Counselors' Values Profile: Implications for Counseling Ethnic Minority Clients

The authors review the empirical literature on counselors' values, describe values salient to the 4 largest ethnic minority groups in the United States, identify similarities and differences between counselors' values and those of the minority groups, and discuss implications for counseling ethnically different clients. Understanding counselors' values can lead to an examination of how these values may affect the counseling process, particularly when clients are from ethnic minority groups that may espouse differing cultural values.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

Ethnic Match and Treatment Outcomes for Child and Adolescent Mental Health Center Clients

This study investigated the effects of client ethnicity and client‐counselor ethnic match on treatment outcomes (i.e., GAF‐difference [from the Global Assessment of Functioning Axis V rating of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, American Psychiatric Association, 1994] and client visitation) of 1,946 child and adolescent community mental health center clients. After controlling for 7 other variables, no differences were observed after adjustment among client ethnicities, age groups, or ethnic match on the GAF‐difference dependent measure. Ethnically matched African American child and adolescent clients had fewer mental health visits than did their nonmatched counterparts. Implications of these findings are discussed.     

Effects of combining disparate groups in the analysis of ethnic differences: Variations among asian american mental health service consumers in level of community functioning

The Asian American population comprises historically, socially, and culturally diverse ethnic groups. Given this diversity, investigators caution that combining disparate ethnic groups together may lead to erroneous conclusions. Whether by choice or necessity, however, mental health studies still typically consider Asian Americans as a single ethnic category rather than as separate ethnic groups. Few investigations have addressed the consequences of this practice. This paper examines the implications of conceptualizing Asian Americans as an ethnic category versus ethnic groups, in an investigation of the community functioning status of clients in publicly funded mental health programs in King County, Washington. When treated as a single ethnic category in a multivariate linear regression model, Asian Americans are found to have a lower level of functioning difficulty than their white counterparts. However, when treated as separate ethnic groups (e.g., Vietnamese, Japanese), only one of five Asian ethnic groups has a significantly lower level of difficulty. In a separate analysis of the Asian American subsample, groups are found to differ significantly from one another with respect to functional status. Several factors, including refugee status, account for this difference.     

Experiential Tasks and Therapist Bias Awareness

All therapists have values, assumptions, and beliefs about groups of people who are different from the dominant culture. How the therapeutic process is shadowed by therapists' assumptions and attitudes toward ethnic minorities is discussed. The author provides experiential techniques such as visualization, role playing, role reversal, family sculpturing, and a written assignment as a vehicle to heighten a family therapists' awareness of underlying assumptions and biases toward clients of an ethnic minority.     

The responsiveness and equality of mental health care to Chicanos and Native Americans

An examination was made of the services received by Chicano and Native American clients in 17 community mental health facilities. Although these minority clients differed from Anglos in demographic variables, there was no evidence that they were rendered inferior or discriminatory services. However, failure to return for therapy was much higher among minority clients. Possible reasons for this failure to return are discussed. It is suggested that for ethnic group clients, equality of services may not mean responsive services.     

Counseling utilization by ethnic minority college students

Although multicultural awareness in counseling has risen substantially in the last decade, little research has examined counseling utilization and outcomes for ethnic minorities on university campuses. A sample of 1,166 African American, Asian American, Caucasian, and Latino help-seeking university students from over 40 universities nationwide filled out the Outcome Questionnaire 45 (OQ45) at the first and last therapy sessions. Caucasian students attended significantly more sessions than all other groups. Greatest distress was found at intake in Asian American students, followed by Latino, African American, and Caucasian students. All groups appeared to benefit from therapy, as noted by a decrease in symptomatology, but none of the groups met the criteria for clinically significant change for the OQ45. Implications for therapists working with minority clients are discussed.     

Replacing client-centred counselling with culture-centred counselling

Models of psychotherapies and counselling do not develop in a social vacuum. They arise out of and rest on several fundamental assumptions-social, linguistic and cultural-most which are understood and shared by the client group and the therapists andor counsellors. The extent to which there is a congruence of shared assumptions facilitates the process of counselling and/or therapy. It does not, however, guarantee its successful outcome. This paper examines the fundamental assumptions underlying client-centred counselling and argues that there is at present a lack of correspondence between the assumptions of the counsellors and those of their client groups-even within their own culture. But among the client groups comprising the ethnic minorities originating from the Indian subcontinent, there is a wide chasm. The clients do not understand or share the fundamental assumptions of their counsellors. As a result, client-centred counselling is irrelevant and does not serve the needs of the clients groups comprising the ethnic minorities. It is in urgent need of a paradigm shaft. It is argued that client-centred therapy needs to be replaced by culture-centred counselling, in which counsellors can be trained. The paper presents the main features of a model of counselling that is applicable not only to the white indigenous population in Britain but to the above ethnic minorities living in Britain.     

Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.     

Racial differences in self-disclosure of suicidal ideation and reasons for living: implications for training

Racial differences in suicidal self-disclosure and reasons for living were investigated in 2 separate studies. In Study 1, a random sample of archival client and therapist intake data from a university counseling center for 1 year was examined, and results indicate that ethnic minority clients do not self-disclose suicidal ideation as readily as their nonethnic minority peers. In addition, a significantly higher number of ethnic minority clients were deemed "hidden ideators" because their suicidal ideation only became evident when a counselor performed a suicide risk assessment. Only 1 of the 36 ethnic minority clients with suicidal ideation in the sample voluntarily self-disclosed this ideation at intake without an assessment by the therapist. Study 2 used the Reasons for Living Inventory (RFL) and compared African American and European American college students from an introductory psychology course. The RFL is a useful instrument to compare potential race differences in reasons people report for choosing not to kill themselves, because it does not require respondents to self-disclose (or to have) current suicidal ideation. The results from Study 2 indicate European Americans report fewer reasons for choosing not to kill themselves than their African American peers and that African Americans scored significantly higher than European Americans on the moral objections and survival and coping beliefs subscales of the RFL. Implications for training counselors in suicide risk assessment, prevention, and treatment with ethnic minorities are discussed.     

Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy.

This study examined treatment outcomes of 86 highly acculturated Hispanic and Anglo substance-abusing adolescents in functional family therapy, testing the hypothesis that ethnic matching of therapist and client is related to better treatment outcomes for clients. Adolescents reported on their substance use pre- and posttreatment on a timeline follow-back interview. Ethnically matched Hispanic adolescents demonstrated greater decreases in their substance use compared with Hispanic adolescents with Anglo therapists. Ethnic match status was not related to treatment outcome for Anglo clients. Thus, the matching hypothesis was supported for Hispanic clients only. The results underscore the importance of greater ethnic diversity among therapists and better cultural competency training for Anglo therapists. More research is needed on individual differences in the effects of ethnic matching.     

Need for affiliation,self-esteem,and social distance of black Americans

One hundred three undergraduate men at Howard University were administered a projective measure of the need for affiliation, a self-esteem scale, and a modified version of the Bogardus Social Distance Scale that compared the subject's social distance from his own ethnic group with his social distance from the average of 20 other American ethnic groups. High need for affiliation and high self-esteem were related to small social distance between own and other ethnic groups. Low need for affiliation and low self-esteem interacted to produce the largest social distance. Implications for occupational mobility are discussed.     

Conceptions of learning and approaches to studying among White and ethnic minority students in distance education

Background. The attainment of White students at UK institutions of higher education tends to be higher than that of students from other ethnic groups, but the causes of this are unclear. Aims. This study compared White students and students from other ethnic groups in their conceptions of learning, their approaches to studying, and their academic attainment. Sample. A stratified sample of 1,146 White students and 1,146 students from other ethnic groups taking courses by distance learning with the UK Open University. Methods. The Mental Models section of the Inventory of Learning Styles and the Revised Approaches to Studying Inventory were administered in a postal survey. Results. The students' questionnaire scores were contaminated by response bias, which varied across different ethnic groups. When adjusted to control for response bias, the scores on the two questionnaires shared 37.2% of their variance and made a significant contribution to predicting the students' attainment. White students were more likely to exhibit a meaning‐directed learning pattern, whereas Asian and Black students were more likely to exhibit a reproduction‐directed learning pattern. However, the variation in attainment across different ethnic groups remained significant when their questionnaire scores and prior qualifications were taken into account. Conclusions. There is a strong relationship between students' conceptions of learning and their approaches to studying, and variations in conceptions of learning in different ethnic groups give rise to variations in approaches to studying. However, factors other than prior qualifications and conceptions of learning are responsible for variation in attainment across different ethnic groups.     

Language matters in counselling diversity

The paper presents a personal view of some issues around therapeutic conversations involving difference and minority experience. Language, discourse and mother-tongue are explored from different theoretical standpoints and considered alongside concepts of difference, otherness and the unvoiced. Intercultural counselling offers a framework for unpacking the meaning of decolonising practice in conversations with clients or counsellors from ethnic or other minorities undertaking counselling or supervision. I discuss possibilities for practice informed by existential and hermeneutic phenomenology, including gestalt therapy interventions to bring in the body alongside discourse, and phenomenological empathy as a non-colonising resource in working across difference and diversity.     

When Being “Essential” Illuminates Disparities: Counseling Clients Affected by COVID‐19

The 2019 novel coronavirus (COVID‐19) has highlighted social disparities in the United States. This article examines how preexisting racial and ethnic disparities, exacerbated by COVID‐19, have negatively affected communities of color that tend to be overrepresented in lower socioeconomic groups, have limited access to health care and education, have an undocumented status, and work in jobs considered “essential.” Counselors are encouraged to use creative strategies to design and facilitate telecounseling and reduced‐ or no‐cost workshops in which attendees can participate safely. Specific cultural considerations, aspects of crisis management, and creative interventions that can be used with clients of color at an appropriate social distance are discussed. Counselors can also instill hope in their clients by promoting sociopolitical development. As the impact of COVID‐19 will be felt for years, it is crucial that counselors be prepared to address the needs of those disproportionately affected.     

Exploring possible ethnic differences and bias in the Rorschach Comprehensive System

In this study I conducted a series of analyses to explore potential ethnic bias in Rorschach Comprehensive System variables using a consecutive series of 432 patients evaluated in 1 setting. The simple association between 188 scores and ethnicity revealed no significant findings after matching on several salient demographic variables. Next, 17 analyses of convergent validity found no evidence for differential validity and no evidence for slope bias. For 13 analyses, there was also no evidence for intercept bias. However, with 4 variables predicting psychotic disorders, regression lines favored minorities and worked against European Americans. These findings are the opposite of what should be seen if the Rorschach was biased against minorities and most likely emerged for statistical reasons related to unmeasured confounds. Finally, principal components analyses revealed no evidence of ethnic bias in the Rorschach's internal structure. Although these findings need to be replicated, the available data support using the Comprehensive System across ethnic groups.     

Seeking Information about Different Ethnic Groups: The Role of Motivation and Confirmation1

Two factors were investigated in terms of their effects on information seeking about ethnic groups: degree to which the information confirmed one's stereotype, and motivation for seeking information. Forty-two English Canadians (Ss) were given the opportunity to seek up to 45 items of information about 18 individuals, 3 from each of six ethnic groups. The three members of each group either confirmed, partially disconfirmed, or totally disconfirmed the group stereotype. Results indicated that more information was sought about the confirming member of each group by the Ss instructed to seek information that interested them. Ss instructed to describe or evaluate ethnic group members sought information equally from all members. These results are discussed in terms of expectancy theory, and in relation to other findings on ethnic perception and ethnic interpersonal attraction.     

Inter- and intra-group differences in psychological concerns among international students

With data gathered from 47 university counseling centers in the United States, this study addresses both inter- and intra-group differences in symptomatology at intake among international students. In Study 1, symptomatology among international students was explored in comparison to US ethnic groups. In Study 2, intra-group differences in symptomatology among international students were examined. In Study 1, data consisted of 14,421 international, White American, African American, Asian American, and Latina/Latino American counseling center clients who completed the CCAPS-62 at intake. Partially supporting our hypothesis, results indicate significant findings among international students in the social anxiety and academic distress domains of the CCAPS-62. Contrary to our expectations, Asian American students reported significantly greater concerns across many domains when compared to other groups. In Study 2, international students (n = 607) were further divided into five continents of origin: Asia, Africa, North America, South America, and Europe. Results indicate that in multiple domains, international students from Asia and Africa reported significantly greater concerns than those from Europe, North America, or South America. Implications of findings for university counseling centers and universities at large are discussed.