Approaching Diversity: A Clinical Perspective

In this one-hour webinar, our panel of experts define diversity in psychotherapy. Diversity in counseling involves therapists demonstrating an understanding of their clients and their struggles with cultural issues and other related experiences. Always emphasizing caring and empathy, diversity in counseling enables therapists to better address unique challenges, considering how a client’s experience may be different from their own.

LEARNING OBJECTIVES INCLUDE:

  • Define diversity in counseling and the impact on clients from diverse backgrounds.
  • Apply theories of counseling that respect and understand the diverse perspectives of our clients.
  • Describe resources that promote diversity of treatment programs and counseling styles.
  • Learn how to move clients through the recovery process by incorporating diversity in therapy.

Approaching Diversity: A Clinical Perspective Podcast, Video and Transcript

CARMEN: 00:03Welcome to Recovery Out Loud, a Niznik Behavioral Health podcast, where we discuss addiction, mental health, and recovery. We’ll explore the true nature of addiction with behavioral health experts and to hear firsthand personal testimony about what the path to recovery really looks like. From Niznik Behavioral Health, I’m your host, Noel Carmen.
CARMEN: 00:34Welcome to Recovery Out Loud. This week’s episode features audio from a webinar hosted by Niznik Behavioral Health. Video recordings of our webinars can be found on our website, which is linked in the description. There, you can also find information about upcoming webinars and other events. Thank you and enjoy.
CARMEN: 00:56Okay. So I think that we are ready to begin this conversation. Welcome everyone to today’s conversation. It should be a fantastic one. I’m Noel CARMEN and we are talking about how these clinicians approach diversity and intersectionality in our practices. We have an incredible panel here today. Before I introduce them, let’s just take care of some housekeeping. Please be aware that you will receive your CE information in an email by the end of business tomorrow. Okay, so onto our fantastic panel. I want to introduce Lindsay Wallach, the director and founder of Meraki Wellness and Healing. I would like to introduce Christian Vasquez. Am I saying that correctly? I hope I’m saying that correctly.
VASQUEZ: 01:42Correctly, Christian Vasquez, yes.
CARMEN: 01:44Vasquez, excuse me. He is the clinical director for Meraki Wellness and Healing. He is an alum HC. Mar Trujllo, she serves as a registered mental health counselor intern. And finally, Allison Moore, finally, but certainly. Certainly not least you, you specialize in substance use and are a lead therapist for Discovery Point Retreat. Welcome everybody to the conversation. Thank you for being here.
WALLICK: 02:14Thank you for having us. Thank you.
CARMEN: 02:16Okay. And to our audience, as always, I would like to invite you to ask all the questions, make all the comments. I will do my very best to address all of them. If I missed some of them, we will make sure in the email following that we will connect you with our speakers and also try to address any questions left unanswered. Okay, so all of that is done. Housekeeping is done. So let’s get to the conversation. So, Christian, I’d really like to start with you, and I’d like to get us all on the same page in terms of defining and describing what we mean when we are talking about approaching our practices from the standpoint of diversity with multicultural populations. Just intersectionality, just all of it, what does that mean?
VASQUEZ: 03:09Well, first and foremost, thank you for having me. It’s a pleasure being here today, being part of this conversation. It’s a conversation that at times can be very controversial and we’re like, very, “Oh, let’s not talk about that,” but we need to. It’s a very important topic discussion and about the question you just asked, I’m going to relate it personally in my clinical experience. So I can also say that based on our modalities and theories and practices that we have learned in school. So I feel that we can always approach that and understand it, dissect it in our mind as far as like what we take from it, what we understand. But to make it more diverse and feel for that multicultural background of how we engage in diversity is basically that within the topic that not one style of practice can be applied to one specific demographic or population of clients. So we have to do our own research, as well. And also with the experience gained over practicing, in view of the clients, making sure that we are understanding and getting a feel for those interactions. I feel that the human connection goes above just one modality or one situational when it comes to diversity.
CARMEN: 04:39Mar, I’m going to throw this to you, and you and I had discussed offline about this being a process. So what does diversity mean for you in terms of your practice?
TRUJILLO: 04:52So where I’m working with miracles and healing with Flimsy and Christian. Thank you also for having me on today. Diversity is so much. Diversity is so broad. You can have diversity both– or in race, in religion, in culture, in ability, or disability, in size, and everything. It’s just the difference, right? That’s what diversity is. There is difference. I think, to say that we are all the same, we don’t see color, we don’t see religion, and I think that that diminishes so much of the human experience, diminishes all of the human experience. And so just understanding that there is a strong difference between humans and between groups throughout our practice, but throughout, really, humanity, it’s a hard thing, I guess, to boil down to one very simple term. But that’s kind of what it is. It’s just this absolute human difference that we have.
CARMEN: 05:59So I think that you’re saying something really interesting, profound, and maybe a little vulnerable. And Allison, I’m going to throw this to you, which is just to build upon that. Looking at difference in terms of diversity, isn’t that kind of a–isn’t that a scary thing to say in a sense? Because in creating an other, we’re looking at difference and that could possibly create a lens that maybe isn’t what we want clinically. Can you take that apart for us, unspool that a little bit?
MOORE: 06:37Well, let me just say thank you as well for having me on. Being an African American woman and then also being a Christian counselor, some clients have a wall when it comes to my spirituality alone because of the environment I work in. I work in a treatment facility, so word gets around. The best advertisement is word of mouth. So clients already have a preconceived idea of me as a clinician before even meeting me. And so when they hear that I’m a Christian counselor or I have this spirituality, one of my clients said, “I thought I was going to come into your office and see crosses hanging all over the walls everywhere.” So they already have a preconceived notion of me. And so diversity comes in all forms. And for me, it is my skin color and my religious beliefs. So I get it from even the client’s point of view being on the clinician side of it.
CARMEN: 07:53And that actually segues right perfectly into the next thing that I would like to bring up is intersection because we’re not all just one thing I know I sound like a broken record/ We’re not all just one thing. We’re not just queer. We’re not just a person of color. You’re a person of color who happens to also have a religious identity. So [inaudible] throw this at you in terms of intersection, because it’s challenging enough, right, just to understand the queer perspective, but take that and then add layers to it. This is a challenging job for we clinicians to make sure that we are able to grasp our clients in this way. Well, what are your thoughts on that?
VASQUEZ: 08:52Yeah, absolutely. We need to learn to think outside the box and just kind of understand that we’re so complex as individuals. There’s so many [inaudible] sometimes coming into. We also need to take that away from the session. We’re coming in and trying to see that individual, not just for that one particular part of the–[silence]
CARMEN: 09:30the eggshell around the topic, Mar, what are your thoughts?
TRUJILLO: 09:35I think that we get defensive sometimes when we are told we have whatever set up– just everybody comes with privilege. It just depends kind of where you are, what kind of privilege you have, how much oppression you face. It’s [inaudible] like you said, we’re such complex creatures. And I think that sometimes when we’re told that we are privileged, it strikes a chord and we get on the defensive. We don’t want to talk about it because that word, privilege, has come to be so negative at times. And so this conversation is hard to have because as clinicians, we believe we’re doing good. That’s the point. That’s why we’re here. We’re here to do good, to help our clients, to put something good into this world. And so then, being thrown kind of this little bit of a bomb saying, “Well, actually, though, you’re being kind of racist right now,” or “You’re being sexist,” or, “Your internal misogyny is showing.” We’re like, “We’re the good guys. We don’t have any of that.” [crosstalk]–
CARMEN: 10:46Do you know who I am? I’m the clinician.
TRUJILLO: 10:50[inaudible] with mental health. [inaudible] that bomb is disarming and we’re not used to being disarmed, we’re used to doing the disarming. So we need to check ourselves so much and our role in a therapeutic relationship, it’s a power, Ray. You’re walking into a power situation where you hold the power and your client is the one who’s being vulnerable with you. And so if you are not doing the research that you need to do, if you are not bettering yourself the way that you need to better yourself, looking at your prejudices, looking at your biases, calling yourself out consistently, which is so hard to do, you’re not going to do good work. And that’s the part that, really, I think a lot of clinicians struggle with consistently.
CARMEN: 11:44Oh, [inaudible].
VASQUEZ: 11:46To piggyback [inaudible] you’re saying, just the fact that we’re having this discussion today, this is what we should be doing. We need to talk about it more. Everybody’s very hush-hush, even us, even right before this, We’re like, “Oh my goodness, we’re getting into some very so if we turn– but this, right here, what we’re doing, this is what we should start doing, talking about it, raising awareness about it. Let’s get a bit more comfortable with talking about these topics that a lot of people are not comfortable with.
CARMEN: 12:14I–
MOORE: 12:14I’d say– oh.
CARMEN: 12:16Sure. No, no, go right ahead.
MOORE: 12:18So I want to jump in and just say that the basis of it is fear. People are scared to talk about it, scared that I’m going to offend you as a clinician, scared I’m going to lose your business, which is a part of our livelihood. I’m scared of how I’m going to be viewed by you or what you’re going to say to others. So it is fear that– the basis of it is fear. And then we live in a cancel culture now. Everybody’s canceled for everything they say. So that’s it. That’s why we don’t talk about things. And if we can have a conversation, just like Lindsay said, like we’re doing right now, that can clear up a lot of preconceived ideas that we have about one another and just be real about it. And it is okay to be offended. Sometimes, it’s okay. That’s a growing thing to be offended like, “Let me examine myself. Why am I offended by what she said or what he said?” So just to be real, I think, will end a lot of what is going on out here, not in just the clinical field, but the world itself.
VASQUEZ: 13:38I love that, Alison, that you have to be your authentic self no matter what. And like you said, we are in this cancel culture that what we say– we have to tippy-toe around certain topics because we don’t know what’s going to happen after that. But if we’re not authentic, then we’re not really showing our clients who we really are as clinicians. And aside from being the professional, we also are people. And that’s the other aspect of it, that sometimes we’re seen at this hierarchy that, “Well, that’s my therapist. My therapist is just this person or this facade.” But we don’t really emphasize on how important it is to also be personable and show your true self. And when you show authenticity with your clients, then it will also follow back in reciprocity. And your client will be a little bit more open to the environment.
CARMEN: 14:33I love what you’re saying about self-check. This is number one on the list. It’s like, “Okay. I– clinician. I’ve just gotten upset or offended by– what is happening inside of me right now? And how would this conceivably affect my clinical work?” If we get offended and shut down, what kind of an example are we being when we’re trying to give the message to all of our clients, “It’s okay to mess up. It’s okay to retract. It’s okay to apologize. It’s okay to reconfigure.” Lindsay, what are your thoughts on that?
VASQUEZ: 15:10Absolutely. If we’re going to be preaching, we need to be following what we preach. so [asking?] ourselves, learning from ourselves. We’re human at the end of the day. And like all of us, we have our preexisting notions about certain things and lack of, sometimes, of education of different, diverse cultures. So it’s okay. It’s okay for us to also feel this way if we’re also– what we’re preaching and allowing our clients to feel comfortable coming out of their shell. It’s okay for us to do the same as the clinicians and just continue always researching and always being open to learning more. Sometimes, as clinicians, it’s our way or the highway or [inaudible] [laughter] or, like other techniques, “This is what’s worked for me for so many years.” But no, let’s think outside the box. Let’s see what’s new. Let’s be innovative. Let’s see we need to reach more people. And that’s what we’re here for, right. We can’t limit ourselves because then we’re limiting access to services that people need. So we, as clinicians, need to really stand out and do what we’re going out there and telling everybody else to do. We’ve got to do some of ourselves.
CARMEN: 16:18So let’s talk boots on the ground now. I would like to hear from each one of you about your specialty, – and I know it’s vast – the diverse populations that you encounter, and the things that work for you as clinicians. What’s your secret sauce, basically, in terms of meeting clients where they’re at. Marh, let’s start with you.
TRUJILLO: 16:49Yeah. Well, I’m Iraqi. I’m very grateful enough to kind of run the gamut on diverse populations. We’re a mental health clinic. We got everything. I know that you said that what we are used to working with, but I kind of want to turn that around and talk a little bit about the diverse populations that I’m working with currently that I don’t have a ton of experience with because I think that kind of lends to our conversation a little bit more. So right now, I have a few clients that identify as queer, a few clients that identify as trans. Trans clients are not clients that I’m used to working with. I don’t know many people who are trans. And so having them in my office, I have had to go down the list even before I meet them, go down the list of what my preconceived notions are, go down the list of my biases, and make sure that I can go into that office to offer them as much help as I can without those biases, without those prejudices, right. And so when we get here, for my client, it’s going to sound strange, but my first session, I always give them an out. I do not want them to think that if they come into my office and they don’t vibe with me and they don’t like me, that they have to stick with me. I want to make sure that they know that if we don’t work well together if they don’t like me, that’s fine. I’ve been broken up with before. You can go find someone else. I will help you find another counselor. I do not want to be the reason you don’t come to counseling anymore. So being honest with yourself that it’s not going to work out with every client. You also don’t have to accept every single client that walks into your door. You don’t have to work with everybody if you do not believe that you can, right. And so giving my clients and out right away, I feel all walks of life, all cultures, all races feels as though like, “Okay, I can sit here comfortably and have this conversation with her. And if I don’t want to be with her anymore, I can leave. I don’t have to stick with her. She’ll help me find someone else.” So for me, that’s worked really well the past few years. And I do it at the beginning of every single session that I have with every– well, not every single session. Every single intake I have with every new client. And that’s worked out really well for me.
CARMEN: 19:23So how do we find that line between who we should be working with and who we need to not necessarily break up with, but as you mentioned, help find the appropriate care? Christine, you want to tackle that?
VASQUEZ: 19:40Absolutely. And just to kind of piggyback a little bit of what Moore said, I mean, they interview us as much as we do the same for the clients. So, for me, it’s always that pre-screening. And I have to kind of go back a little bit of origins to it. So I’m from Miami, Florida. So given that, we know right off the back that we’re going to have a high population of Latino clients from the Caribbean, Central America, South America, many Latinos, diverse backgrounds within the Latino community and within spirituality and etc. So pre-screen for me, it’s key. It’s essential when it comes to the services that we are going to provide initially for a new client and ongoing as well. So, for me, the assessment starts even before that phone calls that we take that we screen on a day-to-day basis, asking questions that are relevant to the clients that we’re listening to, making sure that you have more than bilingual client– I’m sorry, clinicians or staff answering and screening the phone calls. So I’m very big in understanding more the backgrounds of the Latino clients that they do speak Spanish. [foreign], that we’re happy to hear from them, that we can relate to their experiences so that we can also break those barriers initially that they know because what Marh was making– I’m sorry, mentioning about the queer community, LGBTQI, that it takes more than just hanging a little pride flag on your office or practice to say that you’re a competent clinician. You have to also do the practice. Do the training. Do the research. Engage in the community. Get to know the people that you’re providing and serving. So you have to be proactive constantly. And reality is we cannot service every client or every potential client. There is restriction sometimes. We have Creole-speaking clients that call at once. I mean I don’t speak Creole, but we can definitely– at that point, still doesn’t mean that I’m going to hang up the phone call and say, “Well, I don’t speak your language,” blah blah blah, all these other taboos within communities. But we can definitely engage them, try to provide support and services. If we can’t do that for them, what’s available? Having community relationships with other practitioners that will be competent enough, and that’s their niche or their professional experiences dealing with a certain population. But I can tell you with the Latino population that we deal with in Miami, I mean, just in general, that’s a huge portion of how even within Latino and myself being Latino, we have to be so diverse in our approaches engaging every client that we service.
CARMEN: 22:36Let’s talk about privilege versus oppression. Did you guys hear me? [laughter]
VASQUEZ: 22:46Yeah, [crosstalk].
VASQUEZ: 22:47Yes. I’ll keep it going. I’ll keep it going.
CARMEN: 22:50Okay, sorry, did I just do it? Okay, let’s talk about privilege versus oppression. And I think that we need to bring some clarity around that. We keep kind of throwing these words around. They are charged words. I think we can all agree, right? But, also, again, in having a genuine conversation, we need to actually have the conversation. So what are your thoughts there?
VASQUEZ: 23:17I want to go first because I’m very passionate about that too. And I want to mention about also Hispanics. I’m going to throw it out there because this is a very controversial two. But there’s a lot of white-passing Latinos and clinicians also say they identified as white Latinos. So what happens there is sometimes that they don’t profoundly engage with the clients, even though they were Latinos, but they’re still kind of like that privilege of like, “Maybe, well, I don’t think this is the right fit for me.” And I get that in clinical supervision as well when I meet with interns. They might not say it in that way, but in my interpretation, that’s the message that I’m getting. So we definitely need to know. And Marh mentioned this earlier as well, she said, that we need to check ourselves initially. We really do need to know what kind of trans persons are. What are the messages that we’re sending out, even as individually and with the privilege that we feel, or entitlements that we might create in our own perceptions too because I think a lot of that has to do systematically– how privileged we are. Well, if you’re that privileged, share it. Share it with people that are vulnerable, that require other services, that need advocacy in the community. That’s where I’ll leave it at.
CARMEN: 24:41Okay. A large part of privilege in some ways is actually not being aware of the privilege that you are existing in. How do we get to that point as clinicians? Who wants to jump in and take that? I’m not even going to pick one of you for this. One, two, three, go.
TRUJILLO: 25:00So [crosstalk]. So give me the question again? What do you mean? How do we become aware of our privilege?
CARMEN: 25:09Exactly. That is, in essence– you can disagree with me. You are the expert. But in my understanding, part of existing in the privilege is not really being aware of the privilege. So how do we become aware of that?
TRUJILLO: 25:27I think a big part is listening. We’re being told our privilege. Right now in the way that the world is right now, privilege is being called out as it should be, right? Because it’s been under– it’s been hidden for so long. And so we’re being called out now as white people, as white Latinx people, as straight people, even within the black community and colorism, even within the LGBTQ [inaudible] population, right, trans people. So it’s all being called out right now. All we have to do is listen and accept that this is the situation and it’s not bad. It’s not a bad thing to be privileged. It just means that you got to where you are due to things that may have been beyond your control, but you still have them. And so now, once you know a little bit about that privilege that you hold, do the research. Google is free, right? Do the research, find out what those privileges mean for you. Find out what you can do for your community, for other communities. Find out how to educate yourself better. Especially as clinicians, we’re not good clinicians if we’re not continuously educating ourselves, right? We’re going to do a lot of harm if we’re not continuously checking ourselves, as we’ve been saying, and educating ourselves. But to answer your question, the first thing is listen to the people who are telling you that you are privileged. They know.
CARMEN: 26:57Anybody else want to tackle that? Nobody–
MOORE: 27:00I think it’s difficult. Oh, sorry, Lindsay.
VASQUEZ: 27:04Go ahead. No, no, go ahead.
MOORE: 27:06Okay.
VASQUEZ: 27:07I don’t think [inaudible] called privileged. It’s a negative connotation right off the bat. If you come at me, you tell me, I’m privileged, I’m going to be, like, “Well, excuse me, do you know what I went [crosstalk]?” [inaudible] the first initial [inaudible]. I think that, to piggyback on something that Mar said, is providing education a little bit more– it’s going to be an uphill battle. Nobody wants to be called privileged. Absolutely. I don’t [inaudible] privileged. Nobody, because we all in some way feel we’ve had our own struggles. So it’s going to be an [uphill?] battle. I think that we need to talk about it more. We need to take that negative connotation on the word, privilege, in order to be able to do something. But it’s not going to change if we continue having it be that negative. It won’t. It won’t. It’ll be very difficult.
CARMEN: 27:59Because in some way the word privilege creates a bad guy, like, “You’re privileged, so you are the bad guy,” instead of talking about it in a more open sense. Alison?
MOORE: 28:10I think that it’s difficult as a clinician to point out to somebody that they’re privileged because they’re going to be like, “Well, did do you figure I’m privileged?” I’m not privileged. But then I would be going off of my own experiences, my own life experiences. And so to tell you that you’re privileged, yes, it can be offensive to them. And so then you shut off the client-clinician relationship right there. So I think it’s very difficult. And then I was taught in school that as a therapist, you don’t do a whole lot of self-disclosure. So it’s not like I could sit up and go, “Well, girlfriend, let me tell you about what oppression looks like.” [laughter] I can’t do that. So that’s unprofessional. So anyway, I think that it would be difficult, and I really don’t have an answer as to how I can do that as a clinician pointed out that, “You are privileged. And let me tell you how.” [laughter]
CARMEN: 29:13Let me ruin this clinical relationship right now.
VASQUEZ: 29:17Can I just mention one thing, Maddison?
TRUJILLO: 29:20Yeah. And I want to go back and say that– [laughter] I want to go back and say really quickly, I never met like we’re having that conversation with the client other than in moments where it could have come up and it is important. I’m not going to walk into that room with my client and be like, “Hey, you’re a privileged right person. You have no right to be upset.” No, I just meant us as clinicians. But yeah, our own privilege. I just wanted to put that out there. [laughter] But I actually wanted to touch on something you said, Allison, which was we do learn in therapy that self-disclosure is a big no-no. Accepting gifts is a big no-no. All these things, these are like therapy taboos. And in the world of doing multicultural work and being multiculturally competent, we need to challenge those things just a little bit because there are so many cultures. They’re not going to come in here and sit across from us and spill their guts and not know anything about us, right? A lot of people expect some sort of a back and forth, like, “I’ll share something if you share something. That’s how I’m going to feel a little bit more comfortable with you.” I had a client today who brought us all pastries because we discharged her today, and she was excited about what we’ve done for her. Am I going to say no to this gift that she brought us out? They were delicious. [laughter] Am I going to say no to this gift because in school I learned that we don’t accept gifts? I can’t. This is like a thank you. In her culture, this is important. Sharing food is important. So I think also challenging those things a little bit. We walk such a fine line in our conversations and in our sessions between what is right, what is wrong. There’s a lot of gray in there, right? So to the best of your abilities, if this is going to better relationship between you and this client, maybe we need to challenge a few of those taboos a little bit more, because I remember in the therapy school and it was just all like, “You need to be completely stoic. No advice. Just say yes or no.” Or “How do you feel about that?” And that’s about it. There’s nothing else that’s going on there. And so I think challenging that a little bit while we’re talking about multicultural competence is important.
CARMEN: 31:31Anyone else want to jump in? Because all of this is material to mental health. And so I would like to connect the idea of privilege and oppression with what it is we do, which is operate within the mental health world. So can we talk about how mental health is affected in a unique way by individuals who experience oppression versus privilege? Anyone want to? I dare you to answer that one.
VASQUEZ: 32:06Oh, boy.
CARMEN: 32:07Anyone?
VASQUEZ: 32:08Where do we start? I mean, I can tell you that for one, one particular client comes to mind. And I’m actually, with the question that you’re providing us as well kind of relating and also some of our experiences with our clients, which, that’s the whole point here in general and having better practices as clinicians that we recently had a client from Africa that lives in Miami. So, for me, initially, I had to also check myself because I’m like, “Okay, we’re in Miami. This is one of the few cases for me in Meraki Wellness and Healing that is from Africa. They spoke Spanish. But you can tell initially that I was already feeling some type of way like insecure, fear like Alison mentioned as well, fearful of what’s going to happen. You know what I mean? Are we going to connect with this client? All these other issues and situations, but the client came in. Again, keeping in mind who’s in front of me, showing them positive regard, being open with them, and providing them their resources just like any of our other clients, keeping in mind that, “I do see you. I do see who you are as a person, as a person of African descent, as a person that’s now facing, real issues right now and wanting to get services.” So it took a bit of time, but I definitely take it back to just having and trusting yourself as a person first. And what’s going to be the next step? How are you going to approach this person that is of complete background and personal beliefs, and how you’re going to be able to provide services or really support in that initial meet and greet, breaking the ice with the person. So I always take it back as a practical technique. Be open, be yourself, and then let yourself guide you as well of how you’re going to approach that person. And I think that even we’re human beings. We’re going to make mistakes. And if we do, that it’s not the end there that we can overcome situations. We don’t always have to be perfect or how Marh was mentioning that in school, we’re taught to say yes or no or clarify certain things. But, again, we go back to different modality, different practices, different theories. It’s not just one area of clinical practice for each individual. We need to focus on the bigger spectrum of how we can get in tune. And, yes, theory is important, and, yes, how we practice clinically is very important so we can give significant support to our clients. But at the same time, it comes to that personal breaking the ice with the person.
TRUJILLO: 35:12To add to the whole mental health and how it is just to emphasize also that the Hispanic community, rednecks community, there is just as much vulnerability to mental illness as there is to the rest of the population. Mental Health America, which is a great resource for us as clinicians, they have a lot of facts on there. They’re constantly doing a lot of surveys and whatnot. I believe they had mentioned that I think approximately only 33% of the Hispanic culture actually gets any sort of treatment for mental illness. And I believe compared to the average in the United States, it was 43% to compare. And the reason is there’s a lot of barriers for that community in itself. So when it comes to mental health, stigmas is obviously the first one there. In our Spanish culture, you don’t talk about mental health. There is no mental illness. We’re brought up like that since we’re little, since we’re children. And then we go on to a bunch of other go on a detailed list of all the barriers, language and how the resources are not getting to these communities. There’s a lack of resources for a Haitian community here in Miami, even for our Hispanic community down in [homes?], that we have a lot of a big population that they don’t have access to to information in their language. So they don’t even know, there’s no education. So how can they even know what mental health is if they’ve never been taught about it? And then, you add on the stigmas for our culture and a bunch of other stuff in our policies. The list goes on. So when it comes to mental health, there’s a big disparity on these populations not getting access to treatment.
MOORE: 37:01It’s the same for African-Americans, it’s the same thing. You’re looked at as you must be crazy to even think about getting some help. And you have a mental health issue. Parents don’t want to believe that their child is suffering in that area. And then we’re taught in my culture, get you some Jesus and you’ll be okay. And yes, you can do that. And I agree with that being a Christian counselor. But then how do you apply it? What’s the practical application? What do I do when I’m feeling depressed? What do I do when I have a lot of anxiety? Yes, I can pray. And that takes care of the spiritual end but what about the practical, everyday living end of it? And so that’s what I think that my people are missing. That it’s okay that you struggle, and it’s okay to get help, and it’s also okay to pray and get you some Jesus.
CARMEN: 38:07We just had a question come in that I think is really excellent. It’s a lot of words, so bear with me here. “Can you speak to white therapists who encounter clients who casually make overtly racist comments, as our white awareness grows about our own histories and roles in perpetuating racist, homophobic, etc, cultures, it seems only right that we also help our often-white clients to also recognize their own missteps. But that might not– probably not be their presenting goals.” So that’s a really good question because it incorporates education. Yeah, also keeping your own space as a therapist and like we had talked about before, “Hey, you’re kind of a racist.” You can’t do that. So how do we approach this? I know this is a common thing clinicians run into.
VASQUEZ: 39:04I think you can just start off by– and correct me guys, you guys are more direct care than I do, but just like I understand and I hear what you’re coming from and probably that’s what your understanding of that is. And I would just kind of casually incorporate a little bit of just– without making them feel uncomfortable about their comments there. It’s probably just lack of knowledge that just that’s what they’ve been taught or heard. And so it’s common that it’s going to come out in conversation and that just comes out with anybody who makes a racist comment. Just casually like, “Okay, I see what you’re saying. However [laughter]”, and then you can go off on that and I’ll let you guys piggyback on that. Guys?
CARMEN: 39:48Yeah [laughter].
VASQUEZ: 39:48Guys–
CARMEN: 39:49Yeah, sorry, go ahead.
MOORE: 39:51No, go [laughter]. I was going to say, yeah, I tried to just create an atmosphere of comfort just by the smile on my face or just how I sit in my chair. So that they can feel like they can ask the question if it has to do with race, sex, whatever. That’s what I try to create. But of course, it’s up to them if they feel comfortable enough. Probably not at the initial meeting, but I think as they get to know me– because I deal with residential clients, so they’re here all the time, every day. So I think that once they get to know me, they are more comfortable with asking. And then even my colleagues, my colleagues that are white or other races have been able to sit in there. I’ve been able to sit in their office and they ask me different things about my culture and the way I respond, they are able to ask even more questions. They feel more comfortable. So if I do that with my clients, I think that that helps them to learn as well as my colleagues. And also dealing with a lot of African-Americans that come through DPR, definitely, I could deal with them and have great, you know, client clinician relationships and get past some barriers and all of that. But what is that doing for my colleagues who don’t really deal with a lot of African American clients? I want them to be well-rounded as I will need to be. So I don’t want to necessarily take on all of the African-American clients that come to here. I think that we all need to learn about each other’s culture and how to deal with someone’s attitude or their point of view of things.
CARMEN: 41:57Anyone want to add to that?
VASQUEZ: 41:59Absolutely. I think it has to do with, you know, getting to know people, understanding their points of views so that you can also learn from them and vice versa. So if there’s racist or racism behind, you know, the comments behind what they’re– I mean, we’re getting into their world, and that’s why they don’t realize that when they come into therapy, that that might be an objective to work on because it is affecting them. So at a deeper level, you know, what’s the real message? What are we really hearing from our clients by making those comments, all those negative comments about a certain race? But how is that deeply affecting them as well? And coming from a place of showing open-mindedness and able to speak again, since we’re creating this environment that you know, at times for us clinicians, it’s difficult to talk about, then we also have to practice what we preach and find areas where we can also integrate those, those open discussions and how Alison mentioned, once we’re in that setting that I don’t know if that’s a conversation that we would have initially at an intake assessment, but we can definitely have if that’s a repeated theme, as I like to call them as well, something that keeps coming up and again adding layers and affecting their mood, their behavior and how they’re also interacting with other people. How is that, you know, affecting day-to-day interpersonal relationships or their environment? Or are they isolating because they’re really not understanding of other cultures as well? So just kind of opening, throwing ideas in there as well, and just keeping an open mind. I always say motivational interviewing something that has– I have seen it as well and have done my own research with the clients that I work with, that it works all across the board. And you know, you can roll with resistance, get to know that ambivalence that exists. I’m hearing what you’re saying, but on this end, you know, this is really the message that I am actually getting. So we’re challenging some of those distortions as well.
CARMEN: 44:10Mark, did you want to add? We have another kind of comment that I think is really interesting, but I didn’t want to cut you off if you were going to add to that.
TRUJILLO: 44:17No, it’s okay. You can move on.
CARMEN: 44:20Okay. So here’s a comment. So I’m just going to read this. I have seen firsthand how the mental health stigma in the Hispanic community has prevented individuals who have suffered great trauma from seeing [seeking?] out help. I tried to help a minor child who was a victim of a hostage and witnessed a tragic shooting. A year prior, he witnessed another shooting in his family. His mother refused to engage him in services. And this actually Segways right back into, I wanted to slow that stigma conversation, which we had kind of touched on because that is a huge barrier for people. Obviously, this person’s mother did not want to engage in services. I’d be curious to understand why. What are your thoughts?
TRUJILLO: 45:13There’s a lot of stigma in the Latinx community with mental health. Just like Alison said, there’s a lot of like, let’s throw Jesus on it and then pray on it and you’re good to go, not knowing that there is a lot of extra work that you could be doing. I think it also depends on how we pose our services. We need to meet our clients where they’re at. Are we going into this conversation with this mom and who wrote this comment? I’m really not saying you did something like this. This is just an example. But are we going into this conversation with mom being like he’s– he had a lot of trauma, he needs to see a specialist to help them understand what he went through. Are those the kind of words we’re using because those are big words, right? Trauma, specialists. A lot of moms, right? Not even just [inaudible] next to me, but a lot of moms don’t want to have their kids involved in this. They just want to forget, and that’s it, right? So how are we posing this situation? How are we posing the help? Like, “Hey, is there someone your son can talk to about what he saw? And just we can talk about it a little bit, make sure he’s okay”. And then he can move on. So just kind of bringing that down to the space where your clients are. You have to meet them where they’re at. Anything that’s too verbose, anything that gives a lot of clinical term sometimes just does not work for a lot of populations who are in the field like we are. We know all these words, we know what they mean, but most of our clients don’t. So there’s no need for us to pose, help in such a way that we’ll turn them away from it because they don’t understand what we’re saying. So that could be like a– I mean, that is a problem I have seen in how we deal with a lot of trauma cases and a lot of situations that come through the Latinx community.
CARMEN: 47:10That’s really an interesting– you kind of turned the whole thing around, which is how we, as clinicians are presenting to potential– to clients in the sense of can we accidentally inflict shame? Me, even as a mom, it’s like, “I didn’t cause trauma to my child. What are you saying?” And then all of a sudden, now it’s– I’m trying to get help for my kid, and now it’s my fault because my kid has trauma. So that’s a really interesting take. Anyone want to talk on that, [inaudible]?
VASQUEZ: 47:42Definitely. I also think that it has to do– okay. So I’ll take it back from the referral. I’m just doing very [inaudible] personal experiences, too. So when we get those cases, especially with the Latinos, and [within?]– I deal with them a lot. So it’s making that phone call. I always try to also teach and train our staff to show that empathy and come from an area of non-biased, non-judgmental, that, oh, your child, they’re traumatized like [inaudible] says. So we’re using all these key terms or clinical words that for the parents, that’s just– is traumatic for them to hear that their children are being traumatized. So we don’t want to minimize the situation. That’s not what I’m saying here, either. What I am saying is having conversations like, how is your child being affected by this? And speak to them in their language. I always ask clients speak English or do they prefer to speak Spanish. In those phone calls, a lot of the times how I warm up to the clients is just showing that empathy that I can relate to the situation of what’s going on, kind of create more insight for the parents as well of, “Do you really see what’s going on? I can’t believe that this happened. I can’t imagine all the fears that you experience. Your child, I mean, this is something so difficult for you to process.” So with that essence, I think that it captivates the parents. We’re breaking down the stigmas, again, like Lindsey said, about mental health. Normalizing the situation in the sense that we’re not here– your child is not mentally ill, but they’re experiencing situations that are affecting them right now. And we just want to meet this person. We want to see where we can provide additional support. And again, that empathy that goes along with someone that has experienced a traumatic incident, especially with the Latino population.
CARMEN: 49:40Yeah. It is 12:49. We only have ten minutes left. What I want to talk about is actionable items for those watching in terms of, number one, being aware of our own lens. I’ve heard all of you at one point or another in this conversation say, “I had to make a list of what my belief system is,” or, “I had to check myself here,” or, “I had to rephrase how I was speaking with this client.” Give us kind of a clear guide as to how to start looking at our own lens and actionable items for us to begin to change the way we’re approaching diversity in our clinical practice. Who wants to take that?
MOORE: 50:32I think that we just need to be respectful of others, be respectful of what we believe, and that it’s okay to have our own beliefs and that we may not agree with what our client believes. But that doesn’t mean that we can’t help them if we just operate out of respect and understanding that whatever their backgrounds or wherever they come from, their socioeconomic levels that it’s just where they come from that that forms who they are as a person and to appreciate the differences in someone, that we don’t have to be racist or discriminate, that it’s okay to be different, and just because you had this experience, I didn’t have that experience. But let’s talk about it. And give them a safe place to process what it is that they’re dealing with.
CARMEN: 51:35Okay. So I hear you on an attitude of respect. We come into the clinical space with an attitude of respect, an attitude of openness. What about other things we’ve mentioned, like making a list? What about balancing some of our checks with a fellow colleague? Can you talk on some of those things? They seem like they would be really powerful things to do in light of wanting to create an open space.
TRUJILLO: 52:05So there’s a ton of – how do I say? – resources online for clinicians specifically that are– it’s like a personality test. Check your bias, right? And so it goes through a series of questions, a series of scenarios, situations that you’ve never thought of because you’re not in that space, right? But you might be at some point as a clinician. We’re looking at different people. And so take some of those. When we’re talking about a list or a checklist, it’s exhaustive, right? We don’t know how many things you have to put out there. But going through and looking up some resources for– it’s all about research on how to better yourself. So looking up for these resources, taking these kind of hidden bias, little personality tests that kind of tell you, “Hey, actually, you clicked all of these stereotypes about queer people here.” You should probably look into that. You should probably do some research, educate yourself because a lot of times, we don’t even think about some of these marginalized groups because we don’t deal with them firsthand, right, or we’re not part of that marginalized group. And so I just looked one up right now that I’ve done before. It’s learningforjustice.org, and they have a really great, comprehensive kind of test yourself quiz on there that you can look at. And it’s just the beginning, right? It’s all about educating yourself, reading about the cultures your clients come from, making sure that you have, like Alison said, an open mind when you’re talking with them, that even though those biases and those prejudices are there because you’re not a saint, they’re there, right? No matter that, sometimes, how much work we put into them, they’re built into us sometimes. Being able to walk into that conversation, leaving those at the door, right, checking them out the door so that you can provide the best relationship and the most help that you can. But as far as a list or something goes, there’s tons of resources online.
VASQUEZ: 54:13And I think we can formulate it just by being here today. That was step one, coming in here and being open to this discussion and wanting to learn more about it. And if we want to do a one, two, three, kind of checklist that we’ll start off with, let’s be open about the topic, number one. Number two, let’s learn about ourselves and where we’re coming from. Number three, let’s learn. Let’s educate ourselves. Let’s go find these resources. And number four, let’s get more involved in these conversations. And that right there is an opening segue to learning more about this.
CARMEN: 54:49Okay. With only five minutes left, let’s talk therapy for just a second. And again, I mentioned this to you in terms of– talking about therapy approach, it’s almost like I don’t want to say, “Okay, so for people of color, we do this therapy, [laughter] and for the queer community, we do this therapy.” So when I’m saying therapeutic approaches, I’ve kind of wanted your perspective as you have been dealing with different, diverse clientele. So can you guys talk about that in a much more productive way than me trying to parse that off?
VASQUEZ: 55:31I would definitely say that we got to tame our egos. We really do. I think it’s ego-based, sometimes, regardless–
MOORE: 55:39[inaudible].
VASQUEZ: 55:39–of how we see situations. The counter transferences, I mean, we’ve heard that term again. And what Alison mentioned about respect, that really goes a long way. Be respectful. I always say, join the client’s world, meet them where they are. It’s so important to see the world from their eyes. And the more we can relate to their environment, to their world, to what they’re experiencing through their traumas, etc., that we could be more competent in our approach as clinicians and that we roll with that resistance, because sometimes we’re like, “Well, my client is resistant.” But are they really? Who’s the one that’s really resistant? And I can share a lot of information about there is no resistant client. There are resistant therapists, that we are just not where the clients are. So I’ll just keep it very practical. Check your [countertransference?] process your prejudgments and also be very respectful and always set a safe environment for our clients, making sure that they feel safe. I always want to make sure that they have that cozy– that they walk in, that they are treated with respect. And I think that opens doors to many other things in the clinical environment.
CARMEN: 56:59Anyone else want to talk about therapy?
VASQUEZ: 57:02I think that we can just like– we’ll have a client come in, let’s just say for the discussion. He’s queer, but he’s coming with his anxiety. I mean, just because he’s queer, we’re not going to associate that the anxiety is coming because of that. So it’s about the complexity of the issue, like understanding and learning about him. His anxiety may be coming from a completely different reason. Altogether, it has nothing to do with where he stands, whether he’s queer or not. So it’s understanding that so what therapeutic intervention are we going to take? We’re not going to go, “Oh, because he’s this, then we’re going to put him in this box.” No, let’s see where this anxiety is stemming from. And it could be multiple different things. So the interventions that we use, they have to be definitely so customized on the person and what they’re dealing with. So there isn’t a go-to of this person’s this. And that’s the first thing we need to do, is not put people into boxes.
CARMEN: 57:54Such a fine line to walk because here your client comes in and they are queer, so you have to take that into account, but then also realize the things that they’re talking about may have nothing to do with the fact that they’re queer. And my immediate go-to would be, okay, let’s talk about about being queer. And I can see where that is– that takes some real technique to be able to parse all of that out.
TRUJILLO: 58:23Yeah, absolutely. Definitely. And that’s what we need to kind of understand is if they’re coming here, let’s first have that discussion. Let’s see where the client is coming from and standing up and the right there is that pre-notion that we’re like, “Oh, that’s probably why he’s here.” So it’s understanding our client, understanding who we’re dealing with and just being open, being open just to seeing them in a different way.
MOORE: 58:49Yeah, that’s true because I was going to say being judgmental, kind of jumping off of what Christian said and what Lindsey is saying, not being judgmental, that’s the word that came to my mind. As soon as you’re judgmental, then you have messed it up for yourself. You can’t even get past it to see the root cause of what they’re dealing with. So just like Lindsey said, just because they’re queer doesn’t mean that that is the root cause of why they are seeing you. So we have to get past that judgmental phase or stage and just be open and let them process whatever it is. And then as a clinician, we began to pick out, okay, what they may be dealing with. We ask questions. So you could use all kinds of theories and practices, but just make them feel comfortable.
CARMEN: 59:44Okay, so it is 12:59. I feel like we have done a really good job in kind of beginning the conversation. I want to thank all of you. This was really a great, great topic, a great conversation. I even called [Mar?] this morning. I was like, “[Mar?], I’m a little nervous about broaching this. Make me feel better. And she did. So honestly, thank you everyone for joining in the conversation. And again, be looking for your CE information by end of business tomorrow. I hope you all have an amazing day and an amazing weekend. We’ll see you next time.
VASQUEZ: 01:00:28Thank you.
TRUJILLO: 01:00:28Bye.
VASQUEZ: 01:00:29Take care. Bye-bye.
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CARMEN: 01:00:34This has been Recovery Out Loud. Don’t forget to subscribe and stay up to date with notifications for new episodes. But most importantly, if you’re struggling, don’t hesitate to reach out. Help and a new beginning are only a phone call away.