Kristopher G. Hall, Sejal Barden, Abigail Conley
Increases in diverse clientele have caused counselor education to enhance its focus on multicultural pedagogy, using the Tripartite Model (TM) to impart multicultural learning. While knowledge and awareness are important, it also is important to enhance skill development in counselors-in-training. Counselor educators have a unique opportunity to blend knowledge and awareness with skills learned in counseling techniques courses by incorporating microskills training in the multicultural classroom. Additionally, other theories, such as Relational-Cultural Theory (RCT), can be used as a framework to merge the TM and microskills. This article includes an overview of RCT, a brief history on microskills training and a case study to integrate the two concepts for use in counselor training. The reader should begin to see how microskills, RCT and the TM can serve to enhance skill development in the multicultural classroom.
Keywords: microskills, multicultural, Relational-Cultural Theory, counselor education, pedagogy
Counseling as a profession espouses the need for counselors to be culturally competent, as evidenced by the inclusion of diversity training in preparation standards (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2009) and in ethical standards (American Counseling Association [ACA], 2005). According to the 2009 CACREP standards, an institution must provide instruction that includes “an understanding of the cultural context of relationships, issues, and trends in a multicultural society” (Section II, Code G.2, p. 10). Although the importance of multicultural competence is supported in preparatory and ethical standards, current pedagogical practices may be ineffective as graduates of counseling programs frequently report feeling unprepared to effectively work with culturally diverse clients (Bidell, 2005; Bidell, 2012; Rock, Carlson, & McGeorge, 2010). Therefore, counselor educators need to consider how to more effectively meet the challenge and responsibility of cultivating cultural competence for counselor trainees by focusing on increasing skill development (Cates, Schaefle, Smaby, Maddux, & LeBeauf, 2007; Dickson & Jepsen, 2007; Hays, 2008).
Priester et al. (2008) conducted a content analysis of 64 introductory master’s-level multicultural course syllabi to understand the content of contemporary multicultural courses. The authors collected the syllabi by examining counseling program Web sites and contacting the instructor of record. Results indicated high emphasis in multicultural knowledge across syllabi, with over 84% of the syllabi highly emphasizing knowledge and moderate emphasis on self-awareness, with 41% of syllabi emphasizing self-awareness and a significantly lower emphasis of skill acquisition, and with only 12% of syllabi emphasizing skill development. Findings highlight relatively high emphasis on knowledge when working with culturally diverse groups and markedly lower levels of skill acquisition, potentially perpetuating the issue of counselor graduates not feeling adequately prepared. Although knowledge and self-awareness are critical components in developing cultural sensitivity, it is imperative to teach counselor trainees skills that will aid them in therapeutically connecting with their clients (West, 2005).
Counselor preparation programs are responsible for training students how to work with clients from all backgrounds; however, multicultural pedagogy has been found to be lacking in key areas (Braden & Shah, 2005), including focusing primarily on obtaining multicultural knowledge and awareness related to working with diverse groups, while failing to reinforce training in discrete skills (Priester et al., 2008). Knowledge alone does not lead to behavior or attitude change among counselor trainees and may actually reinforce culturally insensitive practices (Alberta & Wood, 2009; Arredondo & Toporek, 2004), creating a significant gap in education; while counselors-in-training are taught effective practices for personal multicultural development, they may not be given the necessary skills to use their new knowledge with diverse clients. Therefore, it is imperative to introduce new theories and integrate current theories into counselor education curricula to ensure that students are receiving well-rounded instruction in relation to multicultural competence.
To this end, the purpose of this paper is to highlight the use of RCT (Miller, 1986) as a vehicle to develop skills and integrate existing emphasis of knowledge and awareness in multicultural courses. The authors will begin with a brief overview of multicultural pedagogy and current approaches to multicultural instruction, followed by an introduction to microskills and a brief overview of RCT. The manuscript will close with a case study which integrates the concepts of the TM, microskills, RCT, implications for the field of counseling and conclusions.
Multicultural Pedagogy
As counseling professionals have become more aware of the complexity and interactions of culture on counseling relationships (Daniel, Roysircar, Abeles, & Boyd, 2004), several models have been developed that make recommendations for what constitutes a culturally competent counselor (Buckley & Foldy, 2010; Collins & Arthur, 2010; Sue, 2001). Although these models were pioneered by recognized experts in the field of multiculturalism, many authors agree that the central model in the field remains the TM, developed by Sue, Arredondo and McDavis (1992) (Holcomb-McCoy & Myers, 1999; Mollen, Ridley, & Hill, 2003). The TM has influenced major counseling bodies such as ACA and CACREP, standardizing multicultural content in counselor training ethics and accreditation (Holcomb-McCoy, 2000). Additionally, the TM has largely influenced current literature on multicultural pedagogy, placing considerable emphasis on teaching multicultural knowledge, skills and awareness to counselors-in-training (Hipolito-Delgado, Cook, Avrus, & Bonham, 2011). Essentially, the TM asks that counselors (a) have the necessary cultural knowledge of the population they will be assisting; (b) be aware of any cultural biases that the counselor may have regarding the client’s culture and biases their client may have due to the counselor’s perceived culture; and (c) have the necessary skills to assist clients of that particular culture, including understanding when to refer to more knowledgeable colleagues.
The TM has been refined on three occasions (1992, 1996, 2001), but past refinements have failed to address some of the major limitations of the model (Arredondo et al., 1996; Sue, 2001; Sue et al. 1992). Criticisms of the model are based on the lack of supporting literature to ground the three-dimensional model, difficulty measuring the factor structure of the model, and lack of relevance for practical application (Constantine, Gloria, & Ladany, 2002). Furthermore, although the TM provides a helpful framework in conceptualizing multiculturalism, it fails to highlight the importance of the therapeutic alliance when working with clients from diverse backgrounds. Extensions and applications of the TM include the development of the multicultural competencies (Sue et al., 1992). While the multicultural competencies highlight the importance of considering culture when developing the relationships, they fail to offer requisite skills that are necessary when developing relationships with culturally diverse clients. For example, the authors espouse using the model to “promote culturally effective relationships, particularly in interpersonal counseling” (Arredondo et al., 1996, p. 55); however, the competencies emphasize only that diverse relationships should be considered, not how they are to be achieved. Given that the TM is the preeminent model in which most multicultural courses are grounded, emphasis on relationships between the client and counselor and relationships between minority clients and majority society is minimal, highlighting the need for alternate conceptualizations and models that emphasize the therapeutic alliance (West, 2005).
Researchers suggest that often counselors teach clients how to best operate within the majority culture, failing to address the significance of contextual factors (e.g., socioeconomic status, education, literacy) that may be related to client distress (e.g., Comstock et al., 2008). When contextual factors are overlooked, the counselor and client are at increased risk for perpetuating cultural misunderstandings and negative attitudes toward counseling (Hartling, Rosen, Walker, & Jordan, 2000). Specifically, failing to attend to contextual factors may lead to disconnection, feelings of being misunderstood, and potential for weakening the therapeutic alliance, which increases the likelihood for treatment withdrawal (Duffey & Somody, 2011). In sum, there is heightened importance for multicultural pedagogy to increase focus on the relational and contextual factors when working with clients from diverse backgrounds. Therefore, it is imperative to teach counselors-in-training specific skills regarding how to be attentive to contextual factors.
Researchers (Roysircar, Gard, Hubell, & Ortega, 2005; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998) have found that exposure to varied multicultural experiences—both inside and outside of the classroom—increase various aspects of multicultural competence. Sodowsky et al. (1998) assessed multicultural competence while controlling for social desirability, race and attitudes of social inadequacy and locus of control. The authors found that multicultural training variables including minority client load, number of research projects, and multicultural training courses significantly contributed to overall multicultural counseling competency. In another study, Roysircar et al. (2005) used a mentoring program in which counseling students in a multicultural course were exposed to middle school students in an English as a Second Language course to develop trainee multicultural awareness. Counseling students in the study reported increased multicultural awareness as a result of the exposure to different cultures (Roysircar et al., 2005). It can be inferred from these studies that the inclusion of multicultural experiences during counselor training can contribute to student development in regard to the TM.
In sum, counselor educators have adapted to CACREP requirements through the application of several teaching models for multicultural competency including didactic (Abreu, 2001; Kim & Lyons, 2003) and experiential (Platt, 2012; Tomlinson-Clarke & Clarke, 2010) models for teaching multicultural competence. However, the efficacy of many of the existing models is unknown. Therefore, it may be helpful to employ a common standard across counselor education curricula to ensure that counselors-in training are receiving similar emphasis on the development of multicultural knowledge, awareness and skills. This common standard already exists in the microskills training that are used in counseling techniques courses.
Microskills
Microskills training is the primary pedagogy used in counselor education training. Counselors-in-training are taught the building blocks of counseling through discrete skills used to simplify abstract concepts (Mollen, Ridley, & Hill, 2003). The training model was developed as a result of work began by Truax and Carkuff (1967), who noticed that beginning and highly experienced counselors were equally skilled in facilitating therapeutic change, an anomaly given an experienced counselor’s increased time in the field. The authors concluded that counseling students were being taught the importance of the relationship in counseling, but not how it is achieved; therefore experienced counselors had the knowledge base but lacked the ability to demonstrate respective skills. Ivey (1971) continued the work of Truax and Carkuff and coined the term microskills or “communication skill units of the [counseling] interview that will help [the student] interact more intentionally with a client” (Ivey & Ivey, 2003, p. 22). Microskills has been the preeminent method of counselor training for over 40 years, with over 450 studies completed on microskills training, highlighting the strong empirical base supporting its utility in counselor education (Ridley, Mollen, & Kelly, 2011). Although microskills are well researched and supported, the need to adapt these core counseling skills when working with diverse clients is not clear. Therefore, we, the authors, propose integrating RCT with microskills training to best meet the needs of diverse mental health clients.
Relational-Cultural Theory: A Fresh Perspective
Counselors are faced with an increased challenge to find ways to relate to diverse clients and build strong therapeutic alliances (Constantine, Hage, Kindaichi, & Bryant, 2007; Owen, Tao, Leach, & Rodolfa, 2011). While it is not feasible for counselors to understand the idiosyncrasies of every culture, it is possible to increase attention to cultural and contextual factors when building the therapeutic alliance (Vasquez, 2007). Furthermore, researchers have suggested that successful counseling must include empathic relationships that are culturally sensitive in nature and that employ techniques grounded in mutual empathy, defined as a mutual exchange of empathic experiences during the counseling session (Comstock, 2005; Duffey & Somody, 2011; Fuertes et al., 2006). Therefore, it is imperative for counselor educators to focus on emphasizing culture and empathy, and how to build therapeutic alliances when teaching counselor trainees to be culturally sensitive. An overview of RCT will be explored as a framework for incorporating the strategies of multicultural pedagogy, strong therapeutic alliance and mutual empathy into counseling with diverse clients.
Overview of RCT’s Basic Tenets
Similar to multicultural theories, RCT is grounded in feminist theory. The theory was developed at the Stone Center for Women in 1977 through weekly meetings with Jean Baker Miller, Irene Stiver, Judith Jordan, and Janet Surrey (Jordan, 2008; West, 2005). Miller’s (1986) book, Towards a New Psychology of Women, solidifies the ideas presented at these meetings and establishes a formal introduction of RCT. Theoretical underpinnings of RCT are grounded in the notion that primary counseling theoretical orientations placed unnecessary blame on the clients for their problems and did not account for the importance of relationships and contextual factors (West, 2005). Therefore, RCT was developed as a theory that emphasizes relationships and external factors, as opposed to focusing on internal pathology and mental illness. RCT states that individuals develop through mutually empowering relationships with others, asserting that the relationship, not autonomy, is the key to growth (Duffey & Somody, 2011). Furthermore, RCT highlights the importance of mutuality and authenticity between client and counselor, both gaining from shared experiences and leaving with a deeper understanding of themselves and the other person’s perspective (Duffey & Somody, 2011).This mutual growth experience begins with the formation of relational images (West, 2005).
Relational images, defined as internal relational schemas or beliefs about an individual’s relationships, are formed from experiences throughout the lifespan (Miller & Stiver, 1997). Positive or negative images form related connections or disconnections within the individual, resulting in the formation of relational images (Miller & Stiver, 1997; Napier, 2002). As individuals move throughout the lifespan, relational images are either confirmed or denied by various experiences. When an event is mutually empowering, it is referred to as a connection (Miller & Stiver, 1997). Conversely, when a person’s experiences are in conflict with their relational images or when they are not mutually beneficial and empowering, they experience disconnections (Napier, 2002). Continuous damage to relational images may lead to negative beliefs including self-blame, isolation and immobilization (Jordan, 2001). Counselors may be at risk of weakening the therapeutic alliance by reinforcing disconnections or by neglecting the cultural context of the client’s concerns (Duffey & Somody, 2011).
Disconnections are an expected occurrence and are necessary for growth (Jordan, 2008). However, constant disconnections can damage the client’s relational images, possibly leading to counseling as a result of feelings of shame, confusion and decreased self-worth (Napier, 2002). When clients successfully move through disconnections, they may experience relational growth or relational resilience. Relational resilience refers to the ability to alter relational images and rebound from disconnection. Clients who experience relational resilience are more able to reconnect to others by increasing mutuality in relationships such as mutual support and growth (Duffey & Somody, 2011). In summary, RCT suggests that all persons seek connections, but internalized feelings may cause them to continually disengage as a mode of self-protection, resulting in a relational paradox; therefore, counselors can use the therapeutic alliance to reframe disconnections and reconstruct relational images (Miller & Stiver, 1997).
Counselors are well-positioned to facilitate dialogues with clients regarding relational disconnections, by discussing reasons and causes for disconnections and enabling the client to avoid placing complete responsibility or blame on their internal self. RCT suggests that the best way to realign and strengthen new relational images is through the therapeutic alliance (Jordan, 2008). The therapeutic alliance gives the client the opportunity to establish positive connections and repair relational distortions (West, 2005). By establishing a strong therapeutic alliance, the counselor provides an environment in which the client is able to begin reconnecting with his/her true self and demonstrating this behavior outside of counseling (Banks, 2006). Freedburg (2007) suggested that clients benefit when they can see their counselor as a fully dimensional human being, encouraging the client to carry the skills learned in therapy back into the real world. Therefore, the client must see the counselor as a mutually engaging human being who sees the client in a way that others have not.
In addition to emphasizing the therapeutic alliance, the use of mutual empathy in RCT encourages counselors to allow themselves to be affected by their client and share their experiences with clients when appropriate (Duffey & Somody, 2011). Mutual empathy also can be taught and reinforced during clinical internship/practicum. RCT suggests that counselors express their connections with their clients and invite feedback about how this has impacted the client (Comstock et al., 2008). During training counselor educators can illuminate instances where mutual empathy could be implemented in the counseling session. Additionally, RCT can be taught in conjunction with the ideas regarding authenticity in counseling. One-way empathy is considered a barrier that blocks authenticity due to creating a more contrived relationship, whereas counselors should instead strive for a relationship based on mutual respect, maximizing possibilities for relational equality and desires for emotional connectedness (Freedburg, 2007). Abernethy & Cook (2011) state that authenticity in counseling with RCT opens up both the client and the counselor to connect in a safe environment. This safe environment is important for multicultural understanding, as researchers (e.g., Comstock et al. 2008) have indicated that minority clients tend to feel disconnected in therapy due to feelings of being misunderstood by majority culture.
The goal of RCT in therapy is to first change negative self-images through mutual empowerment and mutual empathy (West, 2005). The counselor seeks to understand the reasons for relational disconnections and assist the client in repairing their distorted views of the relational process (Miller & Stiver, 1997). For example, a client’s thoughts may change from “I could not make connections, so I am wrong” to “I could not make connections, so the connection is wrong.” Change is achieved through genuine and authentic connections between the client and the counselor, grounded in mutual empathy and mutual exchange of ideas on the direction of treatment and goal setting (Duffey & Somody, 2011; West, 2005).
RCT and Counselor Training
RCT is a practical model which counselor educators can use to integrate multicultural knowledge with skill development through the use of mutual empathy to enhance the therapeutic alliance. Given that relationships between the clients and counselors have been found to be one of the most important aspects of the therapeutic alliance and a consistent predictor of client outcomes, it is clear that there is primacy for the therapeutic alliance when teaching multicultural counseling (Baldwin, Wampold, & Imel, 2007; Castonguay, Constantino, & Holtforth, 2006). RCT emphasizes that individuals grow through their relationships with others and that the primary therapeutic goal is for the client to move out of perceived isolation (Duffey & Somody, 2011). By infusing RCT into multicultural courses, trainees may be better suited to form strong therapeutic alliances and demonstrate culturally appropriate forms of empathy when working with clients from diverse backgrounds. By encouraging counselor trainees to pay increased attention to contextual factors and relationships that may be impacting the client, trainees may have more insight and ability to empathize with their clients (Comstock, 2005; West, 2005). West (2005) suggests that by acknowledging external relationships and contextual factors, clients may feel more engaged in the counseling process, helping to reinforce the therapeutic alliance.
Integrating RCT, the TM, and Microskills Training
Microskills exist as the basis of counselor skill training and are widely used throughout the profession. These skills are carried through the counseling curricula into other courses, reinforcing and developing these basic skills to proficiency. Additionally, counselor educators have attempted to integrate the TM into multicultural training, following accreditation (CACREP, 2009) and ethical code (ACA, 2005) revisions. RCT can be used as a vehicle to blend both microskills and the TM to reinforce and simplify multicultural teaching strategies. Below is an overview of the ways that the TM, microskills and RCT can be combined for multicultural training.
Knowledge
The knowledge portion of the TM encourages multiculturally competent practitioners to gather information regarding the cultural and environmental histories of their clients (Arredondo et al., 1996). This information gathering allows practitioners to create a well-informed picture of client issues for accurate assessments and goal setting. RCT also espouses cultural knowledge through its belief in the client worldview. Client worldviews are important as they give detail to how clients interpret life events and how they form the basis of connections and disconnections (Jordan, 2001).
Understanding worldview can be achieved through targeted, open-ended questioning, which was first introduced during counseling skills courses. Rodriguez and Walls (2000) introduced the concept of culturally educated questioning, in which practitioners use knowledge-based questions to gather information relevant to treatment. Information from previous questions is used to build on more focused questions for a deeper understanding of the client. This concept can be tied into RCT by teaching counseling students to ask future clients questions specific to RCT concepts, including significant relationships and power structures.
Awareness
Multicultural awareness entails understanding how the counselors’ cultural history may impact their clients (Arredondo et al., 1996). It is important for practitioners to understand how their multicultural makeup (e.g., race, gender, age) may have a bearing on the counseling relationship due to the client’s experiences with these factors outside of counseling, as cultural mistrust has been identified as a barrier to treatment in minority clients (Duncan & Johnson, 2007; Whaley, 2001). RCT encourages practitioners to be aware of the power-over structures, which may exist within the relationships presented by the client (Jordan, 2008). Power-over structures include culturally relevant systemic issues that may affect client functioning, creating constant disconnection due to an effort to assimilate into majority culture (Jordan, 2008). It is important for counselors to be aware of how their role as the counselor and the hierarchical nature of the counselor-client relationship may affect the therapeutic alliance. Therefore, counselor educators can remind students of the importance of the relationship development from the onset of the counseling experience.
Skills
From a microskills perspective, counselor educators can remind students of the necessity of relationship building with clients as a foundation for therapeutic engagement. Rogers (1951) asserts that the counseling relationship is a key component for client growth and should be attained before interventions are begun. Young (2012) asserts that students should begin by establishing liking, respect and trust, which leads to client communication and openness. As reinforcement, RCT encourages practitioners to engage in authenticity with clients to create deeper engagement and to demonstrate positive connections that can be repeated outside of counseling (Jordan, 2008). Through the development of the relationship, clients and counselors work to decrease the hierarchical nature of the relationship. Counselor educators use microskills training to teach counselors-in-training to use empathy as a method for connecting to clients and to understand issues from the client’s frame of reference (Ivey & Ivey, 2003). RCT goes a step further with its emphasis on mutual empathy, a technique to allow the client to see, hear and feel that their story has affected the counselor (Jordan, 2001).
Mutual empathy has many similarities to the widely accepted definition of empathy; however, a few key differences exist. Mutual empathy requires that the counselor allow themselves to be affected by the client because detachment may interfere with therapeutic healing (Duffey & Somody, 2011). Mutual empathy is demonstrated by continually checking in with the client through empathic exchange, enabling the counselor to better understand the client’s worldviews and inviting the client to react to the mutual exchange. Allowing the client to react to the exchange constitutes the difference between mutual empathy and empathy, with the counselor inviting the client to engage in empathic exchange instead of the counselor simply making empathic statements. Counselor educators can reinforce this behavior in the classroom by teaching students to request client reactions to certain empathic statements. The act of mutual empathy can create a more meaningful relationship by encouraging both client and counselor to fully participate in the exchange and feel the impact that each participant has on the other (Freedburg, 2007). For example, after making an empathic statement, trainees can be requested to respond based on the empathic statement from the client in order to demonstrate mutual empathy.
In conclusion, infusing central tenets of RCT in multicultural pedagogy through the use of microskills may be an effective way to prepare counselor trainees to meet the demands of working with clients from all backgrounds. RCT’s synthesis of multicultural knowledge and focus on obtaining skills provides trainees with universal tools for developing strong multicultural competence at every stage of the counseling process. By focusing on the relational aspects of counseling through the use of microskills, trainees will be able to demonstrate culturally sensitive counseling. We provide a brief case illustration to highlight core tenets of RCT in practice.
Case Illustration
James (pseudonym) is a 22-year-old college student at a large university and has entered counseling with feelings of “constant anger” and “frustration” toward his family, friends and professors. James states that his actions are pushing others away, resulting in feelings of isolation. He describes spending much time in his bedroom in order to avoid conflict and reports feeling increasingly depressed. When he does engage with others, he finds that conflict often arises, causing him to either minimize the importance of the issue or withdraw from the offending individual in an effort to refrain from lashing out. James reports that while there are important things he would like to say during these moments, he relents because he does not want to heighten conflict.
Through the course of counseling, James describes varying degrees of emotional connection to his family and friends. He currently lives with his older sister and another roommate in a home owned by his parents. James is of Colombian descent and moved back and forth between his home country and Miami between the ages of 9 and 16. His parents are married, although his mother lives in Miami while his father lives in Colombia in order to maintain the family business. Both of his siblings are pursuing what he considers “successful” careers; his older brother is in law school and his older sister is in medical school. James has one year left to complete his undergraduate degree and is currently studying accounting. His relationships with his parents and siblings are important to him; however, he admits to hiding information, including his visits to therapy and feelings regarding friends and familial issues, as he fears reprisal or invalidation. He also consistently compares himself to his older siblings and feels that he does not live up to his potential within his family. Lastly, James has a fairly large social network, belonging to a coed fraternity for the past 2 years. Although he interacts with several members of the organization, he consistently feels misunderstood or ignored.
RCT Counselor Response
RCT is a broad and flexible framework, which can be employed in a multitude of ways. For the purposes of this article, the authors take a closer look at using worldview/cultural context, authenticity, disconnections, and mutual empathy in order to understand a different way to relate to James. The authors also demonstrate how each of these facets can be incorporated with microskills training.
Worldview/cultural context. In order to set the stage for client conceptualization, the initial focus of the relationship should be the client’s cultural context. Exploring the client’s worldview will give the practitioner an opportunity to understand the client’s cultural context and allow the client to feel heard, which is essential to RCT and the therapeutic alliance. After a few sessions, the counselor notes that James operates in many different areas, creating a rich worldview for the counselor to explore.
It is important at this stage to employ culturally educated questioning to enhance the counselor’s multicultural knowledge regarding the client. The counselor asks open-ended questions that are tailored to gather specific information about the client’s worldview as more information is shared between the client and counselor. Through exploration of his worldview, James indicates that his primary identification is a student, which colors all of his other worldviews and affects the primacy of other responsibilities contained within his other cultural contexts. James’s secondary identification is being a fraternity member. However, due to his studies, there are times when he is forced to forgo fraternity events so that he can be prepared for classes. The stress caused from his failing grades and inability to meet fraternal obligations adds to his anger issues. James also discusses his Colombian heritage and the importance of family, giving insight to his decision making. Exploring James’s daily activities, cultural groups and relationships helps build initial rapport and creates an early therapeutic alliance, while also giving insight into possible stressors for James. This alliance is carried through to other parts of the session, as the client feels comfortable giving detail, knowing that his particular worldview will be encouraged and respected.
Connections and disconnections. James feels unheard by his fraternity brothers and inferior to his family members. Deeper investigations into these relationships reveal that James’s peers and family members are not able to accept and understand his feelings, creating an empathic disconnect. The results of this disconnect cause James to become aggressive when he cannot get his point across. Using RCT, the counselor and James analyze the disconnection in each of his familial relationships and how they affect his current functioning and relationships with others. For example, James’s relationship with his brother is often very tense, causing him to retreat from conflict or release his anger in a nonproductive fashion. These behaviors are repeated when James comes into conflict with others, such as his fraternity brothers.
Next, the counselor helps James identify positive, mutually beneficial connections with others in his social circle. When asked what is different about these relationships, he shares that he feels open to discussing his emotions with these individuals and that his feelings are valued. To help build the therapeutic alliance, the counselor directly asks James what can be done to build a similar, mutually beneficial connection within their counseling sessions. James responds that he wants to feel safe and respected so that he can share his views without judgment. The counselor then seeks to create this type of environment using the tenets of mutual empathy and authenticity.
Counselors should be aware of power-over structures, which can alter how relationships are perceived. When counselor educators teach students to employ multicultural awareness, it is important to remind students of how existing societal structures may determine how students form relationships with members of society. RCT asks that counselors analyze client relationships and how they contribute to functioning with regard to positive and negative aspects of various relationships. Counselors can inquire about the important relationships in their clients’ lives and whether these relationships are mutually beneficial.
Mutual empathy and authenticity. While less emphasized in multicultural courses, counselor educators who teach counseling technique courses have the opportunity to reinforce multicultural skill development. Empathy development is taught as a foundational skill in counseling techniques courses, which begins during the initial phases of relationship development. Using RCT, counselor educators can teach the advanced skill of mutual empathy to help deepen the relationship between client and counselor.
In order to move from disconnection to connection, the counselor attempts to create a supportive environment using the RCT concepts of mutual empathy and authenticity by reaffirming the client’s story and attempting to accurately reflect the client’s emotion. When the client shares something that was particularly difficult, the counselor reflects feeling and shows appreciation for the client’s strength in addressing a difficult issue. In order to demonstrate mutual empathy, the counselor shares how he has been affected by James’s disclosure and asks how he feels about that action. James affirms being heard and respected, qualities that are necessary for mutually beneficial connection. For example, after James shares a particularly difficult story regarding feeling frustrated by others making decisions for him, the counselor re-affirms his story through empathic response, but then uses mutual empathy to ask how it feels to hear that his frustration is understood. Using RCT allows the client to feel that he is truly understood, and evidence of a more robust therapeutic alliance is seen through James’s increased willingness to share and explore themes.
Implications for Counselor Educators
Counselor educators have done much to incorporate multicultural development into counseling curricula. Through CACREP and ACA standards, counselor educators have received a blueprint for developing multiculturally competent practitioners. Counselor educators also have an established method of training through microskills, which are used to help students learn the building blocks of counseling. However, at this time very few counseling theories have sought to bridge both multicultural development and microskills training.
The purpose of this article is to provide a tool for counselor educators to help integrate the TM, (awareness, knowledge, skills) into classroom instruction using microskills training. The TM and RCT have concepts that mirror each other and that, when combined, can create a practical framework for students in progressing toward multicultural competence. When microskills training is used as a vehicle for instruction, students will have a tangible and discrete set of skills to use with diverse clients which may increase self-efficacy, improve the counseling relationship and improve treatment outcomes. Using RCT in multicultural coursework provides counselor educators with an educational tool to better apply the TM and meet the need to increase the emphasis of skills in multicultural courses.
Counseling using RCT principles includes bringing meaning to the client’s relationships and exploring his or her relational images (Jordan, 2001). Additionally, Jordan (2010) states that clients must be aware that they are having an impact on their counselors. Counselor educators have the ability to combine elements of RCT with microskills to enhance multicultural development in students. By linking knowledge, awareness and skills with the RCT elements of emphasis on worldview, power-over structures, and mutual empathy, counselor educators give students tangible skills that can be employed with multicultural clients. Funneling these two concepts through microskills gives counselor educators an available and proven framework to structure student learning.
Suggestions for Future Research
Like all theories, RCT is not without shortcomings. Because RCT is based on relational focus and views on openness between counselor and client, RCT may not be suitable for all counseling relationships. For example, Jordan (2010) states that RCT may not be effective with clients who have sociopathic personalities, due to such clients’ avoidance of authentic interactions. If a client is not willing to honestly engage the counselor, mutuality is lost. RCT also requires a level of authenticity that some counselors may not be comfortable with, specifically those with boundary issues. Counselors trained in other theories are taught to keep certain levels of relational distance between themselves and the client. However, Walker (2004) makes note that RCT practitioners strive for a level of relational clarity while avoiding language that implies separateness and objectification.
Currently, research is sparse in the area of using RCT as a method of instruction, most likely because RCT has not yet been operationalized, making it difficult to teach. Previously, the theory has been described as a way of being or an understanding, instead of a direct set of techniques that can be imparted to students. Oakley et al. (2013) have suggested using RCT in a brief model of treatment, stating their intention to develop a manual, which may help counselor educators in teaching the elements of RCT. Researchers should continue to focus on finding ways to clarify the process of RCT; its strong focus on relationships, worldviews and advanced techniques such as mutual empathy could create stronger counselors.
Conclusion
In summary, it is essential for counselors-in-training to be aware of how to put the TM into action. Current multicultural pedagogy primarily emphasizes learning in the knowledge and awareness domains, rarely making skill development a focus during counselor training. Given the changing demographics and increased growth of the minority population in the United States, training counselors to be effective with working with all clients is imperative. Counselor educators are in the unique position to prepare students for multicultural engagement before they begin practice. The infusion of RCT into counseling techniques courses gives counselors-in-training exposure to a different perspective, which incorporates the multicultural competencies with relationship building skills. RCT, with its emphasis on mutual empathy, relationships and contextual factors, enables counselors to gain a greater depth and breadth of minority client experiences, potentially strengthening the therapeutic alliance.
References
Abernethy, C., & Cook, K. (2011). Resistance or disconnection? A relational-cultural approach to supervisee anxiety and nondisclosure. Journal of Creativity in Mental Health, 6(1), 2–14. doi:10.1080/15401383.2011.560067
Abreu, J. M. (2001). Theory and research on stereotypes and perceptual bias: A didactic resource for multicultural counseling trainers. The Counseling Psychologist, 29(4), 487–512. doi:0.1177/0011000001294002
Alberta, A. J., & Wood, A. H. (2009). A practical skills model for effectively engaging clients in multicultural settings. The Counseling Psychologist, 37(4), 564–579. doi:10.1177/0011000008326231
American Counseling Association. (2005). ACA code of ethics. American Counseling Association. Alexandria, VA: Author.
Arredondo, P., & Toporek, R. (2004). Multicultural counseling competencies = ethical practice. Journal of Mental Health Counseling, 26(1), 44–55.
Arredondo, P., Toporek, R., Brown, S. P., Jones, J., Locke, D. C, Sanchez, J., & Stadler, H. (1996). Operationalization of the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 24, 42–78. doi:10.1002/j.2161-1912.1996.tb00288.x
Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842–852. doi:10.1037/0022-006X.75.6.842
Banks, A. L. (2006). Developing student affect in a university self-defense course. Physical Educator, 63, 8–17.
Bidell, M. P. (2005). The Sexual Orientation Counselor Competency Scale: Assessing attitudes, skills, and knowledge of counselors working with lesbian, gay, and bisexual clients. Counselor Education and Supervision, 44(4), 267–279. doi:10.1002/j.1556-6978.2005.tb01755.x
Bidell, M. P. (2012). Examining school counseling students’ multicultural and sexual orientation competencies through a cross-specialization comparison. Journal of Counseling & Development, 90(2), 200–207. doi:10.1111/j.1556-6676.2012.00025.x
Braden, J. P., & Shah, K. G. (2005). A critique of multicultural training in school psychology: Rationale, strategies, and tactics. In C. L. Frisby & C. R. Reynolds (Eds.), Comprehensive handbook of multicultural school psychology (pp. 1023–1047). New York, NY: Wiley.
Buckley, T. R., & Foldy, E. G. (2010). A pedagogical model for increasing race-related multicultural counseling competency. The Counseling Psychologist, 38, 691–713. doi:10.1177/0011000009360917
Castonguay, L. G., Constantino, M. J., & Holtforth, M. G. (2006). The working alliance: Where are we and where should we go? Psychotherapy: Theory, Research, Practice, Training, 43, 271–279. doi:10.1037/0033-3204.43.3.271
Cates, J. T., Schaefle, S. E., Smaby, M. H., Maddux, C. D., & LeBeauf, I. (2007). Comparing multicultural with general counseling knowledge and skill competency for students who completed counselor training. Journal of Multicultural Counseling and Development, 35(1), 26–39. doi:10.1002/j.2161-1912.2007.tb00047.x
Collins, S., & Arthur, N. (2010). Culture-infused counseling: A fresh look at a classic framework of multicultural counselling competencies. Counselling Psychology Quarterly, 23, 203–216. doi:10.1080/09515071003798204
Comstock, D. L. (Ed.). (2005). Diversity and development: Critical contexts that shape our lives and relationships. Belmont, CA: Thomson Brooks/Cole.
Comstock, D. L., Hammer, T. R., Strentzsch, J., Cannon, K., Parsons, J., & Salazar II, G. (2008). Relational-cultural theory: A framework for bridging relational, multicultural, and social justice competencies. Journal of Counseling & Development, 86, 279–287. doi:10.1002/j.1556-6678.2008.tb00510.x
Constantine, M. G., Gloria, A. M., & Ladany, N. (2002). The factor structure underlying three self-report multicultural counseling competence scales. Cultural Diversity & Ethnic Minority Psychology, 8, 334–345. doi:10.1037/1099-9809.8.4.335
Constantine, M. G., Hage, S. M., Kindaichi, M. M., & Bryant, R. M. (2007). Social justice and multicultural issues: Implications for the practice and training of counselors and counseling psychologists. Journal of Counseling & Development, 85, 24–29. doi:10.1002/j.1556-6678.2007.tb00440.x
Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 standards for accreditation. Alexandria, VA: Author.
Daniel, J. H., Roysircar, G., Abeles, N., & Boyd, C. (2004). Individual and cultural-diversity competency: Focus on the therapist. Journal of Clinical Psychology, 60, 755–770. doi:10.1002/jclp.20014
Dickson, G. L., & Jepsen, D. A. (2007). Multicultural training experiences as predictors of multicultural competencies: Students’ perspectives. Counselor Education and Supervision, 47(2), 76–95. doi:10.1002/j.1556-6978.2007.tb00040.x
Duffey, T., & Somody, C. (2011). The role of relational-cultural theory in mental health counseling. Journal of Mental Health Counseling, 33, 223–242.
Duncan, L. E., & Johnson, D. (2007). Black undergraduate students attitude toward counseling and counselor preference. College Student Journal, 41, 696–719.
Freedburg, S. (2007). Re-examining empathy: A relational-feminist point of view. Social Work, 52, 251–259. doi:10.1093/sw/52.3.251
Fuertes, J. N., Stracuzzi, T. I., Bennett, J., Scheinholtz, J., Mislowack, A., Hersh, M., & Cheng, B. (2006). Therapist multicultural competency: A study of therapy dyads. Psychotherapy: Theory, Research, Practice, Training, 43, 480–490. doi:10.1037/0033-3204.44.1.13
Hartling, L. M., Rosen, W. B., Walker, M., & Jordan, J. V. (2004). Shame and humiliation: From isolation to relational transformation. In J. V. Jordan, M. Walker, L. M. Hartling (Eds.), The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute (pp. 103–128). New York, NY: Guilford.
Hays, P. A. (2008). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy. Washington, DC: American Psychological Association.
Hipolito-Delgado, C. P., Cook, J. M., Avrus, E. M., & Bonham, E. J. (2011). Developing counseling students’ multicultural competence through the multicultural action project. Counselor Education and Supervision, 50, 402–421. doi:10.1002/j.1556-6978.2011.tb01924.x
Holcomb-McCoy, C. C. (2000). Multicultural counseling competencies: An exploratory factor analysis. Journal of Multicultural Counseling and Development, 28, 83–97. doi:10.1002/j.2161-1912.2000.tb00609.x
Holcomb-McCoy, C. C., & Myers, J. E. (1999). Multicultural competence and counselor training: A national survey. Journal of Counseling & Development, 77, 294–302. doi:10.1002/j.1556-6676.1999.tb02452.x
Ivey, A. E. (1971). Microcounseling: Innovations in interviewing training. Springfield, IL: Charles C. Thomas.
Ivey, A. E., & Ivey, M. B. (2003). Intentional interviewing and counseling: Facilitating client development in a multicultural society (5th ed.). Pacific Grove, CA: Brooks/Cole.
Jordan, J. V. (2001). A relational-cultural model: Healing through mutual empathy. Bulletin of the Menninger Clinic, 65, 92–103.
Jordan, J. V. (2008). Recent developments in relational-cultural theory. Women & Therapy, 31, 1–4. doi:10.1080/02703140802145540
Jordan, J. V. (2010). Relational-cultural therapy. Washington, DC: American Psychological Association.
Kim, B. S., & Lyons, H. Z. (2003). Experiential activities and multicultural counseling competence training. Journal of Counseling & Development, 81(4), 400–408. doi:10.1002/j.1556-6678.2003.tb00266.x
Miller, J. B. (1986). Toward a new psychology of women (2nd ed.). Boston, MA: Beacon Press.
Miller, J. B., & Stiver, I. P. (1997). The healing connection: How women form relationships in therapy and in life. Boston, MA: Beacon Press.
Mollen, D., Ridley, C. R., & Hill, C. (2003). Models of multicultural competence: A critical evaluation. In D. B. Pope-Davis, H. L. K. Coleman, W. M. Liu, & R. Toporek (Eds.), Handbook of multicultural competencies in counseling & psychology (pp. 21–36). Thousand Oaks, CA: Sage.
Napier, M. B. (2002). Staying connected: Incorporating a client centered nondirective attitude into the Stone Center’s model of relational-cultural therapy (Doctoral dissertation). Retrieved from PsycINFO database. (Accession No. 2002-95020-134)
Oakley, M. A., Addison, S. C., Piran, N., Johnston, G. J., Damianakis, M., Curry, J.,…Weigeldt, A. (2013). Outcome study of brief relational-cultural therapy in a women’s mental health center. Psychotherapy Research, 23(2), 137–151. doi:10.1080/10503307.2012.745956
Owen, J. J., Tao, K., Leach, M. M., & Rodolfa, E. (2011). Clients’ perceptions of their psychotherapists’ multicultural orientation. Psychotherapy, 48(3), 274–282. doi:10.1037/a0022065
Platt, J. J. (2012). A Mexico City-based immersion education program: Training mental health clinicians for practice with Latino communities. Journal of Marital and Family Therapy, 38(2), 352–364. doi:10.1111/j.1752-0606.2010.00208.x
Priester, P. E., Jones, J. E., Jackson-Bailey, C. M., Jana-Masri, A., Jordan, E. X., & Metz, A. J. (2008). An analysis of content and instructional strategies in multicultural counseling courses. Journal of Multicultural Counseling & Development, 36, 29–39. doi:10.1002/j.2161-1912.2008.tb00067.x
Ridley, C. R., Mollen, D., & Kelly, S. M. (2011). Beyond microskills: Toward a model of counseling competence. The Counseling Psychologist, 39, 825–864. doi:10.1177/0011000010378440
Rock, M., Carlson, T. S., & McGeorge, C. R. (2010). Does affirmative training matter? Assessing CFT students’ beliefs about sexual orientation and their level of affirmative training. Journal of marital and family therapy, 36(2), 171–184. doi:10.1111/j.1752-0606.2009.00172.x
Rodriguez, R. R., & Eugene Walls, N. (2000). Culturally educated questioning: Toward a skills-based approach in multicultural counselor training. Applied and Preventive Psychology, 9(2), 89–99.
Rogers, C. R. (1951). Client-centered therapy. Boston, MA: Houghton Mifflin.
Roysircar, G., Gard, G., Hubbell, R., & Ortega, M. (2005). Development of counseling trainees’ multicultural awareness through mentoring English as a second language students. Journal of Multicultural Counseling and Development, 33, 17–36. doi:10.1002/j.2161-1912.2005.tb00002.x
Sodowsky, G. R., Kuo-Jackson, P. Y., Richardson, M. F., & Corey, A. T. (1998). Correlates of self-reported multicultural competencies: Counselor multicultural social desirability, race, social inadequacy, locus of control racial ideology, and multicultural training. Journal of Counseling Psychology, 45, 256–264. doi:10.1037/0022-0167.45.3.256
Sue, D.W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29, 790–821. doi:10.1177/0011000001296002
Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70, 477–486. doi:10.1002/j.1556-6676.1992.tb01642.x
Tomlinson-Clarke, S. M., & Clarke, D. (2010). Culturally focused community-centered service learning: An international cultural immersion experience. Journal of Multicultural Counseling and Development, 38(3), 166–175. doi:10.1002/j.2161-1912.2010.tb00124.x
Truax, C. B., & Carkhuff, R. R. (1967). Toward effective counseling and psychotherapy:
Training and practice. Chicago, IL: Aldine.
Vasquez, M. J. T. (2007). Cultural difference and the therapeutic alliance: An evidence-based analysis. American Psychologist, 62, 878–885. doi:10.1037/0003-066X.62.8.878
Walker, M. (2004). How relationships heal. In M. Walker & W. B. Rosen (Eds.), How connections heal: Stories from relational-cultural therapy (pp. 3–21). New York, NY: Guilford.
West, C. K. (2005). The map of relational-cultural theory. Women & Therapy, 28(3–4), 93–110. doi:10.1300/J015v28n03_05
Whaley, A. L. (2001). Cultural mistrust: An important psychological construct for diagnosis and treatment of African Americans. Professional Psychology: Research and Practice, 32, 555–562. doi:10.1037/0735-7028.32.6.555
Young, M. E. (2012). Learning the art of helping: Building blocks and techniques (5th ed.). New York, NY: Pearson.
Kristopher G. Hall is a doctoral student at the University of Central Florida. Sejal Barden is an Assistant Professor at the University of Central Florida. Abigail Conley is an Assistant Professor at Virginia Commonwealth University. Correspondence can be addressed to Kristopher G. Hall, University of Central Florida, College of Education and Human Performance, 12494 University Boulevard, Orlando, FL 32816, kristopher.g.hall@knights.ucf.edu.
