Full text of "Counseling The Culturally Diverse Theory And Practice"


Full text of "Counseling The Culturally Diverse Theory And Practice" See other formats Counseling the Culturally Diverse Theory and Practice Fifth Edition Derald Wing Sue David Sue



Counseling the Culturally Vlverse

Counseling the Culturally Diverse Theory and Practice Fifth Edition Derald Wing Sue David Sue



Copyright © 2008 by John Wiley & Sons, Inc. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., Ill River Street, Hoboken, NJ 07030, (201) 748-601 1, fax (201) 748-6008, or online at http://www.wiIey.com/go/permissions. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professional services. If legal, accounting, medical, psychological or any other expert assistance is required, the services of a competent professional person should be sought. Designations used by companies to distinguish their products are often claimed as trademarks. In all instances where John Wiley & Sons, Inc. is aware of a claim, the product names appear in initial capital or all capital letters. Readers, however, should contact the appropriate companies for more complete information regarding trademarks and registration. For general information on our other products and services please contact our Customer Care Department within the United States at (800) 762-2974, outside the United States at (317) 572-3993 or fax (317) 572-4002. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our Web site at www.wiley.com. Library of Congress Cataloging-in-Publication Data Sue, Derald Wing. Counseling the culturally diverse : theory and practice / Derald Wing Sue, David Sue. — 5th ed. p. cm. Includes index. ISBN 978-0-470-08632-2 (cloth) 1. Cross-cultural counseling. I. Sue, David. II. Title. BF637.C6S85 2007 158'. 3— dc22 2007002547 Printed in the United States of America.

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Section I The Multiple Dimensions of Multicultural Counseling and Therapy Part! The Affective and Conceptual Dimensions of Multicultural Counseling/Therapy 3 Chapter 1 The Multicultural Journey to Cultural Competence: Personal Narratives 5 My Personal and Professional Journey as a White Person: Reactions to Counseling the Culturally Diverse: Theory and Practice — Mark S. Kiselica 6 My Personal and Professional Journey as a Person of Color: The Heart and Soul of Counseling the Culturally Diverse — Derald Wing Sue 16 Being Chinese American in a Monocultural Society 18 The College and Graduate School Years 20 First Job — A Counseling Psychologist 2 1 Going into Academia 22 Work on Multicultural Counseling and Therapy 23 Expanding Social Justice Horizons 24 Implications for Clinical Practice 26

Chapter 2 The Super ordinate Nature of Multicultural Counseling and Therapy 29 Theme One: Cultural Universality versus Cultural Relativism 3 1 Theme Two: The Emotional Consequences of "Race" 32

vi Contents

Theme Three: The Inclusive or Exclusive Nature of Multiculturalism 33 Theme Four: The Sociopolitical Nature of Counseling/Therapy 34 Theme Five: The Nature of Multicultural Counseling Competence 35 A Tripartite Framework for Understanding the Multiple Dimensions of Identity 36 Individual and Universal Biases in Psychology and Mental Health 40 The Impact of Group Identities on Counseling and Psychotherapy 41 What Is Multicultural Counseling/Therapy? 42 What Is Cultural Competence? 43

Competency One: Therapist Awareness of One's Own Assumptions, Values, and Biases 44 Competency Two: Understanding the Worldview of Culturally Diverse Clients 44 Competency Three: Developing Appropriate Intervention Strategies and Techniques 45 Multidimensional Model of Cultural Competence in Counseling 48 Implications for Clinical Practice 5 1 Parti! The Political Dimensions of Mental Health Practice 53

Chapter 3 The Politics of Counseling and Psychotherapy 55 The Diversification of the United States 59 The Graying of the Workforce and Society 59 The Feminization of the Workforce and Society 60 The Changing Complexion of the Workforce and Society 61 The Education and Training of Mental Health Professionals 64 Definitions of Mental Health 66 Curriculum and Training Deficiencies 70 Counseling and Mental Health Literature 71 Minorities and Pathology 7 1 Relevance of Research 75 Implications for Clinical Practice 76

Contents vii

Chapter 4 Sociopolitical Implications of Oppression: Trust and Mistrust in Counseling/Therapy 79 Effects of Historical and Current Oppression 84 Ethnocentric Monoculturalism 84 Historical Manifestations of Ethnocentric Monoculturalism 88 Therapeutic Impact of Ethnocentric Monoculturalism 9 1 Credibility and Attractiveness in Multicultural Counseling 93 Counseling as Interpersonal Influence 94 Psychological Sets of Clients 95 Therapist Credibility 98 Implications for Clinical Practice 102

Chapter 5

Racial, Gender, and Sexual Orientation Microaggressions: Implications for Counseling and Psychotherapy 105 By Herald Wing Sue & Christina M. Capodilupo Racism, Sexism, and Heterosexism 107 The Evolution of Racism, Sexism, and Heterosexism: Microaggressions 110 The Dynamics and Dilemmas of Microaggressions 112 Therapeutic Implications 121 Implications for Clinical Practice 124 Part!!! The Practice Dimensions of Multicultural Counseling/Therapy 131 Chapter 6 Barriers to Multicultural Counseling and Therapy 133 Characteristics of Counseling/Therapy 137 Generic Characteristics of Counseling/Therapy 137 Culture-Bound Values 140 Focus on the Individual 141 Verbal/Emotional/Behavioral Expressiveness 142

viii Contents

Insight 143 Self-Disclosure (Openness and Intimacy) 145 Scientific Empiricism 146 Distinctions between Mental and Physical Functioning 146 Ambiguity 147 Patterns of Communication 147

Class-Bound Values 148 Language Barriers 151 Generalizations and Stereotypes: Some Cautions 153 Implications for Clinical Practice 154 Chapter 7 Culturally Appropriate Intervention Strategies 157 Communication Styles 160 Nonverbal Communication 162 Sociopolitical Facets of Nonverbal Communication 169 Nonverbals as Reflections of Bias 170 Nonverbals as Triggers to Biases and Fears 1 72 Counseling and Therapy as Communication Style 176 Differential Skills in Multicultural Counseling/Therapy 177 Implications for Multicultural Counseling/Therapy 178 Implications for Clinical Practice 181 Chapter 8 Multicultural Family Counseling and Therapy 183 Family Systems Counseling and Therapy 189 Issues in Working with Ethnic Minority Families 190

Ethnic Minority Reality 190 Conflicting Value Systems 191 Biculturalism 192 Ethnic Differences in Minority Status 1 92 Ethnicity and Language 195 Ethnicity and Social Class 196

Contents ix

Multicultural Family Counseling/Therapy: A Conceptual Model 196 People -Nature Relationship 197 Time Dimension 199 Relational Dimension 201 Activity Dimension 203 Nature of People Dimension 204 Implications for Clinical Practice 205

Chapter 9 Non-Western Indigenous Methods of Healing: Implications for Counseling and Therapy 209 The Legitimacy of Culture-Bound Syndromes: Nightmare Deaths and the Hmong Sudden Death Phenomenon 211 Causation and Spirit Possession 214 The Shaman as Therapist: Commonalities 215 A Case of Child Abuse? 2 1 6 The Principles of Indigenous Healing 219 Holistic Outlook, Interconnectedness, and Harmony 222 Belief in Metaphysical Levels of Existence 223 Spirituality in Life and the Cosmos 225 Implications for Clinical Practice 228

Part IV Racial/Cultural Identity Development in Multicultural Counseling and Therapy 23 1 Chapter 10 Racial/Cultural Identity Development in People of Color: Therapeutic Implications 233 Racial/Cultural Identity Development Models 235 Black Identity Development Models 236 Asian American Development Models 239 Latino/Hispanic American Identity Development Models 240

X Contents

A Racial/Cultural Identity Development Model


Conformity Stage 242 Dissonance Stage 246 Resistance and Immersion Stage 248 Introspection Stage 249 Integrative Awareness Stage 251 Therapeutic Implications of the R/CID Model 252 Conformity Stage: Therapeutic Implications 253 Dissonance Stage: Therapeutic Implications 254 Resistance and Immersion Stage: Therapeutic Implications 255 Introspection Stage: Therapeutic Implications 256 Integrative Awareness Stage: Therapeutic Implications 256 Implications for Clinical Practice 257

Chapter 1 1

White Racial Identity Development: Therapeutic Implications


What Does It Mean to Be White? The Invisible Whiteness of Being Understanding the Dynamics of Whiteness Models of White Racial Identity Development





The Hardiman White Racial Identity Development Model 266

The Helms White Racial Identity Development Model 269 The Process of White Racial Identity Development: A Descriptive Model Implications for Clinical Practice



PartV Social Justice Dimensions in Counseling/Therapy


Chapter 12

Social Justice Counseling/Therapy


Social Justice Counseling Understanding Individual and Systemic Worldviews Locus of Control


292 294

Contents xi

Locus of Responsibility 296 Formation of Worldviews 297 Internal Locus of Control (IC)-Internal Locus of Responsibility (IR) 298 External Locus of Control (EC)-Internal Locus of Responsibility (IR) 300 External Locus of Control (EC)-External Locus of Responsibility (ER) 302 Internal Locus of Control (IC)-External Locus of Responsibility (ER) 303 Multicultural Organizational Development (Meso Level) 305 Culturally Competent Mental Health Agencies 306 Systemic Change (Macro Level) 309 Antiracism as a Social Justice Agenda 310 Social Justice Requires Counseling Advocacy Roles 311

Section II Multicultural Counseling and Specific Populations Part VI Counseling and Therapy Involving Minority Group Counselors/Therapists 315 Chapter 13 Minority Group Therapists: Working with Majority and Other Minority Clients 317 The Politics of Interethnic and Interracial Bias and Discrimination 318 Multicultural Counseling in Minority-Majority and Minority-Minority Relationships 321 Therapist-Client Matching 322 Communication Style Differences 324 Issues Regarding Stage of Ethnic Identity 325 Ethnic Minority and Majority Therapist Perspectives 326 Implications for Clinical Practice 327

xii Contents

Part VI! Counseling and Therapy with Racial/Ethnic Minority Group Populations 329

Chapter 14

Counseling African Americans 33 1 African American Values, Research, and Implications for Counseling and Therapy 332 Family Characteristics 332 Kinship Bonds and Extended Family and Friends 334 Educational Orientation 335 Spirituality 336 Ethnic or Racial Identity 337 African American Youth 337 Racism and Discrimination 340 Implications for Clinical Practice 341

Chapter 15

Counseling American Indians and Alaskan Natives 345 The American Indian and the Alaskan Native 347 Tribe and Reservation 348 American Indian/ Alaskan Native Characteristics, Values, and Implications on Behavior 349 Family Structure 349 American Indian Values 349 Specific Problem Areas for American Indians/Alaskan Natives 351 Education 351 Acculturation Conflicts 352 Domestic Violence 354 Suicide 354 Alcohol and Substance Abuse 355 Implications for Clinical Practice 356

Contents xiii

Chapter 16 Counseling Asian Americans and Pacific Islanders


Asian Americans: A Success Story? Traditional Asian Cultural Values, Behavior Patterns, and Implications for Therapy



Collectivistic Orientation 362 Hierarchical Relationships 363 Parenting Styles 364 Emotionality 365 Holistic View on Mind and Body 366 Academic and Occupational Goals 367 Racism and Prejudice 367 Acculturation Conflicts between Parents and Children 368 Identity Issues 368 Psychotherapy Is a Foreign Concept to Many Asian Americans 369 Expectations of Counseling 370 Counseling Interventions 370 Family Therapy 371 Implications for Clinical Practice 372

Traditional Hispanic Values, Characteristics, Behavior Patterns, and Implications

Family Values 377 Family Structure 378 Sex Role Expectations 379 Spirituality and Religiosity 381 Acculturation Conflicts 382 Educational Characteristics 384 Immigration, Racism, Discrimination, and Other Societal Factors 385 Assessment and Linguistic Issues 386 Implications for Clinical Practice 387

Chapter 1 7

Counseling Hispanic/Latino Americans


for Therapy


xiv Contents

Chapter 18 Counseling Individuals of Multiracial Descent 389 Facts and Figures Related to Biracial/Multiracial Populations 390 Hypodescent: The "One Drop of Blood" Rule 392 Racial/Ethnic Ambiguity, or "What Are You?" 393 The Marginal Syndrome, or Existing between the Margins 395 Stereotypes and Myths of Multiracial Individuals and Interracial Couples 397 A Multiracial Bill of Rights 399 Implications for Clinical Practice 401

VartVUl Counseling and Special Circumstances Involving Racial/Ethnic Populations 405

Chapter 19

Counseling Arab Americans 407 Characteristics of the Arab American Population 408 Facts Regarding Arab Americans and Islam 408 Stereotypes, Racism, and Prejudice 409 Religious and Cultural Background 411 Family Structure and Values 412 Acculturation Conflicts 413 Implications for Clinical Practice 413 Chapter 20 Counseling Jewish Americans 415 Experiences with Prejudice and Discrimination 417 Jewish Identity and Religion 418 Counseling and Therapy with Jewish Clients 420 Implications for Clinical Practice 42 1

Contents XV

Chapter 21 Counseling Immigrants 423 Population Characteristics of Immigrants 424 Immigration Policy and Factors Influencing Receptivity to Immigrants 424 The Impact of September 1 1, 2001, on Immigrants 426 Cultural and Community Adjustments 427 Barriers to Seeking Treatment 428 Implications for Clinical Practice 429

Chapter 11

Counseling Refugees 43 1 Special Problems Involving Refugees 432 Considerations in Work with Refugees 433 Effects of Past Persecution, Torture, or Trauma 433 Culture and Health 434 Safety Issues and Coping with Loss 435 Gender Issues and Domestic Violence 436 Linguistic and Communication Issues 437 Implications for Clinical Practice 438

Part IX Counseling and Therapy with Other Multicultural Populations 441

Chapter 23

Counseling Sexual Minorities 443 Same-Sex Relationships Are Not Signs of Mental Disorders 445 GLBT Couples and Families 447 GLBT Youth 449 Identity Issues 450 Coming Out 451 Aging 452 Implications for Clinical Practice 453

xvi Contents

Chapter 24 Counseling Older Adult Clients


Problems of Older Adults


Physical and Economic Health 457 Mental Health 458 Mental Deterioration or Incompetence 458 Family Intervention 459 Elder Abuse and Neglect 46 1 Substance Abuse 462 Depression and Suicide 462 Sexuality in Old Age 464 Multiple Discrimination 465 Implications for Clinical Practice 466

Economic Status 470 Barriers to Career Choices 471 Discrimination and Victimization 472 Gender Issues 473 Affective Disorders 474 Aging 475 Feminist Identity Theory 477 Therapy for Women 478 Implications for Clinical Practice 479

Chapter 25

Counseling Women


Problems Faced by Women


Chapter 26 Counseling Individuals with Disabilities


The Americans with Disabilities Act Myths about People with Disabilities Programs for Individuals with Disabilities




Counseling Issues with Individuals with Disabilities Models of Disability 491 Life Satisfaction and Depression 492 Sexuality and Reproduction 493 Spirituality and Religiosity 494 Family Counseling 495 Implications for Clinical Practice References Author Index

Subject Index

Since its publication in 1981, Counseling the Culturally Diverse: Theory and Practice (CCD) has become a classic in its field, used in nearly 50 percent of graduate training programs in counseling, and now forms part of the multicultural knowledge base of licensing and certification exams. It continues to lead the field in the theory, research, and practice of multicultural counseling/therapy, and upholds the highest standards of scholarship; it is the most frequently cited text in multicultural psy- chology and ethnic minority mental health. We believe that the success of CCD is related to its (1) integrated conceptual framework, (2) up-to- date coverage of research in the field, (3) ability to actively address clini- cal applications through translating research and concepts to practice, (4) use of numerous examples, vignettes, and case studies that add life and meaning to the material, (5) engaging writing style, and (6) pas- sionate style of communication — hard hitting, intense, and challeng- ing. The 14 specific population chapters, including several new ones, continue to be hailed as among the best thumbnail sketches of how multicultural counseling relates to the various marginalized popula- tions in our society. The fifth edition of CCD does not change its basic formula, which continues to make it a success in the academic and clinical markets. There are significant revisions, however, that reflect changes in the field and new frontiers of importance to the mental health professions. Ma- jor updating of references, introduction of new research and concepts, and future directions in counseling, therapy, and mental health are re- flected in the fifth edition. Section 1 — "The Multiple Dimensions of Multicultural Counsel- ing and Therapy" is divided into five parts that discuss broad theoreti- cal, conceptual, research, and practice issues related to multicultural counseling/therapy, cultural competence, and sociopolitical influences that cut across specific populations. n Part I — "The Affective and Conceptual Dimensions of Multicul- tural Counseling/Therapy" includes Chapter 1: "The Multicultural Journey to Cultural Competence: Personal Narratives" and Chap- ter 2: "The Superordinate Nature of Multicultural Counseling and Therapy." n Part II — "The Political Dimensions of Mental Health Practice" in- cludes Chapter 3: "The Politics of Counseling and Psychotherapy," Chapter 4: "Sociopolitical Considerations of Oppression: Trust and Mistrust in Counseling/Therapy" and Chapter 5: "Racial, Gender, and Sexual Orientation Microaggressions: Implications for Coun- seling and Psychotherapy."



n Part III — "The Practice Dimensions of Multicultural Counseling/Ther- apy" includes Chapter 6: "Barriers to Multicultural Counseling/Therapy," Chapter 7: "Culturally Appropriate Intervention Strategies," Chapter 8: "Multicultural Family Counseling and Therapy" and Chapter 9: "Non- Western and Indigenous Methods of Healing." n Part IV — "Worldview Dimensions in Multicultural Counseling and Therapy" includes Chapter 1 0: "Racial/ Cultural Identity Development in People of Color" and Chapter 11: "White Racial Identity Development." n Part V — "Social Justice Dimensions in Counseling/Therapy" includes Chapter 12: "Social Justice Counseling/Therapy." Section 2 — "Multicultural Counseling and Specific Populations" is di- vided into three parts that cover unique and culture-specific chapters on spe- cial populations. The extensive coverage allows instructors freedom to use all of the chapters in this section or to selectively choose those that fit their course requirements. n Part VI — "Counseling and Therapy Involving Minority Group Coun- selors/Therapists" includes Chapter 13: "Minority Group Therapists: Working with Majority and Other Minority Clients." n Part VII — "Counseling and Therapy with Racial/Ethnic Minority Popu- lations" includes Chapter 14: "Counseling African Americans," Chapter 15: "Counseling American Indians and Alaskan Natives," Chapter 16: "Counseling Asian Americans and Pacific Islanders," Chapter 17: "Counseling Hispanic/Latino Americans," and Chapter 18: "Counseling Individuals of Multiracial Descent." n Part VIII — "Counseling and Special Circumstances Involving Racial/ Ethnic Populations" includes Chapter 19: "Counseling Arab Ameri- cans," Chapter 20: "Counseling Jewish Americans," Chapter 21: "Coun- seling Immigrants," and Chapter 22: "Counseling Refugees." n Part IX — "Counseling and Therapy with Other Multicultural Popula- tions" includes Chapter 23: "Counseling Sexual Minorities," Chapter 24: "Counseling Older Adult Clients," Chapter 25: "Counseling Women," and Chapter 26: "Counseling Individuals with Disabilities." Many of the additions and revisions incorporated into the fifth edition arose from instructor and student feedback. While the emotive and passionate na- ture of the text has proven to be a strength in generating difficult dialogues on race, gender, sexual orientation, and other sociodemographic differences, it has also posed unique challenges to instructors. For some students, the strong passions and feelings aroused by these topics occasionally lead to de-

Vrefa.ce xxi

fensiveness and require a skilled instructor to help them through the learn- ing process. To aid the instructor in helping students process the meaning of their emotional reactions, Chapter 1 presents two personal narratives by Drs. Mark Kiselica and Derald Wing Sue that speak to their racial/cultural awak- ening to reading CCD and to personal reflections of how it came to be written. Dr. Mark Kiselica, a White counseling psychologist, has written in sev- eral professional publications of how influential the book was for his personal awakening to multicultural issues as a graduate student at Penn State Uni- versity. A well-respected scholar and researcher in counseling psychology, Dr. Kiselica describes his initial reactions of anger and disgust with the con- tents of the book and his eventual understanding of his strong emotional re- actions. The inclusion of two brief personal narratives, back to back in the same chapter, illustrate lessons related to topical areas of the text. It is hoped that students will be able to obtain insights into how CCD was developed, from the senior author's perspective, and also understand Kiselica 's initial de- fensiveness and anger toward the contents of the book and how he realized that his strong feelings were defenses against self-exploration. We are hope- ful that many White students will be able (a) to see themselves in Kiselica's account, making the material more meaningful, and (b) to understand the passionate and emotive meaning of the text. Several new and important chapters are included in the fifth edition. First, new chapters on "Racial, Gender, and Sexual Orientation Microaggres- sions: Implications for Counseling and Therapy" (Chapter 5), "Social Justice Counseling/Therapy" (Chapter 12), and one on "Minority Group Therapists: Working with Majority and Other Minority Clients" (Chapter 13) have been added. Chapter 5, on microaggressions, discusses a cutting-edge area of research that has important implications for our society and for the mental health of its marginalized groups. Microaggressions deal with the uncon- scious and subtle manifestations of bias and discrimination that many well- intentioned individuals are unaware they possess. How microaggressions affect the mental health status of marginalized populations, how well- intentioned mental health professionals are unaware that they may be guilty of bias and discrimination, and how they infect the process of counseling/ therapy are discussed in detail. More importantly, we spend considerable time illustrating how microaggressions may lead to a breakdown in the ther- apeutic alliance, and we indicate the importance of research in this area. We are especially grateful for the help of Christina M. Capodilupo in the writing of this chapter. Chapter 12, on social justice counseling/therapy, continues the direc- tion taken toward addressing issues across all marginalized groups in our so- ciety and broadening the umbrella of multiculturalism. Social justice coun- seling is increasingly becoming an area counseling psychology views as

xxii Vrehce

central to the helping professions. Social justice counseling/therapy is an ac- tive philosophy and approach aimed at producing conditions that allow for equal access and opportunity reducing or eliminating disparities in educa- tion, health care, employment, and other areas that lower the quality of life for affected populations, encouraging mental health professionals to consider micro, meso, and macro levels in the assessment, diagnosis, and treatment of client and client systems, and broadening the role of the helping professional to include not only counselor/therapist but advocate, consultant, psychoed- ucator, change agent, community worker, and so on. Chapter 1 3 addresses issues related to interethnic relationships, where the counselor is a member of a marginalized group and the client is of another minority or majority group. This issue has been relatively unexplored and is likely to be controversial. But we believe that such a first step in addressing these relationships in general and to counseling/therapy dyads is much needed. In this chapter, we hope to make the point that multicultural coun- seling is more than White-People of Color, but White-Black, Black-Asian, Asian-Latino, Latino-Native American and numerous combinations. To cover this matter, we briefly review the findings on relationships between various racial/ethnic minorities. Matters related to counselors of color work- ing with White clients, and different racial/ethnic counselor combinations (African American-Asian American, Latino(a)-Hispanic American-Native American, Native American-Asian American, etc.) are described. This chap- ter also discusses other counseling combinations that involve members of tra- ditional marginalized groups as therapists and a dominant member as client. We are also adding four brief chapters covering specific populations be- cause of the unique circumstances they face: "Counseling Arab Americans" (Chapter 19), "Counseling Jewish Americans" (Chapter 20), "Counseling Im- migrants" (Chapter 21), and "Counseling Refugees" (Chapter 22). In light of the current "hot buttons" associated with worldwide events like the conflicts in the Middle East, the terrorist attacks on the World Trade Center, and the strongly divisive issue of immigration, much misunderstanding surround- ing Middle Eastern and immigrant/refugee groups have led to their being de- monized. These new chapters present information and issues that we hope will allow mental health professionals to liberate themselves from such stereotypes, to more fully understand their life circumstance, and to provide helpful and culturally relevant services to them. All chapters have undergone changes, some more than others. We have tried to integrate greater coverage of social class issues throughout the text. The aim of such changes and/or additions is to make sure the topical chapters continue to both reflect and lead the field. Due to positive reactions to the clinical implications section at the end of each chapter, we have decided to re- tain that feature. For instructors using the text, new auxiliary materials have been devel-

Preface xxiii

oped to aid in teaching the concepts to students. We are grateful to Gina Torino, who has developed materials (overheads, tests, resources, learning activities, role-plays, etc.) that correlate with specific chapters of CCD. Profes- sors will find the instructor's manual a valuable tool in teaching the concepts of multicultural counseling and therapy. To further aid instructors using the text are a series of videotapes/DVDs in lecture format produced and developed independently by Microtraining Associates to accompany specific chapters of the book. These tapes were de- veloped to be stand-alone lectures of multicultural counseling to be used in courses on multicultural counseling and therapy, minority mental health is- sues, broader multicultural/diversity topics, or can be used with CCD. With re- spect to the latter, such usage allows instructors to assign specific chapters of the text and show the tapes associated with the content. We are hopeful that such an approach will allow instructors greater freedom in developing their own class activities (see instructor's manual) to supplement both chapter readings and taped lectures. Approximately a dozen tapes can be used throughout the duration of the course. Please see the Instructor's Manual for information on how to order the tapes from Microtraining Associates. There is an African American proverb that states, "We stand on the head and shoulders of many who have gone on before us." Certainly, this book would not have been possible without the wisdom, commitment, and sacri- fice of others. We thank them for their inspiration, courage, and dedication, and hope that they will look down on us and be pleased with our work. We would like to acknowledge all the dedicated multicultural pioneers in the field who have journeyed with us along the path of multiculturalism before it became fashionable. They are too numerous to name, but their knowledge and wisdom have guided the production of CCD. Special thanks go to Lisa Gebo, our editor, who supported the revision efforts and constantly encour- aged the many new directions exemplified in this fifth edition. Working on this fifth edition continues to be a labor of love. It would not have been possible, however, without the love and support of our families, who provided the patience and nourishment that sustained us throughout our work on the text. Derald Wing Sue wishes to express his love for his wife, Paulina, his son, Derald Paul, and his daughter, Marissa Catherine. David Sue wishes to express his love to his wife, Diane, and his daughters, Jenni and Cristi. We hope that Counseling the Culturally Diverse: Theory and Practice, fifth edition, will stand on "the truth" and continue to be the standard bearer of multicultural counseling and therapy texts in the field. Derald Wing Sue David Sue

The Multiple Dimensions of Multicultural Counseling and Therapy

Part ! The Affective and Conceptual Dimensions of Multicultural Co uns eli n (3-/ Therapy

The Multicultural Journey to Cultural Competence: Personal Narratives

Reading Counseling the Culturally Diverse: Theory and Practice (CCD) is very likely to elicit strong emotions among readers. Not only may the content of the book challenge your racial reality but it is pas- sionate, direct, and likely to arouse deep feelings of guilt, defensiveness, anger, sadness, hopelessness, and anxiety in some of you. Becoming culturally competent in mental health practice, however, demands that nested or embedded emotions associated with race, culture, gender, and other sociodemographic differences be openly experienced and dis- cussed. It is these intense feelings that often block our ability to hear the voices of those most oppressed and disempowered. How we, as helping professionals, deal with these strong feelings can either enhance or negate a deeper understanding of ourselves as racial/cultural beings and our understanding of the worldviews of culturally diverse clients. Sara Winter (1977, p. 24), a White female psychologist, powerfully enumer- ates the reactions that many Whites experience when topics of race or racism are openly discussed. These disturbing feelings, she contends, serve to protect us from having to examine our own prejudices and biases. When someone pushes racism into my awareness, I feel guilty (that I could be doing so much more); angry (I don 't like to feel like I'm wrong); defen- sive (I already have two Black friends ... I worry more about racism than most whites do — isn 't that enough); turned off (I have other priorities in my life with guilt about that thought); helpless (the problem is so big — what can I do?). I HATE TO FEEL THIS WAY. That is why I minimize race issues and let them fade from my awareness whenever possible. On the other hand, many marginalized groups react equally strongly when issues of oppression are raised, especially when their stories of discrimination and pain are minimized or neglected. Their reality of racism, sexism, and homophobia, they contend, is relatively unknown or ignored by those in power because of the discomfort that

1 Chapter


6 Affective and Conceptual Dimensions of Multicultural Counseling

pervades such topics. Vernon E. Jordan, Jr., an African American attorney and former confidant of President Bill Clinton, made this point about racism in startling terms. In making an analogy between the terrorist attacks of Sep- tember 1 1 (known by an overwhelming majority in our nation) and those suffered by Blacks (seemingly minimized by the public), Jordan stated: None of this is new to Black people. War, hunger, disease, unemployment, depri- vation, dehumanization, and terrorism define our existence. They are not new to us. Slavery was terrorism, segregation was terrorism, and the bombing of the four little girls in Sunday school in Birmingham was terrorism. The violent deaths of Medgar, Martin, Malcolm, Vernon Dahmer, Chaney, Shwerner, and Goodman were terrorism. And the difference between September 1 1 and the ter- ror visited upon Black people is that on September 11, the terrorists were for- eigners. When we were terrorized, it was by our neighbors. The terrorists were American citizens. Our opening chapter is meant to be a reflective and emotional one. While the entire volume is filled with the knowledge base of multicultural counseling and therapy derived from research findings, it is important to re- alize that cognitive understanding and intellectual competence are not enough. Concepts of multiculturalism, diversity, race, culture, ethnicity, and so forth are more than intellectual concepts. Multiculturalism deals with real human experiences, and as a result, understanding your emotional reactions is equally important in the journey to cultural competence. To aid you in your journey, we present two personal narratives concerning the text you are about to read. We hope that you will carefully monitor your own emotional reactions, not allow them to interfere with your journey to cultural compe- tence, and try to understand them as they relate to your own racial/cultural awakening and identity.

My Versond and Vrofessional Journey as a White Verson: Reactions to "Counseling the Culturally Diverse: Theory and Practice" by Mark S. Kiselica I was shaken to my core the first time I read Counseling the Culturally Different (now Counseling the Culturally Diverse) by Derald Wing Sue (1981). I can re- member the moment vividly. I was a doctoral candidate at Penn State Uni- versity's counseling psychology program, and I had been reading Sue's book in preparation for my comprehensive examinations, which I was scheduled to take toward the end of the spring semester of 1985. I wish I could tell you that I had acquired Sue's book because I was gen-

The Multicultural Journey to Cultural Competence: Personal Narratives 7

Mark S. Kiselica

uinely interested in learning about multicultural counseling, or, as it was la- beled back then, Cross-cultural counseling.! am embarrassed to say, how- ever, that that was not the case. I had purchased Sue's book purely out of ne- cessity, figuring that I had better read the book because I was likely to be asked a major question about cross-cultural counseling on the comps. During the early and middle 1980s, taking a course in multicultural counseling was not a requirement in many graduate counseling programs, including mine, and 1 had decided not to take my department's pertinent course as an elective. I saw myself as a culturally sensitive person, and I concluded that the course wouldn't have much to offer me. Nevertheless, I understood that Dr. Harold Cheatham, the professor who taught the course, would likely submit a ques- tion to the pool of material being used to construct the comps. So, I prudently went to the university bookstore and purchased a copy of Counseling the Cul- turally Different (CCD) because that was the text Dr. Cheatham used for his course. I had decided that reading and studying the book would prepare me for whatever question Dr. Cheatham might devise, so I read it carefully, mak- ing sure to take detailed notes on everything Sue had to say. I didn't get very far with my highlighting and note taking before I started to react to Sue's book with great anger and disgust. Early on in the text, Sue blasted the mental health system for its historical mistreatment of people who

8 Affective and Conceptual Dimensions of Multicultural Counseling were considered to be ethnic minorities in the United States. He especially took on White mental health professionals, charging them with a legacy of ethnocentric and racist beliefs and practices that had harmed people of color and made them leery of counselors, psychologists, and psychiatrists. It seemed that Sue didn't have a single good thing to say about White America, and I was ticked off at himH resented that I had to read his book, and couldn't wait for the task to be over. I wished that there were some other way than reading Sue's book to get through the comps, but I knew I had better com- plete his text and know the subject matter covered in it if I wanted to succeed on the examinations. So, out of necessity I read on, and struggled with the feelings that Sue's words stirred in me. I was very upset as I read and reread Sue's book. I felt that Sue had an axe to grind with White America and that he was using his book to do so. I believed his accusations were grossly exaggerated and, at least to some ex- tent, unfair. And I felt defensive because I am White and my ancestors had not perpetrated any of the offenses against ethnic minorities that Sue had charged. I was so angry at Sue that I vowed I would toss his book away once I passed the comps. I looked forward to the day when I would be relieved of him and his writings. Yet, for reasons I didn't fully understand at the time, my anger, defen- siveness, and resentment began to fade, and rather than dumping Sue's book, I found myself reading it again and again. Something was happening to me, and I couldn't put my finger on it. Surprisingly, once I had reached the point where I understood the content and theory provided in Sue's book, and hence, had achieved my purposes for reading the text, I kept opening it up again. And strangely, with each fresh reading, I experienced new waves of emotions. Instead of reacting with bitterness, I was now feeling sadness — mild sadness at first, but later, a profound sense of sadness, and even grief. At times, my eyes filled with tears, and I found myself now wanting to absorb the message that Sue was trying to convey. What was happening to me? I tried to make sense of my emotions-te- ascertain why I was drawn back to Sue's book again and again in spite of my initial rejection of it. I know it may sound crazy, but I read certain sections of Sue's book repeatedly and then reflected on what was happening inside of me. I spent quite a bit of time alone with Sue's book, sometimes in my office. A couple of other times, I went for long walks in the woods, trying to understand why this book was becoming so important to me. My life was changing and I needed to know why. The tears kept coming. I began to discover important lessons about me, significant insights, prompted by reading Sue's book, that would shape the di- rection of my future. I gradually realized that over my entire life I had iden- tified with oppressed peoples because my ancestors and my immediate family had encountered so many hardships throughout our history. My mother's family was from Ireland, and throughout the ages, they had suffered severe

The Multicultural Journey to Cultural Competence: Personal Narratives 9 poverty and political and cultural domination by the British. Their language, Gaelic, had been taken from them. They were forced to change the spelling of their last name. They left Ireland for a better life in America, realizing that they would never be able to return to their homeland, and their hearts were ripped apart by such a heart-wrenching departure. Yet, they arrived in Amer- ica with the hope of providing something better for their children, and they stood up to the terrible stereotypes about and maltreatment of the Irish by the American establishment. My maternal grandfather worked as a railroad la- borer until it killed him, and my grandmother cleaned the homes of wealthy Americans until she could work no longer, still poor and living in a ghetto at the time of her death. All of these images came back to me as I read Sue's book, and with their arrival, the tears began to fall. More images entered my mind, this time regarding my father's family, who were from Slovakia. They, too, had been poor. They, too, suffered through years of external domination and persecution, including the de- struction of their homes and villages by invading armies and the desecration of their churches and political institutions. My paternal grandparents fled to the United States, and my father was raised in a poor, immigrant neighbor- hood where English was his second language. My father was learning dis- abled and lame from a horrific leg injury for which he received inadequate medical care. For decades, he labored in factories under deplorable conditions that would eventually disable him. Yet, all he ever dreamed about was giving my brothers and sisters and me a better life. Sue's book reminded me of my father and all that he and his family went through, and their suffering surged through me, leaving me teary-eyed. These memories helped me to look at Sue's book from a different point of view. They caused me to realize more fully that the historical experiences of other racial and ethnic groups were similar in some respects to those of my family. And with that particular realization, more tears swelled in my eyes — tears of empathy, and tears of shame. I began to feel — really feelfm what people of color had experienced in this country, and I was ashamed of the fact that it had taken me so long to develop that level of empathic understanding. How could I have been so clueless^ wondered to myself at the time. My head began to spin as a vortex of thoughts swirled in my mind. I now realized that Sue was right! The system had been destructive toward people of color, and although my ancestors and I had not directly been a part of that oppressive system, I had unknowingly contributed to it. I began to think about how I had viewed people of color throughout my life, and I had to admit to myself that I had unconsciously bought into the racist stereotypes about African Americans and Latinos. Yes, I had laughed at and told racist jokes. Yes, I had used the N'word when referring to African Americans. Yes, I had been a racist. Admitting that I have been racist is not an easy thing for me to do. It isn't

1 0 Affective and Conceptual Dimensions of Multicultural Counseling easy now, and it certainly wasn't easy in 1985, when I naively thought I was such a culturally sensitive person. I had good reasons to conclude, albeit er- roneously, that I was not a racist. I had never been a member of the Ku Klux Klan. When I was a boy, I had had a handful of Cuban American and African American friends. My family and I had always supported the Democratic Party and liberal legislative initiatives. Yes, I was one of the good guys, so the word facisf'couldn't apply to me. But I was wrong, blinded by the insular world in which I had been raised, a world of well-meaning Whites in an era of racial segregation that dictated little substantive contact with people who were different from me: a world that socialized American Whites, including me, to become racist. Sue's book forced me to remove my blinders. He helped me to see that I was both a product and an architect of a racist culture. Initially, I didn't want to admit this to myself. That is part of the reason I got so angry at Sue for his book. His accusations don't apply to metwas the predominant, initial thought that went through my mind. But Sue's words were too powerful to let me escape my denial of my racism. It was as though I was in a deep sleep and someone had dumped a bucket of ice-cold water on me, shocking me into a state of sudden wakefulness: The sleep was the denial of my racism; the water was Sue's provocative words, and the wakefulness was the painful recognition that I was a racist. It was very unsettling to achieve this recognition, and I faced a tough dilemma afterward: Should I continue to confront my ethnocentrism and racism and experience all of the discomfort that goes with that process, or should I retreat from that process and go on living my life of comfort in my White-dominated world?What else would I discover about myself if I con- tinued with the process of exploring my cultural biases?Where would it take me? As I wrestled with this dilemma, two considerations helped me to move beyond my anxiety about fully committing myself to becoming a more cul- turally sensitive person. I realized I had an obligation to my ancestors to con- front my fears and cultural biases, for without further growth on my part, I would continue to do to others what had been done to my ancestors. I also was deeply moved by the historical experiences of people of color in the United States. Sue and the contributing authors who wrote some of the chap- ters in the first edition of his book did a nice job of summarizing these expe- riences. Their work inspired me to learn more about the history and experi- ences of people who were culturally different from me. As I look back on this period of soul-searching, I now realize that the reading of CCD sparked a period of important White racial identity develop- ment for me. Prior to reading Sue's book, I had not thought of myself as a racial being nor considered my role as a White person in a racist society. Reading CCD pushed me to have a greater awareness of racial issues. My de-

The Multicultural Journey to Cultural Competence: Personal Narratives


cision to explore racial matters further led me to make an important profes- sional decision that would have a lasting impact on me and move me to yet deeper levels of understanding about my Whiteness: I decided to apply for and accept a predoctoral internship in clinical child and adolescent psychol- ogy in the outpatient unit of the Community Mental Health Center of the University of Medicine and Dentistry of New Jersey (UMDNJ), which was located in the heart of Newark, New Jersey. Because the center at UMDNJ served primarily African American and Latino families, the internship pro- vided me with extensive contact with people who are culturally different from me. So, when I left Penn State in the summer of 1986 to begin my in- ternship in Newark, I was about to immerse myself in a cross-cultural expe- rience. The year I spent in Newark changed me forever. Developing everyday relationships with African American and Latino colleagues at UMDNJ, study- ing about the history and traditions of African Americans and Latinos, and counseling children, adolescents, and families from these two racial/ethnic groups gave me a real-world feel for the material I had first read about in CCD. By immersing myself in the cultures of these two populations, I acquired an affective understanding about racism and oppression, which is a form of un- derstanding that Sue said is necessary for true multicultural growth. I also became acutely aware of my Whiteness. Being one of the few White, non- Latino people at UMDNJ, I was now the minority, and I stood out as a White person. I enjoyed many conversations with my colleagues and clients about our respective roots. I learned that we shared distinct, yet overlapping, his- torical experiences. I understood for the first time the advantages I had en- joyed by being White in America, of how the system is open to people who look like me but is often closed and dangerous for people of color. To put it in a different way, I recognized that my White skin and blond hair and blue eyes afforded me White privilege'in a racist society. Best of all, I experienced the joy that comes with crossing cultural boundaries and discovering the beauty of different cultures and people. When my year in Newark was over, I felt compelled to write an account of these experiences, which had been prompted by reading CCD. I had a week off between the completion of my internship and the start of a new job at the Piscataway campus of UMDNJ. Rather than go on vacation, I sequestered myself in the bedroom of our apartment in Bordentown, New Jersey, where my wife and I lived at the time, pouring my heart into writing about my cross- cultural experiences. When that week was over, I had completed the first draft of a manuscript titled Reflections of a Multicultural Internship Experience. I sent the manuscript to Dr. Cheatham, who was still a professor at Penn State, and asked him to critique my paper, even though I had never enrolled in his course. In a gesture of kindness and generosity I will always appreciate, Harold not only reviewed the manuscript, but he encouraged me to try to

1 2 Affective and Conceptual Dimensions of Multicultural Counseling publish it. Shortly afterward, I noticed a call for manuscripts for a special issue of the Journal of Counseling and Development (JCD) on multiculturalism as a fourth force in counseling, which was to be edited by Paul Pedersen, a well- known multicultural scholar who was a professor of counseling at Syracuse University at the time. I considered sending my manuscript to Dr. Pedersen but hesitated due to several doubts I had about the paper. I had little experi- ence as a writer and feared that my paper was too personal and heartfelt for a professional journal. I also felt vulnerable knowing that I was about to allow others to read my intensely personal experiences. I nevertheless submitted the manuscript to Dr. Pedersen. Much to my surprise, the manuscript was ac- cepted for publication after the reviewers who read it commented that it was a very special article representing a unique voice in the field. I was now on my way to complementing my clinical experiences of counseling the culturally different with extensive scholarship on the subject. In the fall of 1 990, 1 took a position as an assistant professor of counseling psy- chology at Ball State University in Muncie, Indiana, and my article about my multicultural internship appeared in JCD during the following year. Over the course of the next 1 5 years, I would focus many of my 100-plus publications on the subjects of multicultural counseling and education, and the process of confronting prejudice and racism. I owe much of my productivity in multi- cultural counseling to Dr. Derald Wing Sue, not only for the influence Coun- seling the Culturally Diverse had on me, but also for the personal manner in which Dr. Sue has mentored me. That he and I would become friends is yet another reason why I am grateful that I read his book. On January 30, 1995, approximately 10 years after I had read CCD for the first time, I decided to write a letter to Dr. Sue. By this point in my career, I was an assistant professor of counselor education at Trenton State College (now The College of New Jersey). I had just published my first book, Multi- cultural Counseling with Teenage Fathers, the seventh volume in the Sage Series on Multicultural Aspects of Counseling. I wanted to mark the publication of my book by expressing my gratitude to Dr. Sue for the profound impact he had on me. So, once again, I poured my heart into words, composing a three- page letter to Dr. Sue. In my letter, I told him the entire story about my com- prehensive exams, my initial and later reactions to his book, and the racial identity development his words had prompted in me. I also described the im- pact of some of his subsequent publications on me, and I thanked him for the role he had played in my life. A few weeks later, the phone in my office rang, and Dr. Sue was on the other end of the line. He introduced himself to me and then reported that, al- though he had received many letters from people about his book over the years, he had never read any commentary about his book that was as moving and honest as mine. So, he was calling to thank me for my thoughtfulness.

The Multicultural Journey to Cultural Competence: Personal Narratives


I will cherish that phone call for the rest of my life. It was a fantasy come true to talk with a man who had become one of my idols. We talked for a while about our lives and our interests. When I hung up the phone at the con- clusion of our conversation, I was in a state of disbelief. Derald Wing Sue had just taken the time to call and thank me. This thoughtful gesture was just one of many acts of kindness by people like Derald, who understand the importance of affirming multicultural allies. People like Harold Cheatham, Cheryl Thompson, Joe Ponterotto, Paul Peder- sen, Don Locke, MaryLou Ramsey, Roger Herring, Allen Ivey Michael D'An- drea, Judy Daniels, Larry Gerstein, Leo Hendricks, Sharon Bowman, Kelley Kenney, Mark Kenney, Nancy Boyd -Franklin, Courtland Lee, Bea Wehrly, John McFadden, Fred Bemak, Rita Chung, Charles Ridley, Chalmer Thomp- son, Sandra Tomlinson- Clarke, Vivian Ota Wang, Mary Swigonski, and Amy ReynoldsaH accomplished, respected scholars who have supported and af- firmed my efforts to be a positive contributor to the multicultural movement. This support was crucial to me because the emotionally laden process of de- veloping multicultural sensitivity did not stop with the completion of my in- ternship in 1986. On the contrary, my cultural immersion experience in Newark was only one phase of my White racial identity development, and I would need the understanding and counsel of these and other friends as I struggled with the ups and downs of my never-ending multicultural journey. What were these strugglesTFor one, I went through a period of over- identifying with people of color, which is a common reaction of Whites who experience guilt after they have an awakening about themselves as racial beings. For a while, I acted as though I were one of the saved, a former racist who was now on a mission to save other, fellow Whites from their racism. At times, I became a judgmental nuisance to my White friends. I also became overbearing with friends who were people of color, seeking their approval for my conversion and annoying them in the process. I got slammed a few times for this behavior, and at other times, as I continued to cross cultural bound- aries, I encountered the stinging resentment of me by people of color who drew conclusions about my character based simply on that fact that I am White. As I became more involved in intercultural forums and organizations, I grew weary of the tensions that had to be negotiated about racial matters. These were painful times, so I retreated from substantive interracial contact for about a year, feeling that the price I had to pay for my cross-cultural involvement just wasn't worth it. During this hiatus I did a lot of soul- searching, and I confided in people I trusted about the feelings I was having, emerging with some new perspectives about racial matters and relations. I realized that we will never make progress with the racial problems that have plagued our country unless Whites like me are willing to accept and manage the pain and discomfort associated with negotiating racial issues. I recognized

14 Affective and Conceptual Dimensions of Multicultural Counseling more fully the complicated nature of racial issues and was less prone to judge others for their racism, even though I stood ready to confront racism whenever it reared its ugly head. I gradually re-engaged myself in the work to promote cultural harmony, joining national organizations, such as the Southern Poverty Law Center, and local movements, such as the Newtown Township No Place for Hate Campaign, to combat prejudice in all its forms. Through my work with these organizations and my continued interchange with students, colleagues, and friends about racial issues, I have realized that a variety of different tactics are necessary in the battle to eliminate hate. Viru- lent racism must be confronted with strong systemic policies and community- wide stands communicating that hatred will not be tolerated. More subtle forms of racism can be addressed by taking a less ardent approach, one that involves the tricky challenge of balancing discomforting confrontation with empathic understanding. I have learned that the language we use to promote multiculturalism can be problematic, and that we must replace certain termi- nology, such as teaching tolerance, "with the words, fostering apprecia- tion/People who sense that they are being tolerated"don't feel welcome, but people who know that they are being appreciated"feel that they have an honored place at the table. As I have made these discoveries and moved toward higher stages of White racial identity development, Derald Wing Sue has repeatedly influ- enced me along the way, affirming me and promoting my growth through his continued writings and encouragement. For example, in one especially co- gent article, Derald criticized the professions of counseling and psychology for sometimes lacking a soul (Sue, 1993), thereby affirming that there must be a place in the professional literature for publications like mine, which tend to be written both from the head and the heart. Bolstered by his words, I have published several influential manuscripts in which I have merged material from counseling theory and research with narratives about my own highly personal reflections regarding racism, anti-Semitism, and multicultural edu- cation (Kiselica, 1991, 1998, 1999a, 1999b, 2003). Derald has also reinforced my belief that people from different backgrounds must work together in order to address interracial difficulties when he wrote, If we are to move for- ward, both minority and majority researchers must make a genuine effort to reach out to one another for mutual understanding and respect"(Sue, 1993, p. 245 ) . In addition, Derald has welcomed Whites like me to the multicultural movement by expressing his belief, We should view them White multicul- tural scholarsjas allies because the future of multiculturalism depends on the positive alliances we form with our White brothers and sisters"(p. 248). Fi- nally, like me, Derald emphasized the importance of empathic understanding regarding racial matters when he offered this compassionate statement re- garding White racism:

The Multicultural Journey to Cultural Competence: Personal Narratives


I do not believe that any of us were born wanting to be biased, prejudiced, racist, or sexist. These statements are not meant to absolve White people from the guilt of bias and discrimination (although guilt is counterproductive), but to indicate that some White researchers are engaged in a different battle: overcoming nega- tive aspects of their cultural conditioning. (Sue, 1993, pp. 247-248) Derald's influence on me has not been limited to these writings or that one unforgettable phone call he made to me in 1995. On two occasions, he and I served on the same panels at conference symposia pertaining to multi- cultural counseling and education (Iwamasa, 1995; McCree SBromley, 2002). A few years ago, I played a key role in convincing the administration of The College of New Jersey to bring Derald to our campus to give an address for our Multicultural Lecture Series, during which he shared his keen obser- vations about the status of racial relations in our country. Every time we see each other at conferences of the American Psychological Association, the American Counseling Association, and other professional organizations, we enjoy a warm exchange, updating each other about our families and our work. From time to time, we talk via the phone or e-mail, discussing both professional issues and personal matters that are important to us. Throughout all of these contacts, Derald Wing Sue has welcomed me to the multicultural movement and made me feel that I am his respected col- league. To think that he and I have reached this stage in our relationship in spite of my initial, unfair reactions to the first edition of CCD is a remarkable accomplishment, for which we both deserve credit and about which I am once again moved to tears. As for me, I feel proud of the fact that I worked through my strong, harsh reactions to Derald's book and saw the truth and wisdom in his observations. I am grateful to Derald for writing that book be- cause it was the catalyst for so much growth in me. I know that his words will echo in my mind for years to come as I continue on my multicultural jour- ney. I also have no doubt that this, the fifth edition of Counseling the Culturally Diverse, will have a positive influence on a new generation of counseling stu- dents, just as it did with me over 20 years ago. To those students, I send my warmest regards and my wish that you will embrace this book and the soul- searching that it will stimulate in you. And if you struggle with unsettling feelings as you read Dr. Sue's latest edition, please know that I will be there to help you during your multicultural journey, just as Derald Wing Sue was there to support me with mine. In closing, to Derald Wing Sue, I say this: Thank you for being my brother!

1 6 Affective and Conceptual Dimensions of Multicultural Counseling My Versonal and Vrofessional Journey as a Verson of Color: The Heart and Soul of "Counseling the Culturally Diverse" by Derald Wing Sue* I am grateful to Mark Kiselica for his willingness to share such deep personal reflections with all of us. Mark's honesty in confronting his own racism is re- freshing, and his insights invaluable to those who wish to become allies in the struggle for equal rights. He is a rarity in academic circles, even rarer because he was willing to put his words on paper for the whole world to read as a means to help others understand the meaning of racism on a human level. Mark Kiselica's courageous and open exploration of his initial reactions to CCD indicates what I have come to learn is a common, intensely emotional experience from many readers. Because CCD deals openly, honestly, and pas- sionately with issues of racism, sexism, and homophobia, and challenges our belief that we are free of biases, it is likely to evoke defensiveness, resent- ment, and anger in readers. In Mark's case, he did not allow these reactions to sabotage his own self-exploration and journey to cultural competence. Counseling the Culturally Diverse: Theory and Practice represents a labor of love, and is written from my heart and soul. It is filled with all the passion, frustration, and anger concerning the detrimental nature and harm our soci- ety and its helping professions have wrought on many marginalized groups, albeit unintentionally. Its goals are to enlighten you about how counseling and psychotherapy may represent cultural oppression, and to provide a vi- sion of change that is rooted in social justice. Let me say at the onset that my anger is not directed at White Americans nor our country. The anger is di- rected, however, at White supremacy, sexism, heterosexism, and the many manifestations of bigotry and discrimination that accompany it. As someone once said about racism, White people are not the enemies, but White su- premacy is!' When first written in 1981, I knew my words and assertions would come across as provocative and accusatory and would make many in the field defensive and angry, despite the fact that it was based heavily on research findings. Upon publication, that was what happened. I received calls from colleagues who criticized the book and claimed that it was a prime example of White bashing. Strangely enough, while many colleagues and students found the book distressful and disturbing, it became a success that surprised

Adapted from Sue, D. W. (2005). The Continuing Journey to Multicultural Competence. In R. K. Conyne and F. Bemak (eds.), Journeys to Professional Excellence: Lessons from Leading Counselor Educators and Practitioners (pp. 73-84). Alexandria, VA: American Counseling Association. Re- printed with permission

The Multicultural Journey to Cultural Competence: Personal Narratives 1 7

Figure 1.2

Derald Wing Sue

even my publisher. Much of this was fueled by scholars and students of color who embraced it and claimed it was one of the few texts that spoke to their experiential reality. Since its publication, Counseling the Culturally Diverse has gone through four revisions, and I am proud to say it is now the most fre- quently used text on multicultural counseling; further, it forms the knowl- edge base of many items on counseling and psychology licensing exams. Many have credited the text as the forerunner of the cultural competence movement, but in actuality the product was the result of many pioneers of color whose important contributions have been overlooked, ignored, or neglected. Many professors and students have written to me about their reactions to CCD. Some assert that it is too political and too emotional. I have also dis- covered that my writings are often seen by people in the profession as too filled with emotions, and not consistent with the objective style so prevalent in academia. That has been one of my pet peeves regarding so-called Schol- arly writings"in the field. Many of my colleagues operate from a mistaken notion that rational thought can only come from objective discourse, devoid of emotions. To me, speaking from the heart and with passion is not antago- nistic to reason. Further, speaking the truth, especially pointing out how counseling and therapy have oppressed, harmed, and damaged marginalized

1 8 Affective and Conceptual Dimensions of Multicultural Counseling groups (often unintentionally) is difficult for many of my White colleagues and students to hear. They are likely to react negatively making it difficult for them to accept challenges to their concept of mental health practice, and per- haps their own complicity in perpetuating unjust treatment of clients of color. I suppose they view my writings as accusatory and off-setting. Yet, how does one nicely"and objectively speak about stereotyping, prejudice, and dis- crimination in the helping professions and the helping professional?Should I soften the message and not speak about the unspeakable? Being Chinese American in a Monocultural Society To understand the passion of CCD, it may be helpful to share some of my life experiences as a minority in this society. The lessons I have learned as a Chi- nese American, born and raised in a predominantly White western society, have played a central role in the content and context of this text. I was born and raised in Portland, Oregon, to proud parents who believed strongly in the primacy of the family and extolled the virtues of hard work and achievement. My father emigrated from China; indeed, he stowed away on a ship to the United States at the age of 14. Not knowing how to speak English and unfa- miliar with this country, my father survived. And that has been the story of our family, surviving in the face of great odds. My brothers and sister have learned that lesson well, and it has been watching my mother and father deal with our early experiences of poverty and discrimination that has taught us to struggle and fight against social injustice. I attribute my work on social justice, multiculturalism, and diversity to these early experiences. As a family, we have always been in awe at the courage it must have taken for our father to journey to a strange country without family, friends, formal education, or employable skills. Yet, my father married, raised five sons and one daughter, and was able to provide for the family. He met my mother and married her when she was 1 6, both never attaining an education beyond the third grade. My mother taught herself to read and write English, but my father refused to part with the old ways; his pride in being Chinese was immense, and he eventually made his mark in Portland's Chinatown, where he became a respected elder in the community. Prior to that, he found work in the shipyards and as a gambler, and provided as best he could for the family. Despite the limited schooling of my parents, they always stressed the importance of an education. They instilled within us the value and impor- tance it had for our future. It always amazes my colleagues when I tell them that I have three brothers with doctorates, all in the field of psychology. My sister, unlike her brothers, became a computer programmer. The earliest memories of my childhood are filled primarily with images of a close-knit family who struggled economically to make ends meet. For the brief period we were on welfare, I could sense the shame and humiliation my

The Multicultural Journey to Cultural Competence: Personal Narratives 1 9 parents felt. Everyone in the family worked to contribute until we could again stand with our heads held high. People who have never seriously lacked the necessities of life will never truly understand the experience of being poor, constantly worrying about how to pay even the most inexpensive bills, what a catastrophic event a broken appliance represents, not being able to pay for school field trips, walking miles every day to save bus fare, working after school till midnight to help the family finan- cially, purchasing soda or candy as holiday gifts for one another, having to completely support ourselves through college and graduate school, and knowing that others seemed to shun us because we were poor. To deal with our isolation, we kept to ourselves as a family and learned to depend only on ourselves or one an- other. In graduate school I recall how my classmates in counseling psychology often spoke about the desire to help those less fortunate than them, actively spoke against inequality in our society, and spoke of their desire to work on behalf of social justice. I never doubted their sincerity, but I often doubted their ability to understand what they spoke so passionately about. To me, the many social injustices they talked about were purely an intellectual exercise. While well intentioned, they seemed much more interested in private prac- tice, opening an office, and hanging out their shingles. Perhaps I am being harsh on them, but that was how it struck me then. These experiences led me to conclude that helping others required understanding worldviews influenced by socio- economic status and race on both cognitive and emotional levels. When I was in fourth grade, my father wanted better housing for his family, and moved us outside of Chinatown. The new neighborhood, which was primarily White, was not receptive to a family of color, and we were not only objects of curiosity, but of ridicule and scorn as well. As I reflect upon it now, this was the beginning of my racial/cultural awakening and my experience with racial prejudice and discrimination. And, while I did not know it then, it was the be- ginning of my journey to understanding the meaning of racism, and the many social injustices that infect our society. But in those early days, I allowed the reactions of my classmates to make me feel ashamed of being Chinese. My older brother David and my younger brother Stan entered Aber- nathy grade school with me, where we immediately became objects of hos- tility and constant teasing. We were called thing-chong chinaman, "made fun of because of our slanty eyes"and strange language. In Chinatown, we lived among other Chinese Americans, accepted by the community and pro- tected and buffered from the larger society. In the southeast district of Port- land, we were no longer in the majority, and were considered undesirable by many. As I recall, this was the most unpleasant and painful part of my early childhood. We were the victims of stereotyping, considered to be nerdspas- sive, weak, inhibited, and subhuman aliens. Because my brother Dave was the oldest, he was often forced to fight White classmates on behalf of his younger brothers.

20 Affective and Conceptual Dimensions of Multicultural Counseling

I vividly recall one incident that was to forever change my perception of being Chinese American. A large group of White students, who had been an- tagonistic to us for the better part of our early school years, chased the three of us to our front yard. There they circled us, chanting unmentionable names, and told us to leave the neighborhood. I was truly frightened, but stood shoulder to shoulder with Dave and Stan to confront the large group. All three of us were much smaller than our White peers and I kept glancing to our house porch, trying to get my brothers to break for it. Dave, however, kept inching toward the group, and I could see he had somehow turned his fear to anger. I realized later that for us to start running would reinforce the stereotype that Asians were weaklings and were afraid to fight. Just as it appeared a fight was imminent, my mother opened the door of the house, strode to the edge of the porch, and in a voice filled with anger, asked what was going on. When no one responded, she said if a fight was to happen, it should be fair. She identified one of the ringleaders, probably the biggest of the boys in the group. Then she asked my brother Dave to fight him. This not only shocked us, but the entire group of boys. To make a long story short, Dave gave the other boy a bloody nose due to a series of lucky blows. The fight ended as fast as it had begun. At times, I have often wondered what would have happened if he had lost. It was a gamble that my mother was will- ing to take, because she believed that despite the outcome, pride and integrity could not be lost. I will never forget that incident. It taught me several important lessons in life that have remained with me to this day and form the basis of much of my professional work. First, we live in a society that has low tolerance for racial/cultural differences. Our unconscious social conditioning makes it easy for us to associate differences with deviance, pathology, and lesser value in society. Second, stereotypes held by society can also do great harm to racial/ethnic minorities. Not only are they held by the majority culture, but they can become deeply ingrained in minorities as well. When facing the wrath of the band of boys, I never imagined Dave would stand his ground and fight as he did. More astonishing, however, was to witness a tiny Asian woman — my mother — take charge of the situation and encourage a fight. Any thought on my part that Asians were weak and unable to fight back disappeared that day. Third, I felt a sense of pride in being a member of the Sue family and of being Chinese; something my Dad had al- ways stressed. No group, I realized, should be made to feel ashamed of themselves. The College and Graduate School Years In my college and graduate school years, I continued to feel like an outsider. Perhaps that was the reason I chose to go into the field of psychology. Not only was I always trying to understand people as an observer, but I became attuned to myself as a racial/cultural being. While my classmates were friendly and accepting, I felt that the curriculum often lacked validity and did

The Multicultural Journey to Cultural Competence: Personal Narratives 2 1

not seem to match my experiential reality. I found psychology fascinating, but the theories of human behavior seemed culture bound and limited in their ability to ex- plain my own personal journey as an Asian American. This was especially true when I entered the counseling psychology program at the University of Ore- gon. Despite being enthused and motivated by graduate work, my education continued to be monocultural. Indeed, while the terms multicultural, diversity, cultural competence, and racial identity are common in psychology curricula to- day, they were nonexistent during my graduate school years. While issues re- lating to minority groups were occasionally raised in my courses, the focus was always on the uniqueness of the individual or the universal aspects of the human condition. My professors operated with the certainty that similarities could bridge all differences, that stressing differences was potentially divisive, and that we were all the same under the skin. It was only later that I realized why I was so alienated from these concepts, although they had a degree of legitimacy. First, as an Asian American, the avoidance of discussing racial differences negated an im- portant aspect of my racial identity. Second, I realized that my professors knew little about racial groups and felt uncomfortable with talking about group differences. During my undergraduate and graduate years, I became very involved with the Vietnam antiwar movement, participated in teach-ins, demonstra- tions, and other educational forums, trying to get others to see the moral in- justice of the United States' actions. For the first time in my life, I no longer felt like an outsider. I felt a powerful kinship and camaraderie that made me realize the power of the collective and group action. At times it was almost spiritual. I also be- came involved intellectually with the Free Speech movement and the Third World Strike. I longed to be at Berkeley or San Francisco State University, where all the demonstrations and outpouring of intellectual thought emerged. I could relate well to the denunciations of oppression and injustice, and they stirred up feelings from my childhood. The Black Power movement, rise of the Black Panthers, the words of Malcolm X, Huey Newton, H. Rap Brown, and other activists seemed to resonate with my experiential reality. They spoke about oppression, injustice, prejudice, and discrimination in a way that made more sense to me than much of my graduate school educa- tion. First Job^A-Counseling Psychologist I guess you would say that it was no coincidence that my first job was as a counseling psychologist at the University of California, Berkeley, Counseling Center. Throughout my doctoral studies, I always believed that I wanted to practice and work with clients. While I interviewed at places that offered me a larger salary, the allure of Berkeley and its social activism was too much to resist. As it was at the end of the Third World Strike, my Berkeley years represented a

22 Affective and Conceptual Dimensions of Multicultural Counseling racial and cultural awakening for me unsurpassed in any other period of my life. In Oregon, there were few Asian Americans, but at Berkeley, the student body was greatly represented by Asian Pacific Islanders. While I was working at Berkeley, I had the good fortune to meet my fu- ture wife, Paulina. She was in her last year of obtaining a teaching credential, and was a resident assistant at one of the dormitories on campus. I must con- fess that I was originally attracted to her because of her startling beauty. But, it did not take me long to realize that she was exceptionally intelligent and firm in her beliefs and values, and I marveled at her racial/ethnic pride. Con- trary to my early feelings of inferiority associated with being Asian, she had never experienced such feelings; another important seed was planted in my journey to cultural awareness and pride. We eventually married and raised two children, a son and a daughter, whom I hope will always feel pride in their ethnic heritage. At the counseling center, I saw many Asian American clients, many of them expressing personal and social problems that were similar to mine. It was not the cultural differences, and the invalidation of being a racial minority in this country, that seemed to affect their lives, but the sociopolitical pressures placed upon them. Like me, they were made to believe that being different was the prob- lem. It was at that period in my life that I came to the realization that being different was not the problem. It was society's perception of being different that lay at the basis of the problems encountered by many racial/ethnic minorities. While I like to think that I helped them in their adjustment to societal intolerance, I confess that they helped me more. They validated my thinking, made me see how coun- seling/therapy attempted to adjust them to an intolerant system, and demon- strated how the practices of clinical work were antagonistic to their cultural and life experiences, and the importance of realizing that much of the prob- lems encountered by minorities lay in the social system. Going into Academia While I enjoyed working with clients, I was not satisfied with the slow pace of therapy and the knowledge that the problems encountered by many cli- ents were due to external circumstances. I discovered that many of the problems encountered, for example, by Asian Americans and other people of color were due to systemic forces such as discrimination, prejudice, and injustice. Having access to data at the Berkeley Counseling Center on Asian American students led me to conduct a series of studies on Chinese and Japanese students. The results reaffirmed my belief that sociopolitical forces were important considerations in the lives of people of color. The results of my early research instilled a hunger in me to contribute to the knowledge base of psychology. At that time, getting research published in top-notch psychology journals was difficult. Ed- itors and editorial boards did not consider ethnic research of importance or of

The Multicultural Journey to Cultural Competence: Personal Narratives 2 3

major relevance to the profession. It was a difficult time to get multicultural research published. My early work on Asian American psychology and my eventual move into academia, however, eventually brought me to the attention of the Amer- ican Personnel and Guidance Association (now the American Counseling Association), and I was appointed editor of their flagship journal. As the youngest editor ever appointed (at the age of 3 1 ), I was still quite naive about the internal organizational politics of the association. I radically altered the appearance of the journal, appointed many racial/ethnic minority members to the editorial board, and changed the philosophy of the journal to be more inclusive. The journal published major articles on racial/ethnic minority mental health, work with minorities, systems intervention, and psycho - educational approaches. Many of our special issues pushed the envelope on social justice; one of them, on human sexuality, caused quite a stir in the profession. There was a move to remove me as editor because of the contro- versial nature of the topics and my stand on social justice issues. While it was one of the most painful periods of my professional life, fortunately many col- leagues rallied to my defense. Nevertheless, the toll from those who called for my resignation or removal made me decide not to continue in my second term. The lesson, however, that I learned from this experience was that swimming up- stream, or going against the prevailing beliefs/practices of the times, can lead to great stress and pain. Work on Multicultural Counseling and Therapy Throughout the 70s, my clinical experience and research on minority mental health led me to conclude that traditional counseling and psychotherapy were Western European constructions that were oftentimes inappropriately applied to racial/ethnic minorities. Indeed, I began to realize that while men- tal health providers could be well intentioned in their desire to help clients of color, the goals and process of counseling and psychotherapy were often an- tagonistic to the life experiences and cultural values of their clients. Without awareness and knowledge of race, culture, and ethnicity, counselors and other helping professionals could unwittingly engage in cultural oppression. Studying the culture - bound nature of counseling led me to study other racial groups as well. What I found were similar concerns among African American, Latino/Hispanic American, and Native American colleagues. All felt that traditional mental health concepts and practices were inappropriate and sometimes detrimental to the life experiences of the very clients they hoped to help. My work led to several publications that attacked the culture-bound nature of mental health practice and suggested radical changes in the deliv- ery of services to a diverse population. Because I took great pains to docu- ment my work, it was well received on an academic level, but failed to have

24 Affective and Conceptual Dimensions of Multicultural Counseling a major impact on mental health delivery systems. Psychologists continued to believe that traditional forms of counseling and psychotherapy could be uni- versally applied to all populations and situations. In the early 1980s, things began to change. Increasingly, ethnic minor- ity psychologists voiced concerns with the need for counselors to own up to their biases, stereotypes, and inaccurate assumptions of people of color. I credit two major events that radically altered my work and influence on the field. First, Leo Goldman, a valued colleague and elder in the field of coun- seling psychology, asked me to write a book for his series on counseling and human services. He was one of the few White psychologists who seemed gen- uinely to understand my research and ideas. More importantly, being a critic himself of traditional counseling, he encouraged me to put what I had to say in a book that would be unconstrained by reviewers. Concurrently, Allen Ivey, then president of the division of counseling psychology asked me to chair the education and training committee and to develop standards or com- petencies for multicultural counseling. These publications became two of the most frequently cited in the field (Ponterotto Sabnani, 1989). Expanding Social Justice Horizons In 1997 I was invited to address President Clinton's Race Advisory Board on what the average American could do to help eradicate racism. As some of you may recall, the National Dialogue on Race was one of President Clinton's at- tempts to address what many of us consider to be one of the great social ills of our society, that of racism. The preparation that went into the national address, which was shown on C-Span, CNN, and many major outlets, combined with my in- creasing awareness of racism and the hate mail that I received as a result of my testi- mony, made me realize several things. First, honest discussions of racism are difficult for our society, and hot buttons are pushed in people when this is brought to their at- tention. Second, negative reactions are often the result of defensiveness brought forth by their denial of personal responsibility for racial inequities in our society. Third, it made me realize the reason why many have difficulty in the battle to eliminate racism. It is because they are unaware of their own personal and professional complicity in perpet- uating racism. That experience had a major impact on my current work and my bur- geoning belief that social therapy or work toward social justice is also a part of what helping professionals should be doing. I do not mean to minimize the importance of counseling and therapy (it will always be needed), but such an approach tends toward remediation rather than prevention. If injustice in the form of racism, sexism, homophobia, and other forms of social oppression form the ba- sis of the many individual and social ills of society, do not we as helping professionals also have a moral and ethical responsibility to address those systemic forces responsible for psychological problems? R. D. Laing, an existential psychotherapist, once

The Multicultural Journey to Cultural Competence: Personal Narratives 2 5

made a statement that went something like this: Is schizophrenia always a sick response to a healthy society TOr, can schizophrenia be seen as a healthy response to a sick society Changing the individual to adjust or conform to a sick system or unhealthy situation may (unwittingly) be the goal of unen- lightened therapy. If depression, anxiety and feelings of low self-esteem are the result of unhealthy societal forces (stereotyping, limited opportunities, prejudice, and discrimination), shouldn't our efforts be directed at eradicat- ing societal policies, practices, and structures that oppress, rather than simply changing the individual? While all of us must make choices about where to place our efforts, it is now clear to me that multiculturalism and the eradication of racism are about social justice. And this current edition of CCD is filled with this belief. Social justice is about equal access and opportunity and about building a healthy, validating society for all groups. That is why it is so important that psychology, and especially coun- seling, move toward cultural competence and multiculturalism. In this edi- tion, I make several important points that have since guided my understand- ing of prejudice and discrimination. First, the goal of our societyand by association, of the helping professionsshould be to make the invisible, vis- ible. What I call ethnocentric monoculturalism and whiteness represent invis- ible veils that define the reality of most White Americans. Second, power re- sides in the group that is able to define reality (in this case, White America). Last, the group that owns history possesses the power to impose their world- view or reality upon less powerful groups. As such, if one's reality or truth does not correspond with those in power, unintentional oppression may be the result. From viewing the importance of changing individuals so they can function better in our society, to work with organizations and systems, I have become increasingly involved in social policy. In closing, please note that understanding the worldview of diverse populations means not only acquiring knowledge of cultural values and dif- ferences, but being aware of the sociopolitical experiences of culturally di- verse groups in a monocultural society. This perspective means the ability to empathize with the pain, anguish, mistrust, and sense of betrayal suffered by persons of color, women, gays, and other marginalized groups. Sad to say, this empathic ability is blocked when readers react with defensiveness and anger upon hearing the life stories of those most disempowered in our society. I implore you not to allow your initial negative feelings to interfere with your ultimate aim of learning from this text as you journey toward cultural competence. I have al- ways believed that our worth as human beings is derived from the collective relationships we hold with all people; that we are people of emotions, intu- itions, and spirituality, and that the lifeworld of people can only be under- stood through lived realities. While I believe strongly in the value of science and the importance psychology places on empiricism, Counseling the Culturally Diverse is based on the premise that a profession that fails to recognize the

2 6 Affective and Conceptual Dimensions of Multicultural Counseling

heart and soul of the human condition is a discipline that is spiritually and emotionally bankrupt. In many respects, CCD isthestory of my life journey as a per- son of color. As such, the book not only touches on the theory and practice of multicultural counseling and psychotherapy but also reveals the hearts and souls of our diverse clienteles.

Implications for Clinical Practice

1 . Listen and be open to the stories of those most disempowered in this so- ciety. Counseling has always been about listening to our clients. Don't allow your emotional reactions to negate their voices because you be- come defensive. Know that while you were not born wanting to be racist or sexist, your cultural conditioning has imbued certain biases and prejudices in you. No person or group is free from inheriting the biases of this society. It does not matter whether you are gay or straight, White or person of color, or male or female. All of us have inherited biases. Rather than deny them and allow them to unintentionally control our lives and actions, openly acknowledge them so that their detrimental effects can be minimized. As a helping professional, the ability to un- derstand the worldview of clients means listening in an open and non- defensive way. 2. Understanding groups different from you requires more than book learning. While helpful in your journey to cultural competence, it is also necessary to supplement your intellectual development with experien- tial reality. Socialize, work with, and get to know culturally diverse groups by interacting with them on personal and intimate levels. You must actively reach out to understand their worldviews. After all, if you want to learn about sexism, do you ask men or womenlf you want to learn about racism, do you ask Whites or persons of colorlf you want to understand homophobia, do you ask straights or gays? 3. Don't be afraid to explore yourself as a racial/cultural being. An over- whelming number of mental health practitioners believe they are de- cent, good, and moral people. They believe strongly in the basic tenets of the Declaration of Independence, the U.S. Constitution, and the Bill of Rights. Concepts of democracy and fairness are present throughout these important and historic documents. Because most of us would not intentionally discriminate, we often find great difficulty in realizing that our belief systems and actions may have oppressed others. As long as we deny these aspects of our upbringing and heritage, we will continue to be oblivious to our roles in perpetuating injustice to others. As men- tioned in this chapter, multiculturalism is about social justice.

The Multicultural Journey to Cultural Competence: Personal Narratives 2 7 4. When you experience intense emotions, acknowledge them and try to understand what they mean for you. For example, CCD speaks about unfairness, racism, sexism, and prejudice, making some feel accused and blamed. The l'sms"of our society are not pleasant topics, and we often feel unfairly blamed. However, blame is not the intent of multi- cultural training, but accepting responsibility for rectifying past injus- tices and creating a community that is more inclusive and equitable in its treatment of racial/ethnic minorities are central to its mission. We re- alize that it is unfair and counterproductive to attribute blame to coun- selors for past injustices. However, it is important that helping profes- sionals realize how they may still benefit from the past actions of their predecessors and continue to reap the benefits of the present social/ed- ucational arrangements. When these arrangements are unfair to some and benefit others, we must all accept the responsibility for making changes that will allow for equal access and opportunity. Further, our concerns are directed at the present and the future, not the past. While history is important in many ways, there are certainly enough issues in the here and now that require our attention. Prejudice and discrimina- tion in society are not just things of the past. 5. Don't be afraid or squelch dissent and disagreements. Open dialogue — to discuss and work through differences in thoughts, beliefs, and val- uesis-crucial to becoming culturally competent. It is healthy when we are allowed to freely dialogue with one another. Many people of color believe that dialogues on race, gender, and sexual orientation turn into monologues in order to prevent dissenting voices. The intense expres- sions of affect often produce discomfort in all of us. It is always easier to avoid talking or thinking about race and racism, for example, than en- tering into a searching dialogue about the topics. The academic protocol, and to some extent the politeness protocol, serve as barriers to open and honest dialogue about the pain of discrimination, and how each and every one of us perpetuate bias through our silence or obliviousness. 6. Last, continue to use these suggestions in reading throughout the text. While every chapter ends with a section titled Implications for Clinical Practice, "we encourage you to apply these five suggestions at the end of every reading. What emotions or feelings are you experiencing? Where are they coming from?Are they blocking your understanding of the material?What do they mean for you personally and as a helping professionalTake an active role in exploring yourself as a racial cultural being, as Mark Kiselica did.

The Superordinate Nature of Multicultural Counseling and Therapy

What is multicultural counseling/therapylsn't good counsel- ing, "good counseling?How applicable are our standards of clinical practice for racial/ethnic minority populations?Is there any difference between counseling a White client and counseling a Black clientiWhat do we mean by multiculturalism and diversityDo other special populations such as women, gays and lesbians, the elderly, and those with disabilities constitute a distinct cultural group ?What do we mean by the phrase cultural competence?


Professor Jonathon Murphy felt annoyed at one of his Latina social work graduate students. Partway through a lecture on family systems theory, the student had interrupted him with a question. Dr. Murphy had just fin- ished an analysis of a case study on a Latino family in which the 32-year- old daughter was still living at home and could not obtain her father 's ap- proval for her upcoming marriage. The caseworker's report suggested excessive dependency as well as "pathological enmeshment" on the part of the daughter. As more and more minority students entered the program and took Dr. Murphy 's classes on social work and family therapy, this sort of question began to be asked more frequently, and usually in a challeng- ing manner.

Student: Aren't these theories culture-bound? It seems to me that coun- seling strategies aimed at helping family members to individuate or be- come autonomous units would not be received favorably by many Latino families. I've been told that Asian Americans would also find great discomfort in the value orientation of the White social worker. Professor: Of course we need to consider the race and cultural back- ground of our clients and their families. But it's clear that healthy de- velopment of family members must move toward the goal of maturity, and that means being able to make decisions on their own without being dependent or enmeshed in the family network. Student: But isn 't that a value judgment based on seeing a group 's value


3 0 Affective and Conceptual Dimensions of Multicultural Counseling

system as pathological? I'm just wondering whether the social worker might be culturally insensitive to the Latino family. She doesn't appear culturally competent. To describe a Latino family member as "excessively dependent" fails to note the value placed on the importance of the family. The social worker seems to have hidden racial biases, as well as difficulty relating to cul- tural differences. Professor: I think you need to be careful about calling someone incompetent and "racist. " You don 't need to be a member of a racial minority group to un- derstand the experience of discrimination. All counseling and therapy is to some extent multicultural. What we need to realize is that race and ethnicity are only one set of differences. For example, class, gender, and sexual orienta- tion are all legitimate group markers. Student: I wasn 't calling the social worker a racist. I was reading a study that indicated the need for social workers to become culturally competent and move toward the development of culture-specific strategies in working with racial minorities. Being a White person, she seems out of touch with the family 's ex- perience of discrimination and prejudice. I was only trying to point out that racial issues appear more salient and problematic in our society and that Professor [interrupting and raising his voice]: I want all of you [class mem- bers] to understand what I'm about to say. First, our standards of practice and codes of ethics have been developed over time to apply equally to all groups. Race is important, but our similarities far exceed differences. After all, there is only one race, the human race! Second, just because a group might value one way of doing things does not make it healthy or right. Culture does not always justify a practice! Third, I don 't care whether the family is red, black, brown, yellow, or even white: Good counseling is good counseling! Further, it's im- portant for us not to become myopic in our understanding of cultural differ- ences. To deny the importance of other human dimensions such as sexual ori- entation, gender, disability, religious orientation, and so forth is not to see the whole person. Finally, everyone has experienced bias, discrimination, and stereotyping. You don 't have to be a racial minority to understand the detri- mental consequences of oppression. As an Irish descendant, I've heard many demeaning Irish jokes, and my ancestors certainly encountered severe dis- crimination when they first immigrated to this country. Part of our task, as therapists, is to help all our clients deal with their experiences of being dif- ferent. In one form or another, difficult dialogues such as these are occurring throughout our training institutions, halls of ivy, governmental agencies, cor- porate boardrooms, and community meeting places. Participants in such di- alogues come with different perspectives and strong convictions that operate from culturally conditioned assumptions outside their levels of awareness. These assumptions are important to clarify because they define different re-

The Superordinate Nature of Multicultural Counseling and Therapy 3 1

alities and determine our actions. In the helping professions, insensitive counseling and therapy can result in cultural oppression rather than libera- tion Constantine, 2007) Let us explore more thoroughly the dialogue be- tween professor and student to understand the important multicultural themes being raised. Theme One: Cultural Universality versus Cultural Relativism One of the primary issues raised by the student and professor relates to the etic Culturally universal)versus emic Culturally specific)perspectives. The professor operates from the etic position. He believes, for example, that good counseling is good counseling;that disorders such as depression, schizophre- nia, and sociopathic behaviors appear in all cultures and societies;that mini- mal modification in their diagnosis and treatment is required;and that West- ern concepts of normality and abnormality can be considered universal and equally applicable across cultures Howard, 1992;Suzuki, Kugler, fAquiar, 2005) The student, however, operates from an emic position and challenges these assumptions. She tries to make the point that lifestyles, cultural values, and worldviews affect the expression and determination of deviant behavior. She argues that all theories of human development arise from a cultural con- text and that using the Euro-American value of ihdependence"as healthy developmentespecially on collectivistic cultures such as Latinos or Asian Americanseiay constitute bias Iyey, Ivey, Myers, Sweeney, 2005;D. Sue, D. W. Sue, 8B. Sue, 2006) This is one of the most important issues currently confronting the help- ing professions. There is little doubt that to a large degree the code of ethics and standards of practice in counseling, psychotherapy, social work, and other mental health specialties assume universality. Thus, if the assumption that the origin, process, and manifestation of disorders are similar across cul- tures were correct, then guidelines and strategies for treatment would appear to be appropriate in application to all groups. In the other camp, however, are mental health professionals who give great weight to how culture and life experiences affect the expression of de- viant behavior and who propose the use of culture-specific strategies in coun- seling and therapy ^loodley {West, 2005;Parham, White, SAjamu, 1999; D. W. Sue EEonstantine 2005) Such professionals point out that current guidelines and standards of clinical practice are culture-bound and often in- appropriate for racial/ethnic minority groups. Which view is correcfShould treatment be based on cultural univer- sality or cultural relativismTew mental health professionals today embrace the extremes of either position, although most gravitate toward one or the

3 2 Affective and Conceptual Dimensions of Multicultural Counseling other. Proponents of cultural universality focus on disorders and their conse- quent treatments and minimize cultural factors, whereas proponents of cul- tural relativism focus on the culture and on how the disorder is manifested and treated within it. Both views have validity. It is naive to believe that no disorders cut across different cultures/societies or share universal character- istics. In addition, one could make the case that even though hallucinating may be viewed as normal in some cultures Cultural relativism) proponents of cultural universality argue that it still represents a breakdown in normal" biological-cognitive processes. Likewise, it is equally naive to believe that the relative frequencies and manners of symptom formation for various disorders do not reflect the dominant cultural values and lifestyles of a society. Nor would it be beyond our scope to entertain the notion that various diverse groups may respond better to culture-specific therapeutic strategies. A more fruitful approach to these opposing views might be to address the following two questions:What is universal in human behavior that is also relevant to counseling and therapy?and What is the relationship between cultural norms, values, and attitudes, on the one hand, and the manifestation of be- havior disorders and their treatments, on the other?

Theme Two: The Emotional Consequences of "Race" A tug-of-war appears to be occurring between the professor and the student concerning the importance of face'ln the therapeutic process. Disagree- ments of this type are usually related not only to differences in definitions, but also to hot buttons being pushed in the participants. We address the for- mer shortly but concentrate on the latter because the interaction between the professor and the student appears to be related more to the emotive qualities of the topic, as discussed in Chapter 1. What motivates the profes- sor, for example, to make the unwarranted assumption that the Latina was accusing the social worker of being a racist?What leads the professor, whether consciously or unconsciously, to minimize or avoid considering race as a powerful variable in the therapeutic processTHe seemingly does this by two means: |)diluting the importance of race by using an abstract and universal statement fhere is only one race, the human racejand ^shifting the dialogue to discussions of other group differences gender, sexual orientation, disability, and class)and equating race as only one of these many variables. We are not dismissing the importance of other group differences in af- fecting human behavior, nor the fact that we share many commonalities re- gardless of our race or gender. These are very legitimate points. We submit, however, that like many others the professor is uncomfortable with open discussions of race because of the embedded or nested emotions that he has

The Superordinate Nature of Multicultural Counseling and Therapy 3 3 been culturally conditioned to hold. For example, discussions of race often evoke strong passions associated with racism, discrimination, prejudice, per- sonal blame, political correctness, anti-White attitudes, quotas, and many other emotion-arousing concepts. At times, the deep reactions that many people have about discussions on race interfere with their ability to com- municate freely and honestly and to listen to others. Feelings of guilt, blame, anger, and defensiveness in the case of the professor)are unpleasant. No wonder it is easier to avoid dealing with such a hot potato. Yet it is precisely these emotionally laden feelings that must be expressed and explored before productive change will occur. In Chapter 1 1 we devote considerable space to this issue. Until mental health providers work through these intense feel- ings, which are often associated with their own biases and preconceived no- tions, they will continue to be ineffective in working with a culturally di- verse population. Theme Three: The Inclusive or Exclusive Nature of Multicultural m

While the professor may be avoiding the topic of race by using other group differences to shift the dialogue, he raises a very legitimate content issue about the inclusiveness or exclusiveness of multicultural dialogues. Are def- initions of multiculturalism based only on race, or does multiculturalism en- compass gender, sexual orientation, disability, and other significant reference groups^sn't the professor correct in observing that almost all counseling is multicultural?We believe that resistance to including other groups in the multicultural dialogue is related to three factors: J )Many racial minorities believe that including other groups 4s in the previous example )in the multi- cultural dialogue will enable people who are uncomfortable with confronting their own biases to avoid dealing with the hard issues related to race and racism; £ (taken to the extreme, saying that all counseling is multicultural makes the concept meaningless because the ultimate extension equates all differences with individual differences; and ?)there are philosophical dis- agreements among professionals over whether gender and sexual orienta- tion, for example, constitute distinct overall cultures. We believe that each of us is born into a cultural context of existing beliefs, values, rules, and practices. Individuals who share the same cultural matrix with us exhibit similar values and belief systems. The process of so- cialization is generally the function of the family and occurs through partici- pation in many cultural groups. Reference groups related to race, ethnicity, sexual orientation, gender, age, and socioeconomic status exert a powerful influence over us and influence our worldviews. Whether you are a man or a woman, Black or White, gay or straight, dis- abled or able-bodied, married or single, and whether you live in Appalachia or

34 Affective and Conceptual Dimensions of Multicultural Counseling

New York all result in sharing similar experiences and characteristics. While this text is focused more on racial/ethnic minorities, we also believe in the in- clusive definition of multiculturalism.

Theme Four: The Sociopolitical Nature of Counseling/Therapy The dialogue between professor and student illustrates nicely the symbolic meanings of power imbalance and power oppression. Undeniably the rela- tionship between the professor and student is not an equal one. The profes- sor occupies a higher-status role and is clearly in a position of authority and control. He determines the content of the course, the textbooks to read, right or wrong answers on an exam, and he evaluates the learning progress of stu- dents. Not only is he in a position to define reality Standards of helping can be universally applied; normality is equated with individualism; and one form of discrimination is similar to another) but he can enforce it through grading students as well. As we usually accept the fact that educators have knowledge, wisdom, and experience beyond that of their students, this dif- ferential power relationship does not evoke surprise or great concern, espe- cially if we hold values and beliefs similar to those of our teachers. However, what if the upbringing, beliefs, and assumptions of minority students render the curriculum less relevant to their experiential reality ?More important, what if the students' worldviews are a more accurate reflection of reality than are those of the professors? Many racial/ethnic minorities, gays and lesbians, and women have ac- cused those who hold power and influence of imposing their views of reality upon them. The professor, for example, equates maturity with autonomy and independence. The Latina student points out that among Hispanics collec- tivism and group identity may be more desirable than individualism. Unfor- tunately, Dr. Murphy fails to consider this legitimate point and dismisses the observation by simply stating, Culture does not always justify a practice/In the mental health fields, the standards used to judge normality and abnor- mality come from a predominantly Euro-American perspective. As such, they are culture-bound and may be inappropriate in application to culturally diverse groups. When mental health practitioners unwittingly impose these standards without regard for differences in race, culture, gender, and sexual orientation, they may be engaging in cultural oppression Neville, Worthing- ton, ESpanierman, 2001) As a result, counseling and psychotherapy be- come a sociopolitical act. Indeed, a major thesis of this book is that counsel- ing and psychotherapy have done great harm to culturally diverse groups by invalidating their life experiences, by defining their cultural values or differ- ences as deviant and pathological, by denying them culturally appropriate care, and by imposing the values of a dominant culture upon them.

The Superordinate Nature of Multicultural Counseling and Therapy 3 5 Theme Five: The Nature of Multicultural Counseling Competence The Latina student seems to question the social worker's clinical or cultural competence in treating a family of color. In light of the professor's response to his student, one might question his cultural sensitivity as a teacher as well. If counseling, psychotherapy, and education can be viewed as sociopolitical acts, and if we accept the fact that our theories of counseling are culture- bound, then is it possible that mental health providers trained in traditional Euro-American programs may be guilty of cultural oppression in working with clients of colorTThe question our profession must ask is this:Is coun- seling/clinical competence the same as multicultural counseling compe- tenceTDr. Murphy seems to believe that good counseling"subsumes cul- tural competence, or that it is a subset of good clinical skills. Our contention, however, is that cultural competence is superordinate to counseling compe- tence. Let us briefly explore the rationale for our position. While there are disagreements over the definition of cultural compe- tence, many of us know clinical incompetence when we see it;we recognize it by its horrendous outcomes, or by the human toll it takes on our minority clients. For example, for some time the profession and mental health profes- sionals themselves have been described in very unflattering terms by multi- cultural specialists: J )they are insensitive to the needs of their culturally di- verse clients, do not accept, respect, and understand cultural differences, are arrogant and contemptuous, and have little understanding of their prejudices Ridley, 2005;Thomas SSillen, 1972)2 (clients of color, women, and gays and lesbians frequently complain that they feel abused, intimidated, and ha- rassed by nonminority personnel Atkinson, Morten, €Sue, 1998; Presi- dent's Commission on Mental Health, 1978)? (discriminatory practices in mental health delivery systems are deeply embedded in the ways in which the services are organized and in how they are delivered to minority popula- tions, and are reflected in biased diagnosis and treatment, in indicators of dangerousness,"and in the type of personnel occupying decision-making roles f. L. Cross, Bazron, Dennis, Ssaacs, 1989)and ^(mental health pro- fessionals continue to be trained in programs in which the issues of ethnicity, gender, and sexual orientation are ignored, regarded as deficiencies, por- trayed in stereotypic ways, or included as an afterthought Laird SEreen, 1996;Ponterotto, Utsey ffedersen, 2006;U.S. Public Health Service, 2001) From our perspective, mental health professionals have seldom func- tioned in a culturally competent manner. Rather, they have functioned in a monoculturally competent manner with only a limited segment of the popu- lation White Euro-Americans) but even that is debatable. We submit that much of the current therapeutic practice taught in graduate programs derives mainly from clinical experience and research with middle- to upper-class Whites Constantine, 2007) Even though our profession has advocated

3 6 Affective and Conceptual Dimensions of Multicultural Counseling

moving into the realm of empirically supported treatments EST) little evi- dence exists that they are applicable to racial/ethnic minorities Atkinson, Bui, {Mori, 2001) A review of studies on EST reveals few, if any, on racial minority populations, which renders assumptions of external validity ques- tionable when applied to people of color Atkinson et al.;Hall, 200 1;S. Sue, 1999) If we are honest with ourselves, we can only conclude that many of our standards of professional competence Eurocentric)are derived primarily from the values, belief systems, cultural assumptions, and traditions of the larger society. Thus, values of individualism and psychological mindedness and using rational approaches'!^ problem solve have much to do with how compe- tence is defined. Yet many of our colleagues continue to hold firmly to the be- lief that good counseling is good counseling, thereby dismissing the central- ity of culture in their definitions. The problem with traditional definitions of counseling, therapy, and mental health practice is that they arose from monocultural and ethnocentric norms that excluded other cultural groups. Mental health professionals must realize that good counseling"uses White Euro-American norms that exclude three quarters of the world's population. Thus, it is clear to us that the more superordinate and inclusive concept is that of multicultural counseling competence, not clinical/counseling competence. Standards of helping derived from such a philosophy and framework are in- clusive and offer the broadest and most accurate view of cultural competence.

A Tripartite Framework for Understanding the Multiple Dimensions of identity All too often, counseling and psychotherapy seem to ignore the group di- mension of human existence. For example, a White counselor who works with an African American client might intentionally or unintentionally avoid acknowledging the racial or cultural background of the person by stating, We are all the same under the skin "or Apart from your racial background, we are all unique/We have already indicated possible reasons why this hap- pens, but such avoidance tends to negate an intimate aspect of the client's group identity. These forms of microinvalidations will be discussed more fully in Chapter 5. As a result, the African American client might feel misunder- stood and resentful toward the helping professional, hindering the effective- ness of multicultural counseling. Besides unresolved personal issues arising from the counselor, the assumptions embedded in Western forms of therapy exaggerate the chasm between therapist and minority client. First, the concepts of counseling and psychotherapy are uniquely Euro- American in origin, as they are based on certain philosophical assumptions

The Superordinate Nature of Multicultural Counseling and Therapy 3 7 and values that are strongly endorsed by Western civilizations. On the one side are beliefs that people are unique and that the psychosocial unit of ope- ration is the individual;on the other side are beliefs that clients are the same and that the goals and techniques of counseling and therapy are equally ap- plicable across all groups. Taken to its extreme, this latter approach nearly as- sumes that persons of color, for example, are White and that race and culture are insignificant variables in counseling and psychotherapy. Statements like There is only one race, the human race"and Apart from your racial/cul- tural background, you are no different from me"are indicative of the ten- dency to avoid acknowledging how race, culture, and other group dimen- sions may influence identity, values, beliefs, behaviors, and the perception of reality farter, 2005;Helms, 1990;D. W. Sue, 2001) Related to the negation of race, we have indicated that a most problem- atic issue deals with the inclusive or exclusive nature of multiculturalism. A number of psychologists have indicated that an inclusive definition of multi- culturalism gender, ability /disability, sexual orientation, etc.) can obscure the understanding and study of race as a powerful dimension of human ex- istence farter, 2005;Helms Sichardson, 1997) This stance is not intended to minimize the importance of the many cultural dimensions of human iden- tity but rather emphasizes the greater discomfort that many psychologists experience in dealing with issues of race rather than with other sociodemo- graphic differences. As a result, race becomes less salient and allows us to avoid addressing problems of racial prejudice, racial discrimination, and sys- temic racial oppression. This concern appears to have great legitimacy. We have noted, for example, that when issues of race are discussed in the class- room, a mental health agency, or some other public forum, it is not uncom- mon for participants to refocus the dialogue on differences related to gender, socioeconomic status, or religious orientation $a Dr. Murphy) On the other hand, many groups often rightly feel excluded from the multicultural debate and find themselves in opposition to one another. Thus, enhancing multicultural understanding and sensitivity means balancing our understanding of the sociopolitical forces that dilute the importance of race, on the one hand, and our need to acknowledge the existence of other group identities related to social class, gender, ability/disability, age, religious affili- ation, and sexual orientation, on the other p. W. Sue, Bingham, Porche- Burke, 8/asquez, 1999) There is an old Asian saying that goes something like this:All individ- uals, in many respects, are ^)like no other individuals, b)like some indi- viduals, and ()like all other individuals/While this statement might sound confusing and contradictory, Asians believe these words to have great wis- dom and to be entirely true with respect to human development and identity. We have found the tripartite framework shown in Figure 2.1 p. W. Sue, 2001 )to be useful in exploring and understanding the formation of personal

3 8 Affective and Conceptual Dimensions of Multicultural Counseling

Figure 2 A Tripartite Development of Personal Identity

identity. The three concentric circles illustrated in Figure 2.1 denote individ- ual, group, and universal levels of personal identity. Individual level: "All individuals are, in some respects, like no other individuals, " There is much truth in the saying that no two individuals are identical. We are all unique biologically, and recent breakthroughs in mapping the human genome have provided some startling findings. Biologists, anthropologists, and evolutionary psychologists had looked to the Human Genome Project as potentially providing answers to comparative and evolutionary biology, to find the secrets to life. Although the project has provided valuable answers to many questions, scientists have discovered even more complex questions. For example, they had expected to find 100,000 genes in the human genome, but approximately 20,000 were initially found, with the possible existence of another 5,000-enly two or three times more than are found in a fruit fly or a nematode worm. Of those 25,000 genes, only 300 unique genes distinguish us from the mouse. In other words, human and mouse genomes are about 85 percent identicallWhile it may be a blow to human dignity, the more important question is how so relatively few genes can ac- count for our humanness. Likewise, if so few genes can determine such great differences between species, what about within the speciesHuman inheritance almost guaran-

The Superordinate Nature of Multicultural Counseling and Therapy 3 9

tees differences because no two individuals ever share the same genetic en- dowment. Further, no two of us share the exact same experiences in our so- ciety. Even identical twins, who theoretically share the same gene pool and are raised in the same family are exposed to both shared and nonshared ex- periences. Different experiences in school and with peers, as well as qualita- tive differences in how parents treat them, will contribute to individual uniqueness. Research indicates that psychological characteristics and behav- ior are more affected by experiences specific to a child than are shared expe- riences Plomin, i989;Rutter, 1991) Group level: "All individuals are, in some respects, like some other individuals. " As mentioned earlier, each of us is born into a cultural matrix of beliefs, values, rules, and social practices p. W. Sue, Ivey, EPedersen, 1996) By virtue of social, cultural, and political distinctions made in our society, perceived group membership exerts a powerful influence over how society views sociodemo- graphic groups and over how its members view themselves and others Atkinson et al., 1998) Group markers such as race and gender are relatively stable and less subject to change. Some markers, such as education, socio- economic status, marital status, and geographic location, are more fluid and changeable. While ethnicity is fairly stable, some argue that it can also be fluid. Likewise, debate and controversy surround the discussions about whether sexual orientation is determined at birth and whether we should be speaking of sexuality or sexualities. Nevertheless, membership in these groups may result in shared experiences and characteristics. They may serve as powerful reference groups in the formation of worldviews. On the group level of identity, Figure 2.1 reveals that people may belong to more than one cultural group \.e., an Asian American female with a disability) that some group identities may be more salient than others (ace over religious orienta- tion) and that the salience of cultural group identity may shift from one to the other depending on the situation. For example, a gay man with a disabil- ity may find that his disability identity is more salient among the able-bodied but that his sexual orientation is more salient among those with disabilities. Universal level: "All individuals are, in some respects, like all other individuals. " Be- cause we are members of the human race and belong to the species Homo sapiens, we share many similarities. Universal to our commonalties are biological and physical similarities, b)common life experiences birth, death, love, sadness, etc.) £)self-awareness, and d)the ability to use symbols such as language. In Shakespeare's Merchant of Venice, Shylock attempts to ac- knowledge the universal nature of the human condition by asking, When you prick us, do we not bleed3\gain, while the Human Genome Project in- dicates that a few genes may cause major differences between and within spe- cies, it is startling how similar the genetic material within our chromosomes is and how much we share in common.

40 Affective and Conceptual Dimensions of Multicultural Counseling Individual and Universal Biases in Vsychology and Mental Health Unfortunately, psychologyand mental health professionals in particular — have generally focused on either the individual or universal levels of identity, placing less importance on the group level. There are several reasons for this orientation. First, our society arose from the concept of rugged individualism, and we have traditionally valued autonomy independence, and uniqueness. Our culture assumes that individuals are the basic building blocks of our so- ciety. Sayings such as be your own person, "Stand on your own two feet," and don't depend on anyone but yourself'reflect this value. Psychology and education represent the carriers of this value, and the study of individual dif- ferences is most exemplified in the individual intelligence testing movement that pays homage to individual uniqueness {Suzuki, Kugler, Skquiar, 2005) Second, the universal level is consistent with the tradition and history of psychology, which has historically sought universal facts, principles, and laws in explaining human behavior. Although an important quest, the nature of scientific inquiry has often meant studying phenomena independently of the context in which human behavior originates. Thus, therapeutic inter- ventions from which research findings are derived may lack external validity Chang 8S. Sue, 2005) Third, we have historically neglected the study of identity at the group level for sociopolitical and normative reasons. As we have seen, issues of race, gender, sexual orientation, and disability seem to touch hot buttons in all of us because they bring to light issues of oppression and the unpleasantness of personal biases (ielms aRichardson, f997;D. W. Sueetal., f 998) In addi- tion, racial/ethnic differences have frequently been interpreted from a deficit perspective and have been equated with being abnormal or pathological Puthrie, 1 997; Lee, 1993; White EParham, 1990) We have more to say about this in the next chapter. Nevertheless, disciplines that hope to understand the human condition cannot neglect any level of our identity. For example, psychological explana- tions that acknowledge the importance of group influences such as gender, race, culture, sexual orientation, socioeconomic class, and religious affiliation lead to more accurate understanding of human psychology. Failure to ac- knowledge these influences may skew research findings and lead to biased conclusions about human behavior that are culture-bound, class-bound, and gender-bound. Thus, it is possible to conclude that all people possess individual, group, and universal levels of identity. A holistic approach to understanding per- sonal identity demands that we recognize all three levelsindividual Unique- ness) group Shared cultural values and beliefs) and universal (ommon fea- tures of being human) Because of the historical scientific neglect of the group level of identity, this text focuses primarily on this category.

The Superordinate Nature of Multicultural Counseling and Therapy 4 1

Before closing this portion of our discussion, however, we would like to add a caution. While the concentric circles in Figure 2.1 might unintention- ally suggest a clear boundary, each level of identity must be viewed as per- meable and ever-changing in salience. In counseling and psychotherapy, for example, a client might view his or her uniqueness as important at one point in the session and stress commonalities of the human condition at another. Even within the group level of identity, multiple forces may be operative. As mentioned earlier, the group level of identity reveals many reference groups, both fixed and nonfixed, that might impact our lives. Being an elderly, gay, Latino male, for example, represents four potential reference groups operat- ing on the person. The culturally competent helping professional must be willing and able to touch all dimensions of human existence without negat- ing any of the others. The Impact ofCrroup identities on Counseling and Vsychotherapy Accepting the premise that race, ethnicity, and culture are powerful variables in influencing how people think, make decisions, behave, and define events, it is not far-fetched to conclude that such forces may also affect how different groups define a helping relationship Fraga, Atkinson, SWampold, 2002; D. W. Sue, 2001) Multicultural psychologists have noted, for example, that theories of counseling and psychotherapy represent different worldviews, each with its own values, biases, and assumptions about human behavior JCatz, 1985) Given that schools of counseling and psychotherapy arise from Western European contexts, the worldview that they espouse as reality may not be that shared by racial/ethnic minority groups in the United States, nor by those who reside in different countries Parham, White, £Ajamu, 1999) Each cultural/racial group may have its own distinct interpretation of reality and offer a different perspective on the nature of people, the origin of disor- ders, standards for judging normality and abnormality, and therapeutic ap- proaches. Among many Asian Americans, for example, a Self orientationls con- sidered undesirable while a group orientationls highly valued. The Japan- ese have a saying that goes like this:The nail that stands up should be pounded back down/The meaning seems clear:Healthy development is considering the needs of the entire group, while unhealthy development is thinking only of oneself. Likewise, relative to their Euro-American counterparts, many African Americans value the emotive and affective quality of interpersonal interactions as qualities of sincerity and authenticity Parham, 1997;Parham et al., 1999) Euro-Americans often view the passionate expression of affect as irrational, lacking objectivity, impulsive, and immature on the part of the communicator. Thus, the autonomy- oriented goal of counseling and psycho-

42 Affective and Conceptual Dimensions of Multicultural Counseling

therapy and the objective focus of the therapeutic process might prove an- tagonistic to the worldviews of Asian Americans and African Americans, re- spectively. It is therefore highly probable that different racial/ethnic minority groups perceive the competence of the helping professional differently than do mainstream client groups. Further, if race/ethnicity affects perception, what about other group differences, such as gender and sexual orientation? If that is the case, minority clients may see a clinician who exhibits therapeu- tic skills that are associated primarily with mainstream therapies as having lower credibility. The important question to ask is, Do groups such as racial/ ethnic minorities define cultural competence differently than do their Euro- American counterparts?Anecdotal observations, clinical case studies, con- ceptual analytical writings, and some empirical studies seem to suggest an affirmative response to the question Constantine, 2007;Fraga et al., 2002; McGoldrick, Giordano, 85arcia-Preto, 2005;Nwachuku Svey, 1991;D. W. Sue Sue, 1999;Wehrly, 1995) What Is Multicultural Counseling/Therapy? In light of the previous analysis, let us define multicultural counseling /therapy MCT )as it relates to the therapy process and the roles of the mental health practitioner: Multicultural counseling and therapy can be defined as both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients, recognizes client identities to include individual, group, and universal dimensions, advocates the use of universal and culture- specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems. (D. W. Sue & Torino, 2005) This definition often contrasts markedly with traditional definitions of coun- seling and psychotherapy. A more thorough analysis of these characteristics is described in Chapter 4. For now, let us extract implications for counseling practice from the definition just given. 1 . Helping role and process. MCT involves broadening the roles that coun- selors play and expands the repertoire of therapy skills considered help- ful and appropriate in counseling. The more passive and objective stance taken by therapists in clinical work is seen as only one method of helping. Likewise, teaching, consulting, and advocacy can supplement the conventional counselor or therapist role.

The Superordinate Nature of Multicultural Counseling and Therapy 43

2. Consistent with life experiences and cultural values. Effective MCT means using modalities and denning goals for culturally diverse clients that are consistent with their racial, cultural, ethnic, gender, and sexual orien- tation backgrounds. Advice and suggestions, for example, may be effec- tively used for some client populations. 3 . Individual, group, and universal dimensions of existence. As we have already seen, MCT acknowledges that our existence and identity are composed of individual Uniqueness) group, and universal dimensions. Any form of helping that fails to recognize the totality of these dimensions negates important aspects of a person's identity. 4. Universal and culturespecifc strategies. Related to the second point, MCT believes that different racial/ethnic minority groups might respond best to culture-specific strategies of helping. For example, research seems to support the belief that Asian Americans are more responsive to direc- tive/active approaches and that African Americans appreciate helpers who are authentic in their self-disclosures. Likewise, it is clear that com- mon features in helping relationships cut across cultures and societies as well. 5. Individualism and collectivism. MCT broadens the perspective of the help- ing relationship by balancing the individualistic approach with a collec- tivistic reality that acknowledges our embeddedness in families, signifi- cant others, communities, and cultures. A client is perceived not just as an individual, but as an individual who is a product of his or her social and cultural context. 6. Client and client systems. MCT assumes a dual role in helping clients. In many cases, for example, it is important to focus on the individual cli- ents and encourage them to achieve insights and learn new behaviors. However, when problems of clients of color reside in prejudice, dis- crimination, and racism of employers, educators, and neighbors, or in organizational policies or practices in schools, mental health agencies, government, business, and society, the traditional therapeutic role ap- pears ineffective and inappropriate. The focus for change must shift to altering client systems rather than individual clients. What Is Cultural Competence! Consistent with this definition of MCT, it becomes clear that a culturally com- petent healer is working toward several primary goals p. W. Sue et al., 1 982; D. W. Sue, Arredondo, McDavis, I992;D. W. Sue et al., 1998) First, a cul- turally competent helping professional is one who is actively in the process of becoming aware of his or her own assumptions about human behavior,

44 Affective and Conceptual Dimensions of Multicultural Counseling

values, biases, preconceived notions, personal limitations, and so forth. Sec- ond, a culturally competent helping professional is one who actively attempts to understand the worldview of his or her culturally different client. In other words, what are the client's values and assumptions about human behavior, biases, and so on?Third, a culturally competent helping professional is one who is in the process of actively developing and practicing appropriate, rele- vant, and sensitive intervention strategies and skills in working with his or her culturally different client. These three goals make it clear that cultural competence is an active, developmental, and ongoing process and that it is as- pirational rather than achieved. Let us more carefully explore these attributes of cultural competence. Competency One:Therapist Awareness of One's Own Assumptions, Values, and Biases In almost all human service programs, counselors, therapists, and social workers are familiar with the phrase, Counselor, know thyself. "Programs stress the importance of not allowing our own biases, values, or hang-ups to interfere with our ability to work with clients. In most cases, such a warning stays primarily on an intellectual level, and very little training is directed at having trainees get in touch with their own values and biases about human behavior. In other words, it appears to be easier to deal with trainees' cogni- tive understanding about their own cultural heritage, the values they hold about human behavior, their standards forjudging normality and abnormal- ity, and the culture-bound goals toward which they strive. What makes examination of the self difficult is the emotional impact of attitudes, beliefs, and feelings associated with cultural differences such as racism, sexism, heterosexism, able-body-ism, and ageism. For example, as a member of a White Euro-American group, what responsibility do you hold for the racist, oppressive, and discriminating manner by which you person- ally and professionally deal with persons of colorTThis is a threatening ques- tion for many White people. However, to be effective in MCT means that one has adequately dealt with this question and worked through the biases, feel- ings, fears, and guilt associated with it. Competency Two:Understanding the Worldview of Culturally Diverse Clients It is crucial that counselors and therapists understand and can share the worldview of their culturally diverse clients. This statement does not mean that providers must hold these worldviews as their own, but rather that they can see and accept other worldviews in a nonjudgmental manner. Some have

The Superordinate Nature of Multicultural Counseling and Therapy 45 referred to the process as cultural role taking: The therapist acknowledges that he or she has not lived a lifetime as an Asian American, African Ameri- can, American Indian, or Hispanic American person. It is almost impossible for the therapist to think, feel, and react as a racial minority individual. Nonetheless, cognitive empathy, as distinct from affective empathy, may be possible. In cultural role taking the therapist acquires practical knowledge concerning the scope and nature of the client's cultural background, daily liv- ing experience, hopes, fears, and aspirations. Inherent in cognitive empathy is the understanding of how therapy relates to the wider sociopolitical system with which minorities contend every day of their lives. Competency Three :Developing Appropriate Intervention Strategies and Techniques Effectiveness is most likely enhanced when the therapist uses therapeutic modalities and defines goals that are consistent with the life experiences and cultural values of the client. This basic premise will be emphasized through- out future chapters. Studies have consistently revealed that ^(economically and educationally marginalized clients may not be oriented toward talk therapy,'^ (self-disclosure may be incompatible with the cultural values of Asian Americans, Hispanic Americans, and American Indians; ?)the socio- political atmosphere may dictate against self-disclosure from racial minorities and gays and lesbians; ^)the ambiguous nature of counseling may be an- tagonistic to life values of certain diverse groups;and |>)many minority cli- ents prefer an active/directive approach to an inactive/nondirective one in treatment. Therapy has too long assumed that clients share a similar back- ground and cultural heritage and that the same approaches are equally effec- tive with all clients. This erroneous assumption needs to be buried. Because groups and individuals differ from one another, the blind ap- plication of techniques to all situations and all populations seems ludicrous. The interpersonal transactions between the counselor and client require dif- ferential approaches that are consistent with the person's life experiences $ue et al., 1996) In this particular case, and as mentioned earlier, it is ironic that equal treatment in therapy may be discriminatory treatment ITherapists need to understand this. As a means to prove discriminatory mental health practices, racial/ethnic minority groups have in the past pointed to studies re- vealing that minority clients are given less preferential forms of treatment dedication, electroconvulsive therapy, etc.) Somewhere, confusion has oc- curred, and it was believed that to be treated differently is akin to discrimi- nation. The confusion centered on the distinction between equal access and opportunities versus equal treatment. Racial/ethnic minority groups may not be asking for equal treatment so much as they are asking for equal access and opportunities. This dictates a differential approach that is truly nondiscrimi-

46 Affective and Conceptual Dimensions of Multicultural Counseling natory. Thus, to be an effective multicultural helper requires cultural compe- tence. In light of the previous analysis, we define it in the following manner: Cultural competence is the ability to engage in actions or create conditions that maximize the optimal development of client and client systems. Multicultural counseling competence is defined as the counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic so- ciety (ability to communicate, interact, negotiate, and intervene on behalf of cli- ents from diverse backgrounds), and on a organizational/societal level, advocat- ing effectively to develop new theories, practices, policies, and organizational structures that are more responsive to all groups. (D. W. Sue & Torino, 2005) This definition of cultural competence in the helping professions makes it clear that the conventional one-to-one, in-the-office, objective form of treatment aimed at remediation of existing problems may be at odds with the sociopolitical and cultural experiences of their clients. Like the complemen- tary definition of MCT, it addresses not only clients individuals, families, and groups)but also client systems institutions, policies, and practices that may be unhealthy or problematic for healthy development) This is especially true if problems reside outside rather than inside the client. For example, preju- dice and discrimination such as racism, sexism, and homophobia may impede the healthy functioning of individuals and groups in our society. Second, cultural competence can be seen as residing in three major do- mains:^ (attitudes/beliefs components understanding of one's own cul- tural conditioning that affects the personal beliefs, values, and attitudes of a culturally diverse population;b (knowledge component-understanding and knowledge of the worldviews of culturally diverse individuals and groups;and £)skills components ability to determine and use culturally appropriate intervention strategies when working with different groups in our society. Table 2.1 provides an outline of cultural competencies related to these three domains. Third, in a broad sense, this definition is directed toward two levels of cultural competence: the person/individual and the organizational/system levels. The work on cultural competence has generally focused on the micro level, the individual. In the education and training of psychologists, for ex- ample, the goals have been to increase the level of self-awareness of trainees potential biases, values, and assumptions about human behavior)to acquire knowledge of the history, culture, and life experiences of various minority groups; and to aid in developing culturally appropriate and adaptive inter- personal skills finical work, management, conflict resolution, etc.) Less emphasis is placed on the macro levebthe profession of psychology, organi- zations, and the society in general Lewis, Lewis, Daniels, ©'Andrea, 1998; D. W. Sue, 2001) We suggest that it does little good to train culturally com-

The Superordinate Nature of Multicultural Counseling and Therapy 47 Table 2.1 Multicultural Counseling Competencies I. Cultural Competence: Awareness 1 . Moved from being culturally unaware to being aware and sensitive to own cultural heritage and to valuing and respecting differences. 2. Aware of own values and biases and of how they may affect diverse clients. 3. Comfortable with differences that exist between themselves and their clients in terms of race, gender, sexual orientation, and other sociodemographic variables. Differences are not seen as deviant. 4. Sensitive to circumstances personal biases;stage of racial, gender, and sexual orientation identity; sociopolitical influences, etc.)that may dictate referral of clients to members of their own sociodemographic group or to different therapists in general. 5. Aware of their own racist, sexist, heterosexist, or other detrimental attitudes, beliefs, and feelings. II. Cultural Competence: Knowledge 1 . Knowledgeable and informed on a number of culturally diverse groups, especially groups therapists work with. 2. Knowledgeable about the sociopolitical system's operation in the United States with respect to its treatment of marginalized groups in society. 3. Possess specific knowledge and understanding of the generic characteristics of counseling and therapy. 4. Knowledgeable of institutional barriers that prevent some diverse clients from using mental health services. III. Cultural Competence: Skills 1 . Able to generate a wide variety of verbal and nonverbal helping responses. 2. Able to communicate $end and receive both verbal and nonverbal messages)accurately and appropriately. 3. Able to exercise institutional intervention skills on behalf of their client when appropriate. 4. Able to anticipate impact of their helping styles, and limitations they possess on culturally diverse clients. 5. Able to play helping roles characterized by an active systemic focus, which leads to environmental interventions. Not restricted by the conventional counselor/therapist mode of operation. Source: D.W. Sue et al. }992)and D. W. Sue et al. J998) Readers are encouraged to review the original 34 multi- cultural competencies, which are fully elaborated in both publications. petent helping professionals when the very organizations that employ them are monocultural and discourage or even punish psychologists for using their culturally competent knowledge and skills. If our profession is interested in the development of cultural competence, then it must become involved in impacting systemic and societal levels as well. Last, our definition of cultural competence speaks strongly to the devel- opment of alternative helping roles. Much of this comes from recasting heal- ing as involving more than one-to-one therapy. If part of cultural competence involves systemic intervention, then roles such as a consultant, change agent, teacher, and advocate supplement the conventional role of therapy. In con- trast to this role, alternatives are characterized by the following:

48 Affective and Conceptual Dimensions of Multicultural Counseling n Having a more active helping style n Working outside the office home, institution, or community) n Being focused on changing environmental conditions as opposed to changing the client n Viewing the client as encountering problems rather than having a problem n Being oriented toward prevention rather than remediation n Shouldering increased responsibility for determining the course and outcome of the helping process It is clear that these alternative roles and their underlying assumptions and practices have not been perceived as activities consistent with counseling and psychotherapy. Multidimensional Model of Cultural Competence in Counseling Elsewhere, one of the authors p. W. Sue, 2001 )has proposed a multidimen- sional model of cultural competence (MDCCfn counseling/therapy. This was an at- tempt to integrate three important features associated with effective multicul- tural counseling: \ )the need to consider specific cultural group worldviews associated with race, gender, sexual orientation, and so on;? Components of cultural competence Awareness, knowledge, and skills)and ?)foci of cul- tural competence. These dimensions are illustrated in Figure 2.2. This model is used throughout the text to guide our discussion because it allows for the sys- tematic identification of where interventions should potentially be directed. Dimension I: Group-Specific Worldviews In keeping with our all-encompassing definition of multiculturalism, we include the human differences associated with race, gender, sexual orienta- tion, physical ability, age, and other significant reference groups. Figure 2.2 originally identified only five major groups organized around racial/ethnic categories. This dimension can be broadened to include multiracial groups and other culturally diverse groups such as sexual minorities, the elderly, women, and those with disabilities. In turn, these group identities can be further broken down into specific categories along the lines of race/ethnic- ity African Americans, American Indians, Asian Americans, and Euro- Americans) sexual orientation Straights, gays, lesbians, and bisexuals) gen- der
The Superordinate Nature of Multicultural Counseling and Therapy 49

Figure 2.2

A Multidimensional Model for Developing Cultural Competence



go 11 3d






Dimension 2 Components of Cultural Competence


Dimension II: Components of Cultural Competence As we have already stated, most multicultural specialists have used the divi- sions of awareness, knowledge, and skills to define cultural competence. To be effective multicultural therapists, specialists must be aware of their own biases and assumptions about human behavior, must acquire and have knowledge of the particular groups they are working with, and must be able to use cul- turally appropriate intervention strategies in working with different groups.

Dimension III: Foci of Therapeutic Interventions A basic premise of MCT is that culturally competent helping professionals must not confine their perspectives to just individual treatment, but must be able to intervene effectively at the professional, organizational, and societal levels as well. Figure 2.3 reveals the four foci of intervention and develop- ment.

Focus 1: Individual. To provide culturally effective and sensitive mental health services, helping professionals must deal with their own biases, prejudices, and misinformation/lack of information regarding culturally diverse groups in our society. In this case, positive changes must occur in their attitudes, be- liefs, emotions, and behaviors regarding multicultural populations. Focus 2: Professional. It is clear that our profession has developed from a West- ern European perspective. As a result, how we define psychology the study

5 0 Affective and Conceptual Dimensions of Multicultural Counseling

of mind and behavior) may be biased and at odds with different cultural groups. Further, if the professional standards and codes of ethics in mental health practice are culture bound, then they must be changed to reflect a multicultural worldview. Focus 3: Organizational. Since we all work for or are influenced by organiza- tions, it is important to realize that institutional practices, policies, programs, and structures may be oppressive to certain groups, especially if they are monocultural. If organizational policies and practices deny equal access and opportunity for different groups or oppress them Redlining in home mort- gages, laws against domestic partners, inequitable mental health care, etc.) then they should become the targets for change. Focus 4: Societal. If social policies facial profiling, misinformation in educa- tional materials, inequities in health care, etc.)are detrimental to the mental and physical health of minority groups, for example, does not the mental health professional have a responsibility to advocate for changeDur answer, of course, is affirmative. Often, psychologists treat individuals who are the victims of failed sys- temic processes. Intervention at the individual level is primarily remedial when a strong need exists for preventive measures. Because psychology con-

The Superordinate Nature of Multicultural Counseling and Therapy


centrates primarily on the individual, it has been deficient in developing more systemic and large-scale change strategies.

Using our tripartite levels of identity model figure 2.1) the multidimen- sional model of cultural competence figure 2.2) and the foci of cultural competence figure 2.3) we can discern several guiding principles for effec- tive MCT. 1 . Understand the terms Sociodemographic"and diverse backgrounds" in the MCT definition to be inclusive and encompass race, culture, gen- der, religious affiliation, sexual orientation, elderly, women, disability, and so on. 2. Realize that you are a product of cultural conditioning and that you are not immune from inheriting biases associated with culturally diverse groups in our society. As such, you must be vigilant of emotional reac- tions that may lead to a negation of other group values and lifestyles. 3. When working with different cultural groups, attempt to identify culture-specific and culture-universal domains of helping. Do not ne- glect the ways in which American Indians, Latinos/Hispanics, and African Americans, for example, may define normality-abnormality, the nature of helping, and what constitutes a helping relationship. 4. Be aware that persons of color, gays/lesbians, women, and other groups may perceive mental illness/health and the healing process differently than do Euro-Americans. To disregard differences and impose the con- ventional helping role and process on culturally diverse groups may constitute cultural oppression. 5. Be aware that Euro- American healing standards originate from a cul- tural context and represent only one form of helping that exists on an equal plane with others. As a helping professional, you must begin the task of recognizing the invisible veil of Euro-American cultural stan- dards that influence your definitions of a helping relationship. As long as counselors and therapists continue to view Euro-American standards as normative, they will unwittingly set up a hierarchy among the groups. 6. Realize that the concept of cultural competence is more inclusive and superordinate than is the traditional definition of clinical competence. Do not fall into the trap of good counseling is good counseling. Know that cultural competence must replace clinical competence. The latter is cul-

5 2 Affective and Conceptual Dimensions of Multicultural Counseling

ture bound, ethnocentric, and exclusive. It does not acknowledge racial, cultural, and gender differences sufficiently to be helpful. To assume universality of application to all groups is to make an unwarranted in- ferential leap. 7. If you are planning to work with the diversity of clients in our world, you must play roles other than that of the conventional counselor. Simply concentrating on the traditional clinical role ignores the impor- tance of interventions at other levels. New helping roles such as con- sultant, advisor, change agent, facilitator of indigenous healing systems, and so on have been suggested as equally valuable. 8. Realize that organizational/societal policies, practices, and structures may represent oppressive obstacles that prevent equal access and op- portunity. If that is the case, systems intervention is most appropriate. 9. Use modalities that are consistent with the lifestyles and cultural sys- tems of clients. In many cases, psychoeducational approaches, working outside of the office, and engaging in practices that violate traditional Euro-American standards ^dvice giving and self-disclosure)may be dictated. 10. Finally, but most important, realize that MCT
Part !! The Political Dimensions of Mental Health Practice

The Politics of Counseling and Psychotherapy

On August 29, 2005, Hurricane Katrina struck the Gulf Coast with de- structive winds of 1 75 mph to occasional gusts of 215 mph. It caused ex- tensive damage to the coasts of Louisiana, Mississippi, and Alabama, and is acknowledged as the most destructive tropical cyclone on record to strike the United States. In New Orleans it caused sections of the levee system to collapse and flooded 80 percent of the city, much of which is below sea level. Widespread property damage resulted, as well as over one thousand deaths and over one million displaced people, leading to the greatest humanitar- ian crisis since the Great Depression (Gheytanchi et al, 2007).


An unprecedented mandatory evacuation of the city was issued; major transportation systems such as airlines, buses, and trains were suspended or developed alternative routes. Residents took whatever belongings they could carry and left the city in droves, usually by automobile; they clogged major roads and highways in their desire to flee the hurricane; tourists also sought alternative transportation ( rental cars) as many airlines and trains were completely booked. It is estimated that 80 to 85 percent of the popula- tion left New Orleans. Approximately 150,000 people did not leave the city. It is difficult to determine the percentage that was either unwilling or unable to obey the evacuation order. Nevertheless, both the Louisiana Superdome and the New Orleans Convention Center were designated "refuges of last resort" for citizens who did not leave. Tens of thousands of people overwhelmed the capacity and resources of the Superdome. Air conditioning, electricity, and plumbing failed, food and water were scarce, conditions were uncomfort- able and unsanitary, and rumors of rape, suicide, and drug dealing floated about. It took an agonizing 9 days to rescue the citizens; long before then, the flood damage and human waste in the Superdome were declared po- tential biohazards. In light of all the resources available to U.S. govern- mental agencies, the general consensus is that rescue efforts in the gulf states were examples of ineptitude and neglect. Many openly wonder why



The Political Dimensions of Mental Health Practice

the most powerful nation in the world moved so slowly and with apparent dis- regard for the human suffering of its own citizens. In general, people of color be- lieve that the failure to help was intimately linked to race and class bias (Bourne, Watts, Gordon, & Figueroa-Garcia, 2006). It may seem surprising and unusual for us to open a chapter on Counseling the Culturally Diverse with a description of Hurricane Katrina. While the event is certainly ingrained in the consciousness of everyone, just how does it relate to the topic of multicultural counseling and therapy?Why should we give it such broad prominence ?After all, as mental health practitioners, we are here to help people, especially our clients, whether they are Black or White, rich or poor. While this statement is true, it fails to recognize how sociopolitical forces play an intimate part in determining how people view the world, especially as it relates to issues of racism and classism. Katrina is a prime example of the clash of racial realities and the multitude of political is- sues that are likely to arise in clinical sessions between counselors and cul- turally diverse clients. Let us pose some major questions related to Katrina and tease out their political and mental health implications. 1 . How much of the inadequate and inept response on the part of govern- ment officials and other key individuals had to do with race and class? A disproportionate number of Blacks and the poor bore the brunt of the suffering and loss. Horrifying images of mainly African American citi- zens who could not leave and who were confined for days in the Super- dome or convention center without food or water made it clear that it was marginalized groups in our society who suffered most American Psychological Association APA] 2006) In what ways does this tragedy reveal how social and economic stratifications exist within our society? How might such stratifications affect the quality of life of minorities and the de- livery of mental health services to those most disempowered in our society (see Chapter 12)? 2. Did the 1 50,000 who stayed do so voluntarily In the mass media, com- mentators often decried the fact that citizens who chose to stay had only themselves to blame. However, the 2000 U.S. Census revealed that 27 percent of New Orleans households were without privately owned transportation, primarily due to poverty. While more affluent citizens could hop into their cars or pay for transportation to leave, how could they expect the homeless, the poor, the elderly, and the disabled to leave without transportation ?Are we blaming the victims'Some have argued that the blame rightly lies with a society that foresaw what could hap- pen, but failed to act because of classicism and racism G-heytanchi et al., 2007) When clients of color come to us for help, how might "blaming the victim " operate in our assessment, diagnosis, and treatment of them (see Chapter 4)?

The Politics of Counseling and Psychotherapy 5 7

3. Why do so many people of color object to the use of the term refugees" to refer to the displaced citizens of the gulf statesTThe Reverend Jesse Jackson vehemently denounced the term and even President George Bush openly discouraged its use. In what ways might the use of the term reflect potential racial biasTDoes the term itself reveal society's mind- settbat large groups of people are not Americans/'are lesser beings, and are dispensable peVos fBanaji, 2005? In counseling and psycho- therapy, how do our unconscious, biased perceptions of clients of color, women, and gays influence the clinical process (see Chapter 5)? 4. In a televised fundraiser for the victims of Hurricane Katrina, rapper Kanye West departed from his script and claimed that George Bush doesn't care about Black people. "He went on to say:! hate the way they portray us in the media. You see a Black family it says, They're looting.' You see a White family, it says, They're looking for food.'" West's comments were prompted by photos, one from the Associated Press and the other from Getty Images, that juxtaposed a young Black man wading in water up to his chest, carrying a case of soda and a float- ing bag, with a White couple wading in the same murky water, holding bags of food. The first image had a caption stating that the Black man had been Tooting a grocery store/While the second caption read after finding bread and soda from a local grocery store. Tooting'and find- ing'have two completely different meanings. In what ways are clients and counselors influenced by a biased racial curriculum in their socialization pro- cesses (via media, education, and social groups), and what are the implications for clinical practice (Sue, 2003; Chapters 3, 10, and 11)? 5. Why do people of color perceive racism operating before, during, and after KatrinaTWhy do many Whites tend to claim that race had noth- ing to do with the responsesWhy is the worldview of persons of color so different from that of their White counterparts'^ an ABC poll re- ported 9/11/05, Whites and Blacks responded quite differently to a question asking whether the response would have been quicker if the citizens were White instead of Black. Only 17 percent of Whites said yes, "while 66 percent of Blacks said yes. "What do you think ac- counts for this major difference in perceptionTurther, which perspec- tive is the correct oneTWhen counseling culturally diverse clients, how does one reconcile such major differences in worldviews (see Chapters 6 and 7)? 6. While many Whites deny that race played a role, media commentators and Bush administration officials seemed willing to entertain the notion that poverty and class did play a part in who was affected. Indeed, First Lady Laura Bush came to her husband's defense by claiming that the president cares deeply about all Americans'and stated that it was clear that poor people were more vulnerable and that's what we saw on TV, not race. Does she have a point hereX)r, if not, why is it easier for many

5 8 The Political Vimensions of Mental Health Practice to acknowledge class issues poverty)as opposed to race issues Helms, 1 994? As a helping professional, what emotional reactions around "race " do you possess that may act as a barrier to effective multicultural counseling (Chap- ters 1,2, and 6)? 7. During initial search-and-rescue efforts, authorities who were attempt- ing to reach citizens trapped in attics and rooftops reported gunfire and suspended searches, for fear of their lives. Members of the Association of Black Psychologists have expressed outrage at the suspension of res- cue efforts by authorities. After all, they reasoned, when people's lives are at stake all efforts should be made, regardless of the danger. Why did they not call in troops or police to help safeguard themlf in Iraq we are willing to endure enemy fire to police citizens of another country, why not in our ownDid the fact that those who needed rescuing were Black have anything to do with suspending rescue effortsrSocial psychologi- cal findings on the failure to help'lndicate that in emergency situa- tions, Blacks are significantly less likely to receive help than if the vic- tims are White povidio, Gaetner, Kawakami, EHodson, 2002) How might the unconscious biases of helping professionals affect their ability to deliver culturally appropriate mental health services to marginalized groups (Chapters 7 and 11)? While Katrina is a relatively recent event, the differing perspectives of persons of color and other marginalized groups reveal how race, class, and other sociodemographic categories may ultimately be linked to the historical and current experiences of oppression in the United States Ponterotto, Ut- sey, fPedersen, 2006) As such, helping professionals must understand the worldview of culturally diverse clients from both a cultural and a political perspective Pudley, 2005) Clients of color, for example, are likely to ap- proach counseling and therapy with a great deal of healthy skepticism re- garding the institutions from which therapists work, and even the conscious and unconscious motives of the helping professional. The main thesis of CCD is that counseling and psychotherapy do not take place in a vacuum isolated from the larger social-political influences of our societal climate Constan- tine, 2006;Katz, 1985;Liu, Hernandez, Mahmood, SStinson, 2006) Coun- seling people of color, for example, often mirrors the nature of race relations in the wider society as well as the dominant-subordinate relationships of other marginalized groups gay/lesbian, women, and the physically chal- lenged) It serves as a microcosm, reflecting Black- White, Asian-White, His- panic-White, American Indian- White, interethnic, and minority-majority re- lations. We will explore the many ways in which counseling and psychotherapy have failed with respect to providing culturally appropriate mental health

The Politics of Counseling and Psychotherapy 5 9

services to disempowered groups in our society. We do this by using racial mi- norities as an example of the damaging majority-minority relationships that historically characterize many other marginalized groups. Many readers may have a very powerful negative reaction to the following material. However, only by honestly confronting these unpleasant social realities and accepting responsibility for changing them will our profession be able to advance and grow {Strickland, 2000) For racial/ethnic minorities, these failures can be seen in three primary areas4)the education and training of mental health professionals, 2)biased and inaccurate therapeutic and mental health liter- ature, and ?)the inappropriate process and practice of counseling and psychotherapy. We deal with only the first two areas in this chapter. Thera- peutic process and practice is discussed in chapters 6 and 7. Prior to our jour- ney, however, it is important to present some important demographic data re- garding the diversification of the United States, and its implications for our society and the mental health profession. The Diversification of the United States

The United States is the most diverse nation in the world. Nowhere is the di- versification of society more evident than in the workplace, where three ma- jor trends can be observed: })the graying of the workforce Burris, 2005) 2)the feminization of the workforce Taylor {Kennedy, 2003) and ?)the changing complexion of the workforce Sue, Parham, Santiago, 1998) The Graying of the Workforce and Society As the baby boomers head into old age those born between 1 946 and 1961) the elderly population of those 65 and older will surge to 53.3 million by 2020, an increase of 63 percent from 1996 Study: 2020 Begins, 1996) In 1950, the elderly population stood at 8 percent; in the year 2000 it was 13 percent, and by 2050 it will be 20 percent. The dramatic increase in the el- derly population can be attributed to the aging baby boomer generation, de- clining fertility rates, and increased longevity Huuhtanen, 1994;Keita & Hurrell, 1994;Sue, Parham, Santiago, 1998) The median age of people in the workforce has risen from 36.6 years in 1990 to 40.6 in 2005. In 2005, 70 percent of workers were in the 25 to 54 age group, and the number of work- ers 55 and older rose 15 percent. The implications are many. n There is a serious lack of knowledge concerning issues of the elderly and the implications of an aging population on mental health needs, occu- pational health, quality-of-life issues, economic impact, and social ser- vice needs.


The Political Vimensions of Mental Health Practice

n In American society, the elderly suffer from the beliefs and attitudes of society $tereotypes)that diminish their social status;they have declin- ing physical and mental capabilities, have grown rigid and inflexible, are incapable of learning new skills, are crotchety and irritable, and should step aside for the benefit of the young Brammer, 2004;Zastrow, 2004) More importantly is the belief that their lives are worth less than their younger counterparts. n The elderly are increasingly at the mercy of governmental policies and company changes in social security and pension funds that reduce their benefits and protection as they begin their retirement years. n Social service agencies are ill prepared to deal with the social and men- tal health needs of the elderly. Many of these disparities are due to ageism. The Feminization of the Workforce and Society- Women are increasingly playing a larger and more significant role in society. Over a fifteen-year period from 1 990 to 2005 women accounted for 62 percent of the net increase in the civilian labor force. The upward trend is dramatic:38 percent in 1970, 42 percent in 1980, and 45 percent in 1990 TJ.S. Department of Labor, Women's Bureau, 1992) The trend is not confined to single women alone, but also to married women. For example, in 1950, married women ac- counted for less that 25 percent of the labor force;only 12 percent of women with preschool children worked, and only 28 percent with school-age children worked. Now, however, 58 percent of married women are in the labor force, 60 percent with preschoolers work, and 75 percent with school-age children work. The problem, however, is that women continue to occupy the lower rungs of the occupational ladder but are still responsible for most domestic re- sponsibilities. The implications of these changes and facts are many. n Common sense would indicate that women are subjected to a greater number of stressors than their male counterparts. This is due to issues related to family life and role strain. Studies continue to indicate that working women carry more of the domestic burden, more responsibil- ity for child care arrangements, and more responsibility for social and interpersonal activities outside of the home than do married or part- nered men Morales SSheafor, 2004) n Family relationships and structures have progressively changed as we have moved from a traditional single-earner, two-parent family to two wage earners. The increasing number of women in the workforce can- not be seen in isolation from the wider social, political, and economic context Farley, Smith, SBoyle, 2003) For example, one quarter of the

The Politics of Counseling and Psychotherapy 6 1

nation's families are poor, one sixth have no health insurance, one in six small children live in a family where neither parent has a job, women continue to be paid less than men, and 25 percent of children will be on welfare at some point before reaching adulthood. Social workers must be cognizant of these changes and the implications for their work. n These disparities are systemic in nature. If counselors are concerned with the welfare of women, then it is imperative that meaningful poli- cies and practices be enacted to deal with gender disparities.

The Changing Complexion of the Workforce and Society People of color have reached a critical mass in the United States, and their numbers are expected to continue increasing Lum, 2004) The rapid increase in racial/ethnic minorities in the United States has been referred to as the diversification of the United States"or, literally, the changing complexion of society/From 1990 to 2000, the U.S. population increased 13 percent, to over 281 million U.S. Census Bureau, 2001) Most of the population in- crease consisted of visible racial/ethnic minority groups VREG)The Asian American/Pacific Islander population increased by almost 50 percent, the Latino/Hispanic population by over 58 percent, African Americans by 16 per- cent, and American Indians/Alaska Natives by 15.5 percent, in marked con- trast to the 7.3 percent increase of Whites. Currently, people of color consti- tute over 30 percent of the U.S. population, approximately 45 percent of whom are in the public schools p. W. Sue et al., 1998;U.S. Bureau of the Census, 2000) Projections indicate that persons of color will constitute a nu- merical majority sometime between 2030 and 2050 p. W. Sue et al.) The rapid demographic shift stems from two major trends:immigration rates and differential birth rates. The current immigration rates documented immigrants, undocumented immigrants, and refugees )are the largest in U.S. history. Unlike the earlier immigrants, who were primarily White Europeans oriented toward assimilation, the current wave consists primarily of Asian $4 percent) Latin American £4 percent) and other VREGs who may not be readily assimilated Atkinson et al., 1 998) In addition, the birth rates of White Americans have continued to decline Euro-American =1.7 per mother)in comparison to other racial/ethnic minorities £.g., African American =2.4, Mexican American =2.9, Vietnamese =3.4, Laotians =4.6, Cambodians = 7.4, and Hmong =11.9) Societal implications of the changing complexion are many: n Approximately 75 percent of those now entering the labor force are vis- ible racial/ethnic minorities and women. The changing complexion and feminization of the workforce have become a reality.

62 The Political Vimensions of Mental Health Practice n By the time the so-called baby boomers retire, the majority of people contributing to social security and pension plans will be racial/ethnic minorities. In other words, those planning to retire primarily White workers )must depend on their coworkers of color. If racial/ethnic mi- norities continue to encounter the glass ceiling and to be the most un- dereducated, underemployed, underpaid, and unemployed, the eco- nomic security of retiring White workers looks grim. n Businesses are aware that their workforces must be drawn increasingly from a diverse labor pool and that the current U.S. minority market- place equals the entire gross domestic product of Canada; projections are that it will become immense as the shift in demographics continues. The economic viability of businesses will depend on their ability to ef- fectively manage a diverse workforce, allow for equal access and op- portunity, and appeal to consumers of color. On a much larger scale, however, a nation that denies equal access and opportunity to these groups bodes poorly for our future viability. n Students of color now constitute 45 percent of the population in our public schools. Some school systems, such as California's, reached a ra- tio of 50 percent students of color as early as the late 1980s. Thus, it ap- pears that our educational institutions must wrestle with issues of mul- ticultural education and the development of bilingual programs. n The diversity index of the United States stands at 49, indicating that there is approximately one in two chances that two people selected at random are racially or ethnically different. These three pressing trends are only the tip of the iceberg in considering the importance of diversity:the demographic growth of the elderly, of women, and people of color in mental health practice. For the profession to respond adequately, it must also address issues of sexual orientation, ability/disability, religion, socioeconomic status, and so forth C-uadalupe ftum, 2005) In recognition of the changing composition of the nation, there has re- cently been a movement by business and industry toward diversity training, the infusion of multicultural concepts into school curricula, as well as at- tempts to fight bigotry, bias, and discrimination in our social, economic, and political systems. Yet, the changing demographics have also caused alarm in many of our White citizens, and have often resulted in conflicts and major clashes. Perhaps this is to be expected, as different worldviews, lifestyles and value systems challenge the myth of the melting pot concept and as we move from a monocultural to a multicultural society. Mental Health Implications Like they are for the rest of society, the implications for the mental health pro- fessions are many.

The Politics of Counseling and Psychotherapy 6 3

1 . First, the clash of worldviews, values, and lifestyles is inescapable, not only for the therapist's personal life, but for the professional one as well. It is impossible for any of us not to encounter client groups who differ from us in terms of race, culture, and ethnicity. Increasingly therapists will come into contact with diverse clients who may not share their worldview of what constitutes normality-abnormality; who define helping in a manner that contrasts sharply with our codes of ethics and standards of practice; that require culture-specific strategies and ap- proaches in counseling and psychotherapy; and who may correctly or incorrectly perceive the profession as a sociopolitical tool. 2. If counselors and therapists are to provide meaningful help to a cultur- ally diverse population, we must reach out and acquire not only new understandings, but develop new, culturally effective helping ap- proaches. To prepare counselors with multicultural expertise means ^revamping our training programs to include accurate and realistic multicultural content and experiences, b) developing multicultural competencies as core standards for our profession, and <:)providing continuing education for our current service providers £ue, Bingham, Porche-Burke, 8/asquez, 1999) 3 . Because therapeutic and ethical practice may be culture bound, therapists who work with diverse clients may be engaging in cultural oppression, using unethical and harmful practices for that particular population. Our professional organizations need to adopt ethical guidelines, codes of ethics, standards of practice, and bylaws that are multicultural in scope ^VPA, 2004; Sue, 2001) Omission of such standards and failed transla- tion into actual practice are inexcusable, and represent a powerful indict- ment of our low priority and lack of commitment to cultural diversity. If we are indeed committed to multiculturalism, then each and every one of us must become advocates in demanding that our professional associ- ations seriously undertake a major revision of standards used to ascertain counseling competence. Furthermore, these multicultural criteria must be incorporated into licensing and credentialing standards as well. 4. The education and training of psychologists have, at times, created the impression that its theories and practices are apolitical and value free. Yet, we are often impressed by the fact that the actual practice of ther- apy can result in cultural oppression; that what happens in the thera- pist's office may represent a microcosm of race relations in the larger so- ciety;that the so-called psychological problems of minority groups may reside not within, but outside of our clients; and that no matter how well intentioned the helping professional, he or she is not immune from inheriting the racial biases of his or her forebears. 5. Since none of us is immune from inheriting the images/stereotypes of the larger society, we can assume that most therapists are prisoners of

64 The Political Dimensions of Mental Health Practice their own cultural conditioning. As a result, they possess stereotypes and preconceived notions that may be unwittingly imposed upon their culturally different clients. It may affect how they define problems, the goals they develop, and the standards that they use to judge normal and abnormal behavior. If their biases and prejudices influence their work with culturally diverse clients they may potentially oppress and harm them. Thus it is imperative that all therapists explore their own stereo- types and images of various minority groups. Since many of our stereo- types are unconscious, we need to work tirelessly in uncovering them, with as much nondefensiveness as possible. One of the greatest obsta- cles to this process is our fear that others will see our racism, sexism, heterosexism, and biases. Thus, we try to deny the existence of these stereotypes or to hide them from public view. This works against our ability to uncover them. The Education and Training of Mental Health Vrofessionals While national interest in the mental health needs of ethnic minorities has increased, the human service professions have historically neglected this population \J.S. Public Health Service, 2001 ) Evidence reveals that the pop- ulations of color, in addition to the common stresses experienced by every- one else, are more likely to encounter problems such as immigrant status, poverty cultural racism, prejudice, and discrimination. Yet studies continue to reveal that American Indians, Asian Americans, African Americans, and Latino /Hispanic Americans tend to underutilize traditional mental health services, in a variety of contexts Cheung Snowden, 1 990;Kearney, Draper, fBaron, 2005) Some years back, S. Sue and associates found that clients tended to terminate counseling/therapy at a rate of more than 50 percent after only one contact with the therapist. This was in marked contrast to the less than 30 percent termination rate among White clients S. Sue, Allen, & Conaway, 1975;S. Sue SMcKinney, 1974;S. Sue, McKinney, Allen, alall, 1974;S. Sue, Fujino, Hu, Takeuchi, ffiane, 1991) While utilization data for groups of color are changing, these early findings led many to search for en- lightened explanations. For example, some researchers hypothesized that minority-group indi- viduals underutilize and prematurely terminate counseling/therapy because of the biased nature of the services themselves Kearney, Draper, EBaron, 2005) The services offered are frequently antagonistic or inappropriate to the life experiences of the culturally different client;they lack sensitivity and un- derstanding, and they are oppressive and discriminating toward minority cli- ents Cokley, 2005) Many believed that the presence of ill-prepared mental health professionals was the direct result of a culture-bound and biased train-

The Politics of Counseling and Psychotherapy 6 5 ing system Mio, 2005;Utsey, Grange, EAllyne, 2006) While directors of training programs report that multicultural coursework has increased signif- icantly in mental health education pernal SCastro, 1994;Hills gStrozier, 1992) it is interesting to note that graduate students in mental health pro- grams have a different view. They report few courses offered in multicultural psychology and inadequate coverage of work with diverse populations within required core courses Allison, Crawford, Echemendia, Robinson, & Knepp, 1994;Mintz, Bartels, Sideout, 1995) It is our contention that reports of increased multicultural coverage ^vhile gaining a degree of prominence )are inflated and/or are superficially developed. Most graduate programs continue to give inadequate treatment to the mental health issues of ethnic minorities. Cultural influences affecting personality formation, career choice, educational development, and the manifestation of behavior disorders are infrequently part of mental health training or they are treated in a tangential manner Parham, White, fAjamu, 1997;Vazquez 8&argia- Vazquez, 2003) When minority-group experiences are discussed, they are generally seen and analyzed from the White, Euro- American, middle-class perspective. In programs where minority experiences have been discussed, the focus tends to be on their pathological lifestyles and/or maintenance of false stereotypes. The result is twofold: | profes- sionals who deal with mental health problems of ethnic minorities lack un- derstanding and knowledge about ethnic values and their consequent inter- action with a racist society and £)mental health practitioners are graduated from our programs believing minorities are inherently pathological and that therapy involves a simple modification of traditional White models. This ethnocentric bias has been highly destructive to the natural help- giving networks of minority communities puran, 2006) Oftentimes mental health professionals operate with the assumption that racial and ethnic mi- norities never had such a thing as Counseling'and psychotherapy'until it was lhvented"and institutionalized in Western cultures. For the benefit of those people, the mental health movement has delegitimized natural help- giving networks that have operated for thousands of years by labeling them as unscientific, supernatural, mystical, and not consistent with professional standards of practice/Mental health professionals are then surprised to find that there is a high incidence of psychological distress in the minority com- munity, that their treatment techniques do not work, and that some cultur- ally diverse groups do not utilize their services. Contrary to this ethnocentric orientation, we need to expand our per- ception of what constitutes valid mental health practices. Equally legitimate methods of treatment are nonformal or natural support systems, so powerful in many minority groups family, friends, community self-help programs, and occupational networks) folk-healing methods, and indigenous formal systems of therapy Lee, 1996;Moodley &Vest, 2005) Instead of attempting

66 The Political Dimensions of Mental Health Practice to destroy these practices, we should be actively trying to find out why they may work better than Western forms of counseling and therapy. Definitions of Mental Health Counseling and psychotherapy tend to assume universal ^(applications of their concepts and goals to the exclusion of culture-specific {emic)views pra- guns, 2002) Likewise, graduate programs have often been accused of foster- ing cultural encapsulation, a term first coined by Wrenn } 9 62) The term refers specifically to 4)the substitution of modal stereotypes for the real world, b)the disregarding of cultural variations in a dogmatic adherence to some universal notion of truth, and £)the use of a technique-oriented definition of the counseling process. The results are that counselor roles are rigidly de- fined, implanting an implicit belief in a universal concept of healthy"and normal." If we look at criteria used by the mental health profession to judge nor- mality and abnormality, this ethnocentricity becomes glaring. Several funda- mental approaches that have particular relevance to our discussion have been identified p. Sue, D. W. Sue, 85. Sue, 2006)^)normality as a statis- tical concept, b)normality as ideal mental health, and ()abnormality as the presence of certain behaviors Research criteria) First, statistical criteria equate normality with those behaviors that oc- cur most frequently in the population. Abnormality is defined in terms of those behaviors that occur least frequently. In spite of the word statistical, however, these criteria need not be quantitative in nature:Individuals who talk to themselves, disrobe in public, or laugh uncontrollably for no apparent reason are considered abnormal according to these criteria simply because most people do not behave in that way. Statistical criteria undergirds our no- tion of a normal probability curve, so often used in IQ tests, achievement tests, and personality inventories. Statistical criteria may seem adequate in specific instances, but they are fraught with hazards and problems. For one thing, they fail to take into account differences in time, community stan- dards, and cultural values. If deviations from the majority are considered ab- normal, then many ethnic and racial minorities that exhibit strong cultural differences from the majority have to be so classified. When we resort to a sta- tistical definition, it is generally the group in power that determines what constitutes normality and abnormality. For example, if a group of African Americans were to be administered a personality test and it was found that they were more suspicious than their White counterparts, what would this mean? Some psychologists and educators have used such findings to label African Americans as paranoid. Statements by Blacks that The Man'ls out to get them may be perceived as supporting a paranoid delusion. This inter-

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pretation, however, has been challenged by many Black psychologists as being inaccurate GrierSEobbs, 1968, 1971;Guthrie, 1997;Parham, White, SAjamu, 1999) In response to their heritage of slavery and a history of White discrimination against them, African Americans have adopted various behaviors hi particular, behaviors toward Whites)that have proven impor- tant for survival in a racist society. Playing it cool'has been identified as one means by which Blacks, as well as members of other minority groups, may conceal their true thoughts and feelings. A Black person who is experiencing conflict, anger, or even rage may be skillful at appearing serene and com- posed. This tactic is a survival mechanism aimed at reducing one's vulnera- bility to harm and to exploitation in a hostile environment. The personality test that reveals Blacks as being suspicious, mistrustful, and paranoid needs to be understood from a larger social-political perspec- tive. Minority groups who have consistently been victims of discrimination and oppression in a culture that is full of racism have good reason to be sus- picious and mistrustful of White society. In their classic book Black Rage, Grier and Cobbs ^968)point out how Blacks, in order to survive in a White racist society, have developed a highly functional survival mechanism to protect them against possible physical and psychological harm. The authors perceive this Cultural paranoia "as adaptive and healthy rather than dysfunctional and pathological. Indeed, some psychologists of color have indicated that the absence of a paranorm among minorities may be more indicative of pathology than of its presence. The absence of a paranorm may indicate either poor reality testing denial of oppression/racism in our society)and/or naivetan understanding the operation of racism. Second, humanistic psychologists have proposed the concept of ideal mental health as a criteria of normality. Such criteria stress the importance of attaining some positive goal. For example, the consciousness-balance of psy- chic forces Freud, 1960; Jung, 1960) self-actualization/creativity Maslow, 1968; Rogers, 1961) competence, autonomy, and resistance to stress All- port, 1961;White, 1963) or self-disclosure jfourard, 1964)have all been his- torically proposed. The discriminatory nature of such approaches is grounded in the belief of a universal application ^11 populations in all situations)and reveals a failure to recognize the value base from which the criteria are de- rived. The particular goal or ideal used is intimately linked with the theoret- ical frame of reference and values held by the practitioner. For example, the psychoanalytic emphasis on insight as a determinant of mental health is a value in itself London, 1988) It is important for the mental health profes- sional to be aware, however, that certain socioeconomic groups and ethnic minorities do not particularly value insight. Furthermore, the use of self- disclosure as a measure of mental health tends to neglect the earlier discus- sion presented on the paranorm. One characteristic often linked to the healthy personality is the ability to talk about the deepest and most intimate

68 The Political Vimensions of Mental Health Practice aspects of one's life;to self-disclose. This orientation is very characteristic of our counseling and therapy process, in which clients are expected to talk about themselves in a very personal manner. The fact that many minorities are initially reluctant to self-disclose can place them in a situation where they are judged to be mentally unhealthy and in this case, paranoid Parham, 2002) Definitions of mental health such as competence, autonomy, and re- sistance to stress are related to White middle-class notions of individual ma- turity Ahuvia, 2001;Triandis, 2000) The mental health professions origi- nated from the ideological milieu of individualism Iyey, D'Andrea, Ivey, & Simek-Morgan, 2007) Individuals make their lot in life. Those who succeed in society do so because of their own efforts and abilities. Successful people are seen as mature, independent, and possessing great ego strength. Apart from the potential bias in defining what constitutes competence, autonomy, and resistance to stress, the use of such a person-focused definition of maturity places the responsibility on the individual. When a person fails in life, it is be- cause of his or her own lack of ability, interest, maturity, or some inherent weakness of the ego. If, on the other hand, we see minorities as being sub- jected to higher stress factors in society and placed in a one-down position by virtue of racism, then it becomes quite clear that the definition will tend to portray the lifestyle of minorities as inferior, underdeveloped, and deficient. Ryan J971)was the first to coin the phrase blaming the victim'to refer to this process. Yet a broader system analysis would show that the economic, so- cial, and psychological conditions of minorities are related to their oppressed status in America, as illustrated in our Katrina example. Third, an alternative to the previous two definitions of abnormality is a research one. For example, in determining rates of mental illness in different ethnic groups, psychiatric diagnosis, "presence in mental hospitals, "and scores on objective psychological inventories'are frequently used $amuda, 1998) Diagnosis and hospitalization present a circular problem. The defini- tion of normality-abnormality depends on what mental health practitioners say it is!In this case, the race or ethnicity of mental health professionals is likely to be different from that of minority clients. Bias on the part of the prac- titioner with respect to diagnosis and treatment is likely to occur £onstan- tine, Myers, Kindaichi, EMoore, 2004) The inescapable conclusion is that minority clients tend to be diagnosed differently and to receive less preferred modes of treatment Paniagua, 2001) Furthermore, the political and societal implications of psychiatric diag- nosis and hospitalization were forcefully pointed out nearly 40 years ago by Laing J 967, 1969)and Szasz ^970, 1971) While it appears that minorities underutilize outpatient services, they appear to face greater levels of invol- untary hospital commitments Snowden SCheung, 1990) Laing believes that individual madness is but a reflection of the madness of society. He de-

The Politics of Counseling and Psychotherapy 6 9

scribes schizophrenic breakdowns as desperate strategies by people to liber- ate themselves from a false self'used to maintain behavioral normality in our society. Attempts to adjust the person back to the original normality $ick society)are unethical. Szasz states this opinion even more strongly: In my opinion, mental illness is a myth. People we label "mentally ill" are not sick, and involuntary mental hospitalization is not treatment. It is punish- ment The fact that mental illness designates a deviation from an ethnical rule of conduct, and that such rules vary widely, explains why upper-middle-class psychiatrists can so easily find evidence of "mental illness " in lower-class indi- viduals; and why so many prominent persons in the past fifty years or so have been diagnosed by their enemies as suffering from some types of insanity. Barry Goldwater was called a paranoid schizophrenic Woodrow Wilson, a neu- rotic Jesus Christ, according to two psychiatrists . . . was a born degenerate with a fixed delusion system. (Szasz, 1970, pp. 167-168) Szasz \ 9&7, 1999)sees the mental health professional as an inquisitor, an agent of society exerting social control over those individuals who deviate in thought and behavior from the accepted norms of society. Psychiatric hos- pitalization is believed to be a form of social control for persons who annoy or disturb us. The label mental illness may be seen as a political ploy used to control those who are different, and therapy is used to control, brainwash, or reorient the identified victims to fit into society. It is exactly this concept that many people of color find frightening. For example, many Asian Americans, American Indians, African Americans, and Hispanic/Latino Americans are increasingly challenging the concepts of normality and abnormality. They be- lieve that their values and lifestyles are often seen by society as pathological and thus are unfairly discriminated against by the mental health professions Constantine, 2006) In addition, the use of 6bjective"psychological inventories as indica- tors of maladjustment may also place people of color at a disadvantage. Many are aware that the test instruments used on them have been constructed and standardized according to White middle-class norms. The lack of culturally unbiased instruments makes many feel that the results obtained are invalid. Indeed, in a landmark decision in the State of California I^arry P. v. California, 1986) a judge ruled in favor of the Association of Black Psychologists' claim that individual intelligence tests such as the WISC-R, WAIS-R, and Stanford Binet could not be used in the public schools on Black students. The improper use of such instruments can lead to an exclusion of minorities in jobs and pro- motion, to discriminatory educational decisions, and to biased determination of what constitutes pathology and cure in counseling/therapy Samuda, 1998) Further, when a diagnosis becomes a label, it can have serious conse- quences. First, a label can cause people to interpret all activities of the affected

70 The Political Dimensions of Mental Health Practice

individual as pathological. No matter what a Black person may do or say that breaks a stereotype, his or her behavior will seem to reflect the fact that he or she is less intelligent than others around him or her. Second, the label may cause others to treat an individual differently even when he or she is perfectly normal. Third, a label may cause those who are labeled to believe that they do indeed possess such characteristics Rosenthal 9acobson, 1968)or that the threats of being perceived as less capable can seriously impair their per- formance Steele, 1997;Steele Skronson, 1995) Curriculum and Training Deficiencies It appears that many of the universal definitions of mental health that have pervaded the profession have primarily been due to severe deficiencies in training programs. Various specialists £hen, 2001;Mio {Morris, 1990)have asserted that the major reason for ineffectiveness in working with culturally different populations is the lack of culturally sensitive material taught in the curricula. It has been ethnocentrically assumed that the material taught in traditional mental health programs is equally applicable to all groups. Even now, when there is high recognition of the need for multicultural curricula, it has become a battle to infuse such concepts into course content Vera, Buhin, SShin, 2006) As a result, course offerings continue to lack a non- White perspective, to treat cultural issues as an adjunct or add-on, to con- tinue portraying cultural groups in stereotypic ways, and to create an aca- demic environment that does not support minority concerns, needs, and issues £rieger ffoliver, 2001) Further, a major criticism has been that train- ing programs purposely leave out antiracism, antisexism and antihomopho- bia curricula for fear they require students to explore their own biases and prejudices garter, 2005;Vera, Buhin, gghin, 2006) Because multicultural competence cannot occur without students or trainees confronting these harmful and detrimental attitudes about race, gender, and sexual orientation, the education and training of psychologists remain at the cognitive and ob- jective domain, preventing self-exploration. It allows students to study the material from their positions of safety. The curriculum must also enable stu- dents to understand feelings of helplessness and powerlessness, low self- esteem, poor self-concept, and how they contribute to low motivation, frus- tration, hate, ambivalence, and apathy. Each course should contain ^)a consciousness-raising component, £)an affective •> 'experiential component, ?)a knowledge component, and 4)a skills component. Importantly, it was re- commended by the American Psychological Association £004)that psychol- ogy training programs at all levels provide information on the political nature of the practice of psychology, and that professionals need to Gwn"their value positions.

The Politics of Counseling and Vsychotherzpy 7 1 Counseling and Mental Health Literature Many writers have noted how the social science literature, and specifically research, has failed to create a realistic understanding of various ethnic groups in America (Juthrie, 1997;Samuda, 1998;Thomas Sillen, 1972)In fact, certain practices are felt to have done great harm to minorities, by ig- noring them, maintaining false stereotypes, and/or distorting their lifestyles. Mental health practice may be viewed as encompassing the use of social power and functioning as a handmaiden of the status quo Halleck, 1971; Katz, 1985) Social sciences are part of a culture-bound social system, from which researchers are usually drawn; moreover, organized social science is often dependent upon it for financial support. Ethnic minorities frequently see the mental health profession in a similar wayas- a discipline concerned with maintaining the status quo Highlen, 1996) As a result, the person col- lecting and reporting data is often perceived as possessing the social bias of his or her society. Social sciences, for example, have historically ignored the study of Asians in America pong fflomokos-Cheng Ham, 2001) This deficit has contributed to the perpetuation of false stereotypes, which has angered many younger Asians concerned with raising consciousness and group esteem. When studies have been conducted on minorities, research has been ap- pallingly unbalanced. Many social scientists |ones, 1997; Wilson EStith, 1991 )have pointed out how White social science'has tended to reinforce a negative view of African Americans among the public by concentrating on unstable Black families instead of on the many stable ones. Such unfair treat- ment has also been the case in studies on Latinos that have focused on the psychopathological problems encountered by Mexican Americans Falicov, 2005) Other ethnic groups, such as Native Americans button SBroken Nose, 2005)and Puerto Ricans parcia-Preto, 2005)have fared no better. Even more disturbing is the assumption that the problems encountered by minorities are due to intrinsic factors facial inferiority, incompatible value systems, etc.)rather than to the failure of society J
72 The Political Vimensions of Mental Health Practice

supremacist notions |ones, 1997; Samuda, 1998) The classic work of Thomas and Sillen i^972)refer to this as scientific racism and cite several his- torical examples to support their contention: \)l 840 census figures fabri- cated)were used to support the notion that Blacks living under unnatural conditions of freedom were prone to anxiety, £ (mental health for Blacks was contentment with subservience, ? (psychologically normal Blacks were faithful and happy-go-lucky, 4)influential medical journals presented fan- tasies as facts, supporting the belief that anatomical, neurological, or en- docrinological aspects of Blacks were always inferior to those of Whites, £)the Black person's brain is smaller and less developed, 6)Blacks were less prone to mental illness because their minds were so simple, and f) the dreams of Blacks are juvenile in character and not as complex as Whites. More frightening, perhaps, is a survey that found that many of these stereo- types continue to be accepted by White Americans:20 percent publicly ex- pressed a belief that African Americans are innately inferior in thinking abil- ity, 19 percent believe that Blacks have thicker craniums, and 23.5 percent believe they have longer arms than Whites Pious EWilliams, 1995) One wonders how many White Americans hold similar beliefs privately, but be- cause of social pressures do not publicly voice them. Furthermore, the belief that various human groups exist at different stages of biological evolution was accepted by G. Stanley Hall. He stated ex- plicitly in 1904 that Africans, Indians, and Chinese were members of adoles- cent races and in a stage of incomplete development. In most cases, the evi- dence used to support these conclusions was either fabricated, extremely flimsy, or distorted to fit the belief in non-White inferiority Thomas ffiillen, 1972) For example, Gossett \ 96 3 Reports that when one particular study in 1895 revealed that the sensory perception of Native Americans was superior to that of Blacks, and that of Blacks was superior to that of Whites, the results were used to support a belief in the mental superiority of Whites. Their re- actions were slower because they belonged to a more deliberate and reflec- tive race than did the members of the other two groups'p. 364) The belief that Blacks were born athletes, "as opposed to scientists or statesmen, de- rives from this tradition. The fact that Hall was a well-respected psychologist, often referred to as the father of child study/and first president of the Amer- ican Psychological Association, did not prevent him from inheriting the racial biases of the times. The Genetically Deficient Model The portrayal of people of color in literature has generally taken the form of stereotyping them as deficient in certain desirable attributes. For example, de Gobineau's \9\5) Essay on the Inequality of the Human Races and Darwin's (1859) The Origin of Species by Means of Natural Selection were used to support the genetic intellectual superiority of Whites and the genetic inferiority of the

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Tower races. "Galton }869)wrote explicitly that African Negroes"were half-witted men'who made Childish, stupid and simpleton like mistakes," while Jews were inferior physically and mentally and only designed for a par- asitical existence on other nations of people. Terman (f 916) using the Binet scales in testing Black, Mexican American, and Spanish Indian families, con- cluded that they were uneducable. The genetically deficient model is present in the writings of educational psychologists and academicians. In 1989, Professor Rushton of the University of Western Ontario claimed that human intelligence and behavior were largely determined by race, that Whites have bigger brains than Blacks, and that Blacks are more aggressive $amuda, 1998) Shockley }972)has ex- pressed fears that the accumulation of weak or low intelligence genes in the Black population will seriously affect overall intelligence. Thus, he advocates that people with low IQs should not be allowed to bear children;they should be sterilized. Allegations of scientific racism can also be seen in the work of the late Cyril Burt, eminent British psychologist, who fabricated data to sup- port his contention that intelligence is inherited and that Blacks have inher- ited inferior brains. Such an accusation is immensely important when one considers that Burt is a major influence in American and British psychology, is considered by many to be the father of educational psychology, was the first psychologist to be knighted, was awarded the APA's Thorndike Prize, and that his research findings form the foundation for the belief that intelligence is in- herited. The publication of The Bell Curve Herrnstein {Murray, 1 994)continues to echo the controversy in both the public and academic domains. The two authors assert that intelligence is inherited to a large degree, race is correlated with intellect, and programs such as Head Start and Affirmative Action should be banished because they do no good. Instead, resources and funding should be reallocated to those who can profit from it ^leaning White Amer- icans) Samuda }998)concludes about the authors:Simply stated, they es- sentially recommend that those of lower intelligence should serve those of higher intelligence "p. 175) He further concludes: The Bell Curve remains astonishingly antiquated and immune to evidence from the physiological and neurobiological sciences, quantitative genetics, and statistical theory, and it overlooks the significance of environmental factors that research has uncov- ered'p. 176) The questions about whether there are differences in intelligence be- tween races are both complex and emotional. The difficulty in clarifying this question is compounded by many factors. Besides the difficulty in defining face, "there exist questionable assumptions regarding whether research on the intelligence of Whites can be generalized to other groups, whether middle-class and lower-class ethnic minorities grow up in similar environ- ments to middle- and lower-class Whites, and whether test instruments are

74 The Political Dimensions of Mental Health Practice

valid for both minority and White subjects. More important, we should rec- ognize that the average values of different populations tells us nothing about any one individual. Heritability is a function of the population, not a trait. Eth- nic groups all have individuals in the full range of intelligence, and to think of any racial group in terms of a single stereotype goes against all we know about the mechanics of heredity. Yet, much of social science literature con- tinues to portray ethnic minorities as being genetically deficient in one sense or another. Those interested in both the issues and consequences in the test- ing of American minorities and the technical and sociopolitical analyses of The Bell Curve are directed to the excellent rebuttal by Samuda |998) The Culturally Deficient Model. Well-meaning social scientists who challenged the genetic deficit model by placing heavy reliance on environmental factors nevertheless tended to per- petuate a view that saw minorities as culturally disadvantaged, deficient, or deprived. Instead of a biological condition that caused differences, the blame now shifted to the lifestyles or values of various ethnic groups pana, 1993; Sumada, 1998) The term cultural deprivation was first popularized by Riess- man's widely read book, The Culturally Deprived Child \ 962) It was used to in- dicate that many groups perform poorly on tests or exhibit deviant charac- teristics because they lack many of the advantages of middle-class culture Education, books, toys, formal language, etc.) In essence, these groups were culturally impoverished! While Riessman introduced such a concept so as to add balance to work- ing with minorities and ultimately to improve their condition in America, some educators strenuously objected to the term. First, the term culturally de- prived means to lack a cultural background Enslaved Blacks arrived in Amer- ica culturally naked) which is contradictory, because everyone inherits a cul- ture. Second, such terms cause conceptual and theoretical confusions that may adversely affect social planning, educational policy, and research. For example, the oft-quoted Moynihan Report ^toynihan, 1965)asserts that St the heart of deterioration of the Negro society is the deterioration of the Black family. It is the fundamental source of the weakness in the Negro commu- nity]!. 5) Action was thus directed toward infusing White concepts of the family into those of Blacks. Third, cultural deprivation is used synonymously with deviation from and superiority of White middle-class values. Fourth, these deviations in values become equated with pathology, in which a group's cultural values, families, or lifestyles transmit the pathology. Thus it provides a convenient rationalization and alibi for the perpetuation of racism and the inequities of the socioeconomic system. The Culturally Diverse Model. There are many who now maintain that the culturally deficient model only serves to perpetuate the myth of minority inferiority. The focus tends to be a

The Politics of Counseling and Psychotherapy 7 5

person-blame one, an emphasis on minority pathology, and a use of White middle-class definitions of desirable and undesirable behavior. The social science use of a common, standard assumption implies that to be different is to be deviant, pathological, or sick. Is it possible that intelligence and person- ality scores for minority group children really measure how Anglicized a per- son has becomeTrherefore, minorities should no longer be viewed as defi- cient, but rather as culturally diverse. The goal of society should be to recognize the legitimacy of alternative lifestyles, the advantages of being bicultural Ca- pable of functioning in two different cultural environments) and the value of differences.

Relevance of Research

So far, our discussion of minority portrayal in the professional literature has been a general one. We have made minimal reference to research as it relates to minorities in particular. Research findings are supposed to form the basis of any profession that purports to be a science. The data generated from research should be objective and free of bias. As we have seen in the last sec- tion, what a researcher proposes to study and how he or she interprets such findings are intimately linked to a personal, professional, and societal value system. Cheek }987)goes so far as to assert that Social science is a vehicle of White supremacy." It is an inescapable conclusion that personal and societal values often affect the interpretation of data as it relates to minorities Atkinson, Bui, & Mori, 2001) A very similar analogy can be drawn with respect to the mental health profession. For example, the profession's preoccupation with pathol- ogy tends to encourage the study of personality deficits and weaknesses rather than strengths or assets. Racist attitudes may intensify this narrow view, as minorities may be portrayed in professional journals as a neurotic, psychotic, psychopath, parolee, and so on, instead of as a well-rounded person. It is not surprising that minority groups are often suspicious of the mo- tives of the researcher. The researcher of ethnic matters may find his or her attitudes and values toward minority groups being challenged. No longer can the researcher claim that research is solely in the interest of science and is morally neutral. The late Carl Rogers, a well-known humanistic psychologist, stated, If behavioral scientists are concerned solely with advancing their science, it seems most probable that they will serve the purpose of whatever group has the power"4uoted in Brecher EBrecher, 1961, p. 20) C. W. Thomas }970)has even voiced this thought in stronger form: White psychologists have raped Black communities all over the country. Yes raped. They have used Black people as the human equivalent of rats run through

76 The Political Dimensions of Mental Health Practice Ph.D. experiments and as helpless clients for programs that serve middle-class White administrators better than they do the poor. They have used research on Black people as green stamps to trade for research grants. They have been vul- tures, (p. 52) Blacks point to what is known as the Tuskegee experiment'as a prime example of this allegation. The Tuskegee experiment was carried out from 1932 to 1972 by the U.S. Public Health Service, in which over 600 Alabama Black men were used as guinea pigs in the study of what damage would oc- cur to the body if syphilis were left untreated. Approximately 399 were allowed to go untreated, even when medication was available. Records indi- cate that seven died as a result of syphilis, and an additional 1 54 died of heart disease that may have been caused by the untreated syphilis !In a moving cer- emony in 1997, President Clinton officially expressed regret for the experi- ment to the few survivors and apologized to Black America. Experiments of this type are ghastly, and give rise to suspicions that people of color are being used as guinea pigs in other experiments of this sort. It is this type of study and others that portray people of color as deviants that makes minorities ex- tremely distrustful about the motives of the White researcher. Whereas social scientists in the past have been able to enter ethnic communities and conduct their studies with only minimal justification to those studied, researchers are now being received with suspicion and overt hostility. Minorities are actively raising questions and issues regarding the values system of researchers and the outcome of their research. The question increasingly asked relates to the motives of the researcher. Is research conducted for some definable good, or is it opportunistic, exploitative, and potentially damaging to the target popu- lations?

If the mental health profession and its practitioners are to receive acceptance from marginalized groups in our society, they must demonstrate, in no un- certain terms, their good faith and their ability to contribute to the betterment of a group's quality of life. This demonstration can take several directions. 1 . The mental health profession must take the initiative in confronting the potential political nature of mental health practice. For too long we have deceived ourselves into believing that the practice of counseling/ therapy and the database that underlie the profession are morally, eth- ically, and politically neutral. The results have been ^subjugation of minority groups, b (perpetuation of the view that they are inherently pathological, perpetuation of racist practices in treatment, and

The Politics of Counseling and Psychotherapy 77 d)provision of an excuse to the profession for not taking social action to rectify inequities in the system. 2. Mental health professionals must move quickly to challenge certain as- sumptions that permeate our training programs. We must critically re- examine our concepts of what constitutes normality and abnormality, begin mandatory training programs that deal with these issues, critically examine and reinterpret past and continuing literature dealing with the culturally different, and use research in such a manner as to improve the life conditions of the researched populations. 3. We must make sure that educational programs can no longer present a predominantly White Anglo-Saxon Protestant WASP)orientation. The study of minority group cultures must receive equal treatment and fair portrayal on all levels of education. Courses dealing with minority group experiences and internship practices must become a required part of the training programs. 4. Research can be a powerful means of combating stereotypes and of cor- recting biased studies. The fact that previous studies have been used to perpetuate stereotypes does not preclude the usefulness of research. If social scientists believe that research has been poorly conducted or mis- interpreted to the detriment of minority groups, they should feel some moral commitment to investigate their beliefs. Researchers cannot es- cape the moral and ethical implications of their research and must take responsibility for the outcome of their studies. They must guard against misinterpretations and take into account cultural factors and limitations of their instruments. 5. Social scientists must realize that many so-called pathological socio- emotional characteristics of ethnic minorities can be directly attributed to unfair practices in society. There must be a shift in research, from focusing on the poor and culturally diverse to focusing on the groups and institutions that have perpetuated racism and obstructed needed changes. 6. We need to balance our study by also focusing on the positive attributes and characteristics of ethnic minorities. Social scientists have had a ten- dency to look for pathology and problems among minorities. Too much research has concentrated on the mental health problems and cultural conflict of minorities, while little has been done to determine the ad- vantages of being bicultural. Hopefully, such an orientation will do much to present a more balanced picture of different minority groups.

Sociopolitical Implications of OppressiomTmst and Mistrust in Counseling/Therapy

I have worked with very few African American clients during my intern- ship at the clinic, but one particular incident left me with very negative feelings. A Black client named Malachi was given an appointment with me. Even though I'm White, I tried not to let his being Black get in the way of our sessions. I treated him like everyone else, a human being who needed help. At the onset, Malachi was obviously guarded, mistrustful, and frus- trated when talking about his reasons for coming. While his intake form listed depression as the problem, he seemed more concerned about non- clinical matters. He spoke about his inability to find a job, about the need to obtain help with job-hunting skills, and about advice in how best to write his resume. He was quite demanding in asking for advice and infor- mation. It was almost as if Malachi wanted everything handed to him on a silver platter without putting any work into our sessions. Not only did he appear reluctant to take responsibility to change his own life, but I felt he needed to go elsewhere for help. After all, this was a mental health clinic, not an employment agency. Confronting him about his avoidance of re- sponsibility would probably prove counterproductive, so I chose to focus on his feelings. Using a humanistic-existential approach, I reflected his feel- ings, paraphrased his thoughts, and summarized his dilemmas. This did not seem to help immediately, as I sensed an increase in the tension level, and he seemed antagonistic toward me. After several attempts by Malachi to obtain direct advice from me, I stated, " You 're getting frustrated at me because I'm not giving you the an- swers you want. " It was clear that this angered Malachi. Getting up in a very menacing manner, he stood over me and angrily shouted, "Forget it, man! I don 't have time to play your silly games. " For one brief moment, I felt in danger of being physically assaulted before he stormed out of the office. This incident occurred sever aly ears ago, and I must admit that I was left with a very unfavorable impression of Blacks. I see myself as basically a good person who truly wants to help others less fortunate than myself. I



80 The Political Dimensions of Mental Health Practice know it sounds racist, but Malachi's behavior only reinforces my belief that Blacks have trouble controlling their anger, like to take the easy way out, and find it difficult to be open and trusting of others. If I am wrong in this belief, I hope this workshop [multicultural counseling /therapy] will help me better under- stand the Black personality. A variation of the above incident was supplied at an in-service training workshop by a White male therapist, and is used here to illustrate some of the major issues addressed in this chapter. In Chapter 3 we asserted that mental health practice is strongly influenced by historical and current sociopolitical forces that impinge on issues of race, culture, and ethnicity. Specifically, we made a point that £)the therapeutic session is often a mi- crocosm of race relations in our larger society, b)the therapist often inherits the biases of his or her forebears, and ()therapy represents a primarily Euro- American activity that may clash with the worldviews of culturally diverse clients. In this case, we question neither the sincerity of the White therapist nor his desire to help the African American client. However, it is obvious to us that the therapist is part of the problem and not the solution. The male therapist's preconceived notions and stereotypes about African Americans appear to have affected his definition of the problem, assessment of the situ- ation, and therapeutic intervention. Let us analyze this case in greater detail to illustrate our contention. First, statements about Malachi's wanting things handed to him on a Silver platter/his avoidance of responsibility, "and his wanting to take the easy way out'are symbolic of social stereotypes that Blacks are lazy and un- motivated. The therapist's statements that African Americans have difficulty Controlling their anger, "that Malachi was menacing, "and that the thera- pist was in fear of being assaulted seem to paint the picture of the hostile, an- gry, and violent Black male-again an image of African Americans to which many in this society consciously and unconsciously subscribe. While it is al- ways possible that the client was unmotivated and prone to violence, studies suggest that White Americans continue to cling to the image of the danger- ous, violence-prone, and antisocial image of Black men |. M. Jones, 1997) Is it possible, however, that Malachi has a legitimate reason for being angry? Is it possible that the therapist and the therapeutic process are contributing to Malachi's frustration and angerls it possible that the therapist was never in physical danger, but that his own affectively based stereotype of the danger- ous Black male caused his unreasonable fear?Might not this potential mis- interpretation be a clash of different communications styles that triggers un- realistic racial fears and apprehensionsWe strongly encourage you to explore these questions with colleagues and students. Second, mental health practice has been characterized as primarily a

Sociopolitical I triplications of Oppression 8 1

White middle-class activity that values rugged individualism, individual re- sponsibility, and autonomy. Because people are seen as being responsible for their own actions and predicaments, clients are expected to make decisions on their own "and to be primarily responsible for their fate in life/The tra- ditional therapist's role should be to encourage self- exploration so that the client can act on his or her own behalf. The individual-centered approach tends to view the problem as residing within the person. If something goes wrong, it is the client's fault. In the last chapter we pointed out how many problems encountered by minority clients reside externally to them bias, dis- crimination, prejudice, etc.)and that they should not be faulted for the ob- stacles they encounter. To do so is to engage in victim blaming Ridley, 2005; W. Ryan, 1971) Third, therapists are expected to avoid giving advice or suggestions and disclosing their thoughts and feelingsnet only because they may unduly influence their clients and arrest their individual development, but also be- cause they may become emotionally involved, lose their objectivity, and blur the boundaries of the helping relationship pack-Brown EWilliams, 2003) Parham J997)states, however, that a fundamental African principle is that human beings realize themselves only in moral relations to others Collectiv- ity, not individuality) Consequently, application of an African-centered worldview will cause one to question the need for objectivity absent emo- tions, the need for distance rather than connectedness, and the need for dichotomous relationships rather than multiple roles"p. 110) In other words, from an African American perspective, the helper and helpee are not separated from one another but are bound together both emotionally and spiritually. The Euro-American style of objectivity encourages separation that may be interpreted by Malachi as uninvolved, uncaring, insincere, and dis- honest-fchat is, playing silly games." Fourth, the more active and involved role demanded by Malachi goes against what the helping profession considers therapy. 'Studies seem to in- dicate that clients of color prefer a therapeutic relationship in which the helper is more active, self-disclosing, and not adverse to giving advice and suggestions when appropriate p. W. Sue, Ivey, fPedersen, 1996) The ther- apist in this scenario fails to entertain the possibility that requests for advice, information, and suggestions may be legitimate and not indicative of patho- logical responding. The therapist has been trained to believe that his role as a therapist is to be primarily nondirective;therapists do therapy, 'hot provide job-hunting information. This has always been the conventional counseling and psychotherapy role, one whose emphasis is a one-to-one, in-the-office, and remedial relationship aimed at self-exploration and the achievement of insight Atkinson, Thompson, SGrant, 1993) We will have more to say about how these generic characteristics of counseling and psychotherapy

82 The Political Vimensions of Mental Health Practice may act as barriers to effective multicultural counseling/therapy in the next chapter. Many of the previous conflicts lead us to our fifth point. If the male ther- apist is truly operating from unconscious biases, stereotypes, and precon- ceived notions with his culturally different client, then much of the problem seems to reside within him and not with Malachi. In almost every introduc- tory text on counseling and psychotherapy, lip service is paid to the axiom, Counselor, know thyself. 'In other words, therapeutic wisdom endorses the notion that we become better therapists the more we understand our own motives, biases, values, and assumptions about human behavior. Unfortu- nately as indicated in the last chapter, most training programs are weak in having their students explore their values, biases, and preconceived notions in the area of racist/sexist/homophobic attitudes, beliefs, and behaviors. We are taught to look at our clients, to analyze them, and to note their weak- nesses, limitations, and pathological trends;less often do we either look for positive healthy characteristics in our clients or question our conclusions. Questioning our own values and assumptions, the standards that we use to judge normality and abnormality and our therapeutic approach is infre- quently done. As mental health professionals, we may find it difficult and un- pleasant to explore our racism, sexism, and homophobia, and our training often allows us the means to avoid it. When the therapist ends his story by stating that he hopes the workshop will help me better understand the Black personality, "his worldview is clearly evident. There is an assumption that multicultural counseling/ther- apy simply requires the acquisition of knowledge, and that good intentions are all that is needed. This statement represents one of the major obstacles to self-awareness and dealing with one's own biases and prejudices. While we tend to view prejudice, discrimination, racism, and sexism as overt and in- tentional acts of unfairness and violence, unintentional and covert forms of bias may be the greater enemy because they are unseen and more pervasive. Like this therapist, well-intentioned individuals experience themselves as moral, just, fair-minded, and decent. Thus, it is difficult for many mental health professionals to realize that what they do or say may cause harm to their minority clients: Unintentional behavior is perhaps the most insidious form of racism. Uninten- tional racists are unaware of the harmful consequences of their behavior. They may be well-intentioned, and on the surface, their behavior may appear to be re- sponsible. Because individuals, groups, or institutions that engage in uninten- tional racism do not wish to do harm, it is difficult to get them to see themselves as racists. They are more likely to deny their racism The major challenge fac- ing counselors is to overcome unintentional racism and provide more equitable service delivery. (Ridley, 1995, p. 38)

Sociopolitical I implications of Oppression 8 3

Sixth, the therapist states that he tried to not let Malachi's being Black get in the way"of the session and that he treated him like any other human being/This is a very typical statement made by Whites who un- consciously subscribe to the belief that being Black, Asian American, Latino American, or a person of color is the problem. In reality, color is not the problem. It is society's perception of color that is the problem! In other words, the locus of the problem Racism, sexism, and homophobia (resides not in marginalized groups, but in the society at large. Often this view of race is manifested in the myth of color blindness:If color is the problem, let's pretend not to see it. Our contention, however, is that it is nearly impossible to overlook the fact that a client is Black, Asian American, Hispanic, and so forth. When operating in this manner, color-blind therapists may actually be obscuring their understandings of who their clients really are. To over- look one's racial group membership is to deny an intimate and important aspect of one's identity. Those who advocate a color-blind approach seem to operate under the assumption that Black is bad and that to be different is to be deviant. Last, and central to the thesis of this chapter, is the statement by the counselor that Malachi appears guarded and mistrustful and has difficulty being open ^elf-disclosing) We have mentioned several times that a coun- selor's inability to establish rapport and a relationship of trust with culturally diverse clients is a major therapeutic barrier. When the emotional climate is negative, and when little trust or understanding exists between the therapist and the client, therapy can be both ineffective and destructive. Yet if the emo- tional climate is realistically positive and if trust and understanding exist be- tween the parties, the two-way communication of thoughts and feelings can proceed with optimism. This latter condition is often referred to as rapport, and sets the stage in which other essential conditions can become effective. One of these, self-disclosure, is particularly crucial to the process and goals of counseling because it is the most direct means by which an individual makes him- or herself known to another. This chapter attempts to discuss the issue of trust as it relates to minor- ity clients. Our discussion does not deal with cultural variables among certain groups Asian Americans, American Indians, etc.)that dictate against self- disclosure to strangers. This topic is presented in Chapter 6. We first present a brief discussion of the sociopolitical situation as it affects the trust-mistrust dimension of certain culturally diverse populations. Second, we look at fac- tors that enhance or negate the therapist's cultural effectiveness as it relates to the theory of social influence. Third, we systematically examine how ther- apist credibility and similarity affect a client's willingness to work with a ther- apist from another race/culture.

84 The Political Dimensions of Mental Health Practice Effects of Historical and Current Oppression Mental health practitioners must realize that racial/ethnic minorities and other marginalized groups
Sociopolitical I triplications of Oppression 8 5

historical origins of education, counseling/guidance, and our mental health systems, which have their roots in Euro-American or Western cultures pigh- len, 1994;Wehrly, 1995) As a result, American p. S. psychology has been severely criticized as being ethnocentric, monocultural, and inherently bi- ased against racial/ethnic minorities, women, gays/lesbians, and other cul- turally diverse groups Constantine ffiue, 2006;Laird SSreen, 1996;Ridley, 2005) As voiced by many multicultural specialists, our educational system and counseling/psychotherapy have often done great harm to our minority citizens. Rather than educate or heal, rather than offer enlightenment and freedom, and rather than allow for equal access and opportunities, historical and current practices have restricted, stereotyped, damaged, and oppressed the culturally different in our society. In light of the increasing diversity of our society, mental health profes- sionals will inevitably encounter client populations that differ from them- selves in terms of race, culture, and ethnicity. Such changes, however, are be- lieved to pose no problems as long as psychologists adhere to the notion of an unyielding, universal psychology that is applicable across all populations. While few mental health professionals would voice such a belief, in reality the very policies and practices of mental health delivery systems do reflect such an ethnocentric orientation. The theories of counseling and psycho- therapy, the standards used to judge normality-abnormality, and the actual process of mental health practice are culture-bound and reflect a monocul- tural perspective of the helping professions pighlen, 1994; Katz, 1985; D. Sue, 1990) As such, they are often culturally inappropriate and antagonis- tic to the lifestyles and values of minority groups in our society. Indeed, some mental health professionals assert that counseling and psychotherapy may be handmaidens of the status quo, instruments of oppression, and transmitters of society's values palleck, 1971;D. W. Sue Sue, 1990;A. Thomas Sillen, 1972) We believe that ethnocentric monoculturalism is dysfunctional in a pluralistic society such as the United States. It is a powerful force, however, in forming, influencing, and determining the goals and processes of mental health delivery systems. As such, it is very important for mental health pro- fessionals to unmask or deconstruct the values, biases, and assumptions that reside in it. Ethnocentric monoculturalism combines what Wrenn J 962, 1985)calls cultural encapsulation and what J. M. Jones \912, 1997)refers to as cultural racism. Five components of ethnocentric monoculturalism have been identified p. W. Sue, 2004;D. W. Sue et al., 1998) Belief in Superiority First, there is a strong belief in the superiority of one group's cultural heritage history, values, language, traditions, arts/crafts, etc.) The group norms and values are seen positively, and descriptors may include such phrases as more

86 The Political Vimensions of Mental Health Practice advanced"and fnore civilized. "Members of the society may possess con- scious and unconscious feelings of superiority and feel that their way of do- ing things is the best way. In our society White Euro-American cultures are seen as not only desirable, but normative as well. Physical characteristics such as light complexion, blond hair, and blue eyes; cultural characteristics such as a belief in Christianity <>r monotheism) individualism, Protestant work ethic, and capitalism;and linguistic characteristics such as standard English, control of emotions, and the written tradition are highly valued components of Euro- American culture J
Sociopolitical I triplications of Oppression 8 7

Power to Impose Standards Third, the dominant group possesses the power to impose their standards and beliefs on the less powerful group. This third component of ethnocentric monoculturalism is very important. All groups are to some extent ethnocen- tric;that is, they feel positively about their cultural heritage and way of life. Minorities can be biased, can hold stereotypes, and can strongly believe that their way is the best way. Yet if they do not possess the power to impose their values on others, then hypothetically they cannot oppress. It is power or the unequal status relationship between groups that defines ethnocentric mono- culturalism. The issue here is not to place blame but to speak realistically about how our society operates. Ethnocentric monoculturalism is the indi- vidual, institutional, and cultural expression of the superiority of one group's cultural heritage over another combined with the possession of power to im- pose those standards broadly on the less powerful group. Since minorities generally do not possess a share of economic, social, and political power equal to that of Whites in our society, they are generally unable to discriminate on a large-scale basis. The damage and harm of oppression is likely to be one- sided, from majority to minority group. Manifestation in Institutions Fourth, the ethnocentric values and beliefs are manifested in the programs, policies, practices, structures, and institutions of the society. For example, chain-of-command systems, training and educational systems, communica- tions systems, management systems, and performance appraisal systems often dictate and control our lives. Ethnocentric values attain Untouchable and godfather-like"status in an organization. Because most systems are monocultural in nature and demand compliance, racial/ethnic minorities and women may be oppressed. J. M. Jones (^997)labels institutional racism as a set of policies, priorities, and accepted normative patterns designed to subjugate, oppress, and force dependence of individuals and groups on a larger society. It does this by sanctioning unequal goals, unequal status, and unequal access to goods and services. Institutional racism has fostered the en- actment of discriminatory statutes, the selective enforcement of laws, the blocking of economic opportunities and outcomes, and the imposition of forced assimilation/acculturation on the culturally different. The sociopoliti- cal system thus attempts to define the prescribed role occupied by minorities. Feelings of powerlessness, inferiority, subordination, deprivation, anger and rage, and overt/covert resistance to factors in interracial relationships are likely to result. The Invisible Veil Fifth, since people are all products of cultural conditioning, their values and beliefs ^vorldviews Represent an invisible veil that operates outside the level

88 The Political Vimensions of Mental Health Practice

of conscious awareness. As a result, people assume universality:that regard- less of race, culture, ethnicity, or gender, everyone shares the nature of reality and truth. This assumption is erroneous but is seldom questioned because it is firmly ingrained in our worldview. Racism, sexism, and homophobia may be both conscious intentional )and unconscious Unintentional) Neo-Nazis, skinheads, and the Ku Klux Klan would definitely fall into the first category. While conscious and intentional racism as exemplified by these individuals, for example, may cause great harm to culturally different groups, it is the lat- ter form that may ultimately be the most insidious and dangerous. As men- tioned earlier, it is the well-intentioned individuals who consider themselves moral, decent, and fair-minded who may have the greatest difficulty in un- derstanding how their belief systems and actions may be biased and preju- diced. It is clear that no one is born wanting to be racist, sexist, or homopho- bic. Misinformation related to culturally diverse groups is not acquired by our free choice, but rather is imposed through a painful process of social condi- tioning;all of us were taught to hate and fear others who are different in some way p. W. Sue, 2003) Likewise, because all of us live, play, and work within organizations, those policies, practices, and structures that may be less than fair to minority groups are invisible in controlling our lives. Perhaps the great- est obstacle to a meaningful movement toward a multicultural society is our failure to understand our unconscious and unintentional complicity in per- petuating bias and discrimination via our personal values/beliefs and our in- stitutions. The power of racism, sexism, and homophobia is related to the in- visibility of the powerful forces that control and dictate our lives. In a strange sort of way, we are all victims. Minority groups are victims of oppression. Ma- jority group members are victims who are unwittingly socialized into the role of oppressor. Historical Manifestations of Ethnocentric Monoculturalism The European-American worldview can be described as possessing the fol- lowing values and beliefs: rugged individualism, competition, mastery and control over nature, a unitary and static conception of time, religion based on Christianity, separation of science and religion, and competition |
Sociopolitical I triplications of Oppression 8 9

toms, and practices were seen as backward and uncivilized, and attempts were made to make over the heathens. "Such a belief is also reflected in Euro-American culture and has been manifested also in attitudes toward other racial/ethnic minority groups in the United States. A common belief is that racial/ethnic minorities would not encounter problems if they assimilate and acculturate. Monocultural ethnocentric bias has a long history in the United States and is even reflected as early as the uneven application of the Bill of Rights," which favored White immigrants/descendants over minority"populations Barongan et al., 1997) Over some 200 years ago, Britain's King George 111 accepted a Declaration of mdependence'from former subjects who moved to this country. This proclamation was destined to shape and reshape the geopolitical and sociocultural landscape of the world many times over. The lofty language penned by its principal architect, Thomas Jefferson, and signed by those present was indeed inspiring: We hold these truths to be self- evident, that all men are created equal." Yet as we now view the historic actions of that time, we cannot help but be struck by the paradox inherent in those events. First, all 56 of the signato- ries were White males of European descent, hardly a representation of the cur- rent racial and gender composition of the population. Second, the language of the declaration suggests that only men were created equal; what about women Third, many of the founding fathers were slave owners who seemed not to recognize the hypocritical personal standards that they used because they considered Blacks to be subhuman. Fourth, the history of this land did not start with the Declaration of Independence or the formation of the United States of America. Nevertheless, our textbooks continue to teach us an ethno- centric perspective Western Civilization)that ignores over two thirds of the world's population. Last, it is important to note that those early Europeans who came to this country were immigrants attempting to escape persecution Oppression) who in the process did not recognize their own role in the op- pression of indigenous peoples American Indians)who had already resided in this country for centuries. As Barongan et al. \997, p. 654)described, the natural and inalienable rights of individuals valued by European and Eu- ropean American societies generally appear to have been intended for European Americans only. How else can European colonization and exploitation of Third World countries be explained? How else can the forced removal of Native Amer- icans from their lands, centuries of enslavement and segregation of African Americans, immigration restrictions on persons of color through history, incar- ceration of Japanese Americans during World War II, and current English-only language requirements in the United States be explained? These acts have not been perpetrated by a few racist individuals, but by no less than the governments of the North Atlantic cultures If Euro-American ideals include a philosophi-

90 The Political Vimensions of Mental Health Practice

cal or moral opposition to racism, this has often not been reflected in policies and behaviors. We do not take issue with the good intentions of the early founders. Nor do we infer in them evil and conscious motivations to oppress and dominate others. Yet the history of the United States has been the history of oppression and discrimination against racial/ethnic minorities and women. The Western European cultures that formed the fabric of the United States of America are relatively homogeneous compared not only to the rest of the world, but also to the increasing diversity in this country. This Euro-American worldview continues to form the foundations of our educational, social, economic, cul- tural, and political systems. As more and more White immigrants came to the North American con- tinent, the guiding principle of blending the many cultures became codified into such concepts as the melting pot'and assimilation/acculturation. The most desirable outcome of this process was a uniform and homogeneous con- solidation of culturesin- essence, to become monocultural. Many psychol- ogists of color, however, have referred to this process as cultural genocide, an outcome of colonial thought G-uthrie, 1997;Parham et al., 1999;Samuda, 1998;A. Thomas fiBillen, 1972) Wehrly f 995, p. 24)states, Cultural as- similation, as practiced in the United States, is the expectation by the people in power that all immigrants and people outside the dominant group will give up their ethnic and cultural values and will adopt the values and norms of the dominant society-the White, male Euro- Americans." While ethnocentric monoculturalism is much broader than the concept of race, it is race and color that have been used to determine the social order Carter, 1995) The White race 'has been seen as being superior and White culture as normative. Thus, a study of U.S. history must include a study of racism and racist practices directed at people of color. The oppression of the indigenous people of this country Native Americans) enslavement of African Americans, widespread segregation of Hispanic Americans, passage of exclusionary laws against the Chinese, and the forced internment of Japanese Americans are social realities. Thus it should be of no surprise that our racial/ethnic minority citizens may view Euro-Americans and our very institutions with considerable mistrust and suspicion. In health care delivery systems and especially in counseling and psychotherapy, which demand a certain degree of trust among therapist and client groups, an interracial en- counter may be fraught with historical and current psychological baggage related to issues of discrimination, prejudice, and oppression. Carter \995, p. 27)draws the following conclusion related to mental health delivery sys- tems:Because any institution in a society is shaped by social and cultural forces, it is reasonable to assume that racist notions have been incorporated into the mental health systems."

Sociopolitical I triplications of Oppression 9 1

Therapeutic Impact of Ethnocentric Monoculturalism Many multicultural specialists JCochman, 1981;Locke, 1998;Parham, 2002; Ponterotto, Utsey, fPedersen, 2006)have pointed out how African Ameri- cans, in responding to their forced enslavement, history of discrimination, and America's reaction to their skin color, have adopted toward Whites be- havior patterns that are important for survival in a racist society These be- havior patterns may include indirect expressions of hostility, aggression, and fear. During slavery, to rear children who would fit into a segregated system and who could physically survive, African American mothers were forced to teach them 4)to express aggression indirectly, b)to read the thoughts of oth- ers while hiding their own, and £)to engage in ritualized accommodating- subordinating behaviors designed to create as few waves as possible. This pro- cess involves a mild dissociation'whereby African Americans may separate their true selves from their roles as Negroes"Boyd-Franklin, 2003; C. A. Pinderhughes, 1973) In this dual identity the true self is revealed to fellow Blacks, while the dissociated self is revealed to meet the expectations of prej- udiced Whites. From the analysis of African American history, the dissocia- tive process may be manifested in two major ways. First, playing it cool"has been identified as one means by which Af- rican Americans or other minorities may conceal their true feelings Boyd- Franklin, 2003; Cross, Smith, ffayne, 2002;Grier SCobbs, 1971; A. C. Jones, 1985) This behavior is intended to prevent Whites from knowing what the minority person is thinking or feeling and to express feelings and behaviors in such a way as to prevent offending or threatening Whites |ones SShorter-Gooden, 2003;Ridley, 2005) Thus, a person of color who is expe- riencing conflict, explosive anger, and suppressed feelings may appear serene and composed on the surface. This is a defense mechanism aimed at protect- ing minorities from harm and exploitation. Second, the Uncle Tom syndrome may be used by minorities to appear docile, nonassertive, and happy-go- lucky. Especially during slavery, Blacks learned that passivity is a necessary survival technique. To retain the most menial jobs, to minimize retaliation, and to maximize survival of the self and loved ones, many minorities have learned to deny their aggressive feelings toward their oppressors. The overall result of the experiences of minorities in the United States has been to increase their vigilance and sensitivity to the thoughts and be- haviors of Whites in society. We mentioned earlier that African Americans have been forced to read the thoughts of others accurately in order to survive Cross, Smith, SPayne, 2002) It has been found that certain minority groups, such as African Americans, are better readers of nonverbal commu- nication that their White counterparts JCochman, 1981;D. W. Sue, 1990) This will be discussed in greater detail in Chapter 7. Many African Americans have often stated that Whites say one thing but mean another. This better

92 The Political Vimensions of Mental Health Practice

understanding and sensitivity to nonverbal communication has enhanced Black people's survival in a highly dangerous society. As we see later, it is im- portant for the minority individual to read nonverbal messages accurately — not only for physical survival, but for psychological reasons as well. In summary, it becomes all too clear that past and present discrimina- tion against certain culturally diverse groups is a tangible basis for minority distrust of the majority society Ponterotto, Utsey, JPedersen, 2006) White people are perceived as potential oppressors unless proved otherwise. Under such a sociopolitical atmosphere, minorities may use several adaptive devices to prevent Whites from knowing their true feelings. Because multicultural counseling may mirror the sentiments of the larger society, these modes of behavior and their detrimental effects may be reenacted in the sessions. The fact that many minority clients are suspicious, mistrustful, and guarded in their interactions with White therapists is certainly understandable in light of the foregoing analysis. Despite their conscious desires to help, White ther- apists are not immune from inheriting racist attitudes, beliefs, myths, and stereotypes about Asian American, African American, Latino/Hispanic American, and American Indian clients p. W. Sue, 2005) For example, White counselors often believe that Blacks are nonverbal, paranoid, and an- gry, and that they are most likely to have character disorders garter, 1995; A. C. Jones, 1985)ortobe schizophrenic Pavkov, Lewis, {Lyons, 1989) As a result, they view African Americans as unsuitable for counseling and psychotherapy. Mental health practitioners and social scientists who hold to this belief fail to understand the following facts: 1 . As a group, African Americans tend to communicate nonverbally more than their White counterparts and to assume that nonverbal communi- cation is a more accurate barometer of one's true feelings and beliefs. E. T. Hall |976)observed that African Americans are better able to read nonverbal messages high context)than are their White counterparts and that they rely less on verbalizations than on nonverbal communi- cation to make a point. Whites, on the other hand, tune in more to ver- bal messages than to nonverbal messages (ow context) Because they rely less on nonverbal cues, Whites need greater verbal elaborations to get a point across p. W. Sue et al., 1996) Being unaware of and insen- sitive to these differences, White therapists are prone to feel that African Americans are unable to communicate in complex"ways. This judg- ment is based on the high value that therapy places on intellectual/ver- bal activity. 2. Rightfully or not, White therapists are often perceived as symbols of the Establishment who have inherited the racial biases of their forebears. Thus, the culturally diverse client is likely to impute all the negative ex- periences of oppression to them. This may prevent the minority client

Sociopolitical I triplications of Oppression 9 3

from responding to the helping professional as an individual. While the therapist may be possessed of the most admirable motives, the client may reject the helping professional simply because he or she is White. Thus, communication may be directly or indirectly shut off. 3. Some culturally diverse clients may lack confidence in the counseling and therapy process because the White counselor often proposes White solutions to their concerns Atkinson et al., 1998) Many pressures are placed on minority clients to accept an alien value system and reject their own. We have already indicated how counseling and psycho- therapy may be perceived as instruments of oppression whose function is to force assimilation and acculturation. As some racial/ethnic minor- ity clients have asked, Why do I have to become White in order to be considered healthy? The playing it cool'and Uncle Tom'responses of many minorities are present also in the therapy sessions. As pointed out earlier, these mechanisms are attempts to conceal true feelings, to hinder self-disclosure, and to prevent the therapist from getting to know the client. These adaptive survival mecha- nisms have been acquired through generations of experience with a hostile and invalidating society. The therapeutic dilemma encountered by the help- ing professional in working with a client of color is how to gain trust and break through this maze. What the therapist ultimately does in the sessions will determine his or her trustworthiness. To summarize, culturally diverse clients entering counseling or therapy are likely to experience considerable anxiety about ethnic/racial/cultural dif- ferences. Suspicion, apprehension, verbal constriction, unnatural reactions, open resentment and hostility, and passive or cool behavior may all be ex- pressed. Self-disclosure and the possible establishment of a working relation- ship can be seriously delayed or prevented from occurring. In all cases, the therapist's trustworthiness may be put to severe tests. A culturally effective therapist is one who 4)can view these behaviors in a nonjudgmental man- ner i;.e„ they are not necessarily indicative of pathology but are a manifesta- tion of adaptive survival mechanisms) b)can avoid personalizing any po- tential hostility expressed toward him or her, and £)can adequately resolve challenges to his or her credibility. Thus, it becomes important for us to un- derstand those dimensions that may enhance or diminish the culturally dif- ferent client's receptivity to self- disclosure.

Credibility and Attractiveness in Multicultural Counseling

Theories of counseling and psychotherapy attempt to outline an approach de- signed to make them effective. It is our contention that multicultural helping

94 The Political Dimensions of Mental Health Practice

cannot be approached through any one theory of counseling p. W. Sue et al., 1996) There are several reasons for such a statement. First, theories of coun- seling are composed of philosophical assumptions regarding the nature of man"and a theory of personality As pointed out earlier, these characteris- tics are highly culture-bound JCatz, 1985;D. W. Sue, 1995a) The true'ha- ture of people is a philosophical question. What constitutes the healthy and unhealthy personality is also debatable and varies from culture to culture and from class to class. Second, theories of counseling and psychotherapy are composed also of a body of therapeutic techniques and strategies. These techniques are applied to clients with the hope of effecting change in behaviors, perceptions, or atti- tudes. A theory dictates what techniques are to be used and, implicitly, in what proportions forey, 2005;D. W. Sue et al., 1996) For example, it is clear that humanistic-existential therapists behave differently than do rational-emotive ones. The fact that one school of counseling/therapy can be distinguished from another has implicationsTt suggests a certain degree of rigidity in working with culturally different clients who might find such tech- niques offensive or inappropriate. The implicit assumption is that these tech- niques are imposed according to the theory and not based on client needs and values. Third, theories of counseling and psychotherapy have often failed to agree among themselves about what constitutes desirable outcomes. This makes it extremely difficult to determine the effectiveness of counseling and therapy. For example, the psychoanalytically oriented therapist uses Ih- sightfthe behaviorist uses behavior changefthe client-centered person uses Self-actualization,"and the rational-emotive person uses fational cog- nitive content/processes. 'The potential for disagreement over appropriate outcome variables is increased even further when the therapist and client come from different cultures. Counseling as Interpersonal Influence Therapy may be conceptualized as an interpersonal-influence process in which the counselor uses social power to influence the client's attitudes and behaviors. Strong \ 969)is probably the person most credited with providing a conceptual framework for understanding parallels between the role of the therapist, the process of therapy, and the outcome of therapy with those of the persuasive communicator, the influencing process, and opinion/behavior change, respectively. Specifically, counselors who are perceived by their cli- ents as credible Expert and trustworthy) and attractive are able to exert greater influence than are those perceived as lacking in credibility and at- tractiveness Heesacker 8Earroll, 1997) Regardless of the counseling orien- tation person-centered, psychoanalytic, behavioral, transactional analysis,

Sociopolitical I triplications of Oppression 9 5

etc.) the therapist's effectiveness tends to depend on the client's perception of his or her expertness, trustworthiness, and attractiveness. Most of the studies on social influence and counseling have dealt ex- clusively with a White population Heesacker, Conner, EPritchard, 1995) Thus, findings that certain attributes contribute to a counselor's credibility and attractiveness may not be so perceived by culturally diverse clients. It is entirely possible that credibility, as defined by credentials indicating special- ized training £.g., MFCC, MSW, PsyD, PhD, MD) might only indicate to a Latino client that the White therapist has no knowledge or expertise in work- ing with Latinos. This assumption is based on the fact that most training pro- grams are geared for White middle-class clients and are culturally exclusive. It seems important, therefore, for helping professionals to understand what factors/conditions may enhance or negate counselor credibility and attrac- tiveness when working with clients of color. Psychological Sets of Clients The therapist's credibility and attractiveness depend very much on the mind- set or frame of reference for culturally diverse clients. We all know individu- als who tend to value rational approaches to solving problems and others who value a more affective 4ttractiveness)approach. It would seem reason- able that a client who values rationality might be more receptive to a rational counseling approach as a means to enhance counselor credibility. Under- standing a client's psychological mindset may facilitate the therapist's ability to exert social influence in counseling. In a very useful model, Collins J 970) proposed a set of conceptual categories that can be used to understand people's perception of communicator (:ounselor)credibility and receptive- ness to influence. We apply those categories here with respect to the therapy situation. Note that race, ethnicity, and the experience of discrimination often affect the type of set that will be operative in a minority client. 1. The problem-solving set: Information orientation. In the problem-solving set, the client is concerned about obtaining correct information Solutions, out- looks, and skills )that has adaptive value in the real world. The client accepts or rejects information from the therapist on the basis of its perceived truth or falsity:Is it an accurate representation of reality TThe processes that are used tend to be rational and logical in analyzing and attacking the problem. First, the client may apply a consistency test and compare the new facts with ear- lier information. For example, a White male therapist might try to reassure an African American client that he is not against interracial marriage, but hes- itate in speech and tense up whenever the topic is broached Utsey, Gernat, {Hammer, 2005) In this case, the verbal or content message is inconsistent with nonverbal cues, and the credibility and social influence of the therapist


The Political Dimensions of Mental Health Practice

are likely to decline. Second, the Black client may apply a corroboration test by actively seeking information from others for comparison purposes. If he or she hears from a friend that the therapist has racial hang-ups, then again the therapist's effectiveness is likely to be severely diminished. The former test makes use of information that the individual already has Understanding of nonverbal meanings) while the latter requires him or her to seek out new in- formation Asking a trusted African American friend) Through their experi- ences, clients of color may have learned that many Whites have little expert- ise when it comes to their lifestyles and that the information or suggestions that they give are White solutions or labels. Likewise, many Puerto Ricans who come for counseling and therapy expect information, advice, and direct suggestions. Therapists who do not value the problem-solving set and who may be affectively oriented may actually have great difficulties in relating to the client. 2. The consistency set. People are operating under the consistency set whenever they change an opinion, belief, or behavior in such a way as to make it con- sistent with other opinions, beliefs, or behaviors. This principle is best illus- trated in Festinger's classic book A Theory of Cognitive Dissonance \ 951) Stated simply, the theory says that when a person's attitudes, opinions, or beliefs are met with disagreement inconsistencies) cognitive imbalance or dissonance will be created. The dissonance is psychologically uncomfortable and pro- duces tension with drive characteristics. The result is an attempt to reduce the dissonance. For example, since therapists are supposed to help, we naturally believe that they would not do something to hurt us. The rules of the consis- tency set specify that good people do good things"and bad people do bad things/It is important to note that the consistency set states that people are not necessarily rational beings but rationalizing ones. A therapist who is not in touch with personal prejudices or biases may send out conflicting messages to a minority client. The counselor may verbally state, I am here to help you, 'but at the same time indicate racist attitudes and feelings nonverbally. This can destroy the counselor's credibility very quickly, for example, in the case of a minority client who accurately applies a consistency set such as, White people say one thing, but do another. You can't believe what they tell you. 'A culturally different client will actively seek out disclosures on the part of the therapist to compare them with the information he or she has about the world. Should the therapist pass the test, new information may be more readily accepted and assimilated. 3. The identity set. An individual who strongly identifies with a particular group is likely to accept the group's beliefs and conform to behaviors dictated by the group. If race or ethnicity constitute a strong reference group for a cli- ent, then a counselor of the same race/ethnicity is likely to be more influen-

Sociopolitical I triplications of Oppression 9 7

tial than is one who is not. A number of studies $ee reviews by Atkinson, 1983, 1985; Atkinson EBchein, 1986)indicate that certain similarities be- tween the counselor and client may actually enhance therapeutic longevity and therapist preference. For example, racial similarity between therapist and client may actually increase willingness to return for therapy and facili- tate effectiveness. The studies on this are quite mixed, as there is considerable evidence that membership group similarity may not be as effective as belief or attitude similarity. It has also been found that the stage of cultural or racial identity affects which dimensions of similarities will be preferred by the racial/ethnic minority client Cross, Smith, SPayne, 2002; Helms, 1995; Parham, 1989) We have much more to say about cultural identity develop- ment later. It is obvious, however, that racial differences between counselor and client makes bridging this gap a major challenge. 4. The economic set. In the economic set, the person is influenced because of the perceived rewards and punishments that the source is able to deliver. In this set, a person performs a behavior or states a belief in order to gain rewards and avoid punishments. In the counseling setting, this means that the thera- pist controls important resources that may affect the client. For example, a therapist may decide to recommend the expulsion of a student from the school or deny a positive parole recommendation to a client who is in prison. In less subtle ways, the therapist may ridicule or praise a client during a group counseling session. In these cases, the client may decide to alter his or her be- havior because the therapist holds greater power. The major problem with the use of rewards and punishments to induce change is that while it may as- sure behavioral compliance, it does not guarantee private acceptance. As noted, racial/ethnic minorities are well versed in recognizing power differentials and behaving accordingly i.e., playing it cool or using the Uncle Tom approach; Cross et al., 2002) Furthermore, for rewards and coercive power to be effec- tive, the therapist must maintain constant surveillance. Once the surveillance is removed, the client is likely to revert back to previous modes of behavior. For culturally diverse clients, therapy that operates primarily on the eco- nomic set is more likely to prevent the development of trust, rapport, and self-disclosure. 5. The authority set. Under this set, some individuals are thought to have a par- ticular position that gives them a legitimate right to prescribe attitudes or be- haviors. In our society, we have been conditioned to believe that certain au- thorities police officers, chairpersons, designated leaders, etc.)have the right to demand compliance. This occurs via training in role behavior and group norms. Mental health professionals, like counselors, are thought to have a legitimate right to recommend and provide psychological treatment to disturbed or troubled clients. It is this psychological set that legitimizes the

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counselor's role as a helping professional. Yet for many minorities, it is exactly these roles in society that are perceived as instruments of institutional op- pression and racism. The 1996 O. J. Simpson trial and verdict brought out major differences in how African Americans and White Americans perceived the police. African Americans were more likely as a group, to entertain the notion that police officers deliberately tampered with evidence because Simpson was a Black man; White Americans, however, were much less in- clined to believe the police could act in such a manner. It should be clear at this point that characteristics of the influencing source therapist )are of the utmost importance in eliciting types of changes. In addition, the type of mental or psychological set placed in operation often dictates the permanency and degree of attitude/belief change. While these sets operate similarly for both majority and minority clients, their manifesta- tions may be quite different. Obviously, a minority client may have great dif- ficulty identifying identification set)with a counselor from another race or culture. Also, what constitutes credibility to minority clients may be far dif- ferent from what constitutes credibility to a majority client. Therapist Credibility Credibility
Sociopolitical I triplications of Oppression 9 9

bias exists in training programs. Indeed, it may have the opposite effect, by reducing credibility! Additionally, reputation-expertness Authority set) is unlikely to impress a minority client unless the favorable testimony comes from someone of his or her own group. Thus behavior-expertness, or demonstrating the ability to help a client, becomes the critical form of expertness in effective multicultural counseling problem-solving set) It appears that using counseling skills and strategies appropriate to the life values of the culturally diverse client is crucial. We have already mentioned evidence that certain minority groups prefer a much more active approach to counseling. A counselor playing a relatively inactive role maybe perceived as being incompetent and unhelpful. The following ex- ample shows how the therapist's approach lowers perceived expertness. Asian American maie client: It's hard for me to talk about these issues. My parents and friends . . . they wouldn 't understand . . . if they ever found out I was coming here for help White male therapist: I sense it's difficult to talk about personal things. How are you feeling right now? Asian American client: Oh, all right. White therapist: That's not a feeling. Sit back and get in touch with your feel- ings, [pause] Now tell me, how are you feeling right now? Asian American client: Somewhat nervous. White therapist: When you talked about your parents' and friends' not understanding and the way you said it made me think you felt ashamed and disgraced at having to come. Was that what you felt? While this exchange appears to indicate that the therapist could \ )see the client's discomfort and ? (interpret his feelings correctly, it also points out the therapist's lack of understanding and knowledge of Asian cultural values. While we do not want to be guilty of stereotyping Asian Americans, many do have difficulty, at times, openly expressing feelings publicly to a stranger. The therapist's persistent attempts to focus on feelings and his direct and blunt in- terpretation of them may indicate to the Asian American client that the ther- apist lacks the more subtle skills of dealing with a sensitive topic or that the therapist is shaming the client $ee Chapter 15) Furthermore, it is possible that the Asian American client in this case is much more used to discussing feelings in an indirect or subtle manner. A di- rect response from the therapist addressed to a feeling may not be as effective as one that deals with it indirectly. In many traditional Asian groups, subtlety is a highly prized art, and the traditional Asian client may feel much more comfortable when dealing with feelings in an indirect manner. In many ways, behavioral manifestations of therapist expertness over- ride other considerations. For example, many educators claim that specific

1 00 The Political Vimensions of Mental Health Practice

therapy skills are not as important as the attitude one brings into the thera- peutic situation. Behind this statement is the belief that universal attributes of genuineness, love, unconditional acceptance, and positive regard are the only things needed. Yet the question remains:How does a therapist commu- nicate these things to culturally diverse clientsWhile a therapist might have the best of intentions, it is possible that his or her intentions might be misun- derstood. Let us use another example with the same Asian American client. Asian American client: I'm even nervous about others seeing me come in here. It's so difficult for me to talk about this. White therapist: We all find some things difficult to talk about. It's important that you do. Asian American client: It 's easy to say that. But do you really understand how awful I feel, talking about my parents? White therapist: I've worked with many Asian Americans and many have similar problems. In this sample dialogue we find a distinction between the therapist's in- tentions and the effects of his comments. The therapist's intentions were to reassure the client that he understood his feelings, to imply that he had worked with similar cases, and to make the client feel less isolated ie., that others have the same problems) The effects, however, were to dilute and dis- miss the client's feelings and concerns and to take the uniqueness out of the situation. Trustworthiness. Perceived trustworthiness encompasses such factors as sin- cerity, openness, honesty, or perceived lack of motivation for personal gain. A therapist who is perceived as trustworthy is likely to exert more influence over a client than is one who is not. In our society, many people assume that certain roles such as ministers, doctors, psychiatrists, and counselors exist to help people. With respect to minorities, self-disclosure is very much depend- ent on this attribute of perceived trustworthiness. Because mental health professionals are often perceived by minorities to be agents of the Establish- ment/trust is something that does not come with the role Authority set) In- deed, many minorities may perceive that therapists cannot be trusted unless otherwise demonstrated. Again, the role and reputation you have as being trustworthy must be evidenced in behavioral terms. More than anything, challenges to the therapist's trustworthiness will be a frequent theme block- ing further exploration and movement until it is resolved to the satisfaction of the client. These verbatim transcripts illustrate the trust issue. White male therapist: I sense some major hesitations It's difficult for you to discuss your concerns with me.

Sociopolitical Implications of Oppression 101

Black male client: You 're damn right! If I really told you how I felt about my [White] coach, what's to prevent you from telling him? You Whities are all of the same mind. White therapist [angry]: Look, it would be a lie for me to say I don 't know your coach. He 's an acquaintance, but not a personal friend. Don 't put me in the same bag with all Whites! Anyway, even if he were a close friend, I hold our discussion in strictest confidence. Let me ask you this question: What would I need to do that would make it easier for you to trust me? Black client: You 're on your way, man! This verbal exchange illustrates several issues related to trustworthi- ness. First, the minority client is likely to test the therapist constantly regard- ing issues of confidentiality. Second, the onus of responsibility for proving trustworthiness falls on the therapist. Third, to prove that one is trustworthy requires, at times, self-disclosure on the part of the mental health profes- sional. That the therapist did not hide the fact that he knew the coach Open- ness) became angry about being lumped with all Whites Sincerity) assured the client that he would not tell the coach or anyone else about their sessions Confidentiality) and asked the client how he could work to prove he was trustworthy genuineness)were all elements that enhanced his trustworthi- ness. Handling the prove to me that you can be trusted'ploy is very difficult for many therapists. It is difficult because it demands self-disclosure on the part of the helping professional, something that graduate training programs have taught us to avoid. It places the focus on the therapist rather than on the client and makes many uncomfortable. In addition, it is likely to evoke de- fensiveness on the part of many mental health practitioners. Here is another verbatim exchange in which defensiveness is evoked, destroying the helping professional's trustworthiness: Black female client. Students in my drama class expect me to laugh when they do "steppin' fetchin'" routines and tell Black jokes I'm wondering whether you 've ever laughed at any of those jokes. White male therapist: [long pause] Yes, I'm sure I have. Have you ever laughed at any White jokes? Black client: What's a White joke? White male therapist: I don 't know [nervous laughter]; I suppose one making fun of Whites. Look, I'm Irish. Have you ever laughed at Irish jokes? Black client: People tell me many jokes, but I don 't laugh at racial jokes. I feel we 're all minorities and should respect each other. Again, the client tested the therapist indirectly by asking him if he ever laughed at racial jokes. Since most of us probably have, to say ho 'Would be


The Political Dimensions of Mental Health Practice

a blatant lie. The client's motivation for asking this question was to find out (^)how sincere and open the therapist was and £ (whether the therapist could recognize his racist attitudes without letting it interfere with therapy. While the therapist admitted to having laughed at such jokes, he proceeded to destroy his trustworthiness by becoming defensive. Rather than simply stopping with his statement of Yes, I'm sure I have, "or making some other similar remark, he defends himself by trying to get the client to admit to sim- ilar actions. Thus the therapist's trustworthiness is seriously impaired. He is perceived as motivated to defend himself rather than help the client. The therapist's obvious defensiveness in this case has prevented him from understanding the intent and motive of the question. Is the African American female client really asking the therapist whether he has actually laughed at Black jokes before?Or is the client asking the therapist if he is a racisfBoth of these speculations have a certain amount of validity, but it is our belief that the Black female client is actually asking the following impor- tant question of the therapistJTow open and honest are you about your own racism, and will it interfere with our session here?Again, the test is one of trustworthiness, a motivational variable that the White male therapist has obviously failed. To summarize, expertness and trustworthiness are important compo- nents of any therapeutic relationship. In multicultural counseling/therapy, however, the counselor or therapist may not be presumed to possess either. The therapist working with a minority client is likely to experience severe tests of his or her expertness and trustworthiness before serious therapy can proceed. The responsibility for proving to the client that you are a credible therapist is likely to be greater when working with a minority client than with a majority client. How you meet the challenge is important in determining your effectiveness as a multicultural helping professional.

It is clear that counseling and psychotherapy, in both process and goals, con- tain a powerful sociopolitical dimension. How minority clients relate to ther- apists different from themselves often mirrors the state of interracial rela- tionships in the wider society. Several guidelines suggested from this chapter can aid us in our journey toward cultural competence. 1 . In working with diverse clients, it is important to distinguish between behaviors indicative of a true mental disorder and those that result from oppression and survival. A client of color may not readily self-disclose to you and may engage in specific behaviors for self-protection. These represent functional survival skills rather than pathology.

Sociopolitical Implications of Oppression 103

2. Do not personalize the suspicions a client may have of your motives. If you become defensive, insulted, or angry with the client, your effec- tiveness will be seriously diminished. 3 . Monitor your own reactions and question your beliefs. All of us are vic- tims of our social conditioning and have unintentionally inherited the racial biases of our forebears. Be willing to understand and overcome your stereotypes, biases, and assumptions about other cultural groups. 4. Be aware that clients of color or other marginalized groups may con- sider your professional credentials insufficient. Know that your credi- bility and trustworthiness will be tested. Evidence of specialized train- ing is less impressive than factors such as authenticity, sincerity, and openness. Tests of credibility may occur frequently in the therapy ses- sion, and the onus of responsibility for proving expertness and trust- worthiness lies with the therapist. 5. In multicultural counseling/therapy you may be unable to use the cli- ent's identification set (nembership group similarity )to induce change. At times, racial dissimilarity may prove to be so much of a hindrance as to render therapy ineffective. In this situation, referring out should not be viewed negatively or as a defeat. One could argue that a counselor or therapist who is aware of limitations and is nondefensive enough to refer out is evidencing cultural competence. 6. Be aware that difficulties in multicultural counseling may not stem from race factors per se, but from the implications of being a minority in the United States and thus having secondary status. In any case, a broad statement on this matter is overly simplistic. By virtue of its definition, multicultural therapy implies major differences between the client and the helper. How these differences can be bridged and under what con- ditions a therapist is able to work effectively with culturally diverse cli- ents are key questions.

Racial, Gender, and Sexual Orientation Microaggressionsilmplications for Counseling and Psychotherapy

Derald Wing Sue SEhristina M. Capodilupo

Tiffany is a 25-year-old Haitian American bisexual female who self- identifies as Black. She was born and raised in a large metropolitan city in the northeast. Both of Tiffany's parents emigrated from Haiti when they were children. Tiffany attended a prestigious university to obtain her grad- uate degree and currently teaches Trench at a private secondary school. Recently, Tiffany has been feeling hopeless about various aspects of her life, including her career and future. She feels "beaten down " and "emo- tionally exhausted" and has visited a community mental health counsel- ing center to address these concerns. She was assigned to work with Kate, a 28-year-old White therapist. In the first therapy session, Tiffany described her experiences inter- viewing for teaching positions. She had been thrilled at the response her resume had generated — she received an interview at nearly every school! However, Tiffany felt that there were similar responses to her when she was greeted by interviewers. She described "a look of shock or surprise on their faces " when they met her in the waiting room, and on more than one occasion, interviewers even repeated her first and last name to make sure she was the applicant. Tiffany tried to "shake the experience off" and won- dered if their reactions were related to her race. When exploring the topic in counseling, Kate suggested that Tiffany may have been nervous and reading too much into the interviewers ' reactions. She also implied that Tiffany's sensitivity may have been a defense against fears of rejection. Even if there might have been racial overtones, it was such a small matter that she should just shrug it off. Tiffany agreed with the therapist that she might have overreacted, but tried to impress upon Kate that the experience had really stayed with her over the last year. She now felt reluctant to enter the job market, even though she was not happy with her current position. Tiffany also relayed to Kate that she did not "feel free to be myself" at school. She mentioned several "incidents " that depressed and frustrated her. When asked to explain, she described how students frequently referred to things as gay when they meant stupid or undesirable. She also relayed a story about comments and "looks " she received from several of the teach-




The Political Dimensions of Mental Health Practice

ers when she came to school with her hair short and braided (as opposed to long and straight, which is how she wore it when she was originally hired). She had not given much thought to her change in hairstyle, but noticed immediately that it was a "conversation piece" in the teacher's lounge. She got asked questions such as, "Wow, what caused this change?" A male teacher even remarked to her that she had "looked like a model with her hair straight but now looked more butch. " The therapist was able to empathize with Tiffany, and shared a similar feeling that "as a woman, people always seem to think it is their right" to make comments about physical appearance. Even though Tiffany appreciated Kate's comments about being a woman, she had a nagging feeling that Kate was un- comfortable discussing race issues. She felt that Kate didn 't seem to "get it. " Tiffany also wanted to talk about similar experiences with other teachers at her school, but she now felt reluctant to share other incidents with the thera- pist. She had noticed Kate's facial features express surprise when she mentioned in their first session that she was bilingual in French and English, and that she had obtained a master's degree. The look was similar to what Tiffany had ob- served in her interviews, and she began to feel uncomfortable with Kate. When she shared this impression, Kate denied that race had anything to do with her reactions. She suggested that Tiffany was projecting her own fears and doubts about her competence onto Kate to make the fears more manageable. Tiffany felt discouraged and invalidated from their discussions and failed to return for an- other session. There is clearly misunderstanding and miscommunication between Tiffany and her therapist. This anecdote illustrates how racial, gender, and sexual orientation microaggressions can have a detrimental impact on marginalized groups and also undermine the therapeutic process. First, Tiffany has a nagging suspicion that the White job interviewers were sur- prised or taken off guard to find a Black woman with such sterling credentials on her resume and application. Yet, she is placed in an unenviable position of not being absolutely certain that interviewers were reacting to her race. Sec- ond, being bisexual and hearing students use gay"in a negative fashion made her feel uncomfortable because it assailed her sexual identity. Third, her change in hairstyle was obviously disturbing to fellow teachers because her appearance did not conform to their standards. Fourth, Kate's attempt to connect with her by stressing their similar experiences as women seemed to have a negative rather than a positive impact on the therapeutic relationship. Finally, the therapist seems unaware that she has invalidated Tiffany's expe- riential reality by suggesting that race did not play a role in her reaction or the reactions of the interviewers, and that the locus of the problem resided with the client's own fears and doubts. The incidents experienced by Tiffany are examples of microaggressions. Microaggressions are brief, everyday exchanges that send denigrating mes-

Racial, Qender, and Sexual Orientation Microaggressions 107

sages'to a target group such as people of color, women, and gays Sue et al., 2007) These microaggressions are often subtle in nature and can be mani- fested in the verbal, nonverbal, visual, or behavioral realm. They are often en- acted automatically and unconsciously Solorzano, Ceja, £¥osso, 2000) al- though the person who delivers the microaggression can do so intentionally or unintentionally $ue et al., 2007) The interviewers who were surprised to see Tiffany reacted nonverbally facial expression)and verbally Repeating her name to make sure it was her) While seemingly innocuous, the hidden mes- sage communicated by the interviewers was that Black people are less quali- fied, competent, and educated. This proved to be very distressful for Tiffany As we shall see, microaggressions may seem innocent and innocuous, but their cumulative nature can be extremely harmful to the victim's physical and men- tal health. In addition, they create inequities such as not being offered a job because of unconscious biases and beliefs held by the interviewers. To help understand the effects of microaggressions on people of color, women, and gays/lesbians, it would be important to ask the following ques- tions: What do microaggressions look like?How can people who commit microaggressions be so unaware of their actionslf they represent uninten- tional slights and insults, have I been guilty of committing microaggressive acts?What types of psychological impact do they have on marginalized groups?What lessons can we learn from a better understanding of the psy- chological dynamics of racial, gender, and sexual orientation microaggres- sionsln what ways do microaggressions cause problems in the therapeutic process and relationshipTThese questions will be addressed by } Reviewing literature on racism, sexism, and heterosexism; 2 presenting a framework for classifying and understanding the hidden and damaging messages of microaggressions; and presenting findings from studies that have ex- plored the experiences of people exposed to microaggressions. Racism, Sexism, and Heterosexism

Most people associate racism with blatant and overt acts of discrimination that are epitomized by White supremacy and hate crimes. Studies suggest, however, that what has been called old-fashioned racism'has seemingly de- clined povidio 8Gaertner, 2000) However, the nature and expression of racism $ee Chapter 3)has evolved into a more subtle and ambiguous form, perhaps reflecting people's belief that overt and blatant acts of racism are unjust and politically incorrect'povidio, Gaertner, Kawakami, fHodson, 2002) In a sense, racism has gone underground, become better disguised, and is more likely to be covert. A similar process seems to have occurred with sexism as well. Three types of sexism have been identified:overt, covert, and subtle Swim 8Cohen, 1997) Overt sexism is blatant unequal and unfair

1 08 The Political Vimensions of Mental Health Practice treatment of women. Covert sexism refers to unequal and harmful treatment of women that is conducted in a hidden manner Swim SSohen, 1997) For example, a person may endorse a belief in gender equality but engage in hir- ing practices that are gender biased. The third type, subtle sexism, represents unequal and unfair treatment of women that is not recognized by many people because it is perceived to be normative, and therefore does not appear unusual'? wim, Mallett, Stangor, 2004, p. 117) Whereas overt and covert sexism are intentional, subtle sexism is not deliberate or conscious. An ex- ample of subtle sexism is sexist language, such as the use of the pronoun he" to convey universal human experience. In many ways, subtle sexism contains many of the features that define aversive racism, a form of subtle and unintentional racism povidio SSaert- ner, 2000) Aversive racism is manifested in individuals who consciously as- sert egalitarian values, but unconsciously hold anti-minority feelings;there- fore, aversive racists consciously sympathize with victims of past injustice, support the principles of racial equality, and regard themselves as nonpreju- diced. At the same time, however, they possess negative feelings and beliefs about historically disadvantaged groups that may be unconscious G-aertner ®ovidio, 2006) Inheriting such negative feelings and beliefs about mem- bers of marginalized groups \.e., people of color, women, and lesbians/gays) is unavoidable and inevitable due to the socialization process in the United States Sue, 2004) where biased attitudes and stereotypes reinforce group hi- erarchy C-aertner JBovidio, 2006) Subtle sexism is very similar to aversive racism in that individuals support and actively condone gender equality, yet unknowingly engage in behaviors that contribute to the unequal treatment of women Swim SEohen, 1 997) For example, it has been found that people who endorsed egalitarian beliefs rated male and female leaders equally, but their nonverbal behaviors reflected greater negativity toward female leaders Butler SSeis, 1990) In one study, participants were asked to pronounce 72 familiar and 72 unfamiliar famous and unfamous names of men and women. Participants assigned fame to more male names and used a lower criterion to judge the fame of familiar male names than female names. However, these same participants did not explicitly endorse stereotypes or sexism Banaji SGreenwald, 1995) Much like aversive racism, subtle sexism devalues women, dismisses their accomplishments, and limits their effectiveness in a variety of social and professional settings Benokraitis, 1997) Researchers have used the templates of modern forms of racism and sexism to better understand the various forms of heterosexism, though research in this area is relatively new Morrison {Morrison, 2002) Hetero- sexism and antigay harassment has a long history and is currently prevalent in the United States, with as many as 94 percent of lesbian, gay, and bisexual ^GB) adults reporting hate crime victimization Herek, Cogan, SGillis, 2002) Antigay harassment can be defined as verbal or physical behavior

Racial, (kender, and Sexual Orientation Microaggressions 109 that injures, interferes with, or intimidates lesbian women, gay men, and bi- sexual individuals'Burn, Kadlec, {Rexler, 2005, p. 24) Although antigay harassment includes comments and jokes that convey the idea that LGB in- dividuals are pathological, abnormal, or unwelcome, authors identify subtle heterosexism by the indirect nature of such remarks Burn et al.) For ex- ample, blatant heterosexism would be calling a lesbian a dyke, "whereas subtle heterosexism would be referring to something as gay'to convey that it is stupid. As in the case of Tiffany hearing this remark may result in a vi- carious experience of insult and invalidation Burn et al.) Subtle heterosex- ism is related both to aversive racism and subtle sexism in that those who en- gage in it may not intend to display prejudice toward LGB individuals, particularly in the case of comments or jokes related to LGB persons Plum- mer, 2001) There is evidence to suggest that heterosexuals do not associate homophobic language with sexual orientation fhurlow, 2001) Further, studies that have measured the use of heterosexist language and antigay and homophobic attitudes have found that participants who use this language were not strongly antigay or biased against LGB individuals Burn, 2000; Plummer, 2001) Researchers have also used the templates of modern racism and sexism to understand modern homonegativity Morrison {Morrison, 2002) As op- posed to old-fashioned homonegativity, which refers to an antigay sentiment that is based on religious or moral condemnation \.e., Male homosexuality is a sin/ modern homonegativity reflects the belief that prejudice against LGB persons no longer exists, and that this group contributes to its own mar- ginalization by overemphasizing sexual orientation M orr i son ' Kenny, & Harrington, 2005) There is considerable evidence to support the notion that old-fashioned and modern homonegativity are distinct concepts Morrison & Morrison, 2002) Researchers simulated a movie theater situation and cre- ated two conditions: covert and overt. In both conditions, there was a con- federate wearing a t-shirt that implied a gay sexual orientation. In the covert condition, there were two movies playing to choose from, enabling partici- pants who chose not to sit next to the confederate to do so on grounds of movie preference. In the overt condition, this justification of movie choice was removed and participants were told that due to a technical glitch, the same movie would be shown in both theaters. The researchers found that those who scored highest on modern homonegativity were more likely to avoid sitting next to the confederate, but only in the covert condition. Those who scored high on old-fashioned homonegativity elected not to sit next to the confederate regardless of condition M orr i son 8Vlorrison, 2002) This research is very similar to the foundational research of aversive racism, which found that well-intentioned White liberals who endorsed racial equality were less likely to help a Black confederate with a simulated car breakdown when the situation was ambiguous and they were not sure their help was needed


The Political Dimensions of Mental Health Practice

Gaertner, 1973) In other words, when the situation is ambiguous and the individual is able to justify his or her actions based on some criteria other than the target's identity, he or she will act in a discriminatory and biased manner. What makes this phenomenon particularly complex is that such ambiguity and alternative explanations obscure the true meaning of the event, not only for the person who engages in this behavior, but also for the person on the re- ceiving end of the action. This is the central dilemma created by micro- aggressions, which are manifestations of these subtle forms of racism, sexism, and heterosexism.

The Evolution of Racism, Sexism, and Heterosexism: Microaggressions As mentioned previously, microaggressions are brief and commonplace daily verbal or behavioral indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults that potentially have a harmful or unpleasant psychological impact on the target person or group"$ue et al., 2007) Microaggressions can also be de- livered environmentally through the physical surroundings of target groups where they are made to feel unwelcome, isolated, unsafe, and alienated. For example, a prestigious eastern university conducts new faculty orientations in their main conference room, which displays portraits of all past presidents of the university. One new female faculty member of color mentioned that during the orientation she noticed that every single portrait was that of a White male. She described feelings of unease, alienation, and a strong desire to quickly leave the room. To her, the all-White males' portraits sent a power message: Your kind does not belong here. "You will not be comfortable here.'Tf you stay, there is only so far you can rise at this UniversitylEnvi- ronmental microaggressions can occur when there is absence of students of color on college campuses, or few women in the upper echelons of the work- place. Research suggests that the socialization process culturally conditions racist, sexist, and heterosexist attitudes and behaviors in well intentioned in- dividuals, and these biases are often automatically enacted without conscious awareness, particularly for those who endorse egalitarian values povidio & Gaertner, 2002) Based on literature covering subtle forms of racism, sexism, and heterosexism, one might conclude the following about microaggressions: They })tend to be subtle, unintentional, and indirect, 2)often occur in sit- uations where there are alternative explanations, ? Represent unconscious and ingrained biased beliefs and attitudes, and ^)are more likely to occur when people pretend not to notice differences, thereby denying that race, gender, or sexual orientation had anything to do with their actions $ue et al.,

Racial, (kender, and Sexual Orientation Microaggressions


2007) Three types of microaggressions have been identified: microassault, microinsult, and microinvalidation. Microassault The term microassault refers to a blatant verbal, nonverbal, or environmental attack intended to convey discriminatory and biased sentiments. This notion is related to overt racism, sexism, and heterosexism in which individuals de- liberately convey derogatory messages to target groups. Using epithets like spic or faggot, hiring only men for managerial positions, and deliberately serving Black patrons last are examples. Unless we are talking about White supremacists, most perpetrators with conscious biases will engage in overt racism, sexism, and heterosexism only under three conditions: \) when some degree of anonymity can be ensured, 2)when they are in the presence of others who share or tolerate their biased beliefs and actions, or ?)when they lose control of their feelings and actions. Two recent high-profile ex- amples exemplify the latter:} )Actor Mel Gibson made highly inflammatory anti-semitic public statements to police officers when he was arrested for driving while intoxicated, and 2)comedian Michael Richards, who played Kramer on the television show Seinfeld, went on an out-of-control rant at a comedy club when he publicly insulted African American audience members by hurling racial epithets at them and demeaning their race. Gibson and Richards disclaimed being anti-semitic or racist and issued immediate apolo- gies, but it was obvious both had lost control. Because microassaults are most similar to old-fashioned racism, no guessing game is likely to occur as to their intent-te-hurt or injure the recipient. Both the perpetrator and recipient are clear about what has transpired. We submit that microassaults are, in many respects, easier to deal with than behavior that is unintentional and outside the perpetrator's level of awareness hiicroinsults and microinvalidations) Microinsult Microinsults are unintentional behaviors or verbal comments that convey rudeness or insensitivity or demean a person's racial heritage identity, gender identity, or sexual orientation identity. Despite being outside the level of con- scious awareness, these subtle snubs are characterized by an insulting hidden message. When the interviewers expressed surprise (lonverbally and ver- bally)that a Black female Tiffany)could possess such outstanding creden- tials on her resume, they were conveying a hidden messageBiacks are less capable intellectually. African Americans consistently report that intellectual inferiority is a common communication they receive from Whites in their everyday experiences $ue et al., in press) Similarly, when teachers in a class- room consistently call on male students rather than females to answer ques- tions, the hidden message is that men are brighter and more capable than women. When California Governor Arnold Schwarzenegger referred to

112 The Political Vimensions of Mental Health Practice Democrats as girly men, "he meant to ridicule his political opponents, but what he insinuated was that women and men who possess feminine traits are weak and ineffective. Microinvalidation Microinvalidations are verbal comments or behaviors that exclude, negate, or dismiss the psychological thoughts, feelings, or experiential reality of the tar- get group. Like microinsults, they are unintentional and usually outside the perpetrator's awareness. When Kate dismissed Tiffany's belief that race played a role in her interviews and suggested that her interpretation was due to personal insecurities, she negated the client's thoughts and feelings. The hidden message delivered to Tiffany is that she is overly sensitive and para- noid. Because Kate is in a position of power as a White therapist, she is able to define Tiffany's experiential reality, thereby engaging in microinvalidation. When a male interviewer informs a female applicant that r believe the most qualified person should get the job, "he is potentially conveying a message that women are not qualified and his decision will have nothing to do with the applicant's gender/When gay students are always selected last by fellow classmates for sports teams, and share their feelings of discrimination with gym teachers, they are likely to be told that they are misreading the situation invalidating their experiences of discrimination) To further illustrate the concepts of microinsults and microinvalida- tions, Table 5.1 provides examples of comments, actions, and situations, as well as their accompanying hidden message and/or assumption. There are 12 distinct categories represented in this table:alien in one's own land, ascrip- tion of intelligence, assumption of abnormality, color blindness, criminality/ assumption of criminal status, denial of individual racism/sexism/hetero- sexism, myth of meritocracy, pathologizing cultural values/communication styles, second-class status, sexual objectification, use of sexist/heterosexist language, and traditional gender role prejudice and stereotyping. Some of these categories may be more applicable to certain forms of microaggressions facial, gender, or sexual orientation) but they all seem to share commonal- ities. The Dynamics and Dilemmas of Microaggressions Let us use the case of Tiffany to illustrate some of the dynamics and dilemmas presented by microaggressions. Research on subtle forms of racism povidio et al., 2002; Ridley, 2005) sexism £wim et al., 2004) and heterosexism Morrison {Morrison, 2002)provide evidence that they operate in individ- uals who endorse egalitarian beliefs, adamantly deny that they are biased, and consider themselves to be moral, just, and fair. What people consciously believe or say £.g., Thave no gay biasjhowever, is oftentimes at odds with

Racial, (Render, and Sexual Orientation Microaggressions 113 what they actually do £.g., avoiding sitting next to an ostensibly gay man) Proving that one's actions or comments stem from an unconsciously held set of negative beliefs toward the target group is virtually impossible when alter- native explanations exist. Because Whites who engage in microaggressions truly believe they act without racial bias toward persons of color, for example, they will disclaim any racist meaning. The subtle and insidious nature of racial microaggressions is not only outside the level of awareness of perpe- trators, but recipients also find their ambiguity difficult to handle. Victims are placed in an unenviable position of not only questioning perpetrators, but themselves as well pid I misread what happened)In the face of micro- aggressions, many members of historically marginalized groups describe feel- ing a vague unease that something is not right, and that they were insulted or disrespected. In this respect, overt acts of racism, sexism, or heterosexism may be easier to handle than microaggressions because the intent and mean- ing of the event is clear and indisputable folorzano et al., 2000;Sue, 2004) Microaggressions toward marginalized groups, however, pose special prob- lems. Four psychological dilemmas have been identified when microaggres- sions occur $ue et al., 2007) Dilemma One: Clash of Racial Realities For Tiffany, one major question was, were interviewers reacting to her race, or did she misinterpret their verbal and nonverbal behavior^Vlthough per- sonal experience tells her that many Whites believe Blacks to be less capable and competent, chances are the White interviewers would be offended at such a suggestion. They would likely deny they possessed any stereotypes and even point to the number of people of color they have hired. In other words, they would emphasize that they and their organizations do not dis- criminate on the basis of color, gender, sexual orientation, or creed. The ques- tion becomes, whose reality is the true realityX)ftentimes the perceptions held by the dominant group differ significantly from those of marginalized groups in our society. For example, studies show that many Whites believe racism is no longer prevalent in our society nor important in the lives of people of color £ue, 2004) heterosexuals believe that homophobia is a thing of the pasf'and that gay harassment is on the decline Morrison & Morrison, 2002)and men ^nd women)assert that women have achieved equal status and are no longer discriminated against $wim 8Eohen, 1997) Most importantly, individuals in power positions do not consider themselves capable of discrimination based on race, gender, or sexual orientation be- cause they believe themselves free of bias. On the other hand, people of color perceive Whites to be racially insensitive, that they enjoy holding power over others, and that they think they are superior £ue et al., in press) LGB indi- viduals consider homonegativity and gay harassment to be a crucial aspect of their everyday existence Burn et al., 2005) and women contend that sexism


The Political Dimensions of Mental Health Practice

Table 5 A Examples of Racial, Gender, and Sexual Orientation Microaggressions

Alien in Their Own Land When Asian Americans and Latino Americans are assumed to be foreign-born.

Where are you from? Where were you born? You speak good English."

You are not American.

A person asking an Asian American to teach them words in their native language.

You are a foreigner.

Ascription of Intelligence Assigning intelligence to a person of color or a woman based on their race/gender.

You are a credit to your race."

People of color are generally not as intelligent as Whites.

WowlHow did you become so good in math?

It is unusual for a woman to be smart in math.

Asking an Asian person to help with a math or science problem.

All Asians are intelligent and good in math/sciences.

Color Blindness Statements that indicate a White person does not want to acknowledge race.

When I look at you, I don't see color."

Denying a person of color's racial/ethnic experiences.

America is a Melting Pot."

Assimilate/acculturate to dominant culture.

There is only one race, the human race."

The individual is denied as a racial/cultural being.

Criminality/ Assumption of Criminal status A person of color is presumed A White man or woman to be dangerous, a criminal, or a clutches their purse or checks deviant based on their race. their wallet as a Black or Latino approaches or passes.

You are a criminal.

A store owner follows a customer of color around the store.

You are going to steal. You are poor. You do not belong.

Racial, (kender, and Sexual Orientation Microaggressions


Table 5.1 continued

A White person waits to ride the next elevator when a person of color is on it.

You are dangerous.

Use of Sexist/Heterosexist Language

Terms that exclude or degrade women and LGB persons.

Using the pronoun he "to refer to all people.

Male experience is universal. Female experience is meaningless.

Assuming only two options for Relationship Status:Married or Single

LGB partnerships do not matter or are meaningless

An assertive woman is labeled a bitch."

Women should be passive.

A heterosexual man who hangs out with his female friends more than his male friends is labeled a faggot."

Men who act like women are inferior (vomen are inferior]! gay men are inferior.

Denial of Individual Racism/Sexism/Heterosexism

A statement made when bias is denied.

I'm not racist. I have several Black friends."

I am immune to racism because I have friends of color.

As an employer, I always treat men and women equally."

I am incapable of sexism.

Myth of Meritocracy

Statements which assert that race or gender does not play a role in life successes.

I believe the most qualified person should get the job."

People of color are given extra, unfair benefits because of their race.

Men and women have equal opportunities for achievement."

The playing field is even, so if women cannot make it, the problem is with them.


116 The Political Dimensions of Mental Health Practice

Table 5.1 continued

Pathologizing Cultural Values/Communication Styles

The notion that the values and communication styles of the dominant/White culture are ideal.

Asking a Black person:Why do you have to be so loud/ animatedTTust calm down." To an Asian or Latino person: Why are you so quietWe want to know what you think. Be more verbal. Speak up more."

Assimilate to dominant culture.

An individual who brings up race/culture in work/school setting is dismissed.

Leave your cultural baggage outside.

Second Class Citizen

Occurs when a target group member receives differential treatment from the power group.

A person of color mistaken for a service worker.

People of color are servants to Whites Thev couldn't nossihlv occupy high status positions.

A female doctor is mistaken for a nurse.

Women occupy nurturing roles.

A taxi cab passes a person of color and to pick up a White passenger.

You are likely to cause trouble and/or travel to a dangerous neighborhood.

A person of color is ignored at a store counter as attention is given to a White customer behind them.

Whites are more valued customers than people of color.

A lesbian woman is not invited out with a group of girlfriends because they think she would be bored if they talk to men.

You don't belong.

Racial, (kender, and Sexual Orientation Microaggressions 117

Table 5.1 continued

Traditional Gender Role Prejudicing and Stereotyping

Occurs when expectations of traditional roles or stereotypes are conveyed.

A female student asks a male professor for extra help on a chemistry assignment, and he asks, What do you need to work on this for anyway?

Women are less canable in math and science.

A person asks a woman her age and upon hearing she is 31, looks quickly at her ring finger.

Women should be married during child bearint? apes VJ- LI 1 11 1^ Villi L' \_ C1X IL LcL CI & V- J because that is their primary purpose.

A woman is assumed to be a lesbian because she does not put a lot of effort into her appearance.

Lesbians do not care about being attractive to others.

Sexual Obj edification

Occurs when women are treated like objects at men's disposal.

A male stranger puts his hands on a woman's hips or on the small of her back to pass by her.

Your body is not yours.

Men whistle and catcall as a woman walks down the street.

Your body/appearance is for men's enjoyment and pleasure.

Assumption of Abnormality

Occurs when it is implied that there is something wrong with being LGB.

Two men holding hands in public receive stares from strangers.

You should keep your displays of affection private because they are offensive.

Students use the term gay'to describe a fellow student who is socially ostracized at school.

People who are weird and different are gay."

Adapted from Sue et al., 2007.

118 The Political Dimensions of Mental Health Practice is alive and well in social and professional settings Burn, 2000) While research supports the fact that those most disempowered are more likely to have a more accurate perception of reality, it is groups in power that have the ability to define reality. Thus, people of color, women, and LGB individuals are likely to experience their perceptions and interpretations being negated or dismissed. Dilemma Two: The Invisibility of Unintentional Expressions of Bias Although Tiffany did not ask her fellow teachers in the student lounge the meaning behind their comments about her hair, one can imagine that they might feel stunned and surprised to learn that Tiffany felt offended. They would likely explain that they were only remarking about the drastic change in her hairstyle and that race had nothing to do with it. They might even state they would have responded the same way to any woman who changed her hair so dramatically. To Tiffany, however, it was less about the content of what they said than the tone of voice fear, apprehension, and defiance of expec- tations) which indicated they were reacting to her race and gender. The mes- sage being conveyed to Tiffany was that she was violating White standards of appearance and that her braided hair, a natural Black hairstyle, was threat- ening. How could Tiffany prove that the teachers sounded scared when they made comments to herTShe cannot replay a tape of their voices or show a video of their facial expressions-her only evidence is her felt experience and interpretation, which are easily explained away and disregarded by teachers with alternative explanations. That the microaggression is essentially invis- ible to the perpetrator creates a psychological dilemma for victims that can leave them frustrated, feeling powerless, and even questioning their own sanity $ue et al., in press) Dilemma Three: Perceived Minimal Harm of Microaggressions Oftentimes, when perpetrators are confronted about microaggressions, they accuse the victim of overreacting or being hypersensitive, or touchy. Because the microaggression is often invisible to the perpetrator, they cannot under- stand how the event could cause any significant harm to the victim. They see the event as innocent, innocuous, and often tell victims to just let it go. "Vis- ible and overt forms of discrimination, however, are more readily acknowl- edged as being dangerous and harmful $ue, 2004) It has been found that chronic experiences of discrimination and exclusion create levels of stress that are traumatic for target groups Bloom, 1997;Pierce, 1995) Racism and racial/ethnic discrimination cause significant psychological distress fang & Meyers, 2001;Krieger Sidney, 1996) depression ^omas-Diaz SGreene, 1994;Kim, 2002) and negative health outcomes Harrell, Hall, {Taliaferro, 2003) Researchers have even coined the term racism-related stress Harrell, 2000) With regard to sexism, studies have found that 94 percent of women

Racial, Qender, and Sexual Orientation Microaggressions 119

queried reported experiencing sexual harassment, 92 percent reported disre- spect because of their gender, and 87 percent reported experiencing sexism from strangers Berg, 2006) Researchers have long contended that the socio- political climate of the United States serves to subjugate, degrade, and objec- tify women Root, 1992) Similarly, research has found a host of negative effects related to stigmatization based on sexual orientation APA Division 44, 2000) This stress has been linked to depression P'Augelli, 1989) substance abuse, running away, and prostitution APA Division 44, 2000) Despite the perpetrator's perception that microaggressions result in minimal harm, more recent research has suggested that subtle forms of racism, sexism, and heterosexism cause significant distress and negatively impact well-being. One study that looked at racial microaggressions in the lived experience of African Americans found that the cumulative effect of these events was feelings of self-doubt, frustration, and isolation £olorzano et al., 2000) Another study found that consequences of microaggressions for African Americans included feelings of powerlessness, invisibility, and loss of integrity £ue et al., in press) In a similar study, Asian Americans reported feeling belittled, angry, invalidated, invisible, and trapped by their experi- ences of racial microaggressions $ue, Bucceri, Lin, Nadal, {Torino, 2007) With regard to subtle sexism, researchers have discovered that everyday sexist events, such as sexist language, gender role stereotyping, and objecti- fying commentaries lead to feelings of anger, anxiety, and depression in women $wim, Hyers, Cohen, {Ferguson, 2001) In this same study, female participants who recorded daily incidents in diaries reported an average of one to two experiences of subtle sexism a week \n the study they were to record daily hassles and then judge how prejudicial they felt they were) A recent study found that the impact of daily, personal sexist interaction has an incremental effect that may result in the disturbing posttraumatic Stress DisorderjPTSD symptomology'Berg, 2006, p. 984) There is very little research on the effects of subtle heterosexism on LGB persons. One study provided LGB participants with subtle heterosexism sce- narios £.g., a heterosexual assumes two unmarried men who spend a lot of time together are gay)to first assess if the participants found such scenarios to be offensive and prejudicial due to the indirect nature of the scenario) Not only were participants offended by the scenarios and felt they were prejudi- cial against LGB persons, but they were also less likely to come out as a con- sequence of feeling offended Burn, Kadlec, £Rexer, 2005) When one as- sumes that people of color, women, and LGB individuals are constantly exposed to multiple microaggressions, it becomes clear that their cumulative nature takes a huge psychological toll on their lives. Thus, microaggressions cause significant harm and psychological distress to victims. That perpetrators tend to deny the existence of the microaggressions because they are invis- ible)only serves to compound the detrimental effects.

120 The Political Dimensions of Mental Health Practice

Dilemma Four: The Catch-22 of Responding to Microaggressions When a microaggression occurs, the recipient is often placed in an unenvi- able position of having to decide what to do. This is compounded by the nu- merous questions likely to go through the mind of the recipient. Did what I think happened really happenTIf it did, how can I possibly prove itTHow should I respond?Will it do any good if I bring it to the attention of the per- petrator If I do, will it affect my relationship with coworkers, friends, or ac- quaintancesln Tiffany's case, will it jeopardize her chances of being hired if she confronts the interviewersMany well-intentioned perpetrators are un- aware of the exhausting nature of these internal questions, and how they sap the spiritual and psychic energy of victims. Tiffany was obviously caught in a conflict:Should I respond by asking what interviewers, teachers, or her stu- dents meant by their comments, or should I bother to respond at all?As a Black female, Tiffany has probably experienced many microaggressions throughout her lifetime, and so microaggressive comments from coworkers do not feel random Ridley, 2005) On the other hand, White teachers who have not faced similar experiences are unable to see a pattern running throughout incidents encountered by people of color-hidden bias associ- ated with race. People of color, for example, use context and experiential reality to interpret the meaning of microaggressions. The common thread op- erating in multiple situations is that of race. Whites, however, see such situ- ations as isolated incidents, so the pattern of racism experienced by persons of color is invisible to them. The fundamental issue is that responding to a microaggression can have detrimental consequences for the victim. If Tiffany responds to the teachers and shares her feelings, they might invalidate her racial reality by claiming that the incident had absolutely nothing to do with race;an extremely com- mon stance taken by well-intentioned Whites. They might attribute Tiffany's reactions to some internal attribute being touchy or insecure) If she chooses to pursue the matter she could be accused of being a troublemaker reinforc- ing a commonly held stereotype of the angry Black woman. Tiffany might feel compelled to avoid this label and to simply forgo the hassles. Unfortunately, it has been found that such a reaction takes a psychological toll on the re- cipient because it requires Tiffany to suppress and obscure her authentic thoughts and feelings in order to avoid further discrimination franklin, 2004) Confronting sexual orientation microaggressions is further complicated by LGB individuals who may not necessarily be out of the closet. In one study, half of lesbian and gay participants were uncomfortable disclosing their sex- ual orientation, and two-thirds occasionally feared for their public safety P'Augelli, 1989) The reality of looming gay harassment and differential (mequal)treatment may prevent LGB persons from coming out in a variety

Racial, Qender, and Sexual Orientation Microaggressions 121 of settings, especially when there is evidence to suggest that the environment is heterosexist. For example, Tiffany hears students at schools using the term gay'in a derogatory fashion in public areas and observes that teachers never object or take issue with its use. The message she receives from colleagues is that they are complicit through their silence. Telling others she is offended by the word butch may out her, or will cause the other teachers to wonder about her sexual orientation. She might also fear that the teachers will tell her she is hypersensitive and overly emotionalbeth microaggressions themselves! Let us look at the meaning of these two terms. The first, hypersensitive, conveys that Tiffany is sensitive about her sexual orientationas- if there is no valid reason she should be-therefore, her experiential reality of being a bisexual person who always feels marginalized is invalidated. The second, overly emotional, is a gender role stereotype about women. Women are sup- posed to be nurturing and caring, and so therefore emotional ^nd by associ- ation, irrational)when it comes to making sense of real issues. Tiffany runs the risk of hearing any one of these things if she confronts the microaggres- sions she experiences. On the flip side, by not confronting these experiences, she is forced to shoulder the burden herself with detrimental mental health consequences. In one study, African American participants revealed some strategies for dealing with this catch-22:empowering and validating the self and the sanity check. Empowering and validating the self refers to a process of interrupting the racism by calling it what it is"and staying true to one's thoughts and feelings-that the incident is related to their race. Sanity check refers to a process of checking in with like-minded and same-race people about microaggressive incidents. Talking about the incident with someone who has faced similar discrimination helped participants to feel validated in their experience that the incident is racially motivated Sue et al., in press) Therapeutic Implications We have repeatedly emphasized that clients of color tend to prematurely ter- minate counseling and therapy at a 50 percent rate after only initial contact with a mental health provider $la Tiffany) We submit that racial micro- aggressions may lie at the core of the problem. Likewise, if gender and sexual orientation microaggressions operate through therapists, they may also affect the therapeutic alliance for these groups as well. The result is that clients of color, women, and gays may not receive the help they need. In counseling and psychotherapy, the credibility of the therapist is paramount in determin- ing whether clients stay or leave sessions Strong, 1969) Credibility is com- posed of two dimensions: expertness and trustworthiness. Expertness is a function of how much knowledge, training, experience, and skills clinicians possess with respect to the population being treated. It is an ability component.

122 The Political Vimensions of Mental Health Practice

Trustworthiness, however, is a motivational component that encompasses trust, honesty, and genuineness. While expertness is always important, trustwor- thiness becomes central in multicultural counseling and therapy. Effective counseling is likely to occur when both therapists and clients are able to form a working relationship, therapeutic alliance, or some form of positive coalition. In mental health practice there is a near universal belief that effective and beneficial counseling requires that clients trust their coun- selors Corey, 2005;Day, 2004) Essentially the therapist works to build rap- port and establish a connection with the client through verbal and nonverbal interventions. Research supports the idea that the therapeutic alliance is a key component in therapy work and is correlated with successful outcomes Lui fPope-Davis, 2005) When clients do not feel heard or understood, or when they are not sure they can trust the therapist, they often fail to return. A comprehensive report on the role of culture, race, and ethnicity in mental health care suggests that racism plays a major role in creating inequities that result in inferior and biased treatments for diverse clients ^Surgeon General, 2000) Because all people inherit bias about various identity groups through cultural conditioning in the United States, no one, including helping profes- sionals, is free from these biases Ridley, 2005) Therefore, racial, gender, and sexual orientation dynamics that exist in society are often recreated and re- enacted between the therapist and client in the therapy room. This fact poses a unique dilemma in therapy, for several reasons. Helping professionals are supposed to work for the welfare of all groups, are trained to be Objective," are inclined to see problems as internally situated, and are usually in a posi- tion of power over the client. Mental health professionals who enter the field usually have a strong desire to help clients regardless of race, creed, gender, and so on. They operate under the dictum of liberating clients from their dis- tress and doing no harm "whenever possible. Because helping professionals view themselves as just, fair, and nondiscriminating, they find it difficult to believe that they commit microaggressions and may be unhelpful and even oppressive. The fact that therapists possess unconscious biases and prejudices is problematic, especially when they sincerely believe they are capable of pre- venting these attitudes from entering sessions. Rather than heal or help, however, well-intentioned therapists may contribute to the oppressive ex- periences of culturally diverse clients. Although there have certainly been movements to understand the sociopolitical context of clients, less attention is given to the social context of the therapeutic relationship, which may re- flect a microcosm of negative race relations in the larger society. Lastly, coun- selors often find themselves in positions of power through their ability to de- fine their client's experiential reality \.e., interpretation) which may prove harmful, especially if counselors adamantly deny the presence of micro- aggressions both inside and outside of the therapy situation. There is recent

Racial, Qender, and Sexual Orientation Microaggressions 123 research to suggest that prejudice and bias continue to be manifested in the therapeutic process, despite the good intentions of mental health profession- als (Jtsey, Gernat, Siammar, 2005) Manifestations of Microaggressions in Counseling /Therapy The importance of understanding how microaggressions manifest in the ther- apeutic relationship cannot be understated, especially as this phenomenon may underlie the high prevalence of dropout rates among people of color. Let us use the case of Tiffany to illustrate how microaggressions may operate in the counseling process. 1. Tiffany revealed to Kate her experiences of racial, gender, and sexual orientation microaggressions, using therapy as a space for deeper ex- ploration of a meaningful issue. Because Kate and Tiffany are not the same race, they do not share similar racial realities pilemma One: Clash of Racial Realities)or worldviews. The therapist has minimal un- derstanding of what constitutes racial microaggressions, how they make their appearance during everyday interactions, how she herself may be guilty of microaggressive behaviors, the psychological toll it takes on persons of color, and the negative effects they have on the therapeutic relationship. We have emphasized earlier that cultural competence re- quires helping professionals to understand the worldviews of their cul- turally diverse clients. 2. The therapist tends to minimize the importance of the shocked reac- tions of interviewers to Tiffany's resume, believes the event is trivial, and cannot relate to the negative impact these microaggressions have on her client. Even if the reactions do have some racial overtones, the therapist concludes they are insignificant $ small matter)and Tiffany should simply ignore them or Shrug it offpilemma Three:Minimal Harm) For Tiffany, on the other hand, the looks of surprise represent one of many cumulative messages of intellectual inferiority about her race. She is placed in a constant state of vigilance by maintaining her sense of integrity in the face of constant invalidations and insults. Racial, gender, and sexual microaggressions are a constant reality for people of color as they assail group identities and experiences. White people seldom understand how much time, energy and effort are ex- pended to retain some semblance of worth and self-esteem. No wonder Tiffany is emotionally exhausted, frustrated, and occasionally doubts her own interpretations. 3 . Another major detrimental event in the first session is that the therapist locates the source of problems within Tiffany: insecurities about her own abilities. While there may be some legitimacy to this interpreta-

124 The Political Vimensions of Mental Health Practice tion, Kate is unaware that she has engaged in person-blame and that she has invalidated Tiffany's experiential reality by dismissing race as an important factor. When Tiffany observes that Kate might not under- stand her experiences as a Black woman, Kate was shocked and hurt. As a mental health professional, Kate probably considers herself unbi- ased and objective. She attempts to relate to Tiffany as a woman first, with an attempt to empathize and connect with Tiffany over the subtle sexist comments Tiffany describes at work. This reaction, however, rep- resents a colorblind reaction and only reinforces Tiffany's feelings of in- validation by removing the salience of her race from the conversation pilemma Two:Invisibility) 4. As a client, Tiffany is caught in a damned if you do, and damned if you donT'conflict pilemma Four:Catch-22) Both inside and outside of therapy, Tiffany is probably internally wrestling with a series of ques- tions:Did what I think happen, really happen Was this a deliberate act or an unintentional slightUow should I respond'Sit and stew on it, or confront the personTWhat are the consequences if I do?If I bring the topic up, how do I prove Ms it really worth the effortrShould I just drop the matter TThese questions take a tremendous psychological toll on many people of color. If Tiffany chooses to do nothing, she may suf- fer emotionally by having to deny her own experiential reality, or allow her sense of integrity to be assailed. Feelings of powerlessness, alien- ation, and frustration may not only take a psychological but physical toll on her. If she chooses to raise issues with the interviewers, students, or fellow teachers, she risks being isolated by others, seen as a trouble- maker, oversensitive, and even paranoid. Worse yet, if she raises these issues in therapy, her reality is invalidated and her reactions are pathol- ogized by the therapist. Table 5.2 provides several more therapy-specific examples of microaggres- sions, using the same organizing themes presented in Table 5.1. We ask that you study these themes and ask yourself if you have ever engaged in these or similar actions. If so, how can you prevent your own personal microaggres- sions from impairing the therapy process?

Implications for Clinical Practice Clients trust mental health professionals to take an intimate and deeply per- sonal journey of self-exploration with them through the process of therapy. They grant these professionals the opportunity to look into their inner world and also invite them to walk where they live in their everyday lives. Therapists

Racial, Qender, and Sexual Orientation Microaggressions


Table 5.2 Examples of Racial, Gender, and Sexual Orientation Microaggressions in Therapeutic Practice


Alien in Their Own Land

When Asian Americans and Latino Americans are assumed to be foreign-born.

A White client does not want to work with an Asian American therapist because she will not understand my problem." A White therapist tells an American-born Latino client that he/she should seek a Spanish-speaking therapist.

You are not American.

Ascription of Intelligence

Assigning a degree of intelligence to a person of color or woman based on their race or gender.

A school counselor reacts with surprise when an Asian American student had trouble on the math portion of a standardized test.

All Asians are smart and good at math.

A career counselor asking a you think you're ready for college?

It is unusual for people of color to 11 1 rrpp c\

A school counselor reacts with surprise that a female student scored high on a math portion of a standardized test.

It is unusual for women to be smart and good in math.

Color Blindness

Statements which indicate that a White person does not want to acknowledge race.

A therapist says I think you are being too paranoid. We should emphasize similarities not people's differences'Vvhen a client of color attempts to discuss her feelings about being the only person of color at her job and feeling alienated and dismissed by her coworkers.

Race and culture are not important variables that affect people's lives.



The Political Dimensions of Mental Health Practice

Table 5.2 continued

A client of color expresses Your racial experiences are not concern in discussing racial valid, issues with her therapist. Her therapist replies with, When I see you, I don't see color."

Criminality/ Assumption of Criminal status A person of color is presumed When a Black client shares that You are a criminal, to be dangerous, criminal, or she was accused of stealing from deviant based on their race. work, the therapist encourages the client to explore how she might have contributed to her employer's mistrust of her.

A therapist takes great care to You are deviant. ask all substance abuse questions in an intake with a Native American client, and is suspicious of the client's nonexistent history with substances.

Use of Sexist/Heterosexist Language Terms that exclude or degrade During the intake session, a Heterosexuality is the norm, women and LGB groups. female client discloses that she has been in her current relationship for one year. The therapist asks how long the client has known her boyfriend.

When an adult female client Application of language that explains she is feeling isolated applies to adolescent females to at work, her male therapist adult females/your problems asks, Aren't there any girls you are trivial, can gossip with there?

Racial, Qender, and Sexual Orientation Microaggressions 127 Table 5.2 continued

Denial of Individual Racism/Sexism/Heterosexism A statement made when a A client of color asks his/her Your racial/ethnic experience is member of the power group therapist about how race affects not important, renounces their biases. their working relationship. The therapist replies, Race does not affect the way I treat you."

A client of color expresses hesitancy in discussing racial issues with his White female therapist. She replies r understand. As a woman, I face discrimination also."

Your racial oppression is no different than my gender oppression.

A therapist's nonverbal I am incapable of behavior conveys discomfort homonegativity yet I am when a bisexual male client is unwilling to explore this describing a recent sexual experience with a man. When he asks her about it, she insists she has no negative feelings toward gay people'and says it is important to keep the conversation on him.

Myth of Meritocracy

Statements which assert that race or gender does not play a role in succeeding in career advancement or education.

A school counselor tells a Black student that If you work hard, you can succeed like everyone else." A female client visits a career counselor to share her concerns that a male coworker was chosen for a managerial position over her, despite that she was better qualified and in the job longer. The counselor responds that he must have been better suited for some of the job requirements."

People of color/women are lazy and/or incompetent and need to work harder. If you don't succeed, you have only yourself to blame blaming the victim)


128 The Political Dimensions of Mental Health Practice Table 5.2 continued

Pathologizing Cultural Values/Communication Styles

The notion that the values and communication styles of the dominant/White culture are ideal.

A Black client is loud, emotional, and confrontational in a counseling session. The therapist diagnoses her with borderline personality disorder. A client of Asian or Native American descent has trouble maintaining eye contact with his therapist. The therapist diagnoses him with a social anxiety disorder.

Assimilate to dominant culture.

Advising a client, Do you Leave your cultural baggage really think your problem stems outside, from racism?

Second Class Citizen Occurs when a member of the power group is given preferential treatment over a target group member.

A male client calls and requests a session time that is currently taken by a female client. The therapist grants the male client the appointment without calling the female client to see if she can change times.

Males are more valued than women.

Clients of color are not welcomed or acknowledged by receptionists.

White clients are more valued than clients of color.

Traditional Gender Role Prejudicing and Stereotyping Occurs when expectations of A therapist continually asks the Women should be married, and traditional roles or stereotypes middle age female client about dating should be an important are conveyed. dating and putting herself out topic/part of your life. there'despite that the client has not expressed interest in exploring this area.

Racial, Qender, and Sexual Orientation Microaggressions 129

Table 5.2 continued

A gay male client has been with Gay men are promiscuous. Gay his partner for 5 years. His men cannot have monogamous therapist continually probes his relationships, desires to meet other men and be unfaithful.

A therapist raises her eyebrows Women should not be sexually when a female client mentions adventurous, that she has had a one night stand.

Sexual Obj edification Occurs when women are A male therapist puts his hands Your body is not yours, treated like objects at men's on a female client's back as she disposal. walks out of the session.

A male therapist is looking at Your body/appearance is for his female client's breasts while men's enjoyment and pleasure, she is talking.

Assumption of Abnormality Occurs when it is implied that there is something wrong with being LGB.

The therapist of a 20-year old Your sexuality is something that lesbian inadvertently refers to is not stable, sexuality as a phase."

When discussing her Bisexuality represents a bisexuality, the therapist confusion about sexual continues to imply that there is orientation, a Crisis of identity."

Adapted from Sue et al., 2007.

130 The Political Vimensions of Mental Health Practice

and counselors have an obligation to their clients, especially when their clients differ from them in terms of race, gender, and/or sexual orientation, to work to understand their experiential reality. There is evidence to suggest that racial, gender, and sexual orientation microaggressions are everyday experi- ences too innumerable to count. These experiences impact clients in ways that researchers are only beginning to understand. There is much work to be done to better understand the nuances and processes involved in this very complex phenomenon. Therapists and counselors are in a position to learn from their clients about microaggressions and their relationship to their presenting con- cerns and developmental issues. It is imperative to encourage clients to ex- plore their feelings about incidents that involve their race, gender, and sexual orientation so that the status quo of silence and invisibility can be destroyed. 1. Be aware that racial, gender, and sexual orientation microaggressions are a constant reality in the lives of culturally diverse groups. They take a major psychological toll on people of color, women, and LGB individ- uals. The socioemotional problems brought to therapy often reside in the effects of microaggressions rather than an attribute of the indi- vidual. 2. Be aware that everyone has, and continues to engage in, unintentional microaggressions. As a helping professional these microaggressions may serve as impediments to effective multicultural counseling and therapy. All therapists have a major responsibility to make the invisible, visible. What biases, prejudices, and stereotypes do you hold that may result in microaggressions rWhat must you do to minimize allowing them to im- pact your client in the therapy sessions? 3. Do not invalidate the experiential reality of culturally diverse groups. Entertain the notion that they may have a more accurate perception of reality than you, especially when it comes to issues of racism, sexism, or heterosexism. Reach out to culturally diverse clients, try to understand their worldviews, and don't be quick to dismiss or negate racial, gender, or sexual orientation issues. 4. Don't get defensive if your culturally diverse client implies that you have engaged in a microaggressive remark or behavior. Try to clarify the situation by showing you are open and receptive to conversations on race, gender, or sexual orientation. Remember, we all commit micro- aggressive blunders. In some cases, a simple I'm sorry"and encour- agement to the client to feel free to raise similar issues will do wonders for the therapeutic relationship. Remember, it's how the therapist re- covers, not how he or she covers up, that is important.

The Practice Dimensions of Multicultural Co un s eli n <3- /Therapy

Barriers to Multicultural Counseling and Therapy

One of the most difficult cases I have ever treated was that of a Mexican American family in southern California. Fernando M. was a 56-year-old recent immigrant to the United States. He had been married some 35 years to Refugio, his wife, and had fathered 10 children. Only four of his chil- dren, three sons and one daughter, resided with him. Fernando was born in a small village in Mexico and resided there until 3 years ago, when he moved to California. He was not unfamiliar with California, having worked as a bracero for most of his adult life. He made frequent visits to the United States during annual harvest seasons. The M. family resided in a small, old, unpainted rental house that sat on the back of a dirt lot and was sparsely furnished with their belong- ings. The family did not own a car, and public transportation was not available in their neighborhood. While their standard of living was far be- low U.S. poverty levels, the family appeared quite pleased at their relative affluence when compared with their life in Mexico. The presenting complaints concerned Fernando. He heard threaten- ing voices, was often disoriented, and stated that someone was planning to kill him and that something evil was about to happen. He became afraid to leave his home, was in poor physical health, and possessed a decrepit ap- pearance that made him essentially unemployable. When the M. family entered the clinic I was asked to see them, be- cause the bilingual therapist scheduled that day had called in sick. I was hoping that either Fernando or Refugio could speak enough English to un- derstand the situation. As luck would have it, neither could understand me, nor I them. It became apparent, however, that the two older children could understand English. Since the younger one seemed more fluent, I called on him to act as a translator during our first session. I noticed that the parents seemed reluctant to participate with the younger son, and for some time the discussion between the family members was quite animated. Sensing something wrong and desiring to get the session underway, I in- terrupted the family and asked the son who spoke English best what was wrong. He hesitated for a second, but assured me that everything was fine.



134 The Practice Dimensions of Multicultural Counseling/Therapy

During the course of our first session, it became obvious to me that Fer- nando was seriously disturbed. He appeared frightened, tense, and, if the inter- pretations from his son were correct, he was also hallucinating. I suggested to Refugio that she consider hospitalizing her husband, but she was adamant against this course. I could sense her nervousness and fear that I would initiate action to have her husband committed. I reassured her that no action would be taken without a follow-up evaluation and suggested that she return later in the week with Fernando. Refugio said that it would be difficult since Fernando was afraid to leave his home. She had to coerce him into coming this time and did not feel she could do it again. I looked at Fernando directly and stated, "Fernando, I know how hard it is for you to come here, but we really want to help you. Do you think you could possibly come one more time? Dr. Escobedo [the bilingual ther- apist] will be here with me, and he can communicate with you directly. " The youngest son interpreted. The M. family never returned for another session, and their failure to show up has greatly bothered me. Since that time I have talked with several Latino psy- chologists who have pointed out multicultural issues that I was not aware of then. Now I realize how uninformed and naive I was about working with Lati- nos, and I only hope the M. family have found the needed help elsewhere. While Chapter 4 dealt with the sociopolitical dynamics affecting multi- cultural counseling/therapy, this chapter discusses the cultural barri- ers that may render the helping professional ineffective, thereby denying help to culturally diverse clients. The previous example illustrates important mul- ticultural issues that are presented in the following series of questions:

1 . Was it a serious blunder for the therapist to see the M. family or to con- tinue to see them in the session, when he could not speak Spanish and the parents could not speak English?Should he have waited until Dr. Escobedo returned? 2. While it may seem like a good idea to have one of the children interpret for the therapist and the family, what possible cultural implications might this have in a Mexican American family ?Can one obtain an ac- curate translation through family interpretersTWhat are some of the pitfalls? 3. The therapist tried to be informal with the family in order to put them at ease. Yet some of his colleagues have stated that how he addresses cli- ents last names or first names )may be important. When the therapist used the first names of both husband and wife, what possible cultural interpretation from the family may have resulted? 4. The therapist saw Mr. M.'s symptoms as indications of serious pathol- ogy. What other explanations should he have entertained?Should he

Barriers to Multicultural Counseling and Therapy 135

have so blatantly suggested hospitalizationTHow do Latinos perceive mental health issues? 5. Knowing that Mr. M. had difficulty leaving home, should the therapist have considered some other treatment avenueslf so, what might they have been? The clash of cultural and therapeutic barriers exemplified in these ques- tions is both complex and difficult to resolve. They challenge mental health professionals to \ )reach out and understand the worldviews, cultural val- ues, and life circumstances of their culturally diverse clients; £)free them- selves from the cultural conditioning of what they believe is correct thera- peutic practice;? )develop new but culturally sensitive methods of working with clients;and ^)play new roles in the helping process outside of conven- tional psychotherapy Atkinson, Thompson, SSrant, 1993)Three majorpo- tential barriers to effective Multicultural Therapy MCT)are illustrated in this case:class-bound values, language bias and misunderstanding, and culture- bound values. First, Fernando's paranoid reactions and suspicions'and his hallucina- tions may have had many causes. An enlightened mental health professional must consider whether there are sociopolitical, cultural, or biological reasons for his symptoms. Can his fears, for example, symbolize realistic concerns fear of deportation, creditors, police, etc.)How do Latino cultures view hal- lucinations?Some studies indicate that cultural factors make it more accept- able for some Spanish-speaking populations to admit to hearing voices or see- ing visions. Indeed, Appendix I of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders £000)now recognizes a large group of culture-bound syndromes, or disorders that seem to appear only in specific cultures and societies. Another consideration is the life circum- stances of Fernando's work. Could his agricultural work and years of expo- sure to pesticides and other dangerous agricultural chemicals be contributing to his mental state?Counselors and psychotherapists often focus so much on the internal dynamics of clients that there is a failure to consider external sources as causes. It is important for therapists to consider these explanations. In addition, mental health practice has been described as a White, middle-class activity that often fails to recognize the economic implications in the delivery of mental health services. Class-bound factors related to socio- economic status may place those suffering from poverty at a disadvantage and deny them the necessary help that they need. For example, Fernando's family is obviously poor, they do not own an automobile, and public trans- portation is not available in the rural area where they reside. Poor clients have difficulties traveling to mental health facilities for treatment. Not only is attending sessions a great inconvenience, but it can also be costly to arrange

136 The Practice Dimensions of Multicultural Counseling/Therapy private transportation for the family. It seems that meeting the needs of the M. family might have entailed home visits or some other form of outreach. If the M. family was unable to travel to the therapist's office for treatment, what blocked the therapist from considering a home visit, or a meeting point be- tween the destinationsMany therapists feel disinclined, fearful, or uncom- fortable doing the former. Their training dictates that they should practice in their offices, and that clients should come to them. When mental health ser- vices are located away from the communities that they purport to serve, out- reach programs are not available, and economic considerations are not ad- dressed by mental health services, institutional bias is clearly evident. Second, language barriers often place culturally diverse clients at a dis- advantage. The primary medium by which mental health professionals do their work is through verbalization talk therapies) Ever since Freud devel- oped the talking cure, psychotherapy has meant that clients must be able to verbalize their thoughts and feelings to a practitioner in order to receive the necessary help. In addition, because of linguistic bias and monolingualism, the typical form of talk is via Standard English. Clients who do not speak Standard English, possess a pronounced accent, or have limited command of English like the M. family)may be victimized. The need to understand the meaning of linguistic differences and lan- guage barriers in counseling and psychotherapy has never been greater. As we mentioned previously, the result of changing demographics is that many of our clients are born outside of the United States and speak English as their second language. While the use of interpreters might seem like a solution, such a practice may suffer from certain limitations. For example, can inter- preters really give an accurate translation?Cultural differences in mental health concepts are not equivalent in various cultures. In addition, many concepts in English and Spanish do not have equivalent meanings. Likewise, the good intentions of the therapist to communicate with the M. family via the son, who seemed to speak English fluently, might result in a cultural family violation. It may undermine the authority of the father by disturbing the patriarchal role relationships considered sacred in traditional Latino fami- lies. There is no doubt that the need for bilingual therapists is great. Yet the lack of bilingual mental health professionals does not bode well for linguistic minorities. Third, a number of culture -bound issues seemed to be played out in the delivery of services to the M. family. The therapist's attempt to be informal and to put the family at ease resulted in greeting Mr. M. by using his first name Fernando) as opposed to a more formal title Mx. M.) In traditional Latino and Asian cultures, such informality or familiarity may be considered a lack of respect for the man's role as head of the household. Another cultural barrier might be operative in asking the son whether something was wrong. It is highly probable that the animated family discussion was based on objec-

Barriers to Multicultural Counseling and Therapy 137

tions to the son's interpreting because it placed the father and mother in a de- pendency position. Yet as you recall, the son denied that anything was wrong. Many traditional Latinos do not feel comfortable airing family issues in pub- lic and might consider it impolite to turn down the therapist's suggestion to have the younger son interpret. Characteristics of Counseling/Therapy Counseling and psychotherapy may be viewed legitimately as a process of in- terpersonal interaction, communication, and social influence Lui EPope- Davis, 2005) For effective therapy to occur, the therapist and client must be able to send and receive both verbal and nonverbal messages appropriately and accu- rately. While breakdowns in communication often happen between people who share the same culture, the problem becomes exacerbated between people of different racial or ethnic backgrounds. Many mental health profes- sionals have noted that racial or ethnic factors may act as impediments to therapy by lowering social influence Locke, 1998;Paniagua, 1998;D.W. Sue, 2001) Misunderstandings that arise from cultural variations in communica- tion may lead to alienation or an inability to develop trust and rapport. Cul- ture clashes can often occur between the values of counseling and psycho- therapy and the values of culturally diverse groups. (keneric Characteristics of Counseling/Therapy All theories of counseling and psychotherapy are influenced by assumptions that theorists make regarding the goals for therapy, the methodology used to invoke change, and the definition of mental health and mental illness. Coun- seling and psychotherapy have traditionally been conceptualized in Western individualistic terms Iyey, Ivey, Myers, SSweeny, 2005) Whether the particular theory is psychodynamic, existential-humanistic, or cognitive- behavioral in orientation, a number of multicultural specialists Ponterotto, Utsey EPedersen, 2006;Ridley, 2005)indicate that they share certain com- mon components of White culture in their values and beliefs. Katz J 98 5 )has described these components of White culture. These values and beliefs have influenced the actual practice of counseling and psychotherapy, as can be seen clearly in Tables 6.1 and 6.2. In the United States and in many other countries as well, psychotherapy and counseling are used mainly with middle- and upper-class segments of the population. As a result, culturally diverse clients do not share many of the values and characteristics seen in both the goals and the processes of therapy. Schofield J964)has noted that therapists tend to prefer clients who exhibit

138 The Practice Dimensions of Multicultural Counseling/Therapy

Tabic 6. 1 Generic Characteristics of Counseling

Standard English Verbal communication Individual centered Verbal/emotional/ behavioral expressiveness Client-counselor communication Openness and intimacy Cause-effect orientation Clear distinction between physical and mental well- being

Standard English Verbal communication Adherence to time schedules pO-minute sessions) Long-range goals Ambiguity

Standard English Verbal communication

Nuclear family

the YAVIS syndrome: young, attractive, verbal, intelligent, and successful. This preference tends to discriminate against people from different minority groups or those from lower socioeconomic classes. This led Sundberg (1981) to sarcastically point out that therapy is not for QUOID people Quiet, ugly, old, indigent, and dissimilar culturally) Three major characteristics of coun- seling and psychotherapy may act as impediments to effective counseling. 1. Culture-bound values: individual centered, verbal/emotional/behav- ioral expressiveness, communication patterns from client to counselor, openness and intimacy, analytic/linear/verbal (ause-effect (approach, and clear distinctions between mental and physical well-being. 2. Class-bound values: strict adherence to time schedules ^0-minute, once or twice a week meetings) ambiguous or unstructured approach to problems, and seeking long-range goals or solutions. 3. Language variables: use of Standard English and emphasis on verbal communication. Table 6.2 summarizes these generic characteristics and compares their compatibility to those of four racial/ethnic minority groups. As mentioned earlier, such a comparison can also be done for other groups that vary in gen- der, age, sexual orientation, ability/disability, and so on. While an attempt has been made to clearly delineate three major vari- ables that influence effective therapy, these variables are often inseparable from one another. For example, use of Standard English in counseling and

Barriers to Multicultural Counseling and Therapy 139 Table 6.2 Racial/Ethnic Minority Group Variables

Asian Americans

Asian language Family centered Restraint of feelings One-way communication from authority figure to person Silence is respect Advice seeking Well-defined patterns of interaction foncrete structured) Private versus public display ^hame/disgrace/pride) Physical and mental well-being defined differently Extended family

Nonstandard English Action oriented Different time perspective Immediate, short-range goals

Bilingual background

African Americans

Black language Sense of people-hood" Action oriented Paranorm due to oppression Importance placed on nonverbal behavior Extended family

Nonstandard English Action oriented Different time perspective Immediate, short-range goals Concrete, tangible, structured approach

Black language

Latino/Hispanic Americans

Spanish-speaking Group centered Temporal difference Family orientation Different pattern of communication Religious distinction between mind/body

Nonstandard English Action oriented Different time perspective Extended family Immediate short-range goals Concrete, tangible, structured approach

Bilingual background



The Practice Dimensions of Multicultural Counseling/Therapy

Table 6.2 continued

American Indians

Tribal dialects

Nonstandard English

Bilingual background

Cooperative, not competitive individualism

Action oriented

Different time perspective

Present-time orientation

Immediate, short-range goals

Creative/experimental/intuitive/ nonverbal Satisfy present needs Use of folk or supernatural explanations Extended family

Concrete, tangible, structured approach

therapy definitely places those individuals who do not speak English fluently at a disadvantage. However, cultural and class values that govern conven- tions of conversation can also operate via language to cause serious misun- derstandings. Furthermore, the fact that many African Americans, Latino/ Hispanic Americans, and American Indians come from predominantly lower- class backgrounds often compounds class and culture variables. Thus, it is often difficult to tell which variables are the sole impediments in therapy. Nevertheless, this distinction is valuable in conceptualizing barriers to effec- tive multicultural counseling/therapy.

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 each member of society is born. While being bi- cultural is a source of strength, the process of negotiating dual group mem- bership may cause problems for many minorities. The term marginal person was first coined by Stonequist (^937)and refers to a person's inability to form dual ethnic identification because of bicultural membership. Racial and eth- nic minorities are placed under strong pressures to adopt the ways of the dominant culture. The cultural deficit models tend to view culturally diverse groups as possessing dysfunctional values and belief systems that are often handicaps to be overcome, be ashamed of, and avoid. In essence, racial and ethnic minorities may be taught that to be different is to be deviant, patho- logical, or sick.

Culture-Bound Values

Barriers to Multicultural Counseling and Therapy 141

Many social scientists F3oyd-Franklin, 2003; Duran, 2006; Guthrie, 1997;Halleck, 1971)believe that psychology and therapy may be viewed as encompassing the use of social power, and that therapy is a handmaiden of the status quo. The therapist may be seen as a societal agent transmitting and functioning under Western values. An early outspoken critic, Szasz (1970) believes that psychiatrists are like slave masters, using therapy as a powerful political ploy against people whose ideas, beliefs, and behaviors differ from the dominant society. Several culture-bound characteristics of therapy may be responsible for these negative beliefs. Focus on the Individual Most forms of counseling and psychotherapy tend to be individual centered le., they emphasize the I-thou"relationship) Pedersen £000)notes that U.S. culture and society are based on the concept of individualism and that competition between individuals for status, recognition, achievement, and so forth, forms the basis for Western tradition. Individualism, autonomy and the ability to become your own person are perceived as healthy and desirable goals. If we look at most Euro-American theories of human development fi- aget, Erickson, etc.) we are struck by how they emphasize individuation as normal and healthy development Ivey, D 'Andrea, Ivey EBimek-Morgan, 2002) Pedersen notes that not all cultures view individualism as a positive orientation;rather, it may be perceived in some cultures as a handicap to at- taining enlightenment, one that may divert us from important spiritual goals. In many non-Western cultures, identity is not seen apart from the group ori- entation Collectivism) The Japanese language does not seem to have a dis- tinct personal pronoun I. The notion of atman in India defines itself as partic- ipating in unity with all things and not being limited by the temporal world. Many societies do not define the psychosocial unit of operation as the individual. In many cultures and subgroups, the psychosocial unit of opera- tion tends to be the family, group, or collective society. In traditional Asian American culture, one's identity is defined within the family constellation. The greatest punitive measure to be taken out on an individual by the family is to be disowned. What this means, in essence, is that the person no longer has an identity. While being disowned by a family in Western European cul- ture is equally negative and punitive, it does not have the same connotations as in traditional Asian society. Although they may be disowned by a family, Westerners are always told that they have an individual identity as well. Like- wise, many Hispanic individuals tend to see the unit of operation as residing within the family. African American psychologists Parham et al., 1999)also point out how the African view of the world encompasses the concept of groupness." Our contention is that racial/ethnic minorities often use a different psy- chosocial unit of operation, in that collectivism is valued over individualism.

142 The Practice Dimensions of Multicultural Counseling/Therapy This worldview is reflected in all aspects of behavior. For example, many tra- ditional Asian American and Hispanic elders tend to greet one another with the question, How is your family today?Contrast this with how most Americans tend to greet each othenHow are you today?One emphasizes the family group)perspective, while the other emphasizes the individual perspective. Affective expressions in therapy can also be strongly influenced by the particular orientation one takes. When individuals engage in wrongful be- haviors in the United States, they are most likely to experience feelings of guilt. In societies that emphasize collectivism, however, the most dominant affective element to follow a wrongful behavior is shame, not guilt. Guilt is an individual affect, while shame appears to be a group one ft reflects on the family or group) Counselors and therapists who fail to recognize the importance of defin- ing this difference between individualism and collectivism will create diffi- culties in therapy. Often we are impressed by the number of our colleagues who describe traditional Asian clients as being dependent/Unable to make decisions on their own/and Tacking in maturity/Many of these judgments are based on the fact that many Asian clients do not see a decision-making process as an individual one. When an Asian client states to a counselor or therapist, f can't make that decision on my own;I need to consult with my parents or family/he or she is seen as being quite immature. After all, ther- apy is aimed at helping individuals make decisions on their own in a mature" and fesponsible'manner. Verbal/Emotional/Behavioral Expressiveness Many counselors and therapists tend to emphasize the fact that verbal/emo- tional/behavioral expressiveness is important in individuals. For example, we like our clients to be verbal, articulate, and able to express their thoughts and feelings clearly. Indeed, therapy is often referred to as talk therapy, indicating the importance placed on Standard English as the medium of expression. Emotional expressiveness is also valued, as we like individuals to be in touch with their feelings and to be able to verbalize their emotional reactions. In some forms of counseling and psychotherapy, it is often stated that if a feel- ing is not verbalized and expressed by the client, it may not exist. We tend to value behavioral expressiveness and believe that it is important as well. We like individuals to be assertive, to stand up for their own rights, and to engage in activities that indicate they are not passive beings. All these characteristics of therapy can place culturally diverse clients at a disadvantage. For example, many cultural minorities tend not to value ver- balizations in the same way that Americans do. In traditional Japanese cul- ture, children have been taught not to speak until spoken to. Patterns of com-

Barriers to Multicultural Counseling and Therapy 143

munication tend to be vertical, flowing from those of higher prestige and sta- tus to those of lower prestige and status. In a therapy situation many Japan- ese clients, to show respect for a therapist who is older, wiser, and who occu- pies a position of higher status, may respond with silence. Unfortunately an unenlightened counselor or therapist may perceive this client as being inar- ticulate and less intelligent. Emotional expressiveness in counseling and psychotherapy is fre- quently a highly desired goal. Yet many cultural groups value restraint of strong feelings. For example, traditional Hispanic and Asian cultures empha- size that maturity and wisdom are associated with one's ability to control emotions and feelings. This applies not only to public expressions of anger and frustration, but also to public expressions of love and affection. Unfortu- nately, therapists unfamiliar with these cultural ramifications may perceive their clients in a very negative psychiatric light. Indeed, these clients are often described as inhibited, lacking in spontaneity, or repressed. In therapy it has become increasingly popular to emphasize expressive- ness in a behavioral sense. For example, one need only note the proliferation of cognitive -behavioral assertiveness training programs throughout the United States and the number of self-help books that are being published in the popular mental health literature. This orientation fails to realize that there are cultural groups in which subtlety is a highly prized art. Yet doing things indirectly can be perceived by the mental health professional as evi- dence of passivity and a need for an individual to learn assertiveness skills. Therapists who value verbal, emotional, and behavioral expressiveness as goals in therapy may be unaware that they are transmitting their own cul- tural values. These generic characteristics of counseling are antagonistic not only to lower-class values, but to different cultural ones as well. In their ex- cellent review of assertiveness training, Wood and Mallinckrodt }990)warn that therapists need to make certain that gaining such skills is a value shared by the minority client, and not imposed by therapists. For example, state- ments by some mental health professionals that Asian Americans are the most repressed of all clients indicate that they expect their clients to exhibit openness, psychological-mindedness, and assertiveness. Such a statement may indicate the therapist's failure to understand the background and cul- tural upbringing of many Asian American clients. Traditional Chinese and Japanese cultures may value restraint of strong feelings and subtleness in ap- proaching problems. Insight Another generic characteristic of counseling is the use of insight in both counseling and psychotherapy. This approach assumes that it is mentally ben- eficial for individuals to obtain insight or understanding into their underlying

144 The Practice Dimensions of Multicultural Counseling/Therapy dynamics and causes. Educated in the tradition of psychoanalytic theory, many theorists tend to believe that clients who obtain better insight into themselves will be better adjusted. While many behavioral schools of thought may not subscribe to this, most therapists use insight in their individual prac- tice, either as a process of therapy or as an end product or goal. We need to realize that insight is not highly valued by many culturally diverse clients. There are major class differences as well. People from lower socioeconomic classes frequently do not perceive insight as appropriate to their life situations and circumstances. Their concern may revolve around questions such as Where do I find a jobrHow do I feed my family^nd How can I afford to take my sick daughter to a doctorTWhen survival on a day-to-day basis is important, it seems inappropriate for the therapist to use insightful processes. After all, insight assumes that one has time to sit back, reflect, and contemplate motivations and behavior. For the individual who is concerned about making it through each day, this orientation proves coun- terproductive. Likewise, many cultural groups do not value insight. In traditional Chi- nese society, psychology has little relevance. It must be noted, however, that a client who does not seem to work well in an insight approach may not be lacking in insight or psychological-mindedness. A person who does not value insight is not necessarily one who is incapable of insight. Thus, several major factors tend to affect insight. First, many cultural groups do not value this method of self- exploration. It is interesting to note that many Asian elders believe that thinking too much about something can cause problems. In a study of the Chinese in San Francisco's Chinatown, Lum i^982)found that many believe the road to mental health was to Avoid morbid thoughts/Advice from Asian elders to their children when they encountered feelings of frustration, anger, depression, or anxiety was simply, Don't think about it. "Indeed, it is often believed that the reason one experiences anger or depression is precisely that one is thinking about it too much! The traditional Asian way of handling these affective elements is to keep busy and don't think about it. "Granted, it is more complex than this, because in traditional Asian families the reason self- exploration is discouraged is precisely because it is an individual approach. Think about the family and not about yourself'is advice given to many Asians as a way of dealing with negative affective elements. This is totally contradictory to Western notions of mental health;namely, that it is best to get things out in the open in order to deal with them. Second, many racial/ethnic minority psychologists have felt that insight is a value in itself. For example, it was generally thought that insight led to behavior change. This was the old psychoanalytic assumption that when people understood their conflicts and underlying dynamics, the symptoms or behavior would change or disappear. The behavioral schools of thought have since disproved this one-to-one connection. While insight does lead to be-

Barriers to Multicultural Counseling and Therapy 145

havior change in some situations, it does not always seem to do so. Indeed, behavioral therapies have shown that changing the behavior first may lead to insight Cognitive restructuring and understanding)instead of vice versa. Self-Disclosure Qpenness and Intimacy) Most forms of counseling and psychotherapy tend to value one's ability to self-disclose and to talk about the most intimate aspects of one's life. Indeed, self-disclosure has often been discussed as a primary characteristic of a healthy personality. The converse of this is that people who do not self- disclose readily in counseling and psychotherapy are seen to possess negative traits such as being guarded, mistrustful, or paranoid. There are two difficul- ties in this orientation toward self-disclosure. One of these is cultural, and the other is sociopolitical. First, intimate revelations of personal or social problems may not be ac- ceptable because such difficulties reflect not only on the individual, but also on the whole family. Thus, the family may exert strong pressures on the Asian American client not to reveal personal matters to strangers or outsiders. Sim- ilar conflicts have been reported for Hispanics I^eong, Wagner, ffata, 1995; Paniagua, 1998)and for American Indian clients Herring, 1999;LaFrom- boise, 1998) A therapist who works with a client from a minority back- ground may erroneously conclude that the person is repressed, inhibited, shy, or passive. Note that all these terms are seen as undesirable by Western stan- dards. Related to this example is many health practitioners' belief in the desir- ability of self-disclosure. Self-disclosure refers to the client's willingness to tell the therapist what he or she feels, believes, or thinks. Jourard 1 964)suggests that mental health is related to one's openness in disclosing. While this may be true, the parameters need clarification. Chapter 4 uses as an example the paranorm of Grier and Cobbs }968) People of African descent are especially reluctant to disclose to White counselors because of hardships that they have experienced via racism Ridley, 2005) African Americans initially perceive a White therapist more often as an agent of society who may use information against them, rather than as a person of goodwill. From the African Ameri- can perspective, noncritical self-disclosure to others is not healthy. The actual structure of the therapy situation may also work against in- timate revelations. Among many American Indians and Hispanics, intimate aspects of life are shared only with close friends. Relative to White middle- class standards, deep friendships are developed only after prolonged contacts. Once friendships are formed, they tend to be lifelong in nature. In contrast, White Americans form relationships quickly, but the relationships do not necessarily persist over long periods of time. Counseling and therapy also seem to reflect these values. Clients talk about the most intimate aspects of their lives with a relative stranger once every week for a 50 -minute session.

146 The Practice Dimensions of Multicultural Counseling/Therapy To many culturally different groups who stress friendship as a precondition to self-disclosure, the counseling process seems utterly inappropriate and ab- surd. After all, how is it possible to develop a friendship with brief contacts once a week? Scientific Empiricism Counseling and psychotherapy in Western culture and society have been de- scribed as being highly linear, analytic, and verbal in their attempt to mimic the physical sciences. As indicated by Table 6.1, Western society tends to em- phasize the so-called scientific method, which involves objective, rational, linear thinking. Likewise, we often see descriptions of therapists as objective, neutral, rational, and logical Utsey, Walker aCwate, 2005) Therapists rely heavily on the use of linear problem solving, as well as on quantitative eval- uation that includes psychodiagnostic tests, intelligence tests, personality in- ventories, and so forth. This cause-and-effect orientation emphasizes left- brain functioning. That is, theories of counseling and therapy are distinctly analytical, rational, and verbal, and they strongly stress the discovery of cause-and-effect relationships. The emphasis on symbolic logic contrasts markedly with the philoso- phies of many cultures that value a more nonlinear, holistic, and harmonious approach to the world D. W. Sue ffionstantine, 2003) For example, Amer- ican Indian worldviews emphasize the harmonious aspects of the world, in- tuitive functioning, and a holistic approacha-world view characterized by right-brain activities Qrnstein, 1972) minimizing analytical and reduction- istic inquiries. Thus, when American Indians undergo therapy, the analytic approach may violate their basic philosophy of life. It appears that the most dominant way of asking and answering ques- tions about the human condition in U.S. society tends to be the scientific method. The epitome of this approach is the experiment. In graduate schools we are often told that only through the experiment can we impute a cause- and-effect relationship. By identifying the independent and dependent vari- ables, and controlling for extraneous variables, we are able to test a cause- and-effect hypothesis. While correlation studies, historical research, and other approaches may be of benefit, we are told that the experiment repre- sents the epitome of our science Seligman 8£sikszentmihalyi, 200 1 ) As in- dicated, other cultures may value different ways of asking and answering questions about the human condition. Distinctions between Mental and Physical Functioning Many American Indians, Asian Americans, Blacks, and Hispanics hold differ- ent concepts of what constitutes mental health, mental illness, and adjust-

Barriers to Multicultural Counseling and Therapy 147

merit. Among the Chinese, the concept of mental health or psychological well-being is not understood in the same way as it is in the Western context. Latino/Hispanic Americans do not make the same Western distinction be- tween mental and physical health as do their White counterparts Rivera, 1984) Thus, nonphysical health problems are most likely to be referred to a physician, priest, or minister. Culturally diverse clients operating under this orientation may enter therapy expecting therapists to treat them in the same manner that doctors or priests do. Immediate solutions and concrete tangible forms of treatment ^dvice, confession, consolation, and medication )are ex- pected. Ambiguity The ambiguous and unstructured aspect of the therapy situation may create discomfort in clients of color. The culturally different may not be familiar with therapy and may perceive it as an unknown and mystifying process. Some groups, such as Hispanics, may have been reared in an environment that ac- tively structures social relationships and patterns of interaction. Anxiety and confusion may be the outcome in an unstructured counseling setting. Patterns of Communication The cultural upbringing of many minorities dictates different patterns of communication that may place them at a disadvantage in therapy. Coun- seling, for example, initially demands that communication move from cli- ent to counselor. The client is expected to take the major responsibility for initiating conversation in the session, while the counselor plays a less active role. However, American Indians, Asian Americans, and Hispanics func- tion under different cultural imperatives, which may make this difficult. These three groups may have been reared to respect elders and authority figures and not to speak until spoken to. Clearly defined roles of domi- nance and deference are established in the traditional family. Evidence in- dicates that Asians associate mental health with exercising will power, avoiding unpleasant thoughts, and occupying one's mind with positive thoughts. Therapy is seen as an authoritative process in which a good ther- apist is more direct and active, and portrays a kind of father figure Henkin, 1985;Mau Sfepson, 1988) A racial/ethnic minority client who is asked to initiate conversation may become uncomfortable and respond with only short phrases or statements. The therapist may be prone to interpret the behavior negatively, when in actuality it may be a sign of respect. We have much more to say about these communication style differences in the next chapter.

148 The Practice Dimensions of Multicultural Counseling/Therapy

Class-Bound Values

Social class and classism have been identified as two of the most overlooked topics in psychology and mental health practice Liu, Ali, Soleck, Hopps, Dunston, Pickett, 2004;L. Smith, 2005) While many believe that the gap in income is closing, statistics suggest the opposite4ncome inequality is in- creasing. Those in the top 5 percent of income have enjoyed huge increases, while those in the bottom 40 percent are stagnant APA Task Force on Socio- economic Status, 2006) In the United States, 32 million Americans live in poverty. Blacks are three times more likely to live in poverty than Whites;the rate of poverty for Latinos is 23 percent; for Asian/Pacific Islanders it is 11 percent;and for Whites it is 8 percent Liu et al., 2004) These statistics clearly suggest that social class may be intimately linked to race because many racial/ ethnic minority groups are disproportionately represented in the lower socio- economic classes Lewis et al., 1998) Research indicates that lower socioeconomic class is related to higher incidence of depression Lorant, Deliege, Eaton, Robert, Philippot, & Ansseau, 2003) lower sense of control Chen, Matthews, 8Boyce, 2002) and poorer physical health (Jallo Matthews, 2003) Mental health profes- sionals are often unaware of additional stressors likely to confront clients who lack financial resources, nor do they fully appreciate how those stressors af- fect their clients' daily lives. For the therapist who comes from a middle- to upper-class background, it is often difficult to relate to the circumstances and hardships affecting the client who lives in poverty. The phenomenon of poverty and its effects on individuals and institutions can be devastating Liu, Hernandezs, Mahmood, gStinson, 2006) The individual's life is character- ized by low wages, unemployment, underemployment, little property own- ership, no savings, and lack of food reserves. Meeting even the most basic needs of food and shelter is in constant jeopardy. Pawning personal posses- sions and borrowing money at exorbitant interest rates only leads to greater debt. Feelings of helplessness, dependence, and inferiority develop easily under these circumstances. Therapists may unwittingly attribute attitudes that result from physical and environmental adversity to the cultural or indi- vidual traits of the person. For example, note the clinical description of a 12- year-old child written by a school counselor: Jimmy Jones is a 12-year-old Black male student who was referred by Mrs. Peter- son because of apathy, indifference, and inattentiveness to classroom activities. Other teachers have also reported that Jimmy does not pay attention, daydreams often, and frequently falls asleep during class. There is a strong possibility that Jimmy is harboring repressed rage that needs to be ventilated and dealt with. His inability to directly express his anger had led him to adopt passive-aggressive means of expressing hostility (i.e., inattentiveness, daydreaming, falling asleep).

Barriers to Multicultural Counseling and Therapy 149

It is recommended that Jimmy be seen for intensive counseling to discover the ba- sis of the anger. After 6 months of counseling, the counselor finally realized the basis of Jimmy's problems. He came from a home life marked by extreme poverty where hunger, lack of sleep, and overcrowding served to severely diminish his energy level and motivation. The fatigue, passivity, and fatalism evi- denced by Jimmy were more a result of poverty than of some innate group or individual trait. Likewise, poverty may cause many parents to encourage children to seek employment at an early age. Delivering groceries, shining shoes, and hustling other sources of income may sap the energy of the school- child, leading to truancy and poor performance. Teachers and counselors may view such students as unmotivated and potential juvenile delinquents. Considerable bias against people who are poor has been well docu- mented APA Task Force on SES, 2006;L. Smith, 2005) While considerable controversy exists over whether classism is unidirectional directed toward those in lower classes)or bidirectional Equally likely to occur between the classes;Lui, et al., 2004;Smith, 2005) it is clear to us that those who occupy the lower rungs of our society are the most likely to be oppressed and harmed. For example, lower social class clients are perceived more unfavor- ably than upper social class clients by clinicians Iiave less education, are dys- functional, and make poor progress in therapy) Research concerning the inferior and biased quality of treatment to lower-class clients is histori- cally legend Atkinson, et al., 1998;Pavkov et al., 1989; Rouse, Carter, & Rodriguez- An drew, 1995) In the area of diagnosis, it has been found that an attribution of mental illness was more likely to occur when the person's history suggested a lower rather than higher socioeconomic class origin Liu et al., 2006) Many studies seem to demonstrate that clinicians given identical test protocols tend to make more negative prognostic statements and judgments of greater maladjustment when the individual was said to come from a lower- rather than a middle-class background. In the area of treatment, Garfield, Weiss, and Pollock }973)gave coun- selors identical descriptions Except for social class)of a 9-year-old boy who engaged in maladaptive classroom behavior. When the boy was assigned upper-class status, more counselors expressed a willingness to become ego- involved with the student than when lower-class status was assigned. Like- wise, Habemann and Thiry }970)found that doctoral candidates in coun- seling and guidance programmed students from low socioeconomic backgrounds into a noncollege-bound track more frequently than into a col- lege-preparatory one. Several conclusions can be drawn from these findings:} )low socioeco- nomic class presents stressors to people, especially those in poverty, and may seriously undermine the mental and physical health of clients; 2 )failure of

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helping professionals to understand the life circumstance of clients who lack financial resources and/or their unintentional class biases may affect their ability to delivery appropriate mental health services;and ?)classism and its discriminating nature can make its appearance in the assessment, diagnosis, and treatment of lower socioeconomic clients. In addition, the class-bound nature of mental health practice empha- sizes the importance of assisting the client in self- direction through the pres- entation of the results of assessment instruments and self-exploration via ver- bal interactions between client and therapist. However, the values underlying these activities are permeated by middle-class values that do not suffice for those living in poverty. We have already seen how this operates with respect to language. As early as the 1960s, Bernstein (J964)investigated the suitabil- ity of Standard English for the lower class in psychotherapy and has con- cluded that it works to the detriment of those individuals. In an extensive his- toric research of services delivered to minorities and low socioeconomic clients, Lorion \ 973 (found that psychiatrists refer to therapy those persons who are most like themselvesWhite rather than non-White, and from upper socioeconomic status. Lorion (J974)pointed out that the expectations of lower-class clients are often different from those of psychotherapists. For example, lower-class clients who are concerned with survival or making it through on a day-to-day basis expect advice and suggestions from the coun- selor. Appointments made weeks in advance with short, weekly, 50-minute contacts are not consistent with the need to seek immediate solutions. Addi- tionally, many lower-class people, through multiple experiences with public agencies, operate under what is called minority standard time {Jchindler- Rainman, 1 967) This is the tendency of poor people to have a low regard for punctuality. Poor people have learned that endless waits are associated with medical clinics, police stations, and governmental agencies. One usually waits hours for a 10- to 1 5 -minute appointment. Arriving promptly does little good and can be a waste of valuable time. Therapists, however, rarely understand this aspect of life and are prone to see this as a sign of indifference or hostility. People from a lower socioeconomic status may also view insight and at- tempts to discover underlying intrapsychic problems as inappropriate. Many lower-class clients expect to receive advice or some form of concrete tangible treatment. When the therapist attempts to explore personality dynamics or to take a historical approach to the problem, the client often becomes con- fused, alienated, and frustrated. A harsh environment, where the future is uncertain and immediate needs must be met, makes long-range planning of little value. Many clients of lower socioeconomic status are unable to relate to the future orientation of therapy. To be able to sit and talk about things is perceived as a luxury of the middle and upper classes. Because of the lower-class client's environment and past inexperience with therapy, the expectations of the minority individual may be quite dif-

Barriers to Multicultural Counseling and Therapy 151 ferent, or even negative. The client's unfamiliarity with the therapy process may hinder success and cause the therapist to blame the client for the failure. Thus, the minority client may be perceived as hostile and resistant. The re- sults of this interaction may be a premature termination of therapy. Consid- erable evidence exists that clients from upper socioeconomic backgrounds have significantly more exploratory interviews with their therapists, and that middle-class patients tend to remain in treatment longer than lower-class patients C-ottesfeld, 1995;Leong, Wagner, 8Cim, 1995;Neighbors, Caldwell, Thompson, 8-ackson, 1 994) Furthermore, the now-classic study of Holling- shead and Redlich J968)found that lower-class patients tend to have fewer ego -involving relationships and less intensive therapeutic relationships than do members of higher socioeconomic classes. Poverty undoubtedly contributes to the mental health problems among racial/ethnic minority groups, and social class determines the type of treat- ment a minority client is likely to receive. In addition, as Atkinson, Morten, et al. 1 998, p. 64)conclude, ethnic minorities are less likely to earn incomes sufficient to pay for mental health treatment, less likely to have insurance, and more likely to qualify for public assistance than European Americans. Thus, ethnic minorities often have to rely on public government-sponsored) or nonprofit mental health services to obtain help with their psychological problems." Working effectively with clients who are poor requires several major conditions. First, the therapist must spend time understanding his or her own biases and prejudices Liu et al., 2004) Not confronting one's own classist at- titudes can lead to a phenomenon called White trashism. 'Manifestation of prejudicial or negative attitudes can be found in descriptors like frailer park- ism, 'hillbillyism/'tippity "fed-neck, "and so on. These attitudes can af- fect the diagnosis and treatment of clients. Second, it becomes essential that counselors understand how poverty affects the lives of people who lack fi- nancial resources;behaviors associated with survival should not be patholo- gized. Third, counselors should consider that taboos against information- giving activities and a more active approach in treatment might be more appropriate than the passive, insight-oriented and long-term models of ther- apy. Last, poverty and economic disparities that are root causes affecting the mental health and quality of life of people in our society demand a social jus- tice approach $ee Chapter 12)

Language Barriers KerMoua, a Laotian refugee, suffered from a variety of ailments but was unable to communicate with her doctor. The medical staff enlisted the aid of 12-year-old Jue as the liaison between the doctor and mother. Ker was diagnosed with a

152 The Practice Dimensions of Multicultural Counseling/Therapy

prolapsed uterus, the result of bearing 12 children. She took medication in the doses described by her son, but became severely ill after two days. Fortunately, it was discovered that she was taking an incorrect dosage that could have caused lasting harm. The hospital staff realized that Jue had mistranslated the doctor's orders. When inquiries about the translation occurred, Jue said "I don 't know what a uterus is. The doctor tells me things I don 't know how to say. " (Burke, 2005) Asking children to translate information concerning medical or legal problems is common in many communities with high immigrant popula- tions, but may have devastating consequences: J )it can create stress and hurt the traditional parent-child relationship; £ (children lack the vocabu- lary and emotional maturity to serve as effective interpreters;?) children may be placed in a situation where they are privy to confidential medical or psychiatric information about their relatives; and ^)they may be unfairly burdened with emotional responsibilities that only adults should carry C ole- man, 2003) As of this writing, California Assembly Bill 775 was introduced to ban the use of children as interpreters. California will become the first state to do so, if passed. Further, the federal government has acknowledged that not providing adequate interpretation for client populations is a form of dis- crimination. As our opening case of the M. family suggests, the lack of bilin- gual therapists can result in both inferior and damaging services to linguistic minorities. Recently, the National Council on Interpreting in Health Care £005 published national standards for interpreters of health care that ad- dress issues of cultural awareness and confidentiality. Clearly, use of Standard English in health care delivery may unfairly dis- criminate against those from a bilingual or lower socioeconomic background and result in devastating consequences yedantam, 2005) This inequity oc- curs in our educational system and in the delivery of mental health services as well. The bilingual background of many Asian Americans, Latino/Hispanic Americans, and American Indians may lead to much misunderstanding. This is true even if a minority group member cannot speak his or her own native tongue. Early language studies fll. E. Smith, 1957;M. E. Smith EKasdon, 1961)indicate that simply coming from a background where one or both of parents have spoken their native tongue can impair proper acquisition of En- glish. Even African Americans who come from a different cultural environ- ment may use words and phrases Black Language, or Ebonics )not entirely understandable to the therapist. While considerable criticism was directed toward the Oakland Unified School District for their short-lived attempt to recognize Ebonics in 1996, the reality is that such a form of communication does exist in many African American communities. In therapy, however, African American clients are expected to communicate their feelings and thoughts to therapists in Standard English. For some African Americans, this

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is a difficult task, since the use of nonstandard English is their norm. Black language code involves a great deal of implicitness in communication, such as shorter sentences and less grammatical elaboration but greater reliance on nonverbal cues) On the other hand, the language code of the middle and upper classes is much more elaborate, relies less on nonverbal cues, and en- tails greater knowledge of grammar and syntax. Romero }985)indicates that counseling psychologists are finding that they must interact with consumers who may have English as a second lan- guage, or who may not speak English at all. The lack of bilingual therapists and the requirement that the client communicate in English may limit the person's ability to progress in counseling and therapy. If bilingual individu- als do not use their native tongue in therapy, many aspects of their emo- tional experience may not be available for treatment. For example, because English may not be their primary language, they may have difficulty using the wide complexity of language to describe their particular thoughts, feel- ings, and unique situations. Clients who are limited in English tend to feel like they are speaking as a child and choosing simple words to explain com- plex thoughts and feelings. If they were able to use their native tongue, they could easily explain themselves without the huge loss of emotional com- plexity and experience. In therapy, heavy reliance is placed on verbal interaction to build rap- port. The presupposition is that participants in a therapeutic dialogue are ca- pable of understanding each other. Therapists often fail to understand an African American client's language and its nuances for rapport building. Fur- thermore, those who have not been given the same educational or economic opportunities may lack the prerequisite verbal skills to benefit from talk ther- apy. A client's brief, different, or poor verbal responses may lead many ther- apists to impute inaccurate characteristics or motives. As a result, the client may be seen as uncooperative, sullen, negative, nonverbal, or repressed on the basis of language expression alone. Since Euro-American society places such a high premium on one's use of English, it is a short step to conclude that linguistic minorities are inferior, lack awareness, or lack conceptual thinking powers. Such misinterpretation can also be seen in the use and interpretation of psychological tests. So-called IQ and achievement tests are especially no- torious for their language bias. (kenerdizntions and Stereotypes: Some Cautions White cultural values are reflected in the generic characteristics of counsel- ing Table 6.1;see also Table 12.1) These characteristics are summarized and can be compared with the values of four racial/ethnic minority groups Amer- ican Indians, Asian Americans, Blacks, and Hispanics ^ee Table 6.2) Al-

154 The Practice Dimensions of Multicultural Counseling/Therapy though it is critical for therapists to have a basic understanding of the generic characteristics of counseling and psychotherapy and the culture-specific life values of different groups, overgeneralizing and stereotyping are ever- present dangers. For example, the listing of racial/ethnic minority group vari- ables does not indicate that all persons coming from the same minority group will share all or even some of these traits. Furthermore, emerging trends such as short-term and crisis intervention approaches and other less verbally ori- ented techniques differ from the generic traits listed. Yet it is highly improb- able that any of us can enter a situation or encounter people without form- ing impressions consistent with our own experiences and values. Whether a client is dressed neatly in a suit or wears blue jeans, is a man or a woman, or is of a different race will likely affect our assumptions. First impressions will be formed that fit our own interpretations and generalizations of human behavior. Generalizations are necessary for us; without them, we would become inefficient creatures. However, they are guidelines for our behaviors, to be tentatively applied in new situations, and they should be open to change and challenge. It is exactly at this stage that generalizations remain generalizations or become stereotypes. Stereotypes may be defined as rigid preconceptions we hold about all people who are members of a particular group, whether it be defined along racial, religious, sexual, or other lines. The belief in a perceived characteristic of the group is applied to all members without regard for individual variations. The danger of stereotypes is that they are impervious to logic or experience. All incoming information is distorted to fit our preconceived notions. For example, people who are strongly anti-semitic will accuse Jews of being stingy and miserly and then, in the same breath, accuse them of flaunting their wealth by conspicu- ous spending. The information in Tables 6.1, 6.2, and 12.1 should act as guidelines rather than absolutes. These generalizations should serve as the background from which the figure emerges. For example, belonging to a particular group may mean sharing common values and experiences. Individuals within a group, however, also differ. The background offers a contrast for us to see in- dividual differences more clearly. It should not submerge, but rather increase the visibility of the figure. This is the figure-ground relationship that should aid us in recognizing the uniqueness of people more readily. Implications for Clinical Practice In general, it appears that Western forms of healing involve processes that may prove inappropriate and antagonistic to many culturally diverse groups. The mental health professional must be cognizant of the culture -bound, class-bound, and linguistic barriers that might place minority clients at a dis- advantage. Some suggestions to the clinician involve the following:

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1. Become cognizant of the generic characteristics of counseling and psychotherapy. It is clear that mental health services arise from a par- ticular cultural context and are imbued with assumptions and values that may not be applicable to all groups. 2 . Know that we are increasingly becoming a multilingual nation and that the linguistic demands of clinical work may place minority populations at a disadvantage. Be sensitive and ready to provide or advocate for multilingual services. 3 . Consider the need to provide community counseling services that reach out to the minority population. The traditional one-to-one, in-the- office delivery of services must be supplemented by methods that are more action oriented. In other words, effective multicultural counseling must involve roles and activities in the natural environment of the cli- ents Schools, churches, neighborhoods, playgrounds, etc.)rather than just in mental health clinics. 4. Realize that the problems and concerns of many minority groups are re- lated to systemic and external forces rather than internal psychological problems. The effects of poverty, discrimination, prejudice, immigration stress, and so forth indicate that counselors might be most effective in aiding clients to deal with these forces rather than pursuing self- exploration and insight approaches. 5. While most theories of counseling and psychotherapy prescribe the types of actions and roles played by a therapist, these may prove mini- mally helpful to minority clients. The more passive approach must be expanded to include roles and behaviors that are more action oriented and educational in nature. As a helping professional, you may need to expand your repertoire of helping responses. 6. Be careful not to overgeneralize or stereotype. Knowing general group characteristics and guidelines is different from rigidly holding on to pre- conceived notions. In other words, knowing that certain groups such as African Americans and Asian Americans may share common values and worldviews does not mean that all Asian Americans, for example, are the same. Nor does our discussion imply that Euro-American ap- proaches to therapy are completely inapplicable to minority groups. 7. Try not to buy into the idea that clinical work is somehow superior to other forms of helping. We are aware that many of you are attracted to the conventional psychotherapist role, that your professors may unin- tentionally give you the impression that it is the epitome of the thera- peutic relationship, or that it represents a higher and more sophisticated form of helping. Such an attitude of arrogance not only may be detri- mental to those being served, but also limits your ability to work with a culturally diverse population.

Culturally Appropriate Intervention Strategies

As an Asian American trainee, I always thought I could use my dual her- itage and experience to help Chinese immigrants cope with issues they ex- perienced in the United States. It was with that thought in mind that I en- tered my first counseling experience with a Chinese immigrant while serving an externship in New York 's Chinatown. My client was Betty Lau, a 30-year-old woman, living with her parents, who presented with de- pression, somatic symptoms, and conflicts related to parental wishes versus her own desires. Betty felt guilty and at fault for her family's tension and unspoken conflicts; both parents disapproved of her new male friend, who occupied her time on the weekends. Her father was unemployed, depressed most of the time, and seemed removed from the family; her mother felt overburdened and ineffective and did little of the housework. Being the oldest sibling, Betty felt obligated to help economically and was increas- ingly assuming most of the household duties. She harbored strong, unex- pressed resentments toward her parents and seemed to feel trapped. Betty believed that if she was a better daughter, more understanding, and worked harder, the family problems would diminish greatly. She often wondered aloud why she could not be more grateful toward her parents, as they sacrificed much to bring the family to a new country. Over the past year, her unhappiness grew so intense that she could not sleep nor eat well. She began to lose weight rapidly and sought help at the clinic. Betty was a very difficult client to work with. She refused to involve her parents in family counseling and made me promise not to tell them about her use of our services. She was relatively quiet in the sessions, spoke in a barely audible voice, seemed unresponsive to questions, and volun- teered little in the way of information. She seldom made eye contact, a sign of her shyness or depression. Her responses were polite, but very brief, and she avoided "feeling" statements. Instead, she talked about her fatigue, loss of appetite, headaches, inability to sleep, and other physical ailments. Talking with Betty was like "pulling teeth, " as our sessions were punctu- ated by long silences. It was clear to me that Betty was too submissive and that part of her depression was putting family interests above her own. I

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saw two therapeutic goals for her: (1) encourage Betty to think of her own needs first, leave her family, live alone, and not let her parents override her wishes, or (2) if Betty chose to stay at home, she needed to be more forceful in setting limits for her parents. Betty was obviously dependent and enmeshed in the pathology of the family. She had to rid herself of her guilt feelings, learn to stand up for her own rights, and not be a doormat to the world. At 30 years of age she needed to make a life of her own, get married, and start her own family. My clinical goals at that time were to have Betty be more independent, assert herself appropriately (via as- sertiveness training), and express her feelings openly and honestly toward her parents. In the sessions, however, Betty had considerable difficulty with role- playing and talking about her feelings. While she indirectly acknowledged har- boring feelings of resentment, she could never directly bring herself to verbally ex- press them. Role-plays and behavioral rehearsal techniques failed miserably. When I tried the "Gestalt Empty Chair" technique and encouraged her to speak to her parents in the empty chair, she seemed to "freeze up " and would not co- operate. After her third appointment with me, Betty failed to return for any fu- ture sessions. This case illustrates nicely how a Western European approach to coun- seling may lead to mistaken assessment, diagnosis, and treatment of culturally diverse clients. Even though the therapist is an Asian American trainee, he or she is still trained in a Western tradition that unintentionally pathologizes cultural values. The therapist seems not to consider how culture influences help-seeking behaviors, the manner of symptom formation, and what constitutes culturally relevant helping among different diverse groups. Let us briefly analyze the case to illustrate these points. First, it is very clear that the therapist is using Western-European stan- dards to judge normality-abnormality and desirable -undesirable goals. Part of the problem resides in the implicit assumption that individuality is health- ier, that people should be their own person'and that individuation from the family ^specially at age 30)is both desirable and healthy. In an individual- centered approach, there is a tendency to locate the problem as residing in the client. Change, therefore, starts with getting the client to take responsibility for his or her own life situation. A collectivistic orientation, however, may lead to a completely different view of Betty's dilemma. This contrast in cul- tural values and worldviews is most explicitly stated by a Chinese counselor commenting on a very similar case. I just cannot understand why putting the family 's interest before one 's own is not correct or "normal" in the dominant American culture. I believe a morally responsible son or daughter has the duty to take care of his or her parents, whether it means sacrifice on his or her own part or not What is wrong with

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this interdependence? To me, it would be extremely selfish for the client to leave her family when the family is in such need of her. ...In contemporary China, submergence of self for the good of the family, community, and country is still val- ued, and individualism condemned. Western mental health practice could fail should we adopt American counseling theories and skills without considerable alteration Although I do not think the client has a significant psychological problem, I do believe that the parents have to become more sensitive to their daughter's needs. It is not very nice and considerate for the parents to think only of themselves at the cost of their daughter's well-being. If I were the counselor of this client, I would do everything in my power to try to help change the parents, rather than the client. I feel strongly that it is the selfish person who needs to change, not the selfless person. " (Zhang, 1994, pp. 79-80) Second, culture has been found to influence help-seeking behaviors and how psychological distress is expressed in counseling. It is entirely pos- sible that Betty's reluctance to talk about her feelings toward her parents and focus on somatic complaints are manifestations of cultural dynamics. Re- straint of strong feelings as a cultural dictate in Asian cultures is widely ac- knowledged, and an unenlightened therapist might perceive the client as re- pressed, inhibited, or avoiding feelings. The therapist might unwittingly not realize that asking Betty to express resentments toward her parents might violate a cultural dictate of filial piety. Further, among traditional groups, going for psychological help may bring shame and disgrace to the family, and there are strong cultural sanctions against disclosure of family problems for fear that it would bring dishonor to everyone. Studies reveal that Asians and Asian Americans tend to underutilize counseling services, especially those associated with psychiatric problems. When Chinese do seek help, they are likely to present with more severe psychological disorders and with a pre- ponderance of somatic complaints. Some suggest that the former finding is related to a Chinese disinclination to seek psychiatric help unless it is a last resort to overwhelming problems. As a result, the disorders that are presented are more severe. These factors may account for Betty's reluctance to involve the parents in counseling, her concern that they not be told, and her use of somatic complaints as an entre to discussing her problems. For Betty and many Asian clients, physical complaints are viewed as less stigmatic than psy- chological ones, and are a condition more acceptable to seek help for. Third, the actual process of counseling and psychotherapy may be antag- onistic to the values held by culturally diverse clients. Betty's perceived resis- tance to counseling ^hort but polite responses, unresponsiveness to ques- tions, "avoidance of feeling statements, "and lack of eye contact) and the therapist's use of potentially inappropriate counseling techniques getting cli- ent to express feelings, role-plays, and behavioral rehearsal)may prove to be an oppressive and humiliating experience for the client. The therapist seems

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not to be aware of differences in communication style influenced by culture. For example, Chinese culture values restraint of strong feelings, and eye con- tact is avoided in the presence of higher-status individuals. The therapist may be prone to interpret avoidance of eye contact and speaking in a softer voice as signs of depression"or unassertiveness. "Further, we have stated that in many cultures similar to the Chinese, subtlety and indirectness in discussing delicate matters are highly valued attributes of communicaton. Discussion of personal and private matters is done indirectly rather than directly. In this case, Betty may be communicating her psychological and familial conflicts by talk- ing about somatic complaints as a means to an end. Many Asian helpers are aware of this fact and would allow the client to Save face"by appearing to speak about physical/medical problems, but in actuality be discussing family matters. The relationship of communication style to helping styles is intimately bound to one another. The counselor's use of role-plays, behavioral rehearsal, and the confrontive Gestalt Empty Chair'technique may be placing clients in an awkward position because it asks them to violate basic cultural values. The case of Betty illustrates the major focus of this chapter: under- standing the need for culturally appropriate intervention strategies. Over 30 years ago, the importance of cultural flexibility in counseling and the need to approach counseling with culture-specific techniques was voiced by Draguns

Be prepared to adapt your techniques (e.g., general activity level, mode of verbal intervention, content of remarks, tone of voice) to the cultural background of the client; communicate acceptance of and respect for the client in terms that are in- telligible and meaningful within his or her cultural frame of reference; and be open to the possibility of more direct intervention in the life of the client than the traditional ethos of the counseling profession would dictate or permit, (p. 4) It is ironic that this statement continues to hold and that despite the large ac- cumulation of research in support of Draguns' conclusions, the profession of counseling and psychotherapy continues to operate from a universal per- spective.

Effective therapy depends on the therapist and client being able to send and receive both verbal and nonverbal messages accurately and appropriately. It requires that the therapists not only send messages ^nake themselves under- stood)but also receive messages Attend to clients) The definition for effective therapy also includes verbal Content of what is said) and nonverbal how


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something is said)elements. Most therapists seem more concerned with the accuracy of communication getting to the heart of the matter) than with whether the communication is appropriate. The case of Betty illustrates how traditional Asian culture prizes a person's subtlety and indirectness in com- munication. The direct and confrontational techniques in therapy may be perceived by traditional Asian or Native American clients as lacking in respect for the client, a crude and rude form of communication, and a reflection of insensitivity puran, 2006) In most cases, therapists have been trained to tune in to the content of what is said rather than how something is said. When we refer to communication style, we are addressing those factors that go beyond the content of what is said. Some communication specialists believe that only 30 to 40 percent of what is communicated conversationally is verbal Condon S¥ousef, 1975; Ramsey ffiirk, 1983; Singelis, 1994) What people say and do is usually qualified by other things that they say and do. A gesture, tone, inflection, posture, or degree of eye contact may enhance or negate the content of a message. Communication styles have a tremen- dous impact on our face-to-face encounters with others. Whether our con- versation proceeds with fits or starts, whether we interrupt one another con- tinually or proceed smoothly, the topics we prefer to discuss or avoid, the depth of our involvement, the forms of interaction Ritual, repartee, argu- mentative, persuasive, etc.) and the channel we use to communicate yerbal- nonverbal versus nonverbal-verbal)are all aspects of communication style Pouglis, 1987; Wolfgang, 1985) Some refer to these factors as the social rhythms that underlie all our speech and actions. Communication styles are strongly correlated with race, culture, and ethnicity. Gender has also been found to be a powerful determinant of communication style Jf. C. Pearson, 1985;Robinson afoward-Hamilton, 2000) Reared in a Euro-American middle-class society, mental health profes- sionals may assume that certain behaviors or rules of speaking are universal and possess the same meaning. This may create major problems for therapists and other culturally distinct clients. Since differences in communication style are most strongly manifested in nonverbal communication, this chapter con- centrates on those aspects of communication that transcend the written or spoken word. First, we explore how race/culture may influence several areas of nonverbal behavior: £)proxemics, b)kinesics, ()paralanguage, and d) high-low context communication. Second, we briefly discuss the function and importance of nonverbal behavior as it relates to stereotypes and preconceived notions that we may have of diverse groups. Last, we pro- pose a basic thesis that various racial minorities such as Asian Americans, American Indians, African Americans, and Latino/Hispanic Americans pos- sess unique communication styles that may have major implications for men- tal health practice.

162 The Practice Dimensions of Multicultural Counseling/Therapy

Nonverbal Communication Although language, class, and cultural factors all interact to create problems in communication between the culturally diverse client and therapist, an oft- neglected area is nonverbal behavior puran, 2006;Singelis, 1994) What people say can be either enhanced or negated by their nonverbals. When a man raises his voice, tightens his facial muscles, pounds the table violently, and proclaims, Goddamn it, I'm not angrylhe is clearly contradicting the content of the communication. If we all share the same cultural and social up- bringing, we may all arrive at the same conclusion. Interpreting nonverbals, however, is difficult for several reasons. First, the same nonverbal behavior on the part of an American Indian client may mean something quite differ- ent than if it were made by a White person puran, 2006) Second, nonver- bals often occur outside our levels of awareness but influence our evaluations and behaviors. It is important to note that our discussion of nonverbal codes will not include all the possible areas, like olfaction l^aste and smell) tactile cues, and artifactual communication (lothing, hairstyle, display of material things, etc.) Proxemics The study of proxemics refers to perception and use of personal and interper- sonal space. Clear norms exist concerning the use of physical distance in so- cial interactions. E. T. Hall J969^dentified four interpersonal distance zones characteristic of U.S. culture:intimate, from contact to 18 impersonal, from 1.5 ft to 4 ft; social, from 4 ft to 12 ft; and public lectures and speeches) greater than 12 ft. In this society, individuals seem to grow more uncomfortable when oth- ers stand too close rather than too far away. These feelings and reactions as- sociated with a violation of personal space may range from flight, withdrawal, anger, and conflict |. C . Pearson, 1985) On the other hand, we tend to allow closer proximity or to move closer to people whom we like or feel interper- sonal attraction toward. Some evidence exists that personal space can be re- framed in terms of dominance and status. Those with greater status, prestige, and power may occupy more space larger homes, cars, or offices) However, different cultures dictate different distances in personal space. For Latin Americans, Africans, Black Americans, Indonesians, Arabs, South Ameri- cans, and French, conversing with a person dictates a much closer stance than is normally comfortable for Euro-Americans |. V. Jensen, 1985;Nydell, 1996) A Latin American client's closeness may cause the therapist to back away. The client may interpret the therapist's behavior as indicative of aloof- ness, coldness, or a desire not to communicate. In some cross-cultural en- counters, it may even be perceived as a sign of haughtiness and superiority. On the other hand, the therapist may misinterpret the client's behavior as an

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attempt to become inappropriately intimate, a sign of pushiness or aggres- siveness. Both the therapist and the culturally different client may benefit from understanding that their reactions and behaviors are attempts to create the spatial dimension to which they are culturally conditioned. Research on proxemics leads to the inevitable conclusion that conver- sational distances are a function of the racial and cultural background of the conversant Mindess, 1999; Susman 8Rosenfeld, 1982; Wolfgang, 1985) The factor of personal space has major implications for how furniture is arranged, where the seats are located, where you seat the client, and how far you sit from him or her. Latin Americans, for example, may not feel com- fortable with a desk between them and the person they are speaking to. Euro- Americans, however, like to keep a desk between themselves and others. Some Eskimos may actually prefer to sit side by side rather than across from one another when talking about intimate aspects of their lives. Kinesics While proxemics refers to personal space, kinesics is the term used to refer to bodily movements. It includes such things as facial expression, posture, char- acteristics of movement, gestures, and eye contact. Again, kinesics appears to be culturally conditioned Mindess, 1999) Much of our counseling assess- ments are based upon expressions on people's faces {. C. Pearson, 1985)We assume that facial cues express emotions and demonstrate the degree of re- sponsiveness or involvement of the individual. For example, smiling is a type of expression in our society that is believed to indicate liking or positive af- fect. People attribute greater positive characteristics to others who smile;they are intelligent, have a good personality, and are pleasant $ingelis, 1994) However, when Japanese smile and laugh, it does not necessarily mean hap- piness but may convey other meanings Embarrassment, discomfort, shyness, etc.) Such nonverbal misinterpretations also fueled many of the conflicts in Los Angeles directly after the Rodney King verdict, when many African Americans and Korean grocery store owners became at odds with one an- other. African Americans confronted their Korean American counterparts about exploitation of Black neighborhoods. African Americans became in- censed when many Korean American store owners had a constant smile on their faces. They interpreted the facial expression as arrogance, taunting, and lack of compassion for the concerns of Blacks. Little did they realize that a smile in this situation more rightly indicated extreme embarrassment and apprehension. On the other hand, some Asians believe that smiling may suggest weak- ness. Among some Japanese and Chinese, restraint of strong feelings
164 The Practice Dimensions of Multicultural Counseling/Therapy for extreme situations. Unenlightened therapists may assume that their Asian American client is lacking in feelings or is out of touch with them. More likely, the lack of facial expressions may be the basis of stereotypes, such as the state- ment that Asians are inscrutable, "Sneaky "deceptive, "and backstab- bing." A number of gestures and bodily movements have been found to have different meanings when the cultural context is considered LaBarre, 1985) In the Sung Dynasty in China, sticking out the tongue was a gesture of mock terror and meant as ridicule;to the Ovimbundu of Africa, it means you're a fool"
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would agree with that premise, but in most cases, therapists attribute nega- tive traits to the avoidance of eye contact: shy, unassertive, sneaky, or de- pressed. This lack of understanding has been played out in many different situ- ations when Black-White interactions have occurred. In many cases it is not necessary for Blacks to look at one another in the eye at all times to commu- nicate E. J. Smith, 1981) An African American may be actively involved in doing other things when engaged in a conversation. Many White therapists are prone to view the African American client as being sullen, resistant, or uncooperative. E. J. Smith \98l, p. 155)provides an excellent example of such a clash in communication styles: For instance, one Black female student was sent to the office by her gymnasium teacher because the student was said to display insolent behavior. When the stu- dent was asked to give her version of the incident, she replied, "Mrs. X asked all of us to come over to the side of the pool so that she could show us how to do the backstroke. I went over with the rest of the girls. Then Mrs. X started yelling at me and said I wasn 't paying attention to her because I wasn 't looking directly at her. I told her I was paying attention to her (throughout the conversation, the stu- dent kept her head down, avoiding the principal's eyes), and then she said that she wanted me to face her and look her squarely in the eye like the rest of the girls {who were all White]. So I did. The next thing I knew she was telling me to get out of the pool, that she didn 't like the way I was looking at her. So that's why I'm here. " As this example illustrates, Black styles of communication may not only be different from their White counterparts, but also may lead to misinterpre- tations. Many Blacks do not nod their heads or say uh-huh'to indicate they are listening E. T. Hall, 1976;Kochman, 1981;E. J. Smith, 1981) Going through the motions of looking at the person and nodding the head is not necessary for many Blacks to indicate that they are listening E. T. Hall, 1974, 1976) Statistics indicate that when White U.S. Americans listen to a speaker, they make eye contact with the speaker about 80 percent of the time. When speaking to others, however, they tend to look away 4void eye contact) about 50 percent of the time. This is in marked contrast to many Black Amer- icans, who make greater eye contact when speaking and make infrequent eye contact when listening! Paralanguage The term paralanguage is used to refer to other vocal cues that individuals use to communicate. For example, loudness of voice, pauses, silences, hesita- tions, rate, inflections, and the like all fall into this category. Paralanguage is

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very likely to be manifested forcefully in conversation conventions such as how we greet and address others and take turns in speaking. It can commu- nicate a variety of different features about a person, such as age, gender, and emotional responses, as well as the race and sex of the speaker Banks & Banks, 1993;Lass, Mertz, acimmel, 1978;Nydell, 1996) There are complex rules regarding when to speak or yield to another person. For example, U.S. Americans frequently feel uncomfortable with a pause or silent stretch in the conversation, feeling obligated to fill it in with more talk. Silence is not always a sign for the listener to take up the conver- sation. While it may be viewed negatively by many, other cultures interpret the use of silence differently. The British and Arabs use silence for privacy, while the Russians, French, and Spanish read it as agreement among the par- ties pall, 1969, 1976) In Asian culture, silence is traditionally a sign of re- spect for elders. Furthermore, silence by many Chinese and Japanese is not a floor-yielding signal inviting others to pick up the conversation. Rather, it may indicate a desire to continue speaking after making a particular point. Often silence is a sign of politeness and respect rather than a lack of desire to continue speaking. The amount of verbal expressiveness in the United States, relative to other cultures, is quite high. Most Euro-Americans encourage their children to enter freely into conversations, and teachers encourage students to ask many questions and state their thoughts and opinions. This has led many from other countries to observe that Euro-American youngsters are brash, immodest, rude, and disrespectful ^rvine &ork, 1995;Jensen, 1985) Like- wise, teachers of minority children may see reticence in speaking out as a sign of ignorance, lack of motivation, or ineffective teaching Banks SBanks, 1993) when in reality the students may be showing proper respect 1[o ask questions is disrespectful because it implies that the teacher was unclear) American Indians, for example, have been taught that to speak out, ask ques- tions, or even raise one's hand in class is immodest. A mental health professional who is uncomfortable with silence or who misinterprets it may fill in the conversation and prevent the client from elab- orating further. An even greater danger is to impute incorrect motives to the minority client's silence. One can readily see how therapy, which emphasizes talking, may place many minorities at a disadvantage. Volume and intensity of speech in conversation are also influenced by cultural values. The overall loudness of speech displayed by many Euro- American visitors to foreign countries has earned them the reputation of being boisterous and shameless. In Asian countries, people tend to speak more softly and would interpret the loud volume of a U.S. visitor to be ag- gressiveness, loss of self-control, or anger. When compared to Arabs, how- ever, people in the United States are soft-spoken. Many Arabs like to be bathed in sound, and the volumes of their radios, phonographs, and televi-

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sions are quite loud. In some countries where such entertainment units are not plentiful, it is considered a polite and thoughtful act to allow neighbors to hear by keeping the volume high. We in the United States would view such behavior as being a thoughtless invasion of privacy. A therapist or counselor working with clients would be well advised to be aware of possible cultural misinterpretations as a function of speech vol- ume. Speaking loudly may not indicate anger and hostility and speaking in a soft voice may not be a sign of weakness, shyness, or depression. The directness of a conversation or the degree of frankness also varies considerably among various cultural groups. Observing the English in their parliamentary debates will drive this point home. The long heritage of open, direct, and frank confrontation leads to heckling of public speakers and quite blunt and sharp exchanges. Britons believe and feel that these are acceptable styles and may take no offense at being the object of such exchanges. How- ever, U.S. citizens feel that such exchanges are impolite, abrasive, and irra- tional. Relative to Asians, Euro-Americans are seen as being too blunt and frank. Great care is taken by many Asians not to hurt the feelings of or em- barrass the other person. As a result, use of euphemisms and ambiguity is the norm. Since many minority groups may value indirectness, the U.S. emphasis on getting to the point'and hot beating around the bush'hiay alienate oth- ers. Asian Americans, American Indians, and some Latino/Hispanic Ameri- cans may see this behavior as immature, rude, and lacking in finesse. On the other hand, clients from different cultures may be negatively labeled as eva- sive and afraid to confront the problem. High-Low Context Communication Edward T. Hall, author of such classics as The Silent Language J959)and The Hidden Dimension }969) is a well-known anthropologist who has proposed the concept of high-low context cultures Hall, 1976) A high-context HC) communication or message is one that is anchored in the physical context ^ituation)or internalized in the person. Less reliance is placed on the explicit code or message content. An HC communication relies heavily on nonverbals and the group identification/understanding shared by those communicating. For example, a normal-stressed ho'by a U.S. American may be interpreted by an Arab as yes/A real negation in Arab culture would be stressed much more emphatically. A prime example of the contextual dimension in under- standing communication is demonstrated in the following example: I was asked to consult with a hospital that was having a great deal of difficulty with their Filipino nurses. The hospital had a number of them on its staff, and the medical director was concerned about their competence in understanding and following directions from doctors. As luck would have it, when I came to the

168 The Practice Dimensions of Multicultural Counseling/Therapy hospital, I was immediately confronted with a situation that threatened to blow up. Dr. K., a Euro-American physician, had brought charges against a Filipino American nurse for incompetence. He had observed her incorrectly using and monitoring life support systems on a critically ill patient. He relates how he en- tered the patient's room and told the nurse that she was incorrectly using the equipment and that the patient could die if she didn 't do it right. Dr. K. states that he spent some 10 minutes explaining how the equipment should be at- tached and used. Upon finishing his explanation, he asked the nurse if she un- derstood. The Filipino nurse nodded her head slightly and hesitantly said, " Yes, yes, Doctor. " Later that evening, Dr. K. observed the same nurse continuing to use the equipment incorrectly; he reported her to the head nurse and asked for her immediate dismissal. While it is possible that the nurse was not competent, further investigation revealed strong cultural forces affecting the hospital work situation. What the medical administration failed to understand was the cul- tural context of the situation. In the Philippines, it is considered impolite to say "no " in a number of situations. In this case, for the nurse to say "no " to the doc- tor (a respected figure of high status) when asked whether she understood would have implied that Dr. K. was a poor teacher. This would be considered insulting and impolite. Thus, the only option the Filipino nurse felt open to her was to tell the doctor "yes. " In Filipino culture, a mild, hesitant yes"is interpreted by those who understand as a no'br a polite refusal. In traditional Asian society, many in- teractions are understandable only in light of high-context cues and situa- tions. For example, to extend an invitation only once for dinner would be considered an affront because it implies that you are not sincere. One must extend an invitation several times, encouraging the invitee to accept. Arabs may also refuse an offer of food several times before giving in. However, most Euro-Americans believe that a host's offer can be politely refused with just a ho, thank you." If we pay attention to only the explicit coded part of the message, we are likely to misunderstand the communication. According to E. T. Hall }976) low-context LQcultures place a greater reliance on the verbal part of the message. In addition, LC cultures have been associated with being more op- portunistic, more individual rather than group oriented, and as emphasizing rules of law and procedure E. J. Smith, 1981) It appears that the United States is an LC culture Although it is still higher than the Swiss, Germans, and Scandinavians in the amount of con- texting required) China, perhaps, represents the other end of the contin- uum;its complex culture relies heavily on context. Asian Americans, African Americans, Hispanics, American Indians, and other minority groups in the United States also emphasize HC cues. In contrast to LC communication, HC is faster, as well as more econom-

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ical, efficient, and satisfying. Because it is so bound to the culture, it is slow to change and tends to be cohesive and unifying. LC communication does not unify but changes rapidly and easily. Twins who have grown up together can and do communicate more eco- nomically HC)than do two lawyers during a trial ^C) B. Bernstein's |964) work in language analysis refers to restricted codes HC)and elaborated codes IX) Restricted codes are observed in families where words and sentences collapse and are shortened without loss of meaning. However, elaborated codes, where many words are used to communicate the same content, are seen in classrooms, diplomacy, and law. African American culture has been described as HC. For example, it is clear that many Blacks require fewer words than their White counterparts to communicate the same content Jrvine EYork, 1995; Jenkins, 1982; Stan- back fPearce, 1985;Weber, 1985) An African American male who enters a room and spots an attractive woman may stoop slightly in her direction, smile, and tap the table twice while vocalizing a long drawn out uh huh." What he has communicated would require many words from his White brotherFThe fact that African Americans may communicate more by HC cues has led many to characterize them as nonverbal, inarticulate, unintelligent, and so forth.

Sociopolitical Facets of Nonverbal Communication There is a common saying among African Americans:ff you really want to know what White folks are thinking and feeling, don't listen to what they say, but how they say it. "In most cases, such a statement refers to the biases, stereotypes, and racist attitudes that Whites are believed to possess but that they consciously or unconsciously conceal. Rightly or wrongly, many minority individuals through years of per- sonal experience operate from three assumptions. The first assumption is that all Whites in this society are racist. Through their own cultural conditioning, they have been socialized into a culture that espouses the superiority of White culture over all others |. M. Jones, 1997; Parham, 1993; Ridley, 2005) The second assumption is that most Whites find such a concept dis- turbing and will go to great lengths to deny that they are racist or biased. Some of this is done deliberately and with awareness, but in most cases one's racism is largely unconscious. The last of these assumptions is that nonverbal behaviors are more accurate reflections of what a White person is thinking or feeling than is what they say. There is considerable evidence to suggest that these three assumptions held by various racial/ethnic minorities are indeed accurate |vlcIntosh, 1989;Ridley, 2006;D. W. Sue et al., 1998) Counselors and mental health

170 The Practice Dimensions of Multicultural Counseling/Therapy practitioners need to be very cognizant of nonverbal cues from a number of different perspectives. In the last section we discussed how nonverbal behavior is culture bound and how the counselor or therapist cannot make universal interpre- tations about it. Likewise, nonverbal cues are important because they often \ )unconsciously reflect our biases and ? (trigger off stereotypes we have of other people. Nonverbals as Reflections of Bias Some time ago, a TV program called Candid Camera was the rage in the United States. It operated from a unique premise, which involved creating very un- usual situations for naive subjects who were then filmed as they reacted to them. One of these experiments involved interviewing housewives about their attitudes toward African American, Latino/Hispanic, and White teen- agers. The intent was to select a group of women who by all standards ap- peared sincere in their beliefs that Blacks and Latinos were no more prone to violence than were their White counterparts. Unknown to them, they were filmed by a hidden camera as they left their homes to go shopping at the lo- cal supermarket. The creator of the program had secretly arranged for an African Amer- ican, Latino, and White youngster dressed casually but nearly identically )to pass these women on the street. The experiment was counterbalanced;that is, the race of the youngster was randomly assigned as to which would ap- proach the shopper first. What occurred was a powerful statement on un- conscious racist attitudes and beliefs. All the youngsters had been instructed to pass the shopper on the purse side of the street. If the woman was holding the purse in her right hand, the youngster would approach and pass on her right. If the purse was held with the left hand, the youngster would pass on her left. Studies of the film re- vealed consistent outcomes. Many women, when approached by the Black or Latino youngster Approximately 1 5 feet away) would casually switch the purse from one arm to the otherlThis occurred infrequently with the White subject. Why? The answer appears quite obvious to us. The women subjects who switched their purses were operating from biases, stereotypes, and precon- ceived notions about what minority youngsters are like:They are prone to crime, more likely to snatch a purse or rob, more likely to be juvenile delin- quents, and more likely to engage in violence. The disturbing part of this ex- periment was that the selected subjects were, by all measures, sincere indi- viduals who on a conscious level denied harboring racist attitudes or beliefs. They were not liars, nor were they deliberately deceiving the interviewer.

Culturally Appropriate Intervention Strategies 171 They were normal, everyday people. They honestly believed that they did not possess these biases, yet when tested, their nonverbal behavior purse switch- ing )gave them away. The power of nonverbal communication is that it tends to be least under conscious control. Studies support the conclusion that nonverbal cues oper- ate primarily on an unawareness level pePaulo, 1992;Singelis, 1994) that they tend to be more spontaneous and more difficult to censor or falsify Mehrabian, 1972) and that they are more trusted than words. In our soci- ety, we have learned to use words Spoken or written)to mask or conceal our true thoughts and feelings. Note how our politicians and lawyers are able to address an issue without revealing much of what they think or believe. This is very evident in controversial issues such as gun control, abortion, and is- sues of affirmative action and immigration. Nonverbal behavior provides clues to conscious deceptions or uncon- scious bias ptsey et al., 2005) There is evidence that the accuracy of non- verbal communication varies with the part of the body used:Facial expres- sion is more controllable than the hands, followed by the legs and the rest of the body Hansen, Stevic, EWarner, 1982) The implications for multicul- tural counseling are obvious. A therapist who has not adequately dealt with his or her own biases and racist attitudes may unwittingly communicate them to a culturally different client. If counselors are unaware of their own biases, their nonverbals are most likely to reveal their true feelings. Studies suggest that women and minorities are better readers of nonverbal cues than are White males pall, 1976; Jenkins, 1982; J. C. Pearson, 1985; Weber, 1985) Much of this may be due to their HC orientation, but another reason may be survival. For an African American person to survive in a predomi- nantly White society, he or she has to rely on nonverbal cues more often than verbal ones. One of our male African American colleagues gives the example of how he must constantly be vigilant when traveling in an unknown part of the country. Just to stop at a roadside restaurant may be dangerous to his physi- cal well-being. As a result, when entering a diner, he is quick to observe not only the reactions of the staff ^vaiter/ waitress, cashier, cook, etc.)to his en- trance, but the reactions of the patrons as well. Do they stare at him?What type of facial expressions do they haveDo they fall silentDoes he get served immediately, or is there an inordinate delay TThese nonverbal cues reveal much about the environment around him. He may choose to be himself or play the role of a humble"Black person who leaves quickly if the situation poses danger. Interestingly, this very same colleague talks about tuning in to nonver- bal cues as a means of psychological survival. He believes it is important for mi- norities to accurately read where people are coming from in order to prevent

172 The Practice Dimensions of Multicultural Counseling/Therapy invalidation of the self. For example, a minority person driving through an unfamiliar part of the country may find himself or herself forced to stay at a motel overnight. Seeing a vacancy light flashing, the person may stop and knock on the manager's door. Upon opening the door and seeing the Black person, the White manager may show hesitation, stumble around in his or her verbalizations, and then apologize for having forgotten to turn off the va- cancy light. The Black person is faced with the dilemma of deciding whether the White manager was telling the truth or is simply not willing to rent to a Black person. Some of you might ask, Why is it important for you to know?Why don't you simply find someplace else?After all, would you stay at a place where you were unwelcomeTinding another place to stay might not be as important as the psychological well-being of the minority person. Racial/eth- nic minorities have encountered too many situations in which double mes- sages are given to them. For the African American to accept the simple state- ment, I forgot to turn off the vacancy light, 'hiay be to deny one's own true feelings at being the victim of discrimination. This is especially true when the nonverbals facial expression, anxiety in voice, and stammering )may reveal other reasons. Too often, culturally different individuals are placed in situations where they are asked to deny their true feelings in order to perpetuate White decep- tion. Statements that minorities are oversensitive paranoid^nay represent a form of denial. When a minority colleague makes a statement such as I get a strange feeling from John;I feel some bias against minorities coming out," White colleagues, friends, and others are sometimes too quick to dismiss it with statements like, You're being oversensitive/Perhaps a better approach would be to say, What makes you feel that way^rather than to negate or invalidate what might be an accurate appraisal of nonverbal communication. Thus, it is clear that racial/ethnic minorities are very tuned in to non- verbals. For the therapist who has not adequately dealt with his or her own racism, the minority client will be quick to assess such biases. In many cases, the minority client may believe that the biases are too great to be overcome and will simply not continue in therapy. This is despite the good intentions of the White counselor/therapist who is not in touch with his or her own biases and assumptions about human behavior. Nonverbals as Triggers to Biases and Fears Often people assume that being an effective multicultural therapist is a straightforward process that involves the acquisition of knowledge about the various racial/ethnic groups. If we know that Asian Americans and African Americans have different patterns of eye contact and if we know that these patterns signify different things, then we should be able to eliminate biases

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and stereotypes that we possess. Were it so easy, we might have eradicated racism years ago. While increasing our knowledge base about the lifestyles and experiences of minority groups is important, it is not a sufficient condi- tion in itself. Our racist attitudes, beliefs, and feelings are deeply ingrained in our total being. Through years of conditioning they have acquired a strong ir- rational base, replete with emotional symbolism about each particular mi- nority. Simply opening a text and reading about African Americans and Lati- nos/Hispanics will not deal with our deep-seated fears and biases. One of the major barriers to effective understanding is the common as- sumption that different cultural groups operate according to identical speech and communication conventions. In the United States, it is often assumed that distinctive racial, cultural, and linguistic features are deviant, inferior, or embarrassing J
1 74 The Practice Dimensions of Multicultural Counseling/Therapy

a White person, a Black individual might say: "I've heard what you've said, but what do you really mean?" Such was the case with the African American professor who believed that his White colleagues were fronting and being insincere. While Black Americans may misinterpret White communication styles, it is more likely that Whites will misinterpret Black styles. The direction of the misunderstanding is generally linked to the activating of unconscious triggers or buttons about racist stereotypes and fears they harbor. As we have repeat- edly emphasized, one of the dominant stereotypes of African Americans in our society is that of the hostile, angry, prone-to-violence Black male. The more animated and affective communication style, closer conversing dis- tance, prolonged eye contact when speaking, greater bodily movements, and tendency to test ideas in a confrontational/argumentative format lead many Whites to believe that their lives are in danger. It is not unusual for White mental health practitioners to describe their African Americans clients as being hostile and angry. We have also observed that some White trainees who work with Black clients respond nonverbally in such a manner as to indicate anxiety, discomfort, or fear leaning away from their African American cli- ents, tipping their chairs back, crossing their legs or arms, etc.) These are nonverbal distancing moves that may reflect the unconscious stereotypes that they hold of Black Americans. While we would entertain the possibility that a Black client is angry, most occasions we have observed do not justify such a descriptor. It appears that many Euro-Americans operate from the assumption that when an argument ensues, it may lead to a ventilation of anger with the out- break of a subsequent fight. What many Whites fail to realize is that African Americans distinguish between an argument used to debate a difference of opinion and one that ventilates anger and hostility pePaulo, 1992;Irvine & York, 1995;Kochman, 1981;Shade ^Jew, 1993) In the former, the affect indicates sincerity and seriousness;there is a positive attitude toward the ma- terial;and the validity of ideas is challenged. In the latter, the affect is more passionate than sincere;there is a negative attitude toward the opponent;and the opponent is abused. To understand African American styles of communication and to relate adequately to Black communication would require much study in the ori- gins, functions, and manifestations of Black language |enkins, 1982) Weber ^985 jbelieves that the historical and philosophical foundations of Black lan- guage have led to several verbal styles among Blacks. Rapping (lot the White usage, rap session)was originally a dialogue between a man and a woman in which the intent was to win over the admiration of the woman. Imaginary statements, rhythmic speech, and creativity are aimed at getting the woman

Culturally Appropriate I intervention Strategies 175

interested in hearing more of the rap. It has been likened to a mating call, an introduction of the male to the female, and a ritual expected by some African American women. Another style of verbal banter is called woofing, which is an exchange of threats and challenges to fight. It may have derived from what African Amer- icans refer to as playing the dozens, which is considered by many Blacks to be the highest form of verbal warfare and impromptu speaking JCochman, 1981; Jenkins, 1983; Weber, 1985) To the outsider, it may appear cruel, harsh, and provocative. Yet to many in the Black community, it has historical and functional meanings. The term dozens was used by slave owners to refer to Black persons with disabilities. Because they were considered damaged goods, disabled Black people would often be sold at a discount rate with eleven (me dozen)other damaged slaves Weber, 1985) It was primarily a selling ploy in which dozens"referred to the negative physical features. Often played in jest, the game requires an audience to act as judge and jury over the originality, creativity, and humor of the combatants: Say man, your girlfriend so ugly, she had to sneak up on a glass to get a drink of water. . . . Man, you so ugly, yo mamma had to put a sheet over your head so sleep could sneak up on you. (Weber, 1985, p. 248) A: Eat shit. B: What should I do with your bones? A: Build a cage for your mother. B: At least I got one. A: She is the least. (Labov, 1972, p. 321) A: Got a match? B: Yeah, my ass and your face or my farts and your breath. (Kochman, 1981, p. 54) Woofing and playing the dozens seem to have very real functional value. First, they allow training in self-control about managing one's anger and hos- tility in the constant face of racism. In many situations, it would be consid- ered dangerous by an African American to respond to taunts, threats, and in- sults. Second, woofing also allows a Black person to establish a hierarchy or pecking order without resorting to violence. Last, it can create an image of being fearless where one will gain respect. This verbal and nonverbal style of communication can be a major aspect of Black interactions. Likewise, other minority groups have characteristic styles that may cause considerable difficulties for White counselors. One way of contrasting communication style differences may be in the overt activity

176 The Practice Dimensions of Multicultural Counseling/Therapy

Table 7.1 Communication Style Differences (Overt Activity Dimension — Nonverbal/Verbal)

ninv.i iv ci i j ill v.1 n ci n n 3

Asian Americans

Whites Tf III IV..1

1JICIV l\ 1

1. Speak softly/slower

1 . Speak softly

1. Speak loud/fast to control listener

1 . Speak with affect

2. Indirect gaze when listening or speaking

2. Avoidance of eye contact when listening or speaking to high-status persons

2. Greater eye contact when listening

2. Direct eye contact prolonged )when speaking, but less when listening

3. Interject less;seldom offer encouraging communication

3. Similar rules

3. Head nods, nonverbal markers

3. Interrupt turn taking)when can

4. Delayed auditory ^ilence)

4. Mild delay

4. Quick responding

4. Quicker responding

5. Manner of expression low-keyed, indirect

5. Low-keyed, indirect

5. Objective, task oriented

5. Affective, emotional, interpersonal

dimension ^he pacing/intensity) of nonverbal communication. Table 7.1 contrasts five different groups along this continuum. How these styles affect the therapist's perception and ability to work with culturally different clients is important for each and every one of us to consider. Counseling and Therapy as Communication Style Throughout this text we have repeatedly emphasized that different theories of counseling and psychotherapy represent different communication styles. There is considerable early research support for this statement. The film se- ries Three Approaches to Psychotherapy Shostrom, 1966) which features Carl Rogers, Fritz Perls, and Albert Ellis, and the Three Approaches to Psychotherapy: II Shostrom, 1977) which features Carl Rogers, Everett Shostrom, and Arnold Lazarus, have been the subject of much analysis. Some general con- clusions may be tentatively drawn from all of these studies polliver, Williams, &C-old, 1980; Weinrach, 1987) Each theoretical orientation Rogers, person-centered therapy; Perls, existential therapy; Ellis, rational- emotive therapy; Shostrom, actualizing therapy; and Lazarus, multimodal therapy)can be distinguished from one another, and the therapy styles/skills exhibited seem to be highly correlated with their theoretical orientations. For example, Rogers's style emphasizes attending skills Encouragement to talk: minimal encouragers, nonverbal markers, paraphrasing, and reflecting feel-

Culturally Appropriate Intervention Strategies 177

ings) Shostrom relies on direct guidance, providing information, and so forth, while Lazarus takes an active, reeducative style. Differential Skills in Multicultural Counseling/Therapy Just as race, culture, ethnicity, and gender may affect communication styles, there is considerable evidence that theoretical orientations in counseling will influence helping styles as well. There is strong support for the belief that dif- ferent cultural groups may be more receptive to certain counseling/commu- nication styles because of cultural and sociopolitical factors Herring, 1997; Lin, 2001;Wehrly, 1995) Indeed, the literature on multicultural counseling/ therapy strongly suggests that American Indians, Asian Americans, Black Americans, and Hispanic Americans tend to prefer more active-directive forms of helping than nondirective ones Cheatham et al., 1997;Ivey 8vey, 2003;D. W. Sue et al., 1998) We briefly describe two of these group differ- ences here to give the reader some idea of their implications. Asian American clients who may value restraint of strong feelings and believe that intimate revelations are to be shared only with close friends may cause problems for the counselor who is oriented toward insight or feelings $a the case of Betty) It is entirely possible that such techniques as reflec- tion of feelings, asking questions of a deeply personal nature, and making depth interpretations may be perceived as lacking in respect for the client's integrity. Asian American clients may not value the process of insight into underlying processes. For example, some clients who come for vocational in- formation may be perceived by counselors as needing help in finding out what motivates their actions and decisions. Requests for advice or informa- tion from the client are seen as indicative of deeper, more personal conflicts. Although this might be true in some cases, the blind application of techniques that clash with cultural values seriously places many Asian Americans in an uncomfortable and oppressed position. Many years ago, Atkinson, Maruyama, and Matsui J978)tested this hypothesis with a number of Asian American students. Two tape recordings of a contrived counseling session were prepared in which the client's responses were identical but the coun- selor's responses differed, being directive in one and nondirective in the other. Their findings indicated that counselors who use the directive ap- proach were rated more credible and approachable than were those using the nondirective counseling approach. Asian Americans seem to prefer a logical, rational, structured counseling approach to an affective, reflective, and am- biguous one. Other researchers have drawn similar conclusions Atkinson & Lowe, 1995;Leong, 1986;Lin, 2001) In a classic and groundbreaking study, Berman J979)found similar re- sults with a Black population. The weakness of the previous study was its fail- ure to compare equal responses with a White population. Berman's study

178 The Practice Dimensions of Multicultural Counseling/Therapy

compared the use of counseling skills between Black and White male and fe- male counselors. A videotape of culturally varied client vignettes was viewed by Black and White counselor trainees. They responded to the question, What would you say to this personTThe data were scored and coded ac- cording to a microcounseling taxonomy that divided counseling skills into at- tending and influencing ones. The hypothesis made by the investigator was that Black and White counselors would give significantly different patterns of responses to their clients. Data supported the hypothesis. Black males and fe- males tended to use the more active expressive skills directions, expression of content, and interpretation )with greater frequency than did their White counterparts. White males and females tended to use a higher percentage of attending skills. Berman concluded that the person's race/culture appears to be a major factor in the counselor's choice of skills, that Black and White counselors appear to adhere to two distinctive styles of counseling. Berman also concluded that the more active styles of the Black counselor tend to include practical advice and allow for the introjection of a counselor's values and opinions. The implications for therapy become glaringly apparent. Mental health training programs tend to emphasize the more passive attending skills. Ther- apists so trained may be ill equipped to work with culturally different clients who might find the active approach more relevant to their own needs and values. Implications for Multicultural Counseling/Therapy Ivey's continuing contributions Iyey, 1981, 1986,Tvey &vey, 2003)in the field of microcounseling, multicultural counseling, and developmental coun- seling seem central to our understanding of counseling/communication styles. He believes that different theories are concerned with generating dif- ferent sentences and constructs and that different cultures may also be ex- pected to generate different sentences and constructs. Counseling and psychotherapy may be viewed as special types of temporary cultures. When the counseling style of the counselor does not match the communication style of his or her culturally diverse clients, many difficulties may arise:pre- mature termination of the session, inability to establish rapport, or cultural oppression of the client. Thus, it becomes clear that effective multicultural counseling occurs when the counselor and client are able to send and receive both verbal and nonverbal messages appropriately and accurately. When the counselor is able to engage in such activities, his or her credibility and attrac- tiveness will be increased. Communication styles manifested in the clinical context may either enhance or negate the effectiveness of MCT. Several ma- jor implications for counseling can be discerned.

Culturally Appropriate Intervention Strategies 179

Therapeutic Practice As practicing clinicians who work with a culturally diverse population, we need to move decisively in educating ourselves about the differential mean- ings of nonverbal behavior and the broader implications for communication styles. We need to realize that proxemics, kinesics, paralanguage, and high- low context factors are important elements of communication, that they may be highly culture-bound, and that we should guard against possible misin- terpretation in our assessment of clients. Likewise, it is important that we be- gin to become aware of and understand our own communication/helping style:What is my clinical/communication style?What does it say about my values, biases, and assumptions about human behaviorTHow do my non- verbals reflect stereotypes, fears, or preconceived notions about various racial groups?What nonverbal messages might I be communicating unknowingly to my clientiln what way does my helping style hinder my ability to work effectively with a culturally different client?What culturally/racially influ- enced communication styles cause me the greatest difficulty or discomfort? Why? We believe that therapists must be able to shift their therapeutic styles to meet the developmental needs of clients. We contend further that effective mental health professionals are those who can also shift their helping styles to meet the cultural dimensions of their clients. Therapists of differing theo- retical orientations will tend to use different skill patterns. These skill patterns may be antagonistic or inappropriate to the communication/helping styles of clients. In research cited earlier, it was clear that White counselors by virtue of their cultural conditioning and training)tended to use the more passive at- tending and listening skills in counseling/therapy, while racial/ethnic minor- ity populations appear more oriented toward an active influencing approach. There are several reasons why this may be the case. First, we contend that the use of more directive, active, and influencing skills is more likely to provide personal information about where the thera- pist is coming from ^elf-disclosure) Giving advice or suggestions, interpret- ing, and telling the client how you, the counselor or therapist, feel are really acts of counselor self-disclosure. While the use of attending or more nondi- rective skills may also self-disclose, it tends to be minimal relative to using in- fluencing skills. In multicultural counseling, the culturally diverse client is likely to approach the counselor with trepidation:What makes you any dif- ferent from all the Whites out there who have oppressed me?What makes you immune from inheriting the racial biases of your forebears TBef ore I open up to you $elf-disclose] I want to know where you are coming from." How open and honest are you about your own racism, and will it interfere with our relationship X]an you really understand what it's like to be Asian, Black, Hispanic, American Indian, or the like?In other words, a culturally

180 The Practice Dimensions of Multicultural Counseling/Therapy

diverse client may not open up ^elf-disclose )until you, the helping profes- sional, self-disclose first. Thus, to many minority clients, a therapist who ex- presses his or her thoughts and feelings may be better received in a counsel- ing situation. Second, the more positive response by people of color to the use of in- fluencing skills appears to be related to diagnostic focus. Studies support the thesis that White therapists are more likely to focus their problem diagnosis in individual, rather than societal terms perman, i979; Draguns, 2002; Nwachuku 9vey, i991;D. W. Sue et al., i998) In a society where individ- ualism prevails, it is not surprising to find that Euro-American counselors tend to view their client's problems are residing within the individual rather than society. Thus, the role of the therapist will be person-focused because the problem resides within the individual. Skills utilized will be individual- centered Attending) aimed at changing the person. Many minorities accept the importance of individual contributions to the problem, but they also give great weight to systemic or societal factors that may adversely impact their lives. Minorities who have been the victims of discrimination and oppression perceive that the problem resides externally to the person Societal forces) Active systems intervention is called for, and the most appropriate way to at- tack the environment Stressors )would be an active approach Lewis et al., 1 998) If the counselor shares their perception, he or she may take a more ac- tive role in the sessions, giving advice and suggestions, as well as teaching strategies becoming a partner to the client) Finally, while it would be ideal if we could effectively engage in the full range of therapeutic responses, such a wish may prove unrealistic. We can- not be all things to everyone. That is, there are personal limits to how much we can change our communication styles to match those of our clients. The difficulty in shifting styles may be a function of inadequate practice, inability to understand the other person's worldview, or personal biases or racist atti- tudes that have not been adequately resolved. In these cases, the counselor might consider several alternatives: \ )seek additional training/education, £)seek consultation with a more experienced counselor, prefer the client to another therapist, and ^(become aware of personal communication style limitations and try to anticipate their possible impact on the culturally diverse client. Often, a therapist who recognizes the limitations of his or her helping style and knows how it will impact a culturally diverse client can take steps to minimize possible conflicts. Interestingly, one study ^ao, Sue, EHayden, 1991)found that once rapport and a working relationship are established with a minority client, the counselor may have greater freedom in using a helping style quite different from that of the client. The crucial element appears to be the counselor's abil- ity to acknowledge limitations in his or her helping style and to anticipate the negative impact it may have on the culturally diverse client. In this way, the

Culturally Appropriate Intervention Strategies


helping professional may be saying to the client, I understand your world- view, and I know that what I do or say will appear very Western to you, but I'm limited in my communication style. I may or may not understand where you're coming from, but let's give it a try. "For some minority clients, this form of communication may be enough to begin the process of bridging the communication-style gap.

This chapter has made it abundantly clear that communication styles are strongly influenced by such factors as race, culture, ethnicity, and gender. Most of the studies we have reviewed lend support to the notion that various racial groups do exhibit differences in communication styles. If counseling and therapy are seen as subsets of the communication process, then it may have significant implications for what constitutes helping. Some general sug- gestions gleaned from this chapter might prove helpful: 1. Recognize that no one style of counseling or therapy will be appropri- ate for all populations and situations. A counselor or therapist who is able to engage in a variety of helping styles and roles is most likely to be effective in working with a diverse population. 2. Become knowledgeable about how race, culture, and gender affect communication styles. It is especially important to study the literature on nonverbal communication and test it out in a real-life situation by making a concerted and conscious effort to observe the ways in which people communicate and interact. Your clinical observation skills will be greatly enhanced if you sharpen your nonverbal powers of observa- tion of clients. 3. Become aware of your own communication and helping styles. Know your social impact on others and anticipate how it affects your clients. How we behave often unconsciously reflects our own beliefs and val- ues. It is important for us to realize what we communicate to others. Further, knowing how we affect people allows us to modify our behav- iors should our impact be negative. To do this, we need to seek feedback from friends and colleagues about how we impact them. 4. Try to obtain additional training and education on a variety of theoret- ical orientations and approaches. Programs that are primarily psycho - analytically oriented, cognitively oriented, existentially oriented, person-centered oriented, or behaviorally oriented maybe doing a great disservice to trainees. The goals and processes espoused by the theories may not be those held by culturally different groups. These theories

The Practice Dimensions of Multicultural Counseling/Therapy tend to be not only culture -bound, but also narrow in how they con- ceptualize the human condition. Know that each school of counseling and therapy has strengths, but they may be one-dimensional; they concentrate only on feelings, or only on cognitions, or only on behaviors. We need to realize that we are feeling, thinking, behaving, social, cultural, spiritual, and political beings. In other words, try to think holistically rather than in a reductionist man- ner when it comes to conceptualizing the human condition. It is important for training programs to use an approach that calls for openness and flexibility both in conceptualizing the issues and in actual skill building. In many respects, it represents a metatheoretical and eclectic approach to helping. Rather than being random, haphazard, and inconsistent, the metatheoretical approach is an attempt to use helping strategies, techniques, and styles that consider not only indi- vidual characteristics, but cultural and racial factors as well.

Multicultural Family Counseling and Therapy

Several years ago, a female school counselor sought my advice about a Mexican American family she had recently seen. She was quite concerned about the identified client, Elena Martinez, a 13-year-old student who was referred for counseling because of alleged peddling of drugs on the school premises. The counselor had formed an impression that the parents "did not care for their daughter, " "were uncooperative, " and "were attempting to avoid responsibility for dealing with Elena 's delinquency. " When pressed for how she arrived at these impressions, the counselor provided the following information. Elena Martinez was the second oldest of five siblings, ages 15,12,10, and 7. The father was an immigrant from Mexico and the mother a natu- ral citizen. The family resided in a blue-collar Latino neighborhood in San Jose, California. Elena had been reported as having minor problems in school prior to the "drug-selling incident. " For example, she had "talked back to teachers, " refused to do homework assignments, and had "fought" with other students. Her involvement with a group of other Latino students (suspected of being responsible for disruptive school-yard pranks) had got- ten her into trouble. Elena was well known to the counseling staff at the school. Because of the seriousness of the drug accusations, the counselor felt that something had to be done and that the parents needed to be informed immediately. The counselor reported calling the parents to set up an interview with them. When Mrs. Martinez answered the telephone, the counselor ex- plained that a police officer had caught Elena selling marijuana on school premises. Rather than arrest her, the officer turned the student over to the vice principal, who luckily was present at the time of the incident. After the explanation, the counselor had asked that the parents make arrangements for an appointment as soon as possible. The meeting would be aimed at in- forming the parents about Elena 's difficulties in school and coming to some decision about what could be done. During the phone conversation, Mrs. Martinez seemed hesitant about selecting a day and time to meet and when pressed by the counselor, excused



184 The Practice Dimensions of Multicultural Counseling/Therapy

herself from the phone. The counselor reported overhearing some whispering on the other end, and then the voice of Mr. Martinez. He immediately asked the coun- selor how his daughter was and expressed his consternation over the entire situa- tion. At that point, the counselor stated that she understood his feelings, but it would be best to set up an appointment for the following day and to talk about it then. Several times the counselor asked Mr. Martinez about a convenient time for the meeting, but each time he seemed to avoid the answer and to give excuses. He had to work the rest of the day and could not make the appointment. The coun- selor strongly stressed how important the meeting was for the daughter 's welfare, and that several hours of missed work was a small price to pay in light of the sit- uation. The father stated that he would be able to make an evening session, but the counselor informed him that school policy prohibited evening meetings. When the counselor suggested that the mother could initially come alone, further hesita- tions seemed present. Finally, the father agreed to attend. The very next day, Mr. and Mrs. Martinez and a brother-in-law (Elena 's godfather) showed up in her office. The counselor reported being upset at the presence of the brother-in-law when it became obvious that he planned to sit in on the session. At that point, she explained that a third party present would only make the session more complex and the outcome counterproductive. She wanted to see only the family. The counselor reported that the session went poorly, with minimal cooperation from the parents. The father and mother volunteered little in the way of information. The case of Elena Martinez exemplifies major misunderstandings that often occur in working with culturally diverse families. The counselor's obvious lack of understanding concerning Latino cultural values and how they traditionally affect communication patterns are present once again. This lack of knowledge and the degree of insensitivity to the Latino family's expe- rience in the United States can lead to negative impressions such as, They are uncooperative, avoiding responsibility and not caring for their children. The failure to understand cultural differences and the experiences of minority sta- tus in the United States compounds the problems. Consider the following points as you think about this case. First, it is entirely possible that the incidents reported by the counselor mean something different when seen from traditional Mexican American culture. Again, like many Euro-American therapists, this counselor possesses a value system of egalitarianism in the husband-wife relationship. The help- ing professional may be prone to making negative judgments of patriarchal Mexican American roles. In Latino culture, division of roles husband is pro- tector/provider while wife cares for the home/family )allows both to exercise influence and make decisions. Breaking the role divisions ^specially by the woman)is done only out of necessity. A wife would be remiss in publicly making a family decision getting up an appointment)without consulting or

Multicultural Family Counseling and Therapy 185

obtaining agreement from the husband. Mrs. Martinez's hesitation on the phone to commit to a meeting date with the counselor may be a reflection of the husband-wife role relationship rather than a lack of concern for their daughter. The counselor's persistence in forcing Mrs. Martinez to decide may actually be asking her to violate cultural dictates about appropriate role behaviors. Second, the counselor may have seriously undermined the Latino con- cept of the extended family by expressing negativism toward the godfather's attendance at the counseling session. Middle-class White Americans consider the family unit to be nuclear husband, wife, and children related by blood) while most minorities define the family unit as an extended one. A Hispanic child can acquire a godmother
186 The Practice Dimensions of Multicultural Counseling/Therapy

Fourth, the case of Elena and the Martinez family raises another im- portant question:What obligation do educational and mental health services have toward offering flexible and culturally appropriate services to minority constituents?Mr. Martinez's desire for an evening or weekend meeting brings this issue into clear perspective. Does the minority individual or family always have to conform to system rules and regulations?vVe are not arguing with the school policy itselfift some schools, there are very legitimate rea- sons for not staying after school ends high crime rate, etc.) What we are ar- guing for is the need to provide alternative service deliveries to minority fami- lies. For example, why not home visits or sessions off the school premises? Social workers have historically used this method with very positive results. It has aided the building of rapport ^he family perceives your genuine inter- est) increased comfort in the family for sharing with a counselor, and allowed a more realistic appraisal of family dynamics. Counselors frequently forget how intimidating it may be for a minority family to come in for coun- seling. The Martinez's lack of verbal participation may be a function not only of the conflict over the absence of the godfather, but also of the impersonal and formal nature of counseling relative to the personal orientation of the Hispanic family personalismo) Let us now use another couple counseling case to illustrate other con- trasting role relationship issues that arise in multicultural family counseling. Esteban and Carmen 0., a Puerto Rican couple, sought help at a community mental health clinic in the Miami area. Mr. 0. had recently come to the United States with only a high school education, but had already acquired several suc- cessful printing shops. Carmen, his wife, was a third-generation Latina raised in Florida. The two had a whirlwind courtship that resulted in marriage after only a three-month acquaintance. She described her husband as handsome, outspo- ken, confident, and strong, a person who could be affectionate and sensitive. Car- men used the term machismo several times to describe Esteban. The couple had sought marital counseling after a series of rather heated ar- guments over Esteban 's long work hours and his tendency to "go drinking with the boys " after work. She missed his companionship, which was constantly pres- ent during their courtship but now seemed strangely absent. Carmen, who had graduated from the University of Florida with a BA in business, had been work- ing as an administrative assistant when she met Esteban. While she enjoyed her work, Carmen reluctantly resigned the position prior to her marriage, with the urging of Esteban, who stated that it was beneath her and that he was capable of supporting them both. Carmen had convinced Esteban to seek outside help with their marital difficulties, and they had been assigned to Dr. Carla B., a White female psychologist. The initial session with the couple was characterized by Esteban 's doing most of the talking. Indeed, Dr. B. was quite annoyed by Esteban 's arrogant attitude. He frequently spoke for his wife and interrupted

Multicultural Family Counseling and Therapy 187

Dr. B. often, not allowing her to finish questions or make comments. Esteban stated that he understood his wife's desire to spend more time with him but that he needed to seek financial security for "my children. " While the couple did not have any children at the present time, it was obvious that Esteban expected to have many with his wife. He jokingly stated, "After three or four sons, she won 't have time to miss me. " It was obvious that his remark had a strong impact on Carmen, as she ap- peared quite surprised. Dr. B., who during this session had been trying to give Carmen an opportunity to express her thoughts and feelings, seized the opportu- nity. She asked Carmen how she felt about having children. As Carmen began to answer, Esteban blurted out quickly, "Of course, she wants children. All women want children. " At this point Dr. B. (obviously angry) confronted Esteban about his ten- dency to answer or speak for his wife and the inconsiderate manner in which he kept interrupting everyone. "Being a 'macho man ' is not what is needed here, " stated Dr. B. Esteban became noticeably angry and stated, "No woman lectures Esteban. Why aren 'tyou at home caring for your husband? What you need is a real man. " Dr. B. did not fall for Esteban 's baiting tactic and refused to argue with him. She was nevertheless quite angry with Esteban and disappointed in Carmen 's passivity. The session was terminated shortly thereafter. During the next few weeks Carmen came to the sessions without her hus- band, who refused to return. Their sessions consisted of dealing with Esteban 's "sexist attitude" and the ways in which Carmen could be her "own person. " Dr. B. stressed the fact that Carmen had an equal right in the decisions made at home, that she should not allow anyone to oppress her, that she did not need her husband's approval to return to her former job, and that having children was an equal and joint responsibility. During Carmen 's six months of therapy, the couple separated from one an- other. It was a difficult period for Carmen, who came for therapy regularly to talk about her need "to be my own person, " a phrase used often by Dr. B. Carmen and Esteban finally divorced after only a year of marriage. As in individual therapy, family systems therapy may be equally culture - bound and, when inappropriately applied, can have disastrous consequences. Dr. B. failed to understand the gender role relationship between traditional Puerto Rican men and women, unwittingly applied a culture-bound defini- tion of a healthy male-female relationship to Esteban and Carmen, and al- lowed her own feminist) values to influence her therapeutic decisions. While we cannot blame her for the divorce of this couple, one wonders whether this would have happened if the therapist had clarified the cultural issues and conflicts occurring between the couple and realized how the val- ues of couple counseling and those manifested in Puerto Rican culture might be at odds with one another.

188 The Practice Dimensions of Multicultural Counseling/Therapy For example, the egalitarian attitude held by the therapist may be in conflict with Puerto Rican values concerning male-female relationships and the division of responsibilities in the household. Traditional Puerto Rican families are patriarchal, a structure that gives men authority over women and the ability to make decisions without consulting them C~arcia-Preto, f 996; Ramos-McKay, Comas-Diaz, aRivera, f 988) Encouraging Carmen to be her own person, having a right to make independent decisions, and sharing the decision-making process with Esteban might be violating traditional gender role relationships. These men-women relationships are reinforced by the constructs of machismo and marianismo. Machismo is a term used in many Latino cultures to indicate maleness, virility, and the man's role as provider and protector of the family. The term denotes male sexual prowess, allows males greater sexual freedom, and dictates a role that makes them respon- sible for protecting the honor of the women in the family. In the United States, machismo has acquired negative connotations, has been patholo- gized, and is often equated with sexist behavior pe La Cancela, 1991) The construct of marianismo is the female counterpart, which is derived from the cult of the Virgin Mary;while men may be sexually superior, women are seen as morally and spiritually superior and capable of enduring greater suffering C-arcia-Preto, 1996) Women are expected to keep themselves sex- ually pure and to be self-sacrificing in favor of their children and especially the husband; she is the caretaker of the family and the homemaker. These gender role relationships have existed for centuries within Puerto Rican cul- ture, although intergenerational differences have made these traditional roles an increasing source of conflict. Dr. B. is obviously unaware that her attempts to interrupt Esteban's dialogue, to encourage Carmen to speak her mind freely, and to derogate machismo may be a violation of Puerto Rican cultural values;it may also be perceived as an insult to Esteban's maleness. The therapist is also unaware that her gender being a woman )might also be a source of conflict for Esteban. Not only may he perceive Dr. B. as playing an inappropriate role ^he should be at home taking care of her husband and children) but also it must be a great blow to his male pride to have a female therapist taking charge of the sessions. We are not making a judgment about whether the patriarchal nature of a cultural group is good or bad. We are also not taking the position that egali- tarian relationships are better than other culturally sanctioned role relation- ships. What is important, however, is the realization that personal values ^quality in relationships) definitions of desirable male-female role relation- ships, and the goals of marital or family therapy independence, or becoming one's own person)may be culture-bound and may negatively impact multi- cultural family counseling/therapy. Effective multicultural family therapy is very difficult not only because of these cultural clashes, but also because of the way in which they interact with class issues ^he Martinez family)

Multicultural Family Counseling and Therapy 189 Family Systems Counseling and Therapy Family systems therapy encompasses many aspects of the family which may include marital or couple counseling/therapy parent-child counseling, or work with more than one member of the family ^ichols Schwartz, 2002) Its main goal is to modify relationships within a family in order to achieve har- mony Becvar 83ecvar, 2003) Family systems therapy is based on several as- sumptions: |)It is logical and economical to treat together all those who ex- ist and operate within a system of relationships \n most cases, it implies the nuclear family)2)the problems of the Identified patient"are only symp- toms, and the family itself is the client; f>)all symptoms or problematic be- haviors exhibited by a member of the family serve a purpose;4)the behav- iors of family members are tied to one another in powerful reciprocal ways Circular causality emphasized over linear causality)and $)the task of the therapist is to modify relationships or improve communications within the family system Corey 2005;McGoldrick, Giordano, 8&arcia-Preto, 2005) There are many family systems approaches, but two characteristics seem to be especially important. One of these, the communications approach, is based on the assumption that family problems are communication difficul- ties. Many family communication problems are both subtle and complex. Family therapists concentrate on improving not only faulty communications but also interactions and relationships among family members fiatir, 1967, 1983) The way in which rules, agreements, and perceptions are communi- cated among members may also be important |. Haley, 1967) The structural approach also considers communication to be important, but it emphasizes the interlocking roles of family members Minuchin, 1974) Most families are constantly in a state of change;they are in the process of structuring and re- structuring themselves into systems and subsystems. The health of a family is often linked to the members' abilities to recognize boundaries of the various systemsaHiances, communication patterns, and so forth. From a philo- sophical and theoretical perspective, both approaches appear appropriate in working with various minority groups. For example, they appear to n Highlight the importance of the family versus the individuals the unit of identity n Focus on resolving concrete issues n Be concerned with family structure and dynamics n Assume that these family structures and dynamics are historically passed on from one generation to another n Attempt to understand the communication and alliances via reframing n Place the therapist in an expert position

190 The Practice Dimensions of Multicultural Counseling/Therapy Many of these qualities, as we have seen, would be consistent with the worldviews of racial/ethnic minorities. Many culturally different families fa- vorably view its emphases on the family as the unit of identity and study, un- derstanding the cultural norms and background of the family system, and the need to balance the system. The problem arises, however, in how these goals and strategies are trans- lated into concepts of the family"or what constitutes the healthy"family. Some of the characteristics of healthy families may pose problems in therapy with various culturally different groups. They tend to be heavily loaded with value orientations that are incongruent with the value systems of many cul- turally different clients ^VlcGoldrick, Giordano, £Pearce, 2005) They tend to n Allow and encourage expressing emotions freely and openly n View each member as having a right to be his or her own unique self ihdividuate from the emotional field of the family) n Strive for an equal division of labor among members of the family n Consider egalitarian role relationships between spouses desirable n Hold the nuclear family as the standard As in the cases of the Martinez family and Esteban/ Carmen, these transla- tions in family systems therapy can cause great problems in working with culturally diverse clients. It is clear that culturally effective family systems therapists must escape from their cultural encapsulation, understand the sociopolitical forces that affect minority families, become aware of major dif- ferences in the value system that they possess when contrasted with racial/ cultural family values, and understand structural family relationships that are different from their own concepts of family. Issues in Working with Ethnic Minority Families Effective multicultural family counseling and therapy must incorporate the many racial, cultural, economic, and class issues inherent in the two clinical family examples given earlier. While not unique to families of color, there are life events that differentiate the experiences of people of color from middle - class White families. Several factors have been identified as important for cul- turally sensitive family therapists to take into consideration B-oyd-Franklin, 2003;Ho, 1997;McGoldrick et al., 2005) Ethnic Minority Reality This refers to the racism and poverty that dominate the lives of minorities. Lower family income, greater unemployment, increasing percentage falling

Multicultural Family Counseling and Therapy 191

below the poverty line, and other issues have had major negative effects not only on the individuals, but on family structures as well. The relocation of 120,000 Japanese Americans into concentration camps during World War II, for example, drastically altered the traditional Japanese family structures and relationships p. W. Sue SCirk, 1973) By physically uprooting these U.S. cit- izens, symbols of ethnic identity were destroyed, creating identity conflicts and problems. Furthermore, the camp experience disrupted the traditional lines of authority. The elderly male no longer had a functional value as head of household; family discipline and control became loosened; and women gained a degree of independence unheard of in traditional Japanese families. Likewise, African American families have been victims of poverty and racism. Nowhere is this more evident than in statistics revealing a higher in- cidence of Black children living in homes without the biological father pres- ents percent, as compared with 43 percent for Whites Wilkinson, 1993) More Black families are classified as impoverished 46 percent) than are White families }0 percent) In addition, many more Black males are single, widowed, or divorced 47 percent) compared with Whites 28 percent) The high mortality rate among Black males has led some to call them an endan- gered species in which societal forces have even strained and affected the Black male-female relationship Parham et al., 1999) Under slavery, class distinctions were obliterated; the slave husband was disempowered as the head of the household, and the man's inability to protect and provide for kin had a negative effect upon African American family relationships Wilkinson, 1993) Conflicting Value Systems Imposed by White Euro-American society upon minority groups, conflicting value systems have also caused great harm to them. The case of Elena Mar- tinez reveals how the White counselor's conception of the nuclear family may clash with traditional Latino/Hispanic emphasis on extended families. It ap- pears that almost all minority groups place greater value on families, histori- cal lineage Reverence of ancestors) interdependence among family mem- bers, and submergence of self for the good of the family Uba, 1994) African Americans are often described as having a kinship system in which relatives of a variety of blood ties ^unts, uncles, brothers, sisters, boyfriends, preach- ers, etc. )may act as the extended family Black, 1 996;Hines Si oyd- Franklin, 2005) Likewise, the extended family in the Hispanic culture includes nu- merous relatives and friends Falicov, 2005;Garcia-Preto, 2005) as evidenced in the case of Elena Martinez. Perhaps most difficult to grasp for many men- tal health professionals is the American Indian family network, which is struc- turally open and assumes village-like characteristics Herring, 1999; Red Horse, 1983;Sutton broken Nose, 2005) This family extension may include several households. Unless therapists are aware of these value differences,

192 The Practice Dimensions of Multicultural Counseling/Therapy

they may unintentionally mislabel behaviors that they consider bizarre or make decisions that are detrimental to the family We have more to say about this important point shortly. Biculturalism Biculturalism refers to the fact that minorities in the United States inherit two different cultural traditions. The therapist must understand how bicultural- ism influences the structures, communications, and dynamics of the family. A 22-year-old Latino male's reluctance to go against the wishes of his parents and marry a woman he loves may not be a sign of immaturity. Rather, it may reflect a conflict between duality of membership in two groups or between the positive choices of one cultural dictate over another. A culturally effective therapist is one who understands the possible conflicts that may arise as a re- sult of biculturalism. Related to biculturalism is the therapist's need to understand the pro- cess of acculturation and the stresses encountered by culturally diverse fami- lies. While the term was originally used to indicate the mutual influence of two different cultures on one another, biculturalism is best understood in the United States as the interaction between a dominant and nondominant cul- ture. Some questions that need to be addressed by family systems therapists when working with culturally diverse families areWhat are the psychologi- cal consequences to nondominant families as they encounter the dominant culture What effects does the dominant culture have on minority family dy- namics and structure What types of issues or problems are likely to arise as a result of the acculturation processTor example, a recently migrated family often has parents who are allied with the culture of their country of origin while their offspring are more likely to adapt to the dominant culture more rapidly. In many cases, children may be more oriented to the culture of the larger society, resulting in intergenerational conflicts £ushue SSciarra, 1995) However, it is important for the therapist to understand the socio- political dimensions of this process. The problem may not be so much a func- tion of intergenerational conflict as it is the dominant-subordinate clash of cultures pushue SSciarra, 1995;Szapocznik fKurtines, 1993) The multi- culturally skilled family therapist would focus on the problems created by cultural oppression and reframe the goal as one of stressing the benefits of in- tergenerational collaboration and alliance against a common foe £ushue & Sciarra, 1995) Ethnic Differences in Minority Status These differences refer to the life experiences and adjustments that occur as a result of minority status in the United States. All four racial/ethnic minor- ity groups have been subjected to dehumanizing forces:

Multicultural Family Counseling and Therapy 193 n The history of slavery for Black Americans has not only negatively im- pacted their self-esteem but has also contributed to the disruption of the Black male/female relationship and the structure of the Black family. Slavery imposed a pathological system of social organization on the African American family, resulting in disorganization and a constant fight for survival and stability. Despite the system of slavery however, many African Americans overcame these negative forces by sheer force of will, by reasserting their ties of affection, by using extended kinship ties, by their strength of spirit and spirituality, and by their multigener- ational networks }Vilkinson, 1993) It would be highly beneficial if the family systems therapist recognized these strengths in the African American family, rather than stressing its instability and problems. n Racism and colonialism have made American Indians immigrants in their own land, and the federal government has even imposed a defini- tion of race upon them iTiey must be able to prove they are at least one- quarter Indian blood) Such a legal definition of race has created prob- lems among Native Americans by confusing the issues of identity. Like their African American brothers and sisters, Native Americans have experienced conquest, dislocation, cultural genocide, segregation, and coerced assimilation button (Broken Nose, 2005;Tafoya EDel Vec- chio, 2005) American Indian family life has been strongly affected by government policies that include using missionaries, boarding schools, and the Bureau of Indian Affairs in an attempt to civilize the heathens. The results have been devastating to Native Americans:learned help- lessness; gambling, alcohol, and drug abuse; suicide; and family rela- tionship problems Tofoya S3el Vecchio, 2005) A family systems ther- apist must be aware of the multigenerational disruption of the Native American family through over 500 years of historical trauma. n Immigration status among Latino/Hispanics and Asian refugees/immi- grants IJegal resident to illegal alien)and the abuses, resentments, and discrimination experienced by them are constant stressful events in their lives. Anti-immigrant feelings have never been more pervasive and intense. This negativism is currently symbolized in continuing de- bate of the guest worker program, amnesty for illegal immigrants, and the formation of vigilante groups like the Minute Men, who patrol the border between Mexico and the United States. Mean-spirited and with potentially devastating consequences, current attempts to expel immi- grant children from school who are in the United States illegally, and to deny them jobs, nonemergency health care, and other social services have increased fears of deportation and other reprisals. In addition to the hostile climate experienced by recent immigrants, the migration ex- perience can be a source of stress and disappointment. The multicul- tural family systems therapist must differentiate between the reasons

194 The Practice Dimensions of Multicultural Counseling/Therapy

for migration because their impact on the family may be quite different. A family deciding to migrate in search of adventure or wealth volun- tary decision)will experience the change differently than will refugees/ immigrants who must leave because of war or religious and/or political persecution. Attitudes toward assimilation and acculturation might be quite different between the two families. Skin color and obvious physical differences are also important factors that determine the treatment of minority individuals and their families. These physical differences continue to warp the perception of White America in that persons of color are seen as aliens in their own land. Equating physi- cal differences, and particularly skin color, with being alien, negative, patho- logical, or less than human has a long history. Travel logs of early European seafarers describe their encounters with Blacks and the images and judg- ments associated with Africans: And entering in [a river], we see A number ofblacke soules, Whose likelinesse seem 'd men to be, But ail as blacke as coles. (Quoted in Jordan, 1969, pp. 4-5) J. M. Jones J997, p. 475)pointed out that the Oxford English Dictionary defi- nition of the word black prior to the sixteenth century was the following: Deeply stained with dirt; soiled, dirty, foul Having dark or deadly purposes, malignant; pertaining to or involving death, deadly; baneful, disastrous, sinis- ter. . . . Foul, iniquitous, atrocious, horrible, wicked Indicating disgrace, cen- sure, liability to punishment, etc. It is clear then, that the concept of blackness was associated with being bad, ugly, evil, and nonhuman. J. M. Jones J997)also observes the rela- tionship between color name and a classic clinical report of multiple person- ality disorder. In the Three Faces of Eve Thigpen {Eleckley, 1954, p. 476) the two personalities-Eve White and Eve Black*eflect positive associations with Whiteness and negative ones with Blackness: Eve Black is lacking in culture but curiously likable. She is playful, childlike, en- tertaining. Her superego is nonfunctional, which makes her a delight, the one who has all the fun. Black is where the "fun " things go to be. Yet, just as there is a kind of nostalgia and envy directed at Eve Black, there is judgment and casti- gation, as well. A certain voyeurism makes Eve Black someone one would like to be around, but wouldn 't want in one's family. Eve White, by contrast, has "all the right stuff. " She is socialized to traditional values, properly "feminine, " de-

Multicultural Family Counseling and Therapy 195 voted, even heroic. Her saintliness is admired, but somehow she is repressed, and one's admiration for her is tinged with sadness. The personality traits associated differentially with Eve White and Eve Black are not pulled from thin air;instead, they suggest the content of cultural be- liefs about the races as well as the genders. These cultural beliefs did not, in f 954, depart substantially from the first conclusions about racial differences by Englishmen in 1550! While skin color is probably the most powerful physical characteristic linked to racism, other physical features and differences may also determine negative treatment by the wider society. External societal definitions of race have often resulted in ideological racism that links physical characteristics of groups Usually skin color)to major psychological traits Feagin, 1989) Be- liefs that Blacks are great athletes but poor scholars are sentiments that have shaped U.S. treatment of African Americans. Likewise, other physical fea- tures, such as head form, facial features, color and texture of body hair, and so on all contrast with the ideal image of blond hair and fair skin. Not only is there an external negative evaluation of those who differ from such desired" features, but many persons of color may form negative self-images and body images and attempt to become Westernized in their physical features. One wonders, for example, at the psychological dynamics that have motivated some Asian American women to seek cosmetic surgery to reshape their eyes in a more Westernized fashion. Ethnicity and Language These dimensions refer to the common sense of bonding among members of a group that contributes to a sense of belonging. The symbols of the group ^thnicity)are manifested primarily in language. Language structures mean- ing, determines how we see things, is the carrier of our culture, and affects our worldviews. Many minority clients do not possess vocabulary equiva- lents to standard English and when forced to communicate in English may appear flat, "nonverbal, "uncommunicative," and Tacking in insight" Romero, 1985) The problem is linguistic, not psychological. In psycho- therapy, where words are the major vehicle for effective change, language has been likened to what a baton is to the conductor and what a scalpel is to the surgeon Russell, 1988) Studies in the field of linguistics and sociolinguistics support the fact that language conveys a wealth of information other than the primary con- tent of the message;the cues of background, place of origin, group member- ship, status in the group, and the relationship to the speaker can all be deter- mined Kennedy, 1996;Kochman, 1981;Russell, 1988) Thus, the gender, race, and social class of the speaker can be accurately identified. More importantly,

196 The Practice Dimensions of Multicultural Counseling/Therapy

however, these studies also suggest that the listener utilizes this sociolinguis- tic information to formulate opinions of the speaker and in the interpretation of the message. Because our society values standard English, the use of non- standard English, dialects, or accented speech is often associated with unde- sirable characteristics-being less intelligent, uncouth, lower class, unsophis- ticated, and uninsightful. Thus, while racial/ethnic minority groups may use their linguistic characteristics to bond with one another and to communicate more accurately, the larger society may invalidate, penalize, or directly pun- ish individuals or groups who exhibit bilingualism or group-idiosyncratic use of language. Ethnicity and Social Class These refer to aspects of wealth, name, occupation, and status. Class differ- ences between mental health professionals and their minority clients can often lead to barriers in understanding and communication. This was clearly evident in the case of Elena Martinez, in that the counselor had difficulty re- lating to a missed day of work. Needless to say, understanding class differ- ences becomes even more important for therapists working with minority families, because they are disproportionately represented in the lower socio- economic classes. Many argue that class may be a more powerful determi- nant of values and behavior than race or ethnicity. For example, we know that the wealthiest one million people in the United States earn more than the next tOO million combined, that the top t percent own over 40 percent of the nation's wealth, and that the gap between the rich and the poor is in- creasing Thurow, 1995) From a political perspective, some believe that racial conflicts are promulgated by those at the very top, to detract from the real cause of inequities: a social structure that allows the dominant class to maintain power pell, 1993) While there is considerable truth to this view, not all differences can be ascribed to class alone. Further, while one cannot change race or ethnicity, changes in social class can occur. We contend that all three are important, and the therapist must understand their interactions with one another.

Multicultural Family Counseling/Therapy: A Conceptual Model Effective multicultural family counseling/therapy operates under principles similar to that outlined in earlier chapters. First, counselors need to become culturally aware of their own values, biases, and assumptions about human behavior ^specially as it pertains to the definition of family) Second, it is im- portant to become aware of the worldview of the culturally different client and how that client views the definition, role, and function of the family. Last, ap-

Multicultural Family Counseling and Therapy 197

Table 8. 1 Cultural Value Preferences of Middle- Class White Euro- Americans and Racial/Ethnic Minorities: A Comparative Summary

Area of

Middle-Class White





People to nature/ environment

Mastery over

Harmony with

Harmony with

Harmony with

Harmony with

Time orientation






People relations






Preferred mode of activity



Being-in- becoming


Being-in- becoming

Nature of man

Good 4>ad



Good {bad


Source: From Family Therapy with Ethnic Minorities p. 232)by M. K. Ho, 1987, Newbury Park, CA:Sage. Copyright 1987 by Sage Publications. Reprinted by permission.

propriate intervention strategies need to be devised to maximize success and minimize cultural oppression. While in earlier chapters the focus was on indi- vidual clients and their ethnic/racial groups, our concern in this chapter is with the family unit as defined from the group's perspective. In attempting to understand the first two goals, we are using a model first outlined by Kluck- hohn and Strodtbeck J 961) This model allows us to understand the world- views of culturally diverse families by contrasting the value orientations of the four main groups we are studying illustrated in Table 8.1)Asian Ameri- cans, Native Americans, African Americans, and Latino/Hispanic Americans. People-Nature Relationship Traditional Western thinking believes in mastery and control over nature. As a result, most therapists operate from a framework that subscribes to the be- lief that problems are solvable and that both therapist and client must take an active part in solving problems via manipulation and control. Active inter- vention is stressed in controlling or changing the environment. As seen in Table 8.1, the four other ethnic groups view people as harmonious with na- ture. Confucian philosophy, for example, stresses a set of rules aimed at pro- moting loyalty, respect, and harmony among family members M^oodley & West, 2005) Harmony within the family and the environment leads to har- mony within the self. Dependence on the family unit and acceptance of the environment seem to dictate differences in solving problems. Western culture advocates defining and attacking the problem directly. Asian cultures tend to

198 The Practice Dimensions of Multicultural Counseling/Therapy

accommodate or deal with problems through indirection. In child rearing, many Asians believe that it is better to avoid direct confrontation and to use deflection. A White family may deal with a child who has watched too many hours of TV by saying, Why don't you turn the TV off and studyTo be more threatening, the parent might say, You'll be grounded unless the TV goes off fAn Asian parent might respond by saying, That looks like a boring pro- gram;! think your friend John must be doing his homework now, "or, I think father wants to watch his favorite program. "Such an approach stems from the need to avoid conflict and to achieve balance and harmony among members of the family and the wider environment. In an excellent analysis of family therapy for Asian Americans, S. C. Kim } 98 5 (points out how current therapeutic techniques of confrontation and of having clients express thoughts and feelings directly may be inappro- priate and difficult to handle. For example, one of the basic tenets of family therapy is that the identified patient IP)typically behaves in such a way as to reflect family influences or pathology. Often, an acting-out child is sym- bolic of deeper family problems. Yet most Asian American families come to counseling or therapy for the benefit of the IP, not the family Attempts to di- rectly focus in on the family dynamics as contributing to the IP will be met with negativism and possible termination. S. C. Kim J 985, pp. 346)states, A recommended approach to engage the family would he to pace the family's cul- tural expectations and limitations by (1) asserting that the IP's problem (there- fore not the IP by implication) is indeed the problem; (2) recognizing and re- inforcing the family's concerns to help the IP to change the behavior; and (3) emphasizing that each family member's contribution in resolving the prob- lem is vitally needed, and that without it, the problem will either remain or get worse bringing on further difficulty in the family. Thus, it is apparent that U.S. values that call for us to dominate nature \.e., conquer space, tame the wilderness, or harness nuclear energy (through control and manipulation of the universe are reflected in family counseling. Family systems counseling theories attempt to describe, explain, predict, and control family dynamics. The therapist actively attempts to understand what is going on in the family system Structural alliances and communication pat- terns) identify the problems dysfunctional aspects of the dynamics) and attack them directly or indirectly through manipulation and control thera- peutic interventions) Ethnic minorities or subgroups that view people as harmonious with nature or believe that nature may overwhelm people $cts of God)niay find the therapist's mastery-over-nature approach inconsistent or antagonistic to their worldview. Indeed, attempts to intervene actively in changing family patterns and relationships may be perceived as the problem because it may potentially unbalance that harmony that existed.

Multicultural Family Counseling and Therapy 199

Time Dimension How different societies, cultures, and people view time exerts a pervasive influence on their lives. U.S. society may be characterized as preoccupied with the future ^
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First, if time differences exist between the minority family and the White Euro-American therapist, it will most likely be manifested in a differ- ence in the pace of time:Both may sense things are going too slowly or too fast. An American Indian family who values being in the present and the im- mediate experiential reality of being may feel that the therapist lacks respect for them and is rushing them Herring, 1997;Sutton {Broken Nose, 2005) while ignoring the quality of the personal relationship. On the other hand, the therapist may be dismayed by the delays, "mefficiency, "and lack of commitment to change"among the family members. After all, time is pre- cious, and the therapist has only limited time to impact upon the family. The result is frequently dissatisfaction among the parties, no establishment of rap- port, misinterpretation of the behaviors or situations, and probably discon- tinuation of future sessions. Second, Inclan J985)pointed out how confusions and misinterpreta- tions can arise because Hispanics, particularly Puerto Ricans, mark time dif- ferently than do their U.S. White counterparts. The language of clock time in counseling pO-minute hour, rigid time schedule, once-a-week sessions )can conflict with minority perceptions of time £arcia-Preto, 1996) The follow- ing dialogue illustrates this point clearly: "Mrs. Rivera, your next appointment is at 9:30 a.m. next Wednesday. " "Good, it's convenient for me to come after I drop off the children at school. " Or, "Mrs. Rivera, your next appointment is for the whole family at 3:00 p.m. on Tuesday. " "Very good. After the kids return from school we can come right in. " (In- clan, 1985, p. 328) Since school starts at 8 a.m., the client is bound to show up very early, while in the second example the client will most likely be late School ends at 3 p.m.) In both cases, the counselor is most likely to be inconvenienced, but worse yet is the negative interpretation that may be made of the client's mo- tives ^nxious, demanding, or pushy in the first case, while resistant, passive- aggressive, or irresponsible in the latter one) The counselor needs to be aware that many Hispanics may mark time by events rather than by the clock. Third, many minorities who are present-time oriented overall would be more likely to seek immediate, concrete solutions than future-oriented, ab- stract goals. In earlier chapters we noted that goals or processes that are in- sight oriented assume that the client has time to sit back and self-explore. Ca- reer/vocational counseling, in which clients explore their interests, values, work temperaments, skills, abilities, and the world of work, may be seen as highly future oriented. While potentially beneficial to the client, these ap- proaches may pose dilemmas for both the minority family and the counselor.

Multicultural Family Counseling and Therapy 20 1

Relational Dimension In general, the United States can be characterized as an achievement- oriented society, which is most strongly manifested in the prevailing Protes- tant work ethic. Basic to the ethic is the concept of individualism: \ )The in- dividual is the psychosocial unit of operation;^ )the individual has primary responsibility for his or her own actions;^ndependence and autonomy are highly valued and rewarded; and ^)one should be internally directed and controlled. In many societies and groups within the United States, however, this value is not necessarily shared. Relationships in Japan and China are often described as being lineal, and identification with others is both wide and linked to the past Ancestor worship) Obeying the wishes of ancestors or de- ceased parents and perceiving your existence and identity as linked to the his- torical past are inseparable. Almost all racial/ethnic minority groups in the United States tend to be more collateral in their relationships with people. In an individualistic orientation, the definition of the family tends to be linked to a biological necessity p.uclear family) while a collateral or lineal view en- compasses various concepts of the extended family. Not understanding this distinction and the values inherent in these orientations may lead the family therapist to erroneous conclusions and decisions. Following is a case illustra- tion of a young American Indian. A young probationer was under court supervision and had strict orders to remain with responsible adults. His counselor became concerned because the youth appeared to ignore this order. The client moved around frequently and, ac- cording to the counselor, stayed overnight with several different young women. The counselor presented this case at a formal staff meeting, and fellow profes- sionals stated their suspicion that the client was either a pusher or a pimp. The frustrating element to the counselor was that the young women knew each other and appeared to enjoy each other's company. Moreover, they were not ashamed to be seen together in public with the client. This behavior prompted the coun- selor to initiate violation proceedings. (Red Horse, Lewis, Feit, & Decker, 1981, p. 56) If an American Indian professional had not accidentally come upon this case, a revocation order initiated against the youngster would surely have caused irreparable alienation between the family and the social service agency. The counselor had failed to realize that the American Indian family network is structurally open and may include several households of relatives and friends along both vertical and horizontal lines. The young women were all first cousins to the client, and each was as a sister, with all the households representing different units of the family. Likewise, African Americans have strong kinship bonds that may en-

202 The Practice Dimensions of Multicultural Counseling/Therapy compass both blood relatives and friends. Traditional African culture values the collective orientation over individualism |. H. Franklin, 1988;Hines & Boyd-Franklin, 2005) This group identity has also been reinforced by what many African Americans describe as the sense of peoplehood'developed as a result of the common experience of racism and discrimination. In a society that has historically attempted to destroy the Black family, near and distant relatives, neighbors, friends, and acquaintances have arisen in an extended family support network Black, 1996) Thus, the Black family may appear quite different from the ideal nuclear family. The danger is that certain as- sumptions made by a White therapist may be totally without merit or may be translated in such a way as to alienate or damage the self-esteem of African Americans. For example, the absence of a father in the Black family does not nec- essarily mean that the children do not have a father figure. This function may be taken over by an uncle or male family friend. M. B. Thomas and Dansby J985)provide an example of a group-counseling technique that was detri- mental to several Black children. Clients in the group were asked to draw a picture of the family dinner table and place circles representing the mother, father, and children in their seating arrangement. They reported that even before the directions for the exercise were finished, a young Black girl ran from the room in tears. She had been raised by an aunt. Several other Black clients stated that they did not eat dinners together as a family except on spe- cial occasions or Sundaysaecording to Willie J981)a typical routine in some affluent Black families. The importance of family membership and the extended family system has already been illustrated in the case of Elena Martinez. We give one ex- ample here to illustrate that the moral evaluation of a behavior may depend on the value orientation of the subject. Because of their collective orienta- tion, Puerto Ricans view obligations to the family as primary over all other re- lationships G-arcia-Preto, 2005) When a family member attains a position of power and influence, it is expected that he or she will favor the relatives over objective criteria. Businesses that are heavily weighted by family members, and appointments of family members in government positions, are not un- usual in many countries. Failure to hire a family member may result in moral condemnation and family sanctions Inclan, 1 985) This is in marked contrast to what we ideally believe in the United States. Appointment of family mem- bers over objective criteria of individual achievement is condemned. It would appear that differences in the relationship dimension between the mental health provider and the minority family receiving services can cause great conflict. While family therapy may be the treatment of choice for many minorities (>ver individual therapy) its values may again be antago- nistic and detrimental to minorities. Family approaches that place heavy em- phasis on individualism and freedom from the emotional field of the family

Multicultural Family Counseling and Therapy 203

may cause great harm. Our approach should be to identify how we might capitalize on collaterally to the benefit of minority families. Activity Dimension One of the primary characteristics of White U.S. cultural values and beliefs is an action doing)orientation:} )We must master and control nature;? )we must always do things about a situation;and ?)we should take a pragmatic and utilitarian view of life. In counseling, we expect clients to master and control their own life and environment, to take action to resolve their own problems, and to fight against bias and inaction. The doing mode is evident everywhere and is reflected in how White Americans identify themselves by what they do Occupations) how children are asked what they want to do when they grow up, and how a higher value is given to inventors over poets and to doctors of medicine over doctors of philosophy. An essay topic com- monly given to schoolchildren returning to school in the fall is What I did on my summer vacation." It appears that both American Indians and Latinos/Hispanics prefer a being or being-in-becoming mode of activity. The American Indian concepts of self-determination and noninterference are examples. Value is placed on the spiritual quality of being, as manifested in self-containment, poise, and harmony with the universe. Value is placed on the attainment of inner ful- fillment and an essential serenity of one's place in the universe. Because each person is fulfilling a purpose, no one should have the power to interfere or impose values. Often, those unfamiliar with Indian values perceive the per- son as stoic, aloof, passive, noncompetitive, or inactive. In working with families, the counselor role of active manipulator may clash with American Indian concepts of being-in-becoming Noninterference) Likewise, Latino/Hispanic culture maybe said to have a more here-and- now or being-in-becoming orientation. Like their American Indian counter- parts, Hispanics believe that people are born with dignidad dignity )and must be given respecto Respect) They are born with innate worth and importance; the inner soul and spirit are more important than the body. People cannot be held accountable for their lot in life Status, roles, etc. (because they are born into this life state hiclan, 1985) A certain degree of fatalismo |atalism)is present, and life events may be viewed as inevitable l,o que Dios manda, what God wills) Philosophically, it does not matter what people have in life or what position they occupy farm laborer, public official, or attorney) Status is possessed by existing, and everyone is entitled to respecto. Since this belief system de-emphasizes material accomplishments as a measure of success, it is clearly at odds with Euro-American middle-class so- ciety. While a doing-oriented family may define a family member's worth via achievement, a being orientation equates worth simply to belonging. Thus,

204 The Practice Dimensions of Multicultural Counseling/Therapy

when clients complain that someone is not an effective family member, what do they meanThis needs to be clarified by the therapist. Is it a complaint that the family member is not performing and achieving doing) or does it mean that the person is not respectful and accommodating to family structures and values being ^ Ho }987)describes both Asian Americans and African Americans as operating from the doing orientation. However, it appears that doing'ln these two groups is manifested differently than in the White American lifestyle. The active dimension in Asians is related not to individual achieve- ment, but to achievement via conformity to family values and demands. Con- trolling one's own feelings, impulses, desires, and needs to fulfill responsibil- ity to the family is strongly ingrained in Asian children. The doing orientation tends to be more ritualized in the roles of and responsibilities toward mem- bers of the family. African Americans also exercise considerable control En- dure the pain and suffering of racism^n the face of adversity to minimize dis- crimination and to maximize success. Nature of People Dimension Middle-class Euro-Americans generally perceive the nature of people as neu- tral. Environmental influences such as conditioning, family upbringing, and socialization are believed to be dominant forces in determining the nature of the person. People are neither good nor bad but are a product of their envi- ronment. While several minority groups may share features of this belief with Whites, there is a qualitative and quantitative difference that may affect family structure and dynamics. For example, Asian Americans and American Indians tend to emphasize the inherent goodness of people. We have already discussed the Native American concept of noninterference, which is based on the belief that people have an innate capacity to advance and grow ^elf- fulfillment )and that problematic behaviors are the result of environmental influences that thwart the opportunity to develop. Goodness will always triumph over evil if the person is left alone. Likewise, Asian philosophy bud- dhism and Confucianism jbelieves in peoples' innate goodness and prescribes role relationships that manifest the good way of life/Central to Asian belief is the fact that the best healing source lies within the family paya, 2005;Wal- lace Shapiro, 2006)and that seeking help from the outside £.g., counsel- ing and therapy )is nonproductive and against the dictates of Asian philos- ophy. Latinos may be described as holding the view that human nature is both good and bad hiixed) Concepts of dignidad and respecto undergird the belief that people are born with positive qualities. Yet some Hispanics, such as Puerto Ricans, spend a great deal of time appealing to supernatural forces so that children may be blessed with a good human nature Inclan, 1985) Thus,

Multicultural Family Counseling and Therapy


a child's badness'htay be accepted as destiny, so parents may be less inclined to seek help from educators or mental health professionals for such problems. The preferred mode of help may be religious consultations and ventilation to neighbors and friends who sympathize and understand the dilemmas (hange means reaching the supernatural forces) African Americans may also be characterized as having a mixed concept of people, but in general they believe, like their White counterparts, that people are basically neutral. Environmental factors have a great influence on how people develop. This orientation is consistent with African American be- liefs that racism, discrimination, oppression, and other external factors create problems for the individual. Emotional disorders and antisocial acts are caused by external forces System variables )rather than internal, intrapsychic, psy- chological forces. For example, high crime rates, poverty, and the current structure of the African American family are the result of historical and cur- rent oppression of Black people. White Western concepts of genetic inferior- ity and pathology African American people are born that way)hold little va- lidity for the Black person.

It is extremely difficult to speak specifically about applying multicultural strategies and techniques to minority families because of their great varia- tions, not only among Asian Americans, African Americans, Latino/Hispanic Americans, Native Americans, and Euro-Americans, but also within the groups themselves. Worse yet, we may foster overgeneralizations that border on being stereotypes. Likewise, to attempt an extremely specific discussion would mean dealing with literally thousands of racial, ethnic, and cultural combinations, a task that is humanly impossible. What seems to be required is a balance of these two extremes:a framework that would help us both to understand differences in communication styles/structural alliances in the family and to pinpoint more specifically cultural differences that exist within a particular family. 1 . Know that our increasing diversity presents us with different cultural conceptions of the family. Whether groups value a lineal, collateral, or individualistic orientation has major implications for their and our defi- nitions of the family. One definition cannot be seen as superior to an- other. 2. Realize that families cannot be understood apart from the cultural, so- cial, and political dimensions of their functioning. The traditional defi- nition of the nuclear family as consisting of heterosexual parents in a

206 The Practice Dimensions of Multicultural Counseling/Therapy long-term marriage, raising their biological children, and with the father as sole wage earner is a statistical minority. Extended families, in- termarriage, divorce, openly gay/lesbian relationships, commingling of races, single parent, and two parents working outside the home makes the conventional normal family'tiefinition an anomaly 3. When working with a racial/ethnic group different from you, make a concerted and conscientious effort to learn as much as possible about their definition of family, the values that underlie the family unit, and your own contrasting definition. 4. Be especially attentive to traditional cultural family structure and ex- tended family ties. As seen in the case of Elena Martinez, nonblood rela- tives may be considered an intimate part of the extended family system. Understanding husband-wife relationships, parent-child relationships, and sibling relationships from different cultural perspectives is crucial to effective work with minority families. 5. Do not prejudge from your own ethnocentric perspective. Be aware that many Asian Americans and Hispanics have a more patriarchal spousal relationship, while Euro-Americans and Blacks have a more egalitarian one. The concept of equal division of labor in the home be- tween husband and wife or working toward a more equal relationship may be a violation of family norms. 6. Realize that most minority families view the wifely role as less important than the motherly role. For instance, the existence of children validates and cements the marriage; therefore, motherhood is often perceived as a more important role. Therapists should not judge the health of a family on the basis of the romantic egalitarian model characteristic of White culture. 7. Do not overlook the prospect of utilizing the natural help-giving net- works and structures that already exist in the minority culture and com- munity. It is ironic that the mental health field behaves as if minority communities never had anything like mental health treatment until it came along and invented it. 8. Recognize the fact that helping can take many forms. These forms often appear quite different from our own, but they are no less effective or le- gitimate. Multicultural counseling calls for us to modify our goals and techniques to fit the needs of minority populations. Granted, mental health professionals are sometimes hard pressed in challenging their own assumptions of what constitutes counseling and therapy, or they feel uncomfortable in roles to which they are not accustomed. However, the need is great to move in this most positive direction.

Multicultural Family Counseling and Therapy 207

9. Assess the importance of ethnicity to clients and families. Be aware that acculturation is a powerful force and that this is especially important for the children, since they are most likely to be influenced by peers. Many tensions and conflicts between the younger generation and their elders are related to culture conflicts. These conflicts are not pathological, but normative responses to different cultural forces. iO. Realize that the role of the family therapist cannot be confined to cul- ture-bound rules that dictate a narrow set of appropriate roles and be- haviors. Effective multicultural family counseling may include validat- ing and strengthening ethnic identity, increasing one's own awareness and use of client support systems Extended family, friends, and reli- gious groups) serving as a culture broker, becoming aware of advan- tages and disadvantages in being of the same or different ethnic group as your client, not feeling you need to know everything about other eth- nic groups, and avoiding polarization of cultural issues. i i . Accept the notion that the family therapist will need to be creative in the development of appropriate intervention techniques when working with minority populations. With traditional Asian Americans, subtlety and indirectness may be called for rather than direct confrontation and interpretation. Formality in addressing members of the family, espe- cially the father Mr. Lee rather than Tom) may be more appropriate. For African Americans, a much more interactional approach £s op- posed to an instrumental one)in the initial approaches are often deter- mined by cultural/racial/system factors, and the more you understand about these areas, the more effective you will become.

Non-Western Indigenous Methods of Healingilmplications for Counseling and Therapy

Vang Xiong is a former Hmong (Laotian) soldier who, with his wife and child, resettled in Chicago in 1980. The change from his familiar rural sur- roundings and farm life to an unfamiliar urban area must have produced a severe culture shock. In addition, Vang vividly remembers seeing people killed during his escape from Laos, and he expressed feelings of guilt about having to leave his brothers and sisters behind in that country. Five months after his arrival, the Xiong family moved into a conveniently lo- cated apartment, and that is when Vang's problems began: Vang could not sleep the first night in the apartment, nor the second, nor the third. After three nights of very little sleep, Vang came to see his re- settlement worker, a young bilingual Hmong man named Moua Lee. Vang told Moua that the first night he woke suddenly, short of breath, from a dream in which a cat was sitting on his chest. The second night, the room suddenly grew darker, and a figure, like a large black dog, came to his bed and sat on his chest. He could not push the dog off and he grew quickly and dangerously short of breath. The third night, a tall, white-skinned female spirit came into his bedroom from the kitchen and lay on top of him. Her weight made it increasingly difficult for him to breathe, and as he grew frantic and tried to call out he could manage nothing but a whisper. He at- tempted to turn onto his side, but found he was pinned down. After 15 minutes, the spirit left him, and he awoke, screaming. He was afraid to re- turn to the apartment at night, afraid to fall asleep, and afraid he would die during the night, or that the spirit would make it so that he and his wife could never have another child. He told Moua that once, when he was 1 5, he had a similar attack; that several times, back in Laos, his elder brother had been visited by a similar spirit, and that his brother was subsequently unable to father children due to his wife 's miscarriages and infertility. (To- bin d Friedman, 1983, p. 440) Moua Lee and mental health workers became very concerned in light of the high incidence of sudden death syndrome among Southeast Asian refugees. For some reason, the incidence of unexplained

210 The Practice Dimensions of Multicultural Counseling/Therapy

deaths, primarily among Hmong men, would occur within the first 2 years of residence in the United States. Autopsies produced no identifiable cause for the deaths. All the reports were the same A person in apparently good health went to sleep and died without waking. Often, the victim displayed labored breath- ing, screams, and frantic movements just before death. With this dire possibil- ity evident for Vang, the mental health staff felt that they lacked the expertise for so complex and potentially dangerous a case. Conventional Western means of treatment for other Hmong clients had proved minimally effective. As a re- sult, they decided to seek the services of Mrs. Thor, a 50-year-old Hmong woman who was widely respected in Chicago's Hmong community as a shaman. The description of the treatment follows. That evening, Vang Xiong was visited in his apartment by Mrs. Thor, who began by asking Vang to tell her what was wrong. She listened to his story, asked a few questions, and then told him she thought she could help. She gathered the Xiong family around the dining room table, upon which she placed some candles alongside many plates of food that Vang 's wife had prepared. Mrs. Thor lit the candles, and then began a chant that Vang and his wife knew was an attempt to communicate with spirits. Ten minutes or so after Mrs. Thor had begun chant- ing, she was so intensely involved in her work that Vang and his family felt free to talk to each other, and to walk about the room without fear of distracting her. Approximately 1 hour after she had begun, Mrs. Thor completed her chanting, announcing that she knew what was wrong. Vang said that she had learned from her spirit that the figures in Vang 's dreams who lay on his chest and made it so difficult for him to breathe were the souls of the apartment's previous ten- ants, who had apparently moved out so abruptly they had left their souls behind. Mrs. Thor constructed a cloak out of newspaper for Vang to wear. She then cut the cloak in two and burned the pieces, sending the spirits on their way with the smoke. She also had Vang crawl through a hoop, and then between two knives, telling him that these maneuvers would make it very hard for spirits to follow. Following these brief ceremonies, the food prepared by Vang's wife was enjoyed by all. The leftover meats were given in payment to Mrs. Thor, and she left, as- suring Vang Xiong that his troubles with spirits were over. (Tobin & Friedman, 1983, p. 441) Clinical knowledge regarding what is called the Hmong sudden death syndrome indicates that Vang was one of the lucky victims of the syndrome, in that he survived it. Indeed, since undergoing the healing ceremony that re- leased the unhappy spirits, Vang has reported no more problems with night- mares, or with his breathing during sleep. Such a story may appear unbe- lievable and akin to mysticism to many people. After all, most of us have been trained in a Western ontology that does not embrace indigenous or alterna-

Non- Western Indigenous Methods of Heating 211

tive healing approaches. Indeed, if anything, it actively rejects such ap- proaches as unscientific and supernatural. Mental health professionals are encouraged to rely on sensory information, defined by the physical plane of existence rather than the spiritual plane Fukuyama SBevig, 1999;Wallace Shapiro, 2006) Such a rigid stance is unfortunate and shortsighted because there is much that Western healing can learn from these age-old forms of treatment. Let us briefly analyze the case of Vang Xiong to illustrate what these valuable lessons might be and draw parallels between non- Western and Western healing practices.

The Legitimacy of Culture-Bound Syndromes: Nightmare Deaths and the Hmong Sudden Death Vhenomenon The symptoms experienced by Vang and the frighteningly high number of early Hmong refugees who have died from these so-called nightmare deaths have baffled mental health workers for years. Indeed, researchers at the Fed- eral Center for Disease Control and epidemiologists have studied it, but re- main mystified p. Sue, D. W. Sue, ffi. Sue, 2006;Tobin Friedman, 1983) Such tales bring to mind anthropological literature describing voodoo deaths and bangungut, or Oriental nightmare death. What is clear, however, is that these deaths do not appear to have a primary biological basis, and that psy- chological factors primarily belief in the imminence of death-either by a curse, as in voodoo suggestion, or some form of punishment and excessive stress)appear to be causative Moodley, 2005) Beliefs in spirits and spirit pos- session are not uncommon among many cultures, especially in Southeast AsiaFJiade, 1972;Faiver, Ingersoll, O'Brien, McNally, 2001) Such world- view differences pose problems for Western-trained mental health profes- sionals who may quickly dismiss these belief systems and impose their own explanations and treatments on culturally diverse clients. Working outside of the belief system of such clients may not have the desired therapeutic effect, and the risk of unintentional harm i|n this case the potential death of Vang) is great. That the sudden death phenomenon is a culture-bound reality is being increasingly recognized by Western science ^amarck SJennings, 1991) Most researchers now acknowledge that attitudes, beliefs, and emo- tional states are intertwined and can have a powerful effect on physiological responses and physical well-being. Death from bradycardia flowing of the heartbeat) seems correlated with feelings of helplessness, as in the case of Vang there was nothing he could do to get the cat, dog, or white-skinned spirit off his chest) The text revision of the fourth edition of the American Psychiatric

212 The Practice Dimensions of Multicultural Counseling/Therapy Table 9. 1 Culture-Bound Syndromes from the DSM-IV

Culture-bound syndromes are disorders specific to a cultural group or society but not easily given a DSM diagnosis. These illnesses or afflictions have local names with distinct culturally sanctioned beliefs surrounding causation and treatment. Some of these are briefly described. Amok. This disorder was first reported in Malaysia but is found also in Laos, the Philippines, Polynesia, Papua New Guinea, and Puerto Rico, as well as among the Navajo. It is a dissociative episode preceded by introspective brooding and then an outburst of violent, aggressive, or homicidal behavior toward people and objects. Persecutory ideas, amnesia, and exhaustion signal a return to the premorbid state. Ataque de nervios. This disorder is most clearly reported among Latinos from the Caribbean but is recognized in Latin American and Latin Mediterranean groups as well. It involves uncontrollable shouting, attacks of crying, trembling, verbal or physical aggression, and dissociative or seizure-like fainting episodes. The onset is associated with a stressful life event relating to family £.g., death of a loved one, divorce, conflicts with children) Brain fag. This disorder is usually experienced by high school or university students in West Africa in response to academic stress. Students state that their brains are fatigued and that they have difficulties in concentrating, remembering, and thinking. Ghost sickness. Observed among members of American Indian tribes, this disorder is a preoccupation with death and the deceased. It is sometimes associated with witchcraft and includes bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, anxiety, and a sense of suffocation. Koro. This Malaysian term describes an episode of sudden and intense anxiety that the penis of the male or the vulva and nipples of the female will recede into the body and cause death. It can occur in epidemic proportions in local areas and has been reported in China, Thailand, and other South and East Asian countries. Mai de ojo. Found primarily in Mediterranean cultures, this term refers to a Spanish phrase that means 6vil eye. "Children are especially at risk, and symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting, and fever. Nervios. This disorder includes a range of symptoms associated with distress, somatic disturbance, and inability to function. Common symptoms include headaches, brain aches, sleep difficulties, nervousness, easy tearfulness, dizziness, and tingling sensations. It is a common idiom of distress among Latinos in the United States and Latin America. Rootwork. This refers to cultural interpretations of illness ascribed to hexing, witchcraft, sorcery, or the evil influence of another person. Symptoms include generalized anxiety, gastrointestinal complaints, and fear of being poisoned or killed yoodoo death) Roots, spells, or hexes can be placed on people. It is believed that a cure can be manifested via a root doctor who removes the root. Such a belief can be found in the southern United States among both African American and European American populations and in Caribbean societies. Shen-k'uei (Taiwan); Shenkui (China). This is a Chinese described disorder that involves anxiety and panic symptoms with somatic complaints. There is no identifiable physical cause. Sexual dysfunctions are common premature ejaculation and impotence) The physical symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of white turbid urine" believed to contain semen. Excessive semen loss is feared and can be life threatening because it represents one's vital essence.

Non- Western Indigenous Methods of Healing 213 Table 9.1 continued

Susto. This disorder is associated with fright or soul loss and is a prevalent folk illness among some Latinos in the United States as well as inhabitants of Mexico, Central America, and South America. Susto is attributed to a frightening event that causes the soul to leave the body. Sickness and death may result. Healing is associated with rituals that call the soul back to the body and restore spiritual balance. Zar. This term is used to describe spirits possessing an individual. Dissociative episodes, shouting, laughing, hitting the head against a wall, weeping, and other demonstrative symptoms are associated with it. It is found in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. People may develop a long-term relationship with the spirit, and their behavior is not considered pathological.

Association's Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR; American Psychiatric Association, 2000)has made initial strides in recogniz- ing the importance of ethnic and cultural factors related to psychiatric diag- nosis. The manual warns that mental health professionals who work with im- migrant and ethnic minorities must take into account )the predominant means of manifesting disorders £.g., possessing spirits, nerves, fatalism, in- explicable misfortune) £)the perceived causes or explanatory models, and ?)the preferences for professional and indigenous sources of care. Interest- ingly, the DSM-IV-TR now contains a glossary of culture-bound syndromes in Appendix I $ee Table 9.1 for a listing of these disorders) They describe culture-bound syndromes as recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be "illnesses, " or at least afflictions, and most have local names Culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations. (American Psychiatric Association, 2000, p. 898) In summary, it is very important for mental health professionals to be- come familiar not only with the cultural background of their clients, but to be knowledgeable about specific culture-bound syndromes. A primary danger from lack of cultural understanding is the tendency to overpathologize Over- estimate the degree of pathology)the mental health professional would have been wrong in diagnosing Vang as a paranoid schizophrenic suffering from delusions and hallucinations. Most might have prescribed powerful antipsy- chotic medication or even institutionalization. The fact that he was cured so quickly indicates that such a diagnosis would have been erroneous. Interest- ingly, it is equally dangerous to underestimate the severity or complexity of a refugee's emotional condition as well.

214 The Practice Dimensions of Multicultural Counseling/Therapy

Causation and Spirit Possession Vang believed that his problems were related to an attack by undesirable spir- its. His story in the following passage gives us some idea about beliefs associ- ated with the fears. The most recent attack in Chicago was not the first encounter my family and I have had with this type of spirit, a spirit we call Chia. My brother and I endured similar attacks about six years ago back in Laos. We are susceptible to such at- tacks because we didn 't follow all of the mourning rituals we should have when our parents died. Because we didn 't properly honor their memories we have lost contact with their spirits, and thus we are left with no one to protect us from evil spirits. Without our parents ' spirits to aid us, we will always be susceptible to spirit attacks. I had hoped flying so far in a plane to come to America would pro- tectme, but it turns out spirits can follow even this far. (Tobin ^Friedman, 1983, p. 444) Western science remains skeptical of using supernatural explanations to explain phenomena and certainly does not consider the existence of spirits to be scientifically sound. Yet belief in spirits and its parallel relationship to re- ligious, philosophic, and scientific worldviews have existed in every known culture, including the United States £.g., the witch hunts of Salem, Massa- chusetts) Among many Southeast Asian groups, it is not uncommon to posit the existence of good and evil spirits, to assume that they are intelligent beings, and to believe that they are able to affect the life circumstances of the living Fadiman, 1997;E. Lee, 1996) Vang, for example, believed strongly that his problems were due to spirits who were unhappy with him and were punishing him. Interestingly, among the Hmong, good spirits often serve a protective function against evil spirits. Because Vang's parental spirits had de- serted him, he believed he was more susceptible to the workings of evil forces. Many cultures believe that a cure can come about only through the aid of a shaman or healer who can reach and communicate with the spirit world via divination skills. While mental health professionals may not believe in spirits, therapists are similar to the Hmong in their need to explain the troubling phenomena experienced by Vang, and to construe meaning from them. Vang's sleep dis- turbances, nightmares, and fears can be seen as the result of emotional dis- tress. From a Western perspective, his war experiences, flight, relocation, and survivor stress
hion- Western Indigenous Methods of Healing 215

et al., 1987) The most frequent diagnoses for this group were generally Ma- jor Affective Disorder and PTSD. In addition to being a combat veteran, Vang is a disaster victim, a survivor of a holocaust that has seen perhaps 200,000 of the approximately 500,000 Hmong die. Vang's sleeplessness, breathing diffi- culties, paranoid belief that something attacked him in bed, and symptoms of anxiety and depression are the result of extreme trauma and stress. Tobin and Friedman (1983, p. 443)believed that Vang also suffered from survivor's guilt, and concluded, Applying some of the insights of the Holocaust literature to the plight of the Southeast Asian refugees, we can view Vang Xiong 's emotional crisis (his breath- ing and sleeping disorder) as the result not so much of what he suffered as what he did not suffer, of what he was spared "Why should I live while others died?" so Vang Xiong, through his symptoms, seemed to he saying, "Why should I sleep comfortably here in America while the people I left behind suffer? How can I claim the right to breathe when so many of my relatives and countrymen breathe no more back in Laos?" Even though we might be able to recast Vang's problems in more ac- ceptable psychological terminology the effective multicultural helping pro- fessional requires knowledge of cultural relativism and respect for the belief system of culturally different clients. Respecting another's worldview does not mean that the helping professional needs to subscribe to it. Yet the coun- selor or therapist must be willing and ready to learn from indigenous models of healing and to function as a facilitator of indigenous support systems or in- digenous healing systems Atkinson, Thompson, 8Srant, 1993) The Shaman as TherapistCommonalities It is probably safe to conclude that every society and culture has individuals or groups designated as healerslhose who comfort the ailing. Their duties involve not only physical ailments, but those related to psychological distress or behavioral deviance as well garner, 1990) While every culture has mul- tiple healers, the shaman in non-Western cultures is perhaps the most pow- erful of all because only he or she possesses the ultimate magico-religious powers that go beyond the senses Eliade, 1972) Mrs. Thor was a well- known and respected shaman in the Hmong community of the Chicago area. While her approach to treating Vang ihcense, candle burning, newspaper, trance-like chanting, spirit diagnosis, and even her home visit)on the surface might resemble mysticism, there is much in her behavior that is similar to Western psychotherapy. First, as we saw in Chapter 4, the healer's credibility is crucial to the effectiveness of therapy. In this case, Mrs. Thor had all the cul- tural credentials of a shaman;she was a specialist and professional with long

216 The Practice Dimensions of Multicultural Counseling/Therapy years of training and experience dealing with similar cases. By reputation and behavior, she acted in a manner familiar to Vang and his family. More impor- tantly she shared their worldview as to the definition of the problem. Sec- ond, she showed compassion while maintaining a professional detachment, did not pity or make fun of Vang, avoided premature diagnosis or judgment, and listened to his story carefully. Third, like the Western therapist, she of- fered herself as the chief instrument of cure. She used her expertise and abil- ity to get in touch with the hidden world of the spirits hi Western terms we might call it the unconscious )and helped Vang to understand become con- scious of)the mysterious power of the spirits Unconscious )to effect a cure. Because Vang believed in spirits, Mrs. Thor's interpretation that the nightmares and breathing difficulties were spiritual problems was intelligible, desired, and ultimately curative. It is important to note, however, that Vang also continued to receive treatment from the local mental health clinic in coming to grips with the deaths of others his parents, fellow soldiers, and those of other family members) In the case of Vang Xiong, both non-Western and Western forms of healing were combined with one another for maximum effect. The presence of a mental health treatment facility that employed bilingual/bicultural prac- titioners, its vast experience with Southeast Asian immigrants, and its will- ingness to use indigenous healers provided Vang with a culturally appropri- ate form of treatment that probably saved his life. Not all immigrants, however, are so fortunate. Witness the following case of the Nguyen family. A Case of Child Abuse? Mr. and Mrs. Nguyen and their four children left Vietnam in a boat with 36 other people. Several days later, they were set upon by Thai pirates. The occu- pants were all robbed of their belongings; some were killed, including two of the Nguyens' children. Nearly all the women were raped repeatedly. The trauma of the event is still very much with the Nguyen family, who now reside in St. Paul, Minnesota. The event was most disturbing to Mr. Nguyen, who had watched two of his children drown and his wife being raped. The pirates had beaten him severely and tied him to the boat railing during the rampage. As a result of his experiences, he continued to suffer feelings of guilt, suppressed rage, and night- mares. The Nguyen family came to the attention of the school and social service agencies because of suspected child abuse. Their oldest child, 12-year-old Phuoc, came to school one day with noticeable bruises on his back and down his spinal column. In addition, obvious scars from past injuries were observed on the child's upper and lower torso. His gym teacher had seen the bruises and scars and im- mediately reported them to the school counselor. The school nurse was contacted about the possibility of child abuse, and a conference was held with Phuoc. He

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denied that he had been hit by his parents and refused to remove his garments when requested to do so. Indeed, he became quite frightened and hysterical about taking off his shirt. Since there was still considerable doubt about whether this was a case of child abuse, the counselor decided to let the matter drop for the mo- ment. Nevertheless, school personnel were alerted to this possibility. Several weeks later, after 4 days of absence, Phuoc returned to school. The homeroom teacher noticed bruises on Phuoc's forehead and the bridge of his nose. When the incident was reported to the school office, the counselor immedi- ately called Child Protective Services to report a suspected case of child abuse. Because of the heavy caseload experienced by Child Protective Services, a social worker was unable to visit the family until weeks later. The social worker, Mr. P., called the family and visited the home on a late Thursday afternoon. Mrs. Nguyen greeted Mr. P. upon his arrival. She appeared nervous, tense, and frightened. Her English was poor, and it was difficult to communicate with her. Since Mr. P. had specifically requested to see Mr. Nguyen as well, he inquired about his whereabouts. Mrs. Nguyen answered that he was not feeling well and was in the room downstairs. She said he was having "a bad day, " had not been able to sleep last night, and was having flashbacks. In his present condition, he would not be helpful. When Mr. P. asked about Phuoc's bruises, Mrs. Nguyen did not seem to un- derstand what he was referring to. The social worker explained in detail the rea- son for his visit. Mrs. Nguyen explained that the scars were due to the beating given to her children by the Thai pirates. She became very emotional about the topic and broke into tears. While this had some credibility, Mr. P. explained that there were fresh bruises on Phuoc's body as well. Mrs. Nguyen seemed confused, denied that there were new injuries, and denied that they would hurt Phuoc. The social worker pressed Mrs. Nguyen about the new injuries until she suddenly looked up and said, "Thuoc Nam. " It was obvious that Mrs. Nguyen now understood what Mr. P. was referring to. When asked to clarify what she meant by the phrase, Mrs. Nguyen pointed at several thin bamboo sticks and a bag of coins wrapped tightly in a white cloth. It looked like a blackjack! She then pointed downstairs in the direction of the husband's room. It was obvious from Mrs. Nguyen 's ges- tures that her husband had used these to beat her son. There are many similarities between the case of the Nguyen family and that of Vang Xiong. One of the most common experiences of refugees forced to flee their country is the extreme stressors that they experience. Constantly staring into the face of death was, unfortunately, all too common an experi- ence. Seeing loved ones killed, tortured, and raped;being helpless to change or control such situations;living in temporary refugee or resettlement camps; leaving familiar surroundings;and encountering a strange and alien culture can only be described as multiple severe traumas. It is highly likely that many

218 The Practice Dimensions of Multicultural Counseling/Therapy

Cambodian, Hmong/Laotian, and Vietnamese refugees suffer from serious Posttraumatic Stress Disorder and other forms of major affective disorders. Mr. and Mrs. Nguyen's behaviors flashbacks, desire to isolate the self, emo- tional fluctuations, anxiety and tenseness )might all be symptoms of PTSD. Accurate understanding of their life circumstances will prevent a tendency to overpathologize or underpathologize their symptoms Mollica et al., 1987) These symptoms, along with a reluctance to disclose to strangers and dis- comfort with the social worker, should be placed in the context of the stres- sors that they experienced and their cultural background. More important, as in the case of the Nguyen family, behaviors should not be interpreted to indi- cate guilt or a desire not to disclose the truth about child abuse. Second, mental health professionals must consider potential linguistic and cultural barriers when working with refugees, especially when one lacks both experience and expertise. In this case, it is clear that the teacher, school counselor, school nurse, and even the social worker did not have sufficient understanding or experience in working with Southeast Asian refugees. For example, the social worker's failure to understand Vietnamese phrases and Mrs. Nguyen's limited English proficiency placed serious limitations on their ability to communicate accurately. The social worker might have avoided much of the misunderstanding if an interpreter had been present. In addition, the school personnel may have misinterpreted many culturally sanctioned forms of behavior on the part of the Vietnamese. Phuoc's reluctance to dis- robe in front of strangers the nurse)may have been prompted by cultural taboos rather than by attempts to hide the injuries. Traditional Asian culture dictates strongly that family matters are handled within the family. Many Asians believe that family affairs should not be discussed publicly, and espe- cially not with strangers. Disrobing publicly and telling others about the scars or the trauma of the Thai pirates would not be done readily. Yet such knowl- edge is required by educators and social service agencies that must make en- lightened decisions. Third, both school and social service personnel are obviously unen- lightened about indigenous healing beliefs and practices. In the case of Vang Xiong, we saw how knowledge and understanding of cultural beliefs led to appropriate and helpful treatment. In the case of the Nguyen family, lack of understanding led to charges of child abuse. But is this really a case of child abuse?When Mrs. Nguyen said Th6 Nam, "what was she referring to? What did the fresh bruises along Phuoc's spinal column, forehead, and bridge of the nose mean?And didn't Mrs. Nguyen admit that her husband used the bamboo sticks and bag of coins to beat Phuoc? In Southeast Asia, traditional medicine derives from three sources: Western medicine ThaTay) Chinese or Northern medicine ThflBac) and Southern medicine ThaNam) Many forms of these treatments con- tinue to exist among Asian Americans and are even more prevalent among

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the Vietnamese refugees, who brought the treatments to the United States Hong fflam, 2001) ThfiNam, or traditional medicine, involves using natural fruits, herbs, plants, animals, and massage to heal the body. Massage treatment is the most common cause of misdiagnosis of child abuse because it leaves bruises on the body. Three common forms of massage treatment are Bt Gidfatching the wind/Cao Gicfcratching the wind, "or Coin treat- ment/ and Gia Hoi pressure massage, "or dry cup massage) 1 The latter involves steaming bamboo tubes so that the insides are low in pressure, ap- plying them to a portion of the skin that has been cut, and sucking out bad air"or hot wind."Cao Gidnvolves rubbing the patient with a mentholated ointment and then using coins or spoons to strike or scrape lightly along the ribs and both sides of the neck and shoulders. Bt Gidnvolves using both thumbs to rub the temples and massaging toward the bridge of the nose at least 20 times. Fingers are used to pinch the bridge of the nose. All three treat- ments leave bruises on the parts of the body treated. If the social worker could have understood Mrs. Nguyen, he would have known that Phuoc's 4 day absence from school was due to illness, and that he was treated by his parents via traditional folk medicine. Massage treatments are a widespread custom practiced not only by Vietnamese, but also by Cambodians, Laotians, and Chinese. These treatments are aimed at curing a host of physical ailments such as colds, headaches, backaches, and fevers. In the mind of the practitioner, such treatments have nothing to do with child abuse. Yet, the question still remains:Is it considered child abuse when traditional healing practices result in bruisesTThis is a very difficult question to answer because it raises a larger question: Can culture justify a practice, especially when it is harmfulWhile unable to answer this last ques- tion directly ^ve encourage you to dialogue about it) we point out that many medical practitioners in California do not consider it child abuse because J )medical literature reveals no physical complications as a result of Tha Nam;^)the intent is not to hurt the child but to help him or her;and {$)it is frequently used in conjunction with Western medicine. However, we would add that health professionals and educators have a responsibility to educate parents concerning the potential pitfalls of many folk remedies and indigenous forms of treatment. The Principles of Indigenous Healing Ever since the beginning of human existence, all societies and cultural groups have developed not only their own explanations of abnormal behaviors, but also their culture-specific ways of dealing with human problems and distress Harner, 1990;Solomon 8*Vane, 2005) Within the United States, counsel- ing and psychotherapy are the predominant psychological healing methods. In other cultures, however, indigenous healing approaches continue to be

220 The Practice Dimensions of Multicultural Counseling/Therapy

widely used. While there are similarities between Euro-American helping systems and the indigenous practices of many cultural groups, there are ma- jor dissimilarities as well. Western forms of counseling, for example, rely on sensory information defined by the physical plane of reality W estern science) while most indigenous methods rely on the spiritual plane of exis- tence in seeking a cure. In keeping with the cultural encapsulation of our pro- fession, Western healing has been slow to acknowledge and learn from these age-old forms of wisdom fonstantine, Myers, Kindaichi, EMoore, 2004; C. C. Lee, 1996) In its attempt to become culturally responsive, however, the mental health field must begin to put aside the biases of Western science, to acknowledge the existence of intrinsic help-giving networks, and to incorpo- rate the legacy of ancient wisdom that may be contained in indigenous mod- els of healing. The work and writings of Lee £. C. Lee, 1996;Lee {Armstrong, 1995; Lee, Oh, EMountcastle, 1992)are especially helpful in this regard. Lee has studied what is called the universal shamanic tradition, which encompasses the centuries-old recognition of healers within a community. The anthropologi- cal term shaman refers to people often called witches, witch doctors, wizards, medicine men or women, sorcerers, and magic men or women. These indi- viduals are believed to possess the power to enter an altered state of con- sciousness and journey to other planes of existence beyond the physical world during their healing rituals ^loodley, 2005) Such was the case of Mrs. Thor, a shaman who journeyed to the spirit world in order to find a cure for Vang. A study of indigenous healing in 16 non- Western countries found that three approaches were often used Lee et al., 1992) First, there is heavy re- liance on the use of communal, group, and family networks to shelter the dis- turbed individual $audi Arabia) to problem solve in a group context Nige- ria) and to reconnect them with family or significant others Korea) Second, spiritual and religious beliefs and traditions of the community are used in the healing process. Examples include reading verses from the Koran and using religious houses or churches. Third, use of shamans galled piris and fakirs in Pakistan and Sudan )who are perceived to be the keepers of timeless wisdom constitutes the norm. In many cases, the person conducting a healing cere- mony may be a respected elder of the community or a family member. An excellent example that incorporates these approaches is the Native Hawaiian ho'oponopono healing ritual Nishihara, 1978; Rezentes, 2006) Translated literally, the word means & setting to right, to make right, to cor- rect. In cultural context, ho 'oponopono attempts to restore and maintain good relations among family members, and between the family and the supernat- ural powers. It is a kind of family conference family therapy)aimed at restor- ing good and healthy harmony in the family. Many Native Hawaiians con- sider it to be one of the soundest methods of restoring and maintaining good

Non- Western Indigenous Methods of Healing 22 1

relations that any society has ever developed. Such a ceremonial activity usu- ally occurs among members of the immediate family but may involve the ex- tended family and even nonrelatives if they were involved in the pilikia trouble) The process of healing includes the following: 1 . The ho 'oponopono begins with pule weke Opening prayer )and ends with pule ho 'opau ^losing prayer) The pule creates the atmosphere for the healing and involves asking the family gods for guidance. These gods are not asked to intervene, but to grant wisdom, understanding, and hon- esty. 2. The ritual elicits 'oia'i'o or truth telling, "sanctioned by the gods, and makes compliance among participants a serious matter. The leader states the problem, prays for spiritual fusion among members, reaches out to resistant family members, and attempts to unify the group. 3. Once this occurs, the actual work begins through mahiki, a process of getting to the problems. Transgressions, obligations, righting the wrongs, and forgiveness are all aspects of ho 'oponopono. The forgiving/ releasing/severing of wrongs, the hurts, and the conflicts produces a deep sense of resolution. 4. Following the closing prayer, the family participates in pani, the termi- nation ritual in which food is offered to the gods and to the participants. In general, we can see several principles of indigenous Hawaiian heal- ing:} (Problems reside in relationships with people and spirits;? )harmony and balance in the family and in nature are desirable;? (healing must in- volve the entire group and not just an individual;4)spirituality, prayer, and ritual are important aspects of healing; f (the healing process comes from a respected elder of the family;and 6 (the method of healing is indigenous to the culture Jlezentes, 2006) Indigenous healing can be defined as helping beliefs and practices that originate within the culture or society. It is not transported from other re- gions, and it is designed for treating the inhabitants of the given group. Those who study indigenous psychologies do not make an a priori assumption that one particular perspective is superior to another flikulas, 2006) The West- ern ontology of healing £ounseling/therapy) however, does consider its methods to be more advanced and scientifically grounded than those found in many cultures. Western healing has traditionally operated from several as- sumptions: \ (reality consists of distinct and separate units or objects the therapist and client, the observer and observed)? (reality consists of what can be observed and measured via the five senses;? (space and time are fixed and absolute constructs of reality; and 4)science operates from universal principles and is culture-free pighlen, 1996) While these guiding assump-

222 The Practice Dimensions of Multicultural Counseling/Therapy tions of Western science have contributed much to human knowledge and to the improvement of the human condition, most non-Western indigenous psychologies appear to operate from a different perspective. For example, many non-Western cultures do not separate the observer from the observed, and believe that all life forms are interrelated with one another, including mother nature and the cosmos; that the nature of reality transcends the senses;that space and time are not fixed;and that much of reality is culture- bound Walsh Shapiro, 2006) Let us briefly explore several of these paral- lel assumptions and see how they are manifested in indigenous healing prac- tices. Holistic Outlook, Interconnectedness, and Harmony The concepts of separation, isolation, and individualism are hallmarks of the Euro-American worldview. On an individual basis, modern psychology takes a reductionist approach to describing the human condition Le., id, ego, and superego;belief, knowledge, and skills;cognitions, emotions, and behaviors) In Western science, the experimental design is considered the epitome of methods used to ask and answer questions about the human condition or the universe. The search for cause and effect is linear and allows us to identify the independent variables, the dependent variables, and the effects of extraneous variables that we attempt to control. It is analytical and reductionist in char- acter. The attempt to maintain objectivity, autonomy, and independence in understanding human behavior is also stressed. Such tenets have resulted in separation of the person from the group yaluing of individualism and uniqueness) science from spirituality, and man/woman from the universe. Most non-Western indigenous forms of healing take a holistic outlook on well-being in that they make minimal distinctions between physical and mental functioning and believe strongly in the unity of spirit, mind, and mat- ter. The interrelatedness of life forms, the environment, and the cosmos is a given. As a result, the indigenous peoples of the world tend to conceptualize reality differently. The psychosocial unit of operation for many culturally di- verse groups, for example, is not the individual, but the group Collectivism) In many cultures, acting in an autonomous and independent manner is seen as the problem because it creates disharmony within the group. Illness, distress, or problematic behaviors are seen as an imbalance in people relationships, a disharmony between the individual and his or her group, or as a lack of synchrony with internal or external forces. Harmony and balance are the healer's goal. Among American Indians, for example, harmony with nature is symbolized by the circle, or hoop of life McCormick, 2005;Sutton (Broken Nose, 2005) Mind, body, spirit, and nature are seen as a single unified entity with little separation between the realities of life, medicine, and religion. All forms of nature, not just the living, are to be

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revered because they reflect the creator or deity. Illness is seen as a break in the hoop of life, an imbalance, or a separation between the elements. Many indigenous beliefs come from a metaphysical tradition. They accept the in- terconnectedness of cosmic forces in the form of energy or subtle matter less dense than the physical)that surrounds and penetrates the physical body and the world. Both the ancient Chinese practice of acupuncture and chakras in Indian yoga philosophy involve the use of subtle matter to rebalance and heal the body and mind Highlen, 1996) Chinese medical theory is concerned with the balance of yin £old)and yang hot)in the body, and it is believed that strong emotional states, as well as an imbalance in the type of foods eaten, may create illness $o, 2005) As we saw in the case of Phuoc Nguyen, treatment might involve eating specific types or combinations of foods, or using massage treatment to suck out bad"or hof'air. Such concepts of ill- ness and health can also be found in the Greek theory of balancing body flu- ids blood, phlegm, black bile, and yellow bile;Bankart, 1997) Likewise, the Afrocentric perspective also teaches that human beings are part of a holistic fabric-that they are interconnected and should be ori- ented toward collective rather than individual survival Boyd-Franklin, 2003;Graham, 2005) The indigenous Japanese assumptions and practices of Naikan and Morita therapy attempt to move clients toward being more in tune with others and society, to move away from individualism, and to move toward interdependence, connectedness, and harmony with others Bankart, 1997;C. P. Chen, 2005) Naikan therapy, which derives from Buddhist prac- tice, requires the client to reflect on three aspects of human relationships: J )what other people have done for them, 2)what they have done for oth- ers, and ?)how they cause difficulties to others Wallace SShapiro, 2006) The overall goal is to expand awareness of how much we receive from oth- ers, how much gratitude is due them, and how little we demonstrate such gratitude. This ultimately leads to a realization of the interdependence of the parts to the whole. Working for the good of the group ultimately benefits the individual. Belief in Metaphysical Levels of Existence Some time back two highly popular books — Embraced by the Light Eadie, 1992 )and Saved by the Light Brinkley, 1 994^nd several television specials described fascinating cases of near-death experiences. All had certain com- monalities;the individuals who were near death felt like they were leaving their physical bodies, observed what was happening around them, saw a bright beckoning light, and journeyed to higher levels of existence. Although the popularity of such books and programs might indicate that the American public is inclined to believe in such phenomena, science has been unable to validate these personal accounts and remains skeptical of their existence. Yet

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many societies and non-Western cultures accept, as given, the existence of different levels or planes of consciousness, experience, or existence. They be- lieve the means of understanding and ameliorating the causes of illness or problems of life are often found in a plane of reality separate from the physi- cal world of existence. Asian psychologies posit detailed descriptions of states of consciousness and outline developmental levels of enlightenment that extend beyond that of Western psychology. Asian perspectives concentrate less on psychopathol- ogy and more on enlightenment and ideal mental health Pankhania, 2005; Walsh 8/aughan, 1993) The normal state of consciousness, in many ways, is not considered optimal and may be seen as a psychopathology of the av- erage"Maslow, 1968) Moving to higher states of consciousness has the ef- fect of enhancing perceptual sensitivity and clarity, concentration, and sense of identity, as well as emotional, cognitive, and perceptual processes. Such movement, according to Asian philosophy, frees one from the negative path- ogenic forces of life. Attaining enlightenment and liberation can be achieved through the classic practices of meditation and yoga. Research findings indi- cate that they are the most widely used of all therapies Walsh £6hapiro, 2006) They have been shown to reduce anxiety, specific phobias, and sub- stance abuse J
Non- Western Indigenous Methods of Healing 22 5

Chinese methods of healing and Hindu chakras also acknowledge another reality that parallels the physical world. Accessing this world allows the healer to use these special energy centers to balance and heal the body and mind. Occasionally, the shaman may aid the helpee or novice to access that plane of reality so that he or she may find the solutions. The vision quest, in conjunction with the sweat lodge experience, is used by some American In- dians as religious renewal or as a rite of passage Heinrich, Corbin, ffhomas., 1990;D. Smith, 2005) Behind these uses, however, is the human journey to another world of reality. The ceremony of the vision quest is intended to pre- pare the young man for the proper frame of mind;it includes rituals and sa- cred symbols, prayers to the Great Spirit, isolation, fasting, and personal re- flection. Whether in a dream state or in full consciousness, another world of reality is said to reveal itself. Mantras, chants, meditation, and the taking of certain drugs peyote)all have as their purpose a journey into another world of existence puran, 2006) Spirituality in Life and the Cosmos Native American Indians look on all things as having life, spiritual energy, and importance. A fundamental belief is that all things are connected. The universe consists of a balance among all of these things and a continuous flow of cycling of this energy. Native American Indians believe that we have a sacred relationship with the universe that is to be honored. All things are connected, all things have life, and all things are worthy of respect and reverence. Spirituality focuses on the harmony that comes from our connection with all parts of the universe — in which everything has the purpose and value exemplary of personhood, includ- ing plants (e.g., "tree people "), the land ("Mother Earth "), the winds ("the Four Powers"), "Father Sky," "Grandfather Sun," "Grandmother Moon," "The Red Thunder Boys. " Spiritual being essentially requires only that we seek our place in the universe; everything else will follow in good time. Because everyone and everything was created with a specific purpose to fulfill, no one should have the power to interfere or to impose on others the best path to follow (J. T. Garrett & Garrett, 1994, p. 187). The sacred Native American beliefs concerning spirituality are a truly alien concept to modern Euro-American thinking. The United States has had a long tradition in believing that one's religious beliefs should not enter into scientific or rational decisions puran, 2006) Incorporating religion in the rational decision-making process or in the conduct of therapy has generally been seen as unscientific and unprofessional. The schism between religion and science occurred centuries ago and has resulted in a split between science/psychology and religion Fukuyama SSevig, 1999) This is reflected

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in the oft-quoted phrase Separation of Church and State/The separation has become a serious barrier to mainstream psychology's incorporation of indigenous forms of healing into mental health practice, especially when re- ligion is confused with spirituality. While people may not have a formal reli- gion, indigenous helpers believe that spirituality is an intimate aspect of the human condition. While Western psychology acknowledges the behavioral, cognitive, and affective realms, it only makes passing reference to the spiri- tual realm of existence. Yet indigenous helpers believe that spirituality tran- scends time and space, mind and body, and our behaviors, thoughts, and feel- ings Lee Armstrong, i995;D. Smith 2005) These contrasting worldviews are perhaps most clearly seen in defini- tions of the good life/and how our values are manifested in evaluating the worth of others. In the United States, for example, the pursuit of happiness is most likely manifested in material wealth and physical well-being, while other cultures value spiritual or intellectual goals. The worth of a person is anchored in the number of separate properties he or she owns, and in their net worth and ability to acquire increasing wealth. Indeed, it is often assumed that such an accumulation of wealth is a sign of divine approval Condon & Yousef, 1975) In cultures where spiritual goals are strong the worth of a per- son is unrelated to materialistic possessions, but rather resides within indi- viduals, emanates from their spirituality, and is a function of whether they live the fight life/People from capitalistic cultures often do not understand self-immolations and other acts of suicide in countries such as India. They are likely to make statements such as life is not valued there'br, better yet, life is cheap/These statements indicate a lack of understanding about actions that arise from cultural forces rather than personal frustrations;they may be symbolic of a spiritual-valuing rather than a material-valuing orientation. One does not have to look beyond the United States, however, to see such spiritual orientations;many racial/ethnic minority groups in this coun- try are strongly spiritual. African Americans, Asian Americans, Latino/His- panic Americans, and Native Americans all place strong emphasis on the in- terplay and interdependence of spiritual life and healthy functioning. Puerto Ricans, for example, may sacrifice material satisfaction in favor of values per- taining to the spirit and soul. The Lakota Sioux often say Mitakuye Oyasin at the end of a prayer or as a salutation. Translated, it means to all my rela- tions, "which acknowledges the spiritual bond between the speaker and all people present, and extends to forebears, the tribe, the family of man, and mother nature. It speaks to the philosophy that all life forces, Mother Earth, and the cosmos are sacred beings, and that the spiritual is the thread that binds all together. Likewise, a strong spiritual orientation has always been a major aspect of life in Africa, and this was also true during the slavery era in the United States.

Non-Western Indigenous Methods of Healing 227

Highly emotional religious services conducted during slavery were of great im- portance in dealing with oppression. Often signals as to the time and place of an escape were given then. Spirituals contained hidden messages and a language of resistance (e.g., "Wade in the Water" and "Steal Away"). Spirituals (e.g., "No- body Knows the Trouble I've Seen ") and the ecstatic celebrations of Christ's gift of salvation provided Black slaves with outlets for expressing feelings of pain, hu- miliation, and anger. (Hines & Boyd-Franklin, 1996, p. 74) The African American church has a strong influence over the lives of Black people, and is often the hub of religious, social, economic, and political life. Religion is not separated from the daily functions of the church, as it acts as a complete support system for the African American family with the minis- ter, deacons, deaconesses, and church members operating as one big family. A strong sense of peoplehood is fostered via social activities, choirs, Sunday school, health-promotion classes, day care centers, tutoring programs, and counseling. To many African Americans the road to mental health and the prevention of mental illness lie in the health potentialities of their spiritual life. Mental health professionals are becoming increasingly open to the po- tential benefits of spirituality as a means for coping with hopelessness, iden- tity issues, and feelings of powerlessness Fukuyama EBevig, 1999) As an example of this movement, the Association for Counselor Education and Su- pervision ACES)recently adopted a set of competencies related to spiritual- ity. They define spirituality as the animating force in life, represented by such images as breath, wind, vigor, and courage. Spirituality is the infusion and drawing out of spirit in one 's life. It is experienced as an active and passive process. Spirituality is also described as a capacity and tendency that is innate and unique to all persons. This spiritual ten- dency moves the individual towards knowledge, love, meaning, hope, transcen- dence, connectedness, and compassion. Spirituality includes one's capacity for creativity, growth, and the development of a values system. Spirituality encom- passes the religious, spiritual, and transpersonal. (American Counseling Associ- ation, 1995, p. 30) Interestingly enough, it appears that many in the United States are ex- periencing a Spiritual hunger, "or a strong need to reintegrate spiritual or re- ligious themes into their lives G-allup, 1995;Hage, 2004;Thoresen, 1998) For example, it appears that there is a marked discrepancy between what pa- tients want from their doctors and what doctors supply. Often, patients want to talk about the spiritual aspects of their illness and treatment, but doctors are either unprepared or disinclined to do so page, 2006) Likewise, most mental health professionals feel equally uncomfortable, disinclined, or un- prepared to speak with their clients about religious or spiritual matters.

228 The Practice Dimensions of Multicultural Counseling/Therapy

Thoresen J998)reported in a meta-analysis of over 200 published studies that the relationship between spirituality and health is highly positive. Those with higher levels of spirituality have lower disease risk, fewer physical health problems, and higher levels of psychosocial functioning. It appears that people require faith as well as reason to be healthy, and that psychology may profit from allowing the spirit to rejoin matters of the mind and body drawbridge, Cohen, Shema, QCaplan, 1997) In general, indigenous healing methods have much to offer to Euro- American forms of mental health practice. The contributions are valuable not only because multiple belief systems now exist in our society, but also because counseling and psychotherapy have historically neglected the spiritual di- mension of human existence. Our heavy reliance on science and on the re- ductionist approach to treating clients has made us view human beings and human behavior as composed of separate noninteracting parts Cognitive, be- havioral, and affective) There has been a failure to recognize our spiritual being and to take a holistic outlook on life. Indigenous models of healing re- mind us of these shortcomings and challenge us to look for answers in realms of existence beyond the physical world.

We have repeatedly stressed that the worldviews of culturally diverse clients may often be worlds apart from the dominant society. When culturally di- verse clients attribute disorders to causes quite alien from Euro-American di- agnosis, when their definitions of a healer are different from that of conven- tional therapists, and when the role behaviors process of therapy)are not perceived as therapeutic, major difficulties are likely to occur in the provision of therapeutic services. As a Western-trained therapist, for example, how would you treat cli- ents who believed \ )that their mental problems were due to spirit posses- sion, 2)that only a shaman with inherited powers could deal with the prob- lem, and £)that a cure could only be effected via a formal ritual (hanting, incense burning, symbolic sacrifice, etc. )and a journey into the spirit world? Most of us have had very little experience with indigenous methods of treat- ment and would find great difficulty in working effectively with such clients. There are, however, some useful guidelines that might help bridge the gap be- tween contemporary forms of therapy and traditional non- Western indige- nous healing. 1 . Do not invalidate the indigenous belief systems of your culturally di- verse client. On the surface, the assumptions of indigenous healing methods might appear radically different from our own. When we en-

Non-Western Indigenous Methods of Healing 229 counter them, we are often shocked, find such beliefs to be unscientific, and are likely to negate, invalidate, or dismiss them. Such an attitude will invalidate our clients as well. Entertaining alternative realities does not mean that the therapist must subscribe to that belief system. It does mean, however, that the helping professional must avoid being judg- mental. This will encourage and allow the client to share his or her story more readily, to feel validated, and to encourage the building of mutual respect and trust. Remember that cultural storytelling and personal nar- ratives have always been an intimate process of helping in all cultures. 2. Become knowledgeable about indigenous beliefs and healing practices. Therapists have a professional responsibility to become knowledgeable and conversant about the assumptions and practices of indigenous heal- ing so that a process of desensitization and normalization can occur. By becoming knowledgeable and understanding of indigenous helping ap- proaches, the therapist will avoid equating differences with deviance. Despite different explanations, many similarities exist between Western and non- Western healing practices. 3. Realize that learning about indigenous healing and beliefs entails expe- riential or lived realities. While reading books about non- Western forms of healing and attending seminars and lectures on the topic is valuable and helpful, understanding culturally different perspectives must be supplemented by lived experience. We suggest that you consider at- tending cultural events, meetings, and activities of the different cultural groups in your community. Such actions allow you to observe cultur- ally different individuals interacting in their community, and to see how their values are expressed in relationships. 4. Avoid overpathologizing and underpathologizing a culturally diverse client's problems. A therapist or counselor who is culturally unaware and who believes primarily in a universal psychology may often be cul- turally insensitive and inclined to see differences as deviance. They may be guilty of overpathologizing a culturally different client's problems by seeing it as more severe and pathological than it truly may be. There is also a danger, however, of underpathologizing a culturally diverse cli- ent's symptoms. While being understanding of a client's cultural con- text, having knowledge of culture -bound syndromes, and being aware of cultural relativism are desirable, being oversensitive to these factors may predispose the therapist to minimize problems. 5. Be willing to consult with traditional healers or make use of their ser- vices. Mental health professionals must be willing and able to form part- nerships with indigenous healers, or develop community liaisons. Such an outreach has several advantages:} Traditional healers may provide knowledge and insight into client populations that would prove of

The Practice Dimensions of Multicultural Counseling/Therapy value to the delivery of mental health services;? )such an alliance will ultimately enhance the cultural credibility of therapists; and ?)it al- lows for referral to traditional healers ^hamans, religious leaders, etc.) when treatment is rooted in cultural traditions. Recognize that spirituality is an intimate aspect of the human condition and a legitimate aspect of mental health work. Spirituality is a belief in a higher power, which allows us to make meaning of life and the uni- verse. It may or may not be linked to a formal religion, but there is little doubt that it is a powerful force in the human condition. A counselor or therapist who does not feel comfortable dealing with the spiritual needs of clients, or who believes in an artificial separation of the spirit $oul) from the everyday life of the culturally different client, may not be pro- viding the needed help. Just as therapists might inquire about the phys- ical health of their clients, they should feel free and comfortable to in- quire about their client's values and beliefs as they relate to spirituality. We do not, however, advocate indoctrination of the client nor prescrib- ing any particular pathway to embracing, validating, or expressing spir- ituality and spiritual needs. Be willing to expand your definition of the helping role to community work and involvement. More than anything else, indigenous healing is community oriented and focused. Culturally competent mental health professionals must begin to expand their definition of the helping role to encompass a greater community involvement. The in-the-office set- ting is often nonfunctional in minority communities. Culturally sensi- tive helping requires making home visits, going to community centers, and visiting places of worship and other areas within the community. The type of help most likely to prevent mental health problems allow clients to build and maintain healthy connections with their family, their god$) and their universe.

Part IV Racial/ Cultural Identity Development in Multicultural Counseling and Therapy

Racial/ Cultural Identity Development in People of Color: Therapeutic Implications

For nearly all my life I have never seriously attempted to dissect my feelings and attitudes about being a Japanese American woman. Aborted attempts were made, but they were never brought to fruition, because it was un- bearably painful. Having been born and raised in Arizona, I had no Asian friends. I suspect that given an opportunity to make some, I would have avoided them anyway. That is because I didn 't want to have anything to do with being Japanese American. Most of the Japanese images I saw were negative. Japanese women were ugly; they had "cucumber legs, " flat yel- low faces, small slanty eyes, flat chests, and were stunted in growth. The men were short and stocky, sneaky and slimy, clumsy, inept, "wimpy look- ing, " and sexually emasculated. I wanted to be tall, slender, large eyes, full lips, and elegant looking; I wasn 't going to be typical Oriental! At Cal [University of California, Berkeley], I've been forced to deal with my Yellow-White identity. There are so many "yellows" here that I can 't believe it. I've come to realize that many White prejudices are deeply ingrained in me; so much so that they are unconscious To accept myself as a total person, I also have to accept my Asian identity as well. But what is it? I just don 't know. Are they the images given me through the filter of White America, or are they the values and desires of my parents? . . . Yesterday, I had a rude awakening. For the first time in my life I went on a date with a Filipino boy. I guess I shouldn 't call him a "boy, " as my ethnic studies teacher says it is derogatory toward Asians and Blacks. I only agreed to go because he seemed different from the other "Orientals" on campus. (I guess I shouldn 't use that word either.) He 's president of his Asian fraternity, very athletic and outgoing When he asked me, I fig- ured, "Why not?" It'll be a good experience to see what its like to date an Asian boy. Will he be like White guys who will try to seduce me, or will he be too afraid to make any move when it comes to sex? ...We went to San Francisco 's Fisherman 's Wharf for lunch. We were seated and our orders were taken before two other White women. They were, however, served first. This was painfully apparent to us, but I wanted to pretend that it was just a mixup. My friend, however, was less forgiving and made a public

234 identity Development In Multicultural Counseling and Therapy fuss with the waiter. Still, it took an inordinate amount of time for us to get our lunches, and the filets were overcooked (purposely?). My date made a very pub- lic scene by placing a tip on the table, and then returning to retrieve it. I was both embarrassed, but proud of his actions. This incident and others made me realize several things. For all my life I have attempted to fit into White society. I have tried to convince myself that I was different, that I was like all my other White classmates, and that prejudice and discrimination didn 't exist for me. I wonder how I could have been so oblivious to prejudice and racism. I now realize that I cannot escape from my ethnic her- itage and from the way people see me. Yet I don 't know how to go about resolv- ing many of my feelings and conflicts. While I like my newly found Filipino "male" friend (he is sexy), I continue to have difficulty seeing myself married to anyone other than a White man. (Excerpts from a Nisei student journal, 1989) This Nisei lTiird-generation)Japanese American female is experiencing a racial awakening that has strong implications for her racial/cultural identity development. Her previous belief systems concerning Euro- Americans and Asian Americans are being challenged by social reality and the experiences of being a visible racial/ethnic minority. First, a major theme involving societal portrayals of Asian Americans is clearly expressed in the student's beliefs about racial/cultural characteristics: She describes the Asian American male and female in a highly negative man- ner. She seems to have internalized these beliefs and to be using White stan- dards to judge Asian Americans as being either desirable or undesirable. For the student, the process of incorporating these standards has not only attitu- dinal but behavioral consequences as well. In Arizona, she would not have considered making Asian American friends even if the opportunity presented itself. In her mind, she was not a typical Orientalfshe disowned or felt ashamed of her ethnic heritage;and she even concludes that she would not consider marrying anyone but a White male. Second, her denial that she is not an Asian American is beginning to crumble. Being immersed on a campus in which many other fellow Asian Americans attend forces her to explore ethnic identity issuesa-process she has been able to avoid while living in a predominantly White area. In the past, when she encountered prejudice or discrimination, she had been able to deny it or to rationalize it away. The differential treatment she received at a restau- rant and her male friend's labeling it as discrimination"makes such a con- clusion inescapable. The shattering of illusions is manifest in a realization that J)despite her efforts to fit in, "it is not enough to gain social acceptance among many White Americans;? )she cannot escape her racial/cultural her- itage;and ?)she has been brainwashed into believing that one group is su- perior over another. Third, the student's internal struggle to cast off the cultural condition-

Racial/ Cultural identity Development in People of Color 235

ing of her past and the attempts to define her ethnic identity are both painful and conflicting. When she refers to her Yellow- White Identity, writes about the negative images of Asian American males but winds up dating one, uses the terms Oriental'and boy'i|n reference to her Asian male friend)but ac- knowledges their derogatory racist nature, describes Asian men as Sexually emasculated'but sees her Filipino date as athletic, "butgoing, "and Sexy" expresses embarrassment at confronting the waiter about discrimination but feels proud of her Asian male friend for doing so, and states that she finds him attractive but could never consider marrying anyone but a White man, we have clear evidence of the internal turmoil she is undergoing. Understanding the process by which racial/cultural identity develops in persons of color is crucial for effective multicultural counseling/therapy. Fourth, it is clear that the Japanese American female is a victim of eth- nocentric monoculturalism. As we mentioned previously, the problem being experienced by the student does not reside in her, but in our society. It resides in a society that portrays racial/ethnic minority characteristics as inferior, primitive, deviant, pathological, or undesirable. The resulting damage strikes at the self-esteem and self/group identity of many culturally different indi- viduals in our society;many, like the student, may come to believe that their racial/cultural heritage or characteristics are burdens to be changed or over- come. Understanding racial/cultural identity development and its relation- ship to therapeutic practice are the goals of this chapter. Racial/Cultural identity Development Models One of the most promising approaches to the field of multicultural counsel- ing/therapy has been the work on racial/cultural identity development among minority groups Atkinson, Morten, et al., 1998;Cross, 1971, 1995, 2001; Helms, 1984, 1995;Kim, 1981; Ruiz, 1990) Most would agree that Asian Americans, African Americans, Latino/Hispanic Americans, and Ameri- can Indians have a distinct cultural heritage that makes each different from the other. Yet such cultural distinctions can lead to a monolithic view of minority group attitudes and behaviors Atkinson, Morten et al., 1998) The erroneous belief that all Asians are the same, all Blacks are the same, all His- panics are the same, or all American Indians are the same has led to numer- ous therapeutic problems. First, therapists may often respond to the culturally diverse client in a very stereotypic manner and fail to recognize within-group or individual dif- ferences. For example, research indicates that Asian American clients seem to prefer and benefit most from a highly structured and directive approach rather than an insight/feeling-oriented one Hong ffiomokos-Cheng Ham, 2001;Root, 1998;Sandhu, Leung, Slang, 2003) While such approaches

236 identity Development In Multicultural Counseling and Therapy may generally be effective, they are often blindly applied without regard for possible differences in client attitudes, beliefs, and behaviors. Likewise, con- flicting findings in the literature regarding whether people of color prefer therapists of their own race seem to be a function of our failure to make such distinctions. Preference for a racially or ethnically similar therapist may really be a function of the cultural/racial identity of the minority person ^vithin- group differences)rather than of race or ethnicity per se. Second, the strength of racial/cultural identity models lies in their po- tential diagnostic value Helms, 1984;Vandiver, 2001) Premature termina- tion rates among minority clients may be attributed to the inappropriateness of transactions that occur between the helping professional and the culturally diverse client. Research now suggests that reactions to counseling, the coun- seling process, and counselors are influenced by cultural/racial identity and are not simply linked to minority group membership. The high failure-to- return rate of many clients seems to be intimately connected to the mental health professional's inability to assess the cultural identity of clients accu- rately. A third important contribution derived from racial identity models is their acknowledgment of sociopolitical influences in shaping minority iden- tity $a the Nisei student) Most therapeutic approaches often neglect their potential sociopolitical nature. The early models of racial identity develop- ment all incorporated the effects of racism and prejudice Oppression )upon the identity transformation of their victims. Vontress J 971) for instance, theorized that African Americans moved through decreasing levels of de- pendence on White society to emerging identification with Black culture and society Colored, Negro, and Black) Other similar models for Blacks have been proposed W. E. Cross, 1971;W. S. Hall, Cross, aFreedle, 1972;B. Jack- son, 1975;C. W. Thomas, 1970, 1971) The fact that other minority groups such as Asian Americans M^aykovich, 1973; D. W. Sue €S. Sue, 1971a; S. Sue ©. W. Sue, 1971b) Hispanics A. S. Ruiz, 1990;Szapocznik, Santis- teban, Kurtines, Hervis, Spencer, 1982) women powning {Roush, 1985; McNamara ERickard, 1989) lesbians/gays Cass, 1979) and disabled indi- viduals pikin, 1999)have similar processes may indicate experiential valid- ity for such models as they relate to various oppressed groups. Black Identity Development Models Early attempts to define a process of minority identity transformation came primarily through the works of Black social scientists and educators W. E. Cross, 1971;B. Jackson, 1975;C. W. Thomas, 1971) While there are several Black identity development models, the Cross model of psychological ni- grescense the process of becoming Black^s perhaps the most influential and well documented W. E.Cross, 1971, 1991, 1995;W. S.Halletal., 1972)The

Racial/Cultural identity Development in People of Color 237

original Cross model was developed during the civil rights movement and de- lineates a five-stage process in which Blacks in the United States move from a White frame of reference to a positive Black frame of reference: pre- encounter, encounter, immersion-emersion, internalization, and internalization- commitment. The pre-encounter stage is characterized by individuals African Americans)who consciously or unconsciously devalue their own Blackness and concurrently value White values and ways. There is a strong desire to as- similate and acculturate into White society. Blacks at this stage evidence self- hate, low self-esteem, and poor mental health yandiver, 2001) In the en- counter stage, a two-step process begins to occur. First, the individual encounters a profound crisis or event that challenges his or her previous mode of thinking and behaving;second, the Black person begins to reinter- pret the world, resulting in a shift in worldviews. Cross points out how the slaying of Martin Luther King, Jr. was such a significant experience for many African Americans. The person experiences both guilt and anger over being brainwashed by White society. In the third stage, immersion-emersion, the person withdraws from the dominant culture and becomes immersed in African American culture. Black pride begins to develop, but internalization of positive attitudes toward one's own Blackness is minimal. In the emersion phase, feelings of guilt and anger begin to dissipate with an increasing sense of pride. The next stage, internalization, is characterized by inner security as conflicts between the old and new identities are resolved. Global anti-White feelings subside as the person becomes more flexible, more tolerant, and more bicultural/multicultural. The last stage, internalization-commitment, speaks to the commitment that such individuals have toward social change, social justice, and civil rights. It is expressed not only in words, but also in ac- tions that reflect the essence of their lives. It is important to note, however, that Cross's original model makes a major assumption:The evolution from the pre-encounter to the internalization stage reflects a movement from psy- chological dysfunction to psychological health yandiver, 2001) Confronted with evidence that these stages may mask multiple racial identities, questioning his original assumption that all Blacks at the pre- encounter stage possess self-hatred and low self-esteem, and aware of the complex issues related to race salience, in his book Shades of Black W. E. Cross J991)revised his theory of nigrescence. His changes, which are based on a critical review of the literature on Black racial identity, have increased the model's explanatory powers and promise high predictive validity yandiver et al., 2001;Worrell, Cross, 8/andiver, 2001) In essence, the revised model contains nearly all the features from the earlier formulation, but it differs in several significant ways. First, Cross introduces the concept of race salience, the degree to which race is an important and integral part of a person's ap- proach to life. The Black person may either function with face'tonscious- ness playing a large role in his or her identity or a minimal one. In addition,

238 identity Development In Multicultural Counseling and Therapy

salience for Blackness can possess positive pro-Black) or negative ^mti- Black) valence. Instead of using the term pro-White"in the earlier pre- encounter stage, Cross now uses the term race salience. Originally, Cross be- lieved that the rejection of Blackness and the acceptance of an American perspective were indicative of only one identity, characterized by self-hate and low self-esteem. His current model now describes two identities:} )pre- encounter assimilation and £)pre- encounter anti-Black. The former has low salience for race and a neutral valence toward Blackness, while the latter de- scribes individuals who hate Blacks and hate being Black high negative salience) In other words, it is possible for a Black person at the pre-encounter stage who experiences the salience of race as very minor and whose identity is oriented toward an American'perspective not to be filled with self-hate or low self-esteem. The sense of low self-esteem, however, is linked to the pre-encounter anti-Black orientation. According to Cross, such a psychological perspective is the result of miseducation and self-hatred. The miseducation is the result of the negative images about Blacks portrayed in the mass media, among neighbors, friends, and relatives, and in the educational literature Blacks are unintelligent, criminal, lazy, and prone to violence) The result is an incorpo- ration of such negative images into the personal identity of the Black person. Interestingly, the female Nisei student described earlier in this chapter, though Japanese American, would seem to possess many of the features of Cross' pre-encounter anti-Black identity. Several other changes were made by Cross in his later stages. First, the immersion-emersion stage once described one fused identity ^nti-White/ pro-Black jbut is now divided into two additional ones:anti-White alone and anti-Black alone. While Cross speaks about two separate identities, it appears that there are three possible combinations: anti-White, pro-Black, and an anti-White/pro-Black combination. Second, Cross has collapsed the fourth and fifth stages internalization and internalization-commitment)into one: internalization. He observed that minimal differences existed between the two stages except one of Sustained interest and commitment. This last stage is characterized by Black self-acceptance and can be manifested in three types of identities:Black nationalist high Black positive race salience) bicultural- ist Blackness and fused sense of Americanness) and multiculturalist hiul- tiple identity formation, including race, gender, sexual orientation, etc.) While Cross' model has been revised significantly and the newer ver- sion is more sophisticated, his original 1971 nigrescense theory continues to dominate the racial identity landscape. Unfortunately, this has created much confusion among researchers and practitioners. We encourage readers to fa- miliarize themselves with his most recent formulation W. E. Cross, 1991, 1995)

Racial/ Cultural identity Development in People of Color 239 Asian American Identity Development Models Asian American identity development models have not advanced as far as those relating to Black identity. One of the earliest heuristic, type"models was developed by S. Sue and D. W. Sue |971b)to explain what they saw as clinical differences among Chinese American students treated at the Univer- sity of California Counseling Center:^) traditionalista-person who inter- nalizes conventional Chinese customs and values, resists acculturation forces, and believes in the Old ways,'^) marginal persona-person who at- tempts to assimilate and acculturate into White society, rejects traditional Chinese ways, internalizes society's negativism toward minority groups, and may develop racial self -hatred $a the Nisei student)and Asian Ameri- ca«a-person who is in the process of forming a positive identity, who is eth- nically and politically aware, and who becomes increasingly bicultural. Kitano \ 982) also proposed a type model to account for Japanese American role behaviors with respect to Japanese and American cultures: (^positive -positive, in which the person identifies with both Japanese and White cultures without role conflicts;? (negative-positive, in which there is a rejection of White culture and acceptance of Japanese American culture, with accompanying role conflicts;?)positive-negative, in which the person accepts White culture and rejects Japanese culture, with concomitant role conflict;and ^)negative-negative, in which one rejects both. These early type models suffered from several shortcomings F. Y. Lee, f 991) First, they failed to provide a clear rationale for why an individual de- velops one ethnic identity type over another. While they were useful in de- scribing characteristics of the type, they represented static entities rather than a dynamic process of identity development. Second, the early proposals seem too simplistic to account for the complexity of racial identity development. Third, these models were too population specific in that they described only one Asian American ethnic group Chinese American or Japanese Ameri- can) and one wonders whether they are equally applicable to Korean Ameri- cans, Filipino Americans, Vietnamese Americans, and so on. Last, with the exception of a few empirical studies F. Y. Lee, 1991;D. W. Sue £Frank, 1973) testing of these typologies is seriously lacking. In response to these criticisms, theorists have begun to move toward the development of stage/process models of Asian American identity develop- ment f. Kim, 1981;F. Y. Lee, 1991;Sodowski, Kwan, S>annu, 1995) Such models view identity formation as occurring in stages, from less healthy to more healthy evolutions. With each stage there exists a constellation of traits and characteristics associated with racial/ethnic identity. They also attempt to explain the conditions or situations that might retard, enhance, or impel the individual forward.

240 identity Development in Multicultural Counseling and Therapy

After a thorough review of the literature, J. Kim f 981)used a qualita- tive narrative approach with third-generation Japanese American women to posit a progressive and sequential stage model of Asian American identity de- velopment: ethnic awareness, White identification, awakening to social po- litical consciousness, redirection to Asian American consciousness, and in- corporation. Her model integrates the influence of acculturation, exposure to cultural differences, environmental negativism to racial differences, personal methods of handling race-related conflicts, and the effects of group or social movements on the Asian American individual. 1 . The ethnic awareness stage begins around the ages of 3 to 4, when the child's family members serve as the significant ethnic group model. Pos- itive or neutral attitudes toward one's own ethnic origin are formed de- pending on the amount of ethnic exposure conveyed by the caretakers. 2. The White identification stage begins when children enter school, where peers and the surroundings become powerful forces in conveying racial prejudice that negatively impacts their self-esteem and identity. The re- alization of differentness"from such interactions leads to self-blame and a desire to escape racial heritage by identifying with White society. 3 . The awakening to social political consciousness stage means the adoption of a new perspective, often correlated with increased political awareness. J. Kim } 98 1 jbelieved that the civil rights and women's movements and other significant political events often precipitate this new awakening. The primary result is an abandoning of identification with White society and a consequent understanding of oppression and oppressed groups. 4. The redirection stage means a reconnection or renewed connection with one's Asian American heritage and culture. This is often followed by the realization that White oppression is the culprit for the negative experi- ences of youth. Anger against White racism may become a defining theme with, concomitant increases of Asian American self-pride and group pride. 5 . The incorporation stage represents the highest form of identity evolution. It encompasses the development of a positive and comfortable identity as Asian American and consequent respect for other cultural/racial her- itages. Identification for or against White culture is no longer an impor- tant issue. Latino/Hispanic American Identity Development Models While a number of ethnic identity development models have been formu- lated to account for Hispanic identity ^ernal SCnight, 1 993;Casas 9?ytluk, 1 995;Szapocznik et al., 1 982) the one most similar to those of African Amer-

Racial/Cultural identity Development in People of Color 241 icans and Asian Americans was proposed by A. S. Ruiz \ 990) His model was formulated from a clinical perspective via case studies of Chicano/Latino sub- jects. Ruiz made several underlying assumptions. First, he believed in a cul- ture-specific explanation of identity for Chicano, Mexican American, and Latino clients. While models about other ethnic group development or the more general ones were helpful, they lacked the specificity of Hispanic cul- tures. Second, the marginal status of Latinos is highly correlated with malad- justment. Third, negative experiences of forced assimilation are considered destructive to an individual. Fourth, having pride in one's cultural heritage and ethnic identity is positively correlated with mental health. Last, pride in one's ethnicity affords the Hispanic greater freedom to choose freely. These beliefs underlie the five-stage model. 1. Causal stage. During this period messages or injunctions from the envi- ronment or significant others either affirm, ignore, negate, or denigrate the ethnic heritage of the person. Affirmation about one's ethnic iden- tity is lacking, and the person may experience traumatic or humiliating experiences related to ethnicity. There is a failure to identify with Latino culture. 2. Cognitive stage. As a result of negative/distorted messages, three erro- neous belief systems about Chicano/Latino heritage become incorpo- rated into mental sets:()Ethnic group membership is associated with poverty and prejudice; £) assimilation to White society is the only means of escape;and ? Assimilation is the only possible road to success. 3. Consequence stage. Fragmentation of ethnic identity becomes very no- ticeable and evident. The person feels ashamed and is embarrassed by ethnic markers such as name, accent, skin color, cultural customs, and so on. The unwanted self-image leads to estrangement and rejection of one's Chicano/Latino heritage. 4. Working-through stage. Two major dynamics distinguish this stage. First, the person becomes increasingly unable to cope with the psychological distress of ethnic identity conflict. Second, the person can no longer be a pretender'by identifying with an alien ethnic identity. The person is propelled to reclaim and reintegrate disowned ethnic identity frag- ments. Ethnic consciousness increases. 5. Successful resolution stage. This last stage is exemplified by greater accept- ance of one's culture and ethnicity. There is an improvement in self- esteem and a sense that ethnic identity represents a positive and suc- cess-promoting resource. The Ruiz model has a subjective reality that is missing in many of the empirically based models. This is expected, since it was formulated through a

242 identity Development In Multicultural Counseling and Therapy

clinical population. It has the added advantage of suggesting intervention fo- cus and direction for each of the stages. For example, the focus of counseling in the causal stage is disaffirming and restructuring of the injunctions;for the cognitive stage it is the use of cognitive strategies attacking faulty beliefs;for the consequence stage it is reintegration of ethnic identity fragments in a pos- itive manner;for the working-through stage, ethnocultural identification is- sues are important;and for the successful resolution stage, the promotion of a positive identity becomes important. A Racial/Cultural identity Development Model Earlier writers perry, 1965;Stonequist, 1937)have observed that minority groups share similar patterns of adjustment to cultural oppression. In the past several decades, Asian Americans, Hispanics, and American Indians have ex- perienced sociopolitical identity transformations so that a Third World con- sciousness has emerged, with cultural oppression as the common unifying force. As a result of studying these models and integrating them with their own clinical observations, Atkinson, Morten, and Sue J 979, 1989, 1998) proposed a five-stage Minority Identity Development model MID)in an at- tempt to pull out common features that cut across the population-specific proposals. D. W. Sue and D. Sue }990, 1999)later elaborated on the MID, renaming it the Racial/Cultural Identity Development model R/CID )to en- compass a broader population. As discussed shortly, this model may be ap- plied to White identity development as well. The R/CID model proposed here is not a comprehensive theory of per- sonality, but rather a conceptual framework to aid therapists in understanding their culturally different clients' attitudes and behaviors. The model defines five stages of development that oppressed people experience as they struggle to understand themselves in terms of their own culture, the dominant culture, and the oppressive relationship between the two cultures: conformity, disso- nance, resistance and immersion, introspection, and integrative awareness. At each level of identity, four corresponding beliefs and attitudes that may help thera- pists better understand their minority clients are discussed. These attitudes/ beliefs are an integral part of the minority person's identity and are manifest in how he or she views ^)the self, b)others of the same minority, pothers of another minority, and d) majority individuals. Table 10.1 outlines the R/CID model and the interaction of stages with the attitudes and beliefs. Conformity Stage Similar to individuals in the pre-encounter stage W. E. Cross, 1991) minor- ity individuals are distinguished by their unequivocal preference for domi-

Racial/Cultural identity Development in People of Color 243

Table 10.1 The Racial/Cultural Identity Development Model

Stages of





toward Others

toward Others




of the Same

of a Different



toward Self



Stage 1 —

Self- depreciating




on form it v Vjviiiuiiiiiiy

or npntrpil Hi if 1 to

or npiTtr^il Hup to

or npii1r;il

low race salience

low race salience

Stage 2 —

Conflict between

Conflict between

Conflict between

Conflict between






cuulu ci vj yjL Lia ting

anH cJrnim-

vifws of minnritv

£inH ornun UllU gl V7 Li. IJ


hierarchy and


feelings of shared


Stage 3—



Conflict between



experiences and

feelings of empathy

and immersion

feelings of

for other minority


Stage 4 —

Concern with basis

Concern with

Concern with

Concern with the


of self-appreciation

nature of

ethnocentric basis

basis of group-


forjudging others



Stage 5 —





Integrative appreciation awareness Source: From Donald R. Atkinson, George Morten, and Derald Wing Sue, Counseling American Minorities: A Cross Cul- tural Perspective, 5th ed. Copyright Q998 Wm. C. Brown Publishers, Dubuque, IA. All rights reserved. Reprinted by per- mission.

nant cultural values over their own. White Americans in the United States represent their reference group, and the identification set is quite strong. Lifestyles, value systems, and cultural/physical characteristics that most re- semble White society are highly valued, while those most like their own mi- nority group may be viewed with disdain or may hold low salience for the person. We agree with Cross that minority people at this stage can be oriented toward a pro -American identity without subsequent disdain or negativism toward their own group. Thus, it is possible for a Chinese American to feel positive about U.S. culture, values, and traditions without evidencing disdain for Chinese culture or feeling negatively about oneself Absence of self-hate) Nevertheless, we believe that they represent a small proportion of persons of color at this stage. Research on their numbers, on how they have handled the

244 identity Development In Multicultural Counseling and Therapy

social-psychological dynamics of majority-minority relations, on how they have dealt with their minority status, and on how they fit into the stage mod- els progression issues)needs to be conducted. We believe that the conformity stage continues to be most characterized by individuals who have bought into societal definitions about their minor- ity status in society. Because the conformity stage represents, perhaps, the most damning indictment of White racism, and because it has such a pro- found negative impact on persons of color, understanding its sociopolitical dynamics is of utmost importance for the helping professional. Those in the conformity state are really victims of larger social-psychological forces oper- ating in our society. The key issue here is the dominant-subordinate rela- tionship between two different cultures Atkinson, Morten, et al., 1998; Freire, 1970;B. Jackson, 1975) It is reasonable to believe that members of one cultural group tend to adjust themselves to the group possessing the greater prestige and power in order to avoid feelings of inferiority. Yet it is ex- actly this act that creates ambivalence in the minority individual. The pres- sures for assimilation and acculturation ^nelting-pot theory) are strong, creating possible culture conflicts. These individuals are victims of ethnocen- tric monoculturalism p. W. Sue, 2004)(J (belief in the superiority of one group's cultural heritageite language, traditions, arts-crafts, and ways of behaving White) over all others; ?) belief in the inferiority of all other lifestyles (lon-White)and ?)the power to impose such standards onto the less powerful group. The psychological costs of racism on persons of color are immense. Con- stantly bombarded on all sides by reminders that Whites and their way of life are superior and that all other lifestyles are inferior, many minorities begin to wonder whether they themselves are not somehow inadequate, whether members of their own group are not to blame, and whether subordination and segregation are not justified. K. B. Clark and Clark 1 947 (first brought this to the attention of social scientists by stating that racism may contribute to a sense of confused self-identity among Black children. In a study of racial awareness and preference among Black and White children, they found that 4) Black children preferred playing with a White doll over a Black one, b)the Black doll was perceived as being bad, "and £ (approximately one third, when asked to pick the doll that looked like them, picked the White one. It is unfortunate that the inferior status of minorities is constantly re- inforced and perpetuated by the mass media through television, movies, newspapers, radio, books, and magazines. This contributes to widespread stereotypes that tend to trap minority individuals: Blacks are superstitious, childlike, ignorant, fun loving, dangerous, and criminal;Hispanics are dirty, sneaky, and criminal;Asian Americans are sneaky, sly, cunning, and passive- Indians are primitive savages. Such portrayals cause widespread harm to the

Racial/Cultural identity Development in People of Color 245 self-esteem of minorities who may incorporate them D. W. Sue, 2003) The incorporation of the larger society's standards may lead minority group mem- bers to react negatively toward their own racial and cultural heritage. They may become ashamed of who they are, reject their own group identification, and attempt to identify with the desirable good"White minority. In the Autobiography of Malcolm X j^. Haley, 1966) Malcolm X relates how he tried desperately to appear as White as possible. He went to painful lengths to straighten and dye his hair so that he would appear more like White males. It is evident that many minorities do come to accept White standards as a means of measuring physical attractiveness, attractiveness of personality, and social relationships. Such an orientation may lead to the phenomenon of racial self- hatred, in which people dislike themselves for being Asian, Black, Hispanic, or Native American. People at the conformity stage seem to possess the fol- lowing characteristics. 1. Attitudes and beliefs toward the self (self-depreciating attitudes and beliefs). Physical and cultural characteristics identified with one's own racial/ cultural group are perceived negatively, as something to be avoided, denied, or changed. Physical characteristics black skin color, giant- shaped eyes'bf Asians) traditional modes of dress and appearance, and behavioral characteristics associated with the minority group are a source of shame. There may be attempts to mimic what is perceived as White mannerisms, speech patterns, dress, and goals. Low internal self- esteem is characteristic of the person. 2. Attitudes and beliefs toward members of the same minority (group-depreciating attitudes and beliefs). Majority cultural beliefs and attitudes about the mi- nority group are also held by the person in this stage. These individuals may have internalized the majority of White stereotypes about their group. In the case of Hispanics, for example, the person may believe that members of his or her own group have high rates of unemployment be- cause they are lazy, uneducated, and unintelligent/Tittle thought or validity is given to other viewpoints, such as unemployment's being a function of job discrimination, prejudice, racism, unequal opportuni- ties, and inferior education. Because persons in the conformity stage find it psychologically painful to identify with these negative traits, they divorce themselves from their own group. The denial mechanism most commonly used is, I'm not like them;I've made it on my own;I'm the exception." 3. Attitudes and beliefs toward members of different minorities (discriminatory). Because the conformity-stage person most likely strives for identifica- tion with White society, the individual shares similar dominant atti- tudes and beliefs not only toward his or her own minority group, but

246 identity Development in Multicultural Counseling and Therapy

toward other minorities as well. Minority groups most similar to White cultural groups are viewed more favorably, while those most different are viewed less favorably. For example, Asian Americans may be viewed more favorably than African Americans or Latino/Hispanic Americans in some situations. While a stratification probably exists, we caution readers that such a ranking is fraught with hazards and poten- tial political consequences. Such distinctions often manifest themselves in debates over which group is more oppressed and which group has done better than the others. Such debates are counterproductive when used to \ (negate another group's experience of oppression, £)foster an erroneous belief that hard work alone will result in success in a dem- ocratic society, Shortchange a minority group le., Asian Americans) from receiving the necessary resources in our society, and 4)pit one minority against another divide and conquer jby holding one group up as an example to others. 4. Attitudes and beliefs toward members of the dominant group (group- appreciating attitude and beliefs). This stage is characterized by a belief that White cultural, social, and institutional standards are superior. Mem- bers of the dominant group are admired, respected, and emulated. White people are believed to possess superior intelligence. Some indi- viduals may go to great lengths to appear White. Consider again the ex- ample from the Autobiography of Malcolm X, in which the main character would straighten his hair and primarily date White women. Reports that Asian women have undergone surgery to reshape their eyes to con- form to White female standards of beauty may but not in all cases)typ- ify this dynamic.

Dissonance Stage No matter how much one attempts to deny his or her own racial/cultural her- itage, an individual will encounter information or experiences that are in- consistent with culturally held beliefs, attitudes, and values. An Asian Amer- ican who believes that Asians are inhibited, passive, inarticulate, and poor in people relationships may encounter an Asian leader who seems to break all these stereotypes £.g., the Nisei student) A Latino who feels ashamed of his or her cultural upbringing may encounter another Latino who seems proud of his or her cultural heritage. An African American who believes that race problems are due to laziness, untrustworthiness, or personal inadequacies of his or her own group may suddenly encounter racism on a personal level. De- nial begins to break down, which leads to a questioning and challenging of the attitudes/beliefs of the conformity stage. This was clearly what happened when the Nisei student encountered discrimination at the restaurant.

Racial/ Cultural identity Development in People of Color 247

In all probability, movement into the dissonance stage is a gradual pro- cess. Its very definition indicates that the individual is in conflict between dis- parate pieces of information or experiences that challenge his or her current self-concept. People generally move into this stage slowly but a traumatic event may propel some individuals to move into dissonance at a much more rapid pace. W. E. Cross } 971 Jstated that a monumental event such as the as- sassination of a major leader like Martin Luther King, Jr. can often push people quickly into the ensuing stage. 1 . Attitudes and beliefs toward the self (conflict between self-depreciating and self- appreciating attitudes and beliefs). There is now a growing sense of per- sonal awareness that racism does exist, that not all aspects of the mi- nority or majority culture are good or bad, and that one cannot escape one's cultural heritage. For the first time the person begins to entertain the possibility of positive attributes in the minority culture and, with it, a sense of pride in self. Feelings of shame and pride are mixed in the in- dividual, and a sense of conflict develops. This conflict is most likely to be brought to the forefront quickly when other members of the minor- ity group may express positive feelings toward the person:We like you because you are Asian, Black, American Indian, or Latino. "At this stage, an important personal question is being asked:Why should I feel ashamed of who and what I am? 2. Attitudes and beliefs toward members of the same minority (conflict between group-depreciating and group-appreciating attitudes and beliefs). Dominant- held views of minority strengths and weaknesses begin to be questioned as new, contradictory information is received. Certain aspects of the minority culture begin to have appeal. For example, a Latino/Hispanic male who values individualism may marry have children, and then suddenly realize how Latino cultural values that hold the family as the psychosocial unit possess positive features. Or the minority person may find certain members of his group to be very attractive as friends, col- leagues, lovers, and so forth. 3. Attitudes and beliefs toward members of a different minority (conflict between dominant-held views of minority hierarchy and feelings of shared experience). Stereotypes associated with other minority groups are questioned, and a growing sense of comradeship with other oppressed groups is felt. It is important to keep in mind however, that little psychic energy is associ- ated with resolving conflicts with other minority groups. Almost all en- ergies are expended toward resolving conflicts toward the self, the same minority, and the dominant group. 4. Attitudes and beliefs toward members of the dominant group (conflict between group-appreciating and group-depreciating attitudes). The person experiences

248 identity Development in Multicultural Counseling and Therapy a growing awareness that not all cultural values of the dominant group are beneficial. This is especially true when the minority person experi- ences personal discrimination. Growing suspicion and some distrust of certain members of the dominant group develops. Resistance and Immersion Stage The minority person tends to endorse minority-held views completely and to reject the dominant values of society and culture. The person seems dedicated to reacting against White society and rejects White social, cultural, and insti- tutional standards as having no personal validity. Desire to eliminate oppres- sion of the individual's minority group becomes an important motivation of the individual's behavior. During the resistance and immersion stage, the three most active types of affective feelings are guilt, shame, and anger. There are considerable feelings of guilt and shame that in the past the minority in- dividual has sold out his or her own racial and cultural group. The feelings of guilt and shame extend to the perception that during this past Sellout'the minority person has been a contributor and participant in the oppression of his or her own group and other minority groups. This is coupled with a strong sense of anger at the oppression and feelings of having been brainwashed by forces in White society. Anger is directed outwardly in a very strong way toward oppression and racism. Movement into this stage seems to occur for two reasons. First, a resolution of the conflicts and confusions of the previous stage allows greater understanding of social forces Racism, oppression, and discrimination)and his or her role as a victim. Second, a personal question- ing of why people should feel ashamed of themselves develops. The answer to this question evokes feelings of guilt, shame, and anger. 1 . Attitudes and beliefs toward the self (self-appreciating attitudes and beliefs). The minority individual at this stage is oriented toward self- discovery of one's own history and culture. There is an active seeking out of infor- mation and artifacts that enhance that person's sense of identity and worth. Cultural and racial characteristics that once elicited feelings of shame and disgust become symbols of pride and honor. The individual moves into this stage primarily because he or she asks the question, Why should I be ashamed of who and what I am?The original low self-esteem engendered by widespread prejudice and racism that was most characteristic of the conformity stage is now actively challenged in order to raise self-esteem. Phrases such as Black is beautiful'represent a symbolic relabeling of identity for many Blacks. Racial self-hatred be- gins to be actively rejected in favor of the other extreme: unbridled racial pride. 2 . Attitudes and beliefs toward members of the same minority (group-appreciating attitudes and beliefs). The individual experiences a strong sense of identi-

Racial/Cultural identity Development in People of Color 249

fication with and commitment to his or her minority group as enhanc- ing information about the group is acquired. There is a feeling of con- nectedness with other members of the racial and cultural group, and a strengthening of new identity begins to occur. Members of one's group are admired, respected, and often viewed now as the new reference group or ideal. Cultural values of the minority group are accepted with- out question. As indicated, the pendulum swings drastically from orig- inal identification with White ways to identification in an unquestion- ing manner with the minority group's ways. Persons in this stage are likely to restrict their interactions as much as possible to members of their own group. 3. Attitudes and beliefs toward members of a different minority (conflict between feelings of empathy for other minority group experiences and feelings ofculturo- centrism). While members at this stage experience a growing sense of comradeship with persons from other minority groups, a strong cultur- ocentrism develops as well. Alliances with other groups tend to be tran- sitory and based on short-term goals or some global shared view of op- pression. There is less an attempt to reach out and understand other racial-cultural minority groups and their values and ways, and more a superficial surface feeling of political need. Alliances generally are based on convenience factors or are formed for political reasons, such as com- bining together as a large group to confront an enemy perceived to be larger. 4. Attitudes and beliefs toward members of the dominant group (group depreciat- ing attitudes and beliefs). The minority individual is likely to perceive the dominant society and culture as an oppressor and as the group most re- sponsible for the current plight of minorities in the United States. Char- acterized by both withdrawal from the dominant culture and immer- sion in one's cultural heritage, there is also considerable anger and hostility directed toward White society. There is a feeling of distrust and dislike for all members of the dominant group in an almost global anti- White demonstration and feeling. White people, for example, are not to be trusted because they are the oppressors or enemies. In extreme form, members may advocate complete destruction of the institutions and structures that have been characteristic of White society. Introspection Stage Several factors seem to work in unison to move the individual from the re- sistance and immersion stage into the introspection stage. First, the individ- ual begins to discover that this level of intensity of feelings finger directed toward White society )is psychologically draining and does not permit one to really devote more crucial energies to understanding themselves or to their

250 identity Development in Multicultural Counseling and Therapy own racial-cultural group. The resistance and immersion stage tends to be a reaction against the dominant culture and is not proactive in allowing the individual to use all energies to discover who or what he or she is. Self- definition in the previous stage tends to be reactive ^gainst White racism) and a need for positive self-definition in a proactive sense emerges. Second, the minority individual experiences feelings of discontent and discomfort with group views that may be quite rigid in the resistance and im- mersion stage. Often, in order to please the group, the individual is asked to submerge individual autonomy and individual thought in favor of the group good. Many group views may now be seen as conflicting with individual ones. A Latino individual who may form a deep relationship with a White person may experience considerable pressure from his or her culturally sim- ilar peers to break off the relationship because that White person is the en- emy. "However, the personal experiences of the individual may, in fact, not support this group view. It is important to note that some clinicians often confuse certain char- acteristics of the introspective stage with parts of the conformity stage. A mi- nority person from the former stage who speaks against the decisions of his or her group may often appear similar to the conformity person. The dynam- ics are quite different, however. While the conformity person is motivated by global racial self-hatred, the introspective person has no such global nega- tivism directed at his or her own group. 1 . Attitudes and beliefs toward the self (concern with basis of self-appreciating atti- tudes and beliefs). While the person originally in the conformity stage held predominantly to majority group views and notions to the detri- ment of his or her own minority group, the person now feels that he or she has too rigidly held onto minority group views and notions in order to submerge personal autonomy. The conflict now becomes quite great in terms of responsibility and allegiance to one's own minority group versus notions of personal independence and autonomy. The person be- gins to spend more and more time and energy trying to sort out these aspects of self -identity and begins increasingly to demand individual au- tonomy. 2 . Attitudes and beliefs toward members of the same minority (concern with the un- equivocal nature of group appreciation). While attitudes of identification are continued from the preceding resistance and immersion stage, concern begins to build up regarding the issue of group-usurped individuality. Increasingly, the individual may see his or her own group taking posi- tions that might be considered quite extreme. In addition, there is now increasing resentment over how one's group may attempt to pressure or influence the individual into making decisions that may be inconsistent

Racial/ Cultural identity Development in People of Color 251

with the person's values, beliefs, and outlooks. Indeed, it is not unusual for members of a minority group to make it clear to the member that if they do not agree with the group, they are against it. A common ploy used to hold members in line is exemplified in questions such as How Asian are you^nd How Black are you? 3. Attitudes and beliefs toward members of a different minority (concern with the ethnocentric basis for judging others). There is now greater uneasiness with culturocentrism, and an attempt is made to reach out to other groups in finding out what types of oppression they experience and how this has been handled. While similarities are important, there is now a move- ment toward understanding potential differences in oppression that other groups might have experienced. 4. Attitudes and beliefs toward members of the dominant group (concern with the basis of group depreciation). The individual experiences conflict between attitudes of complete trust for the dominant society and culture and at- titudes of selective trust and distrust according to the dominant individ- ual's demonstrated behaviors and attitudes. Conflict is most likely to oc- cur here because the person begins to recognize that there are many elements in U.S. American culture that are highly functional and desir- able, yet there is confusion as to how to incorporate these elements into the minority culture. Would the person's acceptance of certain White cultural values make the person a sellout to his or her own raceTThere is a lowering of intense feelings of anger and distrust toward the domi- nant group but a continued attempt to discern elements that are ac- ceptable. Integrative Awareness Stage Minority persons in this stage have developed an inner sense of security and now can own and appreciate unique aspects of their culture as well as those in U.S. culture. Minority culture is not necessarily in conflict with White dominant cultural ways. Conflicts and discomforts experienced in the previ- ous stage become resolved, allowing greater individual control and flexibility. There is now the belief there are acceptable and unacceptable aspects in all cultures, and that it is very important for the person to be able to examine and accept or reject those aspects of a culture that are not seen as desirable. At the integrative awareness stage, the minority person has a strong commitment and desire to eliminate all forms of oppression. 1 . Attitudes and beliefs toward the self (self-appreciating attitudes and beliefs). The culturally diverse individual develops a positive self-image and experi- ences a strong sense of self-worth and confidence. Not only is there an

252 identity Development In Multicultural Counseling and Therapy integrated self-concept that involves racial pride in identity and culture, but the person develops a high sense of autonomy. Indeed, the client be- comes bicultural or multicultural without a sense of having gold out one's integrity/In other words, the person begins to perceive his or her self as an autonomous individual who is unique individual level of identity) a member of one's own racial-cultural group group level of identity) a member of a larger society, and a member of the human race hniversal level of identity) 2. Attitudes and beliefs toward members of same minority (group-appreciating at- titudes and beliefs). The individual experiences a strong sense of pride in the group without having to accept group values unequivocally. There is no longer the conflict over disagreeing with group goals and values. Strong feelings of empathy with the group experience are coupled with awareness that each member of the group is also an individual. In addi- tion, tolerant and empathic attitudes are likely to be expressed toward members of one's own group who may be functioning at a less adaptive manner to racism and oppression. 3 . Attitudes and beliefs toward members of a different minority (group-appreciating attitudes). There is now literally a reaching-out toward different minor- ity groups in order to understand their cultural values and ways of life. There is a strong belief that the more one understands other cultural values and beliefs, the greater is the likelihood of understanding among the various ethnic groups. Support for all oppressed people, regardless of similarity to the individual's minority group, tends to be emphasized. 4. Attitudes and beliefs toward members of the dominant group (attitudes and be- liefs of selective appreciation). The individual experiences selective trust and liking from members of the dominant group who seek to eliminate oppressive activities of the group. The individual also experiences open- ness to the constructive elements of the dominant culture. The empha- sis here tends to be on the fact that White racism is a sickness in society and that White people are also victims who are also in need of help.

Therapeutic Implications of the R/CID Model Let us first point out some broad general clinical implications of the R/CID model before discussing specific meanings within each of the stages. First, an understanding of cultural identity development should sensitize therapists and counselors to the role that oppression plays in a minority individual's de- velopment. In many respects, it should make us aware that our role as help- ing professionals should extend beyond the office and should deal with the many manifestations of racism. While individual therapy is needed, combat-

Racial/ Cultural identity Development in People of Color 253 ing the forces of racism means a proactive approach for both the therapist and the client. For the therapist, systems intervention is often the answer. For cul- turally diverse clients, it means the need to understand, control, and direct those forces in society that negate the process of positive identity Thus, a wider sociocultural approach to therapy is mandatory. Second, the model will aid therapists in recognizing differences between members of the same minority group with respect to their cultural identity. It serves as a useful assessment and diagnostic tool for therapists to gain a greater understanding of their culturally different client. In many cases, an accurate delineation of the dynamics and characteristics of the stages may re- sult in better prescriptive treatment. Therapists who are familiar with the se- quence of stages are better able to plan intervention strategies that are most effective for culturally different clients. For example, a client experiencing feelings of isolation and alienation in the conformity stage may require a dif- ferent approach than he or she would in the introspection stage. Third, the model allows helping professionals to realize the potentially changing and developmental nature of cultural identity among clients. If the goal of multicultural counseling/therapy is intended to move a client toward the integrative awareness stage, then the therapist is able to anticipate the se- quence of feelings, beliefs, attitudes, and behaviors likely to arise. Acting as a guide and providing an understandable end point will allow the client to un- derstand more quickly and work through issues related to his or her own identity. We now turn our attention to the R/CID model and its implications for the therapeutic process. Conformity Stage :Therapeutic Implications For the vast majority of those in the conformity stage belief in the superior- ity of White ways and the inferiority of minority ways) several therapeutic implications can be derived. First, persons of color are most likely to prefer a White therapist over a minority therapist. This flows logically from the belief that Whites are more competent and capable than are members of one's own race. Such a racial preference can be manifested in the client's reaction to a minority therapist via negativism, resistance, or open hostility. In some in- stances, the client may even request a change in therapist preferably some- one White) On the other hand, the conformity individual who is seen by a White therapist may be quite pleased about it. In many cases, the minority client, in identifying with White culture, may be overly dependent on the White therapist. Attempts to please, appease, and seek approval from the helping professional may be quite prevalent. Second, most conformity individuals will find that attempts to explore cultural identity or to focus in upon feelings are very threatening. Clients in this stage generally prefer a task-oriented, problem-solving approach, because

254 identity Development in Multicultural Counseling and Therapy an exploration of identity may eventually touch upon feelings of low self- esteem, dissatisfaction with personal appearance, vague anxieties, and racial self-hatred, and may challenge the client's self-deception that he or she is not like the other members of his or her own race. Whether you are a White or minority counselor working with a con- formity individual, the general goal may be the same. There is an obligation to help the client sort out conflicts related to racial/cultural identity through some process of re-education. Somewhere in the course of counseling or therapy, issues of cultural racism, majority-minority group relations, racial self-hatred, and racial cultural identity need to be dealt with in an integrated fashion. We are not suggesting a lecture or solely a cognitive approach, to which clients at this stage may be quite intellectually receptive, but exercis- ing good clinical skills that take into account the client's socioemotional state and readiness to deal with feelings. Only in this manner will the client be able to distinguish the difference between positive attempts to adopt certain val- ues of the dominant society and a negative rejection of one's own cultural value ^ characteristic of the integrative awareness stage) While the goals for the White and minority therapist are the same, the way a therapist works toward them may be different. For example, a minor- ity therapist will likely have to deal with hostility from the racially and cul- turally similar client. The therapist may symbolize all that the client is trying to reject. Because therapy stresses the building of a coalition, establishment of rapport, and to some degree a mutual identification, the process may be es- pecially threatening. The opposite may be true of work with a White thera- pist. The culturally different client may be overeager to identify with the White professional in order to seek approval. However, rather than being detrimental to multicultural counseling/therapy, these two processes can be used quite effectively and productively. If the minority therapist can aid the client in working through his or her feelings of antagonism, and if the ma- jority therapist can aid the client in working through his or her need to over- identify, then the client will be moved closer to awareness than to self- deception. In the former case, the therapist can take a nonjudgmental stance toward the client and provide a positive minority role model. In the latter, the White therapist needs to model positive attitudes toward cultural diversity. Both need to guard against unknowingly reinforcing the client's self-denial and rejection. Dissonance Stage :Therapeutic Implications As individuals become more aware of inconsistencies between dominant- held views and those of their own group, a sense of dissonance develops. Pre- occupation and questions concerning self, identity, and self-esteem are most likely brought in for therapy. More culturally aware than their conformity

Racial/ Cultural identity Development in People of Color 255 counterparts, dissonance clients may prefer a counselor or therapist who pos- sesses good knowledge of the client's cultural group, although there may still be a preference for a White helper. However, the fact that minority helping professionals are generally more knowledgeable of the client's cultural group may serve to heighten the conflicting beliefs and feelings of this stage. Since the client is so receptive toward self-exploration, the therapist can capitalize on this orientation in helping the client come to grips with his or her identity conflicts. Resistance and Immersion Stage :Therapeutic Implications Minority clients at this stage are likely to view their psychological problems as products of oppression and racism. They may believe that only issues of racism are legitimate areas to explore in therapy. Furthermore, openness or self-disclosure to therapists not of one's own group is dangerous because White therapists are £nemies"and members of the oppressing group. Clients in the resistance and immersion stage believe that society is to blame for their present dilemma and actively challenge the establishment. They are openly suspicious of institutions such as mental health services be- cause they view them as agents of the establishment. Very few of the more ethnically conscious and militant minorities will use mental health services, because of its identification with the status quo. When they do, they are usu- ally suspicious and hostile toward the helping professional. A therapist work- ing with a client at this stage of development needs to realize several impor- tant things. First, he or she will be viewed by the culturally different client as a sym- bol of the oppressive society. If you become defensive and personalize the at- tacks, you will lose your effectiveness in working with the client. It is impor- tant not to be intimidated or afraid of the anger that is likely to be expressed; often, it is not personal and is quite legitimate. White guilt and defensiveness can only serve to hinder effective multicultural counseling/therapy. It is not unusual for clients at this stage to make sweeping negative generalizations about White Americans. The White therapist who takes a nondefensive pos- ture will be better able to help the client explore the basis of his or her racial tirades. In general, clients at this stage prefer a therapist of their own race. However, the fact that you share the same race or culture as your client will not insulate you from the attacks. For example, an African American client may perceive the Black counselor as a sellout of his or her own race, or as an Uncle Tom. Indeed, the anger and hostility directed at the minority therapist may be even more intense than that directed at a White one. Second, realize that clients in this stage will constantly test you. In earlier chapters we described how minority clients will pose challenges to therapists in order to test their sincerity openness, nondefensiveness, and competencies.

256 identity Development In Multicultural Counseling and Therapy Because of the active nature of client challenges, therapy sessions may become quite dynamic. Many therapists find this stage is frequently the most difficult to deal with because counselor self- disclosure is often necessary for establish- ing credibility. Third, individuals at this stage are especially receptive to approaches that are more action oriented and aimed at external change Challenging racism) Also, group approaches with persons experiencing similar racial/cul- tural issues are well received. It is important that the therapist be willing to help the culturally different client explore new ways of relating to both mi- nority and White persons. Introspection Stage :Therapeutic Implications Clients at the introspection stage may continue to prefer a therapist of their own race, but they are also receptive to help from therapists of other cultures as long as the therapists understand their worldview. Ironically, clients at this stage may, on the surface, appear similar to conformity persons. Introspection clients are in conflict between their need to identify with their minority group and their need to exercise greater personal freedom. Exercising personal au- tonomy may occasionally mean going against the wishes or desires of the mi- nority group. This is often perceived by minority persons and their group as a rejection of their own cultural heritage. This is not unlike conformity per- sons, who also reject their racial/cultural heritage. The dynamics between the two groups, however, are quite dissimilar. It is very important for therapists to distinguish the differences. The conformity person moves away from his or her own group because of perceived negative qualities associated with it. The introspection person wants to move away on certain issues but perceives the group positively. Again, self-exploration approaches aimed at helping the cli- ent integrate and incorporate a new sense of identity are important. Believ- ing in the functional values of White American society does not necessarily mean that a person is selling out or going against his or her own group. Integrative Awareness Stage :Therapeutic Implications Clients at this stage have acquired an inner sense of security as to self-identity. They have pride in their racial/cultural heritage but can exercise a desired level of personal freedom and autonomy. Other cultures and races are appre- ciated, and there is a development toward becoming more multicultural in perspective. While discrimination and oppression remain a powerful part of their existence, integrative awareness persons possess greater psychological resources to deal with these problems. Being action or systems oriented, cli- ents respond positively to the designing and implementation of strategies aimed at community and societal change. Preferences for therapists are not

Racial/ Cultural identity Development in People of Color


based on race, but on those who can share, understand, and accept their worldviews. In other words, attitudinal similarity between therapist and cli- ent is a more important dimension than membership-group similarity.

We have already given considerable space to outlining specific therapeutic suggestions, so a repeat of these would be redundant. Rather, in proposing the R/CID model, we have been very aware of some major cautions and pos- sible limitations that readers should take into account in working with mi- nority clients. 1 . Be aware that the R/CID model should not be viewed as a global per- sonality theory with specific identifiable stages that serve as fixed cate- gories. The process of cultural identity development is dynamic, not static. One of the major dangers is to use these stages as fixed entities. In actuality, the model should serve as a conceptual framework to help us understand development. 2. Do not fall victim to stereotyping in using these models. Most minority clients may evidence a dominant characteristic, but there are mixtures from other stages as well. Furthermore, situations and the types of pre- senting problems may make some characteristics more manifest than others. It is possible that minority clients may evidence conformity characteristics in some situations but resistance and immersion charac- teristics in others. 3. Know that minority development models are conceptual aids and that human development is much more complex. A question often raised in the formulation of cultural identity development models is whether identity is a linear process. Do individuals always start at the beginning of these stagesls it possible to skip stagesXlan people regressln gen- eral, our clinical experience has been that minority and majority indi- viduals in this society do tend to move at some gross level through each of the identifiable stages. Some tend to move faster than others, some tend to stay predominately at only one stage, and some may regress. 4. Know that identity development models begin at a point that involves interaction with an oppressive society. Most of these are weak in for- mulating a stage prior to conformity characteristics. Recent Asian im- migrants to the United States are a prime example of the inadequacy of cultural identity development models. Many of the Asian immigrants tend to hold very positive and favorable views of their own culture and possess an intact racial/cultural identity already. What happens when

258 identity Development In Multicultural Counseling and Therapy

they encounter a society that views cultural differences as being de- viantTWill they or their offspring move through the conformity stage as presented in this model? 5. Be careful of the implied value judgments given in almost all develop- ment models. They assume that some cultural resolutions are healthier than others. For example, the R/CID model obviously does hold the in- tegrative awareness stage as a higher form of healthy functioning. 6. Be aware that racial/cultural identity development models seriously lack an adequate integration of gender, class, sexual orientation, and other sociodemographic group identities. William Cross has made some beginning attempts to do so. 7. Know that racial/cultural identity is not a simple, global concept. A great deal of evidence is mounting that while identity may sequentially move through identifiable stages, affective, attitudinal, cognitive, and behavioral components of identity may not move in a uniform manner. For example, it is entirely possible that the emotions and affective ele- ments associated with certain stages do not have a corresponding one- to-one behavioral impact. 8. Begin to look more closely at the possible therapist and client stage com- binations. As mentioned earlier, therapeutic processes and outcomes are often the function of the identity stage of both therapist and client. White identity development of the therapist can either enhance or re- tard effective therapy.

White Racial Identity Development: Therapeutic Implications

What Does It Mean to Be White?

42 -year-old White businessman Q: What does it mean to be White? A: Frankly, I don 't know what you 're talking about! Q: Aren't you White? A: Yes, but I come from Italian heritage. I'm Italian, not White. Q: Well then, what does it mean to be Italian? A: Pasta, good food, love of wine [obviously agitated]. This is getting ridiculous!


OBSERVATIONS: Denial and/or conflicted about being White. Claims Italian heritage, but unable to indicate more than superficial understanding of ethnic meaning. Expresses annoyance at the question.

2 6 -year- old White female college student Q: What does it mean to be White? A: Is this a trick question? [pause] I've never thought about it. Well, I know that lots of Black people see us as being prejudiced and all that stuff. I wish people would just forget about race differences and see one another as human beings. People are people and we should all be proud to be Americans.

OBSERVATIONS: Seldom thinks about being White. Defensive about prejudicial associations with Whiteness. Desires to eliminate or dilute race differences.

6 5 -year-old White male retired construction worker Q: What does it mean to be White? A: That's a stupid question [sounds irritated]! Q: Why?



identity Development in Multicultural Counseling and Therapy

Look, whatareyou . . . Oriental? You people are always blaming us for stereo- typing, and here you are doing the same to us. When you say "us, " to whom are you referring? I'm referring to Americans who aren 't colored. We are all different from one another. I'm Irish, but there are Germans, Italians, and those Jews. I get an- gry at the colored people for always blaming us. When my grandparents came over to this country, they worked 24 hours a day to provide a good living for their kids. My wife and I raised five kids, and I worked every day of my life to provide for them. No one gave me nothing! I get angry at the Black people for always whining. They just have to get off their butts and work rather than going on welfare. At least you people [reference to Asian Americans] work hard. The Black ones could learn from your people. OBSERVATIONS: Believes question stereotypes Whites and expresses resentment with being categorized. Views White people as ethnic group. Expresses belief that anyone can be successful if they work hard. Believes African Americans are lazy and that Asian Americans are successful. Strong anger directed toward minority groups. 34-year-old White female stockbroker Q: What does it mean to be White? A: I don 't know [laughing]. I've never thought about it. Q: Are you White? A: Yes, I suppose so [seems very amused]. 0: Why haven 'tyou thought about it? A: Because it's not important to me. Q: Why not? A: It doesn 't enter into my mind because it doesn 't affect my life. Besides, we are all unique. Color isn 't important. OBSERVATIONS: Never thought about being White because it's unimportant. People are individuals, and color isn 't important. These are not atypical responses given by White Euro-Americans when asked this question. When people of color are asked the same question, their answers tended to be more specific: 29-year-old Latina administrative assistant 0: What does it mean to be White? A: I'm not White; I'm Latina! Q: Are you upset with me? A: No Its just that I'm light, so people always think I'm White. Its only when I speak that they realize I'm Hispanic.

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Q: Well, what does it mean to be White? A: Doyou really wantto know?. . . Okay, it means you're always right. Itmeans you never have to explain yourself or apologize You know that movie [Love Story, which features the line, "Love means never having to say you 're sorry]? Well, being White is never having to say you're sorry. It means they think they 're better than us. OBSERVATIONS: Strong reaction to being mistaken for being White. Claims that being White makes people feel superior and is reflected in their disinclination to admit being wrong. 39-year-old Black male salesman Q: What does it mean to be White? A: Is this a school exercise or something? Never expected someone to ask me that question in the middle of the city. Do you want the politically correct answer or what I really think? Q: Can you tell me what you really think? A: You won 't quit, will you [laughing]? If you 're White, you 're right. If you 're Black, step back. Q: What does that mean? A: White folks are always thinking they know all the answers. A Black man's word is worth less than a White man 's. When White customers come into our dealership and see me standing next to the cars, I become invisible to them. Ac- tually, they may see me as a well-dressed janitor [laughs], or actively avoid me. They will search out a White salesman. Or when I explain something to a customer, they always check out the information with my White colleagues. They don 't trust me. When I mention this to our manager, who is White, he tells me I'm oversensitive and being paranoid. That's what being White means. It means having the authority or power to tell me what's really hap- pening even though I know it's not. Being White means you can fool yourself into thinking that you 're not prejudiced, when you are. That's what it means to be White. OBSERVATIONS: Being White means you view minorities as less competent and ca- pable. You have the power to define reality. You can deceive yourself into believing you 're not prejudiced. 21 -year-old Chinese American male college student ^najoring in ethnic studies) 0: What does it mean to be White? A: My cultural heritage class was just discussing that question this week. 0: What was your conclusion?


identity Development in Multicultural Counseling and Therapy

A: Well, it has to do with White privilege. I read an article by a professor at Wellesley. It made a lot of sense to me. Being White in this society automati- cally guarantees you better treatment and unearned benefits and privileges than minorities. Having white skin means you have the freedom to choose the neighborhood you live in. You won 't be discriminated against. When you en- ter a store, security guards won 't assume you will steal something. You can flag down a cab without the thought they won 'tpickyou up because you 're a minority. You can study in school and be assured your group will be portrayed positively. You don 't have to deal with race or think about it. Q: Are White folks aware of their White privilege? A: Hell no! They 're oblivious to it. OBSERVATIONS: Being White means having unearned privileges in our society. It means you are oblivious to the advantages of being White. D. W. Sue, 2003, pp. 115+20) The Invisible Whiteness of Being The responses given by White Euro-Americans and persons of color are radi- cally different from one another. Yet the answers given by both groups are quite common and representative of the range of responses students give in our diversity and multicultural classes. White respondents would rather not think about their Whiteness, are uncomfortable or react negatively to being labeled White, deny its importance in affecting their lives, and seem to believe that they are unjustifiably accused of being bigoted simply because they are White. Strangely enough, Whiteness is most visible to people of color when it is denied, evokes puzzlement or negative reactions, and is equated with nor- malcy. Few people of color react negatively when asked what it means to be Black, Asian American, Latino, or a member of their race. Most could readily inform the questioner about what it means to be a person of color. There sel- dom is a day, for example, in which we the authors)are not reminded of being racially and culturally different from those around us. Yet Whites often find the question about Whiteness quite disconcerting and perplexing. It appears that the denial and mystification of Whiteness for White Euro-Americans are related to two underlying factors. First, most people sel- dom think about the air that surrounds them and about how it provides an essential life-giving ingredient, oxygen. We take it for granted because it ap- pears plentiful; only when we are deprived of it does it suddenly become frighteningly apparent. Whiteness is transparent precisely because of its everyday occurrenceits institutionalized normative features in our cul- tureand because Whites are taught to think of their lives as morally neu-

White Racial identity Development 263

tral, average, and ideal p. W. Sue, 2004) To people of color, however, Whiteness is not invisible because it may not fit their normative qualities yalues, lifestyles, experiential reality, etc.) Persons of color find White cul- ture quite visible because even though it is nurturing to White Euro- Americans, it may invalidate the lifestyles of multicultural populations. Second, Euro-Americans often deny that they are White, seem angered by being labeled as such, and often become very defensive \.e., I'm not White, I'm Irish."You're stereotyping, because we're all different/There isn't anything like a White race J In many respects, these statements have validity. Nonetheless, many White Americans would be hard pressed to de- scribe their Irish, Italian, German, or Norwegian heritage in any but the most superficial manner. One of the reasons is related to the processes of assimila- tion and acculturation. While there are many ethnic groups, being White al- lows for assimilation. While persons of color are told to assimilate and ac- culturate, the assumption is that there exists a receptive society. Racial minorities are told in no uncertain terms that they are allowed only limited access to the fruits of our society. Thus, the accuracy of whether Whiteness defines a race is largely irrelevant. What is more relevant is that Whiteness is associated with unearned privilegeadvantages conferred on White Ameri- cans but not on persons of color. It is our contention that much of the denial associated with being White is related to the denial of White privilege, an is- sue we explore in a moment. Understanding the Dynamics of Whiteness Our analysis of the responses from both Whites and persons of color leads us to the inevitable conclusion that part of the problem of race relations ^nd by inference multicultural counseling and therapy)lies in the different world- views of both groups. It goes without saying that the racial reality of Whites is radically different from people of color p. W. Sue, 2005) Which group, however, has the more accurate assessment related to this topicTThe answer seems to be contained in the following series of questions:If you want to un- derstand oppression, should you ask the oppressor or the oppressed^ you want to learn about sexism, do you ask men or womenlf you want to un- derstand homophobia, do you ask straights or gays?If you want to learn about racism, do you ask Whites or persons of colorlt appears that the most accurate assessment of bias comes not from those who enjoy the privilege of power, but from those who are most disempowered I-Ianna, Talley, 8&uin- don, 2000;Neville et al., 2001) Taking this position, the following assump- tions are made about the dynamics of Whiteness. First, it is clear that most White folks perceive themselves as unbiased in- dividuals who do not harbor racist thoughts and feelings;they see themselves

264 identity Development In Multicultural Counseling and Therapy

as working toward social justice and possess a conscious desire to better the life circumstances of those less fortunate than they. While admirable qualities, this self-image serves as a major barrier to recognizing and taking responsibility for admitting and dealing with one's own prejudices and biases. To admit to being racist, sexist, or homophobic requires people to recognize that the self-images that they hold so dear are based on false notions of the self. Second, being a White person in this society means chronic exposure to ethnocentric monoculturalism as manifested in White supremacy £onstan- tine, 2006) It is difficult, if not impossible, for anyone to avoid inheriting the racial biases, prejudices, misinformation, deficit portrayals, and stereotypes of their forebears fokley, 2006) To believe that one is somehow immune from inheriting such aspects of White supremacy is to be naive or to engage in self- deception. Such a statement is not intended to assail the integrity of Whites, but to suggest that they also have been victimized. It is clear to us that no one was born wanting to be racist, sexist, or homophobic. Misinformation is not acquired by free choice, but is imposed upon White people through a painful process of cultural conditioning. In general, lacking awareness of their biases and preconceived notions, counselors may function in a therapeutically inef- fective manner. Third, if White helping professionals are ever able to become effective multicultural counselors or therapists, they must free themselves from the cultural conditioning of their past and move toward the development of a nonracist White identity. Unfortunately, many White Euro-Americans sel- dom consider what it means to be White in our society. Such a question is vexing to them because they seldom think of race as belonging to thenmer of the privileges that come their way by virtue of their white skin. Katz J 985, pp. 616617)points out a major barrier blocking the process of White Euro- Americans investigating their own cultural identity and worldview: Because White culture is the dominant cultural norm in the United States, it acts as an invisible veil that limits many people from seeing it as a cultural system Often, it is easier for many Whites to identify and acknowledge the different cul- tures of minorities than accept their own racial identity The difficulty of ac- cepting such a view is that White culture is omnipresent. It is so interwoven in the fabric of everyday living that Whites cannot step outside and see their beliefs, val- ues, and behaviors as creating a distinct cultural group. Ridley J 995, p. 38)asserts that this invisible veil can be unintention- ally manifested in therapy with harmful consequences to minority clients: Unintentional behavior is perhaps the most insidious form of racism. Uninten- tional racists are unaware of the harmful consequences of their behavior. They may be well-intentioned, and on the surface, their behavior may appear to be re-

White Racial identity Development 265

sponsible. Because individuals, groups, or institutions that engage in uninten- tional racism do not wish to do harm, it is difficult to get them to see themselves as racists. They are more likely to deny their racism. The conclusion drawn from this understanding is that White counselors and therapists may be unintentional racists:J JThey are unaware of their bi- ases, prejudices, and discriminatory behaviors;? )they often perceive them- selves as moral, good, and decent human beings and find it difficult to see themselves as racist; ?)they do not have a sense of what their Whiteness means to them;and 4)their therapeutic approaches to multicultural popu- lations are likely to be more harmful ^tnintentionally)than helpful. These conclusions are often difficult for White helping professionals to accept be- cause of the defensiveness and feelings of blame they are likely to engender. Nonetheless, we ask that White therapists and students not be turned off by the message and lessons of this chapter. We ask you to continue your multi- cultural journey in this chapter as we explore the question, What does it mean to be White?

Models of White Racial identity Development A number of multicultural experts in the field have begun to emphasize the need for White therapists to deal with their concepts of Whiteness and to ex- amine their own racism forvin fWiggins, 1989;Helms, 1984, 1990;Pon- terotto, 1988;D. W. Sue et al., 1998) These specialists point out that while racial/cultural identity development for minority groups proves beneficial in our work as therapists, more attention should be devoted toward the White therapist's racial identity. Since the majority of therapists and trainees are White middle-class individuals, it would appear that White identity develop- ment and its implication for multicultural counseling/therapy would be im- portant aspects to consider, both in the actual practice of clinical work and in professional training. For example, research has found that the level of White racial identity awareness is predictive of racism pope-Davis SDttavi, 1994; Wang, David- son, Yakushko, Savoy, Tan, fBleier, 2003)|)The less aware subjects were of their White identity, the more likely they were to exhibit increased levels of racism; and 2)women were less likely to be racist $panierman, Poteat, Beer {Armstrong, 2006) It was suggested that this last finding was corre- lated with women's greater experiences with discrimination and prejudice. Evidence also exists that multicultural counseling/therapy competence is correlated with White racial identity attitudes Neville et al. 2001) Other research suggests that a relationship exists between a White Euro-American therapist's racial identity and his or her readiness for training in multicultural

266 identity Development In Multicultural Counseling and Therapy

awareness, knowledge, and skills Carney fKahn, 1984;Helms, 1990;Sab- nani, Ponterotto, SBorodovsky, 1991;Utsey, Gernat, SHammar, 2005) Since developing multicultural sensitivity is a long-term developmental task, the work of many researchers has gradually converged toward a conceptual- ization of the stages/levels/statuses of consciousness of racial/ethnic identity development for White Euro-Americans. A number of these models describe the salience of identity for establishing relationships between the White ther- apist and the culturally different client, and some have now linked stages of identity with stages for appropriate training Bennett, f 986;Carney SCahn, 1984;Sabnanietal., 1991) The Hardiman White Racial Identity Development Model One of the earliest integrative attempts at formulating a White racial identity development model is that of Rita Hardiman \ 982) Intrigued with why cer- tain White individuals exhibit a much more nonracist identity than do other White Americans, Hardiman studied the autobiographies of individuals who had attained a high level of racial consciousness. This led her to identify five White developmental stages:(J ^lavetfeck of social consciousness, 2 Ac- ceptance, ^resistance, 4 (redefinition, and ^internalization. 1. The naivete stage Jack of social consciousnesses characteristic of early childhood, when we are born into this world innocent, open, and un- aware of racism and the importance of race. Curiosity and spontaneity in relating to race and racial differences tend to be the norm. A young White child who has almost no personal contact with African Ameri- cans, for example, may see a Black man in a supermarket and loudly comment on the darkness of his skin. Other than the embarrassment and apprehensions of adults around the child, there is little discomfort associated with this behavior for the youngster. In general, awareness and the meaning of race, racial differences, bias, and prejudice are either absent or minimal. Such an orientation becomes less characteristic of the child as the socialization process progresses. The negative reactions of parents, relatives, friends, and peers toward issues of race, however, begin to convey mixed signals to the child. This is reinforced by the edu- cational system and mass media, which instill racial biases in the child and propel him or her into the acceptance stage. 2. The acceptance stage is marked by a conscious belief in the democratic ideal-that everyone has an equal opportunity to succeed in a free soci- ety and that those who fail must bear the responsibility for their failure. White Euro-Americans become the social reference group, and the so- cialization process consistently instills messages of White superiority and

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minority inferiority into the child. The underemployment, unemploy- ment, and undereducation of marginalized groups in our society are seen as support that non-White groups are lesser than Whites. Because everyone has an equal opportunity to succeed, the lack of success of mi- nority groups is seen as evidence of some negative personal or group characteristic Tow intelligence, inadequate motivation, or biological/ cultural deficits) Victim blaming is strong as the existence of oppression, discrimination, and racism is denied. Hardiman believes that while the navetstage is brief in duration, the acceptance stage can last a lifetime. 3. Over time, the individual begins to challenge assumptions of White su- periority and the denial of racism and discrimination. Moving from the acceptance stage to the resistance stage can prove to be a painful, con- flicting, and uncomfortable transition. The White person's denial sys- tem begins to crumble because of a monumental event or a series of events that not only challenge but also shatter the individual's denial system. A White person may, for example, make friends with a minor- ity coworker and discover that the images he or she has of these people"are untrue. They may have witnessed clear incidents of unfair discrimination toward persons of color and may now begin to question assumptions regarding racial inferiority. In any case, the racial realities of life in the United States can no longer be denied. The change from one stage to another might take considerable time, but once completed, the person becomes conscious of being White, is aware that he or she harbors racist attitudes, and begins to see the pervasiveness of oppres- sion in our society. Feelings of anger, pain, hurt, rage, and frustration are present. In many cases, the White person may develop a negative reaction toward his or her own group or culture. While they may ro- manticize people of color, they cannot interact confidently with them because they fear that they will make racist mistakes. This discomfort is best exemplified in a passage by Sara Winter J 977, p. 1) We avoid Black people because their presence brings painful questions to mind. Is it OK to talk about watermelons or mention "black coffee "? Should we use Black slang and tell racial jokes? How about talking about our experiences in Harlem, or mentioning our Black lovers? Should we conceal the fact that our mother still employs a Black cleaning lady?. . . We're embarrassedly aware of trying to do our best but to "act natural " at the same time. No wonder we 're more comfortable in ail-White situations where these dilemmas don 't arise. According to Hardiman J 982) the discomfort in realizing that one is White and that one's group has engaged in oppression of racial/ethnic minorities may propel the person into the next stage.

268 identity Development In Multicultural Counseling and Therapy

4. Asking the painful question of who one is in relation to one's racial her- itage, honestly confronting one's biases and prejudices, and accepting responsibility for one's Whiteness are the culminating marks of the re- definition stage. New ways of defining one's social group and one's mem- bership in that group become important. The intense soul searching is most evident in Winter's personal journey as she writes, In this sense we Whites are the victims of racism. Our victimization is different from that of Blacks, but it is real. We have been programmed into the oppressor roles we play, without our informed consent in the process. Our unawareness is part of the programming: None of us could tolerate the oppressor position, if we lived with a day-to-day emotional awareness of the pain inflicted on other hu- mans through the instrument of our behavior. ...We Whites benefit in concrete ways, year in and year out, from the present racial arrangements. All my life in White neighborhoods, White schools, White jobs and dealing with White police (to name only a few), I have experienced advantages that are systematically not available to Black people. It does not make sense for me to blame myself for the advantages that have come my way by virtue of my Whiteness. But absolving my- self from guilt does not imply forgetting about racial injustice or taking it lightly (as my guilt pushes me to do). (Winter, 1977, p. 2) There is realization that Whiteness has been defined in opposition to people of colorfiamely, by standards of White supremacy. By being able to step out of this racist paradigm and redefine what her Whiteness meant to her, Winter is able to add meaning to developing a nonracist identity. The extremes of good/bad or positive/negative attachments to White"and people of color'begin to become more realistic. The per- son no longer denies being White, honestly confronts one's racism, un- derstands the concept of White privilege, and feels increased comfort in relating to persons of color. 5 . The internalization stage is the result of forming a new social and personal identity. With the greater comfort in understanding oneself and the de- velopment of a nonracist White identity comes a commitment to social action as well. The individual accepts responsibility for effecting per- sonal and social change without always relying on persons of color to lead the way. As Winter explains, To end racism, Whites have to pay attention to it and continue to pay attention. Since avoidance is such a basic dynamic of racism, paying attention will not hap- pen naturally. We Whites must learn how to hold racism realities in our atten- tion. We must learn to take responsibility for this process ourselves, without wait- ing for Blacks' actions to remind us that the problem exists, and without depending on Black people to reassure us and forgive us for our racist sins. In my

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experience, the process is painful but it is a relief to shed the fears, stereotypes, im- mobilizing guilt we didn't want in the first place. (1977, p. 2) The racist-free identity, however, must be nurtured, validated, and sup- ported in order to be sustained in a hostile environment. Such an indi- vidual is constantly bombarded by attempts to be resocialized into the oppressive society. There are several potential limitations to the Hardiman }982)model: \)The select and limited sample that she uses to derive the stages and enu- merate the characteristics makes potential generalization suspect;? )the au- tobiographies of White Americans are not truly representative, and their ex- periences with racism may be bound by the era of the times;? )the stages are tied to existing social identity development theories, and the model proposes a navetestage that for all practical purposes exists only in children ages 3 to 4 years \t appears tangential in her model and might better be conceptual- ized as part of the acceptance stage of socialization)and 4)there have been no direct empirical or other postmodern methods of exploration concerning the model to date. Despite these cautions and potential limitations, Hardiman has contributed greatly to our understanding of White identity development by focusing attention on racism as a central force in the socialization of White Americans. The Helms White Racial Identity Development Model Working independently of Hardiman, Janet Helms }984, 1990, 1994, 1995) created perhaps the most elaborate and sophisticated White racial identity model yet proposed. Helms is arguably the most influential White identity de- velopment theorist. Not only has her model led to the development of an as- sessment instrument to measure White racial identity, but it also has been scrutinized empirically garter, 1990;Helms 8£arter, 1990)and has gener- ated much research and debate in the psychological literature. Like Hardiman 1 982) Helms assumes that racism is an intimate and central part of being a White American. To her, developing a healthy White identity requires move- ment through two phases: ^abandonment of racism and 2) defining a nonracist White identity. Six specific racial identity statuses are distributed equally in the two phases xontact, disintegration, reintegration, pseudoinde- pendence, immersion/emersion, and autonomy. Originally, Helms used the term stages to refer to the six, but because of certain conceptual ambiguities and the controversy that ensued, she has abandoned its usage. 1 . Contact status. People in this status are oblivious to and unaware of racism, believe that everyone has an equal chance for success, lack an under- standing of prejudice and discrimination, have minimal experiences

270 identity Development in Multicultural Counseling and Therapy with persons of color, and may profess to be color-blind. Such statements as People are people, T don't notice a person's race at all, "and You don't act Black'are examples. While there is an attempt to minimize the importance or influence of race, there is a definite dichotomy of Blacks and Whites on both a conscious and unconscious level regarding stereo- types and the superior/inferior dimensions of the races. Because of obliv- iousness and compartmentalization, it is possible for two diametrically opposed belief systems to coexist:^ (Uncritical acceptance of White su- premacist notions relegates minorities into the inferior category with all the racial stereotypes, and £)there is a belief that racial and cultural dif- ferences are considered unimportant. This allows Whites to avoid per- ceiving themselves as dominant group members, or of having biases and prejudices. Such an orientation is aptly stated by Peggy Mcintosh in her own White racial awakening: My schooling gave me no training in seeing myself as an oppressor, as an unfairly advantaged person, or as a participant in a damaged culture. I was taught to see myself as an individual whose moral state depended on her individual moral will Whites are taught to think of their lives as morally neutral, normative, and average, and also ideal, so that when we work to benefit others, this is seen as work which will allow "them " to be more like "us. " (1989, p. 8) 2. Disintegration status. While in the previous status the individual does not recognize the polarities of democratic principles of equality and the un- equal treatment of minority groups, such obliviousness may eventually break down. The White person becomes conflicted over irresolvable racial moral dilemmas that are frequently perceived as polar opposites: believing one is nonracist, yet not wanting one's son or daughter to marry a minority group member; believing that all men are created equal, even though society treats Blacks as second-class citizens; and not acknowledging that oppression exists, and then witnessing it £.g„ the beating of Rodney King) Conflicts between loyalty to one's group and humanistic ideals may manifest themselves in various ways. The person becomes increasingly conscious of his or her Whiteness and may experience dissonance and conflict, resulting in feelings of guilt, de- pression, helplessness, or anxiety. Statements such as, My grandfather is really prejudiced, but I try not to be"and i'm personally not against interracial marriages, but I worry about the children, "are representa- tive of personal struggles occurring in the White person. While a healthy resolution might be to confront the myth of mer- itocracy realistically, the breakdown of the denial system is painful and anxiety provoking. Attempts at resolution, according to Helms, may in- volve J (avoiding contact with persons of color, |!)not thinking about

White Racial identity Development 271 race, and peeking reassurance from others that racism is not the fault of Whites. 3. Reintegration status. This status can best be characterized as a regression in which the pendulum swings back to the most basic beliefs of White superiority and minority inferiority. In their attempts to resolve the dis- sonance created from the previous process, there is a retreat to the dom- inant ideology associated with race and one's own socioracial group identity. This ego status results in idealizing the White Euro-American group and the positives of White culture and society;there is a conse- quent negation and intolerance of other minority groups. In general, a firmer and more conscious belief in White racial superiority is present. Racial/ethnic minorities are blamed for their own problems. I'm an Italian grandmother. No one gave us welfare or a helping hand when we came over [immigrated]. My father worked day and night to provide us with a decent living and to put all of us through school. These Negroes are always com- plaining about prejudice and hardships. Big deal! Why don 't they stop whining and find a job? They're not the only ones who were discriminated against, you know. You don 't think our family wasn 't? We never let that stop us. In America everyone can make it if they are willing to work hard. I see these Black welfare mothers waiting in line for food stamps and free handouts. You can 't convince me they're starving. Look at how overweight most of them are Laziness — that's what I see. (quoted from a workshop participant) 4. Pseudoindependence status. This status represents the second phase of Helms's model, which involves defining a nonracist White identity. As in the Hardiman model, a person is likely to be propelled into this phase because of a painful or insightful encounter or event that jars the per- son from the reintegration status. The awareness of other visible racial/ ethnic minorities, the unfairness of their treatment, and a discomfort with their racist White identity may lead a person to identify with the plight of persons of color. There is an attempt to understand racial, cul- tural, and sexual orientation differences and a purposeful and conscious decision to interact with minority group members. However, the well- intentioned White person at this status may suffer from several prob- lematic dynamics: J) While intending to be socially conscious and helpful to minority groups, the White individual may unknowingly perpetuate racism by helping minorities adjust to the prevailing White standards;and £ (choice of minority individuals is based on how simi- lar they are to him or her, and the primary mechanism used to under- stand racial issues is intellectual and conceptual. As a result, under- standing has not reached the experiential and affective domains. In

272 identity Development In Multicultural Counseling and Therapy

other words, understanding Euro-American White privilege, socio- political aspects of race, and issues of bias, prejudice, and discrimination tend to be more an intellectual exercise. 5. Immersion/ emersion status. If the person is reinforced to continue a per- sonal exploration of him- or herself as a racial being, questions become focused on what it means to be White. Helms states that the person searches for an understanding of the personal meaning of racism and the ways in which one benefits from White privilege. There is an in- creasing willingness to confront one's own biases, to redefine White- ness, and to become more activistic in directly combating racism and oppression. This status is different from the previous one in two major ways:It is marked by \ )a shift in focus from trying to change Blacks to changing the self and other Whites and ^increasing experiential and affective understanding that was lacking in the previous status. This later process is extremely important. Indeed, Helms believes that a suc- cessful resolution of this status requires an emotional catharsis or re- lease that forces the person to relive or re-experience previous emotions that were denied or distorted. The ability to achieve this affective/expe- riential upheaval leads to a euphoria, or even a feeling of rebirth, and is a necessary condition to developing a new, nonracist White identity. As Winter states, Let me explain this healing process in more detail. We must unearth all the words and memories we generally try not to think about, but which are inside us all the time: "nigger, " "Uncle Tom, " "jungle bunny, " "Oreo, " lynching, cattle prods, castrations, rapists, "black pussy, " and black men with their huge penises, and hundreds more. (1 shudder as I write.) We need to review three different kinds of material: (1) All our personal memories connected with blackness and black people including everything we can recall hearing or reading; (2) all the racist images and stereotypes we 've ever heard, particularly the grossest and most hurt- ful ones; (3) any race-related things we ourselves said, did or omitted doing which we feel bad about today Most whites begin with a good deal of amne- sia. Eventually the memories crowd in, especially when several people pool rec- ollections. Emotional release is a vital part of the process. Experiencing feelings seems to allow further recollections to come. I need persistent encouragement from my companions to continue. (1977, p. 3) 6. Autonomy status. Increasing awareness of one's own Whiteness, reduced feelings of guilt, acceptance of one's role in perpetuating racism, and renewed determination to abandon White entitlement lead to an au- tonomy status. The person is knowledgeable about racial, ethnic, and cultural differences; values the diversity; and is no longer fearful, in-

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timidated, or uncomfortable with the experiential reality of race. De- velopment of a nonracist White identity becomes increasingly strong. Indeed, the person feels comfortable with his or her nonracist White identity does not personalize attacks on White supremacy and can ex- plore the issues of racism and personal responsibility without defen- siveness. A person in this status walks the talk'and actively values and seeks out interracial experiences. Characteristics of the autonomy sta- tus can be found in the personal journey of Kiselica: / was deeply troubled as I witnessed on a daily basis the detrimental effects of in- stitutional racism and oppression on ethnic-minority groups in this country. The latter encounters forced me to recognize my privileged position in our society be- cause of my status as a so-called Anglo. It was upsetting to know that I, a mem- ber of White society, benefited from the hardships of others that were caused by a racist system. I was also disturbed by the painful realization that I was, in some ways, a racist. I had to come to grips with the fact that I had told and laughed at racist jokes and, through such behavior, had supported White racist attitudes. If I really wanted to become an effective, multicultural psychologist, extended and profound self-reckoning was in order. At times, I wanted to flee from this un- pleasant process by merely participating superficially with the remaining tasks . . . while avoiding any substantive self-examination. (1998, pp. 10-1 1 ) Helm's model is by far the most widely cited, researched, and applied of all the White racial identity formulations. Part of its attractiveness and value is the derivation of defenses/protective strategies, "or what Helms {995) formally labels information-processing strategies JPSs) which White people use to avoid or assuage anxiety and discomfort around the issue of race. Each sta- tus has a dominant IPS associated with it: contact obliviousness or denial;d«- integration suppression and ambiva\ence;reintegration selective perception and negative out-group distortion;pseudoindependence reshaping reality and selective perception;immersion/emersion =hypervigilance and reshaping:and autonomy flexibility and complexity. Table 11.1 lists examples of IPS state- ments likely to be made by White people in each of the six ego statuses. Understanding these strategic reactions is important for White American identity development, for understanding the barriers that must be overcome in order to move to another status, and for potentially developing effective training or clinical strategies. The Helms model, however, is not without its detractors. In an article critical of the Helms model and of most Stage'models of White racial iden- tity development, Rowe, Bennett, and Atkinson J994)raised some serious objections. First, they claim that Helms's model is erroneously based on racial/ethnic minority identity development models discussed in the previ- ous chapter) Because minority identity development occurs in the face of

2 74 identity Development in Multicultural Counseling and Therapy Table 11.1 White Racial Identity Ego Statuses and Information-Processing Strategies 1. Contact status: satisfaction with racial status quo, obliviousness to racism and one's participation in it. If racial factors influence life decisions, they do so in a simplistic fashion. Information-processing strategy IPS)Obliviousness. Example:I"m a White woman. When my grandfather came to this country, he was discriminated against, too. But he didn't blame Black people for his misfortunes. He educated himself and got a job:That's what Blacks ought to do. If White callers to a radio station]spent as much time complaining about racial discrimination as your Black callers do, we'd never have accomplished what we have. You all should just ignore if'quoted from a workshop participant) 2. Disintegration status: disorientation and anxiety provoked by irresolvable racial moral dilemmas that force one to choose between own-group loyalty and humanism. May be stymied by life situations that arouse racial dilemmas. IPS:Suppression and ambivalence. Example:! myself tried to set a nonracist example for other Whites]by speaking up when someone said something blatantly prejudiced-how to do this without alienating people so that they would no longer take me seriously was always tricky-and by my friendships with Mexicans and Blacks who were actually the people with whom I felt most comfortable'Blauner, 1993, p. 8) 3. Reintegration status: idealization of one's socioracial group, denigration, and intolerance for other groups. Racial factors may strongly influence life decisions. IPS:Selective perception and negative out-group distortion. Example:So what if my great-grandfather owned slaves. He didn't mistreat them and besides, I wasn't even here then. I never owned slaves. So, I don't know why Blacks expect me to feel guilty for something that happened before I was born. Nowadays, reverse racism hurts Whites more than slavery hurts Blacks. At least they got three square (neals]a day. But my brother can't even get a job with the police department because they have to hire less-qualified Blacks. That £ xpletive]happens to Whites all the time'quoted from a workshop participant) 4. Pseudoindependence status: intellectualized commitment to one's own socioracial group and deceptive tolerance of other groups. May make life decisions to help other racial groups. TPS:Reshaping reality and selective perception. Example:Was I the only person left in American who believed that the sexual mingling of the races was a good thing, that it would erase cultural barriers and leave us all a lovely shade of tan?. . . Racial blending is inevitable. At the very least, it may be the only solution to our dilemmas of race'Allen, 1994, p. C4) 5. Immersion/emersion status: search for an understanding of the personal meaning of racism and the ways by which one benefits and a redefinition of Whiteness. Life choices may incorporate racial activism. IPS:Hypervigilance and reshaping. Exampleift's true that I personally did not participate in the horror of slavery, and I don't even know whether my ancestors owned slaves. But I know that because I am White, I continue to benefit from a racist system that stems from the slavery era. I believe that if White people are ever going to understand our role in perpetuating racism, then we must begin to ask ourselves some hard questions and be willing to consider our role in maintaining a hurtful system. Then, we must try to do something to change if'quoted from a workshop participant)

White Racial identity Development 275 Table 11.1 continued 6. Autonomy status: informed positive socioracial group commitment, use of internai standards for self- definition, capacity to relinquish the privileges of racism. May avoid life options that require participation in racial oppression. IPS:Flexibility and complexity. Example:! live in an integrated Black-White]neighborhood and I read Black literature and popular magazines. So, I understand that the media presents a very stereotypic view of Black culture. I believe that if more of us White people made more than a superficial effort to obtain accurate information about racial groups other than our own, then we could help make this country a better place for all peoples"quoted from a workshop participant) Source: Helms J995, p. 185) stereotyping and oppression, it may not apply to White identity, which does not occur under the same conditions. Second, they believe that too much emphasis is placed on the development of White attitudes toward minorities, and that not enough is placed on the development of White attitudes toward themselves and their own identity. Third, they claim that there is a concep- tual inaccuracy in putting forth the model as developmental via stages tin- ear )and that the progression from less to more healthy seems to be based on the author's ethics. Last, Rowe £006)attacks the Helms model of white racial identity development because it is based upon the White Racial Identity At- titude Scale Helms EEarter, 1990)which he labels a pseudoscience"be- cause he asserts that the psychometric properties are not supported by the empirical literature. It is important to note that the critique of the Helms l^984)model has not been left unanswered. In subsequent writings, Helms \ 994, 1995)has disclaimed the Rowe et al. |994)characterization of her model and has attempted to clarify her position. The continuing debate has proven beneficial for two reasons. First, the Helms model has evolved and changed Whether because of these criticisms or not) so that it has become even more intricate and clear. For example, Helms denies ever being a stage theorist, but to prevent continuing future confusion, she now prefers the term status and describes her thinking on this issue in detail Helms, 1995) Second, in responding to the Helms model, Rowe et al. J994)offered an alternative means of conceptualizing White identity that has contributed to the increasing understanding of White iden- tity development. Briefly, Rowe et al. }994)prefer to conceptualize White racial identity as one of types or statuses rather than stages. They take care in explaining that these types are not fixed entities but are subject to experiential modification. They propose two major groupings, with seven types of racial consciousness: unachieved Avoidant, dependent, and dissonant)and achieved dominative, conflictive, reactive, and integrative) Movement from type to type is depend- ent on the creation of dissonance, personal attributes, and the subsequent

276 identity Development in Multicultural Counseling and Therapy

Table 11.2 Rowe, Bennett, and Atkinson's Model of White Racial Consciousness Types and Their Characteristics

I. Unachieved A. Avoidant types ignore, avoid, deny, or minimize racial issues. They do not consider their own racial identity, nor are they seemingly aware of minority issues. B. Dependent types have minimal racial attitudes developed through person experience or consideration. They most often follow the lead of significant others in the life, such as would a child with his or her parent. C. Dissonant types often feel conflict between their belief systems and contradictory experiences. This type may break away from these attitudes depending on the degree of support or the intensity of the conflict. As such, it is a transitory status for the person. n. Achieved A. Dominative types are very ethnocentric and believe in White superiority and minority inferiority. They may act out their biases passively or actively. B. Conflictive types oppose direct and obvious discrimination but would be unwilling to change the status quo. Most feel that discrimination has been eliminated and that further efforts constitute reverse racism. C. Reactive types have good awareness that racism exists but seem unaware of their personal responsibility in perpetuating it. They may overidentify with or be paternalistic toward minorities. D. Integrative types have integrated their sense of Whiteness with a regard for racial/ethnic minorities . . . fmd]integrate rational analysis, on the one hand, and moral principles, on the other, as they relate to a variety of racial/ethnic issues'Kowe, Bennett, {Atkinson, 1994, p. 141)

environmental conditions encountered by the person. As a result, the primary gateway for change involves the dissonant type. Persons can move between all types except two unachieved ones, avoidant and dependent. These latter two are characterized by a lack of internalized attitudes. Space does not permit an extended discussion of the model;we have chosen to summarize these types and their characteristics in Table 1 1.2.

The Vrocess of White Racial identity Development: A Descriptive Model Analysis of the models just discussed reveals some important differences. First, the identity development models seem to focus on a more definite and sequential movement through stages or statuses. They differ, however, in where they place the particular stages or statuses in the developmental pro- cess. Given that almost all models now entertain the possibility that develop- ment can vary kioping and recycling) the consciousness development

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model allows greater latitude conceptually for movement to various types. Rowe et al. ^994)seem to offer a more fluid process of racial experience by White people. Consequently, the model is also less bound by the context or era of the times identity formed during the civil rights movement versus cur- rent times) The addition of nonachieved statuses is missing in the develop- ment theories and may capture more closely the passive'teel that Whites experience in their racial identity development. However, the essential concept of developing a positive White identity is conspicuously absent from the consciousness model. It lacks richness in al- lowing White people to view their developmental history better and to gain a sense of their past, present, and future. Struggling with racial identity and issues of race requires a historical perspective, which development theories offer. It is with this in mind that we have attempted to take aspects of White racial identity/consciousness development into consideration when formu- lating a descriptive model with practical implications. In our work with White trainees and clinicians, we have observed some very important changes through which they seem to move as they work toward multicultural competence. We have been impressed with how Whites seem to go through parallel racial/cultural identity transformations. This is especially true if we accept the fact that Whites are as much victims of socie- tal forces i.e., they are socialized into racist attitudes and beliefs)as are their minority counterparts. No child is born wanting to be a racist! Yet White people do benefit from the dominant-subordinate relationship in our society. It is this factor that Whites need to confront in an open and honest manner. Using the formulation of D. W. Sue and D. Sue }990)and D. W. Sue et al. } 998) we propose a seven step process that integrates many character- istics from the other formulations. Furthermore, we make some basic as- sumptions with respect to those models: })Racism is an integral part of U.S. life, and it permeates all aspects of our culture and institutions Ethnocentric monoculturalism$)Whites are socialized into the society and therefore in- herit all the biases, stereotypes, and racist attitudes, beliefs, and behaviors of the larger society;? Jhow Whites perceive themselves as racial beings follows an identifiable sequence that can occur in a linear or nonlinear fashion;4)the status of White racial identity development in any multicultural encounter affects the process and outcome of interracial relationships;and f )the most desirable outcome is one in which the White person not only accepts his or her Whiteness but also defines it in a nondefensive and nonracist manner. 1 . Naivete phase. This phase is relatively neutral with respect to racial/cul- tural differences. It lasts during the first 3 years of life and is marked by a nave curiosity about race. As mentioned previously, racial awareness and burgeoning social meanings are absent or minimal and the young child is generally innocent, open, and spontaneous regarding racial

278 identity Development In Multicultural Counseling and Therapy differences. Between the ages of 3to 5, however, the young White child begins to associate positive ethnocentric meanings to his or her own group and negative ones to others. Bombarded by misinformation through the educational channels, mass media, and significant others in his or her life, a sense of superiority is instilled in the concept of white- ness and the inferiority of all other groups and their heritage. The fol- lowing passage describes one of the insidious processes of socialization that leads to propelling the child into the conformity phase. It was a late summer afternoon. A group of white neighborhood mothers, obvi- ously friends, had brought their 4- and 5-year-olds to the local McDonald's for a snack and to play on the swings and slides provided by the restaurant. They were all seated at a table watching their sons and daughters run about the play area. In one corner of the yard sat a small black child pushing a red truck along the grass. One of the white girls from the group approached the black boy and they started a conversation. During that instant, the mother of the girl exchanged quick glances with the other mothers who nodded knowingly. She quickly rose from the table, walked over to the two, spoke to her daughter, and gently pulled her away to join her previous playmates. Within minutes, however, the girl again approached the black boy and both began to play with the truck. At that point, all the mothers rose from the table and loudly exclaimed to their children, "It's time to go now! "(Taken from D. W. Sue, 2003, pp. 89-90) 2. Conformity phase. The White person's attitudes and beliefs in this stage are very ethnocentric. There is minimal awareness of the self as a racial being and a strong belief in the universality of values and norms gov- erning behavior. The White person possesses limited accurate knowl- edge of other ethnic groups, but he or she is likely to rely on social stereotypes as the main source of information. As we saw, Hardiman (^982)described this stage as an acceptance of White superiority and minority inferiority. Consciously or unconsciously, the White person believes that White culture is the most highly developed and that all others are primitive or inferior. The conformity stage is marked by con- tradictory and often compartmentalized attitudes, beliefs, and behav- iors. A person may believe simultaneously that he or she is not racist but that minority inferiority justifies discriminatory and inferior treatment, and that minority persons are different and deviant but that people are people"and differences are unimportant pelms, 1984) As with their minority counterparts at this stage, the primary mechanism operating here is one of denial and compartmentalization. For example, many Whites deny that they belong to a race that allows them to avoid per- sonal responsibility for perpetuating a racist system. Like a fish in water, White folks either have difficulty seeing or are unable to see the invis-

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ible veil of cultural assumptions, biases, and prejudices that guide their perceptions and actions. They tend to believe that White Euro- American culture is superior and that other cultures are primitive, infe- rior, less developed, or lower on the scale of evolution. It is important to note that many Whites in this phase of development are unaware of these beliefs and operate as if they are universally shared by others. They believe that differences are unimportant and that people are people, "we are all the same under the skin, "we should treat every- one the same, "problems wouldn't exist if minorities would only as- similate, "and discrimination and prejudice are something that others do. The helping professional with this perspective professes color blind- ness, views counseling/therapy theories as universally applicable, and does not question their relevance to other culturally different groups. The primary mechanism used in encapsulation is denial-denial that people are different, denial that discrimination exists, and denial of one's own prejudices. Instead, the locus of the problem is seen to reside in the minority individual or group. Minorities would not encounter problems if they would only assimilate and acculturate {netting pot) value education, or work harder. 3. Dissonance phase. Movement into the dissonance stage occurs when the White person is forced to deal with the inconsistencies that have been compartmentalized or encounters information/experiences at odds with denial. In most cases, a person is forced to acknowledge Whiteness at some level, to examine their own cultural values, and to see the con- flict between upholding humanistic nonracist values and their contra- dictory behavior. For example, a person who may consciously believe that all men are created equal and that he or she treats everyone the same suddenly experiences reservations about having African Ameri- cans move next door or having their son or daughter involved in an interracial relationship. These more personal experiences bring the in- dividual face to face with his or her own prejudices and biases. In this situation, thoughts that I am not prejudiced,"! treat everyone the same regardless or race, creed, or color/and I do not discriminate'col- lide with the denial system. Additionally, some major event {he assas- sination of Martin Luther King, Jr., the Rodney King beating, etc.)may force the person to realize that racism is alive and well in the United States. The increasing realization that one is biased and that Euro- American society does play a part in oppressing minority groups is an unpleasant one. Dissonance may result in feelings of guilt, shame, anger, and depression. Rationalizations may be used to exonerate one's own inactivity in combating perceived injustice or personal feelings of

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prejudice; for example, i'm only one person what can I do?or Everyone is prejudiced, even minorities. "As these conflicts ensue, the White person may retreat into the protective confines of White culture Encapsulation of the previous stage)or move progressively toward in- sight and revelation Resistance and immersion stage) Whether a person regresses is related to the strength of positive forces pushing an individual forward Support for challenging racism) and negative forces pushing the person backward Rear of some loss) For example, challenging the prevailing beliefs of the times may mean risking ostracism from other White relatives, friends, neighbors, and colleagues. Regardless of the choice, there are many uncomfortable feelings of guilt, shame, anger, and depression related to the realization of inconsistencies in one's belief systems. Guilt and shame are most likely related to the recognition of the White person's role in perpetuat- ing racism in the past. Guilt may also result from the person's being afraid to speak out on the issues or take responsibility for his or her part in a current situation. For example, the person may witness an act of racism, hear a racist comment, or be given preferential treatment over a minority person but decide not to say anything for fear of violating racist White norms. Many White people rationalize their behaviors by believing that they are powerless to make changes. Additionally, there is a tendency to retreat into White culture. If, however, others Rvhich may include some family and friends) are more accepting, forward movement is more likely. 4. Resistance and immersion phase. The White person who progresses to this stage will begin to question and challenge his or her own racism. For the first time, the person begins to realize what racism is all about, and his or her eyes are suddenly open. Racism is seen everywhere Advertising, television, educational materials, interpersonal interactions, etc.) This phase of development is marked by a major questioning of one's own racism and that of others in society. In addition, increasing awareness of how racism operates and its pervasiveness in U.S. culture and institu- tions are the major hallmark of this level. It is as if the person has awak- ened to the realities of oppression, sees how educational materials, the mass media, advertising, and other elements portray and perpetuate stereotypes, and recognizes how being White grants certain advantages denied to various minority groups. There is likely to be considerable anger at family and friends, in- stitutions, and larger societal values, which are seen as having sold him or her a false bill of goods democratic ideals)that were never practiced. Guilt is also felt for having been a part of the oppressive system. Strangely enough, the person is likely to undergo a form of racial self-

White Racial identity Development 28 1

hatred at this stage. Negative feelings about being White are present, and the accompanying feelings of guilt, shame, and anger toward one- self and other Whites may develop. The White liberal syndrome may de- velop and be manifested in two complementary styles:the paternalistic protector role or the overidentification with another minority group Helms, f 984;Ponterotto, 1988) In the former, the White person may devote his or her energies in an almost paternalistic attempt to protect minorities from abuse. In the latter, the person may actually want to identify with a particular minority group Asian, Black, etc.)in order to escape his or her own Whiteness. The White person will soon discover, however, that these roles are not appreciated by minority groups and will experience rejection. Again, the person may resolve this dilemma by moving back into the protective confines of White culture Con- formity stage) again experience conflict dissonance) or move directly to the introspective stage. 5. Introspective phase. This phase is most likely a compromise of having swung from an extreme of unconditional acceptance of White identity to a rejection of Whiteness. It is a state of relative quiescence, intro- spection, and reformulation of what it means to be White. The person realizes and no longer denies that he or she has participated in oppres- sion and benefited from White privilege, or that racism is an integral part of U.S. society. However, individuals at this stage become less mo- tivated by guilt and defensiveness, accept their Whiteness, and seek to redefine their own identity and that of their social group. This accept- ance, however, does not mean a less active role in combating oppres- sion. The process may involve addressing the questions, What does it mean to be White?Who am I in relation to my Whiteness?and Who am I as a racial/cultural being? The feelings or affective elements may be existential in nature and involve feelings of disconnectedness, isolation, confusion, and loss. In other words, the person knows that he or she will never fully under- stand the minority experience, but feels disconnected from the Euro- American group as well. In some ways, the introspective phase is simi- lar in dynamics to the dissonance phase in that both represent a transition from one perspective to another. The process used to answer the previous questions and to deal with the ensuing feelings may in- volve a searching, observing, and questioning attitude. Answers to these questions involve dialoging and observing one's own social group and actively creating and experiencing interactions with various mi- nority group members as well.


Integrative awareness phase. Reaching this level of development is most characterized as ^understanding the self as a racial/cultural being,

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£)being aware of sociopolitical influences regarding racism, Appre- ciating racial/cultural diversity, and 4) becoming more committed toward eradicating oppression. The formation of a nonracist White Euro-American identity emerges and becomes internalized. The person values multiculturalism, is comfortable around members of culturally different groups, and feels a strong connectedness with members of many groups. Most important, perhaps, is the inner sense of security and strength that needs to develop and that is needed to function in a society that is only marginally accepting of integrative, aware White persons. 7. Commitment to antiracist action phase. Someone once stated that the ulti- mate White privilege is the ability to acknowledge it but do nothing about it. This phase is most characterized by social action. There is likely to be a consequent change in behavior and an increased commitment toward eradicating oppression. Seeing wrong'and actively working to fight'lt requires moral fortitude and direct action. Objecting to racist jokes, trying to educate family, friends, neighbors, and coworkers about racial issues, taking direct action to eradicate racism in the schools, workplace, and in social policy <)ften in direct conflict with other Whites)are examples of individuals who achieve this status. Movement into this phase often can be a lonely journey for Whites because they are oftentimes isolated by family, friends, and colleagues who do not understand their changed worldview. Strong pressures in society to not rock the boat, threats by family members that they will be disowned, avoidance by colleagues, threats of being labeled a troublemaker, or not being promoted at work are all possible pressures for the White person to move back to an earlier phase of development. To maintain a non- racist identity requires Whites to become increasingly immunized to so- cial pressures for conformance and to begin forming alliances with per- sons of color or other liberated Whites who become a second family to them. As can be seen, the struggle against individual, institutional, and societal racism is a monumental task in this society. Implications for Clinical Vractice It is important to stress again the need for White Euro-American counselors to understand the assumptions of White racial identity development models. We ask readers to seriously consider the validity of these assumptions and en- gage one another in a dialogue about them. Ultimately, the effectiveness of White therapists is related to their ability to overcome sociocultural condi- tioning and make their Whiteness visible. To do so, the following guidelines and suggestions are given.

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1. Accept the fact that racism is a basic and integral part of U.S. life and permeates all aspects of our culture and institutions. Know that as a White person you are socialized into U.S. society and, therefore, inherit the biases, stereotypes, and racist attitudes, beliefs, and behaviors of the society 2. Understand that the level of White racial identity development in a cross-cultural encounter forking with minorities, responding to mul- ticultural training, etc. (affects the process and outcome of an interracial relationship including counseling/therapy) 3 . Work on accepting your own Whiteness, but define it in a nondef ensive and nonracist manner. How you perceive yourself as a racial being seems to be correlated strongly with how you perceive and respond to racial stimuli. 4. Spend time with healthy and strong people from another culture or racial group. As a counselor, the only contact we usually have comes from working with only a narrow segment of the society. Thus, the knowledge we have about minority groups is usually developed from working with troubled individuals. 5. Know that becoming culturally aware and competent comes through lived experience and reality. Identify a cultural guide, someone from the culture who is willing to help you understand his or her group. 6. Attend cultural events, meetings, and activities led by minority com- munities. This allows you to hear from church leaders, attend commu- nity celebrations, and participate in open forums so that you may sense the strengths of the community, observe leadership in action, personal- ize your understanding, and develop new social relationships. 7. When around persons of color, pay attention to feelings, thoughts, and assumptions that you have when race-related situations present them- selves. Where are your feelings of uneasiness, differentness, or outright fear coming fromT>o not make excuses for these thoughts or feelings, dismiss them, or avoid attaching meaning to them. Only if you are will- ing to confront them directly can you unlearn the misinformation and nested emotional fears. 8. Dealing with racism means a personal commitment to action. It means interrupting other White Americans when they make racist remarks and jokes or engage in racist actions, even if it is embarrassing or fright- ening. It means noticing the possibility for direct action against bias and discrimination in your everyday life.

Part V Social Justice Dimensions in Co uns eli n (^/Therapy

Social Justice Counseling/Therapy

Multicultural counseling and therapy must be about social jus- tice; providing equal access and opportunity to all groups; being inclusive;removing individual and systemic barriers to fair men- tal health treatment;and ensuring that counseling/therapy services are directed at the micro, meso, and macro levels of our society p. W. Sue, 2001) As such, it is important for us to understand what we mean by social justice and why it is such an important foundation of multicul- tural counseling and therapy Lee, 2007; Toporek, Gerstein, Fouad, Roysircar, asrael, 2006; Warren SConstantine, 2007) Let us use a specific case study to illustrate how a social justice orientation repre- sents a paradigm shift in how we view the locus of the problem and the need to develop organizational and systemic intervention skills.


Malachi Rolls (a pseudonym) is a 12-year-old African American student attending a predominantly White grade school in Santa Barbara, Califor- nia. He has been referred for counseling by his teachers because of "con- stant fighting " with students on the school grounds. In addition, his teach- ers note that Malachi was doing poorly in class, inattentive, argumentative toward authority figures, and disrespectful. The most recent incident, an especially violent one, required the assistant principal to physically pull Malachi away to prevent him from seriously injuring a fellow student. He was suspended from school for 3 days and subsequently referred to the school psychologist. Malachi was diagnosed with a conduct disorder and the psychologist recommended immediate counseling to prevent the un- treated disorder from leading to more serious antisocial behaviors. The rec- ommended course of treatment consisted of medication and therapy aimed at eliminating Malachi 's aggressive behaviors and "controlling his under- lying hostility and anger. " Malachi's parents, however, objected strenuously to the school psy- chologist's diagnosis and treatment recommendations. They described their son as feeling isolated, having few friends, being rejected by class- mates, feeling invalidated by teachers, and feeling "removed" from the


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content of his classes. They noted that all of the "fights " were generally instigated through "baiting " and "name calling " by his White classmates, that the school climate was hostile toward their son, that the curriculum was very Eurocentric and failed to include African Americans, and that school personnel and teachers seemed naive about racial or multicultural issues. They hinted strongly that racism was at work in the school district and enlisted the aid of the only Black counselor in the school, Ms. Jones. Although Ms. Jones seemed to be under- standing and empathic toward Malachi's plight, she seemed reluctant to inter- cede on behalf of the parents. Being a recent graduate from the local college, Ms. Jones feared being ostracized by other school personnel. The concerns ofMalachi 's parents were quickly dismissed by school officials as having little validity. These officials contended thatMalachi needed to be more accommodating, to reach out and make friends rather than isolating himself, to take a more active interest in his schoolwork, and to become a good citizen. Further, they asserted it was not the school climate that was hostile, but that Malachi needed to "learn to fit in. " "We treat everyone the same, regardless of race. This school doesn 't discriminate, " stated the school officials. (D. W. Sue & Constantine, 2003, pp. 214-215) If you were a counselor or social worker, how would you address this caseTWhere would you focus your energiesTTraditional clinical approaches would direct their attention to what they perceive as the locus of the prob- lemMalachi and his fighting with classmates. This approach makes several assumptions:} )the locus of the problem resides in the person;? )behaviors that violate socially accepted norms are considered maladaptive or disor- dered;? Remediation or elimination of problem behaviors is the goal;4)the social context or status quo guides the determination of normal versus ab- normal and healthy versus unhealthy behaviors;and £)the appropriate role for the counselor is to help the client fit in'and become a good citizen. Tak- ing a social justice approach, however, might mean challenging these as- sumptions and even reversing them in the following way: 1. The locus of the problem may reside in the social system ()ther stu- dents, hostile campus environment, alienating curriculum, lack of mi- nority teachers/staff /students, etc. (rather than the individual. 2 . Behaviors that violate social norms may not be disordered or unhealthy. 3. While remediation is important, the more effective long-term solution is prevention. 4. The social norms, prevailing beliefs, and institutional polices and prac- tices that maintain the status quo should be challenged and changed. 5. Organizational change requires a macrosystems approach involving other roles and skills beyond the traditional clinical one.

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These five perspectives illustrate several basic principles of social justice counseling, which is the topic of this chapter. Let us briefly describe some of them, using the case of Malachi to illustrate our points. Principle One: A failure to develop a balanced perspective between person and system focus can result in false attribution of the problem. It is apparent that school officials have attributed the locus of the problem to reside in Malachi;that he is impulsive, angry, inattentive, unmotivated, disrespectful, and a poor stu- dent. He is labeled as possessing a conduct disorder with potential antisocial traits. Diagnosis of the problem is internal-tbat is, it resides in Malachi. When the focus of therapy is primarily on the individual, there is a strong ten- dency to see the locus of the problem as residing solely in the person Cos- grove, 2006)rather than in the school system, curriculum, or wider campus community. As a result, well-intentioned counselors may mistakenly blame the victim £.g., the problem is a deficiency of the person)when, in actuality, it may reside in the environment. We would submit that it is highly probable that Malachi is the victim of a monocultural educational environment that alienates and denigrates him pavidson, Waldo, Sudanis, 2006)curricula that does not deal with the contributions of African Americans or portrays them in a demeaning fashion;teaching styles that may be culturally biased; grading practices that emphasize individual competition; a campus climate that is hostile to minority students perceived as less qualifiedjsupport ser- vices Counseling, study skills, etc.)that fail to understand the minority stu- dent experience; and the lack of role models presence of only one Black teacher in the school) For example, would it change your analysis and focus of intervention if Malachi gets into fights because he is teased mercilessly by fellow students who use racial slurs jigger, jungle bunny, burr head, etc.)* Suppose he is the only Black student on the campus and feels isolated. Sup- pose the curriculum doesn't deal with the contributions of African Americans and presents Black Americans in demeaning portrayals. In other words, sup- pose there is good reason for why this 12-year-old feels isolated, rejected, de- valued, and misunderstood. Principle Two: A failure to develop a balanced perspective between person and system focus can result in an ineffective and inaccurate treatment plan potentially harmful toward the client. A basic premise of the ecological model in social jus- tice practice is the assumption that person-environment interactions are crucial to diagnosing and treating problems (Goodman, Liang, Helms, Latta, Sparks, fWeintraub, 2004) Clients, for example, are not viewed as isolated units, but as embedded in their families, social groups, communities, institu- tions, cultures, and in major systems of our society Vera SSpeight, 2003) Behavior is always a function of the interactions or transactions that occur between and among the many systems that comprise the life of the person. For example, a micro level of analysis may lead to one treatment plan while a macro analysis would lead to another. In other words, how a helping

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professional defines the problem affects the treatment focus and plan. If Malachi's problems are due to internal and intrapsychic dynamics, then it makes sense that the therapy be directed toward changing the person. The fighting behavior is perceived as dysfunctional and should be eliminated through Malachi learning to control his anger, or through medication that may correct his internal biological dysfunction. But, what if the problem is external?Will having Malachi stop his fighting behavior result in the elimi- nation of teasing from White classmates?Will it make him more connected to the campus?Will it make him feel more valued and acceptedrWill he re- late more to the content of courses that denigrate the contributions of African AmericansTTreating the symptoms or eliminating fighting behavior may ac- tually make Malachi more vulnerable to racism. Principle Three: When the client is the organization or a larger system and not an individual, it requires a major paradigm shift to attain a true understanding of problem and solution identification. Let us assume that Malachi is getting into fights because of the hostile school climate and the invalidating nature of his educational experience. Given this assumption, we ask the question Who is the clientTIs it Malachi or the schoolTfn his analysis of schizophrenia, R. D. Laing, an existential psychiatrist, once asked the following questiomrs schizophrenia a sick response to a healthy situation, or is it a healthy response to a sick situationln other words, if it is the school system that is dysfunc- tional $ick)and not the individual client, do we or should we adjust that per- son to a sick situationln this case, do we focus on stopping the fighting be- havior ?Or, if we view the fighting behavior as a healthy response to a sick situation, then eliminating the unhealthy situation ^easing, insensitive ad- ministrators and teachers, monocultural curriculum, etc.)should receive top priority for change Lee, 2007) Principle Four: Organizations are microcosms of the wider society from which they originate. As a result, they are likely to he reflections of the monocultural values and practices of the larger culture. In this case, it is not far-fetched to assume that White students, helping professionals, and educators may have inherited the racial biases of their forebears. Further, multicultural education specialists have decried the biased nature of the traditional curriculum. While education is supposed to liberate and convey truth and knowledge, it has oftentimes been the culprit in perpetuating false stereotypes and misinformation about various groups in our society. It has done this, perhaps not intentionally, but through omission, fabrication, distortion, or selective emphasis of informa- tion designed to enhance the contributions of certain groups over others. The result is that institutions of learning become sites that perpetuate myths and inaccuracies about certain groups in society, with devastating consequences to students of color. Further, policies and practices that treat everyone the same'may themselves be culturally biased. If this is the institutional context from which Malachi is receiving his education, little wonder that he exhibits

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so-called problem behaviors. Again, the focus of change must be directed at the institutional level. Principle Five: Organizations are powerful entities that inevitably resist change and possess many ways to force compliance among workers. To go against the policies, practices, and procedures of the institution, for example, can bring about major puni- tive actions. Let us look at the situation of the Black teacher, Ms. Jones. There are indications in this case that she understands that Malachi may be the vic- tim of racism and a monocultural education that invalidates him. If she is aware of this factor, why is she so reluctant to act on behalf of Malachi and his parentsTFirst, it is highly probable that, even if she is aware of the true problem, she lacks the knowledge, expertise, and skill to intervene on a sys- temic level. Second, there are many avenues open to institutions that can be used to force compliance on the part of employees. Voicing an alternative opinion against prevailing beliefs can result in ostracism by fellow workers, a poor job performance rating, denial of a promotion, or even an eventual fir- ing. This creates a very strong ethical dilemma for mental health workers or educators when the needs of their clients differ from those of the organiza- tion or employer. The fact that counselors' livelihoods depend on the em- ploying agency School district )creates additional pressures to conform. How do counselors handle such conflictsDrganizational knowledge and skills be- come a necessity if the therapist is to be truly effective. So, even the most en- lightened educator and counselor may find their good intentions thwarted by their lack of systems intervention skills and fears of punitive actions. Principle Six: When multicultural organizational development is required, al- ternative helping roles that emphasize systems intervention must be part of the role repertoire of the mental health professional. Because the traditional counseling/ therapy roles focus on one-to-one or small group relationships, they may not be productive when dealing with larger ecological and systemic issues. Com- petence in changing organizational policies, practices, procedures, and struc- tures within institutions requires a different set of knowledge and skills that are more action oriented. Among them, consultation and advocacy become crucial in helping institutions move from a monocultural to a multicultural institution pavidson, Waldo, SAdams, 2006) Malachi's school and the school district need a thorough cultural audit, institutional change in the campus climate, sensitivity training for all school personnel, increased racial/ ethnic personnel at all levels of the school, revamping of the curriculum to be more multicultural, and so on. This is a major task that requires multicultural awareness, knowledge, and skills on the part of the consultant. Principle Seven: Although remediation will always be needed, prevention is better. Conventional practice at the micro level continues to be oriented toward remediation rather than prevention. While no one would deny the important effects of biological and internal psychological factors on personal problems, more research now acknowledges the importance of sociocultural

292 Social Justice Dimensions in Counseling/Therapy factors inadequate or biased education, poor socialization practices, biased values, and discriminatory institutional policies)in creating many of the dif- ficulties encountered by individuals. As therapists, we are frequently placed in a position of treating clients who represent the aftermath of failed and op- pressive policies and practices. We have been trapped in the role of remedia- tion ^tempting to help clients once they have been damaged by sociocul- tural biases) While treating troubled clients Remediation) is a necessity, our task would be an endless and losing venture unless the true sources of the problem Stereotypes, prejudice, discrimination, and oppression) are changed. Would it not make more sense to take a proactive and preventative approach by attacking the cultural and institutional bases of the problem? Social Justice Counseling The case of Malachi demonstrates strongly the need for a social justice orien- tation to counseling and therapy. Indeed, multicultural counseling/therapy competence is intimately linked to the values of social justice page, 2005; Sue, 2001;Warren EGonstantine, 2007) If mental health practice is con- cerned with bettering the life circumstances of individuals, families, groups, and communities in our society, then social justice is the overarching um- brella that guides our profession. The welfare of a democratic society very much depends on equal access and opportunity fair distribution of power and resources, and empowering individuals and groups with a right to deter- mine their own lives. Smith 2003)defmes a socially just world as having ac- cess to: Adequate food, sleep, wages, education, safety, opportunity, institutional sup- port, health care, child care, and loving relationships. "Adequate " means enough to allow [participationjin the world . . . without starving, or feeling economically trapped or uncompensated, continually exploited, terrorized, devalued, battered, chonically exhausted, or virtually enslaved (and for some reason, still, actually enslaved), (p. 167). Bell |997)states that the goal of social justice is: Full and equal participation of all groups in a society that is mutually shaped to meet their needs. Social justice includes a vision of society in which the distribu- tion of resources is equitable and all members are physically and psychologically safe and secure, (p. 3) Given these broad descriptions, we propose a working definition of so- cial justice counseling/therapy:

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Social justice counseling /therapy is an active philosophy and approach aimed at producing conditions that allow for equal access and opportunity; reducing or eliminating disparities in education, health care, employment, and other areas that lower the quality of life for affected populations; encouraging mental health professionals to consider micro, meso, and macro levels in the assessment, diag- nosis, and treatment of client and client systems; and broadening the role of the helping professional to include not only counselor/therapist but advocate, con- sultant, psychoeducator, change agent, community worker, etc. It is clear that systems forces can be powerful and oppressive;Malachi Rolls is a prime example of how a failure to understand systemic dynamics may derail productive change. Becoming culturally competent requires not only changes at an individual practice level, but also changes associated with how we define our helping role. Unfortunately an overwhelming majority of mental health practitioners desire to enter direct clinical service, especially counseling and psychotherapy $hullman, Celeste, Strickland, 2006) The mental health profession has implicitly or explicitly glamorized and defined the clinician as one who conducts his or her trade working with individu- alsin- an office environment. While the development of individual inter- vention skills has been the main focus in many graduate training programs, little emphasis is given to other roles, activities, or settings Toporek & McNally, 2006) Thus, not only might therapists be lacking in systems- intervention knowledge and skills, but they may also become unaccustomed to, and uncomfortable about, leaving their offices. Yet work with racial/eth- nic minority groups and immigrant populations suggests that out-of-office sites/activities Client homes, churches, volunteer organizations, etc.)and al- ternative helping roles Ombudsman, advocates, consultants, organizational change agents, facilitators of indigenous healing systems, etc.) may prove more therapeutic and effective Atkinson et al., 1 993;Warren ffionstantine, 2007) Social justice counseling with marginalized groups in our society is most enhanced when mental health professionals \)can understand how individual and systemic worldviews shape clinical practice and £)when they are equipped with organizational and systemic knowledge, expertise, and skills. Let us now turn our attention to both. Understanding Individual and Systemic Worldviews It has become increasingly clear that many diverse groups hold worldviews that differ from members of the dominant culture and their practicing thera- pists. In a broader sense, worldviews determine how people perceive their re- lationship to the world riature, institutions, other people, etc.) Worldviews are highly correlated with a person's cultural upbringing and life experiences |
294 Social Justice Dimensions in Counseling/Therapy set of assumptions about physical and social reality that may have powerful effects on cognition and behavior. "Put in a much more practical way, not only are worldviews composed of our attitudes, values, opinions, and con- cepts, but they also affect how we think, define events, make decisions, and behave. For marginalized groups in America, a strong determinant of world- views is very much related to the subordinate position assigned to them in so- ciety. Helping professionals who hold a worldview different from that of their clients, and who are unaware of the basis for this difference, are most likely to impute negative traits to clients. In most cases, for example, clients of color are more likely to have worldviews that differ from those of therapists. Yet many therapists are so culturally unaware that they respond according to their own conditioned values, assumptions, and perspectives of reality with- out regard for other views. Without this awareness, counselors who work with culturally diverse groups may be engaging in cultural oppression. Social justice counseling makes it a necessity to understand how race and culture- specific factors may interact in such a way as to produce people with differ- ent worldviews. Two different psychological orientations are important in the formation of worldviews4)locus of control and £)locus of responsibility. The manner in which they interact results in the formation of four different psychological outlooks in life and their consequent characteristics, dynamics, and implications for social justice counseling. Locus of Control

Rotter's 1 966 (historic work in the formulation of the concepts of internal- external control and the internal-external |-E)dimension has contributed greatly to our understanding of human behavior. Internal owfro/ IC (refers to people's beliefs that reinforcements are contingent on their own actions and that they can shape their own fate. External control EQrefers to people's be- liefs that reinforcing events occur independently of their actions and that the future is determined more by chance and luck. Early researchers Lefcourt, 1966;Rotter, 1966, 1975)have summarized the research findings that cor- related high internality with \) greater attempts at mastering the envi- ronment, £ (superior coping strategies, ? (better cognitive processing of in- formation, 4) lower predisposition to anxiety, higher achievement motivation, 6 (greater social action involvement, and 7 (greater value on skill-determined rewards. As can be seen, these attributes are highly valued by U.S. society and constitute the core features of mental health. Ethnic group members, people from low socioeconomic classes, and women score significantly higher on the external end of the locus-of-control continuum $ee reviews by Sue, 1978 and Koltko-Rivera, 2004) Using the

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I-E dimension as a criterion of mental health would mean that minority, poor, and female clients would be viewed as possessing less desirable attri- butes. Thus, a clinician who encounters a minority client with a high exter- nal orientation Jt's no use trying/There's nothing I can do about it, "and You shouldn't rock the boatjmay interpret the client as being inherently apathetic, procrastinating, lazy, depressed, or anxious about trying. The problem with an unqualified application of the I-E dimension is that it fails to take into consideration the different cultural and social experiences of the individual. This failure may lead to highly inappropriate and destructive ap- plications in therapy. It seems plausible that different cultural groups, women, and people from a lower socioeconomic status £ES)have learned that control operates differently in their lives than how it operates for soci- ety at large Ridley, 2005) For example, externality related to impersonal forces £hance and luck)is different from that ascribed to cultural forces, and from that ascribed to powerful others. Chance and luck operate equally across situations for everyone. However, the forces that determine locus of control from a cultural perspective may be viewed by the particular ethnic group as acceptable and benevolent. In this case, externality is viewed posi- tively. American culture, for example, values the uniqueness, indepen- dence, and self-reliance of each individual. It places a high premium on self- reliance, individualism, and status achieved through one's own efforts. In contrast, the situation-centered Chinese culture places importance on the group 4n individual is not defined apart from the family) on tradition, so- cial roles-expectations, and harmony with the universe Jloot, 1998) Thus, the cultural orientation of the more traditional Chinese tends to elevate the external scores. Note, however, that the external orientation of the Chinese is highly valued and accepted. Likewise, high externality may constitute a realistic sociopolitical pres- ence of influence from powerful others. For example, a major force in the lit- erature dealing with locus of control is that of powerlessness. Powerlessness may be defined as the expectancy that a person's behavior cannot determine the outcomes or reinforcements that he or she seeks. There is a strong possi- bility that externality may be a function of a person's opinions about prevail- ing social institutions. For example, low SES individuals and Blacks are not given an equal opportunity to obtain the material rewards of Western cul- ture. Because of racism, African Americans may be perceiving, in a realistic fashion, a discrepancy between their ability and attainment. In this case, ex- ternality may be seen as a malevolent force to be distinguished from the benevolent cultural ones just discussed. It can be concluded that while highly external people are less effectively motivated, perform poorly in achievement situations, and evidence greater psychological problems, this does not neces- sarily hold for minorities and low-income persons. Focusing on external forces may be motivationally healthy if it results from assessing one's chances


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for success against systematic and real external obstacles rather than unpre- dictable fate. Three factors of importance for our discussion can be identified. The first factor, called control ideology, is a measure of general belief about the role of external forces in determining success and failure in the larger so- ciety. It represents a cultural belief in the Protestant ethic: Success is the re- sult of hard work, effort, skill, and ability. The second factor, personal control, reflects a person's belief about his or her own sense of personal efficacy or competence. While control ideology represents an ideological belief, personal control is more related to actual control. Apparently, African Americans can be equally internal to Whites on control ideology, but when a personal refer- ence personal control)is used, they are much more external. This indicates that African Americans may have adopted the general cultural beliefs about internal control, but find that these cannot always be applied to their own life situations because of racism and discrimination) It is interesting to note that Whites endorse control ideology statements at the same rate as they endorse personal control ones. Thus, the disparity between the two forms of control does not seem to be operative for White Americans. A third interesting find- ing is that personal control, as opposed to ideological control, is more related to motivational and performance indicators. A student high on personal con- trol i[nternality) tends to have greater self-confidence, higher test scores, higher grades, and so on. Individuals who are high on the ideological mea- sure are not noticeably different from their externally oriented counterparts. The I-E continuum is useful for therapists only if they make clear dis- tinctions about the meaning of the external control dimension. High exter- nality may be due to J)chance/luck, £ Cultural dictates that are viewed as benevolent, and $)a political force Racism and discrimination )that repre- sents malevolent but realistic obstacles. In each case, it is a mistake to assume that the former is operative for culturally diverse clients.

Another important dimension in world outlooks was formulated from attri- bution theory E. E. Jones et al., 1972;J. M. Jones, 1997)and can be legiti- mately referred to as locus of responsibility. In essence, this dimension measures the degree of responsibility or blame placed on the individual or system. In the case of African Americans, their lower standard of living may be attrib- uted to their personal inadequacies and shortcomings, or the responsibility for their plight may be attributed to racial discrimination and lack of oppor- tunities. The former orientation blames the individual, while the latter ex- planation blames the system. The degree of emphasis placed on the individual as opposed to the sys- tem in affecting a person's behavior is important in the formation of life ori-

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entations. Those who hold a person-centered orientation } )emphasize the understanding of a person's motivations, values, feelings, and goals;2)be- lieve that success or failure is attributable to the individual's skills or personal inadequacies;and ? Relieve that there is a strong relationship between abil- ity, effort, and success in society. In essence, these people adhere strongly to the Protestant ethic that idealizes rugged individualism. On the other hand, situation-centered or system-blame people view the sociocultural environ- ment as more potent than the individual. Social, economic, and political forces are powerful; success or failure is generally dependent on the socio- economic system and not necessarily on personal attributes. The causes of social problems in Western society are seen as residing in individuals who are thus responsible for them. Such an approach has the ef- fect of labeling that segment of the population facial and ethnic minorities) that differs in thought and behavior from the larger society as deviant. Defin- ing the problem as residing in the person enables society to ignore situation- ally relevant factors and to protect and preserve social institutions and be- lief systems. Thus, the individual system-blame continuum may need to be viewed differentially for minority groups. An internal response Acceptance of blame for one's failure )might be considered normal for the White middle class, but for minorities it may be extreme and intrapunitive. For example, an African American male client who has been unable to find a job because of prejudice and discrimination may blame himself What's wrong with me?Why can't I find a job?Am I worthless? Thus, an external response may be more realistic and appropriate institu- tional racism prevented my getting the job? Early research indicates that African Americans who scored external blame system)on this dimension ^)more often aspired to nontraditional occupations, 2)were more in favor of group rather than individual action for dealing with discrimination, £ (en- gaged in more civil rights activities, and ^exhibited more innovative cop- ing behavior Gurin, Gurin, Lao, SSeattie, 1 969) It is important to note that the personal control dimension discussed in the previous section was corre- lated with traditional measures of motivation and achievement grades) while individual systemblame was a better predictor of innovative social ac- tion behavior.

Formation ofWorldviews

The two psychological orientations, locus of control personal control)and locus of responsibility, are independent of one another. As shown in Figure 12.1, both may be placed on the continuum in such a manner that they in- tersect, forming four quadrants:internal locus of controlkiternal locus of re- sponsibility JC-IR) external locus of controlkiternal locus of responsibility


Social Justice Dimensions in Counseling/Therapy

Figure 12.1

Locus of Control

Graphic Representation of Worldviews


Source: From Eliminating Cultural Oppression in Counseling:Toward a General Theory/by D. W. Sue, 1978, Journal of Counseling Psychology, 25, p. 422. Copyright 1978 by the Journal of Counseling Psychology. Reprinted by permission.



Locus of responsibility

Internal person

External system




EC-IR) internal locus of controlexternal locus of responsibility IC-ER) and external locus of controlexternal locus of responsibility EC-ER) Each quadrant represents a different worldview or orientation to life. Theoreti- cally then, if we know the individual's degree of internality or externality on the two loci, we can plot them on the figure. We would speculate that vari- ous ethnic and racial groups are not randomly distributed throughout the four quadrants. The previous discussion concerning cultural and societal influences on these two dimensions would seem to support this speculation. Because our discussion focuses on the political ramifications of the two di- mensions, there is an evaluative desirable-undesirable"quality to each worldview. Internal Locus of Control JCJnternal Locus of Responsibility JR) As mentioned earlier, high internal personal control IC (individuals believe that they are masters of their fate and that their actions do affect the out- comes. Likewise, people high in internal locus of responsibility IR)attribute their current status and life conditions to their own unique attributes;success is due to one's own efforts, and lack of success is attributed to one's short- comings or inadequacies. Perhaps the greatest exemplification of the IC-IR philosophy is U.S. society. American culture can be described as the epitome of the individual-centered approach that emphasizes uniqueness, indepen- dence, and self-reliance. A high value is placed on personal resources for solv- ing all problems, self-reliance, pragmatism, individualism, status achieve- ment through one's own effort, and power or control over others, things, animals, and forces of nature. Democratic ideals such as equal access to op- portunity, "liberty and justice for all, "God helps those who help them- selves, "and fulfillment of personal destiny"all reflect this worldview. The individual is held accountable for all that transpires. Constant and prolonged

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failure or the inability to attain goals leads to symptoms of self-blame de- pression, guilt, and feelings of inadequacy) Most members of the White middle class would fall within this quadrant. Five American patterns of cultural assumptions and values can be iden- tified E. C. Stewart, 1971;Pedersen, 1988;Wehrly, 1995) These are the building blocks of the IC-IR worldview and typically guide our thinking about mental health services in Western society. As we have seen in the Kluckhohn and Strodtbeck model J 961) these values are manifested in the generic characteristics of counseling. The five systems of assumptions may be de- scribed as follows. 1. Definition of activity. Western culture stresses an activity modality of do- ing, and the desirable pace of life is fast, busy, and driving. A being ori- entation that stresses a more passive, experimental, and contemplative role is in marked contrast to American values External achievement, activity, goals, and solutions) Existence is in acting, not being. Activism is seen most clearly in the mode of problem solving and decision mak- ing. Learning is active, not passive. American emphasis is on planning behavior that anticipates consequences. 2. Definition of social relations. Americans value equality and informality in relating to others. Friendships tend to be many, of short commitment, nonbinding, and shared. In addition, the person's rights and duties in a group are influenced by one's own goals. Obligation to groups is limited, and value is placed on one's ability to influence the group actively. In contrast, many cultures stress hierarchical rank, formality, and status in interpersonal relations. Friendships are intense, of long term, and ex- clusive. Acceptance of the constraints on the group and the authority of the leader dictate behavior in a group. 3. Motivation. Achievement and competition are seen as motivationally healthy. The worth of an individual is measured by objective, visible, and material possessions. Personal accomplishments are more impor- tant than place of birth, family background, heritage, or traditional sta- tus. Achieved status is valued over ascribed status. 4. Perception of the world. The world is viewed as distinctly separate from humankind and is physical, mechanical, and follows rational laws. Thus, the world is viewed as an object to be exploited, controlled, and developed for the material benefit of people. It is assumed that control and exploitation are necessary for the progress of civilized nations. 5. Perception of the self and individual. The self is seen as separate from the physical world and others. Decision making and responsibility rest with the individual and not the group. Indeed, the group is not a unit but an aggregate of individuals. The importance of a person's identity is re-

300 Social Justice Dimensions in Counseling/Therapy

inforced in socialization and education. Autonomy is encouraged, and emphasis is placed on solving one's own problems, acquiring one's own possessions, and standing up for one's own rights $ee Table 12.1) Therapeutic Implications It becomes obvious that Western approaches to clinical practice occupy the quadrant represented by IC-IR characteristics. Most therapists are of the opinion that people must take major responsibility for their own actions and that they can improve their lot in life by their own efforts. The epitome of this line of thought is represented by the numerous self-help approaches cur- rently in vogue in our field. Clients who occupy this quadrant tend to be White middle-class clients, and for these clients such approaches might be en- tirely appropriate. In working with clients from different cultures, however, such an approach might be inappropriate. Cultural oppression in therapy be- comes an ever present danger. External Locus of Control ECJnternal Locus of Responsibility JR) Individuals who fall into this quadrant are most likely to accept the dominant culture's definition for self-responsibility but to have very little real control over how they are defined by others. The term marginal man person) was first coined by Stonequist }937)to describe a person living on the margins of two cultures and not fully accommodated to either. Although there is nothing inherently pathological about bicultural membership, J. M. Jones |997)feels that Western society has practiced a form of cultural racism by imposing its standards, beliefs, and ways of behaving onto minority groups. Marginal individuals deny the existence of racism;believe that the plight of their own people is due to laziness, stupidity, and a clinging to outdated tra- ditions;r eject their own cultural heritage and believe that their ethnicity rep- resents a handicap in Western society; evidence racial self-hatred; accept White social, cultural, and institutional standards;perceive physical features of White men and women as an exemplification of beauty;and are powerless to control their sense of self-worth, because approval must come from an ex- ternal source. As a result, they are high in person-focus and external control. It is quite clear that marginal persons are oppressed, have little choice, and are powerless in the face of the dominant-subordinate relationship be- tween the middle-class Euro-American culture and their own minority cul- ture. According to Freire \ 970) if this dominant-subordinate relationship in society were eliminated, the phenomenon of marginality would also disap- pear. For if two cultures exist on the basis of total equality
Table 12.1

Social Justice Counseling/ Therapy The Components of White Culture: Values and Beliefs


Rugged Individualism Individual is primary unit Individual has primary responsibility Independence and autonomy highly valued and rewarded Individual can control environment Competition Winning is everything Win/lose dichotomy Action Orientation Must master and control nature Must always do something about a situation Pragmatic/utilitarian view of life Communication Standard English Written tradition Direct eye contact Limited physical contact Control of emotions Time Adherence to rigid time Time is viewed as a commodity Holidays Based on Christian religion Based on White history and male leaders History Based on European immigrants' experience in the United States Romanticize war

Protestant Work Ethic Working hard brings success Progress & Future Orientation Plan for future Delayed gratification Value continual improvement and progress Emphasis on Scientific Method Objective, rational, linear thinking Cause and effect relationships Quantitative emphasis Status and Power Measured by economic possessions Credentials, titles, and positions Believe 6wn"system Believe better than other systems Owning goods, space, property Family Structure Nuclear family is the ideal social unit Male is breadwinner and the head of the household Female is homemaker and subordinate to the husband Patriarchal structure Esthetics Music and art based on European cultures Women's beauty based on blonde, blue-eyed, thin, young Men's attractiveness based on athletic ability, power, economic status Religion Belief in Christianity No tolerance for deviation from single god concept

Source: From The Counseling Psychologist p. 618)by Katz, 1985, Beverly Hills, CA:Sage. Copyright 1985 by Sage Pub- lications, Inc. Reprinted by permission.

Therapeutic Implications The psychological dynamics for the EC-IR minority client are likely to reflect his or her marginal and self-hate status. For example, White therapists might be perceived as more competent and preferred than are therapists of the cli- ent's own race. To EC-IR minority clients, focusing on feelings may be very

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threatening because it ultimately may reveal the presence of self-hate and the realization that clients cannot escape from their own racial and cultural her- itage. A culturally encapsulated White counselor or therapist who does not understand the sociopolitical dynamics of the client's concerns may unwit- tingly perpetuate the conflict. For example, the client's preference for a White therapist, coupled with the therapist's implicit belief in the values of U.S. cul- ture, becomes a barrier to effective counseling. A culturally sensitive helping professional needs to help the client \ )understand the particular dominant- subordinate political forces that have created this dilemma and ^distin- guish between positive attempts to acculturate and a negative rejection of one's own cultural values. External Locus of Control ECExternal Locus of Responsibility ER) The inequities and injustices of racism seen in the standard of living tend to be highly damaging to minorities. Discrimination may be seen in the areas of housing, employment, income, and education. A person high in system- blame and external control feels that there is very little one can do in the face of such severe external obstacles as prejudice and discrimination. In essence, the EC response might be a manifestation of })having given up or ^at- tempting to placate those in power. In the former, individuals internalize their impotence even though they are aware of the external basis of their plight. In its extreme form, oppression may result in a form of Teamed help- lessnessTpeligman, 1982) When minorities learn that their responses have minimal effects on the environment, the resulting phenomenon can best be described as an expectation of helplessness. People's susceptibility to help- lessness depends on their experience with controlling the environment. In the face of continued racism, many may simply give up in their attempts to achieve personal goals. The dynamics of the placater, however, are not related to the giving up response. Rather, social forces in the form of prejudice and discrimination are seen as too powerful to combat at that particular time. The best one can hope to do is to suffer the inequities in silence for fear of retaliation. Don't rock the boat/keep a low profile, "and Survival at all costs'are the phrases that de- scribe this mode of adjustment. Life is viewed as relatively fixed, and there is little that the individual can do. Passivity in the face of oppression is the pri- mary reaction of the placater. Slavery was one of the most important factors shaping the sociopsychological functioning of African Americans. Interper- sonal relations between Whites and Blacks were highly structured and placed African Americans in a subservient and inferior role. Those Blacks who broke the rules or did not show proper deferential behavior were severely pun- ished. The spirits of most African Americans, however, were not broken.

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Conformance to White Euro-American rules and regulations was dictated by the need to survive in an oppressive environment. Direct expressions of anger and resentment were dangerous, but indirect expressions were fre- quent. Therapeutic Implications EC-ER African Americans are very likely to see the White therapist as sym- bolic of any other Black-White relations. They are likely to show proper" deferential behavior and not to take seriously admonitions by the therapist that they are the masters of their own fate. As a result, an IC-IR therapist may perceive the culturally different client as lacking in courage and ego strength, and as being passive. A culturally effective therapist, however, would realize the basis of these adaptations. Unlike EC-IR clients, EC-ER individuals do un- derstand the political forces that have subjugated their existence. The most helpful approach on the part of the therapist would be \ )to teach the clients new coping strategies, £)to have them experience successes, and ?)to val- idate who and what they represent. Internal Locus of Control IC^xternal Locus of Responsibility £R) Individuals who score high in internal control and system-focus believe that they are able to shape events in their own life if given a chance. They do not accept the fact that their present state is due to their own inherent weakness. However, they also realistically perceive that external barriers of discrimina- tion, prejudice, and exploitation block their paths to the successful attain- ment of goals. There is a considerable body of evidence to support this con- tention. Recall that the IC dimension was correlated with greater feelings of personal efficacy, higher aspirations, and so forth, and that ER was related to collective action in the social arena. If so, we would expect that IC-ER people would be more likely to participate in civil rights activities and to stress racial identity and militancy. Pride in one's racial and cultural identity is most likely to be accepted by an IC-ER person. The low self-esteem engendered by widespread prejudice and racism is actively challenged by these people. There is an attempt to re- define a group's existence by stressing consciousness and pride in their own racial and cultural heritage. Such phrases as Black is beautiful"represent a symbolic relabeling of identity from Negro and colored to Black or African American. To many African Americans, Negro and colored are White labels symbolic of a warped and degrading identity given them by a racist society. As a means of throwing off these burdensome shackles, the Black individual and African Americans as a group are redefined in a positive light. Many racial minorities have begun the process in some form and have banded to-


Social Justice Dimensions in Counseling/Therapy

gether into what was historically called the Third World Movement Asian Americans, African Americans, Hispanic/Latino Americans, American Indi- ans, and others) Studies on the Black social activists of the 1960s found they were generally better educated, more integrated into the social and political workings of their communities, and held more positive attitudes toward Black history and culture facial pride) Finally, evidence tends to indicate they were more healthy along several traditional criteria for measuring men- tal health Kaplan, 1970) Therapeutic Implications There is much evidence to indicate that minority groups are becoming in- creasingly conscious of their own racial and cultural identities as they relate to oppression in U.S. society. If the evidence is correct, it is also probable that more and more minorities are most likely to hold an IC-ER worldview. Thus, therapists who work with the culturally different will increasingly be exposed to clients with an IC-ER worldview. In many respects, these clients pose the most difficult problems for the White IC-IR therapist. These clients are likely to raise challenges to the therapist's credibility and trustworthiness. The help- ing professional is likely to be seen as a part of the Establishment that has op- pressed minorities. Self-disclosure on the part of the client is not likely to come quickly and, more than any other worldview, an IC-ER orientation means that clients are likely to play a much more active part in the therapy process and to demand action from the therapist. An interesting transactional analysis of the mindsets of all four quad- rants can be found in Figure 12.2.

Figure 12.2



Source: From Counseling and Development in a Multicultural Society p. 399) by J. A. Axelson. Copyright @993 by Wadsworth, Inc. Reprinted by permission of Brooks/Cole Publishing Company, Pacific Grove, California 93950, a division of Wadsworth, Inc.

Transactional Analysis of Cultural Identity Quadrants

/. (Assertive/ Passive) I'm O.K. and have control over myself. Society is O.K., and I can make it in the system.

IV. (Assertive! Assertive) I'm O.K. and have control, but need a chance. Society is not O.K., and I know what's wrong and seek to change it.



77. ( Marginal/ Passive ) I'm O.K. but my control comes best when I define myself according to the definition of the dominant culture. Society is O.K.the way it is; it's up to me.

777. ( Passive! Aggresive ) I'm not O.K. and don't have much control; might as well give up or please everyone. Society is not O.K. and is the reason for my plight; the bad system is all to blame.

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Social Justice Counseling: Organizational and Systemic Change In Chapter 2, a Multidimensional Model of Cultural Competence was pre- sented, where the foci for change could be aimed at the individual, profes- sional, organizational, or societal levels ^ee Figure 2.3) These roughly cor- respond to the terms used in social justice work to describe the micro individuals, families, and groups) meso Communities and organizations) and macro levels Social structures, ideologies, and policies)of intervention. The remainder of this chapter will concentrate on social justice work directed at organizations and systems. Multicultural Organizational Development (Meso Level) All helping professionals need to understand two things about institutions: \ )they work within organizations that are oftentimes monocultural in poli- cies and practices and 2)the problems encountered by clients are often due to organizational or systemic factors. This is a key component of the ecologi- cal or person-in-environment perspective Fouad, Gerstein, SToporek, 2006) In the former case, the policies and practices of an institution may thwart the ability of counselors to conduct culturally appropriate helping for their diverse clientele. In the latter case, the structures and operations of an organization may unfairly deny equal access and opportunity Recess to health care, employment, and education)for certain groups in our society. It is possible that many problems of mental health are truly systemic problems caused by racism, sexism, and homophobia. Thus, to understand organiza- tional dynamics and to possess multicultural institutional intervention skills are part of the social justice framework. Making organizations responsive to a diverse population ultimately means being able to help them become more multicultural in outlook, philosophy, and practice. Multicultural organizational development MOD) is a relatively new area of specialty that J )takes a social justice perspective Ending of oppres- sion and discrimination in organizations) 2 (believes that inequities that arise within organizations may not primarily be due to poor communication, lack of knowledge, poor management, person-organization fit problems, and so on, but to monopolies of power;and ?)assumes that conflict is inevitable and not necessarily unhealthy. Diversity trainers, consultants, and many I/O psychologists increasingly ascribe to MOD, which is based on the premise that organizations vary in their awareness of how racial, cultural, ethnic, sexual orientation, and gender issues impact their clients or workers. Institutions that recognize and value diversity in a pluralistic society will provide healthy sites for workers and the consumers of their services. They will also be in a better position to offer culturally relevant services to their diverse populations and allow mental health agencies to engage in organizationally

306 Social Justice Dimensions in Counseling/Therapy sanctioned roles and activities without the threat of punishment. Moving from a monocultural to a multicultural organization requires the counselor or change agent to understand the characteristics of that organization. Ascertain- ing what the organizational culture is like, what policies or practices either fa- cilitate or impede cultural diversity, and how to implement change are crucial to healthy development. Perhaps the easiest way to understand what we mean by healthy organizations that are inclusive is to address what a culturally com- petent system of mental health care would look like. Culturally Competent Mental Health Agencies Social justice provides the rationale for mental health organizations to be- come multicultural, and the unmet needs of marginalized groups are fore- most among them. To meet those needs, not only must an organization em- ploy individuals with cultural competence, but the agency itself will need to have a multicultural culture, if you will. T. L. Cross et al. J989)describe a detailed, six-stage developmental continuum of cultural competence for mental health agencies. These have been given the names J)cultural de- structiveness, cultural incapacity, cultural blindness, ^) cultural precompetence, (>)cultural competence, and 0)advocacy. 1 . Cultural destructiveness. Cross et al. acknowledged the checkered history of organizations and research ostensibly designed to help"certain racial/ethnic groups by identifying the first stage of incompetence as cultural destructiveness. Programs that have participated in culture/ race-based oppression, forced assimilation, or even genocide represent this stratum. Historically, many federal government programs aimed at American Indians fit this description, as do the infamous Tuskegee ex- periments, in which Black men with syphilis were deliberately left un- treated, or the Nazi-sponsored medical experiments that singled out Jews, Gypsies, gays/lesbians, and the disabled, among other groups, for systematic torture and death under the guise of medical research. 2. Cultural incapacity. At this stage, organizations may not be intentionally culturally destructive, but they may lack the capacity to help minority clients or communities because the system remains extremely biased toward the racial/cultural superiority of the dominant group. The char- acteristics of cultural incapacity include discriminatory hiring and other staffing practices, subtle messages to people of color that they are not valued or welcome, especially as manifested by environmental cues building location, decoration, publicity that uses only Whites as mod- els, etc.) and generally lower expectations of minority clients, based on unchallenged stereotypical beliefs.

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3. Cultural blindness. The third stage is one in which agencies provide ser- vices with the express philosophy that all people are the same, and the belief that helping methods used by the dominant culture are univer- sally applicable. Despite the agency's good intentions, services are so ethnocentric as to make them inapplicable for all but the most assimi- lated minority group members. Such services ignore cultural strengths, encourage assimilation, and blame the victim for their problems Outcome is usually measured by how closely a client approximates a middleclass, nonminority existence. Institutional racism restricts mi- nority access to professional training, staff positions, and services'!. L. Cross et al., 1989, p. 15) Organizations at this stage may have more of a fixation on getting the numbers right'and eliminating any apparent signs of hostility toward new groups. While there may be a sincere de- sire to eliminate a majority group's unfair advantages, the focus may end up on limited and legalistic attempts to comply with equal employ- ment or affirmative action regulations. It is difficult for organizations to move past this stage if Whites or other cultural majority members are not willing to confront the ways they have benefited from institutional racism, and risk trying new ways of sharing power. 4. Cultural precompetence. Agencies at this stage have at least looked at the artifacts and values of their organization to recognize their weaknesses in serving diverse groups and developing a multicultural staff fichein, 1990) They may experiment with hiring more minority staff beyond the minimal numbers required to comply with Equal Employment Op- portunity EE O (goals, may recruit minorities for boards of directors or advisory committees, may work cooperatively to perform needs assess- ments with minority groups in their service area, and may institute cul- tural sensitivity training for staff, including management. They may propose new programs specifically for a particular ethnic/cultural group, but if planning is not done carefully, this program may end up marginalized within the agency. One danger at this level is a false sense of accomplishment or of failure that prevents the agency from moving forward along the continuum Another danger is tokenism"?. L. Cross et al., 1989, p. 16) when minority professionals are expected to raise the agency's level of cross-cultural efficacy by simply being present in slightly greater numbers. However, minority staff may lack training in many of the skills or knowledge areas that would allow them to trans- late their personal experience into effective counseling, not to mention training of coworkers. If the task of developing cultural awareness has been given to mi- nority staff (>r motivated majority staff )who do not have the clout to involve all elements of the agency, then this pattern of program devel-

308 Social Justice Dimensions in Counseling/Therapy opment allows for the phony embracing of multiculturalism because the dominant group can remain on the sidelines judging programs and helping the institution to continue on its merry way"parr SStrong, 1987, p. 21) These staff members may sacrifice job performance in other areas and then be criticized. Or they may work doubly hard be- cause they are taking on the extra burden of cultural awareness activi- ties, and then may not receive any acknowledgment, in patterns that continue the oppression of minorities C~allegos, 1982) 5. Cultural competence. Agencies at this stage show Continuing selfassess- ment regarding culture, careful attention to the dynamics of difference, continuous expansion of cultural knowledge and resources, and a vari- ety of adaptations to service models in order to better meet the needs of culturally diverse populations"?. L. Cross et al., 1989, p. 17) They have a diverse staff at all levels, and most individuals will have reached the higher stages of individual racial/cultural identity awareness. That is, they are aware of and able to articulate their cultural identity, values, and attitudes toward cultural diversity issues. This will be true for both majority and minority culture members. Staff will regularly be offered or seek out opportunities to increase their multicultural skills and knowledge. There is recognition that minority group members have to be at least bicultural in U.S. society and that this creates mental health issues concerning identity, assimilation, values conflicts, and so on, for staff as well as clients. There will be enough multilingual staff available to offer clients choices in relating to service providers. If the agency has culture-specific programs under its umbrella, agency staff and clients perceive these programs as integral to the agency, and not just as junior partners. 6. Cultural proficiency. This stage encompasses the highest goals of multi- cultural development. These organizations are very uncommon, given that both the organizational culture and individuals within it are oper- ating at high levels of multicultural competence, having overcome many layers of racism, prejudice, discrimination, and ignorance. Orga- nizations at this stage seek to add to the knowledge base of culturally competent practices by Conducting research, developing new thera- peutic approaches based on culture, and disseminating the results of demonstration projects"T. L. Cross et al., 1989, p. 17) and follow through on their broader social responsibility to fight social discrimi- nation and advocate social diversity"in all forums foster, Jackson, Cross, Jackson, giardiman, 1988, p. 3) Staff members are hired who are specialists in culturally compe- tent practices, or are trained and supervised systematically to reach competency. Every level of an agency board members, administrators,

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counselors, and consumers)regularly participates in evaluations of the agency's multicultural practices and environment and is able to articu- late the agency's values and strategies concerning cultural diversity. If the agency runs culture-specific programs, these programs are utilized as resources for everyone in the agency and community, and not per- ceived as belonging just to that ethnic community JVlunz Sanchez, 1996) Just as we have described a culturally competent system of mental health care for all groups, we encourage counselors and therapists to work toward addressing social justice issues Equity )that involve employment, ed- ucational, legal, and governmental institutions and agencies. For example, what would a fair and equitable educational system look like?How could business and industry move toward equal access and opportunity in the hir- ing, retention, and promotion of all employees?And, what role can coun- selors play to help achieve these social justice goals?As we have repeatedly emphasized, providing a healthy organizational climate will do much to im- prove mental health and the quality of living for all groups in our society. Systemic Change (Macro Level) Increasingly, leaders in the field of counseling psychology have indicated that the profession should promote the general welfare of society;be concerned with the development of people, their communities, and their environment; and should promote social, economic, and political equity consistent with the goals of social justice Toporek, Gerstein, et al., 2006) Thus, social justice counseling includes social and political action that seeks to ensure all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully Goodman et al., 2004) If mental health professionals are concerned with the welfare of society, and if society's purpose is to enhance the quality of life for all persons, then they must ultimately be concerned with the injustices and obstacles that oppress, denigrate, and harm those in our society fyVarren SConstantine, 2007) They must be concerned with issues of classicism, racism, sexism, ho- mophobia, and all the other fsms"that deny equal rights to everyone. As mentioned previously, counselors/therapists practice at three levelsmicro — where the focus is on individuals, families, and small groups;mesowhere the focus communities and organizations;and macrowhere the focus is on the larger society Statutes and social policies) Conventional clinical work operates primarily from the micro level, is aimed primarily at helping individuals, and is not adequate in dealing with these wider social issues. It is too time consuming, is aimed at remediation,

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and does not recognize the fact that many problems clients encounter may actually reside in the social system. Let us use the example of racism to illus- trate some of the basic tenets of antiracism work that are consistent with a so- cial justice approach. We use racism as an example, but social justice work ex- tends to all forms of cultural oppression poverty inadequate health care, immigrant rights, educational inequities, etc.)that deny equal access and op- portunity. Antiracism as a Social Justice Agenda It is not enough for psychologists to simply work with those victimized by stereotyping, prejudice, and discrimination at the micro levels. It is not enough for psychologists, on an individual basis, to become bias free and cul- turally sensitive when the very institutions that educate, employ, and govern are themselves biased in policy, practice, assumption, and structure. In using race and racism as an example of the need to combat social justice issues on a systemic level, psychologists need to realize that racial attitudes and beliefs are formed from three main sources:schooling and education, mass media, and peers and social groups $ue, 2003) Just as these channels can present a biased social construction of knowledge regarding race and race relations, they also offer hope as vehicles to overcome intergroup hostility, misunder- standing, and the development of norms associated with equity and social justice. In essence, psychologists can be helpful in working for a multicultural curriculum in society that stresses social justice Equity and antiracism) It must be done in the schools, all media outlets, and in the many groups and organizations that touch the lives of our citizens. Yet, to use these tools of so- cialization to combat racism and to reconstruct a nonbiased racial reality mean psychologists must impact social policy. Work at the local, state, and federal levels involve psychologists in political advocacy and social change. Gordon Allport, a social psychologist well known for his classic book, The Nature of Prejudice J 954) proposed conditions that offer a guide to an- tiracism work. Since its publication, others have conducted revealing and im- portant work on reducing prejudice through creating conditions found to lower intergroup hostility. It has been found that racism is most likely to di- minish under the following conditions: {) having intimate contact with people of color, ^experiencing a cooperative rather than competing envi- ronment, j5)working toward mutually shared goals as opposed to individual ones, 4)exchanging accurate information rather than stereotypes or misin- formation, ^interacting on equal footing with others rather than an un- equal or imbalanced one, £)viewing leadership or authority as supportive of intergroup harmony, and f (feeling a sense of unity or interconnectedness with all humanity |ones, 1997;Sue, 2003) Further, it appears that no one

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single condition alone is sufficient to overcome bigotry. To be successful in combating racism, all conditions must coexist in varying degrees to reduce prejudice. Social Justice Requires Counseling Advocacy Roles To achieve these conditions in our society is truly an uphill battle. But, just as the history of the United States is the history of racism, it is also the history of antiracism as well. There have always been people and movements directed toward the eradication of racism, including abolitionists, civil rights workers, private organizations Southern Poverty Law Center, NAACP, and B'nai Brith) political leaders, and especially people of color. Racism, like sexism, homophobia, and all forms of oppression, must be on the forefront of social justice work. Efforts must be directed at social change in order to eradicate bigotry and prejudice. In this respect, psychologists must use their knowledge and skills to {) impact the channels of socialization Education, media, groups/organizations)to spread a curriculum of multiculturalism, and ?)aid in the passage of legislation and social policy Affirmative action, civil rights voting protections, sexual harassment laws, etc.) To accomplish these goals, we need to openly embrace systems intervention roles identified by Atkinson et al., ^993)advocate, change agent, consultant, adviser, facilitator of in- digenous support systems, and facilitator of indigenous healing methods. In closing, we include the words of Toporek £006, p. 496)about the social jus- tice agenda and its implications for psychologists: The vastness of social challenges facing humanity requires large-scale interven- tion. Although the expertise of counseling psychologists is well suited to individ- ual empowerment and local community involvement, likewise, much of this ex- pertise can, and should, be applied on a broad scale. Public policy decisions such as welfare reform, gender equity, same-sex marriage and adoption, and home- lessness must be informed by knowledge that comes from the communities most affected. Counseling psychologists, with expertise in consulting, communicating, researching, and direct service, are in a unique position to serve as that bridge.

Multicultural Counseling- ano Specific Populations

Part V! Counseling and Therapy Involving- Minority CtROUP Counselors /Therapists

Minority Group Therapists: Working with Majority and Other Minority Clients

Kavita, a clinician of South Asian descent, is unsure of her ethnic identity and has trouble balancing being American with being South Asian. See- ing South Asian clients only makes this conflict more important to her. Will this affect her attitudes toward treating minority clients? (Gurung & Mehta, 2001, p. 139)

13 Chapter

My challenge has been in my work with men. I have always felt somewhat constrained with my male clients and did not like the impact it had on our therapy. I had talked to other women therapists about my difficulties and found that they had similar experiences. My problems became most evident to me when issues related to privilege, gender, and power needed to be dis- cussed. I found myself caught between being too adversarial and challeng- ing on one hand and the "all-giving " protector trained to soothe pain on the other. (Kort, 1997, p. 97) As a Black counselor, I sometimes have difficulties working with clients of Asian background, especially when they claim to be victims of prejudice. How can they claim to be oppressed when they are so successful? At most college campuses, they are everywhere, taking slots away from us. Some- times I think they are whiter than Whites, (workshop participant) These three vignettes illustrate some of the complex counseling is- sues when minority group therapists work with members of their own group, work with majority culture clients, and work with different minority clients. Although our discussion has focused primarily on the need of White therapists to acknowledge their assumptions, values, and biases when working with clients of color, the same applies to therapists of color as well. Multicultural counseling/therapy is more than White - Black, White-Latino, White-Asian, and so forth. It also includes Asian American-African American, Latino American-African American, Na- tive American-Asian American, and a multitude of combinations where


318 Counseling and Therapy with Minority Group Counselors /Therapists

the counselor is from a marginalized group (jLBT, women, a counselor with a disability, etc.) There are two reasons why dealing with these counseling relationships is important, especially interracial/interethnic counseling. First, demogra- phers predict that within several short decades, people of color will become a numerical majority. The increase in populations of color has meant that con- tact between the groups has also become more frequent, oftentimes resulting in strains and conflicts between Blacks and Asians, Asians and Latinos, and Latinos and Blacks. Second, the number of therapists from diverse groups is also increasing and as indicated throughout, therapists of color are not im- mune from their own cultural socialization or inheriting the biases of the so- ciety as well. For example, one of us found it difficult in clinical work to be nonjudgmental or empathetic to oppositional children during family ses- sions. Instead of patience and understanding, feelings of disapproval when children would speak disrespectfully to a parent would emerge. During self- reflection, the therapist was able to identify the source of these reactions. As a child, he was exposed to a cultural background in which obedience to parents was of paramount importance. Hierarchical communication patterns were the norm, and he was unaware that he used this standard when work- ing with families. It is clear that everyone, regardless of race, gender, sexual orientation, and so on, needs to examine the impact of their own value sys- tem or experiences as members of marginalized groups when providing ther- apy to those of the majority culture or a member of a different ethnic minor- ity group. As with White therapists, the values and assumptions are often invisible to therapists of color as well, and may influence the provision of therapy.

The Politics of Interethmc and Interracial Bias and Discrimination

People of color generally become very wary about discussing interethnic and interracial misunderstandings and conflicts between various groups for fear that such problems may be used by those in power to \ )assuage their own guilt feelings and excuse their own racism-People of color are equally racist, and why should I change when they can't even get along with one an- other, "£) divide and conquer&s- long as people of color fight among themselves, they can't form alliances to confront the establishment, "and ? (divert attention away from the injustices of society by defining problems as residing between various racial groups. Further, as discussed previously, readers have to understand that minority prejudice toward other groups le., people of color or Whites (occurs under an umbrella of White racial superi- ority;while minority groups may discriminate they do not have the systemic power to oppress on a large-scale basis. In other words, while they may be

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able to hurt one another on an individual basis and to individually discrimi- nate against White Americans, they possess little power to cause systemic harm, especially to White Americans. Some people of color have even taken the stand that interethnic prejudice among minorities only serves to benefit those in power. As a result, people of color are sometimes cautioned not to Sir dirty laundryln public. These concerns are certainly legitimate and we would be remiss in not alerting readers to how society has historically used conflicts be- tween racial groups as a justification for continued oppression and avoidance in dealing with White racism. But the admonition don't air dirty laundry in public"speaks realistically to the existence of miscommunications, disagree- ments, misunderstandings, and potential conflicts between and among eth- nic/racial minority groups. When people of color constituted a small per- centage of the population, it was to their advantage to become allies in a united front to challenge the sources of injustice. Avoiding or minimizing interethnic group differences and conflicts served a functional purpose: to allow them to form coalitions of political, economic, and social power to ef- fect changes in society. While historically beneficial on a political and sys- temic level, the downside has been a neglect in dealing with interracial dif- ferences that have proved to become problematic. We believe that the time has long passed when not openly addressing these issues continues to hold unquestioned merit. People of color have al- ways known that they, too, harbor prejudices and detrimental beliefs about other groups. Feminists have acknowledged difficulty in relating to men who hold traditional beliefs about appropriate female gender roles. GLBT groups describe negative reactions to straights who voice beliefs that gay sex is im- moral, marriage should be between a man and a woman, or that their reli- gion condemns such a lifestyle. "If we look at the relationship between groups of color, for example, misunderstandings and mistrust become very obvious. In the early 1990s, the racial discourse in urban America was dom- inated by African American boycotts of Korean mom and pop grocery stores that was followed by the looting, firebombing, and mayhem that engulfed Los Angeles (]hang, 2001) Many in the Black community felt that the Ko- reans were exploiting their communities as had White businesses. Reports of Hispanic and Black conflicts in the inner cities have also been reported throughout the country. As Latinos have surpassed Blacks in numbers, they have increasingly demanded a greater voice in communities and the political process. Since Latinos and Blacks tend to gravitate toward the same inner-city areas and compete for the same jobs, great resentment has grown between the groups Wood, 2006) The immigration issue has also sparked fierce de- bate within the Latino and Black communities, as some Blacks believe jobs are being lost to the huge influx of Latinos ponzales, 1997) In essence, the discourse of race that once was confined to Black- White relations has become

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increasingly multiethnic and multiracial. These differences are reflected in the perceptions groups of color have toward one another. In one major na- tional survey Rational Conference of Christians and Jews, 1994) it was found: 1 . More than 40 percent of African Americans and Hispanics, and one of every four Whites believe that Asian Americans are Unscrupulous, crafty and devious in business." 2. Nearly half the Hispanic Americans surveyed and 40 percent of African Americans and Whites believe Muslims belong to a religion that con- dones or supports terrorism." 3. Blacks think they are treated far worse than Whites and worse than other minority groups when it comes to getting equal treatment in ap- plying for mortgages, in the media, and in job promotions. 4. Only 10 percent of African Americans-a-staggeringly low number — believe the police treat them as fairly as other groups. 5. African Americans believe that everyone else is treated with more equality, and especially that Asian Americans are doing better. 6. There is tremendous resentment of Whites by all minority groups. 7. Two-thirds of minorities think Whites believe they are superior and can boss people around, "are insensitive to other people, "Control power and wealth in America/and do not want to share it with non- Whites." Two primary conclusions are noteworthy here: First, racial/ethnic groups also experience considerable mistrust, envy, and misunderstandings toward one another as well. Surprisingly, African Americans and Latinos held stronger negative beliefs about Asian Americans than did White Americans 40 percent versus 25 percentjSecond, and not surprisingly, people of color continue to hold beliefs and attitudes toward Whites that are very negative and filled with resentments, anger, and strong mistrust. If these conclusions are true, then we might ask the following questions. What effect does in- terethnic bias on the part of therapists of color have upon their culturally di- verse clientslf an African American therapist works with an Asian Ameri- can client or vice versa, what therapeutic issues are likely to ariseiikewise, in light of the strong negative feelings expressed by all groups of color against Whites, how might a therapist of color react intentionally and unintention- ally toward their White clients'Some might argue, however, that a therapist of color working with a White client may be different than a therapist of color working with a client of color because power differentials still exist on a sys- temic level for White clients. Little in the way of research or conceptual schol-

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arly contributions has addressed these issues or questions. It may not be far- fetched, however, to surmise that these racial combinations may share some similar dynamics and clinical issues to White therapist-client of color dyads. Multicultural Counseling in Minority- Majority and Minority-Minority Relationships Not only do we need to engage in self-examination, but it is also clear that we are a stimulus to clients through appearance, speech, or other factors that re- flect differences. These perceived differences may influence the development of a therapeutic relationship. We've had clients make statements such as I like Chinese food"and the Chinese are very smart and family oriented, "or exhibit some discomfort when meeting us for the first time. In one study Fuertes SSelso, 2000) male Hispanic counselors who spoke with a Spanish accent were rated lower in expertise by Euro-American students than those counselors without an accent. This phenomenon may also exist for therapists with other accents and may need to be discussed in therapy to allay anxiety in both the therapist and the client. One graduate student from Bosnia would discuss her accent and would let clients know that English was her second language. Although her command of English was good, this explanation helped establish a more collaborative relationship. Acknowledging differ- ences, or investigating the reasons for client reactions, are important since they may affect the therapeutic process. In one instance, an African Ameri- can psychology intern working with a man in his 70s noticed that the client persisted in telling stories about the Negro fellas'that he served with in the army. He made positive comments about his Black comrades and talked about their contributions to the unit. The intern responded by saying "I guess you noticed I'm B/ac/:"Hinrichsen, 2006, p. 3 1 ) This response led to a discus- sion of client concerns that he would say something that might be considered offensive. He also worried about whether the intern could understand the ex- perience of an older White man. White therapists facing an ethnic minority client often struggle with whether to ask, "How do you feel working with a White therapist?"Th\s situation is also faced by minority therapists working with White clients. When differences between therapist and client are apparent £.g., ethnicity, gender, ability, age)or revealed £.g., religion, sexual orienta- tion) acknowledging them is important. Both African American and Cau- casian American students revealed a stronger preference for openness and self-disclosure when asked to imagine a counselor of a different ethnicity Cashwell, Shcherbakova Silashwell, 2003) Self-disclosure, or the acknowl- edgment of differences, may increase feelings of similarity between therapist and client and reduce concerns about differences. In this respect, the same

322 Counseling and Therapy with Minority Qroup Counselors /Therapists might apply when both the therapist and client are persons of color but are from a different racial/ethnic group. As we have mentioned earlier, cultural differences can impact the way we perceive events. This was clearly seen in a study involving Chinese Amer- ican and Caucasian American psychiatrists IJ-Repac, 1980) Both groups of therapists viewed and rated videotaped interviews with Chinese and Cau- casian patients. When rating White patients, Caucasian therapists were more likely to use terms such as affectionate, "adventurous, "and capable," whereas Chinese therapists used terms such as active, "aggressive, "and febelliouslo describe the same patients. Similarly, White psychiatrists de- scribed Chinese patients as anxious, "awkward, "fiervous, "and quiet," while Chinese psychiatrists were more likely to use the terms adaptable," alert, "dependable, "and friendly. 'It is clear that both majority and mi- nority therapists are influenced by their ethnocentric beliefs and values. Problematic relationship issues involving other areas of diversity may also impact the therapist-client relationship. Kort Quoted at the beginning of the chapter)talked about her difficulties in maintaining an objective per- spective in working with men, especially regarding issues of gender and priv- ilege. Similarly, therapists who are gay or lesbian, have a disability, are older, or are of a different religion need to be aware of their own value orientation and the impact it may have with a more mainstream client. How would you deal with clients who have a very different perspective than your own or who may harbor negative feelings toward member of your groupln the research literature there have been few studies examining the influence of culturally diverse or different therapists working with White, majority culture clients or with different minority group members. We believe this area needs more at- tention, particularly in view of the continuing growth of practitioners in the field who are members of ethnic minorities or other diverse groups. Therapist- Client Matching It is often believed that matching the therapist and client on ethnicity, gen- der, or other dimensions will result in a more positive therapeutic outcome due to similarities in experience, language, or values. However, the findings regarding this are mixed and difficult to interpret since:} (some involve ana- logue studies hypothetical situations )where student or clients indicate their preference regarding the ethnicity of a therapist, ^comparisons usually in- volve only a few ethnic groups, £)most involve very small samples, samples tend to be regional and may not be representative of the population at large, and |>)the outcome measures differ from study to study. It is im- portant to keep these limitations in mind when evaluating existing research, especially when contradictory findings occur. In a meta-analytic review of therapist and client racial-ethnic matching with African American and Cau-

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casian American clients focused on the variables of overall functioning, drop- out rate, and total number of sessions attended, no significant differences were found between ethnically matched and nonethnically matched dyads Bhin et al., 2005) Similar results were found in a large-scale study that in- volved 4,483 college students and 376 therapists from 42 university counsel- ing centers. There was little evidence that therapist-client ethnicity match was associated with either working alliance or outcome. However, the per- centage of ethnic minority participants in the study was relatively small Af- rican American, 3.0 percent, Asian American, 4.2 percent, Hispanic Ameri- can, 7.7 percent, and Alaskan/Native American, 0.3 percent; Erdur, Rude, Baron, Draper, Shankar et al., 2000) The results are in contrast to research that indicates that African American clients state a preference for an African American therapist {
324 Counseling and Therapy with Minority Qroup Counselors /Therapists

to the results reported by Flaherty and Adams J 998) boys rated their al- liance with female therapists low and were more likely to terminate. This dif- ference may be a result of the developmental stage of adolescents and/or be- cause the issue involved was substance abuse. Certain therapist-client ethnic mismatches may be more problematic than others. In examining the outcome of actual therapy sessions, matching has been found to be important for Asian clients. Ethnic matching resulted in significantly more sessions, attended with lower dropout rates Flaskerud, 1991) These results may reflect the importance of linguistic ability, since eth- nic match was also found to be a positive predictor of outcome among Mexi- can Americans for whom English was not their primary language Sue et al., 1991) There are also some preliminary findings involving ethnic matching between African American therapists and Asian American clients and white clients in therapy with Asian therapists Erdur et al., 2000) Asian American clients seen by African American therapists rated the working alliance lower than those working with other ethnic group or White therapists. Similarly, White clients rated their alliance with Asian therapists lower than White cli- ents seen by other therapists. These findings should be regarded with caution because of the very small number of Asian American clients who worked with African American therapists if =1 0)or White clients who had an Asian ther- apist it =14)however, it does bring forth the possibility that certain ethnic combinations of therapist and client may be more problematic than others. The impact of ethnic matching may also depend on client characteris- tics such as the degree of adherence to cultural values. Kim and Atkinson £002)found that Asian American clients with strong traditional values rated Asian American therapists as more empathetic and credible than more West- ernized clients. Conversely, Western-oriented clients judged European American counselors to be more empathetic than did clients with high ad- herence to Asian cultural values. Thus, in ethnically similar therapist-client matches, potential matches or mismatches in cultural identity may need to be explored. Communication Style Differences Communication style differences $ee Chapter 7) which may be displayed by ethnic minorities or therapists, can also impact the expectations or respon- siveness of clients from different backgrounds. American Indians, for ex- ample, are more likely to speak softly, use an indirect gaze, and interject less frequently, whereas Caucasian Americans are more likely to speak loudly, have direct eye contact, and show a direct approach. These same characteris- tics may be displayed by therapists in interacting with clients. Ethnic minor- ity therapists need to be aware of their nonverbal style and determine whether it is affecting the therapeutic relationship. In a study of nonverbal

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communication JCim, Liang, fti, 2003) five Asian American and five Eu- ropean American female therapists were observed conducting one session of career counseling with three Asian American volunteer clients. During the session, Euro- American therapists smiled more frequently and had more pos- tural shifts than did Asian American therapists. In terms of client ratings, fre- quency of smiles was correlated with positive feelings about the session. Al- though the numbers of therapists and clients were few and the study involved an analogue setting, it lends some support to the view that cultural differences in verbal and nonverbal style of communicating feelings may af- fect the therapist-client relationship. Issues Regarding Stage of Ethnic Identity The stage of identity of ethnic minority therapists may also affect their work with clients. Kavita, in the example cited at the beginning of the chapter, re- veals a struggle in identity between being either South Asian or American. This conflict may be unconscious but is displayed by minority therapists dur- ing therapy, especially with clients of the same ethnicity. In a study of 1 50 stu- dents of Indian descent, those who were more Westernized"expressed less interest in serving minority clients. Some individuals may reject their own ethnic group, preferring to have the majority culture as their standard. In this case, ethnic minority therapists may have to acknowledge and resolve iden- tity issues, since it may affect their reactions to a client from the same ethnic- ity or in dealing with clients from the majority culture. Mikki, a 27 -year-old social worker who immigrated to Israel from Ethiopia at the age of 10, worked in a municipal unit for adolescents in distress Recog- nizing the huge gap between his family's traditional lifestyle and the modernity of the Israelis, he soon became to feel ashamed of his parents ...he rejected the boys who represented his traditional Ethiopian self and favored those who rep- resented the Israeli part of him. (Yedidia, 2005, pp. 165-166) During supervision, Mikki came to realize that his hostility to Ethiopian boys was a result of countertransference and that it reflected the inner con- flict he was having between his identification as an Ethiopian versus that of an Israeli. Mikki's reaction was not unusuabYedidia found this same type of identity conflict among other immigrant therapists from Ethiopia and Russia. Immigrant and ethnic minority therapists need to consider possible identity conflicts in their work with culturally or ethnically similar clients. It is highly possible that ethnic minority therapists at the conformity stage of identity de- velopment $ee Chapter 10)may either respond defensively or negatively to an ethnically similar client who is struggling with identity issues.

326 Counseling and Therapy with Minority Qroup Counselors /Therapists Ethnic Minority and Majority Therapist Verspectives Davis and Gelsomino |994)examined the cross-racial practice experiences of White and minority social work practitioners ?3 White, 17 Black, and 3 American Indian) They were asked their perceptions of effectiveness in working with culturally different clients and the source of the clients' prob- lems. Both White and Black therapists believed they worked equally well with White clients. However, the ethnic minority therapists reported being the recipient of greater hostility in cross-racial practice, and White therapists regarded themselves as less effective with minority clients. Interestingly both groups of therapists had similar views regarding the clients' problems-diffi- culties among minority clients were attributed to external sources while in- ternal factors were seen as more important for White clients. While the attri- bution of causes may have some justification, we believe that this response may shortchange both White and minority clients. Environmental and indi- vidual contributions to problems should be assessed for all clients. In a study of 12 therapists f> African American and 7 Euro- Americans) and their responses to clients who were racially different from themselves, some differences and similarities were found JCnox, Burkard, Johnson, Suzuki, a?onterotto, 2003)African American therapists were more likely to routinely address race with ethnic minority clients or when race seemed to be part of the presenting problem. They were also more likely to bring up race if they observed discomfort from their Euro-American clients. Euro- American therapists addressed race less frequently with clients and reported feeling discomfort when doing so. Both groups of therapists did not bring up the issue of race if it was not deemed to be important or if they sensed the cli- ent was uncomfortable with the topic. African American therapists reported being more direct in addressing race through either questions or confronta- tion; one participant asked a client directly what it was like to talk to an African American therapist. Euro-American therapists would also ask but did so less frequently and somewhat less directly: Tow know, I'm a White woman. How do you see that as affecting our relationship here?" JCnox et al., p. 467) Most therapists believed that addressing race had a positive effect on the therapeu- tic alliance and in the outcome of therapy. They felt that therapists who are responsive to cultural issues would be perceived by clients, especially those from ethnic minorities, as more credible and culturally competent. We be- lieve that all therapists should be willing to discuss differences with clients but also be aware of situations where this might not be beneficial. In summary, it is clear that cultural competence goals do not apply only to White helping professionals. All therapists and counselors, regardless of race, culture, gender, and sexual orientation need to J)become aware of their own worldviews, their biases, values, and assumptions about human behavior, £ (understand the worldviews of their culturally diverse clients,

Minority Qroap Therapists 327

and develop culturally appropriate intervention strategies in working with culturally diverse clients. Race, culture, ethnicity, gender, and sexual orientation are functions of everyone.

Implications for Clinical Practice 1 . As with majority culture therapists, ethnic minority and therapists from other diverse groups need to identify cultural issues, values, beliefs, and experiences that may interfere with the provision of therapy to their cli- ents. 2. The therapist's outward appearance, nonverbal behavior, and charac- teristics-such as accentsmay influence the client's perception of credibility and the therapeutic relationship. 3. The use of self-disclosure in acknowledging differences may increase feelings of similarity between the client and therapist. 4. Awareness of communication style differences between the therapist and the client is important. A therapist may inform the client that he or she tends to be more cognitive 0r other style )and ask if this is work- able with the client. 5. Therapists must evaluate their stage of identity and determine how it might impact work with clients of the same or different ethnicity. 6. Addressing ethnic or other differences between the therapist and client can be helpful. In terms of therapists of color, clients are aware of the ethnic difference, and bringing it up in a routine manner deals with the elephant in the room. "However, therapists need to use their clinical judgment to determine when it might be contraindicated.

Counseling and Therapy with Racial/Ethnic Minority <5-roup Populations

Counseling African Americans

During Hurricane Katrina, Blacks felt abandoned by the government and were so distrustful that they believed the poor neighborhoods were allowed to be flooded so that wealthy areas such as the French Quarter in New Or- leans would remain dry. They pointed out a photo depicting a Black man and White woman who were shown carrying bread from a grocery store. The caption for the Black man was "looting" while that for the White woman was "finding" her goods. (J. Washington, 2005) The fact that several school personnel made derogatory remarks about [Black] parents in front of researchers made us wonder what they would say in our absence. At the end of two consecutive meetings, one of which lasted only 5 minutes, the teacher commented that the brevity of the con- ference did not matter because the parent "wouldn 't have understood it anyway. " (Harry, Klingner, &Hart, 2005) Through the media and even in school, I could see that in many people's eyes, Blacks and Whites were not equal. I sometimes felt that I was under attack, but this did nothing but build my strength, character and resilience. (Murphy, 2005, p. 315) In 2005, the African American population numbered 34,361,740, or about 12.2 percent of the U.S. population. In addition, 1.9 million people reported being Black and one or more other races U.S. Census Bureau, 2005c) Of the increase since 1980, 16 percent was due to im- migration. The poverty rate for African Americans remains over two times higher than that of White Americans %5 versus 12 percent) and the unemployment rate is twice as high \ 1 versus 5 percent) Their dis- advantaged status, as well as racism and poverty, contribute to the fol- lowing statistics. In the 25 to 29 age group, nearly 12 percent of Black men were in prison or jail as compared to 1.7 percent of White males Associated Press, 2006, May 21) Over 20 percent of Black males are temporarily or permanently banned from voting in Texas, Florida, and 331

14 Chapter

332 Counseling and Therapy with Racial/Ethnic Minority Groups

Virginia because of felony convictions Cose et al., 2000) The lifespan of African Americans is 5 to 7 years shorter than that of White Americans N. B. Anderson, 1995;Felton, Parson, Misener, SDldaker, 1997) Although these statistics are grim, much of the literature is based on in- dividuals of the lower social class who are on welfare or unemployed, and not enough is based on other segments of the African American population Ford, 1997;Holmes fMorin, 2006) This focus on one segment masks the great diversity that exists among African Americans, who may vary greatly from one another on factors such as socioeconomic status, educational level, cultural identity, family structure, and reaction to racism. Many middle- and upper-class African Americans are receptive to the values of the dominant so- ciety, believe that advances can be made through hard work, feel that race has a relative rather than a pervasive influence in their lives, and embrace their heritage. As Hugh Price, former president of the National Urban League ob- served, "This country is filled with highly successful black men who are leading bal- anced, stable, productive lives working all over the labor market" Holmes JMorin, 2006, p. 1) However, even among this group of successful Black men earn- ing $5,000 a year or more, 6 in 10 reported being victims of racism, and that someone close to them was murdered or had been in jail. The African American population is becoming increasingly heteroge- neous in terms of social class, educational level, and political orientation. In this chapter we discuss value differences exhibited by many African Ameri- cans, issues of racism and discrimination, research findings, and their impli- cations for treatment.

African American Values, Research, and Implications for Counseling and Therapy Family Characteristics Increasingly larger percentages of African American families are headed by single parents. In 2000, 32 percent of all African American families involved married couples, as compared to 53 percent for all households U.S. Census Bureau, 2005c) The African American family has been generally described as matriarchal;among lower-class African American families, over 70 percent are headed by women. Black females who are unmarried account for nearly 60 percent of births, and of these mothers the majority are teenagers. However, these statistics lack an acknowledgment of the strengths in the African American family structure. For many, there exists an extended family network that provides emotional and economic support. Among fami- lies headed by females, the rearing of children is often undertaken by a large

Counseling African Americans 333

number of relatives, older children, and close friends. Within the Black family exists adaptability of family roles, strong kinship bonds, a strong work and achievement ethic, and strong religious orientation Hildebrand, Phenice, Gray, Slines, 1996;McCollum, 1997) African American men and women value behaviors such as assertiveness; within a family, males are more ac- cepting of women's work roles and are more willing to share in the responsi- bilities traditionally assigned to women, such as picking up children from school. Despite the challenges of racism and prejudice, many African Ameri- can families have been able to instill positive self-esteem in their children. Implications. Our reaction to African American families is due to our Euro- centric, nuclear family orientation. Many assessment forms and evaluation processes are still based on the middle-class Euro-American perspective of what constitutes a family. The different family structures indicate the need to consider various alternative treatment modes and approaches in working with Black Americans. In working with African American families, the coun- selor often has to assume various roles, such as advocate, case manager, prob- lem solver, and facilitating mentor Ahai, 1997) In many cases the counselor not only has to intervene in the family but also has to deal with community interventions. A number of African American families who go into counsel- ing are required to do so by the schools, courts, or police. Issues that may need to be dealt with include feelings about differences in ethnicity between the client and counselor, and clarification of the counselor's relationship to the referring agency. For family therapy to be successful, counselors must first identify their own set of beliefs and values regarding appropriate roles and communication patterns within a family. One must be careful not to impose these beliefs on a family. For example, African American parents, especially those of the working class, are more likely than White parents to use physical punishment to discipline their children E. E. Pinderhughes, Dodge, Bates, Pettit, ffielli, 2000) However, while some types of physical discipline have been related to more acting out behavior in White children, this was not found in African American children peater-Deckard, Dodge, Bates, fPettit, 1996) Physical discipline should not necessarily be seen as indicative of a lack of parental warmth, or negativity. Similarly, although critical comments by family mem- bers have been found to contribute to relapse for certain mental disorders in White clients, this effect was not found with Black clients. It is possible that seemingly critical'behavior by Black family members is, in fact, perceived as a sign of caring and concern ^osenfarb, Bellack, fAziz, 2006) Parent education approaches based on White, intact, nuclear families are often inappropriate for African American families. In fact, they may per- petuate the view that minorities have deficient child-rearing skills. Attempts are being made to develop culturally sensitive parent education programs for

334 Counseling and Therapy with Racial/Ethnic Minority Groups African Americans that focus on responses to racism by the family, culture conflicts, single parenting, drug abuse, and different types of discipline. Dif- ferences in family functioning should not be automatically seen as deficits (Jorman 33 alter, 1997) Kinship Bonds and Extended Family and Friends A mother, Mrs. J., brought in her 13-year-old son, Johnny, who she said was having behavioral problems at home and in school. During the interview, the therapist found out that Johnny had five brothers and sisters living in the home. In addition, his stepfather, Mr. W, also lived in the house. The mother's sister, Mary, and three children had recently moved in with the family until their apartment was repaired. The question "Who is living in the home?" caught this. The mother was also asked about other children not living at home. She had a daughter living with an aunt in another state. The aunt was helping the daugh- ter raise her child. When asked, "Who helps you out?" the mother responded that a neighbor watches her children when she has to work and that both groups of children had been raised together. Mrs. J. 's mother also assisted with her chil- dren. Further questioning revealed that Johnny's problem developed soon after his aunt and her children moved in. Before this, Johnny had been the mother's primary helper and took charge of the children until the stepfather returned home from work. The changes in the family structure that occurred when the sister and her children moved in produced additional stress on Johnny. Treatment included Mrs. J. and her children, Mr. W., Mary and her children, and Mrs. J.'s mother. Pressures on Johnny were discussed, and al- ternatives were considered. Mrs. J.'s mother agreed to take in Mary and her children temporarily. To deal with the disruption in the family, follow-up meetings were conducted to help clarify roles in the family system. Within a period of months, behavioral problems in the home and school had stopped for Johnny. He once again assumed a parental role to help out his mother and stepfather. Implications. Montague \ 996 (pointed out several important considerations to make when working with Black families. Because of the possibility of an extended or nontraditional family arrangement, questions should be directed toward finding out who is living in the home and who helps out. It is also im- portant to work to strengthen the original family structure and try to make it more functional rather than change it. One of the strengths of the African American family is that men, women, and children are allowed to adopt multiple roles within the family. An older child like Johnny could adopt a parental role while the mother might take on the role of the father. The

Counseling African Americans 335

grandmother may be a very important family member who also helps raise the children. Her influence and help should not be eliminated, but the goal should be to make the working alliance with the other caregivers more effi- cient. Educational Orientation African American parents encourage their children to develop career and ed- ucational goals at an early age in spite of the obstacles produced by racism and economic conditions. The gap in educational attainment between Black and White children is gradually narrowing. The high school graduation rate for African Americans has increased to 74.2 percent versus 80 percent for White Americans, although African Americans still are behind in receiving their bachelor's degree (14.3 versus 24.3 percent)as compared to White Americans p.S. Census Bureau, 2005c) However, problems are still found in academic performance. Especially at risk are African American boys, who show a ten- dency toward disidentification \he disengagement of academic performance from self-esteem) subsequently losing interest in academics during middle and high school. Behavior problems in school may also be related to parental acknowledgment of racism; African American parents who denied racism had preschool children with higher rates of behavior problems compared to parents who actively took steps to confront experiences with racism Caughy, O'Campo, 9riuntaner, 2004) The educational environment is often negative for African American children. They are two to five times more likely to be suspended from school and receive harsher consequences than their White peers Monroe, 2005) School personnel often hold stereotypes of African American parents as being neglectful or incompetent and blame the child's problem on a lack of support for schooling by the families. As one teacher stated, "The parents are the prob- lem! They [the African American children] have absolutely no social skills, such as not knowing how to walk, sit in a chair... it's cultural" parry SKlinger, 2005, p. 105) These negative views were not at all confirmed by observations made by the researchers after visiting the homes of parents who were criticized; they often observed good parenting skills, support for education, and love for their children. Implications. Factors associated with school failure, especially in African American males, must be identified, and intervention strategies must be ap- plied. This may involve systems, family, and individual interventions. Many school systems have predominantly White teaching staffs, but the student population has changed from being predominantly White to predominantly minority. Because of this, teaching skills that were effective in the past may no longer work. For example, many African American youths display an an-

336 Counseling and Therapy with Racial/Ethnic Minority Groups imated, persuasive, and confrontational communication style, while schools have norms of conformity, quietness, teacher-focused activities, and individ- ualized, competitive activities. Indeed, mainstream teachers may see com- munication patterns, nonstandard movements, and walking style as aggres- sion or misbehavior puhaney, 2000; Monroe, 2005) It is important for educators to recognize culturally based behaviors that are not intended to be disruptive. Many teachers are not sensitive to these cultural differences and may respond inappropriately to minority group members. Students often learn best when curricula and classroom styles are modified, taking cultural factors into consideration. Spirituality D is a 42-year-old African American woman who was married for 20 years and recently divorced. She presented with depressive-like symptoms — feelings of loneliness, lack of energy, lack of appetite, and crying spells. She was raising two children with very little support from her ex-husband Although part of the treatment focused on traditional psychological interventions such as cognitive re- structuring, expression of feelings, and changing behaviors, D 's treatment also consisted of participating in two church-related programs. D's treatment in- volved participating in the women 's ministry of her church to decrease her emo- tional and social isolation and to develop a support network. Treatment also involved participation in "The Mother to Son Program. " The purpose of this program is to provide support to single mothers parenting African American boys. The program provides support for parents and rites of passage programs and mentors for Black boys. (Queener & Martin, 2001, p. 120) Spirituality and religion play an important role in many African Amer- ican families and provide comfort in the face of oppression and economic sup- port. Participation in religious activities allows for opportunities for self- expression, leadership, and community involvement. Among a sample of low-income African American children, those whose parents regularly at- tended church had fewer problems Christian ffiarbarin, 2001) Implications. If the family is heavily involved in church activities or has strong religious beliefs, the counselor could enlist resources £.g., the pastor or min- ister)to deal with problems involving conflicts within the family, school, or community. For many African American families spiritual beliefs play an im- portant role and may have developed as part of a coping strategy to deal with stressors. Churches should be considered as much a potential source of infor- mation as are clinics, schools, hospitals, or other mental health professionals. Church personnel may have an understanding of the family dynamics and living conditions of the parishioners. A pastor or minister can help create

Counseling African Americans 337

sources of social support for family members and help them with social and economic issues. In addition, programs for the enrichment of family life may be developed jointly with the church. Ethnic or Racial Identity- Many believe that minorities go through a sequential process of racial iden- tity or consciousness. For African Americans, the process involves a transfor- mation from a non-Afrocentric identity to one that is Afrocentric Although some African Americans already have a Black identity through early social- ization) The W. E. Cross }991, 1995)model, which was described in detail in Chapter 10, identifies several of these stages: pre-encounter, encounter, immersion-emersion, and internalization. Implications. Those who are at the pre-encounter level are less likely to report racial discrimination, while those in the immersion stage tend to be younger and least satisfied with societal conditions Hyers, 2001) African Americans with the greatest internalization of racial identity report the highest self- esteem Pierre Ssdahalik, 2005) Additionally, African American preferences for counselor ethnicity are related to the stage of racial identity Atkinson & Lowe, 1995) Parham and Helms J 98 1 (found that African Americans at the pre-encounter stage preferred a White counselor, while those in the other stages preferred a Black counselor. Often, however, the most important coun- selor characteristic for African American students is the cultural sensitivity of the counselor. A culturally sensitive counselor (me who acknowledges the possibility that race or culture might play a role in the client's problem ^s seen as more competent than is a culture-blind counselor (me who focuses on fac- tors other than culture and race when dealing with the presenting problem; Pomales, Claiborn, SiaFromboise, 1986;Want, Parham, Baker, ffiherman, 2004) Among a group of working class African American clients, the degree of therapeutic alliance with the European American counselor was affected not only by the stage of racial identity of the client, but also by similarities in gender, age, attitudes, and beliefs. Additionally, clients who had parenting, drug use, or anxiety problems looked for therapists' understanding regarding these specific issues Ward, 2005) African American Youth For many urban Black adolescents, life is complicated by problems of poverty, illiteracy, and racism. The homicide rate for African American youth between the ages of 15 and 24 was nearly 10 times that of White youth in 1989;their suicide rate increased to over twice that of other teenagers between 1 980 and 1992;and they are more likely to contract sexually transmitted diseases than

338 Counseling and Therapy with Racial/Ethnic Minority Groups other groups of teenagers parvey SRauch, 1997) Unemployment can range from 37 percent to nearly 50 percent among Black teenagers. Most African American youth feel strongly that race is still a factor in how people are judged Gannett News Service, 1998) African American children are well aware of occupational status. In one study, they identified service jobs as those performed by Only Black people"and high-status jobs as those per- formed by White Americans Bigler S/werhard, 2003) Issues presented in counseling may differ to some extent between males and females. African American adolescent females, like other females, are burdened by living in a male-dominated society, face issues with racial iden- tity and negative stereotypes, and strive to succeed in relationships and ca- reers. They often undertake adult responsibilities such as the care of younger siblings and household duties at an early age. As a group, although they en- counter both racism and sexism, they display higher self-confidence, lower levels of substance use, and more positive body images than do White female adolescents Belgrave, Chase-Vaughn, Gray, Addison, Sherry, 2000) Their awareness of racial and gender issues is reflected in the following comments: Well, in this time I think it's really hard to be an African American woman ...we are what you call a double negative; we are Black and we are a woman and it's really hard I'd rather say I'm African-American than I'm Black because of the con- nection with the land, knowing that I come from somewhere [Racial identity] is important to me because society sees African American females as always getting pregnant and all that kind of thing and being on wel- fare. (Shorter-Gooden & Washington, 1996, p. 469) In this sample of young African American females, Shorter-Gooden and Washington }996)found that the struggle over racial identity was a more salient factor than was gender identity in establishing self-definition. These adolescents believed that they had to be strong and determined to overcome the obstacles in society's perception of Blackness. About half had been raised by their mother, and most indicated the importance of the mother-daughter relationship. Careers were also important to two-thirds of the females;most felt that the motivation to succeed academically was instilled by their parents. In counseling young African American women, issues involving racial iden- tity and conflict should be explored, and their sense of internal strength should be increased, because it appears to serve as a buffer to racism and sex- ism. African American females often have to deal with the double issue of being both Black and female. They have to fight against negative images to prevent those images being incorporated into their own belief systems; si- multaneously, they must develop pride and dignity in Black womanhood |ordan, 1997)

Counseling African Americans 339

Black youth often do not come to counseling willingly. Often they come because they have been referred or brought in by their parents. Because of this, cooperation may be difficult: Michael is a 19-year-old African American male who was brought to counseling by his aunt, Gloria, with whom he has lived for the past 2 years. Gloria is con- cerned about Michael's future as a result of his being present during a recent drug raid at the home of some friends Although Michael graduated from high school and is employed part-time at a fast food restaurant, he is frustrated with this work and confused about his future. He believes that Black men "don 't get a fair shake " in life, and therefore is discouraged about his prospects about getting ahead Michael's aunt. . . is concerned that Michael's peers are in- volved in gangs and illegal activities. She thinks the rap music he listens to is be- ginning to fill his head with hate and anger. . . . Michael's major issues center around developing a positive identity as an African American man and discov- ering his place in the world. (Frame & Williams, 1996, p. 22) Implications. The type of socialization that African American children and teenagers receive from their parents has been found to be related to social anxiety. Facing racism, African American parents may \ )address racism and prejudice directly and help their children identify with their own race; £)discuss ra ce only when the issue is brought up by their children and con- sider it to be of minor importance;?)focus on human values and ignore the role of race. Neal-Barnett and Crowther £000)found that the third approach was related to higher levels of social anxiety, particularly with African Amer- ican peers. Ignoring racial issues in socialization left children vulnerable to anxiety when Black peers accused them of Acting White. 'They had not had the opportunity to develop coping strategies. Racial socialization of children by African American families helped to buffer the negative effects of racist discrimination Fischer 8Shaw, 1999) Protective factors have included in- creasing positive feelings about self and enhancing the sense of culture for African American youth Belgrave et al., 2000) In the case of Michael, Frame and Williams }996)suggested several strategies for working with Black youth. The first involves the use of metaphors and is based on the African tradition of storytelling. Instead of just responding to Black men don't get a fair shake, "the counselor could get Michael to help identify family phrases or Biblical stories that instill hope. Ad- ditional metaphors could be generated from the writings of contemporary African American figures. The second strategy could be support for Michael's struggle with societal barriers. He could envision himself as a crusader for hu- man rights and learn how to direct his anger in appropriate ways. Third, Michael could be asked to bring in his rap music and discuss what is appealing about it. Issues addressed in the lyrics could be explored, and the counselor

340 Counseling and Therapy with Racial/Ethnic Minority Groups could help with decisions regarding healthy outlets for his feelings of anger or despair. Fourth, family and community support systems could be generated. Members of the extended family, the pastor, teachers, and other important in- dividuals in Michael's life could be asked to meet together in Aunt Gloria's home. All the members could share information about their struggles and search for identity. Use of these techniques, derived from African American experiences, can lead to personal empowerment. Racism and Discrimination The existence of racism has produced a variety of defensive and survival mechanisms among Black Americans. Sixty-one percent of African Ameri- cans believe that the federal response to the disaster caused by Katrina would have been faster if White populations had been involved Washington, 2005) This cultural mistrust, or healthy cultural paranoia, "acts as a coping strategy Phelps, Taylor, SSerard, 2001) A lack of trust and feelings of dis- crimination exist for social services and medical support, especially among the youth Miller, Seib, EDennie, 2001) Only 9 percent of African Ameri- cans believe that they are treated the same as White Americans Tilove, 2001) The experience of perceived racial discrimination leads to lower levels of mastery and higher levels of psychological distress Broman, Mavaddat, & Hsu, 2000) Discriminatory practices may also account for the fact that African Americans are less likely than their White counterparts to receive an anti- depressant for depression and less likely to receive the newer selective sero- tonin reuptake inhibitor 6SRI)medications Blazer, Hybels, Somonsick, & Hanlon, 2000;Melfi, Croghan, Hanna, ERobinson, 2000) Even when re- ceiving medication, African Americans are less likely to use it for themselves or their children because of beliefs about possible side effects and effective- ness £chnittker, 2003) Implications. Since the mental health environment is a microcosm of the larger society, the mental health professional should be willing to address and anticipate possible mistrust from African American clients fyVhaley, 2001 ) If the problem is due to discriminatory practices by an institution, the therapist may have to operate at the institutional level by making certain that clinics evaluate their procedures to ensure prescribing appropriate medications for African American clients. In other cases, the therapist may have to examine the African American client's response to the problem situation. The client may have only a limited or reflexive problem-solving capability. When coun- seling a client about dealing with situations in which racism plays a part, the counselor must assist the client in developing a wider range of options and encourage the development of a more conscious, problem-solving mode. The

Counseling African Americans


Source: From Psychological Functioning in Black Americans:A Conceptual Guide for Use in Psychotherapy/by A. C. Jones, 1985, Psychotherapy, 22, p. 367. Copyright 1982 by Psychotherapy. Reprinted by permission of the Editor, Psychotherapy.

The Interaction of Four Sets of Factors in the Jones Model

Figure 14.1

client must consider the way he or she usually deals with racism and consider other options that might be more productive. A. C.Jones i^985)feels that four sets of interactive factors must be con- sidered in working with an African American client $ee Figure 14.1) The first factor involves the reaction to racial oppression. Most African Americans have faced racism, and the possibility that this factor might play a role in the present problem should be examined. Vontress and Epp J997)described this factor as historical hostility, "a reaction in response to current and past suf- fering endured by the group. Because of this, problems are often perceived through this filter. The second factor is the influence of African American cul- ture on the client's behavior. Clients may vary greatly in their identification with African American traditions. The third factor involves the degree of adoption of majority culture values. The task of the therapist is to help the cli- ent understand his or her motivation and make conscious, growth-producing choices. The fourth factor involves the personal experiences of the individual. African Americans differ significantly in their family and individual experi- ences. For some, this last category may be much more significant than racial identity.

In working with African American youth and adults in counseling situations, certain suggestions can be made about the elements necessary during the vital first few sessions. The first sessions are crucial in determining whether the cli- ent will return. The following steps may help by explaining what counseling is and enlisting the assistance of the client. Prior experiences may render issues of trust very important. The counselor can deal with these issues by discussing

342 Counseling and Therapy with Racial/Ethnic Minority Qroaps

them directly and by being open, authentic, and empathetic. The African American client will often make a decision based on his or her interpersonal evaluation of the counselor. As one client stated, "I am assessing to see if that per- son [counselor] is willing to go that extra mile and speak my language and talk about my Blackness.. . " Ward, 2005, p. 475) The role of the counselor may have to be much broader for the African American client than for the White client. He or she may have to be more directive, serve in an educative function, and help the client deal with agencies or with issues involving employment and health. Al- though the order of these elements can be modified and some can be omitted, these steps may be helpful to the counselor and client: 1 . During the first session, it may be beneficial to bring up the reaction of the client to a counselor of a different ethnic background. Although African Americans show a same-race preference, being culturally com- petent has been shown to be even more important. )A statement such as, Sometimes clients feel uncomfortable working with a counselor of a different race. Would this be a problem for you^br a variant can be used. 2. If the clients are referred, determine their feelings about counseling and how it can be made useful for them. Explain your relationship with the referring agency and the limits of confidentiality. 3. Identify the expectations and worldviews of African American clients, find out what they believe counseling is, and explore their feelings about counseling. Determine how they view the problem and the pos- sible solutions. 4. Establish an egalitarian relationship. In contrast to other ethnic groups, most African Americans tend to establish a personal commonality with the counselor. This may be accomplished by self-disclosure. If the client appears hostile or aloof, discussing some noncounseling topics may be useful. 5 . Determine whether and how the client has responded to discrimination and racism, both in unhealthy and healthy ways. Also, examine issues around racial identity (nany clients at the pre-encounter stage will not believe that race is an important factor) For some, the identification with Afrocentricity may be important in establishing a positive self- identity. In these cases, elements of African/African American culture should be incorporated in counseling. This can be achieved through readings, movies, music, and discussions of African American mentors. 6. Assess the positive assets of the client, such as family including relatives and nonrelated friends) community resources, and church. 7. Determine the external factors that might be related to the presenting problem. This may involve contact with outside agencies for financial

Counseling African Americans 343

and housing assistance. Do not dismiss issues of racism as just an ex- cuse,'instead, help the client identify alternative means of dealing with the problems. 8. Help the client define goals and appropriate means of attaining them. As- sess ways in which the client, family members, and friends have handled similar problems successfully. 9. After the therapeutic alliance has been formed, collaboratively deter- mine the interventions. Usually problem-solving and time-limited ap- proaches are more acceptable.

Counseling American Indians and Alaskan Natives

Some American Indians want to abolish Columbus day and instead have a holiday that honors indigenous people . ..It bothers these young Indians that people still believe Christopher Columbus discovered America when there already were indigenous people living here. (Hanson, 2006, p. I) The U.S. Government had judged that Indians were incapable of manag- ing their own land, so they placed the property in a trust in 1887 and promised that the Indians would receive the income from their land. They never did. On December 1999, a Federal judge ruled that the government had breached its sacred trust duties. (Maas, 2001 ) Of the 1 75 Indian languages spoken in the United States, only about 20 are passed on from mothers to babies. James Jackson, Jr., remembered his experience in a boarding school when a teacher grabbed him when he was speaking his native language and threatened to wash out his mouth with soap: "That's where we lost it [our language]. " (Brooke, 1998) In North America, wars and diseases that resulted from contact with Europeans decimated the American Indian population. It is esti- mated that the population of American Indians had decreased to only 10 percent of its original number by the end of the eighteenth century. The experience of American Indians in America is not comparable to that of any other ethnic group. In contrast to immigrants, who arrived with few resources and struggled to gain equality, American Indians had resources. They had land and status that were gradually eroded by im- perial, colonial, and then federal and state policies |C. W. Johnson et al., 1995) Extermination and seizure of lands seemed to be the primary policy toward the North Americans. Experience with this type of con- tact prompted this observation from a Delaware warrior:! admit that there are good White men, but they bear no proportion to the bad;the bad must be the strongest, for they rule. Indians suffered massive losses of their land. 345

15 Chapter

346 Counseling and Therapy with Racial/Ethnic Minority Groups During the 1830s, over 125,000 Indians from different tribes were forced from their homes in many different states to a reservation in Oklahoma. The move was traumatic for Indian families and, in many cases, disrupted their cultural traditions. Assaults against the Indian culture occurred in attempts to Civilize"the Indians. Many Indian children were forced to be educated in English-speaking boarding schools. They were not allowed to speak their own language and had to spend 8 continuous years away from their families and tribes. Children were also removed from their homes and placed with non- Indian families until the Indian Child Welfare Act of 1978 pianchard, 1983; Choney et al., 1995;K. W. Johnson et al., 1995) These practices had a great negative impact on family and tribal cohesion and prevented the transmission of cultural values from parents to children. The following case study illustrates some of the disruptions caused by a boarding school experience. Mary was born on the reservation. She was sent away to school when she was 12 and did not return to the reservation until she was 20. By the time she returned, her mother had died from pneumonia. She didn 't remember her father, who was the medicine man of the tribe, very well. Shortly after she returned, she became pregnant by a non-Indian man she met at a bar. Mary's father. . . looked forward to teaching and leaving to his grandson John the ways of the medicine man John felt his grandfather was out of step with the 20th century Mary . . . could not validate the grandfather's way of life . . . she remembered having difficulty fitting in when she returned to the reser- vation In response to the growing distance between the two men, she became more and more depressed and began to drink heavily. (Sage, 1997, p. 48) In the past, the tribe, through the extended family, was responsible for the education and training of the children. The sense of identity developed through this tradition has been undermined. In addition, even recent history is full of broken treaties, the seizure or misuse of Indian land, and battles ()ften led by the U.S. government)to remove or severely limit fishing and hunting rights. These acts have made the American Indians very suspicious of the motives of the majority culture, and most of them do not expect to be treated fairly by non-Indian agencies JC. W. Johnson et al., 1995) One of the most serious failings of the present system is that Indian children are often removed from the custody of their natural parents by nontribal government authorities who have no basis for intelligently evaluating the cultural and social premises underlying Indian home life and childrearing. Many of the individu- als who decide the fate of our children are at best ignorant of our cultural values, and at worst contemptuous of the Indian way and convinced that removal, usu- ally to a non-Indian household or institution, can only benefit an Indian child. (Congressional Record, 1997)

Counseling American Indians and Alaskan Natives 347

Chief Calvin Isaac of the Mississippi Band of Choctaw Indians spoke these words during the house hearings of 1978 in support of the Indian Child Welfare Act. Statistics were cited that indicated over 90 percent of American Indian children were being placed by state courts and child welfare workers into non-Indian homes Congressional Record, 1997) Such placements weakened the cultural identity of the children and weakened the tribes as well since values could not be passed on to the children. The passage of the act dramatically reduced this type of placement, although amendments to strengthen or weaken it continue to be brought up. Implications. When working with American Indian children and families, the mental health professional should be aware of the political relationship as it exists between American Indians, the different states, and the U.S. govern- ment. The Indian Child Welfare Act has important implications for child pro- tective services, runaways, and adoption procedures. In general, decisions re- garding the placement of American Indian children are to be held in tribal courts. If they are to be removed from their parents, the first placements to be considered should be with extended family members, other tribal mem- bers, or other Indian families. Testimony from expert witnesses who are fa- miliar with the specific Indian cultural group must be obtained before chil- dren can be removed from their homes. The counselor should understand the history of oppression that has existed and understand local issues and specific tribal history pana, 2000) The American Indian and the Alaskan Native

American Indians/Alaskan Natives form a highly heterogeneous group com- posed of 561 distinct tribes, some of which consist of only four or five mem- bers Bureau of Indian Affairs, 2005) The American Indian, Eskimo, and Aleut population grew rapidly to 2,500,000 by the year 2005. An additional 1.81 million claim to have Indian roots U.S. Census Bureau , 2006a) Female householders with no husband present represented 27 percent of families versus 17 percent of the U.S. average. Fewer American Indians are high school graduates than the general U.S. population percent versus 80 per- cent) Their income level is only 62 percent of the U.S. average, and the poverty rate is twice as high U.S. Bureau of the Census, 2006a) Health sta- tistics also paint a dismal picture. The alcoholism mortality rate is six times higher than that for the U.S. population as a whole Frank, Moore, {Ames, 2000) Injury related deaths hiotor vehicle crashes, suicides, homicides, drownings)are much higher than that of the overall U.S. rate CDC, 2003) Among Native American women at a private care facility in New Mexico, mood disorders were reported by 21 percent, 47 percent had an anxiety dis-

348 Counseling and Therapy with Racial/Ethnic Minority Qroaps

order, and 14 percent had alcohol dependence or abuse. These rates are two to two and one half times higher than found in the general population pu- ran et al., 2004) Rates of obesity and diabetes are much higher in this group than in the U.S. population Balderas, 2000) Over 60 percent of American Indians are of mixed heritage, having Black, White, and Hispanic backgrounds. In addition, American Indians dif- fer in their degree of acculturation Trimble, Fleming, Beauvais, Sumper- Thurman, 1996) The majority of American Indians do not live on reserva- tions, in part because of the lack of economic opportunities K. W. Johnson et al., 1995) although many are returning because of casino jobs or a more nurturing environment. One man who returned described his need for a more friendly place, friendly face, and friendly greetings'^hukovsky, 2001, p.Al) What constitutes an Indian is often an area of controversy. The U.S. Census depends on self-report of racial identity;some tribes have developed their own criteria and specify either tribal enrollment or blood quantum lev- els. Ken Hansen, chairman of the Samish tribe, stated, ft is a fundamental right of any nation, including tribal nations, to define their own membership. If a person meets the criteria for membership in a tribe, they are Indian" £hukovsky, 2001, p. A13) Congress has formulated a legal definition. An individual must have an Indian blood quantum of at least 25 percent to be considered an Indian. This definition has caused problems both within and outside the Indian community. Some believe that belonging to a tribe should be the most important criterion and that those who do not have a tribal affil- iation are wanna-bes."

Tribe and Reservation

For the many Indians living on reservations and for those living in urban areas, the tribe is of fundamental importance. The relationship that Indians have with their tribes is different from that between non-Indians and their societies. Indians see themselves as an extension of their tribe. Implications. The tribe and reservation provide American Indians with a sense of belonging and security, forming an interdependent system. Status and re- wards are obtained by adherence to tribal structure. Indians judge themselves in terms of whether their behaviors are of benefit to the tribe. Personal ac- complishments are honored and supported if they serve to benefit the tribe. Interventions with American Indian families and individuals should include an assessment of the importance of tribal relationships in any decision- making process. The reservation itself is very important for many American Indians, even among those who do not reside there. Many use the word

Counseling American Indians and Alaskan Natives


here"to describe the reservation and the word fhere"to describe every- thing that is outside. The reservation is a place to conduct ceremonies and so- cial events and to maintain cultural identity. Indians who leave the reserva- tion to seek greater opportunities often may lose their sense of personal identity M. J. Anderson ffillis, I995;Lone-Knapp, 2000)

American Indian/ Alaskan Native Characteristics, Values, and

Family Structure It is difficult to describe the Indian family/It varies from matriarchal struc- tures seen in the Navajo, where women govern the family to patriarchal structures, in which men are the primary authority figures. Some general- izations can be made, however. American Indians are characterized by a high fertility rate, a large percentage of out-of-wedlock births, and strong roles for women. For most tribes, the extended family is the basic unit. Children are often raised by relatives such as aunts, uncles, and grandparents who live in separate households G-arrett, 2006;Hildebrand et al., 1996) Implications. The concept of the extended family is often misunderstood by those in the majority culture, who operate under the concept of the nuclear family. The extended family often includes distant relatives and even non- blood friends. It is not unusual to have youngsters stay in a variety of differ- ent households. Misinterpretations can be made if one thinks that only the parents should raise and be responsible for the children. In working with American Indian children, the counselor should determine the roles of other family members so that interventions can include appropriate individuals. If the other family members play important roles, they should be invited to at- tend the sessions. The emphasis on collectivism is strong. If the goals or tech- niques of therapy lead to discord with the family or tribe, they will not be uti- lized. Interventions may have to be developed with the help of the family, relatives, friends, elders, or tribal leaders. American Indian Values Because of the great diversity and variation among American Indians/ Alaskan Natives, it is difficult to describe a set of values that encompasses all groups. However, certain generalizations can be made regarding Indian val- ues G-arrett, 2006;Garwick Skuger, 2000;Swinomish Tribal Mental Health Project, 1991)

350 Counseling and Therapy with Racial/Ethnic Minority Groups 1 . Sharing. Among Indians, honor and respect are gained by sharing and giving, while in the dominant culture, status is gained by the accumu- lation of material goods. Implications. Once enough money is earned, Indians may stop working and spend time and energy in ceremonial activities. The accumulation of wealth is not a high priority, but is a means to enjoy the present with others. Strate- gies to deal with alcohol and drug use may have to take into consideration the value of sharing. 2. Cooperation. Indians believe that the tribe and family take precedence over the individual. Indian children tend to display sensitivity to the opinions and attitudes of their peers. They will actively avoid disagree- ments or contradictions. Most do not like to be singled out and made to perform in school unless the whole group would benefit. Implications. Indian children may be seen as unmotivated in school because of their reluctance to compete with peers in the classroom. Instead of going to an appointment, they may assist a family member needing help. Indians work hard to prevent discord and disharmony. 3. Noninterference. Indians are taught not to interfere with others and to ob- serve rather than react impulsively. Rights of others are respected. This value influences parenting style. Implications. It is important to be aware of how cultural influences have shaped our perception of what is right or wrong in parent-child relationships. American Indians are more indulgent and less punitive to their children than are parents from other ethnic groups MacPhee, Fritz, fMiller-Heyl, 1996) Euro-American parenting styles may conflict with American Indian values. A culturally sensitive parent education program has been developed for Amer- ican Indians that involves J )use of the oral tradition by storytelling to teach lessons to children;? Understanding of the spiritual nature of child rearing and the spiritual value of children;and £)use of the extended family in child rearing. The eight-session program involves a half-hour social time for parents and children before each session. Storytelling and a potluck meal are included. The focus is the application of traditional teaching methods Nur- turing, use of nature to teach lessons, and use of harmony as a guiding prin- ciple for family life;Gorman Salter, 1997) 4. Time orientation. Indians are very much involved in the present rather than the future. Ideas of punctuality or planning for the future may be unimportant. Life is to be lived in the here and now.

Counseling American Indians and Alaskan Natives 351 Implications. Things get done according to a rational order and not according to deadlines. In the majority culture, delay of gratification and planning for future goals are seen as important qualities. In working with these issues, the coun- selor should acknowledge the value differences and their potential conflict and help the individual or family develop possible strategies to deal with these. 5. Spirituality. The spirit, mind, and body are all interconnected. Illness is a disharmony between these elements. Implications. Traditional curative approaches attempt to restore the harmony of these systems. The sweat lodge and vision quest are often used to reestab- lish the connections between the mind, body, and spirit. To treat a problem successfully, all of these elements have to be considered and addressed. Posi- tive emotions can be curative. Medicine is in each event, memory, place, or person, such as talking to an old friend on the phone or watching children play M. T. Garrett fWilbur, 1999) The counselor should help the client identify the factors involved in disharmony;determine curative events, behaviors, and feelings;and utilize client-generated solutions so that a balance is obtained. 6. Nonverbal communication. Learning occurs by listening rather than talk- ing. Direct eye contact with an elder is seen as a sign of disrespect. In- dian families tend to ask few direct questions. Implications. Differences in nonverbal communication can lead to misunder- standings. Several families reported misunderstandings with teachers. An American Indian child who did not look directly at the teacher talking to her was accused of being disrespectful Garwick {Auger, 2000) This interpreta- tion was premature, since the teacher was not aware that among many In- dian groups, eye contact between a child and an elder indicates a lack of re- spect. The mother explained that this was the way her child was brought up. There have been reported cases in which the lack of eye contact has been re- garded as a deficit. For example, a behavior modification procedure was em- ployed to shape eye contact in a Navaho girl Fiverett, Proctor, fEortmell, 1989) It is important to determine whether specific behaviors are due to cul- tural values or are actual problems.

Specific Problem Areas for American Indians/ Alaskan Natives Education American Indian children appear to do well during the first few years of school. However, by the fourth grade, a pattern of decline and dropping out

352 Counseling and Therapy with Racial/Ethnic Minority Groups

develops. Due to a variety of factors, a significant drop in achievement moti- vation occurs around the seventh grade. Few American Indians who pursue higher education graduate |untunen et al., 2001) Although some have ar- gued that American Indian cultural values and beliefs are incompatible with those of the educational system, there is increasing support for the view that perceived barriers to mobility are the culprit for the reduced academic per- formance. In other words, academic success does not lead to the rewards ob- tained by White Americans. Once American Indian children realize their In- dianness, "achievement motivation drops Wood 8Elay, 1996) In addition, many youth can find jobs on the reservation, so they do not see the necessity for White man's education/The inability to complete an education perpet- uates the cycle of poverty and lack of opportunities and may contribute to the high suicide rate among American Indian adolescents JCeane, Dick, Bech- told, Sanson, 1996) Implications. Fewer American Indians and Alaskan Natives than White Amer- icans finish high school, and 1 1 percent have a bachelor's degree versus 24 percent of the U.S. population U.S. Census Bureau, 2006a) The blame for dropout rates has generally been placed on the individual rather than the school environment. Youths who left school often reported feeling pushed out, "and mistrusted teachers who represented the White community that exerted control over their economic, social, and religious lives peyhle & Swisher, 1999) At a systems level, changes need to be made in public schools and higher education to accommodate some of the social and cultural differ- ences of American Indian and Alaskan Native students and the hostile envi- ronment they face. Teachers should understand the sociocultural history re- garding education with American Indian students and utilize curriculum that reflect the students' cultural background ^eyhner, 2002) Schools must ad- dress the perceived lack of reward for academic achievement among these groups. The reasons for these statistics must be remedied. Some tribes have given up on the public school system and have developed their own learning centers and community colleges. Schools must help students bridge the two worlds of Native American and White cultures. Acculturation Conflicts Not only do Indian children and adolescents face the same developmental problems that all young people do, but they are also in a state of conflict over exposure to two very different cultures. They are caught between expecta- tions of their parents to maintain traditional values and the necessity to adapt to the majority culture Jlieckmann, Wadsworth, ffleyhle, 2004) In one study of American Indian adolescents, the most serious problems identified involved family relationships, grades, and concerns about the future. In ad-

Counseling American Indians and Alaskan Natives 353 dition, boys frequently cited their Indianness or being Indian as a problem. Surprisingly, one-third of the girls reported feeling that they did not want to live Bee-Gates, Howard-Pitney LaFramboise, {Rowe, 1996) Although some of the value differences between Indians and non- Indians have been presented, many Indians are acculturated and hold the values of the larger society. The degree of Indian identity versus acculturation and assimilation should always be considered, since it influences receptivity in counseling. Five cultural orientation types were formulated by M. T. Gar- rett and Pichette £000) 1 . Traditional. The individual may speak little English, thinks in the native language, and practices traditional tribal customs and methods of wor- ship. 2. 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. 3. Bicultural. The person is conversant with both sets of values and can communicate in a variety of contexts. 4. Assimilated. The individual embraces only the mainstream culture's val- ues, behaviors, and expectations. 5. Pantraditional. Although the individual has only been exposed to or adopted mainstream values, he or she has made a conscious effort to re- turn to the 61d ways." Implications. It is clear that within-group differences have to be considered in working with American Indians. Because of differences in acculturation, approaches that might be appropriate for a given individual might not be appropriate for all Indians. For example, the types of problems and the thera- peutic process and goals appropriate for an American Indian living on a rural reservation may be very different from those appropriate for an urbanized In- dian who retains few of the traditional beliefs. An American Indian with a traditional orientation may be unfamiliar with the expectations of the domi- nant culture. In contrast, assimilated or marginal American Indians may face issues such as \ )the denial and lack of pride in being a Native American; 2 pressure to adopt the majority cultural values;? )guilty feelings over not knowing or participating in his or her culture;4)negative views of Native Americans;and £>)a lack of a support and belief system. The mental health professional should assess for tribal affiliation if any, languages spoken, self- identity, where the individual grew up, and if there is a current relationship to a tribe or tribal culture tyl. T. Garrett Bichette, 2000) Different strategies will have to be developed according to the degree of cultural identity. Those who are traditionally oriented may need to develop the skills and resources

354 Counseling and Therapy with Racial/Ethnic Minority Qroaps

to deal with mainstream society. Acculturated individuals may need to ex- amine value and self-identity conflicts. Domestic Violence Domestic violence, along with physical and sexual assault, is quite high in many native communities. American Indian women suffer a higher rate of violence £.5 times higher)than the national average phungalia, 2001)This may be an underestimate. Many do not report assaults because of the tension that exists between law enforcement and women. This level of domestic vio- lence may be a result of the loss of traditional status and roles for both men and women, as well as social and economic marginalization. Implications. During counseling, it may be difficult to determine whether do- mestic violence is occurring in a family or couple. American Indian women who are abused may remain silent because of cultural barriers, a high level of distrust with White-dominated agencies, fear of familial alienation, and a his- tory of the inadequacy of state and tribal agencies to prosecute domestic crimes phungalia, 2001) Jurisdictional struggles between state and tribal authorities may result in a lack of help for women. Many tribes acknowledge the problem of family violence and have developed community-based do- mestic violence interventions. Strategies need to be developed from the American Indian perspective;using material or resources from the majority culture can raise issues of domination Jiamby, 2000) When working with a domestic violence issue with an American Indian woman, tribal issues, tribal programs, and family support should be identified. Suicide Robert Jay cob Jensen was first. The lanky 1 7-year-old Sioux Indian, who 'd been drinking heavily and having run-ins with police all summer, slipped into his family 's dank basement last Aug. 30. Over toward the corner, past the rusted-out furnace and broken sewer line, he threaded a braided leather belt over a board nailed between floor beams, buckled it around his neck and hanged himself. On Nov. 16, in the same basement with the same type of belt, Robert's 16-year-old cousin and best friend, Charles Gerry, hanged himself. Three other Indian youths have since taken their lives In the 5 months since Robert's death, 43 reservation boys and girls have attempted suicide. ("Rash of Indian Suicides," 1998) The suicide epidemic is thought to be the result of alcohol abuse, poverty, boredom, and family breakdown. American Indian youth have twice the rate of attempted and completed suicide as other youth. Adoles-

Counseling American Indians and Alaskan Natives 355

cence to adulthood is the time of greatest risk for suicide, especially among young males FxhoHawk, 1997;Middlebrook, LeMaster, Beals, Novins, & Manson, 2001) Among a sample of 1 22 American Indian middle school chil- dren living on a North Plains reservation, 20 percent had made a nonfatal sui- cide attempt and of this group, nearly half had made attempts two or more times LaFromboise, Medoff, Lee, {Harris, in press) Implications. It is difficult to address many of the societal and economic issues that face American Indians. For those who live on a reservation or identify with a tribe, community involvement or programs may exist or may need to be developed. However, there appears to be only a weak association between participation in traditional activities and suicidal ideation LaFromboise et al., in press) Any program developed should be culturally consistent. A promis- ing culturally tailored suicide intervention program was implemented by LaFromboise and Howard-Pitney J995)at the request of the Zuni Tribal High School. The participants were involved in either an intervention or a no- intervention condition. Scores on a suicide probability measure indicated that 81 percent of the students were in the moderate to severe risk ranges. Of the participants, 18 percent reported having attempted suicide, and 40 per- cent reported knowing of a relative or friend who had committed suicide. The program involved the development of suicide intervention skills through role-playing. Other components included self-esteem building, identifying emotions and stress, recognizing and eliminating negative thoughts or emo- tions, receiving information on suicide and intervention strategies, and set- ting personal and community goals. The program was effective in reducing feelings of hopelessness and suicidal probability ratings. Although the long- term effects of the program are not known, the approach seems promising in the prevention of suicide. Intervention programs may have to be developed and targeted for specific tribes. Suicide ideation among the Pueblo was asso- ciated with a friend's suicidal behavior, while it was associated with lower self-esteem and depression among the Northern plain adolescents LaFrom- boise, 2006) Alcohol and Substance Abuse Substance abuse is one of the greatest problems faced by American Indians. They are six times more likely to die of alcohol-related causes than the gen- eral U.S. population Frank, Moore, {Ames, 2000) In Indian Health Service hospitals approximately 2 1 percent of hospitalizations are for alcohol-related problems Morbidity and Mortality Weekly Report, 1994) In Alaska, 32 percent of American Indians/Alaskan Natives of childbearing age reported heavy drinking, which is responsible for the disproportionately high percentage of cases of fetal alcohol syndrome reported in this population Renters for

356 Counseling and Therapy with Racial/Ethnic Minority Groups

Disease Control, 1994) In addition, drug abuse and dependence are very high among young Indian clients. However, it must be remembered that many American Indians/Alaskan Natives do not drink or only drink moder- ately. Abstinence is high among certain tribes, such as the Navajo flyers, Kagawa-Singer, Kumanyika, Lex, fMarkides, 1995) A variety of explanations have been put forth to indicate possible rea- sons for the rise in alcohol abuse $ee Figure 12.1) Substance abuse is often related to low self-esteem, cultural identity conflicts, lack of positive role models, abuse history, social pressure to use substances, hopelessness about life, and a breakdown in the family Bwinomish Tribal Mental Health Project, 1991;Yee et al., 1995) The use of illicit substances is related to the 50 percent dropout rate from school by American Indian youth Beauvais, Chavez, Oet- ting, Deffenbacher, SCornell, 1996) Heavy alcohol use is associated with both low general self-efficacy and feelings of powerlessness in life Taylor, 2000) Drinking alcoholic beverages may initially have been incorporated into cultural practices as an activity of sharing, giving, and togetherness ^winomish Tribal Mental Health Project, 1991) Implications. Successful residential drug treatment programs have incorpo- rated appropriate cultural elements. If alcohol use has been incorporated into tribal or family customs or traditions, the problem would have to be ad- dressed at both the systems and the individual level. Community-oriented programs engage the entire community rather than specific individuals. It had the advantage of directly involving community leaders Hawkins, Cum- mins EMarlatt, 2004) Because of the history of conflicts between tribal, state, and federal agencies, one must be careful not to be seen as imposing White solutions"to problems on the reservation. One tribal community reduced their alcoholism rate from 95 percent to 5 percent in 10 years by cre- ating a community culture in which alcoholism was not tolerated, while revitalizing traditional culture f homason, 2000) Work within the resources of the tribes. Many have developed programs to deal with alcohol and sub- stance abuse issues.

1 . Before working with American Indians, explore ethnic differences and values. It is important to be aware of our own cultural biases and how they might hinder the counseling relationship and the development of appropriate goals. 2. Determine the cultural identity of the client and family members and their association with a tribe or a reservation. Many American Indians

Counseling American Indians and Alaskan Natives 357 adhere completely to mainstream values;others, especially those on or near reservations, are more likely to hold to traditional values. 3. Understand the history of oppression, and be aware of or inquire about local issues associated with the tribe or reservation for traditionally ori- ented American Indians. Many may be distrustful of agencies. 4. Evaluate using a client-centered listening style initially, and determine when to use more structure and questions. Try not to hurry the indi- vidual. Allow him or her time to finish statements and thoughts. 5. Assess the problem from the perspective of the individual, family, ex- tended family, and, if appropriate, the tribal community. Try to deter- mine the cultural experiential aspects. 6. If necessary, address basic needs first, such as problems involving food, shelter, child care, and employment. Identify possible resources, such as Indian Health Services or tribal programs. 7. Be careful not to overgeneralize, but evaluate for problems such as do- mestic violence, substance abuse, depression, and suicidality during as- sessment. In addition, determine the appropriateness of a mind-body- spirit emphasis. 8. Identify possible environmental contributors to problems such as racism, discrimination, poverty, and acculturation conflicts. 9. Help children and adolescents determine whether cultural values or an unreceptive environment contribute to their problem. Strategize differ- ent ways of dealing with the conflicts. 10. Help determine concrete goals that incorporate cultural, family, ex- tended family, and community perspectives. 11. Determine whether child-rearing practices are consistent with tradi- tional Indian methods and how they may conflict with mainstream methods. 12. In family interventions, identify extended family members, determine their roles, and request their assistance. 13. Generate possible solutions with the clients and consider their conse- quences from the individual, family, and community perspectives. Include strategies that may involve cultural elements and that focus on holistic factors
counseling /\sian /vrncricans and Pacific Islanders

Among traditionally oriented Chinese Americans, depression is described with terms such as boredom, discomfort, pain, dizziness, or other physical symptoms, rather than as feelings of sadness. Many feel that a diagnosis of depression is "morally unacceptable" or " experientially meaningless. " (Kleinman, 2004)

16 Chapter

Eric Liu, the son of immigrants from Taiwan, who graduated from Yale and has written speeches for President Clinton, doesn 'tfeel like an "Asian American. " He believes the identity is contrived and unnecessary. (Chang, 1998)

Approximately 25 percent of Americans hold very strong negative stereo- types of Chinese Americans. Henry S. Tang, whose organization sponsored the poll, responded to the findings by stating, "What these numbers do is force us into a realization that we're always having to earn our recogni- tion over and over again. " (Richardson &MacGregor, 2001, p. El ) The Asian American population is growing rapidly and, as of 2007, is currently over 10 million. It includes people from the Far East, Southeast Asia, or the Indian subcontinent. An additional 1,700,000 census respondents checked Asian and one other ethnic group. Because of immigration over two-thirds of Asians are overseas-born, with 79 percent speaking a language other than English at home, and about 40 percent speaking English less than very well. In fact, with the ex- ception of Japanese Americans, Asian American populations are now principally composed of internationally born individuals. Native Ha- waiian and Pacific Islanders totaled 378,782 and numbered 860,965 when combined with those of more than one race p.S. Census Bureau, 2005e) Between-group differences within the Asian American popula- tion may be quite large, since the population is composed of at least 40 distinct subgroups that differ in language, religion, and values Sandhu,


360 Counseling and Therapy with Racial/Ethnic Minority Groups

1997) They include the larger Asian groups in the United States Chinese, Filipinos, Koreans, Asian Indians, and Japanese) refugees and immigrants from Southeast Asia Vietnamese, Laotians, Cambodians, and Hmongs) and Pacific Islanders Hawaiians, Guamanians, and Samoans) Compounding the difficulty in making any generalization about the Asian American population are within-group differences. Individuals diverge on variables such as migra- tion or relocation experiences, degree of assimilation or acculturation, iden- tification with the home country, facility in their native languages and in En- glish, family composition and intactness, amount of education, and degree of adherence to religious beliefs.

Asian Americans: A Success Story? In contrast to many Third World groups, the contemporary image of Asian Americans is that of a highly successful minority that has made it'in society yin, 2000) Indeed, a close analysis of census figures U.S. Census Bureau, 2004c)seems to support this contention. Of those over the age of 25, 44 per- cent of Asian/Pacific Islanders had at least a bachelor's degree, versus 24 per- cent of their White counterparts. Approximately 10 percent of all students at Harvard, 40 percent of those at Berkeley, and 19 percent of those at MIT are Asian Americans $andhu, 1997) Words such as Intelligent, "hardwork- ing, "Enterprising, "and disciplined"are frequently applied to this popula- tion Morrissey, 1997) The median income of Asian American families was $9,300, versus $0,000 for the U.S. population as a whole U.S. Census Bu- reau, 2004c) A closer analysis of the status of Asian Americans reveals disturbing truths that contrast with popular views of their success story. First, in terms of economics, references to the higher median income of Asian Americans do not take into account \ )the higher percentage of Asian American families having more than one wage earner, £)a higher prevalence of poverty de- spite the higher median income \ 4 versus 8 percent for the U.S. population) and ?)the discrepancy between education and income. For example, high rates of poverty exist among Hmong, Guamanian, Indonesian, and Cambo- dian populations in the United States Iwasaki, 2006a) Second, in the area of education, Asian Americans show a disparate pic- ture of extraordinarily high educational attainment and a large, underedu- cated mass. Among the Hmong, only 40 percent have completed high school, and fewer than 14 percent of Tongans, Cambodians, Laotians, and Hmongs 25 years and older have a bachelor's degree U.S. Census Bureau, 2005e) When averaged out, this bimodal distribution indicates how misleading sta- tistics can be.

Counseling Asian Americans and Pacific Islanders 361 Third, there is now widespread recognition that, apart from being tourist attractions, Chinatowns, Manilatowns, and Japantowns in San Fran- cisco and New York represent ghetto areas with prevalent unemployment, poverty, health problems, and juvenile delinquency. People outside these communities seldom see the deplorable social conditions that exist behind the bright neon lights, restaurants, and quaint shops. Over one-third of the residents in these areas complain of depression and emotional tension Sue, D. W. Sue, L. Sue, flakeuchi, 1995) Mass murders committed over the years have been traced to Chinese juvenile gangs operating in China- towns, and recent news reports show this trend to be on the increase. Fourth, although Asian Americans underutilize mental health services, it is not clear if this is due to low rates of socioemotional adjustment difficul- ties, discriminatory mental health practices, or cultural values inhibiting self- referral Asai aCameoka, 200 5 ) It is possible that much of the mental illness, the adjustment problems, and the juvenile delinquency among Asians are hidden. The discrepancy between official and real rates of adjustment diffi- culties may be due to cultural factors such as the shame and disgrace associ- ated with admitting to emotional problems, the handling of problems within the family rather than relying on outside resources, and the manner of symp- tom formation, such as a low prevalence of acting-out disorders. Fifth, Asian Americans have been exposed to discrimination and racism throughout history and continue to face anti-Asian sentiments. In 1995, the number of hate crimes against Asian Americans rose, with assaults increas- ing by 11 percent and aggravated assaults by 14 percent Matthee, 1997) Although some are fourth- and fifth-generation Americans, many are still identified as foreign "and are regarded with suspicion. In a survey of a rep- resentative sample of 1,216 adults to determine their attitudes toward Asian Americans, several disturbing findings were reported (Committee of 100, 2001) Nearly one-third indicated that Chinese Americans would be more loyal to China than the United States, and nearly half of all the people sur- veyed believed that Chinese Americans would pass secret information to China. About a quarter of the sample would disapprove if someone in their family married an Asian American, and 17 percent would be upset if a Sub- stantial "number of Asian Americans moved into their neighborhoods. It is important for counselors, academic advisors, and educators who work with Asian Americans to look behind the success myth and to under- stand the historical and current experiences of Asians in America. The mat- ter is even more pressing for counselors when we realize that Asian Ameri- cans underutilize counseling and other mental health facilities and are more likely to seek help at a counseling service rather than at a psychiatric facility. The approach of this chapter is twofold. First, we attempt to indicate how the interplay of social and cultural forces have served to shape and define the

362 Counseling and Therapy with Racial/Ethnic Minority Groups lifestyle of recent immigrants/refugees and American-born Asians. Second, we explore how an understanding of Asian American values and social ex- periences necessitate the need for modifications in counseling and psycho- therapeutic practices when working with this population. Traditional Asian Cultural Values, Behavior Patterns, and Implications for Therapy In the following section, we present some of the cultural values, behavioral characteristics, and expectations about therapy of Asian Americans, as well as their implications for counseling. Much of the following consists of group generalizations whose accuracy must be determined for each individual client or family, and are not to be applied in a stereotypic manner. Although cultural knowledge is important in helping the counselor identify potential conflict areas, one must be careful not to apply cultural information rigidly. It must be remembered that within- and between-group differences are quite largeseme individuals and families are quite acculturated, and others re- tain a more traditional cultural orientation Kim, 2007) Cultural differences, such as the degree of assimilation, socioeconomic background, family expe- riences, and educational level, impact each individual in a unique manner. Knowledge of cultural values can help generate hypotheses about the way an Asian might view a disorder and his or her expectations of treatment. It must also be remembered that values and behavior patterns evolve and change over time. The therapist's task is to help the clients identify or develop a vari- ety of ways of dealing with problems within cultural constraints and to de- velop the skills to negotiate cultural differences with the larger society. Collectivistic Orientation I was born and raised in Korea and came to the United States in 1 968 I must move back to Seoul to take care of my aging mother, lama man of Asian values (filial piety), and they (his children) are young college graduates of American values (career advancement and development). (Choi, 1999, p. 7) Instead of promoting individual needs and personal identity 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 dis- honor to the family. Asian American parents tend to show little interest in a child's viewpoint regarding family matters. Instead, the emphasis is on family harmony, adapting to the needs of others, and adherence to correct'Values ^othbaum, Morelli, Pott, £Liu-Constant, 2000) Asian American adoles-

Counseling Asian Americans and Pacific Islanders 363 cents appear to retain the expectation to assist, support, and respect their family even when exposed to a society that emphasizes adolescent autonomy and independence F uligni et al., 1999) While Euro-American parents rated being Self-directed'as the most important attribute in children's social com- petence, Japanese American parents chose behaves well'P'Reilly, Tokuno, £Ebata, 1986) Chinese American parents also believed that politeness and calmness were more important to inculcate in their children than did Euro- American parents lose, Huntsinger, ffciaw, 2000) Asian American families differ in the degree in which they place individual needs over family needs. In the case just given, Choi }999)has accepted the fact that his adult chil- dren will not stay with his wife flieir mother)while he is in Korea to take care of his mother. He decries American society, in which individualism pre- vails over collectivism. However, he acknowledges that his children have honored the family by being successful. He understands that they define family obligations in a different manner. Implications. Because of a possible collectivistic orientation, it is important to consider the family and community context during assessment and problem definition. It is important to be open to different family orientations and not automatically consider interdependence as a sign of enmeshment. After do- ing an individual analysis, you might also ask questions such as, How does your family see the problemTor traditionally oriented Asian Americans, a focus on individual client needs and wishes may run counter to the values of collectivism. Determining whether the client is aware of conflicting expecta- tions is also important. Goals and treatment approaches may have to include a family focus £.g., How important are considerations of your family in de- ciding how to deal with the problem^and How would achieving the differ- ent goals affect you, your family, friends, and social community?Questions such as these allow the therapist to assess the degree of collectivism in the cli- ent. Acculturated Asian Americans with an individualistic orientation can often benefit from traditional counseling approaches, but the family should still be assessed, since conflicts due to acculturation differences are common. Hierarchical Relationships Traditional Asian American families tend to be hierarchical and patriarchal in structure, with males and older individuals occupying a higher status. Com- munication flows down from the parent to the child, who is expected to defer to the adults. The sons are expected to carry on the family name and tradition. Even when they are married, their primary allegiance is to the parents. In gen- eral, the mother serves to mediate communication within the family. Second- generation Chinese American high school students place a higher priority on filial piety and obedience to their parents and authorities than do their Euro-

3 64 Counseling and Therapy with Racial/Ethnic Minority Groups American counterparts Feldman &Rosenthal, 1990) Third-generation Japanese Americans still feel the pressure of parental obligations Ina, 1997) Between-group differences do exist. Among Asian American groups, Japan- ese Americans are the most acculturated. The majority are third- to fourth- generation Americans. Filipino American families tend to be more egalitarian, while Korean, Southeast Asian, and Chinese American families tend to be more patriarchal and traditional in orientation Blair 8Qian, 1998) Implications. In family therapy it is important to determine the family struc- ture and communication pattern. Does it appear to be egalitarian or hierar- chicaMf the structure is not clear, addressing the father first and then the mother may be most productive. If English is a problem, use an interpreter with the parents. Having children interpret for the parents can be counter- productive because it upsets the hierarchical structure. For very traditionally oriented families, having communication from members directed to the ther- apist is more congruent with cultural values than having the family members address one another. It is also important to assess for status change within the family. It is not uncommon among Asian immigrants for women to retain their occupational status while men are either underemployed or unem- ployed. A loss of male status may result in family conflict. The father may be- come even more authoritarian to maintain his status. In such cases, it is help- ful to cast societal factors as the identified patient. Parenting Styles When she does something wrong, I think, something like misbehavior, something not good, I will sit down first, think about how to solve this problem. If I have dif- ficulty, I will consult an expert on how to solve this problem. (Kass, 1998, p. 3) Hou-Lin Li and his wife, Luying Deng, had completed a parent educa- tion course after being accused of slapping their 8-year-old daughter for lying and forging their signature on a disciplinary note from a teacher. For this, the state prosecutor, Richard Devine, charged the parents with child abuse and threatened them with deportation back to China. In one sample of under- graduates, Asian American students reported a somewhat higher level of physical and emotional punishment from their parents than did their Euro- American counterparts Jvleston, Heiman, Trapnell, ECarlin, 1999) Asian American parenting styles tend to be more authoritarian and directive than in Euro-American families, although a relaxed style is used with children younger than the age of 6 or 7 |ose et al., 2000;Meston et al., 1999) Prob- lem behavior in children is thought to be due to a lack of discipline. However, differences in parenting style between Asian American groups have been found. Japanese and Filipino American families tend to have the most egali-

Counseling Asian Americans and Pacific Islanders 365

tarian relationships, while Korean, Chinese, and Southeast Asian Americans are more authoritarian E-lair 8Qian, 1998) Implications. Egalitarian or Western-style parent effectiveness training strate- gies may run counter to traditional rearing patterns. Traditional Asian Amer- ican families may feel that their parenting skills are being criticized when exposed to Western techniques or styles. Instead of attempting to establish egalitarian relationships, there can be a focus on identifying different aspects of parenting. Rather than just punishment, Asian parenting styles typically include caretaking, teaching, modeling, and playing. The therapist can help refocus parenting to utilize the more positive aspects of Asian child-rearing strategies. These would be couched in terms of helping the children with problems rather than altering poor parenting. It is also important to commis- erate with parents in terms of raising children in a society with different cul- tural standards. Emotionality- Strong emotional displays, especially in public, are considered to be signs of immaturity or a lack of control. In many Asian families, there is generally less open display of emotions, especially to older children Rothbaum, et al., 2000) Care and concern are shown by attending to the physical needs of family members. The father maintains an authoritative and distant role and is generally not emotionally demonstrative or involved with his children. His role is to provide for the economic and physical needs of the family. Shame and guilt are used to control and train the children. Mothers are more re- sponsive to the children but use less nurturance and more verbal and physi- cal punishments than do Euro- American mothers Kelly STseng, 1992) However, mothers are expected to meet the emotional needs of the children and often serve as the intermediary between the father and the children. When the children are exposed to more open displays of emotions from Western society, they may begin to question the comparative lack of emotion displayed by their parents. Chang-RaeLee J 995, p. 58) in a novel, describes his father as Unencumbered by the needling questions of existence and self- consciousness I wasn 'tsure he had the capacity to love." Implications. Counseling microskills that focus directly on emotions may be uncomfortable and produce shame for traditional Asian Americans. Emo- tional behavior can be recognized in a more indirect manner. For example, if an individual shows discomfort, the therapist could respond by saying either You look uncomfortable'br This situation would make someone uncomfortable. In both cases the discomfort would be recognized, but we have found that Asian American students are more responsive to the second, more indirect ac-

366 Counseling and Therapy with Racial/Ethnic Minority Groups knowledgment of emotions. C.-R. Lee's f 995)reaction to his father's lack of emotional responsiveness could lead to a discussion of value conflicts and how to deal with them instead of blame. It is also helpful to focus on behav- iors more than emotions and identify how family members are meeting each other's needs. In one study |uang STucker, 1991) care and concern be- tween an Asian couple were shown more by taking care of the physical needs of the partner than by verbally expressing care. Western marital therapy, which emphasizes verbal and emotional expressiveness as the main goal, may not be adequate in dealing with some Asian couples or families. Holistic View on Mind and Body A female client complained about all kinds of physical problems such as dizzi- ness, loss of appetite, an inability to complete household chores, and insomnia. She asked the therapist if her problem could be due to "nerves. " The therapist suspected depression since these are some of the physical manifestations of the dis- order and asked the client if she felt depressed and sad. At this point, the client paused and looked confused. She finally stated that she feels very ill and that these physical problems are making her sad. Her perspective is that it was natu- ral for her to feel sad when sick. As the therapist followed up by attempting to de- termine if there was a family history of depression, the client displayed even more discomfort and defensiveness. Although the client never directly contradicted the therapist, she did not return for the following session. (Tsui&Schultz, 1985) Because the mind and body are considered inseparable, Asian Ameri- cans may present emotional difficulties through somatic complaints. Physical complaints are a common and culturally accepted means of expressing psy- chological and emotional stress. It is believed that physical problems cause emotional disturbances and that these will disappear as soon as there is ap- propriate treatment of the physical illness. Instead of talking about anxiety and depression, the mental health professional will often hear complaints in- volving headaches, fatigue, restlessness, and disturbances in sleep and ap- petite ^eung, Chang, Gresham, Nierenberg, £Fava, 2004) Even psychotic patients typically made somatic complaints and sought treatment for those physical ailments Nguyen, 1985) Implications. Treat somatic complaints as real problems. Inquire about med- ications or other physical treatments they may use. To determine if psycho- logical factors are also involved, inquire in the following manner: Dealing with headaches and dizziness can be quite troublesome; how are these af- fecting your mood, relationships, etc.TThis approach legitimizes the physi- cal complaints but allows an indirect way to assess psychosocial factors. De- velop an approach that would deal both with somatic complaints and with the consequences of being 111."

Counseling Asian Americans and Pacific Islanders 367

Academic and Occupational Goals 7 want to write. I have to write This is not the choice my parents would make, and surely not the choice they would wish me to make I must not let it deter my progress or shut down my dreams, my purpose. (Ying, Coombs, &Lee, 1999, p. 357) There is great pressure for children to succeed academically and to have a successful career, since both would be indicative of a good family upbring- ing. As a group, Asian Americans perform better academically than do their Euro-American counterparts. Although Asian American students have high levels of academic achievement, they also have more fear of academic failure compared to their Euro-American peers. They spend twice as much time each week on academics as their non-Asian counterparts Eaton ©embo, 1997) However, this is often accompanied with a price. Asian American adolescents report feeling isolated, depressed, and anxious, and reported little praise for their accomplishments from their parents Lorenzo, Pakiz, Reinherz, {Frost, 1995) Asian American parents often have specific career goals in mind for their children generally in technical fields or the hard sciences) Because choice of vocation may reflect parental expectations rather than personal tal- ent, Asian college students appear more uncertain and lacking in information regarding careers Lucas gBerkel, 2005) Deviations from either academic excellence or appropriate"career choices can produce conflict between family members. Implications. Have parents recognize other positive behaviors and contribu- tions made by their children, not just academic performance. Some may not do well academically. Indicate that there are many ways that parents can feel proud of their children. Asian American students often have a lack of clarity regarding vocational interests and may need information about occupations Lucas fBerkel, 2005) For career or occupational conflicts, acknowledge that the parents are seeking success for their children but that there are many new career options. Give them information about areas other than technical fields. For individual clients, discuss the conflict between academic goals de- fined by the parents and individual desires. Present this as a culture conflict issue and identify the best way of presenting the child's side to the parents. Racism and Prejudice Asian Americans continue to face issues of racism and discrimination. Very negative stereotypes of this group are still held by a large number of Ameri- can adults. Asian Americans report significantly more workplace discrimina- tion than do their Caucasian counterparts tyl. P. Bell, Harrison, McLaugh- lin, 1997) Southeast Asian refugees who experienced racial discrimination

368 Counseling and Therapy with Racial/Ethnic Minority Groups

reported high rates of depression ^oh, Beiser, Kaspar, Hou, ERummens, 1999) Implications. A therapist must assess the effects of possible environmental fac- tors such as racism on mental health issues in Asian Americans. A client should not internalize an issue that is based on discriminatory practices. Instead, the focus should be on how to deal with racism and on possible ef- forts to change the environment. If a problem occurs in school, the therapist should determine the receptivity of the Asian American's peers and the school's academic and social environment to this ethnic group. The same would be done with the place of employment. Intervention may have to oc- cur at a systems level, and the therapist may have to be an advocate for the client.

Acculturation Conflicts between Parents and Children

Children of Asian descent who are exposed to different cultural standards often attribute psychological distress to their parent's backgrounds and dif- ferent values. The issue of not quite fitting in with their peers and being con- sidered too Americanized"by their parents is common. The acculturation gap is perceived by Chinese immigrant mothers to be higher with their sons than daughters Buki, Ma, Strom Strom, 2003) The inability to resolve dif- ferences in acculturation results in misunderstandings, miscommunication, and conflict I*. M. Lee, Choe, Kim, fNgo, 2000) Parents may feel at a loss in terms of how to deal with their children. Some respond by becoming more rigid. One Asian Indian daughter described her parents as displaying a mu- seumization of practices. "On a trip to India, she discovered that there was a wide difference between the parents' version of Ihdian"and what Indians in India actually did. Her parents' version was much more restrictive pas Gupta, 1997) Parent-child conflicts are among the most common presenting problems for Asian American college students seeking counseling Lee, Su, & Yoshida, 2005) Implications. To prevent interpersonal exchanges between parents and their children, the problem should be reframed or conceptualized as acculturation conflicts. In this way both the parents and their children can discuss cultural standards and the expectations from larger society. Identity Issues As Asians become progressively more exposed to the standards, norms, and values of the wider U.S. society, increasing assimilation and acculturation are frequently the result. Bombarded on all sides by peers, schools, and the mass

Counseling Asian Americans and Pacific Islanders 369 media, which uphold Western standards as better than their own, Asian Americans are frequently placed in situations of extreme culture conflict that may lead to much pain and agony regarding behavioral and physical dif- ferences. Asian American college women report lower self-esteem and less satisfaction with their racially defined features than do their Caucasian coun- terparts ^/lintz aCashubeck, 1999) C.-R. Lee J 99 5 (described his experi- ences as Straddling two worlds and at home in neither. "He felt alienated from both American and Korean cultures. As with other adolescents, those of Asian American descent also struggle with the question of Who am in- dividuals undergoing acculturation conflicts may respond in the following manner Huang, 1994) 1 . Assimilation. Seeks to become part of the dominant society to the exclu- sion of his or her own cultural group. 2. Separation. Identifies exclusively with the Asian culture. 3. Integration/biculturalism. Retains many Asian values but adapts to the dominant culture by learning necessary skills and values. 4. Marginalization. Perceives one's own culture as negative, but is unable to adapt to majority culture. Implications. Identity issues are a problem for some Asian Americans and not for others. Some believe that ethnic identity is not salient or important. As- sessing the ethnic self-identity of clients is important because it can impact problem definition and the choice of techniques used in therapy. Assimilated Asian clients are generally receptive to Western styles of counseling and may not want reminders of their ethnicity. Traditionally identified Asians are more likely to be recent immigrants or refugees, and they tend to retain strong cul- tural values and be more responsive to a culturally adapted counseling ap- proach. Bicultural Asian Americans adhere to some traditional values, while also incorporating many Western values. Ethnic self-identity can also influ- ence conceptualization of presenting problems. Acculturated Asian Ameri- can college students have beliefs similar to those of counselors, while less acculturated students who hold traditional views do not flallinckrodt, Shi- geoka, Suzuki, 2005) Psychotherapy Is a Foreign Concept to Many Asian Americans Explain the nature of the counseling and therapy process and the necessity of obtaining information. Implications. Describe the client's role. Indicate that the problems may be in- dividual, relational, environmental, or a combination of these, and that you will perform an assessment of each of these areas. Introduce the concept of

3 70 Counseling and Therapy with Racial/Ethnic Minority Groups coconstructionibxit the problem and solutions are developed with the help of the client and the counselor. Coconstruction reduces the chance that the therapist will impose his or her theoretical framework on the client. For ex- ample, the therapist might explain, In counseling we try to understand the problem as it affects you, your family, friends, and community, so I will ask you questions about these different areas. With your help we will also con- sider possible solutions that you can try out." Expectations of Counseling Counselors often believe that they should adopt an authoritarian or highly directive stance with Asian American clients. What is actually expected by Asian clients is an active role by the counselor in structuring the session and guidelines on the types of responses that they will be expected to make. It can be helpful for the therapist to accept the role of being the expert regarding therapy, while the client is given the role of expert regarding his or her life. Thus, clients assist the therapist by facilitating understanding of the problem and possible means of approaching the problem Chen ffiavenport, 2005) Implications. The counselor should be directive but ensure the full participa- tion from clients in developing goals and intervention strategies. Suggestions can be given and different options presented for consideration by the client. The client can select the option that he or she believes will be the most use- ful in dealing with the problem. Also, encourage the client to develop his or her own solutions. The consequences for any action should be considered, not only for the individual clients, but for the possible impact on the family and community. Even among acculturated Asian American college students, the preference for a helper role involves advice, consultation, and the facili- tation of family and community support systems Atkinson, Kim, ffialdwell, 1998) The opportunity for Asian American clients to try interventions on their own promotes the cultural value of self-sufficiency. Counseling Interventions Asian American clients expect concrete goals and strategies focused on solu- tions. Mental health professionals must be careful not to impose techniques or strategies. Implications. Focus on the specific problem brought in by the client, and help the client develop his or her goals for therapy. This allows the client to pres- ent his or her concerns and reduces the chance that the therapist's worldview will be imposed on the client. Determine what needs to be done if cultural or family issues are involved. Therapy should be time limited, focus on concrete

Counseling Asian Americans and Pacific Islanders 371

resolution of problems, and deal with the present or immediate future. Cog- nitive-behavioral and other solution-focused strategies are useful in working with Asian Americans Chen EDavenport, 2005) However, as with other Eurocentric approaches, these approaches need to be altered because the focus is on the individual, whereas the unit of treatment for Asian Americans may actually be the family, community, or society. Modify cognitive - behavioral approaches to incorporate a collectivistic rather than an individu- alistic perspective. For example, assertiveness training can be altered for Asian clients who have difficulty in asserting themselves. First, consider pos- sible cultural and social factors that may affect assertiveness values placed on modesty, minority status, etc.) Then identify situations where assertiveness might be functional, such as in class or when seeking employment, and situ- ations where a traditional cultural style might be more appropriate ^vith el- ders or parents) Next, determine anxiety-producing cognitions and possible cultural or societal influences. Finally, substitute appropriate thoughts and employ role-playing to increase assertiveness in specific situations. This al- teration of a cognitive-behavioral approach considers cultural factors and is concrete, allowing clients to establish self-control. Family Therapy Although family therapy would seem to be the ideal medium in which to deal with problems for Asian Americans, certain difficulties exist. Most therapy models are based on Euro-American perspectives of egalitarian relationships and require verbal and emotional expressiveness. Some models assume that a problem in a family member is reflective of dysfunction between family members. In addition, the use of direct communication from child to parents, confrontational strategies, and nonverbal techniques such as Sculpting'may be an affront to the parents. Implications. Assess the structure of the Asian American family. Is it hierar- chical or more egalitarian?What is their perception of healthy family func- tioningTHow are decisions made in the family ?How are family members showing respect and contributing to the familyTocus on the positive aspects of the family and reframe conflicts to reduce confrontation. Expand systems theory to include societal factors such as prejudice, discrimination, poverty, and conflicting cultural values. Issues revolving around the pressures of being an Asian American family in this society need to be investigated. Describe the session as a solution-oriented one and explain that family problems are not uncommon. Have communication from family members come through the therapist. Function as a culture -broker in helping the family negotiate con- flicts with the larger society.

3 72 Counseling and Therapy with Racial/Ethnic Minority Groups Implications for Clinical Practice Although Asian culture dictates general principles and values, there is a range of acceptable responses in dealing with situations. Helping Asian American clients formulate different culturally acceptable practices for specific prob- lems can improve their problem-solving abilities. In addition, Asian Ameri- cans also must develop skills to interact with the larger society and to achieve a balance when conflicting values are involved. The following guidelines are based on Asian American cultural values, but the therapist or counselor must be aware of the large differences in degree of acculturation in this population. Many of the counseling skills learned in current mental health programs will be effective with modifications. 1 . Be aware of cultural differences between the therapist and the client as regarding counseling, appropriate goals, and process. How would they affect work with Asian Americans who have a collectivistic, hierarchi- cal, and patriarchal orientation? 2 . Build rapport by discussing confidentiality and explaining the client role and the need to coconstruct the problem definition and solutions. 3. Assess not just from an individual perspective but include family, com- munity, and societal influences on the problem. Obtain the worldview and ethnic identity of the Asian American client. 4. Conduct a positive assets search. What strengths, skills, problem- solving abilities, and social supports are available to the individual or family? 5. Consider or reframe the problem, when possible, as one in which issues of culture conflict or acculturation are involved. 6. Determine whether somatic complaints are involved and assess their influence on mood and relationships. 7. Take an active role, but allow Asian Americans to choose and evaluate suggested interventions. 8. Use problem-focused, time-limited approaches that have been modified to incorporate possible cultural factors. 9. With family therapy, the therapist should be aware that Western-based theories and techniques may not be appropriate for Asian families. De- termine the structure and communication pattern among the members. It may be helpful to address the father first and to initially have state- ments by family members directed to the therapist. Focus on positive aspects of parenting such as modeling and teaching. Use a solution- focused model.

Counseling Asian Americans and Pacific Islanders 3 73

10. In couples counseling, assess for societal or acculturation conflicts. De- termine the way that caring, support, or affection is shown. Among tra- ditional Asians, providing for the needs of the other is as or more im- portant than verbalizations of affection. Obtain their perspective on the goals for better functioning. 1 1 . With Asian children and adolescents, common problems involve accul- turation conflicts with parents, feeling guilty or stressful over academic performance, negative self-image or identity issues, and struggle be- tween interdependence and independence. 12. Among recent immigrants or refugees, assess for living situation, cul- ture conflict, and social or financial condition. Case management skills may be needed to secure help obtaining food and other community re- sources. 13. Consider the need to act as an advocate or engage in systems-level in- tervention in cases of institutional racism or discrimination.

Counseling Hispanic/Latino Americans

I can remember having to hide when I was a kid I would come home and my parents would be maybe 20 or 30 minutes late, and I would cry until they got home because I was afraid they had been deported. (Modie, 2001, p. A6) It was sometimes hard to adjust. When I went outside, I was in America, but inside my house, it was Mexico. My father was the leader of the house. It wasn 't that way for some of my American friends. (Middleton, Arren- dondo, &D Andrea, 2000, p. 24) Jennifer Cortes received the panicked call just after 1 1a.m. Immigration of- ficers were at Bellingham 's Northwest Health Care Linen where her hus- band, Ezequiel Rosas-Cortes, worked sorting laundry. . . . Agents turned Jennifer away as they arrested her husband, an illegal immigrant who, for the first time, had felt confident enough to attend the local fair without fearing arrest. (Gambrell, 2006, p. Al) A thick scar below his right elbow reminds him of his first days in the fields, when he slipped and fell on some sharp farming tools Like many farm- worker children, Gonzales went to work to help his family pay the bills. He was a good student until he dropped out at age 15. He hasn't given up hope . . . but his family comes first. (Kramer, 1998, p. A6) In this chapter, the terms Latino and Hispanic encompass individuals living in the United States with ancestry from Mexico, Puerto Rico, Cuba, El Salvador, the Dominican Republic, and other Latin American countries. However, the terms are not accepted by all groups;some in- dividuals prefer to be referred to as Latinos or La Raza the race) Even within specific subgroups, there are different opinions on the appropri- ate terms of identification. Some Hispanics from Mexico may refer to themselves as Mexicano, Mexican American, Chicano, or Spanish American Comas-Diaz, 2001;G. M. Gonzalez, 1997) The term Hispanic Official

17 Chapter


376 Counseling and Therapy with Racial/Ethnic Minority Groups

U.S. Government designation) will be employed in this chapter to indicate the common background of Spanish language and customs. Although His- panics share many characteristics, it is important to be aware that distinct dif- ferences exist both within and between the different groups. In physical characteristics, the appearance of Hispanics varies greatly and may include resemblance to North American Indians, Blacks, Asians, or fair-skinned Europeans. The U.S. Census recognizes the term as an ethnic designator and not a racial one. Thus, Hispanics can be members of any racial grouping. Mexican Americans are mostly of mestizo ancestry {nixed Spanish and native Aztec-Indian blood) Throughout Latin America, the immigration of European, African, and Asian populations has resulted in a wide range of physical characteristics. According to the U.S. Census U.S. Census Bureau, 2004d) Hispanic Americans comprise a population of over 35 million, of whom nearly 67 per- cent are of Mexican descent, 8.6 percent are from Puerto Rico Puerto Rico became a commonwealth on July 25, 1952, and its residents are U.S. citizens who can move between the island and the mainland without any restric- tions) 3.7 percent are Cuban, and the remaining 22 percent are primarily from Central and South America. Because of their high birthrate and ongo- ing immigration patterns, Hispanics are currently the largest minority group in the United States. Hispanic Americans are a highly heterogeneous popula- tion with large between-group and within-group differences. Some individ- uals are oriented toward their ethnic group, while others are quite accultur- ated to mainstream values. Some have lived for generations within the United States, while a large proportion are recent immigrants. There are an estimated 1 1 million illegal immigrants from Latin American countries Moore, 2001) Those who are undocumented occupy the lowest rung of the labor pool and are often taken advantage of because they have no legal sta- tus. It is estimated that almost half of all migrant farm workers are here ille- gally, many of whom rarely seek health care because of cost and the fear of discovery i^ew York Times News Service, 2001) The majority of Hispanic Americans is situated in metropolitan areas of the United States, but Hispanic Americans populate every state, including Alaska and Hawaii. In certain states and cities they make up a substantial per- centage of the population. Mexican Americans reside primarily in the West- ern states they account for 40 percent of the population of New Mexico and 34 percent of the residents of California and Texas) but have increasingly mi- grated to the Southeastern states. Most Puerto Ricans reside in the North- eastern states and most Cubans live in Florida U.S. Census, 2004d) Hispanics are overrepresented among the poor, have high unemploy- ment, and often live in substandard housing. Most are blue collar workers and hold semiskilled or unskilled occupations. There is a significant discrep- ancy between the annual incomes of Hispanics and Caucasians. Hispanics are

Counseling Hispanic/ Latino Americans


much more likely than Whites to be unemployed 8.1 versus 5.1 percent) In 2002, 21.4 percent of Hispanics lived in poverty as compared to 7.8 percent of Whites. Over 30 percent of Hispanic children were living in poverty versus 17.7 percent of all children in the United States. Puerto Ricans appear to have the highest rate of poverty, while Cubans have the highest incomes U.S. Census Bureau, 2003)

Traditional Hispanic Values, Characteristics, Behavior Patterns, and

In the following sections we consider the values, characteristics, and issues faced by Hispanic families and individuals and consider their implications in treatment. Remember that these are generalizations and their applicability needs to be assessed for particular Hispanic clients and families. Family Values Family tradition is an important aspect of life for Hispanic Americans. Family unity {familismo)\s seen as very important, as are respect for and loyalty to the family. Cooperation rather than competition among family members is stressed. Interpersonal relationships are maintained and nurtured within a large network of family and friends. The development and maintenance of interpersonal relationships are very central to Hispanic families pingfelder, 2005a, 2005b) There is deep respect and affection among friends and family. Hispanic American students are more likely to endorse the following items than are White students:loyalty to the family, strictness of child rearing, reli- giosity, and respect for adults ^egy, 1993) For many Hispanic Americans, the extended family includes not only relatives but often nonblood fela- tives"such as the best man, maid of honor, and godparents. Each member of the family has a role: grandparents Rvisdom) mother Abnegation) father Responsibility) children Obedience) and godparents Resourcefulness; Lopez-Baez, 2006;Ruiz, 1995) Implications. Because of these familial and social relationships, outside help is generally not sought until resources from the extended family and close friends are exhausted. Even in cases of severe mental illness, many Hispanic families waited two or more months before seeking treatment Urdaneta, Sal- dana, {Winkler, 1995) Although there are many positive features of the extended family, emotional involvement and obligations with a large num- ber of family and friends may function as additional sources of stress. Since family relationships are so important, decisions may be made that impact the

378 Counseling and Therapy with Racial/Ethnic Minority Groups

individual negatively. Allegiance to the family is of primary importance, tak- ing precedence over any outside concerns, such as school attendance or work Avila SAvila, 1995; Franklin ESoto, 2002) For example, older children may be kept at home in order to help care for ill siblings or parents, to attend family functions Hildebrand et al., 1996)or to meet a family financial obli- gation Headden, 1997) Under these circumstances, problematic behaviors \.e. r absenteeism)may need to be addressed, but are best understood as a conflict between cultural and societal expectations. Possible solutions are then sought that acknowledge cultural expectations but at the same time meet the demands of societal requirements such as school attendance. Prob- lem definition and solution may need to incorporate the perspectives of both the nuclear and extended family members. Family Structure Hispanics live in family households that are larger than those of non- Hispanics with 26.5 percent having five or more members U.S. Census Bu- reau, 2003) Traditional Hispanic families are hierarchical in form, with spe- cial authority given to the elderly, the parents, and males. Within the family, the father assumes the role of the primary authority figure. Sex roles are clearly delineated Avila Skvila, 1995;Lopez-Baez, 2006;Mejia, 1983) The sexual behaviors of adolescent females are severely restricted, while male children are afforded greater freedom to come and go as they please. Children are expected to be obedient, are usually not consulted on family decisions, and are expected to contribute financially to the family when possible. Parents reciprocate by providing for them through young adulthood and even during marriage. This type of reciprocal relationship is a lifelong expec- tation. Older children are expected to take care of and protect their younger siblings when away from home, and the older sister may function as a surro- gate mother. Even during adolescence, many think of themselves and func- tion as young adults. Marriage and parenthood often occur early in life and are seen as stabilizing influences. Implications. When conducting individual or family sessions with Hispanic clients, assess the structure of the family looking particularly for the family hierarchy. Paniagua }994)recommends interviewing the father for a few minutes during the beginning of the first session, showing recognition of the father's authority, and sensitivity to cultural factors in counseling. In a more acculturated family, the father could still be addressed first, followed by the mother and the children. The pattern of mothers talking and children listen- ing may be comfortable and expected in the traditional culture Lefkowitz, Romo, Corona, Au, ffiigman, 2000) Also, in traditionally oriented Hispanic American families, less importance may be placed on shared interests and joint activities between husband and wife, with more emphasis on social

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events involving families and friends I^egy SVoods, 1992) Deviations from the traditional cultural pattern may produce conflict in family functioning. Determine how decisions are made within the family. If conflicts arise over cultural roles and expectations for family members, assess and treat the prob- lem as a clash between cultural values and mainstream societal expectations. Often, conflicts among family members involve differences in acculturation. In less acculturated families, Szapocznik and Kurtines J993)recommend that acculturation play the role of the identified patient, and the counselor use reframing and negotiation of the conflicting cultural norms and values. Determining different ways in which family members can both demonstrate their allegiance to the family structure and resolve conflicts can be beneficial. One such approach is demonstrated in the following case: During family therapy, a Puerto Rican mother indicated to her son, "You don 't care for me anymore. You used to come by every Sunday and bring the children. You used to respect me and teach your children respect. Now you go out and work, you say, always doing this or that. I don 't know what spirit (me diablo] has taken over you. " (Inclan, 1985, p. 332) In response, the son indicated that he was working hard and sacrificing for the childrenlhat he wanted to be a success in the world and an individ- ual of whom his children could be proud. In examining the case, it is clear that the mother is expressing disappointment. She defines love as being with her, having the family gather together, and subordinating individual desires for the family. The son has adopted a middle-class set of values stressing individ- ual achievement, doing, and the future. The clash in value differences was at the root of the problem. In working with this family, the therapist provided an alternative way of viewing the conflict instead of using terms such as fight'br wrong/He explained that our views are shaped by the values that we hold. He asked about the socialization process that the mother had undergone. She emphasized the good old days"and the socialization and values of her childhood. The son indicated the pain he felt in losing the un- derstanding of his parents, but he felt he had to change in order to succeed in the United States. The therapist pointed out that different adaptive styles may be necessary for different situations and that what is right is dependent on the social context. Both of them began to acknowledge that they still loved one another but might have to show it in different ways. As a result of the ses- sions, the mother and son accepted one another and understood the nature of the original conflict. Sex Role Expectations In working with Hispanic Americans, the counselor will often face problems dealing with conflicts over sex roles. In the traditional culture, men are ex-

380 Counseling and Therapy with Racial/Ethnic Minority Groups pected to be strong, dominant, and the provider for the family tnachismo) whereas women are expected to be nurturant, submissive to the male, and self-sacrificing inarianismo) As head of the family, the male expects the members to be obedient to him. Those with higher levels of ethnic identity are more likely to subscribe to traditional male and female roles Abreu, Goodyear, Campos, 9Newcomb, 2000) Areas in which males may have sex- role conflicts include the following Avila 8wila, 1995;Constantine, Gloria, ffiaron, 2006;Hildebrand et al., 1996) 1 . Submissiveness or assertion in the area of authority. The Hispanic male may have difficulty interacting with agencies and individuals outside of the family and may feel that he is not fulfilling his role. In addition, changes involving greater responsibility of the wife and children may produce problems related to his authority. 2. Feelings of isolation and depression because of the need to be strong. Talking about or sharing views of problems with others may be seen as a sign of weakness. With the additional stress of living in a very different culture, the inability to discuss feelings of frustration and anxiety can produce isolation. 3. Conflicts over the need to be consistent in his role. As ambiguity and stress in- crease, there may be more rigid adherence to traditional roles. 4. Anxiety over questions of sexual potency. For females, conflicts may involve \ Expectations to meet the require- ments of the traditional role, ? (anxiety or depression over not being able to live up to these standards, and ? inability to express feelings of anger Avila &Avila, 1995;Lopez-Baez, 2006; Zanipatin, Welch, Yi, EBardina, 2005) Many Hispanic women are socialized to feel that they are inferior and that suf- fering and being a martyr are characteristics of a good woman. With greater exposure to the dominant culture, such views may be questioned. Certain roles may change more than others. Some women may be very modern in their views of education and employment, but remain traditional in the area of sexual behavior and personal relationships. Others remain very traditional in all areas. Some writers G. M. Gonzalez, 1997;A. Ruiz, 1981)caution that Hispanic sex roles may be misunderstood and are not as negative, inflexible, or rigid as they are sometimes described. For example, the concept of mas- culinity or machismo includes being a good provider. Egalitarian decision making appears to be increasing with later generations of Mexican Americans. Also, many Hispanic women assert their influence indirectly and behind the scenes/thus preserving the appearance of male control L. L. Hayes, 1997) Implications. Adherence to traditional roles among Hispanics is decreasing rapidly in the urban class. Part of the reason for the change is that many

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women are required to act independently in the work setting and to deal with schools and other agencies. In some cases, the woman may become the wage earner, a role that traditionally belongs to the male. As women become more independent, men may feel anxiety. Both may feel that the man is no longer fulfilling his role. Counselors must be able to help the family deal with the anxiety and suspiciousness associated with role change. For both males and females, role conflict is likely to occur if the male is unemployed, if the female is employed, or both. Since both feel that the male should be the provider for the family, an additional source of stress can occur. Acculturation has im- pacted relationships between husbands and wives. In one study of Mexican Americans, less avoidance of conflicts and more expression of feeling during arguments were found in families where both husband and wife were accul- turated. Husbands who were acculturated or bicultural reported more con- flicts concerning sex and more verbal aggression from their wives as com- pared to nonacculturated husbands Flores, Tschann, Marin, SPantoja, 2004) The findings indicate the need to consider the potential impact of ac- culturation on marital relationships. In dealing with sex-role conflicts, the counselor faces a dilemma and a potential value conflict. If the counselor believes in equal relationships, should he or she move the clients in this directionTTherapists working with cultural values different from their own must be particularly careful not to impose their views on their clients. Instead, they must try not only to help the client achieve their goals of greater independence, but to accomplish this within a cultural framework as well. The consequences of change also must be considered. Any counselor who works to help a female client achieve more independence without apprising her of potential problems within her family and community is not fulfilling his or her obligations. Again, the con- flicts in sex roles in both men and women can be cast as involving differing expectations from their ethnic group and mainstream values. Reframing the problem as an external issue that the couple or family can face jointly can re- duce intrafamily conflicts and result in problem-solving approaches to deal with the different sets of expectations. Spirituality and Religiosity Mrs. Lopez, age 70, and her 30-year-old daughter sought counseling because they had a very conflictual relationship The mother was not accustomed to a counseling format At a pivotal point in one session, she found talking about emotional themes overwhelming and embarrassing In order to reengage her, the counselor asked what resources she used when she and her daughter quar- reled. She . . . prayed to Our Lady of Guadalupe. (Zuniga, 1997, p. 149) The therapist employed a culturally adapted strategy of having Mrs. Lopez use prayer to understand her daughter and to find solutions for

382 Counseling and Therapy with Racial/Ethnic Minority Groups the counseling sessions. This format allowed Mrs. Lopez to discuss spiritual guidance and possible solutions to the problem. The use of a cultural per- spective allowed the sessions to continue. The Catholic religion has a major influence in Hispanic groups and is a source of comfort in times of stress. There is strong belief in the importance of prayer and religious views that include:} )sacrifice in this world is helpful to salvation, £)being charitable to others is a virtue, and ?)you should endure wrongs done against you "^a- mamoto fAcosta, 1982) The consequences of these beliefs are that many Hispanics have difficulty behaving assertively. Life's misfortunes are seen as inevitable, and Hispanics often feel resigned to their fate (fatalismo) In addi- tion to the Catholic perspective, some Hispanics believe that evil spirits cause mental health problems. Implications. During assessment, it is important to determine the possible influence of religious or spiritual beliefs. If there is a strong belief in fatalism, instead of attempting to change it, the therapist might acknowledge this atti- tude and help the individual or family determine the most adaptive response to the situation. A therapist might say, Given that the situation is unchange- able, how can you and your family deal with thisTfou are still attempting to have the client develop problem -solving skills within certain parameters. The strong reliance on religion can be a resource. The use of prayer may be used to reinforce problem-solving behaviors since God's support is evoked. Fatalism may be countered by stressing Ayudate, que Dios te ayudara'which is the equivalent of God helps those who help themselves'prganista, 2000) Acculturation Conflicts As with many ethnic minority groups, Hispanic Americans are faced with a society that has a set of values distinctly different from their own. Some main- tain their traditional orientation, whereas others assimilate and exchange their native cultural practices and values for those of the host culture. A bi- cultural orientation allows individuals to maintain some components of the native culture and to incorporate some practices and beliefs of the host cul- ture. Miranda and Umhoefer J 998a, 1998b)believed that a bicultural ori- entation may be the healthiest'resolution to acculturation conflicts. In their study they found that both high- and low-acculturated Mexican Americans scored high on social dysfunction, alcohol consumption, and acculturative stress. Bicultural individuals appeared to fare much better because of an abil- ity to accept and negotiate aspects of both cultures. Perhaps additional stres- sors are involved with either the complete rejection or acceptance of the val- ues of the host culture Miville, Koonce, Darlington, SWhitlock, 2000; Miranda &Jmhoefer, 1998a, 1998b) Some of the issues involved in culture conflict are evident in the following:

Counseling Hispanic/ Latino Americans 383

An Hispanic teenager, Mike, was having difficulty knowing "who he was " or what group he belonged with. His parents had given him an Anglo name to en- sure his success in American society. They only spoke to him in English because they were fearful that he might have an accent. During his childhood, he felt es- tranged from his relatives. His grandparents, aunts, and uncles could speak only Spanish, so they were able to communicate only through nonverbal means. At school, he did not fit in with his African American peers, and he also felt differ- ent from the Mexican American students who would ask him why he was un- able to speak Spanish. The confusion over his ethnic identity was troublesome for him. He attempted to learn Spanish in college but was unable to do so. (Avila & Avila, 1995) During middle school Hispanic children begin to have questions about their identity. Should they adhere to mainstream valuesTFew role models exist for Hispanic Americans. The representation of Hispanic Americans on television has actually decreased over the last 30 years. They currently ac- count for only 2 percent of characters in 1 39 prime-time series. In depictions, they are more likely to behave criminally or to be violent Espinosa, 1997) The mixed heritage of many Hispanic Americans raises additional identity questions. If they are of Mexican/Indian heritage, should they call themselves Mexican American, "Chicano, "Latino, "or Spanish American?What about mixtures involving other racial backgrounds?An ethnic identity pro- vides a sense of belonging and group membership. Many Hispanic youngsters undergo this process of searching for an identity. This struggle may be re- sponsible for such problems as the following: J )Mexican American adoles- cents report more depressive symptoms and conduct disorders than White youth;2)small-town Mexican American youth have more severe and ele- vated rates of alcohol and drug abuse;and ?)suicidal behaviors are high in Hispanic female adolescents and Puerto Rican males Roberts SSobhan, 1992;Tortolero 8R.oberts, 2001) Implications. Ethnic identity issues should be recognized and incorporated within the school curriculum with modules on ethnicity focusing on what it means to be Hispanic, Chicano, or Spanish speaking. Case studies of contri- butions made by different ethnic group members can be presented. Conflicts between mainstream values and ethnic group values can be discussed, and students can engage in brainstorming for methods to bridge their differences. Teaching styles can be altered to accommodate different cultural learning styles. It should be stressed that ethnic identity is part of the normal develop- ment process. In many cases, a bicultural perspective may be the most func- tional, since such a perspective does not involve the wholesale rejection of either culture. In psychotherapy the degree of acculturation should be as- sessed because it has implications for treatment. Hispanic Americans with

384 Counseling and Therapy with Racial/Ethnic Minority Groups

minimal acculturation rarely present mental health issues to counselors and may believe that counseling will take only one session pittman, 200 5;G. M. Gonzalez, 1997) Second-generation Hispanic Americans are usually bilin- gual, but frequently with only functional use of either language. They are often exposed to Spanish at home and exposed to English in the school and on television. Second-generation Hispanic Americans are often marginal in both native and majority cultures. Acculturation also may influence percep- tions of counseling and responses to counseling. Mexican Americans with a strong traditional orientation may have more difficulty being open and self- disclosing than are those with a strong orientation toward the dominant cul- ture G. M. Gonzalez, 1997) Because knowledge of the acculturation level is important, it should be assessed by inquiring about the specific Hispanic group that the individual is from, generational status, primary language, religious orientation and strength of religious beliefs, where they live, the reason for immigration if immigrants) the extent of extended family support, and other information related to acculturation. The therapist needs to determine both the degree of adherence to traditional values and to that of the larger society pingfelder, 2005b) Educational Characteristics Peer pressure to drop out can be nearly overwhelming in the Hispanic commu- nity, as DeAnza Montoya, a pretty Santa Fe teen, can attest. In her neighborhood, it was considered "anglo " and "nerdy " to do well in school "In school they make you feel like a dumb Mexican, " she says, adding that such slights only bring Hispanics closer together. (Headden, 1997, p. 64) Educationally, Hispanic Americans have not been faring well in the public schools. Hispanic students have a very high dropout rate. More than two of five Hispanics aged 25 or older have not completed high school, and more than a quarter have less than a 9th-grade level education VJ.S. Census, 2003) Over one-third drop out before completing high school. This is nearly double the rate for Blacks and nearly four times higher than the rate for White students Moore, 2001) The high pregnancy rate for Hispanic girls also contributes to school dropout rates. In California, Hispanic adolescents are four times more likely than White adolescents to become parents Russell & Lee, 2004) A number of problems contribute to the high dropout rate of His- panic students. As mentioned earlier, many of the educational difficulties faced by Hispanics relate to their varied proficiency with English. Spanish is the primary language spoken in the homes of over half of Hispanic Ameri- cans, and a much larger percentage regularly listen to or speak Spanish on a more limited basis. Second-generation Hispanics are often bilingual. How-

Counseling Hispanic/ Latino Americans 385

ever, their command of both English and Spanish is often limited. Many are exposed first to Spanish in the home and then to English in the school. How- ever, there is some optimism regarding education. Between 1993 and 2003, the college enrollment of Hispanic students rose nearly 70 percent Hayes, 2006) Implications. In general, schools have been poorly equipped to deal with large numbers of Spanish-speaking students. The move against bilingual education and the rapid immersion of Spanish-speak