The educators enrolled in our asynchronous “Happiness for Teachers” course continue to stun me with the extremely high quality of their responses to the assignments. They go WAY beyond what’s necessary and are clearly and deeply committed to not only their personal growth, but also to the growth of their students, family, and friends. Seriously. When I read their assignments, I immediately have more hope for the world . . . and I think to myself, “I want to be your friend!”
But, teaching an asynchronous course is weird. I feel detached. I want to be more connected and more involved. On the other hand, we’ve got hours of video lectures we’ve produced and so the students might be getting more exposure to me than anyone really should bargain for. Maybe I’m too connected and involved? Funny thing how everything often boils down to a dialectic. Hegel (the philosopher) would be so happy he wouldn’t need a happiness course.
Despite the weirdness, our educator-students keep giving us great feedback. Here are a few anonymous examples that have popped into my email inbox without any solicitation:
“I’ve truly enjoyed the material thus far in the class. . . . I hope your class becomes required for all teachers at the EDU dept for certification. It’s the real deal.” S.S.
“Loving the course! Thanks for providing it!” J.E.
“Thank you so much for sharing this video. Just watching it Brings me joy. I love the contributors and all the great things they are doing in their classes! You guys are amazing for doing this.” J.R.
“Loved this course! I shared it with my school! I will send it to my principal now too! Thanks again!” L.W.
“Thanks again for this enriching class. I needed it more than you know and I have so many tools to carry me into next year!” S.M.
Thanks to the Arthur M. Blank Family Foundation, we’re offering yet another section of the course this fall semester. If you’re a Montana educator, and want a big bargain ($195.00) for 3 Grad Credits or 48 OPI Hours, here’s the link to register:
For you non-Montana educators who may still be reading . . . I’m wondering, if we opened the course to anyone across the U.S. would there be much interest?
Just FYI, here’s a copy of the syllabus for the summer version of the course:
Today, I’m online doing the final webinar in a three-part series for PacificSource. The PacificSource organizers and participants have been fabulous. Everything has worked smoothly and the participants have engaged with many excellent thoughts and questions. We’ve got 503 registered for today.
Here’s the title and description of today’s webinar.
Strengths-Based Approaches to Management of Patient Suicidality
John Sommers-Flanagan, Ph.D.
Healthcare providers need to do more than conduct suicide assessments; they also need to flow from assessment into providing interventions to help patients move out of crisis and toward greater emotional regulation, hope, and health. In this webinar, using video clips and vignettes, you will learn at least five specific assessment and management interventions designed to help facilitate patient transitions from crisis to constructive problem-solving. These interventions are based on robust suicide theory, clinical wisdom, and empirical evidence on strategies for working effectively with patients who are suicidal.
For anyone interested, here are the ppts for today:
Recently, I had the honor of presenting to Camp Mak-A-Dream residents (13-20 year-olds) on “Happiness and You.” To empower the residents—all of whom have experienced brain tumors—and resonate with the challenges of being human and having emotions, I shared the Three Step Emotional Change Technique. Then, I invited a volunteer to help me demonstrate how sometimes our brains can trick us by immediately providing the wrong answer to a question. A marvelous young man named Brandon stepped up and volunteered.
Here’s the video link, as recorded by Alli Bristow, last year’s Montana School Counselor of the Year (you can hear her reactions, which are pretty fun too):
You can watch the video, but I’m also sharing a description and rationale for the activities below.
The Riddle Activity
You’ll see me asking Brandon to respond to three riddles. I manage to trick him with the first one. For the second one, he’s briefly fooled, and then catches himself and gives the right answer. On the third, he pauses and gets the right answer the first time.
Why This Activity
I’ve used riddles like these in individual counseling with youth and in group presentations (as illustrated in the video). The riddle activity is all about a basic cognitive therapy message: If we go with our automatic thoughts, without pausing and evaluating them, we can be wrong. However, if we pause to evaluate the situational context and our reactive thoughts, sometimes we can override our automatic and possibly maladaptive impulses (Aaron and Judy Beck would be proud).
The Next Lesson
In the video, you only see Brandon and me doing the riddles. He’s great. When I’m doing this presentation (or using it in counseling) after the riddles, I immediately give the youth a situational example. I say something like, “Okay. Now let’s say I go to the same high school as Brandon, and I know him, and I’m walking by him in the hall at school. When I see him, I say ‘Hi Brandon!” But he just keeps on walking. What are my first thoughts?”
Whether I’m working with a group or with individuals, the young people are usually very good at suggesting possible immediate thoughts. They say things like: “You’re probably thinking he doesn’t like you.” Or, “Maybe you think he’s mad at you.”
At some point, I ask, “Have you ever said hello to someone and have them say nothing back?” There are always head nods and affirming responses.
Way back in our “Tough Kids, Cool Counseling” book, Rita and I wrote about the typical internalizing and externalizing responses that people tend to have in reaction to a possible social rejection. The internalizing response is depressed, anxious, and self-blaming. Internalizing thoughts usually take people down the track of “What did I do wrong” or “What’s wrong with me?” Alternatively, some youth have externalizing thoughts. Externalizing thoughts push the explanation outward, onto the other person. If you’re thinking externalizing thoughts, you’re thinking, “What’s wrong with him?” or “That jerk!” or “Next time, I’m not saying hi to him.” Back in the day, Kenneth Dodge wrote about externalizing thoughts in adolescents as contributing to aggression; he labeled this cognitive error “the misattribution of hostility.”
In counseling and in group presentations, the next step is to ask for neutral and non-blaming explanations for why Brandon didn’t say hello. The youth at Camp Mak-A-Dream were quick and efficient: “He probably didn’t hear you.” “Maybe he was having a bad day.” “He could have had his earbuds in.” “Maybe he was feeling shy?”
What’s the Point?
One goal of these activities is to help young people become more reflective and thoughtful. My neuroscience enthralled friends might say I’m working their frontal lobe muscles. I basically agree that whenever we can engage teens with thoughtful and reflective processes, they may benefit.
But the other goal may be even more important. Although I want to teach young people to be thoughtful, I also want to do that in the context of an engaging, sometimes fun, and interesting relationship. For me. . . it’s not just teaching and it’s not just learning. It’s teaching and learning in the crucible of a therapeutic relationship. As one of my former teen clients once said, “That’s golden.”
Tomorrow, I’ll be online again with PacificSource, doing Part 2 of a three-part webinar series titled, “Caring for People Who are Suicidal.” Last week we focused on how to talk with people in general about this challenging topic. This week, the focus is on: “Blending Traditional and Strengths-Based Approaches to Suicide Assessment“
I’ll be talking for about an hour, which means we’ll really only quickly graze the topic. Below, for webinar viewers and other interested readers, I’ve posted the ppts, and excerpted the section in our Clinical Interviewing text that focuses on assessing suicide plans, patient impulsivity, suicidal intent, and a bit of information on talking with patients about previous attempts.
Once rapport is established and the client has talked about suicidal ideation, it’s appropriate to explore suicide plans. You can begin with a paraphrase and a question:
You said sometimes you think it would be better for everyone if you were dead. Some people who have similar thoughts also have a suicide plan. Do you have a plan for how you would kill yourself if you decided to follow through on your thoughts?”
Many clients respond to questions about suicide plans with reassurance that they’re not really thinking about acting on their suicidal thoughts; they may cite religion, fear, children, or other reasons for staying alive. Typically, clients say something like “Oh, yeah, I think about suicide sometimes, but I’d never do it. I don’t have a plan.” Of course, sometimes clients will deny having a plan even when they do. However, if clients admit to a plan, further exploration is crucial.
When exploring and evaluating a client’s suicide plan, assess four areas (M. Miller, 1985): (a) specificity of the plan; (b) lethality of the method; (c) availability of the proposed method; and (d) proximity of social or helping resources. These four areas of inquiry are easily recalled with the acronym SLAP.
Specificity
Specificity refers to the details. Has the person thought through details necessary to die by suicide? Some clients describe a clear suicide method, others avoid the question, and still others say something like “Oh, I think it would be easier if I were dead, but I don’t have a plan.”
If your client denies a suicide plan, you have two choices. First, if you believe your client is being honest, you can drop the topic. Alternatively, if you suspect your client has a plan but is reluctant to speak about it, you can use the normalizing frame discussed previously.
You know, most people who have thought about suicide have at least had passing thoughts about how they might do it. What kinds of thoughts have you had about how you would [die by suicide] if you decided to do so? (Wollersheim, 1974, p. 223)
Lethality
Lethality refers to how quickly a suicide plan could result in death. Greater lethality confers greater risk. If you believe your client is a very high suicide risk, you might inquire not simply about your client’s general method (e.g., firearms, toxic overdose, or razor blade), but also about the way the method will be employed. Does your client plan to use aspirin or cyanide? Is the plan to slash their wrists or throat with a razor blade? In both of these examples, the latter alternative is more lethal.
Availability
Availability refers to availability of the means. If clients plan to overdose with a particular medication, check on whether that medication is available. (Keep in mind this sobering thought: Most people keep enough substances in their home medicine cabinets to die by suicide.) To overstate the obvious, if the client is considering suicide by driving a car off a cliff and has neither car nor cliff available, the immediate risk is lower than if the person plans to use a firearm and keeps a loaded gun in an unlocked location.
Proximity
Proximity refers to proximity of social support. How nearby are helping resources? Are other individuals available to intervene and provide rescue if an attempt is made? Does the client live with family or roommates? Is the client’s day spent alone or around people? The further a client is from helping resources, the greater the suicide risk.
If you have an ongoing therapy relationship with clients, you should check in periodically regarding plans. One recommendation is for collaborative reassessment at every session until suicide thoughts, plans, and behaviors are absent in three consecutive sessions (Jobes, 2016).
Assessing Client Self-Control
Asking directly about self-control and observing for agitation, arousal, and impulsivity are the main methods for evaluating client self-control.
Asking Directly
If you want to focus on the positive while asking directly about self-control, you can ask something like this:
What helps you stay in control? Or, What stops you from killing yourself?
If you want to explore the less positive side, you could ask:
Do you ever feel worried that you might lose control and make a suicide attempt?
Exploring both sides of self-control (what helps maintaining self-control and what triggers a loss of self-control) can be therapeutic. This is done together with clients to understand their perception of self-control. Rudd (2014) recommended having clients rate their subjective sense of self control using a 1-10 scale (although we prefer 0-10). When clients are feeling or acting “out of control” hospitalization should be considered. Hospitalization can provide external controls and safety until clients feel more internal control.
Here’s an example of a discussion that shows (a) an interviewer focusing on the client’s fear of losing control and (b) an indirect question leading the client to talk about suicide prevention.
Client: I’m afraid of losing control late at night.
Therapist: Sounds like night is the roughest time.
Client: I hate when I’m awake and alone into the night.
Therapist: So, late at night, you’re sometimes afraid you’ll lose control and kill yourself. What has helped keep you from doing it.
Client: I think of how my kids would feel when they couldn’t get me to wake up. I can’t even think of that.
A brief verbal exchange, such as this, isn’t a final determination of safety or risk. However, this client’s children are a mitigating factor that may help with self-control.
Observing for Arousal/Agitation
Arousal and agitation are contemporary terms used to describe what Shneidman originally referred to as perturbation. Perturbation is the inner push that drives individuals toward suicidal acts. Arousal and agitation are underlying components of several other risk factors, such as akathisia associated with SSRI medications, psychomotor agitation in bipolar disorder, and command hallucinations in schizophrenia.
Arousal or agitation adversely affect self-control. Unfortunately, systematic methods for evaluating arousal are lacking. This leaves clinicians to rely on five approaches to assessing arousal, agitation, and impulsivity:
Subjective observation of client increased psychomotor activity (as in an MSE)
Client self-disclosure of feeling unsettled, unusually overactive, or impulse ridden (often accompanied by statements like, “I need to do something”)
Questionnaire responses or scale scores indicating agitation
A history of agitation-related suicide gestures or attempts
Clients report impulsivity around aggression and/or substance use
Assessing Suicide Intent
Suicide intent is defined as how much an individual wants to die by suicide. Suicide intent can be evaluated via clinical interview (Lindh et al., 2020), standardized questionnaire (e.g., the Beck Suicide Intent Scale, Beck et al., 1974), or after completed suicides. When evaluated after suicide deaths, higher suicide intent is linked to lethality of means, more extensive planning, and a negative reaction to surviving the act.
Assessing suicide intent prior to potential attempts is challenging. In an interview, the question can be placed on a scale and asked directly:
On a scale from 0 to 10, with 0 being you’re absolutely certain you want to die and 10 that you’re absolutely certain you want to live, how would you rate yourself right now?
Suicide intent is also related to suicide planning; that means when you’re evaluating suicide plans, you’re also evaluating suicide intent. More specificity and lethality in planning is linked to intent. Overall, standardized questionnaires and clinical interviews are equivalent in their predictive accuracy (Lindh et al., 2020).
Obtaining detailed information about previous attempts is important from a medical-diagnostic-predictive perspective, but less important from a constructive perspective, where the focus is on the present and future. Whether to explore past attempts or to stay focused on the positive is a dialectical problem in suicide assessment protocols. On the one hand, suicide scheduling, rehearsal, experimental action, and preoccupation indicate greater risk and, therefore, are valuable information (Rudd, 2014). On the other hand, to some extent, detailed questioning about intent, plans, and past attempts reinforces client preoccupation with suicide and suicide planning.
Balance and collaboration are recommended. As you inquire about intent, continue to integrate positively oriented questions into your protocol:
How do you distract yourself from your thoughts about suicide?
As you think about suicide, what other thoughts spontaneously come into your mind that make you want to live?
Now that we’ve talked about your plan for suicide, can we talk about a plan for life?
What strengths or inner resources do you tap into to fight back those suicidal thoughts?
Eventually you may reach the point where directly asking about and exploring previous attempts is needed.
Exploring Previous Attempts
Previous attempts are considered the strongest of all suicide predictors (Franklin et al., , 2017). Information about previous attempts is usually obtained through the client’s medical-psychological records or an intake form, or while discussing depressive symptoms during a clinical interview (see Case Example 10.2). It’s also possible that you won’t have information about previous attempts, but you decide to ask directly:
Have there been any times when you were so down and hopeless that you tried to kill yourself?
Once you have or obtain information about a previous attempt or attempts, you have a responsibility to acknowledge and explore it, even if only via a solution-focused question.
You’ve tried suicide before, but you’re here with me now . . . What has helped?
If you’re working with a client who’s severely depressed, it’s not unusual for your solution-focused question to elicit a response like this:
Nothing helped. Nothing ever helps.
One error clinicians often make at this point is to venture into a yes-no questioning process about what might help or what might have helped in the past. If you’re working with someone who is extremely depressed and experiencing the problem-solving deficit of mental constriction, your client will respond in the negative and insist that nothing ever has helped and that nothing ever will help. Encountering a negative response set requires a different assessment approach. Even severely depressed clients can, if given the opportunity, acknowledge that every attempt to address depression and suicidality isn’t equally bad. Using a continuum where severely depressed and mentally constricted clients can rank intervention strategies (instead of a series of yes-no questions) is a better approach:
Therapist: It sounds like you’ve tried many different things to help you through your depressed feelings and suicidal thoughts. Of all the things you’ve tried and all the ideas that professionals like me have recommended, which one has been the worst?
Client: The meds were the worst. They made me feel like I was already dead inside.
Therapist: Okay. Let’s put meds down as the worst option you’ve experienced so far. So, which one was a little less bad than the meds?
Instead of asking the client “What worked best?” and getting a bleak depressive response, the therapist asked which therapeutic recommendation had been “the worst?” Focusing on what’s worst resonates with the negative emotional state of depressed clients. Identifying the most worthless of all therapeutic strategies is more likely to produce a response and you can build from there to strategies that are “a little less bad.” Later in the interview process, you can add new ideas that you suggest or that the client suggests and put them in their appropriate place on the continuum. When this strategy works, it produces a list of ideas (some new and some old) for potential homework and experimentation (see also Sommers-Flanagan & Sommers-Flanagan, 2021).
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As I read through the preceding excerpt, I realize there’s so much more that could be covered. For more info, we also have our strengths-based suicide assessment book, which you can find online through different booksellers. Just search for our name and strengths-based suicide assessment to find a plethora of resources, many of which are free.
When I wrote this, I was listening to Dr. Jennifer Crumlish, a consultant for the CAMS-Care program. Dr. Crumlish provided a fantastic overview of the challenges associated with suicide prevention and interventions, along with introductory information pertaining to implementing the CAMS model. For more on CAMS-Care, see this link: https://cams-care.com/
Earlier in the day, Leah Finch—one of our excellent doc students in counseling—and I, did our presentation. Our participants were awesome. A bit later, I got to be on an “expert panel” along with several very cool people, facilitated by Dr. Jen Preble. We fielded an array of interesting questions from the audience. Very fun.
For those of you interested, here are the ppts Leah and I developed, here they are:
Yesterday I was at Camp Mak-A-Dream talking with young people about happiness. Today, I’ll be online with 400+ professionals doing a presentation titled: Strategies for Listening and Responding to People Who are Suicidal. Today’s presentation is offered through PacificSource, a health insurance provider in the NW United States.
Tomorrow morning Alli Bristow (recent Montana School Counselor of the Year), Hannah Lewis (awesome elementary HPE teacher), and I will travel eastbound and take the Montana I-90 exit #166 for Gold Creek. We won’t be panning for gold. Instead, we’ll get way richer than we would from finding gold—because we’re offering a couple presentations on “Happiness and You” to the Young Survivors Group at Camp Mak-A-Dream.
The Young Survivors group consists of 13-18-year-olds who have experienced brain tumors. As someone who had the good fortune and great privilege of excellent health during my teen years, I can barely imagine the strength, resilience, persistence, and family support these young people have needed to bear their medical challenges. Although Alli, Hannah, and I have powerpoints and presentation plans, our two presentations will truly be an example of us all learning together.
I’m continuing with the theme of featuring diverse identities from the Clinical Interviewing (7th edition) textbook with a case example written by Dr. Umit Arslan. Dr. Arslan is writing about his experience as an international graduate student in counseling, when he was at the University of Montana. Currently, he’s a faculty member at the University of Nebraska-Kearney.
The photo is from when I visited him in Istanbul in January, 2023.
Enjoy!
As you’ll see below, Umit’s experience was unique. Given his Turkish heritage and cultural background, he needed to reflect and engage in a self-awareness process to experiment with finding a better way to introduce himself to clients. What I love most about this essay is Umit’s authentic description of his own experience. His answer to a better way to introduce himself won’t be the right answer for everyone. But his process is open and admirable.
CASE EXAMPLE 2.2: BEING A COUNSELOR FIRST . . . AND TURKISH SECOND, WORKED BETTER THAN BEING TURKISH FIRST . . . AND A COUNSELOR SECOND
Finding the right words and ways to introduce yourself is important. In this essay, Ümüt Arslan, Ph.D., an associate professor of counseling at İzmir Democracy University (Turkey), writes about challenges he faced as an international doctoral student in counseling at the University of Montana. Put yourself in Dr. Arslan’s shoes as he discovers (for him) a better way of introducing himself.
While pursuing my doctoral degree in the U.S., my supervisor and I discussed how to share my cultural identity and accent to clients. When I shared, my clients were not only interested in my appearance and accent, but also about my diet, coffee preferences, job, and of course, about my native country, Turkey. But they were reluctant to talk about themselves.
Clients assumed I was Muslim and against alcohol. Their assumptions were especially challenging because they were inaccurate. I was not religious, and like many Americans, I enjoyed having a beer after work. I wanted to challenge clients’ assumptions about my identity, but worried about countertransference and focusing too much on myself.
One cisgender female client came for an intake interview. She saw me, grabbed her bag (almost the size of a camping tent), and put it on her knees. I couldn’t see her face. I told her she could put the bag down if she wanted to. She declined.
When I re-watched this and other sessions, the striking thing was that my clients (mostly White) appeared stressed at the sight of me, a bearded Turkish man with dark skin. They didn’t even talk about the problems they had written on their intake form. My identity as a Turkish man overshadowed everything else. I needed a path forward.
In class, my supervisor discussed alternative ways to open sessions. I tried asking clients: “If you were the counselor today, what question would you ask yourself?” Clients suddenly engaged with me, giving deep and enthusiastic answers to their own questions. I stopped opening sessions by emphasizing cultural differences. Instead, I focused on my counselor identity, saying: “I completed my master’s degree and am currently a doctoral student. What do you think is the best question for me to ask you for us to have a good start here today?”The message, “I am here with my counselor identity” instead of “I’m a Turkish man in the U.S., and desperate to explain my culture to you,” had an amazing effect. Using a less cultural opening was more culturally sensitive. Clients could naturally introduce their own cultural identities, with fewer assumptions about me. Although I could still talk about culture, emphasizing my counselor identity enabled me to focus on counseling goals, the therapeutic relationship, and evidence-based counseling interventions.
To continue with my plan to feature culturally diverse case examples from the latest edition of Clinical Interviewing, the following excerpt is from Chapter One and focuses on cultural self-awareness. In particular, I LOVE the quotation on intersectionality from Kimberlé Crenshaw.
Cultural Self-Awareness
Those who have power appear to have no culture, whereas those without power are seen as cultural beings, or “ethnic.” (Fontes, 2008, p. 25)
Culture and self-awareness interface in many ways. As Fontes (2008) implied, individuals from dominant cultures tend to be unaware of and often resistant to becoming aware of their invisible and unearned culturally-based advantages (Sue et al., 2020). In the U.S., these “unearned assets” are often referred to as privilege in general, and White privilege in particular (McIntosh, 1998).
Privilege and oppression are best understood in the context of intersectionality. Intersectionality is the idea that overlapping or intersecting social identities within individuals create whole persons that are different from the sum of their parts (Crenshaw, 1989). Social identities that intersect include, but are not limited to: Gender, sexual orientation, sexual identity, race, ethnicity, religion, nationality, mental disorder, physical disability/illness, citizenship, and social class (Hays, 2022). Understanding multiple social identities helps clinicians understand how feelings of oppression can multiply, be activated under distinct circumstances, and be moderated under other circumstances.
Kimberlé Crenshaw (1989, 1991) introduced intersectionality as a lens to facilitate cultural awareness and understanding, but ideas about intersectionality date back at least to Black female abolitionists. In the 1860s, Sojourner Truth articulated Black women’s simultaneous oppression through classism, racism, and sexism (aka “Triple oppression”; Boyce Davies, 2008). Thirty years after she defined intersectionality, Time Magazine asked Crenshaw, “You introduced intersectionality more than 30 years ago. How do you explain what it means today?” (Steinmetz, 2020). She said,
These days, I start with what it’s not, because there has been distortion. It’s not identity politics on steroids. It is not a mechanism to turn white men into the new pariahs. It’s basically a lens, a prism, for seeing the way in which various forms of inequality often operate together and exacerbate each other. We tend to talk about race inequality as separate from inequality based on gender, class, sexuality or immigrant status. What’s often missing is how some people are subject to all of these, and the experience is not just the sum of its parts.
Through the lens of intersectionality, we can develop nuanced ways to have empathy for clients. For example, sometimes clients simultaneously feel privilege and oppression. Thinking and feeling from an intersectional frame can help clinicians be more prepared to view the world from clients’ perspectives (see Case Example 1.2).
CASE EXAMPLE 1.2: EMPATHY FIRST
Maya, an international student of color was in her first practicum. As was her routine, when introducing herself, she acknowledged her accent, her country of origin, along with her eagerness to be of assistance. Her client, a cisgender male university student, was initially polite, but quickly shifted the conversation to his feelings about White privilege, becoming somewhat agitated in the process. He said, “One thing I think you should know that I don’t believe in that White privilege thing. I just came from a class where that’s all everyone was talking about. I know I’m white, but I didn’t get any privilege. I grew up in a trailer park in West Texas. We were what they call ‘White trash.’ Nobody I grew up with had any privilege. We had poverty, abuse, alcoholism, meth, and government bullshit.”
Maya stayed calm. Even though she was activated by her client’s disclosure and was taking some of what he said personally, she focused on empathy first. She also remembered intersectionality and how common it could be for people to have multiple social identities. She said, “I hear you saying that the White privilege concept really doesn’t fit for you. Being in your very last class before coming here made you realize even more that it doesn’t fit. The idea of trying to make it fit feels annoying.”
Maya’s client simply said, “Damn right,” and continued ranting about White privilege, White fragility, and what he viewed as the politically correct environment at the university. As she continued listening and tried feeling along with him, she was able to see glimpses of his personal perspective. Not surprisingly, Maya’s client had social problems related to his tendency to be angry and abrasive. Eventually, after several sessions, they were able to begin talking about what was underneath his agitated emotional response to multicultural ideas and how his tendency to lead with his anger when in conversations with others might be contributing to him feeling even more isolated and different than everyone else. In the end, the client thanked Maya for “being patient with this dumb ass White boy” and helping him learn to be more aware, softer, and less reactive to triggering cultural conversations.
This case illustrates the importance of intersectionality as a concept that can facilitate counselor and client awareness, while also enhancing empathy. Although Maya’s client may have had even worse oppressive experiences had he been a person of color, he was neither interested nor ready to hear that message (Quarles & Bozarth, 2022). Instead, Maya used her knowledge of intersectionality to have empathy with the part of her client’s social identity that had experienced oppression.
Developing cultural self-awareness is difficult. One way of expressing this is to note, “We don’t know what we don’t know.” When someone tries to help us see and understand something about ourselves that’s outside our awareness, it’s easy to feel defensive. Despite the challenges, we encourage you to be as eager for change and growth as possible, and offer three recommendations:
Be open to exploring your own cultural identity. Gaining greater awareness of your ethnicity is useful.
If you’re from the dominant culture, be open to exploring your privilege (e.g., White privilege, wealth privilege, health privilege) as well as hidden ways that you might judge or have bias toward diverse groups and individuals (e.g., transgender, disabled).
If you’re outside the dominant culture, be open to discovering ways to have empathy not only for members within your group, but also for other diversities and for the struggles that dominant cultural group members might have as they navigate challenges of increasing cultural awareness. Engaging in mutual empathy is a cornerstone of relational cultural psychotherapy (Gómez, 2020).
[End of Case Example 1.2]
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