The Practice of Collaborative Counseling and Psychotherapy

Developing Skills in Culturally Mindful Helping

David Pare

• Publisher: SAGE Publications, Inc
• Year: 2012
• ISBN:
  9781506319858
• Edition: 1
• Topic: Education
• Subtopic: Counseling in Career Development

The Practice of Collaborative Counseling and Psychotherapy: Developing Skills in Culturally Mindful Helping is a comprehensive introduction to counseling and psychotherapy skills designed to teach future practitioners how to develop and foster collaborative relationships with their clients. Keeping power relations and cultural diversity at the forefront, Paré's text examines, step by step, the skills involved in collaborative therapeutic conversation—an approach that encourages a contextual view of clients and counteracts longstanding traditions of focusing primarily on individual pathology. Indeed, this insightful text teaches students how to keep clients at the heart of their therapy treatment by actively engaging them in the helping process. Guided by the notion of local knowledge, Paré acknowledges the resourcefulness of clients, showing how to capitalize on existing skills and abilities to construct useful change. This textbook reinvigorates the training of counselors and psychotherapists by drawing on a wide range of contemporary ideas and practices. The Instructor's teaching site include instructional videos which feature a diverse group of practitioners demonstrating the skills introduced in the text.

For more information about the videos that accompany this book, watch a brief introductory video from author David Pare now!

David Pare, PhD is a psychologist and family therapist. He is also a full professor at the University of Ottawa, Faculty of Education, where he teaches counselling and psychotherapy. The director of the Glebe Institute, A Centre for Constructive and Collaborative Practice, Dr. Pare has a long-standing interest in collaborative approaches to counselling and supervision. He is co-editor of Collaborative Practice in Psychology and Therapy (with Glenn Larner) and Furthering Talk: Advances in the Discursive Therapies (with Tom Strong).

Chapter 1 Culture, Counseling, and Care

Introduction: Counseling as a Cultural Practice

As the elevator door closes, Maria takes a deep breath and tries to shed some of the day's hectic energy. This next hour is supposed to be for her. She turns her attention inward for a moment and notices she's feeling some complicated emotions on the verge of her first therapy session ever. For the past 2 years she has been training as a counselor and has come to appreciate the complexity and sensitivity of the craft. But today she will sit in the other chair. Maria is immediately aware of a sense of vulnerability: As much as she looks forward to the chance to talk about the various challenges she's dealing with in her life, she's also aware she'll be opening up to someone she's never met. She pulls the slip of paper out of her pocket and glances at it one last time: Daniel Brooks, Suite 345.

In the waiting area, Maria's phone rings as she sits down. Her husband Azim wants her to pick up some milk on the way home. He's talkative on the other end of the line, and Maria feels she's attracting unwanted attention.

“Okay, honey, gotta run. I'll see you at dinner. Make sure to change Kyla.”

Maria turns the ringer off and puts her phone away as a tall African American man steps into the waiting area.

“Maria?” he says, scanning the faces around the room.

“That would be me,” says Maria, standing and extending her hand.

“Good to meet you; I'm Daniel Brooks. My office is just down this way.”

Maria follows Daniel down the hall, marvelling at what feels like a curious mixture of excitement and dread as she prepares to put words to the various stressors that led her to this moment.

And thus begins a conversation with a purpose. In the exchange about to unfold, Maria as the client¹ will seek help with challenges she faces, and Daniel as the counselor will attempt to support Maria in diminishing her distress. This book is devoted to a detailed examination of the multiplicity of skills that Daniel and other counselors employ in this critical work.

As we shall see, rigorous and specialized as many of the skills are, they also have a familiarity about them because they are centered on a practice widely employed by the general public, namely, talk. This makes them less mysterious than, say, the skills required to isolate a gene from a strand of chromosomes or to etch microscopic circuits onto carbon wafers. Counseling and psychotherapy² are highly refined disciplines, yet conversation more generally is a practice engaged in by virtually all human beings. In addition to that, many stereotypical depictions of counseling and psychotherapy have seeped into popular culture, making the practices that much more familiar, although tailored for popular consumption. And finally, most readers of this text will have had some previous academic exposure to counseling theories and practice. This all adds up to a lot of assumptions about a topic that deserves a more open-minded inquiry in preparation for practice.

And so as tempting as it is to plunge immediately into exploring the diversity of counseling skills, I invite you to pause for a moment to reflect on what sets therapeutic conversation apart from ordinary talk. Just what is it that practitioners are attempting to accomplish, and what are key issues and ideas that demand our attention before we proceed? To rush forward without asking these key questions is to treat therapeutic conversation like a recipe-driven, formulaic, linear task—a gravely simplistic view of the practice. Instead, this book begins with reflections designed to prepare the way for developing skills that are used thoughtfully, with an eye to the big picture. This involves looking at counseling with fresh eyes, holding on for a little longer to the desire to refine the skills of the craft. Have no fear, we will soon get to those skills—the book is devoted to them. But for now let's just behold the practice called counseling, in both its beautiful simplicity and its intriguing complexity.

Remembering that counseling and psychotherapy are cultural practices is a useful way to examine them with a discerning eye. Imagine for a moment that we venture forth as anthropologists encountering an unfamiliar social ritual for the first time. As mentioned, this is not easy: The media are awash with portrayals of counseling and therapy, and your own education to this point has added further impressions. It's difficult to bring a genuine curiosity to a cultural activity not entirely new to us. But shed your knowledge and assumptions for a moment, and you will see a cultural ritual increasingly prevalent among industrialized nations and less so in the developing world. The ritual has many variations, but all are born of a desire to offer support and comfort to those who are experiencing some form of distress. Broadly speaking, the practice is a response to human suffering (Gehart & Paré, 2008).

Look more closely and you will notice that although there are many approaches to counseling and therapy—hundreds of them by some counts (Duncan & Miller, 2000)—they all feature an encounter between people relying on language as a central tool of the craft. Things quickly become more complex on closer inspection because unlike numbers, language isn't stable and universal. Words express lived experience, yet their meanings curiously vary from person to person, capturing the nuance of unique cultural contexts. What we notice is that counseling inevitably involves speakers and listeners with distinct backgrounds—it's a social practice that involves the coming together of cultures or, as Courtland Lee and colleagues (2009) point out, “all counseling interactions are cross-cultural” (p. xix).

The implication of this, of course, is that multicultural counseling is not a subdiscipline of counseling in general. Culture is not a variable or factor but the space in which counseling conversations—all conversations for that matter—happen. A saying that helps to capture this idea is, “We are the fish; culture is the water.” Culture is all around us, influencing how we think, feel, and act—the backdrop to, or context for, each of our conversations.

The view of counseling as cross-cultural conversation gives rise to a number of important themes that will be threaded throughout the chapters of this book. Like the construct of culture, the themes are not isolated issues to consider or specialized practices to apply in narrowly defined situations: They suffuse the work and are always at play. These themes will not be referred to constantly throughout this text but will be the backdrop to the many counseling exchanges depicted throughout the book.

In the rest of this chapter, I'll say a few words about these themes as a way to prepare the ground for your encounters with them later. You may find that some speak to you immediately, whereas others require further reflection. My intention in providing capsule descriptions of these themes up front is to orient you to ideas that will be revisited and developed more fully as the chapters unfold. So I encourage you to let the themes wash over you, knowing you can flip back to this introduction at any time as you progress through the book.

Conversation

Talk as Intervention

Curious as it may seem, the emphasis on counseling as conversation is so far virtually absent within the field. More often, counseling conversations are depicted as vehicles for delivering some form of helpful intervention distinct from the conversation itself. But counseling differs from other helping professions in that the conversation is the intervention. As Friedman (1993) says, “therapy is a conversation in which dialogue between therapist and client leads to the generation of new meanings, understandings, and options for action” (p. 273). Counselors talk with clients, and the talk itself is what is helpful.

If this seems confusing, a sideways glance at other professions helps. In many helping professions, the intervention or treatment is not primarily about speech: Consider the wielding of a scalpel or the scribbling of a prescription. In other cases, the intervention is delivered through words (as an exercise plan or dietary regime, for example), but it's the plan or regime and not the words used to convey it that are seen as the intervention. With counseling, it is the words themselves, and of course the nonverbals, that are also a key element of conversation, that are central to the professional practice. We might not blink if someone were to say, “She's an excellent doctor, but a lousy talker and listener.” Make the same comment about a counselor, and it begs the question of on what possible grounds they're being evaluated. Counselors talk and listen, and these exchanges are the cornerstone of their professional skill.

Honing Familiar Skills to a New Level

Counseling conversations share many features with other forms of conversation. And so students new to the profession arrive with a lifetime of experience. In some ways, refining one's counseling practice is more about further mastering a long-developed skill than taking on some arcane practice foreign to the uninitiated. Nevertheless, just because we've always conversed doesn't mean that there isn't a great deal to learn and refine. There's a story about Margaret Atwood, the acclaimed Canadian novelist, being told by a neurosurgeon at a cocktail party of his plans to write novels upon retiring. Atwood paused to sip from her drink before responding, “Yes, and I think I'll take up neurosurgery.”

We assume neurosurgery requires knowledge and skills that take years to acquire, yet most of us already know how to write. If you've tried writing a novel, you probably know it takes far more than the ability to string words together. So too for conversation. We may be reasonably adept at participating in conversations—after all, it's a familiar practice we've engaged in since the age of about 2. But are these conversations helpful to others? Learning to have helpful conversations with clients facing diverse mental, emotional, relational, physical, and spiritual challenges is a lifetime's project. Counseling is founded on a great many skills used in daily life but involves using the familiar tool of language for some highly particular purposes. And as much as those purposes may vary, they always happen in the context of culture.

Culture

Recognizing the Role of Culture

Counseling and psychotherapy have developed amid a long Western tradition of individualism that places primary emphasis on people as distinct and self-contained entities. This is changing as rapid globalization puts us face to face with the cultural imbeddedness of our experience and the critical importance of intercultural relationships. There's been a striking growth in the attention paid to culture as it relates to counseling in recent years (cf. Arthur & Collins, 2010; Baruth & Manning, 2007; Ivey, Ivey, & Zalaquett, 2009; Lee et al., 2009; Lee & Ramsey, 2006; McAuliffe, 2007; Monk, Winslade, & Sinclair, 2008; Pedersen, Draguns, Lonner, & Trimble, 2008; Ponterotto, Casas, Suzuki, & Alexander, 2010; Sue, Ivey, & Pedersen, 2009). Yet the field struggles to incorporate culture into the center of the practice: to understand culture not as an add-on to attend to when doing a specialized form of counseling designated as multicultural but rather as the substance of the practice itself. Culture permeates counseling in countless ways:

1. Counseling is a practice with cultural origins that is understood and performed differently (if at all) in different geographic locations and at different historical moments.
2. Counseling theories are discourses developed in the context of various cultural institutions such as psychology, psychiatry, and education, reflecting the values and beliefs associated with those points of origin.
3. When counselor and client(s) meet, they always bring their diverse cultural understandings and meanings to the conversation.
4. Counseling is practiced in language, a cultural creation itself that is the primary vehicle for the expression of and construction of meaning.

Culture in Pluralistic Terms

No doubt the previous list can be extended in various ways. On close inspection, it seems culture permeates not just counseling but all human affairs. But what exactly am I referring to in referencing culture? The word has a long history and a surprisingly diverse array of meanings attached to it (cf. Monk et al., 2008). Historically, culture has most often been tied to the notion of ethnicity or race but in a manner that fails to capture the complexity of our diverse social locations (Arthur & Collins, 2010; Lee et al., 2009; Monk et al., 2008; Paré, 1996, 2008). A more useful way forward is to understand culture in pluralistic terms. In other words, we all inhabit many cultural subgroups, and our participation in these groups shifts over time and across contexts.

Student Voices: Talia: Changing Identities

I was recently told by a new friend that I was the first Jewish person they had ever met, but that I did not “look or act the part.” Being someone who is opened minded and accepting, I responded by asking, “What were you expecting Jews to be like?” She told me she thought all Jews had dark hair, big noses and are rich—all stereotypical characteristics I had heard linked to Jewish people in the past. My friend's response struck me for a number of reasons. First of all, I was surprised that at 24-year, having lived her whole life in big cities, I was the first Jew she had ever met. This situation made me want to introduce my friend to a variety of Jewish people to show her that we are just like everyone else: We come in all colors, shapes and sizes. Within the counselling profession, we need to be mindful of our own stereotypes and make sure that we remain curious, and remember that just like us, our clients have multiple stories.

Some sources (cf. MacCluskie, 2010; Miraglia, Law, & Collins, 2006) refer to culture as the rituals and traditions, beliefs, behaviors, lifestyles, and so on in which various groups of clients engage. This is one familiar way to talk of culture; this book uses another familiar connotation of the word. It refers to the groups themselves: the people who share and engage in the various traditions. Lee's (2006) definition fits with this view: “Culture can be broadly defined as any group of clients who identify or associate with one another on the basis of some common purpose, need or similarity of background” (p. 179).

Looked at this way, we can see that all of us simultaneously inhabit a multiplicity of subcultures—or as Pedersen (1991) puts it, “each of us belongs to many different cultures at different times, in different environments and in different roles” (p. 4). Box 1.1 shows what this looks like graphically. It may be easier to picture when attached to an example, however. Box 1.2 depicts Maria, whom we met at the opening of the chapter and whom we will follow throughout this book. Her brief vignette is intended to demonstrate the many subgroups of society she inhabits: the multiplicity of her cultural locations.

Box 1...