Aging: Challenges for Clinicians

New Online CE Course @pdresources.org

Aging: Challenges for CliniciansAging: Challenges for Clinicians is a new 3-hour online continuing education (CE) course that provides a review of the aging process, illustrating potential challenges and effective solutions.

Americans are living longer and there are proportionately more older adults than in previous generations due to the post-World War II baby boom. Many Americans are now living into their eighties and beyond. In healthcare, the volume of older people may soon outnumber the supply of healthcare professionals trained in geriatrics.

Aging presents many challenges for people as they encounter new physical and psychosocial issues. It is vital for healthcare professionals to be familiar with the challenges of aging in order to effectively treat the aging population. This course will provide information on the normal process of aging, and point out problems commonly thought to be normal that require medical or psychological evaluation and treatment. Case examples will illustrate scenarios of aging persons who may be at risk but are not aware there is a problem. Use this information for referral as appropriate to ensure the highest level of functioning for your patients.

Course #31-01 | 2017 | 54 pages | 20 posttest questions


Click here to learn more.

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion.

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

Addressing Clients’ Prejudices in Counseling

By Bailey P. MacLeod

Addressing clients’ prejudices in counselingCounselors-in-training are often encouraged to be aware of and discuss issues that they think would be difficult for them to address with clients in counseling. A first-year counseling student recently disclosed that due to his values of multicultural awareness and acceptance, he would find it difficult to work with a client who expressed any prejudices in counseling. Given the counseling profession’s shift to a multicultural and social justice paradigm when working with clients, this is a valid concern but one rarely discussed when training counselors to work with culturally different individuals.

How should counselors handle prejudices that clients express in counseling? Do these prejudices need to be addressed if they are not related to the client’s presenting issue? The counseling profession has established values of awareness, knowledge and skills in multicultural counseling and social justice as a way to address power, privilege and oppression. Focus has largely been placed on how to guide treatment of culturally different clients in ways that acknowledge their unique worldviews. Under the banner of social justice and advocacy, counselors must also address the societal, historical and political issues that continue to oppress others. However, little information has been provided on how to address the biases of clients who may hold power and privilege in society, especially White clients who express prejudices.

Granted, prejudice is not a common presenting issue that brings clients to counseling. However, it is not uncommon for clients to express such values and beliefs in the counseling context. We are all cultural beings with unique values, histories and worldviews, and racism and prejudice affect everyone in some way. As counselors, we are taught to work within the worldview of the client, and social justice maintains that we must also work within a conceptual framework of how oppression at individual, societal and institutional levels can affect a person’s growth and development. By addressing biases that clients bring to counseling — biases that have the potential to be harmful to their own growth and the growth of others — we are addressing aspects of their worldview, while also adhering to the values of social justice.

I experienced this dilemma firsthand while working with college students during my training as a counselor. Feeling caught off guard, I struggled with how to handle a situation in which a client expressed racial stereotypes in counseling. I had little guidance from supervisors or professors concerning how to make sense of the situation. After researching the meaning of racism and prejudice and discussing with other counselors the best way to meet clients’ needs while also addressing power and privilege, I developed some considerations and interventions that counselors can use if they ever experience a client expressing prejudices in counseling.

In multicultural counseling and social justice training, counselors are primarily exposed to information that will help culturally different and oppressed clients, even as these counselors focus on awareness of their own prejudicial experiences and culture. This article addresses ways to work with clients who have the power to oppress. This is an issue that is aligned with the goals of social justice, albeit at an individual level, in an attempt to address biases in those who hold them.

Of course, culturally different persons can also express biases and stereotypes toward other groups, but these biases may have different meanings and origins. The interventions and conceptual issues presented in this article can be tailored to other situations, but the emphasis is largely around working with White clients who endorse stereotypes or biases toward people commonly oppressed in society. Therefore, the goal is to provide counselors with considerations and possible interventions to help these clients gain more insight and awareness that will potentially stimulate their personal growth.

Addressing Prejudice: Is it Ethical?

I have already made an argument concerning why it is important to address clients’ prejudices when expressed in counseling, both for the individual and society. However, I had many questions about my role as a counselor when I experienced this situation with a client. Was it my job to address prejudice if the client didn’t see it as an issue? Would I be promoting an “agenda” that was not part of the client’s worldview?

Ethically, we have a responsibility to respect the client’s worldview by maintaining an accepting and nonjudgmental stance. At the same time, it is our ethical responsibility to work within an understanding of social justice and advocacy. As with most ethical dilemmas, there are various ways to handle this situation but rarely a clearly defined “right” way to act. One possible path is to avoid addressing the client’s comments in therapy. But ignoring the issue could result in colluding with the client’s attitudes and maintaining the status quo of oppression. It could also send the message to the client that it is acceptable to avoid uncomfortable discussions. A counselor who experiences strong negative feelings toward the client’s values and beliefs but does not address the client about them may become resentful and critical of the client, possibly causing an impasse in counseling.

On the other hand, several consequences could occur if the counselor does address the client’s racist statements and beliefs. For example, the way the counselor addresses the issue may cause the client to feel embarrassed, ashamed or misunderstood, especially if the client is aware of the negative connotations of being viewed as “racist.” The context of therapy, the counselor-client dynamics and the way in which the client presents these beliefs are important considerations. For instance, let’s say a counselor who identifies as gay is working with a client who makes homophobic statements in counseling. This situation is both professionally and personally relevant to the counselor, who considers disclosing to the client that he identifies as gay. Before doing so, however, the counselor must ask who will really benefit from such a disclosure — the counselor or the client?

At a minimum, counselors should give clients the option and space to discuss racial and other prejudicial issues in the context of their own worldviews and experiences. Before deciding how to intervene in similar situations involving clients’ prejudices, counselors should take the following important steps.

  • Consider the client’s goals and how prejudice is related to these goals.
  • Assess the client’s racial identity.
  • Assess the function these stereotypes and biases serve for the client.
  • Consider how the racist comments relate to cultural racism.
  • Assess what cultural values and strengths maintain these beliefs.
  • Identify cultural strengths the client can use to stop relying on these biases.
  • Clarify your own motivations and reactions in the process of addressing prejudice.
  • Assess the client’s motivation for change in this area.


Conceptualization and Interventions

Similar to counseling for most other issues, it is not always feasible to expect clients who express prejudices and biases to completely resolve all of their issues. Much of the change in the area of prejudice depends on the factors just discussed and how much clients wish to change this aspect of themselves. However, at minimum it may be important to develop an awareness of the origins and functions of clients’ prejudicial attitudes as a means of better understanding their presenting issues. This can assist counselors in developing appropriate interventions that ultimately address clients’ concerns and possibly help them become more aware of their own biases.

One useful way to conceptualize White clients in relation to prejudices is through Janet Helms’ White racial identity development model. The idea of a White identity focuses mainly on the implications of having unearned, race-based power and privilege with the potential to oppress others who do not have that same privilege. The model emphasizes the transition from being unaware of one’s White racial background to an awareness and integration of one’s Whiteness into other parts of identity by giving up power and appreciating differences. The developmental status of a client will affect how he or she views other races and the relationship the client has with other races.

The first status in the White racial identity development model is contact. A client who is in the contact stage may claim not to see race (color-blind attitude) and may not understand the meanings associated with race. The disintegration status usually occurs when a White person is confronted with and feels guilty about racial inequality but experiences ambivalence about how this inequality relates to him or her. The reintegration status is usually triggered by an experience in which the White individual feels he or she has been treated unfairly or discriminated against. This individual may believe in the superiority of being White and in the intolerance of other races.

Afterward, the person may move into the pseudo-independence status, which is characterized by an intellectual understanding of White privilege. However, the person still may lack any concrete experiences related to this understanding. The immersion/emersion status involves the person having a more personal understanding of how he or she contributes to racism in society. However, the person may be hypervigilant to the point of having extreme reactions to perceived racism. Moving past this status will allow a person to attain autonomy, or a nonracist identity. These statuses are not fixed and absolute, of course, but they provide a useful tool in recognizing how clients see their White identity and understanding their reactions to issues of race.

When I work with clients who express certain thoughts, feelings or behaviors that they find problematic, I usually look for their origins and the functions that they serve in clients’ lives. I also apply this method in situations in which clients express prejudices during counseling, asking where these attitudes came from and what purpose they serve for the client. Assessing the client’s experiences with racism, social and familial history with prejudice, and parental reactions to race and culturally different people in childhood provides useful information about the origin of these values. It also allows the counselor to better empathize with and validate the client’s current experience instead of shaming the client or judging the client’s values.

The function of these attitudes is also very important for understanding the deeper meaning of the attitudes outside of the judgmental stance of “racism.” When a person’s self-esteem is threatened, especially in a racially charged situation, there is a tendency to defend with an in-group (pro-White) bias. The use of prejudicial comments or beliefs may be more powerful for White individuals who also hold another aspect of their identity that is oppressed. For example, a White gay man may express racist beliefs in reaction to a situation where his sexuality is threatened. This can lead to unhealthy and inaccurate distortions of information to preserve identity and avoid painful emotions associated with unearned privilege. Denial and rationalization of racial issues and prejudice is a way for clients to avoid painful aspects of race-related issues and any responsibility for privileged behavior. Stereotyping less privileged cultures can also allow clients to avoid changing the way they interact with others, while placing the blame for prejudice on those who are oppressed. These reactions tend to emerge when clients feel that some aspect of their identity is being threatened and they need to find a way to defend against those uncomfortable feelings.

Interventions can be loosely tailored to the client’s identity status and the function of these prejudicial beliefs to gain insight and move to a more integrated understanding of White privilege and oppression. For example, helping clients explore the origin of their beliefs can help them connect their past experiences to their current attitudes, which can raise awareness and increase insight. This also models to the client ways to address difficult conversations concerning race and prejudice. Counselors can also provide psychoeducation about the history of oppressed groups to clients who deny the existence of prejudice in society and in their own behavior or attitudes.

Ambivalence is a common reaction for clients in the disintegration status. Counselors could use interventions to help these clients understand and process ambivalent feelings such as guilt. Counselors who understand a client’s own history with discrimination can help the client connect those experiences and negative emotions with the experiences of others who are subjected to discrimination. This allows the client to develop empathy and understanding for others.

Clients who show a higher-level status of White identity may benefit from exploring what it means to be White and learning to be more flexible in their emotions and reactions to racism. Finally, counselors who understand the deeper meaning of a client’s prejudicial comments (for example, insecurity) can better tailor interventions to address the core issue so the client no longer has to rely on maladaptive coping strategies.

Counselor Considerations

Broaching the subject of prejudice and privilege can be difficult for clients and counselors. Counselors first need to develop a solid therapeutic relationship with their clients to establish trust and prevent shame. Counselors also need to be aware of why and how they respond or do not respond to clients’ values so they can avoid reacting in ways that meet their own needs rather than those of their clients. Therefore, it is important for counselors to be aware of their own experiences and attitudes toward prejudices.

Counselors who are uncomfortable with the topic may avoid discussing it or deny its importance to the client’s concerns. Negative reactions such as guilt, anger or identification with a client’s values may cause a counselor to become blind to the client’s needs and appropriate interventions. Counselors who are not completely comfortable with their own White identity may unintentionally distance themselves from the client in an attempt to avoid White guilt and to identify as a nonracist White person. How a counselor responds to a client’s values has an impact on the effectiveness of counseling. It is important for counselors to monitor their own reactions and maintain self-awareness to properly meet their client’s needs.

Counselors work with important aspects of clients such as their attitudes, values and beliefs. A concern for many counselors, especially beginning counselors, is how to handle client values that conflict with their own. Counselors who are aware of potential problems that clients may present them with in counseling will be more prepared to respond and intervene in effective ways. Hot topics such as racism and prejudice can be especially problematic for counselors who value the tenets of multicultural awareness and social justice in their personal and professional lives, making it difficult to respond therapeutically. Regardless, it is our responsibility as counselors to respect clients’ values. This does not mean, however, that those values cannot be addressed in helpful ways in counseling.

I wanted to highlight this dilemma because it is infrequently discussed in counselor training or workshops. Therefore, the situation can be very jarring and unexpected for counselors. The ideas outlined in this article are just starting points for counselors to consider should they encounter clients who express prejudicial attitudes in counseling sessions. It is important to think about how interventions in counseling can best benefit the client, while also keeping in mind our professional values of multicultural awareness and social justice.

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Those interested in more information on this topic can refer to Bailey P. MacLeod’s article “Social Justice at the Microlevel: Working With Clients’ Prejudices,” published in the July 2013 issue of the Journal of Multicultural Counseling and Development.

 

Bailey P. MacLeod is a doctoral student in the Department of Counseling at the University of North Carolina at Charlotte. Contact her at bmacleod0222@gmail.com.

Source: http://ct.counseling.org/2014/01/addressing-clients-prejudices-in-counseling/

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Related Online CEU Courses:

Multicultural Issues in Counseling – Multiracial Psychology Training is a 3-hour online CEU course that provides specific cultural information and recommendations for training and practice related to each group.

Multicultural Issues in Counseling – Older Adults is a 1-hour online CEU course that explore the key issues regarding the infusion of multicultural competence throughout geropsychology.

Improving Cultural Competence in Substance Abuse Treatment is a 4-hour online continuing education (CE/CEU) course that proposes strategies to engage clients of diverse racial and ethnic groups in treatment.

Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.

Cultural Competence in Substance Abuse Treatment

Course excerpt from Improving Cultural Competence in Substance Abuse Treatment

Improving Cultural Competence in Substance Abuse TreatmentJohn, 27, is an American Indian from a Northern Plains Tribe. He recently entered an outpatient treatment program in a midsized Midwestern city to get help with his drinking and subsequent low mood. John moved to the city 2 years ago and has mixed feelings about living there, but he does not want to return to the reservation because of its lack of job opportunities. Both John and his counselor are concerned that (with the exception of his girlfriend, Sandy, and a few neighbors) most of his current friends and coworkers are “drinking buddies.” John says his friends and family on the reservation would support his recovery—including an uncle and a best friend from school who are both in recovery—but his contact with them is infrequent.

John says he entered treatment mostly because his drinking was interfering with his job as a bus mechanic and with his relationship with his girlfriend. When the counselor asks new group members to tell a story about what has brought them to treatment, John explains the specific event that had motivated him. He describes having been at a party with some friends from work and watching one of his coworkers give a bowl of beer to his dog. The dog kept drinking until he had a seizure, and John was disgusted when people laughed. He says this event was “like a vision;” it showed him that he was being treated in a similar fashion and that alcohol was a poison. When he first began drinking, it was to deal with boredom and to rebel against strict parents whose Pentecostal Christian beliefs forbade alcohol. However, he says this vision showed him that drinking was controlling him for the benefit of others.

Later, in a one-on-one session, John tells his counselor that he is afraid treatment won’t help him. He knows plenty of people back home who have been through treatment and still drink or use drugs. Even though he doesn’t consider himself particularly traditional, he is especially concerned that there is nothing “Indian” about the program; he dislikes that his treatment plan focuses more on changing his thinking than addressing his spiritual needs or the fact that drinking has been a poison for his whole community.

John’s counselor recognizes the importance of connecting John to his community and, if possible, to a source of traditional healing. After much research, his counselor is able to locate and contact an Indian service organization in a larger city nearby. The agency puts him in touch with an older woman from John’s Tribe who resides in that city. She, in turn, puts the counselor in touch with another member of the Tribe who is in recovery and had been staying at her house. This man agrees to be John’s sponsor at local 12-Step meetings. With John’s permission, the counselor arranges an initial family therapy session that includes his new sponsor, the woman who serves as a local “clan mother,” John’s girlfriend, and, via telephone, John’s uncle in recovery, mother, and brother. With John’s permission and the assistance of his new sponsor, the counselor arranges for John and some other members of his treatment group to attend a sweat lodge, which proves valuable in helping John find some inner peace as well as giving his fellow group members some insight into John and his culture.

To provide culturally responsive treatment, counselors and organizations must be committed to gaining cultural knowledge and clinical skills that are appropriate for the specific racial and ethnic groups they serve. Treatment providers need to learn how a client’s identification with one or more cultural groups influences the client’s identity, patterns of substance use, beliefs surrounding health and healing, help-seeking behavior, and treatment expectations and preferences. Adopting Sue’s (2001) multidimensional model in developing cultural competence, this course identifies cultural knowledge and its relationship to treatment as a domain that requires proficiency in clinical skills, programmatic development, and administrative practices. This course focuses on patterns of substance use and co-occurring disorders (CODs), beliefs about and traditions involving substance use, beliefs and attitudes about behavioral health treatment, assessment and treatment considerations, and theoretical approaches and treatment interventions across the major racial and ethnic groups in the United States.

Improving Cultural Competence in Substance Abuse Treatment is a 4-hour online continuing education (CE/CEU) course that proposes strategies to engage clients of diverse racial and ethnic groups in treatment.

Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.

Improving Cultural Competence in Substance Abuse Treatment

By the Substance Abuse and Mental Health Services Administration (SAMSHA)

Improving Cultural Competence in Substance Abuse Treatment is a new 4-hour online continuing education (CE/CEU) course that proposes strategies to engage clients of diverse racial and ethnic groups in treatment.

Improving Cultural Competence in Substance Abuse Treatment

New 4-Hour Online CE Course

Culture is a primary force in the creation of a person’s identity. Counselors who are culturally competent are better able to understand and respect their clients’ identities and related cultural ways of life. This course proposes strategies to engage clients of diverse racial and ethnic groups (who can have very different life experiences, values, and traditions) in treatment. The major racial and ethnic groups in the United States covered in this course are African Americans, Asian Americans (including Native Hawaiians and other Pacific Islanders), Latinos, Native Americans (i.e., Alaska Natives and American Indians), and White Americans. In addition to providing epidemiological data on each group, the course discusses salient aspects of treatment for these racial/ethnic groups, drawing on clinical and research literature. While the primary focus of this course is on substance abuse treatment, the information and strategies given are equally relevant to all types of health and mental health treatment. Course #40-39 | 2015 | 75 pages | 30 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. You can print the test (download test from My Courses tab of your account after purchasing) to mark your answers on it while reading the course document. Then submit online when ready to receive credit.

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); theFlorida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the South CarolinaBoard of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. Congress established the Substance Abuse and Mental Health Services Administration (SAMHSA) in 1992 to make substance use and mental disorder information, services, and research more accessible. http://www.samhsa.gov/