Understanding Cultural Variables in Treatment: A Multicultural Perspective
This content explores the significance of cultural variables in treatment, emphasizing the importance of multicultural competence for counselors. It covers defining multicultural aspects, key personality attributes for multicultural competency, risks of lacking multicultural competence, and different perspectives on cultural blending in America. The images provided visually enhance the concepts discussed.
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Conceptualizing Cultural Variables in Treatment Michele D. Aluoch, LPCC 2017
Defining Multicultural Language Race- the biology of a person, sociopolitical Culture Ethnicity- construct based on shared language, culture, traditions, and history Gender Age Socioeconomic status Spiritual views/other values
Defining Multicultural CULTURE = any group of people who identify or associate with one another on the basis of some common purpose, need, or similarity of background (e.g. music, living arrangements, beliefs, hobbies, etc.), those who have agreement about the way its done (Hendricks, K.T., 2005)
Defining Multicultural the coming together of two or more people from different cultural backgrounds in a helping relationship. (Torres-Rivers, E., Phan, L.T., Maddux, C., Wilbur, M.P., & Garrett, M.T., 2001)
What do we call America? Melting pot- put all into one culture Tossed salad- distinct yet create a new whole Patchwork quilt- interdependent yet unique
Multicultural Competence Multicultural competence- the extent to which counselors possess appropriate levels of self-awareness, knowledge, and skills in working with individuals from diverse cultural backgrounds
Key Personality Attributes: Multicultural Competency Emotional stability- when new and potentially stressful situations Social initiative- taking initiative to approach what s new and different Flexibility- How new situations may be interpreted
Risks if Not Multiculturally Competent Without training: Cultural encapsulation Reactions based on stereotypes Ignoring cultural differences Avoiding critical subjects Focusing on techniques to the exclusion of client factors KEY= Counseling is not culture free!!!
Our Solution: Cultural Immersion (Barden, S.M. & Cashwell, C. S., 2016) Real world exposure to various cultures Development of critical consciousness Movement from interest in knowing more to advocacy and social justice Counselor as guest in other s world Includes interaction with community members Beyond the counseling office Living their ongoing narrative Developmental connections one might not ordinarily have Letting go of the way I do it
History of Multicultural Counseling (Robinson, D.T., & Morris, J.R., 2000) Used to be called minority counseling. As recently as 2000, only 80% required multicultural counseling and only at the one course level. Only 49% of psych /counseling programs integrated the issue of multicultural counseling across courses
Multicultural Counseling Domains professional identity social and cultural diversity human growth and development career development helping relationships group work assessment research and program evaluation
Methods of Equipping Counselors to be Multicultural Competent Taking a multicultural course Infusing multicultural content into courses Both of above
Methods of Equipping Counselors to be Multicultural Competent Traditional strategies- reading assignments, videos, lectures Exposure strategies- presentations by a representative of a given group Participatory strategies- class discussions, simulations, role plays re. personal views, biases, and life experiences Experiential exercises- exchange counseling, community based interventions, use of clinical games in class
The Key Determinants of Culture (Blount, A., & Young, M. E., 2015) Which is more important: past, present or future? How do you view human nature: basically good or evil? What are your views on cohesiveness of the family- should immediate family be our new family or are we enmeshed with families of origin? Emotions: to what extent should emotions be expressed? Whose needs take precedence- the individuals or the familys? How are gender roles defined?
How did I get here? Korn, L., 2016 Who am I? Who are my people? Where do I come from? What is my heritage? Is there a migration story?
Understanding Me- Teach Me Exercise My Top Ten Something about who I am Something about my gifts, talents, hobbies Something about my beliefs, values, priorities Significant memories or issues that have shaped my life What I ve conquered or learned My hope and dreams Things which represent what s of most value to me
Who is my family? Nuclear family? Community? Nontraditional? Who eats together? Who does life day to day together? What is acceptable in terms of physical affection? How are emotions expressed/concealed? What are roles and responsibilities supposed to be? How do I compare to what others in my environment believe?
Role Models Who I learn from? Who influenced me? How I best learn and grow? Who I allow in my story? Who I would change in my story? What aspects? My superheros? What I learned and overcome, changed, or developed over time in relation to others?
Multicultural Supervision Successful multicultural supervision- things you said or did (as the supervisor) that led to successfully facilitating the supervisee s growth and development as a person and a professional or that led to a successful bridging of ethnic/cultural barriers between the supervisor and the supervisee. (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)
Why Multicultural Training Is Important Changing population of U.S. Issues of rapport building and empathy Reducing premature termination Remaining client focused Designing individualistic effective intervention Reducing risk for operating beyond scope of practice Awareness of competencies needed with different cultures To reduce risk of cultural encapsulation To begin to correct incomplete and inaccurate assumptions that may lead to misdiagnosis or unhealthy applications of treatment To remain clinically relevant to the needs of each individual To test the organizational mission, policies and procedures, and approaches used for applicability to all persons served
Multicultural Games- Purposes To sensitive counselors in training to potential issues To overcome sense of powerlessness To deal with the norms of society vs. personal norms To allow for childlike discovery of important factors To test and experiment with approaches with different cultures
Multicultural Games- Examples: Bafa Bafa- * simulated cultures (Apha and Beta groups- each learn everything about the other culture then interact and then switch) Step Forward/Step Back- like Mother, May I? * Characters created with various cultural attributes * May move forward or backward so many steps based on the degree to which some things may or may not be factors in a cultural character s life Cultural Jeopardy- *Used to recall and apply knowledge of information about cultures May I help You?- *game of trying out counseling approaches on various cultures of clients and seeing how it goes Evaluation: experiences, feelings, knowledge, self awareness
Teaching Multiculturally Fier, E.B., & Ramsey, M., 2005 Instructors need to examine own biases Gaps in ethical codes Requires that the power differential and hierarchy be minimized
Testing Multiculturally Hill, J.S., Robbins, R.R., & Pace, T.M., 2012 Tests not normed on various cultures Tests invalid for cultural issues and pathology Ex: MMPI-2
Multicultural Assessment Gerstein, L.H., Rountree, C., & Ordonez, A., 2007 Counselors- go in with hypothesis and tend to seek confirmations- confirmation bias Anthropologists- open ended, hear the story Ideals, beliefs, values, explanations, evaluations, symbols, historical stories, behaviors, experiences Suggestion- move toward this open-ended, client driven approach for assessment
Supervisory Behaviors in Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Creating a safe environment for discussion of multicultural issues, Developing my own self awareness about cultural ethnic identity biases Communicating acceptance of and respect for supervisees culture Listening to and demonstrating genuine respect for supervisees ideas about how culture influences the clinical interaction Providing openness, genuineness, empathy, warmth, nonjudgmental stance Validating integration of supervisees professional and racial/ethnic identities and helping to explore potential blocks to this process Discussing and supporting multicultural perspectives as they relate to the supervisee clinical work
Supervisory Behaviors in Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Tending to feelings of discomfort experienced by trainees concerning multicultural issues Supporting supervisees own racial/ethnic identity development Presenting myself nondefensively by tolerating anger, rage, and fear around multicultural issues Providing supervisees a multiculturally diverse caseload to ensure breadth of clinical experience Attending to racial/ethnic ethnic cultural differences reflected in parallel process issues (supervisor/supervisee and supervisee/client) Discussing realities of racism/oppression and acknowledging that race is always an issue. Acknowledging, discussing, and respecting racial/ethnic multicultural similarities and differences between myself and supervisees and exploring feelings concerning this
Supervisory Behaviors in Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Addressing a broad range of differences (e.g. learning styles, interpersonal needs, social orientation, religious/spiritual beliefs, and race) Checking out the supervisory expectation with supervisees Initiating discussion about the importance of culture Acknowledging and discussing power issues in supervision that may be related to racial/ethnic multicultural differences Encouraging supervisees to share, within supervision, their personal and professional cultural background and experiences Consulting colleagues willingly about my own reactions to racial/ethnic concerns from supervision Acknowledging my own lack of knowledge on racial/ethnic multicultural differences and inviting supervises to give me feedback and teach me
Supervisory Behaviors in Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Testing hypotheses about my supervisees, not accepting just one view Self-disclosing aspects of my own cultural background Engaging supervisees in peer review with each other's cases through case conferences Seeking understanding of supervisees' culture through both didactic and experiential means on my own Providing written and verbal feedback regarding supervisees' multicultural interactions with staff and clients Providing multicultural readings and related training experiences for supervisees Being willing to confront supervisee's inadequate skills, listening if that is challenged on grounds of cultural insensitivity, but not backing away from my own standards and values
Supervisory Behaviors in Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Allowing supervisees to see my clinical work in cross-cultural counseling and/or consultation through tapes or live observation Letting supervisees take responsibility Providing supervisees with information about various cultures Offering supervisees mentorship and other collaborative professional opportunities with me (e.g., co-led presentations, coauthored papers) Departing from Western theoretical perspectives in supervision Having supervisees keep a journal that documents personal reactions to interactions with seminar facilitator and intern colleagues
Supervisory Behaviors in Unsuccessful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Lacking awareness regarding my own racial/ethnic/cultural biases and stereotyping Overlooking and/or failing to discuss cultural issues Becoming defensive around racial/ethnic/cultural issues Failing to establish a working alliance and safe environment Not recognizing the power of the supervisory role Making assumptions about the supervisees' experiences or beliefs, based on their ethnicity or culture Presenting a particular point of view that was rigid and dogmatic Ignoring gender issues in relation to cultural/socioeconomic backgrounds of myself and my supervisees Not acknowledging or discussing racial/ethnic/cultural differences between myself and my supervisees
Supervisory Behaviors in Unsuccessful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Not exploring together the impact of different cultural, socioeconomic, and gender backgrounds on how we conceptualize clients and the therapy process Being inattentive and insensitive to supervisees' insecurities in addressing muiticulturalism/racism Not supporting and encouraging a supervisee's own racial/ethnic identity development Not having a diverse caseload for supervisees thus limiting opportunities for discussion of racial/ethnic/cultural issues Failing to recognize my own position of racial/ethnic privilege Treating supervisees as "spokespersons" for their whole racial/ethnic group Invalidating importance of multicultural supervision by not dedicating enough time to it
Supervisory Behaviors in Unsuccessful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Not exploring together the impact of different cultural, socioeconomic, and gender backgrounds on how we conceptualize clients and the therapy process Being inattentive and insensitive to supervisees' insecurities in addressing muiticulturalism/racism Not supporting and encouraging a supervisee's own racial/ethnic identity development Not having a diverse caseload for supervisees thus limiting opportunities for discussion of racial/ethnic/cultural issues Failing to recognize my own position of racial/ethnic privilege Treating supervisees as "spokespersons" for their whole racial/ethnic group Invalidating importance of multicultural supervision by not dedicating enough time to it
Supervisory Behaviors in Unsuccessful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Not learning about and considering supervisees' racial/ethnic/cultural background Not acknowledging and encouraging supervisees when they use issues of ethnicity in an appropriate and relevant manner in the course of their work with clients Assuming supervisees' cultural awareness without justification Having poor boundaries that were intended to create openness but instead contributed to dual role conflicts with supervisees Insufficient consultation/peer supervision for me to work out my own racial/ethnic/cultural issues Not inviting supervisees to bring [it] to my attention if it feels [to them] that I have done/said something they see as racial Inhibiting my own interventions for fear of being perceived as culturally insensitive
Supervisory Behaviors in Unsuccessful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Assuming, without justification, a racial/ethnic/cultural barrier being a developmental issue for the client Focusing too much on content and not enough on process Misinterpreting body language/nonverbal communication of supervisees Lack of focus on mutual goal setting Becoming too preachy about racism/prejudice Allowing discourse that may inhibit supervisees' free expression Discussing power issues in individual context only and not in a cultural context Not providing enough structure for supervisees who held culturally based expectations for structure Addressing issues of race/ethnicity/culture with supervisees who are not ready for them Demonstrating workaholic style that intimidates supervisees
Cultural Issues in Supervision (Hook, etc., 2016) Self awareness- how does my own reality influence supervision and client therapist interactions? Knowledge- do I have the appropriate knowledge for the populations I am working with? Skills- am I aware of culturally relevant interventions? Initiating discussions about the role and impact of cultural variables Emphasize with and validate that all cultural viewpoints have some validity
Cultural Issues in Supervision (Hook, etc., 2016) Dangers of Not Broaching Multicultural Issues Believing issues are color blind or that every issue definitely has racial, ethnic or other multicultural piece that has to be addressed There are no unfair biases in society anymore- everyone s equal If people want help they should pull themselves up by their bootstraps and do what they need to Assumption that there are no within group differences- all people with a certain feature (e.g. all whites/blacks, all poor/rich people, all men/women, all people of ___ religion, all ____ are the same) Believing that each of our limited experiences give us an accurate realistic foundation upon which to make judgment.
General Guidelines Should be both practical and clinical Balance between narrowly defined characteristics of a culture versus individualized characteristic across culture Letting the client determine how central/not important cultural issues are Should be both didactic and experiential Should be integrated into the counselor s professional identity Should be incorporated into clinical supervision, practicum, internships, and ongoing clinical interactions
Areas of Multicultural Competencies To Address Attitudes Self awareness- cognitive and affective Sensitivity to others Personal background/life experiences Personal limits of competency Sources of discomfort Knowledge Personal multicultural heritage Historical oppression, discrimination, stereotyping Social impact of personal style and values
Areas of Multicultural Competencies To Address Skills Training Relevant research Active involvement with cultural groups outside counseling office (not clients) Ongoing consultation Culturally appropriate interventions Bilingual (if helpful) Awareness of appropriate referral sources and resources in the community Willingness to adapt as needed (assessment/testing, evaluation, clinical goals, style)
Self Evaluation- Multicultural Competency Relinquishing absolute truths Accepting multiple perspectives Critically analyzing techniques and interventions to choose ones with best fit for a given client Hearing how someone s cultural traditions, values, beliefs, and worldviews affect their intrapersonal and interpersonal interactions
Self Evaluation- Multicultural Competency Developing interventions which are culturally sensitive Refuse to use counseling approaches which produce negative, oppressive, or unethical results
Key Personality Attributes: Multicultural Competency Emotional stability- when new and potentially stressful situations Social initiative- taking initiative to approach what s new and different Flexibility- How new situations may be interpreted
Multicultural Counseling Skill Subscale Items Green, R.G., Klerman, Stern, M., Bailey, K., Chambers, K., Calridge, R., Jones, G., Kitson, G., Leek, S., Leisey, M., Vadas, K., Walker, K. (2005): See 50% of my clients more than once Recognize cultural mistakes quickly and recover Use several methods of assessment Able to distinguish between need for brief and long term services Effective crisis interventions Various practice skills and techniques Compatible verbals and nonverbals
Multicultural Counseling Skill Subscale Items Solving problems in unfamiliar settings Having an understanding of racial and ethnic minority groups. Understanding the legalities of immigration. Extensive professional or collegial interactions with minority individuals. Enjoying interacting with people from different cultures. Advocating for people of different cultures. Seeking workshops on multicultural competency
Multicultural Counseling Skill Subscale Items Understanding the roles of age, gender, SES, roles. Self examination of cultural biases. Knowing and applying research methods regarding multicultural practice. Awareness of changing practices for populations served. Monitoring any defensiveness. Working with clients on issues of acculturation if needed. Dealing in non-stereotyped ways.
Multicultural Competency Caldwell, L.D., Tarver, D.D., Iwmoto, D.K., Herzberg, S.E., Cerda-Lizarraga, P., & Mack, T. (April 2008). 1. Color blindness- more homogenous classification of clients 2. Client focused 3.Acknowledegmnet of individual differences 4. Textbook consistent treatment 5. Skills- based 6. Self integration
Our Solution: Cultural Immersion (Barden, S.M. & Cashwell, C. S., 2016) Real world exposure to various cultures Development of critical consciousness Movement from interest in knowing more to advocacy and social justice Counselor as guest in other s world Includes interaction with community members Beyond the counseling office Living their ongoing narrative Developmental connections one might not ordinarily have Letting go of the way I do it
Cultural Auditing Collins, S., Arthur, N., & Wong-Wylie, G., 2010 To make sure counseling assessment and interventions are consistent with what is helpful for the client 1. establishing rapport What conflicts in values might arise? How might my prior history of working with clients from a similar group affect my working with this client? What are my client s cultural norms?
Cultural Auditing Collins, S., Arthur, N., & Wong-Wylie, G., 2010 2. development of trust and respect: What information about the counseling process might the client require to understand the roles and processes involved? What do I bring to this encounter as a person who will support or hinder the development of trust and respect? What can I do to enhance credibility as someone who can help the client reach his or her goals?
