Chapter 13 - Counseling Diverse Clients

Chapter 13

Counseling Diverse Clients

© 2015. Cengage Learning. All rights reserved.

Same Skills, Different People

• The same counseling skills are used with women as with men, just adapted differently; the same theories of change apply to the physically handicapped as to the athlete but with certain modifications.

• Depression or anxiety may not feel qualitatively different to a Latino, African American, or white person but may be expressed quite differently.


Same Skills, Different People

• Group dynamics operate in similar ways in groups of children, middle-aged adults, and older adults, but with significant differences.

• Gay men and lesbian women feel loneliness, frustration, or anger just as do heterosexuals.

• The delinquent, disabled, or drug-addicted clients all respond to empathy, confrontation, and other therapeutic strategies, depending on the counselor’s finesse and sensitivity.


Your Cultural Responsibility

1) examine and explore your own cultural identity 2) educate yourself as completely as you can about

the cultural context for each client’s experience3) learn about the effects of oppression on minority

and disadvantaged groups4) acknowledge and confront your biases and

prejudices with regard to particular groups5) adapt all your counseling knowledge and skills in

such a way that you can help diverse clientele. © 2015. Cengage Learning.

All rights reserved.

Influences of Culture

• Each person is not only strongly influenced by his or her ethnic/racial background but also the culture of his or her gender, religion, socioeconomic class, geographical location, first language, sexual orientation, political affiliation, profession, and similar identities.


What To Ask Clients

• What would be helpful for me to know about you in terms of your cultural background?

• What are some of the groups with which you most closely identify?

• What is it that I need to know in order to understand where you come from and what is most important to you?


Qualities of a Culturally Sensitive Counselor

• Arredondo, 1999; Baruth & Manning, 2012; Lum, 2010; Robinson-Wood, 2014:

• They embrace the concept of cultural pluralism and are extremely committed to learning all they can about racial/ethnic groups different from their own.

• They are aware of how their own ethnicity and cultural backgrounds influence their own values, behavior, and professional practice.



• They realize the extent to which they are not only enriched but also limited by their own ethnic and cultural heritage, a circumstance that can be remedied only through greater openness to new experiences.



• They have developed a perspective in which each person is seen as a unique individual with values that have been influenced by the cultural context of the environment in which he or she was raised.

• They are extremely flexible and eclectic in the ways they work with people, depending on where the client comes from and what he or she needs.


Qualities Continued

• They recognize the influence of cultural background on a client’s concepts of power, growth, time, solution, and other terms that are part of the counseling vernacular.

• They are relatively free of prejudices and biases that tend to stereotype people and free of the ignorant or patronizing attitudes that tend to alienate them. They also acknowledge that this is always a work in progress since we can never be completely bias free.


Qualities Continued

• They are aware of and sensitive to the client’s worldview and work to clarify it and understand it in assessment, diagnosis, and treatment selection.

• They view their professional roles as not only to help their assigned clients but also to take a stand against oppression against marginalized groups.


Are you biased?

• Of course you are, especially if you consider that a bias is a kind of preference based on prior experiences.

• How do you define happiness? • How would you describe a psychologically

healthy person?


Are you biased?

• Your answers to most questions about human behavior, religion, philosophy, or health are rooted in your worldview.

• Is it your job to convince the indigenous client that his depression is not caused by demonic spirits but rather by his irrational belief system? Do you think that if you confronted the client about his ideas he would come back for a second session?


The “Right Way”

• Problems with biases and prejudices arise when we are intolerant about people’s differences. When we adamantly adhere to the notion that our way is the “right” way—whereas others are wrong, corrupt, or naive—we exhibit a rigidity that can only be destructive to our relationships with those unlike us.


The “Right Way”

• In one sense, biases and prejudices are the most natural thing in the world. Throughout history, human beings have been notoriously intolerant of others who are not of their “tribe” and have killed one another with abandon.


Identity Issues

• How would you describe your own cultural identity? Are you a woman, a man, Latino, white, African American, gay, Southerner, or Methodist? Or are you a gay Hispanic man, an African American woman? If you are white, what does that mean to you? Are your European roots especially important to you? What would a counselor need to know and understand about your cultural identity in order to be helpful to you?


Be Honest With Your Biases

• Everyone is a racist; and everyone has biases and prejudices toward others. What we mean is that you prefer to hang out with folks who are “like me” and avoid people who are “not like me.” These are people who are part of your “tribe,” your identified peer group. This may not be based on skin color, or religious preference, but it is certainly based on shared interests, values, and preferences.


Why It is Important To Clients

• Confronting your prejudices and biases is an important component of your counselor training. You can do great damage to clients who may already be feeling somewhat vulnerable and insecure. If they sense and feel your critical judgments of them (and these are very hard to hide), it may further erode their already fragile self-esteem.


Social Justice

• Proponents of social justice counseling argue that the role of the counselor includes not only empowering your clients on a psychological level but also actively confronting the social injustices and inequalities that impact your client’s well-being (Kottler, Englar-Carlson, & Carlson, 2012).


Social Justice

• To be a counselor means to be an active advocate for those clients whose individual aspirations and access to economic resources have been restricted by the dominant culture (Pieterse et al., 2009).


Advocacy Competence

• Client/Student Empowerment. Counselors help clients and students recognize their strengths and learn how to advocate for themselves.

• Client/Student Advocacy. Counselors work with community agencies, community leaders, and school authorities to provide resources and support for clients.


Advocacy Continued

• Community Collaboration. Counselors can use their listening skills to facilitate collaboration among community groups. For example, a counselor helping a child being bullied because of his minority status might bring together school and local leaders, help them identify their common goals, and lead a discussion on how to prevent bullying.


Advocacy Continued

• Systems Advocacy. This competency recognizes that institutions can be resistant to change and suggests counselors use their training in addressing client’s resistance in therapy to address systemic resistance at a school or community level. This might include empathizing with local leaders’ concerns and guiding them towards an action plan that would initiate change at a systemic level.


Examples of Advocacy

• Fred Bemak and Rita Chung launched “Counselors Across Borders” to recruit practitioners to help with trauma issues after catastrophic events and natural disasters.

• Cirecie West-Olatunji recruited some of her students and supervisees to begin a community engagement project in New Orleans, before Hurricane Katrina brought so much attention to the poverty and neglect in certain areas.


Examples of Advocacy

• Gerald Monk secured large grants to address issues of poverty in a multiethnic community in San Diego.

• Selma Yznaga started the Buena Vida community project in Brownsville, Texas, when it was brought to her attention that two-thirds of the residents were living below the poverty line.


More Advocacy Examples

• Sharon Bethea has devoted a lot of her discretionary time working with families in inner-city neighborhoods, developing an “African-centered” social justice counseling model that could be applied to a variety of communities with at-risk youth.



• Cyrus Ellis, a veteran of the Army, found a cause dear to his heart assisting returning soldiers from Afghanistan and their families who were experiencing significant reentry problems.



• Jamila Codrington has specialized in working with African descended women, focusing on issues that resonate with her own personal history growing up in a community with rampant street violence and poverty, yet also incredibly rich in artistic and creative expression.


Your Role

1) find a cause dear to your heart, one that involves both personal passion and professional interest;

2) recruit like-minded individuals to join the mission, providing mutual support, collaboration, and added resources;


Your Role

3) immerse yourself in the culture of the target population, bringing humility and a position of “not-knowing” into the context, deferring to elders and clients as experts on their own experience just as we would do in therapy;

4) adjust, adapt, and invent what we know as counselors to other helping contexts in local and global communities;


Your Role

5) start a project that you are willing to sustain over time, building ongoing relationships that will make the efforts endure over time;

6) think way outside of the box of what is possible and the best way to do things.


Counseling Women

• Though women are not definable as a minority group, they have been subjected to similar marginalization, discrimination, and prejudice that minorities have experienced.

• Most positions of power and influence have been controlled by men.

• Inequalities still exist in many sectors.


Diagnosis Overload

• Women are more likely than men to be diagnosed with major depression, and when they are depressed, they stay depressed longer.

• women who feel powerless, ignored, abused, and neglected in their lives. Eriksen and Kress (2008) noted that women are more likely than men to be diagnosed as suffering from dependent and histrionic personality disorders.


Diagnosis Overload

• Research evidence has found a sex bias in the diagnosis of border-line personality disorder, which is characterized by emotional volatility (Boggs et al., 2005).

• Horsfall (2001) observed that the criteria for these and other disorders in which women predominate are caricatures of traditional female roles—that is, diagnoses that describe women who are overconforming in their efforts to satisfy gender stereotypes.


Diagnosis Overload

• Favorite labels include such terms as hysterical, passive-dependent, and anorexic, which all describe the symptoms of a woman trying too hard to be subordinate, emotional, dependent, and skinny.


Eating Disorders

• Women strive to fulfill some ideal concept of how they should look and in the process often develop distorted images of their body and poor self-concepts.

• Adolescent girls are particularly vulnerable to this eating disorder, which is reinforced when parents, teachers, and sports coaches encourage them to lose weight (Behar, 2006).


Eating Disorders

• Bulimia, or compulsive food gorging, is another way women ruin their bodies through abusive eating habits, often the consequence of rejection and a poor self-concept.

• Eating disorders have proven to be highly challenging to treat effectively; cognitive behavioral, psychodynamic, family systems, and group modalities have all been adapted.


Feminist Approach

• A client’s tendency to suppress anger in favor of the more socially acceptable feminine responses like sadness or forgiveness; her angry feelings would be normalized and validated, and, together, counselor and client might discuss how socialization forces taught her to dismiss her authentic feelings.


Feminist Approach

• Interventions like assertiveness training, self-defense classes, and psychoeducation about handling finances might also be used to help clients practice newly discovered feelings of empowerment in real-world situations (Sharf, 2012).


Relational Cultural Therapy

• RCT counselors believe that relationships are an essential component of people’s existence and that women’s natural growth is toward connection and mutuality rather than autonomy and self-reliance.

• Counselors using this model emphasize an empathic counseling relationship, in which counselors explore women’s past history of painful disconnections and reflect their yearnings for more fulfilling relationships.


Women As Victims

• Women who live in impoverished conditions are unable to gain access to such support systems as child care, health care, and counseling, so they are more likely to develop serious problems before they receive help.


Women As Victims

• Although women are frequent victims of domestic violence, they are reluctant to reveal their experiences or seek help, in part because victims fear they will be judged and criticized for participating in an abusive relationship (Fugate, Landis, Riordan, Naureckas, & Engel, 2005).


Women As Victims

• Women who survive an abusive relationship often experience grief, depression, and a sense of guilt and shame. The family is not a safeguard against violence for women because violent incidents directed toward women often involve family members.


Counseling Men

• Men usually come to counseling because they are in a crisis state and, frequently, because someone else has pushed them into it.

• Regardless of the reason for a man’s getting psychological help, counselors need to be sensitive to the particular issues men face arising out of their socialization experiences.


Counseling Men

• Men learned throughout their childhood to avoid any experience that might feel “feminine” to them.

• With men counseling requires the self-disclosure of vulnerable feelings, the admission of needing help from others, and openness to forming an intimate relationship with a counselor.


Male Cultural Roles

• “The Sturdy Oak” • “Give ’Em Hell” • “The Big Wheel” • “No Sissy Stuff”


Male Cultural Roles

• Living according to this code is virtually impossible; every man experiences hurt, self-doubt, and the need for support from others. Every man needs to share painful feelings and be soothed by the comforting words of an understanding friend or family member. Thus, many men frequently experience a gender role strain or conflict, torn between their authentic needs and yearnings, and their fear of being unmanly.


Socialization Pressures For Men

• The traditional male role has been associated with a broad array of difficulties, including anxiety, depression, marital and relational difficulties, and substance abuse (Liu & Iwamoto, 2006; Shepard, 2005; Wester, Vogel, O’Neil, & Danforth, 2012).


Socialization Pressures For Men

• The fact that men are taught not to cry or show negative feelings also means they lose the opportunity for family members to recognize their pain and come to their aid.

• Some men get so little practice expressing tender feelings that they struggle using the language of feelings; as a result, their intimate partners find them emotionally unavailable or inadequate for providing words of support.


Counseling Tips With Men

• The physical environment should be male friendly; if you are practicing in an agency or private office, make sure there are male-oriented magazines in the waiting room.

• Engage in small talk and appropriate self-disclosure; talking about the parking situation, the building you are in, and other superficial subjects may put the male client at ease.


Counseling Tips With Men

• Respect your client’s comfort level with regard to self-disclosure. Do not confront a man’s reluctance to express feelings or reveal shameful matters until you feel confident that the male client feels safe in the counseling relationship.


More Tips

• If a male client is ambivalent about being in counseling, whether in individual, couples, or family contexts, discuss his ambivalence with him.

• Men can get significant insight into how their presenting issues are related to their socialization experiences by asking them to describe their definition of masculinity and how they learned “to be a man.”


A Few More Tips• Be alert to signs of the male client experience

feelings of shame in the counseling session. Because so many men were shamed (i.e., teased, taunted, humiliated, bullied, and made to feel less than a man) during their formative years, they may have developed what author David Wexler calls, “shame-o-phobia” (Wexler, 2009, p. 47).

• Finally, recognize your own gender role socialization about how a “real man” is supposed to behave.


Counseling Minorities

• Minority clients are diagnosed more often as having more severe disturbances and pathological conditions than white persons—a finding that is not surprising considering that most tests of mental illness are culturally biased and most diagnosticians are not members of minority groups.



• Minority clients tend to use mental health services only in cases of emergency or severe psychopathology, again skewing the perceptions of clinicians, who may be used to working with normal or neurotic whites but very disturbed minorities

• Minority clients more often drop out of treatment prematurely, usually within the first few sessions.



• In inpatient settings, evidence does indicate that African American clients are treated differently than whites, more often receiving stronger medication, seclusion, restraints, and other punitive “therapies”—and less often receiving recreational or occupational therapy.


More on Minorities

• Minority group attitudes toward psychological disturbances are markedly different from those of whites, more often stressing the roles of organic factors. Latinos, for example, may have more faith in the power of prayer than in counseling for healing what they believe are inherited illnesses.


More on Minorities

• Many people feel more comfortable and prefer working with others whom they perceive as similar (particularly with regard to race or ethnic background).

• With minority clients, and particularly with those of the lower class, counselors must adapt their strategies and interventions to cultural differences.


More on Minorities

• Counseling can be viewed as a form of social control, because its goals are most often to help deviants better adjust to the cultural norms of the majority.


Counseling Older Adults

• Treatment plans need to be modified, including increasing the length of sessions and length of overall treatment.

• Counselors need to appreciate the complexity of the issues the elderly are dealing with; simple DSM diagnoses may not be sufficient for categorizing their distress, given the real-life issues of loss and change that are part of everyday life for this population.



• Anxiety is quite common for the elderly, and counselors need to be alert for symptoms reflecting this form of distress. Research suggests that the elderly are highly responsive to treatment for anxiety disorders.

• Treatment plans that include life-review interventions are especially helpful for depression.



• Counselors need to let go of the stereotype that older people tend to be more depressed than younger generations.



• Mild to moderate cognitive changes, sensory impairments, and health issues are associated with aging, and counselors may need to help older clients address these limitations. Treatment plans can include activities like memory training and providing tips on organizing daily activities, as well as referrals to physicians, optometrists, and audiologists.



• Elderly people who have completed counseling often benefit from long-term support groups that can prevent relapse.


Counseling Gay & Lesbians

• IDENTITY DEVELOPMENT • COMING OUT • CAREER ISSUES • RACIAL, ETHNIC, AND REGIONAL ISSUES • ISOLATION • EMOTIONAL DISTRESS • COUPLE ISSUES • ANTI-GAY VIOLENCE


Counseling Those Who Are Physically Challenged

• Career exploration and the establishment of training goals are a major focus of rehabilitation efforts, helping individuals to prepare for alternative forms of meaningful work. Counselors need to recognize, however, that these individuals may have emotional problems not necessarily related to their abilities or disabilities.


Counseling Those Who Are Physically Challenged

• People with disabilities are often able to participate fully in life as a result of social, political, and technological developments.

• Today, we are challenged to think of disabled or handicapped people as “differently abled” as a way to remove the stigma associated with such conditions.

• In one sense, we are all “temporarily abled” persons in that the conditions in one’s life are variable and likely to change over time.


Spirituality & Counseling• Reflect on your own religious and spiritual values, including your

biases toward a specific religion or to the idea of religion in general. • Briggs and Rayle (2005) suggest students ask themselves the

following questions: (a) What are your views concerning religion and spirituality? (b) How do you believe these views will affect your counseling role? (c) How will you be able to empathize with clients who have differing spiritual values than your own? (d) How will you keep your own spiritual values/beliefs from inappropriately influencing the counseling relationship? (Briggs & Rayle, 2005, p. 50).

• Assess for clients’ spiritual and religious functioning, and recognize when their values are relevant to the presenting issue.

• Familiarize yourself with the different belief systems and the role of religion among the various cultural groups you work with.


More on Spirituality• Join with clients in using their spiritual language,

without abandoning or imposing your own beliefs. • When clinically appropriate, recommend interventions

like prayer or meditation that have been demonstrated in research as helpful and are also consistent with the client’s own practices.

• Make it safe for clients to talk about their religious and spiritual beliefs; as you might expect, that means remaining empathic, nonjudgmental, and staying alert for any subtle signs you might express that could discourage clients from sharing their views.


Lastly On Spirituality

• Remember that religious and spiritual beliefs are only a part of a person’s worldview and value system, and explore with clients the overall role their values play in their lives and their sources of meaning and purpose.

• Whitley (2012) suggests keeping a list of clergy in your area whom you know to be open to collaborating with mental health practitioners.


More on Advocacy• Public Information. Counselors can use their

communication skills to disseminate information through media outlets about the negative impact of social injustice on human development.

• Social/Political Advocacy. Counselors need to recognize the larger social problems that require political action to address. They can then identify community leaders and legislators who can impact the political system, communicate to them the need for social change, and actively support them in their change-making efforts.


Chapter 13 - Counseling Diverse Clients

Education

Transcript of Chapter 13 - Counseling Diverse Clients