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Supporting clients through the anxiety and exhaustion of food allergies

By Bethany Bray November 27, 2018

The diagnosis of a food allergy is life-changing, not just for the individual but for those who love and live with that person. In addition to avoiding exposure to certain foods, the condition requires that these families and individuals explain, over and over again, the seriousness of the allergy at schools, restaurants, social gatherings, workplaces, daycare facilities and countless other places.

It can all be exhausting, says Tamara Hubbard, a licensed clinical professional counselor whose son was diagnosed with a peanut allergy six years ago. Families receiving a new allergy diagnosis face steep learning curves that can cause them to worry and to overthink every detail of what their child or other loved one eats or might be exposed to.

“It’s almost like Russian roulette. You don’t know when an [allergic] reaction will happen, even when you take precautions,” Hubbard explains. “There’s a constant level of fear and anxiety at all times in the background that parents and caregivers need help managing.”

Food allergies affect an estimated 4 to 6 percent of children in the United States, according to the U.S. Centers for Disease Control and Prevention. Between 1997 and 2007, food allergies increased 18 percent among American children and adolescents younger than 18.

A food allergy reaction sends someone in the United States to the emergency room every three minutes, reports the nonprofit organization Food Allergy Research & Education (FARE).

Counselors can help clients work through the anxiety and other mental health issues that food allergies sometimes exacerbate, but they can also be a source of support simply by serving as a listening ear. Clients may come to a counselor’s office worn out from the self-advocacy and constant vigilance that a food allergy requires, explains Hubbard, who has a private practice in the suburbs of Chicago that specializes in supporting clients (and their families) with food allergies.

With food allergies, there is sometimes “a constant feeling of having to fight in every conversation to get your point across,” she says. “Just being an empathic, listening ear [as a counselor] and wanting to learn, that makes a huge difference in their anxiety level and ability to release tension.”

At the same time, counselors should research and learn about food allergies to become a competent support to clients, Hubbard emphasizes. For example, they should know that an intolerance or sensitivity to a food is very different from a diagnosed allergy.

With a food allergy, the immune system views the allergen — for example, wheat, shellfish or peanuts — as an invader and overreacts whenever it enters the body. Someone who ingests a food that he or she has an intolerance or sensitivity to will experience discomfort but not the potentially life-threatening reaction that comes with an allergy, Hubbard explains.

Counselors who understand the biological and mental health implications of food allergies can help these clients to live fuller lives, Hubbard says. Although the most important thing counselors can do is learn about and understand food allergies, exercising compassion is also essential, she says.

“Sometimes, even medical professionals aren’t good at that part. They send [people] off with an EpiPen and say, ‘Come back in six months.’ In a perfect world, they would send them off with a list of resources for mental health and wellness,” says Hubbard, an American Counseling Association member. “Counselors can play a very important part to fill in that gap, even if it’s just an empathic ear. That is incredibly therapeutic in itself.”

 

Tempering the uncertainty

The anxiety that families and individuals with food allergies often experience is more complex than simply worrying about possible exposure to an allergen, Hubbard says. Anxiety can spike over everything from sending a child to school and worrying that the staff won’t follow allergy-safe protocols to second-guessing whether a food product might contain nuts, even when the label says it doesn’t.

In the United States, companies are required to note on food labeling whether a product contains one or more of the eight most common allergens. These potential allergens are:

  • Milk/dairy
  • Eggs
  • Fin fish (e.g., salmon, flounder, cod)
  • Shellfish (e.g., crab, lobster, shrimp)
  • Tree nuts (e.g., almonds, walnuts, pecans)
  • Peanuts
  • Wheat
  • Soybeans

However, U.S. companies are not required to disclose whether a product is made in a facility or on equipment that is or was exposed to those eight allergens, Hubbard notes.

With that in mind, navigating grocery stores, restaurants and social gatherings involving food can be anxiety-provoking for those with food allergies — and especially for newly diagnosed families, Hubbard says. Some parents react by restricting their child’s activity to reduce the risk of exposure.

Allergy diagnoses are sometimes given after a person has experienced one initial anaphylactic reaction. This can create uncertainty concerning how much of the allergen is too much. For example, is it OK to be near someone else who is eating the food to which the person is allergic?

“There is fear of the unknown: ‘How much of the allergen will it take for my child to react?’ There are different layers to the anxiety, and it’s important [for counselors] to understand each layer,” Hubbard says. “Also, the anxiety affects each member of the family; they will all feel it. There’s a lot to unpack when you are assessing a client who is dealing with food allergies.”

Counselors who understand the complexity of the issue can help clients find balance and equip them with tools to manage the anxiety, Hubbard notes.

“Ultimately, the goal is to help the client — whether it’s the allergic person themselves or a caregiver — assess the risk for every situation they’re going to be in. Is their anxiety based on fact or emotion? We can tell ourselves that everything is unsafe, or we can navigate [the risk] and take precautions,” she says.

 

Finding balance

There is a balance between living in fear and frustration because of food allergies and still enjoying a good quality of life, Hubbard stresses. “Understand that in many cases, when someone is newly diagnosed, especially if it’s a young child, the person or family may be very overwhelmed initially,” she says, “as there can be a steep learning curve when your lifestyle needs to suddenly change due to a food allergy diagnosis. Some people navigate this well, while others need support and guidance. I typically encourage people to remember that it will take time to get used to the diagnosis and gain all of the necessary knowledge to live a well-balanced life between food allergy fears and empowerment. I also encourage those who are newly diagnosed to learn the basics at first and, over time, as they feel ready, branch out to other related food allergy topics, such as potential treatments, research and advocacy.”

Here are some tips for counselors to keep in mind related to food allergies:

> Prepare for an emotional roller-coaster: Food allergies can be life-threatening, so it’s understandable when individuals (or their families) experience strong emotions such as fear, sadness, anger or guilt connected to the diagnosis. Of course, these emotions can eventually lead to becoming overwhelmed or burning out, Hubbard says.

“If a child has a [allergic] reaction, the parents can feel strong emotions of ‘what did I do wrong?’ At the same time, they could have done everything 100 percent right,” Hubbard says. “The reality is that it’s a big deal, but that doesn’t mean it has to be a … crisis every day.”

Equipping clients with coping mechanisms will not only help them manage their own anxiety and strong emotions but will also keep them from transferring those feelings to the child or family member with the allergy, Hubbard says.

Counselors can also help clients work through their feelings of loss concerning what their life (or their child’s life) might have been like without the limitations of a food allergy. For example, they may yearn to eat at a restaurant without having to ask about the establishment’s allergy protocols or to eat lunch with friends in the school cafeteria instead of sitting at a separate table or worrying about what foods they could be exposed to.

“These children [with food allergies] have to grow up a little quicker in some respects. They have to learn to speak up for themselves and make decisions,” Hubbard says. “It’s about managing the feelings and finding ways to help them empower themselves and advocate to come through with some balance.”

> Move toward acceptance: One of the most important things counselors can do is help clients reach acceptance of the food allergy diagnosis, Hubbard says. This can have similarities to grief work, including helping clients come to terms with the fact that they can’t change the situation, she explains. Narrative therapy can assist clients in reframing their feelings and taking control of their story.

Role-play can be beneficial for clients of all ages because it helps them learn to navigate their feelings and the language they will need to use to advocate for themselves. (For example, how will they explain that they can’t eat the cake at an upcoming birthday party?) Hubbard says she also finds play therapy, mindfulness and cognitive behavior therapy helpful for clients with food allergies.

Above all, she says, counselors should make sure their approaches are tailored to and appropriate for the individual client. “For kids, it’s not appropriate to talk about the risk of death [involved with food allergies], but coping with their feelings and worry is appropriate,” she notes.

Counselors can also model acceptance for clients in session, Hubbard adds. It can be a relief to find that “they don’t have to walk into a session defending themselves,” she says. “They can learn that not every conversation has to be fight-or-flight. It’s a marathon, not a sprint, for sure, just as with any chronic illness. Help clients pace themselves.”

> Find the right words: An individual with food allergies (or the parents of a child with food allergies) will need to explain the allergy to everyone from school staff to well-meaning relatives who are hosting a holiday dinner. Be aware that there can be cultural and generational differences in levels of understanding and flexibility surrounding food allergies, Hubbard advises.

“This can be hard for people who aren’t comfortable speaking up. If they’re not a natural advocate, it will now fall to them to educate [others] and advocate,” she says. “A counselor can help them manage the feelings around that, [including] frustration, burnout and exhaustion.”

> Guide children (and parents) as they grow up: Parents may find themselves growing anxious as their child with food allergies ages, develops more independence and spends more time away from home. Counselors can offer support as these families navigate the child’s developmental milestones. This might include encouraging the family to gradually give the child more freedom and responsibility to make safe choices independently.

For example, teenagers who are beginning to date may have to inform their love interests that they shouldn’t kiss for a while after the person has eaten something containing an allergen. “For every phase of life, there will be an additional need to explain and educate [about the allergy], and that can be exhausting,” Hubbard says.

> Be aware that “relapses” are possible: Clients who have made progress on accepting a food allergy and managing the emotions that come with it can “go back to ground zero” anytime they experience an allergic reaction or exposure scare, Hubbard says. Counselors shouldn’t be disappointed if these clients sometimes backslide on the progress they have previously made in therapy.

> Work with the allergist: Professional counselors shouldn’t hesitate to contact a client’s allergist (if the client grants permission). Counselor practitioners can learn a lot about the specifics of a client’s needs from the allergist, Hubbard says. For example, some food allergies are milder, whereas others can cause a reaction even from airborne exposure (for example, peanut dust). “Each client will have a specific set of data [regarding his or allergy],” Hubbard explains. “It’s important to stay connected with their allergist and check in to help you better understand.”

> Be cognizant that allergy-related bullying does happen: Being aware of allergy-related bullying is especially important for counselors who work in school settings or with children and adolescents in their practice, Hubbard notes. Up to one-third of children with food allergies have faced bullying, according to FARE.

This can include overt bullying, such as taunting or threatening a classmate with an allergen. But allergy-related bullying can also come in less obvious forms, such as when an adult (teacher, sports coach, etc.) points out the individual with an allergy and labels them as the “reason” the class or team can’t have certain foods. This type of scenario can make individuals feel bad about their allergies and the inconveniences they may present, Hubbard says.

 

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The Food Allergy Counseling Professionals Networking Group

Started by Tamara Hubbard, this group is open to counselors who work with clients who are managing food allergies. Connect with them on Facebook: facebook.com/groups/FoodAllergyCounselingProfessionals/ to share resources and network with other professionals who specialize in this area.

 

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Contact Tamara Hubbard and find resources at her website: foodallergycounselor.com

Hubbard also writes a blog on allergy-related issues, including a series titled “Four things counselors should know about food allergies.”

 

 

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Related reading

Hubbard suggests the following resources for counselors or clients looking to learn more about food allergies and their connection to mental health:

 

 

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

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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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.

 

Promoting LGBTQ students’ well-being in schools

By Roberto L. Abreu, Adriana G. McEachern, Jennifer Geddes Hall and Maureen C. Kenny October 2, 2018

Research shows that LGBTQ youth are disproportionately bullied (whether in person or via cyberbullying), verbally and physically harassed, and assaulted in schools by peers and staff. Such hostility has been correlated to lower school performance and psychological and emotional distress, including suicidal ideation and attempt, depression and anxiety.

In the 2015 GLSEN (formerly Gay, Lesbian & Straight Education Network) National School Climate Survey, LGB students reported higher levels of verbal, physical and sexual violence and bullying than did their heterosexual counterparts. Specifically, 98.1 percent of LGB students heard the word “gay” used in a derogatory manner, 85.2 percent reported verbal harassment, and 34.7 percent reported being physically harassed in the past year. In addition, a 2017 meta-analysis (conducted by co-authors Roberto L. Abreu and Maureen C. Kenny) of 27 empirical studies on the effects of cyberbullying on LGBTQ youth revealed that compared with their heterosexual and cisgender counterparts, these students are disproportionately harassed online and through other technology-based means. Such harassment has been correlated to a range of behavioral and emotional difficulties, including suicidal ideation (with some studies suggesting rates as high as 40 percent among LGBTQ youth) and suicide attempts (with rates as high as 30 percent).

Many LGBTQ students identify school counselors as the one school staff member to whom they are most likely to disclose concerns related to their sexual and gender identity. Given this reality, school counselors are uniquely positioned to address myths about LGBTQ youth, to advocate for these students and to effect change.

Dispelling myths

Let’s begin by examining five myths that can have an impact on the identity, safety and well-being of LGBTQ youth. We’ll also look at specific strategies and interventions that counselors can use to address these myths and increase the safety of LGBTQ students.

Myth #1: Parents must be informed of their child’s sexual and gender identity. A 10th-grader discloses to her high school counselor that she identifies as a lesbian. Most of her friends know, but she has yet to tell her parents. She fears their reaction because she has heard them make derogatory remarks toward LGBTQ individuals in the past. Must the school counselor inform the student’s parents?

The American School Counselor Association (ASCA) National Model (2012) stresses the importance of parent and family involvement and its influence on the well-being of students. Although parent engagement is critical when working with LGBTQ youth, school counselors should consider several factors before disclosing to parents a student’s sexual or gender identity. Many LGBTQ students believe they lack parental support, and they may fear rejection, abuse and an unsafe home environment if their parents discover their sexual or gender identity.

Therefore, the counselor in this scenario should first discuss with the student her feelings about informing her parents and assess how they may react to this information. It would be important for the counselor to prepare the student for potential negative parental responses. Role-playing the conversation could be helpful for the student. It would be best to have the minor client make the disclosure to her parents with the counselor present to provide support. It is also important to have a plan in place to provide the client with a safe place to stay should the parents totally reject her and need time to adjust to the situation.

In certain instances, school counselors may have to break confidentiality. For example, what if the student also disclosed to the counselor that she was distraught over the situation and was having suicidal thoughts and feelings of hopelessness because she feared that her parents would never understand or accept her sexual and gender identity? In that situation, there would be potential harm and danger to the minor client. Therefore, the counselor would need to conduct a thorough suicide assessment, then inform the client of the legal and ethical reasons that confidentiality must be breached.

It is important for counselors to check their schools’ policies and procedures in relation to dealing with crisis situations such as suicide. School counselors can work with parents individually or in groups to foster awareness and acceptance of LGBTQ students and to promote understanding of their needs and the challenges these students face every day.

Myth #2: Gender-neutral facilities are a threat to school safety. A school district policy does not allow transgender students to use the restroom that corresponds to their gender identity. A transgender student has brought this to the attention of the school counselor, inquiring about what to do. The student says he often goes the entire school day without going to the restroom.

School counselors should use their role as staff and educators to speak to the school administration about this issue. In talking to school administrators, counselors can present research related to transgender students experiencing a lack of safety in schools and make the argument that forcing these students to use a bathroom that does not align with their gender identity only contributes to this presenting concern.

Some states have passed laws precluding gender-neutral facilities, imposing on the rights of transgender individuals to use the restroom that corresponds to their gender identity rather than their sex at birth. Some of these laws have been incorporated into school policy. The rationale given for these laws has been to protect public privacy and safety. However, there is no research evidence to support this claim.

In 2015, Media Matters for America conducted a survey of 17 school districts in 12 states encompassing approximately 600,000 students. The survey asked about cases of harassment or inappropriate behavior after transgender-inclusive policies had been passed in those districts. The survey results concluded that no incidents of sexual harassment or inappropriate behavior had been reported in those schools, debunking the myth that gender-neutral facilities are a threat to school safety.

Counselors, as social justice agents, must involve themselves in policy. This can be done at school meetings, where counselors can advocate for gender-neutral policies in schools and school districts. Counselors can inform school administrators of their interest in participating in these meetings and being involved in the decision-making process. They can volunteer to conduct information sessions for meeting participants about the academic, personal and career needs of LGBTQ youth. Counselors should actively seek to advocate for transgender youth so that these students can use the bathroom that best aligns with their gender.

Myth #3: School policies and laws protect all students. School policies and laws have focused mainly on reducing bullying but not necessarily on protecting LGBTQ youth and keeping them safe. The 2015 GLSEN report that investigated anti-bullying policies in the nation’s school districts revealed that out of the 13,181 school districts surveyed, 70 percent had anti-bullying policies. However, only 20 percent of these school districts had LGB-inclusive policies, and only 10 percent had LGBT-inclusive anti-bullying policies.

Although anti-bullying policies may be in place, LGBTQ students continue to report higher incidents of bullying and harassment than do other students. Often, these policies are not widely distributed to students and staff, and although most students and staff may be aware of district anti-bullying policies, they are not necessarily aware of LGBT-inclusive anti-bullying policies. 

Furthermore, policies and laws are often influenced by politics and societal opinions. Laws referred to as “no promo homo” involve efforts to prevent national LGBT education, mandate that administrators take a neutral stance on gender identity and prohibit providing specific services to these students. Although seven states (Alabama, Arizona, Louisiana, Mississippi, Oklahoma, South Carolina and Texas) had “no promo homo” laws as of January 2018, many states are working to develop LGBT-inclusive laws and policies that do not discriminate against these youth. For example, many states have developed LGBT anti-discrimination laws. These laws also permit transgender students to participate in sports congruent with their gender identity.

School counselors need to be proactive and work with school administrators to develop LGBT-inclusive policies. Counselors can assist in disseminating and discussing these policies regularly with students, parents and staff. Counselors should educate school administrators on bullying and “no promo homo” laws so they will better understand the detrimental effects of systemic oppression on LGBT youth.

In addition, school counselors should empower LGBTQ students to share with school staff their experiences with bullying and harassment within the school. This will open the door for school personnel to make a personal connection with these students and will help them learn more about the physical and mental health consequences of LGBTQ bullying and lack of representation.

Myth #4: LGBTQ students are safe around all school personnel. Many LGBTQ students do not feel safe at school — around either other students or school personnel. The GLSEN survey from 2015 reported that more than 50 percent of LGBTQ students heard homophobic comments from teachers and school staff. Many of these students believed that reporting harassment or assaults to school personnel would worsen the situation and that no action would be taken. Among those who did disclose bullying, harassment or assault to school staff, 63.5 percent indicated that their reports were ignored. In addition, when these incidents were reported, LGBTQ students faced harsher discipline than did their heterosexual and cisgender peers and were often blamed for the incidents (see research from Shannon Snapp, Jennifer Hoenig, Amanda Fields and Stephen Russell). This lack of support from school personnel places LGBTQ students at greater risk of being victimized.

In 2017, students in California’s San Luis Obispo High School published an edition of the student paper, Expressions, featuring LGBTQ issues. In response, a special education teacher at the school wrote a letter quoting the Bible and stating that those committing homosexual acts “deserve to die.” The school administration chose not to discipline the teacher for the action, stating that teachers as well as students “do not shed their First Amendment rights” at school. Although the teacher resigned soon after the incident, his statement remains a testament to the harassment and discrimination leveled against some LGBTQ students by school personnel.

School counselors need to advocate for and support LGBTQ students in the face of such victimization. Providing training to all students, parents and school staff is critical to reducing incidents of bullying and harassment and increasing awareness and sensitivity to the issues LGBTQ students confront in schools. A middle school in South Florida developed a monthlong program that focused on bullying prevention, including sexual and gender identity sensitivity training at various levels. At the high school level, counselors are forming LGBTQ support groups to provide outlets for these students to discuss specific issues and concerns. These groups provide one way to let these students know that they are valued and that their voices are important.

Myth #5: Sex education is inclusive of all students. Sex education that is LGBTQ inclusive is very limited or nonexistent in our nation’s schools. Often, this lack of inclusion is due to discomfort and lack of knowledge about LGBTQ sexuality on the part of school personnel, students and parents. Many teachers do not feel competent to teach on the topic.

Traditionally, sex education in U.S. schools centered on an abstinence-only curriculum. This ideology changed somewhat in the 1980s because of the AIDS epidemic, the increase in sexually transmitted diseases and teen pregnancy. The curriculum during this time focused on prevention and contraception, but no content was included on LGBTQ sexuality. In the 1990s, there was an effort to develop national guidelines for comprehensive sex education by the Sexuality Information and Education Council of the United States, a task force composed of educators and health professionals. However, these guidelines also lacked specific and clear directives on how to address the needs of LGBTQ students in schools.

Health care reform legislation in 2010 provided states with funding to draft comprehensive sex education in schools. One of the programs created from this initiative was the Personal Responsibility Education Program for young adults. Once again, however, this program
failed to offer educational content or policy language that was inclusive of LGBTQ students.

Given this reality, school counselors can take leadership roles in advocating to administrators and teachers on the importance of including educational information and materials about LGBTQ sexuality in the sex education curriculum. Counselors may need to ensure that the programs being used to teach sexuality are inclusive. Counselors can assist health educators by providing appropriate materials (see hrc.org/resources/a-call-to-action-lgbtq-youth-need-inclusive-sex-education for more information on LGBTQ-inclusive sex education). Counselors can also conduct psychoeducational workshops to dispel myths and misconceptions regarding LGBTQ students with all stakeholders, including students, school staff and parents.

 

A call to action

Clearly, the perpetuation of these myths indicates that something more needs to be done to better support LGBTQ students within school systems. School counselors, as outlined by ASCA, have an ethical obligation to support underserved and oppressed populations. Additionally, school counselor training programs emphasize the role of school counselors as agents of change within the school system and professional leaders who must act as allies and advocates for all students.

This role includes:

  • Being aware of the challenges that LGBTQ students face within the school system
  • Designing a developmental, comprehensive school counseling program to support the LGBTQ student population
  • Advocating for policies and practices that address inequities regarding academic, career and social/emotional domains for LGBTQ students 

Therefore, supporting LGBTQ students and promoting social justice initiatives should be done through large-scale, small-scale and individual interventions in an effort to create a positive school climate for everyone.

Readiness assessment

The first step is to conduct a needs and readiness assessment. This assessment should focus on gauging the school’s current climate related to LGBTQ students and the willingness of staff to make needed changes. Assessments should target students, faculty, staff and parents. Their openness toward acceptance and making changes, as well as the amount of education and training they have received related to LGBTQ populations, is important to assess.

Parents and school personnel may be reluctant to support LGBTQ youth in part because they do not feel prepared to respond to the unique needs of these students. School counselors will need to collaborate and discuss concerns with all stakeholders to comprehensively make appropriate systemic changes. These conversations also allow school counselors to gain awareness of current school policies and procedures related to the treatment of LGBTQ students.

Additionally, before changes can begin, school counselors should collect data that may be reflective of disparities and issues that LGBTQ students face within the school. Such data may include behavioral referrals, truancy rates and negative changes in grades and attitudes/behaviors. Behavioral referrals should be more specific and include incidents of verbal and physical harassment that LGBTQ students have endured as well as LGBTQ students who might be “acting out” in class in reaction to bullying or oppressive interactions.

LGBTQ students who are lacking support and involved with negative interactions often are truant, report somatic complaints and disengage from the learning process. It is therefore important that school counselors collect and examine data concerning absenteeism, visits to the school nurse, incidents of skipping class and dropping grades. This data should be saved and used as well during the measurement of formative and summative program success. This information will help inform what needs exist and how the school can best support LGBTQ students in dealing with their struggles.

It is important to note here that when collecting and analyzing data, counselors should look for patterns and then meet with students individually, regardless of their sexual or gender identity. At the time of this meeting, if the student discloses that their struggles are indeed related to their LGBTQ identity (for example, they are being bullied because of their gender expression), then counselors should move forward with interventions while making sure to protect the student’s confidentiality.

Intervention formulation

After school counselors have conducted a thorough assessment of their schools’ climate and needs, they can begin to formulate interventions and adjust policies to better support LGBTQ students. School counselors should include LGBTQ community members on their advisory boards to assist with inclusivity when promoting change and programming. Change and programming should include interventions at the schoolwide, small group and individual levels. 

Schoolwide interventions addressing bullying and diversity have been deemed most effective in promoting a more positive school environment for all students. These interventions should include procedures and programming specific to the LGBTQ population, such as staff training on LGBTQ issues, multicultural awareness and response procedures regarding victimization of LGBTQ students. Schoolwide strategies and policies to address LGBTQ-specific bullying and harassment must also be outlined.

Schools are also encouraged to provide educational workshops for parents that address issues related to sexual and gender identity, ways of talking at home about bullying (with both victims and perpetrators), and ways to discuss diversity and acceptance beyond the school setting. These conversations should include information that is pertinent and specific to LGBTQ students.

As a universal approach, teachers should be encouraged to incorporate LGBTQ-affirming curricula into their existing core areas of focus at the elementary, middle and high school levels as developmentally appropriate. School counselors also need to include examples of LGBTQ populations and the issues they face in classroom guidance lessons and when promoting positive behavior intervention and character education programs at their schools. Positive recognition of LGBTQ students, parents, staff and community members can also help to promote a more accepting environment overall. Additionally, it is beneficial to foster support from those involved in athletics and other extracurricular activities. This includes recruiting the active assistance and endorsement of coaches and athletes regarding LGBTQ students.

In addition to schoolwide interventions, schools can better support LGBTQ students by providing small group and individual services designed specifically for them. Safe zones/diversity rooms can be designated to serve as a resource for LGBTQ student needs or concerns. These spaces should be run by the school counselor or other trained staff and must respect the confidentiality of the students who use them. These spaces can serve as a safe, supportive environment for LGBTQ and other students to discuss issues they are facing. In addition, they can serve as resource rooms stocked with helpful books, flyers and other materials.

School counselors can also facilitate support groups specifically for LGBTQ students, allowing them to openly discuss their experiences, process their thoughts and feelings, and develop coping strategies. Group topics could include local and national resources available for LGBTQ individuals, LGBTQ role models, family relationships, intimate relationships, coming out, personal and professional issues that LGBTQ individuals encounter, and information about higher education institutions that are affirming of LGBTQ individuals.

Support groups for parents of LGBTQ students should also be offered. These groups would address ways for these parents to support their children. The groups would also provide a forum for parents to share their experiences and concerns with each other and with the school. In addition, many schools now offer a Gay-Straight Alliance (GSA), a student-led organization with a faculty adviser that typically meets to learn about issues that LGBTQ students are facing. GSA is meant to be a group that promotes acceptance, social justice and advocacy. 

School counselors also make themselves available to all students for individual counseling. In many cases, they may be the only mental health professional that students have easy access to for support. It is therefore imperative that school counselors demonstrate cultural competency and provide a safe, affirming environment that includes acceptance and respect for all students.

School counselors need to be aware that LGBTQ students may not present with problems related to their sexuality or gender identity. School counselors also need to consider other contextual factors such as family dynamics when counseling LGBTQ students. In addition to providing leadership toward systemic change, counselors need to have an understanding of issues that specifically affect LGBTQ students on an individual basis. This understanding is achieved through an ongoing process that includes communicating with the local LGBTQ community, participating in continuing education opportunities about LGBTQ students, reading the latest research related to this population and familiarizing themselves with the legal and ethical mandates surrounding LGBTQ students. Most important, school counselors must engage in ongoing self-examination of their own biases, stereotypes and blind spots concerning all students.

The role of school counselors in advocating for LGBTQ students in school is critical. It is school counselors’ professional and ethical responsibility to ensure a safe and harassment-free learning environment for all youth. Connecting with parents and educating them on the continuum of gender and sexual identity can also be an important part of the process. Given counselors’ expertise and skills in supporting diversity and communicating difficult topics, they can play a central role in helping staff, administrators and students create schools that empower LGBTQ youth.

 

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Recommended resources from the authors

  • A Queer Endeavor (aqueerendeavor.org): This site provides educators, school staff, families and students with resources (videos, lesson plans, curriculum development best practices, textbook recommendations) to help support and create an inclusive school environment for sexual minority and gender-expansive students.
  • GLSEN Educator Resources (glsen.org/educate/resources): GLSEN is one of the nation’s largest advocacy groups focused on providing resources that promote the well-being of sexual minority and gender-expansive students in grades K-12. This site provides tools for schoolwide advocacy programming and lesson plans that are LGBTQ inclusive.
  • It’s Pronounced Metrosexual (itspronouncedmetrosexual.com): This site provides online resources (worksheets, videos, articles, books) about privilege and oppression overall, with an emphasis on educating society about topics related to sexual and gender identity. The site serves as a source of information for social justice advocates, researchers and clinicians.
  • American Psychological Association (APA) Safe and Supportive Schools Project (apa.org/pi/lgbt/programs/safe-supportive/default.aspx): APA’s Safe and Supportive Schools Project partners with five professional organizations, including the American Counseling Association and ASCA, to provide training and educational resources. The goal is to help school personnel, leaders of community organizations, parents and students to build positive, supportive and healthy environments that promote acceptance, allowing LGBTQ youth to thrive as their authentic selves.

 

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

Roberto L. Abreu is an assistant professor of counseling psychology at Tennessee State University. His research agenda focuses on the well-being of LGBTQ people of color, with specific attention to parental, school and community acceptance of Latinx LGBTQ youth. Contact him at rabreu@tnstate.edu.

Adriana G. McEachern is a professor emerita, a visiting associate professor and the program director for counselor education in the Department of Leadership and Professional Studies at Florida International University. She is a national certified counselor, certified rehabilitation counselor and licensed mental health counselor in Florida.

Jennifer Geddes Hall is a clinical assistant professor at Clemson University and a licensed professional counselor. She has more than 15 years’ experience working with children and teenagers as a school counselor and clinical mental health counselor in various community settings.

Maureen C. Kenny is a professor of counseling at Florida International University and director of the university’s clinical mental health counseling program.

 

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.

Working memory: A review for children’s mental health providers

By Jerrod Brown and Tracy Packiam Alloway October 1, 2018

Working memory is an essential cognitive skill that allows an individual to learn through the processing and manipulation of information. In other words, working memory is the process through which information is manipulated and then linked to other existing memories.

A wealth of research has investigated the capacity of working memory in children. Working memory is different from short-term memory, which simply stores pieces of information for a limited period of time. Working memory allows an individual to maintain information for use in intricate tasks such as higher-order thought, organization and planning, and language comprehension. Working memory also enables children to perform several important functions, including learning new information, comparing and contrasting different concepts, and making informed decisions.

Working memory is composed of three important tasks:

1) Maintaining new pieces of information for subsequent use

2) Filtering out information that is not relevant to the task at hand

3) Manipulating the relevant information to perform the given task (e.g., navigating to a destination)

Working memory capacity is dependent upon a number of abilities, including attention, behavioral control and cognitive flexibility. Attention is an individual’s ability to focus on a given task while blocking out distractions and other irrelevant information. Behavioral control is the ability to manage one’s impulses and emotions. Cognitive flexibility is the capacity to adapt to feedback and evolving needs.

Children affected by working memory deficits may experience a host of academic, behavioral and emotional issues. The deleterious impact of working memory deficits on academic achievement is apparent in students, from those entering preschool to young adults in college. These impairments may be even more pronounced among children who are affected by various problems related to mental health.

Deficits associated with working memory can negatively impact how a child navigates all areas of life, from academic performance to social interactions. As such, children’s mental health professionals should become familiar with working memory deficits and their impact on day-to-day functioning. Increased awareness and understanding of these problems will help professionals maximize the effectiveness of services provided to these children.

To that end, this article reviews multiple considerations related to working memory that all children’s mental health clinicians need to know.

 

Academic performance: In children, working memory has been linked to everything from academic performance to the symptoms of neurological, developmental and psychological disorders. Working memory is also important from kindergarten to the tertiary level, and is an excellent predictor of academic success, longitudinally.

Assessment: Working memory can be assessed in a reliable and valid manner in children as young as 3. Early identification of working memory deficits that are supported by appropriate interventions can lead to positive outcomes throughout the individual’s life span. A study of more than 3,000 students found that approximately 10 percent had working memory problems that led to learning difficulties in the classroom (see ncbi.nlm.nih.gov/pubmed/19467014). As such, early identification and intervention are key to long-term success.

Attention, behavioral and social problems: Several theories of cognitive processing posit that working memory plays an essential function in attention. In addition, deficits associated with working memory can sometimes contribute to problematic behaviors resulting in school-related and social consequences. This is especially the case when the child has not been properly assessed, treated and supported. One of the most consistent findings in research studies is that students with attention-deficit/hyperactivity disorder have poor working memory, particularly when they have to remember visual information, such as graphs or images.

Classroom difficulties: Working memory impairments often contribute to difficulties in the classroom. For example, students with working memory impairments may have trouble remembering instructions, completing complicated tasks, and comprehending and abiding by directions to solving a math problem or writing a sentence.

Creativity: Although relatively few studies have investigated the role of working memory in creativity, Larry Vandervert and colleagues have posited that working memory is one of the building blocks of creativity (see tandfonline.com/doi/abs/10.1080/10400410709336873). Their rationale hinges on the assumption that working memory serves as the “blackboard of the mind,” enabling an individual to manipulate and combine a variety of pieces of information and ideas in different ways. A study with college students reported that working memory was associated with one particular aspect of creativity — flexibility, which relates to breadth of thinking.

Environmental considerations: An important consideration for children with working memory deficits is limiting their exposure to environments and influences that could exacerbate such issues. These issues may include exposure to caregivers who abuse substances, neglect and maltreatment, and environments filled with chaos and chronic stress.

Importance of early identification: Working memory deficits in preschool may predict the likelihood of dropping out of high school. However, some research offers hope for the development of early interventions that strengthen working memory and the reduction of risk for dropping out of high school.

Information overload: Deficits in working memory can result in children experiencing information overload during learning-based activities. As a result, these children may act out behaviorally or withdraw socially. When misidentified or undertreated, these issues can negatively affect children’s emotional and behavioral health.

Intervention: Interventions that improve working memory hold the potential to positively benefit children’s classroom performance across a range of subjects (see ncbi.nlm.nih.gov/pubmed/20018296). These gains were maintained eight months later (see sciencedirect.com/science/article/pii/S0747563212003032). As such, children’s mental health providers play a vital role in the identification and treatment of working memory deficits.

Learning performance: Problems meeting the learning requirements of school may be attributed to deficits in working memory. Working memory predicts reading and math performance among students with learning disabilities. These associations remain even when controlling for the student’s intelligence and knowledge of language and math. These issues can persist across the child’s life span when such deficits have not been identified, treated and supported.

Learning styles: A prevalent argument in the education research community is that learning styles have a significant influence on how well students will do in school. The learning styles theory argues that individuals learn best in different ways. A popular framework for learning styles is one that separates Verbalizers from Visualizers, and Holistic thinkers from Analytical ones. A study with high schoolers found that students with good working memory excelled at all subjects, regardless of their learning style preference. One explanation is that although students may have a certain preference for acquiring knowledge, those with good working memory won’t be held back if information is not presented in their preferred learning style because they can adapt their learning style to different learning situations.

Note taking: The inability to remember several manageable pieces of information while performing another task such as taking notes on a lecture is an example of a working memory deficit. This can present challenges in group treatment settings in which participants are required to take notes while listening to a live lecture.

Problem-solving: Enhanced working memory capacity can result in improvements in the ability to learn and to solve problems. When working memory is impaired, decision-making and problem-solving abilities can be negatively affected. Treatment providers should consider screening clients for working memory impairments when decision-making and problem-solving abilities are impaired.

Theory of Mind: Theory of Mind (ToM) is the skill to appreciate that the conduct of others is motivated by their opinions, wishes and other mental states. The maturation of ToM has been linked to the cognitive development of both behavioral control and working memory. Working memory has also been linked to false belief and verbal deception in 6- and 7-year-olds.

Thought suppression: Research suggests that working memory could play an important role in the suppression of unwanted or obsessive thoughts. As such, helping children strengthen their working memory capacity should be considered when providing supports and services to individuals struggling to cope with such thoughts.

Trauma: Working memory deficits have been observed in individuals suffering from posttraumatic stress disorder (PTSD). In particular, common PTSD symptoms such as hypervigilance, reliving trauma memories and avoidance of reminders of trauma may interfere with working memory processes.

Underidentification: Despite the previously mentioned consequences, working memory deficits often go unrecognized and untreated in children’s mental health settings. In some instances, professionals may misinterpret working memory impairments as issues with behavior, impulse control and attention. In a survey of classroom teachers, most knew what working memory was but were able to correctly identify only one or two classroom behaviors associated with working memory deficits.

Understand: Professionals should strive to understand the potential consequences associated with working memory deficits in children. Exploration of how working memory deficits may affect academic, emotional, social and interpersonal capacities is of significant importance. Children’s mental health treatment providers should consider incorporating working memory screening and intervention strategies into their clinical programming.

 

Conclusion

Deficits associated with working memory can have profound and diverse impacts on children. Mental health providers are likely to encounter children on a regular basis who are affected by working memory deficits. To minimize the consequences of working memory deficits, clinicians should become more familiar with the implications these problems have on screening and assessment, treatment and educational outcomes, and social functioning abilities. We highly recommend advanced training in working memory for professionals who provide children’s mental health services.

 

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Jerrod Brown is an assistant professor and director of the master’s degree program in human services with an emphasis in forensic behavioral health at Concordia University in Minnesota. He has also been employed with Pathways Counseling Center in St. Paul for the past 15 years. He is the founder and CEO of the American Institute for the Advancement of Forensic Studies and editor-in-chief of Forensic Scholars Today and the Journal of Special Populations. For a complete list of references used in this article, contact him at Jerrod01234Brown@live.com.

 

Tracy Packiam Alloway is a TEDx speaker and an award-winning psychologist. Her research has contributed to scientific understanding of working memory, specifically in relation to education and learning needs. Her research has been featured on or by Good Morning America, Today, Forbes, Bloomberg, The Washington Post, Newsweek and others.

 

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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.

Superheroes and play therapy: The perfect imaginary combination

By Jetaun Bailey and Tonya Davis July 9, 2018

Superheroes have a profound influence on American culture. Recently, Marvel Comics’ Black Panther came to life on the movie screen. It appears the movie had a twofold impact.

First, it brought heroic life to a seemingly little-known character. Second, unlike most other big-screen superhero movies, Black Panther placed value on social consciousness, awareness, community, family and pride. It broke boundaries that went beyond simply box-office sales, introducing a male of presumably African descent as the superhero. During the movie’s opening weekend, many news outlets showed young African American children wearing their dashikis as a symbol of pride in the African ancestry depicted in the movie.

As a culture, we hold our superheroes in high esteem, even if they are fictional characters. Thanks to Black Panther, many African American boys can identify with a superhero for the first time. This experience has likely heightened the imaginations of many African American boys as they imitate characters from Black Panther in their play.

Escaping to the imaginary worlds of our superheroes seemingly has therapeutic powers. Author and blogger Remez Sasson describes imagination as the mental ability to formulate an image that is not tangible through our five senses. For young children, an even deeper escape possibly occurs when watching these types of movies. The imagination is a powerful tool for children, as reported by Patti Teel in Pathways to Family Wellness magazine. When children imagine, they can visualize their heart’s desire, thus welcoming it into their reality.

 

Reaching beyond traditional play therapy

The therapeutic power of imagination is also evident in various therapy practices, specifically play therapy. According to “Helping a Child Through Play Therapy” by Jane Framingham, adults mistakenly think that child’s play is solely for fun and games or to occupy time. Unbeknownst to these adults, through creative and imaginative play, children are developing cognitively and emotionally while improving their self-worth, positive self-image, and communication and coping skills. For those reasons, play can be therapeutic in helping children overcome challenges that might inhibit developmental growth.

To tap into children’s imaginations and gain deeper understanding of their problems, play therapists are reaching beyond traditional play therapy tools such as sand trays, crayons, paints, animals, toys and dolls. Technology appears to have revolutionized the art of play therapy, thus making it easily accessible to counselors. This can be especially important for school counselors, who work in settings in which the counseling process is often limited because of the other administrative duties assigned to them.

Technology-based programs such as Marvel’s Superhero Avatar Creator and DC Super Friends Super Hero Creator represent the infusion of electronic media into play therapy. Based on “The iPad Playroom: A Therapeutic Technique” by Marilyn Snow and colleagues, the infusion of technology increases the imagination and creativity of the child by allowing the child to create media, pictures and other artwork while the therapist is present, either in conjunction with or separate from the therapist. For example, many applications are available to aid children in fueling their imaginations to create family dynamics or events through drawing and colors that possibly hold symbolism to their presenting problems. This invites the opportunity for metaphors to help solve real-world problems.

 

An ideal therapeutic method

This method of integrating superheroes through a technology approach in play therapy potentially could be an ideal therapeutic method of working with children, especially African American males, in the school setting. It appears to offer a nonintrusive approach for getting students involved in counseling because it integrates technology and play without asking probing questions.

As former school counselors, we have been disturbed by the alarming rates of African American boys being suspended because of perceived aggressive behaviors. Through our lenses, we have seen many of these students struggling with low-self-esteem or low self-worth. Ironically, sometimes these issues are not apparent through traditional presentations such as withdrawing or isolating.

The adjustment between school and family cultures has proved problematic for African American males regarding understanding their importance and worth. This likely causes tension in the school setting, resulting in aggression. These adjustment issues, or inability to navigate from one situation to another, is better known as code-switching.

Eric Deggans, in “Learning How to Code-Switch: Humbling, But Necessary,” describes code-switching as beyond the exchange of two languages in a conversation. But in today’s diverse society, the term’s deeper meaning is shifting between different cultures to move through life’s conversations. Deggans, an African American man, implies that code-switching is an essential tool for African Americans to adjust culturally. Therefore, African American males are expected to recognize one set of rules in one setting and understand another set of rules in another setting while maintaining their identity.

 

Uses with a student

We have sought to address these adjustment issues with our African American male clients through the use of play therapy methods. Using the power of imagination in play therapy allows them to foster development and problem-solve issues that have been hindering their overall academic and emotional growth. In one case, Marvel’s Superhero Avatar Creator  was used with an African American male student who was having adjustment issues at school that produced aggressive behaviors both at school and at home. Although the nature of the school setting did not permit long-term therapy, this short-term approach showed significant positive results.

This student created a superhero avatar over the course of four sessions. During the creating phase, the student used his imagination to create a creature that had similar features and skin color to his own, thus solidifying the importance of identity and connection to the creature. Allowing the student autonomy in creating his creature aided in establishing the therapeutic relationship.

The student was able to arrange the way therapy was directed as the therapeutic relationship was established. Through the various stages of play therapy, from gaining insight to reorientation or reeducation, the therapeutic process became a playground in which the student could live out his imagination through his superhero in a way that was vivid and emotionally alive. This experience paved the way for deeper understanding of how the student perceived his school family in relation to his peers, faculty and staff, and his actual family. Through incorporation of a client-centered approach to play therapy, this student showed significant growth in his overall development and was thus able to transfer those skills (i.e., code-switching) between school and family relationships.

Once significant progress was made with the student, his parents were incorporated in one play therapy session. The student’s father decided to create a superhero avatar to bring life to his perceived role as the family protector. In retrospect, through this play therapy family activity, the father could see how his family viewed his role and their individual roles within the family.

The play therapy sessions, infused with the technology of creating superheroes, helped the student use his imagination to bring to life his own unique story and identity. In superhero stories, superheroes conquer their adversaries while overcoming their adversities. The ending of this student’s story depicted similar results.

This form of play therapy is a nonintrusive method that renders promising results by not asking direct questions, but rather allowing students to self-express through play. As such, we do not believe that the traditional mode of counseling would have achieved the same impact on this child’s growth and development. This lends support to the importance of expressive therapy for children, particularly African American boys. Expressive therapies can help children find their voices, especially through play-based techniques using superhero avatars.

 

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Jetaun Bailey, a former school counselor, is a certified school counselor, a licensed professional counselor supervisor and an assistant professor at Alabama A&M University. Contact Jetaun at Jetaun.bailey@aamu.edu or baileyjetaun@hotmail.com.

 

Tonya Davis, a former school counselor, is a nationally certified school psychologist, a licensed professional counselor supervisor and an assistant professor at Alabama A&M University.

 

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Related reading: See the upcoming September issue of Counseling Today magazine for an in-depth cover article on play therapy.

 

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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.

When bias turns into bullying

By Lindsey Phillips June 29, 2018

We all have our biases — but just because bias is a universal part of the human experience doesn’t mean it is something we should ever dismiss offhandedly, either in ourselves or others. That’s because bias has serious consequences, and when left unchecked, it can turn into bullying. A 2012 study of California middle and high school students published in the American Journal of Public Health found that 75 percent of all bullying originated from some type of bias against a person’s race, sexual orientation, religion, disability or other personal characteristic.

People often talk about bullying in general terms. But as Anneliese Singh, a professor of counseling and associate dean for the Office of Diversity, Equity and Inclusion at the University of Georgia, points out, “If you look more closely at ‘general bullying,’ what you’ll see is a lot of bias-based bullying.”

SeriaShia Chatters-Smith, an assistant professor of counselor education and coordinator of the clinical mental health counseling in schools and communities program at the Pennsylvania State University, defines bias-based bullying as bullying that is specifically based on an individual’s identifying characteristics, such as race/ethnicity, gender, sexual orientation or weight. For example, adolescents might create Snapchat stories that attack someone on the basis of their race, weight or sexual orientation, and parents or teachers might treat children differently on the basis of their skin color, notes Chatters-Smith, an ACA member who presented on “Bullying Among Diverse Populations” at the ACA 2017 Conference & Expo in San Francisco. Research indicates that individuals of color, particularly black and Hispanic men, are more likely to be identified as being aggressive, she adds.

In her research on transgender people, Singh, who co-founded the Georgia Safe Schools Coalition and founded the Trans Resilience Project, has found that bias-based bullying can be based on appearance, gender expression or gender identity, and it can range from name-calling to physical and sexual harassment and assault.

A four-letter word

When people start talking about someone having a bias, those four letters typically trigger a negative reaction and shut down conversation, which isn’t productive. Thus, Chatters-Smith argues that helping people understand that everyone has biases is crucial to addressing bias-based bullying.

However, this task can be difficult because people often resist closely exploring their own prejudices. Counselors should help clients realize that just because everyone has biases doesn’t mean they are excused from recognizing and addressing their own, Chatters-Smith argues.

Because bias is often an emotionally charged topic, Chatters-Smith finds it helpful to start with a nonthreatening example. After pointing out bias, she asks clients when they first identified something as their favorite color. Most people can’t remember when this color preference started because they were young, Chatters-Smith says. She explains how after someone establishes a color preference, the brain starts to sort things by that color.

“When you see something that is your favorite color, you are more likely to gravitate toward it. You have more positive feelings toward cars that are your favorite color. … And sometimes a car may not be the best-looking car, but because it’s our favorite color, we gravitate toward it. That is bias,” Chatters-Smith explains.

Bias is a kind of sorting process that our brain goes through, she continues. “The experiences that we have with individuals can then cause us to have specific attitudes toward someone, and when we see them, we prejudge that they are going to act or be a certain way because of those experiences. … We do an automatic sort.”

Counselors are not immune to bias either. For example, a counselor might assume that a black male client who is unemployed did something to cause his unemployment, Chatters-Smith says. If this happens, the counselor needs to take a step back and ask why he or she is entertaining that assumption, she continues.

These internalized biases can also have a direct effect on students. For example, Singh says, LGBTQ students will not feel safe reporting bias-based bullying by their peers when they hear educators or school counselors expressing anti-queer or anti-trans views. Educators can also hold bias against students in special education, which may limit the opportunities those students have to learn, she adds.

Singh, an American Counseling Association member and licensed professional clinical counselor in Georgia, finds cognitive behavior therapy (CBT) helpful because challenging irrational thoughts is at the heart of addressing bias-based bullying. Thus, counselors need to ask clients and themselves some CBT-related questions: Where did you learn this thought? What research supports this idea?

Counselors “have to become strong advocates in order to interrupt those beliefs systems because the person enacting them — whether or not they’re conscious [of it] — isn’t going to stop until there’s an advocacy intervention,” Singh says.

After making clients (or educators) aware of bias, counselors can work with them to figure out times that they might have sorted a person into a category before getting to know that person and then brainstorm ways to manage that differently in the future.

Counselors can also benefit from bias-based bullying training. In working with Stand for State, a bystander intervention program at Penn State, Chatters-Smith found that certain questions or situations related to bias would cause the counselors participating in the bias-based education to pause or stumble. “A person who is not educated to know [how to respond] can get really thrown off guard,” she says.

Chatters-Smith knows from experience. Once in a workshop, she mentioned how saying that all Jewish people are good with money is an example of a racially charged joke. One of the participants responded, “But all Jewish people are good with money.”

Chatters-Smith questioned this statement by asking, “Really? All Jewish people? Where does this stereotype come from? Is this a racially based stereotype that is meant in a negative way?”

“One of the most damaging things that can happen in [a] workshop is if a bias educator is perpetuating bias,” Chatters-Smith contends. This experience helped her realize that the trainers themselves needed training to be effective at bias and discrimination education. She is currently developing workshops and a workbook that will allow counselors to practice answering questions and go through specific scenarios related to bias-based bullying to help them gain confidence and knowledge in handling these challenging situations.

Uncovering bias

A counselor’s role is to interrupt the systems of bias-based bullying, Singh argues. This process starts with the intake assessment, which should clearly define what bias-based bullying is and provide examples, she continues.

Counselors need to ask upfront questions about bias and harassment in counseling to let clients know that these issues exist and that they affect mental health, Chatters-Smith says. The best way to know if it is happening is to ask, she adds.

Of course, when assessing clients, counselors can also be alert to signs that bias-based bullying may be occurring. Anxiety or fear of being bullied may cause younger children to wet their beds at certain times of the year (right before school starts, for example) or to avoid public bathrooms, Chatters-Smith notes. She advises school counselors to pay close attention to the dynamics between students in the cafeteria. “A child can be sitting at a table full of kids because they don’t want to sit alone, but no one is interacting with them. No one is talking to them. They’re purposely being excluded,” she says.

Singh and Chatters-Smith also urge counselors to watch for signs of depression or anxiety, client withdrawal, client complaints that are not tied to anything specific, chronic tardiness, or changes in client behavior such as nervousness, avoiding school or sessions, or missing certain classes.

Counselors should exercise the same level of vigilance with young adult and adult clients. Chatters-Smith finds that counselors often fail to factor in the isolation, feeling of being ostracized and lack of belonging that some minority college students experience at predominantly white institutions. Counselors “know all of [these factors] impact mental health from [the] K-12 research of bullying but seem to forget about it when people graduate from high school,” she argues.

In addition, counselors often “do not factor in the cultural pieces of experiencing bias-based bullying at work. It manifests itself differently,” Chatters-Smith says. For example, individuals may go on short-term or long-term disability, or bullying may result in harassment claims or absenteeism from work. In certain instances, clients may not be able to put a finger on the core issue causing them not to enjoy the workplace, or they find that for some unknown reason, they can’t please a co-worker or employer, she says.

Sometimes, clients don’t even recognize that bias-based bullying could be an issue until the counselor brings it up, Chatters-Smith adds. Thus, she advises counselors to ask questions such as “Have you experienced any prejudice or discrimination at work?” or “Do you have increased anxiety around yearly evaluations for work?”

“In any organization that has built-in hierarchies, bullying [is likely] to occur,” Chatters-Smith says. For example, in the military, transgender individuals still face discrimination, and often discrimination is based on race or socioeconomic status, such as enlisted individuals versus officers who require a college education and receive more money and leadership positions, she explains.

Avoiding assumptions

When people are introduced to the concept of bias-based bullying, they often assume that it involves someone from a dominant group bullying someone from an oppressed group. “When you think about bias-based bullying, typically people are going to gravitate toward majority [versus] minority … but at the same time, it can happen within group,” points out Cassandra Storlie, an assistant professor of counselor education and supervision at Kent State University. She cautions counselors not to overlook the possibility of intracultural bullying because it does happen. For example, a Latino child may bully another Latino child because that child doesn’t speak Spanish, or an individual may bully someone else of the same ethnicity because that person’s skin color is judged to be “too dark” or “too light.”

Just because someone is oppressed does not mean that they can’t be oppressing others, Chatters-Smith emphasizes. “For centuries … African Americans have bullied each other based on darker complexion versus lighter complexion, and the same thing happens in Latino and Hispanic groups as well,” she says. “What makes it identity based and bias based is because there are biases that come along with the perspectives of individuals who are of darker skin. Even though it’s within a specific racial category, the bias is still there, and then the individual still has the psychological impact because they’re being bullied just for who they are.”

In addition, although people of color have a higher likelihood of being bullied in predominantly white settings, bias-based bullying can still occur when they are in settings with higher diversity, Chatters-Smith notes. The bias may just take another form and be based on characteristics other than race, such as sexual orientation, she explains.

Within transgender communities, someone who is more binary identified and operates with certain gender stereotypes may discriminate against another transgender person for not looking enough like a woman or a man, says Singh, a past president of both the Southern Association for Counselor Education and Supervision and the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling. Within-group bullying is particularly painful to the individuals who experience it because the group is supposed to be their source of support and belonging, she says. 

Singh also points out that bias-based bullying can be targeted at anyone based on how he or she is perceived. “If they’re perceived to step out of a gender or sexual orientation box, even if they don’t have that identity, they may experience [bias-based bullying].” In fact, Singh says, a substantial amount of anti-queer and anti-trans bullying is actually experienced by cisgender and straight people.

Creating a positive, safe environment

“Ethnic identities are strong protective factors,” says Storlie, president-elect of the North Central Association for Counselor Education and Supervision. She encourages counselors to find ways to celebrate cultures and differences. If counselors are practicing in a school district or community that isn’t taking preventative measures against bias-based bullying and being inclusive and advocating for all students, then they need to take initiative and educate those communities, Storlie says.

One approach that Storlie, an ACA member and a licensed professional counselor with supervisory designation in Ohio, suggests is to mention how diverse populations are increasing. In fact, according to the National Center for Education Statistics, the percentage of white students enrolled in public elementary and secondary schools decreased to less than 50 percent in 2014, while minority students (black, Hispanic, Asian, Pacific Islander, American Indian/Alaska Native and those of two or more races) made up at least 75 percent of the total enrollment in approximately 30 percent of these schools.

Storlie works with a school district that has Ohio’s second-highest number of students who speak English as a second language. Roughly 50 percent of the student body is Latino — up from approximately 2 percent only two decades ago.

When Storlie first walked into the school district, she couldn’t find any Spanish on the walls of the schools or in school materials, but since she started working with the educators and teachers, all of the school district’s documents are translated. “If you’re handing this information out to students … you’ve got to make sure it’s in the right language,” she argues.

Schools are in transition now because of increased diversity, Storlie notes. “It’s happening across the country where teachers don’t look like the kids that they’re teaching anymore, and they have stereotypes that can be pervasive,” she observes. Thus, counselors need to work with educators and communities to ensure that they are being inclusive.

Storlie advises counselors to facilitate events such as English classes for parents whose first language is not English to improve communication between teachers and parents, and workshops to educate parents, school personnel and the community on bias-based bullying. Counselors might also provide workshops for school personnel on multicultural competency, she says.

The Human Rights Campaign Foundation’s Welcoming Schools program is one helpful resource, Chatters-Smith says. The program provides training and resources such as recommended books, lesson plans and videos to school educators to help them create inclusive, supportive school environments and aid them in preventing bias-based bullying.

Building strong relationships

Storlie has found that teachers and school personnel who instill hope in their students — regardless of any identifying characteristic — have the best outcomes. These students often have higher levels of school engagement, demonstrate greater resilience and enjoy more academic success.

The therapeutic relationship can play a central role in instilling hope and achieving these positive outcomes, Storlie argues. For that reason, she adds, counselors shouldn’t become so focused on theories and techniques that they forget what it means to foster a good relationship with their clients. Among individuals who have been oppressed or marginalized, there is often an “us versus them” attitude, so the challenge for counselors is finding a way to reconnect and develop the relationship, Storlie says.

Trust is one key component of building a strong relationship with clients. However, Chatters-Smith has found that adults don’t always trust children’s reports of bias and discrimination. In her private practice, Chatters-Smith often works with children of color who report that no one believes them when they complain about bias-based bullying. Over time, this disbelief can result in their silence. Thus, she emphasizes, it is crucial that counselors believe children when they report having experienced bias-based bullying and discrimination.

In addition, Storlie stresses the importance of taking a team approach to bias-based bullying. “You can’t do it solo. … You really have to have the team approach because that’s how change happens,” she says. This is especially true for school counselors confronted with high student-to-counselor ratios, she adds.

When school counselors notice bias-based bullying in their schools, they should connect with other leaders in the school district and position themselves as a part of the leadership team, Storlie advises. Then, in this leadership position, counselors can educate school personnel on warning signs and interventions for bias-based bullying, thereby creating a team approach to intervening, she explains.

School counselors should also strive to work with families to address bias-based bullying. Because family members’ work schedules may not coincide with school system hours, counselors might have to get creative to find ways to reach families, Storlie continues. “School counselors who stay in their offices are not going to be able to reach families the same way that … [counselors] doing outreach with families would,” she adds.

In Storlie’s work with undocumented Latino youth, she found that the school counselors who were present, who made a point of getting out of their offices and who were visible to parents — for example, showing up at basketball games after school hours — enjoyed the most effective relationships with families and students. Their students were also more receptive to looking ahead and thinking about their future careers, she adds.

Bystander intervention

“What hurts [children] typically is not specifically the bullying itself. What hurts them is the other children around who stand and watch it happen,” Chatters-Smith asserts. The inaction and silence of bystanders causes people who are bullied to feel depressed and isolated, and it feeds into dysfunctional thinking that they are not good enough and no one cares about them, she adds.

In workshops, Chatters-Smith uses an active witnessing program to train people how to respond to discrimination and bias. Because bias-based bullying is often verbal, onlookers can state that they disagree with what is being said and question the validity of the biased comment, she elaborates. Bystanders can also support the person being bullied by telling them they are not alone or calling for help, she says.

Bystanders can also help people who commit the offense to self-reflect by asking them to repeat what they said and letting them know that it was hurtful, Chatters-Smith continues. If a bystander doesn’t feel safe to intervene at the time of the incident, they can later call a manager (if the bullying incident happened in an establishment or organization) or notify someone about what they witnessed, she advises.

Chatters-Smith has also used ABC’s What Would You Do? — a hidden-camera TV program that acts out scenes of conflict to see if bystanders intervene — in her workshops. She plays the scenarios from the show but not the bystanders’ reactions. Instead, she has workshop participants use the skills they have learned in the workshop to see how they would respond.

The more aware counselors become of bias, prejudice and discrimination in their day-to-day lives, the more it will affect them in their work with clients, Chatters-Smith says. “Practice is what helps us move forward as individuals,” she explains. “When you are at the store, when you are eating in a restaurant, when you are in the mall, when you see these things happening, if you feel [like you] know what to do, you’ll become more aware of what it is and you’ll feel more confident at not only being able to intervene and be empowered in your everyday life but also being able to talk to your clients about their experiences.”

Storlie and Singh both tout training student leaders as an effective approach to preventing bias-based bullying. Often, students — not counselors — are the ones who hear about or witness these instances of bullying. So, counselors can work with these student leader groups to teach them how to intervene, Storlie says.

Another way to create a team approach to bias-based bullying intervention is through the use of popular opinion leaders, Singh says. With this approach, school counselors and teachers nominate student leaders who represent different groups in the school (à la The Breakfast Club). With the counselor’s guidance, these students discuss bias-based bullying, what they’ve noticed and how they might be able to change it. Then, after learning bias-based bullying interventions, the popular opinion leaders try them out and report on which ones worked and which ones didn’t, Singh explains.

An ongoing issue 

Singh warns of the danger of minimalizing bias-based bullying — such as saying that people “don’t mean it” — because it sends a message that it is OK to have bias. Comments that dismiss bias-based bullying “can really add up over time in the form of microaggressions for transgender people,” she argues. “But, more importantly, [these comments create] a hostile environment in society, and that hostile environment in society can set transgender people up for experiencing violence.”

“When children grow up in an environment where they are taught implicit and explicit messages about whose identities matter and whose don’t, and then there’s power attached to that, then you’re going to see those negative health outcomes,” Singh argues. “And they’re not just negative health outcomes and disparities. They’re verbal, physical and sexual harassment that play out across people’s bodies and communities. Those microaggressions add up to macroaggressions on a larger scale.”

Apologizing isn’t the answer either. Often, people who bully, commit a microaggression or say something prejudiced will apologize by saying that they didn’t intend it that way, Chatters-Smith says. “It’s not intent that matters. It’s impact. … Whether or not you intended it, it doesn’t matter. It hurt the person.”

One possible solution is to start bias education at a young age so that over the life span, people are more aware of bias-based bullying and discrimination, Singh says. Counselors can challenge the internalized stereotypes that people learn in society about themselves and others and counter those biased messages with real-life experiences and compassion, she adds.

Education and awareness are key because bias-based bullying is an ongoing issue. “[Bias] is not going to go away. … People are going to find a way to treat each other differently. I think that what will change is more and more people not accepting it,” Chatters-Smith says.

This past spring, social media revealed another case of discrimination when two black men who were waiting for a friend were arrested at a Starbucks in Philadelphia on suspicion of trespassing. The incident might have received little notice except that a white woman posted a video of the arrest on Twitter and challenged the injustice, which prompted protests. Starbucks responded by apologizing and announcing that it would close thousands of stores for an afternoon to conduct racial bias training in May.

Even though this injustice never should have occurred, the public outcry sent a message that these two men were not alone and that bias is not acceptable, Chatters-Smith says. “The intervention is what’s going to change [things],” she says. “If we have more eyes on it, hopefully we can reduce the impact and reduce the duration and the longevity of the impact of these instances.”

Chatters-Smith, Singh and Storlie all agree that counselors have an important role to play in educating people about bias and building strong partnerships between educators, parents, students and communities. “[Counselors] are in the business of helping people challenge inaccurate, internalized thoughts,” Singh points out. “Counselors have to challenge those thoughts and help rebuild beliefs systems that include the value of a wide variety of social identities.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at consulting@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.