Multicultural Competence in Disability Counseling

July 19, 2023
12:56 am

A Literature Review of Disability Counseling

Abstract

This literature review explores the significance of disability counseling competency for counseling professionals in delivering effective and ethical services to clients from diverse backgrounds. It focuses on case management and service delivery for BIPOC (Black, Indigenous, and People of Color) individuals with disabilities. The article examines the challenges in providing counseling and the theoretical frameworks that guide best practices in this field. The review concludes by offering recommendations for enhancing multicultural competence in counseling practice based on the existing literature on this topic.

Keywords: multicultural competency, counseling, BIPOC, disabilities, case management, service delivery, theoretical frameworks.

Introduction

Multicultural counseling competence is the ability of rehabilitation professionals from diverse rehabilitations and counseling sectors to work effectively with consumers with disabilities from various cultural backgrounds. It involves understanding how culture impacts an individual’s beliefs, values, and behaviors and the ability to modify counseling interventions to meet each client’s unique needs. Multicultural competency is particularly critical in counseling BIPOC individuals with disabilities, as they may face multiple forms of discrimination and marginalization. This article examines the importance of multicultural competence in counseling, the skills necessary for culturally competent counseling, the challenges rehabilitation counseling professionals face, and the theoretical frameworks that guide best practices.

Importance of Multicultural Competence in Disability Counseling

O’Hara et al. (2021) focuses on the concept of multicultural research within the field of counseling. The authors argue that since the counseling profession values diversity and social justice, all research conducted within this field can be considered multicultural research. They emphasize that research is a complex system involving multiple parties, such as researchers, participants, reviewers, and readers, each with their own unique cultural identities and norms. As a result, dynamics of power, privilege, oppression, and culture are inherent in all aspects of counseling research, whether acknowledged or not.

Counseling professionals who lack multicultural competency risk perpetuating harmful stereotypes, misunderstanding clients’ experiences, and imposing their values on clients (Gopalkrishnan, 2018). Conversely, culturally competent counselors can build rapport and trust with clients, understand their unique challenges, strengths, and their innate frame of reference and tailor interventions to meet their unique needs (Bernal et al., 2016).

Skills for Competent Multicultural Disability Counseling

According to Farmawati (2020), empathy is an essential skill for a multicultural disability counselor, which means understanding and sharing the feelings and experiences of persons with disabilities. It allows them to connect with their clients and provide the necessary support and understanding. The counselor should be familiar with the cultural greetings and norms of the diverse communities they work with. It helps in building rapport and establishing trust with disabled persons.

Lee and Ditchman (2016) explored the intersection of multiculturalism and disability in the counseling industry. According to their objectives, a decent multicultural counselor should possess cultural awareness and sensitivity while understanding diverse cultural backgrounds, values, beliefs, and practices. They should also be familiar with multicultural counseling models that provide contextually relevant and culturally sensitive approaches to working with diverse populations, including individuals with disabilities.

Deroche (2016) sheds light on the perceived multicultural disability competence of counseling students in CACREP-accredited programs and the factors that influence it. The findings underscore the importance of personal experiences with disability and formal training in multicultural counseling for developing competence in working with individuals with disabilities. The study highlights the significant impact of disability-related life experiences on self-awareness and perceived knowledge. It emphasizes incorporating diverse perspectives and lived experiences into counseling education to enhance cultural competence.

Culturally competent counseling involves several essential skills. Firstly, counseling professionals must be well-informed and acknowledge of their cultural biases and assumptions. They must also be willing to engage in ongoing learning about different cultures and their unique experiences (Conner & Walker, 2017). Secondly, counselors must develop practical communication skills appropriate for different cultural contexts. They must be able to use nonverbal cues, such as eye contact and tone of voice, to convey empathy and build rapport with clients. Thirdly, counselors must be able to thoroughly assess clients’ cultural backgrounds, including their beliefs, values, and attitudes toward people with disabilities who apply for services to better their condition. In the field of rehabilitation counseling, an essential best practice revolves around assisting individuals with disabilities in achieving their career aspirations. One prominent challenge faced by people with disabilities is unemployment. Nevertheless, rehabilitation professionals have taken a proactive stance in addressing this issue by emphasizing its significance and providing comprehensive training programs to empower consumers in securing employment opportunities. Counselors must develop culturally responsive interventions that consider clients’ unique needs and circumstances (Bernal et al., 2016; Carrera, et al., 2020). They must be versed in cultural humility in order to counsel people with disabilities from diverse backgrounds. They must have the ability to establish a client- counselor alliance through building rapport with consumers. “Counselors have various opportunities to validate the consumers’ or clients’ efforts to preserve their cultural identities and values through curative and person-centered counseling paradigms” (Leung & etal., 2007).

Challenges in Multicultural Disability Counseling

Lee (2013) offers valuable advice for counselors seeking to enhance multicultural counseling skills. The author highlights the need for a comprehensive and holistic approach to counseling. According to Lee (2013), the intersection of disability and cultural diversity is a significant challenge. Individuals with disabilities from diverse cultural backgrounds may face unique challenges and barriers that require careful consideration. Culturally sensitive approaches need to be applied to address the specific needs and experiences of individuals with disabilities, recognizing the influence of cultural norms, beliefs, and attitudes.

Fernandes and Lane (2020) addressed the importance of multicultural supervision in counseling, particularly in light of the increasing ethnic and racial diversity in the United States. The researchers highlight the significance of counseling supervisors who know about diverse cultures, ethnicities, social experiences, and spiritual supervisee backgrounds. Cultural factors can contribute to barriers to accessing disability services and resources. Culturally competent counselors can help individuals with disabilities navigate these barriers, such as language barriers, cultural stigma, and limited awareness of available support systems.

Multicultural disability counseling presents several challenges for counseling professionals. Counselors may lack knowledge about specific cultures and make incorrect assumptions about clients based on race or ethnicity. This can lead to misunderstandings and mistrust between the counselor and the client. Cultural differences can create communication barriers, making it difficult for the counselor and client to understand each other (Badcock & Sakellariou, 2022). Counseling professionals may encounter clients with beliefs or attitudes that conflict with their own, leading to ethical dilemmas in treatment planning and service delivery. Finally, BIPOC individuals with disabilities may face multiple forms of discrimination and marginalization, further complicating the counseling process (D’Andrea et al., 2013). For example, Porfyri and others (2022) support that many mental-health-related stigma cases have been observed in the past. This most underlying marginalization and stigma presents another challenging recipe for the counselor amidst clients’ own innate bias. Clients come to counseling holding onto grudges of past experiences, and finding it hard to focus on their current treatment or work with counselors towards their life fulfilling career paths. This concept is called mistrust. Thus, it is critical that counselors, especially those in the mental health, drug rehabilitation, schools and career counseling paradigms include a diverse array of counseling tactics such as community and Carl Roger’s personal centered approach to counseling allowing the client informed choice and utilizing their personal frame of reference (Joseph, 2021). For example, a counselor may perceive that an individual of Hispanic seeking counseling or treatment may be interested in having a family member present during counseling sessions while a Caucasian may be an individualist. An African American on the other hand may prefer a church or community that has their sense of experience or frame of reference to be present to speak to reality and align with their world views. To meet these diverse objectives and informed choices, counselors must be culturally competent and humble to grant each counselee their preference choice to participate in treatment.

Multicultural Disability Counseling

The study conducted by Farmawati (2020) aimed to explore the qualities and characteristics of an appropriate multicultural counsellor for individuals with disabilities. The research utilized qualitative techniques and educational psychology approaches, focusing on three counsellors working at a school in Pemalang. The study spanned over a period of three months.

Through extensive interviews and observations as the primary data collection tools, several key findings emerged from the research. Firstly, a good multicultural counsellor for individuals with disabilities possesses specific characteristics, including empathy, the ability to establish rapport through greetings and communication, wholehearted listening, a deep understanding of cultural values and etiquette when interacting with individuals with disabilities, and proficiency in counselling techniques. These qualities contribute to effective counselling and support for individuals with disabilities.

Theoretical Frameworks and Best Practices

Best practices in multicultural counseling are based on several theoretical frameworks. Mollen and Ridley (2021) analyzed the multicultural counseling competencies. To find their competence in counseling people with disabilities generally. The MCCs have five domains: counselor self-awareness, client worldview, counseling relationship, counseling process, and interventions. Ratts & Greenleaf (2018) emphasized how important it is for counselors to work for social justice and equity. Individual, community and systemic advocacy are all part of the SJCF. Pearson & Bruin (2019) discuss the importance of understanding how the therapist’s cultural identity and experiences impact the counseling relationship. This model encourages mental health professionals to reflect on their biases and assumptions and develop a deeper understanding of how they may influence their interactions with clients.

The Multicultural Counseling Competencies (MCC)

Multicultural Counseling Competencies (MCC) is a framework developed by Derald Wing Sue, Patricia Arredondo, and Roderick J. McDavis in 1992. It is a set of competencies that counselors should possess to provide effective counseling to clients from diverse cultural backgrounds.

The Multicultural Counseling Competencies are based on four main dimensions:

Counselor self-awareness: This dimension emphasizes the importance of counselors being aware of their cultural identity, biases, and assumptions. Counselors must also recognize the influence of their cultural background on their counseling practice.
Knowledge of client’s worldviews: This dimension emphasizes the importance of counselors knowing the client’s cultural background, beliefs, values, and worldviews. This knowledge enables counselors to better acknowledge the client’s experiences, perspectives, and needs.
Counseling skills: This dimension emphasizes the importance of counselors having the necessary skills to effectively counsel clients from diverse backgrounds. This includes flexible counseling techniques to meet the requirements of different clients, the ability to communicate effectively with clients from various cultural backgrounds, and the ability to work with interpreters when necessary.
Understanding institutional and cultural barriers: This dimension emphasizes the significance of counselors understanding the effect of institutional and cultural barriers on their clients. This includes identifying and addressing systemic oppression and discrimination against clients.

The MCC framework, when applied to the context of multicultural disability counseling, offers a valuable framework for counselors to provide effective and culturally sensitive counseling to clients with disabilities from diverse backgrounds. By incorporating the principles of the MCC framework, counselors can address the unique needs and experiences of individuals with disabilities within their cultural contexts.

Firstly, counselor self-awareness becomes essential in multicultural disability counseling. Counselors must recognize biases, assumptions, and attitudes towards disability and different cultures. This self-reflection allows counselors to approach their work without imposing their beliefs or stereotypes.

Secondly, knowledge of clients’ worldviews is crucial. Counselors must strive to understand the cultural values, beliefs, and practices that shape the experiences of individuals with disabilities. This knowledge enables counselors to tailor their interventions and provide support that respects and aligns with the cultural context.

The Social Justice Counseling Framework (SJCF)

The Social Justice Counseling Framework (SJCF) is a theoretical framework developed by Rita Chi-Ying Chung and Frederic P. Bemak in 2012 that highlights the importance of social justice in counseling practice. The SJCF suggests that counseling should focus on individual mental health and consider the social, economic, and political factors contributing to oppression and marginalization.

According to the SJCF, social justice is achieved when individuals and communities can access the resources and opportunities needed to thrive. Counselors who use the SJCF seek to promote social justice by advocating for their clients and communities, challenging oppressive systems and structures, and empowering clients to take action to create positive change in their lives and communities.

The SJCF is based on four fundamental principles:

Awareness: Counselors must have self-awareness of their own biases, principles, and presumptions, as well as the social, economic, and political factors that contribute to oppression and marginalization.
Analysis: Counselors must analyze how oppression and marginalization affect their clients’ lives, as well as the larger social, economic, and political systems that perpetuate these injustices.
Action: Counselors must take action to promote social justice by advocating for their clients and communities, challenging oppressive systems and structures, and empowering clients to take action to create positive change in their lives and communities.
Accountability: Counselors must hold themselves accountable for their actions and continually work to improve their practice in promoting social justice.

Overall, the Social Justice Counseling Framework emphasizes the importance of social justice in counseling practice and provides a framework for counselors to promote social justice through their work. By promoting awareness, analysis, action, and accountability, this model provides a valuable framework for counselors to work toward creating a more just and equitable society.

Person-of-the-Therapist Model (POT) for Disability Counseling

The Person-of-the-Therapist Model (POT) is a theoretical framework developed by Edward S. Neukrug and Allen E. Ivey in 1995 that emphasizes the importance of the therapist’s characteristics in providing effective multicultural counseling. The POT model suggests that the therapist’s self-awareness, values, beliefs, and cultural identity can significantly impact the therapeutic process and outcomes.

According to this model, the therapist’s characteristics can facilitate or hinder effective multicultural counseling. For example, a therapist aware of their own cultural identity and values actively seeks to understand and respect their client’s culture and can manage their own biases and assumptions is likely to be more effective in providing multicultural counseling. In contrast, a therapist who lacks self-awareness has rigid beliefs, and is insensitive to cultural differences may struggle to effectively counsel clients from diverse backgrounds.

The POT model emphasizes the importance of ongoing self-reflection and personal growth for therapists to enhance their multicultural counseling competence. The model suggests that therapists should engage in regular supervision, seek out feedback from clients and colleagues, and continually work to expand their understanding and expertise in working with diverse populations.

Overall, the Person-of-the-Therapist Model highlights the critical role of the therapist’s characteristics in providing effective multicultural counseling. By promoting self-awareness, cultural humility, and ongoing learning, this model provides a valuable framework for therapists to enhance their multicultural counseling competence and better serve clients from diverse backgrounds.

Best Practices for Multicultural Disability Counseling

Atkins et al. (2017) focused on developing multicultural awareness among non-Latino White counselors. Using a qualitative approach grounded in theory, the researchers examined the experiences of 12 counselors who demonstrated a high level of multicultural competence. The study aimed to identify factors contributing to the counselors’ understanding and empathy for oppression and the challenges faced during their multicultural awareness development.

The findings highlighted the significance of early personal experiences with diversity as the most influential factor in developing understanding and empathy for oppression among counselors. These experiences served as a foundation for their ongoing initiative to cultivate multicultural awareness. The counselors actively sought opportunities to learn from culturally diverse clients, work environments, coursework, supervision, and mentoring, maximizing these resources to enhance their multicultural competence.

Best practices for multicultural counseling include several strategies. Firstly, counseling professionals from all background must recognize the importance of cultural humility and a lifelong commitment to learning about different cultures. This involves actively seeking education and training opportunities and ongoing self-reflection and self-assessment. Secondly, counselors must prioritize building rapport and trust with clients, particularly in the early stages of treatment. This may involve using culturally appropriate communication styles and comprehending the client’s unique cultural context. Thirdly, counselors must be eager to adjust their interventions to meet each client’s unique requirements and circumstances. This may involve culturally responsive techniques, such as incorporating clients’ cultural beliefs and practices into treatment planning (D’Andrea et al., 2013).

Individual and Personal Frame of Reference in the Case of BIPOC Disability Counseling

Lievens et al. (2008) focused on the use of a frame of reference and its impact on the criterion-related validity of personality inventories. The study suggests that using a frame of reference in personality inventories can improve their reliability and validity. Reliability refers to the consistency of measurement, while validity refers to the accuracy of the assessment in measuring what it intends to measure. The use of a frame of reference helps reduce within-person inconsistency in responding to generic items. In the context of BIPOC disability counseling, this could be relevant as it may help individuals provide more consistent responses and enhance the reliability of assessments.

Honda et al. (2018) investigate how individuals make frame choices based on reference points in decision-making situations. The study demonstrates that when faced with two logically equivalent frames (e.g., “half full” or “half empty”), individuals tend to choose a frame based on a reference point. For instance, if the amount of water in a glass with a 500 ml capacity increases from 0 ml to 250 ml, people are more likely to describe it as “half full” rather than “half empty.” In BIPOC disability counseling, this notion of reference points and frame choices can shed light on how individuals perceive and communicate their experiences with disability.

Special Issues (Disability) in Case Management and Service Delivery in Multicultural Counseling for BIPOC

BIPOC individuals with disabilities face unique challenges in case management and service delivery in multicultural counseling. They may experience multiple forms of discrimination and marginalization based on race, ethnicity, and disability status. Counseling professionals must be mindful of these difficulties and take steps to make sure that they provide culturally responsive and equitable services (Friedman, 2023).

One approach is to incorporate a disability justice framework into counseling practice. This framework emphasizes the importance of recognizing the intersections of disability and other forms of oppression, such as racism and ableism. It also emphasizes the importance of advocating for the rights and needs of individuals with disabilities and working towards a more just and equitable society. The diverse array of counseling professionals can use this framework to guide their assessment, treatment planning, and service delivery for BIPOC individuals with disabilities (Dancy et al., 2018).

Challenges in the Career Development Process for People with Disabilities

BIPOC individuals with disabilities face various challenges in the career development process. While it is essential to provide equal opportunities for employment to everyone, there are instances where individuals with disabilities, without mental health issues, are still considered to have a mental illness, leading to bias and misdiagnosis. Such biases can result in the creation of wrong labels and stigma, thus affecting disproportionate numbers of BIPOC from jobs that could have improved their lives and those of their family members. Meaningful employment can aid raise people with disabilities, self-worth or aplomb, prolong life expectancy and quality of life, and the lack of employment can create low self-esteem and lead to employment discrimination-related traumas (Dispenza, 2019).

Potgieter et al. (2017) explored the perceptions of individuals with disabilities regarding the challenges faced in career advancement in the South African workplace. The research explains the career development experiences of employees with disabilities and highlights the impact of discriminatory practices within the work environment.

The study adopted a qualitative research design with an exploratory approach. Fifteen individuals with declared disabilities were selected as participants using probability, purposeful, and snowball sampling techniques. Semi-structured interviews were conducted to collect data, which were then analyzed using content analysis.

The findings revealed that individuals with disabilities commonly face challenges in career advancement and often reach a career plateau. The lack of knowledge about disabilities among managers and colleagues was a significant factor negatively impacting the careers of people with disabilities.

Bias in Career Development Counseling

One of the significant concerns for people with disabilities in career development counseling is the bias towards people quest to obtain employment. According to researchers, people with disabilities are more likely to experience mental health issues than the general population, making it essential to provide appropriate support for their mental well-being (Deans, Bhattacharya, & Cordle, 2020). However, not all disabilities necessarily result in mental illness, and it is crucial to distinguish between the two to offer appropriate support. While disabilities can encompass a wide range of conditions that affect a person’s physical, sensory, or cognitive functioning, mental illness is the disorder impacting an individual’s emotional and mental well-being.

By providing a more in-depth discussion, we can better understand the distinction between disabilities and mental illness and appreciate the importance of tailored support.

Misdiagnosis Problems and BIPOC

BIPOC communities face significant challenges when it comes to disabling condition, including stigma, lack of access to care, and misdiagnosis. For instance, African Americans are more likely to be diagnosed with schizophrenia than their white counterparts, even when presenting with similar symptoms (Corrigan, Watson, & Barr, 2016). Such biases can create wrong labels and stigma, leading to disproportionate numbers of BIPOC being excluded from jobs that could have improved their lives and those of their families.

Effect of Employment on Mental Health

Meaningful employment has been shown to positively impact mental health, aiding recovery from mental illness and reducing the risk of relapse (Kidd & Osterling, 2018). Conversely, unemployment can worsen mental health conditions, exacerbating the symptoms and leading to employment discrimination-related traumas. It is, therefore, crucial to provide equal opportunities for employment to people with disabilities and mental health issues and to address biases that may prevent them from accessing these opportunities.

Challenges in the Workplace Faced by People with Disabilities

In addition to the biases and misdiagnoses that people with disabilities may face in career development counseling, they may also encounter challenges in accessing appropriate accommodations in the workplace. For instance, individuals with hearing impairments may require American Sign Language interpreters to communicate effectively with their colleagues and clients. However, not all workplaces may provide such accommodations, affecting their productivity and overall job satisfaction.

Moreover, people with disabilities issues may encounter discrimination in the workplace due to the stigma associated with disabilities generally. This can lead to lower job opportunities, job insecurity, and even job loss (Dispenza, 2019). National Alliance on Mental Illness (NAMI) found that more than 80% of individuals facing mental illness believe that the presence of stigma and discrimination has significantly impacted their capacity to secure and maintain employment. These findings underscore the urgent necessity to address and combat stigma and discrimination within the workplace, aiming to create an environment that ensures equal opportunities for individuals with disabilities and mental health conditions.

Additionally, research has shown that the intersectionality of race and disability can lead to even greater challenges in accessing employment opportunities. For instance, Black individuals with disabilities are more likely to be unemployed than their white counterparts with disabilities (Dixon-Fyle et al., 2020). This highlights the need to address systemic biases and discrimination that may disproportionately affect BIPOC individuals with disabilities.

In conclusion, providing equal opportunities for employment to people with disabilities is crucial. Addressing biases, providing appropriate accommodations, and addressing stigma and discrimination in the workplace can aid in creating a more inclusive and supportive work environment. Moreover, recognizing the intersectionality of race and disability can help identify and address additional challenges that may disproportionately affect BIPOC individuals with disabilities.

BIPOC individuals with disabilities often encounter multiple layers of marginalization and face increased obstacles in accessing healthcare, education, employment opportunities, and social inclusion. They may experience disparities in healthcare access and quality, leading to delayed diagnoses, inadequate treatment, or limited availability of culturally competent care. The study conducted by Waller et al. (2023) focuses on the systemic challenges faced by Black, Indigenous, and People of Color (BIPOC) communities in accessing quality mental health treatment and promoting mental health equity during the COVID-19 pandemic. The researchers highlight the historical impact of racism on BIPOC communities, leading to transgenerational mental health consequences and barriers to accessing appropriate care.

Kabir and Zaidi (2022) studied the implicit bias among healthcare providers toward Black, Indigenous, and People of Color (BIPOC) patients in clinical settings. The research characterized and addressed the impact of implicit bias on healthcare experiences and treatment outcomes for BIPOC individuals. Peer-reviewed studies from 2012 to 2021 were analyzed. The findings revealed that healthcare providers often harbor implicit biases, with positive attitudes toward Whites and negative attitudes toward BIPOC individuals. These biases develop unconsciously through repeated practices based on stereotypes and systemic racism and have significant implications for treatment decisions and the overall quality of care received by BIPOC patients.

Conclusion

This literature review has shed light on the significance of multicultural competence in disability counseling, with a focus on BIPOC individuals. It has highlighted the essential skills required for competent multicultural disability counseling, the challenges inherent in this practice, and the theoretical frameworks and best practices that can guide professionals in providing meaningful support.

The Multicultural Counseling Competencies (MCC) and the Person-of-the-Therapist Model (POT) were identified as valuable frameworks for understanding and addressing the unique needs and experiences of BIPOC individuals with disabilities. These frameworks emphasize the importance of cultural sensitivity, self-awareness, and the establishment of a trusting therapeutic alliance.

Furthermore, the review underscored the significance of considering the individual and personal frame of reference in the case of BIPOC disability counseling. It highlighted the need for service providers to be aware of the intersecting identities and experiences that shape an individual’s disability and cultural background.

Special issues in case management and service delivery for BIPOC individuals with disabilities were explored, revealing the challenges and biases that can arise within career development counseling and the potential for misdiagnosis. It was noted that employment impacts the mental health of individuals with disabilities.

Finally, the literature review drew attention to the challenges faced by people with disabilities in the workplace, highlighting the need for comprehensive support systems, inclusive policies, and increased awareness to promote equal opportunities and combat discrimination.

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Philip Akurigo