gtappan...
I will include here the remarks I made in clarifying the
first posting of this question:
I have extensive experience in the field of mental health.
I would submit that stereotypes of every kind could serve
to pose a problem for any counselor who is unable to limit
their judgment of clients due to these stereotypes.
To the extent that ethical dilemmas include the concept of
compromised effectiveness in counseling, any such bias could
pose a problem.
For example, if a counselor finds himself/herself drifting
into judgmental thoughts upon listening to a client describe
a lifestyle in which she sleeps around in order to satisfy
a drug habit, while attempting to raise a young child, it
will be extremely difficult for the counselor to keep the
results of their emotional response to this judgmental
attitude from reflecting in their 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 counseling.
If a list of such stereotypes were attempted, it would,
quite simply, include any and all stereotypical judgments
which humans have historically made, or might personally
be capable of making.
In elaborating, I will speak primarily from my own experience
here, as I did above, mainly because my experience with these
issues is greater than what I was able to locate by searching
the internet.
If you search terms like:
counselor OR therapist prejudice OR judgment compromise therapy
://www.google.com/search?q=counselor+OR+therapist+prejudice+OR+judgment+compromise+therapy
...the results will primarily be comprised of the documented
standards, used by various therapeutic approaches, which outline
the guidelines for ethical practices.
One example is a pdf file from the American Art Therapy Association
which outlines ethical standards for art therapists:
"Art therapists are 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
socioeconomic status and consider these factors when working
with members of such groups. Art 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."
http://www.arttherapy.org/aboutarttherapy/ethicsfinal2003.pdf
You will find similar principles set forth in the guidelines
for professional organizations and state requirements for
various practitioners: for chemical dependency counselors
and school counselors; for family therapists and music
therapists, and so on.
Now, while the general categories indicated above are designed
to include most prejudices of which one can conceive, they are
less specific than some of the terms you have specified. 'Mental
health diagnosis' and 'physical disorders' would come under the
heading of 'disability', and 'class' would come under the area
of 'socioeconomic status'.
Nor do they get more specific, so as to specify obese people, or
people with a drinking problem. Because of this tendency to
generalize, rather than being 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, feel the same way about alcoholics.
Now, these same 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 I can tell you that, while
the 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 peers. If they are
lucky, they will receive productive feedback from their peers,
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,
judgments, lack of education with regard to a particular illness,
and many other areas.
Realistically, however, 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 the areas you noted:
Religious Affiliation
Many of those who seek counseling have had atypical experiences
in their upbringing. This often leads them into exploring areas
of belief which most people with a 'conventional' upbringing
would never consider appropriate, even if they were exposed to
the opportunity. One example is Wicca, or other forms of paganism,
which many people, out of ignorance, associate with devil-worship,
or something equivalent. If a counselor 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 'socioeconomic status'. There are
some therapists who firmly believe in 'dressing down' when working
with clients from a disadvantaged socioeconomic background. This
doesn't mean looking sloppy, or wearing torn jeans, but just
dressing simply, as in clean dockers and a t-shirt, rather than
a coat and tie. 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 their Ph.D. status. My own feeling is that
the 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 Mustang convertible.
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...
they'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. Perhaps you both have an interest in old
movies. Great! The fact that you have a collection of every old
movie ever made on DVD is not a necessary addition to the dialog.
Ethnicity
This one is so obvious, due to it being one of the prejudices that
has been most dealt with, for the longest time, that you would
think this is the one that needs the least work. Sadly, while
most people, and especially professionals in the area of human
services, such as therapists, are more aware of ethnicity as a
prominent area in which prejudice is not tolerable, there is a
difference between overcoming prejudice *against* someone, and
being well-enough educated to be 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 color 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.
Counseling a senior in regard to their love life will obviously
be a stretch for the counselor whose attitude toward the concept
of a senior enjoying sex is typified by the reaction portrayed
on so many sitcoms when the elderly parent is discovered to be
sexually active by the adult child: "Eyeuuw".
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 judgmental way. They've learned a lot about reading
people in their lifetimes.
Gender:
Well, this is another one you would think we'd hashed out enough
to avoid problems, but the fact is that there are still people,
and therapists, who think a woman would be best to marry and
stay home, and let a guy take care of them. This kind of sexism
can severely compromise the ability of a therapist to nurture
the self-esteem and independence necessary for a female client
to progress.
Of course, it works both ways. A female therapist who is unable
to get past her own expectations that a male should be the
reponsible 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 which will have him
sobbing like a baby.
Sexual Orientation and Practices
I'll put these two together, since prejudice against a gay
male may be inseparable from prejudice against the practice
of anal sex. Of course it is equally possible for a male
therapist to resent a gay female who has therefore become
unavailable to the male population. Realistically, I am only
exploring a small number of possibile prejudices in each of
the areas I'm touching on here. The number of variations of
each one would take a book to catalog.
Obviously, contempt is one of the more difficult emotions to
mask, and a client with an alternate orientation, or the
practitioner of an unusual sexual lifestyle, is likely to
keep this close to their chest. Especially when the DSM-IV,
the Diagnostic and Statistical Manual of Mental Disorders,
specifies some of the practices as Sexual Disorders. Will
it assist the client if this information is never disclosed
or discussed, due to the repugnance which the therapist
expresses, whether consciously or unconsciously? No...
of course not.
Mental Health Diagnosis
While 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,
perceiving and understanding are often two different things.
When you consider that the literature indicates that a
large percentage of therapists initially enter the field
of mental health either seeking to comprehend their own
demons, 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 have more than
a passing 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 behaviors 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 behaviors 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 behaviors. A therapist who is only comfortable with
clients who are acting 'normal' isn't much good to anyone.
Physical Disorders
I touched on this before, when I mentioned the possibility
that an obese person will be seen as lazy, or an alcoholic
seen as an irresponsible drunk. Of course, any disability
which is not understood can engender fear and loathing,
or, at the least, 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 as much the responsibility of the client
to interview the therapist as is it the responsibility of the
therapist to ascertain that a client is a suitable candidate
for a particular kind of therapy...say, a six-month residential
chemical dependency program.
Dr. Marlene Winell suggests a series of questions which a client
can ask their therapist in the initial interview, in her page
about finding a therapist. Here are some of them:
Quote:
Why are you a therapist?
What is your approach to working with people?
Do you use any special techniques other than talking?
How do you suggest we approach my issues in particular?
How will you react if I disagree with you?
What will you do if I do not make any progress?
What kinds of cases have you referred on to other therapists?
Have you been in therapy yourself?
What can you tell me about yourself as a person that
contributes to your ability as a therapist? (e.g.,
experience with parenting, divorce, religion, trauma)
What are your views on _______?(e.g., abortion, gay
lifestyle, drugs, etc.)
How do you handle the ending of therapy?
How will we know when I am finished?
What kind of grievance procedure is available to me if I
feel I have been damaged by therapy?
Unquote
Much more on the page:
http://www.marlenewinell.com/therapist.htm
As for the therapist, most of them 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. And, having removed
the emotional blocks which might cause them to unconsciously
stifle the feelings and behaviors 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,
socioeconomic status, or any combination/permutation of these.
An excellent article on the topic of prejudice and how to move
beyond it, by Jim Cole, Ed.D., is on the Beyond Prejudice
website:
http://www.beyondprejudice.com/under_stand.html
I sincerely hope this satisfies your interest in asking this
question. If there is something which is unclear or which
needs elaboration, please feel free to request a clarification
of the answer, prior to rating it.
sublime1-ga
Additional information may be found from an exploration of
the links resulting from the Google searches outlined below.
Searches done, via Google:
counselor OR therapist prejudice OR judgment
://www.google.com/search?q=counselor+OR+therapist+prejudice+OR+judgment
interview counselor OR therapist prejudice OR judgment
://www.google.com/search?q=interview+counselor+OR+therapist+prejudice+OR+judgment
counselor OR therapist prejudice OR judgment religion
://www.google.com/search?q=counselor+OR+therapist+prejudice+OR+judgment+religion
counselor OR therapist prejudice OR judgment ageism
://www.google.com/search?q=counselor+OR+therapist+prejudice+OR+judgment+ageism
counselor OR therapist prejudice OR judgment sexism
://www.google.com/search?q=counselor+OR+therapist+prejudice+OR+judgment+sexism
counselor OR therapist prejudice OR judgment racism
://www.google.com/search?q=counselor+OR+therapist+prejudice+OR+judgment+racism |
