PSYC:561 Cultural Issues in Psychological Practice

Pluralism

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

Multicultural counseling

A counseling framework 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 their culturally diverse client, thus they should avoid pressuring the 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.

Eurocentric monoculturalism

A preference for the European, especially the English, cultural traditions in American life or the focus on European culture or history to the exclusion of a wider view of the world. This view implicitly regards European culture as preeminent. Mono culturalism 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 diverse populations as they may inflict harm by mislabeling or misdiagnosing problems and treatments.

Filial piety

A prominent virtue in Asian society put forth by Confucius, describing the belief that the 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. This should be considered when counseling Asian Americans.

White privilege

A set of advantages and/or immunities from which white people benefit from which can exist without white people's conscious knowledge of its presence. White privilege maintains the racial hierarchy in the US. White privilege is not the same as racism as the people who benefit from white privilege are often unaware and do not identify as racist or prejudiced.

Race

A social construct which describes populations or groups of people distinguished by different sets of characteristics and beliefs about common ancestry with categories widely based on visible traits (e.g., skin color, facial features, and hair texture) and self-identification.

White racial identity development

A stage theory developed by Helms characterized by 6 stages including: 1) Contact (i.e., individual lacks awareness of cultural and institutional racism and of white privilege and may express stereotypical responses, 2) Disintegration (i.e., person becomes more aware of conflict between humanistic ideals and loyalty to majority and may experience guilt, shame, helplessness at recognition of their own advantages of being white), 3) Reintegration (i.e., greater identification with white ideology/identity, generally becoming defensive about being white with active assertions of superiority while denying racism), 4) Pseudo-independence (i.e., attempt to understand racial differences and increase contact with minority group members usually following an eye-opening experience while still attempting to support the status quo, 5) Immersion/emersion (i.e., focus on own viewpoints, what it means to be White, and on changing majority behavior/attitude characterized by an increase of experiential and affective understanding, emotional catharsis, and "rebirth" necessary to become nonracist) and 6) Autonomy (i.e., characterized by awareness of whiteness with reduced guilt, acceptance of role in perpetuating racism, commitment to social change, knowledge about differences, valuing and seeking out interracial experiences without fear).

Microaggression

A statement, action, or incident regarded as indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority. It may not be direct discrimination. Microaggressions can be split into three categories: 1) microinsult (i.e., unintentional ways of being insensitive/demeaning), 2) micro assault (i.e., blatant, hostile - conveys bias and prejudice), and microinvalidation (i.e., dismiss, exclude other person's experience/beliefs). In therapy, microaggressions may lead to mistrust and distancing.

Cultural racism

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 including aspects of society that overtly and covertly attribute value and normality to whiteness, and devalue, stereotype, and label people of color as "other," different, less than," or render them invisible.

Cultural competence

Ability of therapist to understand the various influence of culture on a person's behavior and interactions. This skill can be defined in three different areas: Awareness (i.e., knowing one's own culture, views, biases, and comfort levels of various backgrounds), knowledge (i.e., the therapist's knowledge of the cultural group both currently and historically, along with any barriers that group may have faced), and skills (i.e., implementing culturally appropriate interventions and receiving and sending information in ways that consider cultural background and recognizing one's own personal limitations). Awareness can be developed via awareness activities change the person's attitudes, opinions, and personal perspective (i.e., journal in multicultural class, immersion). Knowledge can be developed by learning facts and seeking accurate data (i.e., research, reading books). Skill-building activities involve the application of awareness and knowledge in applied settings with diverse clients (i.e., seeking supervision on new skills). Cultural competence is an ongoing process meaning therapists must remain continually engaged.

Multicultural competencies

Ability of therapist to understand the various influence of culture on a person's behavior and interactions. This skill can be defined in three different areas: Awareness (i.e., knowing one's own culture, views, biases, and comfort levels of various backgrounds), knowledge (i.e., the therapist's knowledge of the cultural group both currently and historically, along with any barriers that group may have faced), and skills (i.e., implementing culturally appropriate interventions and receiving and sending information in ways that consider cultural background and recognizing one's own personal limitations). Awareness can be developed via awareness activities change the person's attitudes, opinions, and personal perspective (i.e., journal in multicultural class, immersion). Knowledge can be developed by learning facts and seeking accurate data (i.e., research, reading books). Skill-building activities involve the application of awareness and knowledge in applied settings with diverse clients (i.e., seeking supervision on new skills). Cultural competence is an ongoing process meaning therapists must remain continually engaged.

Minority

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.

Coming out process

Coming out is the process in which individuals reveal to their family and friends that they are gay or lesbian though not everyone goes through the same process or steps. Coming out involves many positives (e.g., self-esteem, building more genuine relationships, and being a role model to others) and negatives (e.g., rejection, harassment, discrimination, and loss of social support), is not a linear process, and the individual typically must "come out" many times throughout their life. It is important to consider all consequences when counseling a patient thinking about coming out. The 6 Stages of Coming Out include: 1) confusion (i.e., question and wonder about sexuality; might experience denial), 2) comparison (i.e., accept possibility that you may be gay), tolerance (i.e., acceptance increases, may isolate self because self-concept is becoming different from society's expectations), acceptance (i.e., have resolved most questions concerning sexual identity and have accepted self), pride (i.e., begin to feel pride, immerse self in LGB culture, may feel anger with or reject hetero community), and synthesis (i.e., integrate sexual identity with other aspects of self so it is just one part of whole identity, feel more congruence)

Cross's Model of Racial Identity

Developed by Cross, this is a four stage Black Identity Development model including 1) pre-encounter stage (i.e., individual is focused on assimilating to the white culture and devalue their own culture or "blackness"), 2) encounter stage (i.e., some significant event occurs that challenges their beliefs causing a paradigm shift away from assimilation), 3) immersion-emersion stage (i.e., individual pulls away from the white culture and immerses themselves into and develops pride in the black culture), and 4) internalization stage (i.e., individual becomes accepting of both white and black cultures, transcends and reconciles, and become flexible and tolerant with a focus on social justice and civil rights).

ADDRESSING model

Developed by Pamela Hays, the "ADDRESSING" model is a framework that facilitates recognition and understanding of the complexities of individual identity. According to Hays, consideration of age, developmental disabilities, acquired disabilities, religion, ethnicity, sexual orientation, socioeconomic status, indigenous group membership, nationality, and gender contributes to a complete understanding of cultural identity, underrepresented groups and oppressive forces.

Assimilation

Generally seen as negative, assimilation is the process by which a person or group adopts a new culture replacing their original culture, leaving only trace elements behind. It is common among immigrant populations attempting to embrace, belong to, and blend in with the dominant as they may feel pressure from members of the majority culture to assimilate quickly.

Culture

Generally, refers to patterns of human activity and the symbolic structures that give such activity significance (i.e., shared customs, beliefs, values, goals, and practices that are common to or characteristic of a specific group). 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.

Cultural universality

In contrast to cultural relativism, this is the view that the concepts of normality and abnormality can 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.

Oppression

Involves the abuse of power whereby a dominant group engages in unjust, harsh, or cruel activities that perpetuate an attitude or belief 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. Thus, the therapist must take steps to be aware of any ways they may be oppressive to culturally diverse clients.

Institutional racism

Occurs when policies, priorities and accepted normative patterns 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. This 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 showing racial favoritism or unfair advantages for one group of people. This is the hardest racism to recognize and works to disempower entire minority groups within the society.

Culture bound

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, disorders, and treatments may be culture bound. A counselor must be careful not to diagnose behaviors that are culturally normal as a disorder because they are viewed as abnormal in the dominant culture and must 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.

Bicultural

Refers to having or combining the cultural attitudes and customs of two nations, peoples, or ethnic groups. One who is bicultural is conversant with both sets of values and customs identifying with two or more cultures (i.e., one's heritage culture and the culture of the country or region in which they have settled). Maintaining biculturality can be difficult if the assimilation is pressured by the dominant culture.

Emic

Refers to 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 their culture.

Poverty and Mental Illness

Studies show a direct correlation between poverty and mental illness in that those in poverty are 2-3 times more likely to develop mental illness than those with higher SES. These families must deal with economic stressors like unemployment and lack of affordable housing, which can lead to increased stress or pathology. There is a strong association between poverty and substance abuse with substance use perpetuating a cycle of poverty. Those living in poverty experience a increased risk of schizophrenia, involuntary hospitalization, less access to services, stigma, and negative orientation.

Racial Identity Development Model

Sue and Sue's 5 stage theory of developing a racial identity based on the Minority Identity Development model. The stages include: 1) Conformity (i.e., the individual is depreciating of their self and their culture and appreciating of the dominant culture), 2) Dissonance and Appreciation (i.e., Conflict between perceptions of self, perceptions of ethnic heritage, and submission to dominant group), 3) Resistance and Immersion (i.e., 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), 4) Introspection (i.e., individual begins to negotiate a positive self-identity separate from both the minority and majority culture attempting to take the best of both cultures), and 5) Integrative awareness (i.e., positive attitude toward their own culture, appreciation of other minorities, and selective acceptance/positivity of the dominant culture).

Etic

The belief that human beings share overwhelming 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

Ethnocentrism

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 ethnocentrism in their practice.

Ethnicity

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.

Worldview

The overall perspective from which one sees and interprets the world characterized by a collection of beliefs about life and the universe held by an individual or a group providing personal insight about reality and meaning. Different cultures frequently have different worldviews (e.g., collectivist vs. individualist).

Individualism

The philosophical, political, economic, or social outlook that emphasizes the independence and worth of every human and the priority of individual goals embraced by the Western world promoting autonomy and 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 embarrassing.

Collectivism

The philosophy is prominent in Eastern cultures, this worldview refers to the 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 to meet the needs of the group. It is in strong contrast to individualism, the prevailing sentiment in the United States.

Cultural relativism

The principle that an individual's beliefs and activities should be interpreted in terms of his or her own culture noting that cultural values and worldviews influence the expression and determination of deviant behavior, making attention to relativism in the clinical context especially important. For example, in some cultures, it is more acceptable to express psychological complaints in physical terms and in others, it is not considered abnormal to experience hallucinations.

Acculturation

The process, which occurs at the individual and group level, is used by the minority culture to imitate the majority culture by adapting various aspects of the majority culture into their culture. This can also be seen bidirectionally, with majority culture adapting certain aspects of the minority culture. It can result in acculturation stress characterized by anxiety depression, and conflict, which accompany moving into a new culture.

Multicultural perspective in counseling

This perspective recognizes the differences among and within clients and how their cultures may impact their values. In this perspective, a counselor must maintain awareness of their own cultural biases and values to prevent them from interfering with interactions with culturally diverse clients. Counselors are also responsible for cultivating knowledge about different cultures and skills that are useful with diverse clients.

When working with Hispanic/Latino clients

it is important to be aware of their collectivist, present-focused, and fatalistic worldview, patriarchal, hierarchical family structure, authoritarian parenting styles, and respect towards elders. They tend to focus more on how personal issues affect family rather than affect individual, thus family therapy may be beneficial. Acculturation status, language barriers, academic issues, and possible undocumented status should be considered. Therapists should be respectful of potentially off-limit topics (i.e., sexual potency) and keep bicultural orientation to allow for movement and flexibility between multiple cultures.

When working with male clients

it is important to be aware that men and boys face many issues in society today such that boys have higher rates of learning disorders and ADHD, higher drop out and lower graduation rates, and more disciplinary problems and 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. Thus, having flexibility with the client and taking them to out of office settings for sessions can help them better adjust to therapy. An authentic relational bond needs to be formed for therapy to be successful. Intersectionality should be addressed as elements of multicultural counseling are important to address problems unique to men and their socialization. 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 include following the client's lead in relation to feelings work, addressing their possible ambivalence regarding therapy, assessing whether they see seeking treatment as a failure, assessing the degree of their adherence to traditional male sex roles, and taking an egalitarian approach.

When working with clients in poverty

it is important to consider the race and gender of clients in poverty and the additional challenges that occur because of intersectionality. Those in poverty generally receive a poor education, pushing them further into the cycle of poverty. They may also experience poor physical development due to poor diet, bad living conditions, lack of safety, etc., poor emotional development due to higher instances of abuse and neglect, lack of healthy role models, future orientation, and resources to address problems, and poor cognitive development again due to diet and high allostatic load, environmental toxins, and under/over stimulation. Barriers to treatment may include logistical issues (e.g., cost, transportation, limited clinic hours, and difficulty finding childcare) multicultural issues (language barriers, trust issues, and miscommunications), and psychological issues (stigma and burden of psychiatric illness). It is important that therapists are understanding of chronic stressors and introduce the benefits of improving mental health, provide reassurance and encouragement, recognize cultural factors, and deliver services in a flexible way (after hours, weekends, in various settings, in home, coordinate with other service providers).

When working with Arab/Muslim clients

it is important to note that family structure is patriarchal and hierarchical by age and gender with high family centric values, social status is important, and worldview is collectivist, so it is important to attend to and emphasize family members/connections, and do not strive for individuation from family. There are high levels of mistrust with authorities. It is common to give gifts and be invited to visit the client's home as hospitality is highly valued. Arab clients may expect detailed advice or directions and revere the counselor as an expert and expect them to make decisions. Therapists should not assume that women are oppressed and avoid using jargon (speak clearly/directly). They tend to be present versus future oriented. There is a high stigma so education about mental illness is important.

When working with African American clients

it is important to note where they are in their racial identity development, as they may react negatively to a white therapist, they may be distrustful of authority figures, therapists included, and connection to family and faith may be utilized as an asset. Additionally, they are less likely to seek treatment, more likely to terminate early, and less likely to report trauma. There are higher rates of PTSD, GAD, poverty, incarceration as well as greater mental health stigma.

When working with Native American clients

o therapists should be cognizant of and recognize history of oppression. It is important to note that many extreme poverty is prevalent, each tribe has its own heritage, and worldview tends to be collectivistic with strong spirituality component and connection to nature. Native Americans value generosity, emphasize present, and observe complementary gender roles. The biggest mental health issues among this group tend to be substance abuse (alcohol), depression and anxiety, suicide (highest rates of completed suicide among all ethnic groups), and domestic violence/violence against women. Barriers to treatment may include trust, stigma, limited resources, and lack of knowledge about services. Additionally, silence is valued, eye contact is a sign of disrespect, humor/stories might be helpful, and group treatment (within culture) fits well with worldview. Therapists should avoid stereotyping and explore the individual's level of acculturation, identity, and values, explore emotions cautiously, avoid spiritual topics until rapport is built, use non-directive methods, and consider existential, humanistic, or experiential methods. CBT is useful in some cases and incorporating the healer or chief may be helpful.

When working with LGBT clients

therapists should 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, consider intersectionality, be aware of their comfortability with their sexuality and where they are in the coming out process, and remember the presenting problem may not be related to sexual orientation. Common disorders in this group include depression and anxiety with higher rates of suicide, bullying, homelessness, and drug use. It is important to create a safe space with an atmosphere of understanding and acceptance using gender neutral language. Additionally, therapists should be aware of community support systems and programs, be open to helping the parents navigate this process and well as the individual, and ensure the individual is prepared for every possible reaction if aiding in the coming out process.

When working with Asian clients

therapists should be aware they tend to be very private as they see emotionality as weakness, family structure is patriarchal with authoritarian parenting style, males and elderly are higher in status, and discussing confidentiality may help build rapport. They may believe that their emotions, desires, behaviors, and individual goals should be kept under control. Asians are typically collectivist in worldview thus autonomy and independence are not necessarily relevant treatment goals. Filial piety is a strong cultural value though it may present as co-dependency. If utilizing family therapy, family structure and communication patters among family should be determined, and it is generally best to address the father first. Therapists should determine the relationship between physical complaints and emotional issues, as many emotional issues present as physical complaints. Therapists may want to consider problem focused time-limited approaches, include family issues, address possible cultural conflicts, and focus on positive assets. In this group, agreeableness and compliance may be mistaken for passive acceptance rather than coping mechanism. It is also common to give gifts. Asians are the least responsive to group therapy.

When working with female clients

therapists should recognize that women still face many issues which can function as stressors (e.g., economic status, lower pay, single parenthood, career barriers, media portrayal, and victimization). It is important to be aware of biological and sociological issues and be able to recognize signs of abuse or violence with awareness of support/advocacy groups and outreach programs for women. Therapists should assess for sociocultural factors and understand women's issues and unique needs in counseling, specifically, girls may experience academic pressure, peer pressure, lower self-esteem, and body image issues. Common problems among women include depression/anxiety, eating disorders, body image issues, and aging. It is important to consider intersectionality which may bring additional stressors

When working with physically disabled clients

therapists, should make sure their office is ADA accessible and can meet all needs, use person first language (i.e., person with disability rather than disabled), match therapy with client's model of disability, identify personal beliefs, understand prejudice/possible countertransference, be careful not to overlook important issues (sex, emotions, relationships), ask about the disability and the person's abilities in a respectful way, respect positive functioning without sensationalizing, focus on positive assets, and determine the relationship between disability and problem; don't assume the problem is about their disability