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Multicultural Therapy. Carolyn R. Fallahi, Ph. D. The need for cultural competence. There is a need for cultural competence within therapy. Traditional approaches have failed to meet the needs of minorities.

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Multicultural therapy

Multicultural Therapy

Carolyn R. Fallahi, Ph. D.


The need for cultural competence
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.


Minority groups
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.


What do we see with minority patients
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?


What are the issues with multicultural therapy
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.


Recurring issue
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.


Multicultural education models
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.


Why aren t these theories enough
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.


What do the contemporary white western theories models emphasize
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.


Contemporary white models
Contemporary White Models emphasize?

  • 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.


Contemporary white models1
Contemporary White Models emphasize?

  • The research has incorporated biases inherent in monocultural theoretical models.


Multicultural research
Multicultural Research emphasize?

  • 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.


Oppression
Oppression emphasize?

  • 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.


Cross cultural training models
Cross-cultural Training Models emphasize?

  • 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.


Cross cultural training models1
Cross-cultural Training Models emphasize?

  • 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.


Future clinicians
Future Clinicians emphasize?

  • 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.


Third competency
Third Competency emphasize?

  • 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.


The distinction between cultural individual differences
The distinction between cultural & individual differences. emphasize?

  • 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”.


Therapists trained from the euro north american cultural belief system
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?


Other issues
Other Issues belief system

  • 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.


A strong conceptual framework
A strong conceptual framework belief system

  • 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.


Barriers to effective multicultural counseling instruction

Melting pot myth belief system

Incongruent student expectations about therapy

Overemphasis on verbal disclosure

Overemphasis on abstract & non-problem-solving strategies.

Ethnocentric worldview

Ignorance of self-racism & cultural identity of others

Monolingual orientation

Overemphasis on long-range goals & the future.

Lack of understanding of the whole person

Lack of understanding of social focus

Lack of appreciation for nonverbal communication

Barriers to effective multicultural counseling instruction


Emphasize
Emphasize belief system

  • Culture

  • Race

  • Ethnicity

  • Dominant culture

  • Bi-culturalism

  • Melting pot myth

  • Pluarlism

  • Oppression

  • Cultural invasion

  • Issues relating to power & internalized racism

  • Marginality

  • Lived experiences & contradictions


Becoming culturally competent
Becoming Culturally Competent belief system

  • 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.


Becoming culturally competent1
Becoming Culturally Competent belief system

  • 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.


Becoming culturally competent2
Becoming Culturally Competent belief system

  • 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?


Enhance cross cultural awareness knowledge
Enhance Cross-Cultural Awareness & Knowledge belief system

  • 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.


Enhance competency
Enhance Competency belief system

  • Promote cross-cultural research & supervision & consultation.


Addressing racism derald wing sue
Addressing Racism: Derald Wing Sue belief system

  • Why do we hold prejudices or stereotypes?

    • Need to understand our world

    • Too much information – need to categorize

    • Makes us feel better about ourselves


John duckitt history of psychology prejudice
John Duckitt – History of Psychology & Prejudice belief system

  • 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.


1920s 1930s
1920s- 1930s belief system

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

    • Movement switched to: where those preconceived attitudes came from.


1930s 1940s
1930s & 1940s belief system

  • 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.


1950s
1950s belief system

  • The prejudiced personality

    • Holocaust & massive genocide

    • Demented disturbed personality

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


1960s 1970s
1960s & 1970s belief system

  • Movement from the individual to a more sociocultural perspective.

    • Prejudice could be understood as a social or cultural norm.

    • Normative approach

    • Consensus model of race relations, Black/white relations.

    • Socialization & conformity

    • Racial integration

    • Conflict, power, & domination were nearly totally neglected.


1980s
1980s belief system

  • 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.


Guthrie even the rat was white
Guthrie & Even the Rat was White belief system

  • 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.


The role of psychology
The role of psychology belief system

  • 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.


Are you a racist
Are you a Racist? belief system

  • 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.


The average american
The average American belief system

  • 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.


Do you oppress
Do you oppress? belief system

  • 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?


African americans
African Americans belief system

  • 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.


Issues
Issues belief system

  • 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.


Cook wiley 2000
Cook & Wiley (2000) belief system

  • 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.


Social relationships strengths
Social relationships & strengths belief system

  • Religion & spirituality

  • Need to assess religion & spirituality

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

  • Interdependence

  • Traditional therapy


Family dynamics
Family Dynamics belief system

  • 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


Gender issues
Gender Issues belief system

  • Identity linked to ability to provide for family.

  • Success related to discrimination.


Latinos latinas
Latinos & Latinas belief system

  • 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.


Issues in therapy
Issues in Therapy belief system

  • 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.


Other issues1
Other Issues belief system

  • Religion

  • Oppression & racism

  • Acculturation

  • Family dynamics

  • Time orientation

  • Elderly versus Youth

  • Family & support system


The dynamics of therapy
The Dynamics of Therapy belief system

  • Family – strength & liability.

  • Great value placed on manners, courtesy, harmonious relationships

  • Conflict, direct argument, & contradiction considered rude.

  • Gender roles

  • Youth

  • Parent & child relationships


Other issues2
Other issues belief system

  • Religion

  • Gender & sexual norms

  • Boys versus girls

  • Homophobia

  • Interdependent & cooperative


Other problems
Other Problems belief system

  • Physical & emotional difficulties of aging.

  • Cultural alienation

  • Racial discrimination

  • Language barriers

  • Lack of health insurance

  • Limited financial resources

  • Different cultural customs & beliefs

  • poverty


Native americans
Native Americans belief system

  • How do we refer to Native Americans?

  • Experiences shared by Native Americans.

    • Loss of tribal lands to US Government

    • Problems with assimilation

    • General lack of respect for their humanity

    • Cultural genocide


Problem areas
Problem Areas belief system

  • Life expectancy

  • High rates of employment

  • School dropout

  • Teen pregnancy

  • Alcoholism

  • Poverty


Therapy issues
Therapy Issues belief system

  • Present orientation to time

  • Indian time

  • Noninterference

  • Direct confrontation

  • Healing process

  • Talking circles


Educational concerns
Educational Concerns belief system

  • 57% obtain a high school degree

    • English

    • Low self-esteem

    • Cultural value differences

    • Health problems

    • Chronic poverty

    • Few positive career models


Alcoholism
Alcoholism belief system

  • 52-80%

  • Lower tolerance?

  • Underuse of mental health services


Asian americans
Asian Americans belief system

  • Family dynamics

    • Confucius laid the general template for Asian families centuries ago.

    • A vertical structure

    • Father at its head

    • Mother deferential & supportive

    • Children obedient to and respectful towards both

    • Family values: duty, work, achievement

    • Methods used: shame, guilt, appeal to duty, honor


Parenting
Parenting belief system

  • Children are expected to not embarrass, shame, or dishonor

  • Authoritarian parenting

  • Other parenting differences.

  • Collectivist values of interdependence, conformity & harmony.

  • Direct confrontations are avoided.


Family
Family belief system

  • Emotional expression considered in bad form.

  • Love & affection not expressed openly

  • Indirect communication

  • Older generation parents & acculturated children

  • Marriage issues


Family1
Family belief system

  • Strong negative stereotypes for marrying a non-Asian.

  • Interracial marriage = betrayal


Therapy issues1
Therapy Issues belief system

  • Problems: enmeshment

  • Codependence

  • Lack of individuation

  • Social anxiety

  • Psychopathological labels

  • Enormous pressure to excel academically

  • Parental emphasis on work ethic


Therapy issues2
Therapy Issues belief system

  • 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


Therapy issues3
Therapy Issues belief system

  • 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


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