Approaching Culture Authentically in Clinical Practice

1. Approaching Culture Authentically in Clinical Practice Dr. Manuel X. Zamarripa, LPC-S Austin Community College Manuel.Zamarripa@austincc.edu Institute of Chicana/o Psychology facebook.com/ChicanoPsychology

4. Culture & Cultural Identities • Microaggressions • The Role of Bias • Individualism v Collectivism • Primary v Secondary Cultural Characteristics • Help Seeking v Help Offering Behaviors • Defensive Behaviors

5. Cultural Competence • The paradox of practicing in the era of cultural competence • Although we have standards, evidence that there are still significant gaps in training and cultural understanding. • One reason, I propose, is because the concepts of culture and diversity have become buzzwords. • We hear and talk about culture often, however, many times a deeper understanding is not acquired in terms of application to clinical practice.

6. Cultural Competence • Result is that sometimes we become desensitized to the words “culture” or diversity” so that some reactions can be “Are we talking culture again?” • Infusing culture and deepening our understanding is equal to continuing to learn and review issues of ethics, counseling skills or interventions.

7. Cultural Context (Pedersen, 2000) • ALL behaviors are learned & displayed within a cultural context • Within their particular cultural contexts, • behaviors can be measured more accurately • personal identity can be more clearly defined • the consequences of problems are better understood • counseling interviews become more meaningful 

8. Cultural Context • Cultural Context is broadly defined to include ethnographic, demographic, status, & affiliation variables • Culture-centered interventions depend on • an inclusive definition of culture • a broad definition of the counseling process • additionally, culture is recognized as • central (not marginal) • fundamental (not exotic)

9. Culturally “Different” (i.e. deficient) • Historically “Different” indicated deficit • Different meant different than the “norm” • White, middle-class, male, heterosexual • Any difference from this norm was “less desirable”

10. Cultural/Social Identities in Therapy(Hayes, 2008) • ADDRESSING Framework • Age/Generation • Developmental Disability • Disability acquired later in life • Religious and Spiritual Orientation • Ethnic and Racial Identity • Socioeconomic Status • Sexual Orientation • Indigenous Heritage • National Origin • Gender

11. Identities & Privilege • Age/Generation – between ages of 30 - 60 • Developmental Disability – no • Disability acquired later in life - no • Religious and Spiritual Orientation – secular or Christian • Ethnic and Racial Identity – European American or White • Socioeconomic Status - brought up or currently middle- or upper- class status • Sexual Orientation - heterosexual • Indigenous Heritage – no meaningful indigenous heritage • National Origin - if you live in the country in which you were born and grew up • Gender - male

12. Cultural Encapsulation • If people around you hold similar identities AND share the same privileges, may rarely question some common beliefs. This is cultural encapsulation. • Therapeutic practice – even with diverse clientele – will not necessarily increase self-awareness.

13. Cultural Encapsulation • We need to look outside the therapy setting to individuals and groups who differ from us AND can facilitate our self-assessment process. • Think about individuals in your intimate circle: How many differ in my areas of privilege?

14. Mental Health Cultural Encapsulation • What are three to five aspects that demonstrate wellness or mental well-being? • Accuracy of communication • Directness/frankness of communication • High Context v Low Context cultures

15. Real Talk • How would your parents respond to “what is your cultural background?” “Do you think culture plays a part in your problem?” • Real Talk, Real People. Need to speak their language. Careful about therapy talk. • How do we bring forth the topic of culture? How do we address social justice issues.?

16. Bringing Culture Forth (Hays, 2008) • How would you describe yourself? • Would you tell me about your cultural heritage or background? (use follow up questions) • What was your religious upbringing? Do you have a religious or spiritual practice now? • What was your family’s economic situation growing up?

17. Bringing Culture Forth (Hays, 2008) • Do you have experience with disability, or have you been a caregiver for someone who does? • Are there ways in which your disability is part of [the presenting problem]? • What did it mean to grow up as a [girl or boy] in your culture and family? • Do you currently have a partner? Could you tell me about the significant intimate relationships you have had?

18. Values • Individualism- the notion that our behaviors and attitudes are guided by incentives that promote independence • Collectivism- the idea that decisions and what is valued as important is based on the betterment of others (e.g. community or family members) (Hays & McLeod, 2010)

19. Values • Some concepts viewed as central to success and progress in therapy – • SELF-awareness, • SELF-fulfillment, • SELF-discovery, • SELF-disclosure and • Emotional expressiveness. • Being emotionally reserved is not often viewed as a positive sign of maturity and self-control

20. Values • "I value independence and egalitarian interactions, but this family does not"

21. Values • "I value independence over interdependence, and I place a higher priority on egalitarian interactions than on respect for authority in most situations. This family places a higher value on respect for the wisdom and decision of elders. They place a high value on interdependence, family cohesion, and the preservation of cultural and religious traditions. (Hays, 2016)"

22. Culture on a Continuum Individualism --------------------- Collectivism

23. I & C Values on a Continuum Profile Place an “X” on each continuum to indicate your place on each value Identity Express distinctiveness ---------------------- Adopt appearance of your social group Self=individual characteristics------------- Self=family characteristics Growth/Change valued----------------------Increasing/maintaining family traditions Family Immediate family---------------------------Extended family Not involved in personal decisions-----------------Equally involved in personal decisions Move away from family-----------------------Stay with family

24. Culture on Continuum Identity Growth/Change valued----------Increasing/maintaining family traditions Growth/Change not valued Decreasing/discarding traditions Family Not involved in personal decisions--------------------Equally involved in personal decisions Overly involved Opinion not valued

25. Culturally Responsive, Competency-based • Continuum of behaviors, beliefs, and contexts • For example: Traditional • Deconstruct what “traditional” means for client. • Focus on the strengths of the meaning for client. • Are there exceptions to client’s belief about this meaning. • Both/And

26. Preventing Defensive Behaviors • Defensive feelings lead to focus on justifying our own ideas, lessening concern for the client’s experience. This shift easily perceived by clients, who may then engage in self-protective behaviors (emotionally distancing selves from you).

27. Preventing Defensive Behaviors • Probably impossible to eliminate defensive feelings. May also be undesirable: emotions often serve as cues that something is wrong. • However, possible and desirable to refrain from engaging in defensive behaviors.

28. Preventing Defensive Behaviors (Hayes, 2008) • Be mindful of the physical sensations that accompany feelings of defensiveness, fear, and pain. • If possible, identify the precipitants of these sensations and feelings to help you predict defensive feelings and behaviors before they occur. • Use these physical sensations as cues to what you are feeling. • When you feel defensive sensations and feelings arise, take a deep breath, exhale slowly, and then focus for a few seconds on your breath.

29. Preventing Defensive Behaviors (Hayes, 2008) • Refrain from defensive behaviors (e.g., talking too much, emphasizing your own accomplishments, emotional distancing). • Question the need for clients’ views to match your own. • Recognize your need for additional information and experiences. • If appropriate, discuss the limitations of your knowledge and experience with the client.

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