Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Voice of Experience: The dangers of cultural un-awareness

By Gregory K. Moffatt March 6, 2020

I know this is hard to believe, but the first class I ever had on cultural awareness was one that I taught. My graduate programs in the 1980s didn’t have a single class on the importance of understanding the diverse backgrounds of our clients. The best we did in those days was a short paragraph at the end of each textbook chapter tipping a hat to cultural awareness. My first exposure to the issue was with Derald Wing Sue and David Sue’s text Counseling the Culturally Diverse. This book, now in its eighth edition, is used in many graduate programs. I still use it today.

For more than 30 years now, I have taught this course on cultural awareness to both graduate and undergraduate students pursuing counseling degrees, and each time I realize the importance of this topic. Frankly, I’d rather see graduate programs drop a personality theory class or something else and add a second or third required course on diversity. In one semester, I can only introduce the topic. Competence is still far from the reach of these young clinicians.

It was during one semester teaching this course when one of my students related the following story. With her permission, I have shared it with every class since that time because she passionately and succinctly conveyed the importance of cultural awareness. Addressing an experience with one of her clients during an internship, she wrote to me the following:

Just yesterday I interviewed a man at the psychiatric hospital while keeping my eyebrow raised in suspicion that he wasn’t being truthful with me. This tall, obese, African American gentleman looked as though he had not bathed for days. The mucus stains and dandruff that covered his shirt immediately triggered thoughts in my mind. As he denied his drug use and other suspecting issues, I secretly assumed he was lying and trying to avoid consequences. Through his missing teeth, he smiled and told me he had never, ever drank alcohol. Flash-forward to the phone call I made to his sister where I learned that he had suffered severe head trauma in the 1960s. This gentleman had been the victim of a riot started over racial disputes and ended by police beating his head to a bloody mess. The man had, indeed, never drank alcohol and was only at the hospital for medication adjustment for his schizophrenia. I went back and apologized for not believing this sweet man. The only head shaking I did yesterday was at myself.

This story is so powerful and moving that when I read it to my students, I sometimes have a hard time holding back tears. Imagine the dangers of cultural un-awareness. I know this is poor English, but I want to emphasize just not being aware. In contrast with the years of my graduate experience when cultural awareness was largely neglected, now most of us know that it matters. But I suspect we hear about it so often that we don’t really give much thought to its implications.

The graduate student I quote above was an intake intern at a major hospital. The least experienced person in the system was the first to have contact with the client. That alone is frightening, but it is not an uncommon situation. If this intern had not discovered her error, the gentleman easily (and errantly) could have been tracked as an addict. At the same time, his real issues would have been ignored. This victim of racial violence would have again been victimized by the systemic racism that had put him across from the intern in the first place.

And what is most frightening of all is that my student was as culturally sensitive as any of us at that stage of our education. She was simply doing what she had been trained to do by an educational system that can overlook important cultural clues.

Someone once said that “the most insidious form of racism is covert racism.” When racists rant on street corners or wear icons indicating their perspective, they are easy to spot and thus easy to avoid. Subtle biased thinking and, more importantly, systemic racial discrimination is much harder to combat because well-intentioned therapists, like my student, don’t even recognize it.

My students are often angry with the Sue and Sue text because the authors are very confrontational in their approach. I experienced the same anger the first time I read it. But I know why the authors approach it this way. Novelist Flannery O’Connor was once asked why she wrote such graphic novels, and she replied, “If you want to communicate with the blind, you must paint large, startling images, and in the world of the deaf, you have to shout.”

I have heard Derald Sue speak several times. He is a brilliant and gentle man, but he isn’t afraid to talk about hard topics. This quiet man isn’t afraid to shout or to paint large, startling images. Maybe this is what it takes for a deaf and blind society to get it.



Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.



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.

A collective voice: Indigenous resilience and a call for advocacy

By Roni K. White, Alaina Hanks, Susan Branco, Nicola Meade and Isaac Burt February 11, 2020

Resilience is one of the characteristics hallmarking the experience of North America’s indigenous tribes. These tribes predate the European exploration and colonization that led to the renaming of these inhabited lands to the United States of America. These acts of occupying launched the dominant discourse and fallacious narrative that Original People no longer exist and began long before the Occupy movement. This ability not just to endure but to remain resilient, despite more than a quincentenary of atrocious acts, government policies, and intentional genocide, speaks to the strengths that exist within Native communities.

With modern technologies expanding platforms for Native people to share history and current events, professional counselors have the opportunity to further their understanding, increase competencies, and expand efficacy. Perhaps the perceived silence of Native voices is not because they are not speaking, but because few are listening.

Too often, professionals who interact with or provide services to a Native tribe record a narrow view. This limited representation misinforms others about the realities that exist and undermines the plurality that is alive. As counselors committed to improving social justice, promoting growth, supporting healing, and championing thriving, we offer a pathway to consider a more informed perspective and tools for advocacy.

Historical relevance

When truth is hidden or unheard, it leads to false teachings and misinformation. Historical accounts are complex, and tribal nations carry their own histories. Explorers, traders and colonizers disrupted the way of life for millions of human beings across North America from the 15th through the 20th centuries. By some accounts, as many as 112 million people — a number that can never be resolved or agreed upon — lived in North America in tribal nations prior to the arrival of European explorers and colonies. The people, constituting self-sufficient nations deeply connected to the lands of North America, have endured immense psychological pain, physical abuse, genocide, and torture at the minds and hands of European colonizers and their descendants.

Despite the intentional disregard and destruction of human life and communities, Native nations continued to promulgate their existence through advocacy and engaging with the U.S. government. In 1824, the U.S. government established the Bureau of Indian Affairs (BIA). In 1830, then-President Andrew Jackson signed the Indian Removal Act, forcing a massive and involuntary migration that resulted in immeasurable fatalities, internment, and the disruption and loss of customs and culture. Persistent broken treaties, ill treatment and racism did not deter Native nations from standing up to the U.S. government or against injustice, discriminatory laws, and other methods to prevent prosperity, equity and health.

From a space of incredible resistance and intelligence, Native nations have effectively changed U.S. laws and practices and transformed the BIA over the years, including the governance and collaboration of sovereign nations. The BIA led the implementation of the Indian Self-Determination and Education Assistance Act of 1975 and the Tribal Self-Governance Act of 1994, which changed how the federal government and sovereign tribal nations interact and conduct business with one another. 

Impact of trauma

The great Oglala Sioux chief Red Cloud understood change and the implication of actions. Red Cloud shared that one’s actions impact seven generations. Change is slow, and the impact of change continues over numerous decades. When we look at the undesirable conditions and circumstances various tribes have faced, it is imperative to comprehend the ways in which the ripple effects of history and laws can impose complex trauma on these individuals and communities.

Science reiterates Red Cloud’s sentiments by demonstrating how prolonged stress, inequality and trauma change neurobiological responses. These changes, also known as epigenetics and psychoneuroimmunology (PNI), support understanding of the increased levels of stress hormones found in Holocaust survivors and their children, resulting in high levels of anxiety and depression, ineffective coping abilities, and decreased social functioning. People from Native nations live under perpetual inequality and discrimination and endure many social injustices. It is reasonable to apply scientific understanding to appreciate the epigenetic and PNI changes experienced within Native nations.

Honoring the privilege to serve Native populations includes incorporating a neuroscience-informed traumatology framework. Having this competency promotes a multifaceted lens to conceptualize the presenting problem and address the underlying root causes that might be outside of the client’s awareness. Neuroscience-informed traumatology provides a pathway of healing, growth, advocacy and improved agency. 

Present snapshot

The U.S. government consistently uses “less than 1%” to describe the population of Native people, but that number represents millions of human beings. Today, there are 573 federally recognized tribes and an unknown number of unrecognized tribes, which at some counts may be around 196. The number of unrecognized tribes fluctuates due to determination of petition to the U.S. government.

Despite the federal government having recognized tribes, a person may be of Native ancestry and not have tribal membership. Not every person with an identity that acknowledges Native ancestry or who has tribal membership lives on land known as an Indian reservation. Tribal governments have the sovereignty to govern tribal land, and these structures vary from tribe to tribe. When working with these clients, understanding their individual experience and relationship to ancestry and identity is essential in establishing and maintaining a healthy therapeutic alliance. One size does not fit all; history teaches us a fraction of one’s experience.

SEATTLE: Indigenous activists march in solidarity with the people of the Standing Rock Sioux in their fight against the Dakota Access Pipeline, September 2016. John Duffy image/Wikimedia Commons https://bit.ly/31NrgqQ

Cultural revitalization efforts

Even with a long history of oppression, violence and genocide, many tribal communities today are reclaiming their histories through cultural revitalization efforts. In areas with high Native populations, you will often see efforts to bring back cultural knowledge in many ways. These efforts expand beyond the occasional localized community event; instead, they intertwine in the very fabric of daily living in these communities.

Although most cultural programs and initiatives are located within tribal territories, you can often find similar efforts in cities with larger Native populations. Look to the American Indian corridor on Franklin Avenue in Minneapolis as an example of the efforts of urban Indians to stay connected through culture. This neighborhood houses an American Indian Center, urban tribal offices, culturally centered schools, Native housing projects, art galleries and more.

The Indian Pueblo Cultural Center is another example of restoring connection. The Pueblos constructed this center on reclaimed land in the city of Albuquerque, New Mexico. It supports cultural, social, educational and economic needs for the 19 Pueblo communities and other Nations of the Southwest. In many major cities, you can often find at least one entity that supports Native people with culturally specific services and programs.

Reclaiming cultural connections is also a global focus. The United Nations declared 2019 as the year of Indigenous languages, and you can see language revitalization efforts everywhere within heavily populated Native communities. These efforts include immersion programs in day care facilities and schools, language camps, community classes, language bowls and the reproduction of media with Indigenous languages. The fact that children are now able to watch the Berenstain Bears in Lakota is evidence of language immersion and acknowledgement. For many tribes, various cultural values are embedded within their respective language. Thus, language efforts closely interconnect to ways of being.

In addition to the multitude of cultural initiatives and programs that exist, Native people are becoming more actively involved in mental health. In October 2010, Dirk Lammers wrote about the outstanding work conducted by the Urban Indian Health Center throughout the cities of South Dakota to improve both the physical and mental health of Native people living off reservations (see https://sduih.org to learn more).

In June 2011, White Swan reported on a program called Dream Makers in Washington state that youth started to assist other students who were struggling with suicide. The youth made small cards with supportive contact information that the students received. This effort, along with training from a specialist from Indian Health Services, led to zero loss of life due to suicide and an unprecedented referral to the school counselor for mental health needs.

In April 2017, Dan Beaton, from the Iroquois Nation, wrote about his work to assist in culture and ceremonies in Canada, and particularly his encounter with the Attawapiskat Nation. He described the beauty of sharing stories and prayers between different tribes and the healing that such events bring through a common reconnecting to a tribal heritage. Mental health continues to be a priority among Native nations. 

Promoting wellness

A plethora of organizations and professional communities are dedicated to promoting wellness among Native nations. The American Indian Health Service (AIHS) serves the urban Native American community in Chicago. It works to address health holistically and has developed innovative medical and behavioral health programs to address the unique needs of indigenous communities. Among these include a Youth Development Program that aims to address emotional health and cultural resiliencies and offers Youth Mental Health First Aid training (visit http://aihschgo.org to learn more about AIHS).

The National Indian Health Board strives to promote successful strategies, identity challenges, support prevention and increase awareness for the behavioral health needs of all American Indian and Alaskan Native people. To acquire valuable resources, visit https://www.nihb.org/behavioral_health/resources.php. Intentional efforts to address prevention and evidence-based treatment for Native people are ongoing. For example, One Sky Center upholds and advocates for culturally appropriate treatment and training to provide mental health and substance abuse services for Native people.

The resilience of Native people encompasses surviving, advocating, healing and thriving. Native Nations and American Indians continue efforts to this day, working on policy issues and engaging in policymaking. The National Congress of American Indians organizes efforts into five policy areas:

  • Community and culture
  • Economic development and commerce
  • Education, health and human Services
  • Land and natural resources
  • Tribal governance

Each year, multiple bills are introduced on the floor of the House of Representatives, and multiple cases are heard in the Supreme Court concerning policies in the aforementioned areas. Today, Vice President of Special Projects for the Cherokee Nation Kimberly Teehee is advocating along with Cherokee Nation Principal Chief Chuck Hoski Jr. to enact the 1835 Treaty of Echota, which would seat a delegate in the House of Representatives. 

Ethics in advocacy

Distinguished endeavors and strides to achieve equity and fairness for Native people have support from collaborative and cooperative organizations, individuals and agencies. Codes of ethics call on professional counselors on multiple levels to advocate with and on behalf of the communities in which they serve. Specifically, the  2014 ACA Code of Ethics includes promoting social justice in its preamble. Furthermore, Standard A.7.a. charges counselors to engage in advocacy efforts to remove barriers to access and equity for their clients. Ratts, Singh, Nassar-McMillan, Butler and McCullough provide professional counselors with guidelines to include advocacy efforts in their work with clients in the 2015 Multicultural and Social Justice Counseling Competencies (MSJCC). Counselors can use these tools in considering how to best collaborate with Native American clients.

Corresponding with the MSJCC, the idea of humility is of utmost importance when an outsider (non-Native) wishes to serve Native American clients. In certain tribes (such as the Navajo), the act of being humble is a primary concern. Although counselors receive education in empathy, techniques and self-awareness, the ability to be humble is not normally taught.

Non-Native counselors looking to work in Native American communities need to acknowledge that they are outsiders. Even though counselors may have good intentions, they will nevertheless need to prove themselves. Having to go through this vetting process is difficult and something that many counselors find arduous and time-consuming. The mindset of the non-Native counselor can mirror the following: I want to help and cannot quite understand the rationale for the resistance I am encountering. However, the belief of the Native American community can mirror the following: People have come and gone and did not have our best interests at heart. It is clear to see the disconnect between these two mindsets.

One way to resolve this issue is to utilize a combination of humility and the MSJCC. For example, consistent with the MSJCC, non-Native counselors need to have self-awareness and critically comprehend their clients’ worldview. This multicultural outlook includes understanding historical privileges and marginalization.

Counselors who operate within this culturally competent framework understand that it is not entirely about their self-identification but also about how one’s identity may be perceived by others. For non-Native counselors whose self-concept is one of overcoming poverty, stress and discrimination, they may see themselves as having a connection to the communities they wish to serve. Conversely, for those in the Native American community, instead of the personal image the counselor wishes to display, they could potentially see an individual who represents past brutalities and halfhearted efforts to help. It takes movement (e.g., courage, patience, openness) on both parties (primarily the counselor) to understand this mindset and have the humility to accept it and be able to move forward positively.

To gain more in-depth understanding of advocacy efforts, it is beneficial to begin learning about a particular Nation or topic area. Attend meetings or sessions on a Nation or topic, learn about the existing efforts and challenges, and use your skills and time with the permission of the appropriate Native leader. Given Native histories, it is important for non-Native counselors to be aware that there might be times when they need to wait for a leader to invite them into a group they are looking to serve. It will also take time for them to be valued as an ally; interest does not equal automatic acceptance.

Sometimes the best gift one can offer is to be the student. History is ever being amended and recorded; remaining open to learning, increasing awareness of one’s relational existence to others, and identifying noninjurious ways to contribute to the change you imagine will allow you to share in amplifying voices and dismantling inequalities.



Roni K. White is the founder of Apricity Wellness Counseling and designer of the “Women in the Workplace: Leadership, Barriers, & Struggles” series. She is a national certified counselor and licensed graduate professional counselor. She aspires for equity in a decolonized world. Contact her at rkwcounseling@gmail.com.

Alaina Hanks is Anishinaabeg and enrolled in the White Earth Nation in Minnesota. She is a licensed professional counselor-in-training and a community advocate with HIR Wellness Center in Milwaukee. Contact her at alaina.hanks@gmail.com.

Susan Branco is a clinical assistant professor with Counseling@Northwestern’s clinical mental health counseling program. Contact her at Susan.Branco@northwestern.edu.

Nicola Meade is an adjunct professor with Old Dominion University. Contact her at nicolaameade@gmail.com.

Isaac Burt is an associate professor at Florida International University. His research interests entail working with historically disenfranchised and marginalized populations. Contact him at iburt@fiu.edu.




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.

Fostering immigrant communities of healing

By Lindsey Phillips January 28, 2020

During the months surrounding the 2016 presidential election, the rhetoric around immigration was so charged that Daniel Gutierrez, a licensed professional counselor (LPC) and American Counseling Association member, noticed a substantial uptick in panic disorders at a free clinic in Charlotte, North Carolina. One therapist even told Gutierrez about a client who was having panic attacks every time that a political ad played on television.

Four years later, Gutierrez, an assistant professor in the counselor education program at William & Mary and coordinator of the addictions emphasis for the university’s clinical mental health counseling program, says he still encounters immigrants who are terrified and no longer understand the immigration process in the United States. Many worry about family members back in the countries they left. Some worry that if they visit these family members, they may not be able to easily return to the United States themselves. Some are confronted by people screaming “Go back home!” as they shop for groceries or walk down the street. Fear, guilt and worry are constant emotions for many immigrants, notes Gutierrez, who is also faculty director of the New Leaf Clinic at William & Mary in Williamsburg, Virginia.

In fact, Gutierrez says that providing counseling services to immigrant populations can sometimes feel like working in a hospital emergency room. “We’re just trying to stop the bleeding for a minute, and sometimes we don’t have time to look at some of the other concerns,” he says. “You don’t even know where to start. There’s so much trauma and anxiety.”

“They have such a history of past trauma that it overshadows everything,” Gutierrez continues. “They’ll have this experience on the border crossing or in their home country, and when they get here, that [experience] influences every relationship.” Gutierrez has seen cases in which a mother has difficulty connecting with her partner and children because of the guilt she feels about a trauma that happened while the family was crossing into the United States. For this reason, counselors often have to deal with larger presenting issues — trauma, anxiety, depression — before they can work on other concerns such as relationship issues, he explains.

Immigrants also face myriad stressors after migrating to a new country, and these stressors take a toll on their mental health. In fact, researchers have identified an immigrant paradox in which recent immigrants often outperform more established immigrants in areas of health, education, conduct and criminal justice.

This paradox illustrates how damaging acculturative stressors such as financial concerns, insufficient living conditions or food, cultural misunderstandings, an inability to communicate or speak a new language, lack of employment, and isolation can be to immigrants. Lotes Nelson, a clinical faculty member at Southern New Hampshire University who often presents on this topic, points out that these stressors can result in symptoms of anxiety, depression, posttraumatic stress disorder (PTSD), conduct disorders (especially for children) or substance abuse issues.

Isolation and the lack of a support system can cause immigrants to turn inward and internalize their symptoms, says Nelson, who lives in St. Augustine, Florida, and, as an LPC and approved clinical supervisor in North Carolina, offers distance counseling services. Her clients who are immigrants often report feeling that something isn’t right — their heart is racing all the time or they constantly feel sad, for example — but they can’t pinpoint what it is or why they feel this way. In addition, they frequently lack people they trust to talk to about their concerns.

One problem is that accessibility to counseling services is limited for immigrant populations. Gutierrez, author of the chapter “Counseling Latinx Immigrant Couples and Families in the USA” in the forthcoming book Intercultural Perspectives on Family Counseling, says that immigrants are less likely to receive mental health services, and when they do, the services are often lower quality than what the majority culture receives. “The counselors who are offering the care [to immigrant populations] are overwhelmed with large caseloads. They are about to hit burnout. … The immigrant stories of journeying over are [also] really difficult,” he explains.

In addition, Gutierrez finds that the counseling profession doesn’t have enough practitioners who understand the cultural implications and nuances of working with immigrants.

Nelson, a national certified counselor and a minority doctoral fellow of the National Board for Certified Counselors, also points out that immigrants may not voluntarily seek counseling because many have not been exposed to mental health care until reaching the United States. So, at least initially, she says, they may not consider counseling to be an acceptable service or treatment. When someone is not familiar with the mental health care process or if they question the validity of therapy, then they are not going to easily share their thoughts, concerns and fears in counseling, explains Nelson, a member of ACA.

Gutierrez and Nelson agree that to overcome some of the barriers that immigrants face in receiving mental health care, work must be done on the part of counselors to cultivate personal relationships and build trust with them. Counselors need to understand where each individual client is from and what that person’s transition to living in the United States has been like. Gutierrez also stresses that if they truly want to make a difference, counselors must enter into partnerships with immigrant populations and the communities that serve them.

Overcoming language barriers

Language is often a barrier when working with immigrant populations, and finding bilingual counselors can be a problem, according to Gutierrez. In 2009, when Gutierrez lived in Orlando, Florida, he sought his own mental health counselor but found only five who were Latinx and spoke both Spanish and English.

Gutierrez, co-founder of the annual Latinx Mental Health Summit, also points out that native Spanish speakers will sometimes use physiological terms to talk about psychological illness, which results in diagnoses being missed or lost in translation. For example, in some Latinx cultures, people may say, “My heart hurts” or “I have pain in my heart” to describe sadness.

Nelson has observed that immigrants who are experiencing anxiety also commonly describe their symptoms physiologically, such as having abdominal pains. Some clients may believe that a stomachache is purely physical and not related to mental health, she points out.

Counselors can overcome some language barriers by working with interpreters. Because of the complexity of translating mental health terms and concepts, Nelson cautions counselors to make sure they are working with qualified interpreters, not just individuals who happen to speak the language. With some clients, certain mental health terms or symptoms may not exist in their cultures, so their language may not even have a word to describe it, she adds.

Nelson invites interpreters to ask her questions to clarify and help them make sense of what they are translating. She also requests that they translate her words verbatim to the client to avoid potential misinterpretations.

Finding qualified interpreters can also be a challenge, Gutierrez points out. Nelson and Gutierrez have used interpreting agencies, hospitals and university language departments to find interpreters. Once counselors do find someone qualified, they then need to ensure that the translator will keep clients’ information confidential, Gutierrez adds. He recommends that counselors have interpreters sign confidentiality agreements. For him, the best-case scenario is working with interpreters in the helping fields (e.g., case management, nursing, health education) because they already understand the importance of client confidentiality.

There is also a danger of misinterpreting body language when working with clients from different cultures, Nelson notes. For example, whereas nodding in U.S. culture typically denotes comprehension, some clients raised in Asian cultures may nod because they are embarrassed about not fully understanding what is being communicated or don’t want to make the therapist feel bad that they don’t understand, Nelson explains.

Nelson has also had clients bring in their children to translate for them in session. When this happens, she explains to the client that even though the children may be capable of translating, the conversation may be beyond the child’s developmental age, so she would prefer working with a translator. However, some clients resist working with a translator and feel safe only when having someone inside their family unit translate their personal information. When this happens, Nelson respects the client’s preference but carefully explains the potential consequences of choosing that option.

Prioritizing family

Many immigrant populations place a high value on family, and this means that counselors should make it a priority too. “If a client has to choose between their child and being seen by [a therapist] … they always prioritize family. They always prioritize children,” Gutierrez says. “So, family cohesion is a stronger predictor of whether [immigrants] engage in services or benefit from services than [it is with] the majority culture.”

Gutierrez says counselors will be more successful engaging with immigrant populations if they offer family services, provide some form of child care, or help clients connect how their own well-being and mental health influence their children’s well-being.

Nelson agrees that counselors must find ways to incorporate the family if they are to be successful in reaching out to immigrant populations. Because child care can be a challenge for many of these clients, she suggests that counselors consider providing clients’ children with a separate room where they can color, watch movies or engage in other developmentally appropriate activities while their parents are in session. However, she acknowledges that this setup is not always possible, so counselors may have to find other ways to accommodate families.

Clients often come to see Sara Stanizai, a licensed marriage and family therapist and owner of Prospect Therapy in Long Beach, California, because they are navigating two conflicting messages: the individualist mindset widely embraced in the United States and the collectivist mindset often emphasized in their homes. Family was so central to one of Stanizai’s adult clients that the client’s mother had to speak with Stanizai before the client could work with her.

If clients come in discussing problems with their family and the therapist’s advice is to set better boundaries, this could work against the clients’ mental health and well-being because being with their family is a priority for them, Stanizai says.

Instead, she works with clients to reframe the issue with their families to find common ground. Rather than focusing on why a client is at odds with his or her parents, she helps the client think about the underlying motivations and values that they all agree on. For example, the client may agree with the parents’ desire for them to have more opportunities and to be successful, even if the client doesn’t fully agree with the parents’ high expectations or demands to get straight A’s.

Because of the stigma that often surrounds mental health within immigrant communities, some clients may not feel able to talk openly with their families about counseling. This is strange for them because they have such strong family units, Gutierrez points out. An inability to turn to their families can prevent these clients from going to counseling because they fear getting “caught,” he adds.

Thus, confidentiality becomes particularly important when working with immigrants whose communities may stigmatize counseling or whose experiences or undocumented status could prevent them from freely sharing their stories. For example, if an individual’s pastor refers the client to Nelson, she will make a point to say, “I know you came here because your pastor recommended counseling, but this does not mean that what you share here goes back to your pastor. This meeting is for you, and anything you say here will stay within this room.”

When working with clients who are immigrants, counselors should consider the individual’s overall support system, which can include family, friends, faith leaders, community elders, local organizations, medical doctors and other professional service providers, Nelson says. She reminds her clients that she is just one part of their support system. For example, if spirituality is important to a client, then she will say, “It sounds like you have great respect for your worship leader. I want you to continue to go to them while you are also coming to counseling. You have a whole host of support around you.”

“If you as a counselor [have] … tunnel vision — ‘this is me and my client’ — when working with immigrants, then it’s more than likely not going to be successful,” Nelson says. “Because if you only look at one of those resources, such as friends, [clients] are going to get a fraction of the treatment that they need.”

Partnering with the community

Gutierrez learned the value of community and partnerships when he worked as a counseling professor at the University of North Carolina at Charlotte (UNCC). Mark DeHaven, a distinguished professor in public health sciences at UNCC, taught Gutierrez about community work and connected him with Wendy Pascual, the former director of Camino Community Center, a local free clinic.

Through his partnership with Pascual, Gutierrez learned that the clinic had 85 people on a waiting list to receive mental health services. He also discovered that primary care was often a starting point for immigrants to receive services. The majority of people at the clinic had mental health issues related to depression, anxiety, stress or trauma, and these issues were often a significant driver of their physiological complaints (e.g., diabetes, high blood pressure). The physical illness was often just a symptom of a mental health concern — one that was going untreated because of a lack of qualified counselors and services.

Gutierrez worked with Pascual and a team of academics, including DeHaven, to fulfill this need and reduce mental health disparity within the immigrant Latinx community in Charlotte. Graduate counseling students at UNCC agreed to provide counseling services for the clinic, so the services remained free for the immigrant population and operated as part of the students’ counseling training.

Gutierrez notes that counselors need to enter into partnerships if they want to make a difference in immigrant communities. He stresses the word partnership. “There’s a difference between partnership and collaboration,” Gutierrez notes. “Collaborating with people in a community is OK; you do your stuff and then you go back home. But partnership [involves] … joining with people in the community and … adopting their mission and vision.”

Partnerships allow counselors to reach immigrant communities and better understand clients’ cultural values. For clients who are immigrants, it is often about the personal relationship and building confianza, or trust, Gutierrez says. But he notes that in Spanish, the word confianza goes further than just trust. “It’s confidence. It’s connection. It’s partnership. It’s someone who invites you in to break bread,” he explains.

Gutierrez cautions counselors not to assume that immigrant clients are going to come to them. Instead, he advises counselors to work within the communities they want to serve. He also recommends attending community events such as church celebrations or local festivals as a first step toward building these partnerships. By attending the annual Puerto Rican festival in Charlotte, he was able to foster relationships with individuals and learn more about what work was already being done to help immigrant communities.

Counselors should “just follow the crowd backward,” he advises. For example, they can look for people organizing food and backpack drives or voter registration efforts and connect with them because these people are the ones who are already doing great work in the community.

Partnerships have also assisted immigrants in finding Nelson, who notes that most of her clients come to see her because of referrals from religious leaders, resettlement agencies or other clients. She also agrees that immigrant families value seeing counselors out and about in their communities, including at events, festivals, fairs, their places of worship and so on.

Even so, counselors must remember to uphold their ethical obligations, such as protecting client confidentiality, during such community interactions, she notes. When a client brings Nelson a flyer for an upcoming event, she carefully weighs her ethical obligations with the needs of the client: Will attending the event harm or benefit her relationship with the client? Could it in any way interfere with the client’s treatment or the progress the client is making?

She also has conversations with the client about boundaries. They discuss how the client wants to handle this dual relationship and talk through scenarios concerning what could happen as a result of Nelson attending the event. Will the client acknowledge her (and vice versa) when they see each other? How does the client want to explain their relationship to family members and friends who may be at the event?

For Gutierrez, the faith-based community has been the biggest asset in working with immigrant populations. In churches and other spiritual communities, immigrants can typically use their own language, connect with others like them, and feel safe and heard, he explains. For this reason, Gutierrez advises counselors to work with pastors and other spiritual leaders to educate them about the benefits of professional counseling. Often, that is all practitioners need to do to increase the number of immigrants who seek counseling, he says.

Gutierrez tested the power of spirituality for immigrant communities by holding identical educational counseling courses (with the same curriculum and instructor) in a clinic and in a church. Whereas only 20-30% of immigrants completed the course at the clinic, 90% of those attending the class at the church stayed because they said they felt the class was closer to God and more aligned with their beliefs, Gutierrez says.

If clients value spirituality, counselors can integrate that into their sessions and adapt interventions to include spirituality (adhering to the competencies developed by the Association for Spiritual, Ethical and Religious Values in Counseling), Gutierrez says. For example, counselors might ask clients how they understand a situation from their own religious or spiritual perspective, or they could discuss the use and function of meditation and prayer, as appropriate, he explains.

Nelson has had immigrant clients with symptoms of depression or anxiety report that “I’m possessed by the devil because I feel this way.” Other clients have told her that in their home country, they would have been taken to church and prayed over for days or weeks for having such feelings. When this happens, she relates mental health needs to medical ones because the concept of medical health is often familiar to these clients, even if mental health is not. She asks them where they went when they had physical pain. When they respond that they went to see a doctor or a healer in their village, she compares that process to seeking a mental health professional to figure out why they feel sad or feel like something is not right with them emotionally, psychologically or socially.

Diagnosing the person, not the culture

“We’ve treated culture in counseling sometimes likes it’s a diagnosis,” Gutierrez asserts. He explains that practitioners sometimes try to adapt counseling approaches to fit specific cultures — for example, using cognitive behavior therapy (CBT) with all Latinx clients. But this method ignores the differences within cultures, he says. CBT may work well for one Latinx client, but another Latinx client may prefer psychoanalysis.

“Good cultural accommodation or adapting culturally responsive care starts with a good conversation about what the client needs and the services you provide,” Gutierrez says.

“There’s still a human being in that chair. … It’s less about the strategies you use and more about the person you’re working with … because they’re dealing with multiple layers of stress, challenges and stigmas. So, find out what their story is before making some assumptions,” he advises.

Being culturally responsive may mean adjusting the length of counseling sessions, Gutierrez notes. Even though a 50-minute clinical session is standard practice in the United States, shorter sessions may work better for some immigrants, he says. 

Likewise, Nelson says it is dangerous for counselors to quickly settle on a diagnosis without knowing the client’s overall picture. On the surface, it may look like an immigrant client is dealing with anxiety over moving to a new country, but counselors should consider everything the person has experienced in their life before, during and after migration, she explains. Past and ongoing traumas and adverse childhood experiences can shape a person’s development and can potentially lead to disruptive behaviors, PTSD, depression and anxiety, she adds.

To learn about clients’ immigration experiences, Nelson often says, “Tell me what you went through physically and mentally. What was the living situation when you were migrating, and what is it now? What kind of threats did you experience?”

Often, clients will resist answering these questions because they are not yet willing to focus on the traumatic experiences they went through, Nelson says. Many clients respond along the lines of “I don’t think about that. That’s over now. I want to focus on the here and now” or “That’s just what I had to do to get here and to get a better life.”

When clients dismiss their past experiences, Nelson respects where they’re at emotionally and cognitively and doesn’t push them to share more of their story in that moment. She admits that it is easy as a counselor to develop an unspoken agenda with clients, so she continually reminds herself that counseling is about allowing clients to tell their stories when and how they need to.

Both Gutierrez and Stanizai stress the importance of counselors educating themselves about different cultures and not placing the burden of this education on clients who are immigrants. Although multicultural training courses can be helpful, it is often equally (if not more) beneficial to learn from the community itself, Stanizai says. Gutierrez agrees that immersion is the best teacher, so he advises counselors to put themselves in settings where they are surrounded by people different from themselves.

Stanizai, who specializes in working with first-generation/bicultural Americans and runs an Adult Children of Tiger Moms support group, advises counselors to spend time reading books and watching media written for and by people in the culture they are working with. “Find a local news source, a radio station, novels or nonfiction that can educate you on not only specific topics but also cultural values and beliefs,” Stanizai says.

Cultural awareness helps counselors learn about privilege, avoid making assumptions or buying into stereotypes about groups of people, and better understand how being an immigrant within mainstream American culture can affect clients’ beliefs and mental health, Stanizai says. Most immigrants will not care whether counselors are familiar with every cultural custom, such as marriage contracts, but they will care, she says, if counselors have a surprised reaction — e.g., “What is that? That’s so different!” — to something they share about their culture.

No matter how much counselors educate themselves, they can never learn about all of their clients’ different experiences and cultures. Gutierrez finds that sometimes counselors are scared to talk about race and ethnicity out of concern about potentially making a mistake. This fear can turn into overcorrection and cause counselors not to ask important questions, he notes.

It is OK, Gutierrez says, for counselors to directly address the issue of a client’s race or ethnicity differing from that of the counselor. For example, a counselor could broach the topic by saying, “My family is Latinx. My parents came here from Cuba. You are Asian. I wonder how you feel about getting help from someone whose background is different from yours?” 

Gutierrez and Stanizai also advise counselors to take a tutorial stance when working with immigrant clients by asking questions about their unique experiences. Counselors could ask, “What was it like to grow up in your family? How much did culture play a part in your childhood? How is your family different from your best friend’s family? How is it the same?”

Counselors’ hubris can also be a barrier to working effectively with clients who are immigrants, Gutierrez warns. If counselors feel like they are going to be savior figures and fix all of the immigrant’s problems, then that mindset undercuts the progress of the client, he explains.

Stanizai agrees. “It’s easy for very well-meaning therapists to get caught up in trying to prove to their clients that they are good people,” she says. “You want to make sure that you’re not processing [clients’ stories] for your own benefit. … That’s really off-putting, and people can sense it a mile away.”

Clearing the way for immigrants

Counselors only have to sit and hear one immigrant’s story or journey to realize how resilient they are, Gutierrez notes. “I don’t give them solutions. They find them,” he says. “They’ve pulled themselves through all these difficulties and challenges, so there’s this amazing resilience in them.”

Often, the pressures and demands of life, of having to concoct strategies to get to work and home, weigh on them, so Gutierrez says he simply provides them with a safe, secure space where they don’t have to feel all of that extra pressure. “Usually I’m just clearing the way for them,” he says.

Providing this space can take many forms. One therapist Gutierrez knows often has clients sing old hymns or folk songs as a symbolic way of allowing them to recapture a piece of their soul that they may have lost during their journey. In this safe space, clients can grieve what they have lost or what worries them in their own way, Gutierrez explains.

Counselors might also consider simply sharing a cup of coffee with their clients. Gutierrez recalls one immigrant client from early in his counseling career who demonstrated his resourcefulness and taught him how to “break the rules.” The client brought Gutierrez a bag of coffee as a thank you, but Gutierrez explained that he couldn’t accept the client’s gift for ethical reasons. The client said, “Oh, so you can’t take it from me?” So, the client opened the bag, walked to the coffee machine and made two cups of coffee. The client then said, “Well, I’m going to drink a cup. We can share it together.”

This moment was a turning point for Gutierrez. Now, he often enjoys a cup of coffee with clients while they talk in session. This small gesture counters some of the hostility and challenges that immigrants face, especially in today’s environment. As Gutierrez points out, it also creates a comfortable counseling atmosphere that will help immigrant clients find peace and lets them know that “there’s room for [them] here.”



RELATED READING: See the online exclusive article “Straddling two worlds,” which explores the complex and critical issue of identity development among immigrant populations.

Also, check out Counseling Today‘s 2016 Q+A with Gutierrez, “Counseling interns get firsthand exposure to immigrant experience.”



Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org


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.

Multicultural encounters

Compiled by Bethany Bray November 21, 2019

The 2014 ACA Code of Ethics calls counseling professionals to “gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population.”

At face value, this is easy enough to understand. But when it comes to multicultural competence, what does it look like to put this “head” knowledge into practical action?

For Letitia Browne-James, a licensed mental health counselor (LMHC) who owns a counseling practice in the Orlando, Florida, area, this endeavor once involved bringing a client’s family into session to better understand how his cultural background, and its views on the role of family, were affecting his mental health.

The client was from a collectivist, Caribbean culture that placed greater importance on the family unit than on its individual members. Family approval was paramount to this client, she explains.

Browne-James also has Caribbean roots, but “I come from a culture where individualism is encouraged and celebrated,” she says. Connecting with this client — and fully understanding his cultural perspective — came via openness, flexibility and creativity on the part of Browne-James, who has a doctorate in counselor education and supervision with a specialization in counseling and social change.

“I invited the client to bring in his family for a few sessions so I could learn more about the family’s views and assess how I could help him individually by helping the entire family system understand mental illness and how to treat it with familial support successfully,” says Browne-James, a core faculty member in the Adler Graduate School’s online program. “We learned that [involving family] was the fastest and most effective way to help the client achieve his counseling goals and live a healthier and productive life in society.”

Browne-James encourages counselors to fully explore each client’s culture, whether that involves doing research, consulting with colleagues, or meeting with a client’s family. It is also helpful to invite clients to speak in sessions about what their cultural identity means to them, how they apply that identity to their life, and how they’d like it to inform their goals and work in counseling.

“I encourage professional counselors to think of multicultural competence as the basics of being a professional and ethical counselor — [to] view their help-seeking behaviors to expand their cultural knowledge as a professional strength rather than a weakness,” says Browne-James, president-elect of the Florida Counseling Association and treasurer of the Association for Multicultural Counseling and Development (AMCD). “I would also encourage them to be patient with themselves, with colleagues and with clients who are at different stages in their cultural journey, while remembering that cultural competence cannot be separated from ethical practice.”

Striving toward multicultural competence

Counseling Today recently reached out to American Counseling Association members of varied backgrounds and practice settings and asked them to share some of their case examples and insights regarding multicultural counseling.

We encourage readers to add their own thoughts to this discussion by posting comments at the bottom of this article, below.



Multicultural competence is a never-ending journey that involves risk, adventure and discovery. Culturally competent counselors strive to enhance their awareness, knowledge and skills to work with others who are culturally different from themselves in meaningful ways. This includes deconstructing long-held assumptions, values, beliefs and biases that do not foster cross-cultural sensitivity. Furthermore, multicultural competence includes the ability to recover from cultural errors and to tolerate, manage and resolve intercultural conflict, no matter the setting.

Every cross-cultural interaction creates learning opportunities for counselors and counselor educators to enhance their awareness, knowledge and skills in multicultural counseling. One way clinicians can create opportunities to gain cultural awareness is by focusing on an art form (e.g., music, film, painting, photography) that interests the client. Counselors can use this information as a pathway to identify the constellation of values and assumptions that impact and inform their client’s worldview.

I remember working with an adolescent client who was in the midst of working through her cultural identity development. The client was born in Nicaragua and adopted at 6 months old by a white upper-middle-class family. She struggled with her racial and ethnic identity since she did not feel tied to her Nicaraguan roots and she did not identify as white. Initially, she was not very expressive, but I was able to reduce the cultural distance between the two of us by focusing on her interest in music.

Even though our identities (age, race, ethnicity, socioeconomic status) and developmental stages were completely different, I used music as a window into her worldview. In one of our first sessions together, the client mentioned that a popular rock band (Twenty One Pilots) was her favorite music artist. I had never heard of that [band] before, but I used this information to spark a conversation about her identity-formation process. I asked the client, “What’s your favorite song [from this band]?” She responded, and I asked her for permission to listen to the song and discuss the lyrics during the session. She agreed, and we dissected the lyrics line by line.

This activity created an environment that allowed the client to feel safe and supported as she opened up about her struggles with her racial and ethnic identity, low self-esteem, and desire to engage in self-harm behaviors. The underlying message in the song also gave me additional information regarding the client’s presenting concerns that she had not previously disclosed.

Fortunately, this cross-cultural encounter facilitated a strong working alliance that led to therapeutic change. I took a risk that proved to be beneficial for the client and created an opportunity to enhance my multicultural competence.

— Whitney McLaughlin is a licensed professional counselor (LPC) and a doctoral candidate at North Carolina State University.


The term multicultural competence can feel vast or intangible. I do my best to embody multicultural competence by remembering that life and counseling are centered around people interacting with people, existing within a system. Every person is different, and understanding that these differences are central to our human experiences is essential.

Beginning with self-exploration of who I am and my worldview is imperative. Models such as Pamela Hays’ approach from her book Addressing Cultural Complexities in Practice: Assessment, Diagnosis, and Therapy can be helpful in the process of understanding who and what I represent within counseling and society. Additionally, every identity I hold and the intersection of my many identities have different meaning in different contexts.

For example, when working with an adolescent [client] who self-identified as black, cisgender and queer, I asked myself, “What may I represent within the context of this counseling relationship?” To the client, my identities as black and cisgender may place me as an insider or safe to speak with, but my identity as heterosexual may place me as an outsider or an oppressor. I had to consider the spectrum of my humanity, the intersections of my various identities, the meaning that can be derived from who I am and what I may represent to my client, and intentionally make space for it all within the counseling relationship.

Then, all the same considerations needed to be made for my client’s identities while also accounting for systemic factors. For example, considering how systemic white privilege, racism, homophobia and heterosexism affected my client’s lived experiences as a black queer male assisted in understanding my client’s needs. Urie Bronfenbrenner’s model can be helpful in conceptualizing the levels and roles of systems (see Counseling Today’s April 2013 cover article “Building a more complete client picture” for additional information).

I recognize this sounds like a lot (and it is), but this can be accomplished through intentionality.

1) Do your homework: This refers to doing your personal work, such as understanding who you are and what you represent. I participate in my own therapy and have frequent conversations with trusted, critical thinkers to stay grounded and aware.

2) Work for your client: This refers to being receptive to understanding your client’s experiences while not requiring that they educate you on every aspect of their identities. For example, when working with the client mentioned above, I made sure I knew how queer was defined broadly while also allowing the client to express what being queer meant to him and his experiences.

3) Have an open dialogue: This refers to not shying away from discussing our identities and the effects of the systems we exist in. This also means not putting the responsibility on our client to broach the topic. With my client, acknowledging the interplay of his many identities across the multiple systems he existed within allowed us to examine the depth and variety of his lived experiences.

— Tyce Nadrich is an LMHC, supervisor and assistant professor of clinical mental health counseling at Molloy College. He also has a private practice in Huntington, New York, where he supervises counseling trainees and works predominantly with adolescents and young adults of color.


There are two things that I impress upon all counselors I train. The first is that Caucasians are not devoid of culture, and the comparative practice of juxtaposing the lived experiences of nonwhite persons to their white counterparts is oppressive. Second, to be a culturally competent counselor, one must first have a deep understanding of [one’s self] as a cultural being.

I specialize in African American mental health, and this has required a great deal of study in black and liberation psychologies, culturally responsive psychotherapies, and culturally congruent treatments and frameworks. This also means always being willing to critique and ask questions about the worldviews and assumptions embedded in the many trainings and presentations I attend each year, to better understand their utility or lack thereof to the populations I serve.

Multiculturalism is a central tenet of my clinical work as well as my work as a counselor educator. As an African American woman being trained in predominantly white settings, most of my clients [when I was] a trainee and in my early career were racially/ethnically and culturally different from me. But the client who stands out most was an African American woman in her mid-40s [who was] accessing care through a hospital-based trauma treatment program for abused and suicidal African American women. She had an extensive trauma history, which included a long history of sexual abuse and intimate partner violence. While she had extensive contact with health care providers in the past, she’d never had a health care provider who looked like her. Despite being racially, ethnically and even culturally similar [to me, her counselor], she expressed a desire and preference for a white-identified counselor.

Oftentimes, we limit our understanding of multiculturalism and cultural competence to working with those who are dissimilar. What this client highlighted for me was how people of color, race, culture, ethnicity and other social locations exist in a complicated relationship to the systemic oppressive forces of racism, sexism, classism, ableism, etc., experienced in the day-to-day lives of people of color. And sometimes you can’t disentangle them, and they create additional barriers to accessing care.

Fast-forward nearly a decade, and though the majority of my clients identify as African American, I am always intentional about exploring the racial and cultural similarities and differences [between myself and] all clients.

— Delishia Pittman is an LPC and a licensed psychologist in Washington, D.C., and director of the clinical mental health counseling program at George Washington University.


I work at one of the largest community colleges in the United States. We currently have about 65,000 students, and I work at one of the largest campuses. Our students are permitted to walk in for “counseling,” which is academic-based and similar to school counseling rather than mental health therapy. Our students are diverse in age, ability, learning, experience, race, nationality, language, citizenship and gender, just to name a few.

A simple request from a student to change their major puts my multicultural counseling and social justice skills [into] action. Very rarely is changing a major merely transactional, which is why it’s not a task that can be done by the student themselves. It requires coming in to meet with an adviser or counselor. [When this occurs], I want to have a conversation with the student about how they arrived at their program of study. As an immigrant, first-generation college student, and marginalized counselor, I’m aware of the environmental influences [that affected my choice of] my first major and how that evolved to my current career.

Most students at my college, but not all, are also first-generation college students, fully Pell [Grant] eligible (low socioeconomic status), immigrants, or first-generation Americans, which impacts their decision on what they should study. I ask what assessments they used, what they have learned about their major/career of choice, and what influences they have in their life to help them decide.

Since my students are so diverse and have so many intersecting identities, I never want to assume that they are also coming from a marginalized background. Some of my students are coming from a place of greater privilege than I had as a student or [have] even now as a professional.

Students sometimes confide that they are studying a major that does not interest them, and we investigate what is pressuring them to study that major, usually in science, technology, engineering or mathematics. I assess if the student has the privilege to change their major to their preferred major. This is important to understand, as not all students are in a place to choose. We assess if we can find additional resources, find integrative programs of study or minors to sneak into their curriculum, and I even offer my support to help advocate to their stakeholders about the possibility of changing their major. Regardless of whether they change majors or not, we come up with an academic plan.

I think it’s important for our profession to understand that in all types of counseling, even in school, career and vocational, where the work seems more transactional, there is an opportunity to implement our multicultural and social justice competencies. We must understand that our clients or students are diverse and have intersecting identities. They are influenced by family, culture, environment, media, peers and even our systems. We need to take all that into consideration to give them the best possible service.

— Margarita Martinez is an academic success counselor and curriculum chair for student development at Northern Virginia Community College. In addition, they serve as vice president for Latinx concerns for AMCD, as secretary for the Virginia Counselors Association, and as co-chair of the strategic plan committee for the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC).


As a black woman in a suburb of Georgia, I have had numerous clients contact me simply because I am black. Georgia is one of those states that is known for having been a part of the Confederacy and having many small cities that are still dangerous for people of color.

I live and work in what is statistically the most diverse city in Georgia. My county is considered one of the most diverse counties in the nation. I am learning more, now than ever, the differences between myself and those with whom I work. I’ve been in academia for about five years without seeing clients and assumed that when I [returned to counseling and] joined a group practice, I would be seeing the “worried well.” But issues surrounding racial trauma and perception are not as commonly addressed as some other daily worries.

I recall one client, a darker-skinned African American male in his early 60s. He’d lived through the civil rights movement in Georgia, retired from one career, and raised all of his children. However, he was experiencing distress because of the way people viewed him as a “large, black, heavy-voiced man.” He felt that whenever he wasn’t whispering, others would assume that he was mad and say that he was yelling.

He also felt that this view of him was useful in his previous career as a prison guard, but once he completed his degree and attempted to start his next career as an elementary school teacher, his colleagues (mostly white women) reported that he was “aggressive, loud and scary,” and his contract wasn’t renewed. This man had struggled to get out of poverty and earn a degree, and in the year 2019, [he] was still experiencing discrimination based on others’ unfair perception of intent. He also felt like his family was telling him to change who he was rather than understanding his predicament.

I understand that my African American experience does not necessarily mirror [that of] other African Americans. Essentially, the only things that my client and I had in common were that we were African American, heterosexual and Georgia residents. He was almost twice my age; I am not a first-generation college student and have not experienced living in poverty. Even with these cultural differences, I know what it is like to be unfairly described as aggressive.

In relation to multicultural competence, there is a lot of attention given to race, ethnicity, sexual orientation and identity. [Yet] there are so many other things that we must consider. The best course of action is to allow our clients to express which aspects of their culture they believe most affect their day-to-day lives. Never assume that [just] because you have one or two things in common, that you’re adequately prepared to address your client’s issues.

— Asha Dickerson is an LPC in Lilburn, Georgia, and a professor at Adler Graduate School. She also serves as AMCD’s Southern Region representative and as president-elect of ACA of Georgia.


Sharpening our multicultural competence requires that counselors enter the experience and suffering of those who are different from us. When we allow the other person to lead us into their unique reality, we may confront fear and anxiety. There is a chance that we may begin questioning our own values and worldview.

An example that comes to mind was an invitation made by a co-worker to join an initiation ritual from the religious tradition of Santeria [a religion brought to Cuba by slaves from western Africa and eventually to the United States by Cuban immigrants]. In this ceremony, my co-worker’s adolescent daughter was being inducted as a priestess. The ceremony was characterized by constant drumming, humming, walking in a circle, and minimal dialogue. Initially, I did not feel comfortable, as the ceremony was very different from my own religious tradition. In addition, I grew up listening to negative comments about santeros within my own culture.

After recognizing my fear of the unknown, I chose to gain knowledge about Santeria. This is a religion that helps its members gain balance and unity of the body, mind and spirit. The priest, or santero, invokes all sources of intelligence (conscious and unconscious, physical and metaphysical, individual and collective) in addressing [a person’s] suffering.

I rejoiced that my initial fear did not stop me from becoming better informed about this person’s religious beliefs [and the religion’s] ancient, holistic healing practices. By studying the ancestral beliefs of Santeria, I found much commonality between this African-based spirituality and modern counseling. Both traditions would like to empower clients in living with meaning and purpose. As [psychologist] Alberto Villoldo said, “Reclaim the courage of our ancestors, and bring that forward into the future.”

Multicultural competence is necessary when interacting with every client, not just clients of color. All clients are multifaceted and deserve that we honor their multiple dimensions of identity and how they shape their mental health and coping skills.

Multicultural competence is fundamental in establishing an effective relationship with our clients. It also invigorates and empowers us in developing a genuine relationship with our clients. It allows us to go beyond surface impressions and helps us discover the client’s deepest values, past and current sources of oppression/survival, and their hidden strengths so that they can creatively manage life’s challenges and opportunities.

— Maria del Carmen Rodriguez is an assistant professor in the Department of Counselor Education in the Nathan Weiss Graduate College at Kean University in New Jersey and president-elect-elect of the New Jersey Counseling Association.


In 1992, I moved from the Midwest and became a professor at Appalachian State University in Boone, North Carolina. Shortly after moving to the Appalachian Mountains, I became a volunteer counselor at the local health department and served in that role for 25 years. My clientele primarily consisted of women who had little opportunity for jobs or education and who experienced barriers of poverty such as [lack of] transportation. My typical clients were women who came from traditional Appalachian mountain culture and were raising children in single-parent families. Therefore, from the onset, my counseling was inherently a multicultural practice because it involved numerous cultural differences between me and my clients — educational, economic, spiritual, etc.

I needed to remember that the therapeutic alliance was critical and consider their cultural beliefs and values. Generally, I focused on welcoming clients and inviting hope. For example, at times I would ask when they had last eaten and made sure I offered them food and beverage before we started the counseling session. Specifically, through readings and professional consultations, I learned the following Appalachian values:

  • Egalitarianism: Be an authority without being authoritarian.
  • Personalism: Use simple, direct, honest, straightforward and respectful speech. Be accessible.
  • Familism: Remember that blood is thicker than water and family structure is resilient.
  • Religious worldview: Explore religion as a possible resource.
  • Sense of place: Explore how clients view being economically deprived [and their view of] the importance of land.
  • Avoidance of conflict: Be respectful toward clients.

However, I also needed to examine each client’s unique pattern of values. For example, one client explicitly stated that I could counsel her for depression, but I could never discuss her Christian religion with her because I was not a religious leader. We agreed to this limit and, over one year, successfully resolved her depression.

I found that multicultural competence is not a result of “magic formulas” or the use of “politically correct terms.” [Rather, it] requires adapting recommended standards to the individual client. Such adaptation within Appalachian culture included:

  • Listening to their story. Explore “Who are they?” Be in their story, and reserve judgment.
  • Being aware of client tendencies to be “street smart,” be dependent on systems due to poverty, and value survival at all costs.
  • Using subtle techniques such as stages of change to understand context, motivational interviewing to invite dialogue, and solution-focused brief therapy to provide practical solutions.
  • Introducing concepts long term. Revisit important concepts repeatedly.

Finally, I found I needed to be brave, risk making mistakes, and learn how to recover from mistakes. I needed to be cautious of being so politically correct that counseling stopped us from being human and real with each other and instead turned the process into an assembly line.

My clients needed me to always remain human, real and compassionate with them so they felt safe and cared for, thereby inviting a genuine, healing dialogue.

— Geri Miller is an LPC, supervisor, licensed psychologist and licensed clinical addictions specialist. She is a professor in the Human Development and Psychological Counseling Department (clinical mental health counseling track) at Appalachian State University.


As an Asian counselor and counselor educator who specializes in play therapy, working with clients who are from a culturally different background than my own happens regularly. Though this difference felt like a burden at first, now I appreciate the lens that I developed because of the intersectionality and complexity of each client’s cultural identity. This lens helps me cultivate my cultural humility, which embraces an interpersonal stance that is other-oriented and open to the other in relation to aspects of cultural identity.

I recall when I was at the beginning of my graduate program training in Texas and still in the beginning stage of my racial and cultural identity development, I experienced unsettling emotional reactions when child clients in play therapy bluntly commented on my appearance or accent such as “You talk funny”; “Are you from China?” [and] “You have black hair!” Because of the great supervision I received, in which I felt safe enough to explore my cultural identity, those reactions gradually dissipated, and I was able to be more fully present with children even when they made some cultural remarks.

I believe working with clients from various cultural backgrounds requires a counselor to have continued openness, self-refection, growth and development over time. Therefore, it requires absolute lifelong commitment from a counselor.

Recently, I began a project in collaboration with immigration lawyers to provide play therapy to unaccompanied and undocumented minors who are in the process of applying for asylum [in the United States]. Although I have extensive experience in providing play therapy to children with trauma and adverse experiences, I realized that I possessed limited knowledge on the historical and political context of some of the countries from which those clients came, particularly in the Northern Triangle of Central America, and on the ever-shifting immigration policies in the U.S. The actions that I am partaking in to educate myself to gain more knowledge in those areas are reading, taking webinars/workshops on immigration policies, joining a state-level immigration emergency action group, and consulting immigration lawyers and paralegals in this project.

I work for a university which is a Hispanic-serving institution and where the majority of the students hold a minority status. I love dedicating my time to conversations with my graduate students from those [Central American] countries and being educated by them about their cultures. Those conversations have helped me be a more culturally informed counselor and counselor educator.

In addition, I have been fortunate in learning from professionals outside of the counseling field who are also providing services to clients with diverse backgrounds. This provides me with a more holistic sense of my clients’ strengths and struggles. I hope collaborative work beyond the boundaries of separate professions becomes more common.

— Yumiko Ogawa is an LPC, counselor supervisor, play therapist supervisor, and associate professor at New Jersey City University.


As many before have said, multicultural competence is an ongoing endeavor. Much of the work
is subtle and nuanced. Many counselors are eager to try out their newly learned advocacy skills. When counselors who hold dominant identities work with minoritized populations, advocacy without self-awareness can cause harm. Actions should not replace deep personal, introspective, multicultural work.

Often, counselors are not aware when clients or students do not regard them as a safe or affirming person. Clients or students may not pursue a counselor’s services if they hear from members of their own cultural groups and communities that the counselor has been unaffirming or has avoided discussing important aspects of a client’s or student’s race, culture or identity. Clients or students may come increasingly late to sessions, cancel, or terminate early without giving a reason. Counselors can brush [this] off or identify an alternative explanation for these occurrences, but these situations may indicate that counselors need more work on developing their own multicultural competence.

Counselors should also consider which clients they tend to have an easier rapport with and which they do not and reflect upon the reasons. We need to move away from intellectual understandings of racism, sexism, classism, ableism, transphobia, etc., and move toward considering how these injustices show up in our lives. For instance, cisgender counselors might ask themselves, “How might I be making my transgender client/student feel invisible by subtly avoiding discussing their trans identity, or am I focusing too much on their trans identity and not listening to their presenting concerns?”

Excelling at wielding social justice language is not a substitute for making authentic connections and fostering ongoing relationships with individuals who hold different identities and life experiences. These relationships outside the office can help counselors connect better with their clients and students.

— Rafe McCullough is an LPC, a licensed professional school counselor, and an assistant professor at Lewis & Clark College in Portland, Oregon. He was a member of the AMCD committee that developed the Multicultural and Social Justice Counseling Competencies endorsed by ACA.


As a visibly identifiable Muslim woman, cultural differences in religious and spiritual practice come into my work in different ways. While some practitioners might choose not to disclose and broach their faith, my hijab serves as an indicator of my religious practice. What this often means is that clients make assumptions about who I am, what I believe, my level of religiosity, and how I practice based on their expectations of who I might be as a Muslim counselor and what society has taught them about my religion.

I can remember a time when I picked up a client assigned to my caseload from the waiting area. I introduced myself briefly in the main lobby and walked her to my private counseling office. As soon as we sat down, before I had a chance to say anything, she looked at me and said, “This isn’t going to work. I’m a very Christian lady, and I’m not going to work with a Muslim.” Because of the personal awareness work that I do as a clinician, I was able to notice and acknowledge my personal reactions and respond appropriately. For example, a few of those immediate reactions and assumptions were:

  • “This client has no idea who I am or how I practice.”
  • “I’m so tired of having to defend my faith and undo the unjust and vilifying narratives of Muslims in the media.”
  • “People who look like her have oppressed people who look like me. I wonder if I’m safe in this room.”
  • “She might feel unsafe in this room because of who she believes I might be.”

Through my personal work and practice of multicultural concepts of awareness, I was able to ground myself and attend to the client. [I reminded] myself that although such an incident may trigger some of my own trauma experiences as a black Muslim woman in a society that attempts to diminish people who look like me, my role in this counseling space was to prioritize the wellness of my client — and to do so with compassion and unconditional empathy and regard. I reminded myself that although she had made some assumptions about me, I had made assumptions about her based on my worldview as well.

Multicultural competence doesn’t just happen naturally. It isn’t something I just choose to have in a moment because it seems relevant. It’s a constant practice and requires deep reflection, critical insight, and a willingness to engage in developing my personal awareness and taking the needed actions to make sure that when I’m in the privileged role of counselor, my clients are valued, honored and respected. That was a very difficult process early on as a beginning counselor with many marginalized identities and experiences that can be triggered by some of the beliefs that my clients hold about me. It’s hard work.

But because of that continuous process of reflection and my own personal work, I was able to hear this client say that she couldn’t work with me because of my faith, and respond by compassionately broaching differences in our cultural identities and allowing her space to share her worldview.

I have had many clients see my hijab and tell me that they can’t work with me because of it, but they all decide to continue working with me after spending our first hour together. I came to realize over time that being a counselor with a cultural identity different than the majority culture was a subtle but powerful form of advocacy. I have been able to build deep, trusting relationships with individuals who had never had a personal interaction with someone who identifies as Muslim. [I] challenged their biases about who Muslims are simply by doing my job and putting in the time and effort to develop my awareness as a clinician.

My visible indicator of religion has also come up many times in various other ways with clients. For example, I have learned that clients who similarly identify as Muslim may also have hesitations about working with me because my hijab serves as an indicator of some form of religiosity that has negatively impacted them in some way. I learned, for instance, the importance of intentionally broaching when working with clients with LGBTQ+ identities because of my knowledge of the oppression and trauma they may have faced specific to religion and the intersection of their cultural identities. For one of my past clients, for example, seeing my hijab for the first time at intake served as a trigger for the trauma [the individual had] experienced in their religious community, and it made them hesitant to work with me. I wouldn’t have known that if I hadn’t taken the time to broach with them.

While some counselors may choose not to broach their religious identities, my practice of wearing a hijab changes that. My role as a competent counselor is to make sure that my clients are empowered and affirmed in their identities when working with me, and that can’t happen if I’m not willing to put the knowledge and awareness that I have into action. I’ve had to recognize how my intersectional privileged and marginalized identities influence the counseling process and take the steps needed to do justice to my clients.

— Zobaida Laota is an LPC associate in North Carolina who recently completed a doctorate in counseling and counselor education at the University of North Carolina at Greensboro.


I think there is value in reading and studying about various cultures, but I think it is more effective when supplemented by building relationships, exploring new insights with colleagues, and engaging in cultural immersion experiences. Learning through relationships and engaging directly in a new culture provide a more authentic experience [for] gaining awareness, sensitivity, knowledge and appreciation.

One specific example from my own journey as a school counselor [who is white] involved seeking out a colleague from Iran to help me understand more about the culture of a student who had just moved to the United States from her country of origin [also in the Middle East]. Being aware that I needed more information about my student’s background (religion, country of origin) and [was] out of my comfort zone, my colleague provided new insights about her [own] faith, life experiences, and the impact of world events/discrimination that provided me a glimpse into her worldview. Although this student’s experience was not identical to my colleague’s, [my colleague’s] knowledge of common experiences, values and cultural strengths provided me needed insights to support this student in a culturally sensitive way.

Other ways that I gain knowledge, awareness and skills include attending counseling conference sessions focused on multicultural counseling topics. Having the opportunity to learn from other colleagues, reflect on my own biases, and explore multiple perspectives has been invaluable in my own development as a counselor. There is also tremendous value in participating in advocacy and social justice efforts with those directly impacted by discrimination, racism and injustice.

Multicultural competence is a lifelong journey. Staying aware of how we are feeling in uncomfortable moments and identifying new blind spots that highlight our personal biases are necessary in our work as counselors. If we begin to adopt a mindset that we are “experts” and have achieved multicultural competence, I fear we will overestimate our competence and not strive for new understanding, which is a disservice to our clients.

I think we have to work diligently and intentionally to seek out supervision, consultation and mentoring from colleagues of various cultural backgrounds. There is value in surrounding yourself with colleagues who can provide different perspectives and identify, as well as challenge, blind spots. I think we sometimes underestimate the value of having a network of diverse colleagues who can keep us honest and challenge us when needed.

— Kimberlee Ratliff is an LMHC and certified school counselor in Washington state, a professor in the American Public University System, and an adjunct faculty member at the University of Puget Sound and the City University of Seattle.



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:

ACA Code of Ethics (counseling.org/knowledge-center/ethics)

ACA-endorsed competencies (counseling.org/knowledge-center/competencies)

  • Multicultural and Social Justice Counseling Competencies
  • Competencies for Counseling the Multiracial Population
  • ALGBTIC Competencies for Counseling LGBQIQA Individuals
  • ALGBTIC Competencies for Counseling Transgender Clients
  • American Rehabilitation Counseling Association Disability-Related Counseling Competencies

Books (counseling.org/publications/bookstore)

  • Multicultural Issues in Counseling: New Approaches to Diversity, Fifth Edition, edited by Courtland C. Lee
  • Counseling for Multiculturalism and Social Justice by Manivong J. Ratts and Paul B. Pedersen
  • Understanding People in Context: The Ecological Perspective in Counseling edited by Ellen P. Cook
  • Experiential Activities for Teaching Multicultural Competence in Counseling edited by Mark Pope, Joseph S. Pangelinan and Angela D. Coker
  • Counseling for Social Justice, Third Edition, edited by Courtland C. Lee

Counseling Today (ct.counseling.org)



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

Letters to the editor: ct@counseling.org



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

Counseling survivors of sexual violence

By Amy E. Duffy November 4, 2019

After spending more than 14 years in the mental health field working with a variety of populations, including gang-affiliated youth, adults with chronic and persistent mental illnesses, combat veterans, and survivors of human trafficking, I am struck with an inescapable theme: Sexual violence plagues every facet of society. Sexual violence does not discriminate, regardless of demographics.

As a counselor, I entered this field to become a helper and to become a part of something bigger than myself. Fred Rogers could not have said it any better: “Look for the helpers. You will always find people who are helping.” This sentiment still rings true in my heart, but one thing the mental health field has shown me is that helping sometimes requires us to combat the systemic and institutionalized injustices that are prevalent in our society.

I recently found myself in a counseling session with a college-age cisgender female who was displaying feelings of hopelessness, crying profusely, and asking me “Why?” She was directly asking me why — after her sexual assault and after exercising every legal right available to her — the system was failing her. I was apologetic for her experience, but I found myself at a loss for words. She was correct; the system was failing her. Our society and our legal system have justice gaps that are expansive. I couldn’t think of an answer I could provide in that moment that would address her feelings of hopelessness.

In subsequent months, as I became aware of similar scenarios playing out with other clients, I began to feel both compassion fatigue and burnout begin to take root. As I’ve mentioned, my intention as a counselor is to help, and I felt that I was not helping enough. I know trauma and its associated treatment modalities like the back of my hand, but that didn’t mean I was doing my part to address the gaps in justice or systemic and institutionalized inequalities that were drastically affecting my clients and their shared experience with sexual violence.

Professional counselors cannot ignore the reality that 1 in 3 women and 1 in 6 men report some form of sexual violence over the course of their lifetimes (according to the National Intimate Partner and Sexual Violence Survey 2010-2012 state report). The Thomson Reuters Foundation conducted a survey in 2018 that concluded that the United States was the 10th most dangerous country for women among the 193 member states of the United Nations; it tied for third among nations where women were most at risk for sexual violence. The foundation defined sexual violence as “rape as a weapon of war; domestic rape; rape by a stranger; the lack of access to justice in rape cases; sexual harassment; and coercion into sex as a form of corruption.” Unfortunately, I have personally borne witness to each of these definitions of sexual violence while working in the mental health and counseling fields.

Given the epidemic of sexual violence, both domestically and globally, it is impossible for counselors to avoid contact with individuals who have survived such violence. To date, counselor education programs do not have a reputation for providing an adequate and thorough understanding of practices for working with this population in their curricula. In addition, progress in the field of sexual violence has been negligible, partially due to the significant gaps in research necessary to better inform prevention, policy and advocacy efforts. These absences of vital counseling resources triggered my desire to explore the Multicultural and Social Justice Counseling Competencies (MSJCC) in search of a plausible answer to this dilemma.


The MSJCC, developed by Manivong Ratts, Anneliese Singh, Sylvia Nassar-McMillan, S. Kent Butler, and Julian Rafferty McCullough, recognize that individuals are part of a larger ecosystem in which privilege and marginalization coexist. The MSJCC provide a framework to best support survivors of sexual violence not simply on the intrapersonal level, as addressed within treatment models and counseling strategies, but on all socio-ecological levels, through advocacy and action. The MSJCC emphasize the importance of understanding individuals in the context of their social environment while advocating for social justice within that social environment.

In addition, the MSJCC framework acknowledges the need for understanding the complexities of diversity and multiculturalism within the counseling relationship, as well as recognizing the negative influence of oppression on mental health and overall well-being. This framework reinforces the need for counselors to recognize and uphold the reality of intersectionality, in which the various social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability contribute to a client’s unique worldview, experience and existence as a human being.

When counselors partner with survivors of sexual violence, both the counselor and the client need to recognize the roles that privilege and marginalization play in sexual violence and within the counseling relationship. Effective treatment and long-term healing cannot exist without this mutual understanding. The reality is that victim-blaming, rape myths and gender inequality are persistent elements in American culture and globally; these cultural characteristics constitute what is known as rape culture. Victim-blaming is the extent to which society holds victims of sexual violence responsible for their own victimization, whereas rape myths are stereotyped false beliefs regarding rape, survivors and perpetrators.

Within rape culture, the survivor is marginalized while the perpetrator is privileged, most commonly due to gender. The privilege of gender is then further extended and embedded into society within systems and institutions that protect the perpetrator. These systems and institutions are built upon the foundations of victim-blaming, rape myths, and gender inequality. For example, states such as North Carolina still have laws that blame the victim and support rape myths. These laws include the inability of a person to withdraw their consent to engage in sexual intercourse once consent has been provided. In addition, a person who voluntarily consumes alcohol and then is sexually assaulted is not protected under North Carolina criminal law because of the fact that they voluntarily incapacitated themselves.

Sexual violence is a gender-based violent act. Approximately 91% of sexual violence survivors are women, whereas roughly 9% are men (according to U.S. Department of Justice statistics on rape and sexual assault for 1992-2000). Each of these individuals has been violated in a perpetrator’s effort to oppress and exert power over the survivor. Within the counseling relationship, the counselor and client need to explore the perceived and actual characteristics of their respective marginalized and privileged statuses relative to the issue of sexual violence and in the full context of the intersectionalities described earlier.

Although toxic masculinity may be a newer term in our culture, the constructs associated with it have historically been interwoven into American culture and should be taken into account when applying the MSJCC framework with survivors of sexual violence. Toxic masculinity describes the rigid characteristics and attitudes that are often (falsely) associated with what it means to “be a man.” These characteristics include strength, violence, sex, power, and an absence of emotion and vulnerability. Toxic masculinity perpetuates sexual violence directed not only toward women but also toward men. Understanding the gender-based nature of sexual violence and social constructs such as toxic masculinity, it is vital for counselors to fully embrace the MSJCC framework and the ways in which it relates to survivors of sexual violence.

In my clinical opinion, a counselor should not enter the counseling relationship without fully understanding and accepting the reality that in American culture, 25% to 35% of people endorse rape myth acceptance and therefore engage in victim-blaming and the perpetuation of gender inequality. Counselors should also understand and accept that toxic masculinity is, in fact, a deficit for all genders. This understanding and acceptance is a component of counselor self-awareness within the MSJCC framework. Counselors must become aware of their own attitudes, beliefs and biases pertaining to sexual violence prior to engaging in a counseling relationship with survivors of sexual violence.

The MSJCC require ongoing self-awareness and personal reflection regarding the beliefs, values and biases possessed by the counselor. This is particularly important when working with survivors of sexual violence because of the socialized cultural beliefs to which all counselors have been exposed. If counselors have not adequately addressed their potential beliefs, values and biases, it can result in bolstering shame among survivors of sexual violence.

Expanding the role of the counselor

A primary concept of the MSJCC is the expansion of the counselor’s role. This expanded role is essential when working with survivors of sexual violence. Traditionally, the counseling process has occurred within the confines of an office setting and on the proverbial therapy couch. That scenario has never been adequate when addressing the needs of those who have experienced sexual violence and thus is long overdue for modification. With the inception of the MSJCC, counselors have a framework for expanding on their traditional role to provide best practices in the presence of a profound gap in justice for their clients. 

Social justice advocacy conducted within the MSJCC framework allows counselors to work at the intrapersonal, interpersonal, institutional, community, public policy, and international/global levels to address the systemic obstacles affecting survivors of sexual violence. In the remainder of this article, I will provide a hypothetical case conceptualization (representing a composite of numerous actual cases) to illustrate this multilayered application of the MSJCC framework by a counselor working with a survivor of sexual violence.

Counselor self-awareness: Beliefs, values, biases

The counselor identifies as Christian, is supportive of homosexuality and same-sex marriage, and opposes marital rape, recognizing that nonconsensual sex within a marriage is, in fact, rape. The counselor recognizes the value in people waiting until marriage to engage in sexual intercourse but believes that imposing this standard on others can inadvertently create significant pressure and shame, particularly if someone is then exposed to sexual violence. The counselor believes sexual intercourse should be between consenting persons who provide affirmative consent (with affirmative consent being defined as the presence of yes means yes rather than simply no means no).

The counselor also believes there is no place for aggression or violence within sexual intercourse. The counselor attributes this aggressive mindset in part to the prevalence of pornography, in which close to 90% of sexual acts include aggression against women (according to the 2010 article “Aggression and Sexual Behavior in Best-Selling Pornography Videos: A Content Analysis Update,” published in the journal Violence Against Women). The counselor believes that sexual violence is about power, control and dominance rather than a perpetrator’s elevated drive for sex or inability to control temptation, and that the latter beliefs reinforce rape myths and victim-blaming. The counselor also recognizes and opposes gender inequality in all spheres of life, including the sexual double standard that exists between men and women. The counselor has had consenting partners throughout her life span and has survived sexual violence twice.

The counselor has explored the antecedents to rape culture to identify her own experiences with these antecedents as well as with associated beliefs, values and biases. The counselor is opposed to traditional gender roles and finds them to be oppressive for all genders. The counselor believes that gender and gender roles should be fluid and not rigid and attributes this belief to being raised in a home where traditional gender roles were not always strictly enforced.

Regarding adversarial sexual beliefs and hostility toward women, the counselor recognizes her personal history of strained relationships with prominent female figures as a child, as well as significant “girl drama” during pre-adolescent and adolescent development. Historically, the counselor has interacted better with males and has had periods of doubting women. Regarding the acceptance of interpersonal violence, the counselor believes in standing up for one’s self, even if that means taking physical action. The counselor supports the Second Amendment but believes gun control is not adequate at this time. The counselor has historically enjoyed action movies but has recently begun exploring violence in the media.

To further understand how the counselor’s beliefs, values and biases could affect the counseling relationship when working with survivors of sexual violence, the counselor completed the Illinois Rape Myth Acceptance Scale (IRMA) and scored a 108 out of 110, indicating greater rejection of rape myths. The counselor also recognizes that this score is not reflective of the counselor’s lifelong involvement with rape myth acceptance and is aware of historically faulty thinking as an adolescent and young adult. The counselor acknowledges that self-reflection and development have contributed to her current IRMA score.

Privilege, marginalization and intersectionality

The counselor also examines the ways in which privilege and marginalization interact within the counseling relationship. The counselor is privileged due to being white, middle class, heterosexual and Christian, and having had the opportunity to obtain a higher level of education, whereas the counselor is marginalized for being a woman.

The client in this case conceptualization is privileged due to being heterosexual and Christian, whereas the client is marginalized for being a black woman of lower socioeconomic means who has not been afforded the opportunity to complete her education to date.

The counselor identifies the MSJCC quadrant of privileged counselor-marginalized client as the most appropriate to describe the counseling relationship. The counselor is also aware, however, that this is the counselor’s own perception of privilege and marginalization within the counseling relationship and that the client may have a different perception.

The socio-ecological model

The counselor begins at the intrapersonal level by sharing her worldview (as previously described) and bearing witness to the client’s worldview. The beliefs, values and biases of both parties are explored. Intersectionality is a main component within the intrapersonal level, with the social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability being explored by both the counselor and the client.

The counselor and the client also have an open discussion about privilege and marginalization, including the ways that they may enrich or create obstacles within the counseling relationship. For instance, both the counselor and the client have a shared experience and openly process their experiences of gender inequality and being discriminated against for being women. At the same time, the counselor openly recognizes the existence of white privilege and verbally acknowledges that her race has not made her life more difficult. The counselor also honors the specific incidences of racism that the client has experienced and is openly willing to share with the counselor.

At the intrapersonal level, the counselor and the client also discuss and process the client’s experiences with self-blame, victim-blaming, and rape myth acceptance. The client shares self-blaming beliefs such as, “I should not have gone out that night” and “I never should have had those drinks.” The client also shares victim-blaming attitudes that others have projected onto her, including how the client’s clothing was too revealing and how she could have been more assertive in her denial to engage in sexual intercourse.

Following the exploration at the intrapersonal level, the counselor begins to support the client at the interpersonal, institutional, community, public policy and international/global levels. At the interpersonal level, the counselor assists the client in exploring her various relationships and identifying a healthy social support network consisting of family, friends, neighbors and co-workers. During this time, the counselor also assists the client in implementing appropriate boundaries within those relationships that have been identified as being unhealthy or unsupportive. The client determines that several familial relationships are unsupportive due to significant victim-blaming attitudes and the demonstration of rape myth acceptance. The client then gives the counselor permission to provide psychoeducation regarding victim-blaming and rape myth acceptance to these family members and to challenge their beliefs that are further victimizing the client.

The family members resist the psychoeducation and continue to engage in victim-blaming and rape myth acceptance. Therefore, the client decides to implement boundaries to appropriately distance herself from these relationships. The client then makes an intentional effort to widen her social network by connecting with other friends and family members. After visiting a shared interest group with the counselor, the client decides to join the group in hopes of also making new friends.

At the institutional level, the counselor and the client begin to explore the social institutions with which the client is associated. During a session, the client shares that she has observed sexual harassment in her workplace and expresses concern that she will continue to be exposed to these interactions. With the client’s permission, the counselor reaches out to the employer and offers to provide an organizational training to the entire staff on sexual harassment and gender inequality in the workplace.

The client also shares that she has been a member of her church for more than a decade. She is finding it increasingly difficult to attend regularly, however, because of the feelings of shame associated with the church’s message regarding purity. The client also shares her perception that the church displays rape myth acceptance frequently during its teachings. With the client’s permission, the counselor reaches out to explore the possibility of meeting with church leaders about their own rape myth acceptance tendencies and to develop a plan with church leaders to provide a more supportive environment for survivors of sexual violence. Furthermore, the counselor uses this experience to develop a program to help all community churches create safe places for survivors of sexual violence.

The counselor’s work does not stop here. As an active member of the community, the counselor has various opportunities to address norms at the community level. For instance, when processing at the intrapersonal level, the client shared her experience with racism, disclosing that she often felt unheard during her school years and was frequently passed over when her hand was raised to contribute to class discussions. Instead, she received discipline referrals for speaking out of turn and being disruptive. The counselor validates the client’s experience with microaggressions and acknowledges this display of racism. The counselor then assists the client in connecting with a community volunteer opportunity in which the client will be tutoring school-age minority females. This gives the client an opportunity to empower not only herself but minority female youth as well.

The counselor also notices that the community has limited events to raise awareness about sexual violence, suggesting that the topic is unimportant, taboo, or not considered to be an issue within the community. With that in mind, the counselor decides to organize a committee of other counselors to coordinate an annual Take Back the Night event. The hope is to engage the community more on the topic and to create a new community norm of open discussion regarding sexual violence.

The public policy level is most closely associated with the gap in justice witnessed by survivors of sexual violence. For that reason, the counselor is intentional about making action at this level a priority. The counselor becomes knowledgeable about state and federal laws that affect survivors of sexual violence and openly shares this information with the client. The counselor attends public forums on the topic and provides expert testimony regarding the need for improved laws that protect survivors. The counselor also meets with state legislators to discuss how laws that reinforce victim-blaming and rape myth acceptance affect survivors of sexual violence and the communities in which they live.

At times, the counselor challenges the language used in sexual violence legal cases, including questions such as “What actions did you take to prevent the alleged sexual assault?” and statements such as “The victim chose to stay.” The counselor does this by reframing these retraumatizing questions and statements to be trauma-informed. In these instances, the counselor reinforces the truth that survivors cannot prevent their sexual assault from happening, nor does one’s decision to be in a specific environment suggest that survivors are responsible for being assaulted.

Similar to the public policy level, the international/global level requires the counselor to take action outside of the office and, at times, behind the scenes. The counselor educates herself on gender inequality on a global level, including human trafficking, farming disparities between men and women, unequal labor wages, lack of education for females, immigration, and child marriage. The counselor joins organizations that address these various topics, which have both direct and indirect associations with sexual violence. The counselor then disperses information on these topics on a blog linked to her website. Finally, the counselor participates in specialized training to complete immigration assessments for those seeking asylum in the United States and those hoping to gain access to their afforded protections under the Violence Against Women Act.


Sexual violence is epidemic in contemporary society. This epidemic is largely fostered by the prevailing rape culture in the United States and worldwide. Thus, it is highly likely that counselors will encounter survivors throughout their careers across a wide range of clientele. This article provides relevant background information on sexual violence and victimization, along with an application of the MSJCC, to promote a deeper understanding of sexual violence and to detail a promising framework for counseling and advocating for these survivors.




Amy E. Duffy is a licensed professional counselor supervisor specializing in trauma and working in private practice in Raleigh, North Carolina. She is currently pursuing her doctoral degree at North Carolina State University, where she is studying gender inequality and sexual violence in her dissertation research. Contact her at amyeduffylpc@gmail.com or HarborBehavioralHealth.com.

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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.




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.