Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Culture-centered counseling

By Lindsey Phillips November 22, 2021

The 2020 census revealed a growing multiracial U.S. population, with the number of people who reported multiple races increasing from 2.9% in 2010 to 10.2% in 2020. Part of this increase stems from changes the U.S. Census Bureau made to the questions about race and ethnicity to more accurately capture the shifting demographics of the nation’s population. These changes included removing the word origin on the instructions for the Hispanic ethnicity question, because this term can mean different things to different people, and adding write-in response areas for the question about racial identity. 

The counseling profession could also benefit from rethinking the way it approaches diversity and multiculturalism. Most of its foundational theories and approaches, such as psychoanalysis, cognitive theory and cognitive behavior therapy, were developed by white men, leading many counselors to ask whether these approaches still meet the needs of an increasingly diverse and multiracial clientele.  

Answers to these questions are not easy or straightforward. Some counselors want to revise or adapt these foundational counseling theories to make them more inclusive, while others argue it’s time to make room for more culture-centered theories or even create new ones.

The thought of adapting traditional forms of counseling to make the process more appropriate for culturally diverse populations bothers Derald Wing Sue, a professor of psychology and education at Teachers College, Columbia University, because “it almost assumes that no societies or other groups ever had anything like counseling or psychotherapy,” he says. Instead, he argues the mental health field should broaden its understanding of Indigenous and non-Western help-giving networks.

Broadening the theoretical perspective 

“All theories of counseling and psychology represent worldviews, primarily ones from the developer of that theory,” says Sue, the author or co-author of several books and articles on multiculturalism, including Counseling the Culturally Diverse: Theory and Practice and Race Talk and the Conspiracy of Silence. Rational emotive behavior therapy, for example, stems from Albert Ellis’ view that problems reside in the cognitive realm. In turn, these theories “represent worldviews that define normality [and] abnormality, what is therapeutic [and] what isn’t therapeutic,” Sue says. “So, the first objective is for therapists and systems of counseling and psychotherapy to deconstruct their worldviews.” 

Sue also argues that theories of counseling and psychotherapy should encompass an understanding of the social-political dynamic that affects the counseling situation. Many clients come to counseling with a worldview that is intimately linked to their status as a member of a marginalized group and the social-political dynamics surrounding that status, he notes. 

“Therapists often don’t understand that in their work, they may be encouraging clients in a forced compliance to assimilate and acculturate [and] to do things the white, Western way,” he says. “A liberated form of helping is one that recognizes strongly the social-political element and is unafraid to include that as part of the counseling session and structure that is going on.” 

Although many theories of counseling and psychotherapy attempt to do this, they have done it in a way that is not well integrated in terms of the system of counseling, he adds.

In addition, Sue, co-founder of the Asian American Psychological Association, points out that counseling theories typically study only one aspect of the human condition: the behavioral self, the feeling self, the cognitive self, etc. But human beings contain more depth; they are also cultural, political and spiritual beings, which traditional counseling can often overlook.  

Culture-centered counseling theories such as liberation psychology, relational-cultural theory and critical race theory begin to address some of the gaps in more traditional counseling approaches. These theories have basic tenets that counselors can use as a foundation for how they interact with clients, says Regina Finan, an American Counseling Association member whose research interests include multiculturalism and social justice. 

One tenet of critical race theory, for example, is that race is a social construction with real-life implications, she notes. Critical race theory asks people “to stretch and expand themselves, and bracket all the things they think they know and understand as ‘right’ and ‘true’ [about race and racism] and make space for things that they can’t understand because they haven’t lived it,” Finan says. “But isn’t [making space for clients’ experiences] what we are trained as counselors to do? … We just don’t always talk about it in terms of race, sexual orientation, gender identity, religion and all these pieces.” 

Even if counselors have never experienced depression or anxiety themselves, they don’t doubt that their clients have, says Finan, an assistant professor of counselor education at the University of West Georgia, and they set about educating themselves on those issues. That is what equity-centered theories are asking counselors to do, she stresses.  

For example, a Black client might have panic attacks whenever they get pulled over by the police. A counselor could choose to use cognitive behavior therapy to help this client because it has been shown to be an effective treatment for panic attacks. But the counselor could also approach this situation using the lens of critical race theory, Finan says. This lens can help situate the client’s fear as rationale within the broader systemic context of police brutality and racial bias. Being culturally aware will help the counselor broach this issue with the client and remind them that the problem is a systemic one, not something that is “wrong” with them. 

Broaching the topic is important, Finan adds, because although the counselor may find that there is a specific fear associated with the client’s race, it is also possible that the client fears getting in trouble. Ultimately, the counselor has more information, and then they can work together and use appropriate techniques to help the client manage the panic attacks and explore the concerns underlying the attacks.

Unlike many traditional counseling theories, Black existentialism asks counselors to broaden their perspectives and sit with the knowledge that there are multiple truths and experiences, notes Linwood Vereen, an associate professor of counseling at Shippensburg University of Pennsylvania. In the article “Black existentialism: Extending the discourse on meaning and existence” (published in The Journal of Humanistic Counseling in 2017), Vereen, an ACA member, and his colleagues explain how Black existentialism aims “to merge both individualistic and collectivist representations and dimensions of the respective self, in such a manner that the real and constructed selves are intricately bound with the social circumstances human beings find themselves situated within.”  

This theoretical approach challenges counselors to find ways of applying this notion of individual existence to clients who live and operate within communities, he adds.

Doralis Coriano Ortiz, an ACA member and licensed clinical professional counselor in Illinois, acknowledges that theories that are more culturally centered can provoke uncomfortable feelings for some counseling professionals because these theories often challenge what they have been taught in the U.S. educational system. These theories often force counselors to confront the racist origins of counseling and psychology and the ways they have appropriated and repackaged Indigenous practices, she says. 

Taking a culture-centered approach 

Culture-centered theories acknowledge that people are affected not just by interpersonal relationships but also by larger systems, notes Finan, the Association for Multicultural Counseling and Development (AMCD) vice president of multiethnic, multiracial and transracial adoptee concerns. This view allows counselors to broaden the context for clients, helping them realize that the counseling relationship involves more than just the counselor and client; it’s about the counselor’s and client’s lived experiences, which are embedded in their families’ lived experiences, as well as privileges and marginalized experiences, she says. 

If a client is struggling with how racism or poverty is affecting them, Finan suggests that the principles of critical consciousness and liberation psychology can be used to engage the client in a conversation about how systemic and historical oppression can shape them. She may have clients complete a family genogram to unpack the role that racism plays in their life. Clients can go back as far as they are able in their family tree, thinking about the experiences that their family had with racism, how that shaped them then and how it continues to shape the client today. 

The goal of this exercise is to help clients clearly understand the systemic nature of racism and realize that these experiences are not their fault, says Finan, co-author of a book chapter on intersectionality in Introduction to 21st Century Counseling: A Multicultural & Social Justice Approach. (The book is co-edited by ACA President S. Kent Butler.) In addition, this strengths-based approach seeks to center the resilience and characteristics of individuals, which in turn can be used to reject deficit narratives created by oppressive systems, she adds.

Monica P. Band, a licensed professional counselor and clinical supervisor who owns the private practice Mindful Healing Counseling Services, with offices in Washington, D.C., and Manassas, Virginia, also highlights how systemic factors affect her clients’ mental health. For example, she has worked with several women of color who were struggling with impostor syndrome. Some counselors may be tempted to focus on changing the client’s thoughts and behaviors around being an “impostor” without first considering context, Band says, but then they are leaving out a large part of the problem. 

“While the experiences of impostor syndrome are not unique to BIPOC [Black, Indigenous and People of Color] folx, the experience takes on a different tone, and cultural influences must be considered,” Band explains. “Most spaces are not created for [this client]; in fact, they often actively exclude her and, historically, have been meant to exclude her via legislation or social norms. So, some of the discomfort that the client is experiencing is not about her ‘not being enough’ but an appropriate and natural reaction to systems which have defined her as ‘not enough,’ and the client has internalized harmful narratives like this.”

She advises counselors to be cautious and avoid pathologizing the client’s distress and instead be active in observing the client’s lived experiences. “When believed, narratives associated with impostor syndrome like ‘I am not good enough’ or ‘I shouldn’t/don’t deserve to be here’ continue to perpetuate the oppressive nature of impostor syndrome by attacking the client’s self-concept,” Band says. “It is our goal as culturally competent counselors to call out and normalize these narratives by providing a broader, historical understanding for our clients by decolonizing and deconstructing their intersecting cultural identities with them.”

First, Band would normalize the client’s complex feelings of shame and pressure to succeed around being an “impostor,” and she would remind the client that the feelings associated with being an impostor, counterintuitively, helped the client survive in oppressive spaces at one point in her or her ancestors’ lives. “When I say surviving oppressive spaces, what I mean is to adapt and assimilate,” she explains. “At some point in history, BIPOC folx learned that in order to survive physically and emotionally, sometimes it was necessary to make oneself smaller, to not be seen, to not take up space, to not be [themselves] — in other words, oppress [themselves] and adapt to the legislation that has excluded [them] from these spaces.”

When these individuals enter spaces where they don’t feel like they belong or that don’t have many people with similar cultural backgrounds or lived experiences, Band continues, they begin to ask themselves, “Is this a mistake? Should I be here? Why am I here? It doesn’t feel safe.”

When Band and the client step back and begin to deconstruct the perspective of belonging considering this context, the client can then grieve the lost opportunity that resulted from intergenerational trauma and inequitable systems. The client can also learn to intentionally respond to these systems rather than react out automatically, Band adds.

“Counselors must contextualize these harmful narratives [and] understand and focus on the history as a source of strength,” Band argues. “The client has autonomy in choosing these narratives as their own once they build conscious awareness. The client and [counselor] then can build upon the strength, energies and spirits of [the client’s] ancestors as motivation and reflection. The counselor is not just working with that individual client in front of them on that couch; they are working with the ancestors and traumas the client brings with them.”

Liberation psychology means redirecting pathology away from individuals and onto systems that create environments where it is not possible for someone to be healthy, says Sarah Sevedge, a licensed mental health counselor in private practice who also holds a doctorate in counseling psychology. LGBTQIA and BIPOC clients have come to see Sevedge because of anxiety, depression and trauma — issues that can stem, she says, from the fact that they live in rural, conservative areas that may be antagonistic toward their identities. Sevedge realizes that the larger societal and systemic issues affecting her clients’ mental health work against their ability to be fully healthy, but often her clients view their mental health issues as personal failures. 

“So many clients look at mental health issues as if something’s wrong with them — they’re anxious, they’re depressed,” Sevedge says. She reminds them not to be upset with their bodies for responding appropriately in unhealthy environments. “If you have high levels of anxiety in an oppressive context, then your body is functioning properly; you’re not the problem,” she explains. “But we don’t always look at it that way.” 

Sevedge also tries to create a brave space within the oppressive environment by not being neutral about the oppression and validating her clients’ experiences. She believes clinicians must be willing to step into a therapist-activist role in the community and actively engage in the larger social dialogue on diversity and multicultural issues. Counselors can do this, she says, by attending Pride and Black Lives Matter events, participating in discussion groups about these topics, and integrating inclusive symbols into their practice (e.g., Pride flags, anti-racist and religious-inclusive artwork). Counselors can also refer clients to peer groups and other social support networks that share similar struggles to help them form community. 

Coriano Ortiz, a bilingual psychotherapist at Live Oak, a psychotherapy group practice in Chicago, often works with first-generation college students of color who attend primarily white institutions. So, if a client tells her that they have anxiety and don’t think that many people like them at school or can relate to their experiences, she doesn’t encourage them to challenge this “irrational thought.” That would only gaslight their experience, she says. Instead, she explores possible systemic issues that could be causing the client to feel this way. She asks questions such as “When did you first feel like others didn’t like you?” and “How is the transition from home to college going? Are you making friends?” These questions quickly reveal the underlying issues at play and help clients realize that their beliefs are not irrational and can be an understandable reaction to white supremacy. 

Clinical work will not always specifically be about race, gender or culture, Finan adds. Sometimes a client’s presenting issue is just about depression or anxiety, but counselors should be open to listening for when culture does play a role, she asserts. 

Decentering whiteness 

Band, an ACA member who serves on ACA’s Anti-Racism Commission, and Coriano Ortiz are intentionally decentering whiteness in their practices by asking their white clients some of the same questions that are often asked of clients from BIPOC communities.

Counselors “don’t [typically] ask white people the same questions we ask people of color,” Band says. “Some of that’s for good reason because the trauma experienced historically is felt and experienced to a greater degree by BIPOC. Counselors want to be respectful of these differences in lived experiences by acknowledging and discussing race, ethnicity and various marginalized identities within the counseling session. However [this focus] often exclude[s] accountability for white people and their lived experiences. For example, by counselors not asking how white people feel about certain sociopolitical events, they are at risk of preserving white supremacy within the space. We can so readily talk with BIPOC folx on how it feels for them as a member of their community in relation to — insert a sociopolitical event — but asking white people the same is uncommon.” 

One of Band’s office locations is near the U.S. Capitol. So, in the aftermath of the Capitol insurrection on Jan. 6 — an event she believes illustrates a buildup and continuation of hate and violence toward marginalized communities — she asked all of her clients what it was like for them to see those events unfold. She got some culturally humbled responses from her white clients. One admitted they had not considered how, as a white person, this event could also affect them. 

“They didn’t think about it because white is the default,” Band stresses. “Right now, white is seen as a monolith; it’s created that way because that’s how white supremacy maintains power. … So, if you don’t ask white people what does that mean for them as white people, then we’re not going to begin to break through the identity development that needs to occur.” 

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This simple question allowed Band’s white clients to become more self-aware and to pause and consider how they are also a part of the community, and it challenged them to reconsider their own privilege and accountability, she says.

“Most of the white clients I work with mean well, and they are deeply empathetic to BIPOC communities, which is why most of their focus is on how that makes others — i.e., BIPOC folx and their families — feel when they are shot, targeted and taken advantage of by the system,” Band says. “They do not focus on how they enable an inequitable system. But the truth is we all must look at our own role in these systems.”

Coriano Ortiz also makes a point to ask her white clients about their cultural background. They frequently respond by saying, “I’ve never thought about it” or “I didn’t realize I had a culture.” She often eases them into this discussion on cultural identity by asking what their holiday traditions look like. This question helps them consider the diversity within white culture, which may be rooted in German, English or Swedish cultures, for example. 

Counseling resources often focus on how to work with BIPOC communities but not on how to work with white people, notes Band, AMCD vice president of Asian American/Pacific Islander concerns. She hopes that as more BIPOC counselors enter the field, the focus will be not just on ways to treat these communities as “others” but also on ways to help BIPOC mental health professionals. This means there will need to be more trainings on how to work with white clients and supervisors and within predominantly white counseling programs, she points out. 

Allowing for other viewpoints

People often equate good mental health with having a positive self-concept or strong self-esteem, says Manuel Zamarripa, a licensed professional counselor supervisor in Texas. But this leaves out the collectivist piece of mental health. 

“The [counseling] field is built on a foundation of individualism,” he says. “There’s nothing wrong with individualism … [but] we need a balance in worldviews as well.” 

When counselors encounter clients who come from a different worldview, they tend to describe the other viewpoint as a deficient version of their own worldview, says Zamarripa, a dean of counseling at Austin Community College District. Instead, he stresses the importance of seeing these different pieces as two positive, healthy and beneficial ends of a continuum. 

For example, a counselor who values autonomy may believe that their client is struggling with self-worth because they don’t have healthy boundaries with their family. Although the client also values autonomy, they place a higher importance on community. If the counselor approaches this from an individualist viewpoint, they may think the client is being difficult, Zamarripa says. But if the counselor understands that both worldviews are positive and healthy, then they can help the client find a solution that honors the client’s values. 

Coriano Ortiz also considers clients’ cultural backgrounds and their intersecting identities before determining the best treatment approach. A common client she sees is a woman of color who assumes a caregiving role in her family because she is the eldest daughter. Approaching this client’s issue with an individualist mindset would only cause more harm, Coriano Ortiz notes, because the client’s goal is not to disconnect from her family. The client loves her family and wants to be with them even though some of their expectations can be a source of stress for her. So, the client needs an approach that values her collectivist culture while also helping her find a way to alleviate the stress and anxiety caused by a caregiving role that was imposed on her at a young age because of the parentification that often happens to girls of color, she says. 

Coriano Ortiz draws on the client’s cultural values by talking about the importance of community care. She asks the client, “If you are always taking care of others, are you allowed to take care of yourself as well?” Then, they discuss how the client can show her family that she also has needs and how being vulnerable and willing to access help from her family, friends and community will ultimately create a more balanced community care dynamic. The client comes in talking about community care, Coriano Ortiz says, but sometimes she needs help realizing that receiving care herself is a part of that.

Some of Coriano Ortiz’s clients also blend their spiritual practices, such as limpias (spiritual cleansing), espiritismo (spiritism), Santería (an Afro-Caribbean religion) and other practices common in Latin America, with therapy. If a client comes in talking about recently getting a limpia, she will ask, “What were you cleansing away during your limpia?” 

“Spiritual beliefs and cultural traditions for those seeking to reconnect with their ancestral wellness practices are important to process in therapy as a valid way of sustaining mental health,” says Coriano Ortiz, co-chair of Reclamation Collective, a nonprofit that helps people who are navigating religious trauma and adverse religious experiences.

Zamarripa, with Jessica Tlazoltiani Zamarripa, co-founded the Institute of Chicana/o Psychology in Austin, Texas, and developed Chicana/o/x affirmative therapy — an approach that assumes the centralizing of culture and that a positive perception of one’s cultural background will be facilitated in therapy. When working with Latinx clients, he incorporates the “pillars of brown wellness” — identity, family and spirituality — as a means of integrating cultural relevance into the therapeutic space. 

Zamarripa also uses the four elements of nature (earth, wind, fire and water) as a way for his clients to reconnect with Indigenous practices. When doing grounding techniques, he invites clients to leave the session and find an area outside where they can take off their shoes and stand in the grass for a few minutes. Then they can let what they were talking about in session flow from them into the earth. “It allows us to appreciate more the importance of nature, the importance of the elements,” he says. “It can teach some clients something new, and for those clients that are marginalized … who have heard this in their family but they don’t practice it, it can help them culturally reconnect.”

Counselors can also draw on narrative therapy and storytelling, which has been a part of Indigenous cultures for years, Coriano Ortiz notes. During her graduate school program, where she specialized in Latinx mental health, she learned about cuento therapy, an intervention that was implemented in Brooklyn, New York, with Puerto Rican children. This therapy integrates Puerto Rican stories or folktales into therapy for children. Cuentos are a big part of Puerto Rican culture, she says. They serve as a way for children to learn lessons, feel hopeful about healing if they’ve gone through adverse childhood experiences, draw from the knowledge of their ancestors, and stay connected to their culture for those who have migrated from Puerto Rico to other parts of the world. This therapy allows children to read stories that are culturally congruent to their own experiences, which helps them build rapport with the counselor and the adults who are part of their support system. Eventually, these clients create their own life story as a way of healing. 

Preparing counseling students 

Finan believes that counselor education and counselor trainings should help equip clinicians to use a culture-centered approach in their work and engage in difficult dialogues about diversity and social justice. However, from her perspective, many counseling programs aren’t doing enough. “We are asking people to engage in really challenging conversations without preparing them to do it,” she says.

To address this issue, she piloted a counselor training workshop using Sue’s Race Talk and the Conspiracy of Silence as a framework for discussing all types of isms and social justice work in counseling. The book provides practical advice on why and how to have difficult conversations about race.

Band suggests counselor education programs help students begin to think about their own identities and biases by having them create positionality statements, which require individuals to consider how differences in social position and power have shaped and continue to shape their identities and access. The exercise asks students to describe their early life experiences of feeling “different,” “othered” or privileged, including the thoughts and emotions they experienced at the time and how they make sense of themselves now. 

As stated in the Multicultural and Social Justice Counseling Competencies, privileged and oppressed identities are contextual and socially constructed, Band notes, so this exercise highlights how someone might hold privilege in one area but may be considered a minority and experience micro- or macroaggressions in another. A positionality statement does not simply ask students to list out their identities or privileges, she says. It asks them to recall others’ reactions to them during times when they felt “different,” “othered” or privileged and how they responded to those interactions. 

With this approach, Band stresses the importance of having students not just write their statements but also share them with the class because it makes the experience more transformative. “This exercise is often deeply emotional because it is detailed and there is a storytelling or narrative aspect to it,” she adds. “It has the potential to be very cathartic.”

Vereen, editor of The Journal of Humanistic Counseling and past president of the Association for Humanistic Counseling, still teaches traditional theory from names such as Sigmund Freud and Alfred Adler in his counseling classes. But he says he does this more as a way of helping students learn from the past and figure out where the theories do and do not apply today. 

For Vereen, theory serves as a learning tool to get counseling students to think about what they would do with a client, not what Adler or another theorist would do. And then he pushes them to consider the current relevancy of these theories by asking, “Now how do you step outside of this [theoretical] framework to then be a better helper to the student or client you’re working with? … [How] does what Adler’s saying [still] apply to the work that you’re doing? And in what way does it impact the relationship that you have with this student or client?” 

Vereen recently restructured one of his graduate exams to help students see the practical application of theory. Rather than giving them a multiple-choice exam on theoretical concepts, he had the students work in groups to discuss ways to apply certain theories to client cases. 

One group explored mental health implications for a pregnant teenager who had been emancipated. They looked up state statutes and thought about ways this young woman might get lost in the system. Then they considered the mental health impacts of carrying a pregnancy to term when it was not her choice, their role as her counselor, possible theoretical approaches they might use, and the ways these approaches did or did not address the client’s needs.

Sue says that his counseling psychology program does a good job of teaching counseling students the importance of social justice. At the same time, he acknowledges it does “a bad job of arming them with the strategies and techniques to bring about change and … of immunizing them against the resistance they are going to encounter.” Often, when counselors attempt to introduce a multicultural framework to an organization or agency, they are told that the strategies they want to use don’t align with the standards of practice or ethics codes that have been established there, he explains. 

Sue recounts how one of his former students finished the graduate program excited to be a school counselor. When he noticed that underrepresented students rarely came to his office at the school where he was hired, he decided to go to them instead. He went outside and played basketball with these students, which led to some great discussion about their mental health. But the head counselor said that his actions were unethical and violated school policy. This exchange left Sue’s former student feeling discouraged. 

“It does no good for any of us to become culturally competent when the very institutions that employ us punish us for it,” Sue says. 

In his latest book, Microintervention Strategies — What You Can Do to Disarm and Dismantle Individual and Systemic Racism and Bias, Sue provides strategies people can use to combat the micro- and macroaggressions that target marginalized groups. 

An evolving profession 

Vereen challenges his fellow counselors to ask themselves a question: “If we continue to operate in the ways that we always have, are we then moving toward being unethical as a profession because we are not advancing what we’ve done to more holistically support the people and communities that we purport to be providing good work for?” 

Sue says there is no one culturally appropriate way to maintain a good system of healing. Instead, to become culturally competent, he urges mental health professionals to work toward four main objectives:

  • Being aware of our own worldviews, values and assumptions about human behavior.
  • Understanding the worldviews of those who differ from ourselves.
  • Developing culturally appropriate intervention strategies and engaging in actions that positively affect the client’s environment.  
  • Recognizing the systemic factors at play that directly and indirectly affect the policies and practices governing the mental health professions. 

Culture-centered theories are “about how we view the world and how we conceptualize who we are in the world and [who] our clients and our students [are],” Finan says. “These are foundational ways of understanding what it means to be a 21st-century counselor. If we don’t … start using some of these theories to enhance our ability to connect with, understand and support clients and students, then we’re not growing with the profession. We’re not evolving.”

 

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@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.

The sensitivity of boundary setting in collectivist cultures

By Shabnam Brady October 11, 2021

In our Westernized culture, we are prone to upholding a dominant approach to managing our relationships that involves boundary setting. Thus, our therapy practices and culture often emphasize setting boundaries as a key element of developing and maintaining “healthy” relationships. The United States mostly engages in an individualistic culture, which can promote and help to sustain boundaries to protect and even nurture a relationship with the self. 

But what about cultures in which the family is at the center and boundaries are often blurred? What is deemed “healthy” in such cultures — and who defines this? These are called collectivist cultures. In collectivist cultures, family members identify closely with one another and often make decisions for the family as a whole rather than for the self. Sacrifice, honor and loyalty are some of the core values of such families and cultures. For example, saying no to the family or setting limits on simple family events or dinners may be perceived as selfish and rude. 

Imagine Maryam, a married mom of two, fatigued from her workweek and yet being asked to host the weekly family dinner. This gathering includes grandparents, uncles, cousins and, of course, mom, dad and siblings. Maryam rushes to the store, then home to cook a very involved rice and stew dish. The family arrives early, adding anxiety to her already-exhausted mental state. 

Later in the week, Maryam attends her therapy session. Her therapist suggests setting limits and saying no to hosting these events in the future or proposing that her sister, Fara, hosts the next time. Maryam agrees, but she struggles because this would mean making a decision for herself and based solely on her own needs. Although this may be considered “healthy” by the dominant culture, it is causing Maryam more stress and, now, added guilt. Maryam may not even feel comfortable sharing these new thoughts with her therapist due to her culture of origin’s boundary for respecting authority (she may potentially view the therapist as the expert and authority). 

Workable boundaries

What do we do, as mental health providers, in the case of Maryam? 

First, we can validate and normalize her emotions. Next, we may pose questions to allow her to further express herself and ponder potential resolutions. In talking with her, we may at some point realize that she is stressed but at the same time happy to see and host her family. There may be no need for behavioral change here; rather, expressing emotions in a safe place and feeling heard by the counselor may be enough for Maryam. Potentially, she may need support identifying her emotions to further express them too. 

If Maryam continues to share concerns about her fatigue level, it may be supportive to suggest what I call a “workable boundary,” with consideration given to her culture and her values. This workable boundary could simply be adjusting the time that everyone comes over so that Maryam has some time to rest first upon arriving home. 

A workable boundary is flexible. It is not rigid like typical boundaries may be perceived or promoted to be. It is similar to a compromise and works to respect the client’s culture of origin and needs. The flexibility may prioritize the client’s culture and empower the client to choose what is workable. 

Straying away from the stringency of a black-and-white approach to boundary setting can be more inclusive. The less we guilt individuals into self-care and self-prioritization, the more we can become aware of their needs, wants, values and cultures. Some individuals in collectivist cultures gain energy, pride, strength and honor when the family is well and happy. 

Prioritizing client boundaries

The connectivity of emotions, identity and well-being in a collectivist family and culture of origin is complex, requiring respect for exceptional and unique boundaries. Roles and authority may serve a special function in the collectivist family experience. 

For example, in my own personal collectivist family experience, as well as in working as a counselor with college and high school students with collectivist cultural backgrounds, I learned that even the majors we chose for our college experiences originated in our family values and expectations. We honored our families by choosing to become accountants, doctors and engineers, among other professions. We struggled and wanted to quit. Yet many of us continued on this path to a field mostly chosen for us by the influence of our collectivist cultures and families. 

Experts on setting boundaries may advise students who are feeling stressed to follow their own career paths, which would encourage straying from the family norm. Here is an opportunity for us to remember our counselor ethics and to prioritize client values over our own and even over those of the dominant culture here in the United States. We can work to be culturally humble and learn to navigate and negotiate values as clients desire to apply them in their own lives. 

The goal of the client seeking counseling at the university counseling center may simply be to feel humbly supported through their time of feeling stuck or yearning to change majors. Their desire may purely be to not feel alone. What seems simple may be forgotten because we are often inundated by the dominant cultural norm of pursuing our own dreams and goals first. While students and clients may report feeling pressure, they may also report feeling pride in their struggles and motivated in their pursuit of this family dream, especially if they are from collectivist, immigrant backgrounds. 

Likewise, choosing whom to marry may be a family-based decision in collectivist cultures. Boundaries may be perceived as vague. Those outside of these families and cultures may view these family roles and relationships as examples of unhealthy enmeshment. Nevertheless, in some cultures, honoring the family will continue to be the foremost concern when making such a major decision. After all, a romantic partner is commonly considered a new member of the family. Thus, the decision requires the approval of the family in these cultures. 

Providing counseling to an individual who is navigating such circumstances and decisions may require offering further values assessment to support the decision-making process. If family is the client’s No. 1 value, this could support the client’s decision to involve the family in choosing a life partner. Setting boundaries prematurely based on individualistic cultural norms may prevent family members from playing their traditional roles in the individual’s life. 

What may be challenging to understand in the dominant culture — including the high value placed on duty, honor and authority — is part of the traditional fabric in some collectivist cultures. Often, we assume that it is harmful for others to choose our life partners. However, in many cultures, this is viewed as the practice of respecting authority and feeling honored to receive this input and potential blessing. Some clients feel excited to enter these life partner journeys with the support and input of their parents and families. Other clients may not, and that is OK too. The purpose of viewing boundary setting from a wider, more culturally inclusive lens is to stop making assumptions about what is “healthy” for all clients and desired by all clients and to stop promoting only the dominant culture’s perspective of boundaries. 

A nonassumptive approach can lead to greater appreciation of the client’s worldview, needs and ability to reach decisions with the support of the therapist. Open-minded, nondominant cultural perspectives can further encourage this process. Taking such steps can also lead to less guilt, potential shame and frustration on the part of clients who experience the world as bicultural (i.e., negotiating and identifying with two cultures). 

It is often more convenient to go along with the dominant culture’s expectations. Likewise, there is frequently less judgment when choosing the dominant culture’s norms. However, this can be harmful for individuals who appreciate and potentially want to choose collectivist cultural values and norms in some life areas. The pressure many may feel in such situations can be overwhelming. For example: wanting to live at home beyond the age of 18, wanting to date someone chosen by one’s parents, wanting to name one’s child with a chosen family name. 

These are just a few examples of the many decisions children and adults who are bicultural may face (and prefer to make) that others can regard as boundary “blurring.” The therapy setting can provide an open, safe space for clients to explore and arrive at decisions that are best for them, taking all cultures involved into consideration rather than focusing only on the expectations of the dominant culture. Counselors can set aside the boundary-setting trend that might seem liberating on the surface but that may in fact be confusing for some individuals from these cultural backgrounds. By diminishing the idea that inflexible boundary setting is the “healthy” option when it comes to managing interpersonal relationships and life decisions, the lifestyles and complexities that many culturally diverse individuals and families experience and prefer can be included and explored.

Sumala Chidchoi/Shutterstock.com

Culturally inclusive practices

I am a bicultural, immigrant American therapist and individual who has experienced and navigated, both personally and in session, the guilt that can arise from the boundary-setting expectations of the dominant culture. In choosing my life partner, I practiced strict boundary setting with family members in my collectivist culture. In choosing to go to graduate school to earn a doctorate, the boundaries were workable, blurred and, at times, enmeshed with my family’s dreams and goals. 

I have supported many diverse clients in navigating different areas of life, including grieving differently than their family, by using workable boundaries that include both their cultural and individual needs. The following steps can support more culturally inclusive practices for navigating boundary setting in collectivist cultures. 

>> Develop and pose questions or prompts that reduce the potential for “dominant culture speak,” such as “your needs” and even the word “boundary.” Instead, consider adding to your language the phrases “cultural considerations” and “family needs tied to your needs and wants.” For example, a possible question to explore with the client is, “I hear that’s hard for you. What are some ways you can meet your family needs that perhaps seem to influence your needs, especially with the weekly family dinners?” 

>> Explore the topic of guilt with clients. How does guilt affect them interpersonally and emotionally? Does it apply in their identity, role and cultures? How, if it all, does guilt come up when considering boundaries with family members, partners or friends? 

>> Investigate what the word “boundary” means to the client. Does it have a meaning? Is it culturally relevant for them or is it a new concept? How would they like to incorporate it into their wellness journey, if at all? 

>> Offer psychoeducation on boundary-setting practices for potential emotional wellness while acknowledging cultural implications. Then ask for feedback and reactions. What does the client think of this concept? Do they agree or disagree? Why? Would they like to explore these practices in their life? 

>> Finally, individualize boundary-setting practices to respect the client’s culture, needs and wants. Assess what these practices are and introduce concepts such as workable boundaries or more innovative ways that may work for the client in an inclusive style. Implement a feedback model in therapy to assess the client’s satisfaction level with such strategies.

 

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Shabnam Brady holds a doctorate in counseling psychology. She is a therapist, professor, author and founder of Therapy for Immigrants (@therapyforimmigrants), an Instagram community whose aim is to raise awareness and expand inclusivity practices in mental health for immigrant communities. Contact her at drbradytherapy@gmail.com.

 

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

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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.

African Americans and the reluctance to seek treatment

By Patricia Bethea Whitfield September 16, 2021

Amid talks of how African Americans have been disproportionately impacted by the COVID-19 pandemic and speculations about their hesitance to be vaccinated, the Tuskegee experiment has been cited numerous times as a kind of landmark explanation of why African Americans are reluctant to seek treatment. In the Tuskegee experiment, African American men were recruited for what they thought was a medical treatment but was actually a study of untreated syphilis that continued long after penicillin was a recognized intervention for the disease. In fact, the men were never treated, and many went on to infect their partners as well. As unethical as this research is now recognized to be, the reluctance of African Americans to trust systems and seek treatment is actually rooted closer to home, in the long history of mental health abuse and failed mental health intervention for African Americans. 

Today, African Americans face numerous challenges that affect their mental health, including high rates of unemployment, poverty and incarceration; health disparities and disability; the emotional and psychological impact of the pandemic; and the steady uptick of police shootings in the African American community. All of these challenges are complicated by the intergenerational trauma of slavery, the very mention of which often arouses an almost visceral reaction even 150-plus years after it ended. In fact, Africans were brought to this country as slave labor and, along the way, laws were passed to ensure that they and their descendants would continue to be enslaved forever. Over time, the color of their skin was equated with servitude and privation in a way that has persisted for over 400 years. Slavery is our common history, and if it is a shame, it is our common shame. 

Now there are new mental health challenges in the emerging myths that discount the history of African Americans and slavery. The first myth is that slavery is a hoax, meaning that Blacks were never enslaved in this country. The second myth is that Blacks were enslaved but slavery was really not that bad. In the first myth, the discounting of history is insidious. It is meant to befuddle and confound in the same kind of gaslighting experienced by the lead character in the movie of the same name (Gaslight). In this case, the myth is intended to create doubt of perception and historical memory such that Black people are being told, “You think you went through hell, but it did not happen.” In an era of turbulent racial tension, the second myth of slavery as a harmless social good conveys a tone of slavery reconsidered for African Americans, and recent voter restriction laws help to flesh out the second boogeyman as a political reality. This historical revisionism retraumatizes, angers and reactivates centuries-old intergenerational fight-or-flight strategies for coping, including confrontation (rallies and marches) and withdrawal. 

According to the Centers for Disease Control and Prevention (2017), non-Hispanic Blacks are more likely than non-Hispanic whites to report feelings of “sadness, hopelessness, worthlessness, or that everything is an effort all or most of the time.” The U.S. Department of Health and Human Services (HHS) Office of Minority Health reported that suicide was the second-leading cause of death among African Americans ages 15 to 24 in 2019, and the death rate from suicide for African American men was four times that of African American women. African Americans have one of the highest rates of poverty in the United States, and according to the HHS Office of Minority Health, African Americans living below the poverty line are twice as likely as other individuals to report psychological distress. In 2019, the Substance Abuse and Mental Health Services Administration reported that among adults who experienced mental health issues in the past year, non-Hispanic Blacks were significantly less likely to receive mental health treatment than non-Hispanic whites (8.7% compared with 18.6%). 

Despite the evident need for mental health counseling, many African Americans are reluctant to seek treatment. Some of this reluctance may be rooted in the reality that, historically, African Americans have had their mental health abused and their mental health treatment administered with a liberal dose of discrimination and bias. Initially, it was assumed that African Americans could not be mentally ill. The general notion was that a person had to own property and actively engage in business and civic affairs to experience mental illness, and because African American slaves “had nothing and nothing to worry about,” they could not be mentally ill. In fact, when both the 1840 and 1850 U.S. census found such low rates of mental illness among slaves, it was concluded that slavery actually protected slaves from the known diagnoses of the time. 

Science rushed to support pro-slavery views. Physicians and scientists promoted the notion that slavery was such a good thing that a slave would have to be mentally ill to want to leave it. Thus, drapetomania emerged as the first race-based diagnosis. Samuel Cartwright, a physician, coined the term in 1851 to describe a “disease” that made slaves develop an irrational urge to run away from slavery. He also identified a second physical and mental abnormality, dysaethesia aethiopica, thought to attack Black people who had too much freedom. This condition was purported to make them sabotage their work, break things and become confrontational with others. 

While early attempts to label African American behavior seem antiquated and almost laughable today, they have had a profound impact on the regulation of Black behavior and the transmission of intergenerational bias. Over time, resistance to oppression and free labor stereotyped African Americans as “lazy” people who did not want to work, and for their most vociferous resistance to slavery, they were often labeled “deranged.” In this way, race and control were conflated with mental illness in the lives of Black people, and that was just the beginning. Slavery in the United States ended in the mid-1860s, and the usefulness of Blacks for free labor and reproduction of more slaves ended with it. Slavery left a lot of broken families who were never able to reconnect. Employment was nearly nonexistent, and Jim Crow laws codified new subservient behaviors for Black people, who had to go to the back door for service and step off the sidewalk to let white people pass. From 1882-1968, 3,446 Black people were lynched in a campaign of terror, according to Tuskegee Institute. 

Also in the late 1800s, Francis Galton coined the term “eugenics,” the notion that only certain people should be able to reproduce. Herbert Spencer supported this idea with his now famous “survival of the fittest” theory or social Darwinism. Eventually, the concept of eugenics was adopted and applied for various purposes: the genocide of the Jews by Adolf Hitler, in immigration policy and, ultimately, in the forced sterilization of people considered mentally defective, including persons with disabilities. According to the Equal Justice Initiative (2013), in addition to persons with disabilities and prisoners, “thousands of poor Southern Black women were sterilized without their knowledge or consent.”

The notions of Galton and Spencer further fueled views on miscegenation, or biological race mixing, and the legal prohibitions against intermarriage. The supposition was that by outlawing mixed-race unions, the white race would remain the strong, pure race, while mixed-race individuals, called “mulattoes,” would meld into the Black race. It worked. By definition, mulattoes disappeared nearly a century ago after the U.S. census dropped that category and mixed-race individuals were forced to self-identify as Black and intermarry with Black people. Legally, the prohibition on mixed-race marriage lasted until the Supreme Court struck it down in Loving v. Virginia in 1967. But in the dominant discourse, it has lasted much longer. 

Well into the 20th century, the realities of Black mental health were minimized in service to age-old views on the dangers of Black people having too much freedom — namely, that it would cause them to lapse into ruin and insanity. Mental health treatment and facilities were fledgling and limited notions for everyone at the time, but for Black people, institutionalization was dismal. Because of segregation, Black people who were mentally ill were housed separately from whites, to the point of being lodged on the grounds or in overcrowded spaces, forced to work in the facilities, and often hired out to support the institutions.

In some cases, individuals were institutionalized for other disorders, other disabilities were mistaken for mental illness, and people were confined on the word of an employer. Despite passage of the Civil Rights Act of 1964, some states continued to provide discriminatory mental health services in which African Americans were more likely to be labeled as aggressive, less likely to engage in talk therapy, more likely to be segregated on pharmaceutical interventions and, in the case of African American men, more likely to be labeled as schizophrenic and restrained. 

Consequently, many African Americans remain skeptical that mental health professionals are here to help them, and they are often right. According to a fact sheet published by the American Psychiatric Association in 2017, African Americans are less likely to receive “guide-line consistent” care, more likely to use the emergency room or a primary care provider for intervention, and less often included in research. In a 2013 study from Earlise Ward, Jacqueline Wiltshire, Michelle Detry and Roger Brown, African Americans were found to be generally reluctant to consider psychological problems, were concerned about the stigma associated with mental illness, and were “somewhat open” to mental health services, although they preferred “religious coping.” A 2015 study by Janeé Avent, Craig Cashwell and Shelly Brown-Jeffy found that in Southern Black communities, the faith leader or “preacher” is often a front-line source of support for church members experiencing mental health distress. 

To attract Black people to mental health counseling, we must address old prejudices around the flawed construct of race, lingering biases in mental health treatment, and the lack of access to mental health services for those living in poverty. We could recruit more counselor education students from marginalized groups, and we could address the shortage of African Americans among counselor education faculty. According to the 2017 CACREP Vital Statistics Report, African Americans make up just 14.52% of counselor educators, and of that number, 4.11% are African American men. We could ask ourselves hard questions about why counselor education textbooks have been silent about what has happened to African Americans in mental health treatment, and when we do that, we could decide not to put that dialogue in a separate section of the book. 

We could have an integrated discussion about the segregated history of mental health treatment in this country. We could stop saying that Black people “drop out” of treatment and start a conversation about why African Americans are skeptical of our labels and our notions and potions as they relate to the historical regulation of Black behavior. Finally, it is late — but not too late — to do due diligence in the clinical assessment of people who bought and sold human beings and, in many cases, perpetrated horrific acts of violence against them. The victims who resisted oppression were labeled “mentally ill,” but we have yet to label the perpetrators of these atrocities. 

For these reasons, the myths that deny the injustices of slavery or that slavery ever even existed are not benign. African Americans have lived for more than 400 years in a kind of psychological fun house with mirrors that reflect everything in exaggerated shapes. The message: “Your life experience does not matter.” 

Ultimately, viewing enslaved people as less than human, recklessly labeling them and then wantonly disregarding African American mental health for two centuries formed the justification for the Tuskegee experiment. So, if African Americans are reluctant to seek treatment, the reluctance has less to do with race and more to do with trust. That is what the reluctance is about. Happily, that is what counseling is about too.

pixelheadphoto digitalskillet/Shutterstock.com

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Patricia Bethea Whitfield holds a doctorate of education and is an associate professor and coordinator of the CACREP-accredited mental health counseling clinical program in the Department of Counseling at North Carolina A&T State University, where she teaches “Counseling Poor and Ethnically Diverse Families.” She is a member of the North Carolina Counseling Association Executive Council, president of the North Carolina Association for Specialists in Group Work, and past president of the North Carolina Association of Marriage and Family Counselors.

 

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

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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.

Supporting AAPI communities: ‘We still need to do more’

By Bethany Bray August 2, 2021

The United States has seen a significant spike in anti-Asian hate crimes and discrimination in the past year. Since spring of 2020, “there was anti-Asian bigotry and misinformation spreading almost as quickly as the [corona] virus itself,” said Rep. Judy Chu at an online panel discussion hosted by the American Counseling Association last month to address the recent rise in anti-Asian sentiment and the professional counselor’s role in addressing it.

“Conversations about mental health have never been more important,” she noted. “With each new report of an innocent Asian American being attacked, many across the country worry, ‘Will I be next?’” Chu, a Democrat who has represented California’s 27th district since 2009, is a psychologist and the first Chinese American woman to be elected to Congress.

She was one of three legislators on the panel discussion held on July 21. The other speakers included Rep. Sharon Tomiko Santos of Washington and Sen. Chris Lee of Hawaii as well as ACA CEO Richard Yep and ACA President S. Kent Butler.

The panelists noted that stigma and barriers, including being isolated or marginalized because of language barriers, often keep those in the Asian American and Pacific Islander (AAPI) community from seeking mental health services. Lee and Santos also discussed how mental health, trauma and the COVID-19 pandemic intersect.

“The issues that we are seeing have a lot to do with the isolation that we’ve experienced under COVID-19 restrictions and the challenges of race that have never been resolved in our country,” said Santos, who has been a community activist for more than 40 years. “What we are seeing, in my opinion, is the exacerbation of those fault lines that have existed in our communities for many, many years. … These are challenges that will involve all of us working together at the state and national level to address.”

Butler noted that counselors are called to help all disadvantaged groups. Not only is helping people regardless of their background or immigration status an ethical mandate but it is also a part of “who we are” as counselors, Butler stressed.

Although numerous measures have been passed by local and federal legislatures to better track and address anti-Asian violence and hostility in the United States, “we still need to do more,” Chu said. “There is so much that can be done to support our communities, and counselors are on the front lines.”

 

 

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Watch the full video of the July 21 event at ACA’s YouTube page: youtu.be/PYAvqIOWEzo

Related reading from Counseling Today

Take action

Support the following initiatives and others by visiting the ACA Take Action page:

  • Teaching Asian Pacific American History Act
  • Stop Mental Health Stigma in Our Communities Act
  • Increasing Access to Mental Health in Schools Act

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

Counseling while Black

By Lindsey Phillips June 29, 2021

The counseling field is not immune to racism, systemic or otherwise. Before the Association for Multicultural Counseling and Development (AMCD) formed, nonwhite members of the American Counseling Association paid their dues but had limited representation on ACA’s board and senate. A group of counselors lobbied for AMCD (then the Association for Non-White Concerns) to become an official ACA division, but their initial requests were denied. It was a struggle to get ACA’s leaders at the time to recognize the need for and legitimacy of a division that would focus on nonwhite needs, but the hard work of advocates finally paid off when the AMCD division became a reality at ACA’s 1972 conference. (See more about AMCD’s history at multiculturalcounselingdevelopment.org/amcd-history.)

Ebony White, an assistant clinical professor and the program director of the master’s in addictions counseling program at Drexel University in Philadelphia, points out that the counseling profession — like other smaller systems in our society — has largely tried to dismiss the role that racism has played and continues to play in the profession and society as a whole. 

“The counseling profession has mimicked that model of sweeping it under the rug,” she asserts. “So, it’s important that there is first an acknowledgment about what has happened, and instead of … saying, ‘This is what we are going to do about [racism],’ counselors should ask, ‘How have we perpetuated racism in our profession?’ And they should look at what’s been published in the literature and incorporate what has worked [for others] into our profession and our organizations to make change.” 

To shed light on embedded racism and help others better understand it, six Black counselors shared their experiences of working in a predominantly white field and their hopes for the future of the profession. 

Acknowledging racism in the counseling field

Black counselors’ intersecting identities affect the way they understand the world around them as well as how others perceive them. “I live and experience situations as a Black woman every day more than I live as a counselor,” says Noréal Armstrong, a licensed clinical mental health counselor supervisor in North Carolina and a licensed professional counselor supervisor (LPC-S) in Texas. 

As a Black woman in the counseling field, Armstrong says she has encountered microaggressions and racism from colleagues. For example, when serving as the department chair of the counseling program at a liberal arts college, Armstrong informed her colleagues about a Council for Accreditation of Counseling & Related Educational Programs (CACREP) standard needed to support the success of the counseling program. But, she says, her white colleagues questioned her, debated options without her and asked to speak to a CACREP representative, who simply confirmed that Armstrong had the correct information. This encounter left her wondering: “Are they questioning me because they lack confidence in me, because I’m a woman or because I’m Black?” 

The uncertainty in this and similar situations is “what keeps me up at night,” Armstrong says. “That’s what has my stomach in knots. That’s what has me frustrated.” 

Armstrong, an ACA member and the vice president of the AMCD Women’s Concerns group, says she didn’t ask her white colleagues why they felt it necessary to bring in the CACREP liaison because she was tired of having to navigate their defensiveness and denial that race played a role in their actions, even if it may have been implicit. 

White, who was part of the panel for ACA’s webinar “Our Community Gathers: A Conversation With Counselors About Mental Health in 2020” and is president-elect of the ACA division Counselors for Social Justice (CSJ), says she has been “dismissed … ignored, oftentimes not heard and many, many, many times called the ‘angry Black woman.’” 

White, the immediate past chair of the North Atlantic Region of ACA, recalls a microaggression that occurred in her last meeting as chair-elect. During the video call, she was looking down and typing notes from the meeting. A white colleague unmuted to remark, “Ebony, you look so angry. What’s wrong?” White was stunned. She had been labeled as “angry” simply for taking notes.

“The reality is that for some people, your complexion is more important than your intellectual ability,” says Raphael Bosley, a licensed mental health counselor associate who works at Cross Connections Counseling and at Courageous Healing in Fort Wayne, Indiana. 

Bosley, an ACA member, acknowledges that this truth weighs on him. He says that he questions himself and what he knows more than other clinicians might. He also finds that he frequently has to elaborate on the rationale behind his professional assessments to colleagues and clients. Bosley admits that sometimes he is the one who doesn’t trust his own thoughts, which he believes is the result of living in a society that has conditioned him to trust his athletic ability more than his intellectual ability. 

He also finds that incorrect assumptions about his intellect can be a natural barrier with some clients in the therapeutic space — a space that involves understanding the brain. “They’re not used to seeing a Black male face as the one providing the service when it comes to dealing with the mind and emotions. Why? Because Black men are angry. Black men have rage. Black men are not supposed to be able to teach me how to calm down and ground myself,” Bosley says.

The (in)ability to be one’s authentic self 

Diversity is not just about issues such as race, ethnicity, gender and religion; it is also about the way we communicate, notes Tyce Nadrich, an assistant professor of clinical mental health counseling at Molloy College. Black counselors often can’t communicate in a way that is natural or authentic to them around their white colleagues, students and clients, he says. Instead, they code-switch, adjusting their style of speech, appearance or behavior to appeal to a different audience, often as a means of receiving fair treatment.

“The amount of code-switching that I think [Black counselors] are required to do is egregious,” says Nadrich, a licensed mental health counselor and coordinator of clinical training at Balance Mental Health Counseling in Huntington, New York. “It’s exhausting because I know if I communicate … the way that is natural to me … I will not be heard because folks will pretend that they don’t understand me or they’ll just dismiss it as not worth listening to.” 

For example, Nadrich says that when he gets upset, he may not use three- or four-syllable words — despite having them in his vocabulary — because that’s not the way he talks when he has heightened emotions. He expresses his feelings in a more casual register.  

Bosley, who is also an associate minister at Greater Progressive Baptist Church in Fort Wayne, concedes that as a Black counselor working in a predominantly white field, he often feels the need to be polished in the way he communicates, even in situations that don’t require it. He feels like there is a spotlight on him 24/7 because of his race. 

For Armstrong, whose areas of interest include substance use, Black women in academia, multiculturalism, the deaf community and spirituality in counseling, code-switching involves adopting a professional discourse of privilege. When speaking with white colleagues, she often avoids personal or emotional language and relies on data and numbers to convey her message and ensure they are listening to her. 

White, whose research interests focus broadly on advocacy and social justice within the Black community, came to the realization that no matter how she spoke or presented herself, people would have preconceived notions about her. She says she has reached a point where she will no longer code-switch for white colleagues because she knows she can’t control how others perceive her. So, she is her authentic self with colleagues, which may include saying “ain’t,” dropping verbs or rolling her neck. 

The fatigue factor 

Too often the burden of raising issues related to racism and educating others falls on Black counselors. “It’s a constant and common fatigue,” White says. “Because advocacy is such a huge part of my identity, I’m not one of those people that really chooses my battles. I’m always chosen to battle, which is tiring and exhausting.”  

White recalls sitting in multiple meetings and being so upset by what was being said or not said about race and diversity that she spoke up because no one else would. “It’s angering that I have to be the one to address it,” she stresses. White is a licensed professional counselor who developed the Center for Mastering and Refining Children’s Unique Skills (M.A.R.C.U.S.), a nonprofit organization that provides tutoring, mentoring and mental health counseling to children and adolescents, especially in the Black community.

A few days after George Floyd was killed by police in Minneapolis in May 2020, Nadrich noticed many of his white colleagues remained silent. So, he decided to broach the issue himself because he knew that students and faculty were hurting. 

After addressing the issue, a few white colleagues told him, “I’ve been thinking about this for so long, but it’s just so hard, so emotional. I’ve been torn up about what to say.” Rather than sharing those words after the fact, Nadrich, an ACA member who specializes in racial ambiguity, diversity and social justice work, wishes his colleagues had stepped up and spoken out against racial violence and injustice before he felt compelled to. 

The burden to respond to the wider community shouldn’t have been placed on his shoulders, Nadrich stresses, especially considering that he isn’t in a leadership role and because he was already dealing with the trauma and grief of yet another horrific act of racial violence being committed against someone in the Black community. 

Bosley says he often deals with white guilt and the burden of being expected to answer or pose questions about race himself. He never knows which one of those tasks will be required of him on a given day. He finds that being a mental health professional only compounds this obligation to educate others. “You have that uninvited burden that [you] need to take advantage of this moment to educate because any silence is going to give permission for the fire to keep burning. Whether that’s right or wrong or whether I should take that on or not, it’s my reality,” he says.

White stresses the importance of self-reflection and awareness, especially for white counselors. Counselors must unpack their own privileged identities and examine what that means for how they operate in the world, she argues. 

“We often talk in terms of ‘what do white people need to do,’ so it becomes another version of us having to educate white people and tell white people what to do when they can literally just read and watch what’s been put out there,” she says, offering the Multicultural and Social Justice Counseling Competencies as one example. 

Having courageous conversations 

Right after George Floyd was murdered, white students and colleagues asked Armstrong, who serves as the new executive director for A Therapist Like Me, a nonprofit organization that connects marginalized clients with marginalized therapists, how she was feeling. She wasn’t sure how to describe her emotions or even how this latest instance of racial violence was affecting her. 

“For the longest, I wasn’t able to put a word to it because I kind of didn’t feel anything. And I don’t mean that in a cold, shut off, numb way,” she explains. “I mean it more so in that, unfortunately, I feel like I’ve become desensitized to it because racial violence and injustice are so ingrained now in our society. It’s another thing I carry with me as a Black person in America.”

Armstrong wondered if her white colleagues were also bothered by these horrific acts of murder and violence against the Black community. Did they have knots in their stomachs? Did they call their family members to check on them too? 

So, Armstrong asked them a straightforward question: How did they feel about George Floyd’s death? But her white colleagues dodged the question. Armstrong’s frustration over this exchange resulted in her presentation, “Please Stop Asking, Because I Am Not Okay: The Struggle for Black Counselors During a Racial Pandemic,” at the North Carolina Counseling Association’s 2021 conference. Her goal, she says, was to start a serious dialogue on issues faced by Black mental health professionals.  

When it comes to race and social justice, counselors “have to get out of their own way and allow conversations to happen,” says ACA President S. Kent Butler. “Just like what we are trained to do as counselors … we must take ourselves out of the equation and be there as a culturally competent counselor for our [clients] so that we do no harm and [do not] negatively impact the outcome of what’s happening within the therapeutic relationship. We’re trying to help clients move forward,” he says. “That same philosophy also needs to go into social justice work. Counselors need to take themselves out of the equation because sometimes they may represent or be a part of the problem. And if you are indeed a part of the problem, then it is imperative that you take measures to understand your role in it and figure out how you may in fact help elicit systemic change. That’s what self-awareness is all about.” 

Camellia Green, an LPC-S with a private practice in New Orleans, agrees that lack of self-awareness often prevents society and the counseling field from moving forward. “In the field of counseling, we’re taught you have to know yourself and be aware of all the potential areas of countertransference. … Clinicians [are encouraged] to go to counseling themselves … but many people don’t,” she says. 

But this mandate goes deeper than counselors just knowing themselves. It requires them to dig into their racial identity development, which isn’t something they get in a continuing education unit, and to question their worldview, which has been developed over their lifetime, says Green, an ACA member who specializes in working with people who have experienced trauma. 

Bosley advises white colleagues to give themselves permission to be a beginner at discussing race. “Be courageous enough … to talk about it,” he says. “Because the same lump that’s in your throat is in my throat when I gotta bring it up. But I recognize if I don’t bring it up, you’re not.”

“And have the commitment not just to talk about it but then to do something about it,” he adds. 

fizkes/Shutterstock.com

Agents of change 

Counselors are in a prime position to put these courageous conversations into action. “We’re supposed to be leading the charge because from a psychological and mental health perspective, we know what’s at the foundation of [racism] … and we’re the ones who can speak to it and say here’s how you change it,” Armstrong says. “But counselors are not doing that.” 

Incongruity between counselors’ words and actions is a big part of the problem, Bosley stresses. He finds counselors often say they are against discrimination, but they don’t publicly speak out against those who are discriminating, or they claim to be “an agent for the voiceless” until they have to speak for them. Then, they are silent. 

“Don’t just use your voice for me when I’m there,” Bosley says. “Use your voice when I’m not there and your friend … [or] colleague is saying something [harmful].”

ACA began its own crucial conversations when the Governing Council released an ACA anti-racism statement in June 2020. Later that year, ACA created an anti-racism task force, which was chaired by Butler, who was then the ACA president-elect. 

The task force proposed an ACA anti-racism action plan, which includes nine initiatives to help combat systemic racism and racial injustices. ACA also recently formed a commission to help counselors understand ways to move this narrative forward, promote research, provide counselors with anti-racism resources, and incorporate more action-based projects such as providing scholarships to help underrepresented counselors attend conferences, adds Butler, the interim chief equity, inclusion and diversity officer and a professor of counselor education at the University of Central Florida, as well as a fellow of the National Association of Diversity Offices in Higher Education. 

The need for more representation 

Another problem within the field is the need for more diverse counselors and therapists. According to the American Psychological Association, only 4% of psychologists are Black, compared with 84% who are white.

Nadrich was one of two Black men in his master’s counseling program. When the class started discussing race, the students would often turn to these two men and explicitly or implicitly ask them their thoughts, as if they were appointed spokespeople for the Black community. Although Nadrich’s doctoral program was more diverse, he was still the first Black man to graduate from the program. 

When Nadrich, along with Michael Hannon (an associate professor of counseling at Montclair University) and four other colleagues, researched the underrepresentation of Black men in counselor education, they faced an interesting dilemma: How could they incorporate the voices of the eight Black men they interviewed without exposing or “outing” their identities? With so few Black male counselor educators, they feared other professionals would easily be able to identify their participants by the way they spoke. (The resulting article, “Contributing Factors to Earning Tenure Among Black Male Counselor Educators,” was named Outstanding Counselor Education and Supervision Article for 2020 by the Association for Counselor Education and Supervision [ACES] Awards Committee.) 

The counseling profession needs to make itself more accessible not only to nonwhite clients but also to nonwhite counselors. “There is very little intentional mentorship when it comes to including and getting … Black people into the counseling profession,” says White, the recent recipient of ACA’s Dr. Judy Lewis Counselors for Social Justice Award. “There’s this ruse … [that] we have all these things available, but it’s not accessible if it’s not attractive.” 

By way of explaining, White recalls attending a division meeting of one of the ACA regions a few years ago where she was greeted by a room filled with white faces. She remembers thinking how unwelcoming the space could be for other Black professionals like herself. As the counselors started discussing business as usual, White felt compelled to ask why there was so little diversity in the room. Her question was met with silence for a full minute. Then, passing comments were made about how the group had tried to address diversity. “It gives you the message that they don’t care; it’s not really of importance or value,” White says.

Although the counseling profession still has work to do to attract diverse counselors and clients, White is hopeful because she has noticed a shift in Black people becoming more open to counseling. “We’ve done something right where now more people in the African American community are considering [entering the] counseling [profession], are getting counseling and are recognizing the value of mental health,” she notes.  

White is also excited by the increase of Black counselors entering leadership positions: ACA’s current president is a Black man; the presidents of CSJ and the Military and Government Counseling Association (MGCA) are Black women; and the presidents-elect of ACA, AMCD, ACES, CSJ, MGCA, the American Rehabilitation Counseling Association, the National Career Development Association, and the Society for Sexual, Affectional, Intersex and Gender Expansive Identities are Black women.

These individuals “are more than qualified, but also I know that our voting body is very white. And so that gives me hope that they were able to see promise,” White says. At the same time, she worries that this shift in representation at the leadership level could cause a backlash. She says she has already heard counselors asking, “How did this happen?” 

The ongoing journey toward cultural competence

Multicultural training is central to preparing counselors to understand the experiences of people who differ from them as well as to be aware of their own privilege and bias. But Butler asks, “How can we change the narrative on systemic racism when the profession has some counselor educators and counseling programs that do not value multiculturalism or change?” 

Nadrich says that the multicultural education offered in his master’s counseling program was insufficient, which was more of a reflection on the dynamics of the one multicultural course he took rather than on the institution, he adds. The instructor of the course didn’t know how to navigate conversations about race and culture. “It was a very Black/white course. We didn’t talk much about anything beyond issues faced by Black and white people. We barely spoke about other oppressed groups and never spoke about topics like intersectionality,” he says. 

Some counseling programs require students to take only one multicultural counseling course, and as Armstrong and Green point out, one course is not enough to prepare clinicians to be culturally competent. Armstrong believes there needs to be an emphasis on cultural self-awareness and community awareness from the onset and through the entirety of the counseling program because cultural competence occurs over time and through practice. 

Multicultural counseling involves more than an organization or department saying that they value it and tacking on an extra cultural assignment to the curriculum, notes Green, a doctoral candidate in the counselor education program at the University of New Orleans. She would like to see counseling programs incorporate multicultural awareness into all counseling courses, not just one.

Butler, whose research interests include African American men, spirituality and ethics in counseling, and diversity and social justice in counseling, agrees that multicultural training needs to be integrated into every aspect of counseling, including theories, techniques and research. His forthcoming textbook, Introduction to 21st Century Counseling: A Multicultural & Social Justice Approach, which he co-edited with Anna Flores Locke and Joel M. Filmore, embeds multicultural and social justice competencies throughout each chapter and serves as a guide to enhance teaching and help counselors better understand themselves, their clients and the world around them.

“Cultural competence is not an endpoint. It’s not a destination. It’s a journey,” White says. And part of the journey involves self-awareness, especially for white people. “Your whiteness shapes your … interactions. It shifts the room. It takes up oxygen,” she notes. 

And people’s own perspectives shape their awareness of others, she continues. “How you see me is not fact,” she says. “It’s your perception of who I am.” So, counselors must be “aware of what shapes those perceptions and then be able to constantly trigger [themselves] to be mindful of those things when interacting with colleagues, students, clients [and] communities,” she adds.

White argues that the profession needs to figure out a way to make diversity training a requirement throughout a counselor’s professional development. For example, she suggests requiring counselors to take a set number of continuing education credits on anti-Black racism.

Counselor educators should also consider if nonwhite counseling students have the same opportunities as their white counterparts when it comes to mentorship and financial assistance, Butler says. It may be helpful to engage in some self-reflection: Are you overlooking working with nonwhite students on a research project? Who receives graduate assistantships in your department? Do mainly white students receive the more desirable graduate assistantships? How do you think nonwhite counseling students perceive you as their instructor or feel about the ways they are treated within your courses? 

Early in Nadrich’s career as a counselor educator, he wrote in his academic profile that he was passionate about mentoring and supporting students of color. Another colleague approached him and asked if his statement would dissuade white students from working with him. Although Nadrich was an untenured new faculty member, he declined to change his profile because he wanted to uphold his own beliefs. He told the colleague it would be OK if some white students didn’t come to see him because of his statement. 

Nadrich points out that his colleague’s comment contained two incorrect assumptions. First, it assumed that white students didn’t already have a large number of staff, faculty and professionals who looked like them and shared similar experiences to go to for support and resources while students of color did. Second, it assumed that Nadrich stating his passion for working with students of color was harmful even though stating other professional preferences, such as a passion for behavioral neuroscience or socioeconomic disparities, would have been viewed as less threatening.

Bridging the gap 

Bosley says it breaks his heart when people still insist they are colorblind anytime the specter of racism is raised. They may think they are making him feel better by uttering such statements, but they are in fact saying that they don’t see race rather than addressing it directly. The message they are sending is that “they don’t even think enough of me to try to see me,” he says. 

Nadrich teaches his counseling students why it is harmful to always look to underrepresented groups to explain themselves, the injustices they face and what others should do to help. “You have to figure out what it means to be you and how you can start bridging the gap between your identities and the identities of the people you serve and work with,” he says. 

If Nadrich is working with an adolescent woman of color, for example, then he knows his identity as a person of color might help bridge the gap between them. But he also recognizes that his identity as a man could widen the gap depending on the client’s own history and experiences. “I have to be cognizant of that,” Nadrich says, “and say overtly to myself, ‘How am I going to make sure that I’m bridging across gender in this situation?’”

And in speaking to his white colleagues, Nadrich asks, “Are you willing to be affected by my lived experience? Are you willing for my lived experience to be relevant to yours or necessary to yours when it doesn’t have to be?” 

Nadrich is grateful for the colleagues who don’t avoid the issue and demonstrate a willingness to bridge this gap. “If you’re willing to be affected by it, now you hear me,” he says. “Now you know what’s going on with me and people like me.”

 

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@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.