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Facilitating trainees' multicultural development and social justice advocacy through a refugee/immigrant mental health program.

Many counseling theories based on dominant group members (e.g., White, heterosexual, middle class) have failed to address the needs of ethnic and racial minority groups and other historically disempowered individuals (e.g., Jackson, 1995; Sue & Sue, 1999). The significance of professional multicultural sensitivity was brought to the forefront of the field with Sue, Arredondo, and McDavis's (1992) development of the Multicultural Counseling Competencies. These competencies suggest that counselors need to develop awareness of themselves as cultural beings, knowledge of different cultures, and consciousness of the impact of oppression and discrimination on individuals. Furthermore, the guidelines emphasize the need to develop skills in carrying out effective interventions for culturally diverse clients (e.g., Arredondo et al., 1996; Sue et al., 1992).

In addition to multicultural models and theories, feminist counseling theories have also highlighted the influence of contextual factors (e.g., political, social, cultural, and economic; e.g., Austad, 2009; Enns, 1997) on clients' lives; however, many, if not most, mental health professionals continue to apply counseling theories solely at the individual level (e.g., Goodman et al., 2004; Matthews & Skowron, 2004; Vera & Speight, 2003). Although individual counseling is beneficial to many clients and issues, it is limited in remediating mental health concerns that may arise from systemic issues in society, such as poverty and discrimination (e.g., Constantine, Hage, Kindaichi, & Bryant, 2007; Fouad et al., 2004; Prilleltensky & Prilleltensky, 2003; Vera & Speight, 2003). This increased attention to systemic influences on mental health has led scholars to urge counselors and other mental health professionals to expand their professional roles beyond the individual level to also include work at other levels, including communities, organizations, and political institutions (Goodman et al., 2004; Prilleltensky & Prilleltensky, 2003; Vera & Speight, 2003). Engagement, social justice activism, or advocacy at such levels is believed to more effectively create social change.

Social justice has been defined as "the fundamental valuing of fairness and equity in resources, rights, and treatment for marginalized individuals and groups of people who do not share equal power in society" (Constantine et al., 2007, p. 24). Advocacy refers to activity or action directed toward changing or transforming the process by which public decisions are made, and hence, affecting the political, social, and economic contexts that significantly influence peoples' lives (Cohen, 2001). Some scholars have proposed that social justice advocacy and multicultural competency need to be combined to best serve mental health clients (e.g., Comstock et al., 2008; Crethar, Torres Rivera, & Nash, 2008; Vera & Speight, 2003). Others have pointed out that multicultural competency is deeply intertwined with professionals' ability to engage in social justice advocacy (e.g., Chung, Bemak, Ortiz, & Sandoval-Perez, 2008; Constantine et al., 2007; Kiselica & Robinson, 2001).

In 2002, the American Counseling Association (ACA) put forth the ACA Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002) to provide guidance for counselors in pursuing advocacy work as an ethical aspect of service delivery. These advocacy competencies involve acting with, or on behalf of, oppressed parties on three levels: the client student level, the school-community level, and the public arena. As Lewis et al. (2002) noted, advocating on the client-student level might include empowering a client to use his or her strengths and resources to confront discrimination, or acting on the client's behalf to help him or her gain access to resources. On a community level, advocacy could entail collaborating with organizations to fight social injustices, or working to change unfair policies on a systems level. Finally, public arena advocacy might involve efforts to educate the public about an important social justice issue, or advocating for a change in a large arena (e.g., statewide legislation).

However, despite this call for increased involvement in social justice advocacy, this value appears not to have fully filtered down to graduate training programs and its trainees (Nilsson & Schmidt, 2005). Actually, there is little evidence that educators encourage students to act individually or in groups to produce social change (Chizhik & Chizhik, 2002; Nilsson & Schmidt, 2005; Rivera-Mosquera, Phillips, Castelino, Martin, & Dobran, 2007). This is unfortunate given that the development of a social justice orientation appears to be an orientation and skill set that needs to be at least partly taught (Broido, 2000).

Currently, there is no established "best practice" for facilitating multicultural competency or social justice advocacy in counselor trainees. There is some evidence that academic course work alone lacks the ability to generate student interest in social welfare problems (Anderson & Harris, 2005). A growing, but limited, body of research suggests that students engaged in experiential, service learning programs can gain the knowledge, attitudes, and skills necessary for multiculmral and social advocacy competence (Astin, Vogelgesang, Ikeda, & Yess, 2001; Ngai, 2006; Rocha, 2000).

Service learning is a teaching strategy that reinforces academic content by giving students practical hands-on experiences in addressing a community need. Research has shown that such hands-on experience can result in increased self-awareness and understanding of others as well commitment to social activism. For example, Astin et al. (2001) examined the impact of a course-based community service intervention on undergraduates' cognitive and emotional development and found that it was associated with more racial understanding, stronger commitment to activism, and greater desire to pursue a career in a service-oriented field after college. Similarly, Ngai (2006) found that among college students in Hong Kong, those who had participated in community service for 120 hours across the summer semester reported more awareness of themselves and their privileges, greater awareness of social injustices, and increased commitment to community service. The community services that these students were involved with included working with underprivileged youth and immigrants. In a comparison study of graduate students in social work, Rocha (2000) found that students who had participated in a course that focused on developing skills in policy efforts, such as persuasion skills, building coalitions, and organizing phone campaigns for advocacy efforts, were both more involved and felt more competent in engaging in policy-related activities compared with students not taking the course. Specifically, these students were more likely to engage in change efforts by being members of committees and coalitions and organizing activities sponsored by a committee or coalition.

For the last 8 years, the counseling department of a mid-western university has provided a service learning venue for counseling trainees to work with refugee and immigrant women. This grant-funded mental health program focuses on serving immigrant and refugee women in the areas of adjustment to the United States, mental health, and domestic violence. The clients come from all over the world, but the majority comes from Somalia, Sudan, Vietnam, Mexico, and Pakistan. Students can be involved in any or all aspects of the program. They provide a variety of services, including psychoeducational workshops, counseling, and psychoeducational home visits. Through these services, they can help clients navigate a myriad of challenges, such as domestic violence, language and career barriers, intergenerational family conflicts, and acculturation struggles.

Students are trained in refugee and immigration policies and processes and the many issues faced by refugee and immigrant populations, including pre- and postimmigration trauma, acculturation, and domestic violence, In addition, those who counsel clients in individual therapy or via psychoeducational home visits are taught that they will be asked to engage in activities that may not normally be associated with traditional counseling. Such activities have consisted of communications with social services, domestic violence shelter staff, and immigration personnel; acting as advocates by way of calling housing authorities, schools, and lawyers on their clients' behalf; working closely with program staff, which includes case managers or advocates of refugee and immigrant backgrounds; and using interpreters to provide services for clients with limited English-speaking ability. All students are supervised for their counseling work by faculty or adjunct instructors. The purpose of this study was to explore students' perceptions and experiences of working with clients who were culturally different in an advocacy capacity.

* Method

Participants

We interviewed 12 graduate students in counseling/counseling psychology, including three master's-level and nine doctoral-level students, all women. Of the participants, 10 self-identified as White, one as African American, and one as Caribbean. Length of involvement in the program varied, with a range of 3 months to 6 years (M = 2.27 years). Depth of involvement within the program also varied. All but one participant had attended or facilitated (students could present, help run workshops, or just observe or attend) psychoeducational workshops, and involvement ranged from two to 15 workshops (M = 5.33). Six students conducted home visits (number of sessions, M = 3.00). Six students provided individual counseling, with most seeing only one client (number of sessions, M = 8.67).

Questionnaire and Procedure

Graduate students who had been involved in the program were contacted via e-mail or phone and were told that interviewers were interested in learning about their experiences. Those interested in participation contacted one of two interviewers to schedule an interview time. Informed consent was discussed prior to the interviews, and written information was provided for each participant. Participants were asked three questions regarding their experiences in the program (using a semistructured interview format): (a) What things have you learned from being involved in the [name of] program? (b) Have you learned anything about yourself or your own culture from your involvement in the program? and (c) In your opinion, has working with the [name of] program been beneficial to you (and if so, how)? None of the interview questions, or follow-up questions, contained the phrases "multicultural competence" or "social advocacy."

Interviews were conducted on a one-to-one basis and lasted between 30 minutes to 1 hour. They were recorded on audiocassette and then transcribed verbatim by an outside individual who was not informed of the study's intent. Participants were given the opportunity to review their interview transcripts to check for accuracy and to provide additional comments if they desired. No additional comments or inaccuracies were conveyed.

Researcher-as-Instrument Statement

Our research team was composed of a European American female faculty member (first author) and two female doctoral students (one Asian American [third author], one European American [second author]). Because the faculty member directs the program, she was she was not involved in recruiting or interviewing participants, nor was she given any identifying information about the participants. As a way to encourage the students' honest sharing about their experiences, they were informed that their comments would be analyzed anonymously and their responses would have no bearing on their participation or evaluation in the program. The two female doctoral students acted as interviewers. These two doctoral researchers had been involved in the program as student coordinators, but not in a supervisory or evaluative function of the participants. Most of the participants had a peer-based relationship with one or both of the interviewers; therefore, it is possible that using student coordinators as interviewers may have either encouraged or hindered honest reflections from the participants. Specifically, the interviewers' preexisting rapport with participants may have fostered more candid statements from the students, or conversely, the interviewers' identities and affiliations with the program may have unintentionally cultivated less candid responses.

Prior to data analysis, the research team discussed the values, assumptions, and biases each research team member had concerning the study. This process of "coming clean" or self-exploration was undertaken to increase the awareness of how our own views might influence the data analysis process and the development and presentation of the results (Locke, Spirduso, & Silverman, 1993; Yeh & Iman, 2007). Such self-exploration processes are considered imperative in qualitative research because the results of a study are influenced by the researchers' involvement in the data (Creswell, 1994; Marshall & Rossman, 1999; Patton, 1990; Strauss & Corbin, 1990). Through this process, we acknowledged our positive bias about the value of the program, and we expected to hear mostly positive statements regarding the participants' involvement. We expected that involvement in the program would be associated with a heightened awareness of other cultures and a greater sensitivity to refugee- and immigrant-specific issues. We also hypothesized that involvement in the program would facilitate social justice advocacy values and skills in the student counselors. Finally, we carried beliefs that multicultural and social justice advocacy competencies are important features to instill in developing counselors and that it is important to include such training in graduate programs.

Data Analysis

We chose to use qualitative methods for our study, as we sought to understand the nature of the participants' experience working with a culturally diverse population in a mental health and advocacy capacity, because we still know little about how a social justice orientation is developed and how students experience such training. We followed the analytical procedure for qualitative investigations proposed by Marshall and Rossman (1999). This involves six stages. Stage 1 is organizing the data; this stage involved becoming familiar with the data, and for the present study, this meant that all research team members individually read all interviews to gain familiarity with the data. In Stage 2 (generating categories, themes, and patterns), each team member individually focused on the same four transcripts (randomly selected) and examined these for patterns, recurrent ideas, or language to create themes. Then, the research team met, discussed, and compared categories and subcategories of the four transcripts with the intent to reach a consensus on categories and subcategories. After we reached an initial consensus of these categories and subcategories, two of the team members individually reread and coded the eight remaining transcripts, revising and adding subcategories when needed. Stage 3 involved coding; in this stage, the research team developed a coding scheme to code the data. The team met several times to discuss revisions of the categories and subcategories until all data were coded and final descriptions for each theme and subcategory were created. The next two stages, Stages 4 and 5, involved working with the data by testing emergent understandings and searching for alternative explanations; that is, we examined the data as a whole to develop a broad understanding of the patterns, including looking for patterns that did not fit the themes. We reconciled discrepancies by searching for alternative explanations to the data and by modifying categorizations when necessary. Stage 6 entailed writing up the report (Marshall & Rossman, 1999).

Once the data analysis was completed, a White male counseling psychologist with expertise in qualitative research audited the results to ensure the trustworthiness of the findings. As a way to ensure trustworthiness, the audit included an examination for confirmability (or objectivity), credibility, and dependability. Specifically, the auditor reviewed the methods, data analysis processes, interviews, and the findings (e.g., categories, subcategories) to ensure that the findings were based on the participants' actual reports (i.e., confirmability). Furthermore, he examined the findings to ensure that they were clear, internally consistent, and meaningful (i.e., credibility). Finally, he evaluated the quality of data collection processes (i.e., dependability), such as the methods used, research questions asked, and that the roles of the researchers were stable and consistent across time (Lincoln & Guba, 1985; Miles & Huberman, 1994). On the basis of the auditor's feedback, we collapsed two themes and renamed a subcategory to make the descriptions fit the data better.

* Results

The results revealed three main categories: (a) development of cultural knowledge, (b) counseling-related skills, and (c) personal growth and reactions. All the categories consisted of several subcategories (see Table 1).

Development of Cultural Knowledge

Development of cultural knowledge was defined as participants' processes of and reactions to learning about culture and the knowledge gained regarding culture and cultural differences. Cultural differences were further defined as cultural knowledge of the unique aspects of a culture (e.g., clothing, food, and gender roles), and understanding of the experiences people may have adjusting to a new culture. This category consisted of a wide range of responses, and three subcategories emerged: (a) the process of learning about culture, (b) factual knowledge, and (c) the understanding of adjustment difficulties.

The process of learning about culture. The first subcategory was identified as the process of learning about culture through participating in the various aspects of the program. Many participants reflected on the cultural learning process and described it as an intense experience. For instance, one participant described her experiences participating in the community workshops as follows:
   I've learned a lot culturally and kind of [about] my own comfort
   zones .... I was a little bit shyer at the beginning, or just
   because I hadn't been around a lot of different cultures or had a
   lot of cultural experience, especially with refugee women from
   other countries. I think when you are in the direct experience
   of being around five to six different cultures at once, with five
   or six languages going on at once, and things like that, I think
   it is just a huge learning experience.


For some participants, exposure to different cultures was initially uncomfortable but, in time, altered their views and perceptions of others. One student who did home visits in a poor area of town that she was not familiar with and also fearful of stated, "I kind of challenged myself to do it anyway and you know, the neighborhoods were not as scary."

In addition to talking about their process of learning about cultures, participants discussed that this process had taught them about how important culture is to people's identity and well-being. One student stated,
   I think I have grown a lot. I have learned a lot about just basic
   [things like] how important culture really is especially for
   people. I really understand why they would want to hold on
   to some of their ties and traditions.


Finally, a few participants also acknowledged that they still had much to learn and that learning about the different cultural groups would benefit them not just as counselors but also as individuals. "I learned that we have much we can learn from them." In these cases, the students often referred to the close relationships and sense of community they observed among the women at the workshops.

Factual knowledge. The second subcategory, factual knowledge, consisted of responses about increased education regarding specific cultural aspects, such as food, clothing, traditions, gender roles and behaviors, and cultural expression of emotions. This category also included information the students learned about how domestic violence is handled within different cultures and immigrant communities, and the roles that immigrant or refugee communities play for their members. All participants addressed learning at least some factual knowledge. In addressing what she learned, one student talked about the Somali culture:
   I really got to learn a little bit more about the women's
   perspective of being a Muslim woman because I always thought, you
   know, there's a lot of persecution against Muslim women in the
   Muslim community, and they don't have any rights; but you know the
   women who are Muslim really value their religion, and I learned to
   have an open mind about the fact that they don't perceive
   themselves to be in a differential position where they're lower
   than somebody else.


The understanding of adjustment difficulties. Included in this third subcategory were students' reflections about the challenges that refugees and immigrants may face as they adjust to the United States. Almost all participants spoke of learning about the challenges refugee and immigrant women may experience during this transition, such as changes in family roles (e.g., having children used as interpreters, changes in gender roles as women begin employment), adjusting to the U.S. system (e.g., learning about bus systems, the process of seeking employment), and experiencing unique immigration and legal issues (e.g., the hardship when being undocumented, the process of getting a green card). This subcategory also included emotional reactions that the participants observed in their clients as related to adjustment and dealing with cultural changes, such as the fears expressed by undocumented clients and the grief and suffering of refugee women. For example, one participant discussed her discovery that immigrants and refugees "suffer while being here." Another participant expressed greater appreciation for how difficult the transition could be and concluded the following about the adjustment process:
   Actually, it seems like a lot harder than 1 expected it to be ....
   You have a lot of people telling you that immigrants should
   do this and immigrants should do that. It's a lot easier to
   talk about what other people should do when they are in a
   new country and things like that when you've never had the
   experience of actually doing it and you're not hearing it from
   a person who's actually had to go through it.


Counseling-Related Skills

This category was defined as counseling-related activities and skills that the participants had to develop or engage in due to working with refugee and immigrant women. Specifically, this category included the participants' descriptions of the new skills or activities they had engaged in and their reactions and changes from performing these new skills or activities. Four subcategories developed in this category: (a) working with an interpreter, (b) doing home visits, (c) engaging in advocacy, and (d) improved counseling skills and confidence.

Working with an interpreter. Several participants reported working with an interpreter in counseling sessions or home visits for the first time, and almost all commented on the challenges with this process. For instance, participants commented on information getting lost in interpretation and clients' statements not being exactly interpreted. Although these challenges posed struggles to participants, some participants also commented on how their struggles allowed them to develop and use other skills. Several students reported that they had become more creative as counselors and that they learned to rely more on nonverbal communication, such as smiles, head nods, and pats on their clients' arms to convey their understandings. As described by one student, "because of language barriers and interpreters, I learned to use warmth and other ways to connect with the women." Another participant stated that she had become more tolerant:
   My tolerance, my understanding of working with clients who
   don't speak the same language that I do ... having to use an
   interpreter has broadened my awareness and my patience of
   working with clients who are not only culturally different, but
   [also] speak a different language.


Doing home visits. Several students commented on their experiences doing home visits (the second subcategory). For many, this seemed to have been a positive experience that provided them with more insight into their clients' cultures, daily lives, and challenges. "The home visits helped me get a little more sensitive about their life by seeing it." However, it also seemed that visiting clients in their homes also enhanced self-awareness about biases and stereotypes. One student described it as follows:
   Home visits helped me to get a close-up experience of the
   home, and realization that the neighborhoods were not as
   scary as the reputation said; that the outside of houses could
   look run down to not gather attention, but the inside was much
   nicer .... [It] challenged my stereotypes.


Engaging in advocacy. A few students also discussed their work as social advocates for the women. They talked about learning what resources were available in the community and getting their clients in touch with these resources, such as social services, tutoring, and legal aid. Several participants also talked about appreciating the process of advocating for their clients. "I loved the chance to do a little advocacy work; [for example,] to do some things like calling a lawyer to find out about what it would take for her to get a divorce." Another student talked about her work in helping prevent a client from being deported.
   I got real creative with her to try not to get her deported, and
   there was somebody that I worked with who worked in [name
   of senator's] office at the time so he worked with him and
   we had a lot of phone calls back and forth. We actually got
   paperwork pushed through Washington to get her to stay, so
   it made me be a lot more resourceful then I ever would have
   imagined I could get. I never knew how to keep somebody
   from being deported.


Improved counseling skills and confidence. Many participants reported improved counseling microskills and counseling confidence due to their experience in the program. Over half indicated that their participation in the program helped hone their counseling microskills. Participants noted that working with clients of different cultural backgrounds encouraged them to rely primarily on the basic skills of reflective listening, empathy, and validation, which in turn seemed to make them aware of the effectiveness of microskills. One participant commented, "It helped me realize that one of the basic premises, I think, of counseling is just validating people and how they feel. It seems so simple but it helped me to go to that level." Another one stated the following:
   The first step is embracing, nurturing, and nourishing people
   that are raw and frightened and alone.... I think in some cases
   [the clients] need to have total acceptance from us first before
   we can, you know, teach them assertiveness training and all that.


These types of experiences seemed beneficial to the participants' counseling confidence. Specifically, working with diverse clients and in different situations increased the students' beliefs in their abilities to handle future counseling situations. One said, "I feel like I'll be better prepared to work with a variety of clients in the future and that's something I'm interested in doing." Another stated, "It will make me a better counselor down the road, and if that issue comes up, at least I know how to do it and I'll avoid the mistake that I probably otherwise would have made"

Personal Growth and Reactions

The last category was defined as participants' description of their personal growth, development, and changes as a result from being involved in the program. The definition included both reflections of inner changes (e.g., view of self) and changes in views and perceptions of others. This category was divided into four subcategories: (a) self-awareness, (b) appreciation of immigrant and refugee women, (c) personal reward, and (d) motivation.

Self-awareness. The self-awareness subcategory was defined as a heightened awareness of oneself as a cultural being, including increased awareness of one's biases and prejudices. Many participants commented that while working with the women, they realized how they had taken their lives and rights for granted and also how they are personally fortunate and privileged. One student commented, "It made me aware of the fact that I've never had to deal with anything that complex and frightening." In describing awareness of her values and biases, another participant stated,
   It's one thing to say, "Oh yes, I can work with other cultures,"
   but then when you're in that situation it's like, "Okay, what?"
   and I really had to think about "Is this my opinion or my value
   that I am bringing in?"


Appreciation of immigrant and refugee women. Many participants commented that as a result of their interactions in the Empowerment Program, they now have a better understanding of what it is like to be a refugee or immigrant and an increased appreciation of these women (the second subcategory). Common words used to express this appreciation were "respect," "compassion," "passion" and "tolerance." They also described the women as "brave," "wonderful," and "amazing." As one participant put it, "How brave clients are because they deal with so many more barriers than I see myself dealing with and ultimately I see them as stronger [than myself]." Another student commented on what immigrants and refugees can provide the U.S. society:
   We are blessed to have people from Somali, Sudan, and
   Ecuador and all these different areas. They are not blights on
   society. They are not economic drains. These are people that
   contribute. They have gifts that can enrich our lives just in
   terms of their culture and how they raise their children and
   the closeness of family. There is so much they have to give us.


Personal reward. This subcategory reflected a sense of pleasure in giving back to the community and a reciprocal feeling of empowerment from working directly with the women. One participant stated about her involvement in the program, "It made me feel like I had something worthwhile to give" Another student indicated that the exposure to the immigrant/refugee women was rewarding:
   I think the experience has just been amazing.... Hearing
   their stories. Having them welcome me when I meet them,
   when I see them at the workshops you know. Or embrace me
   and give me a hug. Just knowing them has been a rewarding
   experience for me.


Motivation. Students participating in the program also seemed to experience an increased sense of motivation for this line of work. Some reported wanting to become more involved with the program or similar efforts. Many shared a belief that their participation was valuable to them on a personal level. One participant described her motivation as follows:
   I need to be a voice for other women.... It's not okay to not
   speak up. So whether I'm in a conversation with somebody
   casually here--whether that means getting involved in international
   organizations and stuff like that, about writing letters
   to legislature or writing aid or something like that--I need to
   do what I can to make sure that it doesn't go silent.


Even though almost all participants appeared to enjoy working with the program and the clients, one participant's motivation did not increase. Rather, this student seemed overwhelmed by the amount of cultural differences and discouraged from future work in situations that require cross-cultural communication. She said, "I appreciate the folks that can work along with that, you know, with the population just because it is so different; but I didn't enjoy it well." This same student expressed her frustration in regard to advocacy and working with an interpreter. "It was challenging too. I was frustrated. I didn't know services around the area that I could refer to, [and I experienced the] frustration of not being able to communicate with the person."

* Discussion

The purpose of this study was to gain knowledge regarding counseling trainees' perception and experiences of working in a mental health and outreach program for disadvantaged and culturally diverse individuals. Several relevant categories were identified, indicating that most students involved in the program had developed both attitudes and skills reflecting growth in multicultural competency and social justice advocacy. Overall, these results support previous discussions in the literature noting that training or involvement in mental health outreach programs and/or service learning programs helps students to develop an intellectual understanding of social problems, sensitivity for these concerns, and a commitment to address them (e.g., Astin et al., 2001; Goodman et al., 2004; Ngai, 2006; Speight & Vera, 2004).

The most pronounced finding of our study, based on the amount of data (participants' description of their learning), was that all of the students learned about culture in some way or another. Participants reported learning about different cultural practices and beliefs, the adjustment challenges of adapting to a new culture, and the importance of culture in everyday life and in counseling, among other things. The service learning program exposed the students to the struggles of immigrants and refugees of different cultures, which seemed to inspire alternative ways of thinking and behaving in the student participants. These experiences appeared to provide avenues for learning regardless of the baseline knowledge or developmental levels of the students; all students (regardless of education level, ethnicity, or prior diversity experience) spoke of learning at least one--usually many--new thing(s) about cultural differences, the importance of culture, and/or the challenges of being an immigrant or refugee.

Much of students' growth in the program appeared to be based on the unique counseling experiences the program offered. The students spoke of learning new skills from doing home visits, working with interpreters, and stepping outside of the traditional counseling role by doing client advocacy. These opportunities provided avenues for students to challenge their comfort levels and, for many, learn new insights. Some participants commented that these incidents catalyzed them to rethink their stereotypes, think more about the implications of culture in counseling, and try different counseling techniques or advocacy.

In similar lines, the results also revealed that for many participants, the experiences led to improved microskills (e.g., empathizing, listening, conveying warmth, basic attending), because these were the most effective ways to overcome cultural differences and interpretation challenges when working with clients. The participants stated that increasing their attending skills and overcoming other challenges resulted in increased counseling confidence. Many felt better prepared to handle future counseling challenges.

Participants also spoke about heightening their self-awareness and increasing their understanding of their own culture, many times recognizing their own cultural privileges. It appears that students' process of learning about other cultures often corresponded to learning about their own cultures, and by comparing their own experiences to those of the immigrants and refugees, they came to better appreciate immigrant and refugee women for the strengths they possess as well as the struggles they encounter. Generally, it seems that by working with clients of different cultures, students can become aware of their own backgrounds, beliefs, and biases, as well as their social impact on others. These findings reflect those of Astin et al. (2001) and Ngai (2006) that service learning with groups that are underprivileged can increase racial understanding and self-awareness.

Another result of actively reflecting on one's own experience of culture, oppression, power, and privilege can be the development of social justice advocacy (Constantine et al., 2007). For many participants in this study, this self-reflecting process seemed enlightening and empowering. This process together with their actual involvement in minority communities and the development of new skills, such as working with interpreters and calling social services on behalf of their clients, seemed to have motivated many of the participants to use their new knowledge to continue to assist immigrants and refugees in the future, a motivation possibly indicating the development of social justice advocacy orientation or commitment.

In light of the current literature on social justice advocacy (e.g., Goodman et al., 2004, Lewis et al., 2002; Toporek, Lewis, & Crethar, 2009), the present findings do suggest that involvement in this service learning mental health program encouraged students to develop some aspects of social justice advocacy as discussed in the literature. For example, Goodman et al. (2004) addressed the need of raising consciousness regarding different cultures and understanding larger institutional and historical factors that maintain discrimination, and many of the participants discussed these and similar issues in the interviews. Many participants also functioned as advocates for their clients with limited English language skills, a need of advocacy pointed out by Toporek et al. (2009). Furthermore, Lewis et al. (2002) highlighted the importance of community collaboration in developing the ACA Advocacy Competencies, and most participants in this study engaged in community collaboration.

However, the ACA Advocacy Competencies (Lewis et al., 2002) and the work of other scholars (e.g., Lopez-Baez & Paylo, 2009; Vera & Speight, 2003) argue for the importance of advocacy at the system level to create change and that counselors can position themselves as allies for others or leaders in the community for system change. Although the participants clearly advocated as community allies, they did not intervene at the system level, nor were they directly instructed or given tools to do so. It is our experience that some students go on to advocate for greater change by joining advocacy groups, contacting political representatives, conducting relevant research, and so on, but this is probably not the majority. One of the students in this study did advocate for her client by calling a senator in Washington, DC, and maybe it is by gaining such hands-on experience that students are propelled into becoming leaders for system change. It is also possible that with more training in social justice advocacy and with higher expectations placed on them for such engagement, more of the participants would have presented with advocacy at such levels. It would be interesting to follow these trainees to see if they continue to integrate advocacy into their professional work after graduation.

Although the findings support that students developed in social justice advocacy engagement and multicultural competency through working in the program, it is noteworthy that not all participants experienced the program in the same way. One participant stood out in particular among the participants. This student expressed that the experience in the program had made her conclude that she did not want to continue working with such culturally diverse clients. This student had experienced much frustration with communication with her clients, all which had taken place through interpreters. She seemed to have experienced a sense of inadequacy trying to help her clients, stating that she was unaware of available resources for her clients. It should be noted that this student had missed the training offered on refugee/immigrant issues, which likely contributed to her feeling unprepared for working with them. In addition, she described herself as coming from a small town with little prior experience to diversity issues and poverty. This finding seems to highlight that growth in multicultural competence and social advocacy is developmental and individual. The reflections of this particular student suggest that moving too quickly into multicultural work without training may scare students and actually propel them against such work. Thus, for advocacy service learning programs to have the desired educational effects, experiential learning must be prefaced by academic instruction to facilitate student readiness, knowledge, skills, and motivation for this line of work. It is also possible that students may need to possess a certain level of multicultural competency prior to engaging in experiential activities to best benefit from the experience.

We also detected other within-group differences. Some participants reported that the program catalyzed their motivation to become advocates for social change, a finding supported by previous studies (Astin et al., 2001; Ngai, 2006). Others just expressed appreciation for the experience without a motivation to continue advocacy work specifically. Although we do not know what specific variables made their motivation differ, because they had similar training and experiences in the program, personal variables may play a role. Research has shown that political interest (Nilsson & Schmidt, 2005) and an interest in participating in culturally diverse activities (Wendler & Nilsson, 2009) are associated with a greater degree of social justice advocacy. Clearly, more research is needed to further understand how disposition, lived experience, and graduate training may contribute to a social justice engagement. However, the findings remind counselor educators that there is variety among students in how a service learning program is experienced.

There are several limitations of this study that must be recognized. Although the current sample represented more than half of the eligible participants, it is possible that those who volunteered to participate were not representative of all students who have been involved in the Empowerment Program, and thus, the full range of experiences and social justice advocacy attitudes may not have been captured. It is possible that those choosing not to participate were less invested in the program, felt less of a benefit from participation, or were just too involved in other activities. Second, because the interviewers were the current and former graduate coordinators of the program, both socially desirable responses and experimenter expectations may have influenced data collection and interpretation. As a way to guard against this, participants were told that their responses would in no way affect their student status and that honest responses were vital. All identifying information was also eliminated on the transcribed interviews. In addition, the investigators journaled their expectations and biases prior to data collection in order to be more fully aware of these biases and in an effort to minimize the influence of these expectations during data analysis. Finally, there was a wide range of student involvement with regard to duration, ranging from 3 months to 6 years, and specifically workshop attendance ranging from two to 15 workshops. It is possible that students with more limited exposure to the program held different views from those with more frequent or long-term involvement, and this was not investigated.

This study has implications for both interventions with refugee/immigrant populations and the training of counseling/ counseling psychology students and practitioners. Specifically for students, involvement in outreach and service learning programs designed to offer direct support experiences to culturally diverse populations appear to help foster greater cultural sensitivity, increased understanding of societal influences on client mental health, and greater compassion and motivation to remedy the problems or barriers that their clients experience. In addition, the development of outreach activities in our training programs not only facilitated professional and personal development of counselors, but also helped "bridge the gap" by providing low-cost services to populations that may not have received access otherwise. In essence, outreach programs can serve a dual purpose, benefiting both the clients and the counselors who work with them.

The same training opportunities may also be needed for practitioners who lack but may desire a greater involvement in social justice advocacy efforts. Because service learning programs may be less available for practitioners, these mental health professionals may choose to become involved in community organizations that are working for underprivileged populations; although not necessarily with a focus on mental health, this involvement may foster gained knowledge and skill about culturally diverse populations and about policy and other efforts needed to create change at a system level. Having such tools not only will help trainees and professionals alike to be more effective counselors serving a culturally diverse clientele, but also may motion them into becoming activists for social change.

Received 10/27/09

Revised 09/18/10

Accepted 10/07/10

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Johanna E. Nilsson, Codi L. Schale, and Supavan Khamphakdy-Brown, Division of Counseling and Educational Psychology, University of Missouri-Kansas City. Correspondence concerning this article should be addressed to Johanna E. Nilsson, Division of Counseling and Educational Psychology, University of Missouri-Kansas City, 225 Education Building, 5100 Rockhill Road, Kansas City, MO 64110 (e-mail: nilssonj@umkc.edu).
TABLE 1
Categories and Subcategories of Empowerment
Program Student Interviews

Category                 Subcategory

Development of           The process of learning about culture
cultural knowledge       Factual knowledge
                         The understanding of adjustment difficulties

Counseling-related       Working with an interpreter
skills                   Doing home visits
                         Engaging in advocacy
                         Improved counseling skills and confidence

Personal growth and      Self-awareness
reactions                Appreciation of immigrant and refugee
                           women
                         Personal reward
                         Motivation
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Title Annotation:Research
Author:Nilsson, Johanna E.; Schale, Codi L.; Khamphakdy-Brown, Supavan
Publication:Journal of Counseling and Development
Article Type:Report
Geographic Code:1USA
Date:Sep 22, 2011
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