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Charting the center and the margins: addressing identity, marginalization, and privilege in counseling.

In order to address the inequities experienced by individuals who experience multiple forms of marginalization, counselors must be able to make linkages between identity, marginalization, and privilege. Equally important is the need to balance individual counseling with advocacy. This perspective requires counselors to understand how identities intersect and the ways in which a counselor's and client's statuses as members of privileged and marginalized groups influence the therapeutic relationship. These expectations are based on the new Multicultural and Social Justice Counseling Competencies (MSJCC), which were recently endorsed by the American Counseling Association. To address these challenges, and to operationalize the MSJCC, the Multicultural and Social Justice Counseling Competencies--Assessment Form (MSJCC-AF) is introduced. This form incorporates intersectionalities and advocacy with counseling.

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The multicultural and social justice counseling movements allege that they speak for all marginalized groups. Both movements contend they are about promoting inclusion, embracing diversity, and eradicating oppression in all of its forms. Yet individuals who experience multiple forms of marginalization (e.g., transgender individuals of color, women of color) continue to live on the margins. Their experiences are largely ignored in the counseling and psychology literature. While counseling and psychology have made great strides in advancing knowledge of marginalized populations (e.g., people of color), less is understood about issues pertaining to individuals who experience multiple forms of marginalization (e.g., women of color), and even less about how privilege and marginalization intersect in people's everyday lives (e.g., for heterosexual women of color). This outcome exists in part because the dominant discourse within the multicultural and social justice counseling perspectives uses singular analytical categories to conceptualize social identity (Silverstein, 2006). When categories that make up social identity are viewed as mutually exclusive, it can lead to the assumption, for example, that all lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals are White, or to the erroneous belief that people who experience multiple forms of marginalization do not also benefit from power and privilege if they possess a privileged identity status. Consequently, issues pertaining to individuals who experience marginalization on multiple levels fall between the cracks, and these individuals' stories and lived experiences remain largely untold and undocumented.

All individuals present a multiplicity of intersecting identities, as well as privileged and marginalized statuses, shaped by motivating forces both internal (e.g., sense of self) and external (e.g., societal oppression) that need consideration. This need arises in part because the amalgamation of identities, and of marginalized and privileged statuses, intersects in ways that lead to marginalization for individuals who are multiply marginalized. For example, women of color are twice as likely to live in poverty compared with non-Latina White women (Downing, 2014). These inequities are attributed to experiencing multiple forms of marginalization (Singh, 2010). Attending to these multicultural and social justice issues is critical. Yet the counseling profession's response to the needs of individuals who are marginalized in multiple ways has been grossly inadequate. Moreover, the single analytical framework popular in counseling and psychology fails to acknowledge the multiple categories of social group identity and of intersecting privileged and marginalized statuses that such clients bring to counseling (Savneet, 2010). A new multidimensional framework is needed.

The concept of intersectionality was coined by Crenshaw (1989), who argued the need to integrate the feminist and antiracism movements to acknowledge the experiences of women of color, who were often left out of the discourse on race and gender. Intersectionality requires being cognizant of within-group differences as well as between-group differences (Crenshaw, 1991). Unfortunately, the lack of clearly established frameworks for addressing intersectionality in counseling makes it difficult for intersectional awareness to gain traction in clinical practice. Given this absence, mental health practitioners may feel inadequate in addressing the multiple categories of identity and status that they and their clients bring to counseling.

When counselors take an intersectional approach in their work, they begin to see how different aspects of identity intersect and connect in the lives of clients. Moreover, counselors begin to realize how client identities are connected to privilege and marginalization in society. This realization leads counselors to recognize that social justice advocacy can be warranted. A social justice advocacy perspective incorporates multilevel interventions and strategies that require counselors to work inside and outside the office environment (Ratts, Toporek, & Lewis, 2010). Such a practice is based on the belief that individual counseling can be helpful in addressing internally based psychological issues, while social justice advocacy can be important to addressing externally based systemic issues. Balancing these two divergent but complementary approaches is important. This article will explore these complex connections.

Addressing the constellation of identities, including privileged and marginalized statuses of individuals in counseling, while incorporating advocacy with counseling requires new structures, models, and approaches. The Multicultural and Social Justice Counseling Competencies (MSJCC) were created to address these new expectations and challenges (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015). No articles to date incorporate intersectionalities and advocacy with the new MSJCC. The MSJCC, developed by Ratts, Singh, Nassar-McMillan, Butler, and McCullough (2016), revise the Multicultural Counseling Competencies (MCC) created by Sue, Arredondo, and McDavis (1992). The American Counseling Association (ACA) has also endorsed the MSJCC.

Currently, there is a theory-to-practice gap that exists for the MSJCC clue to their relative newness in the field. There are no articles to date illustrating practical application of the MSJCC with clients. To address this gap, this article introduces the Multicultural and Social Justice Counseling Competencies--Assessment Form (MSJCC-AF). This form was developed based on the MSJCC. First, an overview of intersectionality is discussed. Next, the MSJCC are introduced to provide context for the use of the MSJCC-AF in counseling and advocacy work. An explanation of the MSJCC-AF is then provided as it applies to clinical practice.

INTERSECTIONALITIES: BRIDGING IDENTITY, MARGINALIZATION, AND PRIVILEGE

Identity, marginalization, and privilege are intertwined. The complexities of identity combine to create a web of privilege and marginalization that influences access to resources such as employment opportunities, quality educational experiences, and equitable access to health care. For purposes of this article, identity is defined as a social category that people give meaning to, such as race, ethnicity, gender, sexual orientation, age, disability status, religion, and economic class, to list a few (Ashmore, Deaux, & McLaughlin-Volpe, 2004). All individuals belong to multiple intersecting social categories. Statuses refer to whether one's identity leads to marginalization (disadvantage) or privilege (advantage) in society. Within the United States, racial identity leads to privilege for White people and marginalization for people of color (Adams, Bell, Goodman, & Joshi, 2016). People can experience both marginalization and privilege due to multiple aspects of their identities (Shield, 2008).

The link between identity, marginalization, and privilege is not readily apparent within the counseling and psychology literature. Social group identity is conceptualized as mutually exclusive, or when connections are made between multiple intersecting identities, such links fail to fully recognize the relationship between marginalized and privileged aspects of identity (Silverstein, 2006). For example, it is not uncommon to disregard the privileged aspect of a person's identity if that person is a member of a marginalized group. The lack of attention to how multiple social categories of identity and status intersect to shape experiences and outcomes is concerning. Evidence of this concern is reflected in three areas of counseling and psychology: (1) research, (2) conceptual models used to explain identity, and (3) language used by mental health practitioners to communicate about intersectionality. Each is briefly discussed here.

Research

Although multiple categories of social group identity intersect in the lives of everyday people, these overlapping identities are conceptualized as mutually exclusive in the research. Boehmer's (2002) search of the MEDLINE database of articles published between 1980 and 1999 found that most articles (85%) omitted the race and ethnicity of LGBTQ participants. More recent research confirms that not much has changed. Singh and Shelton's (2011) content analysis of qualitative studies with LGBTQ participants concluded that there was a lack of research on LGBTQ individuals who are multiply marginalized. Similarly, Coulter, Kenst, Bowen, and Scout (2014) found that LGBTQ-oriented research funded by the National Institutes of Health lacked attention to understanding the health risks of subpopulations within the LGBTQ community. Reimers and Stabb's (2015) content analysis of The Counseling Psychologist and the Journal of Counseling Psychology over a 15-year period found that only 39% of research articles included class, race, and gender in an integrated way, and only 1.9% considered these three categories in a primary way. These studies support what has been known for some time: that health professionals have ignored the importance of intersectionality as a construct. This research gap has been attributed to the lack of a framework for studying intersectionality (Cole, 2009; Hancock, 2007; McCall, 2005; Warner, 2008). Although research conceptualizing identity development as a dynamic and intersecting process exists (Jones & McEwen, 2000), these studies are in the minority.

Conceptual Models

The lack of research on multiple intersecting identities means an absence of new knowledge and conceptual frameworks exploring intersectionality in meaningful ways. There is continued use of antiquated singular analytical frameworks to understand identity in counseling and psychology. For example, racial (Atkinson, Morten, & Sue, 2003; Hardiman, 1982; Helms & Cook, 1999) and sexual (Cass, 1979; Klein, 2013) identity models theorizing race and sex as discrete variables continue to be the popular modus operandi for understanding racial and sexual identity. While relevant for their time, such identity development models do not accurately depict people's experiences. When counselors resort to single analytical frameworks to understand identity, they run the risk of misunderstanding client experiences. Moreover, they fail to understand how a person can simultaneously benefit from privilege while being disadvantaged by oppression.

Language

The language used to communicate about identity, marginalization, and privilege further contributes to mental health professionals' inability to understand the full range of human experiences. For example, use of the term women and people of color or women/people of color implies that all women are White and that people of color are male. Even the term woman of color is restrictive because it obscures other equally relevant facets of identity beyond race and gender. Similarly, the acronym LGBTQ also disregards other relevant aspects of identity. When LGBTQ is used as an umbrella term to encompass the experiences of sexual and gender minorities, it can be easy to incorrectly group the health experiences of the populations represented in this acronym together (Institute of Medicine, 2011). While there are shared experiences among these groups, each population represented in the acronym is a distinct group with unique health concerns. Additionally, use of the term LGBTQ does not fully encompass the diversity of the community, such as transgender individuals of color. This omission makes it challenging to understand subpopulations within the LGBTQ community. Moreover, use of these terms, and those similar to them, conceals the fact that identity and statuses are multidimensional and interlocking (Bowleg, 2012).

The above limitations led to the rise of intersectionality as a construct worthy of study. Yet, in spite of the benefits intersectionality theory has to offer counseling and psychology, it is not without flaws. While the literature on intersectionality has largely brought attention to the experiences of individuals with multiple marginalized statuses, such as Black women of color (Ferguson, 1998), it tends to ignore the consideration that individuals who experience marginalization can also hold privileged statuses (Nash, 2008). For example, Crenshaw's (1989) landmark publication on intersectionality failed to acknowledge that some women of color possess identities that lead to privilege in society. The implicit message is that people are either privileged or marginalized. Privileged statuses are ignored due to the invisible nature of privilege itself (Mcintosh, 1986). Thus, it can be easy to target a person's marginalized status while ignoring other aspects of identity that lead to privilege. Yet the tripartite relationship between identity, marginalization, and privilege impacts the lives of people on a daily basis (Adams et al., 2013).

Better linkages between identity and marginalized and privileged statuses need to be reflected in the theories, structures, and language used in counseling. This point is particularly important when working with individuals who experience multiple forms of marginalization. Understanding the ways that identities and statuses intersect cannot be achieved by using already existing structures and frameworks. Such theories may not accurately encapsulate all aspects of a person's identity. A multidimensional framework and language that fully capture the constellation of identities and statuses people bring to counseling are needed: hence, the development of the MSJCC in counseling.

MULTICULTURAL AND SOCIAL JUSTICE COUNSELING COMPETENCIES: AN OVERVIEW

The MSJCC are aspirational standards for mental health professionals. One ideal is that counselors will be competent in addressing intersecting identities and marginalized and privileged statuses that are prevalent between clients and counselors. Another ideal is that mental health professionals will be competent in providing office-based individual counseling and out-of-office-based advocacy counseling. Successfully balancing these two needs will be the challenge for professional counselors. The MSJCC provide a framework that acknowledges the different ways identity, marginalization, and privilege intersect. What perhaps is unique about the MSJCC is that they consider both counselor and client identities as equally important to understanding the counseling and advocacy relationship (see Figure 1).

At the core of the MSJCC is multicultural and social justice praxis. The assumption is that counselors should use strategies and techniques that align with clients' cultural background and that their work should promote social justice. The MSJCC also introduce new language to the counseling and psychology fields around intersectionality: quadrants and domains. Quadrants represent the interactive nature of power, privilege, and oppression between counselor and client. The quadrant that represents the counselor and client relationship shifts from moment to moment and is dependent on which identity or which marginalized or privileged status is salient for the counselor and the client at a given moment in time. This change occurs because the salience of identity and of marginalized and privileged statuses is constantly changing from one moment to the next (Jones & McEwen, 2000).

Domains, which are represented by the concentric circles in the MSJCC conceptual framework, signify the developmental sequence needed to understand intersectionality: (1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling and advocacy interventions. New competencies were also developed for the MSJCC. Aspirational competencies are highlighted in the counselor self-awareness, client worldview, and counseling relationship domains identified above: attitudes and beliefs, knowledge, skills, and action (AKSA). These competencies build on each other. Attitudes and beliefs lead to knowledge, then to skills, and finally to action.

The socioecological model (SEM) is embedded in the counseling and advocacy interventions domain to illustrate the need to take a multilevel approach with clients. This domain includes separate competencies for interventions at the interpersonal, intrapersonal, institutional, community, public policy, and global/international levels. The SEM acknowledges the symbiotic relationship between individuals and their environment (McLeroy, Bibeau, Steckler, & Glanz, 1988). Within the context of counseling, the SEM provides a multilevel framework for health promotion interventions. Moreover, counseling interventions can occur at the intrapersonal (e.g., individual attitudes, beliefs, and attributes), interpersonal (e.g., family, friends, colleagues), institutional (e.g., school, churches, businesses), community (e.g., spoken and unspoken values and norms in society), public policy (e.g., rules, laws, and policies), or global/international (e.g., world affairs) levels. The SEM requires counselors to intervene with the individual as well as with people, institutions, community norms, policies, and global issues that come into contact with the individual client. Moreover, the multilevel framework that the SEM provides requires counselors to work both inside and outside of the office setting.

MULTICULTURAL AND SOCIAL JUSTICE COUNSELING COMPETENCIES-ASSESSMENT FORM

The MSJCC can potentially transform how counseling is practiced. However, they are a document that is still in its infancy in the field. To help advance practical application of the MSJCC in multicultural counseling and social justice advocacy work, this article introduces the MSJCC-AF (see Appendix A). The MSJCC-AF charts counselor and client identities, and marginalized and privileged statuses, and it helps frame interventions around the SEM. This form can be incorporated into an existing intake form or used as a stand-alone document. It is intended for use at the beginning of sessions as a way to continually evaluate the salience of identity, marginalization, and privilege between counselor and client. Counselors can begin an initial session by charting counselor and client identity and marginalized and privileged statuses. Ideally, a counselor would do this in collaboration with a client. This form provides a means for counselors to initiate discussion with clients regarding the salience of identity, marginalization, and privilege. Such discussions can be important to understanding how power, privilege, and oppression dynamics influence the counseling and advocacy relationship. Each aspect of the form is highlighted here.

Social Group Identities and Statuses

A list of social group categories that shape counselor and client identities as well as marginalized and privileged statuses is provided. This list includes race, gender, sexuality, class, age, ability, and religion. These social group categories are not meant to be exhaustive. This list is intended as a starting point for exploration and further discussion. An "other" category is added so that more social group categories that are relevant to the counselor and client relationship can be considered.

Identity. The identities section of the form requires counselors and clients to list the various identities that correspond to their social group membership. The race category includes the following racial groups: African American/ Black, Asian American, Latino/a American, Native American/Indian, European American/White, and biracial/multiracial. The gender category refers to male, female, and nonbiliary individuals and to cisgender and transgender individuals. Sexuality pertains to lesbian, gay, bisexual, asexual, and heterosexual identity. The class category includes individuals in the working, middle, and upper classes. Age refers to youth and to middle-aged and elder individuals. Ability concerns individuals who are temporarily able-bodied and those who have visible and/or invisible disabilities. Religion pertains to an individual's faith, such as Buddhism, Christianity, or Mormonism.

Marginalized. In the marginalized category, a check mark is placed if an identity leads to marginalization in society. Identities that do not lead to marginalization are left blank. Individuals who are marginalized in the United States are people of color (African American/Black, Asian American, Latino/a American, Native American/Indian, and biracial/multiracial), gender (women, transgender or gender-nonconforming individuals), sexuality (lesbian, gay, and bisexual individuals), socioeconomic class (individuals in poverty), age (youth and elders), ability (individuals with mental and physical disability), and religion (Buddhists, Muslims, Mormons, etc.; Adams et al., 2016).

Privileged. In the privileged category, a check mark is added if an identity leads to privilege in society. The counselor or client should leave blank social group categories that do not lead to privilege. In the United States, people hold privileged statuses in society based on categories including race (White and biracial/multiracial individuals), gender (men), sexuality (heterosexual individuals), class (upper-class individuals), age (young adult and middle-aged individuals), ability (individuals who are temporarily able-bodied), and religion (Christians; Adams et al., 2016).

Salience. Within the salience category, client and counselor can check which aspect(s) of identity they tend to be conscious of in the counseling relationship. T he salience of identity can vary from session to session and even from moment to moment. Therefore, it is important for counselors to periodically check in with clients about what aspects of identity seem salient at a given moment in time.

Totals. The counselor and client should add up the total number of marginalized and privileged identities as well as those that are salient for the counselor and then for the client. These totals can be an important reference point for discussion. The total number of marginalized and privileged statuses for counselor and client can determine how identities as well as power and privilege influence the counseling and advocacy relationship. Moreover, it can shed light on who holds power and privilege and who is marginalized in the relationship relative to social group identity.

Counseling and Advocacy Interventions

The SEM is used to explore spheres of influence and to identify potential counseling and advocacy interventions. Identifying the various influences on a client can provide insight into the extent to which counseling and advocacy interventions are needed. Moreover, counselors can determine with clients whether to intervene at the interpersonal, intrapersonal, institutional, community, public policy, and/or global/international levels. The following guidelines can be helpful in exploring the spheres of influence on a client's life:

* Intrapersonal: Explore the client's values, beliefs, biases, and worldview relative to the presenting problem. Determining whether the client is individualistic and/or collectivistic in orientation can also help determine how the client experiences the world and makes life decisions.

* Interpersonal: Identify the people who come into contact with the client. Determine supportive and nonsupportive family, friends, colleagues, peers, etc. Also, identify potential sources of support if the client has no sources of support.

* Institutional: Identify institutions (e.g., school, business, work, church) that come into interaction with the client. Determine whether these institutions are supportive or nonsupportive of the client. Explore whether current/additional institutions can be sources of support.

* Community: Identify community norms and values that influence the client's perception of the presenting problem.

* Public Policy: Determine how policies (e.g., rules and laws) support and/or do not support the client. Explore whether policies need to be restructured and/or whether new polices need to be created to support the client.

* Global/International: Explore how world affairs contribute to the client's life in both positive and negative ways.

Exploring these spheres of influence can help contextualize client problems. Moreover, spheres of influence can be used to ascertain the degree to which client problems are internally and/or externally driven. This analysis can help determine the extent to which interventions need to occur on the interpersonal, intrapersonal, institutional, community, public policy, and/or global/international levels.

CONCLUSION

The MSJCC-AF supports the new MSJCC as a tool that can inform counseling intervention, teaching, and research. In terms of intervention, the MSJCC-AF can be incorporated into an intake at the outset of counseling. Using the MSJCC-AF during the intake process allows counselors to explore intersectionalities, to determine the contextual factors contributing to client problems, and to consider multilevel interventions using the SEM as a framework. Exploring intersectionalities with clients and determining the contextual factors contributing to client problems likely may not pose too difficult a challenge for counselors. What might be challenging is determining how to employ interventions along the SEM. Many organizations are not set up to allow counselors to work in the community. Most organizations focus on direct interventions that take place in an office environment. Being able to have counselors work in the community will require a change in how services are delivered. There may also be concerns related to client confidentiality and counselor safety when counselors work in the community. These challenges will need to be addressed within individual organizations if the MSJCC-AF is to be fully operationalized.

With respect to teaching, since the MSJCC are relatively new to the field, training will first be needed to introduce helping professionals to the new competencies. Once individuals have a firm grasp of the constructs and framework of the MSJCC, it would be appropriate to introduce helping professionals to the MSJCC-AF. Training on how to apply the MSJCC-AF will likely vary based on an organization's setting. For example, mental health facilities might be able to integrate the MSJCC-AF into their intake forms. Regardless of setting, such trainings will need to cover the costs and benefits of using the MSjCC-AF. The helping professionals who use the form will also need to be well versed on multicultural and social justice issues. For example, they need to be comfortable with discussions around power, privilege, and oppression. They also need to know how to navigate the identities that counselors and clients bring to the working relationship.

Since the MSJCC-AF is a relatively new tool, research will need to be conducted to determine its usefulness to practitioners. For example, does the MSJCC-AF address the constructs identified in the MSJCC? Is the MSJCC-AF a useful tool to address intersectionalities, power, and privilege dynamics in the counseling and advocacy relationship? What are the strengths and gaps inherent in the MSJCC-AF? These questions can be appropriately explored through research.

The MSJCC-AF was developed as a tool to help practitioners operationalize the MSJCC. Mental health professionals who use this form will find that it requires a new way of doing things. More attention from the outset will be required of mental health professionals to discuss the ways identity, marginalization, and privilege intersect in counseling. Integrating advocacy as an intervention will also expand the range of what counselors can offer clients. To be responsive to these new expectations, further training will be required. Professional development can help counselors develop awareness, knowledge, skills, and action plans to implement this new tool with clients.

doi: 10.17744/mehc.39.2.01

Manivong J. Ratts

Seattle University

Manivong J. Ratts, Department of Leadership and Professional Studies, College of Education, Seattle University.

Correspondence concerning this article should be addressed to Manivong J. Ratts, Department of Leadership and Professional Studies, College of Education, Seattle University, Loyola 216, Seattle, WA 98122. E-mail: vong@seattleu.edu

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APPENDIX A

MULTICULTURAL AND SOCIAL JUSTICE COUNSELING COMPETENCIES-ASSESSMENT FORM

Overview: The Multicultural and Social Justice Counseling Competencies--Assessment Form (MSJCC-AF) is intended for use at the outset of counseling and advocacy work with clients. It can also be used periodically in sessions with clients. The form includes two parts. Part A of the form identifies the salience of identities and of marginalized and privileged statuses between client and counselor. Part B of the form explores taking action at the intrapersonal, interpersonal, institutional, community, public policy, and/or global/international levels. Copyright 2016 by Manivong J. Ratts.

Directions: Collaborate with the client to complete Part A and Part B of the MSJCC-AF.

Part A: Counselor and Client Identities

Identities: Using the table provided, list counselor and client identities. Add identities that are relevant if they are not listed. Neither client nor counselor should share identities they are uncomfortable sharing.

Marginalized and Privileged Statuses: Place a check mark on identities that are marginalized or privileged for the counselor and the client. Privileged identities include race (White individuals), gender (men, cisgender individuals), sexuality (heterosexual individuals), class (upper-class individuals), age (young adult, middle-aged individuals), ability (individuals who are temporarily able-bodied), and religion (Christians). Marginalized identities include race (people of color: African American/Black, Asian American, Latino/a American, Native American/Indian, biracial/multiracial individuals), gender (women, nonbiliary individuals, gender-nonconforming individuals, transgender individuals), sexuality (asexual, lesbian, gay, and bisexual individuals), class (individuals in poverty), age (youth and elders), ability (individuals with mental and/ or physical disability), and religion (non-Christians).

Salience: Identify which identity is salient for the client and for the counselor in the therapeutic relationship by stating "Yes" if an identity is salient and "No" if an identity is nonsalient.

Total: Total the number of check marks placed for all marginalized, privileged, and salient identities in the column provided. Aggregate scores are meant to generate discussion around identity, marginalization, and privilege between client and counselor.

Salient/Nonsalient Identities: List identities that are salient/nonsalient for counselor and client under the "salient identities" and "nonsalient identities" section. Discuss what makes these identities salient or nonsalient and their influence on the therapeutic relationship for counselor and client.

Part A: Counselor and Client Identities

Counselor

Social Group     Identity   Marginalized   Privileged   Salience
                                                         (Y/N)

Race
Gender
Sexuality
Class
Age
Ability
Religion
Other
Total

Client

Social Group     Identity   Marginalized   Privileged   Salience
                                                         (Y/N)

Race
Gender
Sexuality
Class
Age
Ability
Religion
Other
Total


How do counselor and client salient identities influence the therapeutic relationship?

How do counselor and client nonsalient identities influence the therapeutic relationship?

Part B: Counseling and Advocacy Interventions

1. Spheres of Influence: Identify the various influences in the client's life in the table provided. Collaborate with the client to explore whether a particular sphere of influence is (1) not supportive, (2) somewhat supportive, (3) supportive, or (4) very supportive of the client's mental health and psychological well-being. Use "N/A" if a category is not applicable. Place a check mark in the appropriate box that corresponds to each level of influence. An "Other" category is provided for each sphere of influence if needed. Explore with the client the following spheres of influence:

* Intrapersonal: Explore the extent to which the client's attitudes, beliefs, behaviors, biological history, and personal history contribute to the mental health and psychological well-being of the client.

* Interpersonal: Explore the extent to which the client's family, friends, significant others, and/or colleagues contribute to the mental health and psychological well-being of the client.

* Institutional: Explore the extent to which institutions such as schools, businesses, employment, religious institutions, and other institutions contribute to the mental health and psychological well-being of the client.

* Community: Explore the extent to which family, social/cultural, community, and/or school/workplace norms contribute to the mental health and psychological well-being of the client.

* Public Policy: Explore the extent to which local, state, national, and/ or international policies and laws contribute to the mental health and psychological well-being of the client.

* Global/International: Explore the extent to which international events, politics, global economics, and war and terrorism contribute to the mental health and psychological well-being of the client.

2. Total Scores: Total the number of check marks placed under the "Not Supportive," "Somewhat Supportive," "Supportive," and "Very Supportive" columns for each sphere of influence. Aggregate scores are meant to generate discussion around the extent to which a sphere of influence impacts the client.

3. Action Steps: The second handout for Part B provides a framework for exploring support systems and potential interventions at the intrapersonal, interpersonal, institutional, community, public policy, and international/global levels. Action steps occur with in-office strategies and extend to out-of-office strategies.

Part B: Counseling and Advocacy Interventions

Action       Spheres of           Items            Not        Somewhat
              Influence                         Supportive   Supportive

In-Office   Interpersonal   Attitudes/Beliefs
                            Individual
                              Behaviors
                            Biological
                              History
                            Personal History
                            Other:
                            Total

            Intrapersonal   Family
                            Friends
                            Significant
                              Other(s)
                            Colleagues
                            Other:
                            Total

            Institutional   School
                            Business
                            Religious
                              Institution
                            Employment
                            Other:
                            Total

Ouc-of-       Community     Family Norms
Office                      Social/Cultural
                              Norms
                            School Norms
                            Workplace Norms
                            Other:
                            Total

            Public Policy   Local
                            State
                            National
                            International
                            Other:
                            Total

               Global/      International
            International     Events
                            International
                              Politics
                            Global Economics
                            War and Terrorism
                            Other:
                            Total

Action       Spheres of           Items         Supportive      Very
              Influence                                      Supportive

In-Office   Interpersonal   Attitudes/Beliefs
                            Individual
                              Behaviors
                            Biological
                              History
                            Personal History
                            Other:
                            Total

            Intrapersonal   Family
                            Friends
                            Significant
                              Other(s)
                            Colleagues
                            Other:
                            Total

            Institutional   School
                            Business
                            Religious
                              Institution
                            Employment
                            Other:
                            Total

Ouc-of-       Community     Family Norms
Office                      Social/Cultural
                              Norms
                            School Norms
                            Workplace Norms
                            Other:
                            Total

            Public Policy   Local
                            State
                            National
                            International
                            Other:
                            Total

               Global/      International
            International     Events
                            International
                              Politics
                            Global Economics
                            War and Terrorism
                            Other:
                            Total

Part B: Counseling and Advocacy Interventions

Action           Spheres of              Identify supportive and
                 Influence               nonsupportive influences
                                         within each sphere of
                                         influence. Then identify
                                         potential interventions
                                         within each sphere of
                                         influence if applicable.

In-Office        Interpersonal
                 Intrapersonal
                 Institutional
Out-of-Office    Community
                 Public Policy
                 Global/International


Caption: Figure I. Multicultural and Social Justice Counseling Competencies. From "Multicultural and Social Justice Counseling Competencies," by M. J. Ratts, A. A. Singh, S. Nassar-McMillan, S. K. Butler, & J. R. McCullough. Retrieved from the American Counseling Association Knowledge Center, http://www.counseling.org/knowledge-center/competencies. Cop/right 2015 by M. J. Ratts, A. A. Singh, S. NassarMcMillan, S. K. Butler, & J. R. McCullough. Reprinted with permission.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:PRACTICE
Author:Ratts, Manivong J.
Publication:Journal of Mental Health Counseling
Article Type:Report
Date:Apr 1, 2017
Words:6135
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