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...American women counselor--client racial similarity.
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Changing population trends and demographic shifts have had a significant impact on counseling services. Racial and ethnic minority groups make up 33% of the U.S. population according to national estimates released by the U.S. Census Bureau (2006b). This fact is compounded by baby boomers, born between 1946 and 1964, who are rapidly aging and form one of the fastest growing populations in the United States (U.S. Census Bureau, 2006b; Woodard & Komives, 2003). As of May 2006, people age 65 years and older account for 12% of the total population. By 2030, an estimated 26% of older Americans will be a member of a visible racial/ethnic group (VREG; U.S. Census Bureau, 2006a). As these population shifts occur, there have been increased efforts to offer services that are more consistent with and sensitive to various dimensions of ethnic minority worldviews (Lee, 1997; Pack-Brown, Whittington-Clark, & Parker, 1998).
LITERATURE REVIEW
The counseling profession is staving to meet the counseling and mental health needs of VREGs. However, many counselors believe that traditional individual and/or group therapy is equally effective with all clients regardless of cultural/ racial differences (Pack-Brown et al., 1998). Counseling, often conceptualized by male, middle-class European Americans, corresponds with Western individualistic terms, values, and beliefs.
In contrast, ethnic minority values tend to be more involved in communal relationships and hold to the belief that they are in harmony with nature. Furthermore, minorities sometimes value age and older people differently than do Caucasians (Brink, 1994). Consequently, the strategies and approaches most often used to invoke change (nonequalitarian, intrapsychic model, one-to-one, office-bound, etc.) may be incompatible with the values of minority clients (Atkinson, Morten, & Sue, 1993; Helms, 1995; Lee, 1997). These cultural differences may result in an underutilization of counseling services by minorities. Furthermore, studies show that 50% of VREG clients who attended counseling drop out after the initial contact as compared with a 30% dropout rate for White clients (Aponte, Rivers, & Wohl, 1995). Studies also show that, compared with other VREGs, Blacks have a significantly higher proportion of treatment dropouts, tend to stay in treatment for less time, and do not have treatment outcomes that are as successful (Aponte et al., 1995). The effects of racism have caused many Blacks to be distrustful of counseling services (Harris, 1998). (In this article, the terms African American and Blacks are interchangeable.)
Upwardly Mobile African Americans
More has been written about African American clients than clients from any other VREG (Helms & Cook, 1999). African Americans' values may stem from their African heritage, which values groupness, community, cooperation and interdependence, respect for elders, and being one with nature. In the Afrocentric worldview, the focus is often on emotional vitality, interdependence, collective survival, the oral tradition, perceptions of time, harmonious blending, and the role of older people (White & Parham, 1990). As a group, African Americans often tend to be more group centered, more sensitive to interpersonal matters, and to value cooperation more than middle-class European Americans (Sue & Sue, 1999).
Approximately 10% of Blacks are members of the upper class, 40% are middle class, and 50% belong to the lower class (Sue & Sue, 1999). Because Blacks are overrepresented in the lower class, the Black middle class continues to be distinct within the Black community because of its economic and social position (Kronus, 1971). Feagin and Sikes (1994) generally described middleclass African Americans as the group within Black America that has had the most recent experience with Whites across the broadest array of social situations. These individuals include white-collar workers and most skilled blue-collar workers; Blacks with higher levels of education; and those who frequent historically White institutions, workplaces, and neighborhoods.
One of the economic advantages of the Black middle class is access to health care (Davis, as cited in Johnson, 1988). A 2003 report by the Office of Minority Health (n.d.) indicated that 53.9% of African Americans used employer-sponsored health insurance. However, recent literature indicates that they may still receive substandard care from medical practitioners (Halbert, Armstrong, Gandy, & Shaker, 2006). Unlike low-income African Americans, many middleclass Blacks more often have medical insurance that covers counseling services. Middle-class Blacks will live longer and require an increasing need for health care, including counseling services.
As customers of health care providers, middle-class Blacks have the privilege of comparing various types of health insurance coverage and costs to find the...
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