Cross Cultural Awareness and Social Justice in Counseling

Cyrus Marcellus Ellis, Jon Carlson

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780415954525
• eBook ISBN: 9781135918699
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Many societal and cultural changes have taken place over the past several decades, almost all of which have had a significant effect on the mental health professions. Clinicians find themselves encountering clients from highly diverse backgrounds more and more often, increasing the need for a knowledge of cross-cultural competencies. Ellis and Carlson have brought together some of the leaders in the field of multicultural counseling to create a text for mental health professionals that not only addresses diversity but also emphasizes the counselor's role as an advocate of social justice. The theoretical foundation for this book rests on research into diversity, spirituality, religion, and color-specific issues. Each chapter addresses the unique needs and relevant issues in working with a specific population, such as women, men, African Americans, Asian Americans, Spanish-speaking clients, North America's indigenous people, members of the LGBT community, new citizens, and the poor, underserved, and underrepresented. Issues that enter into the counselor-patient relationship are discussed in detail for all of these groups, with the hope that this will lead to a greater understanding and sensitivity on the part of the counselor for their patients. This is an important and timely book for both counselors-in-training and those already established as professionals in today's highly diverse and constantly-changing society.

1

COUNSELING FROM A CROSS-CULTURAL AND SOCIAL JUSTICE POSTURE

Rebecca L. Toporek

Paul, a counselor in a university counseling center, disclosed to his colleague that he was having trouble understanding and maintaining empathy for one of his clients. He was concerned because in the past he had looked to clinical issues to explain a lack of connection and typically understood these impasses to be due to unresolved issues of the client. But this time, that strategy didn't seem to work. After some discussion, Paul's colleague recommended that he review his case notes from the past couple of years to identify cases in which Paul experienced a lack of connection with the client or where clients seemed to have left counseling prematurely. After doing this, Paul was disturbed to discover that there did seem to be a pattern across clients that included difficulty empathizing with clients of a particular ethnic background. His notes also indicated that he felt that many of these clients were not taking responsibility for their own distress and instead blamed external sources. Although this was not true in all cases, the pattern was striking and these clients typically did not continue in counseling. He was unsure how to interpret this and what to do.

The Multicultural Counseling Competencies (Sue, Arredondo, & McDavis, 1992) and the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (American Psychological Association [APA], 2002), hereafter referred to as the Multicultural Guidelines, were designed to help counselors, psychologists, and trainees examine their ability to provide services equitably and competently to their clients. These documents offer structures that address multiple areas such as awareness, knowledge, and skill regarding cultural issues, attitudes, and beliefs and interventions.

Since the early 1900s, individual counselors, psychologists, and consumers have raised concerns about the adequacy of mental health provision for individuals who differed from the dominant culture (see Guthrie, 1978; Hall, 1997; Jackson, 1995; Katz, 1985; S. Sue, 1977; Wade, 1993). However, formal recognition of the need to attend to the place of culture in health, wellness, and psychological service has been a decades-long, almost century-long, process. This chapter will provide a historical context for the development of the Multicultural Competencies (D. W. Sue et al., 1992) and the Multicultural Guidelines (APA, 2002). One important aspect of these documents is the attention to sociopolitical and contextual barriers to well-being. Recently, another set of competencies, the American Counseling Association Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002), acknowledge that systemic and institutional barriers (for example, racism, sexism, heterosexism, ableism, poverty, etc.) influence clients' well-being and provide clearer guidance regarding counselors' roles that extend beyond intrapsychic interventions to address client concerns at a more systemic level. Because the ACA Advocacy Competencies extend this important aspect of the Multicultural Competencies, I will include a brief discussion of these. Paul's situation can then be revisited in light of the Competencies and Guidelines, along with recommended self-assessment questions and activities.

WHAT IS COMPETENCE?

Before embarking on an exploration of multicultural competencies, multicultural guidelines, and advocacy competencies, professional counselors need to consider the term competence to help establish some parameters for this discussion. "Competence is a set of skills or attributes that allow one to effectively intervene on the demands of a particular situation or circumstance" (Daniels & Pack-Brown, 2006, p. 5). This general definition reflects the spirit of efforts to identify specific multicultural competencies. Recognizing the complexity and expanse of cultural information and awareness, Parham (2004) suggested a three-tiered competence framework that describes varying levels of competence beginning at a pre-competent level, moving to a competent level, and then a proficient level. In this framework, he described pre-competent as a professional who is aware that competence is important but does not have the skills to implement this cultural awareness, knowledge, and skill in practice. Competent professionals demonstrate skills to effectively intervene in culturally appropriate ways in a particular circumstance. Parham further suggested that professionals who demonstrate a more stable set of skills, awareness, and knowledge consistently over time and circumstances could be considered proficient. Although research has not specifically investigated the implementation of this three-tiered framework for multicultural competence, the recognition that professionals may be at varying levels with respect to competence is useful for considering competence as an ongoing journey.

The metaphor of a journey reflects the nature of professional development. "There can be little doubt that even the best present education and training will become obsolete within a relatively short period of time, unless the psychologist makes a very determined effort to refurbish and to expand his [sic] professional base of knowledge and technique" (Lewinsohn & Pearlman, 1972, p. 48). This classic statement reflects the contemporary need for intentional continuous development of one's knowledge and skills generally. Similarly, an assumption of the Multicultural Competencies (D. W. Sue et al., 1992) and the Multicultural Guidelines (APA, 2002) is that initial training provides a foundation for practice but that the professional must pursue ongoing development. This is particularly true given the breadth of cultural backgrounds presented by clients, the dynamic nature of cultural information, and the influence of historical events on the experience of individuals and communities. Given these definitions and assumptions of competence as a global construct, i'd like to turn the focus more specifically to the concept of cultural competence.

WHAT IS CULTURAL COMPETENCE?

Cultural competence has been defined in numerous ways with most definitions including some element of cultural knowledge as well as self-awareness. D. W. Sue and D. Sue (2003) described the following three characteristics of a culturally competent counselor. First, a culturally skilled counselor actively works toward increasing her or his awareness regarding her or his cultural assumptions, values, and biases. Second, a culturally skilled counselor works toward understanding the client's worldview without negative judgments, has relevant culture-specific knowledge, and understands that culture is complex and dynamic. Third, a culturally skilled counselor actively works toward appropriate, relevant, and sensitive intervention strategies and skills. It is important to note that the language of this definition affirms that the process of becoming culturally competent requires that counselors continuously reflect on their own perspectives and limitations as well as the need for ongoing growth.

Addressing cultural competence from a slightly different perspective, S. Sue (1998) defined cultural competence as "the belief that people should not only appreciate and recognize other cultural groups but also be able to work effectively with them" (p. 440). He asserted that there are three characteristics of cultural competency: (a) being scientifically minded, (b) having skills in dynamic sizing, and (c) culture-specific expertise. Scientific mindedness, according to S. Sue, is demonstrated by therapists who form hypotheses using cultural and individual information, develop creative ways to test their hypotheses, and then appropriately act based on the information they have gathered. Dynamic sizing refers to the skills necessary for distinguishing when it is appropriate to generalize learned cultural information and when individual factors may be more relevant. In addition, dynamic sizing also refers to the ability to determine when to generalize from one's own experience and how to do it appropriately. Culture-specific expertise includes such knowledge as cultural practices and values, immigration trends, family roles and expectations, and help-seeking norms, as well as culturally relevant interventions. It is not assumed that counselors and psychologists would be experts in all cultural backgrounds, but that they consider this knowledge as relevant to their clients and know enough to determine when cultural expertise is needed. For example, if the practitioner is working with clientele that is largely represented by a particular ethnic group, they have a responsibility to gain culture-specific knowledge that is relevant for that group. These definitions are generally representative and as such have been shaped throughout the developmental process of the field of multicultural counseling. Having a sense of this history and the growing pains associated with transformation is important in order to gain a sense of how complex and protracted this evolutionary process has been. The development toward a cultural competent profession is far from complete, yet important progress has been made.

THE NEED FOR MULTICULTURAL COMPETENCIES AND THE TRANSFORMATION OF ORGANIZATIONS

Comprehending the history of the Multicultural Competencies (D. W. Sue et al., 1992) and the Multicultural Guidelines (APA, 2002) involves understanding the growth of the professional literature that identified the need for such documents as well as recognizing the evolution of professional organizations and their response to diversity and cultural competence. Beginning as early as 1932, Sanchez (as cited in Kiselica & Robinson, 2001) raised concerns regarding the use of general psychological theories and tools with diverse populations. Some of the criticisms of traditional counseling theories and practices have been that they define concepts such as health and normalcy in terms of the dominant culture and that they serve to maintain the dominant power structures (D. W. Sue & D. Sue, 2003); that they do not address concerns adequately enough to be relevant to changing communities (Hall, 1997); and that general counseling theories and tools are not sufficient to understand the complexities and significance of a person's experience given their cultural context (Pedersen, 1997). In addition, researchers and advocates have also discussed the role of bias in counseling and mental health diagnosis and treatment (Atkinson et al., 1996; Burkard & Knox, 2004; Constantine & Gushue, 2003; Lott, 2002; Rosenthal, 2004; Schnitzer, 1996; Whaley, 1998).

By 1999, a sufficient body of empirical literature regarding the importance of culture in health and well-being had been accumulated to bring this issue to the attention of the united States surgeon general and was summarized in that office's 1999 report:

More often, culture bears on whether people even seek help in the first place, what types of help they seek, what types of coping styles and social supports they have, and how much stigma they attach to mental illness. Culture also influences the meanings that people impart to their illness. Consumers of mental health services, whose cultures vary both between and within groups, naturally carry this diversity directly to the service setting.... What becomes clear is that culture and social contexts, while not the only determinants, shape the mental health of minorities and alter the types of mental health services they use. Cultural misunderstandings between patient and clinician, clinician bias, and the fragmentation of mental health services deter minorities from accessing and utilizing care and prevent them from receiving appropriate care. (U.S. Department of Health and Human Services, 1999, chap. 2)

Although the professional literature continued to highlight these issues, advocacy for change made slow inroads into professional organizations. Initial organizational changes paralleled the civil rights movement and reflected increased inclusion of diverse members. With greater representation of diversity came greater advocacy for the recognition of culture as an important part of counseling and psychology. In 1972, the Association of Non-White Concerns in Personnel and Guidance (now the Association of Multicultural Counseling and Development [AMCD]) was created as a division of the American Counseling Association (ACA, then known as the American Personnel and Guidance Association) to address the needs of culturally diverse groups and individuals. Within the American Psychological Association (APA) the Office of Ethnic Minority Affairs (OEMA) was established in 1979 as a demonstration of a commitment within APA resources for efforts related to ethnic minority issues and concerns. In the mid-1980s, the Society for the Psychological Study of Ethnic Minority Issues (Division 45 of APA) was created. The establishment of these organizations was an essential step in recognizing the critical influence of culture in counseling and psychology, and acknowledging the need for specific attention and advocacy for these issues and populations. In addition, these organizations provided support and coordination for researching and articulating how culture could be addressed in counseling more appropriately.

MULTICULTURAL COMPETENCIES

The Multicultural Counseling Competencies (D. W. Sue et al., 1992) grew out of decades of research regarding the need for cultural sensitivity, culturally appropriate interventions, bias, and inappropriate service. They were designed to provide a standard for curriculum and training of counselors and other helping professionals as well as to facilitate culturally relevant services across a wide range of culturally diverse groups.

The eventual ACA endorsement of the Multicultural Competencies (D. W. Sue et al., 1992) in 2002 was preceded by a long and arduous journey illustrating the influence of evolution and advocacy. In 1981, Allen Ivey, the president of APA's Society of Counseling Psychology (Division 17) charged its Professional Standards Committee with the task of identifying issues related to cross-cultural counseling. As a result of this work, in 1982, D. W. Sue and colleagues published a call to the profession asserting the need for a change in the way services were provided and the way that competence was conceptualized within the counseling profession. In this call, they identified the need to recognize the relevance of culture in clients' lives and counseling concerns. Further, they asserted that in order to function effectively as a counselor, the professional needs to understand the biases, values, and assumptions that she or he brings into counseling. This report clearly asserted the need for change as well as a specific set of recommendations for improved service; however, little organization action was taken for close to 10 years.

Then, in 1991, the president of AMCD, Thomas Parham, commissioned its Professional Standards Committee to review and revise the competencies proposed by D. W. Sue et al. (1982) integrating research, practice, and input from multicultural professionals (Arredondo & Perez, 2006). The resulting document outlined 31 multicultural counseling competencies, including three dimensions: counselor awareness of own attitudes and beliefs, counselor understanding of the client's worldview, and culturally relevant interventions. Within each of these domains, D. W. Sue and his colleagues (1992) identified the need for awareness, knowledge, and skill. The resulting document strongly encouraged the American Counseling Association (then known as the American Association for Counseling and Development). In 1992, the Multicultural Counseling Competencies were published in ACA's Journal of Counseling and Development (Sue, Arredondo, & McDavis, 1992).

Even after the second proposal of the Multicultural Competencies in 1992, the necessary support for endorsement was not present in the ACA governance structure. Four years later, in response to claims that the competencies needed to be more specific and concrete before they could be considered for adoption, the Professional Standards Committee of AMCD convene...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Acknowledgments
• Editors
• Contributors
• 1 Counseling from a Cross-Cultural and Social Justice Posture
• 2 The Helping Professional as an Advocate
• 3 Developing a Diverse Counseling Posture
• 4 Counseling with Women
• 5 Counseling with Men
• 6 Counseling with African Americans
• 7 Counseling with Asian Americans
• 8 Counseling with Spanish-Speaking Clients
• 9 Counseling with North America’s Indigenous People
• 10 Counseling with Gay, Lesbian, Bisexual, and Transgender People
• 11 Counseling with New Citizens
• 12 Counseling with the Poor, Underserved, and Underrepresented
• 13 The Next Step
• Appendix: Resources
• Index