Counseling Marginalized Groups

Please see attachment for R/CID model

This assignment relates to the information you read regarding the  R/CID Model. 

Reflect upon the information presented in the chapter about the R/CID Model in this week's coursework.  Clients of color or those in other marginalized groups such as LGBT, women, the disabled and so on, all experience stages of identity development.   As a future counselor, what are you most concerned about within yourself as you think about working with clients of diverse groups and each of the stages in the R/CID Model?  What feelings do you anticipate you might have that could be problematic in your work with one or more of these clients?

This assignment should be no more and no less than 2 pages of text, double spaced.  The more you reflect, the more you will become aware of within yourself.  This is an important aspect of your growth as a culturally competent counselor.   Cite and source if/where appropriate.  

Textbook Citation: Sue, D.W.S. D. (2015). Counseling the Culturally Diverse: Theory and Practice. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9781119084372/

These links are pages from the chapter in the textbook related to this assignment

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The African American population was 41.7 million in 2013, representing 13% of the total population. The poverty rate for African Americans remains nearly twice as high as that of all households (25.8% versus 14.3%) (U.S. Census Bureau, 2013, 2014), and the unemployment rate is over twice that of White Americans (9.5% versus 4.6%) (U.S. Department of Labor, 2015). Approxi mately 23% of African American adults do not have a high school diploma (Fry, 2010). Of African American males, 38% are experiencing greater downward mobility out of the middle class compared with the 21% of White males (Acs, 2011). Further, infant mortality for Blacks is over twice that of Whites (Cen ters for Disease Control, 2013), and the lifespan of African Americans is 5 to 6 years shorter than that of White Americans. Although African Americans are only 13% of the U.S. population, 40% of those incarcerated are Black while Whites who make up 64% of the population account for only 39% of those in prison (Hagler, 2015). African American women are also more likely to be arrested than Latinas or White women (Brame, Bushway, Paternoster, & Turner, 2014). Although these statistics are grim, much of the literature is based on the economically disadvantaged rather than on other segments of the African American population (Holmes & Morin, 2006). This focus on those living in poverty masks the great diversity that exists among African Americans and the significant variance in socioeconomic status, educational level, cultural iden tity, family structure, and reactions to racism. For example, 38% of African American households are middle income and 12% are upper income, compared with 44% and 26% of White households respectively (Parlapiano, Gebeloff, & Carter, 2015). Many middle- and upper-class African Americans embrace the values of the dominant society, believe that advances can be made through hard work, feel that race has a relative rather than a pervasive influence on their lives, and take pride in their heritage. As Hugh Price, former president of the National Urban League, observed, “This country is filled with highly successful Black men who are leading balanced, stable, productive lives working all over the labor market” (Holmes & Morin, 2006, p. 1). However, even among this group of successful African American men earning $75,000 a year or more, six in ten reported being victims of racism and having someone close to them murdered or incarcerated.

CHARACTERISTICS AND STRENGTHS

In the following sections, we consider the characteristics, values, and strengths of African Americans and their implications in treatment. The African American population is becoming increasingly heterogeneous in terms of ethnic and racial identity, social class, educational level, and political orientation, so it is important to remember that the following are generalizations; their applicability needs to be assessed for each client.

Ethnic and Racial Identity

Many scholars believe that minorities go through a sequential process of racial identity development. For many African Americans, the process involves a trans formation from a non-Afrocentric identity to one that is Afrocentric (although some African Americans consistently embrace a Black identity through early social ization). The Cross (1991, 1995) model, as described in Chapter 11, identifies the stages of preencounter, encounter, immersion-emersion, and internalization. These stages are associated with differences in perspective regarding the self and relationships with others, beginning with the acceptance of White standards and deprecation of Black culture and culminating in an appreciation of both Black culture and aspects of the White culture. The current stage of an individual’s racial identity affects awareness of and willingness to discuss racial issues or racism (Forsyth, Hall & Carter, 2015).

Implications

African Americans who are at the preencounter level are less likely to report racial discrimination, whereas those in the immersion stage tend to be least satisfied with societal conditions. African Americans with the greatest internalization of Black racial identity report the highest self-esteem (Pierre & Mahalik, 2005). African American preferences for counselor ethnicity are often related to their current stage of racial identity. Parham and Helms (1981) found that African Americans at the preencounter stage preferred a White counselor, whereas those in later stages preferred an African American counselor. In a study involving 128 Black college students, over 75 percent had no preference regarding the race of the counselor for issues such as depression, anxiety, drug or alcohol problems, meeting new people, overcoming loneliness, and dealing with anger. However, 50 percent indi cated preference for a Black counselor for racial issues and problems with personal relationships. Elevated cultural mistrust and strong internalized Afrocentric atti tudes were associated with a stronger preference for a Black counselor (Townes, Chavez-Korell, & Cunningham, 2009). Often, the most important counselor characteristic for African Americans is the cultural sensitivity of the counselor. Culturally sensitive counselors (those who acknowledge the possibility that race or culture might play a role in a client’s Americans with the greatest internalization of Black racial identity report the highest self-esteem (Pierre & Mahalik, 2005). African American preferences for counselor ethnicity are often related to their current stage of racial identity. Parham and Helms (1981) found that African Americans at the preencounter stage preferred a White counselor, whereas those in later stages preferred an African American counselor. In a study involving 128 Black college students, over 75 percent had no preference regarding the race of the counselor for issues such as depression, anxiety, drug or alcohol problems, meeting new people, overcoming loneliness, and dealing with anger. However, 50 percent indi cated preference for a Black counselor for racial issues and problems with personal relationships. Elevated cultural mistrust and strong internalized Afrocentric atti tudes were associated with a stronger preference for a Black counselor (Townes, Chavez-Korell, & Cunningham, 2009). Often, the most important counselor characteristic for African Americans is the cultural sensitivity of the counselor. Culturally sensitive counselors (those who acknowledge the possibility that race or culture might play a role in a client’s problem) are seen as more competent than culture-blind counselors (those who do not assess for environmental issues such as prejudice) (Want, Parham, Baker, & Sherman, 2004). Among a group of working-class African American clients, the degree of therapeutic alliance with White counselors was affected not only by the client’s stage of racial identity but also by similarities in gender, age, attitudes, and beliefs. Additionally, clients facing issues related to parenting, drug use, or anxiety looked for therapists with understanding of these specific issues (Ward, 2005).

Family Structure

Although about 44% of African American households are headed by married couples, many African American families are headed by single parents (Vespa, Lewis, & Kreider, 2013). Black children are significantly less likely than other children to be living with two married parents (44% versus 84% for Asian chil dren, 64% for Hispanic children, and 75% for White children) (Child Trends, 2010). In 2008, 72% of all births to Black women were outside of marriage, compared with 29% for non-Hispanic White women (Black Demographics. com, 2011). The African American family is often described as matriarchal; among lower-class African American families, 63% are headed by women versus 33% of all U.S. households (Taylor, Larsen-Rife, Conger, Widaman, & Cutrona, 2010). Given the varied structure of African American families, it is important to take into account kinship bonds with extended family and friends, as illustrated in the following case study.

Case study

JOHNNY A mother, Mrs. J., brought her 13-year-old son Johnny in for counseling due to recent behavioral problems at home and in school. After asking, “Who is living in the home?” the therapist learned that Johnny lived with his mom, a stepfather, and five brothers and sisters. Also, the mother’s sister, Mary, and three children had been staying with the family while their apartment was repaired. The mother also had a daughter living with an aunt in another state. The aunt was helping the daughter raise her child. When asked, “Who helps you out?” Mrs. J. responded that her mother sometimes helps watch the children but that, more frequently, a neighbor (who has children of a similar age) watches the younger children when Mrs. J. works during school hours. Further questioning revealed that Johnny’s problem developed soon after his aunt and cousins moved in. Before this, Johnny had been his mother’s primary helper and took charge of the children until the stepfather returned home from work. The changes in the family structure that occurred when the sister and her children arrived were stressful for Johnny. Family treatment included Mrs. J. and her children, the stepfather, Mary and her children, and Mrs. J.’s mother. Pressures on Johnny were discussed, and alternatives were considered. Mrs. J.’s mother agreed to invite Mary and her children to come live with her temporarily. To deal with these additional disruptions in the family, follow-up meetings focused on clarifying roles in the family system. Johnny once again assumed the role of helping his mother and stepfather watch the younger children. Within a period of months, his behavioral problems at home and school disappeared.

Implications

Because of the possibility of extended or nontraditional family arrangements, questions should be directed toward clarifying who is living in the home and who helps with childcare. Therapists should work to strengthen and increase functionality of the existing family structure rather than attempt to change it. One of the strengths of the African American family is that men, women, and children are allowed to adopt multiple roles within the family. For example, as in the case of Johnny, older children might adopt a caretaking role, and friends or grandparents might help raise children. In such cases, therapy might focus on enhancing the working alliance among caregivers (Muroff, 2007). A counselor’s reaction to a client’s family structure may be affected by a Eurocentric, nuclear-family orientation. Similarly, many assessment forms and evaluation processes are based on a middle-class EuroAmerican perspective of what constitutes a family. For family therapy to be successful, counselors must first identify their own set of beliefs and values regarding appropriate roles and communication patterns within a family and take care not to impose these beliefs on other families. Similarly, it is helpful to move away from a deficit model to an asset or strengths perspective when evaluating families (Rockymore, 2008). For example, a supportive parenting style that includes warmth, commu nication, and consistent discipline appears to be protective against drug use by African American youth (Gibbons et al., 2010). However, physical discipline or critical comments, unless unduly harsh, should not necessarily be viewed nega tively; each situation should be assessed individually. Culturally sensitive parent education programs designed for African Americans focus on different types of discipline, single parenting, and strategies for dealing with culture conflicts and responding to racism. In working with economically disadvantaged African American families, the counselor may need to assume various roles, including advocate, case manager, problem solver, and facilitating mentor, and to help the family navigate community systems, including the educational or judicial system.

Spiritual and Religious Values

D. D. is a 42-year-old African American woman recently divorced after 20 years of mar riage and raising two children with little support from her ex-husband. She presented with depressive-like symptoms—feelings of loneliness, lack of energy, lack of appetite, and crying spells. . . Although part of the treatment focused on traditional psychologi cal interventions, such as cognitive restructuring, expression of feelings, and changing behaviors, D.’s treatment also included participation in two church-related programs, including the women’s ministry, a program that provides social and emotional support. Treatment also included participation in “The Mother to Son Program,” a program tar geting single mothers parenting African American boys. This program provides sup port for mothers and mentoring relationships for their sons. (Queener & Martin, 2001, p. 120) Spirituality and religion play an important role in many African American families; church participation provides comfort, economic support, and oppor tunities for self-expression, leadership, and community involvement. Over 75% of African Americans state that religion is very important to them and rely on religious and spiritual communities to deal with mental health issues (Avent & Cashwell, 2015). Among a sample of low-income African American children, those whose parents regularly attended church had fewer problems (Christian & Barbarin, 2001). Support systems connected with the church (including friends and club involvement) were found to promote resilience in African American undergraduates exposed to racial microaggressions (Watkins, Labarrie, & Appio, 2010). The African American church often functions as a religious, social, and political hub, facilitating social events that serve to foster a sense of “peoplehood” (Boyd-Franklin, 2010).

Implications

Spiritual beliefs are important to many African Americans and serve as a protective factor in response to stressors. If a client is heavily involved in church activities or has strong religious beliefs, the counselor might consider enlisting church leaders to help the client (or family) deal with social and economic stressors or conflicts involving the family, school, or community. Church personnel are often aware of the family dynamics and living conditions of parishioners. In addition, churches often sponsor parenting programs or activities that enrich family life.

Educational Characteristics

JACKIE Jackie, a 10-year-old African American female, came in with her mother presenting with anger problems, low mood, suicidal thoughts, and family discord. She had always been a stellar student, but her grades had begun to fall from straight As to Bs and Cs. Jackie notes that “she is not smart enough to keep up with the other kids.” (Muroff, 2007, p. 131) African American parents, acutely aware of obstacles produced by racism and economic conditions, often encourage their children to develop career and educa tional goals at an early age. In one study of 1,225 school-aged African American males (6th to 10th graders), 62% aspired to go to college, similar to rates for White male students. Black males with plans to attend college frequently reported positive feelings about their school and teachers (Toldson, Braithwaite, & Rentie, 2009). The gap in educational attainment between African American and White children is gradually narrowing. In 2013, over 90% of African Americans vs 94% of White Americans had completed high school, although only 20% had a bache lor’s degree or higher compared to 40% of Whites (Child Trends, 2014). The educational environment is often negative for African American youth. They are two to five times more likely to be suspended from school and often receive harsher consequences than their White peers (Rudd, 2014). School personnel often hold stereotypes of African American parents as being neglectful or incompetent and blame children’s problems on a lack of parental support for schooling. As one teacher stated, “The parents are the problem! They [the African American children] have absolutely no social skills, such as not knowing how to walk, sit in a chair, . . .it’s cultural” (Harry et al., 2005, p. 105); but when these researchers visited the homes of parents who were criticized, they often observed parental love, effective parenting skills, and family support for education.

Implications

Factors associated with school failure, especially in African American males, must be identified and system-level intervention strategies applied. Traditional educational practices often do not meet the needs of diverse populations. For example, many African American youths display an animated, persuasive, and confrontational communication style, while schools often have norms of quiet conformity; teacher-focused instruction; and individualized, competitive activities. White teachers may perceive the typical communication patterns, physical movement, and walking style of African American youth as aggressive or noncompliant (Monroe, 2005). It is important for educators to recognize culturally based behav iors that are not intended to be disruptive. If teachers are not sensitive to these cul tural differences, they may respond inappropriately to minority group members. Students often learn best when curricula and classroom styles are modified taking cultural factors into consideration.

African American Youth

LEAJAY HARPER LeaJay Harper says she was a typically rebellious teenager raised by a single mother. She left home at 17 and lived on the streets, surviving on stale donated bread and sleeping on church porches. When she was 18, she was arrested for stealing a $10 bag of McDonald’s food. “I was hungry,” she said. She went to jail. (Mulady, 2011, p. 1) For many urban African American adolescents, life is complicated by prob lems of poverty, illiteracy, and racism. African American youth are more likely to be victims of violence, such as stabbings or shootings, but are reluctant to report these incidents because of fear of the police or of being accused of “snitching” (Schwartz et al., 2010). Most African American youth feel strongly that race is still a factor in how people are judged (Pew Research Center, 2010). In fact, White undergraduate females are more likely to overestimate the age of African American youth offenders and believe them to have greater culpability for crimes than White or Latina/o juvenile offenders (Goff et al., 2014). Even young African American children are well aware of stereotypes regarding the occupational status of Afri can Americans. In one study, they identified service jobs as those performed by “only Black people” and high-status jobs as those performed by White Americans (Bigler & Averhart, 2003). Issues presented in counseling may differ to some extent between boys and girls. Although African American adolescent girls display higher self-con fidence, lower levels of substance use, and more positive body images than other groups of adolescent girls (Belgrave, Chase-Vaughn, Gray, Addison, & Cherry, 2000), they often encounter sexism as well as racism. While striving to succeed in relationships and careers, African American adolescent girls not only are burdened by living in a male-dominated society but also undergo the stressors associated with being African American or living in poverty (Talley rand, 2010). Acute awareness of issues of racism and sexism is reflected in the following comment: Well, in this time I think it’s really hard to be an African American woman. . .we are what you call a double negative; we are Black and we are a woman and it’s really hard. . .society sees African American females as always getting pregnant and all that kind of thing and being on welfare. (Shorter-Gooden & Washington, 1996, p. 469) In interviews with African American adolescent girls, Shorter-Gooden and Washington (1996) found that the struggle over racial identity was a more salient factor than gender identity in establishing self-definition. These adolescents believed that they had to be strong and were determined to overcome obstacles resulting from societal misperceptions involving Blackness. About half were raised by single mothers, and most indicated the importance of the mother–daughter relationship. Careers were important to two thirds of the group, and most reported that their parents had instilled strong motivation to succeed academically. Unfortunately, there is a growing trend toward incarceration of African Amer ican girls and young women. They are the fastest-growing incarcerated group of young people in the United States. In California, the arrest rate is 49 per 1,000 for Black girls, compared with 9 per 1,000 for White girls and 15 per 1,000 for Latinas (Pfeffer, 2011). In general, the crimes committed are not violent and are frequently associated with poverty, homelessness, and maltreatment within the home. Further, zero tolerance policies in schools disproportionately affect African American girls, who may be disciplined for talking back, interpersonal conflict, or truancy. LeaJay Harper, quoted at the beginning of this section, was arrested a second time for stealing pajamas and underwear for her young daughter. Instead of jail time, she was sent to a six-month treatment program and now runs the Young Mothers United Program at the Center for Young Women’s Development in San Francisco, helping other African American girls and young women who are at risk of losing their children because of arrests for similar nonviolent offenses (Mulady, 2011).

Implications

African American youth often do not come to counseling willingly. They may be referred by social agencies or brought in by family members. Because of this, lack of interest in counseling may be an issue, as seen in the following case. MICHAEL Michael is a 19-year-old African American male brought to counseling by his aunt, Glo ria, with whom he has lived for the past 2 years. Gloria is concerned about Michael’s future. . .Although Michael graduated from high school and is employed part-time at a fast-food restaurant, he is frustrated with this work and confused about his future. He believes that Black men “don’t get a fair shake” in life and is discouraged about his prospects about getting ahead. . .Michael’s aunt. . .is concerned that Michael’s peers are involved in gangs and illegal activities. She thinks the rap music he listens to is beginning to fill his head with hate and anger. . .Michael’s major issues center around a need to develop a positive identity as an African American man and discover his place in the world. (Frame & Williams, 1996, p. 22) Frame and Williams (1996) suggested several strategies for working with African American youth such as Michael. The first is based on the African tradition of storytelling and involves the use of metaphors. In response to statements like “Black men don’t get a fair shake,” counselors can encourage clients to identify family phrases or Biblical stories that instill hope. Additionally, the writings of prominent African Americans can be used to generate metaphors. To assist Michael with his struggle to overcome societal barriers, he could be encouraged to envision himself as a crusader for human rights as a socially appropriate way of directing his anger. The counselor could also engage Michael in discussions about rap music; issues addressed in the lyrics could be explored, as well as healthy out lets for feelings of anger or despair. Family and community support for Michael could be generated by including extended family, the pastor, teachers, and other important individuals in Michael’s life and encouraging them to discuss their own struggles and search for identity. Use of techniques such as these, derived from African American experiences, can lead to personal empowerment. In counseling African American girls, issues involving racial identity and conflict should be explored. Counselors can help African American girls and women counteract negative images associated with being Black and being female. Enhancing internal strength by developing pride and dignity in Black womanhood can serve as a buffer to racism and sexism and can prevent the incorporation of nega tive images into their own belief systems (Owens, Stewart & Bryant, 2011).

Cultural Strengths

Protective factors and strengths among African Americans include positive ethnic identity or racial pride; resourcefulness and coping skills to deal with societal issues; familial, extended kin, and community support systems; flexible family roles; achievement orientation; and spiritual beliefs and practices (Kaslow et al., 2010; LaTaillade, 2006). Family and religious protective factors have been hypothesized to account for findings that African Americans have lower levels of heavy and binge drinking than any other ethnic group, with the exception of Asian Americans (Substance Abuse and Mental Health Services Administration, 2013). Additionally, African American adolescents have low rates of substance use com pared to Whites and other ethnic groups (Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2014). The African American family structure has many advantages. Among families of relatives, older children, and close friends. For many, the extended family net work provides emotional and economic support. African American families are characterized by flexibility in family roles, strong kinship bonds, a strong work and achievement ethic, and a strong religious orientation (McCollum, 1997; Rocky- more, 2008). Kinship support diminishes risks of internalizing or externalizing problem behaviors in children and can ameliorate conditions such as poor parent ing (Taylor et al., 2010). Among low-income single mothers, many displayed sub stantial parenting involvement with their children and emphasized achievement, self-respect, and racial pride with their children. Despite the challenges of racism and prejudice, many African American fam ilies have been able to instill positive self-esteem in their children by means of role flexibility. African American men and women value behaviors such as asser tiveness; within a family, males are more accepting of women’s work roles and are more willing to share in the responsibilities traditionally assigned to women. Many women demonstrate a “Strong Black Woman” image that includes pride in racial identity, self-reliance, and capability in handling challenges—all while nurturing the family. Although self-efficacy can be a strength, excessive investment in meeting the expectations of such a role can lead to emotional suppression and difficulty expressing vulnerability or distress (Harrington, Crowther, & Shipherd, 2010).

SPECIFIC CHALLENGES

In the following sections we consider challenges often faced by African Americans and consider their implications in treatment. Racism and Discrimination Racism and discrimination are significant concerns within the African American community. As President Obama observed during his eulogy for Rev. Clementa Pinckney and eight of his congregants who were shot to death by a White suprem acist, racial bias can be evident or may occur without realization such as “the subtle impulse to call Johnny back for a job interview—but not Jamal” (Moser, 2015). A study by Bertrand and Mullainathan (2004) did find that résumés with either African American or White sounding names (Lakisha and Jamal versus Emily and Greg) sent to help wanted ads received a differential response. The “White” names received 50% more calls for interviews. African Americans perceive both subtle and direct forms of racism in the United States. Whereas about half of Whites believe Blacks have equal societal opportunities, 81% of Blacks believe more change is necessary (Pew Research Center, 2010). Due to the deaths of unarmed Black men at the hands of the police, 57% of Americans believe that racial relationships are a cause for concern (Dann, 2014a). A Black Lives Matter movement arose to take a stand against police brutality and the anti-Black racism in society. In response to the tragedy involving Sandra Bland, whose stop for changing lanes without signaling resulted in a sequence of events that ended with her death, U.S. Attorney General Loretta Lynch remarked, “I think that it highlights the concern of many in the Black com munity that a routine stop for many of the members of the Black community is not handled with the same professionalism and courtesy that other people may get from the police” (Glum, 2015). The Black Lives Matter movement points out that Black people are singled out and “intentionally left powerless at the hands of the state . . . and are deprived of basic human rights and dignity” (Black Lives Matter, 2015). This movement is gaining strength nationally and challenges instances of racism against African Americans. However, there is a large racial gap between Blacks and Whites in their views about the police and their actions. While 70% of Whites believe that the police treat both races equally, only 28% of Blacks have the same belief (Dann, 2014b). Many African Americans believe that racial profiling occurs frequently. In situations involving suspected racial profiling, Black men often report thinking, “Maybe I am being treated this way because I am Black,” and needing to decide, “Do I protest it or just take it?” (Fausset & Huffstutter, 2009, p. 1). Consciously or unconsciously, many people associate African Americans with crime and favor harsher punishments for African Americans. In research stud ies Whites, when primed to think about crime, focused their attention on Black rather than White faces and were more likely to identify blurry images as weapons when exposed to Black faces. When Whites read descriptions of a juvenile offender convicted of rape, harsher sentences were supported when he was described as Black (Weir, 2014). In a study involving African American defendants who were convicted of killing White victims, Eberhardt and colleagues (2006) found that defendants with darker skin and broader noses were twice as likely to receive the death penalty compared to African Americans who looked less stereotypically black. Similarly, Viglione, Hannon, and DeFina (2011) found that African Amer ican women with lighter skin received shorter sentences than women with darker skin who committed similar crimes. Youth with an incarcerated parent have increased risk of poverty, school failure, emotional distress, criminal activity, and drug use. This effect can fur ther exacerbate the cycle of racial inequality, substance abuse, and imprisonment (Roettger, Swisher, Kuhl, & Chavez, 2011). The experience of perceived racial dis crimination is associated with decreased levels of self-esteem and life satisfaction and increased depressive symptoms in African American and Caribbean Black youth (Seaton, Caldwell, Sellers, & Jackson, 2011). Some African American ado lescents report drug use as a way of coping with feelings of anger in reaction to racial discrimination (Gibbons et al., 2010). African American parents differ in the ways in which they address racism with their children. Some address racism and prejudice directly and help their children to develop a strong Black identity, whereas others consider race to be of minor importance, ignore the topic of race, and focus on human values or discuss the issue only if brought up by their children. Racial socialization can help buffer the negative effects of racism and discrimination (Lee & Ahn, 2013). Neal-Barnett (1997) found that ignoring racial issues in socialization leaves chil dren vulnerable to anxiety when African American peers accused them of “acting White.” In homes where race is not discussed, children have fewer opportunities to develop coping strategies when faced with discrimination. Similarly, protec tive factors for African American youth include parental focus on increasing positive feelings about self and enhancing a sense of pride in one’s culture (Bel grave et al., 2000). Messages of cultural pride from parents is associated with the development of positive ethnic identity, self-esteem, and socioemotional com petence in African American children (Rodriguez, McKay, & Bannon, 2008). Therapists may decide to discuss the positive benefits of racial socialization with African American parents. Implications Since the mental health environment is a microcosm of the larger society, mental health professionals need to identify their own racial attitudes and be ready to address mistrust from African American clients concerned about being viewed through the lens of a stereotype (Jordan, Lovett, & Sweeton, 2012). Therapists should carefully assess both the problems confronting a client and the client’s response to the problem situation, including the way he or she usually deals with racism. Jones (1985) described four interactive factors that should be considered in working with African American clients (see Figure 14.1). The first factor is racial oppression. Most African Americans have faced racism, and the possibility that this factor plays a role in the presenting problem should be examined. Other interactive factors described by Jones include the possible influence of African American culture and traditions on the client’s behavior, the degree to which the client has adopted majority culture values, and the personal experiences of the individual. Individual experiences with racial oppression can vary significantly among African Americans. The task of the therapist is to help the client understand the effects of such experiences and allow the understanding to guide conscious, growth-producing choices.

IMPLICATIONS FOR CLINICAL PRACTICE

The first therapy sessions are crucial in determining whether a client will return. African Americans have a high rate of therapy termination (Fortuna, Alegria, & Gao, 2010). Termination often reflects a counselor’s inability to establish an effective ther apeutic alliance. African American clients tend to prefer an egalitarian relationship, so it is critically important to answer questions, explain the counseling and assess ment process, and enlist the client’s assistance in determining goals and treatment strategies. Prior experiences may render issues of trust very important. The counselor can deal with these issues by discussing them directly and by being open, authentic, and empathetic. Clients often make a decision regarding continuation of therapy based on their personal evaluation of the counselor. As one African American clien t stated, “I am assessing to see if that person [counselor] is willing to go that extra mile and speak my language and talk about my Blackness” (Ward, 2005, p. 475). Counsel ors may need to have a broader role and more flexible style, including being more direct, serving in an educative function, and helping the client deal with agencies or with issues involving health and employment. Although the order of these elements can be modified and some can be omitted, these steps may be helpful to the coun selor and the client:

1. Understand that power and privilege can affect counseling. During the first ses sion, it may be beneficial to bring up the reaction of the client to working with a counselor of a different ethnic background. (Although African Amer icans show a same-race preference, being culturally competent is an even more important factor.) A statement such as, “Sometimes clients feel uncom fortable working with a counselor of a different race. Would this be a prob lem for you?” Be open if the client discusses any experiences with racism or discrimination.

2. Recognize that there is great diversity among African Americans. Assess the clients’ values and preferences by identifying their expectations and worldview and what they believe counseling entails. Explore their feelings about counseling. Determine how they view the problem and possible solutions.

3. If clients are there involuntarily, discuss how counseling can be made useful for them. Explain your relationship with the referring agency and the limits of confidentiality.

4. Assess the positive assets of the client, such as personal strengths, family (includ ing relatives and nonrelated friends), community resources, and church.

5. Help the client define goals and appropriate means of attaining them. Assess ways in which the client, family members, and friends have handled similar problems successfully.

6. Establish an egalitarian relationship. Many African Americans are comfortable establishing a close personal connection with the counselor. This may be accomplished by self-disclosure. If the client appears hostile or aloof, discussing some noncounseling topics may be useful.

7. After the therapeutic alliance has been formed, collaboratively determine inter ventions. Consider culturally adapted evidence-based therapies that have been found to be effective with African Americans. Problem-solving and time-limited approaches may be most acceptable. Analysis of the client’s racial identity and family structure can be helpful in deciding if alternative treatment modes and approaches might be beneficial.

8. Determine any external factors that might be related to the presenting problem. Determine whether and how the client has responded to discrimination and racism, both in unhealthy and healthy ways. Do not dismiss issues of racism as “just an excuse”; instead, help the client address issues of discrimination and identify productive means of dealing with such problems.

9. Examine issues around racial identity, taking into account that many clients at the preencounter stage will not believe that race is an important factor. For some, increased Afrocentric identification will be an important factor in establishing a positive self-identity. In these cases, elements of African/African American cul ture can be incorporated in counseling through readings, movies, music, and discussions of prominent African Americans.

SUMMARY

African Americans represent approximately 13 percent of the U.S. population. On nearly all measures of education, employment, earnings, and psychological and physical health, they experience a standard of living much below their White counterparts. Individual, institutional, and cultural racism account for many of these disparities. The life experience of African Americans affects the manifesta tion of mental disorders, and the therapeutic process. To work effectively with African American clients, therapists must be knowledgeable of their characteristics and strengths. Ethnic and racial identity, family structure, spiritual and religious values, education characteristics, and the experiences of Black youths all suggest important dimensions to consider in counseling African Americans. An important aspect of cultural competency with African Americans is the recognition of pro tective factors and the strengths that have allowed them to survive in an intolerant society. Nine clinical implications for counselor practice are identified.