Gender bias

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Cultural and Contextual

Variables in Clinical Practice

Glenn M. Callaghan, Ph.D.

San José State University

[PSYC 160]

Review of the Homework

Trull: p. 76-77

Sue: Psychotherapeutic Services for Ethnic

Minorities (article)

Davidson: Conceptual and Ethical Issues for

GLB (article)

Kupers & Ross: chapter)

Gender bias (”Issue 2” –

Questions?

Comments?

How does this fit in?

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Culture and Context

Psychotherapy with Racial/Ethnic

Minorities, Disabilities, and those with

Disenfranchised Status

The importance of contextual variables and the sensitivity to diversity

Abilities and disabilities

Gender, minority and disenfranchised status

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What is Culture?

What is the culture of …

 the US?

California?

Northern California?

San Jose?

San Jose State University?

students in the Department of Psychology at SJSU?

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Current Status of Treatment with Diversity

Last two decades - more interest in this area

Argument is made that “interest” or “intention” hasn’t made a difference in terms of competencies

Equivocal data on whether there are differential outcomes for different minority groups (Sue, Zane,

& Young, 1994)

Social class appears not to be a variable that predicts outcome (Garfield, 1994)

Big question on matching therapist to patient on variables

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Things to Consider about

Ethnic/racial Minority Issues

Making assumptions about individuals based on group membership

Are there important cultural influences that we might miss because of our own cultural values?

Are there other groups that also should be addressed (e.g., obese people, older adults, people from rural communities)?

Where do we draw the line?

Who is not disenfranchised?

Is the assumption of differences a discriminatory or racist practice in itself?

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Definitions

Race : “A biological classification system determined by physical characteristics (e.g., skin pigmentation, head form, nasal index, color distribution and texture of body hair) that are of genetic origin, the combination of which helps to distinguish one human subgroup from other subgroups” (Krogman,

1945)

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Definitions

Ethnicity : “a group classification of individuals who share a unique social and cultural heritage (e.g., language, religion, customs) that is passed on from generation to generation” (Rose, 1964).

Within any race, there can be many ethnicities

(Caucasian) and within any ethnicities, there can be many races (American)

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Definitions

Culture : “the configuration of learned behavior whose components and elements are shared and transmitted by the members of a particular society”

(Linton, 1945)

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Definitions

Minority : “a group of people who, because of physical or cultural characteristics, are singled out from others in society in which they live for differential and unequal treatment, and who therefore regard themselves as objects of collective discrimination…Minority status carried with it the exclusion from full participation in the life of society” (Wirth,

1945)

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Definitions

Majority : “In the United States, the group that holds the balance of economic and political power. Also, the group whose cultural value system is deemed by its members to be the model value system, the one to be emulated.” (Bongar & Beutler, 1995)

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Definitions

Acculturation : “a process of attitudinal and behavioral change undergone, willingly or unwillingly, by individuals who reside in multicultural societies or who come in contact with a new culture due to colonization, invasion, or other political changes” (Marin, 1992)

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Limitations of Theories

Factors that limit applicability of theories to racial/ethnic minority groups

Belief that problems are mostly intrapsychic

As opposed to just social

Ignoring social, political, and economic conditions and addressing “the problem”

The fact that our science historically is a science of educated white males

 both research subjects and the researchers

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Limitations of Theories

Factors that limit applicability of theories to racial/ethnic minority groups

That the goal has historically been to get people to adjust to white values and norms

That we start from the assumption that counseling is the solution for everybody

That we evaluate, treat and experience people with our own biases and stereotypes

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Racial/Ethnic Group “Profiles”

Native Americans/American Indians

Diverse and heterogeneous group

511 distinct federally-recognized native entities

365 state-recognized native tribes

200 different languages

About 1.9 million in 1990 (probably low estimate)

Increasingly urbanized - only about 24% live on reservations

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Racial/Ethnic Group “Profiles”

Native Americans/American Indians

Serious mistreatment ever since whites got here

High levels of unemployment, malnutrition, inadequate health care, shortened life expectancy, high levels of substance abuse and suicide

Very little research on what works

Much more likely to use natural helpers and spiritual guidance than mental health services

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Racial/Ethnic Group “Profiles”

African Americans

U.S.’s second largest racial/ethnic minority at about 12.3%

Tremendous diversity within the group, but discrimination reported throughout

Racial identity potentially very important to therapy

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Racial/Ethnic Group “Profiles”

Hispanics/Latinos

Fastest-growing racial/ethnic group in the U.S.

Currently 12.5% of the pop (9% growth from 1990) annual growth rate is 6.1% (probably underestimates)

Diversity within group both inter-cultural (Mexican versus Puerto Rican) and generational (firstgeneration versus third generation)

Within U.S., they tend to be younger, less educated, poorer, and more likely to live in an inner-city neighborhood

Often a language barrier that may make living here even more difficult

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Racial/Ethnic Group “Profiles”

Asian-Americans/Pacific Islanders

3.6% of US pop in 2000

Umbrella term used to describe Japanese,

Chinese, Filipinos, Koreans, Guamians,

Malays, Samoans, and Southeast Asians

Third-largest racial/ethnic minority group

Very diverse group

Portrayed as “model minorities” in terms of educational and economic success

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Racial/Ethnic Group “Profiles”

White

79.1% of US pop in 2000

Umbrella term used to varied backgrounds and cultural histories

Very diverse group

New census category

2.4% respondents are multiracial

2 or more races

What will this mean/allow us to do with these “profiles”?

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Developing “Profiles”

Advantages

Sensitivity to issues

Cultural Sensitivity - ability to recognize issues and how different cultures bring different sets of issues to therapy

Potentially can be competent

Cultural Competence - ability to know these issues for one or more groups and be fluid in provision of services to that group

Help develop guidelines

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Developing “Profiles”

Problems

Beware the new stereotypes, new racism

New heuristic, new prejudice

Proxy variables (stand ins)

Tend to be non-manipulable

Tend to be vague, not behaviorally specific

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Developing “Profiles”

Problems

Examples

“Racial identity”

Acculturation

Religiosity

Geography (urban or rural)

Socio economic status (SES)

How could one manipulate these to bring about change?

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Gender Bias

Kupers & Ross articles

Biases in diagnosing genders

Arguments for and against the DSM being biased

Not biased

 should see differences, these are traits, genders are different

Biased

 look at who is diagnosed more often

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Critical Thinking Moment

How many for and against?

Does it matter?

How does history of development of

DSM play in?

What could the worries be?

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Gender Bias

Counting the Base Rates

Men

ASPD 5.8% males vs. 1.2% females

Also OCPD, soc phob, Nar PD, Intermittent Explosive,

Paraphilias

Women

Maj Dep, HistrionicPD, BPD, Eating, Dependent PD,

PMDD

What do these have in common?

What about Penis Envy as a trait?

What about PMS as a disorder

Late Luteal Phase Dysphoric Disorder  now

Premenstrual Dysphoric Disorder

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Critical Thinking Moment

How about for men?

Homophobia disorder

Sexual conquistador disorder

Emotionally avoidant disorder

Dependency phobia

Workaholism

Lack of parental involvement disorder

Anti-collaborative disorder, anti-collectivist disorder

Mid-life wife-drop disorder

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Broad Considerations

Need to ask

What do we want to know?

What will most help the client?

Who is making these summaries and providing this information?

Will I be participating in a new prejudice?

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Broad Considerations

Do not be satisfied with census categories

Do not buy into cultural sensitivity or cultural competency blindly

Try to appreciate the the complexities of the individual and the situation he or she comes from

Try to look at individual histories

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Getting Back to the Question

The “ Paul question ”:

"What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances, and how does it come about?" (Paul, 1969, p. 44)

The “Follette re-phrase”:

“What principles, requiring what resources, applied in what context, produce the most meaningful change for a particular person?”

(Follette, 2002)

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Rethinking Context

Individual histories

How does this person experience their context?

What is it like to be this person with this background having this problem ?

How will I affect the interaction and ability to bring about change with my background and my way of viewing the world?

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