Multicultural Counseling: Working with People of Color

It is well-documented that working with minority populations can be challenging for therapists, especially for white therapists, largely because of trust and specific cultural issues. Because the current, if not ongoing, issues of racism and bigotry have been brought into the spotlight so starkly once again, I find it to be important and timely to look at these challenges more deeply, so that we, as therapists, can more effectively be part of the solution rather than contribute to the problem.

Williams and Levitt (2007)¹ studied the differences between the values of therapists and clients as they relate to multiculturalism. They found substantial evidence supporting the fact that real value differences exist between therapists and clients and, “therapists cannot be value-neutral and that they routinely convey their values with clients.” (p. 256) Therefore, they say, “the potential exists for therapists to consciously or unconsciously influence clients to become more like themselves.” They point out that most therapists are unaware of the potential negative effects of sharing such values with the client, because they do so intending to benefit the client. Within a multicultural context, there is a higher probability of alienation, shame and/or indoctrination for the client in ways that either shut down the treatment or is counter-indicated for real progress to be gained.

According to the research, among the most prominent ethnic minority groups in this country (African-Americans², Latinos³, Native-Americans⁴, Asian-Americans⁵ and Middle Eastern Americans), common themes exist in their overall experiences with therapy. Additionally, there is vast underutilization of mental health services, primarily for the following reasons: a sense of alienation and shame, stereotyping and lack of trust in the therapist (particularly a white therapist).

Because this phenomenon is so embedded in horrific histories as well as ongoing cultural disparities, it often seems insurmountable to rectify. But it is my strong conviction that we in this field can, and must, put every effort into positively intervening in this issue by fully recognizing it and, coming from a place of authenticity, fully focus respectfully on the unique cultural backgrounds and qualities of each human being we encounter.

¹Williams, D., & Levitt, H. M. (2008). Clients’ experiences of difference with therapists: Sustaining faith in psychotherapy. Psychotherapy Research, 18(3), 256-270.

²Thompson, V. L. S., Bazile, A., & Akbar, M. (2004). African Americans’ perceptions of psychotherapy and psychotherapists. Professional psychology: Research and practice, 35(1), 19.

³Comas-Diaz, L. (2006). Latino healing: The integration of ethnic psychology into psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 43(4), 436.

⁴Heinrich, R. K., Corbine, J. L., & Thomas, K. R. (1990). Counseling Native Americans. Journal of Counseling & Development, 69(2), 128-133 and Trujillo, A. (2000). Psychotherapy with Native Americans: A view into the role of religion and spirituality.

⁵Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental health services research, 3(4), 201-214.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

 

 

Love Your Enemies

I rarely mix therapy with politics, but we are at a very dangerous precipice in our international history.

Hate has always existed. This has always mystified me. Why? And what are the predicating factors involved in the creation and sustainability of hatred? What is it about, really, and what can be done to diminish its destructive power?

By now we have all heard about the tragic events in Charlottesville. The ugliest head of hatred rose up again toward individuals simply because they were “other’’ and this resulted in violence and death. This incident has been hashed and rehashed in the media and will soon fade away like so many similar horrific incidents in our recent and not so recent past. The ongoing phenomenon remains. Hate and violence don’t seem to go away.

Carol Anderson, professor of African American Studies at Emory College, posed a very interesting theory in an interview I saw recently. She suggests that perhaps hatred is an addiction. At first I was adverse to the idea because it hasn’t been mentioned in addiction literature that I’m aware of. But the more I listened, the more it made sense to me. Just as rage can have addictive qualities, so might hatred share many of the same qualities. Both are based on irrational thinking; they both share adrenaline-related proprieties and appear to be based in victor mentality.

The question remains, though, how does this human emotion-driven behavior get treated? What, if anything can those of us in the mental health field do to effectively respond to or treat this infectious and devastating malady? There is no definitive answer to this and may not ever be. But I believe that the question remains valid and worth our ongoing pursuit. I think we have the best shot as a profession, to provide some answers.

In response to the most recently publicized display of targeted hatred, President Obama shared the popular tweet, “People must learn to hate, and if they can learn to hate, they can be taught to love…”

I believe that therapists have an unique opportunity and skill set to help engage clients in the experiencial understanding of love in its purest form, respect. We can provide the path necessary to begin shifting the paradigm of hatred to genuine caring, kindness and respect toward others.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Tapping into Therapeutic Creativity

Many times, we as therapists can feel “stuck” in the process of doing therapy, either with a particular client or more generally with a certain population. It may be an adolescent not wanting to be in therapy, a very depressed older individual or a couple so entrenched in a non-stop pattern of arguing you feel a need for a megaphone just to interject some redirection.

In most, if not all, of these cases we need some moments of calm and self-clarity to be sure, but it might also be helpful to “think outside of the box” as well. Try introducing creative interventions such as art (music, visual arts, poetry or prose).

We could certainly draw from our own experiences by offering stories, metaphors or pieces of music, but I have found it to be much more profound when tapping into the creativity of the clients themselves. Their own storytelling, poetry, artwork, music, etc. can be much more compelling, meaningful and healing if they are left untouched in a respectful manner. That is, we don’t interpret or judge in any way, but instead encourage growth by allowing clients’ creative outlets to portray whatever meaning and purpose they are attempting to express.

A word of caution: those of us who are not specifically trained or certified in expressive art therapies should use these modalities carefully and only adjunctively to the work we are trained in. However, creativity in all its wonderful forms, used with care, can be transformative in moving the therapeutic process forward.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Preparing for Difficult Clients

Working with clients productively isn’t always an easy road. Clinicians frequently run into clients who are challenging, frustrating, maddening or otherwise pushing our emotional buttons in some fashion.

For example, there are clients who have their own anger issues and come in ready to pick a fight. They simply want to argue with us, and question our knowledge or expertise. There are clients who are passive-aggressive, are in denial of their addictions or simply don’t engage in therapy the way we would like in order to make the progress we wish for them. Then there are clients we just don’t like for some reason; they don’t share our values and don’t respect our time or our boundaries.

Often, the rule of wisdom is to refer such clients out so that they can find a better fit and get better care. But before you do that, I have a few suggestions for preparing yourself for your next session.

To begin with, check yourself. How are you feeling? Tired? Anxious? Hungry? Already dreading this appointment or preoccupied with something you’d rather be doing? What buttons are being pushed inside of you by this client? Spend some time slowing down and acknowledging your feelings. Breathe and try divesting yourself from feeling graded (even pass-fail) on the outcome of this session. This is your client’s session, not yours.

Then spend some time thinking about where your client is emotionally and cognitively. As I frequently say to interns, try going behind the curtain of the stage your client occupies to see the stagehands at work. What’s going on behind the behavior or attitudes you’re seeing and experiencing? Behind the anger is there fear or doubt? Behind the bluster is there insecurity or sadness? Is there a traumatized child puppeteer behind the puppet you see?

As you go into your session, attempt to drop all negative pre-conceptions, judgments and expectations into the trash can. Work with the person in front of you who is scared, sad, lonely or vulnerable from a place of authentic respect.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Better Choices, Better World

The whole idea of having choice can be wonderful, but scary at the same time. This is due to the fact that the results of making bad choices can potentially produce unwanted, if not devastating results.

Many, if not all people who seek counseling are somehow caught up in this very dilemma. Choices made in their past or current lives often have had some demoralizing effects— a bad divorce, financial loss, a series of broken relationships, or bad choices made by parents and grandparents before them, being replicated if not complicated in current circumstances.

The affect of one misstep leading to another can create a pattern of mistakes and more distrust as well as anticipation and prophesy of more bad decisions in the future. This cascade of negative events can become overwhelming, eventually defining one’s identity and future without meaningful direction.

Our job as therapists is not about minimizing these realities of our clients’ current situations, but to gently and respectfully suggest that we all have choice about being driven by fear or by courage and hope. Fear alone tends to only make things worse. When afraid, we tend to isolate and not trust, behavior which motivates anger and leads to more stress, depression, and anxiety, often turning into harmful, if not aggressive actions toward self or others.

Finding and making better choices is frequently a difficult process, because this requires a paradigm shift in restructuring one’s belief system, including the ability to find compassion as well as genuine respect for yourself and then for others.  Choosing to not be the victim of hard times means choosing to “think outside the box,” to be open to more possibilities. To find real and permanent value in yourself—not measured by exterior standards—and then to dare to extend the same to others, is to live more boldly and completely.

Most importantly, I believe in the notion that each human being is in fact an integral part of the larger world. Just as a village affects a family, which in turn affects a child, so does the wellbeing of each person alive affect the sustaining value of the larger systems in which that person exists. As therapists, are more able to introduce as well as help maintain the important role of deep, authentic respect for humanity, we assist to insure a heather world in which we all can live.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.