Challenges in Cross-Cultural Counseling

¶ … cross-cultural values and mores to identify the author's interactions with gay, lesbian, and transgendered individuals, Latinas and individuals with disabilities. Further, this paper integrates the case study analyses provided in "Case Studies in Multicultural Counseling and Therapy" and relevant Social Justice Counseling issues to support the discussions. In addition, for each of these three cultures, a discussion concerning what factors should be kept in mind during interfaces with each so that all parties are honored to facilitate work with them as a therapist, colleague, social acquaintance, partner, and neighbor. Finally, an analysis concerning what was especially easy and fun and what was challenging to understand about these cultures given the author's unique worldview is followed by a summary of the research and important findings about these three cultures and cross-cultural values and mores in the conclusion.

Review and Analysis

Gay, Lesbian, and Transgendered Individuals

With growing numbers of states legalizing same-sex marriages and acceptance of the gas, lesbian and transgendered communities increasing across the country, it is reasonable to suggest that counselors in all fields will likely encounter individuals from these communities during their careers. In order to become proficient in cross-cultural counseling situations, it is essential to learn as much about people from other cultures as possible, particularly those with which counselors frequently come into contact. The definition provided by Krentzman and Townsend (2008) indicates that cultural competence means "having the beliefs, knowledge, and skills necessary to work effectively with individuals different from one's self; that cultural competence includes all forms of difference; and that issues of social justice cannot be overlooked" (p. 7). For heterosexual counselors, understanding the world of gay, homosexual and transgendered individuals can represent a challenging enterprise.

The definitions of gay, bisexual and lesbian are common knowledge, but the concept of transgendered may be novel to some counselors. In this regard, Chung (2003) defines transgendered individuals alternatively as: (a) people whose gender identity or behavior deviates significantly from what traditional culture deems appropriate for their biological sex at birth; or (b) people with ambiguous or multisex genitalia. According to Chung, "This definition includes transvestites and transgenderists (part-time and full-time cross-dressers), transexuals (both before and after sex-reassignment operations), and androgynous and intersex (ambiguous or multisex) persons" (2003, p. 78).

To research to date has been largely unsuccessful in precisely determining the prevalence of transgendered individuals in the United States because the majority of these studies have included people that had been placed on waiting lists for surgery only but were considered transsexuals for the purposes of their analysis without any follow-up to determine actual clinical outcomes (Carroll & Gilroy, 2010). Current estimates place the percentage of transgendered individuals in the U.S. At between a range of 3% to 5% to 8% to 10% of the general population, making it highly probable that counselors will encounter individuals from the lesbian, gay and bisexual as well as the transgendered communities at some point in their professional careers (Carroll & Gilroy, 2010).

An interesting point made by Chung (2003) concerns the status of transgendered individuals within mainstream American society in general and within the lesbian, gay and bisexual (LBG) communities in particular. In contrast to growing public acceptance of the LGB cultures, transgendered individuals continue to be stigmatized and experienced discrimination even from the LGB community. In this regard, Chung emphasizes that, "Opponents to inclusion argue that LGB is about sexual orientation (a person's affective and sexual desires for people of the two sexes, whereas transgenderism is about gender identity (a person's self-identification as male or female in self-concept or behavior)" (p. 78).

Opponents of inclusion also maintain that the LGB and transgendered cultures are sufficiently distinct and separate that they should not be grouped together (Chung, 2003). In addition, Chung points out that, "Furthermore, transgendered people are not widely accepted, or may be discriminated against, in the LGB community" (2003, p. 78). These perceptions are slowly changing for the better, though, both within mainstream American society and the LGB communities (Chung, 2003). For instance, Chung adds that, "In recent years an increasing number of LGB organizations have moved toward the direction of inclusiveness. Proponents of inclusion argue that transgendered people are an integral part of the LGB community" (2003, p. 78).

Despite these advances in acceptance, many members of the lesbian, gay, bisexual and transgendered communities remain marginalized throughout American society and even within the LGBT community itself. In fact, McCabe and Rubinson (2008) report that harassment of LGBT young people in the nation's schools continues to threaten the physical safety and emotional stability of LGBT youth. Indeed, young LGBT persons are at three times the risk of experiencing a violent attack compared to their heterosexual peers (McCabe & Rubinson, 2008). In addition, an overwhelming majority (90%) of LGBT young people have experienced physical harassment or assaults based on their perceived sexual orientations, gender and gender expression, appearance, race/ethnicity, disability, or religion versus 62% of heterosexual teenagers (McCabe & Rubinson, 2008)). Not surprisingly, LGBT young people are three times more likely to feel unsafe at school compared to their heterosexual counterparts (McCabe & Rubinson, 2008).

In spite of the growing need, many counselors remain woefully unprepared to work with members of the LGBT community, especially transgendered or transsexual persons. For example, Bess and Stabb (2009) point out that, "Working with transgender and transsexual clients calls for specialized knowledge. Because of the lack of formal specialized training, therapists wishing for specialized training often have to educate themselves about working with transgendered persons" (p. 264). Unfortunately, there remains a dearth of relevant and timely curricular offerings concerning the provision of counseling services to members of the transgendered community (Bess & Stabb, 2009).

Latinas

According to Beam (2014), Latino is a Spanish word, the feminine form of which, Latina, is a term that "refers to people with roots in Latin America and generally excludes the Iberian Peninsula" (para. 3). The U.S. Census Bureau allows respondents to self-identify their status as either Hispanic or Latino/Latina (Beam, 2014). The Census Bureau generally defines Hispanics and Latinos as being "persons who trace their origin or descent to Mexico, Puerto Rico, Cuba, Spanish speaking Central and South America countries, and other Spanish cultures" (cited in Beam, 2014, para. 4). The U.S. Census Bureau, though, does not maintain a separate category for Hispanics since it regards the term Hispanic to mean anyone of Spanish/Hispanic/Latino origin (including those of Spanish, Mexican, Cuban, Dominican Republic, Puerto Rican, and Central or South American origin who are residing in the U.S. And who may be of any race or ethnic group (white, black, Asian, etc.); this category is estimated to account for approximately 15.1% of the total U.S. population, or about 47 million people (U.S. population, 2014).

Notwithstanding their growing numbers in U.S. society, the authors of "Case Studies in Multicultural Counseling," emphasize that many Latinas struggle to "always fit it" with mainstream American society in ways that undermine their heritage and cultural values, with some going so far as relaxing their hair and adapting the expensive fashion styles that are popular in their communities. This need to "fit it" is congruent with the observation by Rodriguez (1999) that, "Both Latinas and Latinos in college face a sense of alienation. There's a sense of being alone and different. The class differentials at the university are very clear: The gardeners and the secretaries are Latinos and other minorities and the [high level] administrators, the professionals and the faculty are Anglos" (p. 47). Given their respective representation in all levels of professional American life, these perceptions are firmly founded in reality rather than stereotypical myth.

Indeed, this emphasis on expensive fashions and other efforts to be accepted by mainstream American society is regressive for most Latinas because the majority of Latinas earn far less than other demographic groups in the United States and their representation in academia and the professions lags behind as well. For instance, Hernandez and Morales (2009) report that, "There is substantial demographic data indicating that Latinas earn considerably less than white men and all other gender and cultural groups in the United States. The salaries of these Latinas tend to be well below national averages and below the salaries earned by all ethnic groups except Native Americans" (p. 46). Moreover, just 2% of all tenured women in higher education are Latinas, and only 3% of all women in American graduate schools are Latinas (Hernandez & Morales, 2009).

Some educationists argue that the education system in the United States structurally disadvantages Latinas from the outset, with most Latinas being regarded by American educators as being "submissive underachievers" (Vives, 2008, p. 2). In many cases, their perceptions are reinforced by the cultural values and mores in the family home where Latinas feel less pressure to achieve academically and professionally (Vives, 2008).

Moreover, there remains a profound dearth of educational resources that can help Latinas achieve their full potential. In this regard, Vives (2008) reports that, "There are inadequate vocational programs for Latinas, sometimes none at all, and they suffer sexual harassment in the schools in greater numbers than other girls" (p. 2). Consequently, Latinas tend to drop out of high school at alarming rates, and even when they do remain in school, they do not perform up to their potential. Given the powerful messages they receive at home and the marginalized conditions they endure in school, it is little wonder these young people are placed at a disadvantage. As Vives (2008) emphasizes, "As a result of this harassment, [Latina] students often stay home, cut class, or don't contribute. They can't concentrate on school work and suffer lowered self-esteem and self-confidence" (p. 2). Furthermore, bilingual services are non-existent or poor at many schools and this leads to disillusionment. There is a pervasive negative attitude of school personnel toward non-English languages and the people who speak them. A critical factor in promoting Latina success is a school staff that believes that all students can succeed-valuing their languages and cultures, providing sound counseling, and involving parents (Vives, 2001).

These educational disparities also mean that even within the Hispanic community, Latinas will continue to be disadvantage when compared to their male counterparts. In this regard, Rodriguez (1999) notes that, "The fact that Latinas do not continue on to receive doctorates in high numbers means that they will continue to be absent from the faculty and administrative leadership pipelines. It means that leadership in the Hispanic community may continue to be in the hands of Latino males" (p. 47).

In fact, even when Latinas manage to overcome the structural and cultural challenges arrayed against them and attain higher educational degrees, they remain largely disenfranchised from positions where they could make a substantive difference in their communities. As Rodriguez concludes, "Latinas are now entering college in greater numbers, but are not in political leadership or other important public policy positions. Latinas are in educational jobs, still clustered in traditional roles" (p. 47). Taken together, it is clear that Latinas are in a unique position in American society where a combination of cultural, social and political factors have served to keep them marginalized from mainstream American society more than any other demographic segment except Native Americans.

Individuals with Disabilities

While it is reasonable to suggest that counselors will come into contact with members of the LGBT and Latinas communities at some point in their professional careers, it is also reasonable to suggest that they will encounter numbers clientele with disabilities. In fact, there are large numbers of individuals with disabilities in the United States today. In this regard, the authors of "Case Studies in Multicultural Counseling" report that there are nearly 50 millions people in the United States aged 5 years and older that have some type of disability, making this group the largest set of marginalized people in the United States after women. Likewise, the U.S. Census Bureau reported that as of the last census (2010), there were nearly 3 million children in the United States with disabilities and current projections indicate that there will be 3.5 million children with disability by 2030 (Waldman & Perlman, 2013).

Understanding the world of the disabled is not an easy task, but it is an essential element of successful counseling. For instance, according to the authors of "Case Studies in Multicultural Counseling," "Specific treatment strategies should be a culturally syntonic fit with the client's sociocultural experience, identities, and sensibilities" (p. 7). These authorities also cite the need to develop an understanding concerning how an individual's disability affects their lives across the broad array of quality of life indicators: "Treatment should be informed by examining how the intersections of person, culture and context, and the congruence (or incongruence) between them, contribute to the client's internally experienced and externally expressed distress" (Case studies in multicultural counseling, p. 7). Although all disabled clients' situations are unique, there are some common features that characterize the disabled in the United States, including lower educational and income levels compared to mainstream American society (Swank & Huber, 2013).

While it might be disingenuous or even offensive for ordinary people to interact inappropriately with the disabled (i.e., yelling at the hard of hearing), counselors have a professional responsibility to interact in appropriate ways. For example, Bess and Stabb (2009) emphasize that, "Multicultural counseling guidelines warn of the dangers of therapists not receiving proper training in working with clients who are different from them" (p. 266). Like the other cultures examined herein, though, many counselors do not receive the training they need to provide appropriate counseling services to the disabled. According to Beecher and Rabe (2007), "Students with disabilities constitute the largest minority in the United States" (p. 84). The Code of Federal Regulations for the Americans With Disabilities Act (ADA) defines disabilities as "a physical or mental impairment that substantially limits one or more of the major life activities of an individual. Major life activities may include "functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working" (cited in Beecher & Rabe, 2007, p. 85). Likewise, the Individuals with Disabilities Education Act (IDEA, 2004) defines the term "emotional disturbance" an any condition that exhibits one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

1. An inability to learn that cannot be explained by intellectual, sensory, or health factors;

2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers;

3. Inappropriate types of behavior or feelings under normal circumstances;

4. A general pervasive mood of unhappiness or depression; or,

5. A tendency to develop physical symptoms or fears associated with personal or school problems (Swank & Huber, 2013).

Because so many people have some type of disability, between 2% and 10% of all clientele encountered by counselors during their careers will have at least one type of disability (Beecher & Rabe, 2007). In many cases, clients will suffer from a number of comorbid conditions, especially as their grow older (Beecher & Rabe, 2007). As Beecher and Rabe caution, though, "However, few of these practitioners are prepared to address the unique concerns faced by these individuals" (2007, p. 85). It is also important to note that the life experiences of people that have disabilities differ according to age and when the disability was acquired (Beecher & Rabe, 2007).

Students with learning disabilities in particular represent a large segment of American society that counselors are increasingly encountering in their practice (Thompson & Littrell, 2009). Although there is a growing body of knowledge concerning the academic needs of these students, far less attention has been paid to their psychological needs (Thompson & Littrell, 2009). According to Thompson and Littrell (2009), there have been some serious implications for counselors as a result of this lack of attention. In this regard, Thompson and Littrell (2009) stress that, "The paucity of research examining the use of psychotherapeutic interventions with adolescents who have been identified as having learning disabilities has led to misunderstandings about these adolescents by counselors and therapists" (p. 61).

The research to date indicates that counselors can achieve optimal clinical outcomes by focusing on the established 16 in-school predictors of post-high school success: (a) career awareness, (b) community experiences, (c) exit exam requirements/diploma, (d) general education, (e) interagency collaboration, (f) occupational courses, (g) paid work experience, (h) parental involvement, (i) program of study, (j) self-determination and advocacy, (k) self-care/independent living, (1) social skills, (m) student support, (n) transition program, (o) vocational education, and (p) work-study (Swank & Huber, 2013). Interventions for students with learning disabilities requires careful coordination between counselors and other stakeholders, including school administrators, teachers, administrators, support staff, and family members (Swank & Huber, 2013). Furthermore, implementing clinical interventions may require time, money and other resources (Swank & Huber, 2013). As Swank and Huber (2013) conclude, though, these investments are worth the effort: "Despite these challenges, researchers have indicated that focusing on crucial in-school predictors may lead to success following high school" (p. 75).