Exploration of the Impact of the Counselor's Cultural and Diversity Background on Stress Coping |
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Pamela K. S. Patrick, Ph.D.
Counselor professionals who provide mental health care for individuals, families and communities who have experienced or been exposed to trauma are at risk for compassion fatigue, burnout, and vicarious traumatization (Avray & Uhlemann, 1996; Patrick, 2006). These stress-induced reactions can emerge as counselors provide mental health care to victims of trauma as well as in response to stress-saturated work environments. In addition, counselors who assist survivors and first responders at disaster sites, as well as during the immediate and extended recovery period, are at high risk for these stress induced responses (Baranowsky, 1999; Batten & Orsillo, 2001; Bell, Kulkarni & Dalton, 2003). Counselor stress response styles may differ in the context of exposure to client traumatic experiences as well as in response to the personal experience of assisting at trauma-infused disaster events. The role of the counselor’s cultural background or diversity status may, therefore, also influence how the counselor copes with burnout, compassion fatigue or vicarious traumatization (Wee & Myers, 2002). Given the breadth and variance of definitions of “culture”, “ethnicity”, “culture/ethnic identity” as well as “diversity” (Trimble & Dickson, 2005), no attempt is made in this presentation to construct an all-inclusive framework within which counselor stress coping is considered. Rather, the emphasis of this review is to consider how and why the counselor’s cultural or diversity background may impact how the counselor responds to intense stress-response inducing counseling activities. Counselor Multiculturalism and Stress Coping Within the counseling profession, emphasis on the importance of sensitivity to the cultural, ethnic, and diversity background of clients is well supported in an expanding professional literature, continuing professional education programs, within ethical codes of conduct, and within counselor education accreditation standards (Chandras, Eddy, & Spaulding, 2000; www.counseling.org). There is, however, minimal research or publication on the multicultural or diversity background of the counseling professional as it interfaces with counselors’ personal experiences of providing counseling services. Stress Coping: Cultural and Diversity Issues Information on the cultural and diversity background of counselor professionals is difficult to obtain. In some instances, counselors do not report cultural or ethnic identity based on experiences of bias or stereotype. Access to education and preparation for the counseling professions may be influenced by economic or social factors found within cultural or ethnically diverse populations, thus reducing the number of practitioners in the counseling professions. From this perspective, investigation of the interaction of the counselor’s culture and diversity background on stress coping represents a challenge to researchers and prevention/intervention efforts. While research is limited on the specific focus of this discussion, there is some evidence that the counselor’s culture, ethnicity or diversity characteristics can impact aspects of the counseling process. For example, in one study, clients reported different preferences for self-disclosure when the counselor was African American or Caucasian (Cashwell, Shcherbakova & Cashwell, 2003). In depth research about counselor preferences for or comfort levels with self-disclosure with clients with similar or different cultural backgrounds to their own, however, is scant. From another perspective, adherence to Asian cultural values by Asian counselors increased the credibility of client perceptions of the counselor in a study by Kim and Atkinson (2002). While these studies produced meaningful results, each serves to provoke questions about the role of the counselor’s ethnic, cultural or diversity background as it relates to counselor responses to the counseling process in general. Extending this reasoning, one can hypothesize a number of possible interactions between counselor cultural and diversity background and stress coping as it may emerge in high-stress work environments or settings. Stress Coping: Burnout, Compassion Fatigue, Vicarious Traumatization Stress response styles have been described as having different characteristics for ethnic/culturally diverse individuals who are experiencing post-traumatic stress disorder following massive natural disaster (Perilla, Norris, & Lavizzo, 2002). Wee and Myers reported higher levels of generalized distress for certain ethnic groups who have provided mental health services to victims of the Oklahoma City bombing (2002), yet also concluded that pre-existing factors may have been responsible for this outcome. The counselor’s ethnic, cultural or diversity background may represent an important link to stress coping across a variety of contexts and practice environments. With the availability of critical incident stress management training programs now readily available, for example, it is reasonable to hypothesize that counselors with a variety of cultural, ethnic, or diversity backgrounds will also be engaged in pursuit of such advanced preparation. With this in mind, exploration of questions that interface with counselor cultural, ethnic and diversity background and the counselor’s stress coping style informs the remainder of this review. Professional education and training for practitioners who are engaged in high stress environments, who are members of critical incident stress response/management teams, or who participate as mental health clinicians on community-based disaster teams is available through professional associations, specialized pre-conference training events, through academic coursework, and through community-based training programs. The availability of education and training opportunities varies in format and emphasis. It can consist of site-based, self-study, or technology supported offerings. Education and training that focuses on compassion fatigue, burnout, or vicarious traumatization is a dual purpose endeavor: The skill sets and information acquired are applicable to helping others and at the same time, are applicable to the counselor ‘s well being. Work Place Training. In-service workshops or skills coping sessions may be offered at the counselor’s place of employment that emphasize the high demands on practice of providing counseling services to traumatized clients, victims of trauma, or to clients referred for counseling following disaster or mass casualty events. In these sessions, presenters may describe the signs and symptoms of burnout, compassion fatigue, or vicarious traumatization with the goal of heightening awareness of the need for self-care, self-assessment, early intervention, and stress management skills development. Certification Programs. Dependent on the location and resources available to the counselor professional, specialized training that leads to certification may be pursued as a direct result, or in anticipation of, volunteering or working at mass casualty or disaster events. Such specialized and advanced certifications prepare counselors as effective practitioners and crisis/disaster responders for victims as well as first responders at disaster sites. While doing so, counselors are exposed to visual, auditory, olfactory, and tactile stimuli associated with disaster sites where urgent mental health interventions are needed. One element of the training programs, therefore, is to increase the counselor’s self-awareness of risk factors for personal burnout or vicarious traumatization when providing counseling services in such contexts. Self-Study and Continuing Professional Education. Counselors can pursue continuing professional development that targets burnout, compassion fatigue, or vicarious traumatization as a strategy to enhance skills, acquire training linked to continuing professional education requirements, or to meet goals linked to identified personal needs or future community-based volunteer commitments. Actions taken to acquire specialized education may, at first, be motivated by needs to prepare for providing counseling to others. During the course of completing the educational offering, the impact on the counselor of exposure to trauma, either directly or vicariously, typically is incorporated into the resource materials used. Based on an assumption that education and training can influence stress coping, questions arise about the culture and diversity sensitivity that is, or is not, embedded in these offerings. Are attendees or participants of diverse cultural or ethnic backgrounds, for example, confident that the strategies presented in publications, workshops, conferences, and certification programs are sensitive to multicultural perspectives regarding stress coping styles? This question leads to a number of other considerations regarding how counselor cultural and diversity background interfaces with onset, impact and long term consequences of burnout, compassion fatigue and vicarious traumatization. Exploring the Issues: Research and Practice Questions When counselors are exposed to high-stress work or crisis/disaster volunteer experiences as a single event, over time at multiple events, or during the course of providing counseling services to traumatized clients in agency, clinic, or private practice settings, the counselor’s risk for negative stress coping outcomes escalates. Counselors can develop burnout, compassion fatigue, or vicarious traumatization in association with: (1) regular exposure to the descriptions of stressful and traumatic events provided by clients during counseling sessions (e.g., counseling victims of child sexual abuse or survivors of domestic violence, assault or abuse; survivors of domestic terrorism); (2) at sites of natural or human-caused disasters with mass casualties and devastation of property and environment (e.g., individuals or families of hurricanes, tsunamis, earthquakes); and/or (3) at locations with mass casualties following acts of domestic or foreign terrorism e.g., 9/11, Oklahoma bombing, school shootings (Patrick, 2006; Webber, Bass, & Yep, 2005). When the clients, casualties, or survivors represent various ethnic, cultural, and diversity populations and the counselors engaged in providing mental health and crisis/disaster intervention services also are of varied ethnic, cultural or diversity backgrounds, there is a potential for less effective service delivery or acceptance of services offered. Another outcome of the pairing of counselor characteristics with traumatized client characteristics may be an increased level of empathy, understanding, and facilitation of communication and help acceptance. The manner in which counselor cultural or diversity background facilitates, moderates, or has no effect on the counselor’s well being under conditions of high stress or traumatic experience has neither been fully researched nor is it well understood. Without a foundation of research upon which to construct prevention or intervention strategies, counselors with multicultural backgrounds may not have access to culturally sensitive prevention or intervention resources. To explore this issue further, a limited number of example questions are posed to drive the discussion, debate, evaluation and assessment of this important aspect of counseling care and counselor well being. These research questions, agendas, or issues are categorized as counselor qualities and characteristics, and as being related to prevention/intervention. Qualities and Characteristics Research Questions
Prevention/Intervention Research Questions
Each of the research questions posed reflects issues that the counseling professions must grapple with. The commitment to sensitivity to culture and diversity values in education, research and practice is well established. It is now time to extend this sensitivity to specialized areas of practice and to the well being of counselors at risk for burnout, compassion fatigue or vicarious traumatization. References Arvay, M., & Uhlemann, M. (1996). Counselor stress in the field of trauma: A preliminary study. Canadian Journal of Counseling, 30, 193-210. Baranowsky, A. B. (1999). The silencing response in clinical practice: On the road to diaglogue. In Figley, C. R. (Ed.). Treating compassion fatigue (155-170). New York: Brunner-Routledge. Batten, S. V., & Orsillo, S. M. (2001). Therapist reactions in the context of collective trauma. AABT: Articles on Trauma, retrieved November 4, 2004, from http://www.aabt.org/ Bell, H., Kulkarni, S., & Dalton, L. (2003). Organizational prevention of vicarious trauma. Journal of Contemporary Human Services, 84, 463-470. Cashwell, C. S., Shcherbakova, J., & Cashwell, T. H. (2003). Effect of client and counselor ethnicity on preference for counselor disclosure. Journal of Counseling and Development, 81, 196-201. Chandras, K. V., Eddy, J. P., & Spaulding, D. J. (2000). Counseling Asian-Americans: Implications for training. Education, 120(2), 239-246. Kim, B. S. K., & Atkinson, D. R. (2002). Asian American client adherence to Asian cultural values, counselor expression of cultural values, counselor ethnicity, and career counseling process. Journal of Counseling Psychology, 49(1), 3-13. Patrick, P. K. S. (2006). Stress induced challenges to the counselor role: Burnout, compassion fatigue and vicarious traumatization. In P. K. S. Patrick (Ed.). Contemporary Issues In Counseling. Manuscript accepted for publication (Allyn and Bacon). Perilla, J. L., Norris, F. H., & Lavizzo, E. A. (2002). Ethnicity, culture, and disaster response: Identifying and explaining ethnic differences in PTSD six months after hurricane Andrews. Journal of Social and Clinical Psychology, 21(1), 20-45. Trimble, J. E., & Dickson, R. (in press). Ethnic identity. In C. B. Fisher & R. M. Lerner (Eds.), Applied developmental science: An encyclopedia of research, policies, and programs. Thousand Oaks: Sage. Retrieved June 17, 2005, from http://www.ac.wwu.edu/~trimble/ethnicity_identity.htm Webber, J., Bass, D. D., & Yep, R. (Eds.). (2005). Terrorism, trauma, and tragedies: A counselor’s guide to preparing and responding (2nd ed.). Alexandria, VA: American Counseling Association. Wee, D., & Myers, D. (2002). Response of mental health workers following disaster. The Oklahoma City Bombing. In C.R. Figley (Ed.). Treating compassion fatigue (pp. 57-83). New York: Brunner/Rutledge. |
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