Topic 9 Developing cultural competence – Working with culturally diverse groups (Week 9)

Question 1

Examine the nature of cultural competence skills required to work respectfully with culturally diverse groups.

Answer 1

“Cultural awareness refers to therapists’ ability to recognize the cultural background of themselves and their clients, including assumptions and biases that influence the process of psychotherapy with diverse clientele.
Cultural knowledge refers to therapists’ understanding of specific cultural groups, their norms, and unique experiences (e.g., how the tenets of Islam and the traumatic experiences of civil war impact a refugee family from Syria), as well as the ways in which historical forms of oppression (e.g., colonialism) continue to impact the assumptions of psychotherapy.
Finally, cultural skills refer to therapists’ ability to actively engage diverse clientele and to modify assessment or treatment methods to better match the cultural needs of clients. Cultural competence has become part of ethical and professional standards of psychology (e.g., American Psychological Association, 2017a, 2017b) and other mental health professions (e.g., American Counseling Association, 2014; National Association of School Psychologists, 2010).”

1. Awareness of how one’s own cultural heritage, gender, class, ethnic-racial identity, sexual orientation,
   disability, and age cohort help shape personal values, assumptions, and biases related to identified
   groups (e.g. Carter, 1995; Comas-Diaz & Greene, 1994; Enns, 1997; Helms, 1995; Kitayama &
   Markus, 1994; Olkin, 1999; Wrohel, 1993).
2. Knowledge of how psychological theory, methods of inquiry, and professional practices are historically
   and culturally embedded and how they have changed over time as societal values and political priorities
   shift (e.g., Betancourt & Lopez, 1993; Goldberger & Veroff, 1995; Prilleltensky, 1990).
3. Knowledge of the history and manifestation of oppression, prejudice, and discrimination in the United
   States and their psychological sequelae (e.g., APA, 1993; Betancourt & Lopez. 1993; Gaines & Reed,
   1995; Perez et al., 1999).
4. Knowledge of sociopolitical influences (e.g., poverty, stereotyping, stigmatization, and marginalization)
   that impinge on the lives of identified groups (e.g., Landrine, 1995; Olkin, 1999; Perez-Foster,
   Moskowit., & Javier, 1996),
5. Knowledge of culture-specific diagnostic categories
   nowledge of such issues as normative values about illness, help-seeking behavior, interactional styles,
   and worldview of the main groups that the clinician is likely to encounter professionally (e.g., Dana,
   1993; McGoldrick et at., 1996; Price & McNcill, 1992).
6. Knowledge of culture-specific assessment procedures and tools (e.g., Dana, 1993) and their empirical
   support.
7. Knowledge of family structures, gender roles, values, beliefs, and worldviews and how they differ across
   identified groups in the United States, along with their impact on personality formation, developmental
   outcomes, and manifestations of mental and physical illness (e.g., APA, 1993; Draguns, 1997; Harwood,
   Miller, & Irizarry, 1995; Kagitcibasi, 1996: Kitayama & Markus, 1994: Kleinman, 1988; Lancy, 1996;
   Landrine, 1992; McGoldrick et al., 1996).
8. Ability to accurately evaluate emic (culture-specific) and etic (universal) hypotheses related to clients
   from identified groups and to develop accurate clinical conceptualizations, including awareness of when
   clinical issues involve cultural dimensions (APA, 1993) and when theoretical orientation needs to be
   adapted for more effective work with members of identified groups (e.g., APA, 1993; Hays, 1995;
   McGoldrick et al., 1996; Olkin. 1999; Ridley, Mendoza, & Kanilz, 1994).
9. Ability to accurately self-assess one’s multicultural competence, including knowing when circumstances
   (e.g., personal biases; stage of ethnic identity; lack of requisite knowledge, skills, or language fluency;
   sociopolitical influences) are negatively influencing professional activities and adapting accordingly (e.g.,
   obtaining needed information, consultation, or supervision or referring the client to a more qualified
   provider; e.g., APA: 1993; Enns, 1997; Olkin, 1999; Sue et al., 1992).
10. Ability to modify assessment tools and qualify conclusions appropriately (including empirical support,
    where available) for use with identified groups (Dana, 1993; Helms, 1992; Jones & Thorne, 1987;
    Kleinman, 1988; Malgady, 1996; Olkin, 1999; Sue et al., 1992).
11. Ability to design and implement nonbiased, effective treatment plans and interventions for clients from
    identified groups (e.g., APA, 1993; Olkin, 1999; Perez et al.. 1999; Ridley ct al., 1994; Sue et al,,
    1992), including the following:
    a. Ability to assess such issues as clients’ level of acculturation, acculturative stress, and stage of gay or
    lesbian identity development (e.g., APA, 1993; Dana, 1993; McCarn & Fassinger, 1996).
    b. Ability to ascertain effects of therapist-client language difference (including use of translators, if
    necessary) on psychological assessment and intervention (e.g., APA, 1993: Dana, 1993; Sue et al.,
    1992).
    c. Ability to establish rapport and convey empathy in culturally sensitive ways (e.g., taking into account
    culture-bound interpretations of verbal and nonverbal cues, personal space, and eye contact; e.g.,
    Dana, 1993; McGoldrick et al.. 1996; Olkin, 1999).
    d. Ability to initiate and explore issues of difference between the therapist and the client, when
    appropriate, and to incorporate these considerations into effective treatment planning (e.g., Olkin,
    1999; Zayas, Torres. Malcolm, & DesRosiers, 1996).

Question 2

Identify effective communication strategies to work with culturally diverse groups in a mental health context.

Answer 2

Skills of culturally competent counsellors:

are able to engage in a variety of verbal and nonverbal helping responses; are able to send and receive both verbal and nonverbal messages accurately & appropriately; and are not tied to only one method or approach to helping but recognize that helping styles & approaches may be culture bound.
are not adverse to seeking consultation with traditional healers or religious and spiritual leaders and practitioners in the treatment of culturally different clients when appropriate.
take responsibility for interacting in the language requested by the client and, if not feasible, make appropriate referrals.
have training & expertise in the use of traditional assessment, and culturally appropriate testing instruments.
attend to and work to eliminate biases, prejudices, and discriminatory contexts in conducting evaluations and providing interventions and develop sensitivity to issues of oppression, sexism, heterosexism, elitism, and racism.
take responsibility for educating their clients to the processes of psychological intervention, such as goals, expectations, legal rights, and the counsellor’s orientation.
How to respond to a client from a multicultural background:

Understand them.
Be informed of their culture, cultural orientation, cultural practices.
Be aware that they may not want to seek formal assistance.
How then can we encourage them to seek assistance?
Make an initial assessment of the mental health concerns.
Usually, there are a range of factors impacting on their mental health.
Mental wellbeing cannot be enhanced unless other (usually very urgent) matters are taken care of.
How can you assist with those other matters?
Need for an inclusive, collaborative response.

Question 3

Develop an understanding of mental health beliefs and therapeutic processes among culturally diverse groups.

Answer 3

Multicultural clients:

Maybe slow to form trusting relationships on the basis of a history of unequal treatment.
Underutilisation of services; early termination: due to biases, stereotypes and assumptions of the services themselves.
Medical model of clinical counselling is seldom a good fit for people in the lower socioeconomic class.
Sometimes cultural traditions contribute to underutilisation.

Question 4

Identify the APA multicultural guidelines relevant to enhancing mental health in culturally diverse communities.

Answer 4

Intersectionality is shaped by the multiplicity of the individual’s social contexts.

2. Understand one’s own attitudes and beliefs – and prejudices.
3. Engagement – language and communication should relate to the lived experience of the client.
4. Understand the role of the social and physical environment in the lives of clients.
5. Recognize and understand historical and contemporary experiences with power, privilege, and oppression. Promote equitable mental and behavioral health services.
6. Promote culturally adaptive interventions and advocacy.
7. Understanding behaviour in an international context.
8. Understand the interactions between development stages and biosociocultural contexts.
9. Conduct culturally appropriate and informed research, teaching, supervision, consultation, assessment, interpretation, diagnosis, dissemination, and evaluation of efficacy.
10. Use a strength-based approached to develop resilience and decrease trauma.