Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

An eight-step process for implementing social justice and advocacy interventions

By Jonnie Seay Lane June 29, 2017

Viewing the landscape of today’s society, it is clear that multicultural and social justice issues have never been more visible. Although prejudice, racism and inequality have always plagued our nation, society is no longer keeping secret or turning its cheek to the omnipresent consequences of privilege and marginalization. Everyone is affected and everyone has a duty to respond, but nobody more so than those “working the fields.”

Gone are the days of counseling in a silo. Our clients live in the real world. And in the real world, our clients suffer privilege and marginalization. Counseling and counselors would be well-advised to prepare for the spectrum of cultural issues that we may encounter in session. In other words, we need to enhance our multicultural competence. Not only is it written into the ACA Code of Ethics, but it also just makes common sense. If we want to continue to work with, for and on behalf of our clients, we need to ebb and flow with the tide, and this is the tide.

If you are a counselor, you might think that you already possess a good deal of cultural competence, but let me unveil three common statements that can lead to a false sense of cultural competence.

1) “I took a class in my master’s program, and it covered a lot of material. I know the multicultural theories and models. I must be culturally competent.”

2) “I have three black friends, and my neighbor is from India. I know how to talk to people of color, and I know their cultural norms. I must be culturally competent.”

3) “I don’t stereotype. I don’t judge others. I must be culturally competent.”

I must confess that, as a white counselor, I’ve found those words bouncing around in my own head from time to time. I used them to strengthen my belief that I was a culturally competent counselor. That belief made me feel good about myself — even if it wasn’t true. Those statements assuaged the guilt I felt knowing that I actually wasn’t as competent as I should be. I used those statements as excuses to avoid growing and sharpening my counseling skills because it was an area that challenged me and even scared me a bit.

Admitting that those three statements, even if factual, did not make me a culturally competent counselor was scary. It meant admitting that I wasn’t as great as I thought I was and that I might not be serving my clients to the best of my abilities. It also meant that I had to do something about it. And change is scary.

But change can be motivating and liberating too. Becoming a better counselor is exciting. Learning new things is exciting. Instead of leaning away from multicultural counseling, I leaned in.

 

A plan of action

I’m currently a doctoral candidate at North Carolina State University, where I have the honor of being under the tutelage of some of the foremost experts in the field. My adviser, Sylvia Nassar, was one of the co-authors of the Multicultural and Social Justice Counseling Competencies (MSJCC), which were endorsed by the American Counseling Association and the Association for Multicultural Counseling and Development in 2015 and released in 2016. She put together a task force of students to continue work on dissemination of the MSJCC. The door opened, and I walked through. I made it my mission to become an expert in multicultural counseling, starting with the MSJCC. Yes, me, the white girl.

As a member of the task force, I facilitated and co-facilitated presentations on the MSJCC at local, state and regional conferences following a variety of formats (e.g., roundtable discussion, PechaKucha presentation, information session and workshop). What became clear to me was that attendees were thirsty to take what they were given and implement it into practice. But something was missing.

As great as our presentations might have been at providing information and inspiring motivation, they lacked a practical approach to next steps. Attendees left excited and motivated. However, without an action plan, excitement and motivation eventually dissipate. With that in mind, I created an eight-step process to implementing the MSJCC.

The eight steps are a basic foundation for enhancing multicultural competence. Implementing them requires understanding of the model and its specific parts. The steps reference sections of the model and particular competencies that are prescribed within. All this to say, the steps are meant to be used after training on multicultural counseling, and the MSJCC model in particular, has been completed. A link to the MSJCC can be found here.

The model is composed of 117 specific competencies that serve as markers of cultural competence. The counseling competencies are embedded in four distinct domains: counselor self-awareness, client worldview, counseling relationship, and counseling and advocacy interventions. The last domain, counseling and advocacy interventions, is composed of six layers and aligns with Urie Bronfenbrenner’s theory of socioecological layers. Those layers are intrapersonal, interpersonal, community, institutional, public policy and global.

The suggested steps were created to be used when considering multicultural enhancement in terms of the socioecological layers. It is in these layers where the action component of the MSJCC is more heavily emphasized. And that is the goal of the steps — to promote action.

I believe the eight steps below provide a starting point for becoming more culturally competent. Use of this eight-step process will result in a singular action. Thus, it serves to make the abstract concrete and to propel movement. Although it is only a starting point, every great ending has to start somewhere.

 

Steps for implementing social justice and advocacy interventions

Step One: Identify the need(s) of your client or population.

Step Two: Decide in which layer(s) your client’s or population’s needs are represented (e.g., a client seeking assistance for solving communicating issues with a co-worker has needs in the interpersonal layer).

Step Three: Review the interventions from the appropriate layer in the model and ask yourself the following questions:

  • In what ways are my client’s or population’s needs being (or not being) met?
  • Which interventions in this layer relate to my client’s or population’s current problem areas?
  • How am I doing as a counselor with each intervention?

Step Four: Communicate your thoughts with others (co-workers, supervisors, collateral sources and, most importantly, your client). Gain insight and perspective from their understanding of the nature, intensity, diagnosis and prognosis of the problem.

Step Five: Decide where effort devoted to a specific intervention will adequately address the need(s) identified in Step One.

Step Six: Develop a strategy for implementing the intervention. Ask yourself the following questions:

  • Who takes ownership of the intervention?
  • What is my role in this intervention?
  • Who else is involved in this intervention?
  • Who or where do I need to elicit assistance from?
  • What are the potential outcomes (pros/cons) of implementing this intervention?
  • What will I need to do to prepare for the outcome of implementing this intervention?
  • What is the timeline for implementing this strategy?

Step Seven: Evaluate the outcome.

  • Did you achieve what you hoped you would?
  • Talk with your client(s). What is his or her perspective in terms of advocacy and social justice?
  • If you have a formal multicultural counseling assessment or questionnaire, employ that before and after implementation.

Step Eight: Make adjustments where necessary or create a “maintenance plan” for this intervention. Ask the following questions:

  • How will I ensure that this competency remains as is?
  • How often will I go back and evaluate the state of this intervention?

Applying a practical approach to enhance multicultural competence reaps benefits for all counselors, regardless of current expertise in the area. This eight-step approach can be helpful for newer counselors who struggle with identifying first steps. It can also be helpful for seasoned clinicians who have a strong foundational skillset but are not familiar with the particular nuances provided by the MSJCC.

Initially, employing these steps will require caution, intentionality and pragmatism. However, as with learning any new counseling skill, frequent and successful use will shape the counselor’s confidence and ease of application. As use of the steps increase, the need to refer to them will decrease, ability will be attained and multicultural competence will be elevated.

 

 

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Jonnie Seay Lane is a licensed substance abuse counselor and licensed professional counselor. She works as the qualified professional substance abuse liaison to the Wake County Department of Social Services in Raleigh, North Carolina. Currently, she is pursuing her doctoral degree at North Carolina State University, where she is studying multicultural counseling competence in her dissertation research. Contact her at jcseay@ncsu.edu.

 

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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.

 

 

Working with Latina/os in counseling

By Jacqueline Michelle Barthelemy June 20, 2017

According to the U.S. Census Bureau, as of July 1, 2015, Latina/os made up approximately 56.5 million of the total U.S. population, making them the largest ethnic or racial minority in the country. The Latina/o population is projected to grow to 120 million by the year 2060.

The question on many counselors’ minds is, how can we work better with our Latina/o clients? With the growing number of Latina/os in the U.S., it is likely we will work with these clients at some point as counselors, and it is our professional obligation to be prepared.

Working with clients in general can be a new learning experience, especially if their cultural background is different from our own. Many master’s programs require counseling students to take a multicultural course to prepare to work with clients of different backgrounds. But textbooks can provide only so much general knowledge. How are counselors supposed to learn how to work with different cultures if they are reduced to a mere chapter in a textbook for a one-semester course?

As someone whose background is Latina, my upbringing has prepared me to better serve people who share my cultural background. Nevertheless, my experiences have made me aware of further areas of growth in serving my clients (for instance, my lack of Spanish fluency is a hindrance).

In my current position, I work with clients and their families to get them more comfortable with the idea of counseling. It is sometimes difficult when working with Latina/o clients because there are so many challenges that bring them to counseling, or there is the stigma of counseling that turns them off to it altogether. If it is their first time going to counseling, their first impression of you, as the counselor, may color all future experiences with the counselors they may see. It is our duty to make clients feel comfortable and let them know that their concerns and goals are a part of the counseling process. Ultimately, clients set the tone for counseling.

 

Traditional Latina/o upbringings

In the Latina/o culture, family comes first (after God); the first relationship you have is the one with your family. Traditional Latina/o families are brought up being very close to their immediate and even extended family members, where everyone cares about everyone. Elders are highly regarded, and children, regardless of age, respect their parents.

Most families live in multigenerational households that include parents, siblings and grandparents. Sometimes extended family members may also reside in the home at one point or another. So when working with these clients, it is best to remember that family plays a vital role in their everyday lives.

When working with the whole family, it may appear that the family is unresponsive to the counseling process. Counselors should be as patient as possible, however, because family members may be waiting for their head of household (typically the male) to start and lead the conversation. The key is to treat and work with the family as a unit because that is how they might live their life traditionally. Family support is everything to Latina/os.

The Latina/o culture has many rich traditions that are passed down generationally. An example is the Mexican holiday of Dia de los Muertos (Day of the Dead, celebrated Nov. 1-2), during which families gather to pay respect for their loved ones. Often they build altars in their homes or at graves, where they place flowers, pan de muerto (bread of the dead, which is sweetened bread eaten the day of or the week leading up to the holiday as a sign of respect to the departed), pictures and the favorite food of their loved ones. Some say small prayers or retell stories of their dearly departed.

Knowing about this while counseling a family can be very beneficial, especially for those who are grieving. Understanding some of their traditions can help to build trust, connect with these clients and strengthen the counseling relationships. If you are counseling a Latina/o family or client who is grieving, talking about or suggesting the altar can help with the process. However, be sure to remember the origins of the family or client you are working with because different cultures in the Latina/o diaspora maintain different traditions.

Most Latina/os’ identities are strongly rooted in being members of specific groups. For example, if the client you are working with is from Guanajuato, Mexico, she or he will most likely take pride in being from that particular state in Mexico. As counselors, we should always ask clients where they are from to get a better understanding of who they are as individuals. Counselors should also be aware that having this sense of pride can cause conflicts in characterization of identity with other members of Latina/o groups.

Faith in one’s religion also plays a very important role in the lives of Latina/o clients. Religion can set the tone for the family as a whole — the tone being that God comes first, the family trusts in Him, they live their lives according to the Scriptures, and they are good and honest people. Many Latina/o clients have makeshift altars with religious artifacts in their homes where they pray the rosary daily (a rosary is a string of beads; some say a prayer per bead as a way to be closer to God or a saint). When counseling these clients, it is best to remember how important their faith is and how much of an impact it has on their lives and the decisions they make daily.

 

Stigmas of counseling in the Latina/o community

I grew up with the best of both worlds — a mixture of traditions blended with new possibilities. Sometimes those ideas conflicted with one another, however.

My grandparents stressed that if I had issues or problems, that I should share them only with my family and no one else. Our reputation and how the world perceived us was important. To share something too personal with strangers or people outside of the family could change people’s views of me, potentially leading to getting overlooked and judged. On the other hand, my mother told me that people would judge me regardless of what I shared, so I might as well be my most authentic self.

I had an amazing support system in my mother and grandparents. They listened to me and allowed me to feel what I felt, regardless of the situation. My family kept me grounded and later led me to my career path as a counselor. I realized that not everyone was as fortunate as I was to have this incredible family support team to believe in them unconditionally.

When I told my mother about my decision to become a counselor, she was supportive and understood what a counselor was. However, my grandparents had a hard time understanding my decision to go back for more schooling. The first thing they asked was, “¿Qué es un consejera?” (What’s a counselor?). I spent an hour trying to explain, but all they understood was that I was going back to school, so I was probably doing something with teaching (because my bachelor’s was in education).

My grandparents believed in getting an education, but they were confused about why I would want to go back to school again. Had I not done enough the first time around? Why was I delaying working full time? My grandparents, like many traditional Latina/os, did not fully understand what counseling was or why someone would utilize the service. They wondered why you would need to tell your problems to someone else when you have family or could pray about your problems.

I knew that as a counselor, I could be a part of a support system for others and help them reach their goals. When working with Latina/o clients, it is helpful to explain that our job as counselors is to be that support system for them, much like their own families. It is best to emphasize that you want to be able to assist them, offer resources and be another source for them to use in achieving their goals.

In the Latina/o culture, counseling is stigmatized. Many families are brought up not to “gossip” or talk about personal or family problems with strangers. Aside from that, most families do not have a clear understanding of what counseling is. Families stress not talking to others about their issues because they know that people can gossip. For some of these families and clients, their reputations are all that they have, and if they are talked about badly, they take it to heart.

It is our job as counselors to educate others about what counseling is and how the counseling process works. It is best to emphasize confidentiality and the rules that are in place to protect clients, as well as the only times when confidentiality needs to be broken. Having Latina/o clients understand the counseling process and what it entails can make all the difference in building good rapport.

The risk is high for any individual who is an undocumented immigrant. The resources available to these individuals are limited, and they have fewer opportunities to vocalize their needs for fear of being reported to Immigration and Customs Enforcement. Clients and potential clients who are Latina/o may be tight-lipped because they do not fully understand where information shared during counseling could end up. Again, I recommend carefully explaining what counseling and confidentiality are.

If the client or family members are working, their work environments may be less than ideal. They may be underpaid or get paid under the table (paid in cash only), and their superiors may subject them to harsh work conditions (for instance, overworking them). Latina/os who are undocumented immigrants live with the uncertainty of not knowing whether today is the day they are going to be deported. Because of this uncertainty, they sometimes do not feel comfortable sharing any personal information with people who are not family. These clients need to know that they can trust the counselor. Counselors need to reassure clients that their offices are safe spaces and what they share will remain confidential.

Some Latina/os choose not to share with family that they are seeking mental health counseling for fear of being judged negatively. When encountering clients who have no family support, it is best to address those concerns and explore other people (both outside and inside the family) they can count on for support.

As a school counselor, I have worked with Latina/o students, and to do so, one of the parents must give consent. The majority of the permission slips come back from the mothers, not the fathers. Typically, it is the mother who is more open to her child receiving counseling services, often on the condition that the father remains in the dark about the services the child receives. One time, I had to stop seeing a student when the father found out the student was receiving counseling services. The father came to the school livid. He gave his verbal and written consent to stop counseling services, and I had to oblige. It was a difficult situation because the student benefited from counseling, and I tried to get the father to see that. Ultimately, however, I had to honor the wishes of the parents and stop counseling services.

Another stigma of counseling with Latina/os is labeling in the educational setting. Many families worry about labels and how they can potentially negatively affect their child. Sometimes these labels can even lead parents to believe something is wrong with the child.

As counselors, it is our job to destigmatize labels and show that labeling is not always negative. When students are struggling academically in school, teachers, school counselors and other staff work together to figure out what is preventing them from succeeding academically. All the necessary avenues are taken (e.g., teacher works on modifying classwork and contacts parents for extra support) before determining a student needs an evaluation to determine if he or she has a learning disability.

When students need Individual Education Programs (IEPs), families are sometimes hesitant to support such plans. They worry what it might potentially mean for their child regarding being labeled. But in these cases, labels can help students receive the necessary services to achieve their academic goals. Remind parents that they are encouraged to be as involved as possible in the IEP process, the process can take a long time to complete (sometimes as long as six months) and that counselors can serve as advocates to assist them with the process.

 

Multigenerational conflicts

Even with what is taught in multicultural classes, not every family adheres to what you assume about Latina/os. As the years progress, younger generational Latina/os are abandoning some traditional norms. They are coming to be their own person and wanting to incorporate new traditions with the ones already established within the family.

An example of this is young Latinas not conforming to the expected gender norms of their culture. Most young Latinas who are raised in traditional families grow up learning that a wife’s place is in the home and taking care of the family, whereas a husband’s role is to provide for that family. Some Latinas are shattering these gender norms and wanting more for their life, such as going to college and putting off marriage and children. This can cause tension within the family unit.

For example, my mother broke barriers in her own family. When she was growing up, it was basically expected that she would be a good person and a future wife. My mother put off marriage and having a child and dedicated her time to figuring out her future. Her parents were not as supportive as she would have liked, and she left home (something that was not expected of young single Latinas).

My mother decided she wanted to go into the medical field, but she did not have her father’s support. Her mother would check on her and take her to night classes without her father knowing. The sneaking around her mother did went on for the duration of the time my mother was in school. It was because of the barriers my mother broke that I have been afforded the life I have now.

As a counselor, you might work with these clients and their families to try to get them to see eye to eye on what traditions they want to continue to uphold. The goals for counseling would be to hopefully reach a healthy and happy balance where everyone in the family is understanding of the others’ opinions.

 

Language barriers

Many Latina/os want and need counseling services, but the language barrier sometimes prevents them from receiving these services. Bilingual counselors are in high demand to reach these families. If counselors can speak Spanish, the family or client may feel more comfortable speaking with them, helping to build good rapport. If you are not fluent in Spanish, there are steps you can take to bridge this language gap, including using digital apps or going to someone who can help you learn the language.

I am not fluent in Spanish, but I have some conversational ability, and this has been a tremendous asset in reaching out and talking with Latina/o clients. If Spanish is your clients’ first language, they may feel more comfortable speaking in their native tongue and may talk more freely about their concerns or what brought them to counseling.

On another note, just because someone speaks a language doesn’t mean they read it well, so be sensitive to literacy levels in a language. Also, just because clients look like they Spanish might be their first language, don’t assume that it is. For example, some Latina/os such as Brazilians speak Portuguese.

 

Breaking down the stigmatization of counseling

How do we get Latina/o clients in our doors if they are hesitant to speak with someone outside of their families? The proactive actions counselors can engage in to break down these barriers include getting familiar with and volunteering in the community. Start small and get acquainted with the community you are targeting. What kind of resources and services does the community offer? Talk and research with other individuals to see how you can have a presence.

While working, see what potential clients are seeking help with (child care, employment, etc.) and figure out where the clients can go to receive those services. Often information is available to help people, but they do not know where to look for it. Knowing where and in what direction to point a client can make all the difference.

Normalize counseling and curtail the stigma; counseling does not equate to being “crazy.” People utilize counseling services for various reasons. Try and provide real-world examples of people taking care of themselves. For instance, you might say, “If you go to see a doctor for a checkup, why wouldn’t you see a counselor for a mental health checkup?” Let potential clients know it is normal to feel overwhelmed. After all, they are only human.

Educate potential clients about the counseling profession. Tell them that your job is not to judge but to listen and work with them to alleviate their stress. Explain that you are there to help them; they decide the counseling process and the direction of counseling. Self-disclose (within reason) about some of your own related experiences with the Latina/o client. Let them know they are not alone in their struggle. Inform them that it is normal to feel stressed and that talking about those stressors can be therapeutic.

Seek others in the community who are working with the Latina/o population, such as doctors, priests and schools. Explain who you are and what you are trying to achieve. Contact local public and private schools to ask about volunteering and working with the school’s counselors to help develop a counseling curriculum. Again, after being seen, you will become a trusted face in the eyes of potential clients. Underfunded schools in particular may not even have a school counselor on staff and would likely welcome the extra support for their students.

Finally, when trying to reach potential clients, think about the community you are working in. Is it in a low socioeconomic area? Is there an issue with trying to afford mental health services? Lack of financial income and insurance are among the reasons that some Latina/os do not seek mental health services. Think about offering pro bono counseling to make quality counseling available to all, regardless of insurance or income.

These clients may be working multiple jobs and face time constraints with raising a family. If they are without a vehicle, transportation to see a counselor may pose an obstacle as well. Counselors might think about being able to point these clients toward quality child care or offering bus passes to help with transportation to and from sessions.

 

Conclusion

Whatever brings Latina/os to counseling, it is important that we do our best to help in whatever way we can. Their first interaction with a counselor may lead them to form an assumption about all counselors moving forward. With the increase in population of Latina/os in the U.S., counselors have to be prepared to better serve these clients and break the stigma of counseling. Counselors must remember to be nonjudgmental and take an active interest in what their clients tell them about their backgrounds. Figure out how to work with others, and see how you can be a positive force in the community you are servicing.

Doing research about the client’s background can help strengthen the rapport between you and show the client that you are taking an interest in what she or he tells you. To work with this community, it would be best to take Spanish-language classes and read as much as you can about the Latina/o culture. Books and classes can certainly help, but the best way to truly serve these families and clients is through community engagement and becoming familiar with their cultural practices.

 

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Jacqueline Michelle Barthelemy is a fourth-year school counselor. She received her master’s in counseling from Saint Xavier University and is currently a doctoral student in the counselor education and supervision program at the Chicago School of Professional Psychology. Contact her at jacqueline.m.barthelemy@gmail.com.

 

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

Planting seeds in Somalia

By Bethany Bray May 1, 2017

A recent mental health conference in Mogadishu broke new ground in many ways. Not only did it draw attention to mental health, a little-discussed or addressed topic in war-torn Somalia, but it is believed to be the first time the American Counseling Association has been represented in Mogadishu.

Yegan Pillay, an ACA member and associate professor in the Department of Counseling and Higher Education at Ohio University, was the keynote speaker for the World Mental Health Day Conference in Mogadishu on Oct. 10.

Pillay, a licensed professional clinical counselor and past chair of ACA’s Human Rights Committee, says the event was a “good starting point.” The one-day event planted seeds to begin addressing mental health issues in a country where many people are “walking wounded” by the trauma of decades of civil war, Pillay says.

The World Mental Health Day Conference was organized by Rowda Olad, a former student of Pillay’s at Ohio University. A Somalian refugee, Olad recently completed a master’s degree in counseling. Pillay said he advised her, upon graduating, to try and influence change – whether at the micro or macro level – in her home country.

“Rowda took the bold step of putting together this conference and inviting stakeholders that make decisions in government,” Pillay says. “It was really groundbreaking.”

Mental health and counseling are “not really on the front burner” in the majority-Muslim country, Pillay says, where the culture also often stigmatizes Western-based interventions.

“I’m not sure where all of this will go, but every journey starts with a single step, as they say. I think it’s movement in the right direction, and I’m optimistic that it will at least raise awareness,” Pillay says. “It’s a tangible concrete step in putting mental health on the agenda in Somalia.”

The conference was co-sponsored by the Somali Ministry of Health and Human Services. Pillay says many of the attendees were government officials, and he tailored his keynote to address the drain that untreated mental illness can cause on an economy, government resources and society.

“I think they will go back to their respective constituents within the ministry and government and — most likely and I hope so — advocate for putting resources into mental health,” he says.

In addition to Pillay, Cherie Bridges Patrick, a licensed independent social worker and clinical supervisor at the Buckeye Ranch, a mental health and social services nonprofit in Ohio, spoke at the Oct. 10 conference.

While in Somalia, Pillay also visited the campus of Benadir University in Mogadishu and met with the school’s dean. “Mental health, counseling and even psychology [are] not well-established or studied in universities [in Somalia],” explains Pillay, who is a native of South Africa.

He hopes that events such as October’s mental health conference will spur Somali students to travel to the U.S. or Europe to be trained in the mental health professions so they can return to Somalia and help those in need.

“Who better to serve the Somali people than Somalis themselves?” he says.

Ohio University is not far from Columbus, Ohio, which is home to one of the largest concentration of Somalian refugees in the U.S. Pillay and his students often work in the Somali community. Pillay is currently working on a translation project for materials about posttraumatic stress disorder that could be distributed in the community.

Pillay says he sees a huge amount of potential for American counselors to train other counselors and advocate for the profession — and mental health in general — internationally, particularly in Africa and other non-Western cultures.

“In many parts of the world, counseling doesn’t exist on its own [as a profession]. ACA is at the forefront of counseling worldwide,” he says.

“We need to really push the boundaries of propagating the benefit of mental health. From a global perspective, there is a great opportunity in the United States because of the number of students who are international” and come to America to study, he says. “There has to be a global focus. Even now, more so, with what’s going on politically. My message would be that we [counselors] transcend the geographical boundaries of the United States and see how we can make a difference for people … regardless of where they’re from. We can certainly lend a hand in terms of human resources [to help] other societies find ways to improve mental health.”

 

Yegan Pillay, an ACA member and associate professor at Ohio University, was the keynote speaker for the World Mental Health Day Conference in Mogadishu, Somalia, on Oct. 10. (Courtesy photo)

 

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Personal safety and international work

While in Mogadishu, Pillay always traveled in an armored vehicle and stayed in the “green zone,” a designated safe area of the war-torn city.

Counselors shouldn’t be discouraged from working in risky areas – either at home or abroad, Pillay says, adding that they should simply be smart and do some research before they go.

“Do your homework and talk to individuals on the ground in the area to give you an accurate sense of what’s happening,” he says. “Be cautious not to put yourself at undue risk, either at home or abroad. Make sure you have somebody [in the area] that can really articulate how safe you’ll be.”

“There’s no guarantee [of safety,] but you can minimize risks,” he says. “I think one has to keep your wits about you and do background checks. Would I advise individuals to go to Somalia to do [counseling] work? I would be hesitant. But short-term work? Yes. I have no second thoughts about having done what I’ve done.

“But if I go back, I would really want to do as much homework as possible to see if things have changed on the ground or not. It’s an individual decision. I’m a person of color and tend to blend into the communities there. I would not necessarily stand out, but if you’re a white female, you would certainly draw attention to yourself. One has to be very cautious.”

 

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ACA members: Interested in getting involved in international counseling work? Consider joining ACA’s International Counseling Interest Network: bit.ly/2o7pWgF

 

Related reading:

Is international certification right for you? Tips on getting a counseling certification outside of the U.S. from Counseling Today columnist Doc Warren Corson: wp.me/p2BxKN-4GF

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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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.

 

Facing the realities of racism

By Laurie Meyers January 25, 2017

When Barack Obama was elected the first African American president of the United States in 2008, some optimistic observers thought that American society had finally reached a post-racial age. As the past two-plus years have highlighted vividly, however, the significance of race and the influence of racism on the American story are far from over.

“Electing a black man and then re-electing a black man for eight years was not going to undo almost 300 years of dysfunction,” says Courtland Lee, a past president of the American Counseling Association who has written extensively about multicultural, racial and social justice issues. “The presidency, unfortunately, plays right into how racism works in the country.”

Indeed, President Obama’s election spurred increased activity among white supremacists. However, white “backlash” was not limited to the far-right fringes of society.

“The [Obama] presidency was earth shattering in many ways. [It] tapped into many people’s deepest darkest fears about this country, the status quo and the fundamental way they thought the country should be,” Lee says. “Their worldview is that people like Obama shouldn’t be in power, which is why [Donald Trump’s campaign slogan] ‘Make American Great Again’ resonated.” Lee and other experts on race relations believe the underlying message of the campaign slogan was “Make America White Again.”

“There was a culmination of white reaction to the changing demographics in this country,” says Lee, a professor in the counselor educator program at the Chicago School of Professional Psychology’s Washington, D.C., campus. He points out that the United States continues to grow more racially diverse and is moving toward a time when whites will be in the minority.

Lee and other experts believe that the fear of this shift is one of the main reasons that anti-immigrant and racist viewpoints have become more publicly prevalent and acceptable, reaching a fever pitch during the 2016 presidential campaign. In the 10 days following the 2016 presidential election, the Southern Poverty Law Center, a nonprofit legal organization that uses legal action, education and advocacy to fight racism and bigotry, received almost 900 reports of bias-related incidents of harassment and intimidation as part of what it termed a “national outbreak of hate.”

“I think we have an environment where people feel comfortable with stereotypes,” says Lee, the author of Multicultural Issues in Counseling: New Approaches to Diversity. “People feel they have a license to act and speak out in very intolerant ways.”

In an atmosphere characterized by intolerance and strained race relations, what is a counselor’s responsibility? How can counselors help their clients and society at large cope with and fight against hatred and ignorance?

Uncovering implicit bias

Counselors should start by looking within, says Lance Smith, an ACA member whose research focus includes racial bias within the counseling profession. Despite the emphasis on diversity that is part of most counselors’ training, societal bias can still influence counselors, he notes.

“I think there’s a bit of hubris in the counseling profession that because we’re so well-trained in matters of personalization and we explore countertransference so rigorously that [racial bias isn’t] something that we have to worry about,” says Smith, an associate professor and school counseling coordinator within the University of Vermont counseling program.

Each year, Smith has all of the students in his classes take the Implicit Association Test on race, and he says that most exhibit an automatic bias in favor of white people. This doesn’t mean that most of his students — and most counselors in general — are not well-intentioned individuals who genuinely want to help others, he emphasizes. “Unfortunately, for most of us” — counselors and noncounselors alike — “white dominance has been downloaded into our software without our permission,” Smith says.

To overcome internal racial bias, counselors need to understand the “false binary” of racism, Smith says. “There’s this powerful notion in society that one is either racist — an ignorant, mean-spirited, Confederate flag-waving, card-carrying member of the KKK — or a good person. And, of course, most counselors know that they are good, moral, kind, beneficent people, so it follows that, by definition, they cannot be racist. Therefore,” he explains, “not only are they likely to fail to interrogate the ways in which they more subtly harm and microaggress their clients and students of color, but they are also likely to ignore, deny and therefore inadvertently support institutional forms of racism such as the school-to-prison pipeline and anti-affirmative action.”

“But racism, and all isms for that matter, are more complex,” Smith continues. “For most of us, it’s not a matter of if I’m racist, but rather how much. How many racist stereotypes do I subconsciously hold? How much do I unknowingly contribute to institutional racism? What are the microaggressions that I am more prone to commit? How much do I ignore white dominance? How much work do I need to do to break free from my segregated social bubble in order to develop authentic and genuine relationships with folks from targeted groups?”

Counselor and psychologist Derald Wing Sue, the author of such books as Race Talk and the Conspiracy of Silence and Microaggressions in Everyday Life: Race, Gender and Sexual Orientation, agrees that counselors — and society at large — need to talk about race and racism more openly. “The first step in being able to talk freely about race is understanding that no one is immune from … racial bias,” he says. The bias may very well be subconscious, he adds, but counselors and others need to be willing to admit the existence of that bias and be willing to make mistakes, even if that includes accidentally offending someone, to talk openly about racial issues.

Unfortunately, bias and racism in the counseling profession — conscious or unconscious — can have more tangible effects than simply stifling conversations. Smith was co-primary investigator of a study in the November 2016 issue of The Counseling Psychologist, “Is Allison More Likely Than Lakisha to Receive a Callback From Counseling Professionals? A Racism Audit Study,” that examined whether potential clients’ perceived racial backgrounds affected whether they received a callback after leaving a voice message requesting counseling services. For the study, an actor using fictitious and stereotypically African American or stereotypically white names left messages with counselors and psychologists inquiring about therapeutic services. Although the perceived racial background of the caller didn’t appear to significantly affect the callback rate, the study authors found that it did affect whether the counselor’s or psychologist’s callback tended to encourage the potential client to seek services. Potential clients named “Allison” were invited to have a phone conversation with the practitioner (an indication of encouragement to seek services) 63 percent of the time, whereas potential clients named “Lakisha” received a similar invitation only 51 percent of the time.

“The primary reason we did the study is that we’ve seen a disparity in mental health services for decades between African American populations and white populations,” Smith says. “But the dominant narrative in counseling has always been, ‘What’s going on with this help-seeking behavior? What is it about the African American community? Why do they not feel safe with us? Maybe it’s economics. Maybe they lack insurance. Maybe they don’t have access because there aren’t counselors in their neighborhood. Maybe African Americans prefer more direct styles of helping.’”

“There was all this discussion about the help-seeker behavior, but we didn’t turn the lens on ourselves,” he explains. “We [the study authors] were asking what are we potentially doing, as a field that is predominantly white, in terms of help-provider behavior that is contributing to the racial disparity in mental health services? I think turning that lens away from blaming the victim and toward ourselves as a field is a significant step that … we’re just starting to take, which also speaks to another element of systemic racism in the field.”

Educational bias

Bias in the counseling field begins in counselor education programs, asserts Cirecie West-Olatunji. She says that when she was serving as the president of ACA in 2013-2014, she was frequently approached at state counseling association conferences by students and counselor educators of color who felt “shut out.”

“I was meeting a lot of early career professionals, doctoral students, students who were nontraditional in any kind of way, who came to me and many times were in tears because they didn’t have anyone to talk to within their system [academic program],” she says. “They didn’t feel safe talking to their supervisors or doctoral chairs about a lot of microaggressions they had experienced with peers. They were having a really marginalized experience that was affecting their careers.”

West-Olatunji, an expert on traumatic stress, says that students and counselor educators of color can feel excluded from the academic community in numerous ways. For example, not being invited by their peers to collaborate on publications, not being assigned mentors and even not being invited to go out socially with colleagues or fellow students to lunch.

Academic bias also affects dissertation topics, contends West-Olatunji, an associate professor at Xavier University of Louisiana and director of the Center for Traumatic Stress Research. “[Doctoral students] want to investigate what is relative to their own experience. [If] they’re black, they want to write about the black experience,” she says. “Oftentimes, the faculty [member] is white and doesn’t relate or doesn’t believe the phenomenon” of the day-to-day experience of being a person of color.

Doctoral students of color are often left to decide whether to potentially alienate their doctoral advisers by insisting that their topics and personal experiences are valid, West-Olatunji says. Faced with the skepticism of experienced faculty members, doctoral students may even begin to doubt their own experiences, she adds. But even if doctoral students of color can convince their advisers to accept their dissertation topics, the question becomes whether advisers can help the students to research something effectively if the advisers don’t really believe in it in the first place, West-Olatunji says.

As a result, doctoral students may end up writing in a pejorative manner about their own experiences or even decide to set aside their chosen topics and tell themselves that they just want to learn how to conduct research, West-Olatunji says. And once these students of color have earned their doctorates and gone on to become professors, West-Olatunji says, they still encounter statements such as, “You won’t get tenure if you write about black people that way.” As a result, she says, they are discouraged from writing about topics that are personally relevant to them. This in turn affects the quality and quantity of research available that addresses the experiences of people of color, she explains.

Experiences such as those West-Olatunji describes may also be influencing the racial gap in the counseling profession. This is something that Smith has researched in the past.

“We were looking at the disparity in white-identified therapists in the field and people of color as counselors in the field,” Smith says of a study that he co-authored in 2011. “We looked at disparities amongst white faculty in CACREP [Council for Accreditation of Counseling & Related Educational Programs] programs and people of color in CACREP programs. Of course we weren’t surprised to find that there was a significant racial disparity in terms of the population of African Americans in society and the population of people of color who were moving through counseling programs.”

This reality is potentially harmful for people of color who might be more comfortable seeking services from counselors of color, Smith points out. “And yet, we’re not doing our jobs in higher education to recruit, train and graduate counselors of color,” he says.

Fear factors

The backlash that Lee spoke about is engendering a significant level of fear in communities across the country. There is a sense among people of color, Sue adds, that the equality they have fought for and the progress they have made in the past 50 years is at risk of being taken away. As a result, many feel unsafe, depressed, angry and powerless, he says.

Patricia Arredondo, a former president of ACA, agrees. Currently a visiting professor of counseling and counseling psychology at Arizona State University, she says that everywhere she goes, people are talking to her about their fears post-election. “Everyone is very aware that if you are Latino or Latina, you are targeted, regardless of birthplace — people who are undocumented or documented,” she says. “The discussion about [building] the border wall is something that affects all of us.”

There is a hypersensitivity and a sense of high anxiety in the Latino community, particularly among families who fear being separated by deportation, Arredondo continues. “Children are afraid that their parents are going to be deported. Counselors have to recognize that this is a real experience for kids and families, not abstract,” she emphasizes.

This increased sense of fear compounds the pre-existing trauma that many people of color live with. “People feel unsafe in the current political climate, not because of one political view but because there has been an increase in hate crimes,” West-Olatunji says. “This is on top of ongoing trauma. It causes problems thinking — thinking is jumbled, we have a hard time making decisions and problems with concentration and focusing. We are constantly managing emotions instead of attending to business at hand.”

Counselors may look at this witches’ brew of problems — a climate of intolerance, hate incidents, increased fear among targeted populations, and lifelong and intergenerational trauma among people of color — and wonder how they can possibly make a difference. Lee says it starts first and foremost with the client. That involves treating the trauma that marginalized clients experience but also getting out into the community and talking to people about the challenges they face and how counselors can help them cope.

“There is a disconnect between academia and what’s really happening in the real world — a disconnect between what counselors learn and what’s happening,” he says.

For instance, Lee says, academia has done a good job of putting together multicultural competencies that serve as guidelines for what it means to be a “culturally competent” counselor. But the competencies aren’t very useful in the field, he says, and practitioners need more than academic standards of cultural competence. They need to understand the trauma that results from police brutality and living in oppressed neighborhoods or what it’s like to live paycheck to paycheck and work multiple jobs simply to get by, he says. This returns to counselors getting out of the office and into the community to talk with people — not just “clients” — about real-world issues.

Arredondo, co-author of Culturally Responsive Counseling With Latinas/os agrees. “I tell my students that book knowledge is limited. You have to read the papers. You have to know what the policies are in the state or city you are in that have an effect on the well-being of clients. [This is] knowledge that you may need to support your clients,” she says.

For instance, Arredondo explains, counselors who are working with Latino populations should know stress reduction techniques that they can share with these clients, but they should also be aware of any community resources that these clients might need, such as Latino community organizations or immigration lawyers for undocumented clients.

Being a part of the community

Beyond doing direct work with clients, counselors can also help their larger communities to address issues of race and racial tensions, Lee says. For example, counselors could make themselves available to facilitate dialogue between civilians and the local police force, he says. “There is a lot of miscommunication between citizens and the police force. I think it would be wonderful if ACA had a training initiative for police forces on not only cultural competency, but just helping police to develop communication and helping skills.” (For a related story, see “Bridging the divide between police and the public,” December 2016.)

Smith also envisions a larger societal role for counselors when it comes to addressing issues of race and racism. “School counselors need to be at the school board advocating for anti-racism curriculum in their schools,” he says. “Clinical mental health counselors need to be on state boards of mental health to ensure that their state licensure includes these robust competencies about anti-racism. Counselors who have research skills need to be engaged with the sheriff’s department and the local police department, helping them to gather data on racial disparities in the community.”

As a whole, counselors need to get out of their offices and into their communities to fight the forces of intolerance because those injustices are part of what is driving clients to their doors, Smith says. “Individual one-on-one traditional counseling is not sufficient to interrupt these systemic biases,” he asserts. “In this age of emerging intolerance where it’s now once again socially and publicly accepted to be an overt bigot, we need to raise our game as counselors.”

Sue, a member of ACA, says that individual counselors need not fear going it alone. “Get a support group — other counselors and co-workers who feel similarly,” he says. “The issue is really to begin to empower yourself. Have meetings where you invite various speakers, educate yourself, build a support group and then begin to talk about strategies.”

“Say you work in a school system that has systems or policies that are unfair to people of color,” Sue continues. “Doing it [making a change] by yourself is impossible. Identify people in the school who may share your beliefs and then make a group presentation to the principal or faculty. There really is an out-of-office strategy. It’s viewing the client not so much as the students who come in to you for help, but the client is now the school system or school district. It is the school system that is causing harm. You are being proactive. When you do counseling, it’s primarily reacting and fixing damage, but if you are proactive and take action against the system, you have won a big victory.”

West-Olatunji views the recent U.S. presidential election as a wake-up call to racial issues in America. “Counselors need to be speaking out about truths. We need to talk about a lot of things,” she says. “There is an argument about whether or not counselors should engage [in political debate]. Put that to rest. People are being harmed, and we don’t have to wait until they come into our offices” to help them.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Racial Microaggressions” by Cirleen DeBlaere, Terrence A. Jordan II & David G. Zelaya

Books & DVDs (counseling.org/publications/bookstore)

  • Counseling for Multiculturalism and Social Justice: Integration, Theory and Application, fourth edition, by Manivong J. Ratts and Paul B. Pedersen
  • Multicultural Issues in Counseling: New Approaches to Diversity, fourth edition, by Courtland C. Lee
  • Culturally Responsive Counseling With Latinas/os by Patricia Arredondo, Maritza Gallardo-Cooper, Edward A. Delgado-Romero and Angela L. Zapata
  • Experiential Activities for Teaching Multicultural Competence in Counseling, edited by Mark Pope, Joseph S. Pangelinan and Angela D. Coker
  • Latino Worldviews in Counseling (DVD in Spanish with English subtitles), hosted by Patricia Arredondo and Jon Carlson

Webinars (counseling.org/continuing-education/webinars)

  • “Why does culture matter? Isn’t counseling just counseling regardless?” with Courtland C. Lee

Podcasts (counseling.org/knowledge-center/podcasts)

  • “Counseling African American Males Post Ferguson” with Tony Spann
  • “Understanding the Ferguson, MO Crisis: A Counselor’s Perspective” with
    Ken Oliver
  • “Multiculturalism and Diversity: What is the Difference? Is Not Counseling … Counseling? Why Does It Matter?” with Courtland C. Lee

ACA divisions

Competencies (counseling.org/knowledge-center/competencies)

  • Multicultural and Social Justice Counseling Competencies

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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.

Practicing cultural humility

By Sidney Shaw December 27, 2016

Privilege is invisible to those who have it.” This pithy statement from sociologist Michael Kimmel reflects the state of research on privilege and also calls attention to the importance of counselors raising self-awareness about how privilege affects their work. A general consensus exists among counselors that they need to be aware of their own privilege and need to be multiculturally competent. These aims can be rendered inert, however, in the absence of a conceptual framework and process that guide counselors to embody cultural responsiveness within counseling sessions.

The Multicultural Counseling Competencies (MCCs), a ubiquitous model in counseling, address three main domains:

  • Counselor knowledge about different cultures and cultural perspectives
  • Counselor skills to utilize culturally appropriate approaches
  • Counselor awareness of their own and their clients’ cultural heritage and the influence of culture on attitudes, beliefs and experiences

This tripartite, developmental model, developed by Derald Wing Sue and colleagues, has for several decades provided a foundation in counseling for how cultural competence is conceptualized, pursued and evaluated. In this article, the acronym MCCs is used to refer to this model. (Note that the Association for Multicultural Counseling and Development endorsed the Multicultural and Social Justice Counseling Competencies in June 2015. These competencies, which were also endorsed by the American Counseling Association Governing Council, revise the MCCs.)

Although the value of the MCCs in terms of counselor development is evident from research and counselor support, they have limitations related to counseling outcomes and the interpersonal process that unfolds between the counselor and the client in sessions. Specifically, outcome research connected to the MCCs has been based largely on counselors’ self-reports of their own levels of multicultural competence. Such evaluations suffer from self-assessment bias and do not capture the client’s experience. The few studies that have examined counselor multicultural competence from both the counselor’s and the client’s perspective have found that counselors typically view their own multicultural counseling competence much higher than clients view the counselor’s multicultural counseling competence. In other words, counselors often have an inflated view of their own multicultural competence in comparison with the client’s view.

This gap in perceived competence is concerning, in part because counselors’ beliefs about their general level of multicultural competence influence their behavior. Specifically, when counselors think they are high in multicultural counseling competence, they are less likely to put effort toward growing in this domain. Likewise, they are less attuned to responses from clients that might indicate the counselors are not as multiculturally competent as they think. Although the MCCs are useful for counselor development and self-evaluation, a more process-oriented framework is needed to address in-session multicultural processes and counselor multicultural competence from the perspective of the client.

With this in mind, multicultural orientation (MCO) offers an empirically supported model for counselors to understand how individual clients experience the multicultural dimension of counseling in the sessions. This article describes a framework for counselors to increase their multicultural counseling effectiveness, privilege the voice of clients and make the counselor’s own invisible privilege a little more visible.

Multicultural orientation

MCO consists of two major domains: the client’s perception of the counselor’s level of cultural humility, and the degree to which the counselor addresses culture and cultural opportunities in the session.

In the words of Joshua Hook and colleagues, cultural humility refers to the counselor’s “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the client.” Cultural humility contains intrapersonal and interpersonal dimensions. Intrapersonally, cultural humility encompasses counselors’ openness to accepting that their own cultural identities and experiences will limit their perspective and awareness in understanding the cultural experiences of others. The interpersonal dimension of cultural humility involves an “other-oriented” stance that includes openness, respect, consideration, humility and interest regarding the client’s cultural identity and experiences.

Cultural opportunities refer to moments in counseling sessions when counselors are presented with opportunities to address and focus on the client’s cultural identity. For example, a cultural opportunity may emerge in a session when a client of a marginalized racial group discusses depression that is linked to being treated unjustly in the workplace. This presents an opportunity for the counselor to explore potential discrimination and the client’s cultural identity.

An essential feature of MCO is that it is rooted in the client’s perspective. Specifically, counselors need to understand the degree to which the client perceives the counselor to be expressing cultural humility and the degree to which the client thinks the counselor seized on or missed cultural opportunities in the session.

Multicultural counseling outcomes

Despite several decades of calls for counselors to develop multicultural competence, scant research exists to demonstrate that counselors’ self-rated multicultural competence is related to counseling outcomes. This is partly because counselors’ self-evaluations of their multicultural competence, while important for self-reflection and understanding and guiding counselor development, do not address clients’ views of their counselors’ competence levels. Emerging research on MCO demonstrates that adopting an interpersonal stance that is focused on cultural opportunities and cultural humility has a positive effect on client outcomes and offers a practical framework for cultural engagement with clients in sessions.

Research in 2016 by Jesse Owen and colleagues found that cultural opportunities had a significant influence on client outcomes. Specifically, researchers examined the perspectives of racial and ethnic minority clients on “missed cultural opportunities” in sessions and the relationship of these missed opportunities to client outcome. Missed cultural opportunities were evaluated by client report on a scale to assess the degree to which the counselor missed opportunities to discuss important cultural factors in the session.

Findings revealed that client improvement and increased wellness at the end of counseling were strongly negatively correlated with missed cultural opportunities. That is to say, as missed cultural opportunities increased, client improvement decreased. Clients experienced better outcomes in counseling when they perceived that their counselor responded to in-session opportunities to address cultural factors. These opportunities are the moments in session when counselors either engage in a culturally responsive way with clients regarding their cultural identity or they miss the opportunity.

In addition, several studies have demonstrated the positive effects of cultural humility on the therapeutic alliance and client outcomes. Instead of assuming that they are high in multicultural competence based on their own self-evaluations, counselors who are high in cultural humility typically engage in collaborative, open exploration with clients regarding their cultural identity as a salient factor in treatment.

Indeed, two recent studies by Owen and colleagues found a strong positive correlation between the client’s perspective of the counselor’s level of cultural humility and client outcomes. Essentially, when clients viewed their counselors as high in cultural humility, those clients experienced much more improvement in counseling than did clients who viewed their counselors as lower in cultural humility.

Cultural humility also mitigates the impact of missed cultural opportunities. Put another way, when counselors miss important cultural opportunities in the session, the negative effects of these missed opportunities on client outcome are neutralized if clients see their counselors as being high in cultural humility.

Implications for counseling

Understanding the role of culture in counseling is a challenging and multifaceted endeavor. Despite the complexities, some distinct themes have emerged regarding the benefits of MCO when significant counselor-client cultural differences are present.

As already mentioned, client perspectives of the two domains of MCO (cultural humility and cultural opportunities) are good predictors of client outcomes. There are also several overlapping themes from this research that suggest why MCO influences client outcomes. These themes suggest that the MCO model can help counselors:

  • Reduce the frequency and impact of microaggressions committed in counseling sessions
  • Effectively utilize dynamic sizing in sessions
  • Create a culture of feedback with clients

Microaggressions in counseling

Overt forms of discrimination based on race, sex, age, sexual orientation and many other identities have a long history in the United States and still persist today, but a more subtle and pernicious form of prejudice manifests in microaggressions. According to Sue and colleagues, microaggressions can take at least three different forms:

  • Microassaults (e.g., purposeful actions of discrimination such as name-calling)
  • Microinsults (e.g., subtle communications that demean a person’s cultural identity)
  • Microinvalidations (e.g., subtle communications that negate a person’s cultural reality, such as displaying colorblind attitudes or telling a person of color that you don’t see color)

Microinsults and microinvalidations generally fall outside of the perpetrator’s conscious awareness. People of privilege frequently view these microaggressions as banal, trivial and not a source of harm for the recipient. However, in addition to promoting stereotypes, microaggressions often cause frustration, anger, low self-esteem and physical health problems for recipients. Although counselors take multicultural counseling courses in which they explore their own biases, research indicates that counselors commonly and unwittingly commit microaggressions toward minority clients.

At least four published empirical studies in the past 10 years have examined the role of microaggressions in counseling. Microaggressions have been found to be associated with weaker working alliances, fewer sessions attended and poorer counseling outcomes. The percentage of racial and ethnic minority clients who reported experiencing microaggressions in counseling in these studies ranged from 53 percent to 81 percent. The most common microaggressions committed by counselors included declarations of colorblindness, avoidance of discussion of cultural issues and denial of their own prejudices.

Mental health professionals commonly commit in-session microaggressions, despite generally having good intentions. Privileged counselors are unlikely to notice when they commit microaggressions in counseling and frequently lack awareness of the untoward effects of these subtle slights.

Several important research findings are instructive regarding in-session microaggressions. Namely, counselors who are viewed by clients as being culturally humble commit fewer microaggressions than do counselors who are viewed as lower in cultural humility. Additionally, when counselors who are high in cultural humility (as viewed by the client) do commit microaggressions, the negative impact of these microaggressions is lessened. A separate study found that the negative effects of microaggressions were mediated when the counselor addressed and discussed the microaggression that occurred. Thus, cultivating cultural humility can help counselors reduce the frequency and impact of inadvertently committing microaggressions and learn to recognize, discuss and attempt to repair microaggressions that they do commit.

Dynamic sizing

The concept of dynamic sizing, as articulated by Stanley Sue in 1998, refers to counselors’ adaptable skills regarding when to generalize cultural knowledge or norms about a client based on cultural identity versus when to individualize. For instance, in their training, counselors gain cultural knowledge about particular groups. For example, “Native people perceive direct eye contact as disrespectful” or “Asian people are collectivistic, not individualistic.”

Such statements may reflect cultural norms and general group characteristics, but dynamic sizing entails the counselor’s ability to know when and how to generalize cultural information about a client in a way that applies to the individual and is not simply stereotyping. My own experience working in Alaska Native health clinics was illuminating in this regard. Specifically, two Alaska Native clients independently pointed out to me that they believed the “direct eye contact is disrespectful” concept was a residual effect of their ancestors being taught to be submissive by white colonizers. Thus, they did not endorse avoidance of direct eye contact in sessions and explicitly preferred more maintained eye contact with me than did some other Alaska Native clients.

MCO provides a conceptual framework that promotes dynamic sizing because it takes an interpersonal stance that focuses on elements of cultural identity and cultural opportunities in the counseling session that are deemed salient by the client. Specifically, MCO guides counselors to understand cultural norms and characteristics but not to view these elements as fixed variables. Instead, this interpersonal stance promotes understanding how culture informs each client’s life from the client’s perspective.

Creating a culture of feedback

Counselors with privileged identities are often unaware of the impacts a lack of privilege can have on marginalized and oppressed populations. In counseling sessions, this privilege frequently manifests through unconscious biases. Well-meaning counselors frequently do not recognize when unconscious biases or microaggressions occur because these are, by definition, unconscious.

Given this reality, it is important that counselors create a culture of feedback. This involves providing space for clients to feel safe and open to explore topics such as discrimination, systemic inequality, microaggressions and their lived experiences of marginalization. More to the point, the MCO model pushes counselors to embrace the fact that these manifestations of inequality (discrimination, microaggressions, etc.) are not something that clients experience only “out there” in the world. These manifestations frequently occur in counseling sessions too. Even well-intended, thoughtful counselors can inadvertently commit microaggressions, engage in stereotyping or exhibit poor cultural awareness, thus setting back or severing the therapeutic bond with clients. MCO helps counselors create a climate of trust and safety in which they can engage clients in difficult dialogues to better understand their perspective.

Putting it into practice

The MCCs and MCO share some broad, overlapping aims of increasing culturally responsive counseling services, reducing disparities and their negative effects, increasing counselor awareness of their biases and reducing these biases. Both models point toward a few central (but certainly not exhaustive) steps to take outside of counseling sessions to increase counselors’ overall multicultural competence. In addition, MCO emphasizes what counselors can do within sessions to increase their overall multicultural competence.

Out-of-session recommendations

  • Assess your level of multicultural competence by honestly completing the Multicultural Competencies Self-Assessment Survey (MCSA) developed by Manivong Ratts.
  • Follow a four-step process toward increasing multicultural competence based on the MCSA. These steps involve assessing your areas of need, defining objectives based on what you learned from the MCSA, designing a plan to meet the objectives and evaluating your success.
  • Engage in intentional cultural self-exploration related to counselor development. For instance, address questions such as: How does my cultural identity and privilege limit my ability to see or understand lack of privilege and marginalization? What are my gut reactions to clients who have different cultural backgrounds than my own? How do I create space for or welcome clients to explore their cultural identities? How open am I to my clients’ feedback about my level of cultural competence and cultural responsiveness?
  • Educate yourself about microaggressions, including the types that counselors commonly commit. Because microaggressions are the behavioral manifestation of beliefs and attitudes, the process is not as simple as telling oneself not to commit microaggressions. However, when practiced in conjunction with evaluating your own privilege, learning about marginalized populations and taking a stance of cultural humility, you can improve your skills in noticing microaggressions and making the necessary repairs.
  • Don’t conflate biases or committing microaggressions with being a bad person or a bad counselor. Like everyone else, counselors absorb and internalize cultural messages and stereotypes communicated through the media and broader culture. Accepting your own imperfection around cultural biases is essential to maintaining a growth mindset, developing cultural humility and benefiting from a new awareness that emerges over time. Denying your own biases and microaggressions will cause them to persist.
  • Read some peer-reviewed articles and engage in ongoing professional development regarding MCO, the MCCs, cultural humility and microaggressions in sessions.

 

In-session recommendations

Although the MCCs and MCO share general aims, their paths to increasing multicultural competence are quite different. In many ways, they are complementary.

The MCCs guide counselors toward developing specific knowledge, skills and awareness through personal work done outside of counseling sessions. For example, the MCCs provide counselors a framework for examining their biases, exploring the influence of their own cultural identities, assessing their multicultural competence for areas of strength and weakness, and developing culturally responsive intervention skills.

However, the final word on the overall cultural competence of a counselor rests in the perspective of each specific client. In other words, “Does this client experience me as culturally competent?” As found repeatedly in the counseling research, the client’s perspective on a number of important elements of counseling is often more strongly associated with counseling outcomes than is the counselor’s perspective. This holds true for core predictors of outcome such as empathy, the therapeutic alliance and multicultural competence/responsiveness. Thus, putting MCO into practice involves establishing an interpersonal stance of cultural humility and a willingness to explore cultural opportunities that are relevant to the client.

With this in mind, some in-session recommendations follow.

  • Reconceptualize your multicultural competence to include an emphasis on privilege and power in relationships, especially regarding their effects in the therapeutic relationship. Counselors often think through the lenses of their theoretical orientations in sessions (existential, cognitive behavior therapy, Gestalt, etc.). Work toward adding culture and privilege to the lenses that you intentionally consider in sessions.
  • Begin by acknowledging, during the informed consent process, the cultural differences between you and the client that the client may (or may not) see as important. Do this by acknowledging, explicitly, your potential lack of awareness of the client’s cultural experiences. For example, “You shared at the beginning of our first session today that you identify as a transgender person, and I know that many transgender people experience discrimination. If this is your experience, then I really want to ensure that I am aware and sensitive to the effects of this. Even though I try to understand clients’ experiences, I may unintentionally miss something that is really important in this area. As a person who is not transgender, I may have blind spots about your experience, but I will work hard to overcome these. If at any point it seems that I am missing or misunderstanding something about your experience in this regard, then I really welcome your comments on this.”
  • Acknowledge your biases or the microaggressions you commit in session, either when you notice them yourself or when your clients point them out. Clients might point these out indirectly, so be sensitive to nonverbal or subtle verbal cues that indicate the client may feel devalued in some way. If you think you might have committed a microaggression in the session but are not sure, check with the client. Depending on the level of severity, this might involve a simple question to the client about your concern regarding something you said or did. In the case of more egregious microaggressions, you might need to discuss it with the client in more detail and apologize for your lack of awareness.
  • Develop a culture of feedback, beginning with the first session and continuing throughout. Although clients are not responsible for teaching counselors about their cultural identities, counselors cannot possibly have complete understanding of how culture influences a particular client. A general example of creating a culture of feedback is as follows: “It is really important for me to make sure that I understand your perspective in our sessions. For instance, although I know some things about your cultural background, I may not fully understand at times how this impacts your life and relates to challenges that have brought you to counseling. I welcome your thoughts about anything you think I may not be getting in our sessions about you, your values or your cultural experiences. I really welcome your feedback.”
  • Near the end of each session, check in with clients about the therapeutic alliance and the cultural dimension of counseling in that session. For example, “Before we end today, I want to ask about how things were for you in our session. How did you feel about our session today? Did I seem to understand things from your perspective? Were there certain things that I missed or misunderstood regarding how culture plays a role in what we discussed today?” Counselors can also ask scaling questions here. For instance, “How would you rate our session today on a scale from 1 to 10, specifically regarding how well I understood the influence of your cultural background in what we discussed today? I would really like your honest feedback about this. If you have feedback that seems negative in some way, I welcome that, and it won’t hurt my feelings.”

Summary

MCO cannot be scripted or manualized, but its central features include communicating respect, practicing humility, being receptive to acknowledging one’s own biases when they occur and practicing culturally inclusive engagement that resonates with clients. An essential element of cultural humility is nondefensiveness around one’s own lack of awareness or demonstrations of incompetence. Thus, before encouraging client feedback, counselors need to be clear about how willing and able they are to receive this feedback with humility.

Cultural competence is not adequately defined by counselors’ self-perceptions of competence. Rather, it is determined by how their clients — especially marginalized clients — view the counselors’ capacity and willingness to understand the cultural forces that influence clients’ lives. Comprehending clients’ subjective cultural experiences and acknowledging our own cultural blind spots in the process are central to cultural humility. This interpersonal stance can help counselors improve client outcomes, honor the cultural experiences of clients and clarify the effects of counselors’ own privilege.

 

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

Sidney Shaw is a core faculty member in the clinical mental health counseling program at Walden University, a certified trainer for the International Center for Clinical Excellence and a workshop presenter. Additional information on multicultural counseling and other counseling topics is available at sidneyleeshaw.wordpress.com. Contact him at sidneyleeshaw@gmail.com.

Letters to the editor: ct@counseling.org

 

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