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Beyond knowledge and awareness: enhancing counselor skills for work with gay, lesbian, and bisexual clients.

Whereas multicultural advances in the area of gay, lesbian, and bisexual issues have been made for increased knowledge and awareness, little development has been made regarding counselor skill building. This article outlines a model of training using role-playing to enhance counselor skill when working with gay male, lesbian, and bisexual male and female clients.

Mientras que avances multiculturales en el campo de cuestiones homosexuales, lesbianas y bisexuales han resultado en un aumento en el conocimiento y la conciencia, poco desarrollo ha resultado en cuanto a la habilitacion de consejeros. Este articulo traza las lineas generales de un modelo de entrenamiento que utiliza el juego de roles para mejorar las tacticas del consejero cuando trabaja con clientes homosexuales, lesbianas, y bisexuales.

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As the twenty-first century becomes well established, the importance of multicultural (MC) counseling has also been well established; however, the importance of MC training (MCT) has fallen behind. A number of different racial and cultural groups are now recognized as having unique counseling needs (Langman, 1995; Pedersen, 1988; Pope, 1995). A number of researchers have defined cultural identity as including demographic variables such as religion, gender, physical ability, socioeconomic status, and sexual orientation as well as ethnographic variables like racial/ethnic identity (Pedersen, 1999). We also support a broad definition of MC counseling, specifically one that includes issues relevant to sexual orientation. This article focuses on gay, lesbian, and bisexual (GLB) MCT issues for counselors and the methods used to help increase MC counseling competency. Although scholarly work is needed regarding transgendered individuals, this article focuses on GLB training issues because of space limitations.

The concept of MC competency was first proposed by and continues to be written about by S. Sue (1998) and others (D. W. Sue et al., 1982). Generally, MC competence has been understood to include three overlapping areas: knowledge, awareness (counselor's own values and biases and client's worldview), and skill/intervention strategies (Arrendondo, 1999; Arrendondo et al., 1996; Pedersen, 1988; D. W. Sue, Arrendondo, & McDavis, 1992). A similar structure has been presented by Washington and Evans (1991), who discussed knowledge, awareness, skill, and action aspects of becoming a heterosexual ally. Others too have indicated that knowledge of different cultures, awareness of one's own feelings, and ability to work with different populations are important (Berg-Cross & Chinen, 1995; Merta, Stringham, & Ponterotto, 1988).

Given that it is now widely accepted that it is important for counseling psychologists to have MC competence, training programs should view MC as vital (Ridley, Mendoza, & Kanitz, 1994). Indeed, it is an ethical obligation for counselors to be competent in working with diverse groups of people (American Counseling Association [ACA], 1995) or to be able to provide alternative services to those whom one is not competent to serve (American Psychological Association [APA], 1992). This competency should include knowledge, awareness, and skill regarding various cultural groups. In other words, the profession has moved from the issue of whether MCT should be provided to how MCT should proceed (Ridley et al., 1994). However, there have been some difficulties associated with providing MCT. An area within MCT that is still in its infancy is that of training in GLB issues.

Whether obtained in one's professional training or independently, all therapists should have some basic knowledge, awareness, and skill regarding GLB issues, especially as this group is one of the largest minority populations, generally including 10-15% of the general population (Kinsey, Pomeroy, & Martin, 1948). However, gaining instruction in the area of GLB counseling can be difficult because most programs do not require such training. Moreover, counselors may face some difficulties when trying to increase their knowledge in this area, especially through independent study. For instance, counselors may have their motivation for learning about GLB issues blocked by their internalized heterosexism and fear of negative professional and personal consequences should they become associated with the area of GLB issues (Elze, 1992; Thompson, 1992; Washington & Evans, 1991). Professionals associated with GLB issues may themselves be automatically labeled by others as GLB and may also not be completely accepted by the GLB community (Washington & Evans, 1991).

It has only been during the past several decades that psychology's negative categorization of gay men was challenged (Hooker, 1957). In her pioneering work, Hooker demonstrated that gay men were not more or less pathological than heterosexual men. Her work led to the Ape's 1975 resolution to have mental health workers "take the lead in removing the stigma of mental illness that has long been associated with homosexual orientations" (APA, 1975, p. 633). As a result, counselors are now expected to actively work to reduce the stigma associated with being gay, lesbian, and bisexual. However, even now little training is available and generally not required by counselor training programs. Dworkin and Guitierez (1989) discussed this issue:
   Information on this topic is not enough. Homosexuality has been
   perceived so negatively throughout history by both the lay and
   therapeutic communities that there is a need not only to teach but
   also to research, develop, and practice models that are gay, lesbian,
   and bisexual affirmative. (p. 7)


The present article is specifically interested in increasing the MC competence of counselors working with GLB clients. Specifically, we discuss in detail how training can increase counselor skill and awareness when working with GLB clients. We also review how training in preparation of working with GLB clients has occurred, and we present some training concepts to increase MC competence. Specifically, we outline a model for the use of structured role-play exercises with GLB scenarios designed to increase therapist's skill when working with this population. However, as a basis for this skills and awareness discussion, we suggest that readers first familiarize themselves with some basic GLB knowledge through study of the literature currently available on GLB issues. A listing of some of the important GLB topics follows, along with a discussion as to why simply gaining knowledge in this area does not automatically translate to increased counseling competency.

knowledge

Even though study on GLB issues is in its infancy, there are some specific pieces of knowledge regarding GLB issues about which counselors should be aware. Specific issues include available GLB support networks, lifestyles, homophobia, heterosexism, and appropriate/inappropriate therapeutic goals when working with GLB clients (Dworkin, 2000; Graham, Rawlings, Halpern, & Hermes, 1984). Practitioners should also know of GLB-affirmative counseling themes that can help support competent service provision to GLB clients (Dworkin, 2000; Fassinger, 1991). The lifelong process of "coming out" for GLB individuals is especially important for practitioners to know about (Browning, Reynolds, & Dworkin, 1998; Rust, 1996; Shannon & Woods, 1998; Slater, 1988). One's identity development as a GLB individual is also an area in need of study for counselors seeking to be competent in working with this population (Browning et al., 1998). Consequently, the reader is referred to one of the several identity development models (e.g., Coleman, Troiden, Cass) reviewed by Levine and Evans (1991). Couples and family issues are also areas of knowledge in which practitioners should be well versed (Bridges & Croteau, 1994; Browning et al., 1998; Friedman, 1991; Kirkpatrick, 1991; Shannon & Woods, 1998).

MCT, in general, often involves didactic teaching about MC counseling or a certain cultural group and tends to focus on merely increasing student knowledge. Although knowledge is a necessary component of MC competence, it is not sufficient, because it is also necessary to increase student awareness and skill in working with diverse populations to be truly considered multiculturally competent (Copeland, 1982; Das, 1995; Merta et al., 1988; Pedersen, 1988). As stated by Johnson (1987),
   In a very clear sense it appears that ... training focuses on
   learning about the culture more than it focuses on learning to
   perform in the culture. The trainee is left to his or her own
   device to evolve higher order strategies for problem solving,
   conducting interpersonal transactions, and making
   attributions. (p. 321)


Indeed, knowledge without awareness or skill can lead to less effective MC counseling.

awareness

In order for counselors to use knowledge about GLB issues, awareness of other and self must also be achieved. Some beginning work has been done in this area. As indicated by Berg-Cross and Chinen (1995), "instead of communicating more effectively, cultural knowledge devoid of personal knowledge inevitably leads to stereotyping and an inability to relate empathetically" (p. 339). Thus, both awareness of others and self-awareness are required for competent work with GLB clients.

Awareness of others can include personal sensitivity to the individuality of people within the GLB community as well as the common experiences and characteristics. S. Sue (1998) described an aspect of other awareness as dynamic sizing: "The therapist has appropriate skills in knowing when to generalize and be inclusive and when to individualize and be exclusive" (p. 446). Dynamic sizing and awareness of others can consequently reduce stereotyping and can possibly lead to more productive work with GLB clients.

Having an awareness of one's own views, self-awareness, is vitally important when working with GLB populations. It is especially necessary for counselors to be self-aware of personal reactions in the area of GLB issues because of society's deeply ingrained negative view (heterosexism/homophobia) of GLB people. Many people, including therapists, hold views that are negative regarding GLB populations, and these same people may be unaware of the effects of such negative views (Murphy, 1992).

Also important is a therapist's awareness of his or her own sexual identity development (heterosexual, gay, lesbian, and bisexual); this is akin to Kiselica's (1991) discussion of the importance of awareness of one's racial identity development. Unlike being aware of other's individuality, awareness of one's self may include a very personal exploration of one's own sexual orientation and beliefs about GLB people (Buhrke & Douce, 1991; Murphy, 1992).

skill

Less work has been conducted on how to increase counselor skill than has been done in the areas of knowledge and awareness. Consequently, we conducted numerous literature searches and found nothing directly relating to actual skill building in the area of GLB issues or MC for counselors. Indeed, Allison, Crawford, Echemendia, Robinson, and Knepp (1994) reported that many applied training programs did not provide courses and experiences with diverse client populations for students. Whereas courses may currently be more available, it may still be difficult to provide students with varied and diversified client experiences.

The lack of information on actual skill building in the GLB and MC areas might possibly be due to the inherent difficulty in increasing MC skill levels (Pedersen, 1988). Indeed, many counselors may find it difficult to add certain MC competencies to their basic skill repertoire. For instance, culture shock and revisited feelings of discomfort that one may not have felt since learning basic counseling skills could block one's ability to perform adequately (Merta et al., 1988; Warnke, Duys, Lark, & Renard, 1998).

Nevertheless, educational/teacher training literature that relates to skill building does exist. Within this literature, role-play exercises were discussed. As a result, what follows is a summary of some of the education/teacher skills literature that relates to role-playing. This literature includes the use of role-play exercises to increase skill and how such experiential activities have been found useful for a number of skills. Also included in this discussion are some guidelines for successful use of role-play exercises. We then conclude with how we believe similar ideas can be used to increase counselor skills when working with GLB populations.

role-play

Role-play and experiential exercises have long been used in counselor training (Beamish & Dalen, 1990). Indeed, the use of"the setting up of more or less unstructured situations in which student's actions are improvised to fit in with their conceptions of role to which they have been assigned" (McKeachie, 1986, p. 174; see also Anderson, Gundersen, Banken, Halvorson, & Schmutte, 1989) has a long history in therapy training. This "type of simulation that focuses attention on the interaction of people with one another" (O'Donnell & Shaver, 1990, p. 3) appears ideally suited to the learning process involved with counseling and working with culturally diverse groups. Role-play is also viewed as being especially helpful regarding the development of interpersonal skills because it is interpersonal and interactional in nature (Waters, Woods, & Noel, 1992).

Role-play exercises have been used to help develop many skills and are quite versatile (Waters et al., 1992). For instance, role-play exercises have been successfully used to develop interpersonal-conflict reduction skills (Bohart, 1977), interpersonal skills (Schinke & Rose, 1976), and assertive skill training (Gorecki, Dickson, Anderson, & Jones, 1981). Role-play exercises have also been used to practice family reunification scenarios (Werrbach, 1993), to aid in the teaching of research ethics (Strohmetz & Skleder, 1992), and to develop the use of hypnotherapy (Sanders, 1985) and psychoanalytic theory (Holmes, 1988). Role-play exercises have also been used in process-consultation training (Errek & Randolph, 1982; Parker, 1991).

Role-plays are used to enhance learning by more actively involving the student in the learning process (Burlbaw, 1991; DeNeve & Heppner, 1997). Mio (1989) also found that "actual one-to-one exchange of ideas with an individual can greatly enhance one's experience with members of another cultural group above and beyond factual knowledge about the group" (p. 43). However, when conducting role-play exercises there are a few guidelines that must be followed if learning is to be maximized.

Role-plays must be conducted in a safe and supportive environment for both the person playing the role of the counselor as well as the person playing the client (Wright, 1989). In order for a role-play exercise to be beneficial, it must be carried out in an environment that is open and promotes interaction (Burton, 1997). When done in a supportive environment, participants have indicated such activities are powerful and rewarding (Holmes, 1988). Thus, instructors must attend to the comfort level of their role-play participants and ensure that a certain level of safety and comfort is present if participants are to benefit from such exercises. Role-play situations must also reflect realistic counselor-client interactions and common client difficulties. Indeed, some refer to role-play exercises as a type of "reality practice" (Burton, 1997).

When role-plays are conducted in a safe and realistic manner, they can have many advantages (Saunders, 1985). For instance, role-play exercises have been used to increase empathy, explore attitudes and feelings, practice skill, provide immediate learning and feedback, increase student involvement, and increase motivation (O'Donnell & Shaver, 1990). Coaches and observers benefit from observing role-plays through observational learning (Wright, 1989). Role-plays can also provide a safe way to practice communication skills, show overconfident people areas for improvement, increase awareness of one's interpersonal skills and ability to attend to others, be used to model acceptable and unacceptable practices, and encourage empathy and insight into others' experience (Wright, 1989).

When role-plays are done appropriately, one of the main positive effects is the possible increase in empathy that participants can experience. For instance, Bohart (1977) reported that role-playing can reduce hostile attitudes and aggressiveness by increasing empathy. Indeed, role-play exercises can help participants explore their own experiences and attitudes toward topics, people, and their own reactions (Hutchinson & Scherman, 1986). As stated by Waters et al. (1992), "students gain empathy and tolerance for viewpoints different from their own" (p. 217). Even observing others performing a role-play exercise can increase one's ability to accurately reflect feelings and empathize with clients (Robinson & Cabianca, 1983). Specifically, taking on the role of a client has been long held to increase one's empathy and warmth toward clients and decrease stereotyping (Anderson et al., 1989; Sanders, 1985).

Conversely, when role-play exercises are not conducted well, or when conducted with certain groups, they can have a number of drawbacks. For example, participants can refuse to participate or become nervous and freeze. In addition, the exercises can be viewed as frivolous, the exercises can take excessive time, and group facilitators can experience a lack of control (O'Donnell & Shaver, 1990). Some people are not interested in role-play because they may be overly anxious or fearful of self-exposure. Role-play exercises can also be overpersonalized by some, and for certain individuals, anxiety can become disruptive (Waters et al., 1992). Role-play exercises may be less appropriate for such participants. In addition, role-play exercises tend to be less effective with larger groups (Cherrington & van Ments, 1994).

role-play exercises for increasing skill

To create the safe environment that is necessary for learning to occur during a role-play exercise, we have developed a model for structured role-play exercise that gradually exposes participants to greater levels of feedback and scenario difficulty. In other words, a developmental approach was taken that is reminiscent of Stoltenberg, McNeill, and Delworth (1998). This gradual increasing of difficulty and feedback exposure is to help provide a less anxious environment that is more conducive to learning and empathy and to the development of awareness. In order to provide realism to aid in learning, the specific role-play scenarios to be used within this structured format were developed on the basis of the GLB literature. Our clinical experiences (although no specific client information was used) were also used in the development of the scenarios.

Our model for role-play exercises is described in the following sections and involves three levels of difficulty with correspondingly greater levels of feedback. After each simulation, the participants provide limited and structured feedback to each other using the following sentence stem: "I noticed--and thought/felt--." This allows those in the counselor role to focus on their skills and the effect their actions may have on their prospective clients. Those in the client role are also afforded the opportunity to increase their awareness and empathy toward GLB clients. In addition, participants can gain from observing competent counseling practices regarding GLB issues and learn from critiquing counseling practices that are less than optimal regarding GLB practices. While the participants are engaging in their role-play scenarios, the training leaders circulate about the room to provide encouragement, constructive feedback, and direction to the participants regarding their work. See Figure 1 for a diagram of the role-play exercises.

[FIGURE 1 OMITTED]

This model was based on the work of other counseling educators. Specifically, the development of the present training model was influenced by three existing training models: the Interpersonal Process Recall model (Egan, 1994), the Triad Model (Pedersen, 1988), and the Structured Group Supervision model (Betz, Morris, Wilbur, & Roberts-Wilbur, 1997). These models address different counselor training, group supervision and feedback, and MC counselor training foci that, when combined with role-play exercises, may add a depth of experience that enables the learning of MC counseling skills.

LEVEL 1

The role-play exercises at this level are conducted in dyads composed of both client and counselor roles. All participants are asked to pair with another participant and act out a scenario. Scenarios at this level are to address language and assumptions that are heterosexist. Prior to the actual role-play exercises, a brief overview lecture on the use of language and heterosexist assumptions is provided to increase participants' knowledge. Following are two examples of this level of difficulty.

Client-initiated role-play. You are a female client in a therapy session with a new therapist. You talk about being depressed over the ending of a relationship with your friend Jane. You are a lesbian but do not feel comfortable saying so outright to your new therapist yet.

Therapist-initiated role-play. You are gathering intake data on a new client. You come to the point in your interview when you gather social and family information. Complete this part of your intake using inclusive language.

After each participant has had the opportunity to assume both the counselor and client role, with different scenarios, this portion of the role-play exercise is complete. However, there is a group discussion prior to moving to the second level of role-play exercises. During this group discussion, a review of the role-play exercises and the participants' reactions are processed. This processing will include a discussion of "culture shock" and the difficulties involved with MC skill building in this area.

LEVEL 2

The second level of role-play exercises adds an observer component. This observer component is assumed by one of the participants. Thus, a client-counselor-observer triad is formed. The scenarios at this level are slightly increased in difficulty and address themes such as open discussion of relational issues including talk of one's same-sex partner and coming out to selected others as a GLB individual. Two examples follow.

Client-initiated role-play. You are a male client who is reporting anxiety. You know you are gay and would do anything not to be gay.

Client-initiated role-play. You are a female client who recently had a sexual encounter with a female friend. You don't know how you feel or what you should do about the relationship/friendship.

After participants have completed all roles (therapist-client-observer), a group discussion about the activity and personal reactions is conducted.

LEVEL 3

The highest level of role-play difficulty and feedback to be used in the model involves a small group role-play. Additional observers are added to the counselor-client-observer triad, thus providing additional feedback. We suggest, however, that the maximum number of observers be carefully gauged so as to not render the role-play exercises ineffectual. Consequently, a maximum of five to six may be appropriate. Scenarios at this final level of role-play include more complex situations and conditions, possibly including GLB identity development issues, coming-out-to-parent situations, spirituality issues, and sociopolitical issues. Two examples follow.

Client-initiated role-play. You are a middle-aged man who has come to therapy concerned about your son. Your son says he is gay. You think it is just a "stage" that he is going through and that he will "grow out" of being gay. You want the therapist to help to make your son "heterosexual."

Client-initiated role-play. You are a bisexual man who is conflicted about your religion. You say that your religion says that homosexuality is a sin and thus you think you should be "just" heterosexual. However, you continue to have same-sex attractions.

Once again at the conclusion of the small group role-plays, a general discussion is conducted to process the participants' experiences and reactions.

summary

When conducting role-play exercises, the reader is cautioned to ensure a safe environment for participants. This may require creating more Level 1 or Level 2 role-play exercises for experiential practice prior to working on Level 3 role-plays. Judging whether additional lower level role-play exercises are necessary can be aided by group discussions between each role-play experience. Finally, a summary discussion after the exercises are completed is suggested to help participants process and solidify their knowledge, awareness, and skill learning. We suggest that all participants discuss as one large group what it was like to participate in the role-play scenarios, review culture shock and how learning new skills can be difficult, and explore how participants can continue their learning on their own and with support from others.

conclusion

This article provides an initial glimpse into counselor skill building with GLB issues, an area that has not yet been investigated by our profession. We encourage the continued development of knowledge regarding GLB and general MC issues and the development of self-awareness and other awareness, but we also advocate for the practical application of skills to improve counselor competence. We feel that our model for skill development provides a starting point for enhancing GLB/MC counseling skill, and we look forward to seeing additional development in this area.

Note. As heterosexual allies interested in learning how to better work with our GLB clients, we completed a GLB issues in counseling course as part of our doctoral program in counseling psychology. We found the knowledge and self/ other awareness gained in the class useful. However, we found the role-play experiences in which we engaged the most beneficial for our actual competence in working with this population. As a result, we began to think about how actual skill in working with GLB clients could best be facilitated once one has gained some basic knowledge and awareness. This article is a result of our thoughts and examinations of the literature in the area of skill building and reflects our desire as heterosexual allies to continue our growth in this area.

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Catherine E. Kocarek, Counseling Center, Bowling Green State University; Nadine J. Pelling, School of Psychology, University of South Australia. This article was presented as a skills workshop at the 1999 Canadian Psychological Association Conference in Halifax, Canada. Authorship for this article is shared equally. Correspondence concerning this article should be addressed to Nadine J. Pelling, School of Psychology, Division of Education, Arts and Social Sciences, University of South Australia, Adelaide, South Australia, Australia 5000 (e-mail: nadine_pelling@yahoo.com.au).
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Author:Kocarek, Catherine E.; Pelling, Nadine J.
Publication:Journal of Multicultural Counseling and Development
Geographic Code:1USA
Date:Apr 1, 2003
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