Cultural Variables in Treatment: A Multicultural Perspective
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Conceptualizing Cultural
Variables in Treatment
Michele D. Aluoch, LPCC
2017
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)
Defining “Multicultural”
Melting pot-
put all into one culture
Tossed salad
- distinct yet create a new whole
Patchwork quilt-
interdependent yet unique
What do we call “America?”
Multicultural competence
- the extent to
which counselors possess appropriate
levels of self-awareness, knowledge, and
skills in working with individuals from
diverse cultural backgrounds
Multicultural Competence
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
Key Personality Attributes:
Multicultural Competency
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!!!
Risks if Not Multiculturally
Competent
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
Our Solution: Cultural Immersion
(Barden, S.M. & Cashwell, C. S., 2016)
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
History of Multicultural Counseling
(Robinson, D.T., & Morris, J.R., 2000)
professional identity
social and cultural diversity
human growth and development
career development
helping relationships
group work
assessment
research and program evaluation
Multicultural Counseling Domains
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
Methods of Equipping Counselors to
be Multicultural Competent
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?
The Key Determinants of Culture
(Blount, A., & Young, M. E., 2015)
Who am I?
Who are my people?
Where do I come from?
What is my heritage?
Is there a migration story?
How did I get here?
Korn, L., 2016
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
Understanding Me- Teach Me
Exercise
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?
Who is my family?
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?
Role Models
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)
Multicultural Supervision
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
Why Multicultural Training Is
Important
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- Purposes
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
Multicultural Games- Examples
:
Instructors need to examine own biases
Gaps in ethical codes
Requires that the power differential and hierarchy be
minimized
Teaching Multiculturally
Fier, E.B., & Ramsey, M., 2005
Tests not normed on various cultures
Tests invalid for cultural issues and pathology
Ex: MMPI-2
Testing Multiculturally
Hill, J.S., Robbins, R.R., & Pace, T.M., 2012
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
Multicultural Assessment
Gerstein, L.H., Rountree, C., & Ordonez, A., 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 Successful
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
Supervisory Behaviors in Unsuccessful
Multicultural Supervision
(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)
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.
Cultural Issues in Supervision (Hook, etc., 2016)
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
General Guidelines
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)
Areas of Multicultural Competencies
To Address
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
Self Evaluation- 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
Key Personality Attributes:
Multicultural Competency
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 Counseling Skill
Subscale Items
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
Multicultural Competency
Caldwell, L.D., Tarver, D.D., Iwmoto, D.K., Herzberg, S.E., Cerda-Lizarraga,
P., & Mack, T. (April 2008).
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
Our Solution: Cultural Immersion
(Barden, S.M. & Cashwell, C. S., 2016)
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?
Cultural Auditing
Collins, S., Arthur, N., & Wong-Wylie, G., 2010
3.
Potential influences of culture on interventions
:
Clients willingness to return to counseling?
What ere the client’s norms with relationship to time,
scheduling, and who participates in counseling?
4.
Potential influences on the client
:
What assumptions do I have about this?
What do I assume is similar? Different?
What are my hypotheses about the client’s concerns? What
aspects of my worldview might conflict with this client?
Am I open to modifying my assumptions?
Cultural Auditing
Collins, S., Arthur, N., & Wong-Wylie, G., 2010
5.
View of culture on presenting concerns
:
What do I believe about human nature and development?
What assumptions do I have about change?
6.
Client’s views on presenting concerns
:
What is the client’s sense of where the problem is located?
How might the client’s conceptualization differ from mine
because of his cultural identity?
Cultural Auditing
Collins, S., Arthur, N., & Wong-Wylie, G., 2010
7.
Sociopolitical influences
:
What is the role of acculturation?
How might my own level of identity support or hinder
my client?
8.
Definition of client goals
:
What methods are consistent with the goals the client
would like to see?
Cultural Auditing
Collins, S., Arthur, N., & Wong-Wylie, G., 2010
9.
Influences of culture on interventions
:
What types of interaction would address this client’s presenting
concerns?
Am I open to incorporating native practices?
What would the client consider indicators if success?
10.
Client progress in counseling
:
Indicators of success?
11.
The influence of culture on termination
:
What are cultural meanings of endings for this person?
Cultural Auditing
Collins, S., Arthur, N., & Wong-Wylie, G., 2010
1. increase self awareness
2. account for clients’ multiple identifications
3. form working hypotheses
4. establish base rates
5. determine sociocultural and sociopolitical contexts
6. find unique qualities
7. determine physical factors
8. psychological conditions and stressors
9. find out which identities shifted over time
Multicultural Assessment Areas
Braun, F.K., Fine, E.S., Grief, D.C., Devenney, J.M., 2010
Video Interview of
Michele Aluoch
Components of Effective Multicultural Counseling
Empathy in general
:
1.
understanding the person’s frame of reference
2.
communicating that understanding to him/her effectively
Cultural empathy
: “retaining one’s separate cultural identity and
simultaneously being aware of and accepting cultural values
and beliefs of the client.”
1. validating the inner experience of the client
2. acknowledging the client’s subjective world
Counseling Empathy Versus Cultural Empathy
Verbal Communication
Language
Phrases
Slang
Nonverbals
Touch
Look
Gestures
Intonation
Dress
Smell
Body movements
Proximity
Counseling Empathy Versus
Cultural Empathy
Are there some things that should be universal for all
people?
Are there some truths and factors that are mostly
agreed upon?
Opposite moral relativism
Criteria=90% or more
Alternative View: Universalism
Kinnier, R.T., Dixon, A.L., Barratt, T.M., & Moyer, E.L. (January 2008)
Describe what the client is experiencing in words he/she can
validate.
Express interest in learning more about the client’s experience.
Clarify language and communication meanings.
Convey an honest desire to be helpful to the client
Face, rather than ignoring or overlooking, cultural differences.
Discuss cultural differences if they are central and pertinent to
that individual’s counseling.
You feel ______________
when/because _____________
and in the future you wish _________________.
Get 3 Yes es.
Cultural Empathy
Sincerity
-
good intention, real-ness
Service energy
- Communicating client value
Knowledge of the client’s culture
- experience, study/research, or allowing
client to teach you
Nonjudgmental
-
avoiding jumping to conclusions and personal prejudices,
framing in context, let go of being “the authority”
Resourcefulness
-
Linking to community resources
Sensitivity
-
awareness of what is/is not an issue for that client
Historical awareness
- knowing the background of this cultural group,
society, gender, community, religious or political group, etc.
Ongoing critical reflection
- ongoing personal assessment and assessment of
the counseling situation
Effective Cross- Cultural Counseling
R religious/spiritual
E
economic class
S sexual identity
P psychological development
E
ethnic/racial identity
C chronological issues
T trauma and threats to well being
F family issues
U unique physical issues
L language and location or residence issues
RESPECTFUL
(D’Andrea, M., & Heckman, E.F., 2008)
Building self-esteem
Learning to set boundaries
Developing assertiveness
Increasing self care
Building independent living skills
Promoting individuality/autonomy
Reinforcing belief that equal opportunities are open
to all
Typical “Euro-American” Traditional
Counseling Goals
Promoting collective well-being
Developing relationships with those in their group
Avoiding conflict, maintaining peace
Building a multi-generational identity
Stimulating one’s personal narratives
Aquiescing to others
Deference to authority
Respect for elders
Equilibrium with nature
Unity with others
Fulfillment of family obligations even unto old age
Alternative “Multicultural” Goals
Language barriers
Premature dropout rates and terminations
Different worldviews
Different values
Historical differences in the life narrative
Research marked by opinions rather than much empirical support
Research largely based on self report or subjective report/observation
Little emphasis on within group differences
False impression that multicultural counseling occurs strictly within
distinct racial and ethnic boundaries
Multicultural counseling excludes whites because it implies that “culture”
doesn’t count for them
Challenges with Multicultural
Counseling
Social justice
-
scholarship and professional action designed to
change societal values, structures, policies, and practices, such
that disadvantaged or marginalized groups gain increased
access to… tools of self determination.”
(Steele, J.M., 2008)
Advocacy
- taking action to produce environmental change on
behalf of clients
(Steele, J.M., 2008)
Social Justice: A Role for Counselors?
Equity
- fair distribution of resources, rights, and responsibilities
to all members of society
Access
-ability for all people to access the knowledge, power,
resources, and services that are crucial to realizing a standard of
living that allows for self-actualization and self-determination
Participation
- The right of every person in society to participate
in and/or be consulted on decisions that affect their lives as well
as other persons in their environmental systems
Harmony
- helping individuals make sacrifices with the
understanding that such sacrifices ultimately maintain the best
interests of all persons concerned
Four Critical Principles of Social Justice
(Crethar, H.C., Rivera, E.T., & Nash, S., 2008)
Goal
=empowerment
increased individual control in their lives
development of new skills
reframing in terms of present strengths
Social Justice: A Role for Counselors?
Going beyond the counseling office to tackle issues of cultural
awareness in the community, churches, schools, and legislative
bodies
Learning and educating others on the history of various cultural and
ethnic groups including their values, ethnicity, worldviews, and
perceived factors of oppression or privilege
Actively questioning other counselors who do not seem to be
culturally appropriate or may be exploitive of someone’s culture
Promoting and using only culturally relevant interventions
Facilitating indigenous healing methods when applicable
Advising others re. cultural issues
Being a community representative and agent of change
Largely absent form counseling programs
IS THIS OUR JOB AND ROLE???
Social Justice Tasks
(Steele, J.M., 2008)
Does client-counselor similarity or difference affect outcome of
counseling?
What are effective counseling processes with this
person/group?
What role do acculturation, age, gender, class, religion, etc.
have in this case?
What tools are best for evaluating this client and setting
treatment goals? (tests, life experiences, self/other report)?
Critical Questions to Consider in
Multicultural Counseling
(Tsang, A.K.T., Bogo, M., & George, U., 2008)
Differences in preference between people of different
cultures
Mexican
- seen as unprofessional and less attractive
clinically
African American
- seen as more trustworthy and
professional when self disclosing
Caucasian
- seen as more trustworthy and professional
when self disclosing
Counselor Self Discloure?
(Cashwell, C.S., Shcherkova, J., & Cashwell, T.H., 2003)
1.
Broaching
- continually inviting the client to speak on multicultural
issues
Five styles
:
1.
avoidant
- a race neutral perspective, all people everywhere are the
same
2.
isolating
- approaching topics of race in a simplistic manner
3.
continuing-congruent
- active client invitation to explore issues of
race, gender, and other multicultural issues, looks at both the
culture and the individualistic factors
4.
integrated/congruent
- not only bringing up multicultural topics but
integrating them into the practice of counseling
5.
infusing
- a consistent commitment to bringing up multicultural
counseling, incorporating issues in counseling, and social justice
outside counseling sessions
Counselors are perceived as more credible by clients when they bring
up multicultural concerns directly.
How To Broach Multicutural Issues
in Counseling
(Day-Vines, N.L. Wood, S.M. Grothaus, T., Craigen, L., Holman,
A., Dotson-Blake, K., & Douglass, M.J., 2007)
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.
Dangers of Not Broaching
Multicultural Issues
Prevents misdiagnosis
Prevents a sense of mistrust by clients
Prevents premature termination
Stronger therapeutic alliance
Feeling of therapist being more emotionally present
Allowance for periods of connection and
disconnection
Effects Of Broaching Multicutural Issues
in Counseling
Zhang, N., & Burkard, A.W., 2008
Disintegration
- conflict results from contradictions in beliefs (e.g.
saying you are not racist yet expressing racist views)
Reintegration
- vacillating between approaching and avoiding racial
issues
Pseudo-independence
- A conscious effort is made to interact with
people for different cultures but primarily at an intellectual level
Immersion/emersion
- deep desire to understand the effects of and
prevent against privilege of our culture or discrimination of a culture
Autonomy
- counselors accept their individual roles in terms of
multicultural issues and then move to social justice action regarding
those issues
Status of Counselors
(
Day-Vines, N.L. Wood, S.M. Grothaus, T., Craigen, L., Holman, A.,
Dotson-Blake, K., & Douglass, M.J., 2007)
I never get a chance. You know how it is. All the white execs
oppressing the low level factory worker. Huh? How do they say
slavery is gone when all the executives are all white and all the
entry level folks are always the rest of us? I’m sure you’ve seen it
too. How many black professional counselors have you ever
even met like you?
Exercise: Deciding How, When, and
If To Broach Topics
You probably can’t even have an idea what I’ve gone through.
I’m sure your parents paid your way for a good opportunity in
life. You never had to break new ground to leave the poverty,
danger, lack of opportunities and make a new path. You
probably had your life taken care of since the time you were
born– school, job, finances, opportunities. I’m not sure you
can even counsel me. Everything’s been one struggle after
another for me and what I’ve done l’ve done on my own.
Exercise: Deciding How, When, and
If To Broach Topics
You didn’t say anything about my hair and
piercings! I am sure you noticed. I bet you don’t
sit that far away with other clients. What do you
think? I’ll get you?
Exercise: Deciding How, When, and
If To Broach Topics
Western
VS.
Eastern
Individuality
Relationship
Democratic
Authoritarian
Nuclear Family Focus
Extended Family Focus
Youth Emphasized
Maturity Emphasized
Independence
Interdependence
Assertiveness
Compliance
Nonconformity
Conformity
Competition
Cooperation
WESTERN VERSUS EASTERN
WORLDVIEWS
Western
VS.
Eastern
Conflict
Harmony
Freedom
Security
Individual Needs
Collective Goals
Responsibility w/i indiv
.
Responsibility in
society
Express Feelings
Control Feelings
Uniqueness of each person
Uniformity of each person
Self actualization
Collective actualization
Future Focus/Goals
Traditionalism
Innovation
Conservatism
Morality-internal, individual
Morality-relational
*
Change
is very good*
*
Support
is very good*
WESTERN VERSUS EASTERN
WORLDVIEWS
See video interview
at
www.rolpc.org
on CEU Videos page
WESTERN VERSUS EASTERN
WORLDVIEWS
Age and Generational Factors
Little to no research on cultural identity
Child Counseling
Traditionalists (1900-1945)
People
: Joe di Maggio, Joe Louis, Dr. Spock, Alfred Hitchcock, Rat Pack, FDR, Duke
Ellington, Ella Fitzgerald, Charles Lindberg, John Wayne, Bob Hope, Elizabeth Taylor
Places/Issues:
Pearl Harbor, Normandy, Hiroshima, Korea, Bay of Pigs
Iwo Jima, World War I, Roaring Twenties, Great Depression, New Deal, World War II, Korean
War
Signs of the times
:
Roadsters, drive ins, 45s, record players, the twist
Beliefs:
Values: Loyalty, Patriotism
Retirement is a well earned reward
Work hard now while you can.
Viewed as resistant to change by Gen Xers.
Build a legacy.
Internal rewards of a job well done are most valued.
Age and Generational Factors
Baby Boomers (1946-1964)
Largest group in size
People
:
Martin Luther King Jr., the Kingston trio, Richard Nixon, John F. Kennedy, the Cleaver family, Rosa Parks, the
Manson family, the Osmonds, Gloria Steinem, Barbara Streisand, John Belushi, Janis Joplin, Captain
Kangaroo, Captain Kirk, the Monkees, the Beatles, the Partridge family, the Rolling Stones
Places
/Issues: Watergate Hotel, Kent State, Wooodstock
Signs of the times
: bell-bottoms, mood rings, Brooks Brothers suits, Rolex watches
Beliefs:
Values: optimism, good education, competitiveness
Be productive
Mentality of never retiring, always working
Fight for what you have, work hard, and save
Build the best career and lifestyle you can.
Build from the bottom up by being faithful till you achieve money, title, achievement.
As get older and retire leaving large gaps especially in upper management
Age and Generational Factors
Generation X (1965-1980)
Half the size of baby boomers
People
: Brat Pack, Bill Clinton, Bill Gates, Monica Lewisnski, Ayatollah Komenini, Ted Bundy, Al
Bundy, Beavis and Butthead, Clarence Thomas, OJ Simpson, Madonna, Michael Jackson,
Michael Jordan
Places/Issues
: Starbucks, anywhere TV and media could take you
Signs of the times
:
AIDS, crack, child molesters, drunk drivers, milk cartons-disappearing kids
Beliefs:
Values
: skepticism, technological advancement (cable, digital TV, VCRs, video games, fax
machines, pages, cell phones, Palm Pilots, computers)
It’s okay to change jobs and environment often.
It’s all modifiable and adaptable.
“Show me the money.”
Freedom and flexibility are most important.
Age and Generational Factors
Millenials (1980-1999)
People
: Prince William, Chelsea Clinton, Claire Danes, Leonardo DiCaprio, Kurt Cobain, Courtney Love,
Barney, Britney, Backstreet Boys, Felicity Buffy, Marilyn Manson, Mark McGuire, Sammy Sosa, Serena
Williams
Places/Issues
: 90210, Dawson’s Creek, Oklahoma City, cyberspace
Signs of the times
: technology (born with cell phones, pagers, and computers, I Pods, access to illegal
drugs, Columbine and school shootings, increases in gang violence
Beliefs:
Values
: self identity, appreciation of diversity
Be real with me.
Self entitlement.
Collaborate discuss, compromise.
Entitlement
Take care of the environment
Build parallel careers.
Each person personally defines what is meaningful for him or her.
Age and Generational Factors
Age & Generational Factors
A Video Interview
Be aware of your own national culture and associated meanings.
This does affect your worldview.
Know the cultural worldviews on critical issues of those you are
interacting with.
First meetings/introductions
: Do I verbally acknowledge the
person, give a handshake, bow, or head nod?
Space and distance
Colors
: (worn)America= navy blue is commonly accepted but in
Asia especially India pinks and reds are commonplace, (writing)-
different colors may signify dif. emotions in some cultures
Adapting to Global Cultural
Meanings
Shoes
- on or off feet?
Dress codes
: Generally being cleaned and well groomed is important.
Professionalism should focus on modesty- women (dresses and skirts
at least to the knees, not trousers sometimes), avoid jeans and looks
that made be considered too casual or offensive to some
Gift giving
: Find out the particular meanings in each respective culture.
Sometimes giving a gift is expected but at other times is offensive.
Which festivals are important to each culture and population? What is
the perceived meaning behind a gift? (e.g. pigskin to Hindus or
Muslims, knives to Chinese
Time
: being punctual versus taking time and being more casual,
meanings behind getting tasks completed versus being flexible
Values
: being versus doing
Adapting to Global Cultural
Meanings
Multicultural Approaches to
Therapy
1. A sense of necessity for change
2. Willingness to experience anxiety
3. Awareness
4.Confronting the problem
5.A will to change.
6. Hope for change.
7. Social support for change.
Elements For Multicultural Therapy
Hanna, F.J., & Cardona, B. (July 2013)
Who is the family?
What does this person believe about
sickness and health?
What is the relationship between the individual and
family?
Who makes the decisions in the family?
How do generations relate?
How is self expression and self determination viewed?
What are the nonverbal protocols?
Key Questions To Put Multicultural
Issues in Context
(Hendricks, K.T., 2005)
Distinguished from empirically supported treatment
What clients say meets their needs
Incorporation of the client’s values into therapy
Racial, ethnic, and linguistic matching of the client’s cultural values into
therapy
Therapy provided in the client’s native language
The explicit cultural or multicultural paradigm of the agency providing
services
Consultation with people in the client’s culture
Culturally Sensitive Treatment (CST)
Roysircar, G. (April 2008)
Outreach efforts to underserved clientele
Provision of services like childcare when needed
Oral administration of materials for illiterate clients
Cultural sensitivity training for staff
Knowledge of referrals to outside sources when needed
Culturally Sensitive Treatment (CST)
Roysircar, G. (April 2008)
Cognitive Match Models
Matching the client’s worldview
Case conceptualization
Strategies and treatment approach
Defining the problem
Goals for problem resolution
Skill development methods
Incorporating the client’s worldview, family supports, community,
etc
Culturally Sensitive Treatment (CST)
Roysircar, G. (April 2008)
Racism Acknowledgement Model
:
Addressing oppression
Looking at racial identity development
Recognition of various identities of the individual
Consciousness raising
Culturally Sensitive Treatment (CST)
Roysircar, G. (April 2008)
Acculturation Models
:
Helping sort through needs of family and community closeness
versus individuality
Dealing with double bind messages- country of origin and U.S.
Culturally Sensitive Treatment (CST)
Roysircar, G. (April 2008)
Spirituality/Religious Models:
Psychoeducation
Relaxation/leisure
Affective expression and regulation
Cognitive coping
Narrative development and processing
Family/community
Future development
Culturally Sensitive Treatment (CST)
Roysircar, G. (April 2008)
Cultural Accommodation Model
Leong, F.T.L, 2011
I- individual
U-universal
G-group
Different cultures
emphasize different
aspects
Every man is:
Like all other men (U)
Like some other men (g)
Like no other man (I)
Cultural Accommodation Model
Leong, F.T.L, 2011
Perceived racism- subjective experience of racism and
prejudice based on one’s personal life experiences
Higher discrimination was related to
characterological
attributions rather than
situational
attributions.
Blacks
Women
Lower socioeconomic groups
Client’s Perceptions of
Discrimination
Frequency of familiarity with new groups alone is not
enough
Critical elements:
Willingness to re-examine worldviews and life
experiences
Development of a higher proportion of neutral or
positive interactions with that group
Preferrable between people of equal status
Confronting Racism
DeRicco, J.M., & Sciarra, D.T. (January 2005)
Know Black history
Consider the generally stronger religious and spirituality base
Be prepared to potentially deal with multigenerational or non-
traditional families- aunts/uncles, grandparents taking care of
the children
Listen regarding the role of community
More than other cultures there is extensive literature on what
is called “the drama of opposition” and desire to make
conflict known/externalizing.
Counseling Black/African Americans-
general
Blacks demonstrate more range of movement, quick responses, and
more energy.
Challenges regarding early or premature termination
Depressed moms more likely than nondepressed moms to yell at,
physically punish, or be inconsistent with their children
Supportive father figures are just as effective as biological parents
and may be even more helpful than absentee biological fathers
Peer mentoring and mediation or community supports work as well
as or in many cases better than counseling
Counseling Black/African Americans-
general
A therapy for black American children that incorporates love of rap music
97%- like rap music
50%- but 1 or more rap CDs per month
Based on social psychology and learning theory
Types of rap:
1.
gangster rap
-violence, guns, profanity
2.
materialistic rap
- wealth, possessions, women
3.
political/protest rap
- political issues, racism, sexism,
ethnic identity
4.
positive rap
- education, responsibility, ethnic pride
5.
spiritual rap
- traditional rap with gospel music
A version of narrative therapy
Rap Therapy
(Elligan, D., 2001)
Stages
:
1.
Assessment
- Determining client appropriateness, building rapport with
the client about artists and topics he/she enjoys
2.
Alliance
- Empathy and rapport building, listening and discussing the
music
3.
Reframing
- Attempt to broaden use of rap music (strengths based)
4.
Role play with reinforcement
- Viewing rap as poetry and narrative
5.
Action and Maintenance
- Using writing to initiate actions steps
(behavioral)
Rap Therapy
(Elligan, D., 2001)
Supportive counseling
- strengths based solution focused therapy
reinforcing or expressing approval for completion of tasks and positive
healthy actions
Information giving
- psychoeducational procedures including
disseminating info. on issues of importance to this population (HIV/AIDS,
higher education, underage pregnancies, job opportunities, stress
management)
Cognitive-Behavioral approaches
- identify and confront irrational, self
defeating thoughts
“Studying is a white thing.”
“I won’t live long so I don’t need to look toward the future.”
“Self defense, violence, prison, are cool things. It shows you’re a man.”
“She got pregnant. It’s not my fault.”
“He/she made me hit him/her.”
“There are no jobs out there for me anyway.”
Counseling Techniques Deemed Successful
For Black Americans
(Harper, F.D., Terry, L.M., Twiggs, R., 2009)
Behavioral
Provide developmentally appropriate movies, videos, and
resources rather than adults resources
Community Support
Linkage to churches or other faith based institutions or
community agencies teaching kids positive values
Linkage to business opportunities, job training and
awareness, childcare
Link to prevention programs in the criminal justice system
Counseling Techniques Deemed
Successful For Black Americans
(Harper, F.D., Terry, L.M., Twiggs, R., 2009)
Consider the importance of the collective goals in society.
Focus on their values of respect, pride, and dignity.
Be an expert and knowledgeable on what you are telling them.
Be very direct.
Provide frequent practical technique and application- behavioral
interventions are appreciated.
Do not expect a lot of emotional expression- This is NOT resistance.
Counseling Asian clients- general
Physical approaches to healing are okay to incorporate including medical
treatments and natural approaches.
Asians people tend to value decorum and conformity.
Symptoms of Asian people often do not come out in verbalized emotions but
moreso in physical somatic complaints related to nervousness and worrying.
More focused than other cultures on credentials- are you an authority?- words,
mannerisms, office materials, office décor
Filial therapy is helpful for parent/child/ family issues (teaching parents empathy,
attending, based play therapy tenants
Great success with cognitive-behavioral therapy counseling Chinese- specific,
direct, goal centered, practical
Counseling Asian clients- general
Be prepared to wait in silence a lot, even 1 month of
counseling
Focused on being in the moment with them for long
periods of time
Avoid looking directly at them for extended time as
they are very aversive to what they perceive as
staring.
Counseling Native American clients-
general
Actively acknowledge respect for the family and the parents as
knowledgeable informants.
Tendency to express more emotion in their native language.
Filial therapy is helpful for parent/child/ family issues (teaching
parents empathy, attending, based play therapy tenants
Core values: respect for authority figures, family interdependence,
loyalty to a person once they connect with him/her as professional
Counseling Hispanic/Latino clients-
general
Actively acknowledge respect for the family and the parents as
knowledgeable informants.
Pride about their history, landscape, poetry, folklore, dance, crafts,
and poetry
Many have endured severe poverty and deprivation
Very close knit mutigenerational families live in the same household
Often, multiple changes of jobs to remain in their land
Modesty
Narrative therapies may work extremely well with them
Counseling Appalachian clients-
general
China
:
1980- first family therapy course for grad students
Emphasis on piety, deference, family obligations, duties, collectivism
Parent-child relationships prioritized over spousal relationships
India
:
Marriage is highly regulated
Issues of increasing rates of suicide among youth- 40% of male and
56% of females in age range of 15-29
HIV treatment: women to stay and care for men with HIV but men
need to abandon women with HIV
International Family Therapy
(Roberts, J., etc 2014)
Israel
Family therapy founded in Israel in 1960s so very highly regarded
However, separate Israeli and Palestinian family therapists create
challenges and limitations regarding who will learn the language and
culture of each
Influence of family members in war at any given time= central issue
Trauma issues related to war- significant
Peru
Family therapy or therapies in general mean someone is mentally ill
Problems all considered family problems
International Family Therapy
(Roberts, J., etc 2014)
Turkey
National family therapy centers in connection with courts
Very specific about term “ family counseling” not family therapy”
Uganda
Over 1,000 tribes so very diversified
45 languages and multiple religions
Mostly rural
Family counseling falls under guidance counseling with schools and
health education regarding issues such and HIV/AIDS
Influence of nature and spirit are important
International Family Therapy
(Roberts, J., etc 2014)
Debate over whether evidence-based general practices or
specific culturally relevant practices are better
General evidence-based practices
:
Patients with similar psychiatric conditions tend to benefit
from similar therapies
Although we may have cultural differences we share
similar qualities
Risk: minimizing distinctions and uniqueness
Evidence Based Multicultural Practices
(LaRoche, M. J., Davis, T. M., & D’Angelo, E., 2015)
Racial and Ethnic minority psychotherapies
Address unique needs of specific groups
E.g, Puerto Rican plurismo and familisimo make
interpersonal therapy much more effective than CBT
Empathy and therapy be tailored to each individual
Risk: over-emphasizing differences
In between : Cultural Evidence-Based Psychotherapies
Use of evidence-based therapies but with adaptations as
client determines certain factors to be relevant
Evidence Based Multicultural Practices
(LaRoche, M. J., Davis, T. M., & D’Angelo, E., 2015)
Here and now experiences where client is at
Five facets
:
Observing thoughts, feelings and sensations
Acting with awareness
Describing inner experiences
Remaining nonjudging of inner experiences
Maintaining nonreactivity to inner experiences
Mindfulness and Culture
(Ivers, N.N., Johnson, D., A., Clarke, P. B., Newsome, D. W,., &
berry, R. A., 2016)
Making sure that there is equal access to resources,
rights, and treatment
Counseling Immigrants
PTSD- countries they fled, war-related violence, threat of
personal injury, torture, sexual assault, malnutrition, disease
Dealing with immigration process and officials- stress
Academic difficulties of children
Lack of peer relationships
Frequent moves
Housing concerns
Differences in values between U.S. and previous country of
residence
Financial difficulties
Common Issues For Immigrants
Nilsson, J.E.., Barazanji, D.M., Heintzelman, A., Siddiqi, M., & Shilla, Y.
(October 2012)
Self esteem issues
Hopelessness
Depression
Guilt
Facing discrimination
Feeling isolated
Feeling judged for family, marriage, and parenting
methods
Common Issues For Immigrants
Lack of freedom for kids to run freely (compared to
home country)
Fears about crime, child abuse, societal issues here
Concerns about lack of respect for the elderly
Lack of respect for their style of disciplining their kids
Lack of access to health insurance and benefits
Pessimism regarding the future
Multi-generational conflicts
Common Issues For Immigrants
Nilsson, J.E.., Barazanji, D.M., Heintzelman, A., Siddiqi, M., & Shilla, Y.
(October 2012); Villalba, J.A., (2009)
Third culture kids
Born in one culture and growing up in another culture
What was seen on TV, Magazines, etc. versus
experience in new culture
Dissonance regarding what to identify with
Conflicted sense of self
Multigenerational conflicts
Transculturals
McDonald, K. E.,2011
Over 3% of US population
Kids commonly known as biracial
Kids with multiple identity choices
Children go through intense emotional experiences as
decisions about identity occur
Third Culture or Multi Heritage Kids
(Maxwell, M.)
Listening to the child’s definitions
Determine significance of presence- how prevalent students
with multiple heritage backgrounds are in a given setting
Layered on top of typical childhood and teenage identity issues
Research does NOT support that challenges are worse
Challenges same as others at given developmental stage-
establishing and maintaining friendships, developing a separate
identity from family of origin, moving on with individual
professional and identity pursuits
To process heritage
: bibliotherapy- uniqueness, resourcefulness,
choices, journaling, role plays, group work regarding “Who am
I?”
Multiple Heritage Identity
Development Model (MHID):
Important because in 2008 14.6% of marriages were interracial
In 2010 2.4 million marriages were interracial
In 2010 over 4.2 million children considered biracial
Still often considered rebels, dangerous, and challenging, deviant by
others
Decentralizing race as an issue
Shifting to another core issue other than race
Taking themselves outside the historical narratives of their races and
creating their own narrative
Dealing with faulty assumptions regarding a life of rejection,
stereotypes and failure
Treatment: what are your hot button topics?, How does race play/not
play into things with the two of you?
Biracial couples
Traditional DSM IV TR based on medical model
Does this fit with multicultural competency?
Other cultures – focus on spirituality, holistic approach
rather than disease and medicine
Other counseling focus areas: bicultural competence,
resiliency, independence, flexibility
Need for resourcefulness, community
Placing cultural bound syndromes?
Mental health is only for “insane people”
Wellness Versus Disease
Consulting native healers, shamans, gurus, and
exorcists
Medical field and professional looked down upon
Extended family and community is agent of change
Arranged marriages and families with 10% or less
divorce
Input of family is essential
No such concept as family therapy
Wellness Versus Disease
Emotional pain
Somatic symptoms
Bad luck or curses from others watching or tracking
me
Regional fables or narratives
What is Distressing?
Needs to be considered to truly have cultural
empathy
What constitutes professional help
Examples
: Acupuncture, bioenergy, evil eye, herbals,
healers, homeopathy, hypnosis, meditation,
miraculous healing, prayer, deliverance, priests,
voodoo, shamans, herbals, vitamins,etc.
Nonconventional Healing and
Alternative Medicine
Immigrant Issues
Video Interviews
1. What are your views concerning religion and
spirituality?
2. How do you believe these views will affect your
counseling role?
3. How will you be able to empathize with clients who
have differing spiritual values than your own?
4. How will you keep your own spiritual values/beliefs
from inappropriately influencing the counseling
relationship?
Counseling People with Spirituality
Issues
Narrative story about your spiritual journey (factors that
shaped it, people/places, significant events, where you
believe you are at today versus where you’d like to
be/think God wants you to be, etc.)
Role play with different types of clients what it might be
like to counsel a person from differing faith or spirituality
beliefs.
Consider what a “holistic” approach means to you. What
skills would you need to develop competencies to work
with people of different ages, races, beliefs, religious,
spiritual approaches?
Developing An Awareness of Role of
Spirituality in the Counselor’s Life
(Turton, 2004; Belaire, Young, Elder, 2005; )
Expected respect for their worldview and acceptance
Expected that religion and spirituality would definitely be included as a significant part of the
counseling process. May include (determine on a case by case basis):
Moral teachings
Scriptures or Bible verses
Praying in Session
Listening to story of their conversion or changes from past conversion, current
struggles, etc.
Hearing some thing about the counselor’s spiritual experience, moral beliefs,
lifestyle, or conversion experiences
Collateral consultation with clergy pastors, or religious “authorities” that the
client can relate to or is accountable to
Use “religious language” in session
Use religious examples, stories, or parables
Be willing to learn about client’s personal spiritual experience, denomination,
journey.
Refer client to someone who understands or can better empathically relate if needed
Accept the religious practices and rituals that are part of client’s experience.
Expectations of Conservative
Christian Counseling Clients
What Evangelical Christians Want From Counse
Prefer
Non Directive Approach
Expect to leave the counseling session with their lives “
spiritually
stimulated
”
Expect to be encouraged to
apply and further Biblical understanding
Goal of Counseling
: Closer relationship with God, more fervent prayer life,
a lifestyle that is consistent with traditional Biblical es, direct
discouragement and challenging of lifestyle and behaviors inconsistent
with the values they are stating they espouse
Overall
: Less likely to attend counseling of the counselor is not a Christian
and does not share their religious orientation (95%); Religious/spiritual
beliefs affect my daily decisions (98%)
Expectations of Conservative Christian
Counseling Clients (Continued)
Five Common Belief Systems of Conservative Christians to be
Aware of in Counseling
:
1)
Self
- focusing on oneself is selfish and is a sin
2)
Truth
- Christianity is the only true way to God
3)
Answers to problems
- the Bible is the answer book
4)
Feelings
-joy and peace are only acceptable
5)
Social issues
- divorce, homosexuality, abortion are not to be
participated in
How would you handle someone who possibly espouses any of
these beliefs?
Beliefs Of Conservative Christians That May Clash with
Traditional Counseling
(Eriksen, Marston, & Korte, 2002)
12 Sample Questions:
1. Do you wish to discuss spiritual issues in counseling when
relevant?
2. Do you believe in God?
3. What is God to you?
4. Is spirituality important to you (scaling)
5. Do you have a religious affiliation? Imp.to you? (scaling)
6.Do you attend a church, synagogue, or another gathering
place?
7. How closely do you follow the teachings of your religion?
Doing a Clinical Counseling
Assessment Incorporating Spirituality
8. How do you experience God’s guidance in your personal
life?
9. Are you aware of any spiritual resources or practices in
your life that could be used to help you cope with or solve
your problem? What are they?
10. Anything about your spirituality or religious community
that concerns you?
11. Would you like your counselor to consult with your
spiritual/religious leader if this could be helpful to you?
12. Are you willing to consider trying religious or spiritualty
based suggestions from your counselor if they could be
helpful to you?
Doing a Clinical Counseling
Assessment Incorporating Spirituality
For self reflection, understanding of spiritual and
religious practices and family systems and multi-
generational dynamics
Charting a spiritual family tree
Spiritual Genograms
(Willow, Tobin, & Tomer, 2009)
Using proven REBT- Rational Emotive Behavior
Therapy (Albert Ellis) but incorporating client belief
systems and spiritual worldview
Rational Christian Therapy
(Johnson, 2006)
Common Misbeliefs in the Counseling Literature
:
God must answer my prayers as I’d like them to be answered.
I absolutely should always be loved unconditionally by all my fellow
churchgoers/Christians.
I ought to undeniably be obeyed by other when I quote Scriptures
to defend my position.
I must never be judged but totally accepted as I am.
I must always be judged
If only I work hard “enough” then God will see that I deserve _____.
Good people should always have “good” things happen to them
and “bad” people should have “bad” things happen to them.
(justice perspective)
People should have mercy on me but they should get what they
deserve (justice).
I must spend the rest of my life paying back for what I said, did, etc.
Rational Christian Therapy
(Johnson, 2006)
Focuses on the interpersonal exchange
Goal- Increasing the number of exceptions to the problem: Observations of
times clients are without the problem, observations of times where the
problem is more resolved (client as expert observer in his/her world)
What treatments are effective for whom and under what circumstances”
Helpful questions:
Was there a time you coped better?
How did you manage?
The miracle question
Consistent with Christian spirituality: God intervening from the future to
impact the present & humans as agents in collaborative partnership with
God (Frederick, 2008)
Solution-Focused Counseling For Clients With
Spiritual Concerns (Guterman & Leite, 2006)
Teachings of Prophet Muhammad
Holy Book- Qur’an
Key behaviors:
1. Pray 5 times per day
2. fast I the month of Ramadan
3. give charity
4. perform the pilgrimage to Makkah at least once in lifetime
Beliefs and practices regarding abstaining fro alcohol
Beliefs and practices regarding modest dress
Importance of role of extended family- multigenerational
Counseling American Muslims
Ahmed, S., & Reddy, L.A., 2007
PTSD symptoms
Self esteem issues
Hopelessness
Depression
Guilt
Facing discrimination
Feeling isolated
Feeling judged for family, marriage, and parenting
methods
Counseling American Muslims
Three categories:
1. detachment or denial of Islam
2. acknowledgement that Islam carries some meaning
3. recognition that Islam is the central principle in
their lives
Counseling American Muslims
Counseling Clients For Whom
Spiritual Worldview May Be a
Factor
Watch videos on Spirituality and Counseling video CEUs
“What Good Is God Anyway?” Video
“Grieving Father Is Angry at God” video
“Dealing with Offenses: Can’t Forgive Self” video
Treatment Goals
:
Helping them develop a worldview tied to their
physical, emotional, and mental wellness.
Helping them draw on collective strengths often
overlooked
Overcoming negative prejudices and stereotypes
Increasing awareness of biases within the counselor,
community, etc.
Social justice and advocacy
Counseling People With Disabilities
D’Andrea, M., Skouge, J., & Daniels, J., 2006
Examine personal prejudices about people with disabilities
(blame, shame, guilt, fear)
Focus on positive attributes of cultivating hopes, dreams
Helping foster creative problem solving regarding this
group
Constructing opportunities for people with disabilities
Assist in fostering inclusion
Awareness of communications and technologies available
Counseling People With Disabilities
D’Andrea, M., Skouge, J., & Daniels, J., 2006
If cultural context is not properly understood clients may be at
risk for more severe diagnosis.
Examples
:
Hispanics 1.5 times more often diagnosed with schizophrenia
than whites.
African Americans are more likely than whites to be diagnosed
as schizophrenic, substance abusers, and having dementia.
Those with lower educational levels are more likely to be given
schizophrenia as a diagnosis rather than mood disorders
Diagnosis In The Multicultural Context
(Hays, D., G., Prosek, E.A., & McLeod, A.L., 2010)
Women are more than twice as likely to be diagnosed with
mood disorders than men.
Men are much more frequently diagnosed as avoidant
personality, antisocial paranoid, and schizoid than women
whereas women are more likely diagnosed as histrionic
and borderline
Solution-
counselor should re-assess diagnostic situations
from a situational locus of control rather than a locus of
control which blames the internal makeup of the client.
Diagnosis In The Multicultural Context
(Hays, D., G., Prosek, E.A., & McLeod, A.L., 2010)
Therapeutic Exchange
Dissolve problems
Reconstruct narratives
Capitalize on strengths and resources
Assist in accessing new resources and information,
developing skills
Strengths based approach
Therapeutic Exchange
Rooted within the person
Versus
Rooted in the system, culture, environment
Alternative explanations: curses, nature, demons,
family of origin, folklore, magical thinking-
All magical thinking (according to cultural models) is
not pathological- e.g. Native American with dream of
bear
Medial Model Versus
Wellness/Holistic Cultural Model
Miller, R., & Prosek, E.A., 2013
For those with emphasis on family and
multigenerational influences
Able to be flexible for a variety of issues
Health
Career
Mental and emotional concerns
Marriage and divorce patterns
Work well with Asians and Africans
Genograms
Trauma may be transmitted across generations
Historical narratives of trauma and resiliency
Meanings of resilience- what constitutes healing and
rebounding
Resilience and the Transgenerational Genogram
Goodman, R. D., 2013
A
self- in- relation model
People grow toward relationship
People grow toward mutuality
Growth happens through relationship
Connection is needed to develop future orientation
Mutual empathy especially as modeled in therapy can model
respect for culture
Through relationship each person has a greater sense of identity
and belonging, worth and mattering
Authenticity and vulnerability can ultimately only be developed
through relationship
Validate and empower clients to social justice
Clinicians appropriately using self disclosure to relate to clients
Relational Cultural Heritage in Mental
Health Counseling
Power struggles and hierarchies
Social injustices
Contextual factors not considered
Central relational paradox- protecting self against the
risks of hurt or rejection in the relationships that are
most needed in someone’s life
If work through everyday challenges can experience
increased growth but if not deterioration
Problem: Disconnection
Multicultural-Ecological Mapping
Individual
Microsystem
- parents, siblings, teachers, classmates,
friends, coworkers
Mesosystem
-interactions between parents, siblings,
teachers, classmates, friends, coworkers
Exosystem
- community resources, school policies,
organizations
Macrosystem
- cultural norms, expectations, values,
and laws
Multicultural-Ecological Mapping
Roysircar, G., & Pignatiello, V., 2011
Seeing people in context
A way of visually mapping and understanding the
influences of family, community and society on the
individual
Addresses the significance of key events : births,
deaths, natural phenomena, life scripts and schemas
that shape actions and social interactions
Community Genograms
Rigazio-DiGilio, S.A., Ivey, A.E., Kunkler-Peck, K.P., & Grady, L.T. (2005).
Tell your story or life narrative
Find a way to visually portray significant features or
your narrative
Examples:
Ebbing or mapping out features you use to describe
yourself, mapping out your house-the furniture,
people, places you store things, what you see or hide,
collages, etc.
Community Genogram
Restorying
About the impact of seeing the self in relation to others
(p18-21)
Focus on yourself. How do you describe who you are?
Focus on your family or origin. How does that affect your
image of yourself?
How does your family or origin define itself?
Focus on your community. Now what happens to your self
definition and image?
How do family of origin and community interact?
Restorying
My heritage
Where I work/what I do
The environment I live in/geography
The hobbies, interest stories, folklore of my people
Natural events (weather, land, traumas, events) in
this area
Who I identify or don’t identify with
Congruence or incongruence with the beliefs, values
and lifestyle of those around meDeveloping A
Things Which Shape People
Definition
Perception of events
Frequency of trauma
What constitutes resiliency
Issue of individualism versus collectivism- whose feelings
matter most
Issue of how trauma is explained- medical versus spiritual,
body versus mind
Western versus Eastern goals
E.g. meaning of dissociation- is it helpful or harmful, what
is harmony and balance?
Trauma as it Relates to Culture
Buse etc (2013)
Role of significant others and family is significant across
culture
Emphasis increasingly on the socio-interpersonal model
Affected by how much can be disclosed and to whom
Healing hindered if self and partner have discrepant ideas
about what should be disclosed
Blaming the victim hinders healing
Social supports more than individual therapy seem to be
accountable for healing culturally from PTSD
Healing From Trauma
Little to no research on cultural identity
Child Counseling
What cultural characteristics define this person?
How can the symptoms be described by cultural characteristics?
How might be related to environmental factors and situational factors?
Which diagnosis fits the entire picture of this client?
How am I being influenced by the culture of my client?
Would I give this same diagnosis to a person from
a different cultural background?
Questions to Ask when Diagnosing
People Of Various Cultures
(Hays, D., G., Prosek, E.A., & McLeod, A.L., 2010)
Does not mean the same thing in various cultures
Some for religious reasons
Some to release pressure
Some as a rite of passage
E.g, self flagellation, genital mutilation
Example: Self Injury
Multicultural Vignettes
How would you handle these cases?
A 83 year old female is referred to you for counseling because she
seems to have worsening depression after becoming a widow when
her husband of 53 years died one year ago. She has been making more
comments lately that she just wants to die and go to be with her
husband and that she has already lived her best days. Additionally her
nursing home facility has reported increasing forgetfulness and
moments where she just does not seem to fully understand or
remember who she is, where she is and be in the present moment.
While collateral sources say she is generally a pleasant lady with nice
stories of life memories with regards to her husband and grown
children there are moments the health aides who work with her report
that she acts entirely different. During these other times she is
suddenly agitated and defensive and may even refuse to take meds or
bathe or do day to day tasks even around the health care nurses who
she normally enjoys. She does have someone stop by daily to help her
with meds and check in on her.
Multicultural Vignettes
#1: No One Cares Anymore
She tends to really dwell on and share many stories about the past fond
memories with her husband before he dies and about her family life when the
kids were growing up. However, she has a tendency to forget more recent things
quite a bit lately. Mary reports having had many more support systems in the
years raising her children. She says that soon thereafter her husband’s death her
kids came around shortly after the funeral but that they “have all left me alone
now” to deal with life by herself. She says that after retiring from her job
teaching, people have seemed to forget about her. She has bene involved in a
church for twenty years but says since her health problems have gotten a little
worse she cannot go as she’d like. She describes the church as large in size and
that they do not reach out to people with life issues like hers as they used to. She
cries and gets choked up stating “no one loves me anymore.” She proceeds to
tell you how her kids have forsaken her, no one else has the time to listen to her
stories, and she is just living her final moments alone. Specifically she says, “I
wish death would come quick. I don’t know what more that’s left for me on this
earth anyway. My best days are gone. Oh the fond memories I have of them. I’d
rather just keep it that way and e happy now. Between the health problems, no
one being there and the loneliness I can’t handle things anymore.”
Multicultural Vignettes
A middle aged Haitian man is in distress saying that he “can’t even feel safe to eat at home
because his mother and brother have cursed his butter and food in his refrigerator. Some
agencies have already branded him psychotic for saying this. He describes a life of having
meals outside the home because he does not know which foods the family members have
cursed and what may happen if he eats them. When asked about his family of origin he
describes coming to US a few years ago from Haiti and how spiritual his family was growing
up. The spirituality of Haiti incorporated a mix of traditional Catholicism with voodoo and
native folklore and curses/blessings of tribal leaders. He states that his mother and brother do
in fact have keys to his apartment and have been angry at him for some time now because
they think he has favor and prosperity in arriving in the US compared to their struggles and
they want him to be cursed for this. During a more thorough clinical diagnostic interview he
describes comments they have made about potions and things. Later in the diagnostic
interview he reports getting sick on bread, butter, and some soup which he thinks the relatives
may have cursed. He does not appear to be hearing any voices, seeing any visual hallucinations
or having other psychosis symptoms. Prior to his coming to US he was never treated for
psychosis. However a referring agency believes him to be psychotic regarding the food
poisoning and paranoid towards his family members. What do you think? How would you
process in therapy with him?
Multicultural Vignettes
#2:
My Family’s Cursing My Butter
:
A 17 year old is in the second half of her senior year of high school. She is
excited about graduating high school and considering her life options for
after high school. Her family and her live in southern Ohio and believe that
she should, like other generations past, just be satisfied with the high school
education, meet someone, and have kids and stay home but not go to
college. Relatives had made it clear per her report that she would be
forsaking the whole family if she leaves them and goes to the big city. They
have spoken with her about the “evils” that lie in the big city versus what
they believe to be the protected and familiar area they live in. They also are
trying to convince her that she will remain around extensive support systems
if she remains in southern Ohio but if she leaves to go to the big city she will
be prone to outside influences without the shelter of her extended family.
Mary believes she can, by going to the big city, possibly do “better” or at
least have career, financial, and other options. She would like to do
something possibly with nursing or with children. She even has thought that
in the long run she can help her family more then.
Multicultural Vignettes
#3.
Leaving For The Big City Beyond
A middle aged man named Clyde comes in to your office. He is tall and
muscular and walks with an air of confidence. When asked why he is
coming in he states that he really does not think he has any problems but
a woman friend of his thinks that the fact that he grew up not knowing
his father and having a bad family life with much trauma has impacted
him. The more he talks he mentions how “whatever he wants in life he
will have” and that he “can make anyone do whatever he wants them to
do.” He talks about how he can only trust people to a certain point but
that relationships will never go beyond that point. “It is all about self
protection and preservation. “Aint no one gonna look after you the way
you look after yourself,” he comments. He also says, “if I don’t like you
even if you’re on fire and burning to death in front of me I wouldn’t dare
piss on the fire to stop it.” He presents with a tough exterior and
continues to talk throughout about how self protection is his ultimate
goal. Where do you go in therapy with him?
Multicultural Vignettes
#4- “All I Need Is Me”:
A wealthy couple comes in with a presenting problem of trying to learn how to
deal with decisions about their life and retirement years from here. Both of
them have had a great deal of money and assets , they each own their own
companies that have bene extremely successful. They have several jets and had
many opportunities to fly a multitude of places for personal and business
interests through the years. They are in their mid fifties and are bored.” They
state that they are seeking counseling to assist them with this place of
indecision. Both remark that they have done everything there is to do and are
facing retirement age or decisions about the future of life and companies but
don’t know where to go from here. The typical tasks of the retirement ages are
things they believe they have already not only done but mastered. There is
nowhere left to travel and nothing left to acquire. They actually cannot imagine
not doing what they are already doing with heading their companies and
managing things. Each has a sense that there has got to be something more but
is not sure how to decide what that something is from there.
Multicultural Vignettes
#5- “Where Do We Go From Here?”:
A 30 year old Japanese woman comes in for grief counseling through her EAP.
She states that she believes she has found “the one” in her current boyfriend
who is 15 years her senior and is divorced. She describes him in highly positive
terms and is quick to remark about his attributes. She states that it has been
nearly two years that she has been dating him, going on trips with him, and
serious with him but that she has old her family from Japan about him in the last
6 months. She speaks about the traditional values of her extended Japanese
family who all live with her at her parent’s household. They are 100 % against
divorce and consider him a low life and a lesser person because he has been
divorced. She also states that they feel I have settles and gone for someone
beneath me not only because he is divorced but because he is not Japanese and
is not from the right type of job and socioeconomic status they would like. She
would like the
backing of her family but is to a point that she is tired of keeping
lies from them about how much she is into him. She also comments that he has
a 10 year old daughter and would have to learn to be a mom if they ended up
getting married
Multicultural Vignettes
#
6- “But They Won’t Accept The Man I Love”:
This is something she is working on as she is spending increasing
amounts of time around his daughter. However, when her family
found out that he has a daughter it is only another strike against
him. She loves her family but is frustrated that they do not give her
the same freedom they have given her baby sister who is in her mid
twenties: “she got pregnant to a loser guy and was allowed to live
on her own in her own place but I am not allowed to have my own
choices at all.” She expresses fear that something as simple as
choosing to find her own apartment would devastate that family
because she is the oldest and the one who is “supposed to uphold
the family’s wishes and interest.”
Multicultural Vignettes
Her cries and she speaks about how her family refuses for her to even talk
about her boyfriend or to consider meeting him. She also feels trapped
because the boyfriend “does not want to force his way into her family
and is going too slow” because she does not want to disrespect her
family’s values. She would like to be engaged to him by now but feels as
if everything is at a standstill because the family won’t move to accept
him and he won’t move to initiate more commitment. She wants help
with deciding if she should just move out to her own place and start her
own life as a sign to her family that she has opinions about making
decisions in her life. However, she is afraid that the family may essentially
disown her and she may lose them and maybe also the boyfriend in the
process.
Multicultural Vignettes
A gentleman aged 72 talks about his stresses with health problems and
being on disability. He has an extremely fixed income. During the
assessment when asked about support systems he mentions a 23 year old
girfriend who comes over to talk with him and really loves (him).” He
says she listens to his stories a few hours per week. He also says the
young lady is a single mom who is trying to make it on her own with a
young child so she needs his disability money. This does not seem to be a
source of concern. While she expresses concern that “other people don’t
understand her like I do and think she is just using me to get free money
to support here and her baby I know she loves me.” He talks about
planning to marry her someday. How do you approach assessment and
treatment with this gentleman?
Multicultural Vignettes
#7.
“My Pretty Young Lady Loves Me So Much”:
A married couple comes to you for counseling. They both express
frustration over the fact that each has had multiple affairs. Recently he
moved in with a lady for 1 1/2 years and she had an affair for several
months with another man while living in their marriage home. However
both state, “we love each other though. No matter who we have affairs
with we keep coming back to each other.” They describe how they
“clicked” as soon as they met and moved in with each other the next day.
They remark “since than we have never been apart from each other.”
They only talk about complimentary attributes they like about each other
but you realize that obviously something caused them repeatedly to go to
affairs and come back and forth together with each other. Their stated
goal is wanting help to process resentments about the affairs though
they laugh and minimize the effects of affairs when talking. They want to
build on strengths in the marriage which have kept them “together” for
22 years so far.
Multicultural Vignettes
#8- “Just Another Affair”:
A dad and his 16 year old teenage daughter come in for group counseling together to work on
their relationship. Though both highlight the fact that the girl is respectful and kind and there
are no major behavioral issues the dad says she can still improve. Dad and mom had been
divorced when the girl was about 7 years old. While the parents have some differences of
opinions they try to keep conflicts to a minimum. Throughout the counseling session dad
remarks about the girl bucking up and learning to be more responsible and handle things as an
adult. She sites several instances where she believes she is doing this to the best of her ability
such as excelling in good grades at school and holding a job. Her dad reports frustrations with
her room not being entirely clean and her not knowing how to balance a checkbook or make
major life decisions. “I was made to do those things at age 5,” dad comments. The daughter
trying to be respectful acknowleged her need for improvement on some areas but states “dad
that isn’t normal. You weren’t supposed to manage a house at age 5. I think you need help
dealing with that. That is not normal for a child to do.” Dad explained how his father dies
before he turned four years old and he was left to be the man of the house for his mom. He
described how his mom would regularly make him make financial decisions for the household
even though he had no concept of things. In counseling his daughter commented, “but dad
you were given responsibilities that no child should have.” How do you handle this discussion
in light of the presenting problem? Where do you go from here?
Multicultural Vignettes
#9- “Adult At Age Five”:
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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?
