Aug 24, 2023 | Volume 13 - Issue 2
Corrine R. Sackett, Heather L. Mack, Jyotsana Sharma, Ryan M. Cook, Jardin Dogan-Dixon
Microaggressions can and do occur in the counseling process, yet there is a dearth of literature about how counselors-in-training (CITs) experience this phenomenon from clients or how they may respond to clients who perpetuate microaggressions against them in a therapeutic setting. Therefore, in this constructivist phenomenological study, we explored CITs’ experiences of microaggressions from clients in the counseling process. Two interviews with six participants of various marginalized identities revealed the following themes: (a) internal reactions, (b) attempts to contextualize, (c) prevalence of microaggressions, (d) navigating microaggressions, and (e) seeking support. Findings and implications for CITs and counselor educators and supervisors are discussed.
Keywords: microaggressions, constructivist phenomenology, counseling process, counselors-in-training, counselor educators
Microaggressions have been defined as intentional or unintentional ongoing verbal or nonverbal offensives experienced by individuals of a marginalized group (Ratts et al., 2016) and as “subtle and stunning” daily racial offenses that impact the health and well-being of individuals (Pierce, 1970). Counselors and counselors-in-training (CITs) of marginalized identities are often uncertain of whether or how to respond to microaggressions in counseling sessions while keeping the counseling relationship intact (Branco & Bayne, 2020). As such, counseling researchers have the opportunity and responsibility to explore the experiences of counselors or CITs who are the target of microaggressions from clients. Scholarship around this topic can help the counseling profession, and counselor education specifically, in developing competencies to help guide CITs and counselors in these situations.
Given the reality that there are clients from privileged groups receiving counseling from CITs from marginalized groups (Haskins et al., 2015; Ratts et al., 2016) and that the counseling process is an intersection of cultural identities between the client and CIT (Ratts et al., 2016), there is potential for microaggressions to occur in this relationship. Various studies have explored microaggressions within the counseling setting as experienced by clients who identify as racial/ethnic minorities (Constantine, 2007; Crawford, 2011; Morton, 2011; Owen et al., 2011, 2014); however, much less is known about counselors’ and CITs’ experiences with clients who may perpetuate microaggressions against them (Branco & Bayne, 2020). Given the dearth of literature focusing on how CITs can and do handle microaggressions from clients, we aimed to help fill this gap in the literature by exploring CITs’ experiences of microaggressions from clients.
In the 1970s, Harvard-trained Black psychiatrist Chester M. Pierce coined the term “microaggression” to describe the insults that he witnessed Black Americans encounter daily (Pierce, 1970). His work has been seminal in laying a foundation for understanding the damage that negative interracial interactions have on Black Americans’ health. Decades later, Sue and colleagues (2007) continued Pierce’s research on microaggressions and expanded its definition to include experiences of cultural bias, prejudice, and power imbalance. Literature about microaggressions in the counseling profession highlights the negative impact of counselors being the offender, or the person who perpetuates microaggressions, toward a racially/ethnically marginalized client in session (Constantine, 2007; Owen et al., 2011).
Although racial microaggressions toward racially/ethnically marginalized people have been studied extensively, microaggressions can also target gender, sexual orientation, ability status, class, religion, and other visible and invisible identities (Chan et al., 2018). The consequences of microaggressions on the counselor–client relationship have been studied in the context of gender (Owen et al., 2010) and sexual orientation (Shelton & Delgado-Romero, 2013). As such, there is a need for more research to explore microaggressions as a phenomenon that affects various identities. When individuals identify with multiple salient identities, they are more likely to experience privilege and oppression. For instance, a person can experience White privilege while simultaneously experiencing marginalization from identifying as queer—this person can belong to both oppressive and oppressed groups. Because one identity can be stigmatized while another is privileged, there is complexity in understanding one’s whole identity rather than only its parts. The Multicultural and Social Justice Counseling Competencies (MSJCC) include a quadrant to represent a privileged client and a marginalized counselor (Ratts et al., 2016) that can be used to conceptualize the dynamic of microaggressions experienced by counselors from clients. It is possible, of course, for counselors and clients to identify with being in more than one quadrant simultaneously as members of both privileged and marginalized groups. Further, the intersectionality of race, gender, sexual orientation, and other identities may increase the frequency and impact of microaggressions (Williams et al., 2021). Microaggressions toward intersecting marginalized identities compound their harmful impact (Nadal et al., 2015).
Oppression on an individual level in the form of microaggressions, regardless of whether they are intentional or unintentional, can have a devastating impact on individuals’ physical and mental health (Pierce, 1970; Ratts et al., 2016). Depression, anxiety, and post-traumatic stress have been reported by researchers as being associated with microaggressions (Williams et al., 2021). Thus, it is feasible that CITs would experience these same mental and physical reactions to microaggressions within the counseling relationship (Branco & Bayne, 2020), which in turn seems likely to influence their work with current and future clients.
Purpose of the Study
     Branco and Bayne (2020) asserted that counselor educators are called to provide training for counselors from marginalized identities to work with clients from privileged identities, and the counselor education field is lacking in this area. Because the cultural experiences and backgrounds of clients and counselors impact the counseling relationship (Constantine, 2007; Crawford, 2011; Morton, 2011; Owen et al., 2011, 2014), counseling process, treatment selection, and outcomes, it is critical that counseling researchers expand inquiry in this area (Hays, 2020). Specifically, counseling researchers need to inquire more about counselors’ experiences with social injustice and how those affect the counseling process. As established, the MSJCC framework allows for counselors and clients from many intersecting privileged and marginalized identities (Ratts et al., 2016). Although previous studies have focused exclusively on racial microaggressions from clients, Branco and Bayne (2020) called for a broader examination to include counselors or CITs who identify with a marginalized status outside of race and ethnicity. As such, the purpose of the current study was to explore CITs’ experiences of microaggressions from clients, regardless of the one or more marginalized identities they carried, through van Manen’s (2016) constructivist hermeneutic phenomenological approach. This is a reflective process focused on the lived experiences of participants. By specifically focusing on CITs’ experiences of microaggressions from clients, we gain insight into how to better provide supervision and training in this area. Thus, the research question that guided this investigation was: “What are CITs’ experiences of microaggressions from clients in the counseling process?”
Method
Research Design Overview
     We chose van Manen’s (2016) constructivist hermeneutic phenomenological approach for this inquiry of CITs’ experiences of microaggressions from clients, as it aims to increase thoughtfulness, grasp essential meaning, and come into closer contact with the world while providing thought-provoking data that are ideal for clinical practice (Sackett & Cook, 2021). van Manen described hermeneutic phenomenological research as choosing a phenomenon of serious interest, investigating the lived experience of the phenomenon, reflecting on its essential themes, describing the phenomenon through writing and rewriting, remaining in pedagogical relationship, and balancing the parts of the whole of the research.
Researcher Reflexivity
     Following van Manen’s (2016) advisement that researchers be aware of and transparent about their own experience of the phenomenon under investigation and the influence of their own values, beliefs, and experiences, we describe our positionality here for transparency. At the time of the study, authors Corrine R. Sackett, Jyotsana Sharma, and Ryan M. Cook were faculty members in counselor education programs at research universities—Sackett was an associate professor and Sharma and Cook were assistant professors. Heather L. Mack and Jardin Dogan-Dixon were graduates of a CACREP-accredited program specializing in clinical mental health counseling; Mack was practicing in agency and private practice settings and Dogan-Dixon was a correctional psychologist. Sackett, Mack, Sharma, and Dogan-Dixon identify as heterosexual and cisgender women, and Cook as a heterosexual and cisgender man. Sackett, Mack, and Cook identify as White, Sharma identifies as Asian Indian and international, and Dogan-Dixon identifies as Black and from a Christian background.
Sackett was drawn to this line of inquiry after a supervision session in which a supervisee disclosed a microaggression from a client related to gender. The supervisee’s site supervisor (a male counselor) was in the session as a co-counselor. Following the session, the CIT and site supervisor processed the event. Although the site supervisor was supportive, he advised the CIT not to address the microaggression with the client because it was not related to the client’s counseling goals. The CIT described feeling dismissed by her site supervisor’s response. She also described uncertainty in how to continue a meaningful counseling relationship with the client afterward without addressing the microaggression. This experience led Sackett to seek guidance from the literature on CITs’ or counselors’ handling of microaggressions from clients, but she found limited scholarly resources. Sackett was influenced by this experience in her conceptualization of the current study, and in analyzing and writing the findings. Further, while recognizing her privileged identities, Sackett has experienced gender microaggressions that have impacted her and the way she views this topic area. Mack, while also recognizing her privileged identities, has experienced gender microaggressions from clients and a site supervisor. Sharma identifies as an international scholar of Asian Indian descent. As an international woman of color, Sharma has experienced many microaggressions since moving to the United States. She has experienced microaggressions from clients, colleagues, and supervisors. Cook has wondered how supportive or unintentionally unsupportive he has been as a supervisor and faculty member with CITs’ experiences of microaggressions. Dogan-Dixon has experienced gendered racial microaggressions from clients, peers, and supervisors in various counseling settings across her training. She initially struggled to address microaggressions in the moment because of potential rejection and backlash; with practice, however, she has learned to address microaggressions in multiple ways, including caring confrontation. She now educates others on how to navigate microaggressions in personal and professional settings. In harnessing the interpretive nature of van Manen’s (2016) approach, instead of bracketing these biases, we embraced them as part of the process (Prosek & Gibson, 2021).
Participants
     Participants included six CITs from CACREP-accredited counselor education programs in the United States. Sampling was purposive for the phenomenon under investigation (Prosek & Gibson, 2021), and all participants met the eligibility criteria of being enrolled in a CACREP-accredited master’s program with a specialty in clinical mental health or school counseling, being enrolled in or completed practicum or internship in their program, and having lived experience of microaggressions from clients in the counseling process. Constructivist qualitative studies tend to have smaller sample sizes that allow for more depth of understanding and intriguing findings (Boddy, 2016). Though we recruited from across the United States, our resulting sample consisted of participants from the Southern region of counselor education programs. Participant ages ranged from 26–30 years. Self-named gender identity included one female, two cisgender female, two cisgender male, and one participant who did not specify gender. Self-named sexual orientation included one straight, one lesbian, two bisexual, and two who did not specify. Participants self-identified their racial/ethnic identities as Hispanic (one), Hispanic/Latina (one), Black/Afro Latino (one), Caucasian (one), and White (two). Those who answered the question of other relevant identities named student or partnership status. Participants were entered into a drawing for one of three $15 Starbucks gift cards after completion of the second interview as a token of appreciation for their time.
Participant Recruitment
     Sackett obtained human subjects research approval from her university of employment’s IRB. Sackett then recruited participants by sending two rounds of emails explaining the purpose of the study to contacts from 387 CACREP-accredited master’s programs in the United States with specialty areas in clinical mental health and school counseling. The email requested the faculty member send the recruitment email with the purpose of the study and a note about what participation entailed to their master’s students who were currently enrolled in, or had completed, practicum or internship in their program. Inclusion criteria included the experience of a microaggression from a client, regardless of marginalized identity(ies) of the CIT. The email asked CITs to contact Sackett if interested in participation. When participants contacted Sackett, she completed the informed consent process and referred them to Mack to schedule the first interview. Ten individuals contacted Sackett with interest in participating in the study. However, four of the initial 10 individuals reported not having experiences of microaggressions to share after hearing the definition of a microaggression from Mack (see Data Collection below).
Data Collection
     Mack conducted two interviews over Zoom with each participant. Two interviews per participant allowed for sustained engagement with the phenomenon, and interviews were spaced from 1 to 3 weeks apart per participant to allow time for reflection between the interviews. This resulted in 12 interviews. Each participant answered demographic questions during the first interview that requested gender, age, race/ethnicity, any other relevant identities, and pseudonym. To begin each interview, Mack broached her identities with participants (Day-Vines et al., 2007) and verbally gave participants a definition of microaggressions as intentional or unintentional ongoing verbal or nonverbal offensives experienced by individuals of a marginalized group (Ratts et al., 2016). Interview questions were centered on CITs’ experiences of microaggressions from clients, in line with van Manen’s (2016) recommendation that the interview be strongly oriented to the phenomenon. Interview questions were developed by Sackett, Mack, and Sharma and were informed by extant literature of counselors’ experiences of microaggressions from clients (e.g., Branco & Bayne, 2020), multicultural counseling competencies (e.g., Ratts et al., 2016), and CITs’ prioritization of information for supervision (e.g., Cook & Welfare, 2018), coupled with the authors’ respective expertise and perspectives. Researchers used the same interview protocol for both interviews, which can be found in the Appendix. While being mindful of the differences between counseling and interviewing (Sackett & Lawson, 2016), Mack utilized counseling skills to facilitate discussion and to communicate empathy (Kleist, 2017). Interviews ranged in length from 24 to 62 minutes (M = 46.1; SD = 11.82), except for Lila’s second interview of only approximately 5 minutes, as she indicated she had nothing to add from the previous interview. Interviews were audio-recorded and later transcribed by a graduate assistant.
Analysis
     We used NVivo Version 12 (QSR, 2018) software to manage the data. Operating from van Manen’s (2016) approach, we were concerned with capturing the essential meaning of the phenomenon, which involved seeing the essential meaning of each participant’s experience, reaching a reflective determination, and explaining the experience. In this process, we gave order to the research and writing by considering the phenomenon in themes. Along with van Manen’s hermeneutic phenomenological approach, we employed the First and Second Cycle coding process described by Miles et al. (2020). After listening to all participant interviews, Sackett reviewed the 12 interview transcripts while utilizing a line-by-line approach to coding (van Manen, 2016). She applied in vivo codes in her first review and then went back through the data to apply a combination of descriptive codes, process codes, emotion codes, and value codes in the First Cycle coding (Miles et al., 2020). This allowed for a way to summarize segments of data. Next, Sackett applied Second Cycle coding, or pattern coding, to group the initial codes into themes. van Manen described this theme development as giving shape to the shapeless in the data.
We followed van Manen’s (2016) recommendation that for deeper understanding, a peer may read a draft of the description of the phenomenon and share their insights of whether the description resonates with their own experience of the participants’ descriptions. As such, Mack, who had conducted the interviews, and Sharma, who listened to the recordings of the interviews, read the steps of First and Second Cycle coding Sackett employed and shared their insights of how the description of the findings reflected their experience of the participants’ accounts. Through this iterative process, we were able to examine, reinterpret, and reformulate themes while keeping in mind van Manen’s guiding question for this process of whether the phenomenon would still be the same if we were to change or delete any theme. We followed van Manen’s advisement to be mindful to capture individual experiential differences in our data analysis and writing process of the phenomenon. In this study, that meant considering the unique identities of each participant, including intersecting identities and how those may impact their experience of microaggressions from clients. We chose to structure our writing of the phenomenon thematically, one of van Manen’s suggestions for organizing the portrayal of the data. There is some overlap in the nuances of the meanings of the themes, as describing a phenomenon is bound to have a somewhat forced quality.
Methodological Integrity
     As suggested by van Manen (2016), the researchers engaged with each other throughout the entire process of data collection and analysis in a collaborative way that led to deeper understanding of the phenomenon. This process strengthened our engagement with the phenomenon and transcended the limits of having a sole researcher. In doing this, we had regular phone calls, video meetings, and emails throughout the study. Sackett kept a reflective journal while listening to the interviews and conducting analysis. Further, we kept a log of each step in the process, including interview data, codes, and theme development, to show the culmination of our interpretation of the findings. Finally, we conducted two member checks through email with each participant. Member checks allowed participants to reflect on the transcripts of the interviews for further insight and to review the themes and allow for feedback on if it was an accurate description of what the experience is like (van Manen, 2016). Therefore, we conducted member checks after interviews were transcribed and after theme development. In the second member check, we invited participants into dialogue around whether the themes reflected their experience of the phenomenon.
Findings
Five themes emerged from our exploration of CITs’ experiences of microaggressions from clients in the counseling process: (a) internal reactions, (b) attempts to contextualize, (c) prevalence of microaggressions, (d) navigating microaggressions, and (e) seeking support. The first theme, internal reactions, had three subthemes: caught off guard, discomfort, and imposter phenomenon. The fourth theme, navigating microaggressions, had five subthemes: fear of responding genuinely, letting it go, attempting to redirect, directly responding, and avoiding. The final theme, seeking support, had three subthemes: site, university, and family and peers. Pseudonyms chosen by the participants are used throughout the Findings section to maintain participants’ confidentiality.
Internal Reactions
     The first theme, internal reactions, embodies what was happening internally with CITs as they experienced microaggressions in the counseling process. This theme includes subthemes centered around being caught off guard, feeling discomfort, and experiencing imposter phenomenon.
Caught Off Guard
     The first subtheme of internal reactions CITs experienced, caught off guard, describes the initial reaction from the microaggression and not being sure how to react outwardly. David cautiously described his reaction to a parent in a school counseling setting as “mostly just confusion and not really being sure how to respond in that particular situation to what the parent had said.” Wesley, on the other hand, also in a school counseling setting, carefully described trying to manage being caught off guard with how he responded nonverbally in the moment:
I put on my poker face. Nonverbally, eyes kind of narrow, brows furrow. . . . [if] they catch me off guard, like one eyebrow goes up. But because . . . of the mask [from the pandemic], they can’t really read my facial expression, they can only see my eyes.
Discomfort
     CITs also conveyed feeling discomfort in their internal reactions to microaggressions, including anxiety, fear, hurt, sadness, and anger. Lila solemnly described her surprise and discomfort with a client making assumptions of her based on ethnicity as “not ashamed, but saddened that she made that difference between us. I didn’t think she would have done that.”
Imposter Phenomenon
     The third subtheme that resonated with CITs’ experiences in terms of internal reactions was imposter phenomenon. CITs often felt microaggressions from clients made them question their competency and even confirmed doubts they already had in the counselor role, as David thoughtfully articulated:
I think this goes back a little bit to the imposter syndrome that a lot of interns feel, and that I know that I’ve certainly felt. It’s like someone seeing me for who I am and confirming all the different feelings that I have about myself. About maybe not being fully capable in the role yet. . . . very much like, “oh you’re seeing me for who I am” and feeling . . . “I agree with you. You’re seeing how I see myself in some situations.”
Attempts to Contextualize
     The next theme, attempts to contextualize, captures CITs’ tendency and desire to try to make sense of the client microaggression and to understand where the client was coming from and why they may have felt that way or may have said those things. For instance, Lila rationalized—while not excusing the microaggression from her client—“I guess the moment when she said that she was ill, and she was going through a lot of issues. So, I kind of understand her, but I don’t think there was a need of saying stuff like that.” Riley came from the perspective that it is part of a counselor’s role to seek to understand the microaggression:
I see where individuals come from and . . . my job will be to understand the perspective of the other individual . . . and show that type of unconditional positive regard and that unconditional empathy toward them. And kind of look at things from their view. I try not to take things . . . too hard. Because it was just the way they were raised.
Prevalence of Microaggressions
     The next theme encompasses CITs’ perspectives that microaggressions are part of their lives and ongoing experiences, and in some cases they described feeling a bit numb or resigned to microaggressions. Riley said that she “didn’t feel anything. I was just like, ‘here this guy goes again.’ I wasn’t frustrated because I didn’t feel my face getting hot. . . . Typically when I get frustrated, my ears start to burn.”
Wesley underscored the prevalence of these experiences in his world, too: “At this point, nothing really surprises me. Maybe it’s me putting on a pair of rose-colored glasses and just using the glass to filter through whatever microaggressions come at me at this point.” He expressed feeling like he had experienced enough microaggressions to “kind of become numb to it. . . . it happens, and you don’t even pay it any mind, especially living in the South.”
Navigating Microaggressions
     The next theme speaks to how CITs navigated, or thought about navigating, the microaggressions with clients. These responses ranged broadly from fear of responding genuinely to letting it go, attempting to redirect, directly responding, or avoiding.
Fear of Responding Genuinely
     The first subtheme captures the participants’ fear of responding genuinely to clients, even when in some cases they would have liked to. Some of this fear centered on participants’ awareness that they may be playing into stereotypes held by clients if they were to respond genuinely, as Riley richly articulated:
That really bothers me . . . I tend to find myself taking a moment to myself, and I’ll be like, “okay, you’re good” . . . “that’s okay. It’s just one thing that one person told you and maybe they were having a bad day.” So, I try to be as understanding as I can.
Riley expressed that society and the media often portray Latina women as “feisty” or “spicy,” and that she does not want to “give [someone] that satisfaction” of confirming the stereotype: “I’m not like that, you know? I’m not spicy. I’m not a food.”
Other CITs described fear of the vulnerability involved with responding genuinely to a client’s microaggression. For example, Blake explained her genuine response and surrounding fear:
And I did disclose to the client that I’m bisexual. I said, “Oh I’m, I’m bi.” But I had that like, even knowing that the client was part of LGBTQ community, I had that question of like, “Why is the client asking? Is this appropriate? What should I say? What do I do?”
Letting It Go
     CITs described often letting microaggressions go for the sake of the client, the counseling, and the counseling relationship. Connecting back to the theme of attempting to contextualize the microaggression, Riley felt it was her responsibility to let it go, “because they’re [microaggressions] from clients, I understand the role as . . . as a student counselor, that I have to kind of push it aside, and bracket those feelings.” Wesley was earnest in his feeling that microaggressions from students’ parents should not get in the way of his work as a school CIT:
Yeah it’s going to take the focus off of the kid. And it’s going to make things awkward. So I’m all for teaching people, but there’s a . . . moment in time when it’s appropriate. And at this point . . . I’m just trying to get through what we’re doing so we can move on to the next parent. No . . . hard feelings, I’m not upset. I’m a little disappointed, but I’m not livid . . . let’s just move on.
Attempting to Redirect
     Some CITs chose to navigate the microaggression by redirecting it back to the client or to another topic without directly addressing the microaggression. For instance, Riley spoke to her efforts to connect these incidents back to clients indirectly: “Even if it’s something said toward us, we try to find a window . . . or different backdoor type of thing to redirect whatever they are saying back to them.”
Directly Responding
     There were times in the CITs’ experiences of microaggressions in counseling where there was a direct response, either by themselves, a part of the client system, or their site supervisors. CITs seemed to view these instances as reparative in the rift the microaggression created in the therapeutic relationship. For example, Wesley fondly recalled a time when a student apologized for his parent’s microaggression after the fact:
They felt that I was uncomfortable, and they felt the need to try and repair it by apologizing for their parents. So it was very validating to me as a person. And to me as a Black person, because the kid realize what their parents had [done] was out of pocket . . . I’m assuming the kid didn’t want our relationship to suffer. . . . So we talked about it. “Look it’s cool it happened, you and I are still good,” and we moved on.
In a different vein, Blake said that responding directly to a youth client questioning her sexual identity in a public area of the practice helped build trust with the client:
[If] I had hesitated, or if I had said, “oh, no, like I’m not like [that],” I think you know, I think people are perceptive and I think that would have damaged [the relationship]. Even if I’m not sure that the disclosure was an additive piece to the relationship, I think that not being forthcoming would have detracted from anything in that moment.
Avoiding
     Finally, within the theme of navigating clients’ microaggressions, participants reported engaging in avoidance afterward in response. This avoidance included instances when the CIT dreaded contact with the client (or the client system) and limited contact when possible. Avoidance also showed up on behalf of the client by discontinuing work with the CIT in individual or group settings. M relayed that her site found a way to separate her and the client who microaggressed against her: “They even said . . . ‘We’re going to not put her in groups with you . . . it’s just not safe for either of you guys.’” Wesley, a school counseling CIT, somberly described parents trying to avoid him after microaggressing against him: “I’ve had a few [parents] request a different . . . counselor when they come in, because they may feel like they soured their relationship with me already. These are the parents . . . who have noticed that they . . . micro-assaulted me.”
Seeking Support
     The final theme, seeking support, captures participants’ experiences (or lack thereof) of seeking and finding support from their sites, university supervisors and faculty, and family and peers.
Site
     CITs often found support at their sites after experiencing microaggressions from clients. This was frequently seemingly because of physical proximity. Often CITs’ site supervisors or other counselors at the site may have witnessed the microaggression or CITs were able to debrief with someone nearby after it happened. David indicated having a quick but meaningful moment of support with his site supervisor before moving on to their next meeting. He recalled that “after the meeting my supervisor and I just kind of like gave each other a look like, ‘ooh that was kind of a strange meeting.’” M was able to debrief with her site supervisor regularly following repeated microaggressions from her client and found her guidance helpful and supportive, especially in the realm of not taking things personally. M said her supervisor encouraged her to “process it on my own, to make sure that it’s not affecting me . . . to where I can’t even use my counseling skills. Like she didn’t want me to go home at night thinking that a patient hates me.”
University
     For the most part, CITs described either not taking these instances of microaggressions to university supervisors or faculty or facing unsupportive responses when they did. Blake relayed feeling shut down by a faculty member’s humor in a class discussion when she brought up how she handled a microaggression with self-disclosure:
Yeah it was a moment of . . . playful questioning of like, “Oh, that’s the decision you made?” That kind of has that implication that maybe it wasn’t the best decision without having more context, right? And I know . . . that [humor is] kind of his approach. But it was a moment, where I was . . . like, “well I don’t really feel like going further with this.”
In some cases, CITs did find helpful and supportive responses from their faculty. Riley described her professor normalizing her experience and giving her what she found to be helpful advice:
[He] told me, “Sometimes we get things like that,” and that’s when he gave me that advice of trying to redirect the question or redirect it back to the client, versus falling into the trap. Well, he called it a trap. Into that little trap they could be setting for us.
Many participants described feeling as though the microaggression was handled by themselves, at their sites, or through processing with family; thus, they felt no need to bring it up in university supervision.
Family and Peers
     CITs frequently described seeking out their families, friends, and peers for support after experiencing a microaggression from a client. Lila processed her experience with her husband, who gave her advice to have more boundaries with her client and “to keep it more professional. . . . I would sometimes disclose about my personal life because she would ask. So I just stopped disclosing.” Riley expressed feeling the need to vent to friends about her experience, “like ‘What the hell was this lady thinking like telling me that?’ . . . just letting it out.”
Wesley sought support from his mother and grandmother in processing microaggressions perpetuated by students’ parents in his school counseling role. He relayed their supportive response:
It was more of a, “These things can happen, you handle it appropriately.” . . . they have had experiences with microaggressions themselves. [They] may not have known what to call them but have experienced it. And pretty much just applauded me for staying neutral, not punishing the kid for what their parents said, and not completely blasting the parent in the meeting because . . . of a joke they let out.
Discussion
In the current study, we explored six CITs’ experiences of microaggressions perpetuated by their clients in counseling settings. The findings from this study provide insight into how novice counselors experience microaggressions from their clients and choose to handle it. We hope these findings enrich the understanding of client-based microaggressions and offer important implications for CITs, counselor educators, and supervisors.
The first theme, internal reactions, reflected the ways in which participants internally processed the microaggression from their client, which is consistent with prior literature of counselors of color’s experiences with microaggressions from clients (Branco & Bayne, 2020). Interestingly, the CITs in the current study described being caught off guard—feeling confused and uncertain with how to respond—while the more seasoned counselors of color in Branco and Bayne’s (2020) study described buffering and bracing for the microaggression, as if they were prepared for it. Counselors in Branco and Bayne’s study (2020) described their readiness for microaggressions from clients was informed by their prior and extensive personal and professional experiences. Although the CITs may have experienced microaggressions in their personal lives and were used to them, as evidenced by the theme of prevalence of microaggressions, their being caught off guard may be attributable to their lack of counseling experience, and more specifically, having never experienced microaggressions from clients and having not yet learned how to navigate this issue.
The CITs further described how microaggressions from clients caused feelings of hurt, fear, anger, sadness (subtheme of discomfort), and experiences of imposter phenomenon. CITs commonly experience confusion, doubt, and worry about their own professional competencies and preparedness as counselors—sometimes internalizing issues in counseling as their own failures (Loganbill et al., 1982; McNeil & Stoltenberg, 2016). Ultimately, CITs in this study also tried to understand the microaggression from their clients’ perspectives. CITs seemed to understand that people inherit their biases from their families and ancestors and reinforce them through microaggressions, oftentimes unintentionally (Williams et al., 2021). Counselors of color in Branco and Bayne’s (2020) study expressed that they tried to make sense of the microaggression as well, and considered their clients’ worldview, racial identity development, and experiences as they evaluated how they would handle the microaggression. The degree to which CITs can consider the clients’ worldview and cultural identity development may depend on their level of professional development (McNeil & Stoltenberg, 2016) and their own identity development (Day-Vines et al., 2007; Jones et al., 2019).
The CITs in the current study described microaggressions as an ongoing part of their lives, as captured in the theme of prevalence of microaggressions. Microaggressions have been referred to as everyday racism, as they are routine and chronic for individuals of racially and ethnically marginalized populations (Williams et al., 2021). This finding is consistent with prior literature of racial microaggressions (Branco & Bayne, 2020; Haskins et al., 2015, Pierce, 1970). Our findings also extend the knowledge base about microaggressions from clients, as microaggressions can target not only race and ethnicity, but also gender, sexual orientation, age, socioeconomic class, and religion. This finding is not unexpected; as informed by the MSJCC (Ratts et al., 2016), counselors and clients possess multiple identities, both privileged and marginalized, and visible and invisible.
The CITs in this study employed a variety of strategies in navigating microaggressions from their clients. Many CITs felt discomfort in the moment, but they were fearful of responding with their genuine reactions for various reasons. Some CITs tried to redirect the microaggressive client by concentrating on the client’s presenting issue or by taking the focus of the conversation elsewhere. Some CITs directly addressed perpetrators’ microaggressions and expressed that this action helped the relationship, while others decided to forgo addressing the microaggressions altogether. In some situations, clients and CITs attempted to avoid each other following the microaggressive incident. These varying responses are not unlike those found in prior research (Branco & Bayne, 2020). A unique contribution to this study is that our participants even experienced microaggressions from clients’ parents, reflecting a larger system that may foster and perpetuate biased opinions and perspectives toward individuals with marginalized identities. When counseling children, parents play an important role in the counseling relationship, despite not being the identified client (Sackett & Cook, 2021).
The final theme, seeking support, reflected the participants’ willingness and desire to seek support for their experiences of microaggression and from whom the support was sought. CITs must decide whether to disclose an issue experienced in counseling, including microaggressions (Branco & Bayne, 2020), and with whom they trust to share this information (Cook & Welfare, 2018; Cook et al., 2019). Some counselors in Branco and Bayne’s (2020) study spoke of seeking support (i.e., coworker, friend), while others did not and chose to process the event independently. The response of the CITs in our study was also somewhat mixed in this regard, as some CITs sought guidance from professionals at their site or, less often, from university faculty or supervisors, while others sought support from individuals in their personal lives. Given that our participants were trainees, it is not unexpected that they would seek guidance from someone more experienced, like a supervisor (McNeil & Stoltenberg, 2016), though interestingly many CITs did not choose to bring these situations to a university supervisor or faculty member. Further, the participants’ satisfaction with the support that they received, especially from their university, varied greatly. Although some participants felt validated, others felt unsupported. It remains to be seen how the response of the supervisors might inform participants’ actions in the future, although Cook et al. (2019) found that CITs who disclosed a salient concern to their supervisors and felt unsupported may be less willing or unwilling to bring up similar issues in the future with the same supervisor.
The finding that CITs in this study were discussing the microaggressions with family and peers must be carefully considered, even though this finding is not entirely unexpected. Ladany et al. (1996) found that CITs commonly discussed issues withheld from their supervisors with peers and friends, although these people were most often also in the mental health field. Further, studies have found that counselors with marginalized identities value the support of others with shared identities (Branco & Bayne, 2020; Haskins et al., 2015). However, like other scholars (Ladany et al., 1996), we wonder how a CIT’s professional development or client’s care might be impacted by heeding the advice of or seeking support from someone who does not possess the necessary training or is bound to the same ethical and professional mandates as a clinical supervisor or infield peer.
Limitations
     There are limitations to this study that are important to note. Although researchers recruited participants from CACREP-accredited programs from across the United States, the resulting sample consisted of only those from the Southern region. CITs’ experiences with microaggressions in this region may be different from those in other parts of the country. Next, we did not explicitly ask about participants’ targeted identities; this information was inferred from participants’ experiences. Although a plethora of existing research focuses on racial microaggressions, we acknowledge that our participants also spoke about other marginalized identities that were salient to them. Additionally, although our sample size was congruent with the constructivist philosophical stance and scope of the study (Boddy, 2016), the sample was relatively small. Counselor educators should consider the transferability to CITs with marginalized identities working with clients of privileged identities. Finally, given van Manen’s (2016) recommendation for an interpretive conversation with participants around the identified themes, scheduling a verbal conversation with each participant for the second member check may have allowed for more input from participants on the findings.
Implications for CITs, Counselor Educators, and Supervisors
     Readers will need to determine, along with the researchers’ description, the naturalistic generalizability of these study findings to their contexts (Hays & McKibben, 2021). However, the findings from this study offer several notable implications for CITs. As with the participants in this study, CITs experiencing uncertainty with how to respond to microaggressions from clients should be expected, given that microaggressions can be difficult to identify and rectify because of their nebulous nature (Williams et al., 2021) and given the lack of training CITs receive on how to navigate these complex issues (Haskins et al., 2015). Further, learning how to best attend to cultural issues in the counseling relationship is a learned skill (Ratts et al., 2016) that is gained through curiosity, intentional learning, lived experience, and continued professional development (McNeil & Stoltenberg, 2016). As evidenced by findings from this study, as well as other studies (e.g., Branco & Bayne, 2020), counselors choose to respond to microaggressions from their clients in a multitude of ways, including offering no response at all. How best to respond to microaggressions is ultimately the choice of the CITs themselves, including the degree to which they discuss their experience and with whom. For example, CITs must consider their position of power in the counselor role, the impact of any decision on the counseling relationship, the intentionality of clients’ microaggressions, and their own emotional well-being
(Pierce, 1970). Given the complexity of this decision, there may be some useful strategies to help inform CITs’ decisions in how to best respond (Hernández et al., 2010; Nadal, 2011).
CITs may find it helpful to broach cultural identities with their clients at the beginning of their working relationship (Day-Vines et al., 2007). By inviting and normalizing conversations of cultural differences, it may make it easier for both parties to openly discuss microaggressions when they occur. CITs may also find it helpful to model humility in the counseling relationship by correcting their own assumptions about clients (Marbley, 2004). Broaching is a skill and a form of immediacy, or processing the here and now of the counseling relationship, which has been found meaningful in the counseling relationship and the counseling process to clients (Sackett & Lawson, 2016; Sackett et al., 2012) and CITs (Sackett et al., 2012). We believe CITs can harness the skill of immediacy (i.e., broaching) to address microaggressions with clients when they occur in counseling. But first, they need to be taught skills to disarm and dismantle microaggressions to reduce the harm and distress they may cause (Sue et al., 2019). Although the onus is not on CITs who experience microaggressions to always address them in the moment, developing a clinical skillset to educate clients on how to recognize their biases, challenge erroneous beliefs that undergird microaggressions, and develop empathy with those they have harmed is important to mitigating the risk of burnout among CITs with marginalized identities (Williams, 2020).
The findings from this study also offer important implications for counselor educators and supervisors. Fickling et al. (2019) contended that the MSJCC framework (Ratts et al., 2016) should be explicitly integrated into clinical supervision. These findings might also provide a rationale for counselor educators to consider how to infuse the MSJCC framework into their classrooms to better prepare students for microaggressions from clients. Specifically, counselor educators and supervisors can examine with CITs how a counselor holding a marginalized identity can engage with a client holding a privileged identity in a counseling relationship, including discussing or role-playing various scenarios and ways to manage microaggressions from clients (Branco & Bayne, 2020). Encouraging counselor self-care strategies (Sue et al., 2019) in processing these scenarios is critical.
Haskins and colleagues (2015) found that counselor educators acknowledged their curriculum was tailored for White students to work with White clients, even if unintentionally. Counselor education program faculty may apply critical race theory tenets to their curriculum to challenge the dominant White discourse in counselor education, as advised by Haskins and Singh (2015). Our findings highlight the value of training related to CITs’ other marginalized identities as well (e.g., gender, sexual orientation, religion, first language) when working with clients of various privileged and/or visible identities, a need identified by Branco and Bayne (2020). The absence of education on navigating microaggressions may lay the foundation for marginalized students to feel as though their experiences are misunderstood or unwelcomed by faculty or supervisors. The current study provides counselor educators and supervisors with information from CITs on how they experience the counseling process when the dynamics of clients with privileged identities and counselors with marginalized identities are present and political (Ratts et al., 2016). Our study findings fill a gap in the literature of the experiences of CITs who encounter clients who offend and perpetuate microaggressions against them while in session.
Because CITs and supervisees control what they share in supervision, fostering an environment that promotes supervisee disclosure is critical (Cook & Welfare, 2018). Studies of intentional nondisclosure (i.e., supervisees’ purposeful withholding of salient information in supervision; Cook & Welfare, 2018; Ladany et al., 1996) found that supervisors can best mitigate supervisees withholding information by attending to the supervisory relationship and demonstrating cultural humility (Cook & Welfare, 2018; Cook et al., 2020). When a CIT voices concerns related to their identities (i.e., a microaggression), counselor educators and supervisors have an opportunity to support such disclosure in a way that validates the CIT’s experience and encourages future disclosures (Cook et al., 2019). Jones et al. (2019) provided situational examples and related response prompts to guide counselor educators and supervisors on ways to broach cultural differences with their supervisees at the beginning of the supervisory relationship and appropriately attend to cultural issues throughout the relationship. Further, as multicultural competence is positively correlated to a stronger supervisory relationship from the supervisees’ perspective (Fickling et al., 2019), supervisors who work to incorporate the MSJCC framework into their supervision will benefit in their supervisory relationships, hopefully leading to increased disclosure of experienced microaggressions, and provision of appropriate support in navigating the CIT–client relationship.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Appendix
Interview Protocol
Tell me about your experience(s) where a client said something that felt like a microaggression toward you.
- What feelings came to you when you experienced the microaggression from your client?
- What thoughts came to you?
- How did you respond (verbally and/or nonverbally)?
- How did the client respond to your response?
- What occurred then?
- How do you feel this impacted your relationship with the client?
Did you process this experience with anyone? With whom did you share about this experience (peers, supervisors, faculty, friends, family, etc.)?
If you processed this with your supervisor(s), was this a doctoral student supervisor, faculty supervisor, or site supervisor?
- How did your supervisor(s) respond?
- How did your supervisor(s) encourage you to respond?
- How did you feel about that response from your supervisor(s)?
- How did you proceed after the feedback from your supervisor(s)?
If any further action was taken with your client following supervision:
- How did your client respond?
- How do you feel about how it went?
- How do you feel this impacted your relationship with the client?
Did you seek [additional] supervision following [remedial] interactions you may have had with your client?
- From whom?
- What was the feedback from your supervisor(s)?
How do you feel this entire experience impacted your relationship with your supervisor(s)?
Any other experiences?
Corrine R. Sackett, PhD, LMFT, is an associate professor at Clemson University. Heather L. Mack, LPC, works for The Well Center in South Carolina. Jyotsana Sharma, PhD, ACS, LCMHC(NH), is an assistant professor at Oklahoma State University. Ryan M. Cook, PhD, LPC, ACS, is an associate professor at the University of Alabama. Jardin Dogan-Dixon, PhD, is a Correctional Psychologist for the Federal Bureau of Prisons. Correspondence may be addressed to Corrine R. Sackett, 225 S. Pleasantburg Dr., Suite D-1, Greenville, SC 29607, csacket@clemson.edu.
				
					
			
					
				
															
					
					Jul 19, 2023 | TPC Outstanding Scholar
 Michael T. Kalkbrenner received the 2022 Outstanding Scholar Award for Concept/Theory for his article, “Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields.”
Michael T. Kalkbrenner received the 2022 Outstanding Scholar Award for Concept/Theory for his article, “Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields.” 
Kalkbrenner (he, him, his), PhD, NCC, is an associate professor of counseling and educational psychology at New Mexico State University. He received his doctorate in counselor education and supervision from Old Dominion University and his MS in mental health counseling from The College at Brockport, State University of New York. Dr. Kalkbrenner’s research agenda is centered on two major themes—psychometrics and college student mental health, and measurement and evaluation of dimensions of integrated mental and physical wellness. He has utilized quantitative, qualitative, and mixed-methods research paradigms, with an emphasis on quantitative methodology in psychometrics and other multivariate statistical analyses. Dr. Kalkbrenner’s teaching pedagogy is based on John Dewey’s theory of experiential learning and the flipped classroom in which the instructor is responsible for the learning environment and students are responsible for their own learning. Dr. Kalkbrenner has clinical experience providing counseling to a variety of populations in an array of different settings, including medical residents, veterans, college students, and children. 
Read more about the TPC scholarship awards here.
				
					
			
					
				
															
					
					Jul 19, 2023 | TPC Outstanding Scholar



 
 
 
 
 
Eric M. Brown, Kristy L. Carlisle, Melanie Burgess, Jacob Clark, and Ariel Hutcheon received the 2022 Outstanding Scholar Award for Quantitative or Qualitative Research for their article, “Adverse and Positive Childhood Experiences of Clinical Mental Health Counselors as Predictors of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress.” 
Brown (he, him, his), PhD, MDiv, LPC, is a counselor educator, mental health counselor, and researcher. He is an assistant professor in the Mental Health Counseling and Behavioral Medicine program at Boston University Chobanian & Avedisian School of Medicine, where he teaches classes on trauma counseling, addiction counseling, and group therapy. His research is focused on issues related to the prevention of burnout in helping professionals. Currently, Dr. Brown researches burnout and the resilience of counselors, teachers, and pastors. 
Carlisle (she, her, hers), PhD, is an associate professor in Old Dominion University’s Counseling and Human Services Department, where she is the Human Services Program director. She also serves as the university’s addictions education coordinator, as well as the chief editor of the Journal of Human Services Scholarship and Interprofessional Collaboration. She has work experience as a PK–12 teacher, school counselor, mental health counselor, and case manager/supervisor, and she has served child, adolescent, and adult populations in school, inpatient residential, and community mental health settings. Dr. Carlisle’s research interests include addictions and addictions education, crisis and trauma education, and interprofessional collaboration and education (IPC/IPE). 
Burgess (she, her, hers), PhD, is an assistant professor and the co-coordinator of the Counselor Education and Supervision PhD Program in the Department of Counseling, Educational Psychology, and Research at the University of Memphis. She earned both her PhD in counselor education and supervision and her MSEd in counseling with a concentration in school counseling from Old Dominion University. Dr. Burgess’s research interests include school counselor preparation and clinical supervision; data-driven, evidence-based practices in PK–12 settings; and assessment. She has presented at national and state conferences, received federal and regional grant funding, and published qualitative and quantitative articles in peer-reviewed journals. 
Clark (not pictured), BS, is a graduate student at Old Dominion University. Hutcheon (not pictured), MA, is a doctoral student at Old Dominion University.
Read more about the TPC scholarship awards here.
				
					
			
					
				
															
					
					Jun 30, 2023 | Dissertation Excellence Award
In the tenth year of TPC‘s Dissertation Excellence Award program, awards were presented to the authors of two winning dissertations, one in qualitative research and one in quantitative research. After receiving submissions from across the United States and through implementation of an improved selection process, the committee selected Drs. Kshipra Jain and Crystal Morris to receive the 2023 Dissertation Excellence Awards. Dr. Jain received the award in qualitative research for her dissertation entitled Experiences of South Asian LGBTQ+ Asylum Seeking Men in the US: A Qualitative Inquiry, and Dr. Morris received the award in quantitative research for her work entitled Silent No More: Exploring the Effects of Mindfulness-Based Strengths Practice on Relationship Satisfaction, Mindfulness, and Well-Being in Female Survivors of Military Sexual Trauma.
 Kshipra Jain (she, her, hers), PhD, NCC, LPC, is a Licensed Professional Counselor (LPC) and Supervisor in Washington, D.C., and a National Certified Counselor (NCC). She has a PhD in counseling (CES) from the George Washington University in Washington, D.C., and a master’s in mental health counseling and behavioral medicine from Boston University School of Medicine. Kshipra is the founder of Saathi Counseling LLC and is currently practicing as a clinician in Washington, D.C. She is passionate about serving and advocating for individuals with marginalized intersectional identities, such as BIPOC, LGBTQ+, immigrants and children of immigrants, and women.
Kshipra Jain (she, her, hers), PhD, NCC, LPC, is a Licensed Professional Counselor (LPC) and Supervisor in Washington, D.C., and a National Certified Counselor (NCC). She has a PhD in counseling (CES) from the George Washington University in Washington, D.C., and a master’s in mental health counseling and behavioral medicine from Boston University School of Medicine. Kshipra is the founder of Saathi Counseling LLC and is currently practicing as a clinician in Washington, D.C. She is passionate about serving and advocating for individuals with marginalized intersectional identities, such as BIPOC, LGBTQ+, immigrants and children of immigrants, and women.
Kshipra has been a board member for Counselors for Social Justice (CSJ) since 2020 and served as the 2020–2021 president for Maryland Counselors for Social Justice (MCSJ). She is also a recipient of the 2018–2019 NBCC Minority Fellowship Program for Mental Health Counselors – Doctoral award. When not involved in professional pursuits, Kshipra enjoys immersing herself in nature, traveling across the globe, reading, cooking, and spending quality time with family and friends.

Crystal Morris (she, her, hers), PhD, NCC, LPC-S, CSC, earned a Bachelor of Science in chemistry with a minor in psychology from the University of Mary Hardin-Baylor, a Master of Education in counseling psychology from Texas A&M University-Central Texas, and her PhD in counselor education and supervision from the University of Texas at San Antonio. She is currently a visiting assistant professor of counseling at St. Edward’s University in Austin, Texas, and an adjunct faculty member in the counseling, health, and kinesiology department at Texas A&M University-San Antonio. She teaches various courses, such as crisis and trauma, group counseling, and counseling theories.
Crystal has worked as a professional school counselor, educator, graduate research assistant, military family life counselor, and private practice therapist. She is a Licensed Professional Counselor Supervisor, National Certified Counselor (NCC), Certified School Counselor (CSC), owner, and clinical director at Butterflies Prospering Wellness Co. She has a wealth of clinical experience that has informed her classwork, teaching, and research. Crystal has experience in the counseling and education field, totaling over 10 years working with at-risk youth, young adults, and military service members and families.
Crystal has advocated in the community through her work with Teach Them to Learn Outreach Ministries, a residential shelter for women and children who have escaped domestic violence. In her private practice, she currently counsels couples; active duty veterans; and adolescents with issues from PTSD/trauma, anxiety, depression, and much more. Beyond her clinical work, Crystal examines the efficacy of mindfulness-based interventions and positive psychology as a trauma-informed protocol. She hopes to advance the theory and understanding of evidence-based treatments for the populations she has worked closely with.
In addition, she is the author of The Butterfly Affect: Living the Single Life Through God’s Eyes, 21 Days of Positive Living, and the coming-soon book in the series, The Butterfly Affect: Establishing Healthy Relationships.
Crystal’s research interests focus on mindfulness-based strengths practices, character strengths and positive psychology as interventions, and exploring relationship satisfaction in female survivors of military sexual trauma. Her research interests also focus on holistic wellness; mental health in the Black and African American communities; multicultural competence and social justice advocacy in counseling; ethics in counseling; relationships (couples); sexual abuse/trauma in women, and PTSD/trauma. Crystal has presented at local, state, and national conferences, and she has written a book chapter on integrative practices for adolescents and children and in a peer-reviewed journal on mindfulness-based strengths practice, with current publications in the works.
TPC looks forward to recognizing outstanding dissertations like those of Drs. Jain and Morris for many years to come.
Read more about the TPC scholarship awards here.
				
					
			
					
				
															
					
					May 10, 2023 | Volume 13 - Issue 1
Shainna Ali, John J. S. Harrichand, M. Ann Shillingford, Lea Herbert
Guyana has the highest rate of suicide in the Western Hemisphere. Despite this statistic, a wide gap exists in the literature regarding the exploration of mental wellness in this population. This article shares the first phase in a phenomenological study in which we explored the lived experiences of 30 Guyanese American individuals to understand how mental health is perceived. The analysis of the data revealed that participants initially perceived mental health as negative and then transitioned to a positive perception of mental health. We discuss how these perceptions affect the lived experience of the participants and present recommendations for counselors and counselor educators assisting Guyanese Americans in cultivating mental wellness.
Keywords: Guyanese American, mental health, phenomenological, mental wellness, perceptions
     In 2014, the World Health Organization (WHO) reported Guyana as having the highest suicide rate in the world (44.2 suicides per 100,000 people; global average is 11.4 per 100,000 people). According to World Population Review (2023), within the Western Hemisphere, even after almost 10 years, Guyana remains the country with the highest rate of suicide—a concerning statistic. Responding to the WHO (2014) report, Arora and Persaud (2020) engaged in research to better understand the barriers Guyanese youth experience in relation to mental health help-seeking and suicide. Their research included 17 adult stakeholders (i.e., teachers, administrative staff, community workers) via focus groups, and 40 high school students who engaged in interviews. Arora and Persaud used a grounded theory approach and found the following themes as barriers to mental health help-seeking in Guyanese youth: shame and stigma about mental illness, fear of negative parental response to mental health help-seeking, and limited awareness and negative beliefs about mental health service. They recommended integrating culturally informed suicide prevention programs in schools and communities. In efforts to extend Arora and Persaud’s findings, we sought to further understand how Guyanese Americans define and experience mental health to better serve them in counseling.
Startled by the statistics presented by the WHO (2014) and Arora and Persaud (2020), we were compelled to focus our attention on this unique immigrant subgroup in the United States. It is important to note that between the WHO’s 2014 report and Aurora and Persaud’s research, no other studies related to Guyanese American suicidality are recorded in the literature. However, two studies on Guyanese American mental health emerged by Hosler and Kammer (2018) and Hosler et al. (2019). Our decision to conduct research on the Guyanese American community was further informed by Forte and colleagues’ (2018) review of immigrant literature in the United States, which stated that “immigrants and ethnic minorities may be at a higher risk for suicidal behavior as compared to the general population” (p. 1). Forte et al. found that immigrants, when compared with individuals in their homeland, were at an increased risk of experiencing mental health challenges like depression and other psychotic disorders. Currently, suicide is listed as the 10th leading cause of death overall in the United States (Heron, 2021). More specifically, within ages 10–34 and 35–44, suicide is the second and fourth leading cause of death, respectively. Heron’s (2021) report, referencing the Centers for Disease Control and Prevention (CDC), highlighted that in the United States, death by suicide (47,511) is 2.5 times higher than homicides (19,141). The prevalence of suicide among Guyanese people within and without the United States warranted further exploration of the experiences of this marginalized group.
The Guyanese American Experience
Comparing all countries with a population of at least 750,000 people, Guyana, a Caribbean nation, is said to have “the biggest share of its native-born population—36.4%—living abroad” due to remoteness and limited opportunities within the country to move from a lower to a higher socioeconomic status (Buchholz, 2022, para. 2). It is estimated that the United States is home to approximately 232,000 Guyanese Americans whose ancestry can be traced back to Guyana (United States Census Bureau, 2019), a country in the northeast of South America, bordered by Brazil, Venezuela, and Suriname. Although approximately 50% of all Guyanese immigrants in the United States reside in New York City alone (Indo-Caribbean Alliance, Inc., 2014), Guyanese people can be found across all 50 states and the District of Columbia (Statimetric, 2022). This draw to the United States, an English-speaking nation, might be linked to the fact that Guyana is the only country in South America that recognizes English as its official language (One World Nations Online, n.d.).
Like most immigrants, Guyanese immigrants travel to the United States seeking a better life and opportunities for themselves and their families. However, the process of transplanting can be bittersweet, in that Guyanese immigrants might be forced to relinquish their identity and customs and embrace American customs through assimilation (Arvelo, 2018; Cavalcanti & Schleef, 2001). For many Guyanese immigrants, being caught between leaving their homeland and beginning life in their adoptive home can lead to a cultural clash, resulting in problematic coping mechanisms (e.g., minimizing/hiding mental health challenges, cultural shedding [adopting American identity and losing cultural heritage]; Arvelo, 2018).
As discussed above, suicide in the Guyanese community is unquestionably a serious concern, but the community faces other challenges in the United States as well. For example, Hosler et al. (2019) found a statistically significant association between discrimination experience and major depressive symptoms in a sample of Guyanese Americans. However, Hosler et al. (2019) also found mean scores on the Everyday Discrimination Scale (EDS; Williams et al., 1997) were lower (i.e., less discriminatory experiences in everyday life) for Guyanese Americans when compared to other groups (Black, White, and Hispanic) because Guyanese Americans have a more cohesive interpersonal network. It would appear that Guyanese Americans experience lower everyday discrimination because they operate within interpersonal spaces that are more cohesive, yet their discriminatory experiences are positively associated with depression symptoms, which is a source of concern.
Another area of concern among Guyanese Americans is intimate partner violence (IPV), yet research remains lacking (Baboolal, 2016), leading us to draw directly from Guyanese literature. In Guyana, IPV is one of the most prevalent forms of violence (Parekh et al., 2012). As a country, although Guyana endorses the commitment to gender equality, women are the majority only in the tertiary sector (e.g., education, human services, clerical services, and tourism). Nicolas et al. (2021) stated that “domestic duties, marriage, and child-bearing, particularly for women between the ages of 25–29, have hindered their labor force participation” (p. 147). They documented that 1 in 6 Guyanese women, mostly from rural parts of the country, hold the belief that beating one’s wife is necessary (i.e., husbands are justified in beating their wives, resulting in domestic violence being a relevant mental health issue). In fact, suicide is identified as a public health issue for Guyanese women, who use it as a means of coping “with economic despair, poverty, and hopelessness . . . [and] to escape family turmoil, relationship issues, and domestic violence” (Nicolas et al., 2021, p. 148). However, even with access to mental health services increasing in Guyana, seeking out mental health care is uncommon due to stigma, lack of communication, inadequate financial resources, limited providers, and other barriers related to access (Nicolas et al., 2021). Within the U.S. literature, there remains a dearth of information on the experiences of this group as it relates to suicide and IPV. Most likely, this is a result of racial categorization within the United States, where, based on phenotype and racial composite, individuals are often lumped into one category, such as Black. As important as Guyanese literature on IPV is to inform the work of counselors, we believe it is equally important for us to engage in research regarding IPV and other mental health challenges on Guyanese Americans specifically. Learning about Guyanese Americans’ perceptions of mental health may facilitate closing the gap in the utilization of mental health services, warranting the current investigation.
Recognizing the noticeable research gap related to the mental health experiences of Guyanese Americans, we conducted a thorough review of the literature related to mental health and well-being. Through databases such as PsycINFO, ProQuest Central, Web of Science, MEDLINE, and SocINDEX, using the search terms “Guyanese Americans, Health and Wellbeing, Mental Health of Guyanese Americans, Access to Mental Health,” 54 search results were found. However, only two applicable studies were found to address Guyanese Americans’ mental health specifically (Hosler & Kammer, 2018; Hosler et al., 2019). The other search results were either not research manuscripts (i.e., reflections and newspaper articles) or addressed other constructs specific to the Guyanese people (e.g., family, education). The first study by Hosler and Kammer (2018) focused specifically on the health profiles of Guyanese immigrants in Schenectady, New York. This study was conducted with 1,861 residents between the ages of 18–64 years. Guyanese Americans from Schenectady were mostly from a low socioeconomic status, which resulted in them being less likely to have health insurance coverage, an identified place to receive care, and access to cancer screenings. They were also identified as being more likely to engage in alcohol binge drinking—all conditions of significant concern to us, resulting in the present study. In fact, Hosler and Kammer reported that Guyanese Americans are among the lowest group of those insured in the United States when compared with other minority groups such as Black and Latinx groups. Some researchers believe ethnocentric stereotyping, cultural incompetence by professionals, a lack of steady employment, and poor previous interactions with the health care system are barriers Guyanese immigrants experience when accessing medical and mental health services (Arvelo, 2018; Cheng & Robinson, 2013; Jackson et al., 2007).
The second study of Guyanese immigrants was conducted by Hosler et al. (2019) and explored everyday discrimination experiences and depressive symptoms in relation to urban Black, Hispanic, and White adults. This study included 180 Guyanese Americans (i.e., both citizens by birth and naturalized citizens/immigrants), all 18 years and older, from Schenectady, New York. The researchers found a significant independent association between the EDS score and major depressive symptoms for Guyanese Americans, suggesting that discrimination experiences might be an important social cause for depression within this community. Based on the reported challenges faced by Guyanese Americans, as well as our desire to contribute meaningfully to the extant body of literature on the Guyanese American community, we conducted a phenomenological inquiry. More specifically, we sought to better understand the lived experiences of Guyanese Americans pertaining to mental health (i.e., definitions, beliefs, practices), and how they access and incorporate mental health resources to mitigate the known mental health risks of this population in the United States, in the hopes of creating tailored methods for culturally responsive care.
Method
Because limited mental health research exists on this unique community, the present study, which is part of a larger research endeavor, sought to explore Guyanese Americans’ lived experiences with mental health. To lay the foundation of understanding, the present study focused on Guyanese Americans’ perceptions of mental health. Phenomenology, a constructivist approach, recognizes the existence of multiple realities and provides an understanding of participants’ lived experiences using their own voices (Haskins et al., 2022). We selected transcendental phenomenology (Moustakas, 1994) as the appropriate methodology for answering our research questions, as it is congruent with the counseling profession’s similar objective of understanding the human being. Akin to the practice of counseling, transcendental phenomenology emphasizes methods of the researcher to best set aside the potential clouds caused by bias in an effort to allow the explored phenomenon to surface. Transcendental phenomenology aligns with one of the core professional values in the American Counseling Association’s Code of Ethics (ACA, 2014), that of supporting “the worth, dignity, potential, and uniqueness of people within their social and cultural contexts” (p. 3). It also aligns with Ratts et al.’s (2015) Multicultural and Social Justice Counseling Competencies (MSJCC), specifically understanding the client’s worldview domain. Our focus on Guyanese Americans, an understudied minority group in the United States (Hosler & Kammer, 2018) originating from a country that has been identified as having the world’s highest suicide rate (WHO, 2014), led us to select this method so that we could maintain cognizance of our surroundings, hold respect for the population, and examine participants’ experiences (Haskins et al., 2022; Hays & Singh, 2012; Hays & Wood, 2011).
Participants
     Before participants were recruited for the study, IRB approval was obtained from the university with whom Shainna Ali, M. Ann Shillingford, and Lea Herbert are affiliated. Purposive criterion sampling was used to recruit participants, leading to a sample of adults who self-identified as Guyanese American (i.e., either immigrated to the United States themselves or had at least one parent who was born in Guyana). Recruitment materials were shared with Guyanese Americans using counseling listservs (i.e., ACA–AMCD Connect and CESNET) and social media platforms (i.e., LinkedIn, Facebook, and Instagram). Members of the research team contacted all participants using email to share details regarding the study and the informed consent document, collect demographic data, and schedule individual interviews. According to qualitative research, sample size recommendations range from six to 12 participants (Creswell, 2013; Guest et al., 2006; Onwuegbuzie & Leech, 2007). Hence, we sought to recruit 15–20 participants to account for the possibility of attrition.
Our recruitment efforts yielded 73 individuals who expressed interest in the study, 60 of whom met all inclusion criteria and were initially contacted. Forty-three individuals were unable to complete an individual interview due to scheduling conflicts; hence, we secured a total of 30 participants who completed the study. Of this number, 17 participated in individual interviews and a total of 23 individuals participated in a one-time focus group to further clarify data from the individual interviews. It should be noted that 10 of the 23 focus group participants also participated in the individual interview. Further recruitment was deemed unnecessary, as the data analysis reached saturation with data from the individual interviews and focus group. We present demographic data on all participants who engaged in the study, both individual interviews and the focus group (N = 30), in Table 1.
Table 1
Participant Demographic Data

Note. This table provides a breakdown of the demographic characteristics of Guyanese American participants (N = 30).
 
Data Collection and Analysis
     Participants engaged in a semi-structured interview lasting 30–60 minutes, conducted by Ali and Shillingford. Interviews were conducted via Zoom, audio-recorded, and transcribed verbatim. The interview protocol consisted of three primary questions, and sub-questions were used to clarify responses: 1) How do you define mental health?; 2) Who in your life has had experiences with mental health?; and 3) What experiences have you had with mental health? Prior to conducting our study, we included in our IRB documentation that data collection of individual interviews would follow saturation guidelines and that a focus group could be used for further data illumination. Following initial data analysis, we found it necessary to conduct a 1-hour follow-up focus group via Zoom to probe deeper into the data and to allow participants to clarify concepts related to emerging themes. Upon the first round of analysis, it was noted that several participants experienced a shift in perceptions regarding mental health. Focus group probes explored whether participants noticed this shift, what may have contributed to this shift, and when the shift occurred.
After all focus group and individual interviews were transcribed, we used guidelines outlined by Moustakas (1994) to analyze the data. First, we immersed ourselves in the data, reviewing each transcript individually. The transcripts were then divided equally among the four researchers, who read through each to become familiar with the data. With each transcript, we identified relevant statements reflecting participants’ lived experiences (horizontalization) as Guyanese Americans within the contexts of mental health beliefs and experiences.
Following this process, we met multiple times to review all transcripts and confer about the textural descriptions. We identified relevant codes, then synthesized the textural descriptions into themes based on commonalities, distilling the meaning expressed by participants. Then we engaged in reduction and elimination via consensus coding. This process included reading and rereading transcripts together, which followed an iterative process of reviewing the text and code, coding, rereading, and recoding, before determining which thematic content was a new horizon or new dimension of the phenomenon.
After all transcripts were analyzed following this reduction process, clustering and thematizing occurred (i.e., thematic content was clustered into core themes based on participant experiences; Hays & Singh, 2012; Moustakas, 1994). We extracted verbatim examples from the transcripts to generate a thematic and visual description of the phenomenon being examined. After completing the initial data analysis, we conducted member checking by sending each participant their individual transcript as well as the written results section. Participants were requested to provide feedback on the accuracy of their transcripts. Additionally, following the focus group and elucidation of themes all participants were offered an opportunity to member check and clarify the degree to which the results aligned with their lived experiences. The participants did not report any errors; however, clarification was offered by one participant.
Trustworthiness and Positionality
     Trustworthiness is a key element of qualitative research in which the research findings accurately reflect the data (Lincoln & Guba, 1985). A critical element of maintaining research credibility is through reflexivity, wherein researchers critically examine procedures employed in relation to power, privilege, and oppression (Hunting, 2014). To safeguard against researcher bias, we worked collaboratively to establish and maintain credibility throughout data collection and analysis processes. Our research team consisted of one Indo-Guyanese American female faculty member, one Afro-Guyanese American female doctoral student, one Black female faculty member, and one Indo-Chinese-Guyanese Canadian male faculty member. All three faculty members belong to CACREP-accredited counselor education programs, and all four researchers have clinical experience working with diverse populations.
To address researcher bias, we engaged in bracketing to minimize the ways in which our experiences influence our approach to research and expectations of the outcomes of the study. Prior to data collection, we discussed our experiences in relation to Guyana, mental health in the Guyanese American community, and our roles as mental health leaders and advocates. We identified our personal experiences, acknowledged our biases, and attempted to bracket while conducting the interviews and focus group. Throughout the data collection and analysis processes, we participated in personal reflection and kept analytic memos documenting our reactions and initial thoughts about the data collected.
Before analyzing the data, we met to confirm analysis procedures, ensuring consistency. We initially analyzed data individually, then determined codes and themes as a team to reduce bias. Throughout the data analysis process, we consulted with each other, addressing questions or concerns related to the data. We also consulted with an outside researcher experienced in qualitative research to obtain critical feedback on the data analysis process and the research findings (Marshall & Rossman, 2006). Our consultant served as an external check of the research methodology and theoretical interpretation of the data.
Findings
The results of the analysis increase understanding of the lived mental health experiences of Guyanese Americans by elucidating perceptions of mental health (Creswell, 2013). All participants shared their beliefs about mental health and the direct and indirect experiences that informed their conceptualization. Three themes surfaced. The first two showed a clear divide in the data: 1) mental health being perceived as negative, stigmatized, elusive, and intimidating; and 2) mental health being perceived as positive, important, helpful, and empowering. It is important to note that these primary themes were not representative of two subsets of participants, and this extracted another theme, which centered on the tendency of participants’ beliefs to transition from negative to positive views of mental health.
The Perception of Mental Health as Negative
     When exploring obstacles, subthemes emerged in which hindrances to mental health were acknowledged to exist across three levels: individual, familial, and sociocultural. In parallel, these three subthemes were echoed in the exploration of factors that participants acknowledged have contributed to their mental wellness. The following section explores the primary themes in detail by highlighting the participants’ voices in describing their lived experiences.
Mental Health Concerns Are a Sign of Weakness
     All participants in the individual interviews shared that they originally believed that mental health developed out of weakness. This belief was often attributed to minimizing remarks from family members. Oftentimes these comments were paired with other suggestions of how to ameliorate symptoms such as praying more, working harder, or contributing to physical health (e.g., drinking tea). Sharon shared:
It was just like, oh no, you just need to read a book or you just need to go and do something and take your mind off of however it is you’re feeling, like there’s no reason for you to be sad, you have a roof over your head and you’re going to school and you’re doing all of these things, it doesn’t matter. There’s no reason for you to be sad or feel any type of way about anything because we provide everything for you.
     Several participants noted that investment in physical wellness was preferable to mental wellness, although physical health was not genuinely prioritized. Participants shared personal and observed maladaptive coping with poor eating habits (i.e., quality and quantity) and excessive substance abuse, namely alcohol. Some participants shared that these tactics were used to manage mental health symptoms or avoidance. Christine shared, “When you’re struggling with things . . . you have nowhere to go to with them except alcohol and the bottom of a rum bottle.” Many participants recognized that coping with alcohol is normalized within the culture. Further, the commonality of these methods normalized consumption and have caused additional issues (e.g., diabetes, heart disease, alcoholism). Arjun noted:
We all have relatives that are kind of stuck on the whole drinking issue. We know a lot of them. They get together with their friends and they “lime,” as we like to call it. They drink in groups and they “gyaff,” they have fun. But it’s a completely different story when they’re by themselves and they’re drinking.
Mental Health Is Taboo
     A general consensus was that all participants in the study once believed that mental health was not important and that mental health problems were shameful and not to be discussed. This consistent trend was one of the reasons that we opted to further understand responses through a focus group. Therefore, a direct probe was offered to the focus group participants to explore if they believed discussing mental health was taboo. When delving deeper into these perceptions, participants noted that these thoughts were informed by the beliefs of others and upheld in the wider cultural paradigm. All participants reported that, generally, mental health should not be talked about in order to save face and be respectful. Because mental health issues were seen to be synonymous with weakness, sharing about mental health was equated with the risk of bringing shame to oneself or to one’s family. For example, Chandra shared that “Guyanese people don’t want a kid that’s broken or a little off.” Hence, if someone opts to discuss their mental illness, it is to be done carefully, or secretly.
Most participants shared that typically, when divulging their symptoms, they went to an elder, often a parent, grandparent, or elder sibling, in an effort to keep concerns within the family system. However, many participants noted being minimized or dismissed when sharing their concerns with family members. Ramona explained her feeling that her family
is really strong about, like, don’t be selfish. And I wonder if they would categorize it under that. Like if you’re taking up too much space or time or whatever, you’re trying to center the attention on you or whatever, so that’s a self-serving thing.
     A generational rule of discourse emerged from the data. Though the tendency was to keep mental health discussions within the family system, it was also atypical for a younger member to address observed issues with an elder. Several participants noted that this hidden guideline kept informed younger generations from being able to utilize their recognition of warning signs to help the given person and the family system. Arjun shared that as he’s gotten older and has learned more about mental health, he has acquired the courage to address the problems he sees with elders, including his uncle:
I said, “Uncle, what’s wrong?” And he said, “No, nothing is wrong.” But he was crying, you could see tears were streaked on his face, but he wouldn’t talk about it—he wouldn’t say anything. It’s not only one time I saw him, it’s multiple times that I’ve seen him when he has been drinking by himself, that he kind of has the same face all the time. Prior to the times that I asked him, I kind of looked at him and I kind of walked away the first couple of times. Because I was kind of like, this is not something that looked like I should butt in, as a child especially. When you’re younger, your parents tell you, “Mind your business.” Or they say, “You’re not an adult, go with the kids.” So . . . the first couple of times I saw him, I kind of avoided it.
Others Are Not To Be Trusted
     Some participants noted that beyond the purpose of family protection, caution to mental health discourse was also due to lack of trust of others. Christine explained: “We had a counseling center on campus, but I was like, ‘Oh, I can’t go talk to anybody,’ because that’s what I was raised with. You don’t talk to strangers about your problems. I had to keep everything inside.” Nevertheless, some families encouraged talking to a religious leader to assist the individual in enhancing devotion and reducing mental health symptoms. Still, regarding professional mental health services, many participants believed, at least at one time, that such services are not helpful, providers are not to be trusted, assistance of that nature is for other (e.g., White) people, and succumbing to that level of desperation is a sign of weakness. When sharing about mistrust in professional mental health assistance, misconceptions and stereotypes surfaced. Ramesh shared:
Oh boy. I have to be honest with you, I feel counseling is, I’ll speak to a shrink and they’ll prescribe drugs to me, like Ritalin or . . . I was like, you know what, I’m better than that. I’m probably totally wrong about it, but that’s just the perception that I have. I’ll be laying on the couch and I’m going to speak into someone and then they’re going to prescribe drugs to me. I don’t want that. I can try to figure this out on myself by talking and trying to do things—positive behavior.
Mental Health Perceived as Positive
     All participants in the individual interviews acknowledged a shift in their perceptions of mental health. Their newfound conceptualization included a holistic view of wellness in which mental wellness was seen as an important component to overall well-being and quality of life. In this newer perception, participants acknowledged the ability to consider more variables influencing mental health than they recognized in the past. For example, many participants noted a link between mind and body, versus the previously held notion that physical health is more important than mental health. A few participants noted that mental health can be influenced by genetics, while some noted that it could be influenced by personality, and others noted that it can be influenced by people and the surrounding environment.
All participants, from both the individual interviews and focus group, concurred that everyone feels mental health effects; furthermore, showing signs of a problem is not attributed to weakness. Moreover, because mental health affects everyone, a widespread belief emerged that we all have the responsibility to foster our mental wellness. Additionally, participants shared several examples of what naturally ensued without investing in strategies for mental health such as challenges with emotional regulation, coping, relationships, and worsening mental health problems.
The Transition Between Negative and Positive Perceptions
     The transition between old and new conceptualizations of mental health was informed by direct and indirect experiences. All participants shared a transition in beliefs in the individual interviews, and this was explored in the focus group for further clarification. Most participants shared that their personal mental health history informed a change in their beliefs. Many of these participants noted the influence of their healing process, most notably seeking professional help. All participants, from both the individual interviews and the focus group, shared at least one example of learning about mental health by observing another person’s experience. For example, Jessie shared, “Unfortunately, I came from a home of domestic violence . . . I was around maybe six, my dad was bipolar . . . [and] he was just a wife beater. That is probably when I can recall [learning] of mental health.” Another example of learning about mental health from others is captured in Reginald’s comment:
[As] an only child . . . my parents took it upon themselves to [teach me]. . . . It wasn’t like, “Okay, sit down. Let me tell you why these things are.” It was just we’ll be talking about somebody else or going over something that happened and then they’ll explain why, but never directly for me. It was always about other people’s kids.
     Many of these individuals emphasized the belief that by paying attention to others, you can learn what is helpful and unhelpful for mental health. Oftentimes this was in their own family; however, extended family and community members were also highlighted. Moreover, a few participants shared their recognition that living with someone who is struggling with their mental health may negatively impact personal wellness (e.g., be triggering). Beyond the family system, some participants noted that exposure to other cultures and perceptions of mental health informed a conceptualization of mental wellness. Seeta shared:
I had friends of other religions or like no religions. And then we would talk about a lot of different things. Like I would ask them questions like, “Oh, so how do things work in your house? Do your parents talk about your God or whatever?” And they’re like, “No.” And I’m like, “So where do your emotions come from?” And they’re like, “Well, you know, we just feel them. Some days I feel angry and some days I feel sad, some days I feel happy.” And I’m just like, “Okay, this is interesting.”
From the quote, it might appear that one’s emotions are in some way connected with God or another higher power; however, this is not something that was observed with other participants of our study. It was more common for participants to share stories of their families using religion as the solution to mental health concerns. For example, Yolanda shared:
My grandmother came when I turned 16 and she kept trying to tell my mom I was showing signs of depression. And my mom was like, “No, she’s like that all the time, like, that’s just how she is.” And my grandma was like, “That’s not normal. You should get her checked out.” And my mom kept saying, “No” and kept denying it. And then my grandma said, “You have to do something.” And then my mom replied, “Oh, I’m going to pray for her.”
     In addition to personal experiences and observations of others, participants noted that improved mental health awareness and education prompted them to think critically about their mental health schemas. Ramesh shared:
My education, I always feel like this is what saved me in the end, because I was able to be around other people to know better and to come back home and be like, “Excuse me, this is not how we do things. This is not how we say things. I don’t know what it was like in Guyana.”
     Some participants associated this with growing older, and others noted their personal initiative to improve mental health knowledge by following mental health pages on social media, taking a related class, and for some, becoming a part of the mental health field themselves. From this vantage point, many participants were able to equate their previously held notions with beliefs embedded in the culture such as generational rules of respect, gender differences, and the impact of colonialism. Participants, despite their gender differences, noted that within the cultural framework, the rule that mental health should not be discussed is disproportionately applicable to males. Participants shared that this is often due to the perception that it is important for men to be strong, and again, mental illness is a symptom of weakness. This was also linked to the breadwinner role and the pressure to provide for the family. However, this was only noted to have detrimental effects, as anger issues, IPV, and alcoholism were noted to arise out of this rule. Some participants noted that the survival aspect of colonialism may have contributed to the lack of privilege to focus on mental health. In addition, the history of colonialism in Guyana (i.e. slavery, indentured labor) could have informed the lack of trust in professional services.
The change in mental health conceptualization was noted to have benefits beyond the participants themselves. Some participants remarked that the shift in perception was recognized in the wider generation. Ramona reflected:
I will say that a lot of folks from my generation have been a lot more like, “Go to therapy. We should be taking care of our thoughts and our feelings or emotions.” That’s important to you in the same way that if you tore a ligament that you would need to get surgery or do whatever.
     Within the newfound conceptualization of mental wellness emerged a vow of social responsibility. All participants, from both the individual interviews and the focus group, shared their intention to help others, and some even noted it as their duty. Ways to help others included advocating for mental health awareness, access, and education; helping to challenge unhelpful cultural beliefs; breaking generational cycles; and protecting others from experiencing similar struggles (e.g., child, sibling).
Discussion
     The findings from this study are enlightening, and some are the first to be documented through research, even if they were observed in practice. Initial perceptions of all participants, from both the individual interviews and the focus group, were that mental health is a taboo topic and seeking mental health services is bad. These perceptions stemmed from fear, mistrust, and limited awareness of the benefits of mental health services. This is consistent with findings from Arora and Persaud (2020), who surmised that Guyanese individuals hold negative views of mental health that significantly impact their help-seeking. Furthermore, the findings point to strong familial and sociocultural influences, such as beliefs about mental health, that swayed individual perceptions of mental health, which is in keeping with recent literature on affirming cultural strengths and incorporating familial identity in working with clients of Guyanese descent (Groh et al., 2018; Nicolas et al., 2021).
Discussing issues related to mental health was viewed as a sign of weakness, which translated to help-seeking being a taboo. It would appear that the stigma associated with mental health remains a common experience for Guyanese Americans, and when coupled with limited communication, insufficient funding, and lack of providers, we can see how Nicolas et al. (2021) found this to be concerning. Cultural clash, ethnocentric stereotyping, and cultural incompetency may also be responsible for Guyanese Americans being distrustful of the health care system, leading them to engage in maladaptive behaviors (i.e., avoidance, use of substances, IPV) and not receive the mental health attention and care they need (Arvelo, 2018; Cheng & Robinson, 2013; Jackson et al., 2007).
It appears that even in the face of discrimination and experiences of mental health challenges like alcoholism, depression (Hosler & Kammer, 2018), and IPV (Parekh et al., 2012), leaning on the support of the community serves to buffer against mental health challenges for Guyanese Americans. It also seems that changing mental health perceptions from negative to positive was significantly related to mental health literacy and exposure to other systems such as school, work, and community (i.e., cross-cultural exchange).
Findings that were not previously documented in the literature suggest that an integrated view of wellness enabled participants to augment their negative abstractions of mental health care. These findings serve as an indication that among Guyanese Americans, although mental health has been perceived as negative, weak, and a taboo, the narrative is beginning to shift to make space for mental health awareness, education, access, and functioning, thereby creating unique implications for counselors seeking to meet the needs of this immigrant subgroup.
Implications
     In combination with prior literature, the results of this study provide a rationale for mental health counselors, marriage and family counselors, school counselors, and counselor educators to inspire dialogue to foster mental wellness. Based on the findings from this study, when working with Guyanese Americans, counselors should focus on three key strategies to support Guyanese American clients: (a) mental health awareness, (b) mental health education, and (c) mental health experience.
Mental Health Awareness
     Participants in this study initially held limited views and awareness of the signs and symptoms of mental health. When awareness was heightened through various means, they were more open to exploring the benefits of services. Counselors can be instrumental in creating awareness by first raising their own awareness pertaining to cultural stigma and its influence on Guyanese Americans’ mental health. For example, unwillingness to attend counseling sessions may be linked to the culturally held perception that discussing mental health, especially beyond the core family system, is taboo. In acknowledging this, counselors can raise awareness of confidentiality, which can be seen as an alignment with the cultural notion that talking about mental health is taboo when it means talking to anyone, and the role of the counselor can be highlighted as a professional collaboration versus communal gossip. Counselors need to be mindful of the collectivistic nature of Guyanese American culture, which causes personal and familial illnesses alike to be perceived as personal problems. Rather than dismiss a client’s concerns about mental health, a counselor can benefit from exploring how the family members’ symptoms, perceptions about mental health, and willingness to adhere to treatment influence the client’s symptoms, perceptions, and commitment to counseling. Further, collectivism spans beyond the protective family system. On one hand, this community orientation can be used to explore a broad range of support, yet on the other hand, depending on the client’s experience, this may also be a widened range of societal pressure (e.g., judgment, criticism, shame).
Mental Health Education
     Increased understanding of mental health appeared to have led participants to seek services and resources to increase their mental health literacy, with the hope of improving their well-being. Counselors and counselor educators can be instrumental in offering Guyanese Americans mental health education. To begin, all mental health professionals should demonstrate a posture of cultural humility when engaged in psychoeducation on mental health and wellness for this population. In order to raise awareness through education, mental health professionals are encouraged to model trust, respect, sensitivity, compassion, and a nonjudgmental stance. Within session, counselors should be prepared to offer information regarding early signs of mental illness, compounding factors (e.g., alcohol, suicidal ideation, domestic violence), obstacles (e.g., stigma), and resources. Additionally, counselors may need to offer psychoeducation on the family system, roles, dynamics, beliefs, experiences, and generational patterns that can influence individual mental health. In the event that a family member with mental health problems is unwilling to seek assistance, helping the client to better understand the diagnosis and cope personally can be empowering. Finally, to employ the collectivistic nature of Guyanese American culture, stigma can be confronted, and mental health education can be effectively offered by providing group counseling within this population. Group counseling can offer a variety of therapeutic factors that can benefit Guyanese Americans such as universality, hope, and corrective recapitulation of the primary family group (Yalom & Leszcz, 2005).
Beyond the counseling office, counselors and counselor educators should consider collaborating with culturally supportive organizations. Workshops and information sessions can be tailored to explore and address cultural, religious, ethnic, and generational differences in addition to offering mental health resources (e.g., signs, symptoms, treatment). Several of the participants in our study shared that access to psychology courses in school helped to improve their knowledge about mental health. In addition to these classes continuing to be offered, accessibility to such courses should be expanded. Schools and universities may benefit from offering workshops and other informational sessions to support mental health. Beyond information being offered, a follow-up may be beneficial by linking school or campus counselors in order to connect an improvement in awareness and education to action, change, and health.
Several participants shared that because of a lack of access to mental health education, their knowledge was attained through social media platforms such as Instagram and TikTok. Although the quality of mental health education was not assessed in the present study, the lack of regulation on social platforms could perpetuate misleading, confusing, and stigmatizing misinformation surrounding mental health. Counselor educators should consider their roles beyond the classroom. In addition to empowering counselor trainees to utilize the suggestions above to foster awareness and education, counselor educators can offer responsive and succinct information via social media. Whereas social media is not an appropriate platform for tailored education or services, brief information can be offered to bridge the gap between awareness, education, and access.
Mental Health Experience
     Growth in awareness and knowledge around mental health resulted in participants intentionally engaging in positive experiences as a way of resisting past harmful and hurtful practices and generational patterns, reauthoring a new narrative of hope and healing. Being wellness-focused, counselors are uniquely positioned to support this community by facilitating positive experiences impacting overall mental health and well-being.
Counselors can honor clients from this community by creating safe spaces for them to share their narratives without judgment. Counselors can foster healing communities through group counseling, where clients collaboratively share each other’s mental burdens and celebrate successes (Yalom & Leszcz, 2005). Counselors can honor collectivism by encouraging clients to participate in support groups in addition to personal counseling. Counselors and counselor educators can enhance the approachability of counselors by improving their visibility in the community. Examples include a community counselor being involved in outreach with a local cultural center, a school counselor offering mentorship with student clubs, a college counselor guest-speaking at a Guyanese American student organization meeting, or a counselor educator offering tailored workshops for the community.
In addition to the aforementioned implications, we believe that in order for counselors to bridge generational gaps in counselor distrust, counselors must acknowledge the lack of representation of diversity within the profession of counseling, the predominance of Western and European cultural and psychologist-centered curriculum, and lapses in poor bioethics and power dynamics among counselors and marginalized communities (Singh et al., 2020). Next, the specific intersectional impacts suggest counselors must adapt a multicultural orientation and illuminate cultural sensitivity. When a clinician enacts cultural sensitivity in session, clients can examine their perceptions of illness and center their multiple identities (Davis et al., 2018).
Limitations and Future Research
     Several limitations that arose from the research process are important to mention. All interviews were conducted virtually. Although secured virtual platforms such as Zoom are considered acceptable for research, lack of face-to-face interviewing may have excluded subtle visual cues and induced video-conferencing fatigue (Spataro, 2020). Though researchers made great attempts to increase participant comfort and review the informed consent before the interview process, it is also plausible that respondents may have censored their responses out of concern for potential breach in confidentiality. A majority of respondents are college-educated, female, first generation, and of Indo-Guyanese descent; hence, the results may not be representative of all Guyanese Americans. Additionally, aligned with phenomenological methods of exploring lived experiences, research prompts were general. Recognizing the concerning statistics surrounding suicide (WHO, 2014), a future study exploring suicidality could be beneficial. Future research might seek to explore a more diverse pool of participants, including diversity in gender, age, ethnicity, and number of years in the United States. To build on the findings from the present study, future studies should explore what factors contribute to Guyanese American mental health as well as what variables may hinder mental wellness. It may also be beneficial to include research from the perspective of children and parents to further understand the influence of family systems and cross-generational norms.
Conclusion
This study highlighted the crucial need to address the mental health literacy of Guyanese Americans. The findings illuminate Guyanese Americans’ perceptions of mental health, including the transition from negative to positive perceptions and its potential influences. Efforts should be made to promote awareness, education, and experience related to mental health awareness for Guyanese Americans. Supporting mental health may help to reduce alarming rates of mental illness in Guyanese Americans and may also have the potential to influence related groups such as Guyanese, American, and Caribbean individuals. Counselors and counselor educators have the potential to play a significant role in supporting these clients by being cognizant and informed about cultural considerations.
 
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Shainna Ali, PhD, NCC, ACS, LMHC, is the owner of Integrated Counseling Solutions. John J. S. Harrichand, PhD, NCC, ACS, CCMHC, CCTP, LMHC, LPC-S, is an assistant professor at The University of Texas at San Antonio. M. Ann Shillingford, PhD, is an associate professor at the University of Central Florida. Lea Herbert is a doctoral student at the University of Central Florida. Correspondence may be addressed to Shainna Ali, 3222 Corrine Drive, Orlando, FL 32803, hello@drshainna.com.