Running a culturally competent service

I co-run a person-centered generalist counselling service that has a specialist focus on those who are GSRD – that is, their gender, sexuality or relationship styles are diverse (or divergent) from cisgender, heterosexual, monogamous etc. Clients who want to come to counselling don’t need to be talking about any of these topics, but should they wish to, we hope to meet them with a higher level of cultural competency than most counselling services in the UK. The service is based in a small city in the midlands that is lucky enough to have at least two universities (and other colleges) offering courses in counselling, which means we get a lot of enquiries from trainees who want to do a placement with us. This counselling service has always had a specialist GSRD focus, and the one thing we knew was that we needed culturally competent counsellors. To do this, we applied a somewhat unconventional method of sifting through applications: we created a series of vignettes.

 

Since we started this approach, we have had 12 applications to the service. Four have gone to interview, and two have been taken on. Two others are not yet at the stage in their course of being ready to see clients and are completing our in-house training sessions to help them become culturally competent counsellors. I want to share some of the responses with you. I haven’t sought permission from any except our current trainees, so I will portmanteau the responses rather than quoting verbatim- and ‘quotes’ are paraphrases.

 

There are five vignettes for applicants to follow. The first asks for thoughts and responses to a bearded client with a name usually considered female, such as ‘Elizabeth’. The next asks how a bisexual client’s identity might be linked to her impulsivity and difficulty making decisions. The third asks for your first and second internal responses to a man telling you he is in multiple ethical relationships. The fourth is a woman who identifies as a submissive who hesitatingly tells you she enjoys receiving pain, and are asked how you feel about this relationship, and how you react internally and externally, and finally there is a 17 year old who is genderqueer and has just come out to their mum. you had seen them for a number of sessions and not known this. where do you go? All these are required answers, with an optional last space for other thoughts. This is our entire application process. We require nothing else until we get to interview (which is in part a 30 minute triad where applicants meet a trans client). We select people out based on their answers. We don’t require everyone to be very competent at all answers, but we look for at a minimum, a lack of judgement based on the responses, and some level of understanding that our client group requires a level of competency that might be different to mainstream counselling.

What interests me is the sheer number of respondents who feel that ‘simply being person-centered’ is enough. There are many responses especially to the first question that state things like ‘this is a client like any other client’. And of course, in one way, they are. But in other ways they are not. They will have unique ways of being in the world. And just responding about the client requires you to make linguistic decisions. Do you choose ‘he’ for the beard? ‘she’ for the name? ‘they’ (or another gender-neutral pronoun) for the ambiguity of the situation? Most responses assume ‘female’. Some responses (including our two trainees) speak of a possible trans identity or genderfluidity, and a willingness to understand and know the client’s experience, some speak to the possibility of a cis woman with an endocrine imbalance, but many, when asked what it would be important to ask, gloss over this completely. It seems that gender has become the elephant in the room. Of course, it is the client’s right to talk about what they want to talk about, but (and I have cheated a bit here) in our service, clients are asked for their pronouns at their assessments. This is a basic component without which counselling cannot proceed authentically, but respondents seem to ignore this in the hope that that will be ok.

For the bisexual and impulsive client I am really pleased that the large majority of respondents don’t make any immediate connection between sexuality and decision-making, although there is a sizeable minority who theorise that the client is ‘confused’ about her sexuality, or that somehow, feeling attracted to ‘both’ genders is out of the client’s control (unlike compulsory heterosexuality?).

Moving on to the multiple relationships question, I loved that one of my trainees immediately assumed that the client was a gay man, and then immediately caught that assumption. That ability to reflect honestly in the application was one of the first indicators that may me feel I wanted to interview him. My other trainee immediately noticed that she would want to be taking care to make good use of supervision when working with a relationship style outside of her own. Other responses tended to comment that ‘if the client doesn’t have a problem with his relationship style, why does he feel the need to talk about it? perhaps this IS a problem, after all’ (paraphrased). This smacks of ‘why do gays have to flaunt themselves?’. Another typical responses to this question is ‘why does he feel the need to have multiple relationships?’, to which I have the question ‘why do you as the counsellor feel the need to (presumably) only have one at a time?’. Somebody suggested that they would tell the client that that information wasn’t relevant to the session. So much for not judging…

The submissive masochist gives perhaps the most intriguing responses. My all-time favourite response has been something like ‘I would feel the client’s pain’. Other responses have been around safeguarding, concern about safety, feeling anger and upset for the client. Judgemental responses have included ‘I would like to know why the client chooses to stay in this type of relationship rather than work through her abusive past’ (no abuse is detailed as part of the vignettes). Positive responses have been around recognising the client’s hesitation as a fear of being judged, and not wanting to judge. Internal feelings and responses TO the client involve feeling that this is violent and controlling and TELLING the client that, that it’s ‘not right’ to be in this style of relationship and that person would work to ‘get the feelings of hurt to surface’, but other internal and external responses have been about recognising that this is not the counsellor’s own personal preference (no-one has thus far said ‘yeah – I get it’), but that consenting adults can consent. Some have mentioned that they would like to check out whether there was informed consent and as long as there was, then all would be fine.

In the genderqueer scenario, responses range from merely ‘thanks for telling me’, to long and considered thoughts about wondering whether the counsellor had missed anything in the six previous sessions; whether they could have acted differently; how to make the space as safe as possible for the client to continue; a desire to explore exactly what a genderqueer identity might mean, rather than rely on a label as a placeholder.

Finally, the final thoughts for our applicants aren’t obligatory. two people have chosen not to respond so far. But many of the other ten gave honest and thoughtful answers, about how these scenarios had caused applicants to think about topics they wouldnt have considered, how they would wish to have further training, something that it seems is not (or not really) covered. It was good to note that even in the sometimes clumsy responses from people (because none of us is an expert across all responses at all times), that people had a genuine desire to try, and to get things right, and to further their knowledge. It was disappointing to see intimated that from those who are current students (I am certain of at least six looking for a trainee placement), there is no real training on these topics at their institutions. Students who claimed knowledge often did so from their own vantage points (usually as gay or lesbian or having a G/L family member, and this gave them an insight into other minorities), but no-one mentioned having any knowledge from their courses.

All in all, this is a really interesting process for us, and has proven very useful in helping to ascertain whether someone would be a good fit for our service. It suggests that there are many trainees out there however, with significant ‘blindspots’ in their understandings, which will probably go unchallenged up to and including the moment when a GSRD client walks into their counselling room. Whilst some of these applicants will clearly rise to the challenge and make good use of supervision and self-reflection, my concern rests with a number of people who judged my theoretical clients as somehow ‘lacking’ and weren’t afraid to tell the clients that they were making that kind of judgement.

 

 

References:

Davies, D. (2007) Not in Front of the Students Therapy Today Vol 18 (1) http://www.therapytoday.net/article/show/1573/not-in-front-of-the-students/

Davies, D and Barker, M J (2015) How gender and sexually diverse-friendly is your therapy training. The Psychotherapist (61) https://issuu.com/ukcp-publications/docs/61_the_psychotherapist_autumn_2015/8

 

 

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