Multicultural Counseling Final Exam

Specific Challenges Prejudice and Discrimination

- Ableism favors those without a disability and implies that those possessing a disability are inferior. - Individuals may be evaluated on a deficit perspective. - Language such as "wheelchair-bound" is discriminatory. - Prejudicial terms such as retarded or lame are often used but are microaggressions. - The general public has low expectations for people with disabilities.

Stereotypes, Racism, and Prejudice:

- Arabs and Arab Americans have been stereotyped in movies as sheiks, barbarians, or terrorists. - Islam has also been portrayed as a violent religion. - Also, many believed that it was okay to question and inspect people with Middle Eastern accents or features.

Collectivistic Orientation:

- Asian families tend to have a family and group orientation. - Children are expected to strive for family goals and not to engage in behaviors that would bring dishonor to the family.

Misconceptions about LGBT Manifestations of bias include

- Assuming a client is heterosexual - Believing same-sex orientation is sinful or a form of mental illness - Failure to understand that societyʼs view of LGBT status is the problem - Focusing on sexual orientation when it is not relevant - Asking clients to renounce sexual orientation - Trivializing LGBT status - Lacking understanding in LGBT identity development - Not understanding impact of internalized negative views - Underestimating consequences of coming out - Misunderstanding importance of intimate relationships - Using a heterosexual framework inappropriately - Presuming LGBT individuals cannot be good parents - Over identifying with LGBT individuals by excessively "understanding."

Sexual Identity Issues:

- Awareness of sexual orientation of gay males and lesbian females tends to occur in the early teens. - Gender dysphoria (disconnect with the biological sex one is born with) is not the same as sexual orientation. - Gender dysphoria is still considered a mental disorder, although the transgender community is seeking to eliminate that classification. - Individuals with gender identity issues report feeling different at an early age. - Cross-sex behaviors and appearance are highly stigmatized in school and society. - The struggle for identity involves one's internal perceptions in contrast to the external perceptions or assumptions about one's sexual orientation.

African American community is becoming more diverse with respect to

- Ethic and racial identity - Social class - Education level - Political orientation

Cultural Values and Characteristics

- Familismo (family unity) is seen as important, as are respect and loyalty to the family. - Family members cooperate, are often religious, possess strict child-rearing practices, and value the extended family. - In general, outside help is not sought until all family resources are exhausted. - Remember that personalismo is a basic cultural value of Hispanic Americans. Although the first meetings may be quite formal, once trust has developed, the clients may develop a close personal bond with the counselor. He or she may be perceived as a family member or friend and may be invited to family functions and given gifts.

Introduction to Older Adults

- Individuals aged 65 and older are 16.2% of the population - The population of older individuals in the United States is growing. It is estimated to reach 20% by 2030, yet mental health services specific to this population are lacking.

Intermarriage, Stereotypes, and Myths

- Intermarriage is not acceptable to many. - The percentage of intermarriages have increased in the United States. - Stereotypes have fluctuated depending on the race and gender of each partner

Effects of Past Persecution, Torture, or Trauma

- Many refugees suffer from post-traumatic stress disorder or elevated rates of mood/anxiety disorders and exhibit dissociation, intrusive thoughts, and hypervigilance. - Central American refugees reported feelings of isolation and high levels of mistrust toward service providers. - Parents often worry about their children's adaptation to the American way of life.

The following are three models of disability affecting the way the condition is perceive

- Moral model - Medical model - Minority model

Racial/Ethnic Ambiguity, or "What Are You?"

- Racial/ethnic ambiguity refers to the inability of people to distinguish the monoracial category of the multiracial individual from phenotypic characteristics. - The "What are you?" question almost asks a biracial child to justify his or her existence in a world rigidly built on the concepts of racial purity and monoracialism.

Racism and Discrimination

- Racism and discrimination are significant concerns within the African American community. - Racism exists in subtle and overt forms. - Cultural mistrust is a reaction to being discriminated against. - "Healthy cultural paranoia" can serve as a coping strategy with respect to racism.

Three major affirmations:

- Resistance - Revolution - Change

Specific Challenges Historical and Sociopolitical Background:

- Since the Middle Ages, the Jewish people have experienced persecution. - For centuries, they have been stereotyped as hungry for wealth, power, and control. - The have been used as scapegoats for financial distress. - The Holocaust killed over 6 million Jews and left many Jewish people poor, displaced, and without families.

Specific Challenges Prejudice and Discrimination

- Terrorist attacks had a dramatic impact on attitudes toward immigrants and refugees. - There has been a dramatic decline in admission of refugees. - The 9/11 attacks increased feelings of nationalism throughout the United States. - The 9/11 attacks also sparked the "English only" movement. - Because of discriminatory practices, there is a decreased use of health care resources by immigrants. - Immigrants fear being deported. - Societal and governmental reactions to immigrants are influenced by social conditions

Multiracialism in the United States

- The biracial baby boom in the United States started in 1967 when the last laws against race mixing (antimiscegenation) were repealed. - It is estimated that multiracial people make up 2.4% of the national population, or more than 7.5 million people. - Census figures underestimate numbers. Research indicates one-third of U.S. Latinas/os admit having a mixed racial background but only 13% select two or more races on census forms. - 30% to 70% of African Americans are multiracial by multigenerational history.

Coming out:

- The decision to "come out" can be extremely difficult. - Coming out to parents, family, and friends can lead to rejection, anger, and grief. - This can be especially difficult for adolescents who are financially dependent on their family. - Black and Latino gay and lesbian youth are more reluctant to disclose their sexual orientation than are their White counterparts. - A counselor should help LGBT individuals with the coming out process (e.g., decision making, role plays).

Disparities in the Judicial System

- The poor often cannot afford bail money and remain in jail. - Many people are priced out of the U.S. legal process. - Petty crimes (e.g., burglary, theft) of the poor take attention away from the larger crimes of wealthier people (e.g., corporate fraud, creating toxic pollutants) - Poor people face elevated rates of many illnesses and diseases. - About 41 million U.S. citizens do not have health insurance. - 61% of uninsured low-income families have at least 1 member working full-time. - About 45,000 deaths a year are associated with lack of health care.

Acculturation Conflicts:

- Traditional. The individual may speak little English, thinks in the native language, and practices traditional tribal customs and methods of worship. - Marginal. The individual may speak both languages, but has lost touch with his or her cultural heritage and is not fully accepted in mainstream society. - Bicultural. The person is conversant with both sets of values and can communicate in a variety of contexts.

Characteristics and Strengths Historical and Sociopolitical Factors

- Until 1952, only White persons were allowed to become naturalized citizens. - With the Immigration Act of 1965, people from any nation were allowed to become naturalized citizens. - There is an ongoing political struggle over immigrants, especially those who are undocumented. - Arizona enacted legislation making it a crime for noncitizens to be in Arizona. - Many citizens are opposed to the number of immigrants entering the United States and to providing a path to citizenship to illegal immigrants.

Characteristics and Strengths The Americans with Disabilities Act

- Was signed into law in 1990, extending the federal mandate of nondiscrimination toward individuals with disabilities to the state and local governments and the private sector. nIt defines disability as a physical or mental impairment.

CHAPTER 15

COUNSELING AMERICAN INDIANS/NATIVE AMERICANS AND ALASKA NATIVES

CHAPTER 16

COUNSELING ASIAN AMERICANS AND PACIFIC ISLANDERS

CHAPTER 14

COUNSELING AFRICAN AMERICANS

CHAPTER 19

COUNSELING ARAB AMERICANS AND MUSLIM AMERICAN

CHAPTER 20

COUNSELING IMMIGRANTS AND REFUGEES

CHAPTER 25

COUNSELING INDIVIDUALS LIVING IN POVERTY

CHAPTER 22

COUNSELING INDIVIDUALS WITH DISABILITIES

CHAPTER 21

COUNSELING JEWISH AMERICANS

CHAPTER 17

COUNSELING LATINAS/OS

CHAPTER 23

COUNSELING LGBT INDIVIDUALS

CHAPTER 18

COUNSELING MULTIRACIAL INDIVIDUALS

CHAPTER 24

COUNSELING OLDER ADULTS

CHAPTER 13

CULTURALLY COMPETENT ASSESSMENT

Introduction to Latinas/os

Latina/o Americans is the U.S. government designation to refer to the common background of the Spanish language among people from various geographic regions (Puerto Rico, Mexico, South America, etc.). • Latina/o Americans are the largest minority group in the United States (17.1% of total population; 54.6 million individuals). • 64% of Latina/o Americans are of Mexican origin; 9.4% are of Puerto Rican descent, 3.7% have Cuban ancestry; 16% originate from Central and South America. • Some 37% are immigrants and about 11% have become U.S. citizens; one quarter are undocumented immigrants and two-thirds of this population are from Mexico. • Three-fourths are third generation or higher. • 41% do not have a high school diploma; 14% have a bachelors degree. • Members of this group have high unemployment, are overrepresented among the poor, and often live in substandard housing

Introduction to LGBT Individuals

Lesbian, gay, and bisexual individuals have an affectional and/or sexual attraction to a person of the same sex. • Bisexual individuals are attracted to both sexes. • Transgender individuals do not identify with their assigned sex at birth. • There are contradictory attitudes toward LGBT individuals. • There is an increased acceptance of LGBT individuals, however, violence and discrimination against them are pervasive. • Approximately 3.5% of the U.S. population identify as part of the LGBT demographic.

SPECIFIC CHALLENGES OF OLDER ADULTS Prejudice and Discrimination:

Older individuals are subject to negative stereotypes and discrimination. •Ageism, very common in our society, is defined as negative attitudes toward the process of aging or toward older individuals. •Women who are older are even more likely to be viewed negatively by society as a whole and many internalize ageist norms.

Poverty and Mental Illness

Poverty often precedes the development of emotional problems such as anxiety and depression • People in poverty face a number of stresses such as family conflict, economic worries, discrimination, and inadequate housing. • Poverty can increase the risk of exposure to violence and trauma.

Existing between the Margins

Root (1990) asserted that mixed-race people begin life as "marginal individuals" because society refuses to view the races as equal and because their ethnic identities are ambiguous, as they are often viewed as fractionated people−composed of fractions of a race, culture, or ethnicity.

To guard against these, it is important for counselors to develop

cultural competence (i.e., knowledge, awareness, and multicultural skills)

African Americans

• African Americans make up about 13% of the U.S. population. • Poverty rate is almost two times higher than of all households (25.8% vs. 14.3%). • Of the African American males between the ages of 25 and 29, 12% are in prison compared to 1.7% for White males. • Unemployment rates are double (9.5% vs. 4.6%). • Infant mortality rate is twice that of Whites and life span is 5 to 6 years shorter than for Whites. • About 38% of African American households are middle income and 12% are upper income, versus 44% and 26% of all households.

The "One Drop of Blood" Rule

• Alvin Poussaint, an African American Harvard psychiatrist, pointed out how powerful Black blood is insofar as assigning the person of mixed racial heritage to the least desirable racial status. • Hypodescent was an attempt by White European immigrants to maintain racial purity and superiority by passing laws against interracial marriages (antimiscegenation), primarily directed at Blacks and Native Americans. • This generated additional property for slaveholders. • People of color were considered inferior so "one drop of blood" would "contaminate" an individual. • It seems that African American and Whites represent the most controversial racial pairings to date.

Introduction to Arab Americans and MuslimAmericans

• Arabs generally come from the Middle East and North Africa. • The primary language is Arabic. • Discrimination and hatred has been directed toward Arab Americans since the 9/11 attacks. • There are over 3,655,789 Arab Americans living in the United States. • They are heterogeneous with respect to race, religion, and politics. • Over half are from Lebanon, 14% from Syria, 11% from Egypt, 9% from Palestine, 4% from Jordan, and 2% from Iraq.

Asian Academic and Occupational Goals

• As a group, Asian Americans perform better academically than do their Euro-American counterparts. • They also have more fear of academic failure compared to their Euro-American peers. • Asian American adolescents report feeling isolated, depressed, and anxious and report little praise for their accomplishments from their parents. • Parents often have specific career goals in mind for their children (e.g., hard sciences).

Racism and discriminatoin

• Asian Americans continue to face issues of racism and discrimination. • One study found that discrimination in early adolescence was related to depression, alienation and lower academic performance. • Asian Americans report more workplace discrimination than do Whites. • Southeast Asian refugees who experienced racial discrimination report higher rates of depression.

Racial Identity Issues:

• Assimilation • Separation or enculturation • Integration/biculturalism • Marginalization

Implications

• Classism creates a physically challenging, socially excluded experience for men, women, and children living in poverty. • Classism is a cognitive and behavioral distancing from the poor. • Psychologists do not pay attention to issues of poverty. • Theory, research and practice are largely inaccessible to poor people. •Many counselors may hold classist assumptions.

common diagnostic errors

• Confirmatory strategy • Attribution errors • Judgmental heuristics • Diagnostic overshadowing

Family Counseling

• Family caregivers are integral to care. •Help reduce the impact of stressors on caregivers. • Emotions such as distress, guilt, self-punishment, or anger may need to be dealt with.

Culturally Sensitive Intake Interviewers:

• Identifying information: Other than demographic information and inquiries about cultural groups to which the client feels connected, also ask about primary language use in the home. • Presenting problem: Obtain his/her perception of the problem and be sure to consider issues such as prejudice or oppression. • History of presenting problem: Get a chronological account of the problem and understand how cultural issues might be related to the problem. • Psychosocial history: Be sure to assess social background, values, and belief (questions for inquiry are presented in the chapter). • Abuse history: Always ask questions around physical, sexual, and emotional abuse history. • Strengths: Identify culturally relevant strengths such as pride in one's identity or culture. • Medical history: Assess medical or physical conditions that may be related to psychological problems; inquire about indigenous healing practices. • Substance abuse history: Assess substance and alcohol use; ask questions about family history as well. • Risk of harm to self or others: Assess harm and ask questions about clients' emotional state.

Indian Characteristics and Strengths

• Indians see themselves as an extension of their tribe. • Tribe and reservation provide American Indians with a sense of belonging and security, forming an interdependent system. • Status and rewards are obtained by adherence to tribal structure. • The reservation itself is very important for many American Indians, even among those who do not reside there. • Indians who leave the reservation to seek greater opportunities often lose their sense of personal identity, because they lose their tribal identity.

Introduction to Muslim Americans

• It is estimated that about 4 to 6 million Muslims (followers of Islam) are living in the United States. •Muslim Americans have liberal attitudes on number of current political issues. • They are highly religious and about half think themselves first as Muslim and then American.

Prejudice, Discrimination, and Misconceptions

• More than 94% of LGBT adults report hate crime victimization. • Cyberbullying and harassment have led to suicides. • LGBT individuals are subject to heterosexism (e.g., the word gay is equated to stupid). • Discrimination can lead to depression. • Bisexual individuals sometimes experience hostility from LG and heterosexual individuals. • Transgender individuals face being viewed as mentally ill, delusional or self-destructive.

Physical Health:

• Older adults often have physical impairment. • About 30% of adults between the ages of 65 and 75 have hearing impairment. • Up to 25% of older adults have insomnia or difficulty falling asleep. • Ethnic minority older Americans tend to have more chronic, debilitating diseases, such as diabetes and heart disease. • The majority of older adults, however, are quite healthy and able to live independent lives requiring minimum assistance.

Introduction to Immigrants and Refugees

• Over 41.3 million immigrants live in the United States • There are 11.2 million undocumented immigrants in the United States. • Immigrants have received a mixed reception from the government and the public. • Many groups have tried to prevent immigrants from entering the United States and have worked to curtail rights (e.g., voting rights).

Strengths of Individuals Living in Poverty

• Particular groups are overrepresented among the poor. • This supports the theory that sociopolitical and historical contexts contribute to poverty. • Poorer people display patience, persistence, and determination. •Women survive labels such as "welfare queen." •Many poor people survive homelessness.

Introduction to Multiracial Individuals

• People of mixed-race heritage are often ignored, neglected, and considered nonexistent in our educational materials, media portrayals, and psychological literature−this can lead to major psychological stress. • In 2000 and 2010, the U.S. Census allowed people to check off more than one race. • Some (e.g., NAACP) argue that a multiracial categorization will dilute the strength of their constituencies. •Multiracial individuals are often asked, "What are you?" and forced to choose one race.

Introduction to Individuals with Disabilities

• People often lack understanding and don't know how to respond to people with disabilities. • There are about 56.7 million individuals with some level of disability. • About 21 million families in the United States have at least one member with a disability. • Individuals with disabilities experience high unemployment rates and have lower rates of college completion. • 90% of people with psychiatric disabilities are unemployed.

Introduction to Immigrants and Refugees

• Refugees are individuals who flee their country of origin in order to escape persecution due to race, religion, nationality, political opinion, or membership in a particular social group. • Asylees are individuals who meet the criteria for refugee status and who are physically present in the United States or at a point of entry when granted permission to reside in the United States. • In 2013, 69,909 refugees were admitted to the United States. •Most refugees come from Asia, the Middle East, Haiti, and African countries.

Introduction to Jewish Americans

• The Jewish population in the United States is 4.2 million. • Jewish Americans have long been the targets of discrimination and hate crimes. •Anti-Semitism is on the rise in Europe. • Outside of Israel, the Jewish population in the United States is the largest in the world. •Many Jewish people immigrated from Russia, Austria, Hungary, and Romania between 1880 and 1942. •Of the Jews outside the United States, most are from the former Soviet Union. • The Jewish population is falling rapidly due to falling birth rate, intermarriage and assimilation. •Most do not follow all religious traditions, but celebrate holidays such as Yom Kippur, Hanukkah, and Passover.

Spirituality and Religi

• The counselor should determine the role that religious beliefs play in the life of a disabled client. • Spirituality can be a source of inner strength and support. •Connection to a higher power is associated with increased life satisfaction.

Asian Characteristics and Strengths

• The family and collectivistic orientations provide individuals with honor and support, which can buffer stressors. • Ethnic pride can be enhanced through connecting with cultural traditions. •Having strong cognitive flexibility is key.

Introduction to Arab Americans

• The first wave of immigration happened from 1875 to World War II (mostly Christian), and the second wave happened after World War II to escape the Israeli-Palestinian conflict. • In contrast to the rest of the U.S. population, Arab Americans are more likely to be married, have generally higher incomes, and speak English well.

Educational Characteristics

• The gap in educational attainment between African Americans and Whites is narrowing. • In 2013, over 90% of African Americans versus 94% of White Americans had completed high school. • For African American males, 62% of 6th to 10th graders aspire to attend college. • African Americans are 2 to 5 times more likely to be suspended from school and receive harsher consequences than Whites. • School personnel hold stereotypes of African American parents as being neglectful and incompetent, whereas they are supportive and caring.

Asian Americans and Pacific Islanders

• The number of Asian Americans in the United States stands at approximately 18,000,000. • Native Hawaiian and other Pacific Islanders number 1.2 million and comprise 0.4% of the total U.S. population. • It is a very heterogeneous group (e.g., East, South, Southeast). •Many Asian Americans speak another language • Asian Americans differ with respect to acculturation and immigration status.

Characteristics and Strengths

• The top .1% of American families own 22% of America's wealth. • The percentage of people living in poverty is underestimated. •A family of four must earn less than $24,250 per year to fall beneath the poverty line. A family of four, making $24,251, would not be considered in poverty.

Native Americans and Alaska Natives

• This group comprises a very heterogeneous group of 565 distinct tribes. • This population was 3.8 million in 2013−1.2% of the total U.S. population. •About 1.8 million report having Indian roots. •About 34% of American Indians live on reservations and 57% live in metropolitan areas. • They have fewer high school graduates compared to the general population (71% vs. 80%). •An individual must have a blood quantum of at least 25% to be considered Indian. • This population suffers disproportionately from depression, anxiety, and substance abuse. • In a clinic in New Mexico, Native American women reported 21% with mood disorders, 47% with anxiety disorder, and 14% with alcohol dependence, which is 2 to 2.5 times higher than the rates found in the general population.

Negative Attitudes and Beliefs

• Wealthy people can become national celebrities based on their wealth. • Intellectualism and critical thinking are the province of more affluent Americans. • Traits such as "crude, irresponsible, lazy, stupid, dirty, and immoral" are more often attributed to poor people than to middle-class people.

Complex Identity Processes

•A growing number of multiracial individuals are choosing "multiracial" as their ethnic identity. •Where the child grows up (i.e. in an integrated neighborhood and school versus in an ethnic community) can have a great impact on identity. • Physical appearance also influences the sense of group belonging and racial self-identification among multiracial individuals.

Characteristics and Strengths

•According to the 2013 U.S. Census, the poverty rate has decreased from 15% in 2012 to 14.5% in 2013. •Children have a poverty rate of 19.9% and are the most likely group to live in poverty. •Women are more likely to live in poverty than men.

Linguistic

•Assessment results can be influenced by linguistic differences or misunderstanding. • There is a lack of bilingual counselors that impact treatment with this population. • Psychopathology can be influenced depending upon the language used when conducting an assessment.

Acculturation Conflicts

•Children with Asian parents encounter a unique challenge because they must deal with cultural differences. •Children are raised with two conflicting viewpoints−an American culture that calls for active parental involvement, and a home life that demands individual and community responsibility.

Introduction to poverty

•Counselors from middle-class backgrounds should learn about life in poverty. • Learn about class-related biases. •Without awareness, counselors may contribute to oppression. • Social class stratification theory underscores understanding of class relations. • Social class oppression is called classism.

Expectations of Counseling

•Explain the nature of the counseling and therapy and the necessity of obtaining information. Describe the clients' role. Indicate that the problems may be individual, environmental, or a combination of these and that will perform an assessment of each of these • Introduce the concept of co-construction—that problem definition and solutions are developed with help of the client and the • Asian clients expect the counselor to take an active structuring the session and providing guidelines types of responses that they will be expected to

Diversity impact in the intake process

•How can I help you? •What do you think is causing your problem? •Why do you think this is happening to you? •What have you done to treat this condition? •How has this condition affected your life?

Characteristics and Strengths Spiritual and Religious Values

•Judaism is the belief in one omnipotent God who created humankind−it is one of the earliest monotheistic religions. •Yom Kippur, the Day of Atonement, is a time set aside to atone for sins during the past year. •The synagogue is a place of worship. •There are many forms of Judaism, ranging from more conservative (e.g., Orthodox) to progressive.

Counseling Issues with Individuals with Disabilities

•Many cognitive and neuropsychological assessments can miss other forms of disabilities, so it is important to assess for issues such as hearing loss with your client. •Counselors may feel uncomfortable when working with people with disabilities or may experience guilt or pity.

Acculturation Conflicts

•Many have assimilated−especially the first wave of immigrants. • The second wave has tended to maintain their traditional identity. • Some wear traditional clothing (e.g., hijab or head scarf). •Also, some are bicultural and integrate both identities.

Multiracial Strengths

•Multiple racial identity integration appears to have higher level of psychological adjustment. • Lower stress level and feelings of alienation •Different advantages to being multiracial • Enhanced cultural competency

Discrimination and Racism

•Multiracial individuals are subjected to instances of racism and discrimination. •About 55% have been exposed to racial slurs or jokes. •Biracial individuals experience same type of discrimination.

Cultural and Religious Values

•Muslims or the followers of Islam believe in one God and individual accountability for their actions. • The Quran is equivalent to the Bible in Christianity. •Within Islam, there are two major groups: Sunni and Shiite • The Sunni group is largest group, accounting for about 90% of Muslims worldwide. • The remaining 10% are Shiites.

Specific Challenges The Cultural Invisibility/Social Exclusion of the Poor:

•Poor people appear less in the media. •When they are shown, they are typically made out to be lazy, promiscuous, dysfunctional, or drug-addicted. •Poor people are also physically excluded from public life (e.g., prohibition against sharing food, illegal to sit or sleep in public spaces). • Ehrenreich called this trend "the criminalization of poverty."

Proceed using the following steps

•Use both clinician skill and client perspective to understand the problem. •Collaborate and jointly define the problem. • Jointly formulate a hypothesis regarding the cause of the problem. • Jointly develop ways to confirm or disconfirm the hypothesis. • Test out the hypothesis using both the client and the counselor as evaluators. • If the conceptualization appears to be valid, develop a treatment plan. • If the hypothesis is not borne out, the counselor and client collect additional data and formulate new, testable hypotheses.