Multicultural Competency
Development
Fernando A. Ortiz, Ph.D.
CHAPTER 1
THE MULTICULTURAL
JOURNEY TO CULTURAL
COMPETENCE
Emotional Roadblocks to the
Path of Cultural Competence
Strong emotions such as:
anger, sadness, and defensiveness
are displayed when discussing
experiences of race, culture,
gender, and other
sociodemographic variables
Emotional Roadblocks to the
Path of Cultural Competence
 These feelings can enhance or negate a deeper
understanding of the worldviews of culturally
diverse clients
 Disturbing feelings serve to protect us from having
to examine our own prejudices and biases (Winter,
1977)
 Multiculturalism deals with real human experiences
and it would behoove the reader to understand
his/her emotional reactions on the journey to
cultural competence
Common Emotions
 I FEEL GUILTY, “I could be doing more”
 I FEEL ANGRY, “I don’t like to feel like I’m wrong”
 I FEEL DEFENSIVE, “Why blame me, I do enough
already”
Common Emotions
 I FEEL TRUNED OFF, “I have other priorities in life”
 I FEEL HELPLESS, “The problem is too big…what can I
do?”
 I FEEL AFRAID, “I am going to do something…I don’t
know what will happen”
Implications for Clinical
Practice
 Do not allow your own emotional reactions negate the
stories of the most disempowered in society
 Try to acknowledge your inherited biases openly so that you
can listen to your clients in a non-defensive way
 Experiences with people of color will enhance one’s cultural
competence
 Explore yourself as a racial/cultural being
 Try to understand what your intense emotions mean for you
when they arise
 Do not squelch dissent or disagreements
 Take an active role in exploring yourself
CHAPTER 2
THE SUPERORDINATE
NATURE OF
MULTICULTURAL
COUNSELING AND
THERAPY
Themes from the Difficult
Dialogue
 Cultural Universality (etic) vs. Cultural Relativism
(emic)
 Emotional Consequences of Race
 Inclusive vs. Exclusive nature of Multiculturalism
 Sociopolitical Nature of Counseling/Therapy
 The Nature of Multicultural Counseling
Competence
Tripartite Framework
 Individual Level
 Group Level
 Universal Level
Tripartite Framework Model
What is MCT?
 1. MCT broadens the perspective of the helping
relationship. The individualistic approach is
balanced with a collectivistic reality that we are
embedded in our families, significant others, our
communities and culture.
 Working with a client is not perceived as solely an
individual matter, but as an individual who is a
product of his or her social and cultural context. As
a result, systemic influences are seen as equally
important as individual ones.
What is MCT?
 2. MCT expands the repertoire of helping
responses. Traditional therapeutic taboos are
questioned.
 Five taboos derived from monocultural code
of ethics/standards of practice are especially
important as examples:
Therapeutic Taboos
 1. Therapists do not give advice and suggestion (it fosters dependency).
 2. Therapists do not self disclose their thoughts and feelings (it is
unprofessional).
 3. Therapists do not barter with clients (it changes the nature of the
therapeutic relationship).
 4. Therapists do not serve dual role relationships with clients (there is a
potential loss of objectivity).
 5. Therapists do not accept gifts from clients (it unduly obligates them).
BECOMING CULTURALLY
COMPETENT
 “Cultural competence is the ability to engage in actions or
create conditions that maximize the optimal development of
client and client systems. It is the acquisition of awareness,
knowledge, and skills needed to function effectively in a
pluralistic democratic society (ability to communicate,
interact, negotiate, and intervene on behalf of clients from
diverse backgrounds), and on an organizational/societal
level, advocating effectively to develop new theories,
practices, policies and organizational structures that are
more responsive to all groups.”
BECOMING CULTURALLY
COMPETENT
 l. Having all of us become culturally aware of our own values, biases and
assumptions about human behavior.
 What stereotypes, perceptions, and beliefs do we hold about culturally diverse
groups that may hinder our ability to form a helpful and effective relationship?
 What are the worldviews they bring to the interpersonal encounter? What value
systems are inherent in the professional’s theory of helping, educating,
administrating, and what values underlie the strategies and techniques used in
these situations?
 Without such an awareness and understanding, we may inadvertently assume
that everyone shares our world view. When this happens, we may become guilty
of cultural oppression, imposing values on our culturally diverse clients.
BECOMING CULTURALLY
COMPETENT
 2. Having all of us acquire knowledge and understanding of
the worldview of culturally diverse groups and individuals.
 What biases, values and assumptions about human behavior
do these groups hold?
 Is there such a thing as an African American, Asian
American, Latino(a)/Hispanic American or American Indian
worldview? Do other culturally different groups (women,
the physically challenged, gays/lesbians, etc.) also have
different world views?
BECOMING CULTURALLY
COMPETENT
 3. Having each of us begin the process of developing appropriate and
effective helping, teaching, communication and intervention strategies in
working with culturally diverse groups and individuals.
 This means prevention as well as remediation approaches, and systems
intervention as well as traditional one-to-one relationships.
 Equally important is the ability to make use of existing indigenoushelping/healing approaches and structures which may already exist in the
minority community.
BECOMING CULTURALLY
COMPETENT
 4. Understanding how organizational and institutional forces may either
enhance or negate the development of multicultural competence.
 It does little good for any of us to be culturally competent when the very
organization that employs us are filled with monocultural policies and
practices.
 In many cases, organizational customs do not value or allow the use of
cultural knowledge or skills. Some organizations may even actively
discourage, negate, or punish multicultural expressions. Thus, it is
imperative to view multicultural competence for organizations as well.
 Developing new rules, regulations, policies, practices, and structures
within organizations which enhance multiculturalism are important.
Implications for Counseling
 Realize that you are a product of cultural conditioning and
that you are not immune from inheriting biases associated
with culturally diverse groups in our society
 Be aware that persons of color, gays/lesbians, women, and
other groups may perceive mental illness/health and the
healing process differently than do Euro-Americans
 Be aware that Euro-American healing standards originate
from a cultural context and represent only one form of
helping that exists on an equal plane with others
 Realize that the concept of cultural competence is more
inclusive and superordinate than is the traditional definition
of “clinical competence”.
Implications for Counseling
 Realize that organizational/societal policies, practices, and
structures may represent oppressive obstacles that prevent
equal access and opportunity. If that is the case, systems
intervention is most appropriate
 Use modalities that are consistent with the lifestyles and
cultural systems of clients
CHAPTER 3
THE POLITICS OF
COUNSELING AND
PSYCHOTHERAPY
Katrina and Counseling?
 Katrina is a prime example of the clash of racial
realities and the multitude of political issues that are
likely to arise in clinical sessions between
counselors and culturally diverse clients
 Counseling and psychotherapy do not take place in
a vacuum isolated from the larger social-political
influences of our societal climate
The Diversification of the
United States
Nowhere is diversification of society more evident
than in the workplace where three major trends can be
observed:
•the graying of the workforce
•the feminization of the workforce
•the changing complexion of the workforce
Graying of the Workforce
 As the baby boomers head into old age, the
elderly population of those 65 and older will
surge to 53.3 million by 2020
 In 2005, 70% of workers were in the 25-54
age group and workers 55 and older rose
15%
Implications
 Lack of knowledge concerning issues of the elderly and the
implications of an aging population on mental health needs
 In American society, the elderly suffer from beliefs and
attitudes of society (stereotypes) that diminish their social
status
 The elderly are increasingly at the mercy of governmental
policies and company changes in social security and pension
funds
 Social service agencies are ill prepared to deal with the
social and mental health needs of the elderly
Feminization of the
Workforce and Society
 Over a fifteen year period from 1990 to 2005
women accounted for 62% of the net
increase in the civilian labor force
 However, women continue to occupy the
lower rungs of the occupational ladder but
are still responsible for most of the domestic
responsibilities
Implications
 Women are subjected to greater number of
stressors than their male counterparts due to issues
related to family life and role strain
 Family relationships and structures have
progressively changed as we have moved from a
traditional single-earner, two-parent family to
two-wage earners
 Women continue to be paid less than men, and
25% of children will be on welfare at some point
before reaching adulthood
The Changing Complexion of
the Workforce and Society
 From 1990 to 2000, the U.S. population increased
13% to over 281 million (U.S. Bureau of the
Census, 2001)
 Projections indicate that persons of color will
constitute a numerical majority sometime between
2030 and 2050 (D. W. Sue et al., 1998)
 The rapid demographic shift stems from two major
trends: immigration rates and differential birthrates
Implications
 By the time the socalled baby boomers retire, the
majority of people contributing to the social
security and pension plans will be racial/ethnic
minorities so if people of color continue to be the
underemployed and underpaid, the economic
security of retiring White workers looks grim
 The economic viability of businesses will depend
on their ability to manage a diverse workforce
effectively
Mental Health Implications
 Counselors must be prepared to become
culturally competent through: (a) revamping
our training programs, (b) developing
multicultural competencies as core standards
for our profession, and (c) providing
continuing education for our current service
providers
CHAPTER 4
SOCIOPOLITICAL
IMPLICATIONS OF
OPPRESSION:
TRUST AND MISTRUST IN
COUNSELING/
PSYCHOTHERAPY
The Case of Malachi
 The therapist felt he was “in danger” but could it be
that the White counselor is not used to passionate
expression of feelings?
 The counselor imposed White, Western values of
individualism and self-exploration onto the client
suggesting Malachi’s problems lie within himself
 The counselor went into the session wanting to treat
Malachi like “every human being” thereby negating
his unique racial-cultural perspective
ETHNOCENTRIC
MONOCULTURALISM
 Ethnocentric monoculturalism is the
individual, institutional and societal
expression of the superiority of one group’s
cultural heritage over another’s. In all cases,
the dominant group or society has the
ultimate power to impose their beliefs and
standards upon the less powerful group.
ETHNOCENTRIC
MONOCULTURALISM
 1. BELIEF IN SUPERIORITY.
 There is a strong belief in the superiority of one group’s
cultural heritage (history, values, language, traditions,
arts/crafts, etc.). The group norms and values are seen
positively and descriptors may include such terms as
“more advanced” and “more civilized”
 Members of the society may possess conscious and
unconscious feelings of superiority and that their way of
doing things is the “best way”
ETHNOCENTRIC
MONOCULTURALISM
 2. BELIEF IN INFERIORITY.
 There is a belief in the inferiority of all other
group’s cultural heritage which extends to their
customs, values, traditions and language.
 Other societies or groups may be perceived as “less
developed”, “uncivilized”, or “primitive”. The life
style or ways of doing things by the group are
considered inferior.
ETHNOCENTRIC
MONOCULTURALISM
 3. POWER TO IMPOSE.
 The dominant group has the power to impose their standards
and beliefs upon the less powerful group. All groups are to
some extent ethnocentric; that is they feel positively about
their cultural heritage and way of life. Yet, if they do not
possess the power to impose their values on others, they
hypothetically cannot oppress.
 It is power or the unequal status relationship between groups
which defines ethnocentric monoculturalism.
ETHNOCENTRIC
MONOCULTURALISM
 4. EMBEDDED IN INSTITUTIONS.
 The ethnocentric values and beliefs are manifested in the programs, policies,
practices, structures and institutions of the society. For example, chain-ofcommand systems, training and educational systems, communication
systems, management systems, performance appraisal systems often dictate
and control our lives. They attain “untouchable and godfather-like” status in
an organization.
 Because most systems are monocultural in nature and demand compliance,
racial/ethnic minorities and women may be oppressed.
ETHNOCENTRIC
MONOCULTURALISM
 5. INVISIBLE VEIL.
 Since people are all products of cultural conditioning, their values
and beliefs (worldview) represent an “invisible veil” which operates
outside the level of conscious awareness.
 As a result, people assume universality; that the nature of reality and
truth are shared by everyone regardless of race, culture, ethnicity or
gender.
 This assumption is erroneous, but seldom questioned because it is
firmly ingrained in our world view.
Therapeutic Impact of
Ethnocentric Monoculturalism
 Dissociate the true self
 “Playing it cool”
 “Uncle Tom syndrome”
 Increased their vigilance and sensitivity
Therapist Credibility:
Expertness and Trustworthiness
 Credibility may be defined as the constellation of
characteristics that makes certain individuals appear
worthy of belief, capable, entitled to confidence,
reliable, and trustworthy:


Expertness depends on how well-informed, capable or
intelligent others perceive the communicator
Trustworthiness is dependent on the degree to which
people perceive the communicator (therapist to make
valid assertions)
Psychological Sets of Clients
 Problem-solving Set—client is concerned about
obtaining correct information
 Consistency Set—If inconsistent information is
presented, cognitive dissonance will take place
 Identity Set—Strong identification with a group
 Economic Set—beliefs and behaviors are
influenced by rewards and punishments
 Authority Set—People in authority positions are
seen to have rights to prescribe attitudes or
behaviors
CHAPTER 5
RACIAL, GENDER, SEXUAL
ORIENTATION
MICROAGGRESSIONS
Microaggressions
 Microaggressions are “brief, everyday exchanges
that send denigrating messages” to a target group
like people of color, women and Gays
 These microaggressions are often subtle in nature
and can be manifested in the verbal, nonverbal,
visual, or behavioral realm and are often enacted
automatically and unconsciously (Solorzano, Ceja,
& Yosso, 2000)
Overt vs. Covert Oppression
Overt Racism, Sexism, and Heterosexism
vs.
Covert Racism, Sexism, and Heterosexism
Microassault
 Blatant verbal, nonverbal or environmental
attack intended to convey discriminatory and
biased sentiments (e.g. epithets like “spic” or
“faggot”)
Microinsult
 Unintentional behaviors or verbal comments
that convey rudeness, insensitivity or demean
a person’s racial heritage/identity, gender
identity, or sexual orientation identity (e.g.
Arnold Schwartzenegger calling Democrats,
“girly men”)
Microinvalidation
 Verbal comments or behaviors that exclude,
negate, or dismiss the psychological
thoughts, feelings, or experiential reality of
the target group (e.g. “the most qualified
person should get the job”)
Categories and Relationship of Racial Microaggressions
Racial Microaggressions
Commonplace verbal or behavioral indignities, whether intentional or unintentional, which communicate hostile,
derogatory, or negative racial slights and insults.
Microinsult
(Often Unconscious)
Behavioral/verbal remarks or comments that
convey rudeness, insensitivity and demean a
person’s racial heritage or identity.
Microassault
Microinvalidation
(Often Conscious)
(Often Unconscious)
Explicit racial derogations characterized
primarily by a violent verbal or
nonverbal attack meant to hurt the
intended victim through name-calling,
avoidant behavior or purposeful
discriminatory actions
Verbal comments or behaviors that
exclude, negate, or nullify the
psychological thoughts, feelings, or
experiential reality of a person of
color.
Environmental
Microaggressions
Ascription of Intelligence
Assigning a degree of intelligence to a person of
color based on their race.
(Macro-level)
Racial assaults, insults and
invalidations which are
manifested on systemic and
environmental levels.
Alien in Own Land
Second Class Citizen
Belief that visible racial/ethnic minority
citizens are foreigners.
Treated as a lesser person or group.
Color Blindness
Pathologizing cultural
values/communication styles
Denial or pretense that a White person does
not see color or race.
Notion that the values and communication styles
of people of color are abnormal
Myth of Meritocracy
Assumption of Criminal status
Statements which assert that race plays a
minor role in life success.
Presumed to be a criminal, dangerous, or
deviant based on race.
Denial of Individual Racism
Denial of personal racism or one’s role in its
perpetuation.
Therapeutic Implications of
Microaggressions
 Clients of color tend to terminate
prematurely
 Microaggresions my lie at the core of the
problem
 Therapist must be credible
 Effective counseling is likely to occur when
there is a strong working alliance
CHAPTER 6
BARRIERS TO
MULTICULTURAL
COUNSELING AND
THERAPY
Marginal Person
The marginal person, coined by Stonequist
(1937) refers to one’s ability to form a dual
ethnic identification due to a bicultural
membership
GENERIC CHARACTERISTICS
OF COUNSELING/THERAPY
 1. Culture-bound values — individual centered,
verbal/emotional/behavioral expressiveness, communication patterns
from client to counselor, openness and intimacy, analytic/linear/verbal
(cause-effect) approach, and clear distinctions between mental and
physical well-being.
 2. Class-bound values — strict adherence to time schedules (50-minute,
once-or-twice-a-week meeting), ambiguous or unstructured approach to
problems, and seeking long-range goals or solutions.
 3. Language variables — use of Standard English and emphasis on
verbal communication.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 1. Focus on the individual.
 Most forms of counseling and psychotherapy
tend to be individual centered — that is, they
emphasize the “I-thou” relationship.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 2. Verbal/Emotional/Behavioral Expressiveness.
 Many counselors and therapists tend to emphasize
the fact that verbal/emotional/behavioral
expressiveness is important in individuals.
 We like our clients to be verbal, articulate, and to
be able to express their thoughts and feelings
clearly.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 3. Insight.
 This characteristic assumes that it is mentally beneficial for
individuals to obtain insight or understanding into their deep
underlying dynamics and causes.
 Born from the tradition of psychoanalytic theory, many
theorists tend to believe that clients who obtain insight into
themselves will be better adjusted.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 4. Self-Disclosure (Openness and Intimacy).
 Most forms of counseling and psychotherapy tend to value one’s ability
to self-disclose and to talk about the most intimate aspects of one’s life.
 Self-disclosure has often been discussed as a primary characteristic of
the healthy personality.
 People who do not self-disclose readily in counseling and psychotherapy
are seen as possessing negative traits such as being guarded, mistrustful,
and/or paranoid.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 5. Scientific Empiricism.
 Counseling and psychotherapy in Western culture and society has been
described as being highly linear, analytic, and verbal in their attempt to
mimic the physical sciences.
 It emphasizes the scientific method - objective rational linear thinking.
The therapist is objective and neutral, rational and logical in thinking.
Quantitative evaluation that includes psychodiagnostic tests, intelligence
tests, and personality inventories are used.
 This cause-effect orientation emphasizes left-brain functioning.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 6. Distinctions between Mental and Physical Functioning.
 Many American Indians, Asian Americans, Blacks, and Hispanics hold a
different concept of what constitutes mental health, mental illness, and
adjustment.
 Among the Chinese, the concept of mental health or psychological wellbeing is
not understood in the same way as it is in the Western context.
 Latino/Hispanic Americans do not make the same Western distinction between
mental and physical health as their White counterparts.
 Thus, nonphysical health problems are most likely to be referred to a physician,
priest, or minister.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 7. Ambiguity.
 The ambiguous and unstructured aspect of the therapy situation may
create discomfort in clients of color. Culturally diverse clients may not
be familiar with therapy and perceive it as an unknown and mystifying
process.
 Some groups, like Hispanics, may have been reared in an environment
that actively structures social relationships and patterns of interaction.
 Anxiety and confusion may be the outcome in an unstructured
counseling setting.
CULTURE BOUND VALUES
OF COUNSELING/THERAPY
 8. Patterns of Communication.
 The cultural upbringing of many minorities dictates different
patterns of communication that may place them at a
disadvantage in therapy.
 Counseling demands that communication move from client
to counselor. The client is expected to take the major
responsibility for initiating conversation in the session,
while the counselor plays a less active role.
Implications for Practice
 Become aware of the generic characteristics of
counseling
 Advocate for multilingual services
 Provide community counseling services in the
client’s natural environments (schools, churches,
etc.)
 Help clients deal with forces such as poverty,
discrimination, prejudice, immigration stress in
contrast to developing personal insight through selfexploration
Implications for Practice
 Focus on action orientation and expand your
repertoire
 Do not overgeneralize or stereotype
 Do not become arrogant and think that
clinical work is superior to other forms of
helping
CHAPTER 7
CULTURALLY
APPROPRIATE
INTERVENTIONS
Communication Styles
 It is important that the therapist and client
send and receive both verbal and nonverbal
messages accurately and appropriately
Nonverbal Communication
 Generally occurs outside the level of
conscious awareness
 Varies from culture to culture
 Important within the counseling context
Context in Communication
 Directness of a conversation or the degree of
frankness also varies considerably among various
cultures
 High Context Communication—anchored in the
physical context—less reliant on explicit code (e.g.
many Asian cultures)
 Low Context Communication—greater reliance on
verbal parts of the message (e.g. Western)
Proxemics
Refers to perception and use of personal and
interpersonal space:




Violation may cause one to withdrawal, become angry,
or create conflict
Some cultures are OK with being very close
If counselor backs away, may be seen as aloofness or
coldness
Counselor may misinterpret clients closeness
Kinesics
Refers to bodily movements (e.g. facial
expression, posture, gestures, eye contact):



Japanese smile may mean discomfort
Latin Americans shake hands with vigor
Eye contact varies according to culture
Paralanguage
Refers to vocal cues other than words (i.e.
loudness of voice, pauses, silences, etc.):


Caseworker may misinterpret silences or
speaking in a soft tone
Speaking loudly may not indicate anger but a
cultural style
Communication Styles
 Black styles of communication are often
animated, interpersonal and confrontational
whereas White middle-class styles of
communication tend to be more objective,
impersonal and nonchallenging
Counseling and Therapy as
Communication Style
 Different forms of psychotherapy possess
varied communication styles (e.g. Rogers
emphasizes attending skills; Shostrom relied
on direct guidance; Lazarus took an active
reeducative style)
 In general, people of color prefer more
active, directive forms of helping than
nondirective ones
Implications for Practice
 Recognize that no one style of counseling will be
appropriate for all situations
 Become knowledgeable about how race, culture, and gender
affect communication styles
 Become aware of your own style
 Obtain additional training and education on a variety of
theoretical orientations and approaches
 Think holistically rather than in a reductionist manner when
conceptualizing the human condition
 Training programs need to use an approach that calls for
openness and flexibility in conceptualizing issues and skill
building
CHAPTER 8
MULTICULTURAL
FAMILY COUNSELING
AND THERAPY
Family Systems Approaches and
Assumptions
 Communications Approach: Family problems are
communication difficulties
 Structural Approach: Emphasizes interlocking
roles
Assumptions:



Separation/individuation is healthy
Egalitarian spousal relations
“Be your own person”
Issues in Working with Ethnic
Minority Families
 Many Black families are poor and suffer from
racism and more Black males are single
 Latinos emphasize the extended family
 Biculturalism stressors
 Strength through slavery
 Native Americans—alcohol abuse
 Language structures vary
 Social class issues
Machismo vs. Marianismo
 Machismo is a term used in many Latino
cultures to indicate maleness, virility, and the
man’s role as provider and protector
 Marianismo derived from the cult of the
Virgin Mary in that women are seen as
morally and spiritually superior and capable
of enduring greater suffering
Value Preference Considerations
Time Dimension
Relational Dimension
Activity Dimension
People-Nature Relationship
Nature of people Dimension
Implications for Practice
 Different cultural conceptions of family
 Families cannot be understood apart from the
culture
 Learn the definition of family for specific groups
 Extended ties may be very important
 Do not prejudge patriarchal relations
 Mother role may be most important
 Helping can take many forms—be creative
CHAPTER 9
NONWESTERN IDIGENOUS
METHODS OF HEALING:
IMPLICATIONS FOR
COUNSELING AND THERAPY
INDIGENOUS HEALING
GUIDELINES
 1. DO NOT INVALIDATE THE INDIGENOUS CULTURAL
BELIEF SYSTEMS OF YOUR CULTURALLY DIVERSE CLIENTS.
 On the surface, the assumptions of indigenous healing methods might
appear radically different from our own. When we encounter them, we
are often “shocked”, find such beliefs to be “unscientific” and are likely
to negate, invalidate or dismiss them.
 Such an attitude will have the effect of invalidating our clients as well,
since these beliefs are central to their world view and reflect their
cultural identity.
INDIGENOUS HEALING
GUIDELINES
 2. BECOME KNOWLEDGEABLE ABOUT
INDIGENOUS BELIEFS AND HEALING PRACTICES.
Counselors/therapists have a professional responsibility to
become knowledgeable and conversant with the assumptions
and practices of indigenous healing so that a “desensitization
and normalization process” can occur.
By becoming knowledgeable and understanding of
indigenous helping approaches, the therapist will avoid
equating differences with deviance!
INDIGENOUS HEALING
GUIDELINES
 3. LEARNING ABOUT INDIGENOUS HEALING AND
BELIEFS ENTAIL EXPERIENTIAL OR LIVED
REALITIES.
While reading books about nonwestern forms of healing
and attending seminars and lectures on the topic is valuable
and helpful, understanding culturally different perspectives
must be supplemented by lived experience.
Even when we travel abroad, few of us actively place
ourselves in situations which are unfamiliar because it
evokes discomfort, anxiety and a feeling of differentness.
INDIGENOUS HEALING
GUIDELINES
 4. AVOID OVERPATHOLOGIZING AND
UNDERPATHOLOGIZING A CULTURALLY DIFFERENT
CLIENT’S PROBLEMS.
 A therapist or counselor who is culturally unaware and who believes
primarily in a universal psychology may oftentimes be culturally
insensitive and inclined to see differences as deviance. They may be
guilty of overpathologizing a culturally different client’s problems by
seeing it as more severe and pathological than it truly may be.
 There is a danger, however, of also underpathologizing a culturally
different client’s symptoms as well. While being understanding of a
client’s cultural context, having knowledge of culture-bound syndromes
and being aware of cultural relativism are desirable, being oversensitive
to these factors may predispose the therapist to minimize problems,
thereby underpathologizing disorders.
INDIGENOUS HEALING
GUIDELINES
 5. BE WILLING TO SEEK THE CONSULTATION OF
TRADITIONAL HEALERS AND/OR UTILIZE THEIR SERVICES.
 Mental health professionals must be willing and able to form
partnerships with indigenous healers or develop community liaisons.
 Such an outreach has several advantages: (a) traditional healers may
provide knowledge and insights into clients populations which would
prove of value to the delivery of mental health services, (b) such an
alliance will ultimately enhance the cultural credibility of therapists, and
(c) it allows for referral to traditional healers (shamans, religious leaders,
etc.) in which treatment is rooted in cultural traditions.
INDIGENOUS HEALING
GUIDELINES
 6. SPIRITUALITY MUST BE SEEN AS AN INTIMATE ASPECT OF
THE HUMAN CONDITION AND A LEGITIMATE ASPECT OF
MENTAL HEALTH WORK.
Spirituality is a belief in a higher power which allows us to make
meaning of life and the universe. It may or may not be linked to a
formal religion, but there is little doubt that it is a powerful force in the
human condition.
Many groups accept the prevalence of spirituality in nearly all aspects
of life; thus separating it from one’s existence is not possible.
INDIGENOUS HEALING
GUIDELINES
 7. HAVING THE ABILITY TO EXPAND OUR DEFINITION OF
THE HELPING ROLE TO COMMUNITY WORK AND
INVOLVEMENT.
 More than anything else, indigenous healing is community oriented and
focused. Culturally competent mental health professionals must begin to
expand their definition of the helping role to encompass a greater
community involvement.
 The in-the-office setting is, oftentimes, nonfunctional in minority
communities. Culturally sensitive helping requires making home visits,
going to community centers, visiting places of worship and areas within
the community. The types of help most likely to prevent mental health
problems are building and maintaining healthy connections, with one’s
family, one’s god(s), and one’s universe.
INDIGENOUS HEALING
IMPLICATIONS
 It is clear that we live in a monocultural society; a society
that invalidates and separates us from one another, from our
spirituality and from the cosmos.
 There is much wisdom in ancient forms of healing which
stress that the road to mental health is through becoming
united and in harmony with the universe.
 Activities that promote these attributes involve community
work. They include client advocacy and consultation,
preventive education, developing outreach programs,
becoming involved in systemic change and aiding in the
formation of public policy that allows for equal access and
opportunities for all.
CHAPTER 10
RACIAL/CULTURAL
IDENTITY DEVELOPMENT:
THERAPEUTIC
IMPLICATIONS
Importance
 1. Understanding Within Group Differences
 2. Influence of Racism and Oppression on Identity
Formation
 3. Assessment Tool
 4. Intervention Implications
RACIAL IDENTITY
ASSUMPTIONS
 1. Racism is a basic and integral part of U.S. life and
permeates all aspects of our culture and institutions.
 2. Persons of color are socialized into U.S. society and,
therefore, are exposed to the biases, stereotypes, and racist
attitudes, beliefs, and behaviors of the society.
 3. The level of racial identity development consciousness
affects the process and outcome of interracial interactions.
RACIAL IDENTITY
ASSUMPTIONS
 4. How people of color perceive themselves as racial beings seems to be
strongly correlated with how they perceive and respond to racial stimuli.
Consequently, race-related reality represent major differences in how
they view the world.
 5. It seems to follow an identifiable sequence. There is an assumption
that people of color who are born and raised in the United States, may
move through levels of consciousness regarding their own identity as
racial beings.
 6. The most desirable development is a multicultural identity that does
not deny or negate one’s integrity.
Levels of Consciousness
 1. Conformity
 2. Dissonance
 3. Resistance and Immersion
 4. Introspection
 5. Integrative Awareness
Self/Other Perceptions
1. Attitude and Beliefs toward Self.
2. Attitudes and Beliefs toward Members of the Same
Minority.
3. Attitudes and Beliefs toward Members of Different
Minorities.
4. Attitude and Beliefs toward Members of the Dominant
Group.
PHASE 1 - CONFORMITY
 Marked by desire to assimilate and acculturate – buys in to
the melting pot analogy.
 Accepts belief in White superiority and minority inferiority.
 Unconscious and conscious desire to escape one’s own
racial heritage.
 Validation comes from a White perspective.
 Role models, lifestyles, and value systems all follow the
dominant group.
CONFORMITY
 Physical and cultural characteristics identified with one’s own
racial/cultural group are perceived negatively, something to be avoided,
denied, or changed.
 Physical characteristics (black skin color, “slant-shaped eyes” of
Asians), traditional modes of dress and appearance, and behavioral
characteristics associated with the minority group are a source of shame.
 There may be attempts to mimic what is perceived as “White
mannerisms”, speech patterns, dress, and goals.
 Low internal self-esteem is characteristic of the person.
CONFORMITY
 These individuals may have internalized the
majority of White stereotypes about their group. In
the case of Hispanics, for example, the person may
believe that members of his or her own group have
high rates of unemployment because “they are lazy,
uneducated, and unintelligent.”
 The denial mechanism most commonly used is “I’m
not like them; I’ve made it on my own; I’m the
exception.”
CONFORMITY
 Belief that White cultural, social, institutional standards are superior.
Members of the dominant group are admired, respected, and emulated.
White people are believed to possess superior intelligence.
 Some individuals may go to great lengths to appear White. In the
Autobiography of Malcolm X, the main character would straighten his
hair and primarily date White women.
 Reports that Asian women have undergone surgery to reshape their eyes
to conform to White female standards of beauty may (but not in all
cases) typify this dynamic.
PHASE 2 - DISSONANCE
 Breakdown of denial system.
 Encounters information discordant with previous beliefs in
the conformity stage.
 Dominant-held views of minority strengths and weaknesses
begin to be questioned.
 Begins to realize that attempts to assimilate or acculturate
may not be fully allowed by larger society.
DISSONANCE
 There is now a growing sense of personal
awareness that racism does exist, that not all
aspects of the minority or majority culture
are good or bad, and that one cannot escape
one’s cultural heritage.
 Feelings of shame and pride are mixed in the
individual and a sense of conflict develops.
PHASE 3 – RESISTANCE AND
IMMERSION
 “Why should I feel ashamed of who and what I am?”
 Begins to understand social-psychological forces associated
with prejudice and discrimination.
 Extreme anger at perceived cultural oppression.
 May be an active rejection of the dominant society and
culture.
 Members of the dominant group viewed with suspicion.
RESISTANCE AND
IMMERSION
 The minority individual at this stage is oriented toward self-discovery of
one’s own history and culture. There is an active seeking out of
information and artifacts that enhance that person’s sense of identity and
worth.
 Cultural and racial characteristics that once elicited feelings of shame
and disgust become symbols of pride and honor. The individual moves
into this stage primarily because he or she asks the question, “Why
should I be ashamed of who and what I am?”
 Phrases such as “Black is beautiful,” represent a symbolic relabeling of
identity for many Blacks. Racial self-hatred becomes something actively
rejected in favor of the other extreme, which is unbridled racial pride.
RESISTANCE AND
IMMERSION
 There is a feeling of connectedness with other members of
the racial and cultural group and a strengthening of new
identity begins to occur. Members of one’s group are
admired, respected, and often viewed now as the new
reference group or ideal. Cultural values of the minority
group are accepted without question.
 As indicated, the pendulum swings drastically from original
identification with White ways to identification in an
unquestioning manner with the minority-group’s ways.
Persons in this stage, are likely to restrict their interactions
as much as possible to members of their own group.
RESISTANCE AND
IMMERSION
 There is also considerable anger and hostility directed
toward White society. There is a feeling of distrust and
dislike for all members of the dominant group in an almost
global anti-White demonstration and feeling.
 White people, for example, are not to be trusted for they are
the oppressors or enemies. In extreme form, members may
advocate complete destruction of the institutions and
structures that have been characteristic of White society.
PHASE 4 - INTROSPECTION
 Increased discomfort with rigidly help group views (i.e., all
Whites are bad).
 Too much energies directed at White society and diverted
from more positive exploration of identity questions.
 Conflict ensures between notions of responsibility and
allegiance to one’s minority group, and notions of personal
autonomy.
 Attempts to understand one’s cultural heritage and to
develop an integrated identity.
INTROSPECTION
 The conflict now becomes quite great in terms of
responsibility and allegiance to one’s own minority
group versus notions of personal independence and
autonomy.
 The person begins to spend greater and greater time
and energy trying to sort out these aspects of selfidentity and begins to increasingly demand
individual autonomy.
PHASE 5 – INTEGRATIVE
AWARENESS
 Develop inner sense of security as conflicts between new
and old identities are resolved.
 Global anti-White feelings subside as person becomes more
flexible, tolerant and multicultural.
 White and minority cultures are not seen as necessarily
conflictual.
 Able to own and accept those aspects of U.S. culture (seen
as healthy) and oppose those that are toxic (racism and
oppression).
INTEGRATIVE AWARENESS
 Develops a positive self-image and experiences a strong sense of selfworth and confidence.
 Not only is there an integrated self-concept that involves racial pride in
identity and culture, but the person develops a high sense of autonomy.
 Becomes bicultural or multicultural without a sense of having “sold out
one’s integrity.”
 In other words, the person begins to perceive his or her self as an
autonomous individual who is unique (individual level of identity), a
member of one’s own racial-cultural group (group level of identity), a
member of a larger society, and a member of the human race (universal
level of identity).
Implications for Clinical
Practice
 Be aware that the R/CID model should be viewed as
dynamic, not static.
 Do not fall victim to stereotyping in using these models
 Know that minority development models are conceptual aids
and that human development is much more complex
 Know that identity development models begin at a point that
involves interaction with an oppressive society
Implications for Clinical
Practice
 Be careful of the implied value judgment given in almost all
development models
 Be aware that racial/cultural identity development models
seriously lack an adequate integration of gender, class,
sexual orientation, and other sociodemographic group
identities
 Know that racial/cultural identity is not a simple, global
concept
 Begin to look more closely at the possible therapist and
client stage combinations
CHAPTER 11
WHITE RACIAL IDENTITY
DEVELOPMENT
WHITE RACIAL IDENTITY
DEVELOPMENT - Assumptions
 1. Racism is a basic and integral part of U.S. life
and permeates all aspects of our culture and
institutions.
 2. White Americans are socialized into U.S. society
and, therefore, inherit the biases, stereotypes, racist
attitudes, beliefs, and behaviors of the society.
WHITE RACIAL IDENTITY
DEVELOPMENT - Assumptions
 3. The level of White racial identity development
in an interracial encounter affects the process and
outcome of our relationships.
 4. How Whites perceive themselves as racial
beings seems to be strongly correlated with how
they perceive and respond to racial stimuli.
Consequently, race-related reality of Whites
represent major differences in how they view the
world.
WHITE RACIAL IDENTITY
DEVELOPMENT - Assumptions
 5. It seems to follow an identifiable sequence. There is an
assumption that White Americans who are born and raised
in the United States, may move through levels of
consciousness regarding their own identity as racial beings.
 6. The most desirable development is not only the
acceptance of whiteness, but also defining it in a
nondefensive and nonracist manner. There is an
understanding that to deny the humanity of any one person
is to deny the humanity of all.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase One – Naiveté
 Early childhood marked by naïve curiosity about race.
 Tendency to be innocent, open, and spontaneous regarding racial
differences.
 May notice differences, but awareness of social meaning are absent or
minimal.
 Racial awareness and the burgeoning social meanings occur between the
ages of 3-5 years.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Two – Conformity
 Characteristics of naiveté may be maintained.
 Minimal awareness of self as a racial/cultural being.
 Strong belief in the universality of values and norms governing behavior.
 Unlikely to recognize the polarities of democratic principles of equality
and the unequal treatment of minority groups.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Two – Conformity
 Compartmentalization of contradictory attitudes,
beliefs and behaviors (i.e., can believe people are
people, but treat minorities differently).
 Because of naiveté and encapsulation, it is possible
for two diametrically opposed belief systems to
coexist in your mind.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Two – Conformity
 (a) Uncritical acceptance of White supremacist
notions which relegates minorities into the inferior
category with all the racial stereotypes.
 (b) Belief that racial and cultural differences are
considered unimportant. This allows Whites to
avoid perceiving themselves as “dominant” group
members, or of having biases and prejudices.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Two – Conformity
 The primary mechanism used in encapsulation is
denial; denial that people are different, denial that
discrimination exists, and denial of your own
prejudices. Instead, the locus of the problem is seen
to reside in the minority individual or group.
 In her own White racial awakening, Peggy
McIntosh (1989) stated:
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Two – Conformity
 “My schooling gave me no training in seeing myself as an oppressor, as
an unfairly advantaged person, or as a participant in a damaged
culture. I was taught to see myself as an individual whose moral state
depended on her individual moral will....Whites are taught to think of
their lives as morally neutral, normative, and average, and also ideal, so
that when we work to benefit others, this is seen as work which will
allow ‘them’ to be more like ‘us.’
 While the Naiveté stage is brief in duration, the Conformity stage can
last a lifetime.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Three – Dissonance
 Obliviousness breaks down when Whites become aware of
inconsistencies.
 Becomes conflicted over irresolvable racial moral dilemmas that are
frequently perceived as polar opposites: believing they are nonracist, yet
not wanting their son or daughter to marry a minority group member;
 Belief that “all men are created equal”, yet seeing society treat people of
color as second class citizens; and not acknowledging that oppression
exists to witnessing it (beating of Rodney King and the unwarranted
persecution of Wen Ho Lee).
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Three – Dissonance
 Become increasingly conscious of whiteness and
may experience dissonance, resulting in feelings of
guilt, depression, helplessness or anxiety.
 Movement into the Dissonance phase occurs when
Whites are forced to deal with the inconsistencies
that have been compartmentalized or encounter
information/experiences at odds with their denial.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Three - Dissonance
 Dissonance may make Whites feel guilty, shameful, angry,
and depressed. Rationalizations may become the manner
used to exonerate their inactivity in combating perceived
injustice or personal feelings of prejudice: “I’m only one
person, what can I do” or “Everyone is prejudiced, even
minorities”.
 As these conflicts ensue, Whites may retreat into the
protective confines of White culture (encapsulation of the
previous stage) or move progressively toward insight and
revelation (resistance and immersion stage).
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Four - Resistance and Immersion
 Whites begin to question and challenge their racism. For the
first time, they begin to realize what racism is all about, and
their eyes are suddenly opened.
 Racism becomes noticeable in all facets of their daily lives
(advertising, television, educational materials, interpersonal
interactions, etc.). A major questioning of their racism and
that of others mark this phase of development. In addition,
increasing awareness of how racism operates and its
pervasiveness in U.S. culture and institutions are the major
hallmark at this level of development.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Four – Resistance and Immersion
 Likely to experience considerable anger at family
and friends, institutions, and larger societal values,
that are seen as having sold them a false bill of
goods (democratic ideals) that were never practiced.
 Guilt is also felt for having been a part of the
oppressive system.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Four – Resistance and Immersion
 The "White liberal" syndrome may develop and be
manifested in two complementary styles: (a) the paternalistic
protector role or (b) an over identification with the minority
group. In the former, Whites may devote energies in an
almost paternalistic attempt to protect minorities from abuse.
 May actually even want to identify with a particular
minority group (Asian, Black, etc.) in order to escape their
Whiteness.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Four – Resistance and Immersion
 May resolve this dilemma by moving back into the protective
confines of White culture (Conformity stage), again experience
conflict (dissonance), or move directly to the Introspective stage.
In many cases, they may develop a negative reaction toward their
group or culture. While they may romanticize People of Color,
Whites cannot interact confidently with them because you fear
making racist mistakes.
 The discomfort in realizing that they are White and that their
group has engaged in oppression of racial/ethnic minorities may
propel them into the next stage.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Five – Introspection
 This phase is most likely a compromise of swinging from an extreme of
unconditional acceptance of White identity to a rejection of Whiteness.
It is a state of relative quiescence, introspection and reformulation of
what it means to be White.
 Realize and no longer deny that they have participated in oppression,
that they benefit from White privilege, and that racism is an integral part
of U.S. society. Less motivated by guilt and defensiveness, accept
Whiteness, and seek to define own identity and that of one’s social
group.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Five – Introspection
 May ask questions: “What does it mean to be White?”
“Who am I in relation to my whiteness?” “Who am I as a
racial/cultural being?”
 Feelings or affective elements may be existential in nature
and involve feelings of lack of connectedness, isolation,
confusion and loss.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Five – Introspection
 Asking the painful question of who you are in relation to your racial
heritage; honestly confronting your biases and prejudices; and accepting
responsibility for your Whiteness is the culminating outcome of the
introspective stage.
 New ways of defining your White EuroAmerican social group and
membership in that group become important.
 No longer deny being White, honestly confront your racism, understand
the concept of White privilege, and feel increased comfort in relating to
persons of color.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Six - Integrative Awareness
 Reaching this level of development is most characterized as:
 (a) Understanding self as a racial/cultural being.
 (b) Awareness of sociopolitical influences with respect to racism,
 (c) Appreciation of racial/cultural diversity,
 (d) Rooting out buried and nested racial fears and emotions.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Six – Integrative Awareness
 Formation of a nonracist White EuroAmerican identity emerges and
becomes internalized. Begin to value multiculturalism, comfortable
around members of culturally different groups, and feel a strong
connectedness with members of many groups.
 Inner sense of security and strength to function in a society that is only
marginally accepting of integratively aware White persons.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Six – Integrative Awareness
 This status is different from the previous one in two major ways: (a) It is
marked by a shift in focus from trying to change people of color to
changing the self and other Whites, and (b) it is marked with increasing
experiential and affective understanding that were lacking in the
previous status.
 Successful resolution of this stage requires an emotional catharsis or
release that forces you to relive or reexperience previous emotions that
were denied or distorted. The ability to achieve this affective upheaval
leads to a euphoria or even a feeling of rebirth and is a necessary
condition to developing a new nonracist White identity.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Seven – Commitment To Antiracist Action
 Most characterized by social action. There is likely to be a consequent
change in behavior, and an increased commitment toward eradicating
oppression as well.
 Seeing “wrong” and actively working to “right it” require moral
fortitude and direct action. Objecting to racist jokes, trying to educate
family, friends, neighbors, and co-workers about racial issues, taking
direct action to eradicate racism in the schools, workplace, and in social
policy often in direct conflict with other Whites.
WHITE RACIAL IDENTITY
DEVELOPMENT – Process
 Phase Seven – Commitment to Antiracist Action
 Become increasingly immunized to social pressures for conformance
because reference group begins to change.
 In addition to family and friends, will begin to actively form alliances
with persons of color and other liberated Whites. They will become a
second family giving validation, and encouraging continuance to the
struggle against individual, institutional and societal racism.
WHITE RACIAL IDENTITY
DEVELOPMENT – Summary
 First, you must actively place yourself in new and oftentimes
uncomfortable situations that impel you to question yourself as a
racial/cultural being, and to increase awareness of racial issues,
especially racism.
 Second, change must occur in the form of new insights, attitudes and
behaviors that lead to a realization of your role in the perpetuation of
racism.
 Third, considerable and continuing energies must be devoted to the
maintenance of a healthy White racial identity. In other words, change
is not enough in the face of societal forces that serve to squelch or
punish dissent.
 Fourth, you must take action to eradicate racism.
CHAPTER 12
SOCIAL JUSTICE
COUNSELING/THERAPY
Multicultural Counseling
Multicultural counseling and therapy must be about
 social justice
 providing equal access and opportunity to all groups
 being inclusive
 removing individual and systemic barriers to fair
mental health treatment
 insuring that counseling/therapy services are directed
at the micro, meso and macro levels of our society
Locus of Control
 Internal control (IC) refers to people’s beliefs that
reinforcements are contingent on their own actions
and that they can shape their own fate
 External control (EC) refers to people’s beliefs that
reinforcing events occur independently of their
actions and that the future is determined more by
chance and luck.
Locus of Responsibility
 This dimension measures the degree of
responsibility or blame placed on the
individual or system
Understanding Individual
and Systemic Worldviews
 Worldviews composed of our attitudes,
values, opinions, and concepts, but they also
affect how we think, define events, make
decisions, and behave
Formation of Worldviews
 Worldviews are formed on a continuum:




internal locus of responsibility (IC-IR), external
locus of control
internal locus of responsibility (EC-IR), internal
locus of control
external locus of responsibility (IC-ER), and
external locus of control
external locus of responsibility (EC-ER)
Cultural Competence for
Mental Health Agencies
1. Cultural Destructiveness: Programs that support
oppression (e.g. Tuskeegee)
2. Cultural Incapacity: Not intentionally destructive
but still believe in White superiority
3. Cultural Blindness: All people are the same and
Western helping methods are applicable
Cultural Competence for
Mental Health Agencies
4.Cultural Precompetence: Looked at “artifacts”
seeing weaknesses in serving minorities
5.Cultural Competence: Diverse staff at all
levels—higher stages of cultural identity awareness
6.Cultural Proficiency: Very rare—high levels of
cultural competence—seek knowledge to develop
better practices
CHAPTER 13
MINORITY GROUP
THERAPISTS: WORKING
WITH MAJORITY AND OTHER
MINORITY CLIENTS
Therapists of Color
 Therapists of color are not immune from
their own cultural socialization or inheriting
the biases of the society as well
Interracial Bias and
Discrimination
 People of color become concerned about
discussing interethnic and interracial
misunderstandings and conflicts between
various groups for :


fear that such problems may be used by those in
power
assuage their own guilt feelings excuse their
own racism
Oppressive Strategies
 Divide and Conquer -“as long as people of
color fight among themselves, they can’t
form alliances to confront the establishment”
 Divert attention away from the injustices of
society by defining problems as residing
between various racial groups
Minority-Majority and MinorityMinority Relationships
 Not only do we need to engage in self-examination,
but it is also clear we are a stimulus to clients
through appearance, speech, or other factors that
reflect differences
 Self-disclosure, or the acknowledgment of
differences, may increase feelings of similarity
between therapist and client and reduce concerns
about differences
Therapists’ and Counselors’
Obligations
All therapists and counselors need to:
 Become aware of their own worldviews, their
biases, values and assumptions about human
behavior
 Understand the worldviews of their culturally
diverse clients
 Develop culturally appropriate intervention
strategies in working with culturally diverse clients
CHAPTER 14
COUNSELING AFRICAN
AMERICANS
African Americans
Various issues plague African Americans:
 unemployment
 poverty
 high prison rates
 lower levels of education
 these issues can primarily be attributed to
racism
African Americans
 However, the African American community is
becoming more diverse with respect to social class,
education level, and political orientation
 Many African American households are




headed by women,
embrace extended family networks,
have strong religious orientations, and
accept varied gender roles
Educational Orientation
 African American parents encourage their
children to develop career and educational
goals at an early age in spite of the obstacles
produced by racism and economic conditions
 Behavioral problems in school may be due to
racism
Spirituality
 Many African Americans are very spiritual
and find their church communities to be very
supportive
 Counselors should advise clients to seek
support through churches
Racism and Discrimination
 Racism exists in subtle and overt forms
 Mistrust is a reaction to being discriminated
against
 Counselors should be aware of mistrust and
work to earn client’s trust
Guidelines for Clinical Practice




During the first session, it may be beneficial to bring up the
reaction of the client to a counselor of a different ethnic
background (e.g. “Sometimes clients feel uncomfortable
working with a counselor of a different race; would this be a
problem for you?”)
If the clients are referred, determine their feelings about
counseling and how it can be made useful for them
Identify the expectations and worldviews of the African
American clients, find out what they believe counseling is, and
explore their feelings about counseling
Establish an egalitarian relationship
Guidelines for Clinical Practice





Determine whether and how the client has responded to
discrimination and racism both in unhealthy and healthy ways.
Also examine issues around racial identity (many clients at the
preencounter stage will not believe that race is an important
factor)
Assess the positive assets of the client, such as family (including
relatives and nonrelated friends), community resources, and the
church
Determine the external factors that might be related to the
presenting problem
Help the client define goals and appropriate means of attaining
them
After the therapeutic alliance has been formed, determine the
interventions collaboratively
CHAPTER 15
COUNSELING AMERICAN
INDIANS AND ALASKAN
NATIVES
American Indians
American Indians have suffered greatly as a
result of:



colonization
disease
land distribution
Cultural Loss
 Culture and language were systematically
striped from over 125,000 tribes
 Stripping American Indians of their culture,
has lead to high rates of alcoholism
The American Indian and the
Alaskan Native
 This is a very heterogeneous group
 Some families are matriarchal and some are
patriarchal in orientation
Tribe and Reservation
 Indians see themselves an extension of their tribe
 Tribe and reservation provide American Indians with a sense
of belonging and security, forming an interdependent system
 Status and rewards are obtained by adherence to tribal
structure
 The reservation itself is very important for many American
Indians, even among those who do not reside there
 Indians who leave the reservation to seek greater
opportunities often lose their sense of personal identity,
since they lose their tribal identity
Specific Problem Areas for
American Indians/Alaskan Natives
 Sharing
 Noninterference
 Time Orientation
 Spirituality
 Nonverbal Communication
Acculturation



Traditional. The individual may speak little English,
thinks in the native language, and practices traditional
tribal customs and methods of worship.
Marginal. The individual may speak both languages but
has lost touch with his or her cultural heritage and is not
fully accepted in mainstream society.
Bicultural. The person is conversant with both sets of
values and can communicate in a variety of contexts.
Acculturation
 Assimilated. The individual embraces only
the mainstream culture’s values, behaviors,
and expectations.
 Pantraditional. Although the individual has
only been exposed to or adopted
mainstream values, he or she has made a
conscious effort to return to the “old ways.”
Guidelines for Clinical Practice





Before working with American Indians, explore ethnic
differences and values
Determine the cultural identity of the client and family members
and their association with a tribe or a reservation
Understand the history of oppression, and be aware of or inquire
about local issues associated with the tribe or reservation for
traditionally oriented American Indians
Evaluate using a client-¬centered listening style initially and
determine when to use more structure and questions
Assess the problem from the perspective of the individual,
family, extended family, and, if appropriate, the tribal
community
Guidelines for Clinical Practice




If necessary, address basic needs first, such as problems
involving food, shelter, child care, and employment--identify
possible resources such as Indian Health Services or tribal
programs
Be careful not to overgeneralize, but evaluate for problems such
as domestic violence, substance abuse, depression, and
suicidality during assessment and determine the appropriateness
of a mind-¬body-¬spirit emphasis
Identify possible environmental contributors to problems such as
racism, discrimination, poverty, and acculturation conflicts
Help children and adolescents determine whether cultural values
or an unreceptive environment contribute to their problem
Guidelines for Clinical Practice




Help determine concrete goals that incorporate cultural, family,
extended family, and community perspectives
Determine whether child-rearing practices are consistent with
traditional Indian methods and how they may conflict with
mainstream methods.
In family interventions, identify extended family members,
determine their roles, and request their assistance
Generate possible solutions with the clients and consider their
consequences from the individual, family, and community
perspectives. Include strategies that may involve cultural
elements and that focus on holistic factors (mind, body, spirit)
CHAPTER 16
COUNSELING ASIAN
AMERICANS AND
PACIFIC ISLANDERS
Asian Americans: A Success
Story?
For example:
 Of those over the age of 25, 44% of Asian/Pacific
Islanders had at least a bachelor’s degree versus
24% by their White counterparts
 However, In the area of education, Asian
Americans show a disparate picture of
extraordinary high educational attainment and a
large undereducated mass (e.g. Hmong, Laotians)
Collectivistic Orientation
 Instead of promoting individual needs and
personal identity, Asian families tend to have
a family and group orientation
 Children are expected to strive for family
goals and not to engage in behaviors that
would bring dishonor to the family
Hierarchical Relationships
 Traditional Asian American families tend to
be hierarchical and patriarchal in structure,
with males and older individuals occupying a
higher status
 Communication flows down from the parent
to the child, who is expected to defer to the
adults
Emotionality
 Strong emotional displays, especially in
public, are considered to be signs of
immaturity or a lack of control
Holistic View on Mind and
Body
 Because the mind and body are considered
inseparable, Asian Americans may present
emotional difficulties through somatic
complaints
Identity Issues
Individuals undergoing acculturation conflicts may
respond in the following manner:





Assimilation--seeks to become part of the dominant society to
the exclusion of his or her own cultural group
Separation--identifies exclusively with the Asian culture
Integration/”biculturalism--retains many Asian values but
adapts to the dominant culture by learning necessary skills
and values
Marginalization--perceives one’s own culture as negative but
is unable to adapt to majority culture
Expectations of Counseling





Explain the nature of the counseling and therapy process
and the necessity of obtaining information
Describe the client’s role
Indicate that the problems may be individual, relational,
environmental, or a combination of these and that you
will perform an assessment of each of these areas
Introduce the concept of co-construction—that the
problem and solutions are developed with the help of the
client and the counselor
Asian clients expect the counselor to take an active role
in structuring the session and guidelines on the types of
responses that they will be expected to make
Family Therapy




Assess the structure of the Asian American family to
find out if it is it hierarchical or more egalitarian
Focus on the positive aspects of the family and
reframe conflicts to reduce confrontation
Expand systems theory to include societal factors
such as prejudice, discrimination
Function as a culture-broker in helping the family
negotiate conflicts with the larger society
Guidelines for Clinical Practice






Be aware of cultural differences between the therapist and the
client as regarding counseling, appropriate goals, and process
Build rapport by discussing confidentiality and explaining the
client role and the need to co-construct the problem definition
and solutions
Assess not just from an individual perspective but include
family, community, and societal influences on the problem
Conduct a positive assets search
Consider or reframe the problem when possible as one in which
issues of culture conflict or acculturation are involved
Determine whether somatic complaints are involved and assess
their influence on mood and relationships
Guidelines for Clinical Practice




Take an active role but allow Asian Americans to
choose and evaluate suggested interventions
Use problem-focused, time-limited approaches that
have been modified to incorporate possible cultural
factors
With family therapy, the therapist should be aware
that Western based theories and techniques may not
be appropriate for Asian families so focus on positive
aspects of parenting such as modeling and teaching
and use a solution-focused model
In couples counseling, assess for societal or
acculturation conflicts
Guidelines for Clinical Practice



With Asian children and adolescents, common
problems involve acculturation conflicts with parents,
feeling guilty or stressful over academic performance,
negative self-image or identity issues, and struggle
between interdependence and independence
Among recent immigrants or refugees, assess for
living situation, culture conflict and social or
financial condition
Consider the need to act as an advocate or engage in
systems-level intervention in cases of institutional
racism or discrimination
CHAPTER 17
COUNSELING
HISPANIC/LATINO
AMERICANS
Hispanic
 Hispanic is the U.S. Government designation
to refer to the common background of the
Spanish language amongst people from
various geographic regions (e.g. Puerto Rico,
Mexico, South America, etc.)
 Hispanics are the largest minority group in
the U.S. (35, 238, 481)
Hispanic Tradition
 Familismo (family unity) is seen as important
as are respect and loyalty to the family
 Family members cooperate, are often
religious, possess strict child rearing
practices, and value the extended family
 In general, outside help is not sought until all
family resources are exhausted
Acculturation Conflicts
 Some maintain their traditional orientation
while others assimilate the host culture
 Being “bicultural” is thought to lead to
optimal levels of mental health
Societal Factors
 Acculturative stress amongst immigrants has
been linked to depression and suicidal
ideation
 Racism and discrimination can also impact
mental health
Personalismo
 Personalismo is a basic cultural value of
Hispanic Americans--although the first
meetings may be quite formal, once trust has
developed, the clients may develop a close
personal bond with the counselor
Guidelines for Clinical Practice





It is important to engage in a respectful, warm, and mutual
introduction with the client because less acculturated Hispanic
Americans expect a more formal relationship and the counselor
will be seen as an authority figure and should be formally
dressed
Give a brief description of what counseling is and the role of
each participant
Explain the notion of confidentiality (especially with illegal
immigrants)
Have the client state in his or her own words the problem or
problems as he or she sees it--determine the possible influence
of religious or spiritual beliefs
Assess the acculturation level
Guidelines for Clinical Practice






Consider whether there are cultural or societal aspects to the
problem
Determine whether a translator is needed
Determine the positive assets and resources available to the
client and his or her family
Discuss possible consequences of achieving indicated goals
for the individual, family, and community
Discuss the possible participation of family members and
consider family therapy
Assess possible problems from external sources, such as need
for food, shelter, or employment, or stressful interactions with
agencies
Guidelines for Clinical Practice




Explain the treatment to be used, why it was selected, and
how it will help achieve the goals
With the client’s input, determine a mutually agreeable length
of treatment--it is better to offer time-limited, solution-based
therapies
Remember that personalismo is a basic cultural value of
Hispanic Americans--although the first meetings may be
quite formal, once trust has developed, the clients may
develop a close personal bond with the counselor. He or she
may be perceived as a family member or friend and may be
invited to family functions and given gifts
Consistently evaluate the client’s or family’s response to the
therapeutic approach you have chosen
CHAPTER 18
COUNSELING
INDIVIDUALS OF
MULTIRACIAL DESCENT
People of Mixed Race
 People of mixed race heritage are often
ignored, neglected, and considered
nonexistent in our educational materials,
media portrayals, and psychological
literature
Facts and Figures
 The biracial baby boom in the United States
started in 1967 when the last laws against
race mixing (anti-miscegenation) were
repealed
 The number of children living in families
where one parent is White and the other is
Black, Asian, or American Indian has tripled
from 1970 to 1990
Racial/Ethnic Ambiguity, or
“What Are You?”
 Racial/ethnic ambiguity refers to the inability of
people to distinguish the monoracial category of the
multiracial individual from phenotypic
characteristics
 The “What are you?” question almost asks a
biracial child to justify his or her existence in a
world rigidly built on the concepts of racial purity
and monoracialism
The Marginal Syndrome
 Root (1990) asserted that mixed-race people
begin life as “marginal individuals” because
society refuses to view the races as equal and
because their ethnic identities are ambiguous
as they are often viewed as fractionated
people—composed of fractions of a race,
culture, or ethnicity
Complex Identity Processes
 A growing number of multiracial individuals who
are choosing “multiracial” as their ethnic identity
 Where the child grows up (i.e. in an integrated
neighborhood and school versus in an ethnic
community) can have a great impact on identity
 Physical appearance also influences the sense of
group belonging and racial self-identification
among multiracial individuals
Multiracial Bill of Rights
Three major affirmations:



Resistance
Revolution
Change
Guidelines for Clinical Practice






Become aware of your own stereotypes and
preconceptions regarding interracial relationships and
marriages
When working with multiracial clients, avoid stereotyping
See multiracial people in a holistic fashion rather than as
fractions of a person
Remember that being a multiracial person often means
coping with marginality, isolation, and loneliness
With mixed-race clients, emphasize the freedom to choose
one’s identity
Take an active psychoeducational approach
Guidelines for Clinical Practice



Since mixed race people are constantly portrayed as
possessing deficiencies, stress their positive attributes
and the advantages of being multiracial and
multicultural
Recognize that family counseling may be especially
valuable in working with mixed-race clients,
especially if they are children
When working with multiracial clients, ensure that
you possess basic knowledge of the history and issues
related to hypodescent (the one drop rule), ambiguity
(the “What are you?” question, marginality, and
racial/cultural identity
CHAPTER 19
COUNSELING ARAB
AMERICANS
Stereotypes, Racism and
Prejudice
 Arabs and Arab Americans have been stereotyped
in movies as sheiks, barbarians, or terrorists
 Islam has also been portrayed as a violent religion
 Also, many believed that it was OK to question and
inspect people with Middle-Eastern accents or
features
Religious and Cultural
Background
 Muslims or the followers of Islam believe in one
God and individual accountability for their actions
 Quran is equivalent to the Bible in Christianity
 Within Islam, there are two major groups - Sunni
and Shiite


The Sunni group is largest group accounting for about
90% of Muslims worldwide
The remaining 10% are Shiites
Family Structure and Values
 While values and families vary widely, there are
some commonalities
 Families tend to be group oriented, interdependent
and patriarchical
 Women are responsible for rearing the children and
for homemaking
 Hospitality is considered very important
 Opposite-sex discussions with those outside the
family may be problematic
Acculturation Conflicts
 Many have assimilated—especially the first wave
of immigrants
 The second wave has tended to maintain their
traditional identity
 Some wear traditional clothing (e.g. hijab or head
scarf)
 Also, some are bicultural and integrate both
identities
Guidelines for Clinical Practice
 Identify your attitudes about Arab American and
Muslims
 Inquire about importance of religion in their lives
 Determine the structure of the family through
questions and observation. With traditional
families, try addressing the husband or male first.
Traditional families may appear to be enmeshed.
Guidelines for Clinical
Practice
 Be careful of self-disclosures that may be
interpreted as a weakness. This will reduce the
therapist’s status among some Arab Americans.
Positive self-disclosures are fine
 In traditionally oriented Arab Americans families,
there may be reluctance to share family issues or to
express negative feelings with a therapist.
 Be open to exploring spiritual beliefs and the use of
prayer or fasting to reduce distress
CHAPTER 20
COUNSELING JEWISH
AMERICANS
Jewish Americans
 Jewish Americans have long been the targets of discrimination and hate
crimes
 Anti-semitism is on the rise in Israel
 The Jewish population in the U.S. is the largest in the world
 Many Jewish people immigrated from Russia, Austria-Hungary and
Romania between 1880-1942
 Of the Jews outside the U.S., most are from the former Soviet Union
 The Jewish population is falling rapidly due to low fertility and
“marrying out”
 Most do not follow all religious traditions, but celebrate holidays such as
Yom Kippur, Hanukah, and Passover
Experiences with Prejudice
and Discrimination






The Holocaust killed over 6 million Jews and left many people poor,
displaced, and without families
Jewish hate crimes are on the rise
May Jewish people fought for civil rights for people of color in the
1960’s
Holocaust deniers are individuals who do not acknowledge or who
question the existence of the genocide that occurred during the
Holocaust
Some Jews experience guilt for not practicing traditional Jewish customs
For many, a Jewish identity centers around a common experience and
history
Judaism
 The belief in one omnipotent God who created
humankind—one of the earliest monotheistic
religions
 Yom Kippur, the Day of Atonement is a time set
aside to atone for sins during the past year
 The synagogue is a place of worship
 There are many forms of Judaism ranging from
more conservative (e.g. Orthodox) to progressive
Implications
 As a counselor, it is important to be aware of the Jewish
identity as well as experiences of discrimination and
harassment
 Many organizations still do not acknowledge Jewish
holidays in the same way as Christian holidays
 Become aware of your own biases and assumptions about
Jewish people
CHAPTER 21
COUNSELING
IMMIGRANTS
Attitudes Toward
Immigrants
 Many groups have tried to prevent immigrants from
entering the U.S. and have worked to curtail rights
(e.g. voting)
 In 2006, the Ohio legislature passed a law that
attempts to exclude immigrant rights, but it was
overturned
 In 1994, California passed proposition 187 which
denied undocumented immigrants a public school
education, medical assistance and other services
Societal Conditions
 Societal and governmental reactions to
immigrants are influenced by social
conditions
 They become negative when economic
conditions result in a loss of jobs or limited
housing
 Terrorist attacks have had a negative impact
on people who appear “foreign”
Immigrant Reactions
 Immigrants may fear being deported
 Many may be reluctant to seek physical or
mental healthcare
 Counselors need to understand that
immigrant clients may be mistrustful for fear
of deportation
Immigrant Rights
 Hospitals are required to provide emergency
care to everyone regardless of documentation
status
 Free community clinics exist and will treat
all immigrants
 Immigrants can ask for interpreters
Barriers to Seeking
Treatment
 Communication due to language difficulties
 Lack of knowledge of mainstream service
delivery
Implications
 Counselors need to be active and become
advocates and spokespeople for immigrants
 Offer services within communities
 Have indigenous healers on staff
 Stay current on local, state, and federal
immigration laws
 Use skilled and knowledgeable interpreters
CHAPTER 22
COUNSELING REFUGEES
Refugees
 Refugees leave their home country due to
persecution
 Individuals are granted asylum when they meet the
criteria for refugee status and who are physically
present in the U.S. or at a point of entry when
granted permission to reside in the U.S.
Special Problems Involving
Refugees
 Refugees are under more stress than immigrants are
 They have been exposed to more traumas than most
immigrants
 Central American refugees in one study showed
high levels of mistrust towards service providers
 Parents often worry about their children’s
adaptation to the American way of life
 Many will have difficulties communicating in
English, will be underemployed and oftentimes—
depressed
Special Problems Involving
Refugees
 Parents often worry about their children’s
adaptation to the American way of life
 Many will have difficulties communicating
in English, will be underemployed and
oftentimes—depressed
Considerations in Working
with Refugees
 Trauma
 Loss
 Feelings of displacement
Refugees and Assessment
As a mental health worker, it will be important for you to
assess:
 Effects of Past Persecution, Torture, or Trauma
 Culture and Health
 Safety issues
 Gender Issues and Domestic Violence
 Linguistic and Communication issues (e.g. the use of
interpreters)
Guidelines for Clinical Practice



Be aware that the client might have day-to-day stressors such as
limited resources, a need for permanent shelter, lack of
employment, or frustrating interactions with agencies--allow
time to understand and provide support related to these
immediate needs, or help the client locate resources related to
specific needs
Be knowledgeable and conversant with the refugee groups you
work with, their pre-migration traumas, and psychological
strategies used to cope with stress
Understand symptom manifestations likely to indicate posttraumatic stress, and other mental disorders that may arise from
experiences of war, imprisonment, persecution, rape and torture
Guidelines for Clinical Practice



Allow time for clients to share their backgrounds,
their pre-migration stories, and changes in their lives
since immigrating
Inquire about client belief’s regarding the cause of
their difficulties, listening for sociopolitical, cultural,
religious or spiritual interpretations
Carefully explain the therapeutic approach that will
be used, why that approach was selected, and how it
will help the client make desired changes
CHAPTER 23
COUNSELING SEXUAL
MINORITIES
Homosexuality
 Homosexuality involves the affectional and/or
sexual orientation to a person of the same sex
 Most males prefer the term gay and females—
lesbian
 Approximately 4-10% of the U.S. population are
homosexual
 Younger Americans seem more accepting of gay
rights and same sex marriages
 However, violence and discrimination is pervasive
Homosexuals and Disorders
 Same Sex Relationships Are Not Signs of Mental
Disorders
 Research supports that homosexuals are not more
psychologically disturbed on account of their
homosexuality
 However, Lesbian and gay youth report elevated
levels of major depression, generalized anxiety
disorder and substance abuse
Assumption of
Heterosexuality
 It is important that counselors do not assume
heterosexuality, not focus on the client’s
sexual orientation if it is irrelevant,
understand the “coming out” process, and
infuse sexual orientation issues into training
programs
GLBT Couples and Families
 About 1.2 million people are part of gay and
lesbian couples in the U.S.—a 300% increase
since 1990
 Children of GLBT couples show healthy
cognitive and behavioral functioning
 GLBT couples may be uncomfortable
showing affection towards one another
GLBT Youth
 Compared to heterosexual youth, GLBT
youth report more substance abuse, sexual
risk taking behaviors, suicidal
attempts/thoughts and personal safety issues
Identity Issues





Awareness of sexual orientation of gay males and lesbian
females tends to occur in the early teens
The struggle for identity involves one’s internal perceptions in
contrast to the external perceptions or assumptions of others
about one’s sexual orientation
Individuals with gender identity issues report feeling “different”
at an early age
Cross-sex behaviors and appearance are highly stigmatized in
school and society
Mental health providers need to help GLBT youth to develop
coping strategies and survival skills and to expand
environmental supports
Coming Out






The decision to come out can be extremely difficult
Coming out to parents, family, and friends can lead to
rejection, anger, and grief
This can be especially difficult for adolescents who
are financially dependent on their family
Black and Latino gay and lesbian youth are more
reluctant to disclose their sexual orientation than are
their White counterparts
A counselor should help GLBT individuals with the
coming out process (e.g. decision-making, role plays)
Mental health providers should assist GLBT
individuals with acquiring social support
Guidelines for Clinical Practice





Examine your own views regarding heterosexuality and
determine their impact on work with GLBT clients--way to
personalize this perspective is to assume that some of your
family, friends or coworkers may be GLBT.
Read the “Guidelines for Psychotherapy with Lesbian, Gay, and
Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and
Bisexual Concerns, 2000)
Develop partnerships, consultation, or collaborative efforts with
local and national GLBT organizations
Assure that your intake forms, interview procedures, and
language are free of heterosexist bias and include a question on
sexual behavior, attraction, or orientation
Do not assume that the presenting problems necessarily are the
result of sexual orientation but be willing to address possible
societal issues and their role in the problems faced by GLBT
clients.
Guidelines for Clinical Practice



Remember that common mental health issues may
include stress due to prejudice and discrimination;
internalized homophobia; the coming out process; a
lack of family, peer, school, and community supports;
being a victim of assault; suicidal ideation or
attempts; and substance abuse
Realize that GLBT couples may have problems
similar to those of their heterosexual counterparts but
may also display unique concerns such differences in
the degree of comfort with public demonstrations of
their relationship or reactions from their family of
origin
Assess spiritual and religious needs
Guidelines for Clinical Practice




Because many GLBT clients have internalized the societal belief
that they cannot have long-lasting relationships, have materials
available that portray healthy and satisfying GLBT relationships
Recognize that a large number of GLBT clients have been
subject to hate crimes--depression, anger, posttraumatic stress,
and self-blame may result
For clients still dealing with internalized homosexuality, help
them establish a new affirming identity
Remember that in group therapy, a GLBT individual may have
specific concerns over confidentiality and different life stressors
as compared with their heterosexual counterparts
Guidelines for Clinical Practice



A number of therapeutic strategies can be useful with
internalized homophobia, prejudice, and
discrimination. They can include identifying and
correcting cognitive distortions, coping skills training,
assertiveness training, and utilizing social supports
If necessary, take systems-level intervention to
schools, employment, and religious organizations
Conduct research on the mental health needs of the
GLBT communities and the effectiveness of current
programs
CHAPTER 24
COUNSELING OLDER
ADULTS
Older Adults
 The population of older individuals in the
United States is growing
 During the past decade the 85-year-old and
older group has increased by 38%, while
those between 75 and 84 increased by 23%
 Ageism has been defined as negative
attitudes towards the process of aging or
toward older individuals
Stereotypes of the Elderly
 Women are more likely than men to be
viewed negatively
 Stereotypes and biases against the elderly are
pervasive
 Some stereotypes include rigidity, senility,
lacking in health/intelligence and having no
sexual desires
Mental Health
 There is a perception that rates of mental
illness are high among the elderly, however,
this is not true
 About 6% of older adults are in the
community mental health system
Mental Deterioration or
Incompetence
 Only a small number of older adults have
dementia
 However, by the year 2040, it is estimated
that 7 million people will have Alzheimer’s
disease
 Cognitive decline is a part of aging and
should not be confused with senility
Sexuality in Old Age
 It is thought that older adults do not engage
in sexual activity, however, many older
adults are sexually active
Guidelines for Clinical Practice





Obtain specific knowledge and skills in counseling older adults.
Critically evaluate your own attitudes about aging and quality of
life
Be knowledgeable about legal and ethical issues that arise when
working with older adults (e.g., competency issues)
Determine the reason for evaluation and the social aspects
related to the problem, such as recent losses, financial stressors,
and family issues
Show older adults respect and give them as much autonomy as
possible regardless of the issues involved or mental status.
Identify medical conditions and prescription and over-thecounter medications because mental conditions are often a result
of physical problems or drug interactions or side effects
Guidelines for Clinical Practice






Presume competence in older adult clients unless the contrary is
obvious
If necessary, slow the pace of therapy to accommodate cognitive
slowing
Provide information in a manner that approximates the client’s
level of reading and comprehension, using alternative methods
such as simplified visuals or videotapes if necessary
Involve older adults in decisions as much as possible
Use multiple assessments and include relevant sources (client,
family members, significant others, and health care providers)
Determine the role of family caregivers, educate them about the
disorder, and help them develop strategies to reduce burnout
Guidelines for Clinical Practice






When working with an older couple, help negotiate issues
regarding time spent alone and together (especially after
retirement
Recognize that it is important to help individuals who are alone
establish support systems in the community
Help the older adult develop a sense of fulfillment in life by
discussing the positive aspects of their experiences
Determine the older adult’s views of the problem, belief system,
stage of life issues, educational background, and social and
ethnic influences
Assist in interpreting the impact of cultural issues such as ethnic
group membership, gender, and sexual orientation on their lives
For adults very close to the end of their lives, help them deal
with a sense of attachment to familiar objects by having them
decide how heirlooms, keepsakes, and photo albums will be
distributed and cared for
CHAPTER 25
COUNSELING WOMEN
Sexism
 Women continue to face barriers in many career
tracks—especially math and science
 Teachers continue to discriminate against women in
classroom setting
 Stereotypes against women inhibit their
performance
 Women also continue to receive about 75% of what
men earn
Economic Issues
 Women continue to be overrepresented in
lower wage jobs (e.g. cashier, secretary,
nurse’s aid, and teaching)
 Mental health professions need to become
aware of economic issues faced by women
and work to assist them as needed
Barriers to Career Choices
 College women perceive more obstacles to their
career choices than do men—for women of color—
it is worse
 When a women does not behave in a stereotypically
feminine manner—she is less liked by others
 Women continue to face difficulties in the
workplace (e.g. harassment, lack of mentorship,
tokenism, etc.)
Discrimination and
Victimization
 Over 70% of women office workers have reported
harassment at their place of employment
 Approximately 20% of female students report being
physically or sexually abused by their dating
partner
 As a result of abuse, many women are depressed
Counselor Bias
 One study revealed that therapists were not aware
of it, but, they were subtly conveying gender role
expectations to women
 Biases can also exist in diagnostic categories (e.g.
Histrionic, Borderline, and Dependent personality
disorders)
 Codependency may reflect a sense of
connectedness and nurturance rather than being
pathological
Feminist Identity Theory
Feminist therapists believe that the patriarchal aspect of U.S.
society is responsible for many of the problems faced by women
Feminist identity theory posits an evolution of consciousness of
societal subjugation of women:







Passive-acceptance—the women accepts traditional gender roles and
believes that men are superior to women
Revelation—events of sexism occur in a way that cannot be ignored
or denied
Embeddedness-emanation—formation of close relationships with
other women
Synthesis—a positive feminist identity is fully developed
Active-commitment—the woman is now interested in turning her
attention towards making societal changes
Therapy for Women




It is important for counselors to be aware of bias in
the counseling process
One study revealed that therapists were not aware of
it, but, they were subtly conveying gender role
expectations to women
Biases can also exist in diagnostic categories (e.g.
Histrionic, Borderline, and Dependent personality
disorders)
Codependency may reflect a sense of connectedness
and nurturance rather than being pathological
Guidelines for Clinical Practice



Possess up-to-date information regarding the biological,
psychological, and sociological issues that impact women--for
example, knowledge about menstruation, pregnancy, birth,
infertility and miscarriage, gender roles and health, and
discrimination, as well as their impact on women, is important
Recognize that most counseling theories are male-centered and
require modification when working with women--for example,
cognitive approaches can focus on societal messages
Attend workshops to explore gender-related factors in mental
health and be knowledgeable about issues related to women
Guidelines for Clinical Practice






Maintain awareness of all forms of oppression and understand how they
interact with sexism
Employ skills that may be particularly appropriate for the needs of
women, such as assertiveness training, gender role analysis, and
consciousness-raising groups
Assess sociocultural factors to determine their role in the presenting
problem
Help clients realize the impact of gender expectations and societal
definitions of attractiveness on the mental health of women so that they
do not engage in self-blame
Be ready to take an advocacy role in initiating systems-level changes as
they relate to sexism in education, business, and other endeavors
Assess for the possible impact of abuse or violence in all women
CHAPTER 26
COUNSELING PERSONS
WITH DISABILITIES
Discrimination


Discrimination is rampant against people with
disabilities—they receive lower pay and have
more difficulty finding employment
The Americans with Disabilities Act (ADA) was
signed into law in 1990 extending federal
mandate of nondiscrimination toward individuals
with disabilities to the state and local
governments and the private sector
Disabilities
 21 million families in the U.S have at least
one member with a disability
 It includes individuals with mental
retardation, hearing impairment or loss,
learning disabilities, psychiatric disorders,
and more
 HIV has recently been added as a disability
Myths about People with
Disabilities
 Most people are in wheelchairs
 People with disabilities are a drain on the economy
 The greatest barriers to people with disabilities are
physical ones
 Businesses dislike the ADA
 Government health insurance covers people with
disabilities
Models of Disability
The following are three models of disability
affecting the way the condition is perceived:
Moral model
 Medical model
 Minority model

Recommendations
 Treat people regardless of disability status
with the same expectations
 Gather information about your client’s
disability—do not solely rely on them to
educate you
 A client’s disability may not be the focus of
treatment