Diversity, Values, and Self‑Awareness in Counselling: Why Inclusive Practice Creates Better Outcomes

 

Diversity is an undeniable part of today’s world. Differences in cultures, values, life choices, etc. While studying counselling, I often question how my own beliefs and values can be a potential barrier in my helping relationship with a client, and whether I have enough self-awareness to positively handle a diverse range of clients professionally.

Understanding diversity in Counselling :

• While seeking help, many diverse factors may influence the client’s decision. Ethnicity, gender, age, religious beliefs, sexuality, disability and so on. A client will always feel more comfortable when they know that their counsellor understands and is non-judgmental about their backgrounds.
• Clients will always feel safer in an environment where the helper (counsellor) makes them feel respected and acknowledged. Studies show that when clients find their therapist to be culturally competent, their dropout rates go lower and engagement rates go higher.
• Data shows that almost 45% of white adults accessed services for mental illness, compared to 27% for Hispanic adults and only 18% for Asian adults. Cultural stigma and lack of inclusivity are the major reasons for this gap in numbers. 

Effects of personal beliefs and values in Counselling :

Just like any other human being, a counsellor’s values and beliefs are shaped by their own upbringing, life events, and environment. 

When they are getting into a new helping relationship, they are naturally already influenced by these beliefs and values.  

For example, if a counsellor grew up in a large family and values their own family bond greatly, they might find it difficult to understand a client who finds peace in independence and autonomy. 

Subconscious bias may influence the counsellor to direct the client towards family bonding over autonomy. And the client will have a hard time getting any benefit from that helping relationship.

In this scenario, the counsellor must have an understanding of how to respect the client’s point of view as an individual, not what the counsellor personally feels.

The helping relationship is always about helping the client to be able to make their own conclusion, not about making decisions for them.

Necessity of self-awareness as a Counsellor :

In the counselling profession, self-awareness is part of the ethical framework. Recognising one's own biases before helping others is non-negotiable.

Self-awareness enables a lifelong commitment to learning more, not just being satisfied with one's own knowledge and acting like an expert. 

True experts are those who never stop learning, always looking forward to enriching their knowledge.

By understanding others' worldviews, looking through a neutral lens, a counsellor can respect the client’s boundaries better and recognise personal triggers more. 

It can also help the counsellor understand their own limitation and enrich their acceptance level.

People may assume it's rude sometimes, but self-awareness is not selfish. It is simply about being honest with oneself; it is a necessity. And I think people who are honest with themselves are usually a safe space for others.

Social and Cultural Attitude towards Mental Illness

According to the World Health Organisation, 1 in 7 people are living with some kind of mental health issues globally; that is over 1 billion people on Earth.

Here in the UK, 1 in 8 people are suffering from mental health issues every week, costing the economy almost £82 billion each year. These numbers clearly show that it is barely fictional and definitely not a sudden trend. 

A lot of us think that motivation is enough to make someone get suddenly energised. Or, telling them to have faith and worship God more is the solution. In a video I witnessed, a brilliant, practising Muslim Psychiatrist (unfortunately, I cannot remember her name) addressed the matter in a simple manner.

She said, ''When someone is depressed, having trouble doing the simple daily activities, and you are telling them to pray more to get rid of the condition, it is like telling a person who is in a wheelchair to suddenly get up and run a marathon.''

What people with mental illness face daily:

• Dealing with overwhelming sadness, fear, and anxiety while trying to act okay so no one can sense the vulnerability. Like it or not, most people are judgmental towards mental health issues. Because of this, the sufferer will naturally try to isolate themself.
• Others don’t understand how hard it is to make a simple decision, as simple as taking a shower or seeing the greenery outside. Writing down every single task just to remind oneself, or trying to concentrate on a close one’s conversation.
• Lacking motivation is an understatement. The sufferer is just waiting for the time in this world to run out, so the loop ends. Some cannot even wait for the end.
• Over 32% of UK employees every week cannot reach their productivity goal due to mental health issues. Almost 40% of employees fear discrimination if they disclose their issues.
• A majority of these sufferers fear being misunderstood by their family and friends. Or, just try to run away from a motivational speech, ‘’cheer up’’ ‘’just snap out of it’’ type of comments.
• A study shows that only 30% of people are receiving proper treatment for their mental health issues. Others are maybe just stuck on a long waiting list for months or years in the GP list, waiting to have the right diagnosis.

Data on Social and Cultural Attitudes:

• Global data shows that almost 80% of people are avoiding diagnosis or treatment due to social stigma and fear of being discriminated. This data came from studies done in 63 countries. Countries with low GDP and low literacy rates mostly don’t even believe in the idea of mental health issues.  
• The literacy level about mental well-being is alarmingly low. Only 15% of the adult population can name 3 common mental health illnesses.
• About 60% of people with mental illness reported discrimination at work. 47% of people reported feeling uncomfortable working together or around someone with any mental health condition. Media portrayal plays a major role in this. I don't remember the last time I watched any character in the movies with mental illness portrayed as positive, other than just a villain.
• Globally, around 1.5 billion people need professional care for their mental well-being. Unfortunately, 70% of them are not even receiving any proper treatment.
• In the UK, 69% of adults see mental illness as a sign of weakness. Based on gender, 78% of men believe the same.
• It is even more heart breaking when family and culture see this as a dishonour to even seek some sort of help. For example, the South Asian community is reported to be the champion in social stigma! They have the lowest number of people who seek help, even though having a 30% rate of depression. The number is 20% when it comes to the Black/African community.
• 69% of UK people believe mental illness is a sign of weakness or a character flaw. When in reality, studies show over and over again that mental health is influenced by social, environmental, psychological, and genetic factors. 

In conclusion, the numbers are highly thought-provoking. Mental health conditions have always been there, just like any other diseases. This is not a new invention of the new century. However, the influential factors may have changed or gotten stronger due to the fast pace of the modern world.

It is truly sad that we pay so much attention to what people are wearing or eating on social media. But we hardly pay attention to the family member having trouble concentrating, or the friend getting distant for a while. We blame technology when we don't even talk to each other over lunch without touching our phones at least once.

Easily Accessible Supports for Mental Health

 

A common misconception of our society is that having mental health issues is only for "Mad People"!

The truth is, only dead people don’t need to worry about their mental well-being!

So, for those of us who are still kinda living and breathing, here are some ways to reach out for help and find support when dealing with mental health issues : 

National Emergency Numbers - 

One should remember their country’s national emergency contact number to get immediate help and support.

For example, in the UK, 999 is the helpline for anyone going through immediate danger, mental and physical. Immediate mental health danger can be suicidal thoughts or wanting to harm others.

Other emergency helpline is 111 for the UK, for moderate to low risk emergency. Anyone can talk to someone on this number 26/7 if they need support. 

GP / NHS -

The general practitioner assesses the mental health condition by listening, analyzing symptoms, lifestyle, sleep, and so on.

They use instruments such as the GAD-7 and PHQ-9 to assess the patient. Can prescribe necessary medication and refer to suitable therapies and other options.

Talking Therapies -

Talking therapies are designed to empower, not to give advice. 

Well-trained professionals are there to help you explore and understand your own feelings, thoughts, emotions, and discuss ways to move on to a better life quality. 

These therapies are extremely confidential and there to support without any judgement.

Tons of talking therapies are available across the UK, which can be accessed via the NHS, privately, through online self-referral, or through organisations that help the community.

Person-centred counselling, Cognitive Behaviour Therapy (CBT), Psychodynamic therapy, etc. are proven to be helpful for anyone dealing with depression, PTSD, anxiety, trauma, burnout, grief and so on.

Charities for Mental Health Support -

There are very reputable charities run by volunteers that provide support day and night, serving as early preventive measures and long-term support in some cases. They are like one-call-away friends!

For example:

• Samaritans - a well-known name who are available 24/7. They receive 1 call every 10 seconds.
• CALM - focuses on suicide prevention all over the UK.
• SANE - provides long-term support for adults with mental illness.
• Mind - is the largest network for providing support, advocacy, information, etc.
• Mental Health Foundation - works on evidence, research and educating people about mental health.
• YoungMinds - a youth-focused charity that supports children and young people and their parents.
• OCD UK - provides support, treatment, knowledge and guidance for people with OCD.
• Headway - a source for people with brain injuries who can access support from neuro-specialists.
• Bipolar UK - is known to provide a good support network for people with bipolar disorder.

Last but not least, educational institutions also provide great support for children, teenagers, and young adults in accessing available support for mental health. Schools, colleges, and universities have counsellors to help safeguard their students.

Personally, I strongly believe teachers of young children, specifically, should take a short term/basic counselling and mental health awareness course before starting to teach. Because they have a noble responsibility to raise the future generation. 

Key Elements of Mental Well-being. What is considered a ‘’Good Mental-Health’’?

 

How we behave, feel, and handle situations are majorly an outcome of our mental health. For this reason, we cannot ignore the importance of our mental well-being. Because it affects not only us but also our surroundings, loved ones, and overall life.

The question is, what is considered good mental health? What are the key elements?

In my eyes, there are 4 key elements : 

1. Genetic Makeup - 

Mental illnesses like depression, bipolar disorder, panic disorder, schizophrenia, etc., can be transferred through genetic makeup. 

If a mother has depression, most likely the child will develop that too in the upcoming years. But having the genes doesn’t necessarily mean that it is destined. One may have the genes in the system, but to activate those genes, environmental circumstances play a major role. 

Data proves that depression has around 50%, bipolar disorder 60-70%, schizophrenia 70-80%, and anxiety 40% heritability risk to genetic makeup.

2. Childhood -

Childhood trauma, like any kind of abuse, neglect, separation, etc., can significantly increase the risk of mental health issues. Lack of care, parental love and connection, and breakup of parents are classic examples of early life trauma.

One of my favourite personas, Dr Gabor Mate, says beautifully, ''The child’s needs are simple: attachment and authenticity. Trauma occurs when we are forced to choose between the two.''

In the UK, studies show that the highest rates of mental health issues are caused by childhood trauma.

Worldwide statistics show that 6 in 10 children under the age of 5 are regularly being abused by their primary caregivers. Some cultures normalize the abuse in the name of discipline and building character.

Alarmingly, 1 in 5 women and 1 in 7 men experience sexual abuse in their childhood globally. That is more than 1 billion people! 

3. Life Experiences -

Financial stability can have a major impact on one’s mental well-being. Stable income, a safe roof over the head, is a measure of secure life quality. 

43% people who are dealing with unemployment have poor mental health and have a higher risk of mortality.

Breakups and divorces are considered to be important life experiences. Research shows that divorce or breakup can increase the risk of emotional dysregulation, anxiety, depression, substance abuse, and suicidal thoughts.

Global data shows 27% of women (age 15-49) and 17% of men worldwide are victims of Intimate Partner Violence (IVP), which can also be classified as domestic violence. That is more than 600 million women and 700 million men we are talking about! Almost 50% of these survivors suffer from depression, PTSD, anxiety disorder, suicidal ideation, etc.

4. Health -

Physical and mental health are simply two sides of the same coin. One cannot exist without the other part.

Chronic pain, illness, long-term hospital stay, poor sleeping schedule, etc., cause a high level of cortisol, leading to stress, anxiety, panic, and depressive disorder.

These mental illnesses are significantly related to cardiovascular and hormonal dysregulation, affecting the entire immune system.

A balanced routine and lifestyle consisting of a healthy diet and physical activity can lower stress hormone cortisol, increase happy hormone dopamine, and balance adrenaline. Also reducing inflammation, avoiding substances that alter brain chemistry are smart moves to improve physical and mental well-being. 

Overall, genetics, childhood, life events, and health give the shape of our mental well-being. All humans are bound by these four elements. And each elements are proven by data and studies that how we cope, connect, function, and survive in life are a combined outcome of all. The numbers related to these are a wake up call that prioritising the emotions and feelings is undeniably necessary.

Understanding Mental Health and Mental Illness

According to WHO -

''Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn and work well, and contribute to their community. It has intrinsic and instrumental value and is a basic human right.''

And,

''A mental disorder (illness) is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour.  It is usually associated with distress or impairment in important areas of functioning.''

In a simple sense, we all have mental health, regardless of our age or gender. But not everyone has good mental health. This eventually turns into a mental illness or disorder.

For example, at all ages, we feel happiness, joy, sadness, fear, anger, shame, and so on. But when the fear, anger, stress, etc of emotions become harmful for us and our surroundings, when they control us instead of us controlling them, that can be classified as illness.

I believe psychology and mental health are as complex and interesting as astrophysics! Amazingly interesting and a bottomless pit at the same time! This is probably why I am drawn to both of these topics!

Data:

- According to Mind UK, in the UK, 1 in 4 people experiences mental illness every year.

- APA shows that many people who are suffering from mental health issues are outside the diagnosis radar.

- Mental Health Foundation revealed among 79% of UK adults feel overstressed each month.

- The World Health Organisation confirmed that each year, almost 280 million people suffer from some kind of mental health issue.

Some examples of mental illness are;

PTSD -

Post-traumatic stress disorder, also known as PTSD, affects at least 3% of the UK population each year (According to the NHS).

When we go through some traumatic events or experiences in life, whether short-term or long-term, later on in life, we can get really triggered by those traumas. As a result of it, nightmares, flashbacks, etc., can occur.

PTSD can affect anyone of any age.

Anxiety and Stress -

Anxiety involves excessive worry and fear, which can lead to physical symptoms like breathlessness, sweating, heart palpitations, etc. Leading people to seek professional help to manage their symptoms so they can function.

Stress can also be described like this, but it is not solely a mental illness; it can definitely lead to it. A little stress can be very useful, but when it becomes long-term and hampers day-to-day life, it becomes lethal.

Depression -

Depression is something I can explain from my personal experience. It is difficult to explain to someone who has never truly experienced it.

It is like you don’t know what the emotions of joy and happiness mean. A void inside, you’re lost and okay being lost in it!

We all feel sad from time to time. But when this sadness or low mood makes you feel like you don’t even understand the meaning of joy or happiness, that is depression. A sad face doesn’t always mean depression. A smiley face can mask depression very well, better than anyone sometimes.

Getting out of bed, brushing your hair, day after day, feels as hard as moving a mountain. Losing interest in your favourite things feels okay. And the embarrassment of not being able to do so, being labeled as lazy, works like salt on a fresh wound. Depression needs treatment, not just motivational speech.

Schizophrenia -

An alarming NHS report says that worldwide, 1 in every 100 people experiences symptoms of schizophrenia.

This illness highly affects thoughts, behaviour, perception of reality, may make hearing voices or cause delusion.

Most patients of schizophrenia are victims of extreme trauma, not violent, definitely not how the media or movies portray schizophrenia.

Overall, mental health and mental illness are something everyone should have some basic knowledge of. It is a positive thing that the awareness of mental health problems is rising, far better than how it was treated historically, inhumanely for centuries. 

How core counselling skills can be used in any relationship

Every human being, in the depths of their psychology, and longing for connection, wants to be heard, understood, and validated.

When I started studying counselling skills, I realised that the core skills are not just for professional counsellors; they are designed for universal use.

For example,

Unconditional Positive Regards -

Any human connection, parenting, friendship, partners, etc, must have the quality, unconditional positive regard. Building a relationship is fairly easy, but maintaining and nurturing it is the real challenge.

Unconditional positive regard is accepting someone for who they are, regardless of their gender, religion, or beliefs. It is about believing and valuing the person as a human, not just judging them based on behaviour only.

UPR is important to reduce shame and build trust in a relationship.

Empathy - 

I truly believe you cannot fake empathy for too long. You might act like an empath, but the truth is, it will come out eventually. I don’t know how it is possible to nourish a relationship you admire without empathy.

It is an art of feeling for others’ feelings. This deepens the connection of any relationship.

Empathy is not just saying, ‘’I am sorry for your loss’’, instead it can be something like, ‘’I cannot imagine how hard it is for you to deal with it alone’’.

Congruence - 

Congruence is simply described as genuineness. Why is congruence important? Because it helps us to understand others better and become a better version of ourselves.

Sometimes the genuineness may come across as sounding rude. This is why showing it with manners and empathy is very important.

For example, a friend might notice that the dress I am wearing is not perfectly fitted, and she says the dress looks bad on me. Instead of this, she might say, "Your dress is beautiful, and if the fit were more accurate, that would make you feel more comfortable while wearing it.’’

Active Listening - 

Active listening is a genuine sign of one’s interest. When someone just says, ‘’I like you,’’ that sounds sweet. But when someone remembers what made you smile months ago, or who was your favourite singer in your high school, that is called actually listening. Because mostly we remember the things we pay attention to.

While opening up about feelings, when we pay attention to someone, their feelings, gestures, etc, that is a solid way to build trust, making others feel valued. This eventually reduces the possibilities of conflicts.

Question and Silence - 

While listening actively, questioning and silence are equally important. These two help to maintain healthy boundaries and create space for the helpee to reflect and process.

A question reduces confusion and shows interest that the listener is actually present in the conversation. At the same time, silence signals patience for answers and creates necessary space for others.

I read somewhere that we only stay silent just to answer back. This can be positive and negative depending on the situation.

If we are in a meeting where answering the questions is mandatory for the sake of progressing fast, that’s ok.

But when we are building a connection with someone, which we want to be meaningful, then we have to learn how to ask and stay quiet.

Being a student of mental health counselling is teaching me a lot. When I am working on my workbooks to research and submit assessments, I am always trying to implement the knowledge I am gathering from the studies in my day-to-day life.

Whether it’s in my parenting or at work as an interpreter, I am mostly keeping the core skills of counselling in the open tab of my brain. These skills are not just my study material anymore; they are helping me every day to understand life better.

Does counselling actually work?

Does counselling work- a really valid question to ask!

Before going into my personal thoughts, I would like to start by stating proper data and evidence.

According to BACP,

• Nearly three quarters of people who’ve had therapy (72%) found it helpful and three quarters (76%) would recommend it. 

• More than one in five (22%) said their children have received counselling or psychotherapy, with most parents finding it positive and a third (33%) described it as very helpful. 

• Most LGBTQ+ people (70%) say they feel comfortable talking to a counsellor or psychotherapist, compared with 61% of non-LGBTQ+ people.

More Evidence on BACP Research

and Evidence Based Insight on Counselling

When and Why Counselling Doesn't Work?

Lack of Motivation -

When the client lacks motivation to make changes or to get better from within, the helping relationship is less likely to blossom in that scenario.

Unstable Lifestyle -

If the client struggles with the stability of lifestyle, for example, being homeless or due to a chaotic environment, a helping relationship won’t be able to mature because of that.

Negative Traits of the Counsellor -

The lack of professionalism, empathy, and flexibility of the counsellor can harm the counselling work inevitably.

Premature Ending - 

A client might not be able to continue the counselling sessions for various reasons. Personal, long waiting list, finance, etc., can prematurely end a helping relationship.

Personal Input

Counselling is not some magic pill that will make the problems disappear in an hour or two.

Think of it as a tree. You plant the seed, water and nurture it, you are patient and consistent. Gradually, the tree grows, and one day you get the result.

Like this, the helping relationship between a counsellor and client takes nurturing. The client has to have faith in it while the counsellor is doing the work ethically and professionally.