Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Culturally competent end-of-life counseling

By Ashley C. Overman-Goldsmith May 1, 2019

End-of-life counseling is an important area of our profession. Unfortunately, it is also an area of the profession that is underdeveloped and seldom researched. Consequently, few resources are available to professional counselors that specifically address multicultural competence in end-of-life counseling.

I first became interested in end-of-life counseling while working as a bereavement program manager and counselor in a private hospice setting. As a bereavement counselor, I worked not only with the families of patients receiving hospice services but also with higher risk patients (those who struggled with psychological and physical pain). The private hospice organization provided social services for patients, but our social workers had large caseloads and found it difficult to meet the emotional and psychological needs of patients and family members who required ongoing therapeutic intervention. To meet those needs, I developed an end-of-life counseling program in which I personally worked with patients and family members deemed medium to high risk.

I currently practice counseling at Sea Change Therapy PLLC, where I help individuals who are struggling with life transitions, including the end of life. In addition to my clinical practice, I am conducting research in end-of-life counseling under the advisement of my dissertation committee at North Carolina State University.

The list of reasons for counseling at the end of life can be similar to the reasons that individuals seek out counseling earlier in life. The largest difference, of course, is that with end-of-life counseling, the client is facing his or her death. This makes this area of counseling all the more challenging. Because these clients die at the end of counseling, counselors are responsible for so much more than just helping clients pursue improvements in a relationship or changes to an existing issue. Counselors are helping these clients achieve goals that may improve the possibility of them experiencing peace before they die. This is a major undertaking.

As an end-of-life counselor, I have witnessed the impact that clients’ lived experiences and aspects of their identity have on their end-of-life experiences. These experiences are personal, unique events that require counselors to be skilled in addressing a multitude of issues regarding both a client’s identity and the dying process. Multicultural and social justice competence is key to counselors being able to provide effective end-of-life counseling and help clients navigate end-of-life experiences successfully.

The Multicultural and Social Justice Counseling Competencies (MSJCC) endorsed by the American Counseling Association are a set of guidelines for developing and maintaining multicultural and social justice competence as counselors. The MSJCC framework aids in understanding the complexities of the counseling relationship, specifically with counselor–client interactions. The MSJCC support counselors in addressing issues that are often not well-recognized but that have a significant impact on the client. These issues include power dynamics, privilege and oppression. The MSJCC are well-supported by our profession and are a very useful tool for promoting cultural competence for counselors.

The Handbook of Thanatology, a resource created for practitioners by the Association for Death Education and Counseling, provides detailed, thought-provoking suggestions on how to be culturally competent when working with clients at the end of life. The handbook includes a combination of research findings, practical implications and recommendations for end-of-life practice.

Using the MSJCC and suggestions from the Handbook of Thanatology, counselors can ensure that they are providing culturally competent and effective end-of-life counseling services to their clients. Using these references, along with information from my professional experience as an end-of-life counselor, I have developed a simple framework for culturally competent end-of-life counseling practice.

Education

Education is an important component of culturally competent practice. Continuing our education beyond the completion of the master’s degree requirement is necessary for growth and effective practice in this field.

As professional counselors, we are required to complete a specific number of continuing education credits yearly to maintain state and national licenses. For many of us, a certain number of these continuing education credits are required in the area of multicultural competence. Continuing education in end-of-life practice is increasingly available, and there are many opportunities for growth across disciplines in this specialty area. For example, there are distance learning programs that provide thanatology coursework, including multicultural competence in end-of-life care. During my personal search for continuing education, I have come across numerous courses or sessions that are outside of the university setting. Professional memberships, local funeral homes, palliative care programs and medical facilities all offer continuing education opportunities, sometimes at little to no cost.

In addition to the more formal avenues for advancing your education, there are ways to learn and grow in the understanding of other cultures through observation, immersion and self-education. The Handbook of Thanatology says that if we want to better understand the beliefs and practices of a particular cultural group, immersing ourselves in that group can aid in this quest. Obviously, that approach is time-consuming and not feasible for all counselors. However, I would recommend, at minimum, that counselors observe and investigate the beliefs and practices of the clients (and clients’ family members) with whom they are working. Don’t fear asking questions that will improve your knowledge.

We are encouraged as counselors to be well-informed about what is going on in the world around us and to consider the ways in which events may affect our clients. For example, changes in health care coverage and policies can impact terminally ill clients and their families. Seeking out details on these changes and working to stay informed not only can help us to prepare for what our clients may be facing but can also provide us with information that could be important to pass along to our clients. Social, cultural and political developments may also influence our clients’ emotional and psychological states. It is important that we maintain an awareness of how these developments could affect clients from varying groups in different ways.

Possessing knowledge of both historical and current events — particularly those resulting in the oppression of a group of individuals due to their race, ethnicity, socioeconomic status, gender or sexual orientation — can help us better understand the lived experiences of our clients. Linking historical and current events can provide us with a clearer perspective on the adversities that our clients and their families continue to face. These adversities are woven into their personal narratives and are often revisited at the end of life. Our clients may want to remember the happy experiences they have had, but they may also recall the adversities they have confronted. Our clients’ worldviews, values, beliefs, and marginalized or privileged statuses (lived experiences) all have an impact on their perceptions of death and dying. In turn, their perceptions of death and dying have an impact on their end-of-life experiences.

Education is the foundation of culturally competent end-of-life counseling. Developing knowledge of the impact of history, events, culture, religion/spirituality and other influencers on our clients’ lived experiences can help us reach a better understanding of their end-of-life experiences. Possessing a solid knowledge base — and continuing to expand that base by seeking out educational opportunities — has a direct impact on the effectiveness of our practice as counselors.

Practice

This section of the framework is designed to be used in addition to the approaches and interventions that end-of-life counselors are already trained in and currently practicing. Like other areas of the counseling profession, end-of-life counseling is not limited to one single approach or a specific set of interventions.

Culturally competent end-of-life counselors embrace the fact that multiculturalism and social justice are central to end-of-life counseling. In culturally competent end-of-life counseling, counselors work to be aware of the many identities that counselors and clients possess, as well as their privileged and marginalized statuses. These identities and privileged or marginalized statuses enter into and influence how each individual will experience interactions that occur during the counseling relationship. Culturally competent end-of-life counselors skillfully facilitate discussions about these identities and statuses. They share information about their own identities, allow clients to explore their personal identities, and work to identify and overcome any barriers that may arise in the counseling relationship.

The knowledge that culturally competent end-of-life counselors possess and continue to build upon (addressed in the education portion of the framework) aids them in better understanding clients’ identities. Open dialogue about these identities can help counselors gain insight into an individual’s unique background. Through this work, clients may even come to recognize their diagnosis or terminal illness as a new identity or way in which they see themselves. When this happens, counselors can help clients examine this new identity and use interventions that are helpful in exploring clients’ perceptions of what this new identity means to them.

Occasionally during this time in the counseling process, clients will discuss experiences that led to their understanding of these identities. These experiences and others that are shared during counseling are the clients’ lived experiences, which may influence how they view themselves and their end-of-life experience. Making space for these discussions (or even initiating them) and asking questions to better understand our clients helps us to become more culturally competent counselors. As a result, trust is built between the counselor and the client, and the counseling relationship is enhanced.

In end-of-life counseling, these discussions usually take place early on in the counseling relationship. In fact, faster development of the counseling relationship can be more critical in end-of-life counseling than in other areas of counseling practice. Allowing opportunities for these discussions early on may greatly enhance the client’s comfort in sharing with the counselor and may aid in achieving the goals of counseling in the limited time available.

The ultimate goal of end-of-life counseling is to facilitate psychological and emotional healing that will allow clients to experience peace. Counselors and clients work together to identify sources of stress or any psychological disturbances (e.g., depression, anxiety) that are preventing the client from achieving peace. Reasons behind the presence of disturbances such as depression or anxiety may vary. Clients might express fear of death, a sense of isolation, a loss of purpose or meaning, struggles with feelings of guilt, conflict in relationships or other concerns. Occasionally, struggles in relationships, personal regrets, feelings around a loss of independence, feelings of loneliness, or emotions connected to experiences with racism, sexism, religious oppression or other forms of oppression may also surface at the end of life.

Culturally competent end-of-life counselors understand that clients’ lived experiences (inclusive of issues such as oppression and discrimination) are unique and personal and should be handled delicately. Providing a safe space for clients to express their feelings surrounding these experiences is an important step in helping them achieve peace at the end of life. This safe space is created early on in the counseling relationship through structure, support, encouragement and unconditional positive regard. It is enhanced when counselors effectively and openly discuss identities, privileged or marginalized statuses, and issues such as oppression and discrimination. Allowing space for the anger, frustration, sadness and other feelings that clients may feel when sharing about these experiences is very important.

The MSJCC emphasize the need for counselors to work outside of the office, meeting directly with the client’s family members and friends (with permission from the client) to determine what relationships exist that will either support the client’s progress in counseling or present barriers to change. With end-of-life counseling, counselors are more likely to work with the client outside of the office. This might include meeting in hospice facilities, nursing facilities, assisted living facilities, hospitals or clients’ homes. As a result, end-of-life counselors are occasionally afforded opportunities to observe interactions that clients have with their family members and friends. If clients have identified resolution of conflict in a relationship as a goal of end-of-life counseling, then counselors are able to intervene.

By facilitating these discussions early on in the counseling relationship, counselors can create the solid foundation necessary for various counseling approaches and interventions. Counselors should ensure that they are using approaches and interventions that are culturally appropriate and that empower clients.

Advocacy

Advocacy at the end of life can be complicated, but it is important that we make sure our clients’ voices are heard. End-of-life counselors often are responsible for updating the interdisciplinary team about the client’s emotional and psychological well-being and the progress being made in counseling.

The interdisciplinary team (sometimes referred to as the multidisciplinary team) generally consists of medical professionals (doctors and nurses) and a group of supportive services professionals that can include some combination of social workers, counselors, psychologists, and clergy or spiritual care counselors. These teams are usually organized and assigned through hospitals and palliative care/hospice organizations. Team members work together to ensure that they are meeting the needs of individuals enrolled in services. Team meetings can vary in approach, but in my experience, each team member is asked to provide an update on the services for which they are responsible, along with any concerns they have about the needs of the individual who is facing end of life.

As counselors, we are often uniquely cognizant of the emotional and psychological needs of our clients. This gives us the ability to identify additional issues that are affecting our clients’ well-being. We can share these concerns and challenges with the interdisciplinary team in many ways. For example, we can relay information about the progress our clients are making in sessions by tracking their levels of depression or distress via simple assessments and then presenting our data during team meetings. We can also bring up any concerns that our clients have voiced during sessions regarding their care or interactions with other team members.

Our role on the team also gives us opportunities to educate the other team members on cultural considerations. The cultural insights we provide may influence discussions that these other team members have with our clients and their family members. Because of our greater level of understanding of the lived experiences of our clients and the impact these have on our clients’ end-of-life experiences, we can provide guidance to the team on how best to provide individualized care to clients.

In our role as advocates, we can also give voice to our clients’ end-of-life wishes. This may sometimes require us to relay difficult and sensitive information (again, with the client’s permission) to family members, team members and caregivers. This might involve the client’s desire concerning the presence or absence of certain individuals during the end-of-life experience, the environment in which the person wishes to die, requests for final meals, the kind of medical care or interventions the person would like to receive, and so on. As advocates, it is important that we relay this information in ways that are sensitive while also being true to our clients’ voices.

In addition to our responsibility to give our clients voice, it is also important that we work to improve the understanding of the attitudes, beliefs, biases and prejudices that exist in our communities, not just in our places of work. Among the ways we can do this are advocating for policies and procedures that rectify existing inequities, offering additional support to marginalized clients, and collaborating with others to address issues of power, privilege and oppression in advanced care settings. Some examples of how these issues arise in advanced care settings include the ways in which information is relayed to marginalized clients and assumptions that all clients have strong support systems, the same knowledge of or experience in health care settings, and similar perspectives on the end of life. Providing education on culturally competent practice to others who work in end-of-life care can also serve as advocacy. Advocacy is a part of cultural competence, and it is an important role that end-of-life counselors can play for clients.

Summary recommendations

Key considerations for providing effective, culturally competent end-of-life counseling are as follows:

  • Seek out educational opportunities that challenge and expand your understanding of multicultural and social justice issues in end-of-life counseling settings.
  • Treat the “whole” client and not just the parts of the client with which you are comfortable.
  • Integrate discussion of both the client’s and counselor’s worldviews, beliefs, attitudes, and marginalized or privileged statuses.
  • Help clients explore their lived experiences and the impact these have on their end-of-life experiences.
  • Advocate for clients by giving them a voice and pursuing social justice in end-of-life policies and practices.

Conclusion

Counselors should continue to strive to be culturally competent to provide the best services possible to our clients. Being culturally competent involves not just our professional selves but also our personal beliefs, values and worldviews. As we become more culturally competent and actively engage in multicultural and social justice advocacy, we will become more well-rounded, effective counselors.

 

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Ashley C. Overman-Goldsmith is a licensed professional counselor, a national certified counselor, and a doctoral student at North Carolina State University. She is the owner and lead therapist at Sea Change Therapy PLLC. Her current research centers on honoring the lived experiences of terminally ill clients while helping these clients resolve issues that affect their end-of-life experience. Contact her at seatherapychange@gmail.com or through her website at ashleyoverman-goldsmith.com.

 

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

When yelling doesn’t work

By Lindsey Phillips April 29, 2019

Stop! Stop throwing that toy! Put it down. Put it down now! Don’t make me say it again. If you don’t stop that right now …” We all know how this story ends — with a frustrated parent and an upset child. But the story doesn’t have to end this way.

In Play Therapy: The Art of the Relationship, Garry Landreth asserts that to improve future adult populations, counselors must equip parents with counseling skills and help them become therapeutic agents in their children’s lives. This plan sounds simple, but how do counselors broach the topic of child discipline, especially when working with clients from cultural backgrounds that differ from their own?

Christa Phipps, a therapist and clinical supervisor at Hickory Grove Counseling Center in North Carolina, notes that parenting and discipline can be touchy subjects, and counselors often fear mentioning it. In fact, she says, the counselors she supervises are terrified to talk with parents about anything that may rupture the therapeutic relationship, so they often skirt around the issue of child discipline. Phipps has also noticed that the one African American counselor she supervises is apprehensive about discussing discipline with clients from other cultures, while her white supervisees are timid about approaching the issue with parents of all cultural groups, including their own.

Phyllis Post, a professor of counseling and director of the Multicultural Play Therapy Center at the University of North Carolina at Charlotte (UNCC), advises counselors to address cultural differences outright rather than pretending that they don’t exist. Post, as an older white woman, acknowledges the cultural differences between her and her clients and asks clients directly how they feel about having her discuss child discipline and parenting with them.

Peggy Ceballos, an associate professor of counseling at the University of North Texas, says that parenting style and child discipline are both closely linked to one’s cultural background. “The main mistake I see is people avoiding those [cultural] conversations” in counseling, she says.

Carla Adkison-Johnson, a professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University, agrees that counselors often avoid the topic of discipline because that is where the cultural aspects of raising a child come into play. Rather than neglecting the topic or making assumptions, counselors should ask clients about their child-rearing values and traditions, she advises. They can do this by asking questions about their parenting: What types of disciplinary methods are you using to prepare your child for adulthood? What behaviors warrant discipline? What are you struggling with right now? Do you feel comfortable with the boundaries between you and your child?

Adkison-Johnson, a licensed professional counselor (LPC) and a member of the American Counseling Association, also points out that how people were disciplined themselves often plays a role in how they parent their own children. Thus, she says, counselors might ask clients how they were disciplined when they were children, whether they are using any of these methods with their own children, and what disciplinary methods their parents used that the clients found ineffective.

In the 2015 article “Child Discipline and African American Parents With Adolescent Children: A Psychoeducational Approach to Clinical Mental Health Counseling,” Adkison-Johnson described an activity that helps identify how parents define discipline and what child behaviors they consider problematic. In the activity, a counselor shows parents a video clip or a written example of a child displaying inappropriate behavior. The counselor then asks the parents what an appropriate behavior would be and how they would handle the problem.

Ceballos advises counselors to introduce the topic of child discipline in ways that are nonjudgmental and accepting. Parents are typically more receptive to learning new skills — including skills related to appropriate discipline methods — when counselors establish a relationship in which clients feel accepted.

Post, an LPC supervisor and registered play therapist, agrees. “I never tell a parent that what they are doing is wrong,” she says. Instead, she introduces alternative parenting techniques.

Counselors should assure clients that their role isn’t to tell parents what to do, Ceballos says. Instead, they are there to offer additional parenting skills, to process those skills with clients, and to see whether clients might want to try the skills because they think that the techniques might work for their families.

When clients feel there is a parenting skill that they can’t incorporate, Ceballos, an ACA member, talks about it with them. She says she wants clients to feel safe and comfortable having these difficult conversations with her rather than telling her that they will try a new skill and then not following through.

Putting discipline in (cultural) context

Ceballos and Adkison-Johnson agree that before discussing child discipline with clients, counselors need to be aware of their own biases and beliefs around parenting. For example, how does a counselor define “good” parenting? How does the counselor’s cultural background influence this definition?

Adkison-Johnson, who co-edited Counseling African American Families in ACA’s Family Psychology and Counseling Series, argues that counselors also need to understand the current and historical context when broaching the topic of child discipline. For example, African American parents are often viewed in society in a pejorative way, as incompetent parents, she says. Thus, counselors must be intentional about dismissing this false perception and reminding themselves that African American clients are competent parents who have goals, ideals and values for their children. Discussing child discipline also means addressing assumptions, she says, including the fact that most counselors may still determine what is in a family’s best interest on the basis of a widely white, middle-class, mainstream perspective.

Rather than waiting for clients to bring up these cultural contexts, counselors should take on the responsibility of learning more about what their clients experience, Adkison-Johnson stresses. For example, counselors should know that African American parents often engage in racial socialization practices as a part of their parenting activities, she says. This involves communicating messages and behaviors to children to bolster their sense of identity, especially given that their life experiences may include racially hostile encounters.

Parents who are undocumented immigrants may instruct their children to behave well at school because they fear being called in for a meeting or having someone look into their family if their child misbehaves, Ceballos adds. For these families, establishing trust in the counseling relationship is crucial because it may be difficult for them to openly discuss how their undocumented status affects their parenting, she explains.

Ceballos advises counselors to use cultural humility when learning about clients’ belief systems regarding parenting and what parenting means within their cultural context. She also recommends that counselors get involved in the community to build trust with parents. For instance, she finds that partnering with schools helps make Latinx parents more comfortable with getting counseling services because it allows counselors to meet these parents in a place that is familiar to them and where they may have already established a level of trust. In addition, schools often have people who know clients’ cultural backgrounds and speak their native languages, she adds.

Yung-Wei Dennis Lin, an assistant professor in the Counselor Education Department at New Jersey City University, points out that some cultures may not be familiar with the counseling profession. A Taiwanese family who immigrates to the United States may not be aware of the role that school counselors play, for example. So, he explains, if a school counselor suddenly contacts the parents in reference to their children, the parents may wonder who this person is and what the person’s role is with their children.

Adkison-Johnson and Lin, an ACA member who specializes in play therapy and filial therapy, say that counselors — including those who have been out in the field for a while — would benefit from interacting with different cultural groups under supervision.

Multicultural development is a lifetime commitment, not just one workshop, class or book, Ceballos adds. She challenges counselors to continue working on recognizing and addressing their unconscious biases. “We learn best through experiences, so … expose [yourself] to different cultural groups, to different cultural experiences … within the community,” she says.

Spanking and the discipline continuum

“When we think of child discipline, we only think of spanking, and I think that’s where we’ve missed the mark,” Adkison-Johnson says. “In general, across all racial groups, child discipline is a broad program of parenting. … It’s [parents] teaching children basically how they want their children to be, how they want to socialize their children within their family structure.”

Spanking generates a lot of heated opinions and often overshadows other aspects of child discipline. Counselors can be prone to taking a position on spanking and focusing exclusively on that aspect of discipline while ignoring all the other parenting tools that people may use along with spanking, Adkison-Johnson says. However, research indicates that “children are more impacted by the whole program of discipline than just the isolation of spanking in and of itself,” she argues.

Spanking also evokes stereotypes of minority cultures relying heavily on physical discipline. In fact, Ceballos did focus interviews with Latinx mothers and found they were cognizant of a pervading stereotype of Latinx parents spanking and abusing their children. The mothers discussed the distress this stereotype causes them and how it made them feel unsafe to discuss child discipline openly with just anyone.

Similarly, Adkison-Johnson acknowledges the stereotype of African American parents primarily using physical discipline to address inappropriate child behavior.

However, Post says, research indicates that parents in all cultural groups spank. “It is not just that some cultural groups spank more,” she adds. In fact, as recently as 2013, two-thirds of parents in a Harris Poll reported that they had spanked their children.

When parents ask Phipps her thoughts on spanking, she tells them that what she thinks is not important and turns the conversation back to what is working for them. “Usually they say that spanking is not working for them. They feel bad about it, but they don’t know what else to do,” she says. “They feel powerless.”

Lin, the recipient of an ACA Best Practices Research Award in 2016 for his work on child play therapy, says that spanking often hurts parents emotionally. Plus, parents often realize that spanking requires double the work. He explains that parents spank to stop the behavior, but then they must wait until the child calms down from crying — as a result of the spanking — to communicate why they spanked them.

Adkison-Johnson finds that physical discipline is often used as a last resort with children. People opposed to spanking typically equate it with violence, she says, and because they consider it a violent act, they feel it is inappropriate. “A blanket injunction with spanking when we have not provided empirical research to support that blanket injunction is problematic because that’s more of an opinion,” she argues.

She notes that parental use of physical discipline is a topic of much debate in the social science and legal literature. Several studies, including a meta-analysis by researchers Elizabeth Gershoff and Andrew Grogan-Kaylor (2016), associate physical punishment with negative childhood outcomes, which supports the premise that physical discipline is equated with violence. However, the most commonly cited studies on the consequences of spanking are correlational and do not show a direct causal link between physical punishment and long-term negative effects on children (see, for example, Robert Larzelere, Ronald Cox and Gail Smith, 2010).

“And from a culturally competent perspective, we’re actually still pushing our own [counseling or psychology profession] agenda because this is the way we want society to be regardless of whether it adequately addresses the child-rearing goals of parents,” she adds.

For this reason, Adkison-Johnson thinks that spanking, which is only one aspect of child discipline, has received too much attention. In fact, from her research with African American parents, she has found that child discipline happens on a continuum — one that is context and age specific. “That means … what the child does warrants the type of discipline that they will receive,” she says. “There’s no spanking randomly. There’s no discussion randomly. There’s no withdrawal of privilege [randomly]. Child discipline in African American homes is comprehensive and strategic and is dictated by the context [of the disciplinary situation] and age of the child.”

With the first behavioral offense, parents may explain what was wrong and tell the child not to do it again, she says. However, if the child has to be told repeatedly not to do something, then the parents may use a more severe form of discipline. As children age — roughly 6 to 11 years old — the discipline may become more restrictive (with physical discipline as a last resort) because the parents realize their children are interacting with the world, peers and the school system, and they want their children to behave a certain way regardless of what others do or say, Adkison-Johnson continues. When children become adolescents, parents typically use less physical discipline and more withdrawal of privilege unless the child commits a serious offense such as disrespecting the parent, she adds.

Several studies (such as one published in 2012 by Jennifer Lansford, Laura Wager, John Bates, Kenneth Dodge and Gregory Pettit) reveal that the negative effects of spanking often seen with white American children aren’t mirrored with African American children, probably because of how and when spanking is used, Adkison-Johnson says.

ACT, don’t react 

Post, Lin, Phipps and Ceballos all use child–parent relationship therapy (CPRT), a play-based treatment for children with behavioral, emotional, social or attachment disorders. The aim of CPRT is to teach parents how to use play therapeutically to strengthen the child–parent relationship and to reduce child behavioral problems and parent stress. CPRT skills include responsive listening, reflecting feelings and limit setting.

One CPRT rule of thumb is for adults to act as thermostats, not thermometers. This saying reminds adults that they control the situation (i.e., the “temperature” in the room) even when a child engages in negative behavior. If the adult is not in charge or not in control of his or her own emotions, then things can turn into a power struggle between the adult and child, further escalating the situation, Ceballos explains.

Because CPRT’s aim is to build a stronger relationship with one’s child, the approach is culturally congruent with Latinx culture and familismo (a Latinx cultural value of dedication, commitment and loyalty to the family), Ceballos says. Thus, when Latinx parents are exposed to CPRT, they are often receptive to learning the associated skills, she adds.

Once when Post was teaching child-centered play therapy skills, an African American student told her that he didn’t see how the child-centered approach would work for his culture, which preferred a more authoritarian or directive parenting style. By the end of the class, however, the student had a new appreciation for the approach. Because African American children grow up in environments that can be racially hostile to them, African American parents often see a need to engage in racial socialization practices — for example, teaching their children to be compliant for their own safety. However, the student eventually recognized the value of also providing these children with a safe space in the playroom where they could freely communicate who they were and what they were feeling. He reasoned that this would help them to grow more confident and competent.

Phipps, an LPC supervisor and a registered play therapist supervisor, recommends an IDEAL response for discipline — one that is:

  • Immediate (within three seconds)
  • Direct (be within 3 feet and make eye contact with the child)
  • Efficient (be measured and use the least amount of firmness possible)
  • Action-based (have the child model appropriate behavior to create motor memory for making future choices)
  • Leveled (aim the response at the behavior, not the child)

Phipps, a member of ACA, also teaches parents how to listen, acknowledge and accept children’s feelings even if they don’t agree with those feelings. For instance, she will often hear a child say, “I feel anxious,” and the parent’s response is, “There is nothing for you to feel anxious about.” That statement is not helpful, Phipps says.

Parents often need help discerning the difference between children’s behaviors and their feelings, she continues. She explains the distinction with the following example. It is OK for a child to feel angry at his or her parents, but it is not OK for the child to hit the parents. Many parents do not recognize the difference between the two, and they discipline the child if he or she gets angry, Phipps says.

Fussing at children because they are not behaving at home or school will not make them feel safe or secure, notes Post, a member of ACA. She advises adults to use the 30-second burst-of-attention technique. For example, when a parent is on the phone and a child is tugging on his or her shirt, the parent should stop for 30 seconds and attend to the child. After the parent gets on the child’s level and listens, then the parent can say, “I’m going back to my phone call now.”

Post, who currently trains teachers to use these skills, recently witnessed the power of listening to children rather than simply reacting to bad behavior. A young boy was being disruptive — throwing things and yelling — in a classroom. Instead of yelling for him to stop or threatening to call his parents, the teacher used CPRT skills. She got down on his level and in a calm voice said, “You feel sad.” The boy was silent for a time, and then he told her that the night before, someone had broken into his home while he was sleeping, and it was chaotic. After the teacher listened to his story, the boy calmed down and returned to the classroom.

Acknowledging feelings is the first step of the ACT model of limit setting. The subsequent steps are communicating the limit and targeting an alternative. Post and Phipps presented on this topic at the ACA 2018 Conference in Atlanta.

Post provides an example of using ACT to correct a child’s behavior. If a child is walking around when the family is eating dinner, the parent would say, “I know you want to get up from the table while we are having dinner, but now is the time to stay at the table and eat with the family. But you can walk around after dinner is over.” In this instance, the parent is providing the child with a way to meet his or her need at another time, Post explains.

Phipps, an adjunct professor at UNCC, practices the skills of the ACT model of limit setting with her counseling students, her counseling supervisees and her clients. With parents, she provides a scenario of a child misbehaving (e.g., throwing a toy), and then they discuss how to respond to the child using ACT. Sometimes, parents even write down the wording to practice later. Next, Phipps brings parents into the playroom so they can watch her execute these skills or even do them along with her. This helps parents feel more comfortable using the skills on their own later.

Although limit setting can be a difficult skill to learn, it is one of the most powerful tools that counselors have, according to Phipps, whose dissertation revealed its effectiveness. She worked with a child who was displaying aggressive behavior at preschool. After two sessions that involved limit setting, the child’s behavior improved at school. Phipps’ study also showed that as the child’s behaviors improved, so did the behaviors of his classmates.

Letting children take control

What happens when setting limits isn’t enough and the child continues to misbehave? Counselors and caregivers can turn toward choice giving. Landreth explains the skill of choice giving in his Choices, Cookies & Kids DVD, which Post says is a great resource for parents because it is humorous and contains relevant examples. When Post was in private practice, she would let parents watch the video while she worked with their child.

Phipps knows from personal experience that setting limits may not always be enough, and she says that choice giving is an easy skill for parents to use. She once had a young client who decided to throw sand in her office rather than play with it. First, Phipps tried setting limits: “I know you want to throw the sand, but the sand is not for … ” The boy threw sand in her face before she could finish her sentence. So, Phipps tried again, getting out the entire sentence this time before he threw sand in her hair. The third time that he picked the sand up, she set the limit again, and he decided to drop it. But when he picked the sand up for the fourth time, Phipps had had enough. She decided to use choice giving: “If you choose to throw the sand again, you are choosing to lose the sand.” The boy decided not to throw the sand.

“When you get to choice giving,” Post says, “do it once and be sure that you can follow through on your choices. [Also] be absolutely sure that you’re ready for this.”

Post advises using the word choose or choosing four times and leading with the positive choice first. She provides the following example: A child is walking around the classroom and won’t sit in a seat. First, the teacher sets a limit: “I know you want to walk around, but now is the time to sit in your seat. You can walk around at recess.” If that doesn’t work, the teacher gives the child a choice: “If you choose to sit in your seat right now, you are choosing to use the iPad for five minutes this afternoon. If you choose not to sit down in your seat, you are choosing not to have your iPad this afternoon.”

“Then that’s it,” Post says. “Then that child has to decide.” If the child is still walking around, the teacher says, “Oh, I see you’ve chosen not to have your iPad this afternoon.” The language should always emphasize that the child, not the adult, is the one choosing, Post explains. If the child gets upset, the teacher can say, “Oh, I am sorry you chose not to have your iPad. I would have chosen for you to have your iPad.”

The decisions the child is allowed to have control over will differ based on the developmental age of the child, Post continues. For example, a 3-year-old shouldn’t be allowed to decide if riding a bike alone around the block is a good idea, but the parents could let the child pick out his or her clothes for preschool.

With both limit setting and choice giving, children learn to control their behavior, begin to think of themselves as choice makers, and assume responsibility for their decisions, Post explains.

Phipps agrees. In her example of the boy throwing sand, the aim was not just to get him to stop throwing it and making a mess. It was for him to learn how to make decisions that would work for him in the real world.

Similarly, counselors can help parents view discipline from a completely different perspective — as a means to help children learn how to make decisions for themselves and control their own behavior, Post says. “It’s not to stop a child from doing something in the grocery store right this minute,” she explains. “It is to help a child learn that they make decisions for themselves and that their decisions count.”

Dealing with resistance

Parents who have been court ordered to attend counseling or whose children have been removed from the home because of the parents’ discipline practices are likely to be resistant to therapy, Adkison-Johnson notes. In such situations, counselors first need to confirm that the parents have a right to be angry, she advises. Counselors must also remember that their duty is to the client (the parent or parents), not the agency that made the referral, she says. (See sidebar, below, on the counselor’s role as a witness in court on physical discipline.)

When working with issues related to child discipline in such cases, counselors should prepare themselves to experience the full brunt of clients’ emotions, Adkison-Johnson says. Sometimes, white counselors feel uneasy with African Americans’ emotions, especially when those emotions involve anger, she adds.

“Be comfortable with the resistance. Be comfortable with the anger. Be comfortable with the fact that the client may not want to talk to you,” Adkison-Johnson advises. “They may have short responses at first. Sometimes they may not want to come back [to] the next session, but [they] come back anyway because they have to.”

Adkison-Johnson stresses the importance of counselors addressing these clients formally (unless they indicate otherwise), shaking the parents’ hands, and using their child’s name. These simple actions show respect for the family dynamic of authority, she explains.

The mental health field has a checkered past when it comes to its treatment of racial minorities, so African American families may also have a healthy paranoia that the clinician isn’t really operating in their favor. As a result, counselors must take baby steps to establish trust, Adkison-Johnson says. She advises doing this by acknowledging the parents’ fears and anger and by showing that the counselor is knowledgeable on the topic and understands the depths of the situation. Another important step toward establishing trust, she adds, is clearly explaining informed consent, limits to confidentiality, and clients’ right to remain silent.

Lin’s counseling students conduct free parenting training, and they post flyers to find parents who are interested. Although the parents are participating voluntarily, the training is sometimes recommended to them by their children’s teachers, and this can cause parents to have a bad attitude initially. Sometimes, parents also complain that they are too busy and don’t have time to complete the homework assignments, such as having uninterrupted playtime with their children for 30 minutes once per week. When parents come in with a negative attitude, Lin reminds his students that they must listen and avoid blaming the parents. One of the first skills counselors teach to parents is how to reflect children’s feelings, so counselors must model this behavior themselves, he stresses.

Sometimes, parents’ resistance to counseling stems from personal or cultural differences. When working with immigrant Taiwanese parents who identified as Christian, Lin’s counseling students voiced frustration that the parents were arguing with them about spanking, including quoting Bible verses on why it was appropriate to discipline their children this way. Lin’s advice in such situations is simple: “Never argue with parents. They have their own value system. They have their own beliefs.”

Instead, he advises counselors to focus on providing parents with additional parenting skills such as limit setting. “The more skills [parents] have, the better,” he says. “They don’t want to hold that stick in their hands all the time.”

Raising an adult 

While reading Michelle Obama’s book Becoming, Post found herself nodding in agreement with the parenting philosophy of the former first lady’s mother, who said she was raising adults, not children. According to the former first lady, “Every move she made, I realize now, was buttressed by the quiet confidence that she’d raised us to be adults. Our decisions were on us. It was our life, not hers, and always would be.”

Today, however, parents often assume their children’s responsibilities rather than viewing their role to be raising future adults. This is a tendency that crosses cultures. Lin recounts a saying in Taiwan: “If I give birth to a child and I don’t teach, then it’s my fault as a father.” This saying relies on the inaccurate belief that parents are responsible for their kids’ behavior, he says.

“When [parents] are so out of control in their own emotions when their kids are throwing a fit, usually it’s because they don’t have a clear boundary between themselves and their kids,” Lin says. With CPRT and filial therapy techniques, counselors can teach parents that children need to learn to be responsible for their own actions. This perspective will help parents remain calm and not become so upset if they misbehave, he adds.

Phipps’ belief is that parents are doing the best they can — whether she agrees with all of their parenting decisions or not. “We need to have a humbler approach to parents. … I have to walk humbly with a parent because I’m not walking in their shoes. I don’t experience that [child’s] behavior every single day,” she says. “I am the expert in the skills, but parents are the experts on their children.”

 

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Being a witness in court on physical discipline

According to a 2013 Harris Poll, nearly 8 in 10 Americans believe that spanking children is sometimes appropriate. The question is when does corporal punishment become abuse?

That answer is complicated because it varies by state. The most common approach, used in more than half of states, says that parents may use reasonable force if necessary to maintain discipline.

Counselors may be asked to inform the courts on this distinction. Being an expert witness on child discipline is a pressing issue right now, notes Carla Adkison-Johnson, a licensed professional counselor and a professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University. In fact, much of her work has moved into expert testimony, which involves discussing her research to inform the court whether a parent should be brought up on criminal charges just for spanking their child. She works to inform court judges on how to distinguish between child discipline and child abuse when dealing with families.

As anti-spanking groups gain more political clout, they put pressure on child protective services to carry out their perspective, and this puts families of color at risk, Adkison-Johnson contends. She says that because of racial bias in our society, African American parents are disproportionately brought up on charges of physical abuse related to the child discipline practices they follow. The large majority of her cases as an expert witness have involved African American parents who have had their children removed from the home and who face potential jail time or a felony because they spanked their child.

Adkison-Johnson says that clinicians might also be called to serve in court as “witnesses of fact” (which differs from the role of an expert witness), particularly if they are working with families that have been mandated to attend counseling. In this role, counselors are working directly with the parents to help them but are also being asked to inform the court about the facts of the case. Thus, the questions that counselors ask these parents and the approach they take in counseling the parents are crucial, she stresses. Counselors must find out what parents have done, and they should ask specific questions about the goals and aspirations parents have for their children. This information will help address the “why” and “how” questions when evaluating parents’ disciplinary approach, she explains.

Adkison-Johnson points out that today’s parents often wrestle with establishing healthy boundaries and may have become more lenient in terms of discipline. The current parenting generation has been told not to spank or to use strict discipline with children and has been directed to instead negotiate with children on what the rules will be, she adds.

Counselors may also be asked to write letters on the progress they are making with clients. Adkison-Johnson advises counselors to let clients read these letters before sending them to the outside agency. “See if the client feels comfortable [that it is] an accurate portrayal of how they parent and what they believe took place in the counseling session, and be open to that discussion,” she says. She finds that clients will sometimes remember a detail that the counselor forgot or overlooked.

“Also, let them know that you are their counselor and not an agent for the court or child protective services and that you are committed to them and the success of their family,” she adds.

— Lindsey Phillips

 

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

Letters to the editor: ct@counseling.org

 

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

Five points of discussion for conversations about racial injustice

By Amanda L. Giordano April 10, 2019

When teaching multicultural counseling courses, I often get questions from White students about how they can leverage their White privilege to help change America’s broken social system that privileges some while oppressing others. In addition to continuing to explore their own White racial identities, I encourage these students to initiate conversations with other White people in their lives about racial injustice. As more White individuals become aware of their White privilege and the racial injustice that exists in our country, greater degrees of systemic change are possible.

Counselors and counselors-in-training are uniquely equipped to facilitate these discussions, given their strong interpersonal skills and passion for advocacy. The goal of the conversation is to invite White individuals to engage in a dialogue about systemic privilege and oppression rather than become defensive. In an effort to assist White individuals who desire to initiate conversations with other White people about racial injustice, this article provides five possible points of discussion.

 

1) What characteristics do we attribute to race? Since the start of this country, we have fallen prey to an insidious scheme based on faulty logic: attributing characteristics and behaviors to race that have no rational correlation. We do it so frequently and so automatically that it often goes unrecognized. For example, if a Latino contractor does not complete his work satisfactorily, we are tempted to conclude, “Latino contractors cannot be trusted.” We erroneously attribute personal work ethic to race. Or, if we are cut off in traffic by a Black woman, we somehow link her behavior to the fact that she is Black rather than to an isolated driving decision.

When we pause and reflect on what characteristics and behaviors we attribute to race, we may be surprised by what we find. Logically, we know that skin color, eye shape and hair texture have no correlation with an individual’s morality, intelligence or trustworthiness — yet we have been socialized to make these associations. This is something that we need to unlearn.

Consider what would happen if someone watched a documentary about Charles Manson and concluded that he was a cult leader because he was White. We likely would explain that Manson’s role as a cult leader was the result of myriad factors (psychological state, early childhood experiences, environment, etc.) and that his behavior cannot be attributed to his race. In the same way, we need to examine the correlations we make between a person’s race and her or his personal characteristics or behaviors. How logical are these attributions? 

2) Do we desire people of color to “act White”? Many White people are genuinely trying to learn how to be culturally competent, but sometimes they can get stuck in a particular mentality: “I enjoy diversity … just as long as people of color act/talk/think in ways that I am familiar with.” Whether intentionally or unintentionally, we may encourage people of color to deemphasize their unique cultural identities to fit into the mold of White cultural norms. As a result, many people of color expend a lot of energy working to make White people feel comfortable around them (such as expressing only certain aspects of themselves while in the company of White individuals).

What is the cause of our desire for people of color to “act White”? It’s likely that we feel more at ease with what is familiar to us. There is a certain way of being that we deem “normal,” and it makes us comfortable when people behave accordingly. Therefore, the desire for people of color to “act White” is for our comfort.

Sadly, we rarely consider the discomfort that people of color face as they navigate White cultural norms every day. Often, their culturally diverse ways of being are not reflected back by those around them. As a result, people of color are forced to learn all the nuances of White cultural norms, whereas White individuals know very little about the cultural norms of other racial/ethnic groups.

What would it be like to let go of the strong grasp we have on our own cultural preferences and enter into the preferences of others (despite the unfamiliarity)? “Different” doesn’t have to be synonymous with “negative”; different can be exciting, invigorating, enlightening. Can we create space for all people to be proud of their cultural identities and to express those identities in whatever ways they choose?

3) Do we acknowledge that multiple interpretations exist for past and current events? Education is an amazing gift, and the opportunity to learn is something we should never take for granted or outgrow. At the same time, we must acknowledge that the stories we’ve read and the accounts we’ve learned in school represent one perspective, one side of the story. Authors of textbooks and class curricula write from their own frames of reference — they are not neutral, blank slates who simply report the facts. These authors make interpretations, derive meaning and present information from their personal lenses. It is important to consider that authors from different cultural backgrounds may have different interpretations, derive different meanings and present information differently, simply due to their frame of reference.

Consider an example from history: the Pueblo Revolt of 1680. Depending on the perspective of the storyteller, this could have been a brutal uprising against the Spanish who were dedicated to bettering the community (Spanish as protagonists) or a liberating revolt in which oppressed Pueblo Native Americans took back the land that was rightfully theirs (Native Americans as protagonists). There are always multiple perspectives to every event, and it is important for us to consider differing viewpoints. Can we concede that what we think we know is only one perspective and that multiple, equally valid viewpoints exist?

4) Does defensiveness keep us from truly listening to people of color? It is important to consider what comes up for us when we hear people of color share their experiences of oppression. If our initial response is defensiveness, it is likely that our focus in that moment is off. Rather than focusing on the lived experience of the speaker, we are focused on what the information says about us. We are not attending to the oppression of our neighbors and how they feel; instead, we are attending to the impact of the information on our own sense of self.

One strategy that can help us maintain the proper focus is to listen with the goal of understanding rather than evaluating. Often when we listen, we are evaluating what we have just heard (Is this information right or wrong? Do I agree or disagree? What does this mean about me?) and simultaneously developing responses and counterpoints in our head. This process keeps the focus on us — our reactions, our beliefs and our assessment — and gets in the way of truly listening. There certainly are times when evaluation in conversation is necessary, but when people of color are sharing their experiences of oppression, it is more helpful to listen with the intent to understand, not to evaluate.

If we feel ourselves becoming defensive, we should do a quick mental check-in: “Am I evaluating what is being said and focusing on what it means about me?” If so, perhaps we should press pause and mentally switch our focus back to the speaker (“What was that like for her? How did she feel when it happened? How did this experience affect her life?”). When a person of color shares her or his experience, can we truly listen with the goal of understanding rather than evaluating?

5) We could do nothing about racial injustice, but do we want to? If we are honest, we all know that something is wrong with our social system. It is clear that people are treated differently as a result of their race. Consider two high school students (one White and one Black) who get caught with marijuana. Sadly, it is more likely that one of these students will be sent home with a warning (to a family who will “get him back on track”), while the other will be ushered into the criminal justice system. Or consider two identically qualified job applicants — one with the last name Jones and the other with the last name Hussain — who submit their résumés for an open position. Again, it is likely that one will get the interview because he seems like a “better fit,” whereas the other will stay on the job market.

We know, just by looking at the world around us, that inequity exists and that things are unjust. We also know that we can go our whole lives without saying or doing anything about it. We can choose to live in silent disapproval and never challenge the status quo, but is that what we want? Saying and doing nothing despite evidence of racial injustice likely means that we are living in opposition to our values (e.g., equality, justice, respect for the innate worth of all human beings), which can lead to incongruence and cognitive dissonance.

Also, if we allow our unjust system to continue, we likely will never experience the true joy that comes from living in a diverse community and celebrating cultural differences. We will not have the opportunity to see the world from different perspectives or to feel the excitement of experiencing new cultural norms. We may never form deep, meaningful relationships with those from different racial/ethnic backgrounds or experience the gifts that come only through diverse friendships. If we remain silent, we may be living life, but are we living it to its fullest? Those with privilege have a responsibility to leverage their unearned advantages to combat injustice and oppression. What does that look like for us personally?

There are many more talking points to consider, but these might help start conversations with White people in our spheres of influence. Let’s remember that as counselors, we have a unique set of interpersonal skills that can be extremely useful when facilitating conversations about racial injustice. We are primed to listen well, validate, and gently present alterative viewpoints. Perhaps we can all commit to using our skills to facilitate meaningful dialogue that could lead to lasting, systemic change.

 

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Amanda L. Giordano is an assistant professor in the Department of Counseling and Human Development Services at the University of Georgia. Her research interests include addictions counseling, multiculturalism, and religious and spiritual issues in counseling. She is a licensed professional counselor and national certified counselor. Contact her at amanda.giordano@uga.edu.

 

Letters to the editor: ct@counseling.org

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

 

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

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

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

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

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

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

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

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

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

 

Why this topic matters to Cebrail

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

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

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

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

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

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

 

Why this topic matters to Donna

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

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

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

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

 

Why this subject is especially relevant

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

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

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

 

Strategies and implications for professional counselors

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

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

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

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

 

 

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

 

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

 

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

Counseling individuals of African descent

By Malik Aqueel Raheem and Kimberly A. Hart March 5, 2019

In 1963, James Baldwin wrote that to be Black and relatively conscious is to be in a state of rage almost all the time. The historical record of people of African descent is filled with triumphs and trials. The great empires and kingdoms of Africa, including Egypt, Mali and the Moors, experienced vast triumphs. Records of tremendous successes, such as those led by Mansa Musa, Hannibal, Queen Nana Yaa Asantewa, Shaka Zulu and Amenhotep IV, demonstrate the great history of people of African descent prior to the trans-Atlantic slave trade and colonization.

The trans-Atlantic slave trade had a unique impact on Africa and on individuals of African descent. Historians report that Brazil was one of the last governments to make slavery illegal in the Americas, in 1888. However, long after slavery formally ended in the United States — in 1865 with ratification of the 13th Amendment — the psychosocial oppression of people of African descent continued. For the next 100 years, Black codes and Jim Crow laws were influential in creating a second-class citizenship for people of African descent. In 1964, the Civil Rights Act was signed, appearing to offer the full promise of freedom, but the civil right for freedom remained existent in theory only. A separate existence dominated by institutional racism — highlighted by such laws and policies as redlining, the federal crime bill of 1994 and the school-to-prison pipeline — was the actualized manifestation of post-slavery experience for many individuals of African descent.

In 1991, the movie Boyz N the Hood included an opening scene of four young males of African descent walking through the neighborhood of South-Central Los Angeles. This could have been any urban area in America during the height of the crack epidemic and the infamous “war on drugs.” One of the four young men shows his peers the remains of a dead body among the weeds of an empty lot. Similar scenes have transpired regularly across the United States and throughout the African diaspora. It stands as one example of the trauma being experienced in many urban areas and inner cities today.

The crises of institutionalized racism, race-based oppression and racial trauma are significant aspects of the intersectionality of individuals of African descent. Counselors need to understand the meaning and impact of this intersectionality on the students and clients they counsel. Understanding the core constructs of historical and complex crisis and trauma for individuals of African descent who present in counseling is an essential phase for developing counselor efficacy.

Definitions

The information presented in this article can be understood and discussed using the definitions that follow. Scholars such as Derrick Bell, Patricia Williams, Kimberlé Williams Crenshaw and Mari Matsuda have contributed to critical race theory. According to the theory, racism has three levels: institutional, individual and internalized. Racism is to be understood as discrimination, marginalization or oppression inequitably inflicted upon individuals identified as belonging to a socially constructed racial category. Racism requires the combination of prejudice, power, access and privilege. For an individual to be racist, he or she must have access to an element of power and privilege to oppress the group being prejudicially discriminated against.

In the 2007 article “Racial microaggressions in everyday life,” Derald Wing Sue and colleagues defined racial microaggressions. Racial microaggressions are brief and commonplace verbal, behavioral or environmental indignities that are used, unintentionally or intentionally, to communicate hostile, derogatory or negative racial slights and insults to the targeted person or group based on their socially constructed racial category.

In 2003, William Smith coined the phrase racial battle fatigue. The term captures the psychological attrition that people of color experience in their daily encounters as they try to deflect racial insults, stereotypes and discrimination. Racial battle fatigue is the cumulative debilitating effect of being on guard against attacks about or because of one’s socially constructed racial category. It is also a theoretical framework for examining social-emotional-psychological stress responses such as frustration, anger, exhaustion, physical avoidance, psychological withdrawal, acceptance of racial stereotypes, and verbal, nonverbal or physical fighting back related to the experience of racism and racial microaggressions in acute episodes or chronic intervals.

Culture is a collective constellation of behavioral norms, values, spirituality, traditions, history, language and unique variables such as food, music, dance and clothing that guide and influence a people’s cognitive and affective complexity. This in turn determines their behavioral response to life circumstances. Culture frequently is identified by ethnic populations. However, the concept of culture is not restricted by ethnic groupings. Microcultural norms influence the unique intersectionality experiences of microcommunities and individuals within identified cultural groups.

Intersectionality is a term coined by Crenshaw in 1989. It is used to recognize systemic influences on individual identity, positionality, access and experience narratives. The primary influence on Crenshaw’s discussion of intersectionality was the exclusion of differential narratives of women of African descent during the feminist movement in the United States. Intersectionality is used in identification of nonmajority sociopolitical experiences that were suppressed by individuals operating from racist and heterosexist sociopolitical majority narratives. Intersectionality is understood to encompass microcultural influences such as religious diversity, nation of origin diversity, gender expression diversity, sexual orientation diversity, ethnic diversity and generational diversity.

White supremacy is the belief and practice that individuals who racially identify as White are superior to all other races, especially to people of African descent or Black people. Within this belief system, people of Whiteness and White culture are considered rightful dominators in dictating normalcy and social policies. Neely Fuller said, “If you do not understand White supremacy, what it is and how it works, everything else you think you understand will confuse you.” The supremacy of Whiteness, like racial categorization, is a sociocultural myth. Nevertheless, these constructs influence trauma.

Trauma is defined as an emotional response to distressing or life-threatening events. Traumatic events overwhelm a person’s ability to cope, leaving the person fearful of injury, mutilation or death. Trauma has affective, cognitive and behavioral influences on human development and functioning. Some trauma is communal in that a collective of individuals sharing some community or temporal space connection is affected by a single traumatic event (e.g., the trans-Atlantic slave trade). Individual trauma affects one individual at one point in time. Complex trauma is identified by compound experiences (i.e., more than one traumatic event is experienced before the healing of a previous trauma or serves to restimulate a traumatic response to a distressing event that was previously managed). Trauma can manifest through vicarious experiences, transgenerational events or the experience of persistent adverse events that may not have been traumatic in isolation. There are different types of trauma and levels of traumatic responses. Trauma is individualized on the basis of perceptions of events and the person’s ability to cope in the present moment of the crisis.

Race-related trauma

A multicultural assessment of problematic behavior for people of African descent should not be limited to a description of mental and emotional deficits or to observations of atypical externalized behaviors. An accurate multicultural assessment must include responses to psychosocial and environmental conditions in which the observed behavior might be a normative and rational response. Behavioral pathology of people of African descent can be a consequence of ecological systems rather than intrapsychological deficits.

Racism is a psychological disease; racism is pathology cultivated through transgenerational neglect, and it has negative influences on perpetrators of racism, victims of racism and racism survivors. Unfortunately, as individuals in society have refused treatment for so long, people of African descent have continued to experience overt and covert culture-deteriorating suffering and trauma as the result of being targets of racism. Racism is both extremely common and extremely complex. Racism is entrenched in societal history, institutions and policies, with the exerted supremacy of Whiteness perpetrated and perpetuated as a societal norm.

Racism is pathology of power marked by ignorance. In 2013, racism scholar and healing racism advocate Lee Mun Wah described the privilege of numbness as an outcome of racism that is experienced by individuals of Whiteness. The privilege of numbness is a paradoxical term used to articulate the adverse impact of racism that influences the ability of individuals of Whiteness to perpetuate racism. Privilege in this equation of racism is one’s positionality of normativity. This privilege is the gift of psychological and emotional numbness resulting in not having to think about:

  • The construct of race or racism
  • How racism is oppressive
  • How complicit and explicit racists are advantaged in direct relationship to the oppressive trauma of individuals of African descent

This article focuses on direct counseling for individuals of African descent. However, it should be noted that healing the trauma of racism needs to include healing the numbness of racists. In general, this includes individuals of Whiteness within institutions of Whiteness reallocating their forcibly gained and complicity perpetuated power that has been used for oppressing individuals through policies and institutional norms.

Individuals of African descent commonly experience racial microaggressions. Racial microaggressions are communications of assumptions, including assumptions of intellectual inferiority, assumptions of criminality, assumed superiority of White values and culture, and assumed universality of the Black experience. People of African descent experience unrelenting forms of direct, vicarious and institutional oppression, marginalization, discrimination and microaggressions. Many of these incidents manifest as hypersurveillance, stigmatization, provocative irritations and recurrent indignities, and people of African descent experience these microaggressions daily. Microaggressive events can accumulate and compound into experiences of racial battle fatigue and race-based trauma, some of which is experienced by a collective group of individuals during the same time period.

Community-experienced trauma

One example of community trauma is the economic devastation in communities of people of African descent resulting from periods of deindustrialization in many urban areas. The convergence of deindustrialization and racial desegregation created losses in vital social and economic capital among communities of African descent. Increases in unemployment and underemployment quickly snowballed into lost wealth and concentrated poverty within communities of African descent.

Although deindustrialization was not targeted racism, the intersection of racism was a compounding factor in the unfortunate and traumatic impact on communities of African descent. Within this atmosphere of community poverty and a reduction in already sparse resources, a dynamic and traumatic upsurge of violence, drugs and institutionalized mass incarceration was also experienced in many of these communities.

Another example of community trauma is manifested through interpersonal violence and economic deprivation within communities of African descent. Men of African descent are the primary targets of this trauma. Nonetheless, women and children of African descent are also exposed to violence in the streets, violence in the schools and violence in the homes. The violence experienced within communities of African descent is a multifaceted intersection of trauma. Structural and institutional racism and oppression have created pandemic conditions of poverty and violence in these communities. By oppressive design, these communities have been deprived access to develop viable, legal and consistent wealth-producing economic avenues. Racist, oppressive and marginalized social structures have translated into drug, sex and weapons trafficking becoming the most consistently accessible sources of economic survival for communities of African descent.

Men of African descent

Men of African descent are disproportionately represented among both perpetrators and victims of violent crimes. According to the National Center for Health Statistics in 2017, men of African descent were nine times more likely than White men to be victims of homicide. Historically, men of African descent were (and continue to be) feared as a threat to the status quo of White supremacy. This social fear remains cloaked in racial stereotypes today. Stereotypically, men of African descent are prejudicially viewed as intimidating, scary and dangerous.

Educational disparities have created a cultural experience known as the school-to-prison pipeline within communities of African descent. The school-to-prison pipeline refers to policies and practices that push children at risk for school failure and civic disengagement due to poverty and marginalization out of the classroom and into the juvenile and criminal justice systems. Current policies such as “zero tolerance” in disciplinary actions have resulted in more suspensions, expulsions and even arrests by law enforcement officers who are typically assigned to schools in areas that are predominantly populated by people of African descent. Students of African descent are six times more likely than White students to be affected by such policies.

Women of African descent

Multigenerational and transgenerational trauma — in the form of coercive segregation of female/male units during slavery, lynchings, sexual violence, murder and intimate partner violence in different forms — have historically been a part of life for women of African descent.

It was previously documented that women on average made 71 cents to every dollar that men made; in comparison, women of color made 65 cents. Reports in 2018 included a marginal increase, with women in America making an average of 80 cents for every dollar that men made. However, that average included a decrease for women of African descent, who received only 63 cents per dollar that men made.

Violence perpetrated by men who are usually their community partners is one of the leading causes of death among women of African descent. A complicated lack of protection from men who were their life mates was a strategy that slave owners and post-slavery oppressors used to dismantle communities of African descent. This also prolonged trauma responses within these communities.

Another part of the marginalization and trauma for women of African descent involves their social image. Within literature and media, Black women are often stereotyped as one of four archetypes: Jezebel, Mammy, Matriarch and Sapphire. Jezebel is characterized as a woman who uses her sexuality as a weapon. Although these women do not necessarily engage in sexual relations, they utilize the lure of sexual possibility and overt sexual innuendo to navigate access and fulfillment of their life desires. Mammy is the woman primarily observed in roles of upkeeping other households; historically, she was the maintainer of a White family’s home and children. The Matriarch is the head of household of the Black family. Also called Medea or big momma, these woman provide protection, wisdom, connection, gospel and community history to the family.

Traditional family structures within communities of African descent include extended family units that are seamlessly interwoven into the family concept. The Matriarch was often the oldest living woman in the family unit, whereas Sapphires were usually women who had an aggressive attitude toward men. These woman were full-hearted and physically strong. They often worked to match men in traditionally male roles, which is often portrayed as an emasculation of their male counterparts. Sapphires are also portrayed as lacking maternal drive and striving for individual equality to the point of pushing men away. The strength and community utility of these archetypes are frequently ignored, whereas exoticism and exploitation of these stereotypes are perpetuated as a means of ongoing marginalization of women of African descent.

Counseling approaches and interventions

As individuals of African descent experience various adversities, crises and traumas related to racism and cultural discrimination on individual, community and generational levels, counselors can offer supports for healing trauma. Counselors must be aware of this history and the current sociopolitical institutions that traumatize and retraumatize individuals of African descent before healing work can begin.

Postmodern, humanistic and cognitive approaches have proved to be efficacious for counseling people of African descent. Other approaches are also being used with this population, however. For example, an African-centered psychological approach has been created as an alternative paradigm. This approach is grounded in traditional African spiritual philosophy but can easily be adapted for the specific religion/spirituality of the person of African descent. Because counseling is a sacred and spiritual relationship between the counselor and the client, it is important that the foundation of the therapeutic relationship be built on authenticity, trust and respect. Important interventions for counseling individuals of African descent include a focus on identity congruence, invitation for repair and the use of spiritual or religious connections salient to the individual or community.

Identity congruence: Culturally competent counselors need to be knowledgeable and sensitive to ethnic and racial issues. Ethnic identity is an aspect of a person’s social identity and self-concept derived from knowledge of their membership in a social group and the value and emotional significance they attach to that membership. Racial identity is one’s psychological response to one’s race. Racial identity reflects the extent to which the person identifies with a particular racial or ethnic group, the person’s self-perceptions because of their identified race and how that identification influences perceptions, emotions and behaviors toward people from other racial/ethnic groups.

Invitation for repair: Multicultural competence principles are rooted in internal awareness and critical reflexivity. Counselors must be aware of their biases and sociopolitical blind spots that might affect the therapeutic relationship. Multiculturally therapeutic relationships can be established using invitation for repair, as described by Malik Aqueel Raheem, Charles Myers and Scott Wickman in 2015.

Invitation for repair is acknowledging that overt and possibly covert differences in experiences exist between the mental health professional and the client. The invitation involves requesting that the client correct the counselor if the client feels that the counselor is not connecting or does not have empathy for the client’s intersectionality. Multicultural social justice principles exhort counselors to become more active advocates in addressing the institutional and environmental factors that influence client distress and trauma.

Spirituality and religion: A protective factor for many people of African descent is their connection between spirituality and psychological well-being. Research has shown that people of African descent are able to regulate and resolve distress through the practice of their spirituality or religious beliefs. Counselors should inquire about and create intervention opportunities that infuse these religious or spiritual norms. This approach will help to develop and maintain therapeutic alliance and efficacious therapeutic outcomes.

According to John Dillard, spirituality is a view of an individual’s place in the universe or a personal inclination or desire for a relationship with a transcendent power or God. Religion is an organized social means through which people express spiritual beliefs. Spirituality and religion do not necessarily have positive correlations for people of African descent. Spirituality can be experienced independent of religious contexts, and not all religions promote spirituality as part of their practices. However, many individuals of African descent are simultaneously religious and spiritual.

A majority of people of African descent identify as Christian from various religious microcultures of Christianity. There is also a movement toward infusing traditional African spirituality into some of their Christian practices. In addition, many in the African diaspora were from West African, and it is estimated that 30 percent of these Africans who were brought to the Americas were Muslim. In Islam, Sufism is the more mystical aspect of the religion. It is believed that the spiritual aspect of Sufism helps the Muslim to have a deeper and stronger connection with Allah (God). In 2018, scenes from the movie Black Panther depicted visitations to the “ancestral plane.” While in the ancestral plane, individuals could discuss issues with their ancestors. The belief that ancestors are ever-present and guiding forces is common among individuals of African descent. The tradition of libations (the ritual pouring of a liquid or other element to honor ancestors) or the West African practices of Vodun (more commonly known as Voodoo in the United States) may also be relevant for some clients of African descent.

Summary

As counselors work with individuals of African descent, acknowledgment of racism and oppressive structures that influence clients’ trauma experiences and trauma responses is vital to building therapeutic alliance. Interventions such as invitation for repair are most effective when used in the present moment of a psychological, affective or behavioral injury to the individual or the therapeutic relationship. Humanistic counseling approaches, including validation and implementation of relevant spiritual or religious practices, have also been shown to be effective for working with individuals of African descent.

 

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

Malik Aqueel Raheem has more than 10 years of clinical experience and seven years as a professional counselor educator at California State University, Fresno. Contact him at malik2xl@gmail.com.

Kimberly A. Hart focuses on multicultural inclusion as an area of counseling practice, counselor preparation and research. She provides presentations and training on mental health and intersectionality. Contact her at hartkimberly27@gmail.com.

 

Letters to the editor: ct@counseling.org

 

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