Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Investigating the impact of barbershops on African American males’ mental health

By Marcie Watkins, Jetaun Bailey and Bryan Gere May 13, 2021

Ralph Ellison, a famous African American novelist, literary critic and scholar, completed a series of essays in Shadow and Act that depicted the many social differences shaping Black and white America. He held the African American barbershop in high regard, proclaiming its significance as an institution as higher than secondary education for the African American male because it was a place of self-expression.

In Shadow and Act, Ellison writes, “There is no place like a Negro barbershop for hearing what Negroes really think. There is more unselfconscious affirmation to be found here on a Saturday than you can find in a Negro college in a month, or so it seems to me.”

This quote from Ellison reveals the historical impact that African American barbershops have had on the African American community in addressing a broad range of issues. It also reveals a foundational support for the therapeutic practices that take place in these barbershops.

During the time Ellison was writing the essays that would make up Shadow and Act, the nation was navigating uncharted waters, with many individuals, especially African Americans, demanding equal rights. Although there were many pressing issues, inequalities in relation to employment and education were considered foremost. African American males were greatly affected by discriminatory practices.

Today, unfortunately, some of these same inequalities still exist, despite major progress being achieved. A considerable body of research shows that the emotional impact of inequality can cause issues such as mild, moderate or severe depression, anxiety and other health-related issues, including high blood pressure, in connection with life stressors such as employment and finances. Although barbers are not typically formally trained to address psychological issues, African American barbershops do provide an avenue for individuals to express and address problems affecting their lives.

Researchers have identified several factors as being responsible for the emergence of the barbershop as the epicenter for African American mental health discourse. These factors include historical and cultural mistrust of health care professionals among the African American community and the low number of mental health professionals of color. Specifically, help-seeking behavior among African Americans has been conditioned by a distrust of formal health institutions and a leaning toward faith-based interventions.

The 2013 article “African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors” by Earlise Ward et al. attributed mental health stigma to increased rates of suicide in African American males, as well as problems with education, marital life, employment and overall quality of life. According to Felecia Wilkins’ 2019 article “Communicating mental illness in the Black American community,” fewer African American males tend to seek out mental health services to address their problems. It is possible, however, that African American men receive mental health services via alternative nonformal and nonmedical institutions such as the African American barbershop.

The nonjudgmental, discursive, yet intimate environment within barbershops engenders individuals to seek them out not only to socialize, but also to obtain and share information, including their personal concerns or challenges, from and with others. African American men with diverse challenges who need input and support to address their needs or to improve their personal well-being may thus consider the barbershop a viable platform for receiving solution-focused counsel and information.

African American barbers: Confidants and counselors

Many African American barbers have unique relationships with their clients, serving as confidants and informal counselors. The significance of this relationship has been captured over the years in several literary works and movies. For instance, in the 1988 movie Coming to America, we see comedic yet intense scenes between the African American barber and his customers regarding relationship advice. In the 2002 movie Barbershop, Eddie (played by Cedric the Entertainer) expounds on the historical roles the African American barber has occupied, including counselor, fashion expert and style coach.

Many might question why barbers are accorded such prominence within the African American community, and especially by African American men. As Erica Taylor explains in “Little Known Black History Fact: History of the Black Barbershop” on blackamericaweb.com, being a barber was the first notable position for newly freed African American males. Taylor further notes that sustainable financial security and professional integrity came along with the profession. Thus, it is likely that many African American men viewed the role of barbers as notable, even if wealthy white customers regarded the job as unskilled.

Historically, the African American community has looked at business ownership, and particularly barbershop ownership, as a symbol of prosperity. In a 1989 article titled “Black-owned businesses in the South, 1790-1880,” Loren Schweninger highlighted the barbering career of John Carruthers Stanly. Stanly, an emancipated slave, became one of North Carolina’s wealthiest businessmen. While in slavery, he owned a barbershop, and by the time he was freed by his owners, he had gained a favorable reputation due to his business skills. A related story found in the Colorado Virtual Library highlights the achievement of another businessman, Barney Ford, who started out as a barbershop owner and eventually became a hotelier and real estate magnate. Collectively, these cases and several others highlight the regard with which the African American community holds barbershops and their operators. African American barbers are viewed as respectable individuals who can be entrusted with the innermost feelings and emotions of members of the community, especially African American men.

In a 2010 Counseling Today article titled “Men welcome here,” Lynne Shallcross wrote that the barber’s chair is more welcoming and less fearful for most men than the therapist’s couch. Perhaps African American men have understood and internalized this notion and feel compelled to highlight the platform of African American barbers and their barbershops as environments that are nonintrusive and welcoming.

A 2019 article, “Lined up: Evolution of the Black barber shop,” captures the perspectives of African American barbers on the pivotal role played by barbers in both the economic and cultural development of African American communities from Buffalo, New York, to Riverside, California. These perspectives capture the display of emotional vulnerability by clients to their barbers. One of the barbers acknowledged the therapeutic practices that go on in the barbershop and his role as an informal therapist. This means that becoming a good barber inevitably requires one to be a good counselor or confidant because many individuals who present for haircuts also use the opportunity to discuss their personal problems, including challenges with mental health.

African American men and mental health issues

In the 2011 article “Use of professional and informal support by Black men with mental disorders,” Amanda Toler Woodward and colleagues reported that African American men are less likely to seek mental health services. At the same time, African American men have more life stressors that cause psychological distress than do other racial groups, according to an article written by K.O. Conner and colleagues in Aging and Mental Health. Specifically, African American men are more likely to be unemployed for longer periods and more likely to be exposed to violence, harassment and discrimination within their communities. Worse still, according to Conner and colleagues, African American men are more likely to be stigmatized due to mental health issues.

James Price and Jagdish Khubchandani, in an article titled “The changing characteristics of African-American adolescent suicides, 2001-2017,” reported an alarming rise in suicide among young African American men. According to the authors, the rate of African American male suicide increased 60% from 2001 to 2017, with young African American males more likely to die by suicide by using firearm (52%) or hanging/suffocating themselves (34%). Conner and colleagues stated that African American men continue to battle insurmountable odds related to unemployment, police brutality and other stressors that lead to increased emotional and psychological distress.

Research shows that within the African American community, mental health issues are rarely discussed, and especially related to how they impact individuals, groups, families and the community. Typically, African American men are socialized to handle difficulties or problems by themselves or with close friends and family members, not with the help of outsiders such as professional mental health service providers.

Programs such as the Confess Project understand the community’s influence in addressing issues related to mental health and overall well-being. Thus, the Confess Project created a solution to bridge the gap concerning the provision of mental health services by exploring the possibility of educating African American barbers. This relates back to Ellison’s position that the knowledge-based institution of the African American barbershop may stand above other institutions in addressing the mental health issues of African American males.

SFBT and the African American barber

The Confess Project Barber Coalition program seemingly utilizes a form of solution-focused brief therapy (SFBT), recognizing the barbers’ coaching abilities and assisting them to encourage African American males to speak about emotional health. Coaching, as defined by the website SkillsYouNeed, involves improving one’s agility, both mental and physical, by remaining in the present instead of the past or future. As noted by F.P. Bannink in a 2007 article, SFBT focuses on the fact that people’s ideas of the nature of their problems, competences and possible solutions are construed in daily life in communication with others. Daily life communication is a form of staying in the present, which is often observed in barbershops.

In a 2014 article, James Lightfoot noted that much of the strength of SFBT involves freeing the process from focusing too deeply on the problem and allowing more attention to be given to the solution and the future instead of the past. Unlike traditional therapy, which might keep clients stuck in their past by rehearsing traumatic experiences, SFBT assists clients in positively looking toward the future to change their behavior.

Developed by Steven de Shazer and Insoo Kim Berg as a short-term intervention, SFBT focuses on problem identification and motivation, the miracle problem, possibility, hope, scaling/goal formation, exceptions, coping, confidence/strength and feedback. The core functioning therefore shifts the focus from mental illness to mental health and changes the role of the counselor from an active role to that of a facilitator or coach, according to Bannink. The seeming intention of the Confess Project is to promote mental health instead of mental illness in the African American community by way of African American barbershops.

Ellison’s quote ended with an understanding that African American barbershops provide an opportunity for self-expression. This has some connection to the “miracle question” proposed in SFBT, which allows clients to describe what they want out of therapy as a method of self-expression. Ellison and de Shazer thus subtly concede that the interactions in the barbershop and those that occur in SFBT are both modes of treatment that encourage and nurture forms of self-expression and emotional connection.

As a counselor and mental health advocate, I (Marcie Watkins) understand the mental health value of the barbershop in the African American community. My husband, Brandon, was a barber during the early stages of our marriage. I believe that he later selected a career in the counseling/human services field based on his experiences as a barber. My husband would often share that the barbershop was a place of community and weekly refuge for African American men. A sense of pride was established as a man with minimal budgetary resources could come to the barbershop for a haircut, therapy, relaxation and socialization — all in one package deal.

My husband stated that “to choose a barber to cut your hair and pay him your hard-earned money was a true sign of trust. If a man can trust you to cut his hair, he will trust you with every secret and problem, just as you would a therapist.” As such, the qualities of a therapist and a barber in the African American community are synonymous. Barbers hear about major life events because getting a haircut precedes weddings, funerals and any other special activity for which one needs “a fresh cut.” As such, my husband also stated, “When a man trusts you to make him look his best, he will trust you to tell you anything. That trust would also be transferred to his son and grandsons for many generations.”

As a mental health advocate, I forged partnerships with Jetaun Bailey and Bryan Gere, both of whom were professions at a historical Black university near my hometown, in educating African Americans on the importance of seeking and receiving mental health. During a conversation about mental health, Ellison’s quote was introduced, which led to a lengthy discussion among us. During our discussion, we shared experiences of observing dynamic exchanges in African American barbershops in which the owners/barbers seemingly served as facilitators/coaches and several patrons took on the role of group members. We also noted that the exchanges at times became heated. However, we noticed that the barber exuded characteristics similar to those of a group facilitator or coach — like those of an SFBT counselor — in controlling the conversations and making sure that everyone had a voice.

We also collectively agreed that a spirt of “call and response” had been infused in the exchanges between the patrons and the owners/barbers. Call and response is rooted in African American culture. This form of expression is interwoven in African American music, religious gatherings and public conversations. For example, a patron might use a solution-focused technique by asking a miracle question. The question might be “Man, what would you do if you had a million dollars?” A response might be “Get out of debt.” Thereafter, a call might be made by a patron or patrons: “Can I get an Amen?” As such, that patron is calling everyone to respond in unified agreement over the answer of “getting out of debt.”

The expression-type groups of author, educator and counselor Samuel Gladding, a past president of the American Counseling Association, can be closely aligned with call and response. Gladding recommends expression-type groups — such as those involving creative arts, music and literature —as ideal in reaching the African American population. These groups might mirror the outlets of how call and response is delivered. Gladding notes that commonly shared positive values among African Americans include creative expression.

It appears through our observation that with this call and response, the barbershop patrons remain in the present while being coached or guided by the barber, which is the core of the counseling relationship in SFBT. This discussion led to development of a presentation during Black History Month in spring 2019 at a historically Black university in Alabama. The presentation was titled “Investigating the Impact of Barbershops on African American Males’ Mental Health: Are Barbers Untrained Solution-Focused Counselors?”

Group Presentation

Approximately 75 participants, mostly students and some faculty and staff, attended our presentation that sparked much dialogue and generated some potential recommendations in getting African American men to seek formal counseling from more traditional avenues. Students were encouraged to interject throughout the presentation (like the call-and-response traditional method in the African American community) rather than waiting until the end. Therefore, if a student felt the need the comment, they were encouraged to raise their hands and wait for the presenter to acknowledge them to speak.

Based on feedback received from the participants, we cannot conclusively state that African American barbers possess innate characteristics that mirror those of SFBT counselors. Considering the responses received, it seems that African American barbers feature characteristics similar to those of client-centered counselors, because they are actively involved in the sharing process of the discussion, such as sharing their own personal struggles. Participants believed that this client-centered approach on the part of African American barbers was developed through years of listening and engaging with different people.

On the other hand, the participants felt that barbershop patrons generally possess the characteristics of solution-focused clients because they come to the barbershop knowing what they would like to express and discuss. This suggests that patrons are taking on the role of “expert” because they are able to open dialogue without any hesitation and anticipate a positive outcome. This might hint that SFBT could serve as an effective “gateway” therapy method for African American men. This approach could likely give them a sense of authority over their problems, thus leading them to explore more therapeutic approaches if their problems require deeper self-assessment.

Several of the students and a few of the staff members had once worked as trained and untrained barbers to support themselves while pursuing their education. They collectively agreed that the barbershop serves as a “one-stop” location for various businesses within the African American communities. In these barbershops, patrons can find flyers, brochures and pamphlets on everything from soul food restaurants to personal trainers. As such, one student stated, “So why not mental health?” He went on to suggest that grants could potentially be written by local and state agencies to conduct mental health presentations in barbershops periodically. He pointed out that impromptu presentations are routinely conducted in barbershops, such as someone promoting a hair show or concert.

Recommendations and conclusion

It is implied that African American men use supportive services in the community more than professional help for coping with life stressors. This method of support is not necessarily recognized through mainstream research, but it is acknowledged through other avenues, such as Ralph Ellison’s quote, as a place of self-expression. Although it does not replace professional counseling, the barbershop could be a window of opportunity for increasing mental health treatment for deeper psychological issues. As the literature reports, programs such as the Confess Project are successful in providing education to barbers to recognize mental health issues. Other mental health agencies could follow suit in reaching this population or simply networking with this organization. Mental health agencies that link with African American barbers will further promote and reshape their scope within the African American community because it will allow them to evolve from givers of advice to advocates in the mental health community.

It is assumed that some community support is instrumental in aiding mental health, and perhaps the African American barbershop should be further recognized as one of those support systems. By educating African American men through their most prized institution, the barbershop, perhaps mental health providers will be able to reach an upcoming generation that is suffering in silence.

A worthwhile goal would be to decrease/eliminate mental health stigma in the African American community by evolving the barber’s role as an advocate for change, because the legacy of the African American barbershop is deeply rooted. It was one of the few initial professions that gave African slaves and freed men financial stability, pride, voice and respectability, and it gave others a chance for self-expression. Moving forward, the institution can be used as a catalyst for change. This change can come in the form of stressing mental health instead of identifying mental illnesses.

Although SFBT could not be directly linked to the characteristics of an African American barber or its patrons as experts, the theory does promote mental health instead of mental illness. Mental health embodies our emotional, psychological and social connections, thus giving everyone a voice of self-expression instead of hiding behind the curtains of shame or stigma associated with mental illnesses.

 

****

Marcie Watkins is an associate licensed professional counselor, a doctoral student and co-owner of Solutions4Success. Contact Marcie at Solutions4success@att.net.

Jetaun Bailey is a licensed professional counselor, certified school counselor and evaluator. Contact Jetaun at BaileyJetaun@hotmail.com.

Bryan Gere is an assistant professor at the University of Maryland Eastern Shore and a certified rehabilitation counselor. Contact Bryan at Bryangere23@gmail.com.

****

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.

The unique challenges that face immigrant clients from Africa

By Stephen Kiuri Gitonga May 10, 2021

Immigrants to the United States have one goal in common: to attain the American dream. For many, this dream means leading a life with fewer struggles than they experienced in their countries of origin. Africa is the second-largest continent in the world, stretching from Senegal to Somali (west to east) and Tunisia to South Africa (north to south). It has 54 countries and a population of approximately 1.3 billion people. There are about 3,000 African tribes, each of which speaks its own language or dialect.

The most widely spoken languages in Africa include English, Arabic, Swahili, French, Portuguese, Akan, Hausa, Zulu, Amharic and Oromo. It can be easy for counselors in the United States to assume that one Black client is like the other Black client, when in fact one might have been born and brought up in the U.S. and the other might be a first-generation immigrant from Africa. Such an assumption would be disadvantageous to clients from Africa because their varied and diverse experiences would be ignored. If these experiences contribute to the client’s presenting problem and yet are disregarded or overlooked by the counselor, then treatment of the presenting problem would be challenging or even elusive. 

It is important for counselors to take stock of the unique challenges that afflict immigrants from Africa and could complicate their lives in the United States. Mental health counselors are encouraged to pay special attention when working with this population to address the presenting mental health problems and other issues unique to these clients that, if left unaddressed, could have a negative impact on their well-being.

Culture shock

Relocating from Africa to the United States is likely to be a culture shock for the immigrant client. In fact, many immigrants from Africa experience culture shock even before they travel to their new country. 

The process of securing a visa to travel to the U.S. is a daunting experience that takes months — and sometimes years — to complete. Applicants physically go to the U.S. Embassy offices in their countries or regions to attend interviews and complete official paperwork related to their travel. At these offices, they are likely to see armed white police officers in full gear, complete with duty belts, guns, sunglasses and other items dangling from the belts. Applicants may feel intimidated by the sight of these officers, having previously been accustomed to seeing Black police officers carrying gear that is less threatening. 

The interview determining potential receipt of a travel visa can go either way, and applicants are aware that if they are denied, they will not necessarily learn why they were not issued visas. Issuance of a visa is the prerogative of the immigration office. There is no provision for explanations in cases of denial, although candidates can submit new applications for consideration in the future. 

Once African immigrants actually travel to the U.S., they are likely to experience culture shock in multiple ways. Depending on such factors as their previous experience with international travel, their country of origin and the port of entry to the U.S., new immigrants may be shocked by the size of the cities, highways, forests, rivers and lakes, and the sheer amount of food that gets served on a plate. They also observe that cars generally carry fewer occupants than they are used to and that there are more people driving up and down the streets than people walking or using public transportation. Immigrants from Africa also quickly realize that they are a minority race in the United States — a stark contrast to their majority status in their country of origin.

Another cultural experience that may be shocking for the new immigrant from Africa is the sole use of English to communicate. Code-switching, which is common among people who are bilingual, is not possible when English is the only language in use. Other things they learn or observe include the high cost of living, differences in dressing, the prevalence of low-context interpersonal interactions, driving on the right side of the road, a love for sports that are unique to Americans, people who are homeless, panhandlers on the streets, and the menace of opioids, to name but a few. 

The COVID-19 pandemic has introduced another complication to the cultural experiences of immigrants from Africa. In line with their social nature, these individuals support one another whenever a member falls sick by visiting and helping with child care, cooking and other household chores. COVID-19 safety guidelines do not allow people to congregate, especially around someone diagnosed with the disease. While the COVID-19 pandemic was peaking, it was common for people to be buried in communal graves. From an African context, it is uncommon for a person to die and for the bereaved family to be unable to complete all the rituals associated with funerals. It may take time for immigrants from Africa to come to terms with these tragic experiences.

Past and present trauma

Depending on their country of origin, some immigrants from Africa may have preexisting posttraumatic stress disorder or other disorders that have gone untreated from such events as war, physical abuse, sexual abuse, accidents, displacement, political violence, intertribal clashes or terrorism. There is ongoing instability in such countries as Somalia, South Sudan, Chad, Ethiopia, the Democratic Republic of Congo, Libya and the Central African Republic, with many casualties every year. In Nigeria, there is ongoing violence instigated by the terrorist organization Boko Haram. 

Survivors of these instabilities may end up immigrating to the U.S. as refugees or enter the country under another status. Their traumatic experiences in their countries of origin, compounded by new traumatic experiences in the new country to which they have immigrated, can be challenging to treat. Many of these individuals may be unaware that they even have a treatable condition. 

Loneliness

Research points to the seriousness of loneliness to one’s mental health. People immigrating to the U.S. may suffer prolonged periods of loneliness before they form meaningful relationships within their host communities. Loneliness can be compounded by cases of rejection, discrimination, isolation, stereotyping, microaggression and so on in their new communities.

They are often unable to communicate on a regular basis with family members back in their country of origin because communication by mail can take a long time and international phone calls are expensive. Loneliness, coupled with other problems, can lead to depression or degenerate to suicidal ideation for this population. 

Language

Only a small minority of immigrants from Africa report English to be their first language. Most of them have learned other languages before English. Student immigrants from non-English-speaking countries encounter fewer problems because they are usually enrolled in English classes during the first semester of their respective programs. Others who were fluent in English in their country of origin are often surprised at how different American English is from other English dialects and accents. 

Fluency in language is important for self-expression and self-esteem. Immigrants who struggle with the English language might have a harder time adjusting to their new life in the U.S. Another disappointment they typically experience is inability to code-switch — i.e., switch from one language to another — like they were used to doing before their relocation. This is because most of the members of the majority culture with whom they now interact speak only in English. 

New identities

Immigrants from Africa are faced with changing their identities in multiple ways upon arrival in the U.S. For example, in their country of origin, there may have been certain activities and roles such as child care, cooking, driving, mowing the lawn, financial management and so on that were classified by gender. In the U.S., these responsibilities are more commonly shared between men and women. 

If African immigrants were wealthy back in their home country, they likely had employed the services of a live-in houseworker to help with such chores as child care, cleaning, laundry and cooking. These chores must now be shared between the couple irrespective of their gender. Assignment of these responsibilities is often a major source of discord among couples who have emigrated from Africa. That is because in many cultures in Africa, it is the responsibility of the woman to cook, clean, do laundry and take care of the children, irrespective of her other daily roles and responsibilities. Once the couple has immigrated to the U.S., it is often difficult for their families back in their country of origin to understand this new setup of shared responsibility. Families in the country of origin will often comment that the immigrants have lost their cultural identity.

Loss

Immigrants from Africa experience multiple losses as they settle in their new country. Examples of losses include identity, wealth, social status, family bonds, language, cultural traditions, freedom, innocence, traditional food, life goals, favorable climate and familiarity. Depending on the impact of these and other losses, immigrants from Africa may need mental health help to cope. 

It has been particularly challenging for African immigrants during the COVID-19 pandemic to deal with the resultant losses. They are used to living a social life in which they congregate for no apparent reason. During the pandemic, they have largely lost this aspect of their culture because of restrictions on in-person socializing. Likewise, when fellow community members are hospitalized, they cannot be visited. When people die from COVID-19, there is added pain due to restrictions on viewing the deceased or completing traditional funeral rites. Additionally, at the height of the pandemic, people who died from COVID-19 were buried in mass graves, while others were cremated. These are not common practices among many cultures from Africa.

Family relationships

There is a common tradition in Africa alluding to the fact that it takes a village to raise a child. Extended family members, relatives and neighbors are all expected to be involved in the well-being and development of growing children. Immigrant couples do not typically have the luxury of the village caring for their children in the U.S., whose dominant culture is individualistic rather than collectivistic. If these parents are busy at work, college or with other commitments, they take their children to day care for a fee because they are no longer surrounded by close family members or friends who would have cared for their children. This can become a major source of family relationship problems for immigrants from Africa, particularly when these fathers must change their traditional attitudes and beliefs to share responsibility for child care. 

Parenting is another source of strained relationships among African immigrant families. This is in part because the village is now absent, and the couple is left to care for their children with little outside help. In addition, parenting styles in the U.S. are different from parenting styles in Africa. African parents’ cultural practice of disciplining a child may be construed as child physical abuse in the U.S., potentially landing these parents in trouble with the law.

In Africa, the cost of raising a child is low in comparison with the U.S. For this reason, immigrant couples may decide to have fewer children or not have children at all. There are also differences between the first generation and second generation of immigrants from Africa. Second-generation children have greater exposure to the mainstream majority culture and are more likely to be influenced by it. Attempts by the parents to teach the second generation the value of maintaining their culture is often met with resistance, and this can strain family relationships.    

The American dream

The common belief among aspiring immigrants from Africa is that the American dream is easily attainable. Some interpret the dream to be good education, wealth, good health, affordable health insurance and stable income. 

While some immigrants do attain the American dream, others struggle. For the latter, the lack of attainment may become a source of self-pity, shame and guilt, particularly because their family back in their country of origin may not understand that not everyone in the U.S. is wealthy. Some begin to question why they immigrated and may consider immigrating back to their countries of origin. Problems could then arise if communication within the family is not effective.

Racism

The Black Lives Matter movement has unearthed social ills that have plagued the United States for many years. As a marginalized population, immigrants from Africa may be the targets and victims of discrimination, racism, bigotry, hatred, microaggression and other social ills often propagated by institutions that are supposed to protect them. 

Now that these ills have been widely exposed, there is a possibility that they will become added sources of anxiety and associated mental health issues. Questions may arise for these immigrants regarding how safe it is to continue living in a country where they are openly not wanted. Family and friends in their country of origin may begin to have similar questions and feelings and urge them to return home.

Education

When immigrants from Africa enter the U.S. on an F-1 student visa, they are expected to maintain their student status and follow the strict guidelines from the U.S. Citizenship and Immigration Services until they complete their studies. Some of the stipulations include maintaining full-time student status by taking the required number of courses per semester and maintaining passing grades. They are not allowed to seek employment without authorization. Such authorization, when granted, permits them to work for 20 hours per week on campus. 

The cost of higher education for international students is high. Many students are not able to afford tuition to complete their studies and may end up dropping out of school. When that happens, they lose their student visa status and begin the cat-and-mouse game of evading U.S. Immigration and Customs Enforcement for violating their immigration status. 

Students who complete their studies are granted the opportunity to apply for a change of status to become U.S. permanent residents, especially if they have completed graduate studies in high-demand programs such as software engineering, nursing, medicine, computer science and so on. The process takes time, but it is the safer route that most students follow to ensure their continued stay in the country and their eventual attainment of the American dream. Before that happens, they live in constant fear of being deported.

Acculturation

Over time, continued interaction between immigrants from Africa and the majority population in the U.S. results in acculturation. Immigrants pick and choose aspects of the majority culture to adopt and aspects of their respective cultures to retain. In a symbiotic and ideal relationship, the majority culture picks aspects of the immigrant population to adopt as well. It is important that counselors working with immigrant clients from Africa encourage them to maintain aspects of their culture that are meaningful to them, lest they lose their identity completely.

Another source of family conflict may happen when children abandon some of their family’s cultural aspects in favor of aspects of the majority culture. This occurs during the preteen and adolescent years when they are developing their identities, often influenced by the majority culture. It becomes a problem if their parents are not in favor of the adopted tenets of the majority culture. 

Drug and alcohol use

Alcohol in most African contexts is used to serve social and traditional purposes. With the mainly communal lifestyles, people look out for one another to avert misuse in a “brother’s keeper” sort of way. But these close relationships are largely or completely absent in African immigrants’ new country of residence. Here, they do not have close friends or family members to keep an eye out for them or with whom they can share their problems. 

Without education and awareness of mental health counseling, some immigrants from Africa turn to self-medication with alcohol, drugs or both. Addiction is now a serious problem afflicting African immigrants, and it is good practice to assess for drug and alcohol use, even if this is not the presenting issue brought to counseling. Left unchecked, drug and alcohol dependence could easily degenerate into a generational problem that afflicts current and future generations.

Treatment guidance

Professional counselors should consider the following items when working with clients who are
African immigrants.

> Assessment: Effective treatment begins with a thorough assessment. In addition to the issues brought to counseling, it is important for mental health counselors to assess for other issues that are not so obvious. For immigrant clients from Africa, counseling may still be a new concept. They might not be comfortable sharing their problems with strangers. Hence the need for counselors to select assessment instruments and procedures that are less intrusive. 

> Rapport: Research points to the significance of developing therapeutic rapport with clients early in the counseling process. It is also necessary to maintain this relationship throughout the counseling process. It will likely require additional effort to build and maintain a trusting relationship when working with immigrant clients from Africa because counseling may be a new concept for them. In addition, it may be necessary to educate these clients on what mental health counseling is all about and their roles and responsibilities in the counseling process. 

> Cultural sensitivity: Mental health counselors are cultural beings, and they bring their culture to the counseling relationship. It is vital for counselors to be constantly aware of their culture, including the biases, beliefs and stereotypes that they hold about immigrant clients from Africa. It is also imperative that counselors refrain from imposing their culture on these clients. 

It is beneficial for counselors to learn about the unique culture of their immigrant clients from Africa by setting time aside for cultural immersion and attending ethnicity-specific cultural activities from time to time. They will then use ethnicity-specific and evidence-based interventions to work with these clients. 

> Self-care and wellness: Mental health counseling can drain our emotions and energy. Therefore, mental health counselors should engage in a self-care regimen, maintaining regular self-care activities and schedules, to reenergize. Likewise, it may be helpful to educate our clients who are immigrants from Africa on how to engage in self-care and identify wellness strategies for their improved mental health and enhanced overall health.

 

****

Stephen Kiuri Gitonga is an assistant professor in the clinical mental health counseling program at Lock Haven University in Pennsylvania. He is a licensed clinical mental health counselor licensed to practice in Idaho, Kentucky, Utah and Pennsylvania. Contact him at skg200@lockhaven.edu.

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

****

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

Addressing the invisibility of Arab American issues in higher education

By Souzan Naser February 5, 2021

COVID-19 has wreaked havoc in just about everyone’s life, and it is not lost on me that individuals are deeply feeling the cost of this pandemic. Too many people are grieving the loss of loved ones, recovering from their own illnesses, suffering from food and housing insecurity, and coping with depression, anxiety and isolation. As we begin to settle in with a new presidential administration, we can begin to have a glimmer of hope that our country will take a more aggressive approach to managing the spread and treatment of COVID-19.

For me, the impact of the pandemic has been less severe, and I feel especially fortunate. I was reaching the midpoint of my sabbatical when the virus took hold and shelter-in-place orders were issued. Like many of those reading this article, I was scheduled to attend the April 2020 American Counseling Association Conference in San Diego, and I was thrilled to have been given the opportunity to present and facilitate a workshop. My presentation, adapted from my doctoral research, was to examine the paucity of Arab American cultural competency training available for college counseling professionals. I also planned to unpack the contemporary needs of Arab American students, their expectations when meeting with a counselor, and the factors that increase their likelihood of engaging with a mental health provider. I am passionate about this research, especially given the lack of adequate mental health services for Arab American students and how this affects their success.

In this piece, my aim is to amplify the micro-level personal concerns of Arab American students who participated in focus group sessions that I led, those whom I counsel and teach, and those more broadly who live in the Arab American community of Chicagoland (Chicago proper and its adjoining suburbs). I will also provide recommendations, based on feedback from students, so that we can keep pace with the contemporary challenges of this population and confidently assist them when they call on us for support while experiencing psychological distress.

Study background

Since 2015, I have been studying the preparedness of community college counselors to effectively engage with Arab American college students. Pre- and post-tests were used to assess counselors’ levels of cultural competency with Arab students. The post-tests were administered after counselors participated in a 90-minute professional development program called Understanding the Arab American College Student.

My study also included Arab American college students, who through a series of focus group sessions offered a rich critique of how the political landscape shapes their experiences and identities. The information they shared also captured the essence of who they are culturally, socially and religiously, and how they navigate their identities at home and school. They also shared the importance of having mental health practitioners who understand their worldview and can be turned to for support.

Background on Arab Americans

Arab American identities are vast and complex, and the Arab American students with whom counselors interact in their offices are just as diverse as the 22 countries these students emigrated from or have ancestral ties to: Algeria, Bahrain, Comoros Islands, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. Members of this community have been immigrating to the United States since the late 1800s and have long been a part of the fabric of American society, making significant economic, educational and political contributions. According to the Arab American Institute, which is one of the longest-standing Arab civic engagement organizations in the U.S., it is estimated that nearly 3.7 million Americans trace their roots to an Arab country. Although Arab Americans live in almost every part of the U.S., more than two-thirds of them reside in just 10 states: California, Michigan, New York, Florida, Texas, New Jersey, Illinois, Ohio, Pennsylvania and Virginia.

There are many assumptions about Arab Americans that can interfere with the therapeutic process and alliance. For instance, Arab and Muslim are not synonymous; in fact, over 60% of Arabs residing in the U.S. are Christian, not Muslim. Arab Americans may be first, second or third generation. Some are fluent in Arabic and English, whereas others may speak only one. Another commonly held misconception revolves around the citizenry status of Arabs. Of Arabs in the U.S., 82% are citizens, the majority of whom are native-born.

Misguided beliefs, stereotypes and popular assumptions may lead us to view members of this community as one-dimensional, but in fact, Arab American students are distinct, so each student should be regarded as an individual with unique experiences.

Political stress

Although we lack data on students who have an Arab background because they are expected to identify as white/Caucasian on most college and university admission forms, a few campuses such as the University of Illinois at Chicago have some data illustrating that Arab Americans make up a significant portion of the student body. Additionally, the college for which I work sits in a congressional district that has one of the largest concentrations of Palestinians in the U.S. It is clear that we also enroll a sizable number of other Arab American students. Because Arab American students constitute a significant percentage of the college population — while simultaneously facing targeting and various forms of racial/ethnic exclusion — it is imperative that our field incorporates a mental health framework that honors this population’s sociopolitical experiences and cultural and religious background.

In addition to facing many of the same challenges that college students generally encounter, such as navigating academic stress, negotiating relationships with friends, and deciding on a major, Arab students are subject to an ongoing and unrelentingly hostile political climate. These students, their families and their communities at large are dealing with the impact of anti-Arab and Islamophobic foreign and domestic policies such as the global war on terror, the Muslim travel ban, mass surveillance, and racial profiling programs promoted under the “countering violent extremism” framework. These policies and programs trickle down into Arab Americans’ everyday lives in the form of hate crimes, discrimination and a generalized sense of fear.

All of this can contribute to the development of mental health issues or exacerbate already-existing psychological disorders. Focus group participants shared how repressive policies shaped by the Trump administration (especially the Muslim travel ban executive order) translated into their everyday experiences of feeling anxious, alienated, intimidated and untrusting of institutions that are meant to be supportive. Several students at the time disclosed their feelings of uncertainty with comments such as, “Personally, I was scared during the election and when Trump became president,” “There’s still some fear that I have about what he can and cannot do to us as Arabs or Muslims,” and “The Muslim ban was very traumatizing, not just to me, but to people who could not come back to the States when they left for vacation.”

In failing to understand the political stress our Arab students are enduring, and by neglecting to engage in meaningful and elevated conversations about political issues that concern them, we run the risk of these students prematurely terminating sessions. Students in the focus group spent a considerable amount of time discussing the factors that would discourage them from returning to see a counselor. The following quotes highlight some of the factors mentioned:

  • “It has to be a judgment-free zone, and if it isn’t, then I wouldn’t return to counseling.”
  • “I don’t want to be judged or misunderstood based on what they’re hearing about Arab Americans in the media.”
  • “There has to be a connection. The counselor has to understand me as an Arab American.”

Culturally competent practitioners must be able to monitor their biases and examine how their own racial/ethnic backgrounds may play a role in forging an authentic relationship with Arab American students. One of the biases mental health professionals may hold that could influence their attitudes toward this population is associating all Arabs or all Muslims with a potentiality for criminality or terrorism. These associations are not held exclusively by professionals in our field. Rather, they are common misconceptions that are the product of government discourse, domestic policies and campaigns such as the global war on terror.

In my research, nearly 70% of the counselors surveyed agreed that many people may hold negative attitudes, stereotypes, preconceived notions and biases about Arab Americans. Other biases, steeped in corporate media, include the portrayal of Arab and Muslim women as docile and submissive — victims of a backward culture and religion from which they need to be rescued. A student who participated in the focus group sessions indicated that they “worry about how counselors get their information about us. Are they getting [it] from media outlets, and how does this impact the way counselors work with us?”

Despite our every attempt as professional counselors to be supportive of Arab and Muslim college students, applying a one-size-fits-all approach without critically examining our understanding of how anti-Arab racism and Islamophobia operate may not serve their best interests. While many counselors who are committed to diversity may have backgrounds in some social justice/racial issues, they usually lack training in the area of Arab American exclusion and discrimination.   

Cultural considerations

While social injustice is a factor to consider when working with Arab American students, they, like any other students, also need to sort through a wide range of micro-level challenges. Family issues, intergenerational dissonance, acculturative stress and identity confusion are just a few of the personal stressors that may compromise this population’s emotional well-being.

In Arab society, family is central. Family is the conduit through which cultural continuity is promoted and through which the rich traditions and values of the homeland are invoked. Both the immediate and extended family are heavily involved in the enculturation, upbringing and decision-making processes of the Arab American students you counsel. Counselors may find that even through adulthood, Arab American students will not make decisions in isolation. Rather, the expectation is that they will consult with members of their family before deciding on a course of action. Because they come from a collectivist society, in which the needs and wants of the group supersede those of the individual, these students may hesitate to act if a course of action or decision does not mirror the values of the family, does not benefit the collective or is considered shameful.

Whereas the dominant white middle-class U.S. values emphasize autonomy and freedom to make decisions without having to defer to others, cultural norms in Arab families dictate the opposite. As clinicians, we should consider how the practice of encouraging students to differentiate their individual identity from that of their family is antithetical to most Arab Americans. When our Arab American students are feeling obligated by their family to make a decision that does not necessarily satisfy their own desires, we should explore how we can assist them in negotiating an outcome that meets their need without being seen as a betrayal to their family.

Rather than viewing these distinct cultural forms as dysfunctional or expecting our Arab American students to align with Euro-North American-centric ideals in order to be healthy and feel supported, I propose that we use the inherent strengths of their own heritage, culture and values. By doing so, we are demonstrating an appreciation for their background and worldviews. Focus group participants shared the importance of integrating their cultural heritage when implementing therapeutic techniques. One participant stated, “Non-Arab counselors need a better understanding of who their Arab students are and the mechanisms our parents use to raise us.” Another suggested, “Counselors shouldn’t assume things about us; they should ask us about our values, beliefs and customs.”

Although it cannot be emphasized enough that family represents a core aspect of Arab culture, we also come to learn that honor, respect, morality, hospitality and generosity are other dominant features of this group. When working alongside Arab American students, it is useful to keep these cultural norms in mind so that these students will feel heard, understood and appreciated.

Intergenerational dissonance — another common source of stress for Arab American students — can arise when students are feeling pressured to hold steadfastly onto traditions of cultural heritage or religious values with which they no longer identify. Students shared the stress of negotiating relationships with their parents, and the acculturation differences between them, with these types of responses:

  • “Our parents worry about us becoming ‘Americanized’ and disregarding our traditions and religious practices.”
  • “I think there are a lot of struggles that Arab Americans face, especially if they were born in America but their families were not.”
  • “We feel obligated to do what our families expect of us.”

Students also candidly shared how intergenerational dissonance leads to other points of contention, including students wanting more freedom than the parents are willing to give, and the negotiation of romantic relationships, marriage and career choice.

Often in immigrant families, the children adopt dominant white middle-class U.S. values at a much faster pace than their parents do. This can cause disharmony and disruption in family functioning. According to psychologist and scholar John Berry, a number of factors, including age at immigration, language fluency and the reason for leaving the home country, determine the ease and comfort with which individuals adjust upon immigrating to the U.S.

During the course of my research and my years spent counseling Arab American students, I have learned that some of these students have assimilated with ease into mainstream U.S. life but have determined that it is equally important to them to maintain the richness and beauty of who they are as Arabs. They view themselves as members of a collectivist people with a strong extended family network, a rich heritage and culture that informs their way of living, and (for some) a religious framework from which they draw strength and guidance. These students have learned how to effectively and strategically weave in and out of the American and Arab in them; they have found a way to manage the conflicts associated with intergenerational dissonance.

Students who are struggling with identity confusion, and pushing back against familial pressures, want to explore the facets of their identity on their own terms. Focus group participants explained the challenges of trying to live “on the hyphen” (as in Arab-American) and navigating the contradictory worlds in which they live:

  • “I feel like Arab students are lost and don’t know how to act. They’re like in between and unsure if they are more Arab or more American.”
  • “Our families struggle with understanding what it’s like for their child to be an Arab living in America. We struggle with being American at school, and we struggle with being Arab at home.”
  • “I live both the Arab and American life, but I feel like non-Arabs see me as the other.”

Arab American students face ongoing angst caused by trying to live out their hyphen, which involves modifying and massaging the parts of their heritage that they want to maintain and embrace and discarding those that are no longer meaningful to them. Negotiating the complexities of their identity is further complicated by living in a hostile political landscape in which they are generally made to feel unwelcome and marginalized.

During the time of my study, Arab American students were in the thick of grappling with the realities of a newly elected president who was targeting members of their community with a travel ban and threats of deportation. Students spent considerable time processing how the election cycle and rhetoric from Donald Trump left them feeling vulnerable and affected their sense of belonging on campus. One student stated that Trump’s jingoistic sentiments during the election period “[bred] all kinds of hostility and hate, not just toward Arabs, but all other minorities, and the results have been disastrous.” According to a 2017 report by the Southern Poverty Law Center, hate crimes against Muslims grew by 67% in 2015, the year that Trump launched his campaign for president.

Arab American students’ sense of security has been punctured by a hostile climate that criminalizes and scrutinizes them. Students are telling us that it is a complicated time to be Arab or Muslim, and they need counseling professionals to have an understanding of how their identities are being shaped by the political landscape. Considering these conditions, how do we establish safety in the therapeutic encounter? How do we affirm these students’ humanity and obviate their concerns?

Counseling considerations

To establish culturally responsive care to Arab American students, we need to consider both the macro-level political stress that is causing these students harm and the micro-level challenges that affect their psychological well-being. As counselors, we have a unique opportunity to strengthen understanding of the contemporary challenges Arab American students face and the therapeutic measures we use to address them.

These students are informing us that they will benefit from counselors who are familiar with family dynamics, intergenerational dissonance and identity confusion. As counselors trained in Euro-North American counseling theory and technique, we need to critically examine the applicability of these models to the Arab American student and modify the strategies we use so that they complement the worldview of this population. If we fail to do so, we may mischaracterize cultural norms, beliefs, values and traditions as oppressive or primitive, which could inadvertently shame the students with whom we are working. We may also construe or unfairly judge these students’ family interactions as unhealthy with blurred boundaries, or consider them enmeshed and fused, interfering with individuation and differentiation of self.

These terms, inherent in Western models of family therapy, are incongruent with the Arab American family system. Applying these concepts may unknowingly leave these students feeling judged, misunderstood or misheard and could lead to premature termination of therapy. Instead, we should consider reframing our understanding of Arab American family dynamics by viewing these interactions as loving, caring and uplifting, and meant to provide unconditional support.

In addition to the factors previously mentioned, students shared other elements that would discourage them from returning to see a counselor:

  • “I had a counselor who would advise me or come up with solutions that were more appropriate for non-Arabs.”
  • “I was given solutions from counselors that do not match what I am looking for or who I am.”

Those who participated in the focus group also explicitly let us know that it is a trying time to be an Arab American student. They are traversing a hostile political climate that is causing them psychological distress. Being well-meaning and using the compassion that called us to this field may not suffice. As counselors, it is our duty to intentionally address any gaps in our knowledge base concerning the roles that culture, racism and oppression play in impeding these students’ abilities to function academically and personally. If we neglect to do so — and if misguided beliefs, popular assumptions or personal biases go unchecked — we may unintentionally revictimize these students. To eliminate the potential for harm, we can monitor our sensitivity to the historical and current oppressions that Arab American students experience. This can be accomplished in part by attending professional development opportunities that increase our understanding of this population’s sociopolitical, cultural and religious needs.

Finally, we can help these students re-create and reimagine the world they live in by acting as agents of change who advocate for and work alongside them to eliminate institutional discrimination. This includes having conversations with administrators to critically examine our campus communities to determine whether we are taking the necessary steps to promote a sense of belonging for this population.

Institutional responsibility includes counting Arab American students on admission forms and monitoring any inequities that could leave these students feeling vulnerable and paralyzed. Our institutions of higher education should also take intentional steps to diversify the recruitment and hiring of faculty and staff to complement the demographics of their respective student body populations. Ultimately, the question that counselors and institutions of higher education should be asking is, “How do we help Arab American students feel safe, understood and integrated?”

 

****

Souzan Naser is an associate professor and counselor at Moraine Valley Community College in Palos Hills, Illinois, where she has won awards for her work on increasing diversity on campus. Her doctoral dissertation addressed the paucity of Arab American cultural competency training available for counseling professionals. She was born in Palestine and raised on the southwest side of Chicago, in the heart of one of the largest concentrated Arab American communities in the U.S. Contact her at nasers2@morainevalley.edu.

 

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

****

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.

Wanted: Bilingual and bicultural counselors

By Lindsey Phillips February 3, 2021

Successful therapeutic relationships are built on trust and understanding, so counselors can ill afford to have words and phrases become “lost in translation.” Cultural competency on the part of counselors is also crucial, especially as clients are becoming more linguistically and culturally diverse.

According to the 2019 American Community Survey conducted by the U.S. Census Bureau, 22% of U.S. households speak a language other than English at home, with 13.5% speaking Spanish. And this number will only increase in the years ahead. The Instituto Cervantes, in its Yearbook of Spanish in the World 2019, estimates that nearly 1 in every 3 Americans will be Hispanic by 2060, making the United States the second-largest Spanish-speaking country in the world after Mexico. The Pew Research Center projects that 19% of Americans will be foreign born by 2050, up from 12% in 2005. It also estimates that 82% of U.S. population growth will come from immigrants and their descendants.

The counseling profession emphasizes cultural competency, but evidence suggests that the mental health field as a whole isn’t keeping up with the rising demand for bilingual and bicultural services. According to survey results released by the American Psychological Association in 2016, approximately 10.8% of U.S. psychologists reported being able to provide services in a language other than English, with only 5.5% able to provide services in Spanish.

This lack of culturally competent services can take a toll on people’s mental health. “When clients can’t find a bilingual counselor, they become more isolated. Often, they don’t talk about their emotional issues because they don’t feel that they can be seen or understood on a linguistic or cultural level,” says Ingrid Ramos, a licensed professional counselor (LPC) and the director of the Bienestar (wellness) and Resilience programs at The Women’s Initiative in Charlottesville, Virginia. “Then, you see a worsening of symptoms.”

To better meet the needs of bilingual and bicultural clients, mental health professionals must become more culturally competent themselves. That goes beyond simply speaking another language or being aware of cultural difference. Clinicians need to be prepared to offer bilingual services and practice cultural humility, which requires better bicultural/bilingual training opportunities and supervision.

Finding the right words

Language is central to counseling because it allows clinicians to build rapport and better understand clients’ life experiences, thoughts and behaviors. But fluency in the client’s native language is often not enough to make a counselor linguistically competent in session. Olga Mejía, an associate professor of counseling at California State University, Fullerton (CSUF), acknowledges that mental health terminology doesn’t always translate. She often tells her counseling students, “There’s Spanish, and then there’s therapeutic Spanish.”

Although Spanish is Mejía’s first language, she admits she felt lost during her first clinical position after completing her doctoral program. Her clients and colleagues alike assumed that she could easily offer mental health sessions in Spanish, but she struggled to translate certain technical terms commonly used in the field such as confidentiality and the cycle of violence.

That’s because the process isn’t as straightforward as translating the words and phrases directly, Mejía explains. A direct translation often doesn’t take into account the cultural context and nuance between languages. Therefore, she advises her counseling students to translate the idea behind the terms rather than searching for the perfect word. For example, even if there isn’t a word-for-word match for boundaries in the client’s language, a counselor can explain that people often set rules or limits in relationships.

According to Ye (Agnes) Luo, an assistant professor of counseling at the University of North Texas, even explaining what a counselor is and how that differs from a psychologist can be challenging because some languages, such as Mandarin, use the same word to describe both professions. And certain countries may not distinguish between these roles the way that the United States does, she adds.

Luo, an American Counseling Association member and LPC in Texas who speaks both Mandarin and English, has learned that she can’t simply ask clients if they understand what counseling is because the client’s understanding of counseling may differ from her own. For example, she has worked with clients from Asian countries who expect counselors to prescribe something to “fix” their presenting issues. These clients viewed her as an authority figure rather than perceiving therapy as a collaborative process, she notes.

Interpreters must also be aware of the nuances involved in the way mental health professionals speak. Ramos advises counselors who use interpreters to discuss the therapeutic process with them before going into session. “Our communication is our tool,” Ramos says. “How we say things, how we ask questions, how we reflect back to the client — that’s the counseling intervention.” Therefore, it is important that interpreters also understand how to communicate in this way when translating for clients, she points out. For example, an interpreter could accidentally misrepresent a counselor’s reflective statement by telling the client, “The counselor is repeating what you just said,” rather than translating the reflective statement.

Medical interpretation can feel more transactional, but because counseling involves emotional disclosure and vulnerability, it requires a certain tone and set of communication skills, continues Ramos, who serves on the board of Creciendo Juntos, an organization that provides support and resources for Latinx families and Latinx-serving organizations in the city of Charlottesville and Albemarle County. For this reason, the Virginia Department of Behavioral Health and Developmental Services distinguishes between medical and mental health interpreting, she says. For example, the agency underscores the importance of mental health counselors and interpreters meeting before a session, while acknowledging this is not always necessary in medical settings.

Counselors also have to be upfront with clients about their bilingual language proficiency, advises Luo, a counselor at C2 Counseling in Corpus Christi, Texas. When searching for her own personal counselor, she found a clinician who advertised herself as bilingual in Mandarin and English. But in their first session together, the counselor asked Luo if it was OK if she spoke in English, not Mandarin, because she had never used Mandarin in a clinical setting. Luo acquiesced, but it was not the experience she had desired or expected.

Cultural competency and humility

Counselors must consider the client’s country of origin, not just the client’s language. “Language is essential,” notes Mejía, a bilingual and bicultural licensed psychologist. “But [clinicians] have to have the language with the cultural competency or cultural sensitivity, along with the cultural humility.” For example, in Spanish, knowing when and how to use tu and usted (both words for you) changes depending on age, gender, seniority and familiarity. If counselors don’t have the cultural understanding of that distinction, then they could hurt their relationship with the client, and the client will not feel seen or heard, she says. 

As Alaina Hanks, a licensed professional counselor-in-training at the Gerald L. Ignace Indian Health Center in Milwaukee, points out, a lack of cultural competency can also have serious repercussions, including potential misdiagnoses. Some of Hanks’ Native American clients have told her that other mental health professionals previously misdiagnosed them as having schizophrenia or depression with psychotic features because they mentioned seeing spirits or receiving guidance from ancestors during a traditional ceremony. Counselors must listen to the client and learn about their culture to accurately determine what is connected to culture and what is clinically significant, she stresses.

“A huge part of [cultural humility] is understanding the history of where you are and what that means,” says Hanks, an ACA member who helped co-author the article “A collective voice: Indigenous resilience and a call for advocacy,” published on CT Online in February 2020. She advises counselors to start by learning the histories of the places where they live and work because these histories, in combination with current policies, affect clients.

Because Ramos, who is from the Dominican Republic, often works with clients from Mexico and Central America, she brings a sense of cultural humility and curiosity into session with her. Sometimes, her clients assume that she understands everything they say just because she speaks Spanish. She knows not to make that assumption. Instead, she routinely asks, “What does that phrase mean in your country?” If she still doesn’t fully grasp what the client is trying to convey, she will dig deeper and ask what the phrase means in their community or family.

“As a bicultural counselor, it’s important to remember that every culture has its own way of speaking about symptoms, illness and treatment,” Ramos says. To gain a better understanding of the presenting issue, she asks clients how they understand or see the problem and how their culture views their symptoms or behaviors. She also asks how people in their culture typically cope with these symptoms or behaviors.

Because Native American approaches to wellness are often about gaining balance, Hanks, who is Anishinaabeg and enrolled in the White Earth Nation in Minnesota, sometimes incorporates the medicine wheel when working with Native American clients. The medicine wheel is a sacred symbol used by many Indigenous tribes to represent all knowledge of the universe. It consists of a circle, divided by a horizontal and vertical line, with four colors (black, white, yellow and red). Each tribe interprets the medicine wheel differently.

In Hanks’ traditional teachings from her Ojibwe tribe, the medicine wheel operates as a way for Indigenous people to understand the world and their roles within it. “I have used it similar to a wellness wheel in helping clients identify where they need balance in their lives or finding ways to reconnect counseling concepts in a cultural framework,” she says. She also uses it to initiate conversations about grief and the cycles of life.

Although the medicine wheel is widely recognized among Native American populations, its use varies from tribe to tribe, Hanks says. For that reason, she cautions counselors to practice cultural humility and get training before incorporating the medicine wheel in their clinical practice. The same can be said about the use of any intervention that might speak more fully to a client’s culture but with which the counselor is largely unfamiliar.

Mejía urges counselors to be curious and culturally humble to ensure that they don’t fall prey to assumptions or black-and-white thinking about a culture. For example, in working with a teenage Latinx client, counselors shouldn’t automatically assume that the client is going to leave home to attend college. Instead, Mejía advises clinicians to slow down and consider: Why wouldn’t the client go away to college? What cultural factors might encourage the client to choose a college closer to home? What would it be like if the client did attend school away from home?

Striving to cultivate cross-cultural relationships

Ramos often uses narrative therapy to incorporate a client’s culture, family context and worldview — including their sense of spirituality — into treatment. She frequently uses Latinx cultural references, such as dichos y refranes (i.e., Spanish proverbs and sayings), to engage clients and make their culture and stories central to the session. For example, in a group format, Ramos may ask clients to share popular sayings used in their family, community or culture that relate to the dynamic the group is discussing. In the past, clients have mentioned dichos such as “El tiempo lo cura todo” (which is similar to “Time heals all wounds”) and “Dios aprieta, pero no ahorca” (which is similar to “When God shuts a door, he always opens a window”). This technique can help clients reconsider how they view themselves and their personal journeys, Ramos says.

Ramos doesn’t believe that counselors have to be proficient in Spanish to incorporate Spanish sayings into their practice. “The main point is always to use invitational language in the counseling setting to elicit the dichos and reflections from the client as a way to honor the cultural meaning the dichos might have for them,” she explains.

Ramos also focuses on cultivating the relationship from the second the client enters her office. In the United States, people have grown accustomed to filling out forms as soon as they enter a health facility, but that isn’t true for all cultures. Ramos points out that many Latinx cultures value personalism (i.e., person-to-person contact). So, she first gets to know her clients and discusses the forms with them rather than simply handing them the forms without any explanation.

Ramos has noticed that if she clearly explains the intake process to her clients who are immigrants or refugees, they are more willing to engage with the steps needed to get services. On the other hand, if she just hands these clients a form, they may hesitate to answer questions because they don’t fully know or trust her yet. Simply saying, “Welcome to the office. How did you find us?” or “How can we serve you today?” can be a nonthreatening way to start the conversation, Ramos suggests. “It doesn’t have to be a 30-minute intervention. It can be five to 10 minutes of explaining why they are here and what the process is,” she adds. 

Counselors also need to be sensitive to literacy levels. Asking clients to fill out forms may cause anxiety or shame if they don’t know how to read or write in their native language, Ramos points out. Cultivating that relationship for the first 10 minutes before having them fill out forms can help put clients at ease. Ramos then asks clients whether they feel comfortable filling out the forms themselves or might prefer her support in doing that. This is a simple way to dismantle the shame around any literacy issues so that focus can be put on clients’ needs, she explains.

Recognizing the need for bilingual/bicultural training

Given the increased demand for counselors who are bilingual/bicultural, there is a corresponding need for counselor education to include more programs aimed at preparing counselors to be linguistically and culturally competent. Unfortunately, says Mejía, an ACA member whose research focuses on immigration and the training of bilingual/bicultural therapists, there are not many programs like this currently in the United States, and for the ones that do exist, there are no standards for this type of training.

Mejía noticed that many of the bilingual counseling students at CSUF lacked the support they needed during their practicum training. They rarely had bilingual/bicultural supervisors, and they often had to translate documents, forms and counseling terms on their own without any guidance, she recalls. “They’ve been learning all the [counseling] skills in English, and all of a sudden, they are expected to do it in a different language,” which was intimidating and challenging, she says.

In response, Mejía started and serves as the director of the Ánimo Latinx Counseling Emphasis program at CSUF. The program consists of five master’s-level courses focused on helping students become self-aware as bilingual and bicultural counselors, knowledgeable of Latinx cultures and therapeutic Spanish, and familiar with interventions appropriate to Latinx and Spanish-speaking clients. It also teaches counseling students about social justice advocacy for issues relevant to the Latinx community and allows students, depending on their proficiency, to practice speaking Spanish in a clinical setting. 

Ánimo, which loosely translates to encouragement or spirit, is in its third year, and Mejía can already see the positive impact the program is having on the counseling students at CSUF. She frequently gets inquiries from students about the program, which speaks to the need for such training. But behind the program’s success is a harsh reality: It took 10 years of determination and dedication on the part of Mejía and her colleagues to receive the institutional support needed to bring the program to fruition.

Bilingual/bicultural training programs such as Ánimo also allow counseling students to support and learn from each other. The students in the program recently decided that they want to establish an Ánimo student group to build a supportive community for bilingual/bicultural counselors, which Mejía thinks is a wonderful idea.

Challenges faced by bilingual/bicultural counselors

Often, there is a cultural “tax” associated with being a bilingual or bicultural counselor. Mejía started the Ánimo program to help counseling students, but she doesn’t get consistent faculty release time (i.e., reduced teaching responsibilities to work on other projects) to fulfill duties related to the program, including training faculty, promoting the program, interviewing prospective students, attending meetings, and conducting exit interviews with graduating students. In addition, prospective and current students often seek her out — as director of the program — for advising and mentoring. Still, she finds a way to balance it all because as a first-generation college graduate herself, she knows how important these connections are and how valuable the program is to other bilingual/bicultural counselors. 

Sometimes, colleagues and agencies may expect bilingual counselors to take on additional roles — including ones that might be outside their scope of knowledge or training. When Ramos was an in-home counselor, she would support clients by attending school or social services meetings with them. Those agencies didn’t always schedule an interpreter because they assumed she would operate as both the client’s interpreter and therapist. “That put me in a situation where my mind that I wanted to use for the emotional support of this family now had to be used for interpreting,” Ramos recalls. Interpreting itself can be taxing, she adds, so she had to set boundaries and assert that she needed an interpreter in certain situations so that she could successfully perform her true job as a counselor.

Luo says some of her bicultural counseling students find it difficult to establish boundaries in session. If a counselor feels personally connected to a client because they share a language or similar culture, a danger exists that the counselor could overidentify and self-disclose too much, she cautions.

Isolation can also be an issue for counselors who find themselves in a region or clinical practice in which they are the only ones who are bicultural or bilingual. All counselors can benefit from participating in support groups with other helping professionals, but bilingual/bicultural counselors have unique challenges that may require them to find support groups with clinicians who also share these struggles, Ramos says. For example, a bicultural counselor may have high caseloads of people whose immigration or socioeconomic status affects their ability to access the resources they need, which in turn may affect their well-being.

Of course, it may not be easy to find this support if counselors live in an area without much diversity. Ramos offers the following suggestions for connecting with other bilingual/bicultural professionals:

  • Reach out to agencies within the community that provide mental health services to see if they have bilingual counselors on staff.
  • Find organizations that provide services to immigrants and refugees and that focus on education and advocacy. Although these organizations may not concentrate solely on mental health, they do work to identify the needs and gaps in services for these populations, Ramos says. And counselors could collaborate with these organizations to build a resource network.
  • Check with the counseling or social work departments at local universities and colleges to find alliances of refugees, immigrants or other minority groups.
  • Attend online webinars and trainings, which are more widely available now because of the COVID-19 pandemic. These events will help counselors connect with other bilingual and bicultural providers.

Improving supervision for bilingual/bicultural trainees

One of Mejía’s motivations for starting the Ánimo program was the lack of available supervisors who are culturally and linguistically competent. A supervisor’s lack of cultural competency is a barrier for counselors-in-training, Mejía asserts. Students often tell her they feel unheard or overlooked when their supervisor doesn’t understand an issue they have as a bicultural counselor or as a counselor working with a client from a different culture.

Mejía also gets frustrated when supervisors ask their trainees to translate another colleague’s session or the clinic’s forms or to answer the phones because they are bilingual. Trainees are not compensated for this work, and these tasks don’t count toward their clinical hours, she points out. Mejía often asks supervisors, “Would an English-speaking trainee be required to do this?”

Ramos has noticed that bilingual/bicultural counselors-in-training tend to dismiss their own feelings and challenges when they don’t have a supervisor who is culturally competent. They may think that they are the only ones dealing with an issue and hesitate to bring up their concerns with their supervisor. “Having a supervisor who can relate culturally with the population you are serving can fill the gap needed in support for the counselor,” she says.

As Hanks observes, it can be challenging for supervisors and counseling professionals who have been in the field for a long time to admit that they don’t know something. But taking a reflective and humble approach to supervision helps bicultural counselors to feel seen and heard, she says.

Hanks recalls a positive experience she had with a supervisor who was curious and didn’t make assumptions. While working in a youth shelter, Hanks was approached by a Native American child because she assumed that Hanks, who is also Native American, would better understand her. Hanks’ supervisor didn’t address the situation by telling her to set better boundaries. Instead, the supervisor said, “I noticed this one child is really close to you. Tell me more about it. Tell me what you think is going on. What do you think about it clinically?” Those questions led to a productive conversation about Hanks’ therapeutic relationship with the client.

Luo has always had supervisors who were culturally different from her, and none of them asked about how their cultural difference affected the dynamics of supervision. Luo encourages supervisors to be the ones to initiate these conversations rather than waiting for trainees to bring up the topic. Now as a supervisor herself, Luo makes a point to always address culture with her supervisees. For example, she might say, “As you have probably noticed, we come from different cultural backgrounds. Do you want to talk about how these cultural factors affect our relationship?”

Bridging cultural differences

In Milwaukee, Mark Denning of the Oneida Nation created the program Unity Fire to address challenges related to the COVID-19 pandemic and social justice struggles. The program is open to the public and uses Native American customs to help unite communities during a time when many people feel isolated, unheard and unsafe.

Hanks attended a unity fire held during the protest over the killing of George Floyd and remembers it being heavy with emotion. The firekeepers taught those attending how to offer a prayer into the fire using traditional sacred medicines. “There’s space at these fires for [cross-cultural] connection,” Hanks says. “That’s why they call it the ‘unity fire.’ It’s all about people uniting again.” 

Ramos’ agency — The Women’s Initiative — aims to create community partnerships. Its Bienestar program provides counseling in Spanish to Latinas and connects Latinx children and men with bilingual providers in the community. It also offers workshops and presentations centered on Latinx cultural values and resiliency, mental health issues, and cultural barriers that this population often faces.

Staff members at The Women’s Initiative also offer support groups for immigrant and refugee women. For example, Ramos led a basket weaving group, which for many clients was a way to connect a culturally significant craft with emotionally relevant concepts such as change, disappointment and resilience.

The Women’s Initiative also partnered with the International Rescue Committee and Hyojin Im, an associate professor in the School of Social Work at Virginia Commonwealth University and an expert on mental health services and refugee communities, to host trauma-informed cross-cultural psychoeducation (TICCP) leadership training for immigrant and refugee communities in Charlottesville. The TICCP program offers a series of workshops that teach bilingual leaders in these communities about the mental health impact of refugee and immigrant trauma and cultural adjustments to a new country.

TICCP has been a way to bring immigrant and refugee communities together and to create leaders within those communities from which others can learn about mental health, Ramos notes. These leaders “can help to make referrals and to deal with the stigma around mental health,” she adds.

Ramos loves connecting bilingual/bicultural therapists with immigrant and refugee communities and empowering these communities to be active participants in their own mental health. “Whenever I can bridge that gap [between cultures], I like to do it,” she says, “because I know it means a client or family will receive a better service.”

****

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.

****

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.

Unmasking White supremacy and racism in the counseling profession

By Patricia Arredondo, Michael D’Andrea and Courtland Lee September 10, 2020

Our country has been roiling through two major pandemics. The first, COVID-19, is still relatively new, and with a vaccine, the incidences of this miserable disease should decrease and diminish over time. In contrast, the pandemic of White racism and White supremacy has long been at the heart of the persistent psychological, emotional and behavioral racial tensions and injustices that we face in the United States. The senseless killing of George Floyd and other Black citizens has raised awareness once again of the violence of White racism and police brutality in many sectors of society.

The National Institute of Mental Health recently published a report indicating that between 17 million and 22 million adults in the United States are in need of professional mental health services each year. It was further determined that only 41% of these individuals receive such services. The fact that a majority of adults in need of mental health services do not receive this important care represents an ongoing health care crisis in our country. And, of course, COVID-19 stressors are only compounding mental health distress.

When researchers focused on the racial disparities linked to this pandemic, those from African, Asian, Latinx and Indigenous backgrounds were found to be substantially overrepresented among those adults not receiving or not having access to mental health care. This finding reflects what supporters of the Black Lives Matter movement and many social justice advocates in general are talking about when they point to disparities resulting from systemic racism and White privilege in this country.

Institutional racism in the profession

In 1982, nearly 40 years ago, Derald Wing Sue wrote, “Counseling is the handmaiden of the status quo.” This phrase relates to the ways that many counselor educators, practitioners, supervisors and students are inextricably linked to perpetuating White racism and White supremacy by remaining silent, noncommittal and inactive in the face of so many forms of structural and institutional racism.

Sadly, this situation is still a reality as unintentional and covert forms of racial injustice continue to be manifested in counselor training, research and practice. For example, how prepared are counseling students to work with those who speak English as a second language, those who are recipients under the Deferred Action for Childhood Arrivals program, families in poverty and so forth? When are counselor training programs requiring community service to link to social justice principles and competencies endorsed by the American Counseling Association? How do counselor training programs prepare students to talk about racism with clients? If counselor educators and counseling programs were to take on these three queries, they would find opportunities to unmask racism and decrease their behavior as a “handmaiden of the status quo.”

Professionals and students alike must commit themselves to move toward bold, courageous and morally grounded actions. We must go beyond our favorite mode of operating, which often involves the overuse of intellectual analysis of these social pathologies. As we critically analyze the mental health impacts of these injustices on our clients’ lives, let us be reminded that Martin Luther King Jr. warned us that an overemphasis on such intellectualization without substantial social justice actions too often results in the paralysis of analysis.

Challenging the counseling status quo

In 1992, Michael D’Andrea, one of the co-authors of this article, wrote a column in Counseling Today (then named The Guidepost) titled “The violence of our silence: Some thoughts about racism, counseling and human development.” In that column, he asserted that if they continued to operate as witnesses and bystanders to various forms of institutional, societal and cultural racism, counseling professionals and students would become guilty of being racists themselves through their silent complicity.

Some progress has been made as a result of a minority of counselor educators, practitioners, supervisors and students taking courageous action to boldly and routinely describe the ways that White supremacy and White racism adversely affect the counseling profession and the racially diverse clients we serve. However, it is apparent that much more needs to be done in these areas. Today, there are education and training programs guiding professionals in moving away from bystander behavior and toward action. The #EquityFlattensTheCurve initiative is offering a Bystander Anti-Racism Project.

Identifying areas of urgency in the counseling profession is also part of unmasking racism. Just take note of the contemporary counseling profession. In doing so, you are likely to see the following: counselor educators, graduate students, supervisors in counseling centers, textbook authors, the theories studied, the research methodology applied in studies, CACREP site visitors, and the leadership in ACA, the Association for Counselor Education and Supervision and other professional associations all seeming to have a homogeneous identity.

Little has substantially changed over the past 50 years. A majority of White counseling students continues to be taught by a majority of White professors. Multicultural counseling is still a one-semester course. Theories of counseling, career development and human development are Eurocentric in nature and dated. Furthermore, counseling research has not advanced knowledge about racism, White supremacy and the well-being of people of color. Samples of convenience continue to be normative, with many research participants coming from White, Western European, English-speaking and often Christian backgrounds.

All of this leads us to assert that the counseling profession has stagnated. This perpetuation of persistent Eurocentric conformity will soon be irrelevant and contribute to greater inequities in the preparation of counselors and the delivery of mental health care. This professional irrelevance will occur as a result of the unprecedented demographic transformation occurring in our nation. As one example, in 2013, for the first time, the percentage of Latinx high school graduates going on to college was higher than that of any other group, as reported by the Hispanic Research Center, and this representation in colleges continues. How many counselors are aware of this demographic shift?

Moving to action: Applying the MCCs 

In 2003, the ACA Governing Council approved the Multicultural Counseling Competencies (MCC), originally published in 1992 by Derald Wing Sue, Patricia Arredondo (one of the co-authors of this article) and Roderick McDavis. The awareness, knowledge and skills paradigm remains as vital today as it was in 1992 when the MCC were published and in 1964 when the Civil Rights Act was passed. The MCC, the subsequent document on operationalization of the competencies that promotes intersecting identities in sociohistorical contexts (1996), and the Multicultural and Social Justice Counseling Competencies (2015) remain anchors to lean on during these times for needed change, increased awareness, more expansive knowledge and bold actions in the counseling profession. The 1992 competencies addressing racism are cited here for further application.

  • Culturally competent counselors possess knowledge and understand about how oppression, racism, discrimination and stereotyping affect them personally and in their work. This allows them to acknowledge their own racist attitudes, beliefs and feelings. Although this standard applies to all groups, for White counselors it may mean that they understand how they may have directly or indirectly benefited from individual, institutional and cultural racism.
  • Culturally competent counselors are constantly seeking to understand themselves as racial-cultural beings and actively strive to develop a nonracist identity.
  • Culturally competent counselors are knowledgeable of sociopolitical influences that impinge upon the life of racial and ethnic minorities. Immigration issues, poverty, racism, stereotyping and powerlessness all leave major scars that may influence the counseling process.
  • Culturally competent counselors become actively involved with [ethnic/racial] minority individuals outside the counseling setting (via community events, social and political functions, celebrations, friendships, neighborhood groups and so forth) so that their perspective of minorities is more than an academic or helping exercise.
  • Culturally competent counselors strive to eliminate biases, prejudices and discriminatory practices. They should be cognizant of clients’ sociopolitical contexts when conducting evaluations and providing interventions. They also continually attempt to develop greater sensitivity to issues of oppression, sexism and racism especially as they affect their clients’ lives.

Racial reckoning: If not now, when?

The country has entered a period of racial reckoning. New incidents of racism and anti-Black behavior are reported on a daily basis on city streets, on college campuses and in stores. The challenge to not be bystanders persists, and as counselors committed to advancing diversity, equity and inclusion, we must be activists and advocates for social justice. We must rise to the task of unmasking White supremacy and White racism in both our professional training and practice as professional counselors.

We need to ask ourselves, if not now, when will we take these actions? If not us, who will make the changes to have the counseling profession move beyond the “violence of our silence” and the role many educators, supervisors and students play as “handmaidens of the status quo”?

 

****

Patricia Arredondo is a past president of the American Counseling Association and the Association for Multicultural Counseling and Development and a founding member of Counselors for Social Justice. She partners with organizations to address diversity, equity and inclusion initiatives through the Arredondo Advisory Group. Contact her at parredondo@arredondoadvisorygroup.com.

Michael D’Andrea is an associate professor at Springfield College in Springfield, Massachusetts. He is one of the founders of Counselors for Social Justice. Contact him at michaeldandrea1@gmail.com.

Courtland Lee is a past president of the American Counseling Association and the Association for Multicultural Counseling and Development. He is a professor in the counselor education program at the Washington, D.C. campus of the Chicago School of Professional Psychology. Contact him at clee@thechicagoschool.edu.

****

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