Issue of Diversity: Race/Ethnicity, Gender, Class, Sexual Orientation, and Age Flashcards
Historical Originals of Culturally Competent Practice: Settlement House Movement
in the 1890s, immigration cities such as Boston, New York, and Chicago were centers of Settlement House work focusing on rapid Americanization of immigrants
What was the primary goals of the Settlement House Movement?
rapid assimilation into American society of newly arrived White ethnic groups
launched numerous social action initiatives designed to reduce the hardships and exploitation of experienced immigrants
Historical Originals of Culturally Competent Practice: Social Work Commitment to Social Justice
inclusion of content on African-Americans in the training of social workers
What was the St. Louis School of Economics?
first formal curriculum including social services to Blacks
Historical Originals of Culturally Competent Practice: What did early social work try to address?
exclusion of Blacks and other racial minorities from welfare, opposed Jim Crow laws, and later participated in the civil rights struggle
When did social work change focus on racism and switched to mental health treatment?
1918
When did social work practice begin to focus on civil rights practice and education?
during the civil rights struggles in the 1960s
What has been the focus of social work practice in recent times?
emphasis on clinical services and individual treatment
Professional Organizations and Structures: Council on Social Work Education (CSWE)
accrediting body for social work education made minority concerns a priority and content on vulnerable populations mandatory after 1970
What does Section 1.05 say in the NASW code of ethics?
sets the expectation that social workers are knowledgeable about cultural differences and diversity, use a “strengths” perspective, are competent in the provision of services to vulnerable populations, and obtain training and education
What does Section 4.02 say in the NASW code of ethics?
addresses social justice issues
social workers should not condone, facilitate, or collaborate with any form of discrimination
What does Section 6.01 and 6.04 say in the NASW code of ethics?
require social workers to advocate for all clients with regard to advancing cultural diversity
How are minorities defined within the NASW code of ethics?
race/ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, and mental/physical disability
What do the scope of programs look like for minorities?
failed to serve diverse communities adequately
mental health services experience excessively high attrition rates, and termination often occurs after the first interview
inadequate or limited treatment and are over-represented in agencies of social control
Scope of Programs: Risks to Disadvantaged of Vulnerable Populations
serious psychiatric disorders due to relocation stress and removal from family and familiar surroundings
racism, and discrimination, poverty, and lack of access to resources heighten the risk of disorders for vulnerable populations
Scope of Program: Asset-based Practice
explores community’s cultural assets as well as deficits
focus on assets contributes to more effective outcomes for members of the dominant culture
one in three adults use natural forms of healthcare
substantial discrepancy across all racial/ethnic groups in the definition of mental health
Definitions: Culture
integrated patterns of human behaviors that include thought, communication, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group
Definitions: Diversity
refers to social groups not easily subsumed in the larger culture
the groups differ by socioeconomic status, gender, sexual orientation, age, and differential ability
Definitions: Ethnicity
a group classification in which members share a unique social cultural heritage passed on from one generation to the next
Definitions: Race
concepts first appeared in the English language 200 years ago
it has tremendous social and political significance and can be defined as a subgroup possessing a definite combination of physical characteristics of a genetic origin
Definitions: Worldview
a significant and integral concept in assessing mental health status, assisting in assessment and diagnosis, and in designing treatment programs
Definitions: Cultural Competence
individual practitioner: ability to function with cultural differences
institution: practice skills, attitudes, policies, and structures that are joined in a system, in an agency, or among professionals and enable that system, agency, or group of professionals to work with cultural differences
What are elements of cultural competence for the individual?
Awareness and acceptance of differences
Awareness of one’s own cultural values
Understanding the dynamics of difference
Development of cultural knowledge
Ability to adapt practice skills to fit the cultural context of the client’s structure, values, and service
What are elements of competence for the organizaiton?
Values Diversity
Institutionalization
Values Diversity
a diverse staff, policies that acknowledge and respect differences, and an organization that regularly initiates cultural self assessments
Instituionalization
the organization has integrated diversity into its structure policies and operations
Communication: Hall’s Theory of Communication
highlights communication styles found in different cultural groups
Hall’s Theory of Communication: Key Dimensions of Communication
Time
Space and Tempo
Reasoning
Verbal Messages
Social Roles
Interpersonal Relations
Social Organization
Hall’s Theory of Communication: High Context Styles of Communication
associated with “minority” cultures in the U.S.
High Context Styles of Communication: General Characteristics
reliance on contextual cues, flexible sense of time, social roles shape interactions, more personal and affective, oral agreements binding, intuitive
Hall’s Theory of Communication: Low Context Styles of Communication
associated with Northern European, white American cultural groups
Low Context Styles of Communication: General Characteristics
formal, complex codes
disregard for contextual codes
reliance on verbal forms of communication
highly procedural
relationships functionally based
linear logic
Hall’s Theory of Communication: Clinical Considerations
conflicting communication styles can lead to cross-cultural misunderstanding
all cultures exhibit great diversity within themselves; clinicians must avoid cultural stereotyping to allow responses to a wide range of differences
inflexible stereotypes of cultural group inhibit practice
Theory: Theoretical Tensions and Dilemmas
theoretical models organized information for culturally competent practice due to a reluctance to integrate new knowledge and skills, as well as value conflicts regarding stereotyping, which contribute to negative perceptions of diverse or vulnerable groups
Theory: The Universal vs. The Specific
major tension reflects democratic values embedded in U.S. society
though we are all equal under the law, we are not all the same
acknowledging differences creates conflicted thinking
The Universal vs. The Specific: Two Concepts that Highlight this Conflict
Etic: characteristics of a particular group seen as universal and generalized
Emic: characteristics of a particular group seen as specific to a given group
The Universal vs. The Specific: Strategic Practice Issues
awareness of characteristics that make groups distinct from other groups and influence communication patterns
understanding of behaviors that are typical or that vary form the norm, but are not necessarily deviant or extreme
What extremes should be avoided to create balanced cultural assessment?
only universal aspects matter; there is not need to acknowledge differences
differences in groups are deterministic
Theory: Theoretical Tensions and Dilemmas: Assessment Model – dimensions of personal identity
variation of the Life Model and Ecological social work practice
considers key characteristics of clients and the impact of social, cultural, environmental variables
Assessment Model: Dimension A
includes age, culture, ethnicity, gender, language, physical ability, race, sexual orientation, social class
individual characteristics are inborn; few controls over change
sociological concept
Assessment Model: Ascription
power and status are ascribed and not achieved through merit
Assessment Model: Dimension B
includes educational background, geographic location, income, marital status, religion, work experience, citizenship status
individual characteristics: a consequence of other two dimensions - social position and achieve status are related
involves access to resources whose availability is determined by social position and historical moments
Assessment Model: Dimension C
considers the historical contexts in which individuals live
contextualizes individual lives
notes the environment impact on the individual
Theoretical Approaches to Culturally Competent Social Work Practice: Information Management
a second major dilemma – potential barriers to acquiring cultural competence skills
generally two distinct approaches which can lead to dichotomized, polarized thinking
Theoretical Approaches to Culturally Competent Social Work Practice: Epistemological
underscores importance of attending differences
addresses underlying assumptions about knowledge
Epistemological: Social Constructionism
derives from social psychology
social context of knowing and interpreting
-meanings arise in particular settings and traditions
-knowledge is historically and culturally situated
-questions assumptions of absolute categories
-deemphasizes the culturally universal, the Etic
Epistemological: Constructivism
a philosophical position that influences individual clinical and family work since the mid-1980s
knowledge is seen as creation of the observer interacting with the environment
reality is constructed and interpreted through cultural, social, and ideological lenses
no objectivity or value-free knowledge
constant analysis of practitioner bias
Epistemological: Strengths
focus of attention is the difference between provider and client
acknowledges the presence of bias, stereotypes, racism, and oppression that is institutionalized in traditional approaches
encourages openness, rejects bias, and promotes open inquiry
Epistemological: Weaknesses
esoteric, abstract, and confusing
can drift into mindless relativism
fosters denial of individual responsibility for behavior
Theoretical Approaches to Culturally Competent Social Work Practice: Anthropological
the usual manner in which cultural competence is taught
cultural orientation practitioners are alerted to norms, and behavioral and emotional signals
Anthropological: Strengths
provides in-depth knowledge about a group
provides confidence in working with a group
Anthropological: Weaknesses
can lead to shallow, stereotypical thinking
can lead to a belief that group/cultural characteristics are deterministic; denies variation within the group
training programs cannot address every group in American society as there are too many
can fail to recognize that culture evolves over time
Anthropological: Balancing Both Perspectives
training and education require an integration of both approaches: a way of approaching clients and specific knowledge about groups when encountering members of an unfamiliar group, a social worker is ethically required to obtain necessary knowledge
Anthropological: Limitations to Culturally Competent Practices
culturally differences maybe harmful or unacceptable
practitioner needs a balanced approach to assess cultural norms in the context of American practices, norms, and laws
Limitations to Culturally Competent Practice: Unacceptable or Illegal Cultural Practices
child labor, honor killings, private or family vengeance, slavery, infant murder, female circumcision, clitorectomies, infibulation, wife or servant beating, bigamy, child marriage, denial of medical care or abandonment of malformed or defective children, extreme forms of disciplining a child
presence of potential harm to self or others, a practitioner must intervene or follow American practices
Knowledge: Acquisition of Knowledge
Reading relevant practice or scientific professional literature
Familiarization with the literature of the relevant groups
Identifying and consulting cultural brokers
Knowledge: Language and Communcation
Learning to speak the language
Using interpreters appropriately
Learning the syntax through which thoughts are put together by clients of different cultural groups
Participating in cultural events of the group under consideration
Forming friendships with members of different groups
Visiting major community, religious, education, and social organizations to express interest and identify major community concerns
Developing an understanding of the socio-political system in the U.S. and its implication for majority and minority groups
Obtaining cultural and historical information about cultural groups
Gaining knowledge and awareness of institutional barriers that limit access to cultural and economic resources for vulnerable groups
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Skills
Interviewing style that encourages honest expression
Avoidance of premature closing; understanding that experience influences perception
Ability to generate and receive a wide range of verbal and non-verbal responses
Willingness to intervene with the agency or institution on behalf of the client
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Attitudes
Awareness of practitioner’s heritage, values, beliefs, and biases
Respect for difference and comfort with differences in others
Sensitivity to countertransference, or the presence of bias that warrants a referral
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Characteristics of Culturally Competent Practitioner
approaches clients in a respectful, warm, accepting, concerned, interested, and empathetic manner; has due regard for individuality and confidentiality
focus on establishing trust and understanding that perceptions of practitioner and client are affected by stereotypes
Displays awareness thats/he may have been socialized to beliefs attitudes, behaviors, stereotypes, biases, and prejudice that affect professional relationships
Able to express limits of knowledge of client’s background to the client and is open to help from the client
Can communicate attitude that cultural differences and their expressions are legitimate
Is aware of a cultural group’s strengths and community resources, and that come types of help may be culturally inappropriate
Is knowledge about life conditions fostered by poverty, racism, and disenfranchisement
While acknowledging the importance of a client’s cultural background, is also aware that these may be peripheral to the client’s situation
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Cultural Destructiveness
One end of the continuum that devalues different cultures and sees them as inferior
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Cultural Incapacity
Recognizes the need but feels unable to provide the services – characterized by immobility
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Cultural Blindness
there are no differences between cultural groups; all are “human,” thus the same; denies institutional racism and oppression
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Cultural Pre-Competency
beginning movement to recognize needs of cultural groups; attention recruiting diverse staff and inclusion of appropriate training
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Cultural Competency
the organization addresses diversity issues with staff and clients
provides appropriate services to different client groups; staff trained and confident with a range of differences
Generalize Principles of Culturally Competent Social Work Practice–Knowledge, Skills, and Attitudes: Cultural Proficiency
idealized end of the continuum, marked by ability to incorporate and respond to new immigrant groups or client groups
Goals of Cultural Competence: Measure of Competence
-Acknowledging effects of cultural differences on the helping process
-Fully recognizing one’s own culture and its impact on thought and action
-Understanding the dynamics of power differences in practice situations
-Understanding the meaning of a client’s behavior in its cultural context
-Knowing when, where, and how to obtain necessary cultural information
Goals of Cultural Competency: To Develop the Attitudes, Knowledge, and Skills to Support Cultural Competency, the Practitioner must have
-Comfort with differences and ability to manage anxiety or defensiveness
-Ability to acknowledge and alter stereotypes and false beliefs
-Ability to respect and appreciate cultural differences
-Ability to think and behave flexibly, see alternative perspectives, and use a wide variety of strategies and interventions
-Ability to identify culturally appropriate goals and treatment processes
Goals of Cultural Competency: Barriers to Cross-Cultural Practice
Cultural Encapsulation
Language Barriers
Class-Bound Values
Culture-Bound Values
Barriers to Cross-Cultural Practice: Cultural Encapsulation
Ethnocentrism, color-blindeness, false universals
Barriers to Cross-Cultural Practice: Language Barriers
verbal, non-verbal, body language, dialect, etc.
Barriers to Cross-Cultural Practice: Class-Bound Values
about treatment and service delivery, power dynamics
Barriers to Cross-Cultural Practice: Culture-Bound Values
imposition of views, misinterpretations, trust/distrust
Process Barriers to Cross-Cultural Practice
Stereotyping
Resistance
Transference or Countertransference
Differing expectations of the nature, goals, and process of treatment by worker and client
Process Barriers to Cross-Cultural Practice: Stereotyping
generalizing, color-blindness, misapplication of information, anxiety about the client’s view of the social worker
Process Barriers to Cross-Cultural Practice: Resistance
self-devaluation, intellectualization, distancing, overt client hostility, or denial of the impact of race, culture, gender, and sexual orientation
Goals of Cultural Competency: Potential Challenges of Specific Pairings in Cross-Cultural Practice
-White social worker/client of color
-Intra-group practice
-Inter-group practice
-Inverted power relationships
Potential Challenges of Specific Pairings in Cross-Cultural Practice: Intra-group Practice
Internalization of oppression, over identification with the client, collusion, assumption of sameness, blind spots, etc
Potential Challenges of Specific Pairings in Cross-Cultural Practice: Inter-group Practice
cultural conflicts and stereotyping
Potential Challenges of Specific Pairings in Cross-Cultural Practice: Inverted Power Relationships
resistance, challenges to social worker’s credibility, etc
Goals of Cultural Competency: Benefits of Cross-Cultural Social Work Practice
-New insights and learning about self and others
-Development of a more extensive repertoire of practice skills
-New modes of communication
-New perspectives for both the client and the social worker
Immigration: Stresses Associated with Immigration
-understanding and gaining entry into an alien culture
-problems with language acquisition
-educated immigrants are often unable to find equivalent employment
-distance from family, friends, and familiar surroundings
Immigration: Waves of Immigration
distinct waves of immigration changed American society
until the 20th century, immigrants were largely from Europe
When did immigration outside of European cultures begin to appear in the United States?
Western part in the late 1880s; primarily of Asian descent
What happened after 1900 regarding immigration in the United States?
large influx of Mexican, Caribbean, and Latino immigrants
What has response to immigrants been like in the United States?
ranging from acceptance to suspicion and hostility
What happened in the 1990s regarding immigration law?
anti-immigration attitudes and policies reemerged as low-skilled jobs were exported
restrictive legislation at the national and state level
several states passed “English only” laws
Welfare reform (TANF) restricted welfare entitlements for immigrants
What states adopted “English only” laws in the 1990s?
Arizona, California and Florida
Immigration: Clinical Issues Associated with Immigration
-symptoms associated with stress
-causes for emigrating are important indicators vulnerable to mental illness caused by experience of torture, deprivation, denial of political or vulnerable economic rights, fears about family
language and worldview have significant impact on how immigrants use social services
historically, stresses of immigration were interpreted through several value frames
Clinical Issues Associated with Immigration: Stresses of Immigration Through Value Frames
focused on the demands of acculturation and assimilation
causal theories seen as deterministic – stress and pathology related to three inter-related factors
shift in emphasis from sociological and psychological factors to contextual/environmental factors
What’re are the three inter-related factors in causal theories?
-Predisposing factors
-Enabling factors
-the need for care
Clinical Issues Associated with Immigration: Assessment of Immigrations’ Needs
Migration/Immigration
Supports
Education
Economic and Housing Resources
Occupational
Institutional/Governmental Supports
Health Resources
Social Networks
Cultural
Life Control
Assessment of Immigrants’ Needs: Migration/Immigration
why, how, and in what manner did immigration occur? Personality changes associated with immigration
Assessment of Immigrants’ Needs: Supports
the presence of a community or relatives
Assessment of Immigrants’ Needs: Education
literacy in language of origin, fluency in English, ability to obtain a livelihood, intergenerational changes in education and employment, etc.
Assessment of Immigrants’ Needs: Economic and Housing Resources
income; debts; savings; transportation; telephone; housing; number of individuals living in setting; and availability of adequate heat, plumbing, and electricity
Assessment of Immigrants’ Needs: Occupational
employment history before immigration and now, demands of employment, safety of the environment, presence of unions, etc.
Assessment of Immigrants’ Needs: Occupational
employment history before immigration and now, demands of employment, safety of the environment, presence of unions, etc.
Assessment of Immigrants’ Needs: Institutional/Governmental Supports
can the client find services? What was available in country of origin?
Assessment of Immigrants’ Needs: Health Resources
use of traditional healers, availability and access to western health and social services, health status prior and subsequent to immigration
Assessment of Immigrants’ Needs: Social Networks
access to friends; relatives; religious bodies; intimate relationships; political, social, and recreational groups (then and now)
Assessment of Immigrants’ Needs: Cultural
Identification with primary cultural groups; use of cultural artifacts and use of American artifacts; types of entertainment, music and foods used; similarities/differences between the U.S. and country of origin
Assessment of Immigrants’ Needs: Life Control
experience of personal power, ability to make choices
Other Clinical Issues: General Concerns about using Interpreters
-many immigrants do not speak fluent English
General Concerns about using Interpreters: Interpreter Preference
First Preference: Bilingual/bicultural, professional social worker
Second Preference: professional interpreting services
What should NOT be done when seeking an interpreter?
children, relatives, friends, or non-professionals employed by an agency should not be used
True or False: Agencies serving non-English speaking clients are ethically and may be legally bound to provide professional interpreters, if they are not able to employ bilingual/bicultural social workers
True
True or False: Federal legislation requires free interpretation to be available for deaf clients in organizations that receive federal money
True
What two styles are utilized when working with an interpreter?
Interpreter as instrument
Interpreters as part of the treatment team
Working with Interpreters: Interpreter as Instrument
the interpreter translates conversation and offers no clarification
Working with Interpreters: Interpreters as Part of the Treatment Team
actively involved in understanding and assessing the needs of the client; the interpreter is a cultural broker between client and worker, and clarifies cultural idioms and norms
Other Clinical Issues: Practice Guidelines for Using an Interpreter
-discuss the evaluation with an interpreter prior to interviewing client
-role of interpreter and social worker should be described to the client, and any concerns about confidentiality should be addressed
-when addressing the client, the social worker should look at the client and not the interpreter
-social worker should understand gender constraints
Other Clinical Issues: Countertransference Issues
-social worker may feel competitive, resentful, or anxious
-social worker is ethically obliged to seek supervision and consultation for these concerns
Racial Ethnic Groups: Five Major Racial/Ethnic Groups
-Asian (Pacific Islanders)
-Blacks
-Latinos (Hispanics)
-Native Americans (American Indian)
-Caucasians (White European)
Racial/Ethnic Groups: Asian American (Pacific Islanders)
a heterogenous population group from Asia and South East Asia; includes Korean, Japanese, Chinese, Cambodian (Khmer), Laotian, Vietnamese, Asian Indian, Hmong, Indonesians, Filipinos, Hawaiians, Samoans, Guam; etc.
What language for Asian Americans primarily speak?
variety of indigenous and major European languages
What religion is common among Asian Americans?
Buddhism, Shinto, Confucianism, Taoism, Islam, and various forms of Christianity
Asian Americans (Pacific Islanders): Major Groupings of Immigrants
from the mid-1800s through to the present
primarily Chinese, Japanese, Korean and Filipino
Major Groupings of Immigrants: Beginning in the mid-1970s through present day
South East Asians, primarily Vietnamese, Cambodian (Khmer), Laotian, and Hmong
first wave of immigrants were middle-class refugees
second wave post-1978 were primarily poor
What have population trends looked like in the U.S. with immigration of Asian Americans?
populations up from 1.5% (3,500,000) to 2.9% (7,274,000) in the early 1990s
Asian Americans (Pacific Islanders): History
Asians experienced discrimination and racism in the U.S.
originally recruited to help build railroads and for agricultural work
What laws have been put in place regarding immigration of Asian Americans?
anti-immigration laws were first enacted in the mid-1880s
ban on Asian naturalization from 1870-1952
Executive Order 9066: Japanese-Americans held in concentration camps during WWII to prevent espionage
Asian Americans (Pacific Islanders): Misconceptions
the model minority
unrealistic stereotypes about Asians produces undue pressure to succeed
Asians are perceived as culturally alien after generations of U.S. residence
viewed as lacking communication skills
Misconceptions of Asian Americans: The Model Minority
problematic stereotype – clouds understanding of social and economic problems, and diverts attention from discrimination
Racial/Ethnic Groups: Special Issues
Cambodian and Vietnamese have experienced extreme violence and many suffered traumas; high rates of PTSD
Racial/Ethnic Groups: Values
-maintain harmonious interpersonal relationships and minimize conlficts
-low priority on individual achievement; family has higher priority
-emotional control is strongly encouraged
-assessment/service delivery planning concerns
-utilization of Western health and mental health services is related to education, English proficiency, and age; use also varies by ethnicity and levels of acculturation
-Asians often use both traditional healers and Western practitioners
-Cambodians display the highest rate of stress and service utilization; Laotians and Hmong are less likely to make use of Western services
Racial/Ethnic Groups: Culture-Bound Syndrome
appear in DSM-5 and describe locality-specific patterns of aberrant behavior and distress
Culture-Bound Syndrome: Amok (Malaysia, Laos, Philippines, Polynesia, Papua New Guinea)
a dissociative disorder found primarily in men
a period of brooding followed by an explosive, violent episode
precipitant is a real or imagined insult or slight
possibly related to a brief psychotic episode or exacerbation of a chronic mental illness
Culture-Bound Syndrome: Dhat (India)
a folk diagnosis that refers to severe anxiety and hypochondriacal concerns associated with somatic complaints (indigestion, palpitations, generalized aches and pains)
Culture-Bound Syndrome: Hwa-Byung (Korean)
a folk syndrome that literally translates into English as “anger syndrome”
symptoms include insomnia, fatigue, panic, fear of impending death dysphoric affect, anorexia, and somatic complaints (indigestion, palpitations, generalized aches and pains)
Culture-Bound Syndrome: Koro (Malaysian)
refers to episode of sudden intense anxiety that the sexual organs will recede into the body and cause death
disorder appears throughout South and East Asia
Culture-Bound Syndrome: Latah (Malaysian)
found in Asia, but the term is originally Malaysian in origin
most common among middle-aged women
defined as hypersensitivity to fright often with echopraxia, echolalia, and dissociative or trance like behavior
Culture-Bound Syndrome: Qi-gong Psychotic Reaction (Chinese)
an acute time-limited episode characterized by dissociative, paranoid, or other symptoms
they appear to be associated with participation in a Chinese folk health-enhancing practice of qi-gong (exercise of vital energy)
Culture-Bound Syndrome: Shenjing Shuairuro (neurasthenia) (Chinese)
a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss
there may also be somatic complaints
often meets the criterion for DSM-5 mood or anxiety disorder
Culture-Bound Syndrome: Shen-k’uei (Taiwan), shenkui (China)
a folk label describing marked anxiety or panic symptoms with accompanying somatic complaints
symptoms are attributed to excessive semen loss
anxiety is rooted in the belief that semen contains a vital essence
Culture-Bound Syndrome: Shin-byung (Korean)
a folk label for a syndrome in which initial phases are characterized by anxiety and somatic complaints, with subsequent disassociation and belief in possession by ancestral spirits
Culture-Bound Syndrome: Taijin Kyofusho (Japanese)
a culturally distinct phobia
can resemble social phobia found in the DSM-5
characterized by intense fear that an individual’s body parts or functions displease, embarrass, or are offensive to other people in appearance, odor, facial expression, or movements
Racial/Ethnic Groups: Blacks
community is diverse, originating from various cultures in different parts of Africa, Latin America, and the Caribbean
they include African Americans, Afro Caribbeans (both English and non-English groups
How much of American is populated with Blacks?
12-14 percent of the U.S. population (3o million)
Blacks: History
Blacks first appeared as indentured servants in the Jamestown colonies (1619) and later fought fought in the Revolutionary War
Slavery was a distinct formative influence on Blacks, providing a shared experience of oppression and injustice based on racial characteristics
Blacks: Emancipation Proclamation
1863
freed blacks from slavery during the Civil War, the aftermath did not achieve the full promise of freedom
through the 1870sand 1950s, Jim Crow Laws disenfranchised African-Americans, creating a separate and unequal community
little effort was expended to provide services and programs to help Blacks
Blacks: The Civil Rights Act of 1964
a new phase in civil rights recognizes that legal remedies are required to end discrimination
History: National Association of Black Social Workers (NABSW)
reaction to the professionalization of social work
many Black social workers feared exclusion from the profession as they lacked academic credentials
National Association of Black Social Workers: NABSW Opposes Transracial Adoption
1972
transracial adoption is seen as destructive to Black children
individual case approaches viewed as a distraction from addressing the Black families multiple social needs
Racial/Ethnic Groups: Clinical Issues
-difference in commitment rates and psychiatric diagnosis
-Black tends to be diagnosed with more severe mental illnesses than Whites
-studies agree Blacks will be diagnosed with schizophrenia more often than White
-Blacks and other groups of poor are often coerced into receiving services
-clinical diagnosis and treatment strategies must respond to Black diversity
Racial/Ethnic Groups: Clinical Issues
-American Blacks vary in socioeconomic background and racial experiences
-epidemiological studies have demonstrated that race makes a difference in commitment rates and psychiatric diagnosis
-Blacks tend to be diagnosed with schizophrenia more often than Whites
-Blacks tend to be coerced into services and are over-represented in agencies of social control
-Clinical diagnosis and treatment strategies must respond to Black diversity; many distinct ethnic groups
Racial/Ethnic Groups: Values
-experience of racism stimulated heightened sensitivity to signs of respect and expressions of interest, concern, and acceptance
-informality is viewed as disrespectful
-Black families historically functioned as a natural helping system; extended Black families often include non-biological members
-Religion is an important source
Racial/Ethnic Groups: Religion
-most Blacks are members of historically Black Protestant churches that provide social and health services
Religion: Caribbean Blacks
members of the Roman Catholic Church
many may practice a religion that resembles Roman Catholicism, but retains elements of the Yoruba African religion
commonly known as Santeria in the Caribbean and Macumba or Lacumbi in South America
Religion: Black Muslims
in recent years, Blacks have joined the Black Muslims or orthodox Islam
nationalist movement that began in the mid-1920s
Religion: Black Muslims Trends
active in economically depressed areas, and demonstrate an ability to motivate those involved in substance abuse, poverty, and criminality
leadership expressed hostility to Whites, and negative attitudes toward Jews
Religion: Afrocentrism
movement emerged during the 1960s , fostered by the Great Society’s poverty program, emphasizing Black control of services to the Black community
Culture-Bound Syndromes: Boufee Delirante
West Africa and Haiti
characterized by sudden outburst of aggressive behavior, marked confusion, and psychomotor excitement
visual and auditory hallucinations can present as well as paranoid ideation
resembles Brief Psychotic Disorder
Culture-Bound Syndrome: Brain Fag
West African
resemble anxiety, depressive, and somatoform disorders
difficulty in concentrating, remembering, and thinking
somatic complaints include pain, pressure, tightness, blurring of vision
distressed is viewed as a symptom of “thinking too much”
Culture-Bound Syndrome: Falling-Out or Blacking Out
Southern U.S. and Caribbean groups
sudden collapse, sometimes preceded by dizziness
eyes are open, but client claims not to be able to see
victim can hear, but feels powerless to move
corresponds to conversion or dissociative disorders
Culture-Bound Syndrome: Rootwork
Southern U.S. among African- and Euro-Americans and among Caribbean groups
ascribes illness and distress to hexing, witchcraft, sorcery, or evil influence
generalized anxiety and somatic complaints
roots need to be removed by a “root doctor”
Culture-Bound Syndrome: Sangre Dormido
Cape Verdean
includes somatic complaints (pain, numbness, tremors, paralysis, convulsions, strokes, blindness, etc.)
Culture-Bound Syndrome: Spell
Southern African-and-Euro-Americans
a trance state in which persons communicate with deceased relatives or spirits
can be associated with a brief personality change
often mistake for a brief psychotic episode
Culture-Bound Syndrome: Zar
North, Central African and Arabic
spirit possession
may experience dissociative episodes, apathy, and withdrawal
within the group, not seen as pathological or psychotic
Racial/Ethnic Groups: Latinos (Hispanic)
compromise about 10% of the U.S. population and rapidly growing
When did Latinos begin to come to America?
absorbed as a result of territorial acquisitions during the middle and late 1800s in home states: Texas, New Mexico, Arizona, Southern California, and Puerto Rico
other group migrated to Florida (from Cuba) or are indigenous
What is common language used among Latinos?
one of five European languages, as well native Indian dialects
Latinos (Hispanics): Religion
primarily Roman Catholic
growing fundamentalist Protestant group and a small Jewish community
some practice Santeria
What states passed “English only” laws?
California, Arizona and Florida
Latinos: Economics
represented among all socioeconomic classes, though they constitute one of the poorest U.S. minorities
one-third have no health insurance
History: The Treaty of Guadalupe Hidalgo
1864
Mexico annexed the U.S. southwest and guaranteed maintenance of the Spanish language
When did the U.S. seize Puerto Rico?
1902 after they declared independence from Spain
When did the U.S. give unilaterally begin to give citizenship to Puerto Ricans?
1917
Common Cultural Traits: Authoridad
respect based on age, gender, and work role
Common Cultural Traits: Compadrozgo
extension of the family kinship network, a special, intimate relationship with non-biologically related individuals
mutual expectations and demands that provide emotional and financial support
Common Cultural Traits: Dignidad
respect for individuals dignity is paramount
involves honest recognition of the status and worth of each individual
Common Cultural Traits: Fatalismo
reliance on fate as the explanation for life’s successes and failures
contributes to passivity and a belief in the inability to influence one’s life
connected to religion. spirituality, and notions of reward and punishment
Common Cultural Traits: Familiaismo
strong emphasis on family ties
group achievement and harmonious relationships valued over individualism
cooperation, sharing, and sacrifice is stressed
Common Cultural Traits: Hembrismo
concept of appropriate gender roles for women
one variation permits women to be assertive, particularly in health care
Common Cultural Traits: Maschismo
role expectations of men
positive connotations: centrality of father role, emphasizing loyalty, fairness, responsibility and family
negative extreme: autocratic domination, abuse of women and children
Common Cultural Traits: Marianismo
gender expectations for women
viewed as morally superior and able to endure more
extreme expression emphasizes self-sacrificing motherhood
conservative expectations around sexuality
Common Cultural Traits: Personalism
focus on the importance of relationships over acquiring status or completing tasks
affiliation, respect, dignity, and cooperation are primary
Common Cultural Traits: Respecto
formal communication of respect based on age, gender, and role
informality seen as insulting and intrusive
Common Cultural Traits: Santeros, Espiritistas, and Curanderos
native healers
latinos often make use of traditional healers in conjunction with Western medicine
associated with the Santeria, Macumba religion
involves use of herbs and beliefs in spirits
Culture-Bound Syndromes: Ataque de nervios
expression of distress principally exhibited by Latinos of Caribbean ancestry
symptoms include uncontrollable shouting, attacks of crying, trembling, various somatic complaints, and verbal and physical aggression
dissociative experiences, seizure-like or fainting spells, and suicidal gestures are prominent in some attacks but absent in others
resembles panic attack
Culture-Bound Syndrome: Bilis and Colera
underlying cause is anger or rage
symptoms include acute nervous tensions, headache, trembling, screaming, stomach disturbances, and occasionally loss of consciousness
symptoms can cause physical stress and can exacerbate other physical problems
Culture-Bound Syndrome: Locura
folk term describing a severe form of a chronic pain psychosis
condition is viewed as a genetic, inherited vulnerability
symptoms include incoherence, agitation, auditory and visual hallucinations, unpredictability, possible violence, and inability to interact socially
Culture-Bound Syndrome: Mal de ojo
a concept that is common in Mediterranean and Latin American culture
translates as “evil eye”
children are most at risk
symptoms include sleep disturbance, crying, diarrhea, vomiting, and fever
Culture-Bound Syndrome: Nervios
idiom of distress and among Latinos
vulnerability to stressful experiences
symptoms include emotional distress, somatic disturbances, and inability to function
differential diagnosis involves a constellation of factors, including the kind of social event associated with onset of the episode and the level of disability
occurs in cases in which there is no mental disorder
presentation resemble adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders and are often misdiagnosed
Common Cultural Traits: Susto
folk illness found in Latin America and other parts of the world
illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness
individuals experience significant strain in social roles
symptoms include sleep and eating disturbances, sadness, lack of motivation, and feeling of low self-worth
illness may be related to major depressive episode, PTSD and somatoform disorders
Racial/Ethnic Groups: (Native) American Indians
groups native to North America continent
Native American Statistics
over 500 tribes/bands of distinct cultural groups with official federal recognition
1.5 million American Indians
half live on federal reservations located mainly in the western continental U.S. Indians are a very young population with half under the age of 18
(Native) American Indians: History
subjected to harsh and unjust treatment including (arguably) genocide, forced relocation, and disenfranchisement
largely impoverished
What did legislation seek to change for Native Americans?
Native American culture and force assimilation
from the 1800s through the 20th century, religion, cultural practices, and forms of government have been restricted or outlawed
What happened to Native Americans after 1880?
active movement to erase Indian culture and language
strategies included compulsory residential schooling away from families, such as the Carlisle School in Ohio
Important Native American Policies: The Indian Self-Determination and Education Assistance Act (1975)
tribes given the right to manage and operate independent health programs
Native American Indians: Policies
The Indian Self-Determination and Education Assistance Act
The Indian Health Care Improvement Act
The Indian Child Welfare Act
Important Native American Policies: The Indian Child Welfare Act
1978
bans transracial adoption of Indian children without tribal permissions
Native American Indians: Values
-a distinct culture including language and religion
-extended family which provides support and mutual aid
-respect and protection of both children and elders
-living in harmony with nature
-Cardinal virtues: bravery, fortitude, kindness, and generosity
-group identity occupies a higher priority than individual achievement
-cyclical and rhythmic perception of time
-family has flexible boundaries and roles
Native American Indians: Clinical Issues
higher risk for mental disorders and substance abuse
disorders usually associated with difficult life circumstances: poverty, racism, inadequate employment, minimal educational opportunities, geographic isolation, and identity conflict
Clinical Issues: Common Disorders
depression, severe anxiety disorders, substance abuse, PTSD, high rates of physical and sexual abuse, neglect, domestic violence, and homicide
Common Disorders: Suicide
higher incidence among Indians
young males suicide two to four times the national average
Culture-Bound Syndrome: Ghost Sickness
a preoccupation with death and the deceases
symptoms include night terrors, weakness, feelings of danger, appetite loss, anxiety, somatic complaints, hallucinations, confusion, and feelings of futility and despair
Culture-Bound Syndrome: Pibloktoq
eskimo and Inuit
an abrupt dissociative episode accompanied by extreme excitement (up to 30 minutes) followed by convulsive seizures lasting up to 12 hours
individual has complete amnesia event
Definitions: Predjudice
based on value judgements, personal histories, inferences about others, and application of normative judgements
Definitions: Discrimination
the act of expressing prejudice
immediate and serious social and economic consequences
Definitions: Stereotyping
exaggerated distorted beliefs about an ethnic, gender, or other gorup
function is to justify discriminatory conduct
Definitions: Oppressed Minority
a group singled out from others in society because of physcial or cultural characteristics
receives unequal treatment and regards itself as an object of collective discrimation
Definitions: Privilege
advantages or benefits given to the dominant group
they are bestowed unintentionally, unconsciously, and automatically
often privileges are transparent to receives
Definitions: Racism
refers to generalization, institutionalization, and assignment of values to real or imaginary differences between people to justify privilege, aggression, or violence
Definitions: Analytical Framework
an “ism” is pervasive, ubiquitous and institutionalized
components are reciprocal and mutually reinforcing
Definitions: Individual
associated with personality, attitudes, behaviors, socialization, self-interest, and interpersonal interactions
Definitions: Cultural
aesthetic, needs, religion, music, values, norms, philosophy
Definitions: Institutions
labor, housing, legal system, health, education, politics, employment, media
Racism and Issues of Diversity: Psychology of Oppression by Frantz Fanon
a theory of impact of societal oppression on vulnerable populations
Psychology of Oppression: Master-Slave Paradigm
the externalized oppressor
Psychology of Oppression: The Intro-Oppressor
the internalized external oppressor
Psychology of Oppression: The Auto-Oppressor
participating in one’s own oppression
Components of the Psychology of Oppression
maladaptive responses to external oppression are characterized by rage and destructive actions
becomes evidence that is then used by dominant members to legitimize oppression
it continues as a self-perpetuating cycle
the way out of this cycle is to destroy the master
later refinement involves transcending the oppression through self-reflection and confrontation
Cycles of Oppression: Early Years
-misinformation
-missing history
-biased history
-stereotypes
Process-Socialization: Cycles Reinforced
-stereotypes, omissions, distortions
-people/systems/institutions we know, love, and trust
-family and neighborhood
-education
-media
-government
-houses of worship
Process-Internalization
-collusion between both oppressed and oppressor
-internalization
-misinformation accepted as “truth”
-difference does not equal different but equals “wrong” or “abnormal”
Psychology of Oppression: Cycle Continues
-engenders anger, guilt, confusion, alienation
path out is dissonance
Racism and Issues of Diversity: Bias in Human Service Clinical Work
health and mental health services express ideology of the dominant culture; may harm clients or reinforce cultural stereotypes
Specific Popluation: Sexism
refers to generalizations and assignment of values to real or imagined difference based on gender
Sexism: Strategic Practice Issue
virtually all social and cultural groups subordinate women
until recently, scientific research failed to capture biological, social, and political differences
women often ignored by the justice system
women often seen only in the mother or care taking role
Who’re key theoreticians regarding new theoretical models towards sexism?
Miller: a psychology particular to women
Gilligan: Moral development in women
Brown: Reinterpretation of battering
Hermann: Complex Post-Traumatic Disorder
New Theoretical Models: Relational Theory–Stone Center
focuses on women’s development as separate from men
challenges idea that the importance of relationships in women’s lives is pathological
New Theoretical Model: Feminist Family Systems Theory – The Ackerman Institute
examines power and gender roles in family interactions, and sexism as a problem in families
Definitions: Heterosexism
the view that heterosexuality is the sole acceptable orientation
Sexual Orientation: Problematic Treatment Models
Moral Model
Medical Model
Reparative/Conversion Psychotherapy
Problematic Treatment Problems: Moral Model
religiously oriented and views homosexuality as sinfyl
Problematic Treatment Problems: Reparative/Conversion Psychotherapy
therapy that focuses on changing sexual orientation; traditional mental health disciplines view this treatment as unethical and with no empirical base
Sexual Orientation: Strategic Practice Issues
-Stigmatization and Violence
-Internalized Homophobia
-Coming Out
-AIDS
-Self-Disclosure depending on situation
-Orientation (Biological) vs. Preference (Choice)
-Limited Civil Rights
What does self-disclosure depend on in practice regarding sexual orientation?
-position/stance of practitioner
-importance of social networks and community
-neutrality and acceptance
-not assuming psychopathology because of sexual orientation
Sexual Orientation: Coutertransference Issues
-discomfort with sexuality
-bias
-stereotyping
-patronizing
Aging: Ageism
attitude towards capabilities and experiences of old age
leads to devaluation and disenfranchisement
Aging: Stereotypes of Elderly
asexual, rigid, impaired by psychological functioning incapable of change
Aging: Strategic Practice Issues
-Social workers are often younger than clients (role reversal)
-generational perceptions differ
-physiological changes
-two categories among elderly
-variation in decline (physical and mental)
-multiple losses experienced by clients
-according to respect and formality sometimes important
Differences in perception when treating elderly due to differences in age?
-socialization around problems, values, and mores
-attitudes toward help, charity, and counseling
What’re the two categories among the elderly?
-Young-old (60-80)
-Old-old or frail-old (80+)
Aging: Clinical Considerations
-shorter, more frequent interviews
-alternative styles of questioning
-more active and directive
-more demonstrative
-reminiscence is an important communication style
-home visits rather than office
-need to consider roles and attitudes of relatives and caretakers
-concern about abuse or exploitation
-access to publicly funded programs
-hearing difficulties: shorter, louder, slower responses
Aging: Countertransference
-reaction to illness and physical incapacity
-mortality
-sense of futility in providing services
-drained by demands
Racial/Cultural Identity Development
-responses to oppression and discrimination are learned and lead to learned behaviors; these can be altered or relearned
What is the sequence of the learning process regarding development of racial/cultural identity?
-combines identity development theory with the effects of specific manifestations of oppression for individual and group development
-model can be applied bot to those who are oppressed and the dominant group
Racial/Cultural Identity Development: Theoreticians
Black Identity Development Theory
White Identity Development Theory
Asian American Identity Development Theory
Racial/Cultural Identity Theory
What model is inclusive or all theories regarding race, sexism, gender and class
The Atkinson Model
