Principles of Multicultural Counseling and Therapy

Uwe P. Gielen, Juris G. Draguns, Jefferson M. Fish, Uwe P. Gielen, Juris G. Draguns, Jefferson M. Fish

• Publisher: Routledge
• Year: 2008
• eBook ISBN: 9781135594244
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In an era of globalization characterized by widespread migration and cultural contacts, psychologists, counselors, and other mental health professionals face a unique challenge: how does one practice successfully when working with clients from so many different backgrounds? Gielen, Draguns, and Fish argue that an understanding of the general principles of multicultural counseling is of great importance to all practitioners. The lack of this knowledge can have several negative consequences during therapy, including differences in expectations between counselor and client, misdiagnosis of the client's concerns, missed non-verbal cues, and the client feeling that she has been misunderstood. This volume focuses on the general nature of cultural influences in counseling rather than on counseling specific ethnic groups. Counseling practices from all over the world, not just those of Western society, are explored. Bringing together the work of a diverse group of international experts, the editors have compiled a volume that is not only concise and teachable, but also an essential guidebook for all mental-health professionals.

1

Principles of Multicultural
Counseling and Therapy

An Introduction

Uwe P. Gielen, Juris G. Draguns,
Jefferson M. Fish

Contents

The Concept of Culture

Ethnic, Racial, Religious, and Gender Identities in a Multicultural World

Some Basic Ingredients of Therapy, Counseling, and Healing

Ecological and Ethical Perspectives on Counseling and Healing

Healers, Therapists, and Counselors

Shamans and Other Traditional Healers

Therapists and Counselors

Multicultural Counseling and Therapy Situations

Organization and Contents of This Book

Concluding Remarks

References

Suggested Readings

Culture hides much more than it reveals and strangely enough what it hides, it hides most effectively from its own participants. Years of study have convinced me that the real job is not to understand foreign cultures but to understand our own.

—Edward T. Hall, The Silent Language

Providing advice and guidance to the confused and perplexed, supporting sufferers emotionally, socially, and spiritually, and attempting to heal those broken in spirit, mind, and body have been human endeavors for thousands of years. Over the years, a broad variety of healers and counselors such as shamans, medicine men and women, medical doctors, herbalists, priests, priestesses, monks, nuns, father confessors, exorcists, mesmerists, phrenologists, faith healers, diviners, astrologers, and, more recently, psychologists, psychiatrists, social workers, counselors, and psychotherapists have offered their services to those in need of help. In past times, healers and sufferers frequently shared a common worldview that helped to support joint expectations about the nature of their bond, the meaningfulness of the healing and counseling efforts, and the means and ultimate goals of their efforts. Today, however, this is less and less the case.

Because many modern societies are steadily becoming more diverse, multicultural, and complex in nature, they are in need of counselors, psychotherapists, social workers, and healers who are able to interact effectively with clients from a broad variety of cultural, ethnic, social, political, and religious backgrounds. Today’s mental health specialists are frequently asked to counsel members of various subcultures and minority groups, immigrants, refugees, foreign students, ever more diverse members of “the” majority culture, and bicultural/multicultural persons who may bring to the therapeutic encounter a bewildering variety of life experiences and cultural beliefs that at times diverge sharply from those of the therapist.

This situation requires a special type of “psychocultural mobility” from mental health specialists who not only must be able to think in terms of a variety of cognitive, sociocultural, and theoretical perspectives but also must acquire the ability to decide which perspective is most appropriate for which situation. Self-knowledge as well as knowledge of other cultures, a positive attitude toward new experiences, multilinguistic skills, and the ability to perceive general human problems and dilemmas beneath the seemingly exotic cultural garb of some of one’s clients are all characteristic of a good multicultural counselor-therapist. These abilities should be accompanied by feelings of compassion with underdogs and the lonely, anxious, unhappy, angry, and confused, as well as the ability to communicate with, and put at ease, clients with different physical characteristics, personalities, belief systems, and life experiences. A good multicultural therapist is mentally flexible, eschews ethnocentric beliefs in the unique superiority of his or her culture, religion, and lifestyle, is able to see his or her culture(s) “in (multi)perspective,” senses some of the client’s unvoiced expectations and hesitations, and both experiences and displays warmth and care toward a broad range of people. In short, the therapist should be able to embrace the old adage “Nothing human is foreign to me,” although, in truth, nobody can fully live up to the ideal implied in this saying.

Given these complex demands, our book is designed to familiarize mental health professionals and their students with recent social scientific thinking on the role of culture in the broader context of therapeutic and counseling interventions. Furthermore, because globalization is a pervasive tendency of our times, we believe that a global perspective that considers American minority groups as well as international cultural currents will prove most helpful in practicing multicultural therapy and counseling. Of course, reading books cannot replace a counselor’s actual immersion in foreign cultures and languages, but it can sensitize her or him and expand her or his cultural horizon. After all, few Western counselors and therapists will ever observe the manifestations of despair of an alienated young Salish Indian in Canada or the complex experiences of educated, modern women walking behind a veil through the streets of Kuwait City. Reading this book cannot replace actual experience, but it can provide a reflective introduction to a broad range of human situations and therapeutic encounters.

The Concept of Culture

In the modern social sciences, the concept of culture has frequently been used as a master term to refer to that part of the environment that has been created by humans. Culture is simultaneously physical, behavioral, and mental in nature, and it exists both outside and inside of us. In the words of the anthropologists Kroeber and Kluckhohn (1952),

Culture consists of patterns, explicit and implicit, of and for behavior acquired and transmitted by symbols, constituting the distinctive achievement of human groups, including their embodiments in artifacts; the essential core of culture consists of traditional ideas and especially their attached values; culture systems may, on the one hand, be considered as products of action, on the other as conditioning elements of further action. (p. 181)

Cultures are composed of complex, functional yet at times contradictory systems made up of socially patterned expectations; coordinated social roles; scripted action sequences; historical, explanatory, and emotionally pleasing narratives; verbal and nonverbal communication systems; and shared values, norms, attitudes, images, metaphors, and goals. Taken together, they help the members of a society to solve the problems associated with living and, more generally, to survive. Thus, healing systems have evolved everywhere in order to help individuals deal with physical and emotional distress in the service of adaptation and survival. As Sussman points out in this volume, a number of shared components can be discerned in healing and medical systems around the world, despite the great diversity of specific medical beliefs and practices found throughout the world. The components include illness classification systems, etiological beliefs, treatment practices, expectations about illnesses and treatment outcomes, designated healing specialists, norms regarding treatment seeking and illness management, and norms regarding consultations with healing specialists. This list can be expanded to include healing systems that deal with individuals who may be physically sick, mentally-behaviorally “sick,” or spiritually “sick” or who present some combination of these complaints. In modern societies, mental health systems have partially diverged from medical systems, although many parallels and much overlap exist between them.

Sussman’s chapter also reminds us that anthropologists have discussed the concept of culture for a much longer time period than psychologists have. Anthropologists tend to endorse more complex and cross-culturally informed conceptions of culture than many therapists and counselors who have only during the last few decades begun to critically examine the pervasive impact of culture upon their professional activities. Consequently, it behooves mental health specialists to learn from cultural and medical anthropologists in order to form a broader perspective and reduce the danger of professional tunnel vision (see also the two chapters by Fish in this regard).

It is important to point out that especially in modern multicultural societies, individuals internalize only selected aspects of the culture(s) that surrounds them. Furthermore, individuals may be members of several cultures and subcultures at once. A Chinese American student born in New York City, for instance, may speak Cantonese with her parents, English with her teachers, and Cantonese or Mandarin “Chinese-English” with some of her friends although she may be able to recognize only a few Chinese characters. She may have internalized some aspects of Chinese beliefs about the importance of hsiao or “filial piety” (felt obligations toward her parents) yet may also endorse seemingly contradictory beliefs about the desirability of behavioral and emotional autonomy as an adolescent. The latter would probably reflect the combined influences of many of her peers, the mass media, and even her developmental psychology textbook. She may resent some of the external and internal pressures that come with being a member of a high-achieving “model minority” yet be secretly proud of it. Perhaps she deeply appreciates her Chinese heritage yet rejects various aspects of it as old-fashioned, unjust, outdated, or just plain irrelevant. In a similar vein, she may have internalized—whether consciously or not—many aspects of American mainstream culture but object to others. Should she choose to enter therapy, it is likely that her bicultural identity and her complex feelings about it will become an important focus of discussion. After all, there is nothing simple about a bicultural identity such as hers, which can be simultaneously puzzling, enriching, constraining, and liberating.

It is likely that a bicultural Chinese counselor-therapist would intuitively recognize some of these complexities and ambivalent feelings but that a monocultural, non—East Asian mental health specialist would find it difficult to fully enter her frame of mind. Multicultural counseling and t herapy are not for the faint of heart: They demand all the skills and emotional requirements inherent in the mental health professions, plus an additional layer of complexities having to do with highly diverse cultural expectations, experiences, modes of communication, and ways of being-in-the-world.

The notion of “internalized culture” underlines that individuals are not carbon copies of their surrounding society. While they are pervasively influenced by it, their personalities, behavioral patterns, thoughts, emotions, and identities reflect simultaneously biological, psychological, and sociocultural influences (Hirsch, this volume). Many individuals, moreover, will believe that supernatural beings and forces rather than the visible members of their group have created and/or are in charge of their bodies, minds, and souls (e.g., Jilek & Draguns; Sussman, both in this volume). Others will display physical symptoms that have an underlying physical substratum yet hold a symbolic significance.

As the quote by Edward Hall at the beginning of this chapter indicates, culture does much of its work outside of our sphere of awareness. We are most likely to become aware of our cultural assumptions when they are violated or when we are plunged into cultural settings different from those that we are used to. Cultural awareness thrives on cultural comparisons and emotion-provoking contradictions. However, the rich variety of existing cultural norms throughout the world does not obligate us to accept cultural relativism in its entirety (Kuriansky, this volume; Tanaka-Matsumi, this volume). In counseling situations, for instance, counselor and client may share many perspectives and beliefs, yet their encounter may still be derailed by seemingly small differences in behavioral expectations. There is wisdom in the remark of the proverbial Vermont farmer who announced, “People is mostly alike, but what differences there is, is mighty important.”

Social scientists discussing the cross-cultural variability of human behavior have adopted a variety of theoretical positions. Cultural relativists such as Fish (this volume) emphasize that an enormous variety of beliefs and behavior can be observed across societies. In contrast, universalists are more concerned with discovering similar psychological processes beneath the rich tapestry of culturally patterned behavior. Psychoanalytic scholars such as Rubin (this volume) postulate that certain personality patterns, ego-defense mechanisms, thought processes, and basic motives can be found around the world. In this volume, both relativists and universalists are given a voice in order to fully represent the range of positions regarding this central issue. In other words, contributors to this volume deal with both the universal psychological processes that purportedly underlie forms of intervention that appear quite different and some of the more culture-specific manifestations of healing and counseling.

Other cross-cultural researchers have focused on a number of value dimensions along which cultures and subcultures can be ordered. These include Hofstede’s five value dimensions (see Draguns, this volume) as well as the important “context dimension” that distinguishes between the poles of high-context cultures (e.g., traditional Japanese small-town culture) and low-context cultures (e.g., modern American culture, especially within or around metropolitan urban centers).

Members of low-context cultures are taught to communicate their thoughts and emotions explicitly and to believe in general principles that can be used to create meaning and order in the sociomoral fabric of society (e.g., liberty, justice, and the pursuit of happiness). In contrast, communication in high-context cultures tends to be indirect, implicit, context-dependent, unspoken, and nonverbal. Such communication patterns are especially likely to occur in relatively homogeneous and collectivistic cultures in which tacit understandings are widely shared. As modern cultures become more heterogeneous in terms of ethnicity and lifestyle, high-context communication patterns become more dysfunctional and are difficult to sustain. This holds especially true when members of different subcultures attempt to convey intricate emotional meanings and subtle social expectations to each other.

The distinction between low-context and high-context cultures frequently proves important for understanding certain cross-cultural misunderstandings in counseling/therapeutic situations. Therapists and counselors from a low-context cultural background, for instance, may find it difficult to “read” clients who matured in a high-context culture. They want their clients to spell out what bothers them so that they can jointly get down to work. The clients, however, may expect that a good counselor “doesn’t need to be told,” that she/he should be empathic and thus able to understand the client’s feelings and expectations through a kind of emotional osmosis. They may think: If she is unable to understand my unspoken meanings and messages, why does she call herself a therapist? In such situations, both therapist and client will easily feel disappointed without being fully aware of the cultural origins of their frustration. Premature termination of therapy by the client is not an uncommon outcome in such situations.

Ethnic, Racial, Religious, and Gender
Identities in a Multicultural World

It has been said that every person is in some ways like all other persons (shared human nature), in some ways like some other persons (shared group characteristics), and in some ways like no other person (a unique individual; Kluckhohn, Murray, & Schneider, 1953). By way of analogy, we may postulate that a person’s subjective identity includes the person’s awareness that she/he is like all (or almost all) others (“I am a human being with human perceptions, thoughts, and feelings rather than an animal, plant, lifeless object, ghost, or demon”), like some others (“I am a married Mayan woman and housewife, different from the racially and culturally mixed Ladinos, a Mayan-speaking rather than Spanish-speaking minority group member, and an inhabitant of Guatemala”), and like no others (“I am a unique person with a specific name and a self inhabiting a unique body”). The special emphasis of this volume is on various culturally shaped group identities together with the associations, thoughts, images, linguistic markers, historical narratives, and feelings that persons associate with their ethnic, racial, religious, and political identities. Especially in collectivistic societies, such group identities form the very core of a person’s subjective and symbolic location in time and sociocultural space.

Cultures offer their members a variety of identities that at times are mandatory and at times optional. Thus, gender identities are usually mandatory, although persons of the same biological sex are allowed to fill these identities out with somewhat different content. Similarly, racial identities in America were until recently considered immutable and unavoidable: “One drop of black blood” automatically turned a person into a Negro and thus a severely disadvantaged person who, furthermore, was thought by most Whites to have certain (predominantly unfavorable) mental and behavioral characteristics. In contrast, in Brazil, people have adopted more than 100 labels for persons of different “racial” visible (biological) makeup (Fish, this volume). Thus, racial identities are socially constructed, vary in complex ways across cultural boundaries, are generally based on misleading biological theories, and are frequently embedded in sociocultural and socioeconomic hierarchies from which individuals cannot easily escape.

The advent of modern forms of cultural pluralism in Canada, Australia, South Africa, the United States, and parts of western Europe has softened or altered the outlines of some identities, making them more malleable, negotiable, and at times even optional. Ethnic identities in particular have been redefined in a variety of ways in the United States and elsewhere. Where...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Series Foreword
• Preface
• Acknowledgments
• 1 Principles of Multicultural Counseling and Therapy
• Part I
• Part II
• Part III
• Part IV
• Part V
• About the Editors
• About the Contributors
• Author Index
• Subject Index