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Multicultural Counseling

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A helping role and process that uses treatment approaches and goals consistent with the life experiences and cultural values of clients.

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The Tripartite Model (Sue & Sue)

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• Awareness: counselor is aware of his/her own cultural heritage, values, and biases • Knowledge: counselor has knowledge of client's worldview - specific knowledge & information about diverse clients' cultural heritage, life experiences & historical background • Skills: counselors can utilize specific verbal and nonverbal culturally appropriate assessment and intervention strategies, & modify these strategies to meet the needs of their diverse client

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Sue and Sue's characteristics of a culturally skilled counselor

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a. Aware of his/her own cultural heritage b. Values and respects differences c. Aware if his/her own values, biases, racist/sexist attitudes, beliefs and feelings and how they may affect ethnic minority clients d. Comfortable with cultural differences that exist between him/herself and his/her clients e. Possess specific knowledge and info about the particular cultural group they are working with f. Has good understanding of the sociopolitical system's operation in the US with respect to its treatment of ethnic minorities g. Aware of institutional barriers that prevent ethnic minorities and other underserved individuals from using mental health services and willing to address/remove barriers

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Benefits of Multiculturalism

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client retention, enhanced treatment outcomes, clients feel more understood and respected, tailoring treatment to client's own uniqueness along with contexts, allows for variety of valid approaches to healing, ethically is the best practice.

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Bias

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a tendency to think, feel and act in a particular way (usually influenced by one's culture, upbringing, experiences and professional training).

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Privilege

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a right that gives the individual a distinct advantage or favor, advantages one holds as a result of membership in a dominant group.

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Oppression

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a state of being suppressed or crushed by an abuse of power. As system of dominion and control that results in a condition of privilege for one group and the disenfranchisement of another group.

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Hays' three characteristics for becoming an effective therapist

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Humility: the ability to see yourself as equal to, and, not better than others, and the capacity to see yourself and others realistically—helps counselors to avoid judging people who are different as inferior. Compassion: an attitude of charity towards others—helps counselors to work with and appreciate clients who challenge their beliefs and values. Critical thinking skills: the counselor's ability to question his/her assumptions and look for explanations that go beyond what seems apparent.

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Worldview: Definition

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philosophy of life, how they perceive the world and their place in it, assumptions about the world

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Worldview: Components

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a. Perception of human nature (good or bad) b. Perception of human relationships: Hierarchical, Collateral/mutual, Individualistic c. Perception of people and nature: Subjugation to nature, Harmony, Mastery over nature d. Time Focus: Past, Present, Future, e. Activity Orientation: Being, Being in becoming, Doing

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Barriers to effective MC counseling

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Language, Class bound values, Culture bound values inherent in the counseling process, oppression, stereotyping, etc -Discomfort with discussing issues, hard to build rapport, personal space problems, power differential, may not accurately diagnose as a result and then use inappropriate interventions, client may go along with this or may prematurely terminate

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How to overcome Barriers to effective MC counseling

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Ask how it's going for them, explain why you are treating them the way you are, develop our own MC competence continuously, increase our knowledge of other cultural groups, become adept at using appropriate skills

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High Context (HC) communication (Sue)

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a message that is anchored in the physical context (situation) or internalized in the person. HC relies heavily on non-verbals and the group identification/understanding shared by those communicating

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Low Context (LC) communications

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place a greater reliance on the verbal part of the message.

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Proxemics

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: Perception and use of personal and interpersonal space (Sue P. 162-163; Hays P.96-98) In U.S. culture: • Intimate—contact to 18 inches • Personal—1.5 ft to 4 ft • Social—4 ft to 12 ft • Public—greater than 12 feet Has implications for how furniture is arranged in office, who sits where, how far you and client(s) sit from each other.

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Kinesics

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Bodily movements such as facial expressions, posture, gestures and eye contact • smiling (Sue page 163-164) • head movements i.e. nodding, head left to right (Sue page 164) • Shaking hands (Sue page 164; Hays page 96-98) • Eye contact (Sue page 164-165; Hays P. 96-98)

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Paralanguage

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Other vocal cues used to communicate such as loudness of voice, pauses, hesitations, rate of speech, inflections. • Pay attention to rules about when to speak and yield or turn-taking (Hays, p. 98; Sue p. 166) • Silence (Sue, p. 166; Hays, P. 97-98) • Amount of verbal expressiveness ( Sue p. 166) • Loudness of speech (Sue, p. 166-167) • Degree of directness versus subtlety (Hays, p. 92, Sue P. 167

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5 specific strategies for establishing rapport and respect, and initiating culturally appropriate interventions with clients

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a. Empathy b. Use appropriate self disclosure c. Take time at onset of therapy to explain nature and purpose of the process, see if they have questions, etc d. Actively attend to verbals and nonverbals e. Avoid or minimize use of psychological jargon

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Cross Model - Pre-Encounter

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1) Assimilation : Low race salience and neutral attitudes towards Blacks 2) Anti-Black: High negative race salience hatred of Black race due to incorporation of negative images of Blacks Low self-esteem

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Cross Model - Encounter

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Challenge to pre-encounter thinking, re-examine perceptions, exposure to racist events, Guilt, shame and anger at acceptance of dominant culture norms, perceptions

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Cross Model - Immersion/Emmersion

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Transition period--Immersion into Black culture, withdrawal from White society, Extreme Black/White dichotomy 1) pro-Black: Black pride 2) anti-White: Anger at White society, oppression & privilege 3) pro-Black/anti-White : Continued transition into advanced state of id dev. with less intense emotional & rigid thinking, more nuanced & less romanticized view of Blackness & less harsh view of Whiteness

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Cross Model - Internalization

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Self-acceptance of Black racial identity, inner peace, loss of anger at White society. Sustained interest and commitment to social justice and civil rights 1)Black nationalist: High Black positive race salience. 2) Biculturalist: strong Black identity integrated with strong sense of American identity 3) Multiculturalist: integration of multiple identities (race, gender, sexual orientation etc.)

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Helms White Racial Identity Model - Contact

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Unaware of or denial of race and racism

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Helms White Racial Identity Model - Disintegration

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Increased awareness of race, oppression. Anxiety, guilt Conflict 1) avoidance of people of color 2) avoiding thoughts re race 3) confirm racism is not Whites' fault

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Helms White Racial Identity Model - Reintegration

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Regression to own group idealization Intolerance &/or denigration of other groups

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Helms White Racial Identity Model - Pseudo-independence

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Initial attempts to form/define non-racist White identity. Attempt to understand and tolerate other groups' experiences mostly on cognitive/intellectual levels versus effective/experiential levels.

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Helms White Racial Identity Model - Immersion Emmersion

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Questioning of personal meaning of White identity, privilege & racism. Increase of affective and experiential understanding of race related experiences. Redefinition of Whiteness

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Helms White Racial Identity Model - Autonomy

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Strengthening of non-racist White identity. Valuing of diversity. Knowledgeable about racial, ethnic and cultural difference. Comfort with race-related experiences. Relinquish perks of privilege.

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Poston Biracial Identity Development Model - Personal identity

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Sense of self is independent of ethnic heritage

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Poston Biracial Identity Development Model - Choice of group categorization stage

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Pressures to identify with one racial orientation

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Poston Biracial Identity Development Model - Enmeshment/denial

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Negative feelings about the denial of one of the racial heritages

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Poston Biracial Identity Development Model -Appreciation

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Valuing of the racial roots of both parents

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Poston Biracial Identity Development Model - Integration

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Wholeness and integration of both identities occur

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5 guidelines for working with interpreters

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1. Schedule extra time 2. Do not use family members or social acquaintances as interpreters 3. Arrange pre-assessment meeting with interpreter 4. Avoid discussions between you and interpreter during session 5. Reassure client about confidentiality and its limits when both you and interpreter are present

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Ethnicity:

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shared biological heritage or ancestry through which individuals have evolved shared values and customs, that includes one's identity or the perception of group membership.

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Culture:

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shared elements including language, history and geographic location involved in thinking--perceiving, believing, evaluating, and behaving--communicating and acting that are passed down from one generation to the next with modifications.

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Descriptive stereotypes

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define how most people in a particular group behave, what they prefer and where their competence lies.

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Nationality/National Origin

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identity derived from country of birth or residence

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ADDRESSING Model

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A framework that can be used to assess relevant aspects of client's cultural identities.

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ADDRESSING

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A—Age and generational influences DD—Developmental and acquired disabilities R—Religion and Spiritual Orientation E—Ethnicity S—Socioeconomic status S—Sexual orientation I—Indigenous heritage N—national origin G—gender

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RESPECTFUL

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R = Religious and spiritual identity E = Ethinic, cultural, and racial backround S = Sexual identity P = Psychological maturity E = Economic class standing and backround C = Chronological developmental challenges T = Threats to well being and Trauma F = Family history, values and dynamics U = Unique physical chariteristics L = Location of residence and language diffrences

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Kluckhohn's Five Existential Categories of Worldview

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1. Human nature; 2. Human relationships ; 3. People/Nature 4. Time Focus: Past, Present, Future; 5. Activity Orientation

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1. Human nature

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how human nature is defined or characterized * Bad *Good and Bad* *Good

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2. Human relationships

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How human relationships are defined Lineal Hierachical—ordered successive positions within the group, group goals important, there is a structured hierarchy Collateral-Mutual—the goals and welfare of extended, lateral groups are important, people are equal in relationships Individualistic—Individual autonomy is important, individual goals are most salient

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3. People/Nature

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What is the relationship between people and nature?: Subjugation to Nature: powerless in face of nature—life determined by external forces Harmony: People and nature coexist in harmony Mastery over nature: People can subjugate and control nature

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4. Time Focus:

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Past, Present, Future

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5. Activity Orientation

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Being—it's enough to just be, live and let live, prefer spontaneous expressions of life Being in Becoming—purpose to develop our inner selves, introspection is highly valued Doing—Be active, work hard, accomplish tasks

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Five ways in which a counselor can use her/his understanding of the client's worldview in the counseling relationship :

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• To facilitate a positive therapeutic alliance • To accurately identify presenting problems and their underlying causes • To select appropriate goals for treatment • To select appropriate therapist roles • To measure success in therapy

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Locus of Control

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• Internal—I control my destiny/fate, • External—luck/chance or other external circumstances shape/control my destiny—others control the type of choices/actions I can take or opportunities that are available to me

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Locus of Responsibility

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• Individual/person-centered—hold individual responsible for their actions/circumstances, strong relationship between ability/effort and success in society • Situation-centered/situation/blame—environment is more powerful than the individual, success or failure determined more by external environment than individual effort

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IC/IR (internal locus of control/internal responsibility)

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Believe they are masters of their own fate, and that their status in life is a direct result of their own unique attributes, efforts and lack of success is attributed to one's shortcomings and inadequacies. -- I must take responsibility for my actions Problems reside in the person -- Self is separate from the group, decision making and responsibility rests with the individual -- I am OK and society is OK -- Clients here like self-help approaches -- Counselors here may be culturally encapsulated (not able to see other perspectives if this view is rigid and could inadvertently be culturally oppressive)

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EC/IR (external control/internal responsibility)

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I have little personal control over my fate, but am still responsible for the outcome of my life --- "Marginal" I'm ok, but my control comes best when I define myself according to the definition of the dominant culture Society is ok (may deny the existence of racism/sexism, etc.) the way it is, it's up to me ---Clients here may want to avoid feelings because it is too threatening to see self-hate

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IC/ER (internal control/external responsibility)

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Believes in their ability to shape the events of their lives if given a chance --- I'm Ok, and have control but need a chance May realistically perceive external barriers to progress Society is not ok, and I know what's wrong and seek to change it --- Problems reside outside of the person --- Clients want counselors to acknowledge external barriers and combat systemic problems

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EC/ER (external control/external responsibility)

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There is very little that I can do to shape my destiny or the outcome of my efforts ---I'm not ok, don't have much control, may as well give up or please everyone else --- Society is not ok, and is the reason for my problems, the system is to blame May look like they give up or try to placate those in power to not rock the boat --- 0May be deferential to IC/IR counselors Counselors can teach clients new coping strategies, have them experience success and validate who they are as people to help with self-empowerment

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Purposes of Assessment

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Establish working alliance Clearly define clinically relevant issues Gather useful contextual information Develop hypothesis and /or tentative diagnosis based on the data obtained Primary purpose is to collect relevant information to guide decisions about treatment

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6 Common sources of personal bias in assessment. Smith

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1. Attribution errors 2. Selective Attention, Transference, Similarity Seeking 3. Defensiveness 4. Psychological Reductionism, Stereotyping, Labeling. 5. Failure to Address Conflicting & Non-stereotypic contexts 6. Self-Interest and Abuse of Power

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Issues with Standardized Tests

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Functional equivalence—the construct or behavior being assessed plays the same role in mainstream and non-mainstream cultures Conceptual equivalence—stimuli (i.e. words, phrases, pictures) that make up the test have similar meanings across cultures Linguistic/translation equivalence—language, symbols, affective impact and format are comparable for mainstream and non-mainstream clients; they convey the same meanings or are expressed in the same way when translated from one language to another.

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Recommendations for making standardized tests more culturally responsive

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• Begin with a thorough, history • Arrange a pre-assessment meeting with client's interpreter or cultural liaison • Choose tests that match the referral question for the client • Explore all possible reasons for the client's test performance • Push the limits on standardized tests • Avoid the use of standardized personality tests for diagnostic purposes with clients with minority identities. Do not use computer generated reports—they do not take contextual information into consideration

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Hays Culturally related strengths

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Personal strengths - pride in one's culture, religious faith or spirituality, sense of humor Interpersonal strengths - Extended families including non-blood related kin, cultural or group specific networks, recreational/playful activities Environmental strengths - Space for prayer/meditation, animals to care for, gardening area

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4 recommendations for making culturally responsive diagnosis

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1. Use ADDRESSING (Axis "VI") 2. Relate ADDRESSING to Axis IV and explore problems that might be related to each part of addressing acronym 3. Be able to explain the meaning of your diagnosis in language the client understands 4. Be CAUTIOUS about diagnosing personality disorders

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Ethnocentric Monoculturalism.

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1. Strong belief in the superiority of one group's cultural heritage over another

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Ways to correct personal bias in assessment

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Stay open to learning Constantly evaluate your external and internal motivation for wanting to be culturally competent Be aware of your own past and experiences Try new ways of being Seek out feedback and support Pay attention to your emotional reactions while interacting with others

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Functional equivalence (Issues with Standardized tests)

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the construct or behavior being assessed plays the same role in mainstream and non-mainstream cultures

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Conceptual equivalence (Issues with Standardized tests)

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stimuli (i.e. words, phrases, pictures) that make up the test have similar meanings across cultures

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Linguistic/translation equivalence (Issues with Standardized tests)

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language, symbols, affective impact and format are comparable for mainstream and non-mainstream clients; they convey the same meanings or are expressed in the same way when translated from one language to another.

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DSMIV Diagnostic Considerations

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•Culture, Age and Gender features added for most diagnoses •Expanded Axis IV Psychosocial and Environmental Problems •New V codes---Identity, Religious/Spiritual and Acculturation Problems •Outline for Cultural Formulation •Glossary of culture bound syndromes

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Recommendations for making standardized tests more culturally responsive

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•Begin with a thorough, history •Arrange a pre-assessment meeting with client's interpreter or cultural liaison •Choose tests that match the referral question for the client •Explore all possible reasons for the client's test performance •Push the limits on standardized tests •Avoid the use of standardized personality tests for diagnostic purposes with clients with minority identities. Do not use computer generated reports—they do not take contextual information into consideration

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Emic

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culturally specific: * Lifestyles, cultural values, and worldviews affect the expression and determination of deviant behavior * All theories of human development are from a cultural context using Euro-American values of independence and healthy development * Theories present bias, especially when used with collectivistic cultures

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Etic

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culturally universal * Disorders appear in all cultures/societies * Minimal modification of diagnosis and treatment is required * Western concepts of normality and abnormality can be considered equally applicable across cultures

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