Defining and Building Multicultural Competence - PowerPoint Presentation

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Defining and Building Multicultural Competence

Michele D. Aluoch, LPCC2018

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Language

Race- the biology of a person, sociopoliticalCulture

Ethnicity- construct based on shared language, culture, traditions, and history

GenderAgeSocioeconomic statusSpiritual views/other values

Defining “Multicultural”

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CULTURE =“any group of people who identify or associate with one another on the basis of some common purpose, need, or similarity of background”

(e.g. music, living arrangements, beliefs, hobbies, etc.), “those who have agreement about the way its done” (Hendricks, K.T., 2005)Defining “Multicultural”

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“the coming together of two or more people from different cultural backgrounds in a helping relationship.”

(Torres-Rivers, E., Phan, L.T., Maddux, C., Wilbur, M.P., & Garrett, M.T., 2001)Defining “Multicultural”

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Melting pot- put all into one cultureTossed salad

- distinct yet create a new wholePatchwork quilt- interdependent yet uniqueWhat do we call “America?”

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Multicultural competence

- the extent to which counselors possess appropriate levels of self-awareness, knowledge, and skills in working with individuals from diverse cultural backgroundsMulticultural Competence

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Emotional stability- when new and potentially stressful situations

Social initiative- taking initiative to approach what’s new and differentFlexibility- How new situations may be interpretedKey Personality Attributes: Multicultural Competency

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Without training:

Cultural encapsulation Reactions based on stereotypesIgnoring cultural differencesAvoiding critical subjectsFocusing on techniques to the exclusion of client factorsKEY= Counseling is not culture free!!!

Risks if Not

Multiculturally Competent

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Real world exposure to various cultures

Development of critical consciousnessMovement from interest in knowing more to advocacy and social justiceCounselor as guest in other’s worldIncludes interaction with community membersBeyond the counseling officeLiving their ongoing narrativeDevelopmental connections one might not ordinarily haveLetting go of the way I do it

Our Solution: Cultural Immersion (Barden, S.M. &

Cashwell, C. S., 2016)

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Used to be called “minority counseling.”

As recently as 2000, only 80% required multicultural counseling and only at the one course level.Only 49% of psych /counseling programs integrated the issue of multicultural counseling across coursesHistory of Multicultural Counseling(Robinson, D.T., & Morris, J.R., 2000)

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professional identity

social and cultural diversityhuman growth and developmentcareer developmenthelping relationshipsgroup workassessmentresearch and program evaluation

Multicultural Counseling Domains

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Taking a multicultural courseInfusing multicultural content into courses

Both of aboveMethods of Equipping Counselors to be Multicultural Competent

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Traditional strategies- reading assignments, videos, lectures

Exposure strategies- presentations by a representative of a given groupParticipatory strategies- class discussions, simulations, role plays re. personal views, biases, and life experiences

Experiential exercises

- exchange counseling, community based interventions, use of clinical games in classMethods of Equipping Counselors to be Multicultural Competent

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Which is more important: past, present or future?

How do you view human nature: basically good or evil?What are your views on cohesiveness of the family- should immediate family be our new family or are we enmeshed with families of origin?Emotions: to what extent should emotions be expressed?Whose needs take precedence- the individuals or the familys?How are gender roles defined?

The Key Determinants of Culture (Blount, A., & Young, M. E., 2015)

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Who am I?Who are my people?

Where do I come from?What is my heritage?Is there a migration story?How did I get here?Korn, L., 2016

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My Top TenSomething about who I amSomething about my gifts, talents, hobbies

Something about my beliefs, values, prioritiesSignificant memories or issues that have shaped my lifeWhat I’ve conquered or learnedMy hope and dreamsThings which represent what’s of most value to meUnderstanding Me- Teach Me Exercise

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Nuclear family? Community? Nontraditional?Who eats together? Who does life day to day together?

What is acceptable in terms of physical affection?How are emotions expressed/concealed?What are roles and responsibilities “supposed” to be? How do I compare to what others in my environment believe?Who is my family?

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Who I learn from?Who influenced me?How I best learn and grow?

Who I allow in my story?Who I would change in my story? What aspects?My superheros?What I learned and overcome, changed, or developed over time in relation to others?Role Models

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Successful multicultural supervision- “things you said or did (as the supervisor) that led to successfully facilitating the supervisee’s growth and development as a person and a professional or that led to a successful bridging of ethnic/cultural barriers between the supervisor and the supervisee.”

(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

Multicultural Supervision

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Changing population of U.S.

Issues of rapport building and empathyReducing premature terminationRemaining client focused

Designing individualistic effective intervention

Reducing risk for operating beyond scope of practiceAwareness of competencies needed with different culturesTo reduce risk of cultural encapsulationTo begin to correct incomplete and inaccurate assumptions that may lead to misdiagnosis or unhealthy applications of treatmentTo remain clinically relevant to the needs of each individualTo test the organizational mission, policies and procedures, and approaches used for applicability to all persons served

Why Multicultural Training Is Important

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To sensitive counselors in training

to potential issuesTo overcome sense of powerlessnessTo deal with the norms of society vs. personal norms

To allow for childlike discovery

of important factorsTo test and experiment with approaches with different culturesMulticultural Games- Purposes

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Bafa

Bafa- * simulated cultures (Apha and Beta groups- each learn everything about the other culture then interact and then switch)Step Forward/Step Back- like Mother, May I?* Characters created with various cultural attributes

* May move forward or backward so many steps based on the degree to which some things may or may not be factors in a cultural character’s life

Cultural Jeopardy- *Used to recall and apply knowledge of information about culturesMay I help You?- *game of trying out counseling approaches on various cultures of clients and seeing how it goesEvaluation: experiences, feelings, knowledge, self awarenessMulticultural Games- Examples:

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Instructors need to examine own biasesGaps in ethical codesRequires that the power differential and hierarchy be minimized

Teaching MulticulturallyFier, E.B., & Ramsey, M., 2005

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Tests not normed on various culturesTests invalid for cultural issues and pathologyEx: MMPI-2

Testing MulticulturallyHill, J.S., Robbins, R.R., & Pace, T.M., 2012

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Counselors- go in with hypothesis and tend to seek confirmations- confirmation biasAnthropologists- open ended, hear the story

Ideals, beliefs, values, explanations, evaluations, symbols, historical stories, behaviors, experiencesSuggestion- move toward this open-ended, client driven approach for assessmentMulticultural AssessmentGerstein, L.H., Rountree, C., & Ordonez, A., 2007

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Creating a safe environment for discussion of multicultural issues,

Developing my own self awareness about cultural ethnic identity biases Communicating acceptance of and respect for supervisees’ cultureListening to and demonstrating genuine respect for supervisees’ ideas about how culture influences the clinical interaction

Providing openness, genuineness, empathy, warmth, nonjudgmental stance

Validating integration of supervisees’ professional and racial/ethnic identities and helping to explore potential blocks to this processDiscussing and supporting multicultural perspectives as they relate to the supervisee’ clinical workSupervisory Behaviors in Successful Multicultural Supervision(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Tending to feelings of discomfort experienced by trainees concerning multicultural issues

Supporting supervisees own racial/ethnic identity developmentPresenting myself nondefensively by tolerating anger, rage, and fear around multicultural issuesProviding supervisees a multiculturally diverse caseload to ensure breadth of clinical experience

Attending to racial/ethnic

ethnic cultural differences reflected in parallel process issues (supervisor/supervisee and supervisee/client)Discussing realities of racism/oppression and acknowledging that race is always an issue.Acknowledging, discussing, and respecting racial/ethnic multicultural similarities and differences between myself and supervisees and exploring feelings concerning thisSupervisory Behaviors in Successful Multicultural Supervision(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Addressing a broad range of differences (e.g. learning styles, interpersonal needs, social orientation, religious/spiritual beliefs, and race)

Checking out the supervisory expectation with superviseesInitiating discussion about the importance of cultureAcknowledging and discussing power issues in supervision that may be related to racial/ethnic multicultural differences

Encouraging supervisees to share, within supervision, their personal and professional cultural background and experiences

Consulting colleagues willingly about my own reactions to racial/ethnic concerns from supervisionAcknowledging my own lack of knowledge on racial/ethnic multicultural differences and inviting supervises to give me feedback and teach meSupervisory Behaviors in Successful Multicultural Supervision(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Testing hypotheses about my supervisees, not accepting “just one view“

Self-disclosing aspects of my own cultural backgroundEngaging supervisees in peer review with each other's cases through case conferencesSeeking understanding of supervisees' culture through both didactic and experiential means on my ownProviding written and verbal feedback regarding supervisees' multicultural interactions with staff and clients

Providing multicultural readings and related training experiences for supervisees

Being willing to confront supervisee's inadequate skills, listening if that is challenged on grounds of cultural insensitivity, but not backing away from my own standards and valuesSupervisory Behaviors in Successful Multicultural Supervision(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Allowing supervisees to see my clinical work in cross-cultural counseling and/or consultation through tapes or live observation

Letting supervisees take responsibilityProviding supervisees with information about various culturesOffering supervisees mentorship and other collaborative professional opportunities with me (e.g., co-led presentations, coauthored papers)Departing from Western theoretical perspectives in supervisionHaving supervisees keep a journal that documents personal reactions to interactions with seminar facilitator and intern colleagues

Supervisory Behaviors in Successful

Multicultural Supervision(Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Lacking awareness regarding my own racial/ethnic/cultural biases and stereotyping

Overlooking and/or failing to discuss cultural issuesBecoming defensive around racial/ethnic/cultural issuesFailing to establish a working alliance and safe environment

Not recognizing the power of the supervisory role

Making assumptions about the supervisees' experiences or beliefs, based on their ethnicity or culturePresenting a particular point of view that was rigid and dogmaticIgnoring gender issues in relation to cultural/socioeconomic backgrounds of myself and my superviseesNot acknowledging or discussing racial/ethnic/cultural differences between myself and my superviseesSupervisory Behaviors in Unsuccessful

Multicultural Supervision

(

Dressel

, J.L,

Consoli

, A.J., Kim, B.S.K., & Atkinson, D.R., 2007

)

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Not exploring together the impact of different cultural, socioeconomic, and gender backgrounds on how we conceptualize clients and the therapy process

Being inattentive and insensitive to supervisees' insecurities in addressing muiticulturalism/racismNot supporting and encouraging a supervisee's own racial/ethnic identity development

Not having a diverse caseload for supervisees thus limiting opportunities for discussion of racial/ethnic/cultural issues

Failing to recognize my own position of racial/ethnic privilegeTreating supervisees as "spokespersons" for their whole racial/ethnic groupInvalidating importance of multicultural supervision by not dedicating enough time to itSupervisory Behaviors in UnsuccessfulMulticultural Supervision (Dressel, J.L, Consoli

, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Not exploring together the impact of different cultural, socioeconomic, and gender backgrounds on how we conceptualize clients and the therapy process

Being inattentive and insensitive to supervisees' insecurities in addressing muiticulturalism/racismNot supporting and encouraging a supervisee's own racial/ethnic identity development

Not having a diverse caseload for supervisees thus limiting opportunities for discussion of racial/ethnic/cultural issues

Failing to recognize my own position of racial/ethnic privilegeTreating supervisees as "spokespersons" for their whole racial/ethnic groupInvalidating importance of multicultural supervision by not dedicating enough time to itSupervisory Behaviors in UnsuccessfulMulticultural Supervision (Dressel, J.L, Consoli

, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Not learning about and considering supervisees' racial/ethnic/cultural background

Not acknowledging and encouraging supervisees when they use issues of ethnicity in an appropriate and relevant manner in the course of their work with clientsAssuming supervisees' cultural awareness without justification

Having poor boundaries that were intended to create openness but instead contributed to dual role conflicts with supervisees

Insufficient consultation/peer supervision for me to work out my own racial/ethnic/cultural issuesNot inviting supervisees to bring [it] to my attention if it feels [to them] that I have done/said something they see as racialInhibiting my own interventions for fear of being perceived as culturally insensitive Supervisory Behaviors in UnsuccessfulMulticultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Assuming, without justification, a racial/ethnic/cultural barrier being a developmental issue for the client

Focusing too much on content and not enough on processMisinterpreting body language/nonverbal communication of supervisees

Lack of focus on mutual goal setting

Becoming too preachy about racism/prejudiceAllowing discourse that may inhibit supervisees' free expressionDiscussing power issues in individual context only and not in a cultural context Not providing enough structure for supervisees who held culturally based expectations for structure Addressing issues of race/ethnicity/culture with supervisees who are not ready for them

Demonstrating workaholic style that intimidates supervisees

Supervisory Behaviors in Unsuccessful

Multicultural Supervision

(

Dressel

, J.L,

Consoli

, A.J., Kim, B.S.K., & Atkinson, D.R., 2007)

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Self awareness- how does my own reality influence supervision and client therapist interactions?

Knowledge- do I have the appropriate knowledge for the populations I am working with?Skills- am I aware of culturally relevant interventions?Initiating discussions about the role and impact of cultural variablesEmphasize with and validate that all cultural viewpoints have some validityCultural Issues in Supervision (Hook, etc., 2016)

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Dangers of Not Broaching Multicultural Issues

Believing issues are color blind or that every issue definitely has racial, ethnic or other multicultural piece that has to be addressedThere are no unfair biases in society anymore- everyone’s equalIf people want help they should pull themselves up by their bootstraps and do what they need toAssumption that there are no within group differences- all people with a certain feature (e.g. all whites/blacks, all poor/rich people, all men/women, all people of ___ religion, all ____ are the same)Believing that each of our limited experiences give us an accurate realistic foundation upon which to make judgment.

Cultural Issues in Supervision (Hook, etc., 2016)

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Should be both practical and clinical

Balance between narrowly defined characteristics of a culture versus individualized characteristic across cultureLetting the client determine how central/not important cultural issues areShould be both didactic and experiential

Should be integrated into the counselor’s professional identity

Should be incorporated into clinical supervision, practicum, internships, and ongoing clinical interactionsGeneral Guidelines

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Attitudes

Self awareness- cognitive and affectiveSensitivity to othersPersonal background/life experiencesPersonal limits of competency

Sources of discomfort

KnowledgePersonal multicultural heritageHistorical oppression, discrimination, stereotypingSocial impact of personal style and valuesAreas of Multicultural CompetenciesTo Address

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Skills

TrainingRelevant researchActive involvement with cultural groups outside

counseling office (not clients)

Ongoing consultationCulturally appropriate interventionsBilingual (if helpful)Awareness of appropriate referral sources and resources in the communityWillingness to adapt as needed (assessment/testing, evaluation, clinical goals, style) Areas of Multicultural CompetenciesTo Address

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Relinquishing absolute truths Accepting multiple perspectives

Critically analyzing techniques and interventions to choose ones with best fit for a given clientHearing how someone’s cultural traditions, values, beliefs, and worldviews affect their intrapersonal and interpersonal interactionsSelf Evaluation- Multicultural Competency

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Developing interventions which are culturally sensitiveRefuse to use counseling approaches which produce negative, oppressive, or unethical results

Self Evaluation- Multicultural Competency

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Emotional stability- when new and potentially stressful situationsSocial initiative

- taking initiative to approach what’s new and differentFlexibility- How new situations may be interpretedKey Personality Attributes: Multicultural Competency

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Green, R.G.,

Klerman, Stern, M., Bailey, K., Chambers, K., Calridge, R., Jones, G., Kitson, G., Leek, S., Leisey, M., Vadas, K., Walker, K. (2005):See 50% of my clients more than onceRecognize cultural mistakes quickly and recover

Use several methods of assessment

Able to distinguish between need for brief and long term servicesEffective crisis interventionsVarious practice skills and techniquesCompatible verbals and nonverbalsMulticultural Counseling Skill Subscale Items

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Solving problems in unfamiliar settingsHaving an understanding of racial and ethnic minority groups.

Understanding the legalities of immigration.Extensive professional or collegial interactions with minority individuals.Enjoying interacting with people from different cultures.Advocating for people of different cultures.Seeking workshops on multicultural competencyMulticultural Counseling Skill Subscale Items

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Understanding the roles of age, gender, SES, roles.

Self examination of cultural biases.Knowing and applying research methods regarding multicultural practice.Awareness of changing practices for populations served.Monitoring any defensiveness.Working with clients on issues of acculturation if needed.Dealing in non-stereotyped ways.Multicultural Counseling Skill Subscale Items

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1. Color blindness- more homogenous classification of clients2. Client focused

3.Acknowledegmnet of individual differences4. Textbook consistent treatment5. Skills- based6. Self integrationMulticultural CompetencyCaldwell, L.D., Tarver, D.D., Iwmoto, D.K., Herzberg, S.E., Cerda-

Lizarraga

, P., & Mack, T. (April 2008).

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Real world exposure to various cultures

Development of critical consciousnessMovement from interest in knowing more to advocacy and social justiceCounselor as guest in other’s worldIncludes interaction with community membersBeyond the counseling officeLiving their ongoing narrativeDevelopmental connections one might not ordinarily haveLetting go of the way I do it

Our Solution: Cultural Immersion (Barden, S.M. &

Cashwell, C. S., 2016)

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To make sure counseling assessment and interventions are consistent with what is helpful for the client

1. establishing rapportWhat conflicts in values might arise?How might my prior history of working with clients from a similar group affect my working with this client?What are my client’s cultural norms?Cultural Auditing

Collins, S., Arthur, N., & Wong-Wylie, G., 2010

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2. development of trust and respect

:What information about the counseling process might the client require to understand the roles and processes involved?What do I bring to this encounter as a person who will support or hinder the development of trust and respect?What can I do to enhance credibility as someone who can help the client reach his or her goals?Cultural Auditing

Collins, S., Arthur, N., & Wong-Wylie, G., 2010

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3. Potential influences of culture on interventions

:Clients willingness to return to counseling?What ere the client’s norms with relationship to time, scheduling, and who participates in counseling?4. Potential influences on the client:What assumptions do I have about this?What do I assume is similar? Different?What are my hypotheses about the client’s concerns? What aspects of my worldview might conflict with this client?

Am I open to modifying my assumptions?

Cultural AuditingCollins, S., Arthur, N., & Wong-Wylie, G., 2010

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5. View of culture on presenting concerns:

What do I believe about human nature and development?What assumptions do I have about change?6. Client’s views on presenting concerns:What is the client’s sense of where the problem is located?How might the client’s conceptualization differ from mine because of his cultural identity?

Cultural Auditing

Collins, S., Arthur, N., & Wong-Wylie, G., 2010

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7. Sociopolitical influences:What is the role of acculturation?

How might my own level of identity support or hinder my client?8. Definition of client goals:What methods are consistent with the goals the client would like to see?Cultural AuditingCollins, S., Arthur, N., & Wong-Wylie, G., 2010

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9.

Influences of culture on interventions:What types of interaction would address this client’s presenting concerns?Am I open to incorporating native practices?What would the client consider indicators if success?10. Client progress in counseling:Indicators of success?

11.

The influence of culture on termination:What are cultural meanings of endings for this person? Cultural AuditingCollins, S., Arthur, N., & Wong-Wylie, G., 2010

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1. increase self awareness2. account for clients’ multiple identifications

3. form working hypotheses4. establish base rates5. determine sociocultural and sociopolitical contexts6. find unique qualities7. determine physical factors8. psychological conditions and stressors9. find out which identities shifted over time

Multicultural Assessment Areas

Braun, F.K., Fine, E.S., Grief, D.C., Devenney, J.M., 2010

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Video Interview of Michele Aluoch

Components of Effective Multicultural Counseling

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Empathy in general

:understanding the person’s frame of referencecommunicating that understanding to him/her effectivelyCultural empathy

: “retaining one’s separate cultural identity and simultaneously being aware of and accepting cultural values and beliefs of the client.”

1. validating the inner experience of the client2. acknowledging the client’s subjective worldCounseling Empathy Versus Cultural Empathy

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Verbal Communication

LanguagePhrasesSlangNonverbalsTouchLookGesturesIntonation

Dress

SmellBody movementsProximityCounseling Empathy Versus Cultural Empathy

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Are there some things that should be universal for all people?Are there some truths and factors that are mostly agreed upon?

Opposite moral relativismCriteria=90% or moreAlternative View: UniversalismKinnier, R.T., Dixon, A.L., Barratt, T.M., & Moyer, E.L. (January 2008)

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Describe what the client is experiencing in words he/she can validate.

Express interest in learning more about the client’s experience.Clarify language and communication meanings.Convey an honest desire to be helpful to the clientFace, rather than ignoring or overlooking, cultural differences.Discuss cultural differences if they are central and pertinent to that individual’s counseling.You feel ______________

when/because _____________

and in the future you wish _________________.Get 3 Yes es.Cultural Empathy

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Sincerity

- good intention, real-nessService energy- Communicating client valueKnowledge of the client’s culture

- experience, study/research, or allowing client to teach you

Nonjudgmental- avoiding jumping to conclusions and personal prejudices, framing in context, let go of being “the authority”Resourcefulness- Linking to community resourcesSensitivity- awareness of what is/is not an issue for that clientHistorical awareness- knowing the background of this cultural group, society, gender, community, religious or political group, etc.

Ongoing critical reflection

- ongoing personal assessment and assessment of the counseling situation

Effective Cross- Cultural Counseling

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R religious/spiritual

E economic classS sexual identityP psychological developmentE ethnic/racial identityC chronological issuesT trauma and threats to well being

F family issues

U unique physical issuesL language and location or residence issuesRESPECTFUL(D’Andrea, M., & Heckman, E.F., 2008)

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Building self-esteemLearning to set boundaries

Developing assertivenessIncreasing self careBuilding independent living skillsPromoting individuality/autonomyReinforcing belief that equal opportunities are open to allTypical “Euro-American” Traditional Counseling Goals

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Promoting collective well-being

Developing relationships with those in their groupAvoiding conflict, maintaining peaceBuilding a multi-generational identityStimulating one’s personal narrativesAquiescing to othersDeference to authorityRespect for eldersEquilibrium with nature

Unity with others

Fulfillment of family obligations even unto old age Alternative “Multicultural” Goals

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Language barriers

Premature dropout rates and terminationsDifferent worldviewsDifferent valuesHistorical differences in the life narrativeResearch marked by opinions rather than much empirical supportResearch largely based on self report or subjective report/observation

Little emphasis on within group differences

False impression that multicultural counseling occurs strictly within distinct racial and ethnic boundariesMulticultural counseling excludes whites because it implies that “culture” doesn’t count for themChallenges with Multicultural Counseling

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Social justice

- scholarship and professional action designed to change societal values, structures, policies, and practices, such that disadvantaged or marginalized groups gain increased access to… tools of self determination.”(Steele, J.M., 2008)Advocacy- taking action to produce environmental change on behalf of clients(Steele, J.M., 2008)

Social Justice: A Role for Counselors?

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Equity

- fair distribution of resources, rights, and responsibilities to all members of societyAccess-ability for all people to access the knowledge, power, resources, and services that are crucial to realizing a standard of living that allows for self-actualization and self-determinationParticipation

- The right of every person in society to participate in and/or be consulted on decisions that affect their lives as well as other persons in their environmental systems

Harmony- helping individuals make sacrifices with the understanding that such sacrifices ultimately maintain the best interests of all persons concernedFour Critical Principles of Social Justice(Crethar, H.C., Rivera, E.T., & Nash, S., 2008)

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Goal=empowerment

increased individual control in their livesdevelopment of new skillsreframing in terms of present strengthsSocial Justice: A Role for Counselors?

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Going beyond the counseling office to tackle issues of cultural awareness in the community, churches, schools, and legislative bodies

Learning and educating others on the history of various cultural and ethnic groups including their values, ethnicity, worldviews, and perceived factors of oppression or privilegeActively questioning other counselors who do not seem to be culturally appropriate or may be exploitive of someone’s culture

Promoting and using only culturally relevant interventions

Facilitating indigenous healing methods when applicableAdvising others re. cultural issuesBeing a community representative and agent of changeLargely absent form counseling programsIS THIS OUR JOB AND ROLE???

Social Justice Tasks

(Steele, J.M., 2008)

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Does client-counselor similarity or difference affect outcome of counseling?

What are effective counseling processes with this person/group?What role do acculturation, age, gender, class, religion, etc. have in this case?

What tools are best for evaluating this client and setting treatment goals? (tests, life experiences, self/other report)?

Critical Questions to Consider in Multicultural Counseling(Tsang, A.K.T., Bogo, M., & George, U., 2008)

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Differences in preference between people of different cultures

Mexican- seen as unprofessional and less attractive clinicallyAfrican American- seen as more trustworthy and professional when self disclosing

Caucasian

- seen as more trustworthy and professional when self disclosingCounselor Self Discloure?(Cashwell, C.S., Shcherkova, J., & Cashwell, T.H., 2003)

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Broaching

- continually inviting the client to speak on multicultural issuesFive styles:

avoidant

- a race neutral perspective, all people everywhere are the sameisolating- approaching topics of race in a simplistic mannercontinuing-congruent- active client invitation to explore issues of race, gender, and other multicultural issues, looks at both the culture and the individualistic factorsintegrated/congruent- not only bringing up multicultural topics but integrating them into the practice of counseling infusing- a consistent commitment to bringing up multicultural counseling, incorporating issues in counseling, and social justice outside counseling sessions

Counselors are perceived as more credible by clients when they bring up multicultural concerns directly.

How To Broach

Multicutural

Issues

in Counseling

(Day-Vines, N.L. Wood, S.M.

Grothaus

, T.,

Craigen

, L., Holman,

A., Dotson-Blake, K., & Douglass, M.J., 2007)

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Believing issues are color blind or that every issue definitely has racial, ethnic or other multicultural piece that has to be addressed

There are no unfair biases in society anymore- everyone’s equalIf people want help they should pull themselves up by their bootstraps and do what they need toAssumption that there are no within group differences- all people with a certain feature (e.g. all whites/blacks, all poor/rich people, all men/women, all people of ___ religion, all ____ are the same)Believing that each of our limited experiences give us an accurate realistic foundation upon which to make judgment.

Dangers of Not Broaching Multicultural Issues

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Prevents misdiagnosisPrevents a sense of mistrust by clientsPrevents premature termination

Stronger therapeutic allianceFeeling of therapist being more emotionally presentAllowance for periods of connection and disconnectionEffects Of Broaching Multicutural Issues

in Counseling

Zhang, N., & Burkard, A.W., 2008

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Disintegration

- conflict results from contradictions in beliefs (e.g. saying you are not racist yet expressing racist views)Reintegration- vacillating between approaching and avoiding racial issuesPseudo-independence- A conscious effort is made to interact with people for different cultures but primarily at an intellectual level

Immersion/emersion

- deep desire to understand the effects of and prevent against privilege of our culture or discrimination of a cultureAutonomy- counselors accept their individual roles in terms of multicultural issues and then move to social justice action regarding those issuesStatus of Counselors(Day-Vines, N.L. Wood, S.M. Grothaus, T., Craigen, L., Holman, A., Dotson-Blake, K., & Douglass, M.J., 2007)

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I never get a chance. You know how it is. All the white execs oppressing the low level factory worker. Huh? How do they say slavery is gone when all the executives are all white and all the entry level folks are always the rest of us? I’m sure you’ve seen it too. How many black professional counselors have you ever even met like you?

Exercise: Deciding How, When, and If To Broach Topics

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You probably can’t even have an idea what I’ve gone through. I’m sure your parents paid your way for a good opportunity in life. You never had to break new ground to leave the poverty, danger, lack of opportunities and make a new path. You probably had your life taken care of since the time you were born– school, job, finances, opportunities. I’m not sure you can even counsel me. Everything’s been one struggle after another for me and what I’ve done

l’ve done on my own.Exercise: Deciding How, When, and If To Broach Topics

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You didn’t say anything about my hair and piercings! I am sure you noticed. I bet you don’t sit that far away with other clients. What do you think? I’ll get you?

Exercise: Deciding How, When, and If To Broach Topics

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Western

VS. Eastern Individuality RelationshipDemocratic AuthoritarianNuclear Family Focus Extended Family FocusYouth Emphasized Maturity EmphasizedIndependence Interdependence

Assertiveness Compliance

Nonconformity ConformityCompetition CooperationWESTERN VERSUS EASTERN WORLDVIEWS

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Western

VS. Eastern Conflict HarmonyFreedom SecurityIndividual Needs Collective GoalsResponsibility w/i

indiv. Responsibility in societyExpress Feelings Control FeelingsUniqueness of each person Uniformity of each personSelf actualization Collective actualizationFuture Focus/Goals TraditionalismInnovation ConservatismMorality-internal, individual Morality-relational*Change is very good* *Support is very good* WESTERN VERSUS EASTERN WORLDVIEWS

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See video interview

at www.rolpc.org on CEU Videos pageWESTERN VERSUS EASTERN WORLDVIEWS

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Age and Generational Factors

Slide83

Little to no research on cultural identity

Child Counseling

Slide84

Traditionalists (1900-1945)

People: Joe di Maggio, Joe Louis, Dr. Spock, Alfred Hitchcock, Rat Pack, FDR, Duke Ellington, Ella Fitzgerald, Charles Lindberg, John Wayne, Bob Hope, Elizabeth TaylorPlaces/Issues: Pearl Harbor, Normandy, Hiroshima, Korea, Bay of Pigs

Iwo Jima, World War I, Roaring Twenties, Great Depression, New Deal, World War II, Korean War

Signs of the times: Roadsters, drive ins, 45s, record players, the twistBeliefs:Values: Loyalty, PatriotismRetirement is a well earned rewardWork hard now while you can.Viewed as resistant to change by Gen Xers.Build a legacy.Internal rewards of a job well done are most valued.

Age and Generational Factors

Slide85

Baby Boomers (1946-1964)

Largest group in sizePeople: Martin Luther King Jr., the Kingston trio, Richard Nixon, John F. Kennedy, the Cleaver family, Rosa Parks, the Manson family, the

Osmonds

, Gloria Steinem, Barbara Streisand, John Belushi, Janis Joplin, Captain Kangaroo, Captain Kirk, the Monkees, the Beatles, the Partridge family, the Rolling StonesPlaces/Issues: Watergate Hotel, Kent State, WooodstockSigns of the times: bell-bottoms, mood rings, Brooks Brothers suits, Rolex watchesBeliefs:Values: optimism, good education, competitiveness

Be productive

Mentality of never retiring, always working

Fight for what you have, work hard, and save

Build the best career and lifestyle you can.

Build from the bottom up by being faithful till you achieve money, title, achievement.

As get older and retire leaving large gaps especially in upper management

Age and Generational Factors

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Generation X (1965-1980)

Half the size of baby boomersPeople: Brat Pack, Bill Clinton, Bill Gates, Monica Lewisnski, Ayatollah Komenini

, Ted Bundy, Al Bundy, Beavis and Butthead, Clarence Thomas, OJ Simpson, Madonna, Michael Jackson, Michael Jordan

Places/Issues: Starbucks, anywhere TV and media could take youSigns of the times: AIDS, crack, child molesters, drunk drivers, milk cartons-disappearing kidsBeliefs:Values: skepticism, technological advancement (cable, digital TV, VCRs, video games, fax machines, pages, cell phones, Palm Pilots, computers)It’s okay to change jobs and environment often.It’s all modifiable and adaptable.

“Show me the money.”

Freedom and flexibility are most important.

Age and Generational Factors

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Millenials

(1980-1999)People: Prince William, Chelsea Clinton, Claire Danes, Leonardo DiCaprio, Kurt Cobain, Courtney Love, Barney, Britney, Backstreet Boys, Felicity Buffy, Marilyn Manson, Mark McGuire, Sammy Sosa, Serena Williams

Places/Issues

: 90210, Dawson’s Creek, Oklahoma City, cyberspaceSigns of the times: technology (born with cell phones, pagers, and computers, I Pods, access to illegal drugs, Columbine and school shootings, increases in gang violenceBeliefs:Values: self identity, appreciation of diversityBe real with me.Self entitlement.Collaborate discuss, compromise.Entitlement

Take care of the environment

Build parallel careers.

Each person personally defines what is meaningful for him or her.

Age and Generational Factors

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Age & Generational Factors

A Video Interview

Slide89

Be aware of your own national culture and associated meanings. This does affect your worldview.

Know the cultural worldviews on critical issues of those you are interacting with.First meetings/introductions: Do I verbally acknowledge the person, give a handshake, bow, or head nod?Space and distance

Colors

: (worn)America= navy blue is commonly accepted but in Asia especially India pinks and reds are commonplace, (writing)- different colors may signify dif. emotions in some cultures Adapting to Global Cultural Meanings

Slide90

Shoes

- on or off feet?Dress codes: Generally being cleaned and well groomed is important. Professionalism should focus on modesty- women (dresses and skirts at least to the knees, not trousers sometimes), avoid jeans and looks that made be considered too casual or offensive to someGift giving: Find out the particular meanings in each respective culture. Sometimes giving a gift is expected but at other times is offensive. Which festivals are important to each culture and population? What is the perceived meaning behind a gift? (e.g. pigskin to Hindus or Muslims, knives to Chinese

Time

: being punctual versus taking time and being more casual, meanings behind getting tasks completed versus being flexibleValues: being versus doingAdapting to Global Cultural Meanings

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Multicultural Approaches to Therapy

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1. A sense of necessity for change2. Willingness to experience anxiety3. Awareness

4.Confronting the problem5.A will to change.6. Hope for change.7. Social support for change.Elements For Multicultural TherapyHanna, F.J., & Cardona, B. (July 2013)

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Who is the family?

What does this person believe about sickness and health?What is the relationship between the individual and family?Who makes the decisions in the family?How do generations relate?

How is self expression and self determination viewed?

What are the nonverbal protocols?Key Questions To Put Multicultural Issues in Context(Hendricks, K.T., 2005)

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Distinguished from empirically supported treatment

What clients say meets their needsIncorporation of the client’s values into therapyRacial, ethnic, and linguistic matching of the client’s cultural values into therapyTherapy provided in the client’s native languageThe explicit cultural or multicultural paradigm of the agency providing servicesConsultation with people in the client’s culture

Culturally Sensitive Treatment (CST)

Roysircar, G. (April 2008)

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Outreach efforts to underserved clienteleProvision of services like childcare when needed

Oral administration of materials for illiterate clientsCultural sensitivity training for staffKnowledge of referrals to outside sources when neededCulturally Sensitive Treatment (CST)Roysircar, G. (April 2008)

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Cognitive Match Models

Matching the client’s worldviewCase conceptualizationStrategies and treatment approachDefining the problemGoals for problem resolutionSkill development methodsIncorporating the client’s worldview, family supports, community, etc

Culturally Sensitive Treatment (CST)

Roysircar, G. (April 2008)

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Racism Acknowledgement Model

:Addressing oppressionLooking at racial identity developmentRecognition of various identities of the individualConsciousness raisingCulturally Sensitive Treatment (CST)Roysircar, G. (April 2008)

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Acculturation Models:

Helping sort through needs of family and community closeness versus individualityDealing with double bind messages- country of origin and U.S.Culturally Sensitive Treatment (CST)Roysircar, G. (April 2008)

Slide99

Spirituality/Religious Models:

PsychoeducationRelaxation/leisureAffective expression and regulationCognitive copingNarrative development and processingFamily/communityFuture developmentCulturally Sensitive Treatment (CST)

Roysircar

, G. (April 2008)

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Cultural Accommodation Model

Leong, F.T.L, 2011

I- individual

U-universalG-groupDifferent cultures emphasize different aspects

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Every man is:Like all other men (U)Like some other men (g)

Like no other man (I)Cultural Accommodation ModelLeong, F.T.L, 2011

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Perceived racism- subjective experience of racism and prejudice based on one’s personal life experiences

Higher discrimination was related to characterological attributions rather than situational attributions.BlacksWomenLower socioeconomic groups

Client’s Perceptions of Discrimination

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Frequency of familiarity with new groups alone is not enoughCritical elements:

Willingness to re-examine worldviews and life experiencesDevelopment of a higher proportion of neutral or positive interactions with that groupPreferrable between people of equal statusConfronting RacismDeRicco, J.M., & Sciarra

, D.T. (January 2005)

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Know Black history

Consider the generally stronger religious and spirituality baseBe prepared to potentially deal with multigenerational or non-traditional families- aunts/uncles, grandparents taking care of the childrenListen regarding the role of community

More than other cultures there is extensive literature on what is called “the drama of opposition” and desire to make conflict known/externalizing.

Counseling Black/African Americans-general

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Blacks demonstrate more range of movement, quick responses, and more energy.

Challenges regarding early or premature terminationDepressed moms more likely than nondepressed moms to yell at, physically punish, or be inconsistent with their children

Supportive father figures are just as effective as biological parents and may be even more helpful than absentee biological fathers

Peer mentoring and mediation or community supports work as well as or in many cases better than counseling Counseling Black/African Americans-general

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A therapy for black American children that incorporates love of rap music

97%- like rap music50%- but 1 or more rap CDs per monthBased on social psychology and learning theory

Types of rap:

1. gangster rap-violence, guns, profanity2. materialistic rap- wealth, possessions, women3. political/protest rap- political issues, racism, sexism, ethnic identity4. positive rap- education, responsibility, ethnic pride5. spiritual rap- traditional rap with gospel music

A version of narrative therapy

Rap Therapy

(

Elligan

, D., 2001)

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Stages

:1. Assessment- Determining client appropriateness, building rapport with the client about artists and topics he/she enjoys2. Alliance- Empathy and rapport building, listening and discussing the music

3.

Reframing- Attempt to broaden use of rap music (strengths based)4. Role play with reinforcement- Viewing rap as poetry and narrative5. Action and Maintenance- Using writing to initiate actions steps (behavioral)Rap Therapy(Elligan, D., 2001)

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Supportive counseling

- strengths based solution focused therapy reinforcing or expressing approval for completion of tasks and positive healthy actionsInformation giving- psychoeducational procedures including disseminating info. on issues of importance to this population (HIV/AIDS, higher education, underage pregnancies, job opportunities, stress management)

Cognitive-Behavioral approaches

- identify and confront irrational, self defeating thoughts“Studying is a white thing.”“I won’t live long so I don’t need to look toward the future.”“Self defense, violence, prison, are cool things. It shows you’re a man.”“She got pregnant. It’s not my fault.”“He/she made me hit him/her.”“There are no jobs out there for me anyway.”Counseling Techniques Deemed SuccessfulFor Black Americans

(Harper, F.D., Terry, L.M., Twiggs, R., 2009)

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Behavioral

Provide developmentally appropriate movies, videos, and resources rather than adults resourcesCommunity SupportLinkage to churches or other faith based institutions or community agencies teaching kids positive values

Linkage to business opportunities, job training and awareness, childcare

Link to prevention programs in the criminal justice systemCounseling Techniques Deemed Successful For Black Americans(Harper, F.D., Terry, L.M., Twiggs, R., 2009)

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Consider the importance of the collective goals in society.

Focus on their values of respect, pride, and dignity.Be an expert and knowledgeable on what you are telling them.Be very direct.

Provide frequent practical technique and application- behavioral interventions are appreciated.

Do not expect a lot of emotional expression- This is NOT resistance.Counseling Asian clients- general

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Physical approaches to healing are okay to incorporate including medical treatments and natural approaches.

Asians people tend to value decorum and conformity.Symptoms of Asian people often do not come out in verbalized emotions but moreso in physical somatic complaints related to nervousness and worrying.

More focused than other cultures on credentials- are you an authority?- words, mannerisms, office materials, office décor

Filial therapy is helpful for parent/child/ family issues (teaching parents empathy, attending, based play therapy tenantsGreat success with cognitive-behavioral therapy counseling Chinese- specific, direct, goal centered, practicalCounseling Asian clients- general

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Be prepared to wait in silence a lot, even 1 month of counseling

Focused on being in the moment with them for long periods of timeAvoid looking directly at them for extended time as they are very aversive to what they perceive as staring.Counseling Native American clients- general

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Actively acknowledge respect for the family and the parents as knowledgeable informants.

Tendency to express more emotion in their native language.Filial therapy is helpful for parent/child/ family issues (teaching parents empathy, attending, based play therapy tenantsCore values: respect for authority figures, family interdependence, loyalty to a person once they connect with him/her as professional

Counseling Hispanic/Latino clients- general

Slide114

Actively acknowledge respect for the family and the parents as knowledgeable informants.

Pride about their history, landscape, poetry, folklore, dance, crafts, and poetryMany have endured severe poverty and deprivationVery close knit mutigenerational families live in the same household

Often, multiple changes of jobs to remain in their land

ModestyNarrative therapies may work extremely well with themCounseling Appalachian clients- general

Slide115

China

:1980- first family therapy course for grad studentsEmphasis on piety, deference, family obligations, duties, collectivismParent-child relationships prioritized over spousal relationshipsIndia:Marriage is highly regulatedIssues of increasing rates of suicide among youth- 40% of male and 56% of females in age range of 15-29

HIV treatment: women to stay and care for men with HIV but men need to abandon women with HIV

International Family Therapy (Roberts, J., etc 2014)

Slide116

Israel

Family therapy founded in Israel in 1960s so very highly regardedHowever, separate Israeli and Palestinian family therapists create challenges and limitations regarding who will learn the language and culture of eachInfluence of family members in war at any given time= central issueTrauma issues related to war- significantPeruFamily therapy or therapies in general mean someone is mentally ill

Problems all considered family problems

International Family Therapy (Roberts, J., etc 2014)

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Turkey

National family therapy centers in connection with courtsVery specific about term “ family counseling” not family therapy”UgandaOver 1,000 tribes so very diversified45 languages and multiple religionsMostly ruralFamily counseling falls under guidance counseling with schools and health education regarding issues such and HIV/AIDS

Influence of nature and spirit are important

International Family Therapy (Roberts, J., etc 2014)

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Debate over whether evidence-based general practices or specific culturally relevant practices are better

General evidence-based practices:Patients with similar psychiatric conditions tend to benefit from similar therapiesAlthough we may have cultural differences we share similar qualitiesRisk: minimizing distinctions and uniquenessEvidence Based Multicultural Practices

(

LaRoche, M. J., Davis, T. M., & D’Angelo, E., 2015)

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Racial and Ethnic minority psychotherapies

Address unique needs of specific groupsE.g, Puerto Rican plurismo and familisimo make interpersonal therapy much more effective than CBTEmpathy and therapy be tailored to each individualRisk: over-emphasizing differences

In between : Cultural Evidence-Based Psychotherapies

Use of evidence-based therapies but with adaptations as client determines certain factors to be relevantEvidence Based Multicultural Practices(LaRoche, M. J., Davis, T. M., & D’Angelo, E., 2015)

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Here and now experiences where client is at

Five facets:Observing thoughts, feelings and sensationsActing with awarenessDescribing inner experiencesRemaining nonjudging of inner experiencesMaintaining nonreactivity to inner experiences

Mindfulness and Culture

(Ivers, N.N., Johnson, D., A., Clarke, P. B., Newsome, D. W,., & berry, R. A., 2016)

Slide121

Making sure that there is equal access to resources, rights, and treatment

Counseling Immigrants

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PTSD- countries they fled, war-related violence, threat of personal injury, torture, sexual assault, malnutrition, disease

Dealing with immigration process and officials- stressAcademic difficulties of childrenLack of peer relationshipsFrequent movesHousing concernsDifferences in values between U.S. and previous country of residenceFinancial difficultiesCommon Issues For Immigrants

Nilsson, J.E..,

Barazanji, D.M., Heintzelman, A., Siddiqi, M., & Shilla, Y. (October 2012)

Slide123

Self esteem issuesHopelessnessDepression

GuiltFacing discriminationFeeling isolatedFeeling judged for family, marriage, and parenting methodsCommon Issues For Immigrants

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Lack of freedom for kids to run freely (compared to home country)Fears about crime, child abuse, societal issues here

Concerns about lack of respect for the elderlyLack of respect for their style of disciplining their kidsLack of access to health insurance and benefitsPessimism regarding the futureMulti-generational conflictsCommon Issues For ImmigrantsNilsson, J.E..,

Barazanji

, D.M., Heintzelman, A., Siddiqi, M., & Shilla, Y. (October 2012); Villalba, J.A., (2009)

Slide125

Third culture kidsBorn in one culture and growing up in another cultureWhat was seen on TV, Magazines, etc. versus experience in new culture

Dissonance regarding what to identify withConflicted sense of selfMultigenerational conflictsTransculturalsMcDonald, K. E.,2011

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Over 3% of US populationKids commonly known as biracial

Kids with multiple identity choicesChildren go through intense emotional experiences as decisions about identity occurThird Culture or Multi Heritage Kids (Maxwell, M.)

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Listening to the child’s definitionsDetermine significance of presence- how prevalent students with multiple heritage backgrounds are in a given setting

Layered on top of typical childhood and teenage identity issuesResearch does NOT support that challenges are worse Challenges same as others at given developmental stage- establishing and maintaining friendships, developing a separate identity from family of origin, moving on with individual professional and identity pursuitsTo process heritage: bibliotherapy- uniqueness, resourcefulness, choices, journaling, role plays, group work regarding “Who am I?”

Multiple Heritage Identity Development Model (MHID):

Slide128

Important because in 2008 14.6% of marriages were interracial

In 2010 2.4 million marriages were interracialIn 2010 over 4.2 million children considered biracialStill often considered rebels, dangerous, and challenging, deviant by othersDecentralizing race as an issueShifting to another core issue other than raceTaking themselves outside the historical narratives of their races and creating their own narrativeDealing with faulty assumptions regarding a life of rejection, stereotypes and failure

Treatment: what are your hot button topics?, How does race play/not play into things with the two of you?

Biracial couples

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Traditional DSM IV TR based on medical modelDoes this fit with multicultural competency?

Other cultures – focus on spirituality, holistic approach rather than disease and medicineOther counseling focus areas: bicultural competence, resiliency, independence, flexibilityNeed for resourcefulness, communityPlacing cultural bound syndromes?Mental health is only for “insane people”Wellness Versus Disease

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Consulting native healers, shamans, gurus, and exorcistsMedical field and professional looked down upon

Extended family and community is agent of changeArranged marriages and families with 10% or less divorceInput of family is essentialNo such concept as family therapyWellness Versus Disease

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Emotional painSomatic symptomsBad luck or curses from others watching or tracking me

Regional fables or narrativesWhat is Distressing?

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Needs to be considered to truly have cultural empathyWhat constitutes professional help

Examples: Acupuncture, bioenergy, evil eye, herbals, healers, homeopathy, hypnosis, meditation, miraculous healing, prayer, deliverance, priests, voodoo, shamans, herbals, vitamins,etc.Nonconventional Healing and Alternative Medicine

Slide133

Immigrant Issues

Video Interviews

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1. What are your views concerning religion and spirituality?

2. How do you believe these views will affect your counseling role?3. How will you be able to empathize with clients who have differing spiritual values than your own?4. How will you keep your own spiritual values/beliefs from inappropriately influencing the counseling relationship?Counseling People with Spirituality Issues

Slide135

Narrative story about your spiritual journey (factors that shaped it, people/places, significant events, where you believe you are at today versus where you’d like to be/think God wants you to be, etc.)

Role play with different types of clients what it might be like to counsel a person from differing faith or spirituality beliefs.Consider what a “holistic” approach means to you. What skills would you need to develop competencies to work with people of different ages, races, beliefs, religious, spiritual approaches?Developing An Awareness of Role of Spirituality in the Counselor’s Life

Slide136

(

Turton, 2004; Belaire, Young, Elder, 2005; )Expected respect for their worldview and acceptanceExpected that religion and spirituality would definitely be included as a significant part of the counseling process. May include (determine on a case by case basis): Moral teachings Scriptures or Bible verses Praying in Session Listening to story of their conversion or changes from past conversion, current struggles, etc.

Hearing some thing about the counselor’s spiritual experience, moral beliefs, lifestyle, or conversion experiences

Collateral consultation with clergy pastors, or religious “authorities” that the client can relate to or is accountable to Use “religious language” in session Use religious examples, stories, or parables Be willing to learn about client’s personal spiritual experience, denomination, journey. Refer client to someone who understands or can better empathically relate if needed Accept the religious practices and rituals that are part of client’s experience.Expectations of Conservative Christian Counseling Clients

Slide137

What Evangelical Christians Want From

CounsePrefer Non Directive Approach

Expect to leave the counseling session with their lives “

spiritually stimulated”Expect to be encouraged to apply and further Biblical understandingGoal of Counseling: Closer relationship with God, more fervent prayer life, a lifestyle that is consistent with traditional Biblical es, direct discouragement and challenging of lifestyle and behaviors inconsistent with the values they are stating they espouseOverall

: Less likely to attend counseling of the counselor is not a Christian and does not share their religious orientation (95%); Religious/spiritual beliefs affect my daily decisions (98%)

Expectations of Conservative Christian Counseling Clients (Continued)

Slide138

Five Common Belief Systems of Conservative Christians to be Aware of in Counseling

:1) Self- focusing on oneself is selfish and is a sin2) Truth- Christianity is the only true way to God3) Answers to problems- the Bible is the answer book4)Feelings-joy and peace are only acceptable

5)

Social issues- divorce, homosexuality, abortion are not to be participated inHow would you handle someone who possibly espouses any of these beliefs?Beliefs Of Conservative Christians That May Clash with Traditional Counseling (Eriksen, Marston, & Korte, 2002)

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12 Sample Questions:

1. Do you wish to discuss spiritual issues in counseling when relevant? 2. Do you believe in God?3. What is God to you?4. Is spirituality important to you (scaling)5. Do you have a religious affiliation? Imp.to you? (scaling)6.Do you attend a church, synagogue, or another gathering place?

7. How closely do you follow the teachings of your religion?

Doing a Clinical Counseling Assessment Incorporating Spirituality

Slide140

8. How do you experience God’s guidance in your personal life?

9. Are you aware of any spiritual resources or practices in your life that could be used to help you cope with or solve your problem? What are they?10. Anything about your spirituality or religious community that concerns you?11. Would you like your counselor to consult with your spiritual/religious leader if this could be helpful to you?12. Are you willing to consider trying religious or spiritualty based suggestions from your counselor if they could be helpful to you?

Doing a Clinical Counseling Assessment Incorporating Spirituality

Slide141

For self reflection, understanding of spiritual and religious practices and family systems and multi-generational dynamicsCharting a spiritual family tree

Spiritual Genograms (Willow, Tobin, & Tomer, 2009)

Slide142

Using proven REBT- Rational Emotive Behavior Therapy (Albert Ellis) but incorporating client belief systems and spiritual worldview

Rational Christian Therapy

(Johnson, 2006)

Slide143

Common Misbeliefs in the Counseling Literature

:God must answer my prayers as I’d like them to be answered.I absolutely should always be loved unconditionally by all my fellow churchgoers/Christians.I ought to undeniably be obeyed by other when I quote Scriptures to defend my position.I must never be judged but totally accepted as I am.I must always be judged If only I work hard “enough” then God will see that I deserve _____.Good people should always have “good” things happen to them and “bad” people should have “bad” things happen to them. (justice perspective)

People should have mercy on me but they should get what they deserve (justice).

I must spend the rest of my life paying back for what I said, did, etc.Rational Christian Therapy(Johnson, 2006)

Slide144

Focuses on the interpersonal exchange

Goal- Increasing the number of exceptions to the problem: Observations of times clients are without the problem, observations of times where the problem is more resolved (client as expert observer in his/her world)What treatments are effective for whom and under what circumstances”Helpful questions:Was there a time you coped better?How did you manage?The miracle questionConsistent with Christian spirituality: God intervening from the future to impact the present & humans as agents in collaborative partnership with God (Frederick, 2008)

Solution-Focused Counseling For Clients With Spiritual Concerns (

Guterman & Leite, 2006)

Slide145

Teachings of Prophet Muhammad

Holy Book- Qur’anKey behaviors:1. Pray 5 times per day2. fast I the month of Ramadan3. give charity4. perform the pilgrimage to Makkah at least once in lifetimeBeliefs and practices regarding abstaining fro alcoholBeliefs and practices regarding modest dressImportance of role of extended family- multigenerational

Counseling American Muslims

Ahmed, S., & Reddy, L.A., 2007

Slide146

PTSD symptomsSelf esteem issues

HopelessnessDepressionGuiltFacing discriminationFeeling isolatedFeeling judged for family, marriage, and parenting methodsCounseling American Muslims

Slide147

Three categories: 1. detachment or denial of Islam

2. acknowledgement that Islam carries some meaning3. recognition that Islam is the central principle in their livesCounseling American Muslims

Slide148

Counseling Clients For Whom Spiritual Worldview May Be a Factor

Watch videos on Spirituality and Counseling video CEUs“What Good Is God Anyway?” Video“Grieving Father Is Angry at God” video“Dealing with Offenses: Can’t Forgive Self” video

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Treatment Goals:

Helping them develop a worldview tied to their physical, emotional, and mental wellness.Helping them draw on collective strengths often overlookedOvercoming negative prejudices and stereotypesIncreasing awareness of biases within the counselor, community, etc.Social justice and advocacyCounseling People With Disabilities

D’Andrea

, M., Skouge, J., & Daniels, J., 2006

Slide150

Examine personal prejudices about people with disabilities (blame, shame, guilt, fear)

Focus on positive attributes of cultivating hopes, dreamsHelping foster creative problem solving regarding this groupConstructing opportunities for people with disabilitiesAssist in fostering inclusionAwareness of communications and technologies availableCounseling People With Disabilities

D’Andrea

, M., Skouge, J., & Daniels, J., 2006

Slide151

If cultural context is not properly understood clients may be at risk for more severe diagnosis.

Examples:Hispanics 1.5 times more often diagnosed with schizophrenia than whites.African Americans are more likely than whites to be diagnosed as schizophrenic, substance abusers, and having dementia.

Those with lower educational levels are more likely to be given schizophrenia as a diagnosis rather than mood disorders

Diagnosis In The Multicultural Context(Hays, D., G., Prosek, E.A., & McLeod, A.L., 2010)

Slide152

Women are more than twice as likely to be diagnosed with mood disorders than men.

Men are much more frequently diagnosed as avoidant personality, antisocial paranoid, and schizoid than women whereas women are more likely diagnosed as histrionic and borderlineSolution- counselor should re-assess diagnostic situations from a situational locus of control rather than a locus of control which blames the internal makeup of the client.

Diagnosis In The Multicultural Context

(Hays, D., G., Prosek, E.A., & McLeod, A.L., 2010)

Slide153

Therapeutic ExchangeDissolve problemsReconstruct narratives

Capitalize on strengths and resourcesAssist in accessing new resources and information, developing skillsStrengths based approachTherapeutic Exchange

Slide154

Rooted within the personVersusRooted in the system, culture, environment

Alternative explanations: curses, nature, demons, family of origin, folklore, magical thinking- All magical thinking (according to cultural models) is not pathological- e.g. Native American with dream of bearMedial Model Versus Wellness/Holistic Cultural ModelMiller, R., & Prosek

, E.A., 2013

Slide155

For those with emphasis on family and multigenerational influencesAble to be flexible for a variety of issues

HealthCareerMental and emotional concernsMarriage and divorce patternsWork well with Asians and AfricansGenograms

Slide156

Trauma may be transmitted across generationsHistorical narratives of trauma and resiliency

Meanings of resilience- what constitutes healing and reboundingResilience and the Transgenerational GenogramGoodman, R. D., 2013

Slide157

A

self- in- relation modelPeople grow toward relationshipPeople grow toward mutualityGrowth happens through relationshipConnection is needed to develop future orientationMutual empathy especially as modeled in therapy can model respect for cultureThrough relationship each person has a greater sense of identity and belonging, worth and matteringAuthenticity and vulnerability can ultimately only be developed through relationship

Validate and empower clients to social justice

Clinicians appropriately using self disclosure to relate to clientsRelational Cultural Heritage in Mental Health Counseling

Slide158

Power struggles and hierarchiesSocial injustices

Contextual factors not consideredCentral relational paradox- protecting self against the risks of hurt or rejection in the relationships that are most needed in someone’s lifeIf work through everyday challenges can experience increased growth but if not deteriorationProblem: Disconnection

Slide159

Multicultural-Ecological Mapping

Slide160

IndividualMicrosystem- parents, siblings, teachers, classmates, friends, coworkers

Mesosystem-interactions between parents, siblings, teachers, classmates, friends, coworkersExosystem- community resources, school policies, organizationsMacrosystem- cultural norms, expectations, values, and lawsMulticultural-Ecological Mapping

Roysircar

, G., & Pignatiello, V., 2011

Slide161

Seeing people in contextA way of visually mapping and understanding the influences of family, community and society on the individual

Addresses the significance of key events : births, deaths, natural phenomena, life scripts and schemas that shape actions and social interactionsCommunity GenogramsRigazio-DiGilio, S.A., Ivey, A.E., Kunkler

-Peck, K.P., & Grady, L.T. (2005).

Slide162

Tell your story or life narrativeFind a way to visually portray significant features or your narrative

Examples: Ebbing or mapping out features you use to describe yourself, mapping out your house-the furniture, people, places you store things, what you see or hide, collages, etc.Community Genogram

Slide163

RestoryingAbout the impact of seeing the self in relation to others (p18-21)

Focus on yourself. How do you describe who you are?Focus on your family or origin. How does that affect your image of yourself?How does your family or origin define itself?Focus on your community. Now what happens to your self definition and image?How do family of origin and community interact?

Restorying

Slide164

My heritageWhere I work/what I do

The environment I live in/geographyThe hobbies, interest stories, folklore of my peopleNatural events (weather, land, traumas, events) in this areaWho I identify or don’t identify withCongruence or incongruence with the beliefs, values and lifestyle of those around meDeveloping A

Things Which Shape People

Slide165

Definition

Perception of eventsFrequency of traumaWhat constitutes resiliencyIssue of individualism versus collectivism- whose feelings matter mostIssue of how trauma is explained- medical versus spiritual, body versus mindWestern versus Eastern goalsE.g. meaning of dissociation- is it helpful or harmful, what is harmony and balance?

Trauma as it Relates to Culture

Buse etc (2013)

Slide166

Role of significant others and family is significant across cultureEmphasis increasingly on the socio-interpersonal model

Affected by how much can be disclosed and to whomHealing hindered if self and partner have discrepant ideas about what should be disclosedBlaming the victim hinders healingSocial supports more than individual therapy seem to be accountable for healing culturally from PTSDHealing From Trauma

Slide167

Little to no research on cultural identity

Child Counseling

Slide168

What cultural characteristics define this person?

How can the symptoms be described by cultural characteristics?How might be related to environmental factors and situational factors?Which diagnosis fits the entire picture of this client?

How am I being influenced by the culture of my client?

Would I give this same diagnosis to a person from a different cultural background?Questions to Ask when Diagnosing People Of Various Cultures(Hays, D., G., Prosek, E.A., & McLeod, A.L., 2010)

Slide169

Does not mean the same thing in various culturesSome for religious reasons Some to release pressure

Some as a rite of passage E.g, self flagellation, genital mutilationExample: Self Injury

Slide170

Multicultural Vignettes

How would you handle these cases?

Slide171

A 83 year old female is referred to you for counseling because she seems to have worsening depression after becoming a widow when her husband of 53 years died one year ago. She has been making more comments lately that she just wants to die and go to be with her husband and that she has already lived her best days. Additionally her nursing home facility has reported increasing forgetfulness and moments where she just does not seem to fully understand or remember who she is, where she is and be in the present moment. While collateral sources say she is generally a pleasant lady with nice stories of life memories with regards to her husband and grown children there are moments the health aides who work with her report that she acts entirely different. During these other times she is suddenly agitated and defensive and may even refuse to take meds or bathe or do day to day tasks even around the health care nurses who she normally enjoys. She does have someone stop by daily to help her with meds and check in on her.

Multicultural Vignettes

#1: No One Cares Anymore

Slide172

She tends to really dwell on and share many stories about the past fond memories with her husband before he dies and about her family life when the kids were growing up. However, she has a tendency to forget more recent things quite a bit lately. Mary reports having had many more support systems in the years raising her children. She says that soon thereafter her husband’s death her kids came around shortly after the funeral but that they “have all left me alone now” to deal with life by herself. She says that after retiring from her job teaching, people have seemed to forget about her. She has bene involved in a church for twenty years but says since her health problems have gotten a little worse she cannot go as she’d like. She describes the church as large in size and that they do not reach out to people with life issues like hers as they used to. She cries and gets choked up stating “no one loves me anymore.” She proceeds to tell you how her kids have forsaken her, no one else has the time to listen to her stories, and she is just living her final moments alone. Specifically she says, “I wish death would come quick. I don’t know what more that’s left for me on this earth anyway. My best days are gone. Oh the fond memories I have of them. I’d rather just keep it that way and e happy now. Between the health problems, no one being there and the loneliness I can’t handle things anymore.”

Multicultural Vignettes

Slide173

A middle aged Haitian man is in distress saying that he “can’t even feel safe to eat at home because his mother and brother have cursed his butter and food in his refrigerator. Some agencies have already branded him psychotic for saying this. He describes a life of having meals outside the home because he does not know which foods the family members have cursed and what may happen if he eats them. When asked about his family of origin he describes coming to US a few years ago from Haiti and how spiritual his family was growing up. The spirituality of Haiti incorporated a mix of traditional Catholicism with voodoo and native folklore and curses/blessings of tribal leaders. He states that his mother and brother do in fact have keys to his apartment and have been angry at him for some time now because they think he has favor and prosperity in arriving in the US compared to their struggles and they want him to be cursed for this. During a more thorough clinical diagnostic interview he describes comments they have made about potions and things. Later in the diagnostic interview he reports getting sick on bread, butter, and some soup which he thinks the relatives may have cursed. He does not appear to be hearing any voices, seeing any visual hallucinations or having other psychosis symptoms. Prior to his coming to US he was never treated for psychosis. However a referring agency believes him to be psychotic regarding the food poisoning and paranoid towards his family members. What do you think? How would you process in therapy with him?

Multicultural Vignettes

#2:

My Family’s Cursing My Butter:

Slide174

A 17 year old is in the second half of her senior year of high school. She is excited about graduating high school and considering her life options for after high school. Her family and her live in southern Ohio and believe that she should, like other generations past, just be satisfied with the high school education, meet someone, and have kids and stay home but not go to college. Relatives had made it clear per her report that she would be forsaking the whole family if she leaves them and goes to the big city. They have spoken with her about the “evils” that lie in the big city versus what they believe to be the protected and familiar area they live in. They also are trying to convince her that she will remain around extensive support systems if she remains in southern Ohio but if she leaves to go to the big city she will be prone to outside influences without the shelter of her extended family. Mary believes she can, by going to the big city, possibly do “better” or at least have career, financial, and other options. She would like to do something possibly with nursing or with children. She even has thought that in the long run she can help her family more then.

Multicultural Vignettes

#3.

Leaving For The Big City Beyond

Slide175

A middle aged man named Clyde comes in to your office. He is tall and muscular and walks with an air of confidence. When asked why he is coming in he states that he really does not think he has any problems but a woman friend of his thinks that the fact that he grew up not knowing his father and having a bad family life with much trauma has impacted him. The more he talks he mentions how “whatever he wants in life he will have” and that he “can make anyone do whatever he wants them to do.” He talks about how he can only trust people to a certain point but that relationships will never go beyond that point. “It is all about self protection and preservation. “

Aint no one gonna look after you the way you look after yourself,” he comments. He also says, “if I don’t like you even if you’re on fire and burning to death in front of me I wouldn’t dare piss on the fire to stop it.” He presents with a tough exterior and continues to talk throughout about how self protection is his ultimate goal. Where do you go in therapy with him?

Multicultural Vignettes

#4- “All I Need Is Me”:

Slide176

A wealthy couple comes in with a presenting problem of trying to learn how to deal with decisions about their life and retirement years from here. Both of them have had a great deal of money and assets , they each own their own companies that have bene extremely successful. They have several jets and had many opportunities to fly a multitude of places for personal and business interests through the years. They are in their mid fifties and are bored.” They state that they are seeking counseling to assist them with this place of indecision. Both remark that they have done everything there is to do and are facing retirement age or decisions about the future of life and companies but don’t know where to go from here. The typical tasks of the retirement ages are things they believe they have already not only done but mastered. There is nowhere left to travel and nothing left to acquire. They actually cannot imagine not doing what they are already doing with heading their companies and managing things. Each has a sense that there has got to be something more but is not sure how to decide what that something is from there.

Multicultural Vignettes

#5- “Where Do We Go From Here?”:

Slide177

A 30 year old Japanese woman comes in for grief counseling through her EAP. She states that she believes she has found “the one” in her current boyfriend who is 15 years her senior and is divorced. She describes him in highly positive terms and is quick to remark about his attributes. She states that it has been nearly two years that she has been dating him, going on trips with him, and serious with him but that she has old her family from Japan about him in the last 6 months. She speaks about the traditional values of her extended Japanese family who all live with her at her parent’s household. They are 100 % against divorce and consider him a low life and a lesser person because he has been divorced. She also states that they feel I have settles and gone for someone beneath me not only because he is divorced but because he is not Japanese and is not from the right type of job and socioeconomic status they would like. She would like the

backing of her family but is to a point that she is tired of keeping lies from them about how much she is into him. She also comments that he has a 10 year old daughter and would have to learn to be a mom if they ended up getting married

Multicultural Vignettes

#6- “But They Won’t Accept The Man I Love”:

Slide178

This is something she is working on as she is spending increasing amounts of time around his daughter. However, when her family found out that he has a daughter it is only another strike against him. She loves her family but is frustrated that they do not give her the same freedom they have given her baby sister who is in her mid twenties: “she got pregnant to a loser guy and was allowed to live on her own in her own place but I am not allowed to have my own choices at all.” She expresses fear that something as simple as choosing to find her own apartment would devastate that family because she is the oldest and the one who is “supposed to uphold the family’s wishes and interest.”

Multicultural Vignettes

Slide179

Her cries and she speaks about how her family refuses for her to even talk about her boyfriend or to consider meeting him. She also feels trapped because the boyfriend “does not want to force his way into her family and is going too slow” because she does not want to disrespect her family’s values. She would like to be engaged to him by now but feels as if everything is at a standstill because the family won’t move to accept him and he won’t move to initiate more commitment. She wants help with deciding if she should just move out to her own place and start her own life as a sign to her family that she has opinions about making decisions in her life. However, she is afraid that the family may essentially disown her and she may lose them and maybe also the boyfriend in the process.

Multicultural Vignettes

Slide180

A gentleman aged 72 talks about his stresses with health problems and being on disability. He has an extremely fixed income. During the assessment when asked about support systems he mentions a 23 year old

girfriend who comes over to talk with him and really loves (him).” He says she listens to his stories a few hours per week. He also says the young lady is a single mom who is trying to make it on her own with a young child so she needs his disability money. This does not seem to be a source of concern. While she expresses concern that “other people don’t understand her like I do and think she is just using me to get free money to support here and her baby I know she loves me.” He talks about planning to marry her someday. How do you approach assessment and treatment with this gentleman?

Multicultural Vignettes

#7. “My Pretty Young Lady Loves Me So Much”:

Slide181

A married couple comes to you for counseling. They both express frustration over the fact that each has had multiple affairs. Recently he moved in with a lady for 1 1/2 years and she had an affair for several months with another man while living in their marriage home. However both state, “we love each other though. No matter who we have affairs with we keep coming back to each other.” They describe how they “clicked” as soon as they met and moved in with each other the next day. They remark “since than we have never been apart from each other.” They only talk about complimentary attributes they like about each other but you realize that obviously something caused them repeatedly to go to affairs and come back and forth together with each other. Their stated goal is wanting help to process resentments about the affairs though they laugh and minimize the effects of affairs when talking. They want to build on strengths in the marriage which have kept them “together” for 22 years so far.

Multicultural Vignettes

#8- “Just Another Affair”:

Slide182

A dad and his 16 year old teenage daughter come in for group counseling together to work on their relationship. Though both highlight the fact that the girl is respectful and kind and there are no major behavioral issues the dad says she can still improve. Dad and mom had been divorced when the girl was about 7 years old. While the parents have some differences of opinions they try to keep conflicts to a minimum. Throughout the counseling session dad remarks about the girl bucking up and learning to be more responsible and handle things as an adult. She sites several instances where she believes she is doing this to the best of her ability such as excelling in good grades at school and holding a job. Her dad reports frustrations with her room not being entirely clean and her not knowing how to balance a checkbook or make major life decisions. “I was made to do those things at age 5,” dad comments. The daughter trying to be respectful

acknowleged her need for improvement on some areas but states “dad that isn’t normal. You weren’t supposed to manage a house at age 5. I think you need help dealing with that. That is not normal for a child to do.” Dad explained how his father dies before he turned four years old and he was left to be the man of the house for his mom. He described how his mom would regularly make him make financial decisions for the household even though he had no concept of things. In counseling his daughter commented, “but dad you were given responsibilities that no child should have.” How do you handle this discussion in light of the presenting problem? Where do you go from here?

Multicultural Vignettes

#9- “Adult At Age Five”:

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