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  • 01 Feb 2018 11:02 AM | ORCA Editor (Administrator)

    Like many counselors, I’m on some Facebook groups and e-mail lists where counselors submit requests for referrals for clients who perhaps don’t fit into a counselor’s schedule or require a specific type of insurance that counselor doesn’t take. Many requests sound something like this: “I’m looking for a counselor for a 45-year old man dealing with grief over the death of his teenage daughter while also handling his high-stress job. Must have evening openings and be in-network with Providence and near his home in Sellwood or Woodstock area.”

    Was all of that information truly necessary in order to find an appropriate referral? Was it necessary to share age, specific location, and the exact issue the client is dealing with?

    The ACA’s rules for its own community forum contain a fairly restrictive interpretation of the ACA Code of Ethics: “It is not permissible to present aspects of a case on a counseling listserv or online forum even if the client’s name is not given. Information shared by a client and clinical impressions must be afforded the same level of confidentiality as the name of the client. Describing a client’s presenting problem, diagnosis, or clinical treatment approach through listservs or online forums – even if the client’s name is not given – is a violation of confidentiality.” (Click here for more info.) 

    There’s also the concept from HIPAA that we can apply here, that of “minimum necessary disclosure,” or, “what is the least amount of personal information I can share to achieve a goal.” If the goal is to find a counselor for the man described above, we can eliminate much of the details from the original request.

    So how could that imaginary referral request above have been made in a manner that obscures the client's information better? How about this: “I’m looking for a counselor in Sellwood or Woodstock, in-network with Providence with evening hours available, who’s experienced with grief and loss in adults.” 

    Aaron Good, MS, CRC, LPC Registered Intern is a counselor in private practice, focusing on career, purpose, and identity. When he's not seeing clients he works for Roy Huggins, consults on marketing and advertising for counselors, and builds houses for immigrant and refugee families.


  • 01 Feb 2018 11:00 AM | ORCA Editor (Administrator)

    When I work with immigrants and refugees, I often think of my late aunt Pragna’s words: Human immigration is the basis of human evolution. It is how we evolve as a species. It is how life flows. I was in my early teens at the time and had scarce knowledge of global events, human psychology, or the capacity of our own species’ ability to persecute and consume its own soul. Twenty years later, those words feel heavy, laden with the pain, suffering, blood, and tears of millions who have escaped trauma and persecution. Some for being gay, some escaping the threat of honor killing for loving someone outside of their caste and religion, poverty, quality of life, political unrest, war and genocide. 

    My work with immigrant and refugee clients has come full circle back to myself. Little did I realize my own privilege of being born into an upper middle class Hindu family in the middle of Mumbai and how disconnected I really was from the challenges in rural India. Despite my own struggle of being a lesbian in India, I woke up to the rude shock of how privileged I was that my family unequivocally had accepted me. Sure, there was plenty of news about honor killings, and persecution of gays in India, but in my mind that happened elsewhere in those villages, far from me. I find it ironic that I have learned so much about my own identity and my own privilege here in Oregon. It would be fair to say I have learned more about India and myself here in Oregon than in India itself. What I have found is that there is a parallel process – while I grapple with the realities of being a woman of color here in Oregon, I also now walk with a new understanding of my own privilege back in India. Both of those realities can co-exist in an integrative fashion. It is true that all our stories – no matter how different – bind us together. Tightly and inexplicably, together. I feel honored to be the holder of the stories my clients have brought to me. I strongly believe that our role as counselors is to bear witness to the human story as a whole. 

    Almost every sixth adult in the United States is foreign born. Approximately 12 million immigrants are undocumented and approximately 60% have been in the United States for over 10 years (Baker & Rytina 2013). Working with this diverse population presents a unique set of legal, sociopolitical and clinical considerations (Sue & Sue 2016). 

    From a legal standpoint, laws governing immigration have been unfair. For example, until 1952 only White people were able to gain naturalized citizenship. This law changed in 1965 with credit going to the Civil Rights movement. Another policy called “Controlled Application Review and Resolution Program” (CARRP) makes it legal under certain circumstances (which the ACLU terms as over-broad criteria) to deny or delay citizenship and visas of people from Middle Eastern, Arab and Muslim countries. Some state laws specifically target immigrants, which essentially legalizes racial profiling. With regard to undocumented immigrants and the possible ending of Deferred Action for Childhood Arrivals (DACA), the implications for millions of immigrant families living in the United States are enormous. Adults who have been here since 2 or 3 years of age are facing the possibility of being deported to a home they have never known. The fear in this population is palpable. All of the above would need to be considered as part of the complex clinical landscape. 

    The role of a therapist while working with this population is somewhat adaptive and multifaceted in nature. The therapist may need to wear different hats. For one, it is important to stay abreast of current affairs and keep a keen eye on new laws that govern the legal status of. Partnering with legal professionals and coordinating client care can also be helpful. Taking the time to understand the current legal status of the individual will help immensely with building a therapeutic alliance so a clear understanding of the fear, anxiety and anticipation can be established. Counselors may find that providing psycho-education, advocacy and knowledge of community resources, such as agencies like Immigrant Refugee Community Organization (IRCO), resources for interpreters, and barriers to or ways of accessing institutional structures such healthcare, education and housing can be extremely helpful. 

    From a broader clinical standpoint, many immigrants and refugees find that seeking mental health treatment can be anxiety-provoking. What can be easily be misinterpreted by a therapist as noncompliant may be a lack of understanding of the process. Therefore, taking a lot of time to explain the process is key. When using interpreters, it’s important to keep in mind that most are not formally trained in mental health and translations in this context could be rife with bias or distress at hearing the information disclosed. On the other hand, interpreters are often a source of comfort and support for the client, especially with language barriers and feeling understood. Sometimes interpreters are the only constant person clients see since case managers and counselors change (if working in an agency). However, it is still recommended that interpreters are oriented to the nature of the work being done in order to adhere to best practices. 

    It’s important for therapists to consider that most immigrants come from countries that are collectivist in nature. This means that interdependency is valued over independence. Western capitalistic culture places an increased value on individualism, while collectivist cultures do not. This fundamental difference should be explored as it has far reaching implications for the quality of the therapeutic alliance between therapist and client. Extended family and community play a very important role in the health of many clients and involving family should be considered. In general, the practice of psychotherapy and counseling is primarily a Western philosophy and, therefore, inherently is influenced by Western thought. Having an operational understanding of that could prove beneficial for the counseling process. This area of practice can become rife with value-based conflicts, judgments, assumptions, and biases. Seeking regular supervision and consultation to clarify values-based questions that may come up for a therapist is highly recommended. In addition, many immigrants and refugees come from cultures with more defined gender roles and that is also a clinical consideration to be attended. 

    There are numerous special considerations for therapists working with refugees that have escaped persecution. The experience of trauma being the foremost. Refugees tend to experience more stress than immigrants due to the nature of their circumstances and the acute threat they experienced which led to them fleeing for their lives. Some may have witnessed their families being murdered or raped, or they themselves may have been beaten and had near death experiences. One of the clients I worked with was threatened to be killed by his own family for marrying outside his caste – a term called honor killing, a practice still active in the more rural parts of India. Another client was tortured and beaten up by corrupt law enforcement for being gay. His family and the police worked in tandem by threatening to kill both him and his partner. 

    They both escaped India together, but got separated in the jungles of Columbia and now months later, he has not yet seen his partner and does not know if he is alive or dead. Post-Traumatic Stress Disorder (PTSD) is common in this population.  However, not all suffer from PTSD and most can adapt well to their new home country given time and support. Complex grief and loss may be experienced due to abrupt separations and loss of their culture and homeland.

    Coping with the level of trauma and grief could prove debilitating for some. 

    Establishing an understanding of the narrative and pre-migration story (Sue & Sue 2016) of the refugee – assessing how their life was before they fled, the circumstances that led up to them fleeing, and where they find themselves now is extremely important. Exploring how they perceive their story is also key to the assessment process. Inquiring about their life in their own country and getting a sense of how they lived, what they did on a daily basis, people they were attached to could prove helpful. For example, one of my clients was extremely close with his mother. His mother had accepted him being gay but was unable to speak up for him against her husband. As such, my client has not spoken to his mother for over a year. 

    Attachment trauma of such nature should be a part of the assessment as that experience will need to be woven into the larger experience of traumatic grief and loss. The initial process of developing a narrative of a client’s journey from their own homeland to the United States can help them develop a comprehensive view of their own story and landscape they have navigated and will be navigating. Exploring the client’s own understanding from the context of their own culture will likely lend itself to providing culturally competent services.

    In our current contentious political environment, visceral fear of immigrants and refugees has at times reached fever pitches. Negative stereotyping has further marginalized an already marginalized population. While the counseling profession has made great strides to become culturally competent as a whole, there is still much work for all of us to do in this area through learning, challenging and overcoming our own assumptions and biases. This area of practice, especially in the Pacific Northwest, is still developmental in nature due to the demographics of the region. Therefore, it is increasingly important that we as a counseling community come together and share our knowledge, ideas and resources and support each other in this complex work.

    Kalindi Kapadia, LPC, CADC III blends western as well as contemplative, insight-oriented Buddhist teachings into her work. With over 14 years in the field of mental health and addictions, she’s been fortunate to work with a very diverse population. She maintains a private practice specializing in working with dual diagnosis, LGBTQI, ethnic minorities, immigrants and refugees and people with cultural adjustment issues.

  • 01 Feb 2018 10:59 AM | ORCA Editor (Administrator)

    Happy New Year!

    Thank you to everyone who attended our Fall Conference in November! It was such a wonderful experience interacting and learning with our counseling community. I would like to thank Brenda Hanson and the rest of the Conference Committee for their extraordinary efforts in making the conference such a success. I am also deeply appreciative of Summer Brown and Dr. David Kaplan, who each provided challenging and informative keynote addresses.

    I would like to take this opportunity to introduce you to ORCA’s new Secretary, Sofia Jasani. Sofia is a student in the Clinical Rehabilitation Counseling program at Portland State University. She has previously worked for the Multnomah County chapter of NAMI as Education Program Director. Welcome Sofia! We are delighted to have you serving ORCA and the counseling profession. 

    The theme of this edition of The Counselor is Effective Advocacy Approaches. In this issue, you will find stories and guidance regarding client and professional advocacy. Advocacy is an essential component of our work as counselors, which is why advocacy is mandated in the American Counseling Association (ACA) Code of Ethics. One tool that I have found to be invaluable is the ACA Advocacy Competencies, which remind us that advocacy necessarily takes place at the client, community, and legislative levels. 

    This special edition of The Counselor comes at a time of multiple important advocacy issues impacting mental health providers and consumers in our state. Recently, Oregonians participated in a special election on Measure 101, which would protect hundreds of millions of dollars in state funding, and potentially billions of dollars in federal funding, for the Oregon Health Plan. We need Measure 101 to pass in order to maintain stability of Medicaid and health insurance premiums in the state, not to mention the job security of counselors and other mental health providers. ORCA worked diligently to ensure the success of Measure 101, partnering with the Yes campaign and mobilizing members to recognize the gravity of the issue for our profession. [placeholder for sentence about whether or not 101 passed]. 

    Concurrently, Oregonians have been grappling with the closure of FamilyCare. While the issue is complex and political, the closure resulted in the loss of over 300 jobs and the disruption of services of thousands of consumers. COPACT, the joint political advocacy group for ORCA and the Oregon Association of Marriage and Family Therapists, ensured that Oregon Health Authority has a viable plan in place for the transition of care for impacted consumers. We also disseminated information about the impact of the closure and shared advocacy opportunities with ORCA members. 

    I am grateful to the many ORCA members who got involved with these important issues. It is our hope that the articles in this issue will provide additional ideas regarding how counselors can support the success of our clients and our profession.

    Sincerely, 

    Joel Lane, PhD, LPC NCC

    President, Oregon Counseling Association


  • 01 Nov 2017 10:28 PM | ORCA Editor (Administrator)

    Counseling the Person with Legal Blindness 

    by Deb Marinos, CRC, LPC Intern

    Imagine: your first consult with a new referral comes in, and they appear to be blind... but you can tell they’re not completely blind. You might feel uncomfortable asking questions or appearing to make assumptions about your new consult. I’m here to help.

    First, legal blindness is defined by the Social Security Administration as a state in which vision is “20/200 or worse in the best eye.” With correction (usually glasses) a person with legal blindness’s vision is fuzzy and labeled Low Vision. They cannot recognize faces or read standard print. You might see a previous diagnosis of Macular Degeneration or Diabetes.

    Some folks with slightly better vision can read and recognize faces; however they have great difficulty in moving around safely, finding objects and doorways. For these folks, you might find a previous diagnosis of Retinitis Pigmentosa or Glaucoma.

    I’ve spent several years helping clients with various degrees of sightedness, and as a person dealing with sensory disability myself, I’d like to offer my colleagues some specific tips to help the counseling room be more accessible and help folks feel more connected to you.

    Transportation is by far the biggest challenge and frustration, especially for those who used to drive. For this reason, rigid policies about lateness and missed appointments will be problematic to the relationship if not managed compassionately. If folks need at the last minute to cancel their appointment because the bus is running late, a phone session might be something to consider.

    First: ask them! Do not assume. Accept clients’ stories of their unique sensory disability and its impacts. Each person has a unique experience and may feel discounted if not feel heard. Appearances can be misleading.

    Ask what makes them most comfortable in greetings. Do they want you to identify yourself? Can they find your door through the door verbally, or by handshake, or signs? What helps?

    Ask, ask, ask! Can they see the clock? Is the lighting hurting their eyes? What are they hearing? (they might be hearing the stress in your voice!). Chuckle when you smile, and make sounds when you are listening or showing compassion. Consider other senses.

    Consider describing the features of your office space. Consider where you place breakable objects – the holidays’ sudden onset of new items, often breakable, can be a minefield. What would it feel like to just give specific directions: “At your three o’clock, a small table sits two feet away from you.”

    Consider: can the client get out to the door out on their own? Will the therapist help – no matter what?

    Make it easy to request accommodations ongoing. Make forms accessible by sending by email or recording audio. You might consider getting a “Pen Friend” by RNIB – it’s an easy recording tool that lets you record to a sticker that can be played back by person with no sight with headphones. Print forms in larger fonts by request.

    Make it ok to clarify as often as needed. Imagine keeping track of your life in your head if you couldn’t write notes. Offer to record sessions on their smart phone. Offer a wide marker and 3x5 cards for notes.

    Thanks for your interest and concern for all of your clients.

    Deb Marinos, MS, CRC, LPC intern has worked with many clients with varying degrees of vision loss for several years. Her practice: Adaptability for Life, LLC provides interactive training for professionals who want to understand how to make their workplace accessible. www.adaptabilityforlife.com

  • 01 Nov 2017 10:27 PM | ORCA Editor (Administrator)

    OACES Corner: Changing Campus Climate 

    by Joel Lane, LPC, Ph.D, ORCA President

    Photo by Gianna Russo-Mitma

    Given the focus on intersectionality in this special edition of The Counselor, I wanted to devote this OACES Corner to sharing some of my observations working in higher education over the past few years. I work as an Assistant Professor of Counselor Education at Portland State University, and in my four-plus years at PSU, I have witnessed some monumental shifts regarding campus climate and the overall university experience for students. There is a good chance you have heard about some of these shifts as well. There have been a multitude of think pieces in recent years about safe spaces, trigger warnings, and related concepts, with much of the coverage being negative (concerns generally involve free speech, coddling, etc.). I would like to take this opportunity to offer my perspective on why these changes are positive, important, and long overdue.

    While there is considerable debate about campus climate trends, there is greater consensus about inequities in higher education on the basis of gender identity, race, sexual orientation, ability, and mental health status. There is a wealth of data demonstrating that some groups have historically enjoyed greater access to higher education, as well as higher retention rates once enrolled. It is my firm belief – and also the consensus among education researchers – that these inequities are self-perpetuating. That is, given that dominant cultures have been overrepresented among college attendees, we should expect this same overrepresentation to exist among those providing education to college students (which is unequivocally the case; for a clear example look no further than the demographics among counselors as a whole versus the demographics of counselor educators). This overrepresentation among educators means that we can also expect an overrepresentation of dominant culture perspectives in higher education curricula, which in turn makes it more likely for students with dominant cultural identities to thrive in higher education, perpetuating a cycle that makes it disproportionately difficult for individuals with minoritized identities to enjoy hte upward mobility that comes from a college education.

    This brings us back to the topic of recent changes in the campus climate, which are being enacted in direct response to these inequalities. Providing safe spaces on campuses, for example, provides individuals with minoritized identities an opportunity to connect with their communities in an environment that is disproportionately comprised of non-minoritized individuals. It also makes it easier for these communities to organize and voice their experiences to the broader campus community. Similarly, despite the overwhelmingly negative public narrative around the issue of offering trigger warnings in class, doing so provides students with trauma histories or mental illnesses greater opportunity to learn and thrive in higher education.

    These types of provisions are important even in a community like Portland (in fact, perhaps even more so), which prides itself on its openness and acceptance of alternative lifestyles. Many Portlanders would be shocked to know the number of times students have confided in me about being harassed on campus due to their transgender identity, ability status, race, and/or sexual orientation. Sadly, this harassment comes not only from other students, but sometimes from other campus faculty and personnel.

    I see this issue as having implications for our counseling practice. Being a counselor has taught me time and again that all clients have different needs and perspectives, and part of what I love about our work is the creativity required of us to be responsive to diverse client perspectives. As an able-bodied, cisgender, heterosexual white man, it is especially important for me to be open to feedback and perspectives from individuals with non-dominant multicultural identities, as without such feedback I am likely limiting my effectiveness as a counselor and as a counselor educator to clients and students who share my identities. I implore all counselors and counselor educators (myself included), regardless of identity status, to strive to better understand how our identities and experiences have shaped our values and worldviews, and to continually learn about the values and worldviews of those who hold identities different from our own.

    Joel Lane, Ph.D is an Assistant Professor and Coordinator of Clinical Mental Health Counseling at Portland State University. He provides supervision to registered interns and conducts research related to the mental health implications of emerging adulthood. He lives in Portland with his wife, Megan, son, Ari, and dog, Magglio. 

  • 01 Nov 2017 10:22 PM | ORCA Editor (Administrator)

    Between Worlds and Identities

    by Neil Panchmatia

    Immigration has been very much in the news recently. The United Nations High Commissioner for Refugees estimates that there are currently about 67.8 million forcibly displaced people around the world in need of immediate protection and assistance (UNHCR, 2017). Throughout the world, an unprecedented number of people continue to leave their home countries, either by choice (or degrees of choice) or by becoming forcibly displaced. Individuals and families are uprooted by social, political, and economic trauma – and too often, they are not well served by the current US system of mental health care.

    Since the early 1990s Oregon has become home to an influx of migration due to economic and political turmoil. Most Oregon refugees initially resettle in the greater Portland metro area; Portland currently ranks eleventh in US cities that resettle international refugees. According to the Oregon DHS, refugees come here from all over the world, prominently from the former USSR (Russia, Ukraine, and Bosnia), South Asia (Bhutan), Southeast Asia (Vietnam, Cambodia, and Burma), the Horn of Africa (Ethiopia and Somalia), the Middle East (Iraq, Iran, and Syria), and Latin America (Cuba).

    Research on displaced individuals has shown that a group’s proximity (in terms of outward appearance, language and culture) to the dominant culture of its host country largely determines its ease of acceptance and integration (Colic-Peisker 2005). Refugees who appear as “other” to the dominant racial/cultural group in a historically homogenous state such as Oregon often suffer a more negative experience around their resettlement. Displaced peoples from East Africa or the Middle East, for instance, live on the peripheries of society and are often segregated (physically as well as culturally). On the other hand, refugee groups such as Russians and Ukrainians that settle in Oregon can experience proximity in terms of skin color to the

    dominant culture, and have therefore enjoyed a relatively easier integration.

    The effects of displacement are well-understood: the trauma resulting from the loss of one’s home, loved ones, and community follows individuals and families all the way to one’s new life in a host country (Marlowe 2010). Such trauma often exacerbates the problematic expectations that you’ll adjust to life in the US as quickly as possible. Most support services here are discontinued within nine months. Refugees are expected to become self-sufficient almost immediately upon arrival by a capitalist system that mythologizes bootstrap-pulling at the expense of general well being (Tyson 2017). Other vital needs such as mental health care are ignored. A preponderance of refugees experience PTSD and similar effects of trauma which go undiagnosed and untreated due to the myriad barriers to accessible care. In Portland, a handful of immigrant and refugee support organizations (e.g., Lutheran Community Services) have stepped up to provide counseling services – yet barriers remain.

    In working with forcibly displaced individuals, counselors may be tempted to prioritize one aspect of identity over more immediate concerns. While the experience of displacement is central, and the resulting trauma there is an important locus of concern in treatment planning, this limiting focus misses the mark in understanding the individual holistically. It is necessary to explore and include other salient components of these clients’ “hyphenated hybridities” toward creating a successful therapeutic alliance (Asghari-Fard & Hossain 2017).

    Research shows that immigrants and refugees maneuvering arrival and adjustment in host cultures do so primarily by constructing and negotiating their identity (Asghari-Fard & Hossain 2017).

    The result is a new, hybrid identity that consists of values, labels and roles that are emphasized differently in different settings. A Somali American would likely identify more as “Muslim” over “Somali” in a mosque setting, more as “Somali” within a community cultural organization, and more as “American” while engaging in civic activities such as voting or running for office. All three intersections of American, Muslim, and Somali are otherwise equally important intersections of identity: they are simply prioritized and performed as the situation demands. Adjustment to life in the US is an ongoing process, one without a finite end, and each individual experiences life between the currents of culture uniquely: constructing and negotiating her/ his/their identity independently and collectively with the larger community.

    In Portland’s Somali community, for instance, identity intersections begin at the individual level and expand out to the societal level. For example, some intersections a Somali-American can have include: being female, black, African, immigrant, Muslim, queer, and differently abled. Identity is uniquely formed and negotiated by each individual. Identity, furthermore, informs the social roles an individual adopts. These social roles are an indication of which aspects of their identity are important to them and to what degree: a Somali woman, for instance, takes on the role of establishing an informal peer-counseling group within the local community in order to support women experiencing domestic violence (which trauma research shows is exacerbated as a result of the displacement experience). She hosts this group within the mosque, which has taken on the role of confronting domestic violence within the broader Muslim community, and so provides her necessary resources. She then may decide to go to graduate school and study counseling, so that she can continue to give back to her community by providing mental health services. She understands that Somali women prefer to work with other women when seeking mental health care. She also understands that needing and

    seeking care carries a deeply embedded stigma within her community, and that individuals are hesitant to seek help. She understands that different sub- groups within her community have very different needs: the elders, youth, men, women, queer individuals, people with disabilities and people from different waves of immigration to Portland. She also understands that while she knows her culture and the experiences of her people best, her audience may be reluctant to see her for services because she is “too close to home” in a collectivistic community where reputations and social perceptions matter. Consequently, she decides to partner up with Lutheran Community Services as a “cultural broker” within the Somali community to start up a culturally responsive counseling program.

    Take the pressure off the client to educate the counselor.

    Mental health professionals should attempt to explore and understand the intersections of identity (or the hyphenated hybridities) of their clients while engaging in cultural humility. A respectful curiosity should be projected within counseling sessions, which creates a safe and brave space for exploration and expression of different intersections of identity. This space should also be designed to take the pressure off of the client to “educate” the counselor. Counselors should enter a session having done their homework and having some basic background information on the cultural and historical background of their clients (a quick Google search, for instance, can reveal so much about Somalia).

    Displaying basic contextual knowledge about a client’s background in session (not cultural assumptions or stereotypes) can be an encouraging experience for clients and can facilitate a deeper exploration of identities.

    The goal, within therapy, is to fully empower clients who have experienced the trauma of displacement and are maneuvering the additional stressors of culture shock, marginalization and other barriers to successful adjustment to life in the US. By creating and maintaining a therapeutic alliance and space that intentionally accommodates and celebrates all intersections of identity, mental health professionals will be able to cross cultural divides and provide the critical care and support needed. In today’s socio-political climate that “others” refugees and migrants and further pushes them to the fringes of society, this deliberate therapeutic intervention of culturally responsive care is nothing short of an act of much-needed social justice activism by helping professionals.

    References

    Asghari-Fard, M., & Hossain, S. Z. (2017). Identity construction of second- generation Iranians in Australia: influences and
    perspectives.
    Social Identities, 23(2), 126–145.

    Hardwick SW, & Meacham JE. “Placing” the refugee diaspora in Portland, Oregon: Suburban expansion and densification in a re-emerging gateway. In: Singer A, Hardwick S, Brettell C, editors. Twenty-first century gateways: Immigrant incorporation in suburban America. Washington, DC: Brookings Institution Press; 2008. pp. 225–256.

    Colic-Peisker, V. (2005). “At Least You”re the Right Colour’: Identity and Social Inclusion of Bosnian Refugees in Australia. Journal of Ethnic and Migration Studies, 31(4), 615–638.

    Marlowe, J. M. (2010). Beyond the Discourse of Trauma: Shifting the Focus on Sudanese Refugees. Journal of Refugee Studies, 23(2), 183-198.

    Tyson, C. (2017). Towards a new framework for integration in the US, (February), 48-49.


    Neil Panchmatia is a graduate student in counseling at PSU. He is from Kenya and wants to work with immigrant and refugee populations, and is also keen on continuing to work with other marginalized groups in Oregon, including racial/ ethnic and gender/sexual minorities as well as individuals with disabilities.

  • 01 Nov 2017 10:20 PM | ORCA Editor (Administrator)

    It’s Intimidating and Important... So Let’s Talk About It 

    by Gianna Russo-Mitma, MS, LMFT, ORCA President-Elect

    Diversity and inclusivity have been in continual conversation within the Oregon Counseling Association, even more so since the change in our country within the last year. With our current President Joel Lane’s vision for our organization, ORCA’s critical goals have focused more on honoring diversity, connecting with more counselors of various backgrounds, and standing up for equity and equality (in small and large ways).

    To get this started within ORCA, the organization’s newsletter, The Counselor (what you are reading right now), asked for articles on diversity, inclusivity, intersectionality, and advocacy. Articles poured in on so many amazing topics from people of all backgrounds – we were thrilled to hear from ORCA members who may have been less vocal in the past! We are so proud of you all for stepping outside of your comfort zone and taking the leap to write for us on such a major topic!

    In my honest opinion, it's daunting to write about diversity as a white, cisgender female (as it should be, as I have admittedly faced much less oppression than other folks). While even trying to write this article, I've been nervously thinking, "What if people think I don't grasp what is happening?" Or wondering if people will say, "This white girl has no clue.” It’s scary to engage in discussions, because truly, I don't fully understand what it's like to be a person of color, or a member of the LGBTQIA community, or part of many marginalized groups; I can only empathize, listen, learn, and be the ally that I am. It is intimidating to engage in discussions like this, but in order to get anything accomplished for this important matter, we have to be uncomfortable, accept that we will make mistakes (then learn from them), pay attention to others’ experiences, and validate.

    I’m thinking: What if people think I don’t grasp what is happening? Or wondering if people will say, This white girl has no clue.

    Intersectionality is defined as the “complex way in which multiple forms of discrimination overlap in the experiences of marginalized folks” (Merriam-Webster). We talk about privilege with topics such as race, gender, citizenship status, and sexuality in mind. We easily forget that other privileges exist (i.e. ability, economic status, education, religion, genetics). With fall’s edition of The Counselor centered on intersectionality, I would like to talk about this topic from my personal experiences. I will preface my article with this: I cannot even fathom what it feels like to be in deeper marginalized groups.

    I am a plus size female with asthma. When you read this, you may construct a quick judgment about me or the groups I belong to, you may have your own thoughts on it all, and you may even disagree that these attributes belong to “less privileged” groups. From my unique and individual experience (as these conversations are), I have faced challenges with these qualities, but probably nowhere near the challenges that others have faced for identities such as race, citizenship status, etc.

    My first memory of being “different” because I had asthma was in elementary school during a (rare) snow day in Las Vegas. All the kids were allowed to go outside at recess and play it in, except the kids with asthma or other health conditions, who were required to stay in the multipurpose room. This marked the first time that I realized I was different from other kids, because until that point, I wasn’t. When P.E. became a required class, I was the kid that had to have a note from their parent that said I couldn't do certain things, and when the teachers forgot your letter from the first day of school, you'd have to mention it to them weekly.

    Each time we had to run the mile, I was allowed to walk it, but then this created the "us and them" scenario, where I was one of the slow/fat/asthmatic/unhealthy/[enter any negative adjective here] kids. It always felt odd and uncomfortable.

    My most recent experience of being told I could not do something due to this health issue was on vacation this summer. After planning for weeks, we decided to sign up for an underwater Caribbean Sea Trek. When we arrived, lo and behold, if you have anything on their medical list (asthma included) you are NOT allowed to do this activity. It is an awful feeling to be reduced to a label, told you’re not allowed. It is an oddly emotional experience. Aside from emotional stuff like this, having asthma (or any chronic health condition) is a huge nuisance. I have to use a Nebulizer (a really invasive machine with tubes and a mouthpiece), and I am always on the go with my inhalers (home, purse, car, etc).

    Considering these turbulent political and societal times (and beyond these times): pause, take a step back, and listen to others' stories. Don't make assumptions. Keep an open mind. Ask questions. Mistakes are how we learn. I would much rather someone ask me questions than assume things about me. And if I, or others, don't feel like answering questions, we won't. Be open to constructive criticism and being educated on topics. Be aware that no one knows everything, including you. I learn things every single day from others, and it's beautiful.

    In conjunction with ORCA's movement to honor diversity and create more discussions like this, our conference theme is “The Constant of Change: Ethical Counseling Embracing Diversity” which starts THIS WEEK on November 2-4 in Tigard. Register here.

    We can, and we will, make society a better place – it just has to start with a conversation together.

    Gianna Russo-Mitma, M.S., LMFT, is ORCA’s President Elect. She has a practice in Portland working with teen girls and self esteem, and co- parents after separation and divorce. Gianna also works with foster care youth, doing mental health assessments at DHS. She is also the lead counselor for Clear Transitions PDX and teaches at University of Portland and at Portland State University as an Adjunct Professor. 

  • 01 Nov 2017 10:17 PM | ORCA Editor (Administrator)

    Weight-Inclusive Care by Hilary Kinavey, LPC

    Body shame and dissatisfaction are a common concern in psychotherapy offices. Therapists are in a unique position to name and dispel myths regarding weight and body size with their clients. Unfortunately, many therapists do not feel adequately trained nor do they fully understand the impact of sizism on the lives of their clients.

    Those of us who have worked in the disordered eating and body dissatisfaction corner of the mental health world know something that we wish everyone knew: there is no weight loss prescription, weight change suggestion or diet that is psychologically benign. Clinically and culturally, we fail to name and acknowledge the impact of weight stigma on us all. People large and small are often hustling for weight and body change and have their worthiness bound up in the pursuit. All too often, weight change is mistakenly seen as a possible and helpful intervention for clients who live in larger bodies or who feel dissatisfied with the bodies they are in.

    It is very true that diets do not work. This is true for fad- diets, plans sold as “lifestyle changes”, and medically prescribed plans. In fact, 95% of diets fail, though often not initially. Typically, dieters regain weight at 2-5 years post diet. This is such a predictable occurrence that we must ask why it is we more commonly blame the individual than the diets or plans themselves? To avoid further harm, it is necessary to consider what could be possible in the lives and wellbeing of our clients if we located weight concern outside of the individual and named it as a cultural concern or mandate? When we critically evaluate the data, what we find is that the evidence that weight is even a risk factor is, at best, incomplete and contradictory. Here are the links to a few research articles critically evaluating weight science and offering data to support a weight-inclusive model of care:

    Weight Science: Evaluating the Evidence for a Paradigm

    The amount of weight bias in the literature (and therefore the medical community) is astounding. Health and mental health care providers must become critical reviewers of the research to provide safe and ethical services. Many studies finding a correlation between weight and health have not controlled for things like SES, weight cycling, fitness, stigma, oppression, trauma, and more. Correlation is different than causation.

    Conversations about inclusion and social justice do not commonly include sizism and fatphobia. It is commonplace to believe that a little shame and public humiliation can provide catalyst for change – something we all know to be false about the change process. The truth? Fat people have always existed and will continue to. This is not an abomination or culture gone wrong. But it is an intersection. Fat people are less likely to be believed, trusted, treated (medically) and hired. Add intersections of race, ability, gender expression, and the injustice multiplies.

    Consider who told you that people can and should lose weight.

    Consider who taught you that people can and should lose weight. Check out the $60 billion+ industry that thrives on this and then research alternative approaches such at Health at Every Size® and Body Trust®. Look deeply into this. You will unearth more freedom for yourself perhaps. But do this for equity, truth and justice. Do this for your clients who expect you to collude with the problem of their body. Do this in the name of wellbeing and liberation.

    Hilary Kinavey, LPC is the cofounder of Be Nourished, a revolutionary business that helps people heal body dissatisfaction and reclaim body trust. The Be Nourished Training Institute offers training for helping professionals who want to move towards weight-safe and inclusive care. You may also find them on Facebook.

  • 01 Nov 2017 10:15 PM | ORCA Editor (Administrator)

    Making It Visible
    by Raina Hassan, LPC, ORCA Past President

    When I heard the upcoming issue of the ORCA newsletter was going to focus on intersectionality, I was both excited and frightened. I was excited because I knew I wanted to write about this topic; I was frightened because I’d never done so before and to embark on such a task—publicly—meant I would likely feel vulnerable in this new experience. But, as a therapist, I often encourage my clients to lean toward new experiences with courage and wholeheartedness, and since I try whenever possible to embody these attributes, I decided to volunteer to write about growing up a biracial woman. For clarity, let me explain that my mother is a white American and my father is a Lebanese-born Palestinian who emigrated to this country as a young man in the 1970s and later became a naturalized US citizen.

    Prior to writing this article, most of what I’d come to understand about my experiences in the world relating to race and gender I’d seen as separate issues. I’ve thought quite a lot about how I’ve been challenged in the world as a woman, and I’ve thought quite a lot about my challenges as a mixed-race person. But, when I see the two together (which is the brilliant value of intersectionality), it shifts the frame of my experiences in a way that highlights the lived experience of these factors in concert. By the way, if you would like more clarity on what the term intersectionality means, Kimberlé Crenshaw, who created the term, offers an inspiring TED Talk (click here to view; trigger warning).

    I’ll illustrate how I experience intersectionality by telling you about some of my experiences.

    When I was in junior high, the first Gulf War was happening. We had televisions in the classrooms, and the name Saddam Hussein was frequently mentioned. Because I have had the immense privilege of being born with white skin, most people would only become aware I was mixed race when they would either inquire about my last name or when they would meet my father (or sometimes at the end of summer, after I’d gotten a lot of sun exposure). Prior to the first Gulf War, my name was difficult for most everyone in my small town to pronounce correctly, but suddenly, it became a target in a new way. A few of my classmates began to chide me with questions like, “Hey, is Saddam Hussein your uncle?” At other times, a specific racial epithet for Middle Eastern folks was uttered to me—in the guise of a joke, of course.

    Sometimes, the racism was not at all disguised with humor. Like the time my family was picketing in front of a movie theater to protest the stereotyped depictions of Arabs in a movie that was showing, and a man in a truck drove by and yelled, “Go back to Saudi Arabia!” (My family is not from Saudi Arabia, by the way, but that’s beside the point.) Or the many prank calls we received over the years, ranging from “jokes” to outright threats. And I won’t even go into the hours upon hours my family and I have wasted being detained in airports.

    So, how did I respond to these experiences? From the jokes to the threats and everything in between, I reacted in pretty much the same way: I got small. I went silent. In therapist speak, I went into a freeze response. Sometimes, as a kid, I would laugh in an attempt to alleviate the discomfort. But as I got older, I learned to go silent and wait it out. What I didn’t do was fight back. What I didn’t do was stand up for myself and call the behavior out—not even the perennial microaggression many biracial people hear: “What are you?”

    Over time and with a lot of effort, I have been able to break out of the freeze response at times. But always, I can feel the familiar urge to get small and silent. Perhaps I can attribute my freeze response, at least in part, to nature or temperament.

    But when seen through the lens of intersectionality, it becomes pretty clear to me that if I had been male, I would have been much more likely to speak up or fight back, as we know that by and large the fight response is often covertly and overtly encouraged in boys and men. As women, we often learn to keep ourselves safe by being quiet, invisible, non-threatening.

    If I had fought back, the fallout from these experiences would likely have been much different than it has been for me. Perhaps I would have gotten into physical altercations at school and on the street. This, no doubt, would have negatively impacted my grades and academic standing. Maybe I would have attempted revenge on those I suspected of the prank calls. This may have gotten me in trouble with the law. Certainly, talking back to the TSA would have carried some hefty circumstances. If I had been a biracial man in these circumstances, perhaps the fallout would have been more visible, more external, mirroring my more externalized reactions to the racism. And when seen through the lens of intersectionality, I can see how my entire

    life may have played out quite differently. But as a biracial woman, I have glided through the educational system—and many social systems—with ease. But the burden had to get absorbed somewhere, and there has been a fallout. But it has been invisible, internal, somatic.

    It occurs to me that by writing about this intersecting experience of race and gender, I have made it visible. And it also occurs to me that writing is a form of fight and protest that I believe is healing. I was telling a friend about my process of writing this article and that it ended up being well over twice the target word count. “You must have had a lot to say,” she noted. Indeed.

    Often, I will encourage my clients to write when they are angry or sad, or both. I am grateful to have had the opportunity to practice that suggestion here, in my own life, with all of you. Thank you for participating in it with me.

    Raina Hassan, LPC, is the past president of the Oregon Counseling Association. She works in private practice in Portland.

  • 01 Nov 2017 10:13 PM | ORCA Editor (Administrator)

    President’s Message

    ORCA leadership has been hard at work preparing for our annual conference, which is quickly approaching! This year’s conference theme is The Constant of Change: Ethical Counseling Embracing Diversity. We are delighted to welcome Summer Brown, LMFT, and Dr. David Kaplan as this year’s keynote speakers. Ms. Brown is a leader in providing LGBTQI+ mental health treatment, while Dr. Kaplan is the American Counseling Association’s Chief Professional Officer and an expert on ACA’s code of ethics for counseling professionals. We’re very excited to have the opportunity to share their wealth of knowledge with you.

    As this is my first newsletter address as ORCA President, I want to take the opportunity to thank you all for electing me to lead this major rebranding effort that led to ORCA receiving the 2017 Best Innovative Practice Award from the ACA Western Region. I am thankful for Raina’s leadership and the mentorship she has provided to me in assuming the role of ORCA President.

    In addition to the Innovative Practice award, this summer we received ACA's 5 Star Branch Award. Gianna Russo-Mitma accepted the award for ORCA while attending the ACA Institute for Leadership Training in Washington D.C. While in D.C., Gianna spent a day on Capitol Hill meeting with congressional leaders, advocating for issues important to the counseling profession, including legislation that would authorize counselors to be reimbursed through Medicare.

    Recently, we hosted a networking picnic for ORCA members and their families. It was wonderful having the opportunity to meet some of you there and to introduce you to my wife Megan and newborn son Ari. I would like to thank our Networking Committee Chair, Sue Ujvary, and the rest of the Networking Committee for all of their work
    in planning such a fun event. Thank you Networking Committee for all that you 
    in planning such a fun event. Thank you Networking Committee for all that you do to help connect our counseling community!

    This edition of The Counselor focuses on issues related to intersectionality in the counseling profession. This topic is deeply important to our work, as cultivating awareness of our own identities and values is an ongoing process all counselors can and should engage in to be more responsive to the identities and values of the clients we serve. I am passionate about addressing treatment disparities in mental health services. One of my primary goals as President is for ORCA to provide leadership and, ultimately, positive change for this issue. It is my hope that the articles in this issue of The Counselor will help us all think more about the dynamic relationships we have with power and privilege, and the work we can do both internally and externally to better respond to the needs of our clients, ourselves, and our community.

    Sincerely,
    Joel Lane, Ph.D, LPC, NCC

    President, Oregon Counseling Association 

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