they have already developed to survive under the strain of poverty. As with any client, counselors should take into account the worldview and individual context of a person living in poverty, says Zoldan, who likes to use strength-based counseling, particularly for those coming from generations of poverty.

Contrary to the stereotype of lazy people just looking for a handout, living in poverty actually requires a significant amount of self-sufficiency, Zoldan points out. These clients typically must navigate public transportation and assistance systems and may juggle multiple jobs with child care and other family responsibilities, all of which requires a great deal of planning, she notes. Zoldan recalls a former client who had a backup plan for any major eventuality, including what to do if she couldn’t pay her rent, couldn’t afford food, lost her primary means of transportation and so on.

Kress notes that those affected by poverty may also acquire skills and strengths — including the ability to accept and handle difficult situations and live in the moment as needed — that aren’t readily apparent to most casual observers. “Identification and expansion of client and client-system strengths help to provide hope and support clients’ well-being,” she says.

In general, people who live in poverty also strongly value relationships, Zoldan says. This can oftentimes be very positive. For example, friends and family members can provide the person both emotional and practical support in the form of child care, meal sharing, housing and so on.

However, in some cases, it can also erect another barrier, Zoldan says. “Relationships are valued above all else,” she observes, meaning that counselors need to be aware that getting these clients to set boundaries or remove themselves from unhealthy living situations can be a complicated proposition.

Simply telling a client to cut off a relationship is not culturally appropriate, Zoldan says, so counselors may need to encourage other alternatives. For instance, if a client is struggling with substance abuse and her mother and sister are still using in their homes, a counselor might suggest that, rather than cutting off all contact, the client and her relatives talk only by phone or meet in public instead of in the relatives’ homes.

Ending or limiting these relationships with family and friends represents a significant loss of connection for clients. So Zoldan and her colleagues encourage these clients to get involved in 12-step programs in which they can get support and build a family of sorts within the recovery group. Zoldan’s agency also encourages group therapy, which can offer another source of connection and support for clients living in poverty.

Semmler is an attachment-focused therapist, so she always circles back to relationships. “When people attach in order to survive, the relationships are not always the most healthy,” she observes. Becoming psychologically healthy may require clients to break some of those ties, so Semmler, during her time with the AIDS project, would encourage clients to make healthy attachments to service providers and other participants in the program.

Helping the youngest living in poverty

Children living in poverty face many challenges that make it difficult for them to get an education, says Christi Jones, an ACA member who is an elementary school counselor in rural Alabama. The board of education for her school district is trying to remove one significant barrier by matching students who are in need of psychological assistance with mental health counselors. Part of Jones’ job is to help facilitate this process.

“At my school, mental health services are provided one day a week,” Jones says. “As a school counselor with approximately 600 students, collaboration with our local mental health agency assists in meeting student needs. At the beginning of each school year, I introduce the mental health counselor to teachers and staff members and assist in developing a schedule. When coming from the outside to work in a school, it is essential to have an understanding of the school culture.”

“I work with the mental health counselor to build relationships with key staff members who can assist in success in the school setting,” she continues. “The mental health counselor in turn ensures I understand what is required for students to qualify to receive services in the school setting. I can then share information about the program with both teachers and parents.”

Jones explains that students in the rural area where she works often need help beyond what she can give them as a school counselor. Transportation is an issue for many of the children’s families, so having an in-house mental health counselor at the school eliminates that barrier and also provides a source of long-term support for children and their families.

Jones sometimes continues to collaborate with the mental health counselor to address a student’s difficulties. In addition, because the mental health counselor is at the school only one day per week, Jones sometimes sees students who need additional support.

Another equally important part of her role as a school counselor is to advocate for students’ overall well-being, which sometimes means helping to meet basic needs such as food and clothing, Jones asserts. “My mentor counselor told me during my first year as a school counselor that basic needs must be met before you can work on issues,” she says. “I provide counseling to my students, but I also believe that social justice is an important part of my role as a school counselor. I work to connect my students and their families to resources.”

It is hard for children to focus on learning if they are hungry or worried about where the next meal is coming from, Jones says, so she worked with church and community leaders to create a weekend backpack program. “Local churches come each Friday and provide backpacks of food from our local food bank for students to take home,” she explains. During the winter and spring school breaks, families are also given enough food to last until school starts again.

Jones also maintains a clothing closet stocked with various seasonal clothes for students in need. She doesn’t wait for these students to approach her before offering assistance.

“If you take the time to get to know your students, it is not hard to find out who is in need,” Jones says. “If they see you on a regular basis and you talk to them, they will share their struggles and successes with you. Also, I see things just by observing students in the halls or in their classrooms. Students will sometimes come to school in flip-flops in cold weather, or you can tell their shoes or clothes are too small. Teachers also provide information about student needs.”

“As the school counselor, I have had the opportunity to help many of the families in my community,” Jones says. “Where I work, it is small enough that you get to watch your students grow up. You know all the families, and you care about your students long after they leave your building. Beyond data, I measure success in graduation invitations and students coming back to tell me they are going to college. [They are] often the first in their family to do so. There are many challenges to working with students living in a rural, high-poverty area, but there are opportunities to make a difference that make it the most rewarding profession.”

Embracing counseling’s core values

The counselors interviewed for this story emphasize that clients living in poverty want help and want to be heard. “The most important advice I can give [to counselors]: Be authentic and be understanding,” Zoldan says.

To build a therapeutic relationship with clients dealing with impoverishment — or any client, for that matter — practitioners must fall back on the core values of counseling, says Almeta McCannon, an ACA member who co-led a roundtable session at the 2016 ACA Conference & Expo in Montréal on counseling people affected by poverty. “I would advise clinicians to go back to the cornerstones of our profession: empathy, compassion, unconditional positive regard,” she says. “These are what allow us to relate to people who have experienced things we could never imagine and still be able to help them through a difficult time or situation. Assuming is the enemy here. I would encourage [counselors to ask] questions about the things that they do not understand and to really listen to the responses to those questions.”

Foss-Kelly believes counselors also need to take the next step and advocate for those living in poverty. “Counselors can play a key role in advocating for the marginalized, including those in poverty,” she says. “Of course, this advocacy begins with individual clients and communities, but it should also include spreading awareness in professional circles and among power brokers. People living in poverty come to counseling in a vulnerable state. We as counselors must fight to help other counselors understand their unique needs.”

 

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To contact the people interviewed for this article, email:

 

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Additional resources

To learn more about the topics addressed in this article, see the following resources offered by the American Counseling Association.

Books (counseling.org/bookstore)

  • ACA Advocacy Competencies: A Social Justice Framework for Counselors edited by Manivong J. Ratts, Rebecca L. Toporek & Judith A. Lewis
  • Counseling for Multiculturalism and Social Justice: Integration, Theory and Application, fourth edition, by Manivong J. Ratts & Paul B. Pedersen
  • Multicultural Issues in Counseling: New Approaches to Diversity, fourth edition, by Courtland C. Lee

Webinars (counseling.org/continuing-education/webinars)

  • “Why Does Culture Matter? Isn’t Counseling Just Counseling Regardless?” with Courtland C. Lee

Podcasts (counseling.org/continuing-education/podcasts)

  • “Hunger, Hope and Healing” with Sarahjoy Marsh
  • “Multiculturalism and Diversity. What Is the Difference? Is Not Counseling … Counseling? Why Does It Matter?” With Courtland C. Lee

VISTAS Online articles (counseling.org/knowledge-center/vistas)

  • “Counselor Training and Poverty-Related Competencies: Implications and Recommendations for Counselor Training Programs” by Courtney East, Dixie Powers, Tristen Hyatt, Steven Wright & Viola May
  • “Preparing Counseling Students to Use Community Resources for a Diverse Client Population: Factors for Counselor Educators to Consider” by Sarah Kit-Yee Lam
  • “Professional Counseling in Rural Settings: Raising Awareness Through Discussion and Self-Study With Implications for Training and Support” by Dorothy Breen & Deborah L. Drew

In addition, counselors who would like to get involved in issues of diversity and social justice may be interested in joining Counselors for Social Justice, a division of ACA. Founded in 2000, CSJ’s mission is to work to promote social justice in society through confronting oppressive systems of power and privilege that affect professional counselors and their clients and to assist in the positive change in society through the professional development of counselors. Visit CSJ’s website at counseling-csj.org.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

Extending the reach of counseling

By Laurie Meyers November 23, 2015

People in need of help don’t always show up automatically on counselors’ doorsteps and request services. Sometimes counselors have to be intentional about first forming connections with potential clients and inviting them to investigate the therapeutic process. In other instances, counselors may Mountain-Climber-Helpneed to get out of their offices and connect directly with people in their own environments to even make them conscious of counseling and let them know that help is available

The American Counseling Association members we spoke to for this article have engaged in different kinds of outreach and advocacy efforts so they can better assist communities in need. In the process, they have deepened their own understanding of different cultures and client populations.

Traffick stop

Human sex trafficking is not something that is limited to developing nations. The practice also goes on in the United States and is more common than most people would ever imagine, according to Stacey Litam.

A doctoral student in counselor education and supervision at Kent State University in Ohio, Litam also works as a licensed professional counselor (LPC) and clinical resident at Moore Counseling and Mediation Services in the Cleveland/Akron area. The practice, which specializes in mental health and substance abuse treatment and mediation, has developed a partnership with the Cleveland court system to identify and assist women who have been or are currently being trafficked for sex.

The practice’s CEO, Martina Moore, has a doctoral degree in counselor education and advocates for trafficking survivors, but it was the Cleveland Municipal Court that approached Moore with the idea of collaborating to create a human trafficking docket (a list of legal cases to be tried in court), says Litam, who became part of the collaborative team at the time of her hire in October 2014. Litam notes that fellow Ohio city Toledo has the fourth-highest rate of human sex trafficking cases in the United States, and she suspects that the success of that city’s human trafficking task force influenced Cleveland’s decision to find ways to identify and help trafficking survivors. Moore Counseling staff members had previous experience working with the Cleveland Municipal Court on other specialized dockets, such as those being heard in drug court.

The Cleveland Specialized Human Trafficking Court Docket identifies women who have been charged with solicitation of prostitution and assigns them to probation officers who work with Moore Counseling to set up an evaluation. Litam conducts the evaluations, looking for criteria indicating that a sex worker is being trafficked or has been trafficked in the past. Sexual trafficking is defined as the recruitment, harboring and transportation of a person for a sexual act using force, fraud or coercion, Litam explains.

For many Americans, the phrase sexual trafficking conjures up images of kidnapping and forced servitude, of someplace “other” or foreign. Litam acknowledges that she held those same perceptions before she began working with the trafficking docket.

“When I first I got into this [work], I thought it was an issue that other countries dealt with,” says Litam, a board member of the Ohio branch of the Association for Humanistic Counseling, a division of ACA. However, she quickly learned that a substantial percentage of women and girls who engage in sex work are actually trafficked.

“I have probably completed about 45 assessments, and about three-quarters of those women met the criteria for trafficking,” says Litam, who adds that trafficking is “very insidious and pervasive.”

“A single woman might meet a man who helps her pay for food for her child or helps her with the rent,” Litam explains. “And then the guy says, ‘If you loved me, you would do this [have sex for money].’ He’s not using violence, but if the woman doesn’t do it, she may lose her housing or her child will go hungry.”

Another tactic that lures women into sex trafficking is a seduction of sorts, Litam says. A trafficker will pursue a romantic relationship with a woman, lavishing her with praise and gifts, until suddenly the woman “owes” him for the “gifts” of fine jewelry or nice clothing and has to pay off her debt, Litam continues.

In other instances, sex trafficking is all about survival, Litam notes, citing the experience of children living on the streets as an all-too-frequent example. “Children who are trafficked are usually runaways, ‘throwaways’ or [in many cases] LGBT [lesbian, gay, bisexual or transgender],” she explains. “Once they are on the street, they will be approached by a trafficker within 48 hours. Imagine that — you are an adolescent, and you are alone and need help. Traffickers are really good at finding them.”

Indeed, traffickers possess many of the skills associated with predators, such as the ability to sniff out the “wounded” and vulnerable, Litam continues. For many adult women who are trafficked, their journey to the streets began years earlier, because they were either trafficked or sexually abused as a child. In other cases, she says, women get caught up in trafficking to feed an addiction.

If Litam’s evaluation determines that a woman has been trafficked, she is eligible — after serving jail time for any solicitation charges — for the voluntary rehabilitation program that Moore Counseling has designed. The two-year program includes mental health counseling, intensive outpatient or residential treatment, substance abuse treatment and group counseling.

Trafficking survivors and women who are still being trafficked often live in unstable environments — typically with other women under the control of a trafficker, in housing they have a hard time paying for, with people who have substance abuse problems or in a home where they are being abused. In some instances, they may even be homeless. Living under such precarious circumstances makes it more difficult for these women to get off the street, let alone seek assistance for substance abuse or mental health issues, Litam points out.

“The two-year duration [of the rehabilitation program] was established in the hope that within this time period, our services would stabilize the client’s mental health, provide addiction treatment and aftercare, and help the client establish safe and stable housing,” Litam says. “Ultimately, I would like to see clients attend at least eight counseling sessions with me. Or, if the client is in need of substance use treatment, I would love for her to complete intensive outpatient treatment and aftercare while meeting with me once a week and perhaps continue to receive counseling afterward if needed.”

However, multiple factors keep many of the women from committing to the full program. “Women do not want to disclose,” Litam says. “I’ve never had a woman say outright, ‘Help me.’”

Some women aren’t ready to leave their traffickers, and those who stay, even if they are willing to come to counseling, are up against a fundamental problem. To the trafficker, time is money.

The women come to Moore Counseling and the rehabilitation program after spending time in jail, which can be as long as five days. By that time, the trafficker is already angry because he’s losing money, Litam explains. So the women are very vigilant and fearful of any time they spend away. Even an hour away will be noticed and questioned, Litam says.

“The benefit of counseling has to outweigh the cost of being away,” Litam says. Most of the women who are still being trafficked determine that isn’t the case, she concludes sadly. Many of the women who are eligible for the rehabilitation program will attend only a few sessions — or even just a single session. Litam says she treats each session as if it were the last one because, in many instances, it might be.

At a bare minimum, Litam makes sure that the women get a card that includes the phone number for the national human trafficking hotline. She also talks with them about having a safety plan, which involves figuring out where they can go, even if only temporarily, if they feel they are in danger. She encourages them to always have a “go” bag prepacked with any necessary personal items. Litam may also use motivational interviewing to help a client explore her ambivalence about her addiction or toward her relationship with her trafficker.

Women aren’t necessarily ready to engage in intensive counseling even if they are no longer being trafficked, Litam says. On average, trafficking survivors come in for four or five sessions before stopping, she says. But it’s not uncommon for these women to contact the program to begin counseling again a few weeks or months after their initial round, she adds.

“Some women may need to briefly touch on the trauma for a few sessions, take a few weeks off, then come back,” Litam explains. “I always welcome the women back when they do call. Trauma work is not on my time; it is on theirs.”

Litam uses a variety of techniques based on the client’s history and current circumstances. “Of course, every survivor will present with different needs depending on her individual resources and history. It’s whatever the client needs,” she emphasizes. “Sometimes they just want to sit and talk and not be judged. Sometimes it’s [the conversation] just about how worried they are about their child.”

One of Litam’s clients has made a significant amount of progress using creative-based interventions to express and release her trauma experiences. “We have also focused on addressing and reframing the cognitive distortions she developed while being trafficked,” Litam says.

Another of Litam’s clients has taken what she has learned through psychoeducation about how trauma affects the brain and applied it to her emotional regulation. “[She] finds peace in her ability to self-regulate her emotions outside of our sessions, has identified triggers and uses diaphragmatic breathing and progressive muscle relaxation as part of her daily self-care routine,” Litam says.

With other clients, Litam uses narrative exposure therapy to help them integrate complex trauma experiences into the context of their lives. “Establishing a timeline may look like placing a piece of rope on the ground with one end representing ‘birth’ and a balled up end representing ‘life that has yet to be lived.’ Clients place objects along the rope to represent positive and traumatic events along their timeline,” Litam explains. “Processing the trauma narrative in a safe place empowers clients to habituate to the trauma. Also, clients can feel empowered to see that much of [their] life has yet to unfold. It is a beautiful reminder and metaphor that things can get better.”

Litam also started a women’s resilience group at the practice where she works. She established it primarily to serve as an extra source of support for her female clients who have been trafficked, but she didn’t want the participants to feel labeled in that way, so she opened the group up to other female clients as well. She says the group represents a place where any woman can feel comfortable seeking peer support. Litam and several other counselors facilitate the group, which meets weekly.

Litam’s advocacy work doesn’t stop at her office door. She is also raising awareness within the law enforcement community about the prevalence of sex trafficking. Currently, she is working with a probation officer to set up a trafficking panel to better educate police officers.

Litam says police officers often lock up women for solicitation without looking for signs of coercion, even if the woman has visible bruises or other injuries. Her hope is that greater awareness by police officers about how common sex trafficking is might lead to earlier intervention and assistance for those being trafficked.

Litam is also an adjunct professor at Northeast Ohio Medical University, where she teaches students to use empathic communication in their patient interviews and examinations to look for signs that an individual is being trafficked or might be in danger. These indicators include constantly watching the door and being hypervigilant of her surroundings and the passage of time (time for which a trafficker will be wondering why she isn’t out making money).

Litam is also excited about research she is conducting with Jesse Bach, executive director of The Imagine Foundation, a nonprofit organization in Cleveland dedicated to ending human trafficking. Litam and Bach are studying human sex trafficker behavioral patterns, demographics and other characteristics in an attempt to establish a kind of trafficking “typology.” Their hope is that by identifying how different human sex traffickers operate, they can better understand how women (or men) are selected and kept under the trafficker’s control. Litam thinks that understanding these factors will also help identify intervention methods that might be more successful when counseling survivors and those currently being trafficked.

“Take, for example, a survivor who came from an unstable home and lacked a strong support system. Unfortunately, traffickers are predators and are excellent at identifying vulnerable women,” she says. “After months of ‘courting’ behaviors in which the trafficker convinces the woman he loves her and showers her with nice things, she may become conflicted in her ability to resist when he finally asks her to engage in commercial sex acts. This woman may need more intensive counseling on topics such as establishing appropriate boundaries, increasing self-efficacy, building strong support systems and CBT [cognitive behavior therapy] techniques.”

Litam says working with survivors and victims of human sex trafficking has become her passion. She believes that she can help these individuals not only by using her counseling skills with them but also by raising awareness of the prevalence of human sex trafficking.

“I would love for the average counselor to know that this is not a problem specific to Third World countries or inner cities, but that it is everywhere,” Litam says. She emphasizes that no neighborhood is exempt from human trafficking, regardless of whether that neighborhood is located in an upper-class suburb, a small town or even a rural area.

‘Learning’ rather than ‘teaching’

Counseling must always start with an understanding of the client’s cultural values, says Rachael Goodman, an assistant professor in the counseling and development program at George Mason University (GMU) in Fairfax, Virginia. This is one of the underlying tenets of counseling and a thread woven through all that counseling students learn as they work toward their degrees. However, Goodman says, experiencing others’ cultural traditions firsthand can impart an understanding that is more powerful than anything learned in the classroom.

In 2013, Goodman, as part of an effort facilitated by Counselors Without Borders, helped lead a group of GMU graduate students on a trip to the Pine Ridge Reservation in South Dakota. There they spent time with the people of the Oglala Lakota Nation as they prepared for and performed their annual Sun Dance ritual. Counselors Without Borders, founded by ACA member Fred Bemak, a professor of counseling and development and director of the Diversity Research and Action Center at GMU, is an organization committed to providing culturally sensitive humanitarian counseling in post-disaster situations.

Goodman thought it was particularly important for the students, who were taking a cross-cultural counseling class, to be exposed to other traditions. “It’s important for us [counselors] not to simply impose what might be misaligned Western models,” she says. “With any community, understanding what their traditions are is important for social justice so that we are not exacerbating marginalization.”

Goodman, who is also a member of Counselors for Social Justice, a division of ACA, planned the trip to coincide with the Sun Dance ritual so the counseling students could see practices that have both spiritual significance and a healing purpose for the Lakota people. A girl’s coming-of-age ceremony was also taking place at the same time.

Goodman and the students arrived before the ceremonies began to help with the preparations. For Lakota traditional services, the ground must be prepared in a certain way — for instance, the students helped build a circular space and a traditional arbor. (Because the Sun Dance is so sacred to the Lakota, Goodman says she is not comfortable giving details about the ritual). The counseling group also helped the young women with their rituals such as quilting and quillwork, which involves dyeing porcupine quills for use in traditional art.

These ceremonies have many healing and spiritual elements, perhaps the most important of which is a reclaiming of the Lakota culture, Goodman says. “It’s very important because of the history of genocide,” she elaborates. “For a long time, the United States government outlawed a number of native practices. The idea that you [as a Lakota person] wouldn’t be able to practice these ceremonies is in itself a trauma, so being able to perform them again is healing in itself.”

The Lakota are reclaiming not just their traditional ceremonies but also their native language, which was also outlawed for a long time, Goodman says. The group she led spent time with school students who were taking a language immersion class intended to sustain and widen the use of the Lakota language.

“I wasn’t aware of the importance of language in spirituality,” Goodman says. “They [the ceremonies] are conducted in Lakota, and if you don’t know [the language], you would have trouble understanding spiritual traditions.”

Goodman and her group also learned about the Lakota method of equine assistance therapy, which she describes as an interesting mix of Western culture and native practices. She says that for the Lakota, the horse doesn’t serve simply as a “feedback” instrument but rather is part of a person’s healthy connection to nature and all beings.

Goodman says all of the activities the group participated in taught the counseling students not only about Native American cultural practices but also helped them realize that counseling and therapy don’t necessarily have to occur in a formal, 50-minute, one-on-one sit-down. Counselors can provide support to clients and communities simply by listening, understanding and witnessing, she says.

Something else that struck Goodman during the trip was how the historical trauma of the Lakota is still very much a part of their present challenges. The people she spoke with emphasized that while the media and even well-meaning helping professionals often focus on issues such as substance abuse and violence on Native American reservations, they are seeing only the surface issues and not recognizing the historical trauma that underlies it all.

The people of Pine Ridge also had a parting message for Goodman and her group: “Let people know. Go back and tell our stories.”

Creative college counseling

Sometimes the biggest need for outreach is in a counselor’s own backyard — or campus. College students remain one of the counseling profession’s most underserved populations, not because there aren’t counselors available to help students but because these students are unlikely to come to the college counseling center for help, even when they desperately need it.

Research indicates that many college and university students aren’t just stressed, but depressed and anxious as well. In fact, 42.4 percent of the almost 75,000 undergraduate students who completed the 2015 annual American College Health Association National College Health Assessment reported experiencing more than average stress within the past 12 months, and 10.3 percent reported feeling tremendous stress. When asked about depression and anxiety during the previous 12 months, 35.3 percent of survey respondents reported feeling so depressed that it was difficult for them to function; 57.7 percent indicated feeling overwhelming anxiety.

At the same time, only a fraction of students in distress appear to be seeking help. The 275 college and university counseling centers that participated in the 2014 National Survey of College Counseling, an annual report sponsored by the American College Counseling Association (ACCA), a division of ACA, reported that only 10.9 percent of college or university students had sought services at a campus counseling center in the past year.

Clearly, “build it and they will come” is not a fitting slogan for campus counseling centers. Tamara Knapp-Grosz, who was the director of the Savannah College of Art and Design (SCAD) counseling center for 15 years, wondered what might happen if the center was proactive about going to the students instead. She started the process by offering workshops on depression at the counseling center and at various other campus meeting facilities, but most students still chose to stay away.

“I started thinking, ‘What is the goal of outreach?’” says Knapp-Grosz, an ACA member who is leaving SCAD to become director of the counseling center at the University of North Texas. First and foremost, she believes college counseling outreach should build a connection not only between the counseling center and the students but also between the students themselves because they have the potential to serve as secondary sources of support for one another.

But Knapp-Grosz, who had become interested in positive psychology during the beginning of her tenure at SCAD, was also struck by the idea of creating “shifts in the energy and atmosphere” during stressful times such as final exams. As she and the counseling center staff brainstormed ways to bring some positivity and levity to the students, their first creative outreach endeavor was born.

When stress levels got high, the counseling center staff and interns would visit various classrooms and celebrate a famous artist’s birthday. Knapp-Grosz, the immediate past president of ACCA, wanted to truly personalize the events and target the students by their areas of study, so the birthday parties were specific to the students’ specialties. For instance, a class of painting students might celebrate Van Gogh’s birthday with a themed cake and trivia. A birthday party for Peanuts creator Charles M. Schulz, thrown for students in the sequential arts (narratives accompanied by illustration such as those found in comic strips, graphic novels and storyboards), produced laughing and dancing, she notes. Word would spread throughout the building about the birthday parties, attracting additional students to join the celebrations.

The birthday party tradition continues through the present day, and Knapp-Grosz believes the benefits extend beyond providing students a brief break from stress. “Students start to connect with each other,” she points out.

They also start to connect with the counseling center personnel. Fliers detailing the services that the counseling center offers are always available at the parties, but that is secondary to the influence of the interactions between the counseling staff and the students, Knapp-Grosz asserts. By being at these “parties,” counseling staff are introducing themselves in a nonthreatening way and helping students become familiar with mental health professionals, perhaps even demystifying their role in the process, she says.

Other in-classroom interventions include “brain breakers,” a brief interval during which a counseling center staff member arrives with a limbo stick and music and invites students to limbo.

Yet another outreach tool, the Pizza Fairy, has achieved almost cultlike status, Knapp-Grosz says with amusement. The Pizza Fairy is a counseling center staff member who shows up in the student residence halls with free pizzas (accompanied by counseling center fliers) that are donated by a local hospital. There is no set schedule, so it is always a surprise when the Pizza Fairy appears.

“He’s become almost an urban legend,” Knapp-Grosz says. “People will text each other about it — ‘Have you seen him? Is he coming?’” In fact, students have even shown up at the counseling center looking for the Pizza Fairy, she notes with satisfaction.

The creative outreach doesn’t stop there. The counseling center has also featured Doughnut Divas who dressed up in costumes and handed out doughnuts in front of classroom buildings in the morning. The Doughnut Divas were replaced by Granola Goddesses when the students requested healthier food.

Then there is a certain iconic character in a big red suit who makes appearances on campus. “Toward the end of the quarter, we do ‘psycho Santa,’” Knapp-Grosz explains. “[Staff members or interns] put on a typical Santa costume but with goofy socks or something, and we’ll have an article about [topics like the] holiday blues. They [the Santas] usually go to the dining halls and hand out candy canes. We’ll sometimes have elves and reindeer too.”

The creative outreach seems to have paid off. Knapp-Grosz notes that over time, use of the counseling center at SCAD has risen to include approximately 50 percent of the student population.

The unconventional approach to outreach also seems to benefit the counseling center staff, Knapp-Grosz observes. “You have less burnout and compassion fatigue,” she says. “It’s refreshing to be out and about, and we are interacting with a broader student population.”

Knapp-Grosz says that before she starts making similar outreach plans at her new job at the University of North Texas, she will need to meet the center staff and learn more about the needs of the student population. She does, however, have an idea involving therapy dogs, inspired by her own dog, a standard poodle. As a breed, poodles have a penchant for dancing.

“If it fits the culture, I would like to have poodle dancing [in the classroom or other campus locations],” Knapp-Grosz says with a laugh. “I just think that would be really cool.”

Connecting with communities

Advocacy and outreach are two of the values at the core of the counseling profession, says ACA President Thelma Duffey, who has made counselor advocacy and outreach one of her presidential initiatives.

“I think counseling outreach provides a way for us to connect with our communities and to participate in advocacy and services,” she says. “It’s an opportunity for counselors to contribute to their communities by offering their areas of knowledge and expertise — at times to people who feel, and sometimes are, unsupported or disconnected.”

 

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To contact the individuals interviewed for this article, email:

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org