Diversity and Treatment Themes

Question 1

General Cultural Issues to Consider:

Answer 1

• Ethnicity
• Acculturation
• Gender Identity/Sexuality Orientation
• Religion/Spirituality
• Disability
• Multigenerational issues
• Non-traditional families
• Socioeconomic status
• Military culture
• Drug culture

Question 2

African American Cultural Considerations:

Answer 2

According to Schiele (2000), culturally responsive counseling for African American clients involves adherence to six core principles:

• Discussion of clients’ issues should be framed in a context that recognizes the totality of life experiences faced by clients as African Americans.
• Equality is sought in the therapeutic counselor–client relationship, and counselors are less distant and more disclosing.
• Emphasis is placed on the importance of changing one’s environment— not only for the good of clients themselves, but also for the greater good of their communities.
• Focus is placed on personal rituals, cultural traditions, and spiritual well being.
• Treatment is a process that involves gaining power in the forms of knowledge, spiritual insight, and community health.
• Treatment is framed within a broader context of how recovery contributes to the overall healing and advancement of the African American community.

Question 3

Asian American Cultural Considerations:

Answer 3

Kim et al. (2004) reviewed references that provide guidelines for family therapy with Korean Americans. They established 11 essential ingredients applicable to Korean and other Asian American groups and families. To provide culturally responsive therapy to Asian Americans, therapists should:

• Establish credibility as a professional in the initial meeting with the family.
• Explain the key principles and expectations of family therapy and the family roles (especially elders/decision makers) in the process.
• Enable clients, particularly male elders or decision makers, to save face.
• Validate and address somatic complaints.
• Be both problem focused and present focused.
• Be directive in guiding therapy.
• Respect the family’s hierarchy.

• Avoid being confrontational and facilitate interactions that are non-
confrontational.

• Reframe problems in positive terms.
• Assess support from community and extended family systems.

• Assess immigration history, if appropriate.
Shame and humiliation can be significant barriers to treatment engagement for Asian Americans. Gaw (1993) suggests that the presence of the following factors may indicate that a client has shame about seeking treatment:

• The client or a family member is extremely concerned about the qualifications of the counselor.
• The client is hesitant to involve others in the treatment process.
• The client is excessively worried about confidentiality.
• The client refuses to cover expenses with private insurance.
• The client frequently misses or arrives late for treatment.
• Family members refuse to support treatment.
• The client insists on having a White American counselor to avoid opening up to another Asian.

Question 4

Latino American Cultural Considerations:

Answer 4

When working with Latino American clients, providers should:

• Use family therapy as a primary method of treatment.
• Assess cultural identity and acculturation level for each family member.

• Determine the family’s level of belief in traditional and complementary
healing practices; integrate these as appropriate.

• Discuss the family’s beliefs, history, and experiences with standard
American behavioral health services.

• Explore migration and immigration experiences, if appropriate.
• Provide additional respect to the father or father figure in the family.
• Interview family members or groups of family members (e.g., children) separately to allow them to voice concerns.
• Generate solutions with the family. Do not force changes in family relationships.
• Provide specific, concrete suggestions for change that can be quickly implemented.
• Focus on engaging the family in the first session using warmth and personalismo.

Question 5

Native American Cultural Considerations:

Answer 5

When working with Native American clients, providers should:

• Use active listening and reflective responses.
• Avoid interrupting the client.
• Refrain from asking about family or personal matters without first asking the client’s permission to inquire about these areas.
• Avoid extensive note-taking or excessive questioning.
• Pay attention to the client’s stories, experiences, dreams, and rituals and their relevance to the client.

• Recognize the importance of listening and focus on this skill during
sessions.

• Accept extended periods of silence during sessions.

• Allow time during sessions for the client to process
information.

• Greet the client with a gentle (rather than firm) handshake and show hospitality (e.g., by offering food and/or beverages).
• Give the client ample time to adjust to the setting at the beginning of each session.
• Keep promises.
• Offer suggestions instead of directions (preferably more than one to allow for client choice).