As professionals, we must be careful not to force our values on clients but guide them toward making their own decisions. I am of Dutch heritage, and it will always be a part of who I am. The values I ascribe primarily to my culture come from how I was raised and the influence of my family members. My values have changed over time due to my own personal life experiences, world views, relationships, and interaction with others. We are all culture-bound to some extent, and it takes an effort to be always aware to monitor our biases so that they do not affect the formation of counseling relationships. In addition, greater differences could exist within the same cultural group than between different cultural groups. I will not only to be sensitive to other cultures, but to my own as well. The biggest challenge I foresee in forming trusting relationships with clients who are culturally different is remembering not to hold my group as the standard by which to determine appropriate behavior in others. Cultural sensitivity is not limited to one group either, but applies to all cultures. Clients and counselors bring a great variety of culturally learned attitudes, values, assumptions, biases, beliefs, and behaviors to the therapeutic relationship. By being ignorant of the values and attitudes of a diverse range of clients, counselors open themselves to criticism and ineffectiveness. Solutions to dealing with the cultural issue in counseling entail rethinking theories and modifying techniques to meet clients’ unique needs and not simply applying the same techniques with all clients. In my career, I am striving to become more self-aware and remember that the clients are the focus. Counselors must confront their own problems and biases, which can lead them to hold limited expectations and preconceived notions during therapy. When working in the field, I feel it is necessary that one’s values and moral beliefs are not imposed onto a client. The topic is quite problematic as it can be very difficult not to express one’s true core beliefs and morals when doing therapy. It can be a fine line between not imposing values, while still helping clients develop self-understanding. Additionally, I believe clients are allowed to make their own mistakes and learn from them too.
The trouble comes when my values clash with those of others. Topics which seem to be very controversially charged such as abortion, drugs/alcohol, and sexual orientation may pose a challenge. In therapy, it is important for me to remain objective to make sure that there is no persuasion or influence on the client in the area of decision making. It is unethical as a counselor to “sell” beliefs in therapy, as it does not allow the client to remain truly autonomous. In my opinion, there is an ethical obligation to remain neutral and not pass judgment. I think it is very possible and necessary for those who decide to work within the field of counseling to check their prejudices at the door. Counselors are not the “behavior” police. The job isn’t to teach moral rules and values or to prevent clients from making their own choices based on their values. I must continually be mindful of the influence my values can have on clients, who could be vulnerable and impressionable. With that comes an ethical responsibility to maintain the sensitive balance between the awareness of our own values and guiding clients to make their own decisions. When it comes to setting goals for my clients, first of all, as a therapist, I should not choose specific goals for the client. Primary responsibility for the direction of therapy is on the client. The goals of counseling are to set clients free and to create conditions that will enable them to engage in meaningful self-exploration. The main counseling goal is to establish rapport and provide a safe and culturally respectful environment for the client. As the client begins to talk about whatever he or she decides, the counselor should be prepared to ask questions to elicit deeper reflection. The goal should be to guide the process deeper to increase understanding of the client’s feelings.
As long as the client does not become overwhelmed, I would continue to broaden the emotional and psychological scope of the session by allowing more difficult material to surface. In my opinion, the best approach is to ask and trust the client’s process when uncertain about what an individual wants to talk about. In my sessions with clients, I would like to focus on the division of responsibility. It is my belief that the proper division of responsibility in counseling should be determined by both the counselor and the client. It is a team effort. Certainly I can help to organize the goals and context of counseling, but it up to the client to put things into action. Therapy requires very active involvement, honesty, and openness. Efforts to change self-perception, emotions and behaviors will require work both in and out of session. I view the relationship first and foremost as a dialogue, and my role as a helper rather than the expert. I view clients as the authority on their own experiences and beliefs, and regard clients as being fully capable of fulfilling their own potential for growth and change. The Client-Directed, Outcome Informed approach is also valuable when determining the proper division of responsibility in a counseling relationship. For counseling to be effective, both the practitioner and the client must be actively involved in developing counseling goals and assessing progress. This means that client feedback is very important and used to direct the counseling session. This is done so that the therapist is helping the client to the best of their ability and that they are getting what they need from the sessions. Also, it is important to openly gauge progress in therapy and expect an open and honest response from the client. A safe environment is crucial to develop a strong therapeutic alliance. Creating a warm and safe physical environment is a major priority of mine. This is easier said than done, especially in the beginning stages when the clients may feel vulnerable, meeting on unfamiliar territory. I would strive to keep the room neutral, free from personal belongings such as books, knick-knacks and personal photographs, etc. I think barriers such as desks should also be avoided, and chairs should be uniform and placed not too close but not too far apart, and even slightly at an angle. Being in direct eye contact could leave some clients feeling very uncomfortable or embarrassed as well. A small clock is important and attention should be paid to the lighting, and room temperature.
Also, I’ve heard that a box of tissues strategically placed where the client can easily reach them is a must. I understand that some clients who seek counselling have been badly let down, hurt or abused by other people, and trust may therefore be a major issue. I understand that trust is something that has to be earned and it can be hard work. The more invested in the relationship, the stronger the trust and bond grows with the client. Potential clients I would have trouble working with would include axis-II personality disorders and those who are homophobic. Being gay myself, it would make me very uncomfortable if I was counseling someone intolerant and hateful of the LGBT community. With Axis-II personality disorders, these clients don’t have much hope for change. Insurance companies often deny reimbursement for these clients as well, leaving counselors struggling. In assessing the ethical ramifications of declining to work with certain clients, I feel the benefits are many and risks are few. It is beneficial for the client find someone who is fully capable and equipped to help them. There could be legal risks if it was claimed as discrimination or the client may be offended, but I believe these things happen few and far in-between. If one were to not make a referral, the risks outweigh the benefits. It is hallmark of the profession to first, “do no harm”. Harm could be inflicted as a result of a client you are not comfortable working with. As a new counselor, when it comes to experiencing problems, I expect that things will go wrong. There are several key issues I foresee arising and may continue to pose an issue during my career. The first issue would be setting up my own practice. A degree in Business Administration would come-in handy here, as forming a practice is similar to opening your own business, and there is a lot that beginning practitioners don’t take into account. Things like dealing with insurance and billing issues. I don’t have much of a finance and accounting background, so it will be a challenge to learn. I don’t think this is something they really touch on in great detail in graduate studies. There should be a class on business/running a practice, as many of us end up in a private practice setting.
My work schedule could be an issue too, as I can picture it being erratic at times, and will have to adjust to that. Clients are who we serve and at the end of the day, I will have to work around client’s schedules. Based on my worldview, values, and beliefs, my theoretical stances that I would conduct therapy using would be holistic/systems, person-centered, existential, and psychodynamic approaches. A holistic and systems approach examines families, school, work, health, etc. and the effect they have on our lives. In person-centered therapy, therapists create a comfortable, non-judgmental environment through demonstrating empathy and unconditional positive regard toward clients while using a non-directive approach. In existential therapy, the therapist helps the client step back and clarify the meaning of his or her experiences and attempts to deepen the person’s awareness. In psychodynamic therapy, the therapist helps a person understand the way childhood experiences continue to affect in the present. However, developing the skills of active listening; accurate, sensitive responding; reflecting feelings; empathy; genuineness; and demonstrating that you are fully present for the client can help to establish a solid foundation of trust no matter what theories are used.
