Natosha Monroe

Today I’m writing about something that is very disturbing and not uncommon here in Afghanistan. It’s not pleasant to write about, but I feel an obligation to do so since I’m here and seeing the realities for myself. I hope that sharing this information with those in my field will help in some way—if not directly, perhaps at least by gaining a better understanding of what the Afghan people must endure and also to better understand the frustration of U.S. Troops who return from this environment.

Once I started visiting with Soldiers who have been off-post and have seen the country on foot and from the windows of their vehicles, I started to hear similar stories of what they sometimes see: little boys with no ears and evidence of sexual abuse. While I had heard about the marginalization of women and of the poorer citizens of the country, I can’t recall ever hearing anything about the sexual abuse of little boys in Afghanistan or the Taliban practice of cutting off their ears. I remember thinking it odd that child rape was highlighted not once but twice in the novel, The Kite Runner—but now I realize it wasn’t so odd after all since the story took place in Afghanistan. Since my first few days here, I’ve heard very similar accounts from multiple reliable sources in addition to numerous stories from Soldiers I’ve just met. The stories and accounts are too similar to not hold some truth, although to be honest I’ve always found it easier to think things like, “Surely that’s exaggerated” or “that’s really horrible but I’m sure it’s very rare.” But unfortunately I know for a fact there are at least some threads of truth to the horrific stories because I’ve now seen it for myself this past week.

On my usual walk to the office, I passed by the hospital waiting room for U.S. military and local Afghan citizens. As usual, there were families and a couple of burqua-clad women but what caught my eye was a cute little boy in traditional Afghan clothing. He was perhaps three or four years old. As I walked by, he had a look of confusion on his face at this woman wearing pants and then a look of fear crept over his face when he saw the large weapon slung over my shoulder. When our eyes met I smiled to convey he shouldn’t be afraid. He smiled back and then turned excitedly to look at his father as if to say, “Did you see that?” And that’s when I saw he had no ears. I looked away so not to stare but the image stayed in my mind all the way back to my office. It was evident there was no previous medical procedure or birth defect—they were obviously cut off without precision of any kind. For the first time in months, I felt tears in my eyes and I needed a moment alone or I knew they’d soon spill over.

If you’ve seen the cover of a recent Time magazine which featured an earless, noseless Afghan woman, this may not be surprising to hear about. That particular edition on my desk at the mTBI program House struck up more than one conversation about how “messed up this country is” and how “messed up the Afghan culture is” as some of the guys put it. Now, before you knee-jerk to those statements by thinking something like, “that’s not nice to say,” realize what these guys have witnessed and seen first-hand that has upset them to the point that they’ve formed such opinions. Thousands of miles away back home in The States it’s simple to romanticize the culture of burqua-clad women and prayer several times a day. But that’s not the entire truth and there are much darker shadows of evil “norms” that the Troops here have seen first-hand.

One Soldier told me of a patrol in a rural town upon which they found an “old man forcing a little boy” to perform oral sex. Another Soldier told me of his friend who was on guard tower duty next to the quarters of Afghan officials who heard noises of one Afghan man and “his little boy” that he kept in his quarters for sex. The Soldiers in such situations are not allowed to do anything that might be “culturally upsetting” to the Afghans—yet they are caught in a moral predicament because they want to help the children. In one case Soldiers separated a man from the child forcefully which led to complaints to their command. Can you imagine stumbling upon a child rape and having to worry about getting into trouble for helping the child? Can you imagine the feeling of frustration as you help one group of people fight against another but you see both “cultures” embracing the principle of “women are for procreation and boys are for recreation”? These are the difficult realities our Troops face.

Before anyone gets angry at the lack of “cultural sensitivity,” let me emphasize that I have no proof of the prevalence and I have not personally witnessed a child rape. (And I won’t due to the nature of my job.) I’m also not saying for a moment that all Afghans participate in these acts. But I also do not discount the truth in the stories Troops have told me and I believe it is naïve to do so. And while I realize it is easier and more comfortable not to discuss such things, pretending this abuse is not occurring here is an injustice to the victims. Due to the fact that it’s a taboo topic amongst the men and that visitors are not exactly encouraged to speak to women here, I think it will be difficult to adequately research the impacts upon Afghan society. That being said, I think that organizations which are dedicated to human rights and fighting child abuse should acknowledge this and do what they can to be advocates for these children who have no voice against their perpetrators. I’m no expert on the effects this kind of abuse has upon children, but I can’t help but think the allowance of it must have an impact upon the Afghan communities and culture overall. I’ve asked a few people in psychology-related fields who have told me that regardless of an increased “normalcy” in comparison to the U.S., the effects of child sexual abuse still have the ability to drastically damage the developing psyche. This makes me wonder: “What happens to that child as he grows up?”

Does he feel shame, guilt, confusion? Does he feel hopeless, powerless, unworthy of anything better? Does he too become an abuser? And here are some other difficult questions: Will such a culture change and begin to embrace human rights and equality? Is it our job/duty to see that it does? Should we just give up or should we fight for those who can’t fight for themselves? Should we just stay home and enjoy the oblivion of our fast food and reality show news? I don’t pretend to know the answers to any of these questions. I’m just one of many hopeful Soldiers doing their jobs here in this foreign place.

Natosha Monroe is an Army Reserve Mental Health Specialist stationed in Afghanistan. She is a counselor and PhD candidate passionate about increasing Troop access to counseling services. Her blog contents are not representative of the Army or Department of Defense in any way.

Pete Saunders

She is four years old. Within minutes after her birth, her mother died. Ten months later, her father died. Altina’s nine other siblings went to the care of aunts, uncles and a grandparent. Nobody wanted Altina. They felt she was responsible for the death of her mother. So, they were ready to place her in foster care. Barely a toddler and Altina already experienced almost unimaginable loss and deprivation.

Dakari was born at full term but developed Cerebral Palsy (CP) due to perinatal asphyxia. During labor, my wife’s blood pressure dropped to dangerously low levels. After a series of unfortunate events including four surgeries, my wife and I lost our ability to produce any more children. We were ‘ok’ with that news considering all that had transpired and especially since I always wanted only one child. My wife wanted three. Watching Dakari interact with other kids has contributed to changing my mind on the number of children I would like to have. I believe where possible, a child should have at least one sibling. I can see many benefits to this family structure especially as a parent of a special needs child. Dakari is very determined to accomplish many things but even more so when he sees other kids doing those things. There are social benefits from having a sibling as well. There is the opportunity to develop respect, interact with and learn from others.

To expand our family, my wife and I decided that we will adopt (not many other options available to us). We told Dakari’s former nanny about our intentions and that was when she told us about a little girl called Altina. Our hearts were filled with empathy initially and then joy. We learned that Altina and Dakari’s birth was only two days apart. This news made us very excited and nervous all at the same time. That was two years ago and we have been faced with a few challenges.

Altina lives in Jamaica (West Indies) while we live in Bermuda. One of the adoption requirements is that we spend a total of six months with her prior to adopting her. We have been unable to do that primarily due to economic reasons. We have been taking care of her for the past two years while she stays with Dakari’s former nanny, who is very close with her family. We have never met Altina in person. We have spoken over the phone; family and friends have met her; and we have seen photos. We do have some concerns with this arrangement. Our main concern (and fear) is that the older she gets, the more difficult it will get to adopt her and integrate her into our family. So why aren’t we closer to adopting her than we are? One reason is that I tend to focus on the tremendous sacrifice it will take to meet the six month requirement. It will mean that either one of us or the entire family moves to Jamaica (my home) for that period. Realistically, it will be quite costly especially for Dakari (due to his developmental needs) for us to do that right now. It has not yet been communicated to Altina that she will be a part of our family. At this stage, I am not certain it is a good idea.

Soon, I will complete my graduate education as a Marriage and Family Counselor and will no doubt be counseling families on adoption. Truthfully, I feel stuck. I do feel a little embarrassed as well. I would really love to hear your thoughts on this situation especially if you have had experience with adoption. Including Altina as a part of our family will be a big step for us. It will bring me great joy to be this little girl’s father and to be the family that gives her a chance at experiencing love, being appreciated, and having someone completely committed to her. I am certain that she will have a lot to offer us as well especially our son.

Pete Saunders is a graduate student at Capella University. He also writes a weekly blog and conducts a weekly video interview on manhood at razorsanddiapers.com

Robbin Miller

I am experiencing extreme frustration in looking for jobs in the healthcare industry. In my neck of the woods, these jobs are only being advertised to social workers due to their training in the medical arena in graduate school and in their internships. Fortunately, I obtained professional work experiences since 1996 working in this industry as a Care Manager; Independent Living Specialist; and Community Organizer for elders and for persons with disabilities in different job avenues.

Two weeks ago, I was denied an interview for a nursing home because the requirement to administer a MDS (Minimum Data Set) to assess the level of functioning for care for elders and for persons with disabilities can be used by both a nurse and a social worker. While the former is true, I found out by looking at the MDS instrument
http://www.cms.gov/NursingHomeQualityInits/downloads/MDS20MDSAllForms.pdf that anyone qualified to use this administer does not have to be a social worker. The nurse has to sign off on it after the evaluator finishes administering the instrument. Furthermore, in my last job as a care manger, the director of the program who was not a social worker or nurse administered this instrument for her clients while the nurse just signed off on it after she was done evaluating the client’s functioning needs.

It is apparent that there may be either a misunderstanding or just blatant discrimination against counselors on who can really administer this instrument in a nursing home setting. I have called and emailed the executive director of the Massachusetts Senior Care Association to inquire why this standard that only a social worker and not a counselor can administer the MDS in a nursing home setting. As of writing this blog, he has not called me back. I was directed to contact this individual through the Massachusetts Home Care Association who responded to my inquiry about this issue.

I am also experiencing frustration in finding a job as an educator/counselor in a home care or healthcare setting for clients and families with specific health conditions. The qualifications call for a social worker only to apply for the job. I applied to this job and stated that I am just as qualified as a social worker to do this job based upon my work experiences and taking graduate courses in Rehabilitation Counseling. So far, no one has contacted me as of yet.

I also applied for a per diem position at a local visiting nurse association as a social worker. Again, I used the same line as mentioned above, and I have not heard from them yet. Stay tune as I will update you next week on my latest adventures in finding a job.

Robbin Miller is a counselor who specializes in mindfulness meditation; Positive Psychology; and Cognitive-Behavioral Therapies; and is also a volunteer cable access producer and co-host of her show, “Miller Chat” in Massachusetts.

Karen Bates

Do people really change? Or is it more of a problem in adapting or transitioning from one developmental stage to another? I ask this question because of the recent behavior of the elderly that I have been noticing of late. Upon vacationing at my mother’s retirement home she had build 7 years ago in a well populated and popular adult community near Hilton Head, one of the discussions was the rise in sexually transmitted diseases. She is a retired public health nurse but she didn’t find this out by reading her professional publications that she still subscribes to. And NO she did not contract one. Her twin sister’s physician raised an eyebrow while making small talk when my mother and her sister (my aunt) were there for a follow-up visit for my aunt who was having some recent health problems after some exploratory procedure she had. My mother accompanies her to a lot of these as they are very close; well they are twins so that’s part of it. So back to the subject of my mother’s community now known as a “city” of ill-refute.

She laughed as did I but I am well aware of this growing trend as I was listening to the county nurse facilitating the communicable disease training I attended last year for my credentialing requirements for the agency I work. Apparently, the fountain of youth, so to speak, is all the erectile dysfunction medications on the market. So, I was pondering the question, if these men were womanizers in the past, I guess they are sort of picking up where they left off. So my word to the wise is, age may slow a person down somewhat, but not if there is a medication out there for it. Add this to the growing list of counseling issues that are bringing this population, many for the first time, into counseling, health care reform and the growing aging population from the baby boomers, behavioral health care counseling for the elderly is a growing occupation and niche. I am not an expert, not yet anyway, but I think it may behoove me to become knowledgeable of counselor competencies for the elderly. As an educated guess I think it would entail:
1. Theories of lifespan development
2. Addictions, particularly that of prescription drugs and alcohol
3. Relationship and marital counseling
4. Career counseling, namely, second-career and career transitioning, and
5. Community resources for referrals to financial planners, health care, and housing.
I have to admit, this population is one that I would not say that I have been interested but it is becoming more and more inviting if not intriguing. Older persons are refreshing. When you think about it, it sort of gives you a whole new outlook on growing old. Or should I say growing young at heart.

Karen Bates is a counselor, addiction specialist, and a doctoral student at Walden University.

Carol Whiteley

Many people feel they are powerless to do anything effective with their lives.* It takes courage to break out of the settled mold, but most find conformity more comfortable. *This is why the opposite of courage in our society is not cowardice, it’s conformity. *As quoted in Think and Grow Rich by Dennis Kimbro and Napoleon Hill

Where did we get the notion that life is pretty much over when we hit retirement? How many times have I heard, “I can’t do that. I’m too old.” Is it programmed in us by our parents or does society “throw us away” after we reach a “certain age?”

I argue against all these old-fogy ideas. We have recently learned that we must keep our brains young by learning new things. What better way to do this than to go back to school and find something exciting and new to explore.

It is tremendously rewarding to be in the counseling program. Yes, I am competing with much younger students since I am already retired. But I have to say that this has not been terribly hard so far. What I lack in short-term memory is more than compensated by my knowledge of what it takes to be successful in life.

Now I’m not talking about money success. I’m talking about the kind of success that brings about contentment and peace. I’ve had plenty of opportunity to learn from failure. I have also learned to be patient with others and my own shortcomings.

But through the counseling program, I have learned that each of us is responsible to find his or her own path in life. We have the capacity to grow and enrich our lives and others as long as we live. I have read about famous theorists who continued to contribute to the field of counseling right up to their last breath. Albert Ellis was giving lectures in a nursing home while he was attached to an oxygen tank shortly before he died.

Therefore I would encourage any student or potential student out there to stop listening to the voice in their head that says “it is too late for me to go to school. Our broken world needs people like us that can shine a light of hope and share our hard earned life lessons.

Carol Whiteley is a counselor in training at Argosy University in Atlanta. http://www.carolsingsoldies.blogspot.com

Ken Oliver

There’s no doubt that many of you have heard about Dr. Laura Schlessinger’s unfortunate rant in which she repeatedly used racial epithets while interacting with a caller. Dr. Laura, the infamous talk-radio personality, subsequently issued an apology for using the word. Her apology, which was viewed suspiciously by many, was followed by a defiant touting of her First Amendment right to free speech and an announcement that she would be ending her longstanding radio show—well, at least in its current format. Barring the fact that the First Amendment has nothing to do with this case (i.e., since the government did nothing to silence the radio host), and that Dr. Laura seemed to have her own agenda with the N-word, and that her PhD is in Physiology, I don’t really have a problem with her. Wait, wait… let me explain why.

Dr. Laura is a shock-jock. Similar to Howard Stern or Rush Limbaugh, she is an entertainer. It is reckless and irresponsible the amount of moral authority we ascribe to entertainers simply because they are commonplace on the airwaves. Do you really think these characters really believe most of the things they say? C’monnnn. Theirs is a business, first and foremost. Controversy, as long as it isn’t too extreme, rules the day in the world of a shock-jock. I’ll say it again…I don’t really have a problem with her.

In fact, I would rather her use the word in my presence, than behind my back. Hey, she believed she was making an intelligent, well-informed argument that would somehow bring the caller to some cathartic realization of her own over-reaction in the presence of the word. I get it. Problem was, it obviously wasn’t all that well-informed or poignant an argument to begin with. But, I digress. I don’t really have a problem with her…remember?

And what about the millions of callers who believe that having a physiologist berate them over the phone will somehow make them feel better—more empowered even—what about them? They aren’t to blame for wanting help. Misguided…misinformed…mistaken…maybe…but, certainly not to blame for yearning for someone to help them. We are constantly inundated with information about treatments offering a quick fix. If you truly could take a pill or make a 5-minute phone call to end all of your ailments, you would try it too. Well, most of you would. So, in that sense, I don’t have a problem with her for trying to capitalize on the insecurities of people. These are primarily adult callers we’re referring to (i.e., I’ve heard children call in over the years as well). She’s just trying to make a buck. I’m not disrespecting her “hustle.” Remember, I don’t really have a problem with HER.

No, my problem is with YOU. Where are you mental health professionals in this discussion? You do realize that Dr. Laura, Dr. Phil, Mr. Mackey from South Park, and Dr. Katz (i.e., the cartoon therapist) all represent you in the eyes of the public. To the uninformed, they do what you do. Therefore, when they do something that reflects poorly on your profession (I was being facetious with Mr. Mackey and Dr. Katz), it also reflects poorly on you. Where is your voice in all of this? I hate to break it to you counselors, but silence and inaction won’t make these things go away. For example, do these shows have disclaimers (i.e., warnings that the show is for entertainment purposes only and not meant to treat, diagnose, etc.)? I don’t know… maybe I just need to stick to doing my Mr. Mackey impressions.

Kenneth Oliver is a counselor in Missouri and an assistant professor at Quincy University in Illinois.

Diana Pitaru

I am not an American; I was born and raised in Romania and although I have American citizenship, I don’t identify as one. I moved to the states 6 years ago and even though it may not seem long, my transition (assimilation) into the American culture has not been easy, well it is not easy since I am still trying to adapt. You can see then, where my interest in multicultural counseling comes from: experience mainly, experience that taught me a lot about being aware of who I am, the importance of where I am from, and what my role is here.

I am even now surprised with how America proclaims itself a pot of multiculturalism, yet many of its people are not really ready to take on the responsibility multiculturalism brings with it. I wonder when the decision was made and whether the people of America were ever asked about their opinion with regards to the definition of multicultural America. I know, forgive my being a little mean and sarcastic but it’s the only way I know –that has worked so far- to deal with being a foreigner in the New World.

I’ve been wanting to be a therapist for a very long time and I’ve been getting myself ready –amongst other things- by being a client, seeing what therapy means from the other side, experiencing with different counselors with different theoretical backgrounds. I am learning a lot from them and what seems –to me at least- to be a recurring theme is this: multiculturalism, the lack of respect and understanding for the different cultures that can be found every two steps you take in America.

In my home country you can’t visit someone (friend, doctor, therapist, etc) empty-handed. It is what it is: whether you are bringing flowers, or chocolates, or cookies it is rude to knock on someone’s door without a gift. Now, you can imagine how embarrassing it was for me when my first American therapist refused my gift and scolded me a little. It took me back when I was 3 and the kindergarten teacher would put me in the corner, to shame for coloring over the lines of the image. How was I supposed to know –after 23 years of presenting gifts to all my hosts- that here it is not only unnecessary, but also frowned upon and unethical?

I know, you’ll quote the ACA Code of Ethics that prohibits us from receiving any gifts from clients. I stopped thinking in such black and white terms a long time ago, not everything is black and white especially in this case where the client has a very strong eastern European accent and just got off the plane. My feelings –as a client- were hurt, I felt ashamed as if I’ve done something wrong, and the last thing I wanted was to pour my heart out to this person who basically judged me right off the bat for who I am –that’s at least how I saw it at that moment-.

In counseling you just can’t take the risk to assume anything about your clients: anything at all. One of the main rules we practice by is not to harm our clients. Culturally competent counselors take all these “little things” into consideration because what might be common sense to you might not be to the client, and vice-versa. We are responsible for treating our clients with respect, keep judgments locked away, and help to the best of our abilities. I personally believe that when dealing with clients from a different culture –and not only, of course- respect for that client should be second nature, not an option.

Diana C. Pitaru is a counselor-in-training, and a student at Walden University. Her theoretical interests are in Gestalt, Art, and Narrative therapy while focusing on multicultural issues and eating disorders.

Kathy Renfree

Last week when I came home from my work at a community mental health clinic, I was exhausted. I made sure that I took time to soothe myself and not make any decisions or have any frank talks that evening. Sure, that helped some, but I could not puzzle out what triggered the exhaustion.

As counselors, we are often the holders of secrets, the receivers of stories filled with emotions, and the givers of relief. We receive training in theories, in ethics and pathology, and we are often supervised to make sure we take care of ourselves. So I was thinking – had I somehow neglected myself recently? Was I not feeling well, or did I have my own problem to solve or work through? None of those fit, leaving me a bit chagrined that I could not figure out my own issue.

I contemplated more; I took a break by reading fluff and enjoying every minute of it. But it still bugged me that I could not articulate what exhausted me. It took a few days and then I started to see through the fog I created (my blind spot). As I reviewed the clients and the work that we had done I realized that the emotions present were not the “popular” emotions that get a lot of press e.g. anger, sadness, despair, or disappointment. I refer to these as popular because, for me, they are the emotions that I see every day, either with clients or on the news, in movies or other media. We can describe them easily and connect them to rather mundane events. “I was mad at him because he was late for dinner”, or “I felt so alone, as if no one cared about me because they didn’t ask me out”. I think most of us have an easy time providing an empathic response to the popular emotions. We do not have to dig too deep to find our own experiences in order to understand where the client “is”. As I dug even deeper, I found that many of the emotions that surfaced last week were ones not easily described, not easily spoken, and are often blanketed in secrecy as our bravado steps up to ward off anyone seeing a crack in the façade.

What I discovered was that the emotions of shame, guilt, and embarrassment were present last week. They crept out from behind the wall of appearance. They insinuated themselves in conversations and narratives. The leapt onto the table and stamped their feet and shouted, “we’re here” “pay attention” “we’ve waited for this moment so long!” Imagine their visit, uninvited surely, us holding the door closed as they tried to get in. However, it was time, time to stop avoiding their visit. No more drawing the blinds and not answering the phone. They were here to stay, and they brought along their companions – sexual abuse, neglect, physical abuse and alcohol and drug abuse.

It is never (and I will say never) easy to be with the overwhelming pain, shame, guilt or embarrassment of an adult, whose child voice enters the room and recounts unspeakable acts. The world stops for a moment, the lights dim to honor the courage spilling into the office. Words are whispered, because saying them softly eases them into reality – into the present. The adult speaks of relief and freedom in sharing the secrets. The child, emboldened, no longer hides behind the adult but walks beside them.

For me, traumas, experienced vicariously. I understood why I was exhausted now and I knew I needed to share what I experienced as I listened to my clients. As counselors, we are encouraged to seek supervision, and or seek therapy at times like this and it is important that we do just that. As time passes, we regain our strength, enough for us to receive and hold again, and to give relief not only to the clients but also to ourselves. Especially when shame, guilt and embarrassment come to visit. How do you give relief to yourself? I invite you to share your thoughts.

Kathy Renfree is a counselor in a community mental health setting, teaches in a graduate counseling program as needed, and is looking forward to building a private practice.