Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Developing competence to address undue police violence

By Darius Green May 10, 2022

In the summer of 2020, many of us were reminded about the tense relationship between law enforcement and those who are Black, Indigenous and people of color (BIPOC), particularly Black Americans. Just a few months prior to the breaking news of the murder of George Floyd, the killing of Breonna Taylor and several others whose deaths came to the national spotlight, I had successfully defended my dissertation that investigated undue police violence and counselor preparation. In the recently published article from my dissertation, “Undue police violence toward African Americans: An analysis of professional counselors’ training and perceptions” (October 2021 Journal of Counseling & Development), I defined undue police violence as the unwarranted and excessive uses of law enforcement officers’ (LEO) inherently violent force that results in physical, emotional and psychological harm to those who directly or vicariously experience it.

While I am hopeful that the spotlight on racism and undue police violence has conjured lasting motivation and action toward change among some counselors, I find myself skeptical about the enduring nature of many of the anti-racist commitments and promises for change from within our profession. My skepticism is rooted in the following. 

  1. Undue police violence is not a new phenomenon. It has occurred throughout the history of the United States in the form of slave patrols, during the Civil Rights movement and in modern institutions of law enforcement (e.g., local, state, federal and immigration officers). 
  2. Racism tends to be adapted and perpetuated even as the status quo is challenged. We see this in the social and political rhetoric of disinformation toward critical race theory and approaches that work against racism. 
  3. Findings from my dissertation suggest that there is considerable room for growth in competence among professional counselors regarding undue police violence. For example, despite 68.2% of the 112 participants indicating having worked with clients who experienced undue police violence, only 17% had clinical training in identifying its impact and only 22.5% had training in advocating against it. 

I am writing this article to build off findings from my study by offering reflective points and practical suggestions for professional counselors seeking to enhance their competence regarding the topic of undue police violence. These reflective points and practical suggestions are grounded in the Multicultural and Social Justice Counseling Competencies (MSJCC) framework.

Reshaping our attitudes

According to the MSJCC, we can start developing and enhancing our competency to address undue police violence by examining and altering our current attitudes and beliefs regarding law enforcement, criminality and racially marginalized populations. Many of us may hold positive beliefs towards LEOs, informed by personal experiences, media representation and the attitudes of those we trust. For example, we may believe that LEOs promote security in society through their roles as first responders and that their use of force toward those deemed to be “bad people” and “criminals” is typically legitimate. Alternatively, when individuals such as Derek Chauvin are highlighted in national media for negligent and violent policing, we may be inclined to believe that the harm they have inflicted is the result of individual bad behavior. When we unquestioningly hold on to these adopted beliefs, we may be hindered from critically reflecting upon and acknowledging the ways in which law enforcement systems perpetuate harm. 

A deconstruction of our belief systems entails a critical questioning and analysis of our current beliefs, the beliefs of others and how these beliefs have been shaped and developed within our social context. While LEOs can certainly function in ways that appear to promote security for some populations, we need to critically analyze instances when our attitudes and beliefs are not held up to be true. We might begin by asking ourselves: What are the purposes and functions of law enforcement? What has influenced my beliefs about LEOs across my life span? What differing beliefs do people hold toward LEOs and why? What impact have LEOs had on me and others in my community? Which members of my community have had experiences that diverge from my own regarding LEOs? What alternatives to policing exist to foster safety and security? 

Deconstruction of our current beliefs is an essential step because many populations do not live in a world in which LEOs are experienced as safe, protective and trustworthy. In fact, my fellow Black Americans and I often feel that we are seen as threatening and criminalizable by LEOs. Native and Indigenous Americans may hold beliefs parallel to those of Black American experiences of LEOs. Women of color, particularly Black women, may experience LEOs as negligent and even perpetrators of sexual violence. 

As we engage in a critical deconstruction of our beliefs and attitudes, it is important for us as counselors to empathize with the experiences of those who are marginalized in ways that often diverge from beliefs that center white, cisgender, male, abled, and middle and upper socioeconomic status experiences.

Building knowledge

Deconstructing our current attitudes to develop more critical ones toward the relationship between marginalized groups and LEOs can be a difficult task in isolation. We often need something outside of our current awareness to challenge our current beliefs. Making use of existing expert knowledge can be a great tool to support an ongoing reshaping of our beliefs about LEOs. Rather than re-creating the wheel, counselors may benefit from drawing upon knowledge from abolitionist authors who have written extensively about law enforcement and the broader criminal justice system in the United States. 

I make this recommendation because the counseling profession is often entangled with the criminal justice system. For example, we may be inclined to rely on law enforcement for emergencies or situations regarding a client’s imminent harm to others. Additionally, many counselors are referred to or work with clients who have direct and frequent contact with LEOs and the broader criminal justice system. Abolitionist writing on undue police violence can provide critical knowledge about the system of violent policing, its sociopolitical history and collective struggles against it. The following list of recently published books serves as a useful starting point for counselors:

  • We Do This ‘Til We Free Us by Mariame Kaba
  • Invisible No More: Police Violence Against Black Women and Women of Color by Andrea Ritchie
  • We Still Here: Pandemic, Policing, Protest and Possibility by Marc Lamont Hill
  • Abolition for the People: The Movement for a Future Without Policing and Prisons edited by Colin Kaepernick

In addition to texts that focus on violent policing and abolition, readings specifically geared toward policing and race-based traumatic stress may be useful for counselors seeking to integrate this knowledge into their practice of counseling and advocacy. As a starting point, it is essential for counselors to know that LEOs’ use of force, whether a mere intimidating presence, physical force or use of a weapon, is inherently violent. This simply means that using force to enforce rules relies on behavior that is violent in any other context. As many of us are aware, violence often begets trauma. 

When undue police violence intersects with racism, beliefs of racial inferiority are communicated from LEOs to those who are BIPOC. A message of racial inferiority is also communicated when institutions within the criminal justice system function to permit these practices without accountability. Moreover, these beliefs are further internalized when helping professionals negate, downplay or are simply oblivious to the impact of these experiences. BIPOC clients may exhibit the weight of racialized violence from LEOs in their developed worldview and identity, social and emotional processes, and neurological and behavioral functioning. The following books and articles may be helpful resources for advancing counselors’ knowledge about race-based trauma and violent policing:

  • My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies by Resmaa Manakem
  • “The trauma lens of police violence against racial and ethnic minorities” by Thema Bryant-Davis and colleagues, Journal of Social Issues (December 2017)
  • “The experiences of African American mothers raising sons in the context of #BlackLives Matter” by J. Richelle Joe and colleagues, The Professional Counselor (March 2019)

Developing skill and taking action

The purpose of the MSJCC is not to simply hoard knowledge and privately reshape our attitudes. Developing competency in multiculturalism and social justice requires us to export our cultivated knowledge and beliefs to support change as accomplices with the individuals, communities and populations that we serve. Without this accompliceship, we risk portraying ourselves and the broader counseling profession as performative and inauthentic. 

In the remainder of this article, I will emphasize four specific areas where counselors can take action.

1) Assessing for undue police violence and its impact. One way for counselors to begin to address the potential traumatic impact of undue police violence is to conduct an ongoing assessment of such occurrences. According to national databases on police violence such as Mapping Police Violence (mappingpoliceviolence.org) and The Washington Post’s Fatal Force database, Black and Hispanic Americans and individuals who experience mental illness are overrepresented in fatal encounters with LEOs. While less often acknowledged, Native and Indigenous Americans also experience police violence at disproportionately higher rates than do their white counterparts. 

Similarly, women of color and transgender and nonbinary people have experienced increased odds of violent encounters with LEOs that may overlap with sexual violence and aggression. Additionally, those who engage in resistance through protests have a heightened risk of experiencing undue police violence. Other populations, such as those who use substances, people without housing, domestic violence survivors and offenders, incarcerated individuals, and the loved ones of these individuals, also warrant the attention of counselors. 

When we know or suspect that our clients have had encounters with LEOs, we need to provide space for clients to share what happened, how they were impacted and what they are doing to cope and heal.

2) Broaching. Broaching — the intentional invitation to discuss matters of race and culture in counseling — can be a useful tool to initiate conversation and meaning making around undue police violence. We broach by acknowledging the connections between our clients’ cultural identities, sociopolitical history and context, and their wellness. We then invite our clients to share and expand on their experiences in a safe relationship with us. 

Care and attention must be given toward how we broach to avoid causing harm. We want to avoid robotic, scripted or inauthentic invitations. We also want to avoid tokenizing or burdening our clients by asking them to educate us on things that we can easily educate ourselves on. For example, it might not be wise to prompt a Black client out of the blue or simply because we are curious to tell us “what it is like to be a Black person in light of the Black Lives Matter movement.” While such a response acknowledges race, it misses out on communicating the ways in which we are attuned to our clients’ specific experience. 

When teaching about crisis and trauma, I often encourage my students to explicitly share their observations of a client’s emotions, behaviors and thoughts as opposed to offering hollow or cliché comments to acknowledge evident distress and pain. When applied to broaching undue police violence and its impact, we want to let clients know that we can see the weight of their experiences, we understand and believe their experience to be valid, and we value their trust in us to share their narrative. 

When we notice that encounters with LEOs, whether directly or vicariously experienced, impact our clients’ wellness, we might respond by first describing our observations and their relationship to culture and race. From there, we can invite clients to respond to the observations that we have brought forth. Throughout the client’s narrative, we want to communicate our attunement to their past and present emotional experiences through active listening techniques. I often encourage students to honor what is authentically present rather than attempting to “fix” clients or evoke the depths of their suffering. Lastly, we want to acknowledge our clients’ willingness to entrust us with their narrative, especially given the likelihood that their experiences have previously been met with skepticism, arguments or invalidation.

When broaching experiences of undue police violence, it is essential that we avoid interrogating, doubting or attempting to offer a “neutral” or “balanced” perspective for our clients. These behaviors are likely to be perceived as invalidating or antagonizing to clients. We also want to avoid placing our clients in stereotypical boxes. For example, not all Black people will experience undue police violence or, as a function of racial identity development, even share the same beliefs about LEOs. 

These sorts of responses run the risk of creating relational ruptures, poking existing traumatic wounds and further stigmatizing clients’ experiences. Instead, we need to trust that our clients are knowledgeable and truthful in how they describe their experiences. Broaching is less about an extraction of information from our clients or investigating claims around their experiences. It is more about creating a relationship in which clients can share their racial and cultural experiences while being met with a nonjudgmental, attuned, affirming and validating presence from a professional. In doing so, we can cultivate spaces that help our clients cope with, integrate and heal from their distressing encounters with LEOs. 

3) Coping and healing. After inviting experiences associated with undue police violence into the counseling room, we need to consider what coping and healing approaches look like. I have found the article “Toward a psychological framework of radical healing in communities of color” by Bryana French and colleagues in The Counseling Psychologist (January 2020) helpful in distinguishing between these two terms. 

French and colleagues describe coping as surviving the experiences of injustice and oppression that inhibit optimal wellness. Coping entails supporting others in getting by and resuming functioning despite the distress from direct and vicarious exposure to undue police violence. Examples of coping might entail developing skill in affect regulation after exposure, altering one’s cognition to minimize distress associated with LEOs, enhancing connectedness to one’s social support systems or setting boundaries around social media usage following the viral sharing of a killing by an LEO. 

While coping is essential, it is often more of a Band-Aid and does not address common roots of the distress from undue police violence: racism and systemically violent policing. French and colleagues’ article describes healing as fostering the collective critical consciousness and resistance against systemic suffering. On an individual level, healing might entail supporting a client’s growth in their critical consciousness around law enforcement and their advancement in racial identity development. On a collective level, healing may look like bringing community members together to foster hope and collective strength using support groups and healing circles. Healing may also include supporting a client’s engagement in various forms of resistance in their community to advocate for changes in laws, policies and norms that promote racist and violent policing practices. 

As professional counselors, we can and should also be collaborating with our clients outside of the counseling room to enact tangible changes in communities where we operate. This might include active participation in organizing protests, demonstrations and calls for action as a complement to the work that we are traditionally trained to do.

4) Engaging in advocacy. It is essential that we address undue police violence in ways that do not solely reflect individual responsibility for experiencing or being impacted by police violence. Being engaged in our communities and society at large through advocacy is one way to achieve this. The following is a nonexhaustive list of actions that counselors can take and support alongside their clients and communities:

  • Share credible educational resources on police violence.
  • Contribute to public education efforts regarding the intersection of undue police violence and race-based traumatic stress.
  • In moments of community unrest associated with undue police violence, organize with other counselors to open our doors for pro bono crisis counseling.
  • Volunteer to support community efforts toward accountability of local law enforcement.
  • Strategize a long-term plan of action with community leaders to minimize contact between LEOs and the public, particularly those who are BIPOC.
  • Organize and advocate alongside clients to call for a divestment in law enforcement while simultaneously investing in public health and wellness initiatives that would foster community safety.
  • Participate in public demonstrations against undue police violence. Specifically, counselors can collaborate with organizers to infuse culturally authentic wellness practices and strategies for maintaining safety.
  • Conduct research on undue police violence, its impact and strategies toward change.
  • Identify and contribute to resources for mutual aid to establish holistic care for clients in need.
  • Integrate information about undue police violence into the classroom and supervision to better prepare counselors-in-training when working with vulnerable populations.
  • Regarding substance use, advocate with local officials of the criminal justice system to allow for approaches that value harm reduction over punishment (e.g., incarceration) following relapse.
  • In schools, advocate for the removal of school resource officers. When this is not achievable, advocate for a systemic restructuring of the roles of school resource officers to minimize contact with students, particularly those most vulnerable to undue police violence.
  • Support or challenge candidates for local, state and national elected positions to make policy changes that minimize contact between LEOs and members of the public, especially those vulnerable to undue police violence.

Pursuing change in community

While we can build competence in isolation, it may be most effective and efficient to initiate this progress in community with others. When working alone, we may find ourselves avoiding blind spots or struggling to sustain our motivation to undergo change.

alexfan32/Shutterstock.com

To tie the contents of this article together, I strongly encourage counselors to form action-focused reading groups around undue police violence. These groups should be different from traditional book clubs that function to gain new wisdom. Instead, these action-focused reading groups should be centered on making change and acting. To be effective in this goal, we may consider defining specific and actionable goals toward change before participating in these groups. Additionally, we can embed time for collective brainstorming, collaboration and reflection over action taken toward any identified goals.

Although the demands of the task are complex and politically charged, we have a responsibility as counselors to address undue police violence in support of the wellness of the client populations we serve. We should expect resistance, defensiveness and other forms of pushing back as we dig into making such important changes. Nevertheless, addressing and minimizing undue police violence is imperative. With the MSJCC as a guiding framework and with collective support from colleagues, counselors can make substantial gains in developing our competence before the next George Floyd-like tragedy inevitably occurs.

 

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Darius Green is an adjunct professor and counselor educator. He earned his doctorate in counselor education from James Madison University in Harrisonburg, Virginia. Contact him at drdariusagreen@gmail.com and follow him on Twitter @dariusagreen.

 

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.

Creating meaningful and lasting change

Counseling Today April 13, 2022

The American Counseling Association’s Antiracism Commission grew out of an action plan developed to acknowledge and address issues of racism and discrimination within the counseling profession. The commission was established approximately one year ago, and its commissioners were appointed not long after that to begin discussing, evaluating and proposing actions to help ACA dismantle systemic and institutional barriers within the association and the profession as a whole.

ACA Antiracism Commission Chair Taunya Tinsley

Counseling Today recently contacted Taunya Tinsley, who chairs the commission, and asked her to respond to a series of questions and provide ACA members with an update on the work that she and her fellow commissioners are undertaking. Tinsley, a licensed professional counselor and national certified counselor, is the owner of Transitions Counseling Services LLC. She has previously served as president of the Association for Multicultural Counseling and Development and as a board member for the Association for Spiritual, Ethical and Religious Values in Counseling.  

 

For those who aren’t aware, can you briefly share some of the backstory of how and why the ACA Antiracism Commission was established?

Under the leadership of [ACA immediate past] President Sue Pressman, the Antiracism Task Force was birthed out of discussions related to an antiracism statement crafted by a team of volunteer members in the spring of 2020. After dialogue, discernment and wordsmithing, the ACA Governing Council issued a strong statement denouncing racism. The statement spoke out against the violence being experienced in Black and Brown communities. Many members who participated in the writing of the statement were dismayed by the number of police-related deaths of unarmed Black and Brown men. 

Once the motion to approve the statement was ratified, there was an immediate call for a task force to be created that would provide ACA with clear guidelines to be utilized to address this growing concern. The call to create a task force was thus realized and voted in by the Governing Council. The ACA leadership proving that they were listening to a cross section of members and volunteers set into motion a strategy geared toward creating a task force that would in return draft an action plan that would ultimately give life to the statement. 

The charge: It is our mission to develop an action plan by which counselors will 1) gain cultural self-awareness in relation to intrapersonal, interpersonal, community and global contexts, 2) enhance cultural competency and 3) provide evidence-based interventions and strategies that will empower counselors and others to facilitate action within local communities addressing racism and disparities that often lead to misunderstandings and/or violence. 

The council selected [ACA President] S. Kent Butler to chair a 31-member task force of representatives from across the ACA membership and leadership. Over the tenure of the Antiracism Task Force, members diligently provided an antiracism action plan. The ACA Antiracism Action Plan was composed of one short-term and one long-term goal from each designated work group. The action plan was provided to ACA staff to be vetted for sustainability and projected expenses. Once the staff completed that portion of the vetting process, the short- and long-term goals of the action plan were brought before the Financial Affairs Committee, followed by the Governing Council due process, for the eventual adoption of the actions. 

The action plan called for a commission to be formed to carry out the action plan and to further develop ACA’s response to systemic racism and discrimination within the association and throughout the counseling profession. The ACA’s first ever Antiracism Commission was established and formed in spring 2021 with goals to discuss, evaluate and propose actions that will guide ACA in breaking down systemic and institutional barriers that exist in the association and the counseling profession.

What is your role in chairing the commission?

My role in chairing the commission is to lead a very distinguished group of my colleagues to facilitate change around issues of racial injustice, systemic racism and how our association must address these challenges. 

As part of my role, it is important that I assist with ensuring the efficient functioning of the leadership team (i.e., commissioners) and communicating accurately and transparently the mission, vision and strategic goals of the team as well as the performance of the team. 

Furthermore, I ensure that the team members receive accurate, high-quality and timely information and reports to enable them to effectively monitor all aspects of the commission’s business as well as ACA’s Antiracism Action Plan. 

Finally, as the chair and coach of the team, it is important that I assist with ensuring that the commission and team members operate to the highest standards of integrity.

What is the commission charged with doing in the immediate future? How about over the long term?

As stated, the goal of the commission is to discuss, evaluate and propose actions that will guide ACA in breaking down systemic and institutional barriers that exist in the association and counseling profession. The commission has been charged with establishing a new organizational culture and assisting with reviewing policies and procedures that are antiracist. 

We are in an immediate and long-term position to create meaningful and lasting changes that reflect our moral integrity and values and that are consistent with [the core professional value stated in the ACA Code of Ethics of] “honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts,” specifically Black, Indigenous and people of color (BIPOC). 

As we foster ongoing, authentic conversations and dialogues about race, racism and anti-Blackness, it is our hope that we can begin to eradicate long-standing systemic racism within ACA and our profession and implement antiracist policies, procedures and trainings.

Why are you personally drawn to this work?

I am personally drawn and committed to this work! It is my core belief that I am required to act justly and to apply love, mercy and grace when providing a ministry of care and counseling. We are in a crucial period in the history of our nation and in our profession, and I am passionate about helping to acknowledge racial and ethnic disparities that impact the mental health, and add to the disparities, of BIPOC and other diverse populations. In addition to developing multiculturally and social justice-competent counselors, counselor educators and leaders, we must strategically address the historical context of systemic racism in our association, the profession and the world.

Do you expect to encounter resistance in the work you’re doing to confront racism and discrimination in the profession? If so, how will you handle that? What keeps you from getting discouraged?

Yes, the world is full of well-intentioned individuals. People with this mentality often operate from a closed-minded stance and make this crucial issue personal to them as opposed to fighting institutionalized racism, behaviors and the systemic barriers that block the pathway of those whom they claim have a right to equity and justice.

I will handle this by meeting people where they are. I will continue to assist them with increasing their self-awareness and worldview knowledge while developing antiracist skills, techniques and interventions.

Hope and faith keep me from getting discouraged!

What one thing do you want readers to walk away knowing about the ACA Antiracism Commission or racism and discrimination within the counseling profession?

The ACA board has approved an action plan to tackle issues of racism and discrimination within the association and throughout the counseling profession. In addition, the ACA Governing Council appropriated more than $200,000 to support these efforts and chart our path forward.

As [ACA CEO] Richard Yep has shared with the membership, the “Antiracism Commission is serving as a guidepost for the work to which ACA has committed. Appointed by ACA Immediate Past President Sue Pressman and current President S. Kent Butler, the commissioners were selected for their demonstrated commitment to promoting racial and social justice in every aspect of their work.” 

As the inaugural commission continues to grow, there will be opportunities for ACA members, divisions and branches to collaborate and partner to advance the counseling profession to ensure a safe, just and equitable space for our clients, colleagues and communities.

 

The 2021-2022 ACA antiracism commissioners are:

Taunya Tinsley, chair

Monica Band

LaTasha Hicks Becton

Shawn Spurgeon

Sam Steen

Ahmad Washington

Ebony White

 

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.” 

fizkes/Shutterstock.com

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.

 

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