Nothing is Something...

Attaining that lovely state of nothingness is no less than an ongoing challenge, although finding myself in that quiet place has a transcendent beauty unlike any other experience. However, I experience the challenge far more than its reward. The mind is like the Energizer bunny, going, going, going... a seeming well of perpetual motion. There's no stopping it, but only the chance of stepping back just enough to be the watcher instead of the thinker.

Supporting meditation (and quietness) Lazar et al. (2005) found "that regular practice of meditation may slow the rate of neural degeneration" of cortical thickness. Their findings suggest that watching those soap bubbles support cortical plasticity which, in turn, helps us with cognitive and emotional processing.



Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T., ...Fischl, B. (2005). Meditation experience is associated with increased cortical thickness. NeuroReport, 16(17), 1893-1897. doi: 10.1097/01.wnr.0000186598.66243.19

Confrontation in Counseling

Confrontation increases the counselor's level of understanding as well as helping the client form a more realistic perspective of incongruous perceptions. Ultimately, this counseling skill helps to "identify and process discrepancies that may resolve with clarification" (Knapp, 2008, p. 139). Leaman (1978) defines confrontation as "an open, honest identification of the client's self-defeating patterns or manipulations" (p. 630). Gadgila, Nokes-Malacha, and Chib (2011) believe that when individuals are forced to compare their flawed perceptions with a realistic model, it can work as a self-explanation toward changing misconstrued beliefs and ideas. Used as a device in counseling, it must be implemented carefully and consciously to "point out the contradictions of their self-defeating thoughts, actions, and feelings" (Spadero, 2012, para. 9).

Situation Description

The following hypothetical situation demonstrates the appropriate use of confrontation in counseling. In this case, the counselor has been working with a woman who was consistently sexually abused by her father from age three through 15. Although she understands, from a logical perspective, that her father was wrong and his abuse continues to cause her severe distress, she maintains that she and her father had a very good relationship. After several sessions the counselor believes the relationship with the client is strong and decides to confront the client regarding the inconsistency with which she refers to her father. The counselor says she hears her client say she understands the victimization she suffered because of her father's abuse, yet she continues to refer to the good relationship she and her father had. The counselor adds that it must be confusing sometimes to integrate both those feelings. After a few moments of silence the counselor asks how she feels about what the counselor just said.

As reasoning for this confrontation, the counselor believes until her client can grasp the dysfunction in her relationship with her father, she will continue to blame herself and take responsibility for his actions. As explained by Zinzow, Seth, Jackson, Niehaus, and Fitzgerald (2010), blaming oneself, even as an adult who can clearly understand the spurious nature of the childhood abuse, is common. Women continue to blame themselves even though they realize logically that children are not consenting players in their abuse. Zinzow et al. (2010) contend in many cases, girls take blame for their abuse, perhaps to maintain some consistency between their experiences and their expectations for the father's role. During confrontation, the counselor may identify and explain how compensatory behavior, such as blaming oneself rather than the perpetrator, causes continued negative consequences such as illness, depression, and misplaced anger (Murtagh, 2010).

The confrontation, in this case, may help the client begin to replace the maladapted thoughts with a more appropriate, logical, adult perspective, in essence, giving the client an opportunity to free herself from the constraints of guilt related to her abuse. Leaman (1978), however, believes confronting maladaptive behavior is a difficult task in counseling. Furthermore, the challenge of integrating new information with the old may be difficult for the client, and the counselor must be sensitive to the client's ability. This type of confrontation would not take place until the counselor is confident in the strength of the client/counselor relationship. Until the relationship is strong, confrontation may not be effective. Worse, it can make clients defensive or cause undue emotional stress (Knapp, 2008).

Degree of Comfort Using Confrontation

Although I have not had the opportunity to use confrontation under any circumstances except for mock counseling sessions, I believe I would be comfortable using this counseling skill with clients when appropriate. The perceptive observation and acknowledgment of inconsistencies with clients is critical; it forces reflection and makes constructive corrections in their belief systems. It can also help to extinguish belief perseverance, which is a common human inaccuracy that surfaces in healthy individuals as well as those struggling with challenges. Furthermore, confrontation helps the counselor better understand the genuine effects of the client's history and experience, thereby contributing to the effectiveness of the therapeutic alliance (Knapp, 2008).

Supporting my personal level of comfort with using this skill, is understanding the purpose and value of facing oneself realistically as an integral part of the therapeutic process (Leaman, 1978). Confrontation awakens the client to personal inconsistencies and contradictions that may contribute to ongoing issues, but involves acknowledging the often harsh realizations of one's inaccurate perceptions. "Counselors sometimes forget how difficult it is to face oneself honestly and how painful vulnerability can become" (Leaman, 1978, p. 631). As a counselor, I intend to support my clients as they move from vulnerability to the strength and empowerment that comes with honest self-evaluation and self-acceptance.

Conclusion

Confrontation in counseling, as in life, is not always comfortable. Like acknowledging or reporting abuse or suicidal behavior, the comfort lies in knowing the action or the process is ultimately beneficial to the client. Although caveats for its use exist, confrontation in counseling has profound purpose and its knowledgeable and deliberate use can benefit the therapeutic alliance and contribute to the forward movement of clients.

References

Gadgila, S., Nokes-Malacha, T. J., & Chib, M. T. (2011). Effectiveness of holistic mental model confrontation in driving conceptual change. Learning and Instruction, 22(1), 47-61. doi: 10.1016/j.learninstruc.2011.06.002

Knapp, H. (2007). Therapeutic communication: Developing professional skills. Thousand Oaks, CA: Sage Publications, Inc.

Leaman, D. R. (1978). Confrontation in Counseling. Personnel & Guidance Journal; Jun78, 56(10), 630-633.

Murtagh, M. P. (2010). The Appropriate Attribution Technique (AAT): A new treatment technique for adult survivors of sexual abuse. North American Journal of Psychology, 12(2), 313-334.

Spadero, N. (2012, July 16). Welcome to Week 7 From Dr. Nina [E-mail to the author]
Zinzow, H., Seth, P., Jackson, J., Niehaus, A., & Fitzgerald, M. (2010). Abuse and Parental Characteristics, Attributions of Blame, and Psychological Adjustment in Adult Survivors of Child Sexual Abuse. Journal of Child Sexual Abuse, 19(1), 79-98. doi: 10.1080/10538710903485989

Culture of Disability

Just as any culture usually derives from a common history, the culture of disability refers to a wide range of people who share commonalities with regard to a loss of some type of functioning. In the eyes of society as well as some individuals who have a disability, these losses make them appear different and separate them from the norm. Individuals can have psychological or physical losses or deficiencies that can challenge normal functioning (normal meaning according to a standard norm.) Many of these individuals have a difficult time doing routine daily activities that most people do without thinking. Self-determination, for many of these individuals is a life-long challenge (Sue & Sue, 2008). Lipp, Kolstoe, and James (1968) believe individuals with disabilities can have complex psychosocial problems deriving primarily from feeling and appearing different from everyone around them.

Commonalities to this group include the inability to find gainful employment, societal perceptions of deficiency, negative self-perceptions, and the challenges of navigating in through a world poorly designed for some disabilities (U.S. Department of Justice, 1991). As with any culture, the culture of disability shares attitudes, beliefs, and values. For example, many individuals with disabilities dislike being treated as deficient people. They find solace and camaraderie and a sense of empowerment working together to surmount the challenges presented by their disabilities. Being a minority culture in a broader culture, they have similar experiences and feelings.

I believe one difference between this culture and others is the unchanging nature of their disabilities. Typically, cultures are not static, but are constantly in flux; however, individuals with disabilities do not have the power to change their physical conditions. Perhaps this is why so many members of this culture work toward changing their own perceptions as well as those of society. Another difference is that in disability culture, its membership is separate from the culture of their family and friends and it ostracizes them from the greater culture.

Implications in Counseling

One implication of counseling individuals with disabilities is creating a reasonably accessible environment in which they can be comfortable. The Americans with Disabilities Act has made significant contributions of creating awareness and effectively changing the design templates in a variety of applications for ease of use for these individuals (Sue & Sue, 2008). Ultimately as with any minority population, counselors need to reflect on personal bias and prejudice toward people with disabilities and learn how to treat them with the same respect given to all clients. Having a disability neither renders a person incompetent, devalued, or useless, nor does it make them superhuman members of society. Sue and Sue (2008) list "Things to Remember when Interacting with Individuals with Disabilities" (p. 484). This inventory contains valuable ideas for counselors working with individuals with disabilities.

Mental health counselors need to assess their own comfort level when working with individuals with disabilities and, as Sue and Sue (2008) mention, focus on the individual, not the disability. It is important to recognize the actual skills of individuals with disabilities without sensationalizing what they can and do accomplish. Helping these individuals explore options and resources is important as well.

References:

Lipp, L., Kolstoe, R., & James, W. (1968). Denial of disability and internal control of reinforcement: A study using a perceptual defense paradigm. Journal of Consulting and Clinical Psychology, 32(1), 72-75. doi: 10.1037/h0025453

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

U.S. Department of Justice. (1991). 1991 ADA Standards for accessible design. Department of Justice ADA Title III Regulation 28 CFR Part 36. Retrieved from http://www.ada.gov/reg3a.html

Silence in counseling

According to Knapp (2008), silence is a normal and beneficial component of therapy. Accommodating comfortable silence gives the client time for reflection, or gathering his or her thoughts. Additionally, it provides the time and quietness for deeper feelings and emotions (Knapp, 2008). Knapp (2008) claims silence is essential in the therapeutic alliance and counselors must provide a space for it, honor it, and work toward being comfortable with it.

Silence is used to demonstrate counselors' patience, their anticipation of additional information, or a further response from the client (Knapp, 2008). When used with attentiveness and appropriate eye contact, it solicits further response and conveys the counselor's genuine interest (Levitt, 2001).

For example, when clients self-disclose, they may experience hesitation, apprehension, or difficulty telling their story appropriately and coherently. The counselor can nod and keep silent, in effect, encouraging clients to take their time and proceed as they can, reflecting and gathering thoughts as necessary. Throughout the silence, the counselor maintains proper eye contact and other aspects of attentiveness. This conveys the counselor's openness for further information.

Silence, as in pausing, allows clients to stop and think as well as feel possible deep emotions released in therapy. It lets the client put thoughts in order or sequence prior to their conveyance to the counselor. Knapp (2008) refers to this as a sorting process. Above all, silence provides a fertile ground for reflection from the client as well as the counselor. Ladany, Hill, Thompson, and O'Brien (2005) believe a strong therapeutic alliance contributes to an easier use of silence. For example, as the client feels comfortable with the counselor, silence is better tolerated and not perceived as critical or invalidating (Ladany, Hill, Thompson, & O'Brien, 2005).

Duba (2004) explains how silence can be instrumental in encouraging self-reflection, but also self-direction. In a group interventions, Duba (2004) perceives silence as a challenge to members to take a risk in disclosing something about themselves. Considering this, it would seem to me that even in the dyadic communication of counseling one individual, counselors' silence can create a platform on which clients may, in essence, take a risk and self-disclose. Without some silence, it may be more difficult for clients to find the right moment to interject an important piece of information.

Considerations

I like to think that we do not always simply use silence, but we accommodate it. When we accommodate it, we are acting consciously and with awareness, allowing a natural flow wherein silence applies itself in its appropriate time and place. Simply "installing" it as a device loses its poignancy and purpose. I am comfortable with silence, in myself and with others. I believe, as does Ladany et al. (2004), that there are conditions and contraindications that set the stage, so to speak, for its effective use in counseling. Only through authentic attentive consciousness and awareness can we make that determination accurately.

As a future consideration, it seems important to mention that Duba (2004) believes in the importance of counselors learning how to navigate the comfortable as well as the uncomfortable aspects of silence. When it is mostly uncomfortable or non-existent in therapy, seek supervision. Silence has an important place in every therapeutic alliance and counselors should be able to accommodate it comfortably.

References:

Duba, J. D. (2004). Using silence: "Silence is not always golden." In L. Tyson, R. Pérusse, J. Whitledge, J. Duba, P. Neufeld, & J. DeVoss (Eds.), Critical incidents in group counseling (pp. 265–270). American Counseling Association.

Knapp, H. (2007). Therapeutic communication: Developing professional skills. Los Angeles: Sage Publications.

Ladany, N., Hill, C. E., Thompson, B. J., & O'Brien, K. M. (2004). Therapist perspectives on using silence in therapy: A qualitative study. Counselling and Psychotherapy Research: Linking research with practice, 4(1), 80–89.

Levitt, D. H. (2001). Active listening and counselor self-efficacy: Emphasis on one microskill in beginning counselor training. Clinical Supervisor, 20(2), 101–115.

Generational Influences

One of the greatest tragedies in American culture is the way families tend to institutionalize or simply ostracize older family members because of ageist views and misperceptions that they are difficult and require excessive care. As Sue and Sue (2008) discuss, many people believe older adults have a higher incidence of mental illness and dementia and can no longer function as valuable members of society. One of the most personally troubling aspects of this institutionalization is that it separates older adults from their younger family members which increases ageist perceptions.

Many older adults, especially those in their 80s were born during World War II when food and other supplies were rationed. This has caused some of them to live an extremely frugal life, saving anything that can be saved and being careful not to squander money or resources. I have an older family member like this. She is so frugal, even though she has far more money than all of the rest of the family put together, she's always saving for that proverbial rainy day. This attitude creates somewhat of a chasm between her and the younger generations because they simply think she's crazy. However, her actions are a direct result of being raised in fear of not having enough. This attitude is the antithesis of today's younger generations, many of whom will spend their paycheck on one pair of designer shoes or jeans. Even adults in their 30s purchase houses they cannot afford, and live paycheck to paycheck, never saving money.

Situations like this create ageist perceptions and somewhat of a catch 22; as families ostracize their older members, the younger generations perceive them as unreachable, or difficult to relate to, deepening the generational gap between the younger and older family members. As the gap widens, the younger generation does not seek the companionship or wisdom of the older generation, and the chasm continues to widen.

Considerations

Older adults are somewhat more predisposed to physical challenges related to ageing which include both chronic and acute, even life threatening conditions (Sue & Sue, 2008). Unfortunately, these physical challenges contribute to ageism and the notion that old people are useless and take excessive amounts of attention and care. In this culture, institutions have replaced the family's care (Pruchno, 2001). Unfortunately, the lack of systems in place that allow family to be cared for within the family home is common.

In support of developing systems that help in the care of older family members, Bytheway (2005) suggests gerontological research may need a shift in the current paradigm that involves interviewing older adults. Designing research to empirically review ageing processes, may serve to correct an antiquated system that contributes to rather than decreases ageist notions. In my estimation, understanding the processes is a more holistic way to understand the end result. I would agree interviewing older adults is not the only way to understand the aging process.

As I mentioned above, the contemporary tradition of placing older generations into institutionalized care contributes to the widened gap between younger and older generations when they begin to exhibit aging. Rather than keeping these members of society as valuable and contributing, it is not uncommon to send them off to live amongst themselves, separating them from the younger members of their families as well as making them less accessible (Pruchno, 2001). Sadly, ageism has a significant effect on longevity (McGuire, Klein, & Chen, 2008).

Implications in Counseling

Generational worldviews, such as the one example above tend to ostracize older populations. When working with an individual like my elder family member, it would be important to hear and acknowledge her perceptions, rather than trying to make her see things in another way. Worldviews, as we know, are fundamental lenses that color the way we perceive everything. Especially with older adults, it is important to validate and support the idea that they continue to be a valued member of society. Although counselors may be one or two generations younger than the older adult, they must work toward understanding the tragic nature of such devaluing, and aim for infusing meaning and purpose into their lives. According to Ryff & Singer (1998), having meaning and purpose in life contributes to psychological health and happiness. Certainly, at the latter stage of life, these are welcome positive human attributes.

Ultimately, it is important to reflect on personal bias that leaves many counselors unwilling or at least reluctant, to work with older individuals. As mentioned by Sue and Sue (2008), "the elderly population is underserved and little understood" (456). Just as with any other culture, counselors are expected to create in-roads by which they can better understand the challenges of ageing.

References:

Bytheway, B. (2005). Ageism and Age Categorization. Journal of Social Issues, 61(2), 361-374. doi: 10.1111/j.1540-4560.2005.00410.x

McGuire, S. L., Klein, D. A., & Chen, S. (2008). Ageism revisited: A study measuring ageism in East Tennessee, USA. Nursing & Health Sciences, 10(1), 11-16. doi: 10.1111/j.1442-2018.2007.00336.x

Palmore, E. (2005). Three decades of research on ageism. Generations, 29, 87-90.

Pruchno, R. (2001). The Complex Nature of Ageism: What Is It? Who Does It? Who Perceives It? The Gerontologist, 41(5), 576-577. doi: 10.1093/geront/41.5.576

Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1-28.

Proxemics and Haptics

Interpersonal distance, body orientation, and touch present interesting and sometimes unconscious ways of communicating. Even without knowing, people react to the striking cultural differences in the use of space and touch. Kennedy, Gläscher, Tyszka, and Adolphs (2009) found personal space is regulated by the human amygdala. In fact, patients with dysfunctional amygdalas lack any proximity sense. Although this research explains the location of regulatory function, proximity sense and the frequency and manner with which people use touch is the combined affect of culture, gender, and sometimes, age (Remland, Jones, & Brinkman, 1991).

The French

Generally speaking, French people expect far less personal space than is typically preferred by Americans. They do not, however, implement casual touch more often than Americans (Remland, Jones, & Brinkman, 1991). These authors found that American dyads were less proximate than were French dyads. Additionally, the French tend to squarely face each other when interacting and are far more at ease with confrontation in social situations (Dion & Bonnin, 2004). Like many Americans, French people do not use casual touch unless they are familiar.

From personal experience, the French seem to feel more comfortable with less space between them and the person with whom they are communicating. After living in France for a relatively substantial amount of time, my French friends would tease me about the distance I kept, saying I didn't like the smell of the French! I never did get used to them speaking so close to my face.

Implications in Counseling

Proxemics

If I were counseling someone from France, I would make sure I prepared a seating arrangement that would accommodate their preference for less personal space between individuals. Keeping a typical American distance might be off-putting, or make them feel ill at ease. Furthermore, distance could convey the counselor's lack of interest.

The French have long been known as a society that will take it to the streets, so to speak. They are not afraid of confrontation and consider themselves equals to governmental or secular powers and will literally demonstrate in the streets to display their dissatisfaction. They typically face controversy head on. Considering their penchant toward equality and squarely facing challenge, I would be prepared to accommodate sitting squarely, facing each other, if that appeared his or her preference.

Haptics

Regarding touch, I would feel uncomfortable using casual touch. When counseling someone from France, I would not use touch as a means of non-verbal communication. I might, however, respond to their typical way of greeting and separating by kissing on both cheeks. They would most likely use cheek kissing (faire la bise) when they were leaving, especially if we had a therapeutically intimate session.

Edward T. Hall argued that "differing cultural frameworks for defining and organizing space, which are internalized in all people at an unconscious level, can lead to serious failures of communication and understanding in cross-cultural settings" (Brown, 2011, para. 2). Additionally, Hall (1960) explains societies thrive on the basis of agreements. Haptics and proxemics are customs to which people agree without knowing they are doing so. I thought Hall's (1960) description of a fundamental error in business was particularly poignant and applicable to the therapeutic environment: the most common error is "ignorance of the secret and hidden language of foreign cultures" (p. 96). As counselors, it seems important to learn these silent languages.

References:

Brown, N. (2011). CSISS Classics. Edward T. Hall: Proxemic Theory. Retrieved July 9, 2012, from http://www.csiss.org/classics/content/13/

Dion, D., & Bonnin, G. (2004). Une étude comparative des systèmes proxémiques français et tunisiens. (French). Recherche Et Applications En Marketing, 19(3), 45-60.

Hall, E. T. (1960). The silent language in overseas business. Harvard Business Review, 38, 1960. Pp. 87-96., 38, 87-96.

Kennedy, D. P., Gläscher, J., Tyszka, J. M., & Adolphs, R. (2009). Personal space regulation by the human amygdala. Nature Neuroscience, 12(10), 1226-1227. doi: 10.1038/nn.2381

Remland, M. S., Jones, T. S., & Brinkman, H. (1991). Proxemic and haptic behavior in three European countries. Journal of Nonverbal Behavior, 15(4), 215-232. doi: 10.1007/BF00986923

Personal Gender Socialization

Personal Gender Socialization

I grew up with the normal social expectations related to my sex. For example, my mother taught me how to cook and sew, but she never mentioned a word about either of those to my brother. He was taught how to mow the lawn. Later, he was expected to go to a good college and my parents funded his education to an expensive school. My sisters and I, on the other hand, were encouraged to pursue higher education, although were told that it was more important for my brother to go to a good school because he was a boy. That had a decided effect, and it still irritates me to an extent. Social roles used to be far more restrictive, although it still appears that some part of the fundamental system in this country continues to value the work quality of men more than women.

Gender Socialization of Lesbians, Gays, and Others
Regarding the gender socialization of lesbians and gays, I imagine a tremendous dissonance between who they think they are and the expectations of others (determined by their gender.) Sue and Sue (2008) describe this identity struggle as between one's internal perceptions compared against the norms for one's gender. For example, if a three year old boy wants to dress up as a princess, his parents may panic because his desire to dress in a female role goes against normal social expectations, or they may laugh and think it is funny. Either reaction could create a conflict between the boy's self identity and the rules and norms for his gender. Tobin et al. (2010) believe children can differentiate gender roles by age 3 or 4. Furthermore, children have the capacity to perceive themselves as matching gender norms and stereotypes or as being different (Tobin et al., 2010).

Gender socialization is similar to our acculturation as Americans, it is quiet, yet the expectations insidious. The subtle and harsh expectations of gender cause isolation and stigmatization for many people who do not behave or think according to gender norms. I disagree (to some extent) that the social construct theory explains every aspect of gender differences, especially as it is applied to some gays, lesbians, bisexuals, and transgender individuals. Certainly the videos we viewed this week were not an example of deviant socialization that caused confusion of gender roles. For most of us, socialization explains our gender orientation, but the biological aspect of hormones and brain function (women's brains are different from men's) has an apparent role as well.

Personal Gender Socialization as an Affect in Counseling
Broverman et al. (1970) studied mental health professionals' idea of mental health for both men and women. The disturbing result showed that the professionals were fairly consistent with their ideas for mental health for both genders, (which varied greatly) however, when they were asked to describe mental health for an adult (no gender specified), their descriptions were far more like the descriptions of male mental health. Although this is an old study, it speaks volumes for the silent, but obvious stereotypes mental health professionals held, and likely still hold, for both genders.

Personal Considerations

It will be important to continue to learn about the Lesbian, Gay, and Transgender populations and review my own bias and prejudice toward this group. My own gender socialization would interfere with understanding what it feels like to be in conflict with my gender, as well as any stereotypes and bias I may hold toward either gender. As mentioned by Sue and Sue (2008) clients may have issues that are a direct result from membership in a minority population, although counselors must not assume that issues are always the result of sexual orientation. If I were deeply entrenched in beliefs that women or men should act in a prescribed set of behaviors (which to some extent I am, even subconsciously,) I would have to work at consciously accepting the behaviors and acknowledging the differences when working with a client who acts outside of those parameters.

References:
Broverman, I. K., Broverman, D. M., Clarkson, F. E., & Rosenkrant, P. S., & Vogel, S. R. (1970). Sex-role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34(1), 1-7. doi: 10.1037/h0028797

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.

Tobin, D. D., Menon, M., Menon, M., Spatta, B. C., Hodges, E. E., & Perry, D. G. (2010). The intrapsychics of gender: A model of self-socialization. Psychological Review, 117(2), 601-622. doi: 10.1037/a0018936

The Unique Issues of Gender

Lesbians face unique issues unlike those faced by their heterosexual counterparts (Sue & Sue, 2008). Many women from this minority population resist seeking help for their issues because of the generally negative bias and prejudice demonstrated by society. Sue and Sue (2008) claim there is a higher rate of domestic violence in lesbian partnerships. This paper addresses several unique aspects and underlying factors of abuse in lesbian partnerships and considers their implications in therapy.

Abuse Between Lesbian Partners

Patzel (2005) claims the reported rate of abuse between lesbian partners is similar to that of heterosexual partners, but because of the perceived stigma associated with lesbian relationships, the prevalence may easily be much higher. Although factors contributing to abuse in lesbian partnerships is similar to their heterosexual counterparts, Patzel (2005) identifies four differences that impact lesbians: "homophobia, merging, reciprocal abuse, and a lack of support" (p. 7). Homophobia refers to the lesbians' internal homophobic feelings that stem from pervasive homophobic societal pressures. This type of internalized homophobia forces isolation and resistance to seek help when domestic abuse occurs.

Krestan and Bepko (1980) characterize merger or fusion as a tendency for women to lose themselves in relationships because of a female tendency toward empathy and a desire for emotional connection. When women engage other women in primary relationships, this tendency may create an imbalance in which both partners' need for connectedness outweigh their ability to remain autonomous (Krestan & Bepko, 1980). Autonomy of one partner may threaten the other partner's perception of the relationship's stability. Further exacerbating the problem is a lack of support by friends and family for the relationship (Patzel, 2005).

Reciprocity in lesbian abuse is the perception and assumptions made by society as well as
the authorities that because two women are equal in size and strength, the abuse is not as critical as the abuse that takes place between a man and a woman. This inaccurate perception prevents lesbians from seeking help. When women do report abuse, the authorities may not respond as they would to the domestic violence of heterosexual couples (Patzel, 2005).

Implications in Counseling

The American Psychological Association (2012) suggests the values and bias of counselors significantly affect the counseling process for lesbians. Broverman et al. (1970) suggest counselors' perceptions may continue to embrace subtle bias and stereotypes. Because of the subtle nature of personal bias, counselors must reflect on personal attitudes toward this population (Sue & Sue, 2008). When counseling lesbian couples for domestic abuse, they must consider homophobia, fusion, reciprocity, and lack of support as critical underlying issues (Patzel, 2005). Developing a strong reliable support system for the couple is critical. Equally beneficial is helping them work toward creating autonomy as a benefit rather than a threat to the relationship.

If appropriate, the partners may wish to explore their own homophobia to develop an authentic acceptance of lesbianism as a psychologically healthy and natural alternative to heterosexual coupling (Sue & Sue, 2008). Ultimately, counselors must educate themselves in understanding that abuse in lesbian partnerships is extraordinarily complex and cannot be resolved with the same solutions used for heterosexual couples. Patzel (2005) believes within the lesbian population, little awareness and acknowledgment of this abuse exists. Counselors may consider advocating for this population by creating an awareness of this complex issue as well as offering guidance toward its ultimate resolve.

References

American Psychological Association. (2012). Issues in Psychotherapy with Lesbian and Gay Men: A Survey of Psychologists. Lesbian, Gay, Bisexual and Transgender Concerned Gay Men: A Survey of Psychologists. Retrieved July 12, 2012, from http://www.apa.org/pi/lgbt/resources/issues.aspx

Broverman, I. K., Broverman, D. M., Clarkson, F. E., & Rosenkrant, P. S., & Vogel, S. R. (1970). Sex-role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34(1), 1-7. doi: 10.1037/h0028797

Krestan, J., & Bepko, C. S. (1980). The problem of fusion in the lesbian relationship. Family Process, 19(3), 277-289. doi: 10.1111/j.1545-5300.1980.00277.x

Patzel, B. (2005). Lesbian partner abuse: Differences from heterosexual victims of abuse. A review from the literature. Kansas Nurse, 80(9), 7-8.

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.

Worldview and Therapy: Counseling Arab Americans

Worldview and Perceptions, Attitudes, Beliefs, Values, and Behaviors

Family

According to Sue and Sue (2008), Arab Americans honor the family and believe in its importance as a primary obligation. Equally important is the "interdependence among (family) members" (Sue & Sue, 2008, p. 412). Arab Americans value conformity and this affects parenting style and the belief that children should behave appropriately. Behavior conflicting with traditional expectations is not tolerated. Women are expected to maintain the home and take care of child rearing, taking a subservient role to the men, however, at Middle Eastern universities, the number of women outnumbers men (Ofori-Attah, 2008). As the authoritative leader of the family, the father remains somewhat detached from the children and acts as the disciplinarian. The father's rule is household law.

The Community and Spiritual Identity

Arab Americans are deeply devout and their sense of religion and spirituality extends into their community in a somewhat collectivist manner. Horan (1995) claims Christian Arab Americans have deliberately chosen integration into American culture, however, Muslim Arab Americans disagree with core American values and have no intention to assimilate. Mackey (1992) claims Muslim Arabs fear jeopardizing religious beliefs and morals because of the conflict with American values. Customs and traditions are related to religion, and for Arab Americans, religion is a central force in their development as well as their evolving identity. Followers of Islam (Muslims) believe following Islamic law (sharia) is crucial to their religious development, and although its legal affect is irrelevant in America, many Muslims continue to use it as a source of personal ethics (Horan, 1995).

Implications in Counseling

Understanding the unique roles of the family is important when working with Arab Americans. These roles may pose challenges for counselors with individualist or feminist values that determine all people should have freedom of expression and personal choice without the approval of one authoritative family member. Counseling Arab Americans may present other unique challenges as well. For example, they may fear that the counselor and the process of counseling may jeopardize their traditional values from exposure to conflicting American morals and beliefs (Mackay, 1992). The counselor must establish a therapeutic environment that will not threaten the family, especially the father. Counseling Arab American women may pose problems related to their identity within the family. In this cultural milieu, a woman should be considered in relation to her husband and family as well as her religious and community obligations (Horan, 1995).

For counselors, it is important to learn about the culture's traditions and worldviews that deeply affect the lives of Arab Americans. Seeking the truth about Muslims is perhaps more important than other religions because of the fear and stereotypes provoked by American propaganda. For example, Islamic doctrine states that women have rights and freedoms separate from their husbands (Haselhurst & Howie, 2011). When counseling any group with unique cultural contexts, acknowledging personal bias is critical to work effectively and in a non-discriminatory manner (Sue & Sue, 2008). Non-Arab Americans are have little accurate information about the Arab culture. Mental health counselors should not hesitate to "collaborate with them to gain an understanding of their lifestyle and beliefs" (Sue & Sue, 2008, p. 414).

References

Haselhurst, G., & Howie, K. (2011). Introduction to Islamic Religion & Arabic Philosophers. Islam Muslim: Islamic Religion, History, Beliefs. Quran / Koran, Mohammed Quotes. Retrieved July 3, 2012, from http://www.spaceandmotion.com/religion-islam-muslim- islamic-quran.htm

Horan, A. E. (1995). Arab-American communities and their acculturation into the American culture and society (Unpublished doctoral dissertation). Walden University.

Mackey, M. (1992). Passion and politics. The turbulent world of Arabs. New York: Penguin.

Ofori-Attah, K. (2008). Going to school in the middle east and north Africa. Westport, CT: Greenwood Press

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.