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Program of Study

Masters in Mental Health and Wellness

Personal and Professional Goals

A personal goal I have for myself is to always seek to be a lifelong learner. A professional goal I have for myself is to obtain LPC licensure and support others through a therapeutic relationship overcome problems and obtain optimal mental health and well-being.

What I Would Like to Get out of This Course

By the end of this course, I hope to have a clear understanding of the effects of trauma and how to best treat those who have experienced trauma. Additionally, I hope to be well-prepared to consult and provide professional development to help others better understand how to support individuals who have experienced trauma.

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The American Counseling Association Code of Ethics provides ethical guidelines for professional counselors. In my future role as an LPC, the ACA Code of Ethics will serve to outline my ethical responsibilities.

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Section 1- Introductions and Assessing Prior Knowledge

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Section 1- Introductions and Assessing Prior Knowledge

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Reflection

Prior to this course, I would have said that I had a good understanding of mental health needs. Being a school counselor, I work with students who have a variety of mental health needs. However, after taking the quizzes to assess my knowledge of mental health, I realized that I had no idea of the prevalence of mental illness. The statistics were shocking. I was also shocked to learn of the average age of onset of certain mental illnesses, and the lack of treatment received. As a future LPC, it is important for me to understand how common mental illness is and how undertreated it is as well.

Artifact- Intro and Assessing Prior Knowledge

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Reflection

Creating the Mental Health Reference Guide was very tedious, but so valuable. I spent several hours researching different mental health disorders, their causes, the importance of early intervention, and the specific types of each mental health disorder. In my research, I came across many resources that will help me in my future role as an LPC. I especially found the "Helpful Resource" section to be useful.

Artifact- Mental Health Reference Guide

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Reflection

For this assignment, I watched The Trials of Gabriel Fernandez. Before watching the documentary, I used the resources provided to learn more about the different types of trauma and their effects. I was surprised to learn of the different types of trauma, especially those that have to do with the workplace. In The Trials of Gabriel Fernandez, I was able to identify several examples of different types of trauma, and the effect trauma had on those who experienced it. Finally, I researched therapeutic intervention approaches that are effective for treating different types of trauma.

Artifact- Developmental Discussion on Trauma

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Completing the Psychological First Aid training helped me better identify needs and how to respond to those needs following a crisis. I appreciate how the training provided very specific actions to take. The training provided concrete guidance in the areas of making initial contact and engagement, ensuring safety and comfort, using techniques to offer stabilization when needed, gathering information to determine needs, providing practical assistance, connecting with social supports, providing coping assistance, and linking the individual or family with collaborative services.

The National Child Traumatic Stress Network (n.d). Training. https://www.nctsn.org/resources/training

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Psychological First Aid (PFA) Online_Certificate

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Section 5- Crisis Prevention and Threat Assessment

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Section 5- Crisis Prevention and Threat Assessment

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As a professional in the field of counseling, I will be called to participate in the development and implementation of crisis prevention plans and threat assessments. This assignment provided me with a thorough understanding of the legal requirements, mental health and threat assessments, at-risk behaviors, multi-agency collaboration, universal screening, referral process, and cultural competence and other considerations that go into completing a crisis prevention plan for youth and juvenile gangs. While this assignment was specific to the topic of gangs, it left me with a clear understanding of how to apply the crisis prevention and threat assessment process to any area.

Artifact- Youth and Juvenile Gang Crisis Prevention and Threat Assessment

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The ABC Crisis Model is a great way to respond to those who may be experiencing a crisis. Crisis intervention is important to prevent long-term problems from developing as a result of the crisis. The ABC Model provides concrete ways to establish rapport with the person in crisis, understand the specific emotional, mental, physical, and behavorial distress, and offer methods that will provide immediate coping support. My biggest take away from this lesson is that a crisis is not always a big event. Rather, a crisis can refer to any situation in which an individual is in distress and unable to cope (Kanel, 2015).

Kanel, K. (2015). A Guide to Crisis Intervention (5 ed.). Belmont, CA. Brooks/Cole

Artifact- ABC Model Scenario

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It is important to be aware of cultural differences and personal biases when delivering responsive services. The ACA Ethical Standards (2014) state that counselors should "gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse population." Becoming culturally competent is a continuous improvement process. The counselor must seek to learn from every interaction, consultation, and observation more about those different from themselves. The life experiences of individuals create unique differences and needs. Becoming culturally competent is critical to be able to support those different than ourselves without bias.

American Counseling Association (2014). Code of ethics. https://www.counseling.org/docs/default-source/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=fde89426_9

Bray, B. (2019). Multicultural encounters. Counseling Today. https://ct.counseling.org/2019/11/multicultural-encounters/

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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.
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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.
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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.
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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.
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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)

"Multicultural and Social Justice Counseling Competencies: Practical applications in counseling" by Manivong J. Ratts, Anneliese A. Singh, S. Kent Butler, Sylvia Nassar-McMillan and Julian Rafferty McCullough

"Making the counseling profession more diverse" compiled by Laurie Meyers

"Counseling in the land of religious liberty" by Cebrail Karayigit and Jason Kushner

"Counseling individuals of African descent" by Malik Aqueel Raheem and Kimberly A. Hart

"Practicing cultural humility" by Sidney Shaw

"Five points of discussion for conversations about racial injustice" by Amanda L. Giordano

"Breaking the silence" by Charmayne Adams, Jillian Blueford, Nancy Thacker, Kertesha B. Riley, Jennifer Hightower and Marlon Johnson

"Addressing ethnic self-hatred in Latinx undergraduates" by Carlos P. Hipolito-Delgado

"Culturally competent end-of-life counseling" by Ashley C. Overman-Goldsmith

"The use of evidence-based practices with oppressed populations" by Geri Miller, Glenda S. Johnson, Mx. Tuesday Feral, William Luckett, Kelsey Fish and Madison Ericksen

"Advancing multicultural and social justice competence in counseling research" by Cirecie West-Olatunji and Jeff D. Wolfgang

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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

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

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Multicultural encounters - Counseling Today

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Counselors share the lessons they've learned along the way in their efforts to translate the ideal of multicultural competence into practical action.

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When supporting individuals who have experienced trauma or are experiencing a crisis, referral and/or collaboration with other support providers may be necessary. Referrals may be made to others in the counseling profession who specialize in areas of particular need, such as substance abuse, marriage and family therapy, eating disorders, or other specific mental disorders. Additionally, referrals to receive medical treatment may be necessary for some physical issues that are impacting emotional state, or when medication may be necessary. ACA Code of Ethics (2014) state that counselors shall make appropriate referrals when the needs of the client are beyond what the counselor is able to address. When making referrals, it is important the counselor collaborates with the new service provider to provide the best level of care in the transition of services.

When a client presents with thoughts, behaviors, or experiences that do or can result in a danger to himself or others, referral to emergency services is necessary. These emergency services may be suicide intervention, law enforcement, mental health crisis evaluation, or emergency shelters.

Referrals to other support services such as support groups, 12 Step Programs, or stress management groups may be beneficial.

American Counseling Association (2014). Code of ethics. https://www.counseling.org/docs/default-source/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=fde89426_9