Culturally Adaptive Counseling Skills

Demonstrations of Evidence-Based Practices

Miguel E. Gallardo, Christine J. Yeh, Joseph E. Trimble, Thomas A. Parham, Miguel E. Gallardo, Christine Jean Yeh, Joseph E. Trimble, Thomas A. Parham

• Publisher: SAGE Publications, Inc
• Year: 2011
• Print ISBN:
  9781412987219
• Edition: 1
• eBook ISBN:
  9781452236452
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

A key supplement for courses on multicultural counseling, this book is a practical volume that will help faculty and students see demonstrations of multicultural counseling in practice. The text covers evidence-based practices for working with five major ethnic groups, while weaving in other factors such as gender, disability, sexuality, and more. Each chapter has two case studies by an invited expert who also provides commentary and lessons drawing upon each case.

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1	Understanding the Skills Identification Stage Model in Context

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Miguel E. Gallardo

Thomas A. Parham

Joseph E. Trimble

Christine J. Yeh

It shouldn’t be theories that define the problems of our situation, but rather the problems that demand, and so to speak, select, their own theorization.

Martín-Baró (1994, p. 314)

________Introduction and Overview

The Maligned Wolf

The forest was my home. I lived there, and I cared about it. I tried to keep it neat and clean. Then one sunny day, while I was cleaning up some garbage a camper had left behind, I heard footsteps. I leaped behind a tree and saw a little girl coming down the trail carrying a basket. I was suspicious of this little girl right away because she was dressed funny—all in red, and her head covered up as if she did not want people to know who she was. Naturally, I stopped to check her out. I asked who she was, where she was going, where she had come from, and all that. She gave me a song and dance about going to her grandmother’s house with a basket of lunch. She appeared to be a basically honest person, but she was in my forest, and she certainly looked suspicious with that strange getup of hers. So, I decided to teach her just how serious it is to prance through the forest unannounced and dressed funny.

I let her go on her way, but I ran ahead of her to her grandmother’s house. When I saw that nice old woman, I explained my problem and she agreed that her granddaughter needed to learn a lesson all right. The old woman agreed to stay out of sight until I called her. Actually, she hid under the bed. When the girl arrived, I invited her into the bedroom where I was in bed, dressed like the grandmother. The girl came in all rosy-cheeked and said something nasty about my big ears. I’ve been insulted before so I made the best of it by suggesting that my big ears would help me to hear better. Now, what I meant was that I liked her and wanted to pay close attention to what she was saying. But she made another insulting crack about my bulging eyes. Now, you can see how I was beginning to feel about this girl who put on such a nice front but was apparently a very nasty person. Still, I’ve made it a policy to turn the other cheek, so I told her that my big eyes helped me to see her better.

Her next insult really got to me. I’ve got this problem with having big teeth, and that little girl made an insulting crack about them. I know that I should have had better control, but I leaped up from that bed and growled that my teeth would help me to eat her better.

Now, let’s face it, no wolf could ever eat a little girl; everyone knows that, but that crazy girl started running around the house screaming, me chasing her to calm her down. I’d taken off the grandmother’s clothes, but that only seemed to make it worse. All of a sudden the door came crashing open, and a big lumberjack is standing there with his axe. I looked at him, and it became clear that I was in trouble. There was an open window behind me and out I went. I’d like to say that was the end of it. But that grandmother character never did tell my side of the story. Before long the word got around that I was a mean, nasty guy. Everybody started avoiding me. I don’t know about that little girl with the funny red outfit, but I didn’t live happily ever after (Fern, 1974).

The challenges of preparing for and providing counseling and clinical services that are culturally responsive are areas the helping professions are taking more seriously. In the United States, the ethnic demographics have changed, both nationally and at the state level (U.S. Census Bureau, 2009). Gone are the days when the norm was systemic resistance to engaging in discussions of multiculturalism and diversity. Currently, most professionals, institutions, and agencies seem intellectually committed to the idea of developing greater levels of multicultural responsiveness, yet seem caught in a state of uncertainty about how to best achieve those objectives.

“The Maligned Wolf,” the story of Little Red Riding Hood from the Wolf’s perspective, provides a template for the underpinnings of the multicultural movement. What the story shapes for us is a much-needed paradigm shift or cultural shift that appropriately redefines modes of assessing, diagnosing, and intervening with clients (Ancis, 2004; Cardemil & Battle, 2003; D. W. Sue & Sue, 2003). It is clear that viewing therapy through a narrow, culturally encapsulated lens no longer meets the ethical standards as set forth by the counseling professions (American Counseling Association [ACA], 2005; American Psychological Association [APA], 2002, 2003). However, the professions’ desire to prioritize clinical responsiveness over cultural responsiveness remains intact (Gallardo, Johnson, Parham, & Carter, 2009). Ultimately, it is still possible for graduate students in most training programs to graduate, complete an internship, and become licensed and not be adequately prepared to meet the needs of underserved and unserved communities. This illustrates the challenges we face in preparing future therapists/counselors to provide services that are culturally and contextually consistent with the lives of those they intend to serve. This also implies that we need to do a better job of assisting graduate training programs to understand the what and the how.

A continuing concern for us is who defines reality for ethnocultural communities as well as how it is defined. In essence, we are suggesting that the issue is one of power: The ability to define reality and make others respond to that definition as if it were their own (Nobles, 2010). Consequently, empowerment is a central component to working with ethnocultural communities (Aldarondo, 2007). Prilleltensky, Dokecki, Frieden, and Ota Wang (2007) would argue that “wellness cannot flourish in the absence of justice, and justice is devoid of meaning in the absence of wellness” (p. 19). Therefore, if you are a member of an ethnocultural community, we encourage you not to allow reality to be defined for you by those who do not share or embrace your cultural worldview. Simultaneously, we encourage those readers who may not identify with one of the five ethnocultural communities addressed in this book to avoid defining realities for others based on your own worldview and cultural lens. It is here that well-intentioned therapists can unintentionally violate those they intend to serve responsively.

It has become clear that as we shift our perspective to better understand ethnocultural communities, the need to become culturally responsive at least parallels, and in some cases supersedes, the desire to become clinically competent (D. W. Sue & Sue, 2003). Research addressing the development of cultural competence continues to permeate much of the current psychological and counseling literature (Aldarondo, 2007; Ancis, 2004; Arredondo, 1998; Gallardo et al., 2009; Hays & Iwamasa, 2006; McAuliffe, 2008; S. Sue, 1998; Toporek & Reza, 2001; Vera & Speight, 2003). In response to the growing body of literature in this area, philosophical mandates for service providers to develop culturally responsive interventions have emerged. We say “philosophical” simply because the translation from theory to practice has been missing from the literature, which has often personally and professionally challenged training programs and practitioners alike. What is often addressed in these “mandates” for cultural competence is a challenge for all service providers to make this paradigmatic multicultural shift when working with ethnocultural communities (APA, 2003). This shift in perspective forces us to reexamine the developmental changes that have occurred in ethical mandates placed on service providers. We are not convinced that our ethical codes should be discarded entirely, but they should be viewed through a cultural lens first and foremost and should integrate culture-specific guidelines for various ethnocultural communities (Gallardo et al., 2009). More specifically, issues such as self-disclosure, multiple relationships, shifting the traditional therapeutic environment, and redefining the traditional therapeutic hour are issues that culturally responsive providers should address with some flexibility, based on the context and culture of their clients, without feeling like they are situating themselves in an unethical predicament. If we struggle in shifting our perspectives, is it because we believe in the universal application of traditional therapeutic techniques? Or, alternatively, does the system that calls for the mandates to make a multicultural shift limit, or present contradictory messages to, service providers and training programs? We argue that in shifting to a more culturally responsive paradigm (rather than making cultural responsiveness secondary or in addition to our clinical responsiveness), we actually broaden our clinical expertise and proficiency. The two should not be separated. In fact, for too long “clinical competence” has existed without the need to also be culturally responsive. Today, with the recent acceptance of the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2002), we are challenged to redefine and continuously reevaluate our modes of practice and, at times, the restrictions that are placed on what is considered “ethical” practice.

Evidence-Based Practice in Psychology

A central premise of this book is the current Evidence-Based Practice in Psychology (EBPP) definition, as supported by the American Psychological Association Presidential Taskforce on Evidence-Based Practice (2006). The APA has defined EBPP as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (p. 273). The EBPP begins with the client/community and asks what already existing research evidence, if any, will assist in achieving the best outcomes. We support this definition of EBPP because it allows for multiple sources of good “evidence” therapeutically, and it begins with a bottom-up perspective. That is, it begins with the client/community and then develops what might work, in what way, and with whom from this perspective. A top-down perspective assumes that what is good for the profession is also good for the communities we serve. There is currently more research being published with this bottom-up perspective in mind, including work with Haitians (Nicolas, Arntz, Hirsch, & Schmiedigen, 2009), cultural adaptations with adolescents (Bernal, Jimenez-Chafey, & Domenech Rodriguez, 2009), and with Chinese Americans (Hwang, 2009). While we are supportive of research to identify what works and with whom (Paul, 1967), we are also aware that an expansion of the “gold standard”—that is, treatments that have been empirically supported—is critical to continuing to advance therapeutic practice with ethnocultural communities. The current EBPP definition allows both the therapist and client to decide what might be the most effective treatment for this person at this moment, based on culture and context. Additionally, the EBPP definition states that “culture is a multifaceted construct, and cultural factors cannot be understood in isolation from social class and personal characteristics that make each patient unique” (APA Presidential Taskforce, 2006, p. 278). The EBPP guidelines state that cultural factors influence not only the nature and expressions of psychopathology, but also clients’ understanding of psychological and physical health (La Roche & Christopher, 2009). Griner and Smith (2006) found that interventions that were specifically designed for the cultural groups they were intended to serve were four times as effective as interventions that were implemented with individuals from a variety of cultural groups. Additionally, they found that interventions that were conducted in the client’s native language, if other than English, were twice as effective as those conducted in English. For us, it is not an either/or discussion, but a both/and. We ultimately need to know what works best and for whom, but in keeping in sync with our proposed paradigm shift, we also need to employ an expanded perspective in our efforts to push the limits of narrowly defined practice standards. Moreover, Norcross (2002) found that empirically supported treatments fail to include the therapist as a person, the therapeutic relationship, and the client’s nondiagnostic characteristics. He further noted that the following therapeutic factors account for variance in therapeutic outcome (the percentages of variance are in parentheses): treatment method (8%), individual therapist (7%), the therapy relationship (10%), patient contributions (25%), interaction (5%), and unexplained variance (45%). Also, a recent study examined the effects of cognitive-behavioral therapy (CBT) and person-centered therapy (PCT) in the treatment of posttraumatic stress disorder (PTSD) (McDonagh et al., 2005). The researchers specifically left out the “specific ingredient” thought to be essential for the treatment of PTSD from a cognitive-behavioral perspective— exposure—when implementing the PCT. They found that while both treatments were well received by patients, significantly fewer dropped out of the PCT than the CBT group, and the benefit to the patients was comparable in both treatment groups. This study further underscores the significance of expanding our perspective of what is good “evidence.” This study also highlights the centrality of common factors in the therapeutic context.

Expanding Our Role

There have been several studies that have examined factors common to all healing approaches (Fischer, Jome, & Atkinson, 1998; Frank, 1961; Frank & Frank, 1991). From this body of work, Fischer et al. found support for four “universal healing conditions” that exist in all cultures: (1) The therapeutic relationship serves as a basis for all therapeutic intervention; (2) a shared worldview or conceptual schema or rationale for explaining symptoms provides the common framework within which the healer and client work together; (3) the client has faith or hope in the process of healing; and (4) the therapeutic ritual or intervention is in the form of a procedure that requires the active participation of both the client and the therapist, and the procedure is believed by both to be the means of restoring the client’s health. It is our belief that work with ethnocultural communities must focus on the four universal healing conditions, while incorporating any research evidence on the client’s culture, context, and presenting concern, within the context of the therapist’s clinical expertise and cultural knowledge.

This reexamination of practice with ethnocultural communities also calls for an expansion of our roles as service providers. The importance of shifting from one-on-one counseling to becoming cultural brokers (Stone, 2005), or social advocates (Parham, White, & Ajamu, 1999; D. W. Sue & Sue, 2003; White & ...

Table of contents

• Cover Page
• Dedication
• Title Page
• Copyright
• Contents
• Acknowledgments
• Foreword
• 1. Understanding the Skills Identification Stage Model in Context
• Part I. African-Centered Applications of the Sism
• Part II. Socioculturally Specific Therapeutic Skills for Latinas/Os: Expanding Our Evidence-Based Practice Perspectives
• Part III. Culturally Adapted Counseling Skills for Asian Americans and Pacific Islanders
• Part IV. North American Indian and Alaska Native Communities: Moving Beyond the Surface Level
• Part V. Middle Eastern Americans: Challenging Misperceptions and Widening the Lens
• Part VI. Where Do We Go From Here? Education, Training, Practice, and Research Implications
• Afterword: On Sending a Wolf of Color Out Into a Socially Unjust World
• Index
• About the Editors
• About the Contributors