Chapter 4: Counseling in a Multicultural World

What is diversity?

appreciating the differences between people, includes differences based on race, ethnicity, nationality, sexual orientation, disability, SES, religion.

What is cultural competence?

•Awareness of own beliefs, values, and prejudices

•Knowledge about other cultures

•Skills to deal with other cultures

What is ethnocentrism?

Judging other cultures based on one's own culture

What should we consider when being culturally sensitive, but not stereotyping?

- Recognize there are patterns of thoughts and behaviors within a similar culture

- But also acknowledge individual difference within a culture (e.g., "not all Native Americans are the same")

- Therapists should consider the client's ethnic identity and level of acculturation before applying cultural generalizations

What is to be considered in the flexibility of family roles with African Americans in therapy?

- Mothers perform fathers roles and vice versa

- AA men are more supportive of women's employment and hold more egalitarian views of marital relationships than EA

- Extended family salient: often live near nuclear family and help with childrearing

- Single parent homes (48% female led, 20% male led of all AA homes), 50% of all unmarried teenage parents are AA

True or false: African Americans are less accepting of homosexuality than other ethnicities

True.

True or false: African Americans value their ethnic identity more than other groups

True

When should you broach the subject of race with African Americans in therapy?

Early. Communicate if the client and therapist are from different races and wonder how client feels about this. Empathize with clients concerns of racism and discrimination

__________-__________ therapy focusing on symptom reduction and resolution of problems seems to work best with African Americans.

Time-limited (direct communication is best).

- Side notes: bring in their family if relevant and focus on their strengths.

What are some issues with Asian Americans and therapy?

- There is stigma. Psychological problems met with shame and rejection from family.

- Only 4% Asian Americans would go to counselor, vs. 26% European Americans.

- Many refuse referral from PCP.

- They are very loyal to family and disclosing personal info to strangers is not acceptable and brings disgrace to family, intense shame.

How do Asian Americans express their mental problems?

Asian Americans often express mental problems thru physical (headache, stomachache) because physical problems bring care and sympathy from family.

What is a collectivist culture?

Highly value harmony, group, and family over individual, cooperation over competition.

True or false: Asian Americans will open up to you once they know you well enough.

True. Asian Americans reserved verbally and emotionally, especially with authority and strangers.

What is directive therapy and what types of techniques are associated with this?

Present, Problem-Focused Psychotherapies: Cognitive Therapy, Behavioral

What is nondirective therapy and what types of techniques are associated with this?

Nondirective, Past-Focused Psychotherapies: Psychodynamic, Humanistic

What is are the views Asian Americans hold with empathy?

Asian empathy is sympathy: compassion, kindheartedness. Greet client with smile, offer drink, warm acceptance.

How do Asian Americans view therapy?

- Asian respect authority: They do not try to form equal relationship.

- The therapist should use problem-focused approach and psychoeducation. Demonstrate credibility right away by offering direct advice.

How should the therapist approach an Asian American's shame and humiliation about having mental problems and needing counseling?

The therapist should reframe it as courage rather than shame and humiliation.

What should the therapist do with an Asian American's culture?

Show an interest and appreciation for it.

What should be done with an Asian American's family with therapy?

If applicable, bring in the family and build alliances

with those in power within the family.

What is Personalismo for Hispanic Americans?

Respect, dignity, worth of self and others. They emphasize support and connection between people more than material goods and social standing.

What is Simpatia for Hispanic Americans?

- Characteristics of being likeable, attractive, fun, easygoing. (Talk with friends, even if late, they prefer service (lawyer, mechanic) from friends, even if incompetent, Conflict is considered rude).

What is Machismo for Hispanic Americans?

- Gender roles clearly delineated

- Patriarchal: the man is head of the house

What is the view of mental health for Hispanic Americans?

High tolerance for mental health problems or spiritual remedies (curandero), but stigma against counseling.

What are three things a therapist should keep in mind with a Hispanic American with therapy?

- Client's personalismo show through with bringing small gifts, invite therapist to home, ask about therapist's family. *Therapist should be careful to respect client and affirm the importance of relationship, loosen boundaries

- Understand the client is not denying or resisting if they are trying to befriend you

- Work within the client's gender roles

What are some problems for Native Americans?

- Alcohol Abuse is a major problem.

- Domestic Violence is major problem.

- Unemployment and poverty.

- Suicide: adolescents twice as likely and adults four times more likely to commit suicide than European Americans.

What is a major identity problem for Native Americans?

- Assimilation.

- Pressure to conform by larger society, but there is pressure from family to remain traditional.

What are strengths for Native Americans?

- More accepting of homosexuality than European Americans

- Spiritual Values: important to most, ancestral spirits revered, all of nature has spirits and interconnected

What kind of culture are Native Americans?

- Collectivistic Culture: cooperation not competition, sharing of possessions more valued than collecting wealth, concerned more with family and group than self

What are the dynamics of families with Native Americans?

- Some tribes patriarchal, some matriarchically, some egalitarian

- Parenting: shared with extended family, noninterference approach, believe child should experience natural consequences from problematic behavior

How do Native Americans view time?

- Loose boundaries of time, no specific plans.

- Meetings begin when everyone IS present and ends when people feel like it.

What are 6 things to keep in mind when Native Americans seek therapy?

- Gentle handshake signifies respect

- Limited eye contact so as not to appear aggressive or arrogant

- Silence shows respect, interruption or fail to pause after speaking is sign of immaturity or lack of wisdom

- Focus on the present, be directive: suggestions, alternative perspectives

- Work out time boundary differences: discuss pros & cons of each side, problem solve

- Help client clarify for themselves identity

- Reinforce positive aspects of Native ancestry

- Use spiritual or family resources if applicable (e.g. family therapy).

What are some questions to ask for values clarification?

- What gives your life meaning? Makes life worth living?(What would you be willing to die for? What is the purpose for life?)

- What are your most important beliefs?

- What relationships are most important in your life (Significant in shaping your outlook on life? What relationships/groups are most important as support for your values/beliefs?).

- What do you most like about: Your Native American culture? American culture?

- When your life seems most discouraging and hopeless, what renews your hope?

What is transgender?

Identify with the gender opposite of their biological sex.

What are issues with therapy for transgender people?

Finding a lifestyle that fits their interest.

What are therapy issues for people in the LGBT community and what therapy does not work?

- Coming Out: process of acknowledging to oneself and the world that the individual is homosexual or bisexual

- Dealing with self-hatred or low self esteem or discrimination in society

- Sexual Reorientation therapy does not work

What is a mastectomy?

removal of the breast

What is phalloplasty?

When skin is taken from other parts of the body and transplanted to the genital area to create a functional penis without erectile tissue.

What is metoidioplasty?

enlarge clitoris over period time using testosterone replacement therapy

What is Inguinal orchiectomy?

To remove testical & sperm cord, chest augmentation with breast prosthesis, surgical creation of a vagina.