PSYC 561- Cultural Issues in Psychological Practice

Question 1

Acculturation

Answer 1

The process used by the minority culture to imitate the majority culture by adapting various aspects of the majority culture. This can also be seen bidirectionally, with majority culture adapting certain aspects of the minority culture. 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.

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

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.
Age and Generational influences
-dominant group: young and middle aged adults; nondominant: children, older adults
Developmental disability
-disabled from birth
Disability
-may have developed at any point in lifespan
-dominant group: nondisabled people; nondominant: people with cognitive, intellectual, sensory, physical and psychiatric disabilities
Religion and spiritual orientation
-dominant group: Christian and secular; nondominant: Muslims, Jews, Hindus, Buddhists, and other religions
Ethnic and racial identity
-dominant group: European Americans; nondominant: Asian, South Asian, Latino, Pacifiic Islander, Middle Eastern and multiracial people
Socioeconomic status
-dominant group: upper and middle class; nondominant: people of lower status by occupation, education, income, or inner city or rural habitat
Sexual orientation
-dominant group: heterosexual; nondominant: people who identify as gay, lesbian, bisexual
Indigenous heritage
-dominant group: European Americans; non dominant: American Indians, Inuit, Alaska Natives, Aboriginal Australians
National origin
-dominant group: US born Americans; nondominant: immigrants, refugees, international students
Gender
-dominant group: men; nondominant: women and people who identify as transgender

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

Assimilation

Answer 3

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.

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 4

Bicultural

Answer 4

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.

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 5

Collectivism

Answer 5

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.

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 6

Coming out process

Answer 6

Coming out is the process in which individuals reveal to their family and friends that they identify as gay or lesbian. 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 pt 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

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 7

Cross’s model of racial identity

Answer 7

Developed by Cross, this is a four stage Black Identity Development model.

• The first stage is the Pre encounter stage, where the individual is focused on assimilating to the white culture and devalues their own culture or “blackness.”
• The second stage is the Encounter stage, which is when some significant event occurs that challenges their beliefs, causing a paradigm shift away from assimilation. –The third stage, the Immersion-Emersion stage, is when the individual pulls away from the white culture and immerses themselves into the black culture. The individual develops pride in black culture.
• The final stage is the internalization stage, where the individual becomes accepting of both white and black cultures, transcends and reconciles, and become flexible and tolerant. They are more focused on social justice and civil rights.

Example: You are treating an African American client that you believe is in the pre encounter stage of Black Identity development (Cross’s Model). The client comes in one day speaking of an encounter with a racist parent of one of her friends that resulted in her not being allowed to hang out with that friend anymore. This experience shattered her identity and shattered the belief that all people are equal. As a therapist you should help the client understand this situation and the implications of it. This will naturally encourage client to move through encounter stage and hopefully into Immersion-Emersion and ultimately internalization.

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 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 relativism

Answer 9

Cultural relativism focus on how a disorder manifests and is treated within the patient’s culture (in contrast to cultural universality, which minimizes cultural factors in diagnosis and treatment). Cultural values and world views influence the expression and determination of deviant behavior, which makes paying attention to relativism in the clinical context critical. In some cultures, it is more acceptable to express psychological complaints in physical terms. In other cultures, it is not considered abnormal to experience hallucinations.

Example: Amy, a Vietnamese immigrant, comes to therapy complaining of headaches and stomachaches. In the course of treatment, the therapist realized that these frequent aches, with no apparent physical cause, were manifestations of anxiety about her family’s financial well-being back in Vietnam. The therapist approached case conceptualizations with a perspective of cultural relativism and understood that this was a valid way of expressing that anxiety, and crafted a plan to address it.

Question 10

Cultural racism

Answer 10

A variation of structural racism that occurs when the assumption of the inferiority of one or more races is embraced by the culture of a given society. Includes aspects of society that overtly and covertly attribute value and normality to white people and whiteness, and devalue, stereotype, and label people of color as “other,” different, less than,” or render them invisible.

Example: Studies have shown that resumes with white-sounding names get calls for interviews at a much higher rate than resumes with Black-sounding names, when qualifications and other resume content is comparable. This is an example of cultural racism, because employers treat the dominant group as superior and more qualified.

Question 11

Cultural universality

Answer 11

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.

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 12

Culture

Answer 12

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 13

Culture bound

Answer 13

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 14

Emic

Answer 14

The belief that cultural differences must be considered in the diagnosis and treatment of culturally diverse groups (Remember EMic - me). The emic perspective emphasizes culture-specific norms and views clients in the context of his/her own culture

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 15

Ethnocentrism

Answer 15

The belief that one’s culture or ethnicity is superior to everyone else’s culture or ethnicity. Ethnocentrism becomes a problem when the dominant culture is ethnocentric and attempts to assimilate all other cultures into it. The therapist must be careful not to perpetuate any ethnocentrism in their practice

EXAMPLE: A clinician has a client referred to them by a doctor for refusing to undergo a surgery the doctor deemed necessary. The client is an indigenous Native from the Amazon and acknowledges he has a medical issue, but does not believe in Western medical practices. He believes the medicine men in his village were wiser and more skilled. The ethnocentric therapist considers this idea ignorant and encourages him to go through with the surgery, ignoring his personal, culture bound beliefs.

Question 16

Etic

Answer 16

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

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 17

Ethnicity

Answer 17

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.

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 18

Eurocentric monoculturalism

Answer 18

A preference for the European, especially the English, cultural traditions in American life. The focusing on European culture or history to the exclusion of a wider view of the world; implicitly regarding European culture as preeminent.
Monoculturalism refers to the promotion of a single homogeneous culture without diversity or dissension. Inherent problems arise because psychology has been traditionally defined by and based upon the following worldview eurocentric monoculturalism. Eurocentric models may not be effective for working with other populations. They may inflict harm by mislabeling or misdiagnosing problems and treatments.

Ethnocentrism is at the heart of oppressor/oppressed relationships. Other important components include the power to impose standards, and manifestation of the ethnocentric view in institutions.

EXAMPLE: a prominent eurocentric idea in counseling is valuing individual responsibility and autonomy. In collectivist cultures, this is not the case. Assuming that all clients value individual agency can be damaging.

Question 19

Filial piety

Answer 19

A prominent virtue in Asian societies put forth by Confucius, this is the belief that children should submit to and take care of their parents, even after they become adults. Children are expected to strive for family goals and to not engage in behaviors that would bring dishonor to the family. Therapists must take this into consideration when counseling Asian Americans.

EXAMPLE: Jen went to medical school due to parental pressure and so she could provide financially for her parents in their elder years. The therapist understood that Jen putting the needs of her family above her own in her career choice twas reflective of filial piety. She was careful to not label it as dysfunctional.

Question 20

Individualism

Answer 20

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.

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 21

Institutional racism

Answer 21

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.

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 22

Microaggression

Answer 22

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); microassault (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 23

Minority

Answer 23

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 in a mono-cultural society often puts one at a significant disadvantage.

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 24

Multicultural competencies

Answer 24

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.

Question 25

Multicultural counseling

Answer 25

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.

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 collectivist perspective.

Question 26

Multicultural perspective in counseling

Answer 26

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.

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 27

Oppression

Answer 27

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

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 28

Pluralism

Answer 28

A condition in which numerous distinct ethnic, religious, or cultural groups participate fully within the dominant society while still maintaining cultural differences, and show mutual respect and tolerance of each other. These groups may interact with each other without conflict or assimilation. In order for this to occur, the dominant culture must recognize the importance of other cultures.

Example: In a pluralistic company culture, cultural differences in attire, personal presentation, speaking style/accent, and skin color would be appreciated. The dominant group would not receive preferential treatment in hiring and promotion.

Question 29

Poverty and mental illness

Answer 29

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.

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 30

Race

Answer 30

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.

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 31

Racial Identity Development Model

Answer 31

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:

• Conformity: the individual is depreciating of their self and their culture and appreciating of the dominant culture.
• White professional preferred and may be idealized (may have neg reaction 2 minority counselor)
• Fear of addressing cultural identity issues
• Client prefers task-oriented approach
• Dissonance and Appreciation: Conflict between perceptions of self, perceptions of ethnic heritage, and submission to dominant group.
• Minority professional may be more effective than White
• Self-exploration becomes major part of process
• Resistance and Immersion: the individual has negative attitudes towards the dominant culture and positive attitudes toward their own culture. Anger turned outward common; immersing oneself in own culture.
• May have difficulty working with White professional (or minority professional!)
• Professional avoids defensiveness, helps client explore basis of beliefs
• Great deal of testing – are you competent/trustworthy?
• Action oriented approaches/group counseling
• Introspection: the individual begins to negotiate a positive self-identity separate from both the minority and majority culture (trying to take the best of both cultures).
• More receptive to non-minority professionals
• Self-exploration key - wanting to integrate cultural heritage into identity
• Integrative awareness: marks a positive attitude toward their own culture, appreciation of other minorities, and selective acceptance/positivity of the dominant culture (comfortable moving between both cultures).
• Professional preference no longer race/minority based
• Worldview exploration effective
• CBT more effective at this stage

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.

Question 32

White privilege

Answer 32

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.

EXAMPLE: 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 33

White racial identity development

Answer 33

This is a stage theory developed by Helms.

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.

Question 34

Worldview

Answer 34

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 frequently 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 35

Counseling-relevant cultural issues for African American clients

Answer 35

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

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.

Question 36

Counseling relevant issues for Hispanic/Latinx clients

Answer 36

• 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 37

Counseling-relevant issues for Native American clients

Answer 37

• recognize history of oppression.
• Many Natives live in extreme poverty.
• 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
• 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 38

Counseling relevant issues for LGBTQ clients

Answer 38

• 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

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 39

Counseling relevant issues for Asian clients

Answer 39

• 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 peity)
• 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 40

Counseling relevant issues for Arab clients

Answer 40

• 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 41

Counseling relevant issues for physically disabled clients

Answer 41

• Make sure the office is ADA accessible and is capable of meeting all needs.
• Refer to person as someone with a disability
• 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.

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 42

Counseling relevant issues for female clients

Answer 42

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

Example:

Question 43

Counseling relevant issues for male clients

Answer 43

• Boys have higher rates of learning disorders and ADHD, higher drop out and lower graduation rates, and more disciplinary problems
• Men have problems expressing and coping with negative emotions, parenting and health issues, financial pressures, violence and aggression, and underemployment
• Most standard therapeutic models do not work on men. Having flexibility with the client and taking them to out of office settings for sessions can help men to adjust better to therapy
• Authentic relational bond needs to be formed for therapy to be successful
• 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.

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 44

Counseling relevant issues for clients in poverty

Answer 44

• 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.