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Multicultural Therapy

Carolyn R. Fallahi, Ph. D.

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The need for cultural competence

There is a need for cultural competence within therapy.

Traditional approaches have failed to meet the needs of minorities.

A large percentage of the population of the United States is composed of people whose racial/ethnic background is something other than white.

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Minority Groups

Most minority groups are:Without underrepresented in traditional clinical/counseling populations.

There aren’t a lot of faculty members who are minorities.

Racial & Gender domination perpetuates these issues.

Mostly white, middle-class males who are the teachers & administrators.

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What do we see with minority patients?

More negative psychiatric diagnoses.

Substandard treatment.

Inferior & differential counseling services for differing racial & ethnic patients.

Underutilization of mental health services. Why? Lack of minority therapists?

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What are the issues with multicultural therapy?

Lack of attention & emphasis on social injustices & problems encountered by minorities.

Sue & Smith: underrepresentation of minority groups in professional counseling training programs reinforces the perception that therapy is generally irrelevant to their needs.

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Recurring Issue

Discomfort of White Therapist working with someone different from them.

This plays out in:Negative stereotyping.

Lack of knowledge about the group of which the patient is a member.

Generalized anxiety about working with different populations.

Need: major reform in graduate programs.

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Multicultural Education Models

Are we creating an environment in which we can foster cross-cultural awareness & understanding?

Theories exposed to are monocultural.No research in the area of cross-cultural awareness development.Theoretical models imply that psychosocial development is uniform for all members of society, regardless of cultural or racial background.

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Why aren’t these theories enough?

Sociopolitical factors such as SES, class, & power are largely ignored.

Selected variables of the authors’ culture, such as individualism are emphasized.

Many variables have limited applicability in pluralistic societies.

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What do the contemporary White Western Theories & Models emphasize?

Tendency to assume that psychosocial development occurs in a similarly orderly & uninterrupted progression for all.

Ethnic & racial awareness & identity have not been considered noteworthy or integral within psychosocial development process.

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Contemporary White Models

Cultural biases & taboos of a given author’s society, including those relating to racism, prejudice, and discrimination have been built into the theories.Members of society who do not represent the dominant culture find that the models do not “fit” their life experiences.Theories of deviance, deprivation, disadvantage, and abnormality are based on the experiences of various groups & how they differ from the model.

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Contemporary White Models

The research has incorporated biases inherent in monocultural theoretical models.

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Multicultural Research

High-status & low-status group – how do individuals become aware of this?

Psychosocial development of minority groups. This new research is beginning to take sociopolitical factors into account.

Quest for self-identity.

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Oppression

Oppression is a common approach. Uncomfortable & “radical framework” for some.Dominant force.Less familiar to therapists, both cognitively & experimentally.Oppression, as a common experience, is the approach that provides a schema to the experiences of Asians, Latinos, African Americans, etc.

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Cross-cultural Training Models

Need to emphasize:Competency: requires that the therapist be culturally aware, in touch with his/her own biases about minority patients, comfortable with such differences, & sensitive to circumstances that may require the referral to circumstances that may require referral to same-culture therapist.

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Cross-cultural Training Models

Second competency area: command of knowledge, such as information sets, that the culturally skilled therapist should have.

Understanding of the effects that the sociopolitical system within the U.S. has an oppressed persons, culture specific knowledge about the particular group being counseled, an understanding of the institutional barriers to the use of mental health services by nondominant groups.

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Future Clinicians

Gain knowledge of specific minority groups.

Focus on concerns such as value changes, acculturation, generational differences, parental pressures, dating, & religious issues.

Supervision on these issues.

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Third Competency

Therapeutic skills: should have a wide repertoire of verbal & nonverbal responses, the ability to send messages accurately & appropriately, and the ability to use appropriate institution intervention.

Assume a universalist approach or a culture-specific approach? This is a controversy that has not yet been settled.

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The distinction between cultural & individual differences.

A person should be seen as an individual & as a member of his/her own cultural group.

Locke: you need to take into account the differences within a person’s culture in the context of the dominant culture.

Each culture is both dynamic & subjective, & his training stresses “learning to work in different cultures rather than merely learning about cultures”.

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Therapists trained from the Euro-North American cultural belief system

Value self-disclosure, highly verbal, & goal-oriented patients.

Issues of self-disclosure? How we interpret self-disclosure or lack there of …. Need to take background into account.

Does the patient feel safe to share?

If the therapist doesn’t see self-disclosure, consider it resistant & nonproductive?

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Other Issues

Lack of role models in terms of therapists, faculty, & administrators, the traditional white majority student population attending programs will continue.Traditionally: therapy has been willing to accept culturally different people if they are willing to become acculturated and reject their cultural distinctiveness.Some of the negative programs based on the melting pot philosophy.

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A strong conceptual framework

Sociopolitical ramifications of therapy:Oppression

Discrimination

Racism

****Programs have to help trainees become aware of themselves as cultural beings.

The culturally different patient becomes the object to be analyzed & studied.

Focus on the stereotypes of the therapist.

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Barriers to effective multicultural counseling instruction

Melting pot mythIncongruent student expectations about therapyOveremphasis on verbal disclosureOveremphasis on abstract & non-problem-solving strategies.Ethnocentric worldviewIgnorance of self-racism & cultural identity of others

Monolingual orientationOveremphasis on long-range goals & the future.Lack of understanding of the whole personLack of understanding of social focusLack of appreciation for nonverbal communication

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Emphasize

CultureRaceEthnicityDominant cultureBi-culturalismMelting pot mythPluarlismOppressionCultural invasionIssues relating to power & internalized racismMarginalityLived experiences & contradictions

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Becoming Culturally Competent

Ethnocentricity: a major obstacle to becoming culturally competent.

Relatively few US scholars cite international journals.

Only 60% US Scientists feel that being connected to international scholars is important.

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Becoming Culturally Competent

Xenophobia: unreasonable fear, distrust, hatred of strangers or foreigners or anything perceived as different.Difficulty accepting others’ worldviews.Accepting differences across cultures as simply differences.Universality assumptions.

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Becoming Culturally Competent

Personality styles.

Reality is defined according to one’s cultural assumptions. People become insensitive to cultural variations among individuals & assume that their own view is the only right one.

So????? How do we increase global competence & collaboration?

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Enhance Cross-Cultural Awareness & Knowledge

Increase our awareness & knowledge on a number of cross-cultural issues.

Encourage study-abroad programs.

Cultural immersion program.

Require coursework.

Require competency in a second language.

Integrate cross-cultural issues & knowledge in our therapy curriculum.

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Enhance Competency

Promote cross-cultural research & supervision & consultation.

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Addressing Racism: Derald Wing Sue

Why do we hold prejudices or stereotypes?

Need to understand our world

Too much information – need to categorize

Makes us feel better about ourselves

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John Duckitt – History of Psychology & Prejudice

Prior to the 1920s – notion of race inferiority & white superiority.Race theories dominated psychological thinking.Black inferiority was thought of as due to evolution or genetics.Seen as intellectually inferior.Prejudice was seen as a natural response to “inferior” races.

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1920s- 1930s

In the 1920s, empirical data did not settle the controversy over African Americans.

Movement switched to: where those preconceived attitudes came from.

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1930s & 1940s

Psychodynamic explanation – prejudice & discrimination was not right.

Irrational & unjustified.

Why so prevalent?

Defense mechanisms.

Same explanation applied to the rise of Nazism & anti-Semitism in Germany.

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1950s

The prejudiced personalityHolocaust & massive genocide

Demented disturbed personality

Pathological personality structure, e.g. authoritarian personality – more prone to prejudice.

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1960s & 1970s

Movement from the individual to a more sociocultural perspective.

Prejudice could be understood as a social or cultural norm.Normative approachConsensus model of race relations, Black/white relations.Socialization & conformityRacial integrationConflict, power, & domination were nearly totally neglected.

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1980s

Ingroup – outgroup research

The new image of prejudice: inevitable outcome of cognitive categorization.

Realization: we as humans have the potential & propensity for prejudice.

Social & intergroup dynamics add to this.

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Guthrie & Even the Rat was White

Extraordinary dedication to the field of racism within psychology.

Eugenics: the study of hereditary improvements of human race by controlled selective breeding.

Sterilization

PhysicalAnthropologists & cultural Anthropologists.

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The role of psychology

1973: Henry Garrett, past APA president:

Argument against racial integration writing that the Black man ‘s brain “on the average is smaller….less fissured and less complex than the white brain.”

Skull capacity differences among humans.

The issue of IQ.

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Are you a Racist?

Overt bigotry versus more subtle bigotry.

Prejudice versus discrimination.

People of color make up over 1/3rd of the population & 45% in our public schools.

2030 & 2050 racial/ethnic minority = numerical majority.

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The average American

Not aware of race issues.

Minimize the impact of racism.

What’s involved? Fear.

Stereotypes serve the function of making you feel better about yourself or about members of a group.

Cultural genocide.

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Do you oppress?

Modern or contemporary racism.Modern racism is unconscious, indirect, subtle, & unintentional.

Failure to help versus conscious desire to hurt.

Dovidio Study

Are these stereotypes harmful?

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African Americans

Black? African American? Ask.

Issues of poverty. Less likely to be employed in managerial & professional jobs.

Black women more likely to complete college degree.

26% poverty for Afr Ams versus 8%for Whites.

Vast inequities.

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Issues

Long history of traumatic events including slavery, racism, & history of other individual & social problems.Indicators of the cumulative effects of trauma – evidenced in health, income, education, & occupational success.In a therapeutic situation: develop awareness of how oppressive experiences like racism & discrimination influence help-seeking behaviors & overall psychological functioning.

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Cook & Wiley (2000)

Afr Ams will share their experiences of oppression in psychotherapy.

Limited knowledge of the history of racism & oppression.

Need increased cultural empathy to validate their experiences.

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Social relationships & strengths

Religion & spirituality

Need to assess religion & spirituality

Harmony & balance – emphasis on the family, community, & nation versus emphasis on the individual.

Interdependence

Traditional therapy

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Family Dynamics

48% married-couple families.

45% maintained by single women with no spouse.

Extended kinship networks

The role of the church

Different parental-child systems.

The legacy of broken families continued following slavery

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Gender Issues

Identity linked to ability to provide for family.

Success related to discrimination.

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Latinos & Latinas

The link between physical & emotional = Medical services.

High tolerance for psychopathology.

Language barriers, sociocultural factors.

Lack of bilingual & bicultural therapists and a lack of cultural sensitivity.

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Issues in Therapy

The terms used to identify.High rates of undereducation.Misplaced in special education classes, non-college tracks, monolingual teachers, culturally insensitive teachers, low achievement expectations.Underemployed: 7% unemployed versus 3.4% Whites.

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Other Issues

Religion

Oppression & racism

Acculturation

Family dynamics

Time orientation

Elderly versus Youth

Family & support system

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The Dynamics of Therapy

Family – strength & liability.

Great value placed on manners, courtesy, harmonious relationships

Conflict, direct argument, & contradiction considered rude.

Gender roles

Youth

Parent & child relationships

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Other issues

Religion

Gender & sexual norms

Boys versus girls

Homophobia

Interdependent & cooperative

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Other Problems

Physical & emotional difficulties of aging.

Cultural alienation

Racial discrimination

Language barriers

Lack of health insurance

Limited financial resources

Different cultural customs & beliefs

poverty

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Native Americans

How do we refer to Native Americans?Experiences shared by Native Americans.

Loss of tribal lands to US GovernmentProblems with assimilationGeneral lack of respect for their humanityCultural genocide

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Problem Areas

Life expectancy

High rates of employment

School dropout

Teen pregnancy

Alcoholism

Poverty

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Therapy Issues

Present orientation to time

Indian time

Noninterference

Direct confrontation

Healing process

Talking circles

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Educational Concerns

57% obtain a high school degreeEnglish

Low self-esteem

Cultural value differences

Health problems

Chronic poverty

Few positive career models

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Alcoholism

52-80%

Lower tolerance?

Underuse of mental health services

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Asian Americans

Family dynamicsConfucius laid the general template for Asian families centuries ago.A vertical structureFather at its headMother deferential & supportiveChildren obedient to and respectful towards bothFamily values: duty, work, achievementMethods used: shame, guilt, appeal to duty, honor

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Parenting

Children are expected to not embarrass, shame, or dishonor

Authoritarian parenting

Other parenting differences.

Collectivist values of interdependence, conformity & harmony.

Direct confrontations are avoided.

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Family

Emotional expression considered in bad form.

Love & affection not expressed openly

Indirect communication

Older generation parents & acculturated children

Marriage issues

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Family

Strong negative stereotypes for marrying a non-Asian.

Interracial marriage = betrayal

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Therapy Issues

Problems: enmeshmentCodependence Lack of individuationSocial anxietyPsychopathological labelsEnormous pressure to excel academicallyParental emphasis on work ethic

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Therapy Issues

Elderly – revered & respected

Parents’ children expected to fulfill their needs, care for them, treat them with reverence, & obey their wishes & plans.

High rate of suicide.

Unequal treatment of girls & boys

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Therapy Issues

Conflicts over family

Family responsibility & obligations

Emphasis on autonomy, overt masculinity, & self-reliance (American values)

Gender issues

Homosexual & transgender Asians

How view mental health problems