This research suggests that most therapists experience, at least once, deep distress. For example, 61% reported experiencing clinical depression, 29% reported suicidal feelings, and 3.5% reported attempting suicide. About 4% reported having been hospitalized. Readers may wish to consider their own experiences in the light of these findings.
Emotional competence in therapy is no less important than intellectual competence, and it is for that reason that we have included, beginning with Chapter 15, clinical scenarios at the end of each chapter. These scenarios describe hypothetical situations that this book’s readers might encounter. Each is followed by a handful of questions designed to provide practice in the processes of the critical thinking explored in detail in Chapters 10–14. The first question in each sequence is a variant of “What do you feel?” Emotional competence leaves little room for denying, discounting, or distorting how we respond emotionally to the challenges of clinical work.
To the extent that these scenarios and questions form the basis of class or group discussion in graduate school courses, internships, in-service training, continuing education workshops, or other group settings, their value may be in direct proportion to the class’s or group’s ability to establish as safe an environment as possible in which participants are free to disclose responses that may be politically incorrect or “psychologically incorrect” (Pope, Sonne et al., 2006) or otherwise at odds with group norms or with what some might consider the “right” response. Only if participants are able to speak honestly with each other about responses that they might be reluctant to speak aloud in other settings and to discuss these responses with mutual respect, will the task of confronting these questions likely prove helpful in developing emotional competence (Pope, Sonne et al., 2006).
Learning to discuss these sensitive topics and our personal responses to them with others can help to strengthen our emotional competence and develop resources for maintaining competence throughout our careers (see Pope, Sonne et al., 2006, for a more thorough discussion of understanding taboos that hurt therapists and clients). Our colleagues also constitute an invaluable source of help to avoid or correct mistakes, identify stress or personal dilemmas that threaten to overwhelm us, and provide fresh ideas, new perspectives, and second and third opinions. A national survey of psychologists, in fact, found that therapists rated informal networks of colleagues as the most effective resource for prompting effective, appropriate, and ethical practice (Pope et al., 1987). Informal networks were seen as more valuable in promoting ethical practice than laws, ethics committees, research, continuing education programs, or formal ethical principles. Our colleagues can help sustain us, replenish us, enrich our lives, and play an important role in our self-care (Chapter 17).
Chapter 7 CULTURE, CONTEXT, AND ETHICS IN PSYCHOTHERAPY AND COUNSELING
In the last few decades, the United States (US) and Canada have become more multiracial, multiethnic, and multilingual. As of 2019, 40% of the US population was Black Indigenous and People of Color (BIPOC) including: 18.5% Latinxs, 13.4% African American, 5.6% Asian American, and 1.3% American Indians (U.S. Bureau of the Census, 2019). Approximately 20% of the US population or 40 million are immigrants (Pew Research Center, 2020). In Canada, 22.3% of the total population in 2016 identified as People of Color and 21.9% of the population as immigrant. The largest ethnic minority community in Canada was composed of people of South Asian descent (5.6%), followed by Chinese (4.6%), First Nations (4.4%), and people who identify as Black (3.5%; Statistics Canada, 2016).
In the field of mental health, several foundational publications (see Comas-Díaz, 2012; Helms & Cook, 1999; Sue et al., 2019; Vasquez, 2007; White & Henderson, 2008) and professional guidelines (see American Psychological Association [APA], 2017b, 2019c; Canadian Psychological Association [CPA], 2017b) underscore the importance of ethnicity and culture in the therapeutic process. These important documents aim to assist therapists in providing culturally responsive services to individuals and communities. Culture, defined as the “complex constellation of [learned] mores, values, customs, traditions, and practices that guide and influence people’s cognitive, affective, and behavioral response to life circumstances” (Parham et al., 1999, p. 14) is an important aspect of the work that we do as therapists. Culture shapes how clients: (a) narrate and make sense of their presenting problems, describe the causes, signs, and symptoms of their problems; (b) discuss what they believe heals or prevents the problems from getting worse; and (c) envision their relationship with healthcare providers including their therapist (Adames & Chavez-Dueñas, 2017; Gallardo et al., 2012; Kleinman et al., 1978; Vasquez, 2007). Culture always shapes how therapists view problems and issues, as well as what we consider to be healthy and unhealthy processes and functional and dysfunctional coping strategies (Vasquez & Johnson, in press). Culture is always in the therapeutic space, even when we fail to honor its presence and significance.
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