Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Counseling in the land of religious liberty

By Cebrail Karayigit and Jason Kushner August 7, 2019

The MerriamWebster online dictionary defines minority as “a part of a population differing from others in some characteristics and often subjected to differential treatment.” The United States is perhaps the most religiously pluralistic country in the world and one of the few to integrate religious freedom into its Constitution. Christianity is far and away the largest religion in the United States, however, and is in some ways the baseline faith that guides — simply as a matter of familiarity — how many counselors approach working with religious traditions that are different from their own.

According to the 2014 Pew Research Center Religious Landscape Study, Christians represent 70.6% of the U.S. population. Meanwhile, religious minorities in the U.S., such as Jews (1.9% of the population), Muslims (0.9%), Hindus (0.7%) and Buddhists (0.7%), are frequently viewed through the context of media and other popular portrayals. These portrayals often perpetuate stereotyped perceptions and promote the notion that religious minorities and Western traditions are in conflict with one another. Counselors, like all humans, have biases that inform our perceptions of self relative to some “other.” Given misunderstandings about religious minorities in the United States, this topic is particularly relevant for counselors because we are part of an inclusive profession that is oriented toward social justice.

Rethinking multiculturalism

In an era in which many people get to know about “others” via social media, an unfortunate side effect is that stereotypes can be easily formed or solidified because we usually see what we want to see. Therefore, counselors have an ethical obligation to cautiously evaluate their sources of information relative to news coverage and social media mentions about religious minority groups in the U.S. As is the case when working with people who are different from us in other characteristics such as gender, race, ethnicity, sexual orientation and degree of ability, there is no substitute for direct contact with religious minority groups to promote counselor competency. According to a report released by Pew in 2017, knowing someone from a particular religious group was associated with warmer feelings for that group. So, direct interaction with people of a faith tradition different from our own (or the absence of a faith tradition altogether) is key to reducing or eliminating our biases — conscious or otherwise — toward religious minorities.

Within and outside the counseling profession, the terms multiculturalism and cultural diversity tend to focus on racial and ethnic minority groups, a practice promoted at least in part because of the categories used by the U.S. Census Bureau and data collected on applicants by American employers. Religious minorities are not so highly visible and are not generally regarded as “important” by mainstream American society because of this relatively hidden status. As counselors, we are in a unique position to interact with people from diverse backgrounds, and in this way, we have a meaningful role to play in ensuring that minority groups’ values are incorporated into American society. Standard A.1.d. of the 2014 ACA Code of Ethics states, “Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent.”

Misconceptions about religious minorities in Western societies are not new, but there remains an opportunity for counselors to lead the discussion and practice of widening the tent to welcome those of minority faiths. To do this, we must be uniquely competent as a collective profession at addressing the needs of this relatively small but growing population.

The relative absence of competence and knowledge about a plurality of traditions, beliefs and spiritual practices is perhaps one reason that counselors may not actively seek opportunities to engage with religious minorities. Within the counseling literature, few studies address the unique experiences of religious minorities. Therefore, engaging more research on this topic is an important step in increasing the visibility of religious minorities within the counseling profession. That larger research base would then inform practice as it does in the cases of other kinds of minority populations with whom counselors practice.

Do’s and don’ts

Perhaps the most important step is to examine our own attitudes and behaviors as counselors toward religious minorities. To that end, in their seminal cultural diversity book Counseling the Culturally Diverse: Theory and Practice, Derald Wing Sue and David Sue focused on the importance of examining our own attitudes by asking the following questions: Have you been influenced by the negative stereotypes regarding individuals of these groups? What would your reaction be if a client came in wearing traditional clothing?

One of the most common mistakes made by counselors is failing to recognize clients’ social and cultural identities and focusing only on visible manifestations of those identities, such as wearing a kippah or hijab. For example, when white American clients come to counseling, we do not typically refer to them as “Catholic clients” or “Protestant clients” and thereby put them in a categorical box. On the other hand, when a client wearing an orange robe comes to counseling, we are more likely inclined to refer to that person as a “Buddhist client.” Such labeling should not be considered the best practice of our profession.

It is necessary to challenge our stereotypical notions of the phenotypical appearance of minority groups to overcome the prejudiced messages that may be sent. Counselors must also be cautious in assuming that clients’ religious identity is the same as their social and cultural identity. Understanding clients’ behavior as a social-cultural concept, especially in today’s American society, is necessary to avoid a fixed and prejudicial view of their identity.

Religious minorities have typically been exposed to a history of oppression, so trust and empathy may be particularly important to them in a counseling relationship. Building rapport and developing a relationship with these clients is crucial to developing effective communication. Counselors should also understand that some religious minorities may be reluctant to seek counseling for a variety of reasons. Therefore, when working with these clients, counselors are encouraged to be active in and affirming of their help-seeking behavior and to assist them in processing resistance if any exists without forcing any particular religious or faith perspective.

In most cases and with most faiths, the individual expression of that faith is a uniquely personal experience. To that end, counselors should explore what it means to their clients without making assumptions based on the counselor’s own perceptions of various faith traditions. It is also important to note that people usually overestimate their openness to minority groups. As suggested in a 2014 study by David Amodio, individuals are typically unaware of their implicit biases. These biases can be particularly difficult to change in an era of news and social media that often reinforces prejudicial or stereotyped thinking rather than calling it into question.

Counselors are also encouraged to examine their use of theories in their practices because many widely used theoretical orientations (e.g., cognitive behavioral, person-centered) are rooted in Western value traditions that may ignore the unique needs of some minority groups. Some approaches focus on inward problems and view the individual as “problematic” outside of the context in which the individual lives. For example, some religious minorities experience a significant amount of tension and stress because of societal pressure and reminders of their differences. For this reason, a theoretical orientation that emphasizes knowledge of the effects of societal pressure and that has a social justice perspective ensures greater likelihood of a therapeutic alliance that will lead to more satisfying outcomes for the client and counselor alike.

As Derald Wing Sue suggested in Counseling the Culturally Diverse, to be multiculturally competent, counselors must also be knowledgeable about discrimination policies. If counselors learn about anti-discrimination policies, they will be able to raise clients’ awareness of their legal rights so that they can challenge discrimination and take appropriate actions when faced with discrimination. To be most effective, counselors need to educate themselves about laws, practices, policies, history and situations in a global context. No one expects counselors to be living encyclopedias, but to be competent healers, we have to be comfortable enough to ask religious minority clients about their faith traditions. In doing this, the counseling profession will expand its reach, make a difference and continue to uphold the value of diversity for which it is known.

Religious competencies

Religious competencies are important for all counselors to have, in particular when working with clients with religious and spiritual issues. Consistent with the 2014 ACA Code of Ethics, the Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC) provides a set of competencies for integrating knowledge of spiritual and religious issues into counseling practice. The purpose of the ASERVIC competencies is to “recognize diversity and embrace a cross-cultural approach in support of the worth, dignity, potential and uniqueness of people within their social and cultural contexts.”

The following competencies shed light on how to improve our ability to serve members of religious minority groups:

  • The professional counselor recognizes that the client’s beliefs (or absence of beliefs) about spirituality and/or religion are central to his or her worldview and can influence psychosocial functioning. Counselors cannot effectively assess their clients’ problems and formulate strategies without first understanding their clients’ worldviews.
  • The professional counselor actively explores his or her own attitudes, beliefs and values about spirituality and/or religion. It is important for counselors to seek self-knowledge through an active practice of self-awareness and self-reflection. For example, counselors can examine their attitudes about religion by asking themselves the following questions: When did I last push the boundaries of my comfort zone to learn about religious topics that are different from my own perspectives?
  • The professional counselor continuously evaluates the influence of his or her own spiritual and/or religious beliefs and values on the client and the counseling process. It is necessary and essential to assess any possibilities of countertransference to prevent the development of a negative relationship with clients. For example, counselors who are very involved with religious organizations should not impose such practices on their clients. Many members of religious minorities have a paradoxical relationship to religion. Although they may have firm religious convictions, attending religious services can be a less frequent activity for them.
  • The professional counselor can identify the limits of his or her understanding of the client’s spiritual and/or religious perspective and is acquainted with religious and spiritual resources and leaders who can be avenues for consultation and to whom the counselor can refer. The fear of not knowing should not keep us from learning from our clients. Our clients are our best teachers. Although we strive to understand clients’ religious perspectives, it is important to allow our clients to educate us about their religious beliefs.
  • The professional counselor responds to client communications about spirituality and/or religion with acceptance and sensitivity. Counseling is a profession based on understanding, which goes well beyond simply showing tolerance for those who are different from us. Seeking understanding and respecting our clients’ religion is key to accepting clients for who they are.
  • The professional counselor can therapeutically apply theory and current research supporting the inclusion of a client’s spiritual and/or religious perspectives and practices. It is important that counselors are flexible enough to modify their treatment perspectives to best match the unique needs of clients. Perceiving psychological functioning as an internalizing problem or an inward-directed form of distress can be problematic when serving some religious minority populations. The most well-known therapeutic techniques do not emphasize a religious perspective; it is important that counselors strive to use techniques that will reduce clients’ symptoms, even if that includes learning about faith-affirming interventions that would be most helpful. One example could include using the egalitarian and empowerment principles of feminist therapy. From that perspective, clients could be encouraged to recognize the many aspects of their religious identity, increase their awareness of the origins of their presenting problems, and enhance their well-being.

Hypothetical case study

To further illustrate the highlighted competencies, we offer a hypothetical case study as an example of how specific strategies could be integrated into counseling practice.

Mary, a 19-year-old college student, was initially referred to counseling because she was experiencing social isolation and increased levels of stress. During the initial interview, Mary, a native-born U.S. citizen, described herself as an American Muslim feminist woman. She reported having never felt treated differently in the past by her friends, teachers or peer groups, perhaps because she was fair skinned, spoke English without an accent, and came from a family of high socioeconomic status. She also changed her original name, Mariam, to the English translation, Mary, while in high school. When Mary was asked about her motivation for doing this, she stated that she wanted to be well-integrated and active in larger American society.

After Mary began college, she decided that she wanted to learn more about her faith tradition, which eventually led her to choose to wear a hijab (headscarf). She realized that the hijab had a large impact on her relationship with her friends and with people in general. She even stated that she started getting fewer likes on her Instagram photos. Although Mary has never questioned her choice, she no longer feels like she fits in with her peer group.

Because building rapport and developing a relationship with a client is crucial in any counseling relationship, the counselor shows genuine interest in Mary’s story and demonstrates an openness to discussing her attitudes toward Mary’s religious beliefs. It is important to closely examine Mary’s own feelings and values regarding the hijab. By having an open dialogue with Mary, the counselor attempts to explore the meaning that Mary ascribes to the hijab. Mary states, “A lot of my friends are asking if I was forced to wear the hijab because a headscarf can be seen as a symbol of oppression. I think that my hijab gives me the freedom to set my own standards in a land of religious liberty, but I cannot convince people about that.”

The counselor acknowledges Mary’s emotional experience by stating, “You value your hijab and see it as a symbol of freedom. While you are also frustrated by your friends’ comments, you are aware that you do not have control over what your friends or society think of your decision.” The counselor further explores Mary’s experience by asking another question: “A friend you haven’t seen for a while sees you after you choose to wear the hijab. What would be different?” Such questions help Mary to reflect changes within herself and her environment.

The counselor knows that understanding Mary’s worldview and experiences is a crucial step toward effectively assessing her presenting problems and then formulating strategies to address them. From here, the counselor will connect on a deeper level the literal and metaphorical symbolism of the hijab. The counselor also examines her own attitudes by asking herself some questions: “What was my initial reaction when this client came in wearing a hijab? Have I been influenced by the negative stereotypes regarding individuals of groups who wear symbols?”

While exploring Mary’s religious values, the counselor avoids responding in a stereotypical manner by asking to be educated by Mary about her background and beliefs. The counselor encourages Mary to do this by saying, “Tell me more about your experiences of being treated differently.”

Mary states, “I do not understand why people focus only on my hijab. My hijab is an important part of my life, but I was born and raised in American culture, and that has always been the most important thing in my life.”

The counselor reflects, “You feel it is unfair that people ignore your core identity, which is your social and cultural identity. You want them to see you as an American Muslim feminist woman, not as an oppressed person who wears a hijab.” The counselor acknowledges Mary’s cultural background as a salient aspect of her identity. This could be an important step toward achieving a positive outcome. If the counselor focused mainly or exclusively on Mary’s religious identity, the counselor might fail to recognize Mary’s social and cultural identity.

The counselor will also help Mary recognize how her religious identity, even if it is not her core identity, may have caused her some disadvantages. The counselor will help Mary examine whether she has suffered from oppression as a member of a subordinate group, both as a woman and as a Muslim. It is important to note that Mary’s overall experiences make her an excellent candidate to benefit from a feminist counseling orientation, especially because of Mary’s stated identity as a feminist. Therefore, the counselor acknowledges the societal impact on Mary’s life.

Because Mary describes herself as a Muslim feminist woman, encouraging her to engage in an action can be an important step toward a commitment to social change. The counselor asks, “Do you like to do tasks between sessions? What is one powerful thing you could do for yourself between now and the next session?” By asking such questions, the counselor empowers Mary to take action and promotes an egalitarian relationship.

Mary answers, “One thing I would like to do is to share my personal story about why I decided to wear a hijab. I hope that this will lead to an open dialogue with my friends, and they will be more comfortable asking questions.”

The counselor asks, “What have you done toward this goal? How will you go about doing this? What difficulty might you have?” The counselor helps Mary to specify her direction and organize small steps toward desired behaviors.

The counselor also encourages Mary to be active in the therapeutic relationship by inviting her to direct the conversation. The counselor might ask, “Are there topics you talked about or discovered that you would like to pick up on next time?”

Finally, for the purpose of achieving better and longer lasting outcomes, it is important to help Mary build her own support system. The counselor says, “I wonder if there are any particular groups that could make you feel more connected and involved in the community?” This is important so that Mary can recognize she is not alone and that there are other women who are experiencing similar experiences. By engaging with other women, Mary can find support and become more assertive in promoting social justice.

Conclusion

In thinking about ways to work with clients from minority religions in the United States, counselors can pick from any number of similar cases in which they counsel people who are different from them in some aspect. It is important to remember that more often than not, a client’s religion, the client’s perspective on that religion, the client’s perspective of others, and what the client wants from a counselor will vary quite a bit. A client’s expression of faith is completely subjective and unique to that person. These hypothetical case studies should not be used to describe the basis of a faith’s visual aspects. Counselors should not make judgments or use phrases that may alienate clients over issues of religion, faith or spirituality. That is why it is important to have a discussion, or at least include a question, about the subject.

There are universal elements to most faith traditions (or the absence thereof) that transcend counselors’ observations about a client’s observable characteristics. The task for counselors is to understand our own perspectives and what they mean to us, and to obtain a general knowledge of many religious/spiritual traditions and how those traditions intersect with the experiences of our clients and the help they are seeking from us.

 

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Cebrail Karayigit is an assistant professor in the Department of Psychology and Counseling at Pittsburg State University in Kansas. Since coming to the United States in 2010, he has gained a reputation as an expert in multicultural counseling and school counseling, which are his areas of research and practice focus. Contact him at ckarayigit@pittstate.edu.

Jason Kushner is a professor of counselor education at the University of Arkansas at Little Rock. He is a licensed professional counselor with experience in school counseling, college counseling and mental health counseling. Contact him at jdkushner@ualr.edu.

 

Letters to the editor: ct@counseling.org

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

 

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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.

Culturally competent end-of-life counseling

By Ashley C. Overman-Goldsmith May 1, 2019

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

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

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

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

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

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

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

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

Education

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

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

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

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

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

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

Practice

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

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

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

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

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

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

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

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

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

Advocacy

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

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

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

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

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

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

Summary recommendations

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

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

Conclusion

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

 

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

 

Letters to the editor: ct@counseling.org

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

 

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

When yelling doesn’t work

By Lindsey Phillips April 29, 2019

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

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

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

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

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

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

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

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

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

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

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

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

Putting discipline in (cultural) context

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

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

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

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

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

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

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

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

Spanking and the discipline continuum

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

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

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

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

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

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

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

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

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

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

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

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

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

ACT, don’t react 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Letting children take control

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

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

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

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

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

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

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

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

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

Dealing with resistance

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

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

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

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

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

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

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

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

Raising an adult 

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

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

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

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

 

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Being a witness in court on physical discipline

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

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

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

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

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

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

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

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

— Lindsey Phillips

 

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

Letters to the editor: ct@counseling.org

 

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

Five points of discussion for conversations about racial injustice

By Amanda L. Giordano April 10, 2019

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

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

 

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

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

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

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

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

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

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

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

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

 

Why this topic matters to Cebrail

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

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

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

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

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

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

 

Why this topic matters to Donna

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

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

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

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

 

Why this subject is especially relevant

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

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

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

 

Strategies and implications for professional counselors

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

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

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

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

 

 

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

 

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

 

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