WK 2 - CC Ch 2

2 Legal, Ethical, and Cross-Cultural Issues

CHAPTER OBJECTIVES

After reading this chapter, you will be able to: 1. Know the basic legal rights of offenders who may be engaged in the correctional counseling process. 2. Know the key ethical and legal considerations when providing counseling services within the institution and within the community. 3. Be aware of the various legal issues associated with the delivery of counseling services. 4. Understand the SOAP process of maintaining case notes and the importance of documentation and records management in counseling. 5. Understand the dynamics associated with the counseling relationship that can lead to ethical violations. PART ONE: LEGAL AND ETHICAL ISSUES Rights of the Correctional Offender One of the most important aspects of correctional counseling that practitioners and students need to be aware of involves the myriad of legal issues that must be considered. In addition, it is important to identify the sources of these rights so that a comprehensive understanding is possible. Before proceeding, however, a quick note should be made. It is likely that legal and ethical issues concerning correctional counseling are not usually the areas of interest to most persons wishing to learn about the correctional counseling process. However, this area of knowledge is fundamental for every counselor working in the criminal justice system for several reasons. First, offenders can be litigious by nature and it is wise for counselors to understand the legal parameters within their field to avoid pitfalls or manipulation by their offender clientele. Second, ethical practice is a key to developing genuine rapport between the counselor and the client. Third, a counselor is essentially incompetent if he or she is not familiar with his or her profession’s strictures on conduct and practice. Confidentiality In relation to counseling, confidentiality is a concept that describes the process of keeping private or secret the information disclosed by a client to a counselor during a counseling session. The essence of confidentiality is very important to the success of counseling. This point was highlighted in the U.S. Supreme Court case of Jaffee v. Redmond (1996). In its opinion, the Court clearly articulated that an atmosphere of confidence and trust is necessary for a client to feel comfortable enough to disclose his or her emotions, memories, and fears. The Court further reasoned that because of the nature of the problems for which clients seek the assistance of counselors, embarrassment or disgrace may be endured if information is not properly contained and is likely to impede the confidential relationship necessary for effective treatment. Beyond these, however, the issue of confidentiality becomes much less clear, especially within the domain of correctional counseling. Remember, correctional counseling describes the process of a trained counselor helping an offender identify and implement better methods of handling stressful life circumstances. Usually, confidentiality will be maintained unless the offender presents a danger to self or others. What needs to be made exceptionally clear, however, is the fact that the client is a convicted offender under the care of the criminal justice system. In these circumstances confidentiality will always yield to issues of security, safety, and order, as well as the concept of punishment in the event the offender discloses participation or knowledge of past, present, or future criminal behavior. This is the reality of correctional counseling. As Masters (2004) states, “In a criminal justice setting, whether during probation, incarceration, or some form of aftercare such as parole, it is impossible to assure a client of complete confidentiality” (p. 170). This is why it is of paramount importance to practice informed consent in all circumstances, and the stipulations governing the informed consent need to be articulated clearly and accurately. The concept of informed consent describes the process of a trained counselor educating the offender on all legal and ethical parameters governing the counseling relationship. In other words, offenders must be told that it is possible that anything they discuss in counseling may be under certain circumstances disclosed to the courts. Masters (2004) captures the essence of this point well by stating “It is ethically indefensible to assure the client of confidentiality or have the client assume that privacy exists when it does not” (p. 171). Offenders have the right to know what kind of treatment they are receiving, the associated risks, as well as the benefits and alternatives. Duty to Warn and the Case of Tarasoff One of the leading court cases governing the concept of confidentiality as it applies to information concerning the safety of a third party is Tarasoff v. Regents (1976). In essence, the court ruled that mental health professionals have the duty and obligation to protect a third party (public) in cases where they reasonably believe a client might endanger the third party; and this duty overrides any obligation to confidentiality. Prosenjit Poddar was a graduate student at the University of California at Berkeley. He was also a voluntary outpatient at the University’s student health center. During a counseling session Poddar told the psychologist that he intended to kill his former girlfriend, Tatiana Tarasoff, when she returned to campus from visiting her aunt in Brazil. In a counseling session he disclosed that he was upset and depressed due to the fact that Tatiana was involved in relationships with other men. Poddar stated that he was going to get a gun and shoot Tatiana. Based on this information the psychologist notified the campus police and informed them of what Poddar had stated. The campus police detained and questioned Poddar, who denied any intention of killing Tatiana. The campus police found Poddar to be rational and released him after he promised to stay away from Tatiana. Meanwhile, Poddar no longer sought counseling from the psychologist and no further action was taken. Two months later, when Tatiana returned, Poddar first stalked her and then stabbed her to death. Based on these circumstances the court stated, “When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more of various steps. Thus, it may call for him to warn the intended victim, to notify the police, or to take whatever steps are reasonably necessary under the circumstances” (Tarasoff v. Regents, 1976, p. 430). Ethics in Correctional Counseling Ethics is a concept that describes the process of focusing on principles and standards that are used to guide the relationships between people and, specifically for our purposes, the relationship between counselor and client (Gladding, 1996). The concept of ethics is often used in conjunction with describing whether certain behaviors are considered legal. For example, someone may state, “Such conduct, within the context of counseling would be considered illegal and unethical.” Appreciate, however, that in such a statement two different disciplines have been called on; one being the study of ethics and the other dealing with law. It may be that one way of teasing out the intended meaning of “ethics” is to think of the term as describing a discipline aimed at studying and identifying the parameters of human behavior and values within particular contexts. When counselors are faced with situations that are difficult to resolve, they are expected to handle these situations in ways that are professionally appropriate for the well-being of the client and the integrity of the counseling process. For example, the American Counseling Association (ACA, 2005) publishes a code of ethics aimed at providing direction and guidelines for counselors to address certain circumstances and this code will be primarily relied upon in this section. Section A.1.a., titled Primary Responsibility, states, “The primary responsibility of counselors is to respect the dignity and to promote the welfare of clients” (ACA, 2005, p. 4). Although not specific in providing dictates of exact behavior, the above section does provide crucial guidance. In essence, when attempting to figure out what behavior is most appropriate, one question to ask oneself is, “Are my actions in accordance with the best interest of my client?” Case Notes and Session Recording One of the most important elements of the correctional counseling process, and which is directly addressed by ethical codes of conduct, is the accurate recording of notes pertaining to the activities of all counseling sessions. Recording and maintaining accurate records is no longer something counselors should do but instead something counselors must do. This is partly due to the litigious nature of current society and the accurate recording of notes is one way to guard against potential liability concerns. In addition, case notes are vital to the process of keeping counseling sessions focused on pertinent issues of concern to the offender(s). To keep counseling sessions on track case notes should reflect the offender’s progress, or lack thereof, especially as it relates to the particular goals of an offender. Case notes provide one avenue for counselors to stay focused on particular issues as well as to verify compliance with legal issues. Regarding clients’ records, the code of ethics, the ACA, in Section A.1.b. (2005) states, “Counselors maintain records necessary for rendering professional services to their clients and as required by laws, regulations, or agency or institution procedures. Counselors include sufficient and timely documentation in their client records to facilitate the delivery and continuity of needed services. Counselors take reasonable steps to ensure that documentation in records accurately reflects client progress and services provided. If errors are made in client records, counselors take steps to properly note the correction of such errors according to agency or institutional policies” (p. 4). One of the most popular methods of capturing necessary information regarding the events that transpire during counseling sessions is described by the acronym SOAP. SOAP notes originally developed by Weed (1964) provide a method of collecting and documenting information that help counselors identify, prioritize, and track the needs of offenders so that they may be attended to in a timely and systematic fashion (Cameron & Turtle-Song, 2002). Each letter of the acronym represents a particular component of the data collection method: Subjective (S)—is a concept that describes the process of interpreting observations based on one’s own mind. This is where a counselor describes his or her impression of a particular offender. Particularly salient to this section is the description of an offender’s expression of feelings, concerns, plans, or goals, as well as the attendant levels of intensity attached to them each (Cameron & Turtle-Song, 2002). Objective (O)—is a concept that describes the process of a particular phenomenon that is observable. The objective portion may consist of an offender’s appearance, certain behaviors, abilities, and so on. In this section counselor observations should be stated in precise and descriptive terms that are quantifiable. Labels, judgments, and opinions should be avoided. Assessment (A)—is a concept that describes the process of a trained counselor providing an evaluation of an offender that incorporates the subjective and objective observations. It usually contains diagnostic terms such as depression, anxiety, anti-social disorder, bi-polar disorder, and obsessive-compulsive disorder (OCD), among others. The assessment component is the section mostly read by outside reviewers or auditors. It should be complete and based on factual evidence that is supported by information contained in the subjective and objective portions of the format (Cameron & Turtle-Song, 2002). Plan/Prognosis (P)—is a concept that describes the particular actions that will be carried out as a result of the assessment. Information contained in the plan usually consists of such entries describing the particular interventions used, educational components used to assist comprehension, the offender’s progress, direction that will be taken in the next session, and the date of the next section. Accountability is a vital component of the counseling process that must be adhered to. The best way to ensure accountability is to accurately and ethically note all happenings of the counseling process and then record these notes in appropriate files. SOAP is one format, among many, that provides guidelines that serve to help counselors ensure they are recording necessary information. Tables 2.1 and 2.2 serve as a guide or reference point. They are not all inclusive, but instead serve as a tool in assisting counselors to make sure they are capturing the essence of what is required in documenting the status of a particular client. The tables contain selections borrowed from the work of Cameron and Turtle-Song (2002). TABLE 2.1 Summary of definitions and examples Section Definitions Examples (S) Subjective What the client tells you. What others tell you about the client. Basically, how the client experiences the world. Client’s feelings, concerns, plans, goals, and thoughts. Intensity of problems and impact on relationships. Client’s orientation time, place, and person. (O) Objective Factual. What the counselor personally observes/witnesses. Quantifiable—what was seen, counted, smelled, heard, or measured. The client’s general appearance. Client’s demonstrated strengths and weaknesses. (A) Assessment Summarized the counselor’s clinical thinking. A synthesis of the analysis of the subjective and objective portion of the notes. Include clinical diagnosis and impressions. (P) Plan Describes the parameters of treatment based on the assessment. Includes interventions used, progress, and direction of future intervention. Informed Consent TABLE 2.2 Guidelines for note taking Dos Dont's Be brief and concise. Keep quotes to a minimum. Use an active voice. Precise and descriptive terminology. Record immediately after each session. Use proper spelling, grammar, and punctuation. Document all contact or attempted contacts. Use only black ink if notes are handwritten. Sign off using legal signature and include your title. Do not use names of other clients, family members, or other individuals named by the client. Avoid terms like seems or appears. Avoid common labels that can be interpreted in various ways. Only use terminology that you are trained to use. Do not leave blank spaces. Do not use margins or try to squeeze additional commentary between lines. As discussed earlier, informed consent is a critical component of any respectable counseling process. It is important to note that there are ethical guidelines that inform the proper process and circumstances in which consent should be obtained from clients. In addition, informed consent is often obtained in separate circumstances that may fall under the umbrella of counseling. For example, within correctional counseling offenders will often be asked to provide consent to the initial assessment. In addition, it is common to have an evaluation component attached to many of the correctional counseling programs, which also require informed consent. Evaluation studies are primarily aimed at measuring selected variables at different points in time to determine if there is any progress in the offender. It is important that clients know the nature of the data that will be collected and the uses of such data. In its ethical standards, the ACA (2005) directly addresses the issue of informed consent as it relates to assessment for the purposes of research as well as counseling relationship. Prior to assessing a client, counselors should “explain the nature and purposes of assessment and the specific use of results in language the client (or other legally authorized person on behalf of the client) can understand, unless an explicit exception to this right has been agreed upon in advance. Regardless of whether scoring and interpretation are completed by counselors, by assistants, or by computer or other outside services, counselors take reasonable steps to ensure that appropriate explanations are given to the client” (ACA, 2005, p. 12). In addition, clients need to be informed, in a manner in which they understand, the likely processes that will take place during counseling sessions. The ACA (2005) makes this clear in Section A.2.a., where it states, “Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both the counselor and the client. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship” (p. 4). Further, clients need to be given clear and distinct information in regard to the counselor who delivers therapeutic services. Beyond matters of confidentiality, clients have a right to know other parameters related to their counselor and their perspective before any counseling begins. Clients should be informed of the counselor’s qualifications and credentials, the parameters related to those credentials, the nature of the counseling relationship, the counselor’s areas of expertise, fees and services offered, the boundaries of privileged communication, the limits of confidentiality, client responsibilities, and any potential risks that may occur as a result of the counseling process. Each of these points of information are important because they educate the client on the process and they ensure that no feelings of betrayal emerge from the client as the counselor administers services and/or ensures compliance with the agreed-upon treatment plan. The information just noted is typically included on what is referred to as a Disclosure Statement in many states. In other states, the official term may be a Declarations and Procedures Form (see Box 2.1). Regardless of the specific name given to the hardcopy form that is used, the counselor should emphasize that it is his or her desire that clients know, upfront, all of the specific details about the counseling process that they are about to become involved in. This is important because this goes well beyond being informed of limitations of confidentiality; it tells the client exactly what he or she should expect in therapy. While the boundaries of confidentiality are indeed important, clients need to understand the mechanics behind the therapeutic process since this optimizes their ability to participate. In many cases, clients may see the process of completing the disclosure statement as a mere formality and some may even find it to be a trifling issue, but the counselor should make sure that this information is understood by the client prior to conducting counseling. If done correctly, the counselor can use this process as a rapport-building opportunity by emphasizing that it is important to him or her, as a professional, to ensure that the client is as fully informed as is possible. The counselor should emphasize that it is his or her desire to provide ethical counseling services when requiring that the client become fully familiar with the elements of the counseling relationship. See Box 2.1 for an example of a Declarations and Procedures document which includes all of the information just discussed. BOX 2.1 Declarations and Procedures Form DECLARATION OF PRACTICES AND PROCEDURES John Smith 101 Main Street, Mayberry, USA 11001 (000) 000-000 Qualifications: I earned an MA degree from the University of ________________________ in 2010. I am a Licensed Professional Counselor (LPC #0000) with the LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS, 8631 SUMMA AVENUE, BATON ROUGE, LOUISIANA 70809, TELEPHONE (225)765-2515. I am also a Licensed Addiction Counselor (LAC #0000) with the Addictive Disorder Regulatory Authority of Louisiana, Baton Rouge, Louisiana 70809. Telephone: (225)922-7700. Counseling Relationship: I see counseling as a process in which you, the client, and I, the counselor, have come to understand and trust one another, work as a team to explore and define present problem situations, develop future goals for an improved life, and work in a systematic fashion toward realizing those goals. Areas of Expertise: I have a specialty in addictions counseling and I am licensed to provide services that are related to the addicted population as well as general counseling services to a wide variety of populations. Fee Scale: The fee for my services typically range from $50.00 to $75.00 per session. However, I do operate on a sliding scale for remuneration, depending on the individual client’s particular financial circumstances and their state of need. Payment is due at the time of service and clients are seen by appointment only. Clients will be charged for appointments that are broken or canceled without 24-hour notice. Payment is not accepted from insurance companies. Services Offered and Clients Served: I approach counseling from a cognitive-behavioral perspective in that patterns of thoughts and actions are explored in order to better understand the client’s problems and to develop solutions. I work in a variety of formats, including individual counseling, couples counseling (related to addiction issues), and family counseling (as related to addiction and recovery). I also conduct group therapy. I see clients of all ages and backgrounds with the exception that I do not work individually with children under the age of six. Code of Conduct: As a counselor, I am required by state law to adhere to the Code of Conduct for Licensed Professional Counselors that has been adopted by my licensing board. A Copy of this code is available upon request. Privileged Communications: Materials revealed in counseling will remain strictly confidential except for: a. The client signs a written release of information indicating informed consent of such release. b. The client expresses intent to harm himself or herself or someone else. c. There is a reasonable suspicion of abuse or neglect against a minor child, elderly person (65 years of age or older), or a dependent adult. d. A court order is received directing the disclosure of information. It is my policy to assert privileged communication on the behalf of the client and the right to consult with the client if at all possible, except during an emergency, before mandated disclosure. I will endeavor to apprise the client of all mandated disclosures as conceivable. In the event of marriage or family counseling, material obtained from an adult client individually may be shared with the client’s spouse or other family members only with the client’s permission. Any material obtained with a minor client may be shared with the client’s parents or guardian. Emergency Situation: If an emergency situation should arise, you may seek help through hospital emergency room facilities or by calling 911. Client Responsibilities: You, the client, are a full partner in counseling. Your honesty and effort is essential to success. If you have suggestions or concerns about your counseling as we work together, I expect you to share these with me so that we can make the necessary adjustments. If it develops that you would be better served by another mental health provider, I will help you with the referral process. If you are currently receiving services from another mental health professional, I expect you to inform me of this and grant me permission to share information with this professional so that we may coordinate our treatment plan and any medication schedules that you are now under. Physical Health: Physical health is an important factor in the emotional well-being of an individual. If you have not had a physical examination in the last year, it is recommended that you do so. Also, please provide me with a list of the medicines that you are now taking. Potential Counseling Risk: The client should be aware that counseling poses potential risks. In the course of working together additional problems may surface of which the client was not initially aware. If this occurs the client should feel free to share these concerns with me. I have read and understand the above information Counselor Signature: ________________________ Date: ________________________ Client Signature: ____________________________ Date: ________________________ I, signature of parent or guardian ________________________, give permission for John Smith to conduct counseling with my (relationship), ________________________ (name of minor) ________________________. Professional Boundary Setting Critical to the survival of any counseling relationship is the fact that certain boundaries must be established and not breached. From a geographical standpoint a boundary is relatively clear. It is a line, often marked by a fence or other physical structure that clearly demarcates where one property begins and another ends. Boundaries between people, however, are often complex and not as clear. Emotions and feelings often add to the complexity making it difficult to decipher what actions are appropriate in certain situations. The concept of a power differential is what usually provides the foundation for the formation of a counseling relationship. The power differential exists because of the specialized knowledge and training the counselor possesses that is ultimately being sought by the client. It is precisely the result of this differential that certain boundaries must not be crossed. To do so would in essence change the foundation of the relationship which in most cases would prove harmful to the client. Especially, in light of the fact that the counseling relationship is one of the most powerful components of the counseling process capable of fostering meaningful transformation in the client. Transference Not all clients, especially those within correctional settings, will be open to the concept of counseling. They may be participating as a result of court order, or in an attempt to garner a lighter sentence or an earlier release. In fact, some clients may be difficult and troublesome for the trained counselor, who may at times feel abused. It is vital that counselors be able to respond to such feelings without inflicting punishment on the client. A particular phenomenon that is common in some counseling relationships is the concept of transference. Transference is a concept that involves a client projecting onto the counselor traits or characteristics of others in the client’s life (Brown & Srebalus, 2003). For example, if a client sees the counselor as possessing traits similar to those of authority figures, the client may respond to or treat the counselor similar to the way he or she has treated other authority figures. This could result in the client becoming hostile or openly agitated with the counselor. Another possibility is that the client may withdraw and become silent if the counselor is perceived as a figure of authority. This response is especially likely for some clients who have experienced abuse at the hands of caregivers and were never allowed to express their feelings or emotion. Countertransference In the event that transference takes place in the counseling relationship, counselors must be vigilant and not allow themselves to further contribute to the phenomenon through the concept of countertransference. Countertransference is a condition where a counselor projects onto the client undeserved qualities or attributes. If a client reacts in a hostile fashion, the counselor may respond emotionally, portraying inappropriate intensity that does not foster growth or functional learning on the part of the client. In such a case the counselor has reacted in a manner described by the concept of countertransference. In essence, the counselor has reacted to the traits or characteristics of the client in the same way the counselor may treat others with similar attributes. As a result, counselors must be able to manage the process of transference in a manner that helps the client become more aware of his or her own emotion and feelings. For the counselor to become a participant, through the process of countertransference, in an unproductive exchange is damaging to the overall health of the counseling relationship. Sexual Attraction In correctional counseling sexual attraction does occur between counselors and offenders. The success of the counseling relationship depends, in large part, on the depth of the connection between the counselor and offender. Sufficient depth within the counseling relationship is needed to foster an environment conducive to offenders so that they share deep feelings and emotions. This requires trust that is established based on the counselor’s genuine expressions of care, compassion, and empathy. As noted by Masters (2004), however, this can sometimes result in the counselor’s professional warmth being misunderstood by offenders, resulting in attraction and crushes. Counselors also need to ensure that their motivations for entering into a counseling relationship are pure. In other words, counselors need to avoid trying to get their own needs met through the counseling relationship. In essence, it is unethical for a trained counselor to engage in a sexual relationship with a client. It is not unethical for a counselor to find a client attractive; it is unethical, however, if the counselor acts on the attraction or serves to perpetuate a sexual relationship through inappropriate behavior. This is primarily because counseling relationships are not based on mutuality. In most cases clients are more vulnerable and perceive the counselor as someone with special knowledge. When sexual relations begin the true objectives of the counseling relationship are lost. In addition, the counselor will be held responsible. In most cases involving sexual relationships between counselors and offenders in criminal justice settings, the counselors will be terminated. Dual Relationships Dual relationship is a situation where a counselor and client enter into a relationship(s) that is beyond or distinguished from the counseling relationship. As mentioned above, sexual relationships certainly constitute dual relationships. In addition, nonsexual dual relationships should also be avoided. Nonsexual dual relationships include business transactions where the counselor and offender engage in some type of business venture while the counseling process is still under way. For example, during a counseling session the offender tells the counselor that he is a skilled carpenter. The counselor needs work done on the house and asks the offender if he would be willing to make some repairs. The offender agrees and the two decide that the work to be done would equate to approximately the same cost of three counseling sessions. The problem with this kind of arrangement lies in the possibility of the services rendered not being satisfactory. In such a case where the repairs are not done properly or the counselor “slacks off” and does not properly attend to the client, the counseling relationship will likely suffer. As a result, counselors should refrain from doing business or accepting gratuities from clients. In addition, due to the same ethical reasons, Gladding (1996) suggests that counselors should not enter into a counseling relationship with close friends, family members, students, lovers, or employees. SECTION SUMMARY Legal issues in counseling can often be important since counselors are charged with protecting the rights of their clients. This is particularly true in regard to the client’s confidentiality and other such concerns. However, the correctional environment opens up a number of additional concerns that are not usually found within the realm of the traditional counseling setting. It is important for the correctional counselor to understand basic legal principles common to the correctional setting so that counselors do not find themselves at cross purposes with the environment in which they work. Correctional counselors have many responsibilities and obligations when providing therapeutic services. First, they have a responsibility to their client. As such, they must promote the dignity and the welfare of their client, even though that client is an offender. This can actually be much more difficult than many novice counselors may realize. Second, counselors must take careful and complete notes of the clinical experiences during each session. These notes are records that are often referred to as case notes. The use of the Subjective, Objective, Assessment, and Plan/Prognosis approach, otherwise known as “SOAP” is presented as an organized and widely recognized method of constructing case notes. Lastly, it is important that the counselor safeguards his or her relationship with the client. To do this, it is important that the client is given informed consent and that this is obtained in writing—typically, a disclosure statement and/or a declarations of practices page. These documents simply inform the client of the counselor’s credentials while also explaining the parameters associated with confidentiality. Though many offenders will already be aware of much of this information, still it is strongly advised that counselors complete the process of obtaining signed informed consent; this safeguards the client and the counselor. Other ethical considerations associated with the client–counselor relationship, such as transference and/or countertransference, dual relationships, stress, and burnout must be attended to by the counselor. LEARNING CHECK 1. ________________________ describes the process of a trained counselor educating the offender on all legal and ethical parameters governing the counseling relationship. a.Notice of confidentiality b.Informed consent c.Dueces Tecum d.Waiver of confidentiality e.HIPAA 2. Transference is the process where the counselor identifies and/or projects expectations onto the client. a.True b.False 3. A(n) ________________________ is a situation where a counselor and client enter into a relationship(s) that is beyond or distinguished from the counseling relationship. a.excess relationship b.dual relationship c.ineffective relationship d.none of the above 4. Countertransference is a concept that describes the process of a counselor projecting onto the client undeserved qualities or attributes. a.True b.False 5. When using SOAP with one’s case notes, we are referring to the process of keeping them clean of incriminating or derogatory information. a.True b.False PART TWO: CULTURAL COMPETENCE AS PART OF ETHICAL SERVICE DELIVERY Defining Cultural Competence Cultural competence describes the process of effectively attending to the needs of individuals through proper consideration of the salient components of their particular culture. One definition that is congruent with our assertion that cultural competence is a theoretical construct is provided by the Department of Health and Human Services (DHHS, 2003) in its report titled Developing Cultural Competence in Disaster Mental Health Programs. “Cultural competence is a set of values, behaviors, attitudes, and practices within a system, organization, program, or among individuals that enables people to work effectively across cultures. It refers to the ability to honor and respect the beliefs, language, interpersonal styles, and behaviors of individuals and families receiving services, as well as staff who are providing such services. Cultural competence is a dynamic, ongoing, developmental process that requires a long-term commitment and is achieved over time” (DHHS, 2003, p. 12). This definition was chosen because its essence implies a philosophy that is meant to incorporate all necessary components of providing quality mental health services to all individuals including minorities. Much of the information that follows relies heavily on a 2001 report produced by DHHS titled Mental Health: Culture, Race and Ethnicity—A supplement to Mental Health: A Report of the Surgeon General. This supplemental report was created in an attempt to directly address the issue of cultural competence as it applies to mental health services through better understanding the nature and extent of mental health disparities, providing evidence of the need for mental health services, and providing possible avenues of action aimed at eliminating mental health disparities. Four groups will be directly addressed: African Americans, Hispanics, American Indians and Alaska Natives, and Asians and Pacific Islanders. Why Cultural Competence Is Important Currently, there is sufficient evidence that shows the rate of mental illness among minority populations is similar to the rate encountered across the population of the United States. Roughly 21% of U.S. population suffers from or has suffered from some type of mental illness. Mental Illness refers to mental disorders, which are considered health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning (DHHS, 2001). The overall rate of approximately 21% of minority populations suffering from mental illness is important to note, primarily because minority populations do not have proportionate access to mental health services. In essence, minority populations contain the same percentages of individuals suffering from mental illness as non-minority populations; however, services are not equitably distributed between the groups. This results in many individuals in minority populations going untreated for mental illness and also suggests that unmet mental health needs are disproportionately higher for minority populations in relation to Caucasian Americans. One important reason for studying cultural competence is to acquire a better understanding of different cultures and the corresponding barriers to mental health services that may exist due to cultural differences and/or misunderstandings. Some of the most common barriers to treatment must first be illuminated in order to have a chance at removing or minimizing them while also improving the quality of services that are provided to minority clients once they reach treatment providers. Some of the more common barriers include cost of mental health services, societal stigma attached to mental illness, need for help, no clear organization of service providers, clinicians’ ignorance concerning cultural issues and bias, and inability to speak the client’s native language (DHHS, 2001). In essence, counselors who provide services to minorities must understand salient cultural issues and their impact on cognition and behavior, especially in light of the fact that minority populations are increasing. In addition, counselors who are unable to adequately appreciate cultural issues must have the courage to admit it and properly refer clients to another provider better equipped to effectively provide competent service. Culture of the Client Prior to examining the impact of the culture on offender mental health issues it is important to note that there is significant diversity within cultural groups. In fact, as mentioned by DHHS (2001) there is more diversity within groups than between groups. This is an important point and is meant to highlight the fact that none of the information provided should be used to stereotype any particular group or culture. The counselor should accumulate as much knowledge on a given racial and/or ethnic group yet at the same time, he or she should follow the client’s lead in distinguishing the degree of racial and/or cultural affiliation that exists. In other words, let the client lead the way in determining what is culturally relevant and what is not. Once baseline cultural underpinnings are established in the therapeutic process, the counselor should integrate the resulting knowledge with his or her own presentation of mental illness as a concept. Indeed, the manner in which the counselor presents “mental illness” (indeed, the very use of the term itself) can be critical to getting minority clients to consider therapeutic possibilities. One of the most problematic issues underlying an individual’s perception of “mental illness,” is the pervasive stigma that still exists in regard to that term. Stigma is the feeling of shame or disgrace due to a circumstance or because of some imperfection. According to Lin and Cheung (1999), Asian patients will often report somatic symptoms such as fatigue or dizziness while omitting emotional symptoms such as fear, shame, or sadness. In essence, it is important that counselors be aware of cultural beliefs in order to decipher symptoms that are likely being presented in ways acceptable to a particular culture. In the foregoing example, it is likely that somatic symptoms of distress are more culturally acceptable and carry less stigma-tization than emotional symptoms, which may be interpreted as personal weakness. Indeed, some social groups may emphasize a need to be “tough” or strong in the face of adversity. Though this may not necessarily be the best approach in coping, it may actually be the most adaptive response available to these groups under the circumstances that they find themselves in. Simply put, there may be no other alternative for the person and the social group but to simply make do with their circumstances. When an entire group is traumatized, it may be difficult to provide extended support as all persons are equally taxed emotionally. Thus, the need for individual members to be “strong” and “adaptive” may be a matter of survival for other members of the group as well as the individual in question since other members may be well beyond their stress threshold and incapable of providing extended empathy. Further, when few resources exist, a sense of helplessness may exist among other family members and friends who might desire to help the individual afflicted by coping challenges but find themselves unable to do so. In such a case, the emphasis on “bucking up” may be the most suitable option that the family member has. In such cases, it is likely that individuals having difficulties will be viewed as lacking self discipline, mental toughness/weakness, perseverance, and other such characteristics commonly reinforced by these groups. Such individuals who display vulnerability to trauma and depressive-related disorders will then tend to be viewed as “weak,” “thrown off,” or inadequate in functioning. This is unfortunate in light of the fact that once biological changes have occurred the only viable solutions are in-depth interventions coupled with, in some cases, medication. Amidst this reality, the social or cultural group undermines the ability of the therapist to effectively administer proper services because of the stigma of shame and embarrassment that is attached to seeking mental health assistance. Another factor that counselors should thoroughly explore is the offender’s family environment. Indeed, it is widely known that “many features of family life have a bearing on mental health and mental illness” (DHHS, 2001, p. 27), both genetically and due to social learning mechanisms that are passed down from generation to generation. Supportive families characterized by healthy relationships among members can provide protection against the development of symptoms of mental illness. Conversely, where familial relationships have broken down and are instead sources of stress symptoms of mental illness can be activated or exacerbated. For all cultural groups, it tends to be true that marital discord, overcrowding or occupancy with inadequate space, as well as general abuse and neglect all tend to exacerbate mental illness (DHHS, 2001). Thus, counselors should attempt to explore family-of-origin dimensions to determine sources of support and to determine sources of familial stressors that may contribute to mental illness. One useful tool that could be implemented is family-of-origin genogram. The genogram is similar to a family tree illustration, but the client and the counselor construct the illustration in a collaborative fashion, with the client providing input while the counselor details and fills out the illustration with information pertaining to family relationships, interactions, history, and issues. The use of the genogram allows the client to compare relationships, to reexamine family-of-origin issues, and to essentially discuss the future of the family system. If used during the beginning phases of the counselor–client relationship, this can be a very effective means of establishing a rapport. Further, because genograms include both immediate and extended family members, it may be especially useful in preventing relapse among minority men who desire to repair the bonds in their families (Suzuki et al., 1996). One barrier to the receipt of mental health services is that of inherent mistrust that minority groups may have of social service agencies and mental health practitioners (particularly practitioners of another racial or ethnic group). Mistrust involves being suspicious or having little confidence in a service or product. Regarding counseling environments mistrust among minorities is widespread (Harper & McFadden, 2003; Sue & Sue, 1990). One study conducted by Sussman, Robins, and Earls (1987) reported that almost half of African Americans expressed fear of mental health treatment as opposed to just 20% of whites. In a 2000 research report, specifically examining cultural issues and minority perceptions of mental health treatment, Senturia, Sullivan, Cixke, and Shiu-Thornton (2000) identified several factors that limit the ability of African American women to seek intervention services. These factors included racism, lack of economic resources, lack of availability of services, perception that such services were for Caucasian women, and hesitancy to involve persons other than their family or local community because of fear of ostracism or being viewed as disloyal to their race. Subjects also indicated fear that stereotypes about race would be reinforced by the system at large (Senturia et al., 2000). This again demonstrates that stereotyping has lead to serious impairments in developing therapeutic connections with the minority community. In fact, from this research it is known that, the impairment exists before the counselor even has a chance to meet with the client. Because of this, counselors must be aware of this, approach this issue with concern, and they must be willing to meet the client where they are at that point and time. Because of the inherent mistrust that may exist, the priority issue that must be taken into consideration by all correctional counselors providing cross-cultural therapeutic services is the stigma often attached to the helping professions. In fact, this stigma has been reported to be the most formidable obstacle to better acceptance and progress within the area of mental illness and mental health (DHHS, 1999). Corrigan and Penn (1998) accurately note that there are still widespread beliefs and attitudes, pertaining to mental illness, that foster negative attitudes, fear, and general discrimination and avoidance of people suffering from mental illness. All of these issues are commonly encountered within the offender population and naturally will impact the prognosis of the offender on the correctional counselor’s caseload. Culture of the Counselor To begin, it is important to understand that there are two broad and comprehensive cultures that tend to influence most trained counselors. When considering this, it should be kept in mind that culture is a concept that describes the process of groups sharing a set of beliefs, norms, and values. Going from this point, counselors need to understand that they are impacted by the counseling culture itself. Indeed, the first broad component of culture that influences a trained counselor is directly related to their training. In the United States, most educational programs offering training in counseling consist of theories and concepts rooted in Western medicine (Harper & McFadden, 2003). In essence, Western medicine focuses on the human body in attempting to understand and uncover causal factors related to disease. As pointed out by Porter (1997), the ideologies of Western medicine are different from many previous healing systems that focused on the relationship and balance between human beings and nature. Many people of varying cultures still view the harmonious relationship between themselves and nature as paramount to their overall mental health (Harper & McFadden, 2003; Sue & Sue, 1999). A counselor’s dismissal or lack of attendance to these important cultural views is likely to result in the client terminating the relationship and not receiving proper care for their mental health problems (Harper & McFadden, 2003; Pederson, 2003; Sue & Sue, 1999). Two additional concepts that have particularly significant impact on the mental health of minorities are racism and discrimination. Racism and discrimination refers to treating individuals or groups adversely based primarily on certain characteristics such as skin color and/or facial features. For our purposes there are two categories of racism and discrimination that are of particular interest. The first deals with racism and discrimination on behalf of the counselor working with a minority offender. The second category of racism and discrimination that must be understood is the consequences or effects of a minority populations’ sustained exposure to racist and discriminative views from the society in which they live. Racist and discriminative views of a counselor have the potential to destroy any possibility of establishing a meaningful and helpful relationship with an offender. Underlying racism and discrimination is the concept of judgmentalism. The primary component of judgmentalism, and what makes this phenomenon so destructive, is the concept of superiority (Elliot & Elliot, 2006). In essence, racism and discrimination stem from feelings of judgmentalism, which is based on an individual’s perception of being superior to another based on race, physical characteristics, or societal status. If an offender perceives the counselor as judgmental, the offender’s likely reaction will be to shut down emotionally thereby limiting any potential growth as a result of the counseling relationship. As is mentioned in various places throughout this text, one of the best ways to guard against judgmentalism is to work toward becoming more open to differing views and methods. The second component of racism and discrimination that counselors must understand is that many incidents that minority offenders endure as a result of discriminatory perceptions are empirically real incidents. The consequences of racism and discrimination will often manifest themselves through mental disorders such as depression and anxiety. Sadly, because these offenders may present with these disorders, there may be a tendency to ignore or disbelieve any contentions they may hold regarding discriminatory actions and/or the effects of institutional racism within the justice system. Minorities in the United States are seldom able to fully distance themselves from the overt or covert implications of racism and discrimination. The cumulative effect is often increased stress which is likely to lead to elevated levels of both anxiety and depression. Counselors should be aware of this phenomenon and be able to work with clients in an attempt to reduce the effects of racism and discrimination. It is unacceptable for non-minority counselors to simply dismiss the effects of racism and discrimination on minority offenders due to erroneous beliefs that racism and discrimination no longer exist. SECTION SUMMARY Before getting into the different minority groups, it is important to understand that the population of the United States is very heterogeneous. This is the point most often implied through the use of the concept melting pot. The United States described as a melting pot is usually an attempt to portray the vast differences among the many different groups occupying the territory. Minority population refers those groups of people smaller in number, and often thought to be different from the larger group of which it is a part. In addition, minority groups usually possess less political power than the majority. As a result, minority groups will often face discriminative practices not commonly experienced by members of a majority. As a result, it is not uncommon to have minority offenders who present symptoms that are in some ways related to their discriminative experiences. One way of effectively working with minority offenders is by counselors being culturally competent. Cultural competence is the idea of understanding how a multitude of different factors influence one’s reasoning and decision-making processes. This general description applies to both counselors and offenders. In order for counselors to successfully work with minority offenders they must intimately understand their own feelings and biases. Without this understanding it is doubtful that a counselor will be able to enact meaningful change within the population of minority offenders on a consistent basis. LEARNING CHECK 1. Culture is not related to mental illness. a.True b.False 2. Cultural competence is usually important in the counseling process but not always. a.True b.False 3. Which of the following often result from racism and discrimination? a.Depression b.Anxiety c.Suspiciousness d.All of the above 4. The counselor’s culture is important to understand when attempting to provide culturally competent counseling. a.True b.False 5. It is uncommon for minority offenders to mistrust mental health providers a.True b.False PART THREE: SPECIFIC RACIAL AND CULTURAL GROUPS African Americans One of the most important components that has to be taken into consideration when providing effective mental health services to minority offenders is the historical context of their race. As of 2001, there were approximately 34 million African Americans, roughly 12% of the population, living in the United States (U.S. Census Bureau, 2001). Most, if not all, African Americans currently residing in the United States can trace their ancestry to the slave trade from Africa. It is estimated that millions of Africans, over a period spanning two centuries, were kidnapped or purchased to be brought to the United States in order to perform manual labor. These African slaves were considered personal property of their owners. According to Thernstrom and Thernstrom (1997), even after the Fourteenth Amendment extended citizenship to African Americans many continued to live in poverty as they still remained dependent and were mostly being kept uneducated. Currently, many African Americans still live in poor neighborhoods largely segregated and clearly delineated from other non-minority settlements. Among these neighborhoods there are few resources and high rates of unemployment, homelessness, crime, and substance abuse (Jones & Hanser, 2005; Wilson, 1987). It is important that counselors understand that due to these circumstances many African Americans experience prolonged perceptions of personal vulnerability. These perceptions of vulnerability and attendant psychological and emotional consequences that originate at the community level will often overpower individual control (Shusta, Levine, Harris, & Wong, 2005; Sue & Sue, 1999). In essence, it is important that counselors truly appreciate the environments and conditions of many African Americans and embrace these factors as part of the counseling process and not limit their roles within the offenders’ decision-making process. Although poverty rates are decreasing many African Americans are still relatively poor. African Americans are much more likely than whites to live in severe poverty with a rate of more than three times that of whites (Joiner, 2006). Currently, there is sufficient evidence indicating that poverty is one of the most frequent correlates in relation to criminal behavior (Joiner, 2006; Shusta et al., 2005). In order to be effective, counselors need to be aware of the effects of poverty and how these effects manifest themselves into cognition and behavior. The historical adversity experienced by African Americans through slavery and exclusion from educational as well as social and economic resources is largely responsible for many of the socioeconomic disparities they face today. Socioeconomic status is linked to mental health. In essence, poor mental health is more common among the impoverished than those who are more affluent (DHHS, 2001). Poor mental health will often translate into criminal behavior especially among those who are homeless or have substance abuse problems. IMPORTANT CONSIDERATIONS WHEN COUNSELING AFRICAN AMERICANS There is extensive literature that compares therapeutic outcomes between African Americans and Caucasian Americans. Amidst this research, numerous studies have sought to determine whether common counseling techniques are equally effective for both Caucasian Americans and African Americans (Jones & Hanser, 2007; Sue & Sue, 1999; McGoldrick, Giordano, Pearce, & Giordano, 1996). One of the most salient components that must be understood by correctional counselors is that the cultural history of minorities is often different from whites. To add to this enigma is the fact that most, if not all, counseling modalities were created by white, Judeo-Christians to address psychological and emotional problems experienced by mostly non-minority clients. In essence, many of the counseling modalities are not equipped to specifically address some of the most salient issues affecting minorities. For example, most counseling modalities stress the importance of introspection and assuming responsibility for one’s decisions. The problem with this when attempting to work with minority offenders is that oftentimes minorities have a clear understanding of their identity as a historically oppressed population (Brown & Srebalus, 2003). In essence, they are able to identify social issues that are independent of themselves as the underlying mechanism of much of their struggle (Brown & Srebalus, 2003), thereby creating a real conflict between counseling theory and group identity among minority populations. This lack of congruence between counseling theory and characteristics specific to cultural history is surely part of the reason why only about half of African Americans, as compared to whites, seek out and receive counseling services. In addition, African Americans are much more likely than whites to prematurely terminate counseling and generally express greater dissatisfaction with the entire helping process (Sue & Sue, 1999). In essence, many of the counselors responsible for providing services to African American populations, as well as other minority populations, are ill equipped to provide culturally effective services largely because they do not fully understand the cultural history and identity of minority populations. Latino Americans (Hispanic Persons) “Hispanic” is a term generally used to describe people of Spanish origin living in the United States (Gladding, 1996). Before discussing the central components related to Hispanic Americans’ mental health issues it is first necessary to distinguish the different groups commonly classified as Hispanic. Currently, the U.S. Census Bureau recognizes four different groups as Hispanic: Mexicans, Puerto Ricans, Cubans, and Central Americans. As described below, Hispanic Americans are very heterogeneous in most circumstances including those that led to or contributed to their migration and, are rapidly expanding. The U.S. Census Bureau projections indicate that by 2050 the number of Hispanics will be roughly 97 million, or one fourth of the U.S. population. MEXICANS There are several important factors (both historical and therapeutic in nature) to consider when counseling Mexicans or Mexican Americans. First, it is useful to remember that after the Mexican war large territories of Mexico became part of the United States. This included land from Texas to California in which many Mexican citizens chose to stay, thereby becoming Americans citizens. In addition to the Mexican war, and as noted by DHHS (2001), there are a myriad of both push and pull factors that heavily influence the flow of Mexicans into the United States. Poor economic conditions in Mexico contribute to the push factor and the need for laborers in the United States influence the pull factor. It is important to note that much of the reasoning behind the origins of migration among all of the Hispanic groups is closely tied to economic factors. In essence, the overwhelming majority of Hispanics who choose to migrate to the United States do so in hopes of providing better circumstances for themselves and their family. The one factor, however, largely responsible for the overwhelming majority of Hispanic Americans being Mexican is the fact that the two countries border each other. Logistically, it is usually easier for Mexicans to come to the United States simply because they do not have as far to travel and especially because migrant travel is often by land, much of which is often covered on foot. It is important for correctional counselors to understand that many of their clients may come from families that are illegally in the United States. The cultural variables associated with this type of extralegal existence must be taken into account. Likewise, the levels of acculturation and assimilation may vary from one Mexican client to another. In a similar vein, the ability to speak the English language can be a barrier unless the correctional counselor speaks Spanish sufficiently well to conduct therapy sessions. Therapy with this and other Hispanic groups can be greatly impaired due to linguistic challenges, and, in some dire cases, the use of an interpreter may be necessary. PUERTO RICANS One of the characteristics that distinguishes Puerto Ricans is that as of 1917, by way of the Jones Act, Puerto Ricans are considered American citizens. Hence, they can enter and exit the mainland of the United States at their will. After World War II many Puerto Ricans began migrating to the mainland in order to find work. Rising populations on the island of Puerto Rico contributed to the high unemployment and made it difficult to find meaningful employment. As the work force began to age many Puerto Ricans who had come to the United States began to return home creating a circular pattern that commenced in the early to mid-1980s (DHHS, 2001). CUBANS The most significant migration of Cuban immigrants began in 1959 after Fidel Castro toppled the Batista government and assumed control of the country. Many of the initial Cuban immigrants were well-educated professionals who have become well established in America. Other immigrants who were not as well established in Cuba also attempted the trip and are commonly referred to as Balseros. Balsero means less than secure and often makeshift watercrafts that were used by many Cuban immigrants because of their poor economic situations. Finally, many of the Cubans who have come to the United States have received full rights to citizenship due to their declared status as political refugees. CENTRAL AMERICANS Central Americans are generally considered those immigrants whose country of origin is El Salvador, Guatemala, or Nicaragua. Central Americans are considered to be the newest Hispanic subgroup in the United States as their distinction is relatively recent. Many of the Central Americans migrated to the United States because of political turmoil and massive atrocities carried out by rivaling political factions in their homeland. A large number of Central Americans arrived in the United States during the 1980s. As with all of the subgroups, however, it is important to understand that migration is a constant process with ebbs and flows. There have been historical and political events over the past decades that have contributed to spikes or shifts in the flow of immigrants but below these peaks lie the relatively stable fact that large numbers of individuals travel toward and often into the United States each year.

1. 1. IMPORTANT CONSIDERATIONS WHEN COUNSELING LATINO AMERICANS

One key reason for at least briefly describing the characteristics of each group’s circumstances causing their migration is because we are able to glean valuable insight into their experiences and possible mental health needs. In addition, how these groups have been received once in the United States is also important. For example, Puerto Ricans, regardless of whether born in the United States or Puerto Rico are considered U.S. citizens. This is important to note because citizenship allows access to government programs and sponsored services aimed at providing needed support. Similarly, many Cuban immigrants have achieved citizenship due to their declared status of political refugees.

Mexican and Central American immigrants, however, are much less likely to be granted citizenship. Many of the Central American immigrants were fleeing war-struck countries mired in political turmoil. Despite these circumstances Central American immigrants are not considered political refugees. Therefore, many Hispanics migrating to the United States arrive without proper documentation. Central Americans, in addition to being undocumented, are also likely to suffer symptoms of post traumatic stress disorder (PTSD) as a result of their experiencing trauma and terror prior to their departure. Also, immigrants who are undocumented live in constant fear of deportation. This reality makes it difficult to find and 

Mexican Americans are by far the most populous subgroup of Hispanics living in the United States. Research has shown that the Mexican Americans living in the United States are further divided into two groups: those born in Mexico and those born in the United States. Another research has found that Mexican Americans born in the United States reported higher rates of depression and phobias as compared to those immigrants born in Mexico (Burnam, Hough, Karino, Escobar, & Telles, 1987). This is an important component related to the Mexican American population that counselors need to understand especially since this finding is far from being considered intuitively obvious. In other words, most people would likely believe that Mexicans born in Mexico and then later coming to the United States would suffer greater degrees of mental illness due to the harsh conditions. In fact, according to Vega et al. (1998) those Mexican immigrants living in the United States for at least 13 years suffered higher rates of mental disorders than those living there for less than 13 years. This consistent pattern of findings among independent investigations begs the question, why? Why is it that Mexican immigrants who have been in the United States the longest suffer from mental illness at greater rates? Some have pointed to the process of acculturation but it is not clear what aspects of acculturation are related to higher rates of disorders.

1. 1. Native Americans: American Indians and Alaskan Natives

American Indians and Alaskan natives occupied North America long before Europeans made their way over to this continent and Russians arrived in what is now Alaska. The plight of American Indians and Alaskan natives is legendary and they have had to overcome and survive ever since European settlers first landed in America and began their push westward. First, American Indians were greatly affected by the various diseases spread through their initial contacts with early European settlers. As they lacked immunity against such new diseases, the population of American Indians plummeted. One common theme in treating this group is the need to address what is called historical trauma, which underscores the generations of suffering and traumatic experiences that have been attributed to this group of people.

Currently, American Indians and Alaskan natives are considered to be the most impoverished ethnic minority group in the United States (DHHS, 2001). Oppression, discrimination, and removal from native lands are directly related to their lack of educational achievements, lack of economic opportunities, and high rates of mental illness and disorder. In a study conducted by Robin, Chester, Rasmussen, Jaranson, and Goldman (1997) more than 70% of American Indians met the guidelines for a lifetime diagnosis of alcohol disorders. Alcohol problems and mental disorders often occur together as evidenced in the fact that of the 70% of American Indians suffering from alcohol disorders many were also found to be suffering from psychiatric disorders. Because of this, substance abuse treatment is one of the most common forms of therapy required for offenders from this cultural group.

In general, studies have found that American Indians and Alaskan natives experience greater psychological distress than the overall population. Almost 13% of American Indians and Alaskan natives report experiencing psychological distress as compared to 9% of the general 

1. 1. Asian Americans and Pacific Islanders

Asian Americans and Pacific Islanders are extremely diverse groups. Lee (1998) reports as many as 43 different ethnic groups are classified as Asian Americans and Pacific Islanders. Asian immigrants now account for approximately 4% of the U.S. population and are rapidly increasing. By 2020 the Asian American and Pacific Islander population is expected to reach 20 million accounting for approximately 6% of the U.S. population. Further, a very substantial portion of Asian Americans are born outside of the United States, collectively comprising more than 25% of all the foreign-born citizens in the United States (Bennett, 1978; Shusta et al., 2005). Indeed, throughout the United States, over 60% of all Chinese Americans, 70% of all Asian Indian Americans, and a full 90% of all Vietnamese Americans are not born in the United States.

Though this population consists of disparate national origins, there are some characteristics that are common to most all Asian American ethnic groups in the United States. Understanding of these characteristics can benefit the correctional counselor to provide services to an Asian American caseload. Shusta et al. (2005) note that each of these characteristics given below can hinder the ability of correctional counselors to develop an effective rapport with Asian Americans:

• 1. Generational status in the United States (first, second, third generation)

• 2. Degree of acculturation and assimilation

• 3. Comfort with and competence in English

• 4. Religious beliefs and cultural value orientation

• 5. Family cultural dynamics.

Some are more relevant than others to specific groups but almost all of these issues are relevant at one point or another when considering Asian Indian Americans, Chinese Americans, Vietnamese Americans (the three largest Asian groups in the United States), as well as Pacific Islanders.

As was noted earlier, proficiency in the English language is a particular hindrance that can cause serious misunderstandings between police officers and Asian American citizens. This issue is somewhat tied to the generational status of an individual Asian American because large percentages of the population of those groups that have immigrated most recently do not speak English. This is particularly true among the Southeast Asian groups. Indeed, nearly 38% of all Vietnamese Americans do not speak English (Shusta et al., 2005). In addition, it is estimated that an approximate 23% of Chinese Americans also do not speak English (Shusta et al., 2005). On the other hand, this is not typically an issue for Asian Indians because of the fact that almost all speak English as a result of prior subjugation during the reign of the British Empire (Almeida, 1996).

Further, Asian families tend to be close-knit and this still tends to be true even though divorce is becoming more prevalent (attributed to Westernized values regarding the role of Asian American women) and Asian American youth are becoming more independent in mindset. However, there are specific dynamics unique to Asian families that may be important to consider. For instance, the father of the house typically acts as the spokesperson for the household, but he may consult with grandparents who may live with him, his spouse, and 

1. 1. SECTION SUMMARY

It is important to understand some of the distinguishing characteristics of each racial group mentioned above. As indicated, each group is comprised of different subgroups and all share considerable diversity. The essence of this portion of the chapter is to highlight some of the critical factors central to each group. For example, when working with African American offenders it is important that counselors be aware of how their ancestry is linked to slave trade. In addition and also related to their origins as slaves, it is important that counselors understand the impact of poverty and the often violent surroundings that many African American offenders often find themselves associated.

Hispanic Americans consist of Mexicans, Cubans, Puerto Ricans, and Central Americans. Each of these groups shares a Hispanic origin but has endured different circumstances surrounding their arrival and presence in America. American Indians and Alaskan Natives are the most impoverished minority group. They have suffered extreme oppression throughout their history that must be considered when attempting to diagnose and treat current symptoms. Similarly, Asian Americans and Pacific Islanders have also suffered from oppression. It is also important to note that some of their oppressive experiences have been at the hands of the criminal justice system. In essence, the histories of these minority groups are a vital part to comprehensively understand how to treat them.

1. 1. LEARNING CHECK

1.

Most violent encounters are perpetrated by strangers as opposed to someone the victim knows well.

• a.True

• b.False

2.

An African American’s origin to the slave trade is not an important factor within the context of current symptoms.

• a.True

• b.False

3.

Generalizations are acceptable when dealing with minority groups and will often serve to save the counselor time so that real work can begin immediately.

• a.True

• b.False

4.

One of the most significant factors associated with American Indians is the high rate of alcoholism and depression.

• a.True

• b.False

5

It is not really important that counselors understand the histories of minority offenders but instead focus should be on the ability to identify current problems and how these problems are manifested in daily circumstances and interactions.

• a.True

• b.False

1. 1. CONCLUSION

Correctional counselors bear a responsibility to their client. This means that correctional counselors must promote the dignity and the welfare of their client, regardless of the fact that they have engaged in criminal behavior. This can be challenging for the counselor, particularly when the offender has committed a crime that is particularly heinous and/or contrasts with the inherent beliefs of the counselor. While ensuring that they are balanced and nonjudgmental in approach, correctional counselors must be sure to take careful and complete notes of their clinical sessions with the offender client. The use of the SOAP is presented to students as the preferred means by which such records should be organized and written.

In addition, it is important that correctional counselors maintain professional boundaries in their relationship with their client. As part of this process, counselors should ensure that the client is given informed consent and that this is obtained in writing, typically in a disclosure statement and/or a declaration of practices page. This process simply informs the client of the counselor’s credentials while also informing the offender of the parameters of confidentiality. Given the client’s criminal background, this can be a very sensitive and important aspect of the initial counseling process. Therefore, it is still strongly advised that counselors complete the process of obtaining signed informed consent; this safeguards the client and the counselor. Other ethical considerations associated with the client–counselor relationship, such as transference and/or countertransference, dual relationships, stress, and burnout, must also be considered by the counselor.

In order to effectively provide mental health services to all offenders, correctional counselors must be culturally competent. Especially among minority offenders, counselors must understand the impact of their cultural experiences and how these experiences influence cognitions and behavior. Correctional counselors must do more than be simply sensitive to cultural issues; they must be able to competently address cultural differences and they must be able to incorporate these differences into their treatment approach. Importantly, correctional counselors must understand the implications of stigma often attached to mental health services and needing help “from the outside,” as well as historical events that heavily impact current behavior. Given the prevalence of minorities within the offender population, it is clear that any person working in correctional treatment will be inept if they fail to make at least a cursory attempt to familiarize themselves with the various cultural issues associated with offenders from various minority groups.

1. 1. Essay Questions

• 1. How would you define cultural competence? In your own words, describe why it is so important that counselors understand the essence of cultural competence, especially within the offender population.

• 2. Explain and describe two of the most common barriers to treatment.

• 3. Define the concept of stigma. What are some of the origins of stigma especially as it relates to counseling?

• 4. What is the difference between covert and overt racism? Provide two examples of each. Is one type of racism more destructive than the other? Why or why not?

• 5. What is meant by the concept of a melting pot? How is this related to the significance of counselors being culturally competent in their ability to effectively provide services?

1. 1. T

      
      

      
      reatment Planning Exercise

In this exercise, the student must consider the case of Ming and provide a discussion of how they might approach the problems that face Ming’s family. Consider all of the issues relevant to acculturation and assimilation, paying particular attention to the dynamics between the younger and the older generation of the Chung family. List and discuss at least eight cultural considerations that you would employ and place them each in the order of priority, noting those that you would address early and those that might remain on the periphery of your clinical concerns.

1. 1. The Case of Chung Ming

Chung Ming is a teenager, 14 years old, and he is ethnic Chinese. His parents immigrated from China when Ming was roughly 9 years old. Ming’s parents have not yet mastered the English language and in some cases, he has had to translate for his family. Lately, Ming has been skipping school and he has been hanging out with a group of other Asian (mostly Chinese) youth that have established a small gang.

Ming’s parents are humiliated by his behavior and do not act as if they are really ready to conduct counseling. They express that they are very troubled by Ming’s behavior and even that he brings dishonor on his family. Ming, on the other hand, is much more Westernized than his parents and he notes that many of his friends have forsaken much of their Chinese views for those more consistent with mainstream American society.

Ming seems indifferent as you watch him while his parents talk, noting that Ming stays out late, drinks at age 14, and he has even stolen small items from various stores in the neighborhood. You can tell by observing that Ming’s father has difficulty with English and is a bit withdrawn. The mother is also withdrawn and does not offer anything to the conversation throughout most of the session.

Ming is on juvenile probation and he seems to meet the requirements of his supervision. The mere fact that he is on probation is problematic with his parents and is also a source of shame for all members of the family.

After the session, you are fairly sure that Ming is still engaged in illegal activities with his prior gang. You make it a point to ultimately contact his probation/parole officer during the next week.

Given the dynamics of this traditionally Chinese family, Ming’s advanced acculturation in Western culture, and the lack of concern that Ming has, you realize that there are many more factors at play than Ming’s simple misbehavior. You consider the cultural dynamics and begin to develop a plan.

1. 1. Bibliography

Almeida, R. (1996). Asian Indian families. In M. McGoldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy (pp. 394–423). New York: Guilford.

American Counseling Association (2005). ACA code of ethics. Alexandria, VA: Author

Bennett, L. A. (1978). Counseling in correctional environments. New York: Human Science Press.

Brown, D., & Srebalus, J. (2003). Introduction to the counseling profession (3rd ed.). Pearson Education, Inc: New York.

Burnam, M., Hough, R., Escobar, J., Karno, M., Timbers, D. M., & Telles, C. A. (1987). Six-month prevalence of specific psychiatric disorders among Mexican American and Non-Hispanic Whites in Los Angeles. Archives of General Psychiatry, 44, 687–694.

C

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