As Counsellors we are going to come across a variety of issues many of which colleges do not prepare us for. In undergrad and masters, we learn the disorders from DSM V and so the common assumption is these are the only kinds of cases we will have to handle.
But let me tell you, when I began my term as an Intern with Meadows of Hope, I encountered a variety of cases that I had never learned about and so did not know how to tackle. For example, consider the case of a 32 year old man, who has done everything possible to fix his relationship with his wife, and then discovers that she had been having an affair with another man, or the case of a man who was showing signs of oedipal complex or a case where a mother of a disabled child is struggling with her family because her husband left her.
How did these make you feel?
Dealing with topics of infidelity, oedipal complex, or dealing with people who seem lost are things that I had no experience with. The obvious danger when handling these cases was - my personal bias would come into play.
A therapist's personal bias has a high chance of breaking the therapeutic relationship. Especially in cases where the client does not trust the therapist or does not want therapy, the therapist's bias can push the client away by replicating the stigma and bias that they face in the outside world or triggering internalized oppression and further damaging the client’s sense of self. Just like triggers, these biases are sometimes unconscious. Say for example, our idea of marriage in India is typically a monogamous happily ever after and the end goal of a romantic relationship is marriage. Counsellors should remember that these are our views and they are not necessarily shared by our clients.
The obvious question is then, how do we deal with these biases? For the personal bias that we know, getting personal therapy helps. Clinical health psychologist and associate clinical professor, William Hua, suggests following eight key steps to finding your own blind spots and understanding their influence on your work with clients.
1. Identify your cultural blind spots and areas of inexperience: Try to understand the impact of marginalization and work on identifying your individual blind spots. For example, “Are you unintentionally minimizing the added stress that your Trans client experiences daily as a result of cisnormativity?”
2. Take the Implicit Association Test (IAT): this aims to highlight potential attitudes and beliefs you may hold about people based on certain characteristics.
3. Form a consultation and accountability group with other therapists and work to build trust and connection with each other: The priority of this group should be to examine implicit biases and their impact in therapy. The group may find things you miss and offer a different perspective.
4. Consider incorporating the Cultural Formulation Interview (CFI) into your initial client intake or during a follow-up session: It is designed to help clinicians gather information about clients with an emphasis on understanding their health narratives and histories from a cultural lens.
5. Create a culturagram to better understand your client’s familial and cultural influences: It examines factors such as reasons for relocation, what language is spoken at home, the impact of trauma and crisis events clients faced, and the influence of client values and ideas about education, work, and family.
6. Read up on books that talk about blind spots: Books on Blind spots by psychologists Mahzarin R. Banaji and Anthony G. Greenwal all talk about unconscious bias and examine how social groups and identities influence our interactions and perceptions unconsciously
7. Attend workshops and seminars on unconscious bias: Keep in mind that the work of identifying and lessening the impact of implicit bias is a lifelong journey. Stay updated!
8. Consider initiating dialogue about implicit bias with your co-workers or other therapists. Normalize conversations about implicit bias and the reality that we all have them.
Finally and most importantly, As Counsellors we must remember that we are not the client. Our job is to help the client find the best way to deal with their problems and this means ensuring that we don't cross the line between Empathy and Sympathy. This means setting aside our ideas of morals and values and tailoring the session to what suits the client best.
References
Hua, W. (2020, March 6). Exposing Our Blind Spots: How to Tackle Unconscious Bias as a Therapist. Lyra Health. https://www.lyrahealth.com/blog/unconscious-bias-therapists/
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