Diversity Issues in Counselling Practice

The importance of considering diversity issues in counselling practice; from the perspective of both client and counsellor.

This essay will critically evaluate importance of considering diversity issues in counselling practice from the perspective of both client and counsellor. This will be achieved by referencing relevant theory and research present in the literature. Although diversity has many dimensions, this essay will be critically discussing only two of its dimensions: race and gender. These dimensions are important to consider for each client as diversity impacts on the counselling practice. According to the BPS’ Code of Ethics and Conduct (British Psychological Society, 2009: 10), the counsellor must “Respect individual, cultural and role differences, including (but not exclusively) those involving age, disability, education, ethnicity, gender, language, national origin, race, religion, sexual orientation, marital or family status and SES”. Furthermore the Health & Care Professions Council (2008) encourages counsellors to not allow personal views or beliefs impact negatively on the professional advice given. The present society is multicultural and every individual should attempt to explore, understand and accept the differences across all dimensions of diversity. Racism is defined by Myers (1993) as the act of exaggeration of differences that portray minorities as having weaker physical and mental abilities than the vast majority of individuals. On the other hand, according to APA (American Psychological Association, 2012: 28), gender is a term used to describe “the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex”.

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There are many factors that contribute towards a bias perception of an individual such as cognitive factors, personality factors, motivational factors and social factors which can lead to a mistreatment (Wilson, 2009). Moller (2011) argues that although in US there are a strong focus and devotion to all dimensions of diversity in counselling psychology, this is not the case for UK as the focus and devotion to all dimensions of diversity do not exist. It used to be presumed that race is genetic, formed at a biological level (Barnes, 2006). Another view on race is that of race being a social construct (López, 1994). The existence of racism is mentioned in various sectors such as employment and housing. Patel and Fatimilehim (1999) have outlined the existence of racism in employment sectors as BME people do not work in managerial positions or become self-employed. Simpson (1981) informed about the existence of racism also in the housing sector where black applicants would experience a lengthier application process. In the past, ethnic minorities did not have much knowledge about each other’s culture and their practices were isolated from each other. However, in the present times, ethnic minorities do want to be integrated in society.

Strakowski, Flaum, Amador, Bracha, Pandurangi, Robinson and Tohen (1996) highlighted that black clients are more likely to receive a schizophrenia and substance abuse diagnosis than white clients would. This is also highlighted by the Department of Health (2005), reported that 9 percent of mental health patients were black and that 44 percent of black clients were more likely than white patients to be detained under the Mental Health Act (Great Britain Department of Health, 1998). According to Williams (1999: 173), racism can have a negative impact on health due to factors such as stress caused by discrimination and “racial bias in medical care”. This is also acknowledged by Bryant-Davis and Ocampo (2005) who state that BME people experiencing lasting chronic low-level racism, exhibit symptoms associated with PTSD (posttraumatic stress disorder) and therefore the negative impact of racism on an individual is traumatic. Furthermore, early findings from Clark and Clark’s study (1947) show signs of internalised racism amongst African American children. During this study, African American children were given the opportunity to play with a black or white doll. It was observed that most children have chosen to play with the white doll, which was interpreted as an exhibition of internalised racism.

On the other hand, racism and gender do not present issues for clients only, but also for counsellors treating the clients. As the counsellor must be aware of own personal views or beliefs and to not allow these to impact negatively on the professional advice given, clients may also have certain responses to their counsellor’s race or ethnicity. It may be difficult for an individual to confide in a counsellor of a different race or ethnicity than the client’s or may not feel fully understood. In turn, it may be challenging for the counsellor to fully understand their client’s perspective and emotions associated with their race. According to Abramowitz and Murray (1983) black clients are more likely to quit therapy if run by a white counsellor and as highlighted by Thompson and Alexander (2006) black clients are more likely to have successful sessions with a black counsellor. Furthermore, Ward (2005) found that minorities often believe that therapists with other culture were indifferent to the client’s cultural practises. However, according to Speight and Vera (2005) there are courses that facilitates cultural awareness, knowledge, the ability to regulate behaviour and beliefs of counsellors for a better approach for diversity.

Furthermore, Beutler, Malik, Alimohamed, Harwood, Talebi, Noble, and Wong (2004) have explored whether therapist gender influences successful therapy and whether gender matching clients has any impact on the therapy. Beutler et al. (2004) found that matching the gender of the therapist and client does not have a major positive impact on the outcome. On the other hand, Speight and Vera (2005) found that a minority of clients prefer gender matching counsellors. For an instance, female clients prefer female therapists. This may suggest that the outcome of therapy would be impacted by therapist’s gender. Therapists must consider own personal own expectations, gender appropriate behaviour, views, or beliefs (such as misogyny and sexist attitudes), socialisation (may be limited by gender roles) and to not allow these to impact negatively on the professional advice given. There are several theories associated with gender such as penis envy. Penis envy is described by Freud (1933) as a transition experienced by girls during the phallic stage of psychosexual development that ensures a heterosexual orientation. Many have argued that the envy was not of the penis itself, but the power associated with having a penis. (Nathan, 1981; Horney, 1942).

For many years, females have been associated with madness. It was assumed that masturbation amongst women was caused by madness and clitoridectomy (removal of a part or the whole clitoris) was performed (Showalter, 1987). The gender related diagnoses have been used along the years to promote gender roles. For an instance Hysteria, another female related mental disorder was characterized by symptoms such as unstable emotions, manipulation, laziness, confrontation, unnatural independence, etc. (Bollas, 2000). On the other hand, men suffering of PTSD in World War I were denied pensions, seen as weak and even executed for cowardice using methods such as electrical treatments (McKenzie, 2012). Males are more likely to not report struggles such as depression which causes more than three times more male suicides a year than female suicides (Office for National Statistics, 2013). The rates of suicide suggest that its occurrence in men more than women, may be due to differences between the two genders.

Galdas, Cheater, and Marshall (2005) found that it is less likely for men to seek help for psychological struggles, mostly due to stereotypical views on gender. Just as in the World War I, males believe that seeking help for psychological struggles is not a manly practise, but rather a womanly response. Galdas, Cheater at al. (2005) also suggested that men not seeking help for psychological struggles may represent a distortion in data accounting for reported psychological struggles where more females are more likely to report psychological struggles. Baron-Cohen, Knickmeyer and Belmonte (2005) also found differences between males and females, namely sex differences in the brain. According to Baron-Cohen et al. (2005) report that due to this difference in the brain’s circuitry, females better than men at empathizing and males stronger at understanding and creating systems. Baron-Cohen et al. (2005) also suggested that individuals suffering from autism have a brain with an extreme male pattern; this sustains that individuals suffering from autism have an impaired ability to empathize and an enhanced systemizing ability. However, Lucas (2012) argued that there are no sex differences in the brain for males and females. Instead, Lucas (2012) insists that the brain is subject to social and cultural influences.

At the present time, as shown by Lago and Smith (2003: 68-69), there is a woman centred counselling practice that regards mainly areas such as alienation and power. This “radical feminist therapy” assumes the following: that women are used by men for sexual gratification; that women are perceived as being in control of a society in which men hold the power; that “motherhood and romantic love” are obligatory for every woman; that women are subject to concealed and obvious violation which may or may not be sexual; that every woman is “inferiorised”, has less money than males, has less freedom than a man and is less credible than a man; and that the woman is subject to “sexism and other systematic oppressions”. Lago et al. (2003: 68-69) states that “As counsellors that work with women, it is vital that we take in the degree of that reduction and of that violence”. Furthermore, Lago et al. (2003: 71) underlines the difference of wages between men and women as a gender inequality in an example of empathy from a counselling session by stating “Women’s wages in this society are an absolute obscenity”. It seems that this feminist therapy underlines that females are still perceived as obedient to males. This is also highlighted in a second woman centred approach called the rhythm model. The rhythm model is addressing “change, growth and life” Lago et al. (2003: 64) which enables the dissolution of “women’s oppression” Lago et al. (2003: 64). The rhythm model has five stages: “building trust – the mothering phase; identifying themes – separating out opposite; exploring the past – understanding the opposites and inner hierarchies; dissolving the inner hierarchies and facing ambivalence – accepting the opposites; and making changes – living with the opposites”. In spite of two women centred approaches, there does not seem to be a perspective or approached addressed specifically to men in the present literature.

In conclusion, future research should explore the existing therapies in terms of diversity and adapt these to various multicultural elements and other dimensions of diversity such as gender. Many males do not ask for help with their psychological struggles due to the stereotypical expectancy for men to be strong and not let their emotions surface. Future research should also explore the possibility to encourage men and women to seek help when struggling with psychological issues, in order to prevent suicides. In the past, ethnic minorities did not have much knowledge about each other’s culture and their practices were isolated from each other. However, in the present times, ethnic minorities do want to be integrated in society. Individuals want a society and norms that promote equality and exclude any stereotypical views associated to gender, as it has happened in the past. Diversity issues in counselling practice are important for both client and counsellor in order to achieve a successful therapeutic outcome. All diversity dimensions impact on both the client and counsellor in a similar, yet different way. In order to minimise issues relate to all dimensions of diversity, counsellors must “Respect individual, cultural and role differences, including (but not exclusively) those involving age, disability, education, ethnicity, gender, language, national origin, race, religion, sexual orientation, marital or family status and SES” (British Psychological Society, 2009: 10). Counsellors must also overcome personal views or beliefs about all dimensions of diversity as this may impact negatively on the professional advice given. The present society is multicultural and every individual should attempt to explore, understand and accept the differences across all dimensions of diversity.