Prejudice and Ethics in Counselling
If a counsellor finds herself drifting into judgemental thoughts upon listening to a client describe a lifestyle in which she eats all day, while attempting to lose weight, it will be extremely difficult for me to keep the results of my emotional response to this judgemental attitude from reflecting in my voice and choice of words in working with the client. Clients may be dysfunctional, but they aren’t emotionally insensitive or unintelligent, and are very likely to hear the implied feelings of the therapist.
Obviously, this will do little to establish or maintain the kind of trust necessary for effective counselling. I need to recognise this more in myself. I am sure that intellectually I try to have no prejudices; however I know that I do because I can tell by the tone of my voice or the little voice that may appear in my head. I know that I am hypocritical in several of these instances. For example, I may think that that unemployed people are lazy, and that fat people are lazy too, when I have been unemployed and not looking for work.
Even though I don’t often think in prejudicial terms I can do if under pressure and stressed, and looking for someone to blame. Therapists are necessarily aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socio-economic status and consider these factors when working with members of such groups.
Therapists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices. Because of the tendency to generalize, rather than be specific, it is quite possible to encounter therapists who simply don’t see obesity as a disability, and therefore excuse themselves, internally, from their prejudice in this area, rationalizing that the person is not disabled, but simply lazy.
There are therapists who within the privacy of their own thoughts, may feel the same way about alcoholics or drug addicts. These therapists may realize that their prejudice is counter-productive to the therapeutic process, and may attempt to avoid voicing their feelings around other therapists or in the presence of their clients, but while they may succeed in not overtly expressing these feelings in front of their clients, they are usually unable to keep from letting them slip in the presence of their friends.
If they are lucky, they will receive productive feedback, who may assist them in overcoming their own prejudices. This, in fact, is the idea behind supervision in the therapeutic process, wherein a therapist is monitored and overseen by another therapist who has more experience. This provides the opportunity for the therapist to be made aware of any limitations being imposed on the therapeutic process due to prejudicial attitudes, judgements, lack of education with regard to a particular illness, and many other areas.
Realistically not all therapists receive the benefits of adequate supervision, and it is quite possible to find those that are limited by the prejudices with which they, knowingly or unknowingly, view the world, of which their clients form a part. Specifically addressing areas: Religious Affiliation Many of those who seek counselling have had atypical experiences in their upbringing. This often leads them into exploring areas of belief which most people with a more conventional upbringing would never consider appropriate, even if they were exposed to the opportunity.
One example is Wicca which many people, out of ignorance, associate with devil-worship or something equivalent. If a counsellor is a devout Christian, with no exposure to the truth behind various forms of paganism, and if the client’s belief in these things comes up in the course of therapy, it may be very difficult for the therapist to resist a little preaching or proselytizing, or to avoid associating the client’s religious beliefs with their coincidentally ‘different’, and likely dysfunctional lifestyle. Obviously, if the client gets a sense of this, they are likely to shut down and be less forthcoming with their thoughts and feelings.
Class This comes under the heading of ‘socio-economic status’. There are some therapists who firmly believe in ‘dressing down’ when working with clients from a disadvantaged socio-economic background. This doesn’t mean looking sloppy or wearing torn jeans, but just dressing simply as in trousers and a t-shirt, rather than a suit. While there is some truth to the value of not unnecessarily emphasizing a visual difference between the therapist and the client there are other therapists who insist that they should dress according to status.
I feel that a therapist should dress in whatever way makes them feel most comfortable, since it is this feeling of being comfortable that the client will notice. Of course, there are other ways in which the therapist can err in contrasting their social status with that of the client. The client may get them to talking about themselves, and the therapist may let it slip that they just bought a new car. This does little to assist the client, and may engender the feeling that “sure, the ideas you talk about work for you, but that’s only because your life and background is so much better than mine… hey’ll never work for me in my situation”. For this reason, therapists are trained not to indulge in disclosure of their personal life beyond what might be useful in establishing rapport with the client. Ethnicity This is a prominent area in which prejudice is not tolerable. There is a difference between overcoming prejudice against someone, and being proactive for someone of a race with which you are not closely acquainted. It is one thing to avoid politically incorrect vocabulary, but quite another to be aware of appropriate role models for those of another race, based on a knowledge of their contributions to society.
Of course a client of colour is very likely to pick up on such limitations on the therapist’s part. Age Ageism is one of the most recent entries into the area of prejudicial conscience. Factors contributing to this prejudice include fear of death and loss of control, an almost worshipful regard for youth and beauty, a societal sense of self-worth based on productivity, and a stereotype of the elderly as being institutionalized and in poor health – something which is simply not the case with the majority of seniors today.
Counselling a senior in regard to their love life will obviously be a stretch for the counsellor who is not age positive. Seniors are especially likely to be aware of, and sensitive to, any indication on the part of the therapist that they view them in some judgemental way as they’ve learned a lot about reading people in their lifetimes. Gender Sexism can severely compromise the ability of a therapist to nurture the self-esteem and independence necessary for a client to progress.
A female therapist who is unable to get past her own expectations that a male should be the strong, responsible provider in a relationship is not likely to be of much value to a male client who needs to take the time away from such responsibilities which will facilitate his ability to explore deeply repressed feelings. Also women who have had a bad experience with a certain type of chauvinistic male may then begin to see men as inferior and have difficulty dealing with an assertive male. A therapist who has herself experienced domestic violence may feel uneasy or threatened by a male who divulges that he is or was a wife-beater.
The therapist must be able to compartmentalise her own feelings in order to treat the client. Sexual Orientation and Practices Prejudice against a gay male may be inseparable from prejudice against the practice of anal sex. It is also equally possible for a male therapist to resent a gay female. Contempt is a difficult emotion to mask, and a client with an alternate orientation, or the practitioner of an unusual sexual lifestyle, maybe more likely to keep this quiet. If this information is never disclosed due to fear of repugnance, it may hamper the progress of therapy. Mental Health Diagnosis
Most therapists have been carefully trained to be cognizant of the very real stigma which a diagnosis of mental illness can cause in the experience of a client. When you consider that a large percentage of therapists initially enter the field of mental health either seeking to comprehend their own problems or out of the desire to help others which is based on having been raised in an emotional environment which promotes the dysfunctional beliefs of co-dependency, it is not hard to understand that they might a familiarity with the trauma of mental illness in the course of their own upbringing.
Such a background can emerge during therapy as fear of, or repulsion by, certain symptoms or behaviours which might have been exhibited by family members during their own childhood, and caused them to experience their own traumas. If these feelings haven’t been resolved, the therapist may resist the very presence of the client whose behaviours trigger unresolved emotions from their own past. It is hardly therapeutic for the therapist to feel threatened by the client when they are at their worst in terms of symptoms or behaviours.
A therapist who is only comfortable with clients who are acting ‘normal’ isn’t much good. Physical Disorders Any disability which is not understood can engender fear and loathing, nervousness and uncertainty. A client with cerebral palsy in addition to a mental disorder may have to work at finding a therapist who has the patience, compassion and education about the physical condition needed to make any headway into the mental condition.
In this sense it is also a responsibility of the client to interview the therapist to ascertain that the therapist is competent. Most therapists eventually realize that the nature of their occupation requires that they work on and resolve their own issues as diligently as they work on resolving the issues of their clients. Having removed the emotional blocks which might cause them to unconsciously stifle the feelings nd behaviours of their clients, they still need to educate themselves in the area of multicultural awareness so as to be able to provide motivation and proactive guidance to the clients in their charge regardless of age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, socio-economic status, or any combination of these. Other things that may induce prejudice are: • Jargon – the use of specialized language, creating barriers which reinforce power differences. Stereotypes – terms used to refer to people from different groups, i. e. older people as ‘old dears’. • Stigma – terms such as ‘mental handicap’ carry a damaging stigma. • Exclusion – this might be inadvertently asking a Muslim what his ‘Christian’ name is, rather than his ‘first’ name. • Depersonalization – this relates to terms such as ‘the elderly’ rather than ‘older people’ and ‘the mentally ill’ rather than ‘people with mental distress’ Use of language with clients: I believe it is critically important to explore our use of language as therapists.
Mindful of some of the settings in which counsellors work and the specific difficulties clients struggle with, we need to be sensitive to some of the words in common use and which are deeply offensive. Working with people who have dependency problem we must be aware not to term suffers as ‘drug user’, ‘drug abuser’, ‘drug pusher’ or ‘recreational drug use’, ‘alcoholic’, ‘alcohol abuser/misuser’ It is only in recent years that we have developed a language to describe the phenomenon of child sexual abuse.
Previously there was no discourse and children’s distress went often unheeded. Burstow (1992: 202) refers to ‘eating disorders’ as ‘troubled eating’. She says ‘There is nothing more orderly than the precise regimen that women who are anorexic follow’. We hear of ‘date rape’ and somehow it is thought to be less traumatic or damaging than other rape. Burstow (1992) refers to ‘psychiatric survivors’ having been ‘psychiatrized’ by the system, and Wilson and Beresford (2000) use the term ‘people with madness and distress’ rather than the more sanitized ‘mental health service users’.
It is important for the therapist to develop awareness of the social and political backdrop to their clients’ stories. Does this woman, for example, stay in a violent relationship because of her personal psychology, or do issues of poverty and powerlessness and lack of appropriate support services contribute to her problems. Is she a black woman? What would her (and her children’s) experience be of a refuge where all the other women, including workers, were white. And if she were a lesbian, how might she be received or understood by her heterosexual peers.