John A. “Jay” Mills, PhD, ABPP

John A. “Jay” Mills, PhD, ABPP
Positive Multiculturalism as Aspirational Ethical Practice: Therapeutic Applications Molly Haas Cowan, PsyD Jeanne M. Slattery, PhD John A. “Jay” Mills, PhD, ABPP

Ground Rules (Ervin, 2014) Be respectful/mindful of others
Self-reflect and become aware of your personal reactions Know your limits and boundaries, disclosing only what is okay for you Sit with tough emotions How do you know when you are feeling defensive? It’s not the emotional response but what you do with it that matters.

Ground Rules (Ervin, 2014) Listen to others' perspectives and ideas even when you disagree Be open to giving and receiving corrective feedback Don't shut others down—and be aware when you feel shut down Remember: You have the right to “screw up” in an attempt to understand yourself, your reactions, and the larger world You have the right to "let it be"

We promise to… (Ervin, 2014) Challenge you Encourage critical thinking
Push buttons and play “devil's advocate” to encourage multicultural competence Provide a safe place to do these things Our overriding assumptions: We've all internalized “isms.” To work effectively in this field we need to explore, deconstruct, and challenge our personal “isms” There are many ways to learn about “isms”

Our Goals Use General Ethical Principles and guild-specific Code of Ethics to guide a multicultural practice; Describe a positive multicultural approach, as well as reasons for paying attention to multicultural issues; Recognize barriers to developing multicultural competency; and Identify strategies for teaching and supervising therapy trainees to apply accepted professional principles in determining how multiculturalism is a part of practice and/or an impediment to optimal practice.

Positive Multiculturalism
Good Practice Positive Multiculturalism Ethical Practice

Aspirational principles of ethics code (APA, 2010)
Beneficence and nonmaleficence Fidelity and responsibility Integrity Justice Respect for people's rights and dignity

Guidelines on multicultural education, training, research, practice, and organizational change (APA, 2002) Guideline #1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves. Guideline #2: Psychologists are encouraged to recognize the importance of multicultural sensitivity/responsiveness, knowledge, and understanding about ethnically and racially different individuals. Guideline #5: Psychologists strive to apply culturally-appropriate skills in clinical and other applied psychological practices. American Psychological Association. (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Retrieved from

Why is it difficult to see the role of race and culture
Why is it difficult to see the role of race and culture? What barriers are there? Empathy for one party is always prejudice against another.– United States Senator Jeff Sessions (R-Ala), July 13, 2009 (cited in Norton & Sommers, 2011) Today the nation is no longer divided along [racial] lines, yet the Voting Rights Act continues to treat it as if it were. –John Roberts (6/2013)

Perceived racism (Norton & Sommers, 2011)
Blacks continue to indicate drastically poorer outcomes for Black than White Americans: "from employment to police treatment, loan rates to education," yet… Norton, M. I, & Sommers, S. R. (2011). Whites see racism as a zero-sum game that they are losing. Perspectives on Psychological Science, 6(3), 215–218. we asked a large national sample of Black and White Americans (N +417; Mage = 50.3, SD 1/4 13.6; 57% Female; 209 White, 208 Black) to use a 10-point scale (1 =not at all; 10=very much) to indicate the extent to which they felt both Blacks and Whites were the target of discrimination in each decade from the 1950s to the 2000s.1 Sommers, S. R., & Norton, M. I. (2006). Lay theories about white racists: what constitutes racism (and what doesn't). Group Processes and Intergroup Relations, 9,

Perhaps this reflects perception as a zero sum game (Norton & Sommers, 2011)
Norton, M. I, & Sommers, S. R. (2011). Whites see racism as a zero-sum game that they are losing. Perspectives on Psychological Science 6(3), 215–218. "Perhaps the most problematic implication of these studies for intergroup relations is that those people who are most likely to think racist thoughts or commit racist acts are also the people least likely to see these attitudes and actions as racist…Those people who behave in racists way do not consider those acts to be biased, then attempts at sensitivity training or other prejudice reduction efforts become more difficult. How can individuals learn to avoid discrimination if they are unable or unwilling to recognize it in their own behavior? How can two people-- or groups of people-- discuss and resolve accusations of racisms if they have drastically different ideas of what racism is?" p. 134

Seeing multicultural ideas can be difficult
Identify situation and assimilate to worldview—unless forced to accommodate.

Some definitions: Role of culture
Race/ethnicity/gender/class/religion/sexual orientation, etc. influence: preferences, values, habits, goals, etc. how we are seen how we see others experiences of oppression and privilege

Some definitions: Multiple identities (Slattery & Park, 2011)
Slattery, J. M., & Park, C. L. (2011). Empathic counseling: Meaning, context, ethics, and skill. Pacific Grove, CA: Brooks/Cole.

What do we see as racism? (Sommers & Norton, 2006)
Discomfort/unfamiliarity (e.g., is uncomfortable around Blacks; doesn't socialize regularly with Blacks) Overt racism (e.g., discourages kids from playing with Blacks; thinks Blacks are not suited for certain professions) Denial of problem (e.g., thinks slavery was so long ago it is unimportant to talk about; doesn't speak up or act when someone else is racist) People of Color are more likely to identify subtle forms of bias as racism White observers often respond to allegations of subtle bias with skepticism or questions about ulterior motives Sommers, S. R., & Norton, M. I. (2006). Lay theories about white racists: what constitutes racism (and what doesn't). Group Processes and Intergroup Relations, 9,

Microaggressions (Sue et al., 2007)
Using racist epithets and offensive language, making racist jokes Making unwarranted assumptions about a person’s behavior or background because of skin color Silencing racial minorities by dominating work or classroom discussions or frequently interrupting them Treating a person as a representative of an entire group solely because of skin color Dismissing claims of racism Giving subtle preference to people who share your racial background or skin color

Barriers to acknowledging racism?
Attitudes are the result of personal experience Perceive self as an expert Expect a favorable outcome from status quo Attitudes are repeatedly expressed Stand to win—or lose—something due to the issue

Barriers to change? Anger/discomfort Shame about making mistakes
May need to acknowledge/give up privilege Lack of knowledge and self-assessed expertise Questions about what should be addressed (and how)

White racial identity (Slattery & Park, 2011)
Contact Disintegration Reintegration Pseudo-independence Independence During the contact phase, Euro Americans are unaware that race has an impact; when they do see the impact of race, they only see it superficially. Euro Americans in disintegration, like People of Color in dissonance, begin to discover that life is unfair, but are unable to make sense of apparently incompatible ideals (e.g., evidence of discrimination with ideals of fairness, honesty, and justice). During reintegration, Euro Americans have resolved this struggle, at least for a while, idealizing their own group while denigrating others. Often this requires selectively perceiving or distorting information (e.g., concluding “that is just the way life is”). These explanations and distortions help resolve the anxiety associated with recognizing injustice. Euro Americans begin to see both Euro Americans and People of Color as varying in “goodness” during pseudo-independence, although they fail to recognize either the privileged positions they hold or the oppressive factors that impact People of Color. They are unable to recognize that Euro Americans have some responsibility for race-related problems and their solution. Positive evaluations depend on a single (Euro American) standard of merit rather than a multiplicity of values. During independence, Euro Americans are increasingly able to recognize racism, think flexibly about their own and other races, and see other people subjectively and as varying rather than as objects in dichotomous categories. They recognize both oppression and privilege and, although they may not become activists, avoid oppressive acts.

What would you do?

Problem with self-reports (Banaji & Greenwald, 2013)
White lies How are you? Do I look fat in these? Gray lies Can you spare a dollar? Is Ms. X at home? Colorless lies How may cigarettes do you smoke a day? Red lies I love you. Blue lies Did you go to church this week? White lies—protect others Gray lies—protect self (to a greater degree than others) Colorless lies—May be unaware of these lies (e.g, that's why we ask people to monitor their pain) Red lies—Promote survival (false claims of wealth or flattery can also do this) Blue lies—as I think it should be (I didn't go to church, but I usually do or I meant to or I know I should) Banaji, M. R., & Greenwald, A. G. (2013). Blindspot: Hidden biases of good people. New York, NY: Delacorte.

Implicit Association Test

Shoot or no shoot? (Watt & Sherbourne, in progress)
Watt, J., & Sherburne, C. L. (2011). Implicit attitudes as viewed through a shoot-no shoot simulation. (Unpublished manuscript).

Reactions to taking Implicit Attitude Test (Casad, Flores, & Didway, 2012)
Accurate Inaccurate Unsure After taking IAT 33% 46% 21% Casad, B. J., Flores, A. J., & Didway, J. D. (2012). Using the Implicit Attitude Test as an unconsciousness raising tool in psychology. Teaching of Psychology, 40,

Why? (Casad et al., 2012) Reasons given for IAT's invalidity
Structure of test is problematic 25% In-group preference 15% Explicit and implicit attitude incongruence 13% Measures cultural stereotypes 8% Measures associations, not prejudice 6% Measures snap judgments Casad, B. J., Flores, A. J., & Didway, J. D. (2012). Using the Implicit Attitude Test as an unconsciousness raising tool in psychology. Teaching of Psychology, 40, Fitting it to worldview and assimilating rather than accommodating. This was at beginning, after doing the IAT

Reactions to taking Implicit Attitude Test (Casad et al., 2012)
Accurate Inaccurate Unsure After taking IAT 33% 46% 21% After lecture/ reading 45% 22% Casad, B. J., Flores, A. J., & Didway, J. D. (2012). Using the Implicit Attitude Test as an unconsciousness raising tool in psychology. Teaching of Psychology, 40, Relate to supervision

What happens when we are colorblind? (Plaut, Thomas, & Goren, 2009)
Whites' color blindness Minorities' psychological engagement Minorities' perception of bias Whites' multiculturalism -.66 *** .57* -.70 ** -- -.54* .54* -.76*** Plaut, V. C., Thomas, K. M., & Goren, M. J. (2009). Is multiculturalism or color blindness better for minorities? Psychological Science, 20(4), Respondents were from 18 work units in a large U.S. health care organization * p < .05, ** p < .01, *** p < .001

What changes are desirable?
Knowledge Attitude But it's probably this intersection that we want—all of these things occurring to a significant degree Self-reflection Behavior

What changes? (Pope, 1993; Reynolds, 1997)
First-order changes (assimilation) Increased awareness, knowledge, skills Second-order change (accommodation) Cognitive restructuring Worldview and paradigm shifts

Bloom's Taxonomy (Anderson, Krathwohl, Airasian, Cruikshank, Mayer, Pintrich, Raths, & Wittrock, 2000) Note: Idea taken from Knapp, Younggren, VandeCreek, Harris, & Martin (2013) Relate to supervision, normalization of process Anderson, L. W., Krathwohl, D. R., Airasian, P. W., Cruikshank, K. A., Mayer, R. E., Pintrich, P. R., Raths, J., & Wittrock. M. C (2000). Taxonomy for learning, teaching, and assessing, A revision of Bloom's taxonomy of educational objectives. Boston: Allyn & Bacon.

Stages of change (Prochaska, 1999)
Precontemplation Contemplation Action Maintenance P P A Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.). The heart and soul of change: What works in therapy (pp. 227–255). Washington, DC: American Psychological Association. normalization of process P A A P

Ethical acculturation model (Handelsman, Gottlieb, & Knapp, 2005)
Personal Ethics High Low Assimilation Integration Marginalization Separation Professional Ethics Modification of Berry's Acculturation Model. Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36, 59–65.

Our modification Personal Commitment to Multicultural Competence High
Low Assimilation Integration Marginalization Separation Professional Commitment Modification of Berry's Acculturation Model. Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36, 59–65.

Recommendations from our experience
Start where you are Foster sensitivity to signs of own biases Engage in empathy-inducing activities Exploration of aesthetic traditions from other countries Direct engagement in perspective-broadening activities Contact with situations causing cognitive dissonance Perform psychosocial histories of clients (seeing beyond symptoms) Some other recommendations that need to be fleshed out. What things do you do that are useful?

Goals for effective therapists-in- context
Acknowledge that all helping occurs in a context Attend to one’s own context, assumptions, and biases on ongoing basis Recognize that different people may draw different conclusions under “similar” circumstances due to different cultures/contexts Remain attentive to attitudes and actions related to therapist’s ongoing multicultural development Consider how multiculturalism modifies/enhances theoretical and practical dimensions of therapy Read professional literature with an eye to multicultural issues Read the news, stay current with cultural issues to be able to perceive culture-influenced issues readily

Questions to consider with client
What is the client’s unique cultural perspective about the world and self? How does culture/context influence the symptoms or problems? How does culture factor in the client’s decision to seek treatment? How might this client might perceive therapist as a result of multicultural factors? What opportunities? What barriers? How does culture influence the therapeutic alliance? What parts of the client’s unique cultural perspective pose difficulties for the therapist?

Multiculturally-informed issues for treatment
Identify and explore microaggressions, oppression, and privilege Assist clients in understanding implications of their worldview Promote consideration of costs and benefits of culture-related choices Empower clients in making conscious choices that are valid from their own context and culture

The Color of Fear http://www.youtube.com/watch?v=-vAbpJW_xEc
Streaming film available at The Color of Fear, Edited by Richard Bock, The Color of Fear is a powerful movie examining closely the issue of racism. Considered by many to be the best film of its kind, exploring the conscious and unconscious behavior of racism. It has been seen by millions of people around the world and was featured on the Oprah Winfrey Show. For more info-Stirfryseminars.com The Color of Fear

Resnick: And so you thought that your children, all five of your children, somehow because of what you saw as your defective mothering, were not on the path of righteousness and were stumbling. [Hmm] And did you feel then that it was good for them or bad for them, if you in fact threw them into the sea—or in a bathtub—in a very real sense? What were you trying to accomplish then when you did take your children’s lives? Yates: Maybe in their innocent years … God would take them up. Resnick: It would be their innocent years and God would take them up? Is that what you said? Yates: Be with him. Uh huh. Resnick: God would take them up to be with Him in heaven? Is that what you mean? [Uh huh.] All right. And if you had not taken their lives, what did you think would happen to them? Yates: Guess they would have continued stumbling. Resnick: And where would they end up? Yates: Hell. Andrea Yates Andrea Yates Confession. (2001, July 14). Clip 8. Houston Chronicle. Retrieved from com/s/chron/Houston_Chronicle/ high.mov.html

Lia Lee and her mother Fadiman, A. (1998). The Spirit Catches You and You Fall Down

Henry Louis Gates Jr. The police responded to Gates's house after neighbor Lucia Whalen reported spotting 'two black males with backpacks' trying to gain entry to the home (Gates, returning home from a trip overseas, and his driver were contending with a stuck front door). The Cambridge Police Department reports, authored by Sergeant James Crowley and Officer James Figueroa, quote an incensed Gates yelling, 'This is what happens to black men in America!,' and, when asked by Crowley to speak with him outside the residence, Gates replied, 'ya, I'll speak with your mama outside.' A disorderly conduct rap was filed against Gates, but quickly dropped by prosecutors. Gates has hosted several PBS television miniseries, including the history and travel program Wonders of the African World and the biographical African American Lives and Faces of America., Director of the W. E. B. Du Bois Institute for African and African American Research news.harvard.edu

References American Psychological Association. (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Retrieved from American Psychological Association. (2010).Ethical principles of psychologists and code of conduct. Retrieved from Banaji, M. R., & Greenwald, A. G. (2013). Blindspot: Hidden biases of good people. New York, NY: Delacorte. Casad, B. J., Flores, A. J., & Didway, J. D. (2012). Using the Implicit Attitude Test as an unconsciousness raising tool in psychology. Teaching of Psychology, 40, Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36, 59–65.

References (cont.) Norton, M. I, & Sommers, S. R. (2011). Whites see racism as a zero-sum game that they are losing. Perspectives on Psychological Science, 6(3), 215–218. Plaut, V. C., Thomas, K. M., & Goren, M. J. (2009). Is multiculturalism or color blindness better for minorities? Psychological Science, 20(4), Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.). The heart and soul of change: What works in therapy (pp. 227–255). Washington, DC: American Psychological Association. Slattery, J. M., & Park, C. L. (2011). Empathic counseling: Meaning, context, ethics, and skill. Pacific Grove, CA: Brooks/Cole. Sommers, S. R., & Norton, M. I. (2006). Lay theories about white racists: What constitutes racism (and what doesn't). Group Processes and Intergroup Relations, 9, Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62, Watt, J., & Sherburne, C. L. (2011). Implicit attitudes as viewed through a shoot-no shoot simulation. (Unpublished manuscript).

John A. “Jay” Mills, PhD, ABPP

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