Self-Assessment: Cultural
Issues as a Lens in Accessing
Clinical Services
Loretta Braxton Ph.D., Durham
and the
Multicultural & Diversity Committee (2009-2010)
VA Psychology Training Council
Contact persons:
Daryl Fujii Ph.D., Honolulu (Daryl.Fujii@va.gov)
Rachael Guerra Ph.D., Palo Alto (Rachael.Guerra@va.gov)
Multicultural/Diversity
Committee
Committee 2009-2010
Loretta E. Braxton Ph.D., Durham, (Co-Chair)
Linda R. Mona Ph.D., Long Beach (Co-Chair)
Lenora Brown Ph.D., St. Louis
Daryl Fujii Ph.D., Honolulu
Rachael Guerra Ph.D., Palo Alto
Jamylah Jackson Ph.D., North Texas
Tina Liu-Tom Ph.D., Honolulu
Monica Roy Ph.D., Boston
Miguel Ybarra Ph.D., San Antonio
Jay Morrison Ph.D., San Francisco (Postdoc)
Velma Barrios, Greater Los Angeles (Intern)
Overview
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Introduction
Learning Objectives
APA Statement on Culturally Relevant
Clinical Services
Self Assessment
Case Vignettes and Exercises
Group Discussion
Summary and Conclusion
References
Learning Objectives
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Acquire self-knowledge regarding your
thoughts, feelings and experiences and
how they may impact your work re
diversity
Inspire development of personal learning
objectives and action plans regarding
strengths and weakness around diversity as
it relates to your work
Self Assessment and
APA Multicultural Guidelines
“…the population of the United States is
racially/ethnically diverse, and that
students, research participants, clients
and the workforce will be increasingly
likely to come from racially/ethnically
diverse cultures.”
APA Guidelines on Multicultural Education, Training,
Research, Practice, and Organizational Change for
Psychologists (2003)
Self Assessment
Our job is to offer the best care
possible within the context of a fluid
standard of care; this is a standard that
evolves as we are presented with more,
and new, research and information.
Importance of self assessment
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Better understanding of ourselves
– What are your limits?
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Better understanding of how who we are
impacts the work that we do.
– What are you afraid will happen that will take
you out of your limits?
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The process of getting off automatic
– What can you do about it?
Positive attributes of people who are
willing to directly address diversity issues
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Resilience
Belief in what you are doing
Cognitive flexibility
Understanding of issues
Positive Outlook
Sincerity
Sensitive to people’s needs and concerns
Walk the talk
Clements & Jones (2006)
Activities That Can Promote SelfExamination
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Low Risk
– Case discussions (Nile, 2008)
– The Zax (Dr. Seuss, 1989)
– What does it mean to ?
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Moderate
– Racial micro-aggression article (Sue et al, 2007)
– The Color of Fear movie (Wah, 1994)
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High Risk
– White Privilege: Unpacking the Invisible Knapsack
(McIntosh, 1988)
The Zax
"The Zax" is a story about the importance of compromise.
There is a North-going Zax and a South-going Zax who
meet face-to-face in the Prairie of Prax. The two
stubborn Zax refuse to move east, west, or an inch except
where they are standing. The Zax become stuck, as they
refuse to move around each other declaring to stand there
for 59 days or better yet, 59 years! Eventually a highway
overpass is built around them. The story ends with the
Zax standing in their respective places. “Never budge in
the least."
Dr. Seuss (1989)
Micro-Affirmations and
Micro-Inequities
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Micro-Messages are small, unspoken and often
unconscious messages that are constantly sent and
received that have a powerful impact on our interactions
with others.
Micro-Affirmations are micro-messages that convey
inclusion, respect, trust and a genuine willingness to see
others succeed.
Micro-Inequities are negative micro-messages that are
small events, subtle acts of disrespect, which are hard to
prove, covert and often unintentional.
Racial Micro-Aggressions
Racial micro-aggressions are brief and commonplace daily
verbal, behavioral, or environmental indignities, whether
intentional or unintentional, that communicate hostile,
derogatory, or negative racial slights and insults toward
people of color.
Sue et al. (2007)
Forms of Micro-Aggression
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Micro-assault
– Explicit racial derogation conducted on an individual level (e.g.,
calling someone colored, Oriental,
– Usually expressed in safe, private situations (e.g., expressing
opinions re the races should never mix while presenting another
view publicly)
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Micro-insult
– Subtle interactions/communications that convey rudeness and
insensitivity
– Verbal or non-verbal
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Micro-invalidation
– Communications that exclude, negate or nullify the
psychological thoughts, feelings, or experiential reality of the
White Privilege
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I can, if I wish, arrange to be in the company of people of
my race most of the time.
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I can be pretty sure of having my voice heard in a group
in which I am the only member of my race.
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Whether I use checks, credit cards or cash, I can count on
my skin color not to work against the appearance of my
financial stability.
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I can do well in challenging situations without being
called a credit to my race.
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If I declare there is a racial issue at hand, or there isn’t a
racial issue at hand, my race will lend me more
credibility for either position than a person of color will
have.
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I am not made acutely aware that my shape, bearing or
body odor will be taken as a reflection on my race.
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I can expect figurative language and imagery in all of the
arts to testify to experiences of my race.
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I can travel alone or with my spouse without expecting
embarrassment or hostility in those who deal with us.
Managing hot buttons
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Share your experiences with others.
Be willing to admit when you don’t
understand or agree with an issue or focus
Use humor but sparingly. Selfdeprecating humor is usually acceptable.
Keep an open mind.
Managing Personal Hot Buttons
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Become vulnerable and open to self-inspection.
Take two deep breathes before responding.
Acknowledge comments by using “I statements”: for
example, “I hear what you are saying. Let me share with
you my thoughts on that.”
Be honest with yourself about your own “hot buttons.”
You may say something similar to “That’s an issue I’ve
thought about a lot. Let me share some of my thoughts
about it with you.”
If something is highly offensive, take a step back and
acknowledge it. “I’m really shocked by that statement. I
need a second to think about that.”
A little self examination
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Why this reaction?
Would someone from a different
background take a different view? Why?
What does this reaction say about me, my
values, my beliefs, my attitudes?
How open am I to being challenged?
Discussion questions
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The identities I’m most conscious of…
What this means for me on a day to day basis..
A time that I felt excluded because of who I
am… How I felt and what I did…
A time that I’ve participated in treating others as
less than, How did I feel and what did I do?
The parts of my identity I’ve done the least
amount of work around include…
Washington, 2009
Case Vignette
A 22 year old male comes to your clinic for
treatment. He is over six feet tall, weighs two
hundred pounds, and is very dark-skinned. The
patient is a recovering substance abuser. He is
withdrawn and often stares intently at the staff
and at other patients. The clinic staff talk about
his “scary” stare and the word gets around that
he should be “watched as a possible danger.”
Anand & Shipler (1994)
Questions to explore:
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What are the possible issues in this case?
You are in charge of this clinic, and you
hear the comments of your staff. How
should you address this issue?
Case Vignette
Chris is a 19 year old Caucasian youth who is seriously
depressed. The depression is thought to be linked to the
sudden death of his father and the increasing
responsibility he is expected to shoulder for his mother
and five sisters. Chris has attempted suicide.
You are a provider who is self-identified gay. Chris and his
mother come to you. They are both very quiet during the
visit. Later you learn that Chris and his mother have
requested a transfer to another therapist.
Anand & Shipler (1994)
Questions to explore
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What are the issues from Chris and his
mother’s perspective?
What are the issues from the perspective
of the provider who happens to be gay?
Brainstorm strategies to address this
situation.
What does it mean to me?
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You have been assigned the task of
creating a definition of the following
terms:
– Culture, Inclusion, Diversity
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Talk about the relationship/differences
between your definitions and the
definitions of others.
Summary
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Discuss the importance of self-examination and
the impact it has on one’s ability to deliver
culturally competent services.
What are your goals for improving your cultural
competence (i.e., What do I need to work on?
What have I learned about myself?)
Am I ready to facilitate this module?
References
Anand, R. & Shipler, L. K. (1994). Multicultural Case Studies: tools for Training. (2 nd
ed). National Multicultural Institute, Washington, D.C.
Clements, P & Jones, J (2006). The diversity training handbook (2nd ed). London: Kogan
Page.
Cornish, J., Schreier, B., Nadkarni, L., Metzger, L. & Rodolfa, E. (2010). Handbook of
multicultural counseling competencies. New Jersey: Wiley.
Dr. Seuss. (1989). The Sneetches and other stories. New York: Random House.
McIntosh, P. (1988). Working Paper 189. White privilege and male privilege: A personal
account of coming to see correspondences through work in women’s studies.
Wellesley College, MA.
Nile, L. N. (2008). Developing Diversity Training for the Workplace: A guide for
trainers (9th ed).Washington, DC: NMCI Publishers.
Nile, L. N. (1997, May). The silent interview. Workshop conducted at the meeting of the
National Multicultural Institute, Washington, D.C.
Rowe, M. P. (2008). Micro-affirmations and micro-inequities.
http://web.mit.edu/ombud/publications/micro-affirm-ineq.pdf.
Sue, D.W., Capodilupo, C. M., Torino, G.C., Bucceri, J. M., Holder, A,M. B., Nadal, K.
L., Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for
clinical practice. American Psychologist, 62, 271-286.
Washington, J. (2009). Advancing our communities: The role of social justice in
multicultural psychology. New Orleans:National Multicultural Conference and
Summit