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ERIC Identifier: ED279995
Publication Date: 1987-00-00
Home Author: Bolton-Brownlee, Ann
Source: ERIC Clearinghouse on Counseling and Personnel
Services Ann Arbor MI.
Issues in Multicultural Counseling.
Highlights: An ERIC/CAPS Digest.
Search for Traditionally, the United States has been defined
ERIC as a melting pot in which various cultures are
Digests
assimilated and blended as immigrants mold their
beliefs and behavior to the dominant white
culture. The melting pot image has given way to a
more pluralistic ideal in which immigrants
maintain their cultural identity while learning to
About
This Site function in the society. Not only are immigrants still
and flocking to America from Cuba, Haiti, Vietnam,
Copyright Guatemala, El Salvador, and other countries (LaFromboise,
1985), but minorities already living in the United States
have asserted their right to have equal access to counseling
(Arcinega and Newlou, 1981). This diversity creates
three major difficulties for multicultural
counseling: 1. the counselor's own culture,
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attitudes, and theoretical perspective; 2. the
client's culture; and 3. the multiplicity of
variables comprising an individual's identity
(Pedersen, 1986).
THE COUNSELOR'S CULTURE
A major assumption for culturally effective
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counseling and psychotherapy is that we can
acknowledge our own basic tendencies, the ways
Instruction
we comprehend other cultures, and the limits our
culture places on our comprehension. It is
essential to understand our own cultural heritage
and world view before we set about
understanding and assisting other people
(Ibrahim, 1985; Lauver, 1986). This
Informatio understanding includes an awareness of one's
n Literacy own philosophies of life and capabilities, a
Blog recognition of different structures of reasoning,
and an understanding of their effects on one's
communication and helping style (Ibrahim,
1985). Lack of such understanding may hinder
effective intervention (McKenzie, 1986).
Part of this self-awareness is the acknowledge
ment that the "counselor culture" has at its core
a set of white cultural values and norms by which
clients are judged (Katz, 1985; Lauver, 1986).
This acculturation is simultaneously general,
professional, and personal (Lauver, 1986).
Underlying assumptions about a cultural group,
personal stereotypes or racism, and traditional
counseling approaches may all signal
acquiescence to white culture. Identification of
specific white cultural values and their influence
on counseling will help to counter the effects of
this framework (Katz, 1985).
Adherence to a specific counseling theory or
method may also limit the success of counseling.
Many cultural groups do not share the values
implied by the methods and thus do not share the
counselor's expectations for the conduct or
outcome of the counseling session. To counter
these differences, effective counselors must
investigate their clients' cultural background and
be open to flexible definitions of "appropriate" or
"correct" behavior (LaFromboise, 1985).
Another counseling barrier is language.
Language differences may be perhaps the most
important stumbling block to effective
multicultural counseling and assessment
(Romero, 1985). Language barriers impede the
counseling process when clients cannot express
the complexity of their thoughts and feelings or
resist discussing affectively charged issues.
Counselors, too, may become frustrated by their
lack of bilingual ability. At the worst, language
barriers may lead to misdiagnosis and
inappropriate placement (Romero, 1985).
THE CLIENT'S CULTURE
As counselors incorporate a greater awareness of
their clients' culture into their theory and
practice, they must realize that, historically,
cultural differences have been viewed as deficits
(Romero, 1985). Adherence to white cultural values has
brought about a naive imposition of narrowly defined
criteria for normality on culturally diverse people
(Pedersen, 1986). Multicultural counseling,
however, seeks to rectify this imbalance by
acknowledging cultural diversity, appreciating
the value of the culture and using it to aid the
client. Although the variety of cultures is vast, the
following examples indicate the types of cultural
issues and their effects on the counseling
situation.
In the cultural value system of Chinese
Americans, passivity rather than assertiveness is
revered, quiescence rather than verbal
articulation is a sign of wisdom, and self-
effacement rather than confrontation is a model
of refinement (Ching and Prosen, 1980). Since
humility and modesty are so valued, it is difficult
for counselors to draw out a response from a
Chinese American in a group setting. The
reticence which reinforces silence and
withdrawal as appropriate ways of dealing with
conflict may be interpreted as resistance by the
uneducated counselor. Democratic counselors
may also be uneasy with the role of the "all-
knowing father" that the Chinese respect for
authority bestows on them (Ching and Prosen,
1980).
Africans place great value on the family,
especially their children, who are seen as a gift
from God, and on social relationships, with a
great emphasis on the community and their place
in it. In this context social conflict resolution
becomes important, so that peace and equilibrium
may be restored to the community, while personal
conduct becomes secondary (McFadden and
Gbekobov, 1984).
Many African values also influence contemporary
American Black behavior, including the notion of unity, the
survival of the group, oral tradition, extended kinship
networks, self-concept, concept of time, and control of the
environment.
In his discussion of counseling the Northern Natives of
Canada, Darou (1987) notes that counseling is seen as
cultural racism when it does not fit native values. These
values are: cooperation, concreteness, lack of interference,
respect for elders, the tendency to organize by space rather
than time, and dealing with the land as an animate, not an
inanimate, object.
Bernal and Flores-Ortiz (1982) point out that
Latin cultures view the family as the primary
source of support for its members. Any
suggestion that the family is not fulfilling that
obligation can bring shame, added stress, and an
increased reluctance to seek professional
services. Involving the family in treatment will
most likely insure successful counseling
outcomes with Latinos.
INDIVIDUAL DIFFERENCES
There is always the danger of stereotyping clients and of
confusing other influences, especially race and
socioeconomic status, with cultural influences. The most
obvious danger in counseling is to oversimplify the
client's social system by emphasizing the most obvious
aspects of their background (Pedersen, 1986). While
universal categories are necessary to understand human
experience, losing sight of specific individual factors
would lead to ethical violations (Ibrahim, 1985).
Individual clients are influenced by race, ethnicity,
national origin, life stage, educational level, social class,
and sex roles (Ibrahim, 1985). Counselors must view
the identity and development of culturally diverse
people in terms of multiple, interactive factors,
rather than a strictly cultural framework
(Romero, 1985). A pluralistic counselor considers
all facets of the client's personal history, family
history, and social and cultural orientation
(Arcinega and Newlou, 1981).
One of the most important differences for
multicultural counseling is the difference
between race and culture. Differences exist
among racial groups as well as within each
group. Various ethnic identifications exist within
each of the five racial groups. Some examples
include: Asian/Island Pacific (Japanese, Korean,
and Vietnamese); Black (Cajun, Haitian, and
Tanzanian); Hispanic (Cuban, Mexican and
Puerto Rican); Native American (Kiowa, Hopi,
and Zuni); and White (British, Dutch, and
German). Even though these ethnic groups may
share the physical characteristics of race, they
may not necessarily share the value and belief
structures of a common culture (Katz, 1985).
Counselors must be cautious in assuming, for
instance, that all Blacks or all Asians have
similar cultural backgrounds. McKenzie (1986)
notes that West Indian American clients do not
have the same cultural experience of Afro-
American Blacks and are culturally different
from other Black subculture groups. Counselors
who can understand West Indian dialects and the
accompanying nonverbal language are more
likely to achieve positive outcomes with these
clients.
CONCLUSION
Although it is impossible to change backgrounds,
pluralistic counselors can avoid the problems of
stereotyping and false expectations by examining
their own values and norms, researching their
clients' backgrounds, and finding counseling
methods to suit the clients' needs. Counselors
cannot adopt their clients' ethnicity or cultural
heritage, but they can become more sensitive to
these things and to their own and their clients'
biases. Clinical sensitivity toward client
expectation, attributions, values, roles, beliefs,
and themes of coping and vulnerability is always
necessary for effective outcomes (LaFromboise,
1985). Three questions which counselors might
use in assessing their approach are as follows
(Jereb, 1982): (1) Within what framework or
context can I understand this client (assessment)?
(2) Within what context do client and counselor
determine what change in functioning is
desirable (goal)? (3) What techniques can be
used to effect the desired change (intervention)?
Examination of their own assumptions,
acceptance of the multiplicity of variables that
constitute an individual's identity, and
development of a client centered, balanced
counseling method will aid the multicultural
counselor in providing effective help.
FOR MORE INFORMATION
Arcinega, M., and B.J. Newlou. "A Theoretical Rationale
for Cross-Cultural Family Counseling." THE SCHOOL
COUNSELOR 28 (1981): 89-96.
Bernal, G., and Y. Flores-Ortiz. "Latino Families in
Therapy: Engagement and Evaluation." JOURNAL OF
MARITAL AND FAMILY THERAPY 8 (1982): 337-365.
Ching, W., and S.S. Prosen. "Asian-Americans in Group
Counseling: A Case of Cultural Dissonance." JOURNAL
FOR SPECIALISTS IN GROUP WORK 5 (1980): 228-
232.
Darou, W. G. "Counseling and the Northern Native."
CANADIAN JOURNAL OF COUNSELING 21 (1987):
33-41.
Ibrahim, F. A. "Effective Cross-Cultural Counseling and
Psychotherapy." THE COUNSELING PSYCHOLOGIST
13 (1985): 625-638.
Jereb, R. "Assessing the Adequacy of Counseling Theories
for Use with Black Clients." COUNSELING AND
VALUES 27 (1982): 17-26.
Katz, J. H. "The Sociopolitical Nature of Counseling." THE
COUSELING PSYCHOLOGIST" 13 (1985): 615-623.
LaFromboise, T. D. "The Role of Cultural Diversity in
Counseling Psychology." THE COUNSELING
PSYCHOLOGIST 13 (1985): 649-655.
Lauver, P. J. "Extending Counseling Cross-Cculturally:
Invisible Barriers." Paper presented at the annual meeting
of the California Association for Counseling and
Development, San Francisco, CA. ED 274 937.
McFadden, J., and K.N. Gbekobov. "Counseling African
Children in the United States." ELEMENTARY SCHOOL
GUIDANCE AND COUNSELING 18 (1984): 225-230.
McKenzie, V. M. "Ethnographic Findings on West Indian-
American Clients." JOURNAL OF COUNSELING AND
DEVELOPMENT 65 (1986): 40-44.
Pederson, P. "The Cultural Role of Conceptual and
Contextual Support Systems in Counseling." AMERICAN
MENTAL HEALTH COUNSELORS ASSOCIATION
JOURNAL 8 (1986): 35-42.
Romero, D. "Cross-Cultural Counseling: Brief Reactions
for the Practitioner." THE COUNSELING
PSYCHOLOGIST 13 (1985): 665-671.
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Abstract
OBJECTIVE: To assess barriers to the counseling of obese patients and identify pharmacists' characteristics
SETTING: Texas.
MAIN OUTCOME MEASURES: Respondents' perceived barriers to pharmacists' counseling of obese patients.
RESULTS: The top three barriers to counseling included lack of time (76.8%), lack of patient demand or expectations
(55.8%), and lack of reimbursement/compensation (49.3%). Pharmacists indicated that they rarely to sometimes
counseled obese patients and were somewhat comfortable with counseling about obesity management. They
perceived obesity management strategies to be somewhat effective in weight loss, but were neutral regarding their
confidence in achieving positive outcomes with counseling. Pharmacists who were more experienced were more
likely to indicate that obesity is controllable without medications. Those who considered obesity controllable without
medications were significantly more likely to view the various obesity management strategies as less effective,
compared with those who did not share this belief. Pharmacists who viewed lack of privacy as a barrier were
significantly less confident in achieving positive outcomes as a result of counseling. Creating awareness among
patients about pharmacists' ability to counsel was perceived as most important in overcoming barriers.
CONCLUSION: Pharmacists identified several barriers to counseling of obese patients. Pharmacists' demographics
and beliefs about obesity were significantly associated with their perceived barriers.
I am going to guess that if you have arrived here, there is something going on in your life or the life of someone
close to you that is puzzling or troubling, and you are seeking information to clarify a choice.
That information may involve thinking, feeling, or behavioral components, and you may have thought about talking
to a professional counselor or are considering a career in counseling. (Yes!)
But before you make that decision, you want information about counseling tools, techniques, models, fields, etc.
I hope to provide you helpful tools, techniques, and recommendations based on my experience as a domestic
violence educator and training.
Counseling is an extraordinary experience. It works. My hope for you is that you find information here that will
guide your search to a clinician or tool (many good educational programs online now) which enhances your sense
of efficacy, brings more contentment,and allows you to live closer to your core values.
Counseling Defined
Counselors assist people with personal, family, educational, mental health, and career problems. Their duties vary
greatly depending on their occupational specialty, which is determined by the setting in which they work and the
population they serve.
Definition of Counseling from the American Counseling Association:
The application of mental health, psychological, or human development principles, through cognitive, affective,
behavioral or systematic intervention strategies that address wellness, personal growth, or career development, as
well as pathology.
First, The New Fields!
Neuroplasticity
Can the human brain change itself? Yes. Read here about neuroplasticity. The brain is a plastic, living organ that
can actually change its own structure and function, even into old age. This revolutionary and recent discovery
promises to overthrow the centuries old notion that the adult brain is fixed or unchanging. Yes, the brain can
function more effectively, which makes us more effective for longer periods of time.
Brain Fitness Programs
1. Brain Gyms :
Our brains resemble our muscles in one key respect: don’t exercise them, and they’re likely to lose
strength. Conversely, many experts now believe that brains stimulated in a healthy manner can better
resist debilitating mental conditions such as Alzheimer’s. In fact, there are brain gyms opening now which
utilize two of the programs found here, HeartMath and Luminosity, and the best of all, Mind Sparke.
2. Positive Psychology :
Positive Psychology is the scientific study of the strengths and virtues that enable individuals and
communities to thrive. The Positive Psychology Center promotes research, training, education, and the
dissemination of Positive Psychology.
– This field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate
what is best within themselves, and to enhance their experiences of love, work, and play.
– Positive Psychology has three central concerns: positive emotions, positive individual traits, and
positive institutions.
– Understanding positive emotions entails the study of contentment with the past, happiness in the
present, and hope for the future.
– Understanding positive individual traits consists of the study of the strengths and virtues, such as the
capacity for love and work, courage, compassion, resilience, creativity, curiosity, integrity, self-
knowledge, moderation, self-control, and wisdom.
– Understanding positive institutions entails the study of the strengths that foster better communities,
such as justice, responsibility, civility, parenting, nurturance, work ethic, leadership, teamwork,
purpose, and tolerance.
Some of the goals of Positive Psychology are to build a science that supports:
Families and schools that allow children to flourish
Workplaces that foster satisfaction and high productivity
Communities that encourage civic engagement
Therapists who identify and nurture their patients' strengths
The teaching of Positive Psychology
Most of us remember our reactions when, as kids, we found out it was time to visit
the dentist. If you were like me, you pretty much went kicking and screaming the
entire way. This resistance, although understandable (especially if you had the work
I had done), was based on a lot of misinformation. Going to the dentist hurt, it was
scary and never ended with a lollipop (as a visit to the doctor sometimes did). But
whatever pain we felt in the dentist chair was minor compared to the pain we would
have felt if our teeth had not been properly maintained by a trained professional.
For many, seeking the services of a professional counselor is a lot like going to the
dentist—but worse. Like the dentist, much of our resistance to going to a therapist
is based on misunderstandings. If these were cleared up, I’m convinced that a much
larger portion of our society would get some basic counseling help … and be
healthier for it.
Let’s examine some of the common barriers that keep people from seeking
counseling.
Denial
One of the most common barriers to counseling is the denial of the existence of a
problem, or at least a problem bad enough to seek professional help. There is
something stoic and resilient about humans; we want to prove ourselves, we want
to overcome. We can admire people for this hardy approach to life, but we must
also mourn for them at times. Refusing to come to terms with an obvious problem in
our life is not laudable, it is foolhardy.
Have you ever looked at your car manual? There are often two maintenance
schedules: One for normal conditions and one for harsh conditions. The schedule
designed for cars operating in harsh conditions involves more frequent tune-ups, oil
changes, and preventative diagnostic exams. Most people follow these schedules
for their autos faithfully; why do we refuse to maintain our personal health?
One of the most common misconceptions among all people regarding mental health
is that everybody else has it together. They all look fine, right? So we adopt the
same approach. We make sure our outside persona gives the appearance that we
are fine.
The greater probability is that almost everyone you see is undergoing some sort of
internal or external struggle. Some are weighed down by physical illness, others
struggle with circumstances they cannot control, such as joblessness or the death of
a close friend; many walk around filled with shame, fear, doubt, guilt, anger,
hopelessness, or a host of other emotional and mental issues. As Christian educator
Christopher West said, it’s like we are all driving around town with flat tires. Since
everyone else is also driving around on flat tires, we think it is normal.
What we fail to realize is that we were not intended to be driving around on our
rims, sparks flying and rubber shredding. If we got a flat tire on our car, few of us
would continue driving on it. We would immediately stop and change the tire before
continuing on our way.
When it comes to our emotional and mental health, many of us have been driving
on our rims for a long time. We are convinced that because our vehicle is still
moving forward, we are just fine. But, this is not how we were designed to operate.
Some of the healthiest people I have ever met are recovering addicts. These folks
have no pretensions and no illusions. They know they have been wounded through
their own actions and the actions of others. They differ from others in that they took
that knowledge of their woundedness and used it to transform their lives. It wasn’t
easy, but they are now the people more likely to be devoted to helping and serving
others.
The real first step in getting healthy, whether from physical, mental, or emotional
wounds, is to admit that something isn’t right. A visit to a professional therapist is
like a diagnostic exam. They are trained to help you discover what has gone wrong;
together you decide what kind of treatment you may or may not need.
Social stigma
Although this is decreasing, a stigma is still attached to seeing a counselor. There is
an impression—especially among those who have never tried counseling—that only
people who are really sick or mentally ill would need to see a therapist.
The good news is that our society is beginning to see the value of professional
counseling. More and more people are using the services of licensed therapists for a
variety of reasons, many of them involving life experiences common to all of us. A
counselor can help a college student learn to manage stress, or to determine if the
stress is being caused by something deeper than a heavy course load. Some benefit
from counseling as they work through the grieving process due to divorce or the
death of a loved one. Others seek counseling for depression and are able to
alleviate it before chemical imbalances occur in the brain.
For others, however, counseling may be the very thing that pulls them away from
serious mental illness or addiction. The first step in most 12-step programs is to
admit that one is powerless over the addiction. This means that on their own power,
they are unable to stop their errant behavior. One of the primary assistants in the
addict’s community of caregivers is a trained professional who can help unlock the
deeper reasons why the individual is seeking solace in his addiction.
Getting healthy is the most important goal for a person, whether the problem is
major or minor. We cannot be concerned about the unhealthy viewpoint of
individuals in society who still maintain that counseling is only for a certain category
of people. As one counselor said, “Get over it and get help.”
Religious stigma
Just as common as social stigma, there is a strain of thought among Christians that
counseling is somehow contrary to God’s Word, and therefore should be avoided.
They hold the Bible up and insist that everything we need for life is contained
within. Although this is a proper spiritual approach, it can definitely be misapplied.
Mental and physical health are similar in this regard. As our medical knowledge
progresses, we understand more clearly just how intricate and wondrous God’s
design is. Unlocking the mysteries of the mind does not replace our faith in Christ, it
illuminates it.
Secular counseling can miss the vital spiritual link to our mental and emotional
health, but trained Christian counselors can offer an integrated approach that
includes body (behaviors), mind (thoughts and emotions), and spirit (our
relationship with God).
Fear
Of all the reasons to avoid counseling, this is the most understandable. Many of the
problems that lead to counseling are caused by painful experiences that a person
often has no interest in reliving. Some of these include:
• Death
• Divorce
• Sexual abuse (childhood, rape, etc.)
• Physical abuse
• Addiction (for the addict or spouse)
• Major trauma or calamity
Just the thought of diving into those painful memories is enough to keep many
people from seeking help throughout their lives. Even as we acknowledge the
reality of this pain, we can also offer encouragement to move forward.
Consider a gunshot wound. The bullet hits its target without warning, completely
upending a person’s world. The initial reaction is shock, pain, and fear. All efforts
are centered on survival. Although the bullet did not kill its target, it caused major
damage. Perhaps the bleeding was stopped and the entrance wound managed to
heal over. Is this person healed at this point? No. The internal damage has never
been properly treated and the bullet still moves around inside, causing further
damage and bleeding. If left untreated forever, the internal wound could eventually
kill the person.
Emotional wounds operate in much the same way. Many of them occur instantly,
such as with the death of a loved one or the discovery of marital infidelity. Pain,
shock, and fear immediately set in and our efforts are bent on simply surviving
another day. Yet, deep within us, the internal wound is still open, bleeding, and
dangerous.
Our fear is based on the pain of reopening the entrance wound, but this focus keeps
us from seeing how destructive and dangerous the internal wound is. Reopening the
wound will be painful for some as they begin counseling, as will finding and
extracting the bullet that caused the wound. Yet, without getting to the source of
our pain, we will never fully heal. We will always carry the weight of our original
wound with us, and we will notice the bleeding from time to time as the wound tells
us that it still isn’t healed, that it is still harming our lives.
Cost
Cost is a common barrier for the practically minded. For those with limited incomes,
it is not unreasonable to consider the price tag for something that seems less
important than rent, food, or clothing. Yet, for those who can afford counseling,
there is an all-too-common practice of bargain hunting for professional therapy.
Would we bargain hunt for heart surgeons or parachute manufacturers? Why, then,
would we cut corners when it comes to our mental and emotional well-being?
I believe some of this attitude comes from our ability to cope with problems in our
lives. To use our earlier analogy, we have become accustomed to driving on flat
tires. If we can just fix one tire, we’ll still be better off, right?
Unfortunately, with professional counseling, as with many aspects of life, you often
only get what you pay for. Choosing the right counselor is as important in many
ways as choosing the right mate. The choice can positively or negatively affect the
rest of your life. This is not the time to pinch pennies.
If you are going to bargain hunt, consider first the total cost of your decision, not
just the cost of professional counseling. How much extra each week do you spend
on food, cigarettes, or alcohol to help calm your nerves, reduce stress, or medicate
your internal pain? Have your problems led you to drop out of school, lose a job, or,
worse yet, your family? How much will your problem cost or hurt you over the
course of your life?
If we only look at the economic arguments, it still makes better financial sense to
find the best counselor regardless of cost. Many company health plans will pay a
portion of the counseling fees, even if the therapist is out of the network. For those
who need counseling but do not have health plans, many good Christian counselors
are willing to write off a portion of their fee or to lower it for poorer individuals.
Another option is to contact a local evangelical church, some of which offer pastoral
counseling or support group counseling at low or no cost. There are usually
solutions to every potential problem. Remember, too, that God is the Great
Physician and desires you to be well. Lift up your concerns in prayer and ask Him to
lead you to the right person and to provide the means.
Bad experiences
While less common than the other barriers, having a previous bad experience with a
therapist can be one of the hardest to overcome. A person with a prior experience
that has not helped, not been focused, or has led to counseling abuse (a rare, but
real occurrence), is unlikely to ever return. This negative experience compounds the
initial trauma or situation that led the person to seek help, and may actually serve
as a prison door locking the individual into his internal pain for the rest of his life.
If you find yourself in this situation, I encourage you to try again. Whatever past
experience you may have had, there are steps you can take to ensure it doesn’t
happen again.
2. If your past experience involved unethical conduct by the therapist, you may
consider bringing ethics charges against him or her. Ethical misconduct can include
inappropriate sexual behavior, breech of confidentiality, unless required by law, or
fraudulent billing practices. If you were harmed, there is a chance others were as
well. Speaking out can prevent future abuse from occurring. If you suspect a
therapist of ethics violations, call Focus on the Family and ask to speak with a
counselor who can help you through the process.
A better tomorrow
There are real barriers to seeking professional help, but none of them are so large
or insurmountable that you should be denied a healthier, happier future. If one or
more of these barriers has kept you from getting counseling, please consider calling
the Counseling Department at Focus on the Family at (719) 531-3400 x7700
weekdays 9:00 a.m. to 4:30 p.m. (MST) to help you move forward with your life.
Copyright © 2004 Focus on the Family. All rights reserved. International copyright
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Section 12
Client Cultural Mistrust & Willingness to Self-Disclose
Question 12 found at the bottom of this page
Answer Booklet | Table of Contents
Get PRINTABLE format of this page
Self-disclosure is literally the sine qua non of most approaches to counseling and
psychotherapy. Due to a history of oppression, however, African Americans in the
United States have been socialized to hide their true feelings, particularly when
relating to Caucasians (Grier & Cobbs, 1968: Ridley, 1984). This can be problematic
for African Americans who seek counseling because they are underrepresented
(compared with their representation in the general population) as professional
counselors and psychologists. Thus, if many African American clients are to receive
counseling they will have to see Caucasian counselors. To the extent that self-
disclosure is essential to successful counseling, it is important that Caucasian
counselors attempt to overcome the barriers to self-disclosure that may exist between
them and their African American clients (Vontress, 1971).
One reason that African American clients may be unwilling to self-disclose
Caucasian counselors is that they simply do not trust Caucasians (Ridley, 1984).
Terrell and Terrell (1981) have identified four areas in which African Americans are
mistrustful of Caucasians: (a) educational and training settings, (b) political and legal
systems, (c) work and business interactions, and (d) interpersonal and social contexts.
They developed the Cultural Mistrust Inventory, which assesses African Americans'
mistrust of Caucasians across these four areas. Terrell and Terrell (1984) found that
premature termination rates for African American clients were significantly related to
the counselors' race and client's trust level. Clients who scored high on cultural
mistrust and who saw Caucasian counselors were most likely to terminate counseling
prematurely. In a more recent study, Watkins and Terrell (1988) found that highly
mistrustful African Americans rated a Caucasian counselor less favorably on measures
of counselor genuineness, self-disclosure, acceptance, trustworthiness, outcome, and
expertness than did African Americans low on mistrust. (They also found that highly
mistrustful African Americans expected less from the counselor, regardless of
ethnicity, than did African Americans low on mistrust.)
Patient counseling-Barriers
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Patient Counseling-Barriers
Dear Pharmainfo.net friends
I appear again to talk once more on patient counseling . In this blog I want to focus on the
barriers that may present themselves to the process of patient counseling. I can tell you, because I
gave lectures on this topic in a number of places, that people have a nature of resisting change
and we must have the patience to talk with them and discuss with them slowly and clearly so that
they can think through all the changes that we are suggesting. The most common pat reply that I
get from many pharmacists, when I tell them that they must do patient counseling is this
“Madam, long queues of patients, stand impatiently before us, waiting for their medicines. To
give them medicines without any dispensing error is in itself a great task. How can you expect us
to do any counseling here?”
So there are barriers for every action and there are barriers here too. These barriers may be
present in the system or in the provider (pharmacist) or in the recipient (patient)(1). Let us
discuss each of these in detail.
System based barriers: as I said in my opening paragraph, there may be resistance from the
people around us, who may say things like:
• Where is the time/space/personnel/material for patient counseling?
• If you give some patient counseling and some adverse things happen, who is going to be
responsible for it?
• Nobody is doing patient counseling, why should we do it?
• Doctors may not like this activity, let us not do it.
• Patients may not like to hear anything.
For all these doubts and problems we must be able to give answers like the following:
• We must create the time and space and personnel and material required for patient counseling.
We must do this because patient counseling is going to bring better results in pharmaceutical
care and thus in healthcare.
• No adverse thing will happen, because we are not telling anything “off the cuff”. We are
keeping in our possession, well researched, prepared documents and we are telling only from
these documents. They are prepared from books such as Drug Information for the patient,
published by USP.
• If we start patient counseling, our institution will get benefit and get good name.
• Doctors will not oppose this activity. In fact they are appreciating it. This is because doctors
usually do not have the time to sit and discuss with each patient, his/her treatment. Whereas a
pharmacist has the time and the necessary information inputs to plug this hole.
• Some patients may not like to take counseling. In such cases we need not do any counseling.
We can give our advice to only those patients who need it.
Provider based Barriers:
• Pharmacist may not have the necessary knowledge/communication skills/interpersonal
behavioral skills/ aptitude/ time to do patient counseling
• Pharmacist may face other problems like; he/she may not know the language of the patient/
may have some speech or hearing problem and so on.
These barriers must be overcome in the following manner:
• Pharmacist must acquire all the necessary inputs like knowledge/ communication skills/ soft
skills including proper body language and aptitude.
• The language problem and any other problem must be suitably addressed by taking help from
some hospital employee.
There may be some barriers from the side of the patient like:
• Patient may not have time/attitude to listen/ capacity to understand.
• Patient may not know any language that the pharmacist knows.
• Patient may be feeling some hesitation due to some cultural type of issues, like girls may be
unwilling to take counseling from boys and boys may be unwilling to take counseling from girls.
• Highly educated people may not like to take counseling.
• Patient may suffer from some defect with respect to hearing or speech.
• Patient may be suffering from some misconceptions or fears due to which nothing will
penetrate his mind.
These barriers may be overcome in the following manner:
• Patient must be convinced with amicable words that counseling is good for him/her.
• Pharmacist must take the help of some employee who knows the language of the patient.
• Here we must deal with the situation as it demands and preferably girls must talk to women and
boys to men.
• We may leave alone those who do not want counseling.
• For the sake of hearing and speech impaired people, we must have models or charts to help us
in giving counseling.
• We must talk to the patients and draw their fears out and dispel them. This is not a one hour
matter, but it will take a few sittings for the pharmacist to gain the confidence of the patient.
Thus, overall, patient counseling is a business, where we overcome the barriers of all types and
the fears of all types, and carry out the process. This is important because it is going to make the
patient’ s life and healthcare much better.
Reference:
1. Proceedings of the National Seminar on Clinical and Hospital Pharmacy, 17th and 18th
October, 1999, pages 36 to 38.
This blog does not contain any plagiarized material.
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Dear mam
Submitted by Indira on Sun, 08/29/2010 - 11:37.
Motivational Interviewing
Health care providers can deploy a variety of approaches to facilitate successful contraceptive use. Many young women feel
that they are ineffective and unable to master anything—life seems out of control. When a young patient says that she
won't be able to remember to take the pill every day, the clinician should try to build on her past successes. For example,
she's doing well in high school, and she has learned to drive a car, therefore, how easy it will be for her to master using
the pill. If the health care provider expects success in people, then they will be successful. The word "try" should not be
used, because it may suggest attempts and failure. Respect the patient's present view and be empathetic, letting her know
that her clinician cares about her. Avoid arguing with the patient; this only creates resistance to change.
There are five stages of change (Table 15). First, the health care provider needs to determine whether or not the patient
sees a need to change her behavior. For example, you may have seen the patient in her car smoking a cigarette or have
detected the odor of cigarettes on her
TABLE 15. The Five Stages of Change
clothing. You can say that you know
she's smoking and wonder if she has First, we see no need to change our behavior.
been thinking about quitting. She may Then, we begin to see a need for change.
We act and begin to change.
reply that she has important tests
We integrate the change.
coming up and she's not sure that it We may relapse; learn new skills, and start again
would be a good time. You can advise
her that when she's ready to stop smoking, you'll be there to help her.
References
1. Association of Reproductive
Health Professionals. Women's SIDEBAR G. Approaching the Male About Contraception
attitudes and perceptions about
Although the focus of this Clinical Proceedings is the periodic well-woman
their healthcare providers and
visit, men who see the primary care provider should be informed about
non-contraceptive health contraceptive options including:
benefits of oral contraception.
○ Condoms
(Survey
conducted by ○ Emergency contraception for their partner
○ Vasectomy
2. Robert A. Becker for the In addition, young single, sexually active men should be made aware of
paternity and statutory rape laws in the state in which they reside.
Association of Reproductive Sensitivity regarding sexually active men not engaged with women should
Health Professionals). January, be maintained. STI issues should be discussed as well with all men.
1996.
Clinicians might consider providing men with a printed handout that briefly
3. Kravitz RL, Leigh JP, Samuels discusses the methods of contraception available to women. The handout
should include a phone number for appointments.
SJ, et al. Tracking career
satisfaction and perceptions of
quality among US obstetricians and gynecologists. Obstet Gynecol 2003;102:463-70.
4. Pariani S, Heer DM, Van Arsdo MD Jr. Does choice make a difference to contraceptive use? Evidence from East
Java. Stud Fam Plann 1991;22:384-90.
5. Cotten N, Stanback J, Maidouka H, et al. Early discontinuation of contraceptive use in Nigeria and the Gambia.
Int Fam Plan Perspect 1992;18:145-9.
6. Lei Z-W, Wu SC, Garceau RJ, et al. Effect of pretreatment counseling on discontinuation rates in Chinese women
given depo-medroxyprogesterone acetate for contraception. Contraception 1996;53:357-61.
7. RamaRao S, Lacuesta M, Costello M, et al. The link between quality of care and contraceptive use. Int Fam Plan
Perspect 2003;29:76-83.
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