In addition to the elements examined so far, issues that arise when a counsellor and client have a shared cultural background need to be considered. There seems to be a tendency in the field to believe that referral to within-group counsellors is what is needed to address the issue of cross-cultural differences between counsellors and clients. However, the question of referral is a complex one. Counsellors need to be sensitive to situations that may indicate the need to refer clients to professionals who are members of their own ethno-cultural group. Sometimes these situations are quite clear, such as when clients clearly indicate the desire to work with someone from the same ethno-cultural background or when language is a barrier. In other cases the need for referral is not as obvious.

The use of interpreters should only be a last resort. Interpreters need to be from the same culture as the client and need to have good understanding/ skills in counselling as well as in the role of cultural interpreters in the process. It is beneficial to have an initial session in which the client is asked to indicate whether or not interpretation is something that should be considered.

According to Draguns (1997), there is no clear-cut preference for within-group counsellors over outsiders. The relationship between the insider versus outsider status of the counsellor is complex and mediated by a number of factors, such as the client’s expectations, distress level and socio-economic status. Moreover, the practical aspects of service delivery make matching culture and ethnicity an unattainable goal.

It has been my experience that the majority of culturally different clients that seek the services of the Problem Gambling Service of the Centre for Addiction and Mental Health do not wish to look for help in their own communities. I have observed that among those clients who self-identified as belonging to an ethno-cultural group, approximately 70% expressed the desire to stay away from their ethnic groups. They expressed this desire as it refers to participating in social activities as well as seeking help for their gambling problems.

Moreover, a recently published needs assessment for the City of Toronto has pointed out that “some individuals in ethno-cultural communities will only utilise services that are delivered by mainstream agencies.”According to the report, this occurs “because of their need and effort to maintain anonymity and have the assurance of strict confidentiality” (Toronto District Heath Council, 1998, p. 16).

This information raises a significant point regarding within-group counsellors. The fact that culturally different clients have difficulty looking for help within their own communities intensifies the need for cultural sensitivity in mainstream agencies. Also, while some clients want a counsellor they can culturally identify with, some do not. All evidence points to the importance of focusing on how to embark in a complex counselling relationship in a way that best integrates cultural differences between client and counsellor.

In addition to developing the framework for becoming a culturally skilled counsellor, which I briefly discussed above, Sue and Sue (1977) have also described how culturally bound values can interfere with the counselling process. These authors pointed out the following areas as sources of dissonance between counsellors and culturally different clients:

a) Belief in behavioural and verbal expressiveness may not be acceptable in other cultures. For example, some cultures, such as Chinese and Japanese, value restraint of feelings and being subtle in approaching problems. Intimate revelations of personal or social problems may not be acceptable. This may lead counsellors to erroneously conclude that the client is repressed, inhibited, shy or passive, all undesirable by Western standards (Sue & Sue, 1977).

b) The structure and concept of self-disclosure may also originate tension. In some cultures, intimate aspects of one’s life are shared only with one’s close friends, after long contacts. It may be quite difficult, therefore, for some clients to develop a friendship with brief contacts once a week. Professionals need to explore clients’ expectations and difficulties with the process during the early stages of the relationship. In addition, clarifying the rationale for the counsellors process is necessary to facilitate clients’ adjustment to some of its basic aspects.

c) Some cultures may not be familiar with counselling and may perceive it as an unknown and mystifying process, especially in unstructured settings. This would require that professionals take the time to discuss with clients the structure and objectives of the counselling process. Clients need to know, for example, why counsellors need information about clients and their behaviours, what it is used for, where it is kept, etc. For example, I have noticed that clients from former communist countries are very concerned about where their files are kept and who will have access to them. With such clients, it would be important to clarify the issue of confidentiality, including clients’ files, from the very beginning of the therapeutic relationship.

d) Some cultures, such as Latin American ones, do not make a clear distinction between mental and physical health. Non-physical problems are likely to be referred to a physician, as well as a priest, a minister or a healer. As such, counsellors may be expected to take on any of these roles. In addition, it is important to evaluate the need to involve spiritual leaders/healers and their roles in the process of changing gambling behaviour. Clients may perceive counsellors as “doctors” who will provide a quick solution or even medication to solve their gambling problem. In my work with problem gamblers in a place as culturally diverse as Toronto, I have seen this happen frequently. When exploring with one of my clients his expectations for our meetings, he said without hesitation that he would like me to give him a prescription. Another client insisted on calling me “doctor.” And yet another one brought to counselling his need to receive some kind of formal forgiveness for the ways he had used to get money to gamble. Referring the latter to a spiritual leader in his religion proved to be a good element in his process of behavioural change.

Moreover, according to Sue and Sue, (1977), values inherent in the process of counselling may produce clashes in any of the following aspects:

1. Client expects authority and direction while therapist tries to mobilize client’s own resources;
2. Client expects change of behaviour through a social network (such as family and friends). Therapist promotes self-control, self-monitoring, and internalized standards;
3. Clients proceed from the authority relationships within the family where they have learned to acknowledge and respect the power differential between them and some professionals, including therapists. Therapist fosters an egalitarian relationship; and
4. Client sees problems and conflicts as being controlled by factor outside of self, in social interactions. Counsellor presents them as being controlled by elements within the client and calls for self-observation and self-awareness.

No single position is better than another. However, awareness of these differences should serve as important guidelines to help professionals examine the appropriateness of their interventions.

So far, I have mentioned some areas that counsellors need to be aware of in order to be more effective when working with culturally different clients. In addition to those, I would like to provide some practical points that can become useful strategies to increase cultural competence.

a. Attend conferences that address related topics.

b. Take courses about specific cultures and about cross-cultural counselling.

c. Explore the ethno-cultural communities your clients come from, walk around, watch how people interact, have meals there, and get familiar with the most popular dishes. Window-shop in the area, familiarize yourself with traditional articles and handicraft items for sale. Ask clients where to go, what part of town would be the best to visit, and talk with your clients about your experience after you have been there.

d. Read newspapers and other publications from those communities, learn about their religious holidays, as well as other customs and celebrations. Try to participate in some activities there. Again, talk with your clients about your experience, ask their opinions about which newspapers to read, which celebrations they prefer, how they celebrate, etc.

e. Talk with clients about the music in their culture, the most popular artists and singers. Try to listen to music from their country. The Internet gives you access to radio stations broadcasting live from anywhere in the world.

f. The Internet can also be a great resource for learning about other countries, without leaving home, by just doing a search on the name of the country.

g. Consult with consulates, members of ethno-cultural groups and social services agencies working with them.

h. Ask for feedback from your clients as to how comfortable they have felt working with a counsellor from a different cultural background.

i. Watch foreign movies.

j. Use alternative ways of communication such as drawing and dancing.

k. Allow for flexibility in terms of meeting places; it may be beneficial to occasionally meet in the client’s own community.

l. Be aware of colloquialisms, slang and stereotypes. Some expressions that are very common for those who grew up speaking English may be unknown to those who speak English as a second language. Terms like “hang a left,” “hop on,” “what’s the scoop,” “until the cows come home,” “I am pooped,” “nothing to write home about,” to mention just a few, may confuse clients and make them feel uncomfortable.

m. It is important that the physical surroundings reflect the cultures of the clients that come for counselling. Pictures, paintings, objects of art, and handicraft items used as decoration need to reflect the culture(s) of the group(s) we work with. Something as simple as a sign with greetings in the languages of those clients can make a difference in the way clients feel when they come for counselling sessions.

n. Counsellors need to do ongoing self-assessments and personal work on stigma, assumptions and biases.

o. Get to know and work in conjunction with community and neighbourhood organizations to assist the client in making links.

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