561- Cultural Issues in Psychological Practice

Question 1

Acculturation

Answer 1

Part of cultural issues in psychological practice, this is the process used by the minority culture to adjust to the majority culture by adapting various aspects of the majority culture in an attempt to blend in and have better opportunities. This can also be seen bidirectionally, with majority culture adapting certain aspects of the minority culture. This occurs at the individual and group level. Acculturation can result in acculturation stress - not unlike post traumatic stress, this type of stress refers to the anxiety depression, and conflict, which accompany moving into a new culture. It should be a factor that guides the therapists section of interventions.

EXAMPLE: You are seeing a client that recently immigrated to the United States from Brazil. He is under a lot of stress as he navigates American culture and acculturates. As his therapist, you will need to help him navigate through this stress and learn to adapt various aspects of American culture without abandoning his Brazilian culture.

Question 2

ADDRESSING model

Answer 2

Part of practicing from a multicultural perspective, ADDRESSING is an acronym of cultural influences and client factors to be aware of in case conceptualization and treatment. Including these dimensions of identity on intake paperwork can help therapists understand the client more fully. ADDRESSING stands for age and generational influences, developmental disability -disabled from birth, disability that is acquired -may have developed at any point in lifespan, religion and spiritual orientation, ethnic and racial identity, socioeconomic status, sexual orientation, indigenous heritage, national origin, and gender. Its a great way to learn information on a client’s worldview.

Example: Sam is a new client who identifies as a cis gender, Jewish female. She is 68 years old. As her therapist does the initial interview, the therapist will want to gather information about how her Jewish heritage/faith and age are influencing her presenting problems, if at all.

Question 3

Anti-racism

Answer 3

Part of multicultural advocacy in counseling, this term refers to actively identifying and opposing racism. It involves advocating policy change, behaviors, and beliefs that perpetuate racism. The process of anti-racism equips people with the tools needed to combat both institutional and systemic racism as well as discrimination through the promotion of diversity. The overall goal of antiracism is to eliminate racism and work toward equality. This is important when it comes to addressing biases a clinician may have. The ACA requires counselors to be activists for their clients when there is something preventing growth and change.

Example:

Question 4

Assimilation

Answer 4

Part of cultural issues in counseling, this is the process by which a person or group adopts a new culture to the point of virtually replacing their original culture, leaving only trace elements behind. Assimilation is common among immigrant populations that seek to blend in with the existing fabric of society and want to be seen and embraced as belonging. Individuals may feel pressure from members of the majority culture to assimilate quickly. Generally seen as negative compared to acculturation.

Example: Juan immigrated to the U.S. with his parents from Guatemala when he was a child. Now he is a teenager and seeking therapy over assimilation conflicts with his parents. He has fully assimilated to US culture, rejecting most aspects of his native culture, language, and customs. He is frustrated that his parents only speak Spanish at home and resist American popular culture.

Question 5

Bicultural

Answer 5

Part of client factors, this is having or combining the cultural attitudes and customs of two nations, peoples, or ethnic groups. An individual who is bicultural is conversant with both sets of values and customs. Identifying with two or more cultures, typically seen with one’s heritage culture and the culture of the country or region in which one has settled. Maintaining biculturality can be difficult if the majority culture pressures assimilation. Being bicultural is a source of strength but negotiating dual group membership can cause problems for many marginalized group members. This is important when considering a client’s worldview.

Example: You are counseling the child of an immigrant. The child is bicultural because she is deeply embedded in the heritage culture at home, but is also active and knowledgeable of American culture due to interactions at school.

Question 6

Collectivism

Answer 6

This is part of multicultural understanding as the philosophical, political, economic or social outlook that emphasizes the interdependence of every human in some collective group and the priority of group goals over individual goals; a way of life in some cultures in which the group is the primary unit, not the individual. The needs and interests of individuals are sacrificed in order to meet the needs of the group as a whole. This philosophy is prominent in Eastern cultures. It is in strong contrast to the prevailing sentiment in the United States, which is individualism. Counselors with backgrounds from individualistic cultures need to take this into account when designing interventions for clients from a collectivistic culture.

Example: When counseling someone from a collectivist culture, the therapist must be careful not to impose his/her own individualistic viewpoint on the client. For instance, the therapist must resist passing judgements on someone she deems “too dependent” because in collectivistic cultures dependence is viewed as natural, while individualistic cultures disparage dependence.

Question 7

Coming out process

Answer 7

This is part of counseling relevant issues, coming out is the process in which individuals reveal that they identify as part of the LGBTQ community. Not everyone goes through the same process or the same steps. This is not a linear process and the individual typically has to “come out” many times throughout their life. There are positives and negatives of coming out. Important to consider all consequences when counseling a client thinking about coming out. Positives include building self esteem, building more genuine relationships, and being a role model to others. Negatives include rejection, harassment, discrimination, and loss of social support. 6 Stages of Coming Out: - Confusion- question and wonder about sexuality; might experience denial - Comparison- accept possibility that you may be gay - Tolerance- acceptance increases, may isolate self because self-concept is becoming different from society’s expectations - Acceptance- have resolved most ?s concerning sexual identity and have accepted self - Pride- begin to feel pride; immerse self in LGB culture; may feel anger with or reject hetero community - Synthesis- integrate sexual identity with other aspects of self so it is just one part of whole identity. Feel more congruence. Its important to recognize that the goal of therapy isn’t always for the client to come out. Clinicians can help them expand environmental supports and develop coping skills.

Example: A 20 year old male was seeking therapy due to anxiety about his sexual orientation. He explained to the therapist that his family would never accept him if they found out he was homosexual, but that he had to tell someone. The therapist offered help and together they explored the consequences of coming out process. He role played coming out to his dad with the therapist.

Question 8

Cultural competence

Answer 8

Therapist’s ability to understand the various influences of culture on a person’s behavior and interactions. Can be defined in three different areas: Awareness, Knowledge, and Skills. -Awareness includes knowing one’s own culture, views, biases, and comfort levels of various backgrounds. -Knowledge refers to the therapist’s knowledge of the cultural group both currently and historically, along with any barriers that group may have faced. -Skills refer to implementing culturally appropriate interventions and receiving and sending information in ways that take into account cultural background; also recognizing one’s own personal limitations. Cultural humility is also involved. Cultural competence is not something that can be learned once, but is instead a lifelong process in which therapists must remain continually engaged.

Example: Danielle is a white therapist who is practicing on a Native American reservation. She attends ceremonies and meetings with tribe’s elders in order to better understand how to help her clients in the context of their culture, thereby increasing her cultural competence.

Question 9

Cultural universality

Answer 9

In contrast to cultural relativism, this is the view that the concepts of normality and abnormality can be universally be applied, regardless of culture. Proponents of this view believe that culturally diverse individuals do not need treatments to be adjusted for them, but can be treated just the same as an individual from a Western culture. When these values are imposed clients can engage in victim blaming.

Example: A therapist that takes a cultural universality approach does not spend much time assessing or exploring a client’s culture as they do not believe it affects the person’s symptoms, interpretation of treatments, or presentation of disorders.

Question 10

Culture

Answer 10

Culture consists of all those things that people have learned to do, believe, value, and enjoy. It is the totality of the ideals, beliefs, skills, tools, customs, and institutions into which members of society are born. Frequently culture has a significant influence on one’s sense of identity, and to understand the client’s internal frame of reference the counselor must understand their culture.

Example: A Muslim woman comes to treatment wearing a head scarf. Woman cover their heads in public in her country of origin so this is a practice rooted in her culture.

Question 11

Culture-bound

Answer 11

Refers to behaviors that are linked to a specific culture or tied to a specific group of people and their values and beliefs. Certain syndromes and disorders may be culture bound, as well as certain treatments. A counselor must be careful not to diagnose something that is considered normal in a culture as a disorder, and also must be sure to be aware of disorders that occur only in specific cultures. Values can be culture bound as well, such as emotional expressiveness, insight, and self-disclosure.

EXAMPLE: The experience and perpetuation of grief is often culture-bound. If you are counseling someone of the Jewish faith that just lost her mom, it is important to know that she might grieve for an entire year based on religious underpinnings.

Question 12

Emic

Answer 12

The belief that cultural differences must be considered in the diagnosis and treatment of culturally diverse groups (Remember Emic - me, multicultural). The emic perspective emphasizes culture-specific norms and views clients in the context of his/her own culture. What is true for one client might not be true for another. If counselors are practicing emically then they are coming from a multicultural perspective.

EXAMPLE: A therapist that takes an emic approach will spend a lot of time assessing or exploring a client’s culture because they believe cultural differences affect how a disorder manifests and how the client should be treated.

Question 13

Ethnicity

Answer 13

Unlike race, its more of a social category. The fact or state of belonging to a social group that has a common national or cultural tradition. Ethnicity generally describes a group’s sense of possessing a shared identity informed by a common language, culture, or religion. Racial and ethnic identities often overlap. It can be important to understand when examine cultural-relevant issues and developing culturally appropriate interventions.

EXAMPLE: The Martinez family came to therapy because the father was hearing voices and sounds no one else heard. The therapist talked about the father’s problems in front of the entire family, using the son to translate, without realizing that the family’s Hispanic ethnicity would prohibit the son from taking on such a role.

Question 14

Etic

Answer 14

The belief that human beings share broad commonalities and that the manifestation and treatment of disorders are similar across ALL cultures and societies (remember etic - Total). The etic perspective emphasizes similarities between all people, assumes universality, and downplays culture-based differences. It teaches counselors that universality can be a bad thing and is important when different cultures express syndromes differently.

EXAMPLE: A therapist that takes an etic approach does not spend much time assessing or exploring a client’s culture because they believe cultural differences do not affect how a disorder manifests and should be treated

Question 15

Ethnocentric monoculturalism

Answer 15

Ethnocentric monoculturalism is the consideration of one culture as being the standard, normal, and most valuable. Any other culture by comparison is seen as inferior, abnormal, and exotic. It is defined by five components. The first is the belief in the superiority of the dominant group. This means the values, beliefs, language, traditions, physical characteristics, and norms of the dominant group are seen as the most civilized, most advanced, and normative. The second component is the belief in the inferiority of others. The third is the power of the dominant group to impose their cultural standards and values on others. The fourth component is manifestation in institutions, meaning that the dominant culture’s values and beliefs are apparent and embedded within policies, practices, and societal structures and institutions. The last component is the invisible veil. This refers to how people see and interpret everything in life through their own values, experiences, and beliefs because of their cultural conditioning. This operates outside of an individual’s conscious awareness and causes them to assume everyone shares the same perceptions of the world. Is at the heart of the oppressor/oppressed relationship and affects trust in the therapeutic relationship. It can also be at the heart of the minority culture seeking therapy.

Ethnocentric monoculturalism is the consideration of one culture as being the standard, normal, and most valuable. Any other culture by comparison is seen as inferior, abnormal, and exotic. It is defined by five components. The first is the belief in the superiority of the dominant group. This means the values, beliefs, language, traditions, physical characteristics, and norms of the dominant group are seen as the most civilized, most advanced, and normative. The second component is the belief in the inferiority of others. The third is the power of the dominant group to impose their cultural standards and values on others. The fourth component is manifestation in institutions, meaning that the dominant culture’s values and beliefs are apparent and embedded within policies, practices, and societal structures and institutions. The last component is the invisible veil. This refers to how people see and interpret everything in life through their own values, experiences, and beliefs because of their cultural conditioning. This operates outside of an individual’s conscious awareness and causes them to assume everyone shares the same perceptions of the world.

Example:

Question 16

Individualism

Answer 16

The philosophical, political, economic or social outlook that emphasizes the independence and worth of every human and the priority of individual goals. The Western world embraces this view which focuses on the autonomy of the individual and promotes freedom of action for the individual over the collective. From this view people are considered “good” if they are strong, self-reliant, assertive and independent. Being dependent upon others is often considered weak. Its important to know how the client views self in relation to others in therapy.

EXAMPLE: When counseling someone from an individualistic background, the therapist should allow the client to guide and inform therapeutic goals because he/she likely values autonomy. When working with a client from a collectivistic background, the therapist might be required to do a little bit of advice giving.

Question 17

Institutional racism

Answer 17

Institutional racism refers to policies, priorities and accepted normative patterns that are designed to subjugate, oppress, and force dependence of individuals and groups on a larger society by sanctioning unequal goals, unequal status, and unequal access to goods and services. Institutional racism may include police practices, unemployment, housing and education issues, discriminatory practices and inadequate welfare programs. Prejudiced attitudes can be found in many cultural elements, including language, education, religion, norms of morality, economics and aesthetics. This is the hardest racism to recognize and works to disempower entire minority groups within the society. When treating clients who have experienced this, it is important for therapists to help them recognize that this is an external factor and separate from the client.

EXAMPLE: An African American client that you are counseling for depression details the institutional racism that her family has had to endure. Her husband and the father of her children was unfairly imprisoned due to the third strike policy. He was sent to jail for years over a personal bag of weed. You empathize with her and help her come to terms with this new reality for her family.

Question 18

Microaggression

Answer 18

Microaggressions are the everyday slights, put-downs, invalidations, and insults directed to socially devalued group members by well-intentioned people who often are unaware that they have engaged in such biased and harmful behaviors. Three categories of microaggressions: microinsults (unintentional ways of being insensitive/demeaning); micro assault (blatant, hostile – conveys bias and prejudice), and microinvalidation (dismiss, exclude other person’s experience/beliefs).

Example: A white woman tells a Black woman that she loves her hair and asks to touch it. This is a microaggression because the white woman thinks she is being complimentary, but she is actually dehumanizing the other woman by exotifying her hair.

Question 19

Minority

Answer 19

An ethnic, racial, religious, or other group having a distinctive presence within a larger society and who differ from the dominant and majority culture in one or more ways, including but not limited to culture, race, sexual orientation, or country of origin. Being a member of a minority group in a mono-cultural society often puts one at a significant disadvantage. It can cover any group that is the subject of oppression and discrimination.

EXAMPLE: As a white therapist, I am part of the majority in the US. I must recognize that I may not understand a minority group member’s unique experiences and I must be open to learning about it from that member.

Question 20

Multicultural competencies

Answer 20

Multicultural competence has three components: awareness, knowledge, and skills. - Awareness includes knowing one’s own culture, views, biases, and comfort levels of various backgrounds. Awareness can be developed via awareness activities which change the person’s attitudes, opinions and personal perspective (i.e. journal in multicultural class, immersion) - Knowledge refers to the therapist’s knowledge of the cultural group both currently and historically, their worldview, and any barriers that group may have faced. Can be developed by learning facts and seeking accurate data (i.e. research, reading books). - Skills refer to implementing culturally appropriate interventions and receiving and sending information in ways that take into account cultural background. Skill-building activities involve the application of awareness and knowledge in applied settings with diverse clients (i.e. seeking supervision on new skills).

EXAMPLE: A multiculturally competent therapist working with diverse populations will understand her own limitations in understanding the marginalized experience, routinely seek education about marginalized groups, and seek training to build her skills in working with these groups.

Multicultural competencies: It is the acknowledgement that multiculturalism leads to social justice initiatives and actions. It includes quadrants (privilege, oppressed statuses), domains (counselor self-awareness, client worldview, counseling relationships, and counseling and advocacy interventions), and competencies (attitudes, beliefs, skills, and action). This is important to keep in mind when practicing with cultural competence.

Question 21

Multicultural counseling

Answer 21

This is a framework for counseling in which the therapist defines goals and uses treatments that are consistent with an individual’s cultural values. The therapist must recognize that their values may not be the same as that of their culturally diverse client, but that does not give them the right to pressure their client to accept their values. The therapist must also recognize some behaviors considered deviant in Western society are not considered deviant in the culture of their clients.
Take into account: race, ethnicity, gender, sexuality, social status, disability, history of oppression, acculturation. How you integrate into practice.

EXAMPLE: A therapist treating an Asian American client is careful when defining goals not to impose his individualistic values on his client, who has more of a Multicultural counseling is an approach to counseling that requires that the counselor consider not only the racial and ethnic background of their clients, but also their age and other social categories including gender identity, sexual orientation, religion, disability status, immigration status, and social class/socioeconomic status. Therapists using multicultural counseling view a client’s presenting issues in the context of their various social identities. Additionally, it involves understanding the history of oppression, marginalization, and power, or lack thereof, in order to see how the combination of all of these factors impacts the client’s experience. It can and should be used with any therapeutic approach or methodology. collectivist perspective.

Question 22

Multicultural perspective in counseling

Answer 22

This perspective recognizes the differences between and within clients and how their cultures may impact their values. According to this perspective, a counselor must maintain awareness of her own cultural biases and values in order to prevent her from interfering with interactions with culturally diverse clients. Counselors are also responsible for cultivating knowledge about different cultures and skills that are useful with culturally diverse clients. The perspective.

EXAMPLE: Josie, a therapist that uses a multicultural perspective, was raised in an impoverished environment, in which the family constantly struggled to put food on the table. Because of her experience, she feels many who are wealthy are wasteful and unappreciative. She must be careful of this bias when working with wealthy clients so she does not harbor resentment or negativity towards a client.

Question 23

Oppression

Answer 23

Oppression is the abuse of power whereby a dominant group engages in unjust, harsh, or cruel activities that perpetuate an attitude or belief toward a marginalized group that is reinforced by society and maintained by a power imbalance. The dominant culture frequently will use its power to marginalize, silence, and otherwise subordinate other cultures. Cultural oppression may occur without the oppressor realizing it; in light of this, the therapist must take steps to be very aware of any ways they may be oppressive to culturally diverse clients. Chronic oppression can lower self-esteem, reduce opportunities, can lead to anger/anxiety/depression and can lead to internalized oppression.

EXAMPLE: Marvin is a young gay male coming to therapy for depression. He describes the oppression he experiences at school, work, and even in his family: - he is bullied at school. - He has been both physically and verbally attacked by his peers. - When he first came out, he lost his job because his boss didn’t approve of his “lifestyle.” - He is bombarded daily with negative stereotypes of homosexuality from the media, family and friends, and religion.

Question 24

Poverty and mental illness

Answer 24

Studies show a direct correlation between poverty and mental illness. Impoverished people are 2 to 3 times more likely to develop mental illness than those w/ higher SES. These families must deal with economic stressors like unemployment and lack of affordable housing, which can lead to mental health disorders. There is also a strong association between poverty and substance abuse. Substance abuse only perpetuates a cycle of poverty. These environments can increase the risk of exposure to violence and trauma.

Example: Richard grew up in a poor family that didn’t have access to mental health or medical resources to help him when he began to show signs of schizophrenia. He began to self-medicate with drugs. As an adult, he is unhoused and has spent time in and out of psychiatric wards of hospitals and prisons for actions related to his addiction and mental illness.

Question 25

Race

Answer 25

Describes populations or groups of people distinguished by different sets of characteristics and beliefs about common ancestry. The most widely used human racial categories are based on visible traits (especially skin color, facial features, and hair texture) and self-identification. Race is a social construct with no significant biological basis, so it is always important to ask rather than assume. It plays an important role in our worldview and is important to distinguish between this and privilege.

Race is a socially defined concept that is used to designate and group segments of the human population that share physical characteristics or ancestry. Self-reported race varies because of social contexts and an individual’s possible identification with more than one race, so it’s important to ask rather than assume. Race has historically been used to establish social hierarchies, where individuals are marginalized and treated differently, resulting in racism. This has led to systemic racism and a society where individuals of minority races experience disrcrimination and prejudice. Race plays a significant role in our individual identities and the way we move through the world since it shapes our experiences and how we’re treated. It’s important to explore the impact that race has had on a client, but it’s also important not to assume that racial identity is the sole issue minority clients experience. It’s also important to address the difference in privilege and worldview and the impact on the therapeutic relationship if the counselor is of a different racial identity than the client.

EXAMPLE: An African American therapist that has experienced racist events may have negative reactions towards a client that expresses microaggressions in the therapy session. These reactions, and the microaggressions are due in part to her race.

Question 26

Racial identity development model (RCID)

Answer 26

5 stage theory of developing a racial identity. Based on the Minority Identity Development model, this is Sue and Sue’s elaboration and adjustment of the previous model. Stages:
1. Conformity - preference for dominant culture
2. Dissonance - event happens - challenging beliefs of conformity
3. Resistance + immersion - accept minority values/culture - reject dominant - anger at oppression and guilt for previous stages
4. Introspection - proactive to find self - pride for culture
5. Integrative awareness - commit to social change
At each level, there’s 4 corresponding attitudes for each model- towards self, others of the same group, others of a different marginalized group, and others of the dominant group. It is important when treating clients because it can help alert therapists to associated challenges at each status of this model.

EXAMPLE: An Asian-American client came in to see Julia. It became apparent that being a member of a minority was highly salient to the client, so Julia began to assess the client to see what stage of the minority identity development model the client might be in. Julia hypothesized that the client was moving into the introspection stage because she was beginning to integrate aspects of American and Asian cultures, forming her own self-identity. Can be less specific and say they’re in one of the early stages or later stages.

Question 27

Racism

Answer 27

Racism: A form of prejudice that assumes that the members of racial categories have distinctive characteristics and that these differences result in some racial groups being inferior to others. Racism generally includes negative emotional reactions to members of the group, acceptance of negative stereotypes, and racial discrimination against individuals; in some cases it leads to violence. This tends to be a key issue in therapy even if some might not see it at first, most minorities have experienced some type of racism or microaggressions that can contribute to their problems. Systemic racism is a key issue in minorities.

Question 28

White privilege

Answer 28

The unearned advantages and privileges that accrue to people of light‐colored skin (usually White European descent).

Set of advantages and/or immunities that white people benefit from on a daily basis beyond those common to all others. White privilege can exist without white peoples’ conscious knowledge of its presence and it helps to maintain racial hierarchy. White privilege is not the same as racism; frequently the people who benefit from white privilege are unaware and do not identify as racist or prejudiced.

When a white male therapist tells his African American client that he does not see her as being Black and that he “doesn’t see color at all” this is a demonstration of his white privilege. He has grown up with the ‘privilege’ of ignoring race because it has not affected him in the same way that it has affected her.

Question 29

White racial identity development

Answer 29

The 2 stage models include This is a stage theory developed by Helms.
The stages are:
1) Contact: individual lacks awareness of cultural and institutional racism and of white privilege. May express stereotypical responses
2) Disintegration: person becomes more aware of conflict between humanistic ideals and loyalty to majority; guilt and shame or helplessness at recognition of their own advantages of being white. [Can be set off by an encounter with racism]
3) Reintegration: becomes more identified with white ideology/identity. Generally become defensive about being white. Active assertion of superiority while denying racism.
4) Pseudo-independence: usually move to this stage following an eye-opening experience; characterized by attempt to understand racial differences and increased contact with minority group members. Attempts are still made within a White framework and support the status quo.
5) Immersion/emersion: focus on own viewpoints, what it means to be White, and on changing majority behavior/attitude. There is an increase of experiential and affective understanding. Emotional catharsis is necessary here. Leads to “rebirth” necessary to become non racist. 6) Autonomy: Awareness of whiteness with a reduced sense of guilt; acceptance of role in perpetuating racism; commitment to social change; knowledgeable about differences; not fearful of encounters, values and seeks out interracial experiences.

EXAMPLE: You are working with a White client and you’re trying to conceptualize where he is at in his racial identity development. The client repeatedly comes in distressed because he feels guilty and shameful for being White, so much so that he has been unable to interact with minorities without crying. It is likely that he is in the Disintegration phase.

White racial identity development refers to the process of White individuals developing racial consciousness and a nonracist White identity. Two stage models include Hardiman White Racial Identity Model and Helms White Racial Identity Model. Helms’ model is the most elaborate and well-known. She assumes racism is a central and intimate part of being a White American, and her model describes movement through two general phases to develop a healthy White identity: abadonment of racism and defining a nonracist White identity. Six specific racial identity statuses are distributed evenly within the two phases: contact, disintegration, reintegration in phase 1 and pseudo-independence, immersion, autonomy in phase 2. The higher level of White identity development, the greater the reported multicultural counseling competence, positive opinions towards minority groups, and good therapeutic alliances.

Question 30

Worldview

Answer 30

The overall perspective from which one sees and interprets the world. A person’s worldview is a framework for making decisions and includes her beliefs about life, reality, meaning. Different cultures have different worldviews.

EXAMPLE: When counseling someone from a collectivist background, the therapist must be careful not to impose her worldview on the client. For instance, the therapist must resist passing judgements on someone he/she deems “too dependent” because in collectivistic cultures dependence is not viewed as badly as it is in individualistic cultures. Collectivistic cultures have a different worldview than individualistic cultures.

Question 31

Counseling-relevant cultural issues for African American clients

Answer 31

Exacerbated when double minority…Important to note where they are in their racial identity development, as they may react negatively to a white therapist. ● May be distrustful of authority figures; egalitarian relationship very important ● Family & faith important - potential asset ● Less likely to seek treatment and more likely to terminate early. ● Reported trauma lower in this population, higher rates of PTSD, higher rates of GAD ● High poverty rate, high incarceration rate ● Stigma associated with getting help, 4 interactive factors to consider when working with African American clients.

Example: Bianca is a Black woman seeking therapy for the first time. She directly challenges the therapist and asks if she really knows what she’s talking about. Bianca’s confrontational attitude may be indicative of where she is in her racial identity development, and the therapist must be careful not to get defensive, or to take it personally.

The four interactive factors to consider while working with AA clients are racial oppression and the reactions to it, influence of the majority culture, influence of Afro-American culture, and personal experiences and endowments.

Question 32

Counseling-relevant cultural issues for Hispanic/Latino clients

Answer 32

Worldview: Religion & family (elders respected; sex roles defined w/ dominant males, submissive women; authoritarian) important* collectivistic* present-focused* fatalism* Focus more on how issues affect family rather than affect individual, try and do family therapy if possible or include family in therapeutic process* Respect familial hierarchy* Take into consideration acculturation status and language barriers, academic issues, and possible undocumented status, with related stressors.* Be respectful of potential topics that are off-limits (i.e. sexual potency when counseling a male head of household as a woman therapist)

Example: The Martinez family came to therapy because the father was hearing voices and sounds no one else heard. The therapist talked about the father’s problems in front of the entire family, using the son to translate, without realizing that the family’s hierarchical family structure would prohibit the son from taking on such a role.

Question 33

Counseling-relevant cultural issues for Native American clients

Answer 33

recognize history of oppression.*
Many live in extreme poverty.*
educational gaps between the majority culture. Make sure to remember each tribe has own heritage*
Worldview considerations: collectivistic, strong spirituality component, harmony with nature, values generosity, emphasize here and now,*
gender roles complementary*
Biggest mental health issues tend to be substance abuse (alcohol), depression & anxiety, suicide (highest rates of completed suicide among all ethnic groups), and domestic violence and violence against women*
Barriers to treatment include trust, stigma, limited resources, and lack of knowledge about services*
Silence is valued; eye contact sign of disrespect.*
Group treatment fits well with worldview since collectivistic*
Non-directive methods- nonadherence* Existential/humanistic/experiential preferred; CBT seen as useful in some cases*
Work with healer and/or chief if possible

Example: Jenny is at a personal crossroads and is feeling anguished about her decision. She seeks therapy, and mentions looking for signs in a nature and relying heavily on advice from her family on what to do. Her therapist should be sensitive and respectful of these sources of information, understanding that Jenny’s collectivistic culture values communing with nature and family. Dismissing these sources as irrelevant would be a mistake.

Question 34

Counseling-relevant cultural issues for LGBTQ clients

Answer 34

Be aware of your own beliefs on this community.* Know how the client identifies and what they prefer to be called, in terms of both gender and sexuality.* Be aware of where they are in the coming out process.* Common disorders include depression, anxiety, etc.* Higher rates of suicide and bullying in schools* High rates of homelessness and drug use.* Intersectionality important to consider* Important to create a safe space with an atmosphere of understanding and acceptance - use gender neutral language (including in assessments)* Remember the issue at hand may have nothing to do with sexual orientation.* Make sure to know community support systems and programs.* If aiding in the coming out process, ensure the individual is prepared for every possible reaction. Can be hard to develop a healthy self-identity because of traditional gender norms.

Example: June identifies as lesbian on her intake form. Her therapist should note her sexual orientation, but not assume that her presenting problem will necessarily be related to her sexuality.

Question 35

Counseling-relevant cultural issues for Asian clients

Answer 35

Tend to be very private, see emotionality as weakness and keep it to themselves.* Believe that emotions, desires, behaviors, and individual goals should be kept under control.* Collectivist orientation; Autonomy and independence are not necessarily treatment goals* What appears to be co-dependency may just be cultural values (filial piety)* Patriarchal and authoritarian parenting style; males and older individuals higher status* Build rapport by discussing confidentiality* Determine the relationship between physical complaints and emotional issues, as many emotional issues present as physical complaints.* Use problem focused time-limited approaches. Always include family issues.* Address possible cultural conflicts.* Focus on positive assets.* Least responsive to groups, maybe due to the sense of violation of privacy.* Common to give gifts.

Example:

Question 36

Counseling-relevant cultural issues for Arab clients

Answer 36

Patriarchal and family centric, hierarchical by age and gender.* Attend to and emphasize family members/connections. Do not strive for individuation from family* Make sure to learn about dating/marriage practices.* Do not assume Arab women are oppressed.* Social status is very important.* High levels of mistrust with authorities due to recent politics* Common to give gifts and may be asked to visit client’s home.* Arab clients may expect detailed advice or directions and revere the counselor as an expert and expect them to make decisions.* Don’t use jargon - speak clearly/directly. Tend to be here and now rather than future oriented* Education about mental illness important

Example:

Question 37

Counseling-relevant cultural issues for Jewish clients

Answer 37

Orthodox have a higher stigma of therapy because they tend to think religion has failed them and are less accepting of the LGBTQ.

-Jewish clients: Discrimination towards Jewish people is very prevalent, there are some very religious jews and not religious jews who still identify as Jewish, this is important to assess during treatment. Culture not just a religion, historical incidences like the holocaust can be important. Oppression experienced, consulting with rabbi, becoming knowledgeable about Jewish culture, culturally adapted interventions is key, respecting holidays, there is a value in therapy in this culture.

Question 38

Counseling-relevant cultural issues for physically disabled clients

Answer 38

Make sure the office is ADA accessible and is capable of meeting all needs.*
Refer to person as someone with a disability- PERSON FIRST LANGUAGE*
Match therapy with client’s model of disability and work from there*
Identify personal beliefs and understand prejudice/possible countertransference*
Be careful not to overlook important issues (sex, emotions, relationships)*
Determine the relationship between disability and problem; don’t assume the problem is about their disability* Respect positive functioning but don’t sensationalize it* Focus on positive assets.

Self-advocacy as empowerment

Including family into therapy and addressing impact on caregivers.

Example: A therapist is looking for office space for her private practice. She immediately rules out locations that are not ADA complaint (stairs only, etc.). She also incorporates accessibility into her policies, such as allowing service animals, accepting checks without requiring a driver’s license, and offering important documentation in an audio and braille version.

Question 39

Counseling-relevant cultural issues for female clients

Answer 39

Stressors:* economic status* lower pay rates compared to male counterparts* single parenthood* career barriers* how they are portrayed in the media* victimization: domestic violence, sexual assault, and rape.* Know signs of abuse or violence.* Know social support groups, advocacy groups, and outreach programs for women.* Girls in school experience academic pressure, peer pressure, self-esteem, and body image issues.* Common problems are depression/anxiety, eating disorders, body image issues, and aging.* Consider intersectionality which may bring additional stressors

PTSD from women is mainly due to sexual traumas.

Microaggression and sexism.

Example:

Question 40

Counseling-relevant cultural issues for male clients

Answer 40

Male clients of minority groups face discrimination. Boys have higher rates of learning disorders and ADHD, and more disciplinary problems* Men have problems expressing and coping with negative emotions, financial pressures, violence and aggression, and underemployment. Therapeutic concerns for men include relational problems, difficulties at work, conflict with model of masculinity, homophobia, pressures from needing to be “the best,” and often need crisis to seek help- if they seek out help its usually viewed as weak. Practice recommendations:* follow the client’s lead in relation to feelings work* address their possible ambivalence in regards to therapy* assess whether they see seeking treatment as a failure* assess the degree of their adherence to traditional male sex roles* Take an egalitarian approach with the client.

Example:

Question 41

Counseling-relevant cultural issues for clients in poverty

Answer 41

Race and gender (intersectionality)* poor education* Poor physical development due to poor diet, bad living conditions, lack of safety, etc.* Poor cognitive development again due to diet and high allostatic load, environmental toxins, and under/over stimulation* Poor emotional development* higher instances of abuse and neglect;* lack of healthy role models, future orientation, and resources to address problems* Barriers to treatment include logistical issues (cost, transportation, limited clinic hours, and difficulty finding child care)* multicultural issues (language barriers, trust issues, and miscommunications)* psychological issues (stigma and burden of psychiatric illness on top of everything else)Important as clinician to:* be understanding of chronic stressors these clients face* evaluate hierarchy of needs* Stress benefits of improving mental health* provide reassurance and encouragement* recognize cultural factors* deliver services in a flexible way (after hours, weekends, in various settings, in home, coordinate with other service providers)

Example: Jen is referred to treatment from a domestic violence clinic. It will be important to assess her basic safety and employment needs before doing deeper psychological work.