Sue Passalacqua
Joseph M. Cervantes
California State University, Fullerton

Contact regarding this manuscript should be made with Joseph M. Cervantes, Department of Counseling, California State University, Fullerton, Tel (714) 278-3669, jcervantes@fullerton.edu

Submitted to Counseling and Values

Abstract

This article examines roles that gender, culture and spirituality play in elements of therapeutic process. It presents an initial literature review on gender, culture and spirituality as these factors relate to shaping identities and defining one's behavior. Discussions on how these three dimensions influence the level of understanding and effective responsiveness that competent, counseling professionals need to consider in a culturally and spiritually diverse society are presented. Three case studies provide a frame of reference designed to illuminate the complexity that professionals are faced with when counseling issues are viewed through one's unique gender, cultural and spiritual worldview. Implications for counselors and the counseling field are provided.

 

Understanding Gender and Culture within the Context of Spirituality: Implications for Counselors

Although significant developments in gender, multicultural, and spiritual/religious research have further defined professional competencies, the impact of globalization and subsequent cultural/ethnic diversity have had a growing influence on professional practice which necessitates a broader base of understanding of human development. There exists a paucity of research for how gender, culture and spirituality intersect and impact intervention and treatment used by counseling professionals (McGoldrick, 1998). In today's global society, consequences of not attending to these salient contextual dimensions may limit the level of understanding for counseling professionals to assist their clients and may even thwart their growth and development (Boyd-Franklin & Lockwood, 1999; Cervantes & Parham, 2005; Comas-Díaz & Greene, 1994; Fukuyama & Funderburk, 2001).
This article asserts the position of an intricate connection between gender, culture, and spirituality which influences the therapeutic process, and is crucial to competent therapeutic assessment and intervention. Understanding gender and cultural differences within the context of spiritual/religious issues has implications for counseling theory, training for counselors and over-all effectiveness of practicing mental health professionals (Fukuyama & Sevig, 1999). Undoubtedly, issues regarding spirituality and religion surface in relation to life events such as religious differences in intimate relationships, deciding on how to raise children, illness and pain, death and dying and learning to live more congruently to one's values. A primary theme offered in this writing is that gender, culture, and spirituality form a significant backdrop to a counselor's efforts to assist an individual through the healing process more completely.

Historically, spiritual/religious issues have been left in the domain of spiritual leaders or quickly referred to those practitioners who are known to do faith-based counseling or ‘Christian counseling' (Ellis, 1986; Shafranske, 1996). Adequacy of a counselor's understanding regarding the scope of religious conflicts and client's cultural differences are now questioned (Bergin, 1991; Taylor, 2000; Warwick, 2002).

A relevant study conducted by O'Connor and Vandenberg (2005) investigating religious beliefs among mental health professionals in their randomly assigned case vignettes demonstrates a level of confusion about how counselors evaluate a client's religion and spirituality in counseling practice. This study implies a lack of conceptual and professional awareness that may provide a critical link to informing and influencing effective responsiveness for counseling professionals with their clients. In addition, is there a more comprehensive and holistic approach to understanding the larger framework of an individual's psychological complaints? Answering this question may be at the helm of a more sophisticated counseling approach that begs consideration in today's society. Arnett (2002) and Giddens (2000) noted that diversity is shaping and creating multitextured personal and social identities which underscore the observation that we are becoming bicultural, multicultural, and hybrid communities.

Gender role socialization and cultural experiences shape identities of women and men, define their behavior, and set up expectations for how they interact in the world (Davenport & Yurich, 1991). Gender role behaviors change between various cultural groups; however, significant themes reflect commonalities across cultures. For example, among many cultural groups, female roles typically reflect caretaking responsibilities while male roles focus on status at work, in relationships and in society. Gender role behaviors may be influenced by spiritual/religious experiences. Spirituality/religion contributes to women's development and men's identity. How men and women view themselves in relationship to the world around them is critical information for counselors to examine (Gilligan, 1991; McGoldrick, 1998).

A critical variable for men and women is reflected in their relatedness to spirituality or religious practices. Spirituality/religion is a part of one's cultural milieu and informs meaning, value and direction of human issues (Miller, 1995; Pargament, 1997; Shafranske & Malony, 1990). Accordingly, one's self-perceptions, worldview and identifiable behaviors are significantly influenced by gender, culture and spirituality, and require practicing therapists to develop a more integrated understanding of how these salient factors shape client behavior. Using these three dimensions to guide therapeutic understanding and intervention suggests an expanded approach and knowledge base to counseling that may be more inclusive and therapeutically respectful to an increasingly diverse population. Further, these dimensions will likely affect the manner in which inquiry is asked of a client and how one's human story unfolds. To examine solely psychological symptoms and complaints as the primary dimension in counseling process disregards the complexity of professional practice now evident (Fukuyama & Funderburk, 2001; Hays, 2001; Stanard, Sandhu, & Painter, 2000).

This article provides a brief literature review on gender, cultural diversity and spirituality. Three case studies are used to analyze implications for counseling professionals and their increasingly diverse clientele. Additionally, this article initiates an exploration of the interplay between gender, culture, and spirituality as it impacts therapeutic practice and scope of the counseling professional. Development of a conceptual base for this integration is an important step toward understanding how the psychology of globalization influences multiple identities and co-occurring psychological symptomology and related behavioral difficulties.

Multidimensionality of Gender
Cultural diversity embodies a number of factors that individuals bring to therapy and gender is a dimension that plays a critical role. The importance of sex and gender as significant variables to consider in counseling process goes largely undisputed. It has been long recognized that men and women reflect various differences as mental health consumers and presenting issues. The work and research of many authors (Daniluk, Stein, & Bockus, 1995; Dupuy, Ritchie & Cook, 1994[MR2]; Maxey, McCullough, Rachal, & Worthington, 1997) has enlightened the mental health profession regarding consequences of not attending to sex differences and gender issues in the training of mental health professionals. For example, several professional organizations address the issue of inclusivity of women's issues and sex differences. The American Psychological Association's ethical principles (1992) were revised to echo the unethical nature of sexist practices in, not only education, but research and therapeutic treatment. Additionally, the American Counseling Association's Ethical Standards include nonsexist practice along with The Council for Accreditation of Counseling and Related Educational Programs (CACREP). CACREP reflects specific mandates in gender training for their counselors (Dupuy, Ritchie & Cook, 1994). Clientele of most mental health professionals reflect primarily women. Consequently, a clearer understanding of women's issues is suggested, and is an arena that is receiving increased awareness in training programs (Zimmerman & Haddock, 2001).
Stevens-Smith (1995) asserted that differences exist between men and women based upon decades of research and documentation. Men and women perceive, process, and behave differently and regardless if those experiences are inherent or learned, gender is one way individuals frame their world and society at large. Stevens-Smith pointed out that a counselor's belief about gender impacts his/her approach when working with men and women, regardless of sexual orientation, and employs counselors to examine their own worldview, not only as a cultural being, but as a gendered being. Understanding human development from a gender perspective is an important conceptual window to consider in order to provide accurate assessments and treatment approaches.

Murray Scher and Glenn Good (1990) pointed out that gender and counseling in this twenty-first century will require counseling professionals to understand gender's impact on the way in which society is defined, organized and functions. Gender related belief systems may inform therapeutic decisions and behavior during counseling if gender schemas are salient for a counselor. For example, display of emotions may play an important role for many male counselors. However, if gender notions are not as essential to a counselor's self-concept, one might choose different therapeutic interventions and behaviors (Maxey, McCullough, Rachal, & Worthington, 1997). Scher and Good (1990) asserted that ignoring the impact of conceptions of gender in professional work is an invitation to disaster and poor therapeutic outcome.

Woven through the social context of gender role assignments and life experiences is the spiritual/religious realm. Although there is a significant literature base in pastoral counseling, there are limited studies and academic discourse related to the intersection of religious counseling and gender (Hickson & Phelps, 1997; Warwick, 2002). Discussions of gender role proscription and socialization are salient to understanding how an individual views oneself relative to spirituality and culture. Maxey, McCullough, Rachal, & Worthington, (1997) asserted that religious differences between women and men may echo cultural stereotypes. The authors' research suggested that in many cultures and religions, women were more religious than men. Writing by Guenther (1992) underscores the importance of understanding how men and women differ with respect to their religious and spiritual awareness and co-related behavior. Consequently, potential clients may perceive a female counselor as more spiritually/religiously aware and sensitive to providing effective therapeutic interventions than a male counterpart.

Case study: Kafta. Kafta is a 32-year-old Middle Eastern female. She sought therapy because she was unhappy with many aspects of her life, especially her home life with her family. Kafta's mother died 2 years earlier from cancer and being the only female among four sibling brothers, she had full responsibility of the domestic chores in the house. Her culture dictated that she remain living at home until marriage. Kafta was a college student who was born and raised in the United States and felt as if she related more to Western values than her Middle Eastern upbringing. However, Kafta's values were in conflict with her father's who expected her to marry someone he chose for her after she graduated from college. Kafta had a secret involvement with a Caucasian man she met at a dance club. She articulated that she was tired of living a lie and was beginning to experience a great deal of anxiety and self-doubt about her future. Her anxiety was increasing as her graduation date neared. She reported feeling pressure to remain faithful to her family's religious beliefs (Muslim) and acquiesce to her father's wishes for her future. However, her exposure to Western individualism gave her options she wanted to keep open.
As a female in a Middle Eastern family, Kafta was expected to wait on her sibling brothers and father and leave all decision making up to the men in the family. Kafta felt conflicted between wanting independence and leaving the safe and secure comfort of her home and her family's protection.

This case exemplifies the importance of considering the intersection of gender, culture, and religious orientation. While not all Middle Eastern families ascribe to a Muslim religious belief system, Kafta's family did. Kafta's dilemma of wanting to both individuate from her family and yet remain under their "protection," appears developmentally appropriate from a Western perspective, apart from her age. However, given her cultural and religious history and gender, Kafta's dilemma had far reaching consequences to her sense of well-being and her family relationships. Having sensitivity and awareness regarding Middle Eastern values and Kafta's personal family background, it would be important not to impose and apply Western values to treatment and intervention strategies. Critical to fostering a safe and healing environment for Kafta, would suggest giving her the opportunity to describe the unique differences and conflict of values that existed in her family. In addition, the context of Kafta's religious traditions impacted life decisions that she had been socialized to consider.
Following a year of counseling by the first author (SP)[MR4], Kafta entered the differentiation phase of development when her brothers moved out of their home and her father remarried. Kafta began to see her gender and cultural socialization expanding as she chose to make different decisions for her future. She started to develop a more enhanced sense of self-determination and reevaluate familiar ways of being in relationships with family members and significant others. Failure to incorporate an understanding of this client's Middle Eastern psychological framework from which gender, culture and religious beliefs played prominent roles, could likely have caused emotional harm. It is interesting to speculate how counseling may have differed if this client's family system had not changed, namely, if the strong male influence remained intact.

Religion and Spirituality
Therapeutic problems may surface when one's life is faced with events and difficulties that lead one to existential dilemmas and examination of the human condition. The search for one's place in the larger collective has been found in religion and spirituality for many diverse communities and cultures (Walsh, 1999; Garrett & Wilbur, 1999). Exploring the meaning behind a painful event or coming to terms with an existential crisis taps into the domain of spirituality and religion that often need further understanding by the counseling profession. Lukoff, Lu, & Turner, (1995) assert that the spiritual/religious dimensions of life reflect some of the most significant cultural aspects framing human experience. Belief system and values tend to be incorporated within a continuum of the cultural and spiritual/religious backdrop. (Lukoff, Lu, Turner, 1995). According to Stanard, Sandhu, & Painter (2000), treating various medical and psychological conditions may require that the assessment of one's spirituality be considered. They suggest that the impact of spirituality has resurged and is becoming a salient and dynamic force in counseling and psychology. Cervantes and Parham (2005) recently commented that religious/spiritual dimensions tend to prominently frame life experiences for people of color.

America's religious history has changed dramatically over the years as communities have become more diverse with respect to culture, ethnicity, values and traditions. From a sociological perspective, religion has remained a constant in mainstream society and belief in God reflects the attitudes of 95% of this country's population (Greeley, 1989[MR6]). However, the spiritual essence of people has become more impactful and can be found in writings of popular books, headlined topics of motivational speakers, new age thinking, and scholarly writings (Constantine, Lewis, Conner, & Sanchez, 2000; Musgrave, Allen, & Allen, 2002; Stanard, Sandhu, Painter, 2000; Prest & Keller, 1993; Miller, 1995; Perlstein, 2001; Shafranske, 1996; Puhakka, 2001; Krippner, 1995; Faiver, Ingersoll, O'Brien, & McNally, 2001; Simoni, Martone & Kerwin, 2002; Weiner, 2001[MR7]).

It is important to make a distinction between various interpretations of religion and spirituality. Most definitions of religion reflect specific social, denominational, and behavioral characteristics that involve group membership as part of a system of worship, whereas, spirituality reflects a more individual experience in search of meaning and value in life and a desire for a relationship with something that is transcendent (Walters & Bennett, 2000; Fukuyama & Sevig, 1999). However, spirituality and religion are interconnected as they reflect a sense of meaning and purpose and both assist in bridging a relationship to mystical aspects of human experience (Lu, Lukoff, & Turner, 1995).

It is beyond the scope of this article to provide a detailed review of the numerous, worldwide variations of religion. A useful source is Wilber (1999) who promotes an understanding of religion and spirituality that organizes a hierarchy of mind, body and spirit. This organization supports a link between gender, culture, and religion/spirituality, and prompts a recognition that this framework can significantly enhance an understanding of an individual's personal, social, and community identity.

Integrating a dialogue that views religious and spiritual concerns as potentially salient with clients, suggests that counselors become competent relative to inquiry in this area. Many culturally diverse female clients can present their psychological complaints wrapped in the influence of their spiritual/religious experiences (Ansley, Rose, & Westefeld, 2001; Comas-Diaz & Greene, 1994; Musgrave, Allen, & Allen, 2002; Thomas, 2001). In Kafta's case example, her Middle Eastern upbringing, culture and religious sensitivity influenced her to enter a process of decision-making that respected Middle Eastern values and her psychological position. Kafta's gender played a critical role in her process of individuating at a pace that became acceptable and less-threatening. However, if in the process of unveiling a client's psychological complaints, the counselor makes a gender-based stereotype about one's spiritual/religious orientation, the process and outcome could be adversely affected.
Additional writing about the role of spirituality and socio-emotional well-being is noted by Musgrave, Allen & Allen, (2002) who discuss the importance of cultural framework and its influence in the religious/spiritual experiences of women of color. For example, some Chicano/Latino populations frame the meaning of health and disease as including spiritual, moral, physiological, social and metaphysical dimensions which are viewed as gifts or punishments from God (Cervantes & Ramirez, 1992; Falicov, 1995). Gender and cultural considerations for some African Americans further reveal that Black women regard prayer and belief in God as preventive health measures. Consequently, African Americans are more likely to involve themselves in church activities and opportunities for prayer (Boyd-Franklin & Lockwood, 1999; Parham, White, & Ajamu, 2000). Comas-Diaz (1994) has commented that spirituality for people of color assumes a pivotal role and provides a source of personal strength. Their ability to, not only endure, but transform their experiences came from a religious belief that God was with them throughout their struggles (Collins, 1991).
Historically, religious and spiritual concerns have been relegated to the back burner for the mental health professional who was more likely not to address them, and not facilitate a discussion about any related themes that may cross over into a psychological and counseling arena. As a result of globalization, the religious/spiritual narrative has become a major dimension to understanding diversity among individuals. Some typical ethical dilemmas in counseling may include: navigating a difference in values within a couple or among family members that may impact religious issues, being responsive to varied cultural and ethnic diversity of peoples and the overlay with the psychological complaint, following the outcome of major traumas such as accidents, natural disasters, and difficult life events, to name a few. Many cultural groups, both within mainstream America and immigrants who come may hold mainstream religious beliefs as well as various combinations of indigenous spiritual beliefs that comprise their human experience. Failure to assess these various belief systems in a systematic way could lead counselors into an unexamined psychological arena that is loaded with various ethical dilemmas and value discrepancies that may impact both assessment and treatment for clients or the respective families.

Overview of Cultural Diversity
Understanding culture and the counseling relationship has evolved significantly since Sue's review (1988) of psychotherapy for people of color. Identifying cultural ideology, language and a conceptual framework took several decades. As a result, it culminated in a more critical appreciation for how culture frames professional relationships (Arredondo, 1999; Carter, 1995; Parham, White, & Ajamu, 1999; Sue, Arrendo, & McDavis, 1992), service delivery (Falicov, 1995; Paniagua, 1998; American Psychological Association, 2003[MR8]), and the philosophical anchoring of this integration relative to culture, context, and counseling (Betancourt & Lopez, 1993; Espin, 1997; Hall, 2001; Parham, 1989; Sue, 1988).
The history of multicultural counseling spans several decades. The 1970s initiated discussions about how mainstream psychology did not attend to concerns of people of color. Subsequently, a surge of research examined the counseling process and its impact on race (Ponterotto, Casas, Suzuki, & Alexander, 1995). According to Sue and Sue (1999), the voice of minority group authors continues to criticize the mental health profession for its inability to meet diverse needs of the culturally different, such as counselor insensitivity and limited knowledge base, biased assessments and treatment strategies and unacknowledged awareness of values and belief differences. These observations continue in spite of the wide availability of counseling guidelines and standards that have been developing over the past decade (American Psychological Association, 1993; 2000; 2003; Arredondo, 1999; Sue, Arredondo, & McDavis, 1992).

Multiple Identities and Culture
Multicultural research in the past decade, has advocated for the inclusivity of other contextual identities in addition to culture and ethnicity. Gender, ethnicity, religion, sexual orientation, age, and disability are considered relevant parameters in assisting the counselor to provide effective counseling techniques and approaches (Hansen, Greene, & Pepitone-Arreola-Rockwell, 2000; Hays, 2001). Robinson and Howard-Hamilton (2000) affirmed that attention to the intersection of gender, culture, class, and race is salient to understanding that psychosocial identities embody each of those constructs and determines one's psychological framework. These authors warned against allowing one identity construct to define an individual's character. They also revealed that making assumptions based upon a monocultural perspective, a view that diminishes an individual's personal and social reality, is potentially unethical practice and could cause psychological harm.

Richardson and Molinaro (1996) reaffirmed what many prior writers have stated, namely, that becoming aware of one's own worldview and culture is a necessary precondition for escaping ethnocentrism. Overcoming one's own biases and prejudices recycles the old adage, "Counselor know thyself." The authors stated that counselors who develop accurate assumptions and appropriate attitudes concerning recognition of potential contextual backgrounds with clients is the higher level competency that should be achieved. They assert that this competence must include an assessment of religious and spiritual practices and beliefs as a mean to validate a more comprehensive view of clients' experience.
The concept of multiple identities in understanding human experience still needs a more lucid, conceptual home. Richardson and Molinaro (1996) have started to lay such a foundation by articulating the salience of religion and spiritual beliefs in counseling relationships, but also in viewing these parameters as diverse as culture.

This conceptual linkage of gender, culture and spirituality has been further developed by Swartz-Kulstad and Martin (1999). These authors stated that to understand cultural journeys of diverse populations, counselors must understand individual experience from the client's ethnocultural and contextual reality, namely, considering interactive and dynamic aspects of emic (individual), etic (universal), and group level variables. Swartz-Kulstad and Martin (1999) described the Cultural and Contextual Guide (CCG) process as an attempt at this integration.

The CCG provides a method for therapists to consider culture and context in their diagnostic and treatment practices through assessment of five contextual cultural factors: cultural orientation, family environment, community environment, communication style and language. Community environment can provide a spiritual/religious social network that exerts a positive influence over an individual's mental health. The authors emphasized that without recognition that individuals experience their cultural worlds in unique ways, and without assessments and interventions to assess those differences, counselors compromise their ability to construct a solid framework for understanding the impact of culture, gender, and spirituality on clients. As a result, the narrative story of the client becomes fragmented, non-integrating, and a holistic picture of the individual does not merge. The goal is to establish an integrative narrative of clients that are intertwined with contextual components and multiple identities that define human experience.
The following client scenario provides an example of how Swartz-Kulstad and Martin's (1999) conceptual framework might be utilized to understand a client's multiple identities.

Case study: Miguel. Miguel is a twenty-two year old college student who moved to Southern California from a small rural area in the Philippines ten years ago, with his parents. Miguel presented at the college mental health center with concerns related to anxiety, isolation and depressive symptomotology over his constant struggle to assimilate and find satisfying relationships. Miguel's situation moved him from a traditional, collectivistic, environment to a marginal and individualistic, cultural environment. In his home community, Miguel enjoyed closely connected relationships with friends and family. He reported a strong connection to his church and religious community. Currently, Miguel reports feelings of isolation and awkwardness in fitting in with his peers. He feels caught between conflicting demands, values and relationships between two dissimilar cultures. As a result, Miguel has been experiencing severe feelings of isolation, anxiety and depression. Miguel reported that his school experiences were fraught with mockery about his style of relating to others. Miguel's socialization experience in the Philippines allowed him to enjoy emotionally close and expressive relationships with men and women. His feelings were compounded by his future plans to continue living in the United States in order to better provide monetary support to his extended family in the Philippines. Even though Miguel reports feeling strongly connected to his religious Christian values and traditions, it brings little comfort to his feelings of isolation. From Miguel's perspective, his future necessitates further assimilation to feel successful, while sacrificing meaningful contacts with others.
 
In this case example, the discrepancy between the allegiance to his native culture and his need to assimilate into the current environment suggests that several issues reflecting culture, gender and spiritual beliefs be examined. This client's contextual life experiences contributed significantly to his complaints about anxiety, isolation and insecurity as a Filipino male. The client expressed feelings of security with the treating therapist (SP) and reported that he has felt more comfortable in the company of women since he has been living in the United States, while feeling unsettled with men since the move.

Analyzing Miguel's situation from the Cultural and Contextual Guide (CCG) process, suggests that an examination of his cultural orientation, family history and cultural background can provide a more integrative knowledge base about this individual. Miguel's cultural background allowed for a more closely connected experience in his relationships with family and friends. He enjoyed a communication style that was emotionally expressive and contributed to more meaningful relationships with community members which included a strong connection to his religious community. In his current Western community, Miguel experienced isolation and feelings of anxiety as his attempt at developing relationships were criticized and misunderstood. Miguel found that his masculinity was being challenged.

As a result of feelings of disharmony, counseling focused on Miguel's perception of being socialized male in his mother culture. His socialization experience in the Philippines allowed him to develop closely connected and emotionally demonstrative relationships with men while maintaining his masculine identity. Miguel's struggle with conflicting cultural and gender beliefs demanded an appreciation of gender that did not compromise his sense of manhood, yet would also help him explore these discrepancies without personal threat.  Counseling issues related to gender and the framing of his manhood identity prompted an awareness of gender and culture that did not compromise his already formed perceptions as a man. Exploring the role that spirituality/religion played in Miguel's life was critical to his assimilation process. He was able to discover that involving himself with a spiritual/religious community that resembled one he had left in the Philippines created a greater sense of belonging. Again, conceptualizing this case from a single point of cultural reality would have missed a salient infrastructure to Miguel's previously developed social and cultural reality.
This case analysis is illustrative of an integrated narrative that highlights the significance of cueing in on the multiple realities of the client. Case conceptualization that was able to interweave the dynamic interplay between the individual and the various contextual identities that comprised Miguel's experience of acculturation to American society provided a more complete picture of his life circumstances.

Alternate Models of Integration
Swartz-Kulstad and Martin's (1999) framework is one model that assists in this integration of multiple identities with culturally diverse populations. Other models have been proposed by Hays (2001), Falicov (1995), Robinson and Howard-Hamilton (2000), Fukuyama & Sevig (1999). A blending of these authors' writings about gender, culture, and spirituality assisted in a more full understanding of the complexities in the following case.

Case study: Jenna. Jenna Red Elk [MR9]is a 27-year-old female of Mixed Native American and Caucasian heritage. Her parents separated when Jenna was 4 years of age and raised primarily by her maternal grandmother until the age of twelve. Both maternal grandmother and natural mother are full blood Cheyenne which also resulted in their maintaining strong tribal loyalties which included Jenna's participation in fancy dancing at many local and national powwow events. Jenna's life was one of idealic fantasy and continuous emotional support in her home that was provided principally by maternal grandmother. Natural mother reportedly had had her share of difficulties with drugs and alcohol and problems maintaining a stable work history. At the age of 12, Jenna's grandmother died of cancer, and natural mother remarried leaving Jenna in care of maternal aunt and uncle. This family change brought a significant benchmark for Jenna who subsequently was shuffled to her paternal grandmother at the end of seventh grade and was raised in a strict Protestant environment where she was exposed to a Lutheran church value system. At the age of 16, Jenna stated that she was impregnated by a "White boyfriend" who subsequently abandoned her resulting in paternal grandmother insisting that she now find her own way in the world. Jenna stated that she managed to support herself and her infant child, graduated from high school and junior college, and subsequently enrolled herself in a four-year university at the age of 22.
Jenna Red Elk presented herself for counseling at the age of 27 as a result of several failed male relationships, anger at men and at God, and still mourning the loss of her maternal grandmother.

This case proved very challenging particularly in light of the therapist being male and this client's prior history of relationship difficulties. In spite of recommendations to refer her to a female therapist, Jenna stated that the personal background of the treating therapist and second author (JMC)[MR10] coupled with his familiarity and professional interest in indigenous ways of healing, prompted her to remain in counseling. Nevertheless, issues of anger at males surfaced as a significant aspect of treatment. This anger became transformed into rage at her father for having abandoned her and subsequently at the other males in her life who had abused her.

A second theme in this counseling was Jenna's own exploration of her ethnic and cultural identity and her confusion about how to handle her biracial background and the exposure to an indigenous belief system that was at odds with contact to later Lutheran indoctrination. Relevant for Jenna in this treatment phase was the need to reconnect with an ethnic identity that was comfortable for her and with a spirituality that did not compromise the teaching she had received both from her maternal grandmother, and later from her paternal grandmother. Following a two-year course of treatment, Jenna became more resolved with the death of her maternal grandmother and the anger she had felt at her father for his abandonment. Jenna was able to reconnect with her indigenous roots, began participating in healing rituals from her Indian background, and initiated her own daughter, now 12 years old, into a supportive community that had previously given her security, understanding, and meaning in her early development.

Gender, Spirituality, and Diverse Populations
Examining how gender impacts one's spiritual or religious experience allows counselors and clinicians to become more astute in their assumptions, interventions, and theory building with culturally diverse populations. As Arnett (2002) has well noted, mainstream society is in the midst of personal and collective transformation that is impacting beliefs, values, and identity. Relevant dialogue proposed by Kanis (2002) about multiple identities and counseling is supportive and validating towards the perspective advanced in this writing. Women and men do interpret religious and spiritual experiences differently; ethnicity and culture does impact counseling in profound ways; gender and gender socialization is a significant dimension in incorporating culture and spirituality. Overt and subtle gender-specific messages have pervasive affects on women's spirituality and religious traditions (Kanis, 2002; Hickson & Phelps, 1997; Worthington, 1989[MR11]). Gender and cultural experiences of each client influence the perception and interpretation of life events, impacts one's religious and spiritual connectedness, and is vital to assessment and treatment of a diverse population of individuals.

A model which incorporates dimensions of gender, culture and spirituality and invites a more sophisticated inquiry about the client's life experience and perspective from these three areas is in need of further development. It is not within the scope of this article to further delineate such a model other than to propose the need in view of a more globalized society that prompts a more integrated and holistic understanding of ethnically diverse communities. However, what is known is that spirituality and religion embody multicultural values and gender experiences. The gendered nature of human experience frames the interpretation of most life events and influences the way in which women and men process information (Arredondo, Anastasia & Cella, 1993; Puhakka, 2001; Kanis, 2002; Nelson, 1996; Gilligan, 1991; Stevens-Smith, 1995). Consequently, gender and culture greatly influence one's spiritual/religious path, physical and mental well-being, supportive relationships and coping mechanisms (Hunt, 1995; Puhakka, 2001; Comas-Diaz & Greene, 1994; Musgrave, Allen & Allen, 2002; Pargament, 1997).[MR12]
Admittedly, not all clients subscribe to a religious/spiritual practice; however, the ability to explore religious and spiritual development in the counseling arena, for those clients where this connection may be salient, can provide additional coping strategies and further develop one's self-efficacy.

Findings & Implications for the Counseling Profession
Addressing human development issues in contemporary society may require a multidimensional frame of reference which is inclusive, holistic and integrative. Some important implications argued in this paper are noted in the following. First, understanding people from a gender perspective recognizes that healthy development for women and men reflects differences and does not necessarily mirror the Western male model of development and individuation (Comas-Diaz & Greene, 1994; Hunt, 1995; Nelson, 1996). If counselors are not gender aware, they risk pathologizing and misdiagnosing their clients. This article suggests that professional practice incorporate cannot afford to ignore a perspective that validates sensitivity and understanding regarding an individual's unique life experiences as a male or a female.

Second, Robinson and Howard-Hamilton (2000) warned against allowing one identity construct to define an individual's character. This assertion lays the foundation for the concept of multiple identities in understanding the human experience. Multicultural research has advocated for the inclusivity of various contextual identities because not to examine the multiplicity of human experiences may place the counselor in a vulnerable position of ineffectiveness (Hay, 2001). The bi-cultural couple who seeks counseling due to conflicting religious and cultural values may truly not be heard without the respect, sensitivity and understanding of culture and context.

Third, the spiritual/religious facet of human experience echoes cultural values. Spiritual and religious experiences have also contributed to the healing of many existential dilemmas. Their significance shapes and impacts human behavior and informs the interpretation of life events for many diverse communities. Further, use of ritual could add a relevant therapeutic advantage to the healing process (Bewley, 1995). Without exploration of continued research in understanding the interacting dynamic of multicultural, gender and spiritual processes, the mental health profession may continue to support existing blind spots and unsophisticated professional practice.

Fourth, research reveals that training and education needs exist for both graduate programs in the mental health fields, as well as for practicing counselors and clinicians regarding current gender constructs and developmental models, multicultural competency skills and spiritual understanding (Hage, 2006; Zimmerman & Haddock, 2001). The authors state that without recognition of effective assessments and interventions to assess these relevant dimensions of human experience, counselors may compromise their ability to understand a more inclusive counseling framework for their clients (Hays, 2001; Swartz-Kulstad & Martin Jr., 1999). It is significant that counselors in practice realize that globalization has now entered the consulting office in very dramatic ways requiring that basic levels of expertise in recognizing relevant contextual factors of the client be an expected level of informed competency.

Fifth, integrating a conceptual knowledge base in counseling theory relative to religion and spirituality cannot be sufficiently understated. A rationale has been provided in this article through case illustration and discussion as to the relevance of this salient dimension in the healing process. There is an anticipated awareness in graduate counseling programs and related course work that instruction in the spiritual lives of individuals can add a holistic foundation to effective therapeutic work that can fortify other areas of a client's life history (Hage, 2006; O'Connor, 2004; Young, Cashwell, Wiggins-Frame, & Belaire, 2002).
The value of this writing desires the promotion of long-term curriculum adjustments for graduate programs, more comprehensive training for trainees, as well as holistic and inclusive dimensions of relevant training for the practicing professional community. Providing the emerging mental health counselor with a realistic set of professional values, attitudes and skills relevant to current societal changes and demands is underscored relative to counseling practice. Mastering this emerging wave of globalization in communities towards a more integrative understanding of the individual is a salient standard of care that is expected of a professional counselor.


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