VTMHCA News

Spring 2007

 

Living Multicultural Counseling

By Jon Bolaski, EdD, LCMHC, January 2007

I direct a counseling center at a large medical school in the West Indies. The Commonwealth of Dominica is located among the Leeward Islands of the Lesser Antilles. It is 26 miles long and 16 miles wide with a population of about 72,000 people. Dominica has enjoyed 28 years as an independent island nation that has been greatly influenced by British, French, West African, and Carib cultures. For example, while English is the official language, French Creole is widely spoken and while the majority of citizens are of African descent, Dominica maintains the only Carib Indian territory in the world.

The highlight of this largely unspoiled pristine country, referred to as the nature island, is its friendly and charming people. It is no wonder that Dominica was selected as the site for Ross University School of Medicine (RUSM), established in 1978, the year of Dominica’s independence. RUSM exists within a relatively peaceful and quiet environment virtually free of human-made distractions making it highly conducive to the pursuit of a medical education.

RUSM principally attracts students from the U.S. including New England states. The majority of these individuals are graduates of U.S. colleges and universities. For a variety of reasons they have chosen to attend one of the 26 off-shore medical schools scattered throughout the Caribbean that funnel students into clerkships and residency programs at the same hospitals as their US counterparts. These bright students, many of whom are motivated by a family tradition of medical practice, are worthy of the opportunity to become physicians in spite of poor standardized test-taking abilities and diverse learning styles. The student body is a vibrant, ambitious, multicultural and international group of young people who have converged in the Caribbean in hopes of creating opportunity.

The international, multicultural aspects of life on the RUSM campus cannot be overstated. On any given day I might meet with students whose roots are in Bolivia, Colombia, or Brazil, or perhaps India, Pakistan, or Afghanistan; maybe Iran, Iraq, or Syria or perhaps Jamaica, Cuba, or Guyana, or of course Ghana, Sierra Leone or Liberia. I might also see students from the Philippines, Sri Lanka, England, Canada and the U.S. This has encouraged me to dramatically broaden my fund of culture-based knowledge, and to strengthen my understanding of culture-driven needs. After all, one could argue that culture determines many aspects of learning.

As a result of culture, every human being learns a language and a meaning system that addresses the forces of nature operating in the world, norms of behavior, and patterns of experiencing the environment. In that interpersonal space shared by client and clinician where two subjectivities intersect, in which linguistic nuance and nonverbal subtlety reign, I continue to experience, to learn, and to thrive. Here the co-construction of the counseling relationship is manifested in the personal exchange embedded within a socio-cultural matrix. It is here that the commitment to the process strengthens the relationship and what I believe to be the likelihood of success.

Presently I work within a team of five clinicians of varying disciplines. Together we weave a tapestry of understanding, a matrix of appreciation for our student clients which we apply in support of their pursuit of a medical degree. Here in the West Indies, almost 3,000 miles from the home where I found comfort, satisfaction and an illusory sense of security, I continue to work with individuals in their development toward a cohesive sense of self as they negotiate the challenging topography of medical school in the Caribbean. As might be imagined, the array of issues presented by students is rich. The complex concerns of students in this multicultural environment are evident, especially when they are experiencing psychological distress, trauma or major choices while studying abroad. A brief sampling of such might include dealing with arranged marriages, the mixing of cultures in an intimate relationship, carrying on the family tradition of practicing medicine, dealing with the choices and burdens of pregnancy, or perhaps accompanying the remains of a deceased friend as a form of atonement…...all this while taking the time to review and reflect on the meaning of each encounter.

While there exist similarities in the manner people experience the challenges associated with transition, strategies for adaptation must be formulated in an atmosphere of openness and understanding that incorporate diversity of personal beliefs and worldviews. The one-size-fits-all model must be challenged. It is critical to develop an understanding of and appreciation for culture-driven perceptions, social functioning, decision-making processes, and conceptualizations of self and environment and to actively apply such to the clinical work. It is imperative for the clinician to meet the client within that client’s cultural context while both struggle with strange situations. The unifying theme within this highly complex clinical context is the intricate role of culture in the expression of distress and strategies of treatment and ultimately adaptation.

To say the least the past four years have been quite important in my personal and professional development. There have been sacrifices (as my family chose to remain in the States); yet there has also been the opportunity for reflective growth; challenging of beliefs, working with distinct and different populations, as well dealing with minimal resources outside of the university community.

While I was drafting this letter to the VTMHCA Newsletter I received an unexpected communication from a former student, now on his way to completing his medical training. I wanted to share it as a reflection of the complexities of personal and social identity.

"I am currently finishing up my last year and will be starting a residency in internal medicine in New England; it’s quite a distance from my family in South America.

I am writing because I never had the chance to say goodbye when I left the island almost 3 years ago. I wanted to thank you for helping me and listening to me throughout my time on the island. I must tell you that I have never felt so broken and unstable like I did during my time there. Last year my dad fell into severe depression, and my mother and I had to take some time off to take care of him because he wouldn't eat or get out of bed. During that time you came to my mind, because even though you may not have known it, those sessions kept me going from week to week. They gave me a reason to get out of bed and keep going because I felt like if only for an hour, somebody was listening to me.

I won't tell you that my anxiety is gone. I know that it is triggered by relationships, and the thought of being rejected. But whenever I feel too anxious I take a deep breath (like you taught me) and remind myself that everything is ok and I will be fine and all this will pass. I wanted to thank you for helping me realize that it's ok to be weak sometimes (even in my machismo culture). You can cry in front of someone and not be embarrassed of showing fear. I never allowed myself to do that before."

Good therapy, wherever it is conducted, requires time to observe, instruct, coach, and to assess as well as to reflect with the view of making meaning in life. Paul Pederson, in an interview commenting upon the changes that have occurred and are occurring in the counseling profession addressed the problems of cultural responsiveness in this way:

"Our clients and students will eventually lead us toward multiculturalism. We don't have the right questions yet, so we will not find the right answers. We need to show how counselors can find common ground without sacrificing their own, or their client's cultural integrity" (Cartwright, 2005, p.220)

Cartwright, B. Y. & D’Andrea, M. (Spring 2005). A personal journey toward culture-centered counseling: An interview with Paul Pedersen. Journal of Counseling & Development, 83, p. 220.