Transcript Ethics_Chapter_4

Multicultural
Perspectives and
Diversity Issues
Chapter Four
The Need for a Multicultural
Emphasis
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In the last couple of decades, helping
professionals have realized that they can no
longer ignore issues involving serving culturally
diverse populations.
All counseling can be thought of as multicultural
if culture is broadly defined to include not only
race, ethnicity, and nationality, but also gender,
age, social class, sexual orientation, and
disability.
Traditional therapy was developed in the West.
Multicultural Terminology
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Ethnicity: a sense of identity that stems
from common ancestry, history,
nationality, religion, and race.
Ethnic Minority Group: a group of
people who have been singled out for
differential and unequal treatment and
who regard themselves as objects of
collective discrimination.
Multicultural Terminology
continued
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Multiculturalism: a generic term that
indicates any relationship between and
within two or more diverse groups.
Cultural diversity: the spectrum of
differences that exists among groups of
people with definable and unique cultural
backgrounds.
Multicultural Terminology
continued
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Multicultural counseling: a helping role and
process that uses approaches and defines goals
consistent with the life experiences and cultural
values of clients, balancing the importance of
individualism versus collectivism in assessment,
diagnosis, and treatment.
Diversity: individual differences such as age,
gender, sexual orientation, religion, and physical
ability or disability.
Multicultural Terminology
continued
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Diversity-sensitive counseling: a concept
that includes age, culture, disability, education
level, ethnicity, gender, language, physique,
race, religion, residential location, sexual
orientation, socioeconomic situation, and
trauma.
Cultural empathy: therapists’ awareness of
clients’ worldviews, which are acknowledged in
relation to therapists’ awareness of their own
personal biases.
Multicultural Terminology
continued
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Culture-centered counseling: a threestage developmental sequence, from
multicultural awareness to knowledge and
comprehension to skills and applications.
Stereotypes: oversimplified and
uncritical generalizations about individuals
who are identified as belonging to a
specific group.
Multicultural Terminology
continued
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Racism: any pattern of behavior that, solely
because of race or culture, denies access to
opportunities or privileges to members of one
racial or cultural group while perpetuating
access to opportunities and privileges to
members of another racial or cultural group.
Unintentional racism: racism that is subtle,
indirect, and outside our conscious awareness.
Multicultural Terminology
continued
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Cultural racism: the belief that one
group’s history, way of life, religion,
values, and traditions are superior to
others.
The Problem of Cultural Tunnel
Vision
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Many new students in training ONLY know
their own culture.
Cultural tunnel vision: a perception of
reality based on a very limited set of
cultural experiences.
Students may misinterpret a healthy
response by the client to the helper’s
cultural/theoretical bias as “resistance.”
Characteristics of the “Culturally
Encapsulated” Counselor
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Defines reality according to one set of cultural
assumptions.
Shows insensitivity to cultural variations.
Accepts assumptions without proof for fear of
disproving his/her own assumptions.
Fails to evaluate other viewpoints and makes
little attempt to accommodate others’ behavior.
Is trapped in one way of thinking that resists
adaptation and rejects alternatives.
Learning to Address “Cultural
Pluralism”
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Cultural pluralism: a perspective that
recognizes the complexity of cultures and
values the diversity of beliefs and values.
Learning about your own culture helps you
acquire multicultural competence.
Self-exploration makes learning about the
race, cultures, and experiences of clients a
manageable process.
The Challenges of Reaching
Diverse Client Populations
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Providers should identify resources in the client’s
family and the larger community and use them
in delivering culturally sensitive services.
Due to psychology being based on Western
assumptions, the influence and impact of racial
and cultural socialization has not always been
considered.
Minority clients are underrepresented in mental
health, and many stop coming after 1 or 2
sessions.
The Challenges of Reaching
Diverse Client Populations cont.
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The medical model of clinical counseling is
rarely a good fit for clients in the lower
socioeconomic classes.
Culturally encapsulated helpers often
incorrectly assume that a lack of
assertiveness is a sign of dysfunctional
behavior that should be changed.
Ethics Codes from a Diversity
Perspective
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Therapists should try to uncover and
respect cultural and experiential
differences.
Counselors are expected to become aware
of their own attitudes and biases that can
interfere with cultural competence.
Counselors, social workers, etc. are
prohibited from discriminating.
Cultural Values & Assumptions
in Therapy
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Sue & Sue (2003) think that helpers needs to
include support systems such as family, friends,
community, self-help programs, and occupational
networks in their perception of mental health
practices.
The diversity-sensitive counseling movement
focuses attention on the problems of
discrimination, oppression, and racism.
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Some believe that this movement lacks moderation
and tries to force its agenda on counseling practice.
Cultural Values & Assumptions
in Therapy continued
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Some would like to see those in the
diversity-sensitive counseling movement
have live demonstrations at conventions or
videotaped counseling interviews with
diverse clients.
Educational videotapes are now available
by Ivey and Ivey’s Microtraining
Associates.
Western vs. Eastern Values
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Contemporary theories of therapy are grounded
in Western assumptions, yet most view the
world differently.
Some say the result has been too much focus on
individualism and not enough on broader social
contexts.
There is a growing belief that religion and
spirituality needs to be included in counseling
practice.
Challenging Professionals’
Stereotypical Beliefs
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Failure to change does not necessarily mean a
lack of motivation, but could be due to limited
choices due to their environment.
Many often assume that “talk therapy” works
best.
Practitioners who counsel ethnic and racial
minority clients without an awareness of their
own stereotypical beliefs can easily cause harm
to their clients.
Assumptions about SelfDisclosure
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Helpers often assume that self-disclosure is
essential for the therapeutic process to work.
It is not acceptable to share personal problems
in some cultures because this will make the
family look bad.
In many cultures a dance, circumlocutions, and
certain rituals may precede intimate disclosures.
If your techniques are not working with a client,
you must learn other ways of connecting with
this client.
Assumptions about
Assertiveness
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Many helpers assume that it is better to
be assertive than to be nonassertive.
Asian Americans are often viewed as
nonassertive and passive, but this
assumption has not been supported by
research according to Sue & Sue (1985).
Assumptions: Self-Actualization
& Trusting Relationships
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Many assume that it is important for the client to
become a fully functioning person.
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Counselors sometimes focus on what is best for the
client and forget to think about how this might impact
others in the life of the client.
Mainstream Americans readily talk about their
personal lives.
Many Asian Americans, Hispanics, and Native
Americans have been brought up not to speak
until spoken to, especially with the elderly or
with authority figures.
Assumptions about Nonverbal
Behavior
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Americans tend to feel uncomfortable with
silence and tend to talk to ease their tension.
Silence may be a sign of respect and politeness
in some cultures.
Direct eye contact, physical gestures, and
probing personal questions may be seen as
offensively intrusive by clients from another
culture.
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Among some Native American and Hispanic groups,
eye contact by the young is a sign of disrespect.
Assumptions about Directness
& Respect
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Western approaches tend to stress
directness, but in some cultures directness
is perceived as a sign of rudeness.
Some cultures prefer to deal with
problems indirectly.
Deference if often a sign of respect in
other cultures outside America.
Addressing Sexual Orientation
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In 1973, the American Psychiatric Association
stopped labeling homosexuality as a form of
mental illness.
In 1975, the mental health system finally began
to treat the problems of gay and lesbian people
rather than treating them as a problem.
Mental health professionals who have negative
reactions to homosexuality are likely to impose
their own values and attitudes, or at least to
convey strong disapproval.
Addressing Sexual Orientation
continued
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Serious damage to a client can occur when a
client discloses his or her sexual orientation well
into an established therapeutic relationship.
The American Psychological Association
developed a committee on lesbian, gay, and
bisexual concerns and they developed guidelines
for psychotherapy (pp. 128-9).
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These guidelines are relevant to all mental health
professionals, not just to psychologists.
Value Issues of Gay and
Lesbian Clients
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Lesbians and gay men are often struggling
between concealing their identity and
“coming out.”
Due to the reality of the AIDS crisis, gay
men often face the loss of friends.
Clinicians who work with gay men need to
be able to talk with their clients about
“safe-sex” (SAFER-SEX) practices.
Educating Counselors about
Concerns of LGB Clients
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Before therapist provide mental health
services to gay and lesbian people and
their children, they should complete
formal, systematic training on sexual
diversity.
A study to assess psychologists’ attitudes
toward gay and lesbian parenting found
that they held affirming attitudes toward
gay and lesbian parenting.
Educating Counselors about
Concerns of LGB Clients cont.
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An advantage of inviting people from the LGB
community to talk with students is that the
discussion is likely to move from abstract ideas
to dealing with real people and real issues.
Practitioners frequently seek training after they
complete their graduate education concerning
working with LGB clients.
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The topics identified in which continuing education
would be helpful included coming out, estrangement
from family, support system development, and
internalized homophobia.
Court Case about a Therapist’s
Refusal to Counsel Gay Clients
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Ms. Bruff was fired by her employer for her
refusal to “counsel anyone on any subject that
went against her religion.
She was offered several other job opportunities
within the agency and she turned them down.
The courts eventually found that she was not
improperly dismissed and that the company
made reasonable attempts to accommodate her
religious beliefs.
The “Bruff” Case continued
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In a counseling relationship, it is NOT the
client’s place to adjust to the therapist’s
values.
Bruff failed to realize that counseling is
NOT about her, but about the client’s
needs and values.
The “Bruff” Case continued
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Our authors think that Bruff should have
informed her potential clients in writing
about her religious convictions and moral
opposition pertaining to homosexuality.
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They also question whether she should have
had a position in a public counseling agency
given her inexperience and ineffectiveness
working with diverse client populations.
Matching Client & Counselor
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C.H. Patterson (1996) states that ALL
counseling is multicultural.
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According to him, all clients belong to multiple
groups that influence their perceptions, belief,
attitudes, and behavior.
This belief allows room for clinicians to
effectively work with clients who differ from
themselves in a number of significant ways.
Matching Client & Counselor
continued
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Counselors become too analytical about
what they say and do when they are
overly self-conscious about their ability to
work with diverse client populations.
The more differences between the client
and the therapist, the stronger the need
to collaboratively find meaning and
understanding.
Matching Client & Counselor
continued
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If there are differences between the client
and the therapist, should the clinician or
the client address this?
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Most clients will not initiate this conversation
due to the power differential between them
and the therapist.
Therefore, the therapist should directly
address these differences.
Matching Client & Counselor
continued
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Our authors believe that the counseling process
is ever-changing and that clinicians must stay
with the client and be led by the client into the
most important areas for him or her.
It is more important to monitor your internal
dialogue and use it as part of the therapy
process than to strive to discover the ideal
match.
The most important aspects of culture-centered
counseling can be learned, but not necessarily
taught.
Matching Client & Counselor
continued
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You can be your own best teacher by
paying attention to the voices within you
and within your clients.
You will only hear the spoken content if
your approach is rigid and concrete.
Unintentional racists can be more
dangerous than those who are more open
with their prejudices.
How to increase the likelihood
of FAILING as a counselor!!
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Be afraid to face the differences between
you and your clients.
Refuse to accept the reality of these
differences.
Perceive these differences are
problematic.
Be uncomfortable working out these
differences.
How to Learn to Work with
Clients that Differ from Us!!
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Be trained in multicultural perspectives, both
academic and experiential.
Agree with the client to develop a working
therapeutic relationship.
Be flexible in applying theories and techniques
to specific situations.
Be open to being challenged and tested.
Be aware of your own value systems, of
potential stereotyping and any traces of
prejudice, and of your cultural
countertransference.
Multicultural Training for Mental
Health Workers
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Referral should not be viewed as a
solution to the problem of inadequately
trained helpers.
You may not have the luxury of referral.
CACREP standards call for supervised
practicum experiences that include people
from the environments in which the
trainee is preparing to work.
Characteristics of the Culturally
Skilled Counselor
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This person first checks his/her attitudes
and beliefs about race, culture, ethnicity,
gender, and sexual orientation.
Second, this person is knowledgeable and
understanding of his or her own
worldview.
Third, this person develops proper skills,
intervention techniques, and strategies
necessary in serving diverse client groups.
Characteristics of the Culturally
Skilled Counselor continued
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La Roche & Maxie (2003) believe that acquiring
cultural competence is an active and lifelong
learning process, rather than a fixed state that is
arrived at.
Multicultural competencies: a set of
knowledge and skills that are essential to the
culturally skilled practitioner.
You can find the essential attributes of culturally
competent counselors on pp. 143-144 in our
text.
Our Authors’ Views on
Multicultural Training
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The first step in acquiring multicultural
counseling skills is for students to become
involved in a self-exploratory class to help
identify any potential blind spots.
Beyond this introductory course, students
could take at least one other course
dealing exclusively with multicultural
issues and minority groups.
Our Authors’ Views on
Multicultural Training continued
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When teaching theories and techniques of
counseling courses, teachers should emphasize
how these concepts can be adapted to the
special needs of diverse client populations and
about the limitations of these concepts.
Trainees should have to have at least one
internship in which they have multicultural
experiences or reframe their experiences from a
multicultural viewpoint.
Our Authors’ Views on
Multicultural Training continued
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Trainees should be encouraged to select
supervised internships that will challenge them
to work on gender and cultural concerns,
developmental issues, and lifestyle differences.
Our authors strongly favor experiential
approaches as a way to increase self-awareness
and to identify and examine attitudes associated
with diversity competence.
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They also see value in didactic approaches as well.
Our Authors’ Views on
Multicultural Training continued
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They believe that experiential learning can help
you increase self-awareness and develop a
sense of empathy toward clients from culturally
diverse backgrounds.
It is critical for you to immerse yourself with
knowledge and approaches specific to the group
with which you are working.
Last, they highly recommend that you open
yourself to people in other cultures through
reading and travel.