The invisible scars hurt the most

I like to think of myself as strong. However, there are times where I feel brittle, emotionally. I tried to walk it off when I herniated two discs in my back, as I find physical pain or discomfort to be much easier to handle than my own emotional weaknesses. Luckily, the present does not find me to be in such a weak state, otherwise I wouldn’t be able to function at top form, let alone write. 

I push myself physically, as I find it to be therapeutic. Feeling the power and accomplishment helps me to feel strong, which I guess I hope turns into an emotional strength too. It’s a bit ironic that I fully accept my “baggage” as a part of me, much like a limb. However, I am going through graduate school in hopes to help other people to work through their “baggage.” I guess it is easier for me to accept it as part of who I am, rather than confront it head on. 

I am not sure what life would be like if I didn’t have the multitude of emotional scars. Would I be more carefree? Would I have less anxiety? Even the thought of having less anxiety makes me…well…anxious. Just like how yoga and meditation induces panic attacks. I suppose it stems from the fear of my mind being “quiet,” as that is when the darkness sneaks in and smothers the light. Smells, sounds, and environments can trigger memories, or they can overcome me like an unexpected dog fart. 

My past likes to taunt me at times, and the more I learn, the more I realize that events from my past are linked to my present and possibly future too. People (family) have told me to “just snap out of it,” and “get over it.” If only they knew the events that lurk in my past…they would understand just how hurtful those words can feel. Secrets that I will most likely take with me to my grave, haunt me on a daily basis. If only I could just “get over it.” 

Until that day though, I live life, one day at a time, nerves exposed to my surroundings. 

Cultural competency: How a counselor’s culture can influence the therapeutic relationship

Abstract

Culture is a single word that encompasses a plethora of categories, which have the ability to influence one’s thoughts, actions, beliefs, and morals. The encapsulation of a myriad of life’s experiences, lessons, and family values into one single word is a challenge, one only rivaled by the role that culture can play in the life of a counselor when involved in a therapeutic relationship with a client. By examining one’s own lens of which they view their surroundings, a clearer picture may emerge, expanding the horizons of perception, and bringing a new light to reality. However, it is imperative to remember that people are individuals first and foremost, and not necessarily their culture, and to treat them as such would be a disservice to society as a whole.

Personal Culture

Being the product of a variety of European cultures, in addition to growing up in a diverse area such as the San Francisco Bay Area, my personal culture is one that contains numerous influences. The maternal side of the family is primarily comprised of German and Irish descent, with small percentages of Swedish and Scandinavian. There is much unknown about the paternal side, other than the presence of Polish descent, as indicated by the last name of *****ski. Assimilation into the dominant culture upon immigrating is often challenging, with feelings of anxiety, confusion, loss of control, fatigue, and even depression can occur when one experiences culture shock (Murdoch & Kaciak, 2011). However, belonging to the majority culture does not necessarily mean that one will not experience culture shock, as indicated by the examination of suicide rates across multiple cultures in one location, specifically San Francisco. Researchers revealed that while Caucasian was the racial majority, they also were more likely to achieve successful suicide (Shiang, 1998) when compared to both racial differences and geographical areas.

Culture, specifically ethnic influence, was not a large part of growing up, since the maternal family had immigrated several generations ago. Hard work was encouraged more than ethnic traditions, which may have contributed to the lack of focus over the generations. The environment in which one lives may play a larger role on the cultural development, rather than the immediate or extended familial parties. The San Francisco Bay Area contains a vast array of ethnicities and cultures, which are evident by the variety of markets, languages, and religious establishments that can be found within the geographic region. When comparing the ethnic diversity among metropolitan Bay Area residents to that of a less diverse and rural locale, the influence of environment versus the biological role involved in the development of an individual’s cultural identity can become confusing. 

Traditions

Traditions, influenced by values, beliefs, and rituals, are passed down from one generation or family to another. They are a form of a living time capsule, as a way to remember the past and carry them into the future (Mohanadoss, 1997). Some traditions die out over the generations, and possibly replaced by new ones. Religious traditions were once a prominent aspect to the maternal side of my family, but have now dwindled as generations pass. My grandmother is a practicing Episcopal Christian who attends church every Sunday and on holy holidays. She is active in her faith and invites neighbors to join her in services, where she also often volunteers as an usher and has worked in their soup kitchen to assist in feeding the homeless. In contrast, my mother considers herself more “spiritual” than religious, and did not pressure me as a child to be active in faith practices, other than family dinners for Easter and Christmas. Her openness led to my not being baptized in any faith, but rather free to experience religion on my own personal terms and to develop my personal belief system.

A tradition that has been durable over the generations is environmental responsibility and conservation. My grandparents grew up during the Great Depression, in which resources were scarce and ingenuity was necessary, influenced such a tradition. Personal gardens and repurposing household items were common in my youth, with my mother making my baby food from produce grown in our own garden instead of store bought jars. While the need to scrimp and be resourceful is not as great due to modern advances and an improved economy, I have carried on the tradition of respecting the environment through implementing the three R’s (reduce, reuse, and recycle), buying local items, composting, and only what I need instead of the extravagances experienced by others.

Some of the cultural aspects within my family bring forth pride, whereas others elicit a sense of shame. While being a very open family, accepting various preferences both within and outside the family, there is some carryover prejudice that is still present within the older generation. An inclusion and acceptance of LGBT within my family is one of which I am proud to admit. Growing up in a family that included an uncle who happened to be gay, made it seem normal, and was a shock when I realized that society was not as accepting as my family, which was made clear when my uncle was the victim of a hate crime during the early 80s in San Francisco. Support by the family is essential for members of the LGBT community, as they face challenges in school, society, and are often targets for violence. Victimization of LGBT adolescents in school has been linked to mental health issues in later stages of development (Russel, Ryan, Toomey, Diaz & Sanchez, 2011), further emphasizing the need for support by family members.

While there is support for one group of individuals within my family, cultural stereotypes still exist among the older generation. As described by Sue and Sue (2013), the assumption of abnormality regarding the LGBT community is not present in my family, but the use of outdated and politically incorrect language that can be quite offending at times, is present. Identifying people as “Oriental” instead of by their nationality (Asian, Chinese, Japanese, and Korean) is one common occurrence among not only the older generation in my family, but their friends as well, suggesting a possible cohort effect.

Worldview

The definition of worldview varies greatly, ranging from “We are what we think” inspired by the Buddha, to the more current view as it being a set of assumptions that have a powerful effect on both cognition and in turn, behavior (Koltko-Rivera, 2004). In short, a worldview influences the way one views their lives, surroundings, and the people in their environment. Worldviews are often unique to an individual and can evolve over the course of time, influenced by experiences and shaped by lessons in life. My personal worldview varies greatly from those beliefs held by my family, which has at times created a rift between us. However, firmly held beliefs, desires, and goals, things praised in Western culture, would seem foreign and wrong to a more collectivist non-Western worldview. 

Keeping the differences in mind, both within my own family and society as a whole, can help in my personal and professional lives. My worldview as it pertains to counseling is indeed influenced by my experiences, but also through learning about different approaches and techniques, in addition to developing a multicultural competency. 

Worldview and counseling

Within the scope of practice, counselors are bound to interact with clients who have a different worldview as their own. Learning about the unique differences, both within a culture and on the individual level, is imperative to effective therapeutic intervention methods. My personal view and approach to counseling is a rather straightforward method, similar to solution-focused brief therapy, which highlights personal accountability and responsibility for one’s actions. In addition to accepting responsibility for their role in the counseling relationship, it would be helpful to make the transition from the “victim” mentality to a survivor, thus regaining control and personal power. Such an approach has been found to be beneficial when working with clients who have experienced trauma (Danzer, 2011), which comprise my target demographic and counseling population within the military.

While my personal worldview and counseling application may work for some clients, it would not be an effective method for all, thus the need for a more client-focused therapeutic approach would be useful, especially when working with a varying population. However, some of my personal experiences that have contributed to my worldview would be useful in the military, especially as it pertains to the LGBT population after the change of Don’t Ask, Don’t Tell. However, barriers may arise during counseling sessions, including the fact that some clients may be happy in their “role” and not desire to make a change, the “Good ole boys club” mentality within the military culture, and I have very little experience with individuals who are considered high-SES.

Addressing barriers

Being aware of possible barriers in counseling it the first step in addressing the challenges that may arise in sessions, but one must proceed past the awareness stage, into the learning phase if change is to occur. While culture may not play a large role in a client’s life, ignoring the differences may become detrimental to the counseling relationship. Learning about the way roles differ within cultures can provide insight into human behavior. One tool that can assist in evaluating the level of importance a client places in their culture occurs during the intake interview. Sue and Sue (2013) suggest special consideration be paid to questions that probe deeper than the standard regarding ethnic background, age, gender, and medication history, a departure from the medical model approach of treatment.

Conclusion

While counselor culture can influence the way they view their clients, the culture of the client can also influence the way they view their counselor. Learning, experience, and having a broad spectrum of cultural competence can help to bridge the disparity that may occur between two conflicting worldviews. It is apparent that culture does play a role in society, it is also important to remember that people are individuals, and not all will adhere to the cultural norms; to assume would be akin to racism and/or prejudice.

**References available upon request**

Oregon legal statutes and ethical implications in the counseling profession

Abstract

            Ethics evolve, just as society changes, often leaving some challenging gray areas which can be confusing and dangerous in the counseling profession. In addition to the ethical quandaries, the legal aspects to counseling are essential to offer protection for all parties involved in a client-counselor relationship. Luckily, several agencies contribute to guidance in both the legal and ethical arenas, assisting counselors in the navigation of the murky areas in practice. Knowing where to find the resources is as important as the application of the ethical and legal codes themselves. Different settings and practices may have varying legal issues, making current codes essential to any practicing counselor. Some of the resources available to guide the ethical and legal questions that may arise during practice are presented in the following paper.

What is the difference?

            Determining whether an issue is legal or ethical can help to guide the actions of a counselor, hopefully resulting in a positive outcome. However, the delineation between the two can be a bit confusing to navigate, which is further complicated by the often misuse of the terms, using them interchangeably, when they do indeed have different meanings.

Ethics, as described by Foster and Black (2007), address the relationship between the client and counselor, in that there is an understanding of the roles each play in the interaction. In addition to the two separate identities involved in the therapeutic relationship, the counselor also has to take into consideration their own behavior, as it relates to ethical implications. That is, an examination of whether their actions are helpful or harmful, to one or both parties. Ethics have been codified, in that the American Counseling Association, or ACA, has published a code of ethics (http://www.counseling.org/resources/codeofethics/TP/home/ct2.aspx), which helps to serve as a guide for counselors, providing a consensus of behavior for professionals that are considered acceptable and helpful to both the client and the counselor.

            The term legal pertains to a consensus of regulations that have been set forth to establish the minimum standard of conduct acceptable (Remley & Herlihy, 2010). One of the key differences between ethics and law is that the latter can differ depending on the state the counselor is practicing. While there are some universal laws that govern the behavior of counselors, learning the local state laws, in addition to the more widespread laws set forth by the government can help the counselor to stay on the right side of the legal system.

Updates and revisions

            In order to keep up with changes in society, the counseling code of ethics changes to address the ethical issues counselors may face in their practice. The ACA has a task force, consisting of eleven experts in the field of counseling and ethics, that are currently working on a collaboration of changes to the ethical guidebook, which is slated to be published in 2014 (http://www.counseling.org/PressRoom/NewsReleases.aspx?AGuid=3dead7fe-795b-4d75-896d-c171079b4b10). Some of the proposed changes include the expansion into the realm of the cyber world, the use of technology in the forms of social media especially, along with providing guidance to counselors on the intricacies of providing services to a more culturally diverse population (Rollins, 2011).

Since its inception in 1963, the Code of Ethics has been revised every seven to ten years, making the upcoming revision a scheduled, but well needed augmentation to keep up with the changes that have occurred since the current Code was published in 2005 (Kocet, 2006). The current Code changed to reflect the changing needs of society since the previous edition, published in 1995, and focused on multicultural, diversity, and social justice issues (Kocet, 2006). Changes made during the revision of the previous edition included the realms of confidentiality, teaching, training, and supervision within the counseling field (Kocet, 2006). In order to become uniform, some states have decided to integrate the ACA Code of Ethics into their licensure boards. As of 2010, 17 states, including the District of Columbia, have adopted the ACA Code of Ethics into their rules and regulations (http://www.counseling.org/counselors/LicensureAndCert.aspx).

Oregon counseling laws

            The primary resource for learning about local governmental and state laws can be found with just a little bit of research. Oregon’s laws regarding counselors can be found online and is a valuable resource for any practicing counselor, and aims to offer protection for the consumer as their main goal (http://www.oregon.gov/OBLPCT/Pages/index.aspx). In addition to addressing the mandatory educational and supervision required for counselors-in-training, the site also offers clients a way of reporting suspected infractions and/or abuse perpetrated by counselors. Oregon Administrative Rules, or OARs, are the state guidelines that govern the acceptable actions by state agencies and individuals operating within the state of Oregon (http://www.oregon.gov/osl/ld/pages/resources/laws/oar.aspx). Some of the counseling-specific regulations that can be found within the Oregon Revised Statutes (ORS) include the reporting of suspected abuse, complaint processes, and continuing education requirements (http://www.oregon.gov/oblpct/Pages/web-lr.aspx).

Examples of issues that may arise

 The ACA has recognized that counselors face many ethical situations during their practice, and has designed the Ethical Decision Making Model to address these issues. The model consists of seven steps, which consist of identifying the problem, applying the ACA Code of Ethics, determining the nature and dimensions of the dilemma, generate potential courses of action, considering the potential consequences of all options and choosing a course of action, evaluating the selected course of action, and implementing the course of action (Forester-Miller & Davis, 1996).

Using the aforementioned steps in analyzing prospective issues that may arise during counseling practice can help to better prepare for when they do occur. Some of the possible scenarios that one could experience as a counselor working with military members include the sharing of records with the client, pursuing a relationship outside of the scope of practice, sharing case records with attorneys or representatives that can influence the degree of disability rating received, counseling sessions conducted via email or other electronic communication while deployed, and offering an assessment of fitness for family court.

Clients do have the right to acquire their case notes from sessions with the counselor, as indicated by the guidelines included in the National Board for Certified Counselors (NBCC), which states that the information included in the session records ultimately belongs to the client and shall be shared with the client if requested (http://www.nbcc.org/assets/ethics/nbcc-codeofethics.pdf). The NBCC regulations are an ethical guideline that incorporates the ACA Code of Ethics into a client- and counselor-centered approach to ethics.

Pursuing a relationship outside of a professional one can be potentially damaging, whether it is of the friend or romantic varieties, and can constitute an abuse of power. As such, in order to reduce harm to the therapeutic relationship, counselors are prohibited from entering into romantic relationships until after five years have passed since the therapeutic interaction has been terminated. The time increased in 2005, which was set at two years according to the 1995 Code of Ethics. The statute addressing such relationships, found in Standard A.5. in the 2005 ACA Code of Ethics also includes a prohibition on romantic/sexual interaction with family members and romantic partners of current clients (Kaplan, 2006).

Sharing of case documents, either with clients or legal representatives via subpoenas can occur and does not cross any boundaries, legal or ethical, as long as the proper releases are signed by the client (http://www.zurinstitute.com/subpoena.html#authorizations). The counselor shall share the minimum amount of information pertinent to the situation.

Advances in electronic communication have required the counseling profession to adapt to the changes in therapeutic intervention methods, including counseling via email, Skype, and telephone. The current ACA Code of Ethics addresses such advancements in Standard A.12, and recognizes that the delivery of counseling via methods other than face-to-face may cross jurisdictional or state laws (Kaplan, 2006). If counseling sessions are to be conducted over the internet, it is imperative to use encryption software in order to maintain confidentiality between clients and counselors.

In addition to providing therapeutic interventions, counselors are often called to provide assessments for fitness of duty, parenting, and emotional stability. In the case of a client asking their counselor to provide a written opinion regarding the fitness of a father to gain full custody of his children, a counselor needs to keep in mind that their decision can influence not only their client, but also the children involved in the custody case. According to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, the clients can obtain legal documents and expert opinions provided by counselors (http://www.law.ucdavis.edu/faculty/bruch/files/appendixb.pdf). However, the counselor must provide impartial information in their assessment.

Conclusion

            The field of counseling, governed by legal and ethical guidelines, is also influenced by changes in society and culture. The need to recognize the differences between the legal and ethical issues that may arise is essential in providing the most effective therapeutic interventions, while maintaining a professional code of conduct that does not cross any boundaries. Maintaining an effective professional relationship with clients, legal entities, and fellow counselors can be challenging at times, but with conscious effort into acquiring the most recent information regarding rules and regulations, counselors can continue to provide the best treatment possible.

**References available upon request**