Article Published: 12/14/2022
Telemental health continues to make counseling more accessible, particularly since the onset of the COVID-19 pandemic when it was the only option for many people to receive care. Regulatory changes and secure technology have since helped counselors and their clients become more comfortable with sessions conducted virtually. As with any kind of counseling, it is important to recognize the different needs within different cultures and communities.
We spoke with two counselors who work with multicultural populations to discuss best practices when providing virtual care.
“Immigrants and refugees face tremendous challenges such as migration stress that may manifest in feelings of depression and anxiety, migration-related trauma, interpersonal violence, lack of economic opportunity, fear of deportation, racism, and poverty,” says John J. S. Harrichand, PhD, NCC, CCMHC, ACS, LPC-S, LMHC, CCTP, assistant professor in the Department of Counseling at The University of Texas at San Antonio.
Language barriers are a significant challenge for counselors, he adds, due to a shortage of bilingual counselors and language interpreters.
“It is not uncommon for counselors to rely on family members, especially children, to provide translation services as a first step in offering care, which opens conversations regarding ethical best practices,” he says.
Other special considerations include a client’s ability to afford the necessary technology and having a secure, private space to meet for counseling sessions.
“More so, if telehealth services are being received, it can be difficult for the counselor to readily observe body language and other visual clues that are more easily accessible during in-person sessions. The reality is that our body also communicates information; in counseling, nonverbal cues from clients express that which is not being verbalized, giving counselors additional information regarding what clients are truly thinking and/or feeling.”
Networking can go a long way when seeking resources for these clients, Dr. Harrichand says.
“Counselors might accommodate immigrant and refugee clients who have limited or little English skills by partnering with a member of The American Association of Language Specialists (TAALS) or the Association Internationale des Interprètes de Conférence (AIIC), and for sign language, the Registry of Interpreters for the Deaf (RID).
“For clients who do not have the means of purchasing a computer or phone to engage in services, some assistance can be obtained by visiting GetInternet.gov,” he continues. “They can also explore services through the Affordable Connectivity Program (ACP) and Lifeline, which are federal programs that provide financial assistance to eligible households for internet services and/or internet-connected devices.”
Because some clients have limited privacy, Dr. Harrichand recommends that counselors are accepting of them using their car or bathroom as the “counseling room” to receive counseling. The fact that they are invested in receiving needed mental health services needs to take precedence over how they do so, he says.
“Many of the students and families we have in our district are migrant, immigrant, or refugee families,” says Angus Raymond, MA, CADC, Director of Prevention & Intervention for a school district in rural Iowa. “There are over 25 languages spoken in the district of just under 3,000 students.”
Raymond also provides school staff members with culturally appropriate training to help them understand and create better relationships with their students.
“There is an enormous cultural divide here. So many students and families have intense trauma histories, some ongoing. These kids are mostly first generation and straddling both worlds, which creates a lot of additional trauma for them. The families aren’t given much support for acculturation into the new community, so the school ends up being the community resource because there are so few other resources here.”
Though Raymond communicates well with his Spanish-speaking clients, he says language barriers still pose a considerable challenge.
“The ‘language lines’ for translation by phone do not always have the languages we need. When they do, the interpreters are only allowed to repeat your questions or dialogue verbatim, which may very well not really translate the meaning of the question.”
Many families who have arrived from refugee camps have never used internet service or laptops.
“The technological divide for them is an immense hurdle and, I’m sure, feels even more daunting than being in so many foreign spaces,” Raymond says. “There is little acculturation help, no mental health or trauma resources, and very little long-term support. They must learn on their own or, hopefully, find other families to help them. If no one in the family speaks English, it is even more difficult.”
Fragmented immigrant families are common, Raymond says.
“Often, it is only individuals or children that immigrate. Rarely do we see an entire family due to the nature of our immigration laws and system. A family cannot just arrive at the border and apply, so there is considerable trauma here as well, due to the policies in place.”
Raymond strives to accommodate these individuals and help them adjust to their new lives and become acclimated to their surroundings.
“I work to involve family members where appropriate, especially if there is someone who has acculturated a bit more to help bridge and give support and context,” he says, adding that sometimes an in-person session may be necessary for a better outcome.
Improving your cultural sensitivity can go a long way when counseling multicultural clients, he says.
“Be humble! Ask questions, be open about your ignorance and be willing to learn. Educate yourself about the cultures in your community and the concerns they may have. Use your scholarly skills to find information that demonstrates that you are trying to understand and make them welcome. And recognize that ‘multicultural’ does not just mean race or ethnicity, it also means ability, identity, and so much more.”
John J. S. Harrichand, PhD, NCC, CCMHC, ACS, LPC-S, LMHC, CCTP, is of Chinese and East Indian ancestry, was born and raised in Guyana, South America, and immigrated to Canada. He completed his BSc (Hons) in psychology and integrative biology from the University of Toronto at Scarborough, his master’s in counseling from Providence Theological Seminary in Otterburne, Manitoba, Canada, and his PhD in counselor education and supervision from Liberty University.
Angus Raymond, MA, CADC, is an NBCC Foundation 2021 Minority Fellowship Program for Addictions Counseling Fellow who received his master’s degree in clinical mental health counseling from Adler University in Chicago, Illinois. Raymond has been a certified drug and alcohol counselor since 2018 and is awaiting licensure to be a licensed mental health counselor (LMHC) in the state of Iowa. He is currently the Director of Prevention & Intervention for a school district in rural Iowa with a diverse student body.
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