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Multicultural Competency Development Fernando A. Ortiz, Ph.D.

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1 Multicultural Competency Development Fernando A. Ortiz, Ph.D.


3 Emotional Roadblocks to the Path of Cultural Competence
Strong emotions such as: anger, sadness, and defensiveness are displayed when discussing experiences of race, culture, gender, and other sociodemographic variables

4 Emotional Roadblocks to the Path of Cultural Competence
These feelings can enhance or negate a deeper understanding of the worldviews of culturally diverse clients Disturbing feelings serve to protect us from having to examine our own prejudices and biases (Winter, 1977) Multiculturalism deals with real human experiences and it would behoove the reader to understand his/her emotional reactions on the journey to cultural competence

5 Common Emotions I FEEL GUILTY, “I could be doing more”
I FEEL ANGRY, “I don’t like to feel like I’m wrong” I FEEL DEFENSIVE, “Why blame me, I do enough already”

6 Common Emotions I FEEL TRUNED OFF, “I have other priorities in life”
I FEEL HELPLESS, “The problem is too big…what can I do?” I FEEL AFRAID, “I am going to do something…I don’t know what will happen”

7 Implications for Clinical Practice
Do not allow your own emotional reactions negate the stories of the most disempowered in society Try to acknowledge your inherited biases openly so that you can listen to your clients in a non-defensive way Experiences with people of color will enhance one’s cultural competence Explore yourself as a racial/cultural being Try to understand what your intense emotions mean for you when they arise Do not squelch dissent or disagreements Take an active role in exploring yourself


9 Themes from the Difficult Dialogue
Cultural Universality (etic) vs. Cultural Relativism (emic) Emotional Consequences of Race Inclusive vs. Exclusive nature of Multiculturalism Sociopolitical Nature of Counseling/Therapy The Nature of Multicultural Counseling Competence

10 Tripartite Framework Individual Level Group Level Universal Level

11 Tripartite Framework Model

12 What is MCT? 1. MCT broadens the perspective of the helping relationship. The individualistic approach is balanced with a collectivistic reality that we are embedded in our families, significant others, our communities and culture. Working with a client is not perceived as solely an individual matter, but as an individual who is a product of his or her social and cultural context. As a result, systemic influences are seen as equally important as individual ones.

13 What is MCT? 2. MCT expands the repertoire of helping responses. Traditional therapeutic taboos are questioned. Five taboos derived from monocultural code of ethics/standards of practice are especially important as examples:

14 Therapeutic Taboos 1. Therapists do not give advice and suggestion (it fosters dependency). 2. Therapists do not self disclose their thoughts and feelings (it is unprofessional). 3. Therapists do not barter with clients (it changes the nature of the therapeutic relationship). 4. Therapists do not serve dual role relationships with clients (there is a potential loss of objectivity). 5. Therapists do not accept gifts from clients (it unduly obligates them).

“Cultural competence is the ability to engage in actions or create conditions that maximize the optimal development of client and client systems. It is the acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds), and on an organizational/societal level, advocating effectively to develop new theories, practices, policies and organizational structures that are more responsive to all groups.”

l. Having all of us become culturally aware of our own values, biases and assumptions about human behavior. What stereotypes, perceptions, and beliefs do we hold about culturally diverse groups that may hinder our ability to form a helpful and effective relationship? What are the worldviews they bring to the interpersonal encounter? What value systems are inherent in the professional’s theory of helping, educating, administrating, and what values underlie the strategies and techniques used in these situations? Without such an awareness and understanding, we may inadvertently assume that everyone shares our world view. When this happens, we may become guilty of cultural oppression, imposing values on our culturally diverse clients.

2. Having all of us acquire knowledge and understanding of the worldview of culturally diverse groups and individuals. What biases, values and assumptions about human behavior do these groups hold? Is there such a thing as an African American, Asian American, Latino(a)/Hispanic American or American Indian worldview? Do other culturally different groups (women, the physically challenged, gays/lesbians, etc.) also have different world views?

3. Having each of us begin the process of developing appropriate and effective helping, teaching, communication and intervention strategies in working with culturally diverse groups and individuals. This means prevention as well as remediation approaches, and systems intervention as well as traditional one-to-one relationships. Equally important is the ability to make use of existing indigenous-helping/healing approaches and structures which may already exist in the minority community.

4. Understanding how organizational and institutional forces may either enhance or negate the development of multicultural competence. It does little good for any of us to be culturally competent when the very organization that employs us are filled with monocultural policies and practices. In many cases, organizational customs do not value or allow the use of cultural knowledge or skills. Some organizations may even actively discourage, negate, or punish multicultural expressions. Thus, it is imperative to view multicultural competence for organizations as well. Developing new rules, regulations, policies, practices, and structures within organizations which enhance multiculturalism are important.

20 Implications for Counseling
Realize that you are a product of cultural conditioning and that you are not immune from inheriting biases associated with culturally diverse groups in our society Be aware that persons of color, gays/lesbians, women, and other groups may perceive mental illness/health and the healing process differently than do Euro-Americans Be aware that Euro-American healing standards originate from a cultural context and represent only one form of helping that exists on an equal plane with others Realize that the concept of cultural competence is more inclusive and superordinate than is the traditional definition of “clinical competence”.

21 Implications for Counseling
Realize that organizational/societal policies, practices, and structures may represent oppressive obstacles that prevent equal access and opportunity. If that is the case, systems intervention is most appropriate Use modalities that are consistent with the lifestyles and cultural systems of clients


23 Katrina and Counseling?
Katrina is a prime example of the clash of racial realities and the multitude of political issues that are likely to arise in clinical sessions between counselors and culturally diverse clients Counseling and psychotherapy do not take place in a vacuum isolated from the larger social-political influences of our societal climate      

24 The Diversification of the United States
Nowhere is diversification of society more evident than in the workplace where three major trends can be observed: the graying of the workforce the feminization of the workforce the changing complexion of the workforce

25 Graying of the Workforce
As the baby boomers head into old age, the elderly population of those 65 and older will surge to 53.3 million by 2020 In 2005, 70% of workers were in the age group and workers 55 and older rose 15%     

26 Implications Lack of knowledge concerning issues of the elderly and the implications of an aging population on mental health needs In American society, the elderly suffer from beliefs and attitudes of society (stereotypes) that diminish their social status The elderly are increasingly at the mercy of governmental policies and company changes in social security and pension funds Social service agencies are ill prepared to deal with the social and mental health needs of the elderly

27 Feminization of the Workforce and Society
Over a fifteen year period from 1990 to 2005 women accounted for 62% of the net increase in the civilian labor force However, women continue to occupy the lower rungs of the occupational ladder but are still responsible for most of the domestic responsibilities

28 Implications Women are subjected to greater number of stressors than their male counterparts due to issues related to family life and role strain Family relationships and structures have progressively changed as we have moved from a traditional single-earner, two-parent family to two-wage earners Women continue to be paid less than men, and 25% of children will be on welfare at some point before reaching adulthood

29 The Changing Complexion of the Workforce and Society
From 1990 to 2000, the U.S. population increased 13% to over 281 million (U.S. Bureau of the Census, 2001) Projections indicate that persons of color will constitute a numerical majority sometime between 2030 and 2050 (D. W. Sue et al., 1998) The rapid demographic shift stems from two major trends: immigration rates and differential birthrates

30 Implications By the time the so­called baby boomers retire, the majority of people contributing to the social security and pension plans will be racial/ethnic minorities so if people of color continue to be the underemployed and under­paid, the economic security of retiring White workers looks grim The economic viability of businesses will depend on their ability to manage a diverse workforce effectively

31 Mental Health Implications
Counselors must be prepared to become culturally competent through: (a) revamping our training programs, (b) developing multicultural competencies as core standards for our profession, and (c) providing continuing education for our current service providers


33 The Case of Malachi The therapist felt he was “in danger” but could it be that the White counselor is not used to passionate expression of feelings? The counselor imposed White, Western values of individualism and self-exploration onto the client suggesting Malachi’s problems lie within himself The counselor went into the session wanting to treat Malachi like “every human being” thereby negating his unique racial-cultural perspective

Ethnocentric monoculturalism is the individual, institutional and societal expression of the superiority of one group’s cultural heritage over another’s. In all cases, the dominant group or society has the ultimate power to impose their beliefs and standards upon the less powerful group.

1. BELIEF IN SUPERIORITY. There is a strong belief in the superiority of one group’s cultural heritage (history, values, language, traditions, arts/crafts, etc.). The group norms and values are seen positively and descriptors may include such terms as “more advanced” and “more civilized” Members of the society may possess conscious and unconscious feelings of superiority and that their way of doing things is the “best way”

2. BELIEF IN INFERIORITY. There is a belief in the inferiority of all other group’s cultural heritage which extends to their customs, values, traditions and language. Other societies or groups may be perceived as “less developed”, “uncivilized”, or “primitive”. The life style or ways of doing things by the group are considered inferior.

3. POWER TO IMPOSE. The dominant group has the power to impose their standards and beliefs upon the less powerful group. All groups are to some extent ethnocentric; that is they feel positively about their cultural heritage and way of life. Yet, if they do not possess the power to impose their values on others, they hypothetically cannot oppress. It is power or the unequal status relationship between groups which defines ethnocentric monoculturalism.

4. EMBEDDED IN INSTITUTIONS. The ethnocentric values and beliefs are manifested in the programs, policies, practices, structures and institutions of the society. For example, chain-of-command systems, training and educational systems, communication systems, management systems, performance appraisal systems often dictate and control our lives. They attain “untouchable and godfather-like” status in an organization. Because most systems are monocultural in nature and demand compliance, racial/ethnic minorities and women may be oppressed.

5. INVISIBLE VEIL. Since people are all products of cultural conditioning, their values and beliefs (worldview) represent an “invisible veil” which operates outside the level of conscious awareness. As a result, people assume universality; that the nature of reality and truth are shared by everyone regardless of race, culture, ethnicity or gender. This assumption is erroneous, but seldom questioned because it is firmly ingrained in our world view.

40 Therapeutic Impact of Ethnocentric Monoculturalism
Dissociate the true self “Playing it cool” “Uncle Tom syndrome” Increased their vigilance and sensitivity During slavery, African-Americans had to respond to their enslavement in order to survive Oftentimes, they would dissociate the true self from the self that had to meet White expectations “Playing it cool” is intended to prevent Whites from knowing what the minority person is thinking or feeling and to express feelings and behaviors in such a way as to prevent offending or threatening Whites “Uncle Tom syndrome” was used by minorities to appear docile, nonassertive, and happy-go-lucky—this was used especially during slavery, Blacks learned that passivity is a necessary survival technique

41 Therapist Credibility: Expertness and Trustworthiness
Credibility may be defined as the constellation of characteristics that makes certain individuals appear worthy of belief, capable, entitled to confidence, reliable, and trustworthy: Expertness depends on how well-informed, capable or intelligent others perceive the communicator Trustworthiness is dependent on the degree to which people perceive the communicator (therapist to make valid assertions) Therapist Credibility

42 Psychological Sets of Clients
Problem-solving Set—client is concerned about obtaining correct information Consistency Set—If inconsistent information is presented, cognitive dissonance will take place Identity Set—Strong identification with a group Economic Set—beliefs and behaviors are influenced by rewards and punishments Authority Set—People in authority positions are seen to have rights to prescribe attitudes or behaviors The problem-solving set: Information orientation. In the problem-solving set, the client is concerned about obtaining correct information (solutions, outlooks, and skills) that has adaptive value in the real world The consistency set People are operating under the consistency set whenever they change an opinion, belief, or behavior in such a way as to make it consistent with other opinions, beliefs, or behaviors The identity set An individual who strongly identifies with a particular group is likely to accept the group’s beliefs and conform to behaviors dictated by the group If race or ethnicity constitutes a strong reference group for a client, then a counselor of the same race/”ethnicity is likely to be more influential than is one who is not The economic set The person is influenced because of the perceived rewards and punishments that the source is able to deliver One performs a behavior or states a belief in order to gain rewards and avoid punishments In the counseling setting, this means that the therapist controls important resources that may affect the client The authority set Some individuals are thought to have a particular position that gives them a legitimate right to prescribe attitudes or behaviors


44 Microaggressions  Microaggressions are “brief, everyday exchanges that send denigrating messages” to a target group like people of color, women and Gays These microaggressions are often subtle in nature and can be manifested in the verbal, nonverbal, visual, or behavioral realm and are often enacted automatically and unconsciously (Solorzano, Ceja, & Yosso, 2000)

45 Overt vs. Covert Oppression
Overt Racism, Sexism, and Heterosexism vs. Covert Racism, Sexism, and Heterosexism   II.      Racism, Sexism, and Heterosexism a.     The distinction is made between overt and covert racism, sexism, and heterosexism b.     Within all three domains, overt expressions are characterized by blatant unequal and unfair treatment of individuals (e.g. gender biased hiring practices) while covert expressions are subtle (e.g. using “he” to convey universal human experiences

46 Microassault Blatant verbal, nonverbal or environmental attack intended to convey discriminatory and biased sentiments (e.g. epithets like “spic” or “faggot”)

47 Microinsult Unintentional behaviors or verbal comments that convey rudeness, insensitivity or demean a person’s racial heritage/identity, gender identity, or sexual orientation identity (e.g. Arnold Schwartzenegger calling Democrats, “girly men”)

48 Microinvalidation Verbal comments or behaviors that exclude, negate, or dismiss the psychological thoughts, feelings, or experiential reality of the target group (e.g. “the most qualified person should get the job”)

49 Racial Microaggressions
Categories and Relationship of Racial Microaggressions Racial Microaggressions Commonplace verbal or behavioral indignities, whether intentional or unintentional, which communicate hostile, derogatory, or negative racial slights and insults. Microinsult (Often Unconscious) Behavioral/verbal remarks or comments that convey rudeness, insensitivity and demean a person’s racial heritage or identity. Microassault (Often Conscious) Explicit racial derogations characterized primarily by a violent verbal or nonverbal attack meant to hurt the intended victim through name-calling, avoidant behavior or purposeful discriminatory actions Microinvalidation (Often Unconscious) Verbal comments or behaviors that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person of color. Environmental Microaggressions (Macro-level) Racial assaults, insults and invalidations which are manifested on systemic and environmental levels. Ascription of Intelligence Assigning a degree of intelligence to a person of color based on their race. Second Class Citizen Treated as a lesser person or group. Pathologizing cultural values/communication styles Notion that the values and communication styles of people of color are abnormal Assumption of Criminal status Presumed to be a criminal, dangerous, or deviant based on race. Alien in Own Land Belief that visible racial/ethnic minority citizens are foreigners. Color Blindness Denial or pretense that a White person does not see color or race. Myth of Meritocracy Statements which assert that race plays a minor role in life success. Denial of Individual Racism Denial of personal racism or one’s role in its perpetuation.

50 Therapeutic Implications of Microaggressions
Clients of color tend to terminate prematurely Microaggresions my lie at the core of the problem Therapist must be credible Effective counseling is likely to occur when there is a strong working alliance


52 Marginal Person The marginal person, coined by Stonequist (1937) refers to one’s ability to form a dual ethnic identification due to a bicultural membership

1. Culture-bound values — individual centered, verbal/emotional/behavioral expressiveness, communication patterns from client to counselor, openness and intimacy, analytic/linear/verbal (cause-effect) approach, and clear distinctions between mental and physical well-being. 2. Class-bound values — strict adherence to time schedules (50-minute, once-or-twice-a-week meeting), ambiguous or unstructured approach to problems, and seeking long-range goals or solutions. 3. Language variables — use of Standard English and emphasis on verbal communication.

1. Focus on the individual. Most forms of counseling and psychotherapy tend to be individual centered — that is, they emphasize the “I-thou” relationship.

2. Verbal/Emotional/Behavioral Expressiveness. Many counselors and therapists tend to emphasize the fact that verbal/emotional/behavioral expressiveness is important in individuals. We like our clients to be verbal, articulate, and to be able to express their thoughts and feelings clearly.

3. Insight. This characteristic assumes that it is mentally beneficial for individuals to obtain insight or understanding into their deep underlying dynamics and causes. Born from the tradition of psychoanalytic theory, many theorists tend to believe that clients who obtain insight into themselves will be better adjusted.

4. Self-Disclosure (Openness and Intimacy). Most forms of counseling and psychotherapy tend to value one’s ability to self-disclose and to talk about the most intimate aspects of one’s life. Self-disclosure has often been discussed as a primary characteristic of the healthy personality. People who do not self-disclose readily in counseling and psychotherapy are seen as possessing negative traits such as being guarded, mistrustful, and/or paranoid.

5. Scientific Empiricism. Counseling and psychotherapy in Western culture and society has been described as being highly linear, analytic, and verbal in their attempt to mimic the physical sciences. It emphasizes the scientific method - objective rational linear thinking. The therapist is objective and neutral, rational and logical in thinking. Quantitative evaluation that includes psychodiagnostic tests, intelligence tests, and personality inventories are used. This cause-effect orientation emphasizes left-brain functioning.

6. Distinctions between Mental and Physical Functioning. Many American Indians, Asian Americans, Blacks, and Hispanics hold a different concept of what constitutes mental health, mental illness, and adjustment. Among the Chinese, the concept of mental health or psychological wellbeing is not understood in the same way as it is in the Western context. Latino/Hispanic Americans do not make the same Western distinction between mental and physical health as their White counterparts. Thus, nonphysical health problems are most likely to be referred to a physician, priest, or minister.

7. Ambiguity. The ambiguous and unstructured aspect of the therapy situation may create discomfort in clients of color. Culturally diverse clients may not be familiar with therapy and perceive it as an unknown and mystifying process. Some groups, like Hispanics, may have been reared in an environment that actively structures social relationships and patterns of interaction. Anxiety and confusion may be the outcome in an unstructured counseling setting.

8. Patterns of Communication. The cultural upbringing of many minorities dictates different patterns of communication that may place them at a disadvantage in therapy. Counseling demands that communication move from client to counselor. The client is expected to take the major responsibility for initiating conversation in the session, while the counselor plays a less active role.

62 Implications for Practice
Become aware of the generic characteristics of counseling Advocate for multilingual services Provide community counseling services in the client’s natural environments (schools, churches, etc.) Help clients deal with forces such as poverty, discrimination, prejudice, immigration stress in contrast to developing personal insight through self-exploration

63 Implications for Practice
Focus on action orientation and expand your repertoire Do not overgeneralize or stereotype Do not become arrogant and think that clinical work is superior to other forms of helping


65 Communication Styles It is important that the therapist and client send and receive both verbal and nonverbal messages accurately and appropriately

66 Nonverbal Communication
Generally occurs outside the level of conscious awareness Varies from culture to culture Important within the counseling context Nonverbals occur outside the level of conscious awareness Proxemics Proxemics refers to the perception and use of personal and interpersonal space (e.g. norms of physical distance) In Western culture, people seem to grow more uncomfortable when others stand too close rather than too far away Kinesics Kinesics refers to bodily movements (e.g. facial expression, posture, characteristics of movement, gestures, and eye contact) Various cultural norms are discussed Paralanguage Paralanguage refers to other vocal cues that individuals use to communicate (e.g. loudness of voice, pauses, silences)

67 Context in Communication
Directness of a conversation or the degree of frankness also varies considerably among various cultures High Context Communication—anchored in the physical context—less reliant on explicit code (e.g. many Asian cultures) Low Context Communication—greater reliance on verbal parts of the message (e.g. Western) Directness of a conversation or the degree of frankness also varies considerably among various cultures High-low context communication High context is anchored in physical context (situation) or internalized in the person—less reliance on explicit code (e.g. .Asian cultures) The text discusses a situation with a Filipino nurse where her subtle, high-context communication was misinterpreted by the hospital staff Low context cultures communicate with a greater reliance on the verbal part of the message (e.g. U.S. culture) Sociopolitical Facets of Nonverbal Communication People of color pay close attention to nonverbals because Whites are racist, however, this is often denied

68 Proxemics Refers to perception and use of personal and interpersonal space: Violation may cause one to withdrawal, become angry, or create conflict Some cultures are OK with being very close If counselor backs away, may be seen as aloofness or coldness Counselor may misinterpret clients closeness

69 Kinesics Refers to bodily movements (e.g. facial expression, posture, gestures, eye contact): Japanese smile may mean discomfort Latin Americans shake hands with vigor Eye contact varies according to culture

70 Paralanguage Refers to vocal cues other than words (i.e. loudness of voice, pauses, silences, etc.): Caseworker may misinterpret silences or speaking in a soft tone Speaking loudly may not indicate anger but a cultural style

71 Communication Styles Black styles of communication are often animated, interpersonal and confrontational whereas White middle-class styles of communication tend to be more objective, impersonal and nonchallenging

72 Counseling and Therapy as Communication Style
Different forms of psychotherapy possess varied communication styles (e.g. Rogers emphasizes attending skills; Shostrom relied on direct guidance; Lazarus took an active reeducative style) In general, people of color prefer more active, directive forms of helping than nondirective ones

73 Implications for Practice
Recognize that no one style of counseling will be appropriate for all situations Become knowledgeable about how race, culture, and gender affect communication styles Become aware of your own style Obtain additional training and education on a variety of theoretical orientations and approaches Think holistically rather than in a reductionist manner when conceptualizing the human condition Training programs need to use an approach that calls for openness and flexibility in conceptualizing issues and skill building


75 Family Systems Approaches and Assumptions
Communications Approach: Family problems are communication difficulties Structural Approach: Emphasizes interlocking roles Assumptions: Separation/individuation is healthy Egalitarian spousal relations “Be your own person”

76 Issues in Working with Ethnic Minority Families
Many Black families are poor and suffer from racism and more Black males are single Latinos emphasize the extended family Biculturalism stressors Strength through slavery Native Americans—alcohol abuse Language structures vary Social class issues

77 Machismo vs. Marianismo
Machismo is a term used in many Latino cultures to indicate maleness, virility, and the man’s role as provider and protector Marianismo derived from the cult of the Virgin Mary in that women are seen as morally and spiritually superior and capable of enduring greater suffering

78 Value Preference Considerations
Time Dimension Relational Dimension Activity Dimension People-Nature Relationship Nature of people Dimension

79 Implications for Practice
Different cultural conceptions of family Families cannot be understood apart from the culture Learn the definition of family for specific groups Extended ties may be very important Do not prejudge patriarchal relations Mother role may be most important Helping can take many forms—be creative People-Nature Relationship Traditional Western thinking believes in mastery and control over nature and therapists operate from a framework that subscribes to the belief that problems are solvable and that both therapist and client must take an active part in solving problems via manipulation and control However, many Asian cultures emphasize harmony within the family and the environment leads to harmony within the self.--dependence on the family unit and acceptance of the environment seem to dictate differences in solving problems and Asian cultures tend to accommodate or deal with problems through indirection Time Dimension U.S. society may be characterized as preoccupied with the future American Indians and African Americans tend to value a present time orientation, while Asian Americans and Hispanic Americans have a combination past-present focus Relational Dimension The U.S. can be characterized as an achievement-oriented society, which is most strongly manifested in the prevailing Protestant work ethic Almost all racial/ethnic minority groups in the United States tend to be more collateral in their relationships with people. Activity Dimension One of the primary characteristics of White U.S. cultural values and beliefs is an action (doing) orientation: (a) We must master and control nature; (b) we must always do things about a situation; and (c) we should take a pragmatic and utilitarian view of life. In counseling, we expect clients to master and control their own life and environment, to take action to resolve their own problems, and to fight against bias and inaction It appears that both American Indians and Latinos/”Hispanics prefer a being or being-in-becoming mode of activity-the American Indian concepts of self-determination and noninterference are examples--value is placed on the spiritual quality of being, as manifested in self-containment, poise, and harmony with the universe and on the attainment of inner fulfillment and an essential serenity of one’s place in the universe


1. DO NOT INVALIDATE THE INDIGENOUS CULTURAL BELIEF SYSTEMS OF YOUR CULTURALLY DIVERSE CLIENTS. On the surface, the assumptions of indigenous healing methods might appear radically different from our own. When we encounter them, we are often “shocked”, find such beliefs to be “unscientific” and are likely to negate, invalidate or dismiss them. Such an attitude will have the effect of invalidating our clients as well, since these beliefs are central to their world view and reflect their cultural identity.

2. BECOME KNOWLEDGEABLE ABOUT INDIGENOUS BELIEFS AND HEALING PRACTICES. Counselors/therapists have a professional responsibility to become knowledgeable and conversant with the assumptions and practices of indigenous healing so that a “desensitization and normalization process” can occur. By becoming knowledgeable and understanding of indigenous helping approaches, the therapist will avoid equating differences with deviance!

3. LEARNING ABOUT INDIGENOUS HEALING AND BELIEFS ENTAIL EXPERIENTIAL OR LIVED REALITIES. While reading books about nonwestern forms of healing and attending seminars and lectures on the topic is valuable and helpful, understanding culturally different perspectives must be supplemented by lived experience. Even when we travel abroad, few of us actively place ourselves in situations which are unfamiliar because it evokes discomfort, anxiety and a feeling of differentness.

4. AVOID OVERPATHOLOGIZING AND UNDERPATHOLOGIZING A CULTURALLY DIFFERENT CLIENT’S PROBLEMS. A therapist or counselor who is culturally unaware and who believes primarily in a universal psychology may oftentimes be culturally insensitive and inclined to see differences as deviance. They may be guilty of overpathologizing a culturally different client’s problems by seeing it as more severe and pathological than it truly may be. There is a danger, however, of also underpathologizing a culturally different client’s symptoms as well. While being understanding of a client’s cultural context, having knowledge of culture-bound syndromes and being aware of cultural relativism are desirable, being oversensitive to these factors may predispose the therapist to minimize problems, thereby underpathologizing disorders.

5. BE WILLING TO SEEK THE CONSULTATION OF TRADITIONAL HEALERS AND/OR UTILIZE THEIR SERVICES. Mental health professionals must be willing and able to form partnerships with indigenous healers or develop community liaisons. Such an outreach has several advantages: (a) traditional healers may provide knowledge and insights into clients populations which would prove of value to the delivery of mental health services, (b) such an alliance will ultimately enhance the cultural credibility of therapists, and (c) it allows for referral to traditional healers (shamans, religious leaders, etc.) in which treatment is rooted in cultural traditions.

6. SPIRITUALITY MUST BE SEEN AS AN INTIMATE ASPECT OF THE HUMAN CONDITION AND A LEGITIMATE ASPECT OF MENTAL HEALTH WORK. Spirituality is a belief in a higher power which allows us to make meaning of life and the universe. It may or may not be linked to a formal religion, but there is little doubt that it is a powerful force in the human condition. Many groups accept the prevalence of spirituality in nearly all aspects of life; thus separating it from one’s existence is not possible.

7. HAVING THE ABILITY TO EXPAND OUR DEFINITION OF THE HELPING ROLE TO COMMUNITY WORK AND INVOLVEMENT. More than anything else, indigenous healing is community oriented and focused. Culturally competent mental health professionals must begin to expand their definition of the helping role to encompass a greater community involvement. The in-the-office setting is, oftentimes, nonfunctional in minority communities. Culturally sensitive helping requires making home visits, going to community centers, visiting places of worship and areas within the community. The types of help most likely to prevent mental health problems are building and maintaining healthy connections, with one’s family, one’s god(s), and one’s universe.

It is clear that we live in a monocultural society; a society that invalidates and separates us from one another, from our spirituality and from the cosmos. There is much wisdom in ancient forms of healing which stress that the road to mental health is through becoming united and in harmony with the universe. Activities that promote these attributes involve community work. They include client advocacy and consultation, preventive education, developing outreach programs, becoming involved in systemic change and aiding in the formation of public policy that allows for equal access and opportunities for all.


90 Importance 1. Understanding Within Group Differences
2. Influence of Racism and Oppression on Identity Formation 3. Assessment Tool 4. Intervention Implications

1. Racism is a basic and integral part of U.S. life and permeates all aspects of our culture and institutions. 2. Persons of color are socialized into U.S. society and, therefore, are exposed to the biases, stereotypes, and racist attitudes, beliefs, and behaviors of the society. 3. The level of racial identity development consciousness affects the process and outcome of interracial interactions.

4. How people of color perceive themselves as racial beings seems to be strongly correlated with how they perceive and respond to racial stimuli. Consequently, race-related reality represent major differences in how they view the world. 5. It seems to follow an identifiable sequence. There is an assumption that people of color who are born and raised in the United States, may move through levels of consciousness regarding their own identity as racial beings. 6. The most desirable development is a multicultural identity that does not deny or negate one’s integrity.

93 Levels of Consciousness
1. Conformity 2. Dissonance 3. Resistance and Immersion 4. Introspection 5. Integrative Awareness

94 Self/Other Perceptions
1. Attitude and Beliefs toward Self. 2. Attitudes and Beliefs toward Members of the Same Minority. 3. Attitudes and Beliefs toward Members of Different Minorities. 4. Attitude and Beliefs toward Members of the Dominant Group.

95 PHASE 1 - CONFORMITY Marked by desire to assimilate and acculturate – buys in to the melting pot analogy. Accepts belief in White superiority and minority inferiority. Unconscious and conscious desire to escape one’s own racial heritage. Validation comes from a White perspective. Role models, lifestyles, and value systems all follow the dominant group.

96 CONFORMITY Physical and cultural characteristics identified with one’s own racial/cultural group are perceived negatively, something to be avoided, denied, or changed. Physical characteristics (black skin color, “slant-shaped eyes” of Asians), traditional modes of dress and appearance, and behavioral characteristics associated with the minority group are a source of shame. There may be attempts to mimic what is perceived as “White mannerisms”, speech patterns, dress, and goals. Low internal self-esteem is characteristic of the person.

97 CONFORMITY These individuals may have internalized the majority of White stereotypes about their group. In the case of Hispanics, for example, the person may believe that members of his or her own group have high rates of unemployment because “they are lazy, uneducated, and unintelligent.” The denial mechanism most commonly used is “I’m not like them; I’ve made it on my own; I’m the exception.”

98 CONFORMITY Belief that White cultural, social, institutional standards are superior. Members of the dominant group are admired, respected, and emulated. White people are believed to possess superior intelligence. Some individuals may go to great lengths to appear White. In the Autobiography of Malcolm X, the main character would straighten his hair and primarily date White women. Reports that Asian women have undergone surgery to reshape their eyes to conform to White female standards of beauty may (but not in all cases) typify this dynamic.

99 PHASE 2 - DISSONANCE Breakdown of denial system.
Encounters information discordant with previous beliefs in the conformity stage. Dominant-held views of minority strengths and weaknesses begin to be questioned. Begins to realize that attempts to assimilate or acculturate may not be fully allowed by larger society.

100 DISSONANCE There is now a growing sense of personal awareness that racism does exist, that not all aspects of the minority or majority culture are good or bad, and that one cannot escape one’s cultural heritage. Feelings of shame and pride are mixed in the individual and a sense of conflict develops.

“Why should I feel ashamed of who and what I am?” Begins to understand social-psychological forces associated with prejudice and discrimination. Extreme anger at perceived cultural oppression. May be an active rejection of the dominant society and culture. Members of the dominant group viewed with suspicion.

The minority individual at this stage is oriented toward self-discovery of one’s own history and culture. There is an active seeking out of information and artifacts that enhance that person’s sense of identity and worth. Cultural and racial characteristics that once elicited feelings of shame and disgust become symbols of pride and honor. The individual moves into this stage primarily because he or she asks the question, “Why should I be ashamed of who and what I am?” Phrases such as “Black is beautiful,” represent a symbolic relabeling of identity for many Blacks. Racial self-hatred becomes something actively rejected in favor of the other extreme, which is unbridled racial pride.

There is a feeling of connectedness with other members of the racial and cultural group and a strengthening of new identity begins to occur. Members of one’s group are admired, respected, and often viewed now as the new reference group or ideal. Cultural values of the minority group are accepted without question. As indicated, the pendulum swings drastically from original identification with White ways to identification in an unquestioning manner with the minority-group’s ways. Persons in this stage, are likely to restrict their interactions as much as possible to members of their own group.

There is also considerable anger and hostility directed toward White society. There is a feeling of distrust and dislike for all members of the dominant group in an almost global anti-White demonstration and feeling. White people, for example, are not to be trusted for they are the oppressors or enemies. In extreme form, members may advocate complete destruction of the institutions and structures that have been characteristic of White society.

105 PHASE 4 - INTROSPECTION Increased discomfort with rigidly help group views (i.e., all Whites are bad). Too much energies directed at White society and diverted from more positive exploration of identity questions. Conflict ensures between notions of responsibility and allegiance to one’s minority group, and notions of personal autonomy. Attempts to understand one’s cultural heritage and to develop an integrated identity.

106 INTROSPECTION The conflict now becomes quite great in terms of responsibility and allegiance to one’s own minority group versus notions of personal independence and autonomy. The person begins to spend greater and greater time and energy trying to sort out these aspects of self-identity and begins to increasingly demand individual autonomy.

Develop inner sense of security as conflicts between new and old identities are resolved. Global anti-White feelings subside as person becomes more flexible, tolerant and multicultural. White and minority cultures are not seen as necessarily conflictual. Able to own and accept those aspects of U.S. culture (seen as healthy) and oppose those that are toxic (racism and oppression).

Develops a positive self-image and experiences a strong sense of self-worth and confidence. Not only is there an integrated self-concept that involves racial pride in identity and culture, but the person develops a high sense of autonomy. Becomes bicultural or multicultural without a sense of having “sold out one’s integrity.” In other words, the person begins to perceive his or her self as an autonomous individual who is unique (individual level of identity), a member of one’s own racial-cultural group (group level of identity), a member of a larger society, and a member of the human race (universal level of identity).

109 Implications for Clinical Practice
Be aware that the R/CID model should be viewed as dynamic, not static. Do not fall victim to stereotyping in using these models Know that minority development models are conceptual aids and that human development is much more complex Know that identity development models begin at a point that involves interaction with an oppressive society

110 Implications for Clinical Practice
Be careful of the implied value judgment given in almost all development models Be aware that racial/cultural identity development models seriously lack an adequate integration of gender, class, sexual orientation, and other sociodemographic group identities Know that racial/cultural identity is not a simple, global concept Begin to look more closely at the possible therapist and client stage combinations


1. Racism is a basic and integral part of U.S. life and permeates all aspects of our culture and institutions. 2. White Americans are socialized into U.S. society and, therefore, inherit the biases, stereotypes, racist attitudes, beliefs, and behaviors of the society.

3. The level of White racial identity development in an interracial encounter affects the process and outcome of our relationships. 4. How Whites perceive themselves as racial beings seems to be strongly correlated with how they perceive and respond to racial stimuli. Consequently, race-related reality of Whites represent major differences in how they view the world.

5. It seems to follow an identifiable sequence. There is an assumption that White Americans who are born and raised in the United States, may move through levels of consciousness regarding their own identity as racial beings. 6. The most desirable development is not only the acceptance of whiteness, but also defining it in a nondefensive and nonracist manner. There is an understanding that to deny the humanity of any one person is to deny the humanity of all.

Phase One – Naiveté Early childhood marked by naïve curiosity about race. Tendency to be innocent, open, and spontaneous regarding racial differences. May notice differences, but awareness of social meaning are absent or minimal. Racial awareness and the burgeoning social meanings occur between the ages of 3-5 years.

Phase Two – Conformity Characteristics of naiveté may be maintained. Minimal awareness of self as a racial/cultural being. Strong belief in the universality of values and norms governing behavior. Unlikely to recognize the polarities of democratic principles of equality and the unequal treatment of minority groups.

Phase Two – Conformity Compartmentalization of contradictory attitudes, beliefs and behaviors (i.e., can believe people are people, but treat minorities differently). Because of naiveté and encapsulation, it is possible for two diametrically opposed belief systems to coexist in your mind.

Phase Two – Conformity (a) Uncritical acceptance of White supremacist notions which relegates minorities into the inferior category with all the racial stereotypes. (b) Belief that racial and cultural differences are considered unimportant. This allows Whites to avoid perceiving themselves as “dominant” group members, or of having biases and prejudices.

Phase Two – Conformity The primary mechanism used in encapsulation is denial; denial that people are different, denial that discrimination exists, and denial of your own prejudices. Instead, the locus of the problem is seen to reside in the minority individual or group. In her own White racial awakening, Peggy McIntosh (1989) stated:

Phase Two – Conformity “My schooling gave me no training in seeing myself as an oppressor, as an unfairly advantaged person, or as a participant in a damaged culture. I was taught to see myself as an individual whose moral state depended on her individual moral will....Whites are taught to think of their lives as morally neutral, normative, and average, and also ideal, so that when we work to benefit others, this is seen as work which will allow ‘them’ to be more like ‘us.’ While the Naiveté stage is brief in duration, the Conformity stage can last a lifetime.

Phase Three – Dissonance Obliviousness breaks down when Whites become aware of inconsistencies. Becomes conflicted over irresolvable racial moral dilemmas that are frequently perceived as polar opposites: believing they are nonracist, yet not wanting their son or daughter to marry a minority group member; Belief that “all men are created equal”, yet seeing society treat people of color as second class citizens; and not acknowledging that oppression exists to witnessing it (beating of Rodney King and the unwarranted persecution of Wen Ho Lee).

Phase Three – Dissonance Become increasingly conscious of whiteness and may experience dissonance, resulting in feelings of guilt, depression, helplessness or anxiety. Movement into the Dissonance phase occurs when Whites are forced to deal with the inconsistencies that have been compartmentalized or encounter information/experiences at odds with their denial.

Phase Three - Dissonance Dissonance may make Whites feel guilty, shameful, angry, and depressed. Rationalizations may become the manner used to exonerate their inactivity in combating perceived injustice or personal feelings of prejudice: “I’m only one person, what can I do” or “Everyone is prejudiced, even minorities”. As these conflicts ensue, Whites may retreat into the protective confines of White culture (encapsulation of the previous stage) or move progressively toward insight and revelation (resistance and immersion stage).

Phase Four - Resistance and Immersion Whites begin to question and challenge their racism. For the first time, they begin to realize what racism is all about, and their eyes are suddenly opened. Racism becomes noticeable in all facets of their daily lives (advertising, television, educational materials, interpersonal interactions, etc.). A major questioning of their racism and that of others mark this phase of development. In addition, increasing awareness of how racism operates and its pervasiveness in U.S. culture and institutions are the major hallmark at this level of development.

Phase Four – Resistance and Immersion Likely to experience considerable anger at family and friends, institutions, and larger societal values, that are seen as having sold them a false bill of goods (democratic ideals) that were never practiced. Guilt is also felt for having been a part of the oppressive system.

Phase Four – Resistance and Immersion The "White liberal" syndrome may develop and be manifested in two complementary styles: (a) the paternalistic protector role or (b) an over identification with the minority group. In the former, Whites may devote energies in an almost paternalistic attempt to protect minorities from abuse. May actually even want to identify with a particular minority group (Asian, Black, etc.) in order to escape their Whiteness.

Phase Four – Resistance and Immersion May resolve this dilemma by moving back into the protective confines of White culture (Conformity stage), again experience conflict (dissonance), or move directly to the Introspective stage. In many cases, they may develop a negative reaction toward their group or culture. While they may romanticize People of Color, Whites cannot interact confidently with them because you fear making racist mistakes. The discomfort in realizing that they are White and that their group has engaged in oppression of racial/ethnic minorities may propel them into the next stage.

Phase Five – Introspection This phase is most likely a compromise of swinging from an extreme of unconditional acceptance of White identity to a rejection of Whiteness. It is a state of relative quiescence, introspection and reformulation of what it means to be White. Realize and no longer deny that they have participated in oppression, that they benefit from White privilege, and that racism is an integral part of U.S. society. Less motivated by guilt and defensiveness, accept Whiteness, and seek to define own identity and that of one’s social group.

Phase Five – Introspection May ask questions: “What does it mean to be White?” “Who am I in relation to my whiteness?” “Who am I as a racial/cultural being?” Feelings or affective elements may be existential in nature and involve feelings of lack of connectedness, isolation, confusion and loss.

Phase Five – Introspection Asking the painful question of who you are in relation to your racial heritage; honestly confronting your biases and prejudices; and accepting responsibility for your Whiteness is the culminating outcome of the introspective stage. New ways of defining your White EuroAmerican social group and membership in that group become important. No longer deny being White, honestly confront your racism, understand the concept of White privilege, and feel increased comfort in relating to persons of color.

Phase Six - Integrative Awareness Reaching this level of development is most characterized as: (a) Understanding self as a racial/cultural being. (b) Awareness of sociopolitical influences with respect to racism, (c) Appreciation of racial/cultural diversity, (d) Rooting out buried and nested racial fears and emotions.

Phase Six – Integrative Awareness Formation of a nonracist White EuroAmerican identity emerges and becomes internalized. Begin to value multiculturalism, comfortable around members of culturally different groups, and feel a strong connectedness with members of many groups. Inner sense of security and strength to function in a society that is only marginally accepting of integratively aware White persons.

Phase Six – Integrative Awareness This status is different from the previous one in two major ways: (a) It is marked by a shift in focus from trying to change people of color to changing the self and other Whites, and (b) it is marked with increasing experiential and affective understanding that were lacking in the previous status. Successful resolution of this stage requires an emotional catharsis or release that forces you to relive or reexperience previous emotions that were denied or distorted. The ability to achieve this affective upheaval leads to a euphoria or even a feeling of rebirth and is a necessary condition to developing a new nonracist White identity.

Phase Seven – Commitment To Antiracist Action Most characterized by social action. There is likely to be a consequent change in behavior, and an increased commitment toward eradicating oppression as well. Seeing “wrong” and actively working to “right it” require moral fortitude and direct action. Objecting to racist jokes, trying to educate family, friends, neighbors, and co-workers about racial issues, taking direct action to eradicate racism in the schools, workplace, and in social policy often in direct conflict with other Whites.

Phase Seven – Commitment to Antiracist Action Become increasingly immunized to social pressures for conformance because reference group begins to change. In addition to family and friends, will begin to actively form alliances with persons of color and other liberated Whites. They will become a second family giving validation, and encouraging continuance to the struggle against individual, institutional and societal racism.

First, you must actively place yourself in new and oftentimes uncomfortable situations that impel you to question yourself as a racial/cultural being, and to increase awareness of racial issues, especially racism. Second, change must occur in the form of new insights, attitudes and behaviors that lead to a realization of your role in the perpetuation of racism. Third, considerable and continuing energies must be devoted to the maintenance of a healthy White racial identity. In other words, change is not enough in the face of societal forces that serve to squelch or punish dissent. Fourth, you must take action to eradicate racism.


138 Multicultural Counseling
Multicultural counseling and therapy must be about social justice providing equal access and opportunity to all groups being inclusive removing individual and systemic barriers to fair mental health treatment insuring that counseling/therapy services are directed at the micro, meso and macro levels of our society

139 Locus of Control Internal control (IC) refers to people’s beliefs that reinforcements are contingent on their own actions and that they can shape their own fate External control (EC) refers to people’s beliefs that reinforcing events occur independently of their actions and that the future is determined more by chance and luck.

140 Locus of Responsibility
This dimension measures the degree of responsibility or blame placed on the individual or system

141 Understanding Individual and Systemic Worldviews
Worldviews composed of our attitudes, values, opinions, and concepts, but they also affect how we think, define events, make decisions, and behave

142 Formation of Worldviews
Worldviews are formed on a continuum: internal locus of responsibility (IC-IR), external locus of control internal locus of responsibility (EC-IR), internal locus of control external locus of responsibility (IC-ER), and external locus of control external locus of responsibility (EC-ER)

143 Cultural Competence for Mental Health Agencies
1. Cultural Destructiveness: Programs that support oppression (e.g. Tuskeegee) 2. Cultural Incapacity: Not intentionally destructive but still believe in White superiority 3. Cultural Blindness: All people are the same and Western helping methods are applicable cultural competence for mental health agencies

144 Cultural Competence for Mental Health Agencies
4. Cultural Precompetence: Looked at “artifacts” seeing weaknesses in serving minorities 5. Cultural Competence: Diverse staff at all levels—higher stages of cultural identity awareness 6. Cultural Proficiency: Very rare—high levels of cultural competence—seek knowledge to develop better practices cultural competence for mental health agencies


146 Therapists of Color Therapists of color are not immune from their own cultural socialization or inheriting the biases of the society as well

147 Interracial Bias and Discrimination
People of color become concerned about discussing interethnic and interracial misunderstandings and conflicts between various groups for : fear that such problems may be used by those in power assuage their own guilt feelings excuse their own racism

148 Oppressive Strategies
Divide and Conquer -“as long as people of color fight among themselves, they can’t form alliances to confront the establishment” Divert attention away from the injustices of society by defining problems as residing between various racial groups

149 Minority-Majority and Minority-Minority Relationships
Not only do we need to engage in self-examination, but it is also clear we are a stimulus to clients through appearance, speech, or other factors that reflect differences Self-disclosure, or the acknowledgment of differences, may increase feelings of similarity between therapist and client and reduce concerns about differences

150 Therapists’ and Counselors’ Obligations
All therapists and counselors need to: Become aware of their own worldviews, their biases, values and assumptions about human behavior Understand the worldviews of their culturally diverse clients Develop culturally appropriate intervention strategies in working with culturally diverse clients


152 African Americans Various issues plague African Americans:
unemployment poverty high prison rates lower levels of education these issues can primarily be attributed to racism

153 African Americans However, the African American community is becoming more diverse with respect to social class, education level, and political orientation Many African American households are headed by women, embrace extended family networks, have strong religious orientations, and accept varied gender roles

154 Educational Orientation
African American parents encourage their children to develop career and educational goals at an early age in spite of the obstacles produced by racism and economic conditions Behavioral problems in school may be due to racism

155 Spirituality Many African Americans are very spiritual and find their church communities to be very supportive Counselors should advise clients to seek support through churches

156 Racism and Discrimination
Racism exists in subtle and overt forms Mistrust is a reaction to being discriminated against Counselors should be aware of mistrust and work to earn client’s trust

157 Guidelines for Clinical Practice
During the first session, it may be beneficial to bring up the reaction of the client to a counselor of a different ethnic background (e.g. “Sometimes clients feel uncomfortable working with a counselor of a different race; would this be a problem for you?”) If the clients are referred, determine their feelings about counseling and how it can be made useful for them Identify the expectations and worldviews of the African American clients, find out what they believe counseling is, and explore their feelings about counseling Establish an egalitarian relationship

158 Guidelines for Clinical Practice
Determine whether and how the client has responded to discrimination and racism both in unhealthy and healthy ways. Also examine issues around racial identity (many clients at the preencounter stage will not believe that race is an important factor) Assess the positive assets of the client, such as family (including relatives and nonrelated friends), community resources, and the church Determine the external factors that might be related to the presenting problem Help the client define goals and appropriate means of attaining them After the therapeutic alliance has been formed, determine the interventions collaboratively


160 American Indians American Indians have suffered greatly as a result of: colonization disease land distribution

161 Cultural Loss Culture and language were systematically striped from over 125,000 tribes Stripping American Indians of their culture, has lead to high rates of alcoholism

162 The American Indian and the Alaskan Native
This is a very heterogeneous group Some families are matriarchal and some are patriarchal in orientation

163 Tribe and Reservation Indians see themselves an extension of their tribe Tribe and reservation provide American Indians with a sense of belonging and security, forming an interdependent system Status and rewards are obtained by adherence to tribal structure The reservation itself is very important for many American Indians, even among those who do not reside there Indians who leave the reservation to seek greater opportunities often lose their sense of personal identity, since they lose their tribal identity

164 Specific Problem Areas for American Indians/Alaskan Natives
Sharing Noninterference Time Orientation Spirituality Nonverbal Communication Sharing. Among Indians, honor and respect are gained by sharing and giving, while in the dominant culture, status is gained by the accumulation of material goods Cooperation. Indians believe that the tribe and family take precedence over the individual Noninterference. Indians are taught not to interfere with others and to observe rather than react impulsively. Rights of others are respected. This value influences parenting style Time orientation. Indians are very much involved in the present rather than the future. Ideas of punctuality or planning for the future may be unimportant Spirituality. The spirit, mind, and body are all interconnected Nonverbal communication. Learning occurs by listening rather than talking. Direct eye contact with an elder is seen as a sign of disrespect

165 Acculturation Traditional. The individual may speak little English, thinks in the native language, and practices traditional tribal customs and methods of worship. Marginal. The individual may speak both languages but has lost touch with his or her cultural heritage and is not fully accepted in mainstream society. Bicultural. The person is conversant with both sets of values and can communicate in a variety of contexts. Traditional. The individual may speak little English, thinks in the native language, and practices traditional tribal customs and methods of worship. Marginal. The individual may speak both languages but has lost touch with his or her cultural heritage and is not fully accepted in mainstream society. Bicultural. The person is conversant with both sets of values and can communicate in a variety of contexts. Assimilated. The individual embraces only the mainstream culture’s values, behaviors, and expectations. Pantraditional. Although the individual has only been exposed to or adopted mainstream values, he or she has made a conscious effort to return to the “old ways.”

166 Acculturation Assimilated. The individual embraces only the mainstream culture’s values, behaviors, and expectations. Pantraditional. Although the individual has only been exposed to or adopted mainstream values, he or she has made a conscious effort to return to the “old ways.” Traditional. The individual may speak little English, thinks in the native language, and practices traditional tribal customs and methods of worship. Marginal. The individual may speak both languages but has lost touch with his or her cultural heritage and is not fully accepted in mainstream society. Bicultural. The person is conversant with both sets of values and can communicate in a variety of contexts. Assimilated. The individual embraces only the mainstream culture’s values, behaviors, and expectations. Pantraditional. Although the individual has only been exposed to or adopted mainstream values, he or she has made a conscious effort to return to the “old ways.”

167 Guidelines for Clinical Practice
Before working with American Indians, explore ethnic differences and values Determine the cultural identity of the client and family members and their association with a tribe or a reservation Understand the history of oppression, and be aware of or inquire about local issues associated with the tribe or reservation for traditionally oriented American Indians Evaluate using a client-¬centered listening style initially and determine when to use more structure and questions Assess the problem from the perspective of the individual, family, extended family, and, if appropriate, the tribal community

168 Guidelines for Clinical Practice
If necessary, address basic needs first, such as problems involving food, shelter, child care, and employment--identify possible resources such as Indian Health Services or tribal programs Be careful not to overgeneralize, but evaluate for problems such as domestic violence, substance abuse, depression, and suicidality during assessment and determine the appropriateness of a mind-¬body-¬spirit emphasis Identify possible environmental contributors to problems such as racism, discrimination, poverty, and acculturation conflicts Help children and adolescents determine whether cultural values or an unreceptive environment contribute to their problem

169 Guidelines for Clinical Practice
Help determine concrete goals that incorporate cultural, family, extended family, and community perspectives Determine whether child-rearing practices are consistent with traditional Indian methods and how they may conflict with mainstream methods. In family interventions, identify extended family members, determine their roles, and request their assistance Generate possible solutions with the clients and consider their consequences from the individual, family, and community perspectives. Include strategies that may involve cultural elements and that focus on holistic factors (mind, body, spirit)


171 Asian Americans: A Success Story?
For example: Of those over the age of 25, 44% of Asian/Pacific Islanders had at least a bachelor’s degree versus 24% by their White counterparts However, In the area of education, Asian Americans show a disparate picture of extraordinary high educational attainment and a large undereducated mass (e.g. Hmong, Laotians)

172 Collectivistic Orientation
Instead of promoting individual needs and personal identity, Asian families tend to have a family and group orientation Children are expected to strive for family goals and not to engage in behaviors that would bring dishonor to the family

173 Hierarchical Relationships
Traditional Asian American families tend to be hierarchical and patriarchal in structure, with males and older individuals occupying a higher status Communication flows down from the parent to the child, who is expected to defer to the adults

174 Emotionality Strong emotional displays, especially in public, are considered to be signs of immaturity or a lack of control

175 Holistic View on Mind and Body
Because the mind and body are considered inseparable, Asian Americans may present emotional difficulties through somatic complaints

176 Identity Issues Individuals undergoing acculturation conflicts may respond in the following manner: Assimilation--seeks to become part of the dominant society to the exclusion of his or her own cultural group Separation--identifies exclusively with the Asian culture Integration/”biculturalism--retains many Asian values but adapts to the dominant culture by learning necessary skills and values Marginalization--perceives one’s own culture as negative but is unable to adapt to majority culture

177 Expectations of Counseling
Explain the nature of the counseling and therapy process and the necessity of obtaining information Describe the client’s role Indicate that the problems may be individual, relational, environmental, or a combination of these and that you will perform an assessment of each of these areas Introduce the concept of co-construction—that the problem and solutions are developed with the help of the client and the counselor Asian clients expect the counselor to take an active role in structuring the session and guidelines on the types of responses that they will be expected to make

178 Family Therapy Assess the structure of the Asian American family to find out if it is it hierarchical or more egalitarian Focus on the positive aspects of the family and reframe conflicts to reduce confrontation Expand systems theory to include societal factors such as prejudice, discrimination Function as a culture-broker in helping the family negotiate conflicts with the larger society

179 Guidelines for Clinical Practice
Be aware of cultural differences between the therapist and the client as regarding counseling, appropriate goals, and process Build rapport by discussing confidentiality and explaining the client role and the need to co-construct the problem definition and solutions Assess not just from an individual perspective but include family, community, and societal influences on the problem Conduct a positive assets search Consider or reframe the problem when possible as one in which issues of culture conflict or acculturation are involved Determine whether somatic complaints are involved and assess their influence on mood and relationships

180 Guidelines for Clinical Practice
Take an active role but allow Asian Americans to choose and evaluate suggested interventions Use problem-focused, time-limited approaches that have been modified to incorporate possible cultural factors With family therapy, the therapist should be aware that Western based theories and techniques may not be appropriate for Asian families so focus on positive aspects of parenting such as modeling and teaching and use a solution-focused model In couples counseling, assess for societal or acculturation conflicts

181 Guidelines for Clinical Practice
With Asian children and adolescents, common problems involve acculturation conflicts with parents, feeling guilty or stressful over academic performance, negative self-image or identity issues, and struggle between interdependence and independence Among recent immigrants or refugees, assess for living situation, culture conflict and social or financial condition Consider the need to act as an advocate or engage in systems-level intervention in cases of institutional racism or discrimination


183 Hispanic Hispanic is the U.S. Government designation to refer to the common background of the Spanish language amongst people from various geographic regions (e.g. Puerto Rico, Mexico, South America, etc.) Hispanics are the largest minority group in the U.S. (35, 238, 481)

184 Hispanic Tradition Familismo (family unity) is seen as important as are respect and loyalty to the family Family members cooperate, are often religious, possess strict child rearing practices, and value the extended family In general, outside help is not sought until all family resources are exhausted

185 Acculturation Conflicts
Some maintain their traditional orientation while others assimilate the host culture Being “bicultural” is thought to lead to optimal levels of mental health

186 Societal Factors Acculturative stress amongst immigrants has been linked to depression and suicidal ideation Racism and discrimination can also impact mental health

187 Personalismo Personalismo is a basic cultural value of Hispanic Americans--although the first meetings may be quite formal, once trust has developed, the clients may develop a close personal bond with the counselor Remember that personalismo is a basic cultural value of Hispanic Americans--although the first meetings may be quite formal, once trust has developed, the clients may develop a close personal bond with the counselor. He or she may be perceived as a family member or friend and may be invited to family functions and given gifts

188 Guidelines for Clinical Practice
It is important to engage in a respectful, warm, and mutual introduction with the client because less acculturated Hispanic Americans expect a more formal relationship and the counselor will be seen as an authority figure and should be formally dressed Give a brief description of what counseling is and the role of each participant Explain the notion of confidentiality (especially with illegal immigrants) Have the client state in his or her own words the problem or problems as he or she sees it--determine the possible influence of religious or spiritual beliefs Assess the acculturation level

189 Guidelines for Clinical Practice
Consider whether there are cultural or societal aspects to the problem Determine whether a translator is needed Determine the positive assets and resources available to the client and his or her family Discuss possible consequences of achieving indicated goals for the individual, family, and community Discuss the possible participation of family members and consider family therapy Assess possible problems from external sources, such as need for food, shelter, or employment, or stressful interactions with agencies

190 Guidelines for Clinical Practice
Explain the treatment to be used, why it was selected, and how it will help achieve the goals With the client’s input, determine a mutually agreeable length of treatment--it is better to offer time-limited, solution-based therapies Remember that personalismo is a basic cultural value of Hispanic Americans--although the first meetings may be quite formal, once trust has developed, the clients may develop a close personal bond with the counselor. He or she may be perceived as a family member or friend and may be invited to family functions and given gifts Consistently evaluate the client’s or family’s response to the therapeutic approach you have chosen


192 People of Mixed Race People of mixed race heritage are often ignored, neglected, and considered nonexistent in our educational materials, media portrayals, and psychological literature

193 Facts and Figures The biracial baby boom in the United States started in 1967 when the last laws against race mixing (anti-miscegenation) were repealed The number of children living in families where one parent is White and the other is Black, Asian, or American Indian has tripled from 1970 to 1990

194 Racial/Ethnic Ambiguity, or “What Are You?”
Racial/ethnic ambiguity refers to the inability of people to distinguish the monoracial category of the multiracial individual from phenotypic characteristics The “What are you?” question almost asks a biracial child to justify his or her existence in a world rigidly built on the concepts of racial purity and monoracialism

195 The Marginal Syndrome Root (1990) asserted that mixed-race people begin life as “marginal individuals” because society refuses to view the races as equal and because their ethnic identities are ambiguous as they are often viewed as fractionated people—composed of fractions of a race, culture, or ethnicity

196 Complex Identity Processes
A growing number of multiracial individuals who are choosing “multiracial” as their ethnic identity Where the child grows up (i.e. in an integrated neighborhood and school versus in an ethnic community) can have a great impact on identity Physical appearance also influences the sense of group belonging and racial self-identification among multiracial individuals

197 Multiracial Bill of Rights
Three major affirmations: Resistance Revolution Change

198 Guidelines for Clinical Practice
Become aware of your own stereotypes and preconceptions regarding interracial relationships and marriages When working with multiracial clients, avoid stereotyping See multiracial people in a holistic fashion rather than as fractions of a person Remember that being a multiracial person often means coping with marginality, isolation, and loneliness With mixed-race clients, emphasize the freedom to choose one’s identity Take an active psychoeducational approach

199 Guidelines for Clinical Practice
Since mixed race people are constantly portrayed as possessing deficiencies, stress their positive attributes and the advantages of being multiracial and multicultural Recognize that family counseling may be especially valuable in working with mixed-race clients, especially if they are children When working with multiracial clients, ensure that you possess basic knowledge of the history and issues related to hypodescent (the one drop rule), ambiguity (the “What are you?” question, marginality, and racial/cultural identity


201 Stereotypes, Racism and Prejudice
Arabs and Arab Americans have been stereotyped in movies as sheiks, barbarians, or terrorists Islam has also been portrayed as a violent religion Also, many believed that it was OK to question and inspect people with Middle-Eastern accents or features

202 Religious and Cultural Background
Muslims or the followers of Islam believe in one God and individual accountability for their actions Quran is equivalent to the Bible in Christianity Within Islam, there are two major groups - Sunni and Shiite The Sunni group is largest group accounting for about 90% of Muslims worldwide The remaining 10% are Shiites

203 Family Structure and Values
While values and families vary widely, there are some commonalities Families tend to be group oriented, interdependent and patriarchical Women are responsible for rearing the children and for homemaking Hospitality is considered very important Opposite-sex discussions with those outside the family may be problematic

204 Acculturation Conflicts
Many have assimilated—especially the first wave of immigrants The second wave has tended to maintain their traditional identity Some wear traditional clothing (e.g. hijab or head scarf) Also, some are bicultural and integrate both identities

205 Guidelines for Clinical Practice
Identify your attitudes about Arab American and Muslims Inquire about importance of religion in their lives Determine the structure of the family through questions and observation. With traditional families, try addressing the husband or male first. Traditional families may appear to be enmeshed.

206 Guidelines for Clinical Practice
Be careful of self-disclosures that may be interpreted as a weakness. This will reduce the therapist’s status among some Arab Americans. Positive self-disclosures are fine In traditionally oriented Arab Americans families, there may be reluctance to share family issues or to express negative feelings with a therapist. Be open to exploring spiritual beliefs and the use of prayer or fasting to reduce distress


208 Jewish Americans  Jewish Americans have long been the targets of discrimination and hate crimes Anti-semitism is on the rise in Israel The Jewish population in the U.S. is the largest in the world Many Jewish people immigrated from Russia, Austria-Hungary and Romania between Of the Jews outside the U.S., most are from the former Soviet Union The Jewish population is falling rapidly due to low fertility and “marrying out” Most do not follow all religious traditions, but celebrate holidays such as Yom Kippur, Hanukah, and Passover

209 Experiences with Prejudice and Discrimination
The Holocaust killed over 6 million Jews and left many people poor, displaced, and without families Jewish hate crimes are on the rise May Jewish people fought for civil rights for people of color in the 1960’s Holocaust deniers are individuals who do not acknowledge or who question the existence of the genocide that occurred during the Holocaust Some Jews experience guilt for not practicing traditional Jewish customs For many, a Jewish identity centers around a common experience and history

210 Judaism The belief in one omnipotent God who created humankind—one of the earliest monotheistic religions Yom Kippur, the Day of Atonement is a time set aside to atone for sins during the past year The synagogue is a place of worship There are many forms of Judaism ranging from more conservative (e.g. Orthodox) to progressive

211 Implications As a counselor, it is important to be aware of the Jewish identity as well as experiences of discrimination and harassment Many organizations still do not acknowledge Jewish holidays in the same way as Christian holidays Become aware of your own biases and assumptions about Jewish people


213 Attitudes Toward Immigrants
Many groups have tried to prevent immigrants from entering the U.S. and have worked to curtail rights (e.g. voting) In 2006, the Ohio legislature passed a law that attempts to exclude immigrant rights, but it was overturned In 1994, California passed proposition 187 which denied undocumented immigrants a public school education, medical assistance and other services

214 Societal Conditions Societal and governmental reactions to immigrants are influenced by social conditions They become negative when economic conditions result in a loss of jobs or limited housing Terrorist attacks have had a negative impact on people who appear “foreign”

215 Immigrant Reactions Immigrants may fear being deported
Many may be reluctant to seek physical or mental healthcare Counselors need to understand that immigrant clients may be mistrustful for fear of deportation

216 Immigrant Rights Hospitals are required to provide emergency care to everyone regardless of documentation status Free community clinics exist and will treat all immigrants Immigrants can ask for interpreters

217 Barriers to Seeking Treatment
Communication due to language difficulties Lack of knowledge of mainstream service delivery

218 Implications Counselors need to be active and become advocates and spokespeople for immigrants Offer services within communities Have indigenous healers on staff Stay current on local, state, and federal immigration laws Use skilled and knowledgeable interpreters


220 Refugees Refugees leave their home country due to persecution
Individuals are granted asylum when they meet the criteria for refugee status and who are physically present in the U.S. or at a point of entry when granted permission to reside in the U.S.                    

221 Special Problems Involving Refugees
Refugees are under more stress than immigrants are They have been exposed to more traumas than most immigrants Central American refugees in one study showed high levels of mistrust towards service providers Parents often worry about their children’s adaptation to the American way of life Many will have difficulties communicating in English, will be underemployed and oftentimes—depressed

222 Special Problems Involving Refugees
Parents often worry about their children’s adaptation to the American way of life Many will have difficulties communicating in English, will be underemployed and oftentimes—depressed

223 Considerations in Working with Refugees
Trauma Loss Feelings of displacement

224 Refugees and Assessment
As a mental health worker, it will be important for you to assess: Effects of Past Persecution, Torture, or Trauma Culture and Health Safety issues Gender Issues and Domestic Violence Linguistic and Communication issues (e.g. the use of interpreters)

225 Guidelines for Clinical Practice
Be aware that the client might have day-to-day stressors such as limited resources, a need for permanent shelter, lack of employment, or frustrating interactions with agencies--allow time to understand and provide support related to these immediate needs, or help the client locate resources related to specific needs Be knowledgeable and conversant with the refugee groups you work with, their pre-migration traumas, and psychological strategies used to cope with stress Understand symptom manifestations likely to indicate post-traumatic stress, and other mental disorders that may arise from experiences of war, imprisonment, persecution, rape and torture

226 Guidelines for Clinical Practice
Allow time for clients to share their backgrounds, their pre-migration stories, and changes in their lives since immigrating Inquire about client belief’s regarding the cause of their difficulties, listening for sociopolitical, cultural, religious or spiritual interpretations Carefully explain the therapeutic approach that will be used, why that approach was selected, and how it will help the client make desired changes


228 Homosexuality Homosexuality involves the affectional and/or sexual orientation to a person of the same sex Most males prefer the term gay and females—lesbian Approximately 4-10% of the U.S. population are homosexual Younger Americans seem more accepting of gay rights and same sex marriages However, violence and discrimination is pervasive

229 Homosexuals and Disorders
Same Sex Relationships Are Not Signs of Mental Disorders Research supports that homosexuals are not more psychologically disturbed on account of their homosexuality However, Lesbian and gay youth report elevated levels of major depression, generalized anxiety disorder and substance abuse Same Sex Relationships Are Not Signs of Mental Disorders Even though the APA no longer considers homosexuality to be a mental disorder, some people still harbor this belief

230 Assumption of Heterosexuality
It is important that counselors do not assume heterosexuality, not focus on the client’s sexual orientation if it is irrelevant, understand the “coming out” process, and infuse sexual orientation issues into training programs

231 GLBT Couples and Families
About 1.2 million people are part of gay and lesbian couples in the U.S.—a 300% increase since 1990 Children of GLBT couples show healthy cognitive and behavioral functioning GLBT couples may be uncomfortable showing affection towards one another

232 GLBT Youth Compared to heterosexual youth, GLBT youth report more substance abuse, sexual risk taking behaviors, suicidal attempts/thoughts and personal safety issues

233 Identity Issues Awareness of sexual orientation of gay males and lesbian females tends to occur in the early teens The struggle for identity involves one’s internal perceptions in contrast to the external perceptions or assumptions of others about one’s sexual orientation Individuals with gender identity issues report feeling “different” at an early age Cross-sex behaviors and appearance are highly stigmatized in school and society Mental health providers need to help GLBT youth to develop coping strategies and survival skills and to expand environmental supports

234 Coming Out The decision to come out can be extremely difficult
Coming out to parents, family, and friends can lead to rejection, anger, and grief This can be especially difficult for adolescents who are financially dependent on their family Black and Latino gay and lesbian youth are more reluctant to disclose their sexual orientation than are their White counterparts A counselor should help GLBT individuals with the coming out process (e.g. decision-making, role plays) Mental health providers should assist GLBT individuals with acquiring social support

235 Guidelines for Clinical Practice
Examine your own views regarding heterosexuality and determine their impact on work with GLBT clients--way to personalize this perspective is to assume that some of your family, friends or coworkers may be GLBT. Read the “Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns, 2000) Develop partnerships, consultation, or collaborative efforts with local and national GLBT organizations Assure that your intake forms, interview procedures, and language are free of heterosexist bias and include a question on sexual behavior, attraction, or orientation Do not assume that the presenting problems necessarily are the result of sexual orientation but be willing to address possible societal issues and their role in the problems faced by GLBT clients.

236 Guidelines for Clinical Practice
Remember that common mental health issues may include stress due to prejudice and discrimination; internalized homophobia; the coming out process; a lack of family, peer, school, and community supports; being a victim of assault; suicidal ideation or attempts; and substance abuse Realize that GLBT couples may have problems similar to those of their heterosexual counterparts but may also display unique concerns such differences in the degree of comfort with public demonstrations of their relationship or reactions from their family of origin Assess spiritual and religious needs

237 Guidelines for Clinical Practice
Because many GLBT clients have internalized the societal belief that they cannot have long-lasting relationships, have materials available that portray healthy and satisfying GLBT relationships Recognize that a large number of GLBT clients have been subject to hate crimes--depression, anger, posttraumatic stress, and self-blame may result For clients still dealing with internalized homosexuality, help them establish a new affirming identity Remember that in group therapy, a GLBT individual may have specific concerns over confidentiality and different life stressors as compared with their heterosexual counterparts

238 Guidelines for Clinical Practice
A number of therapeutic strategies can be useful with internalized homophobia, prejudice, and discrimination. They can include identifying and correcting cognitive distortions, coping skills training, assertiveness training, and utilizing social supports If necessary, take systems-level intervention to schools, employment, and religious organizations Conduct research on the mental health needs of the GLBT communities and the effectiveness of current programs


240 Older Adults The population of older individuals in the United States is growing During the past decade the 85-year-old and older group has increased by 38%, while those between 75 and 84 increased by 23% Ageism has been defined as negative attitudes towards the process of aging or toward older individuals

241 Stereotypes of the Elderly
Women are more likely than men to be viewed negatively Stereotypes and biases against the elderly are pervasive Some stereotypes include rigidity, senility, lacking in health/intelligence and having no sexual desires

242 Mental Health There is a perception that rates of mental illness are high among the elderly, however, this is not true About 6% of older adults are in the community mental health system

243 Mental Deterioration or Incompetence
Only a small number of older adults have dementia However, by the year 2040, it is estimated that 7 million people will have Alzheimer’s disease Cognitive decline is a part of aging and should not be confused with senility

244 Sexuality in Old Age It is thought that older adults do not engage in sexual activity, however, many older adults are sexually active

245 Guidelines for Clinical Practice
Obtain specific knowledge and skills in counseling older adults. Critically evaluate your own attitudes about aging and quality of life Be knowledgeable about legal and ethical issues that arise when working with older adults (e.g., competency issues) Determine the reason for evaluation and the social aspects related to the problem, such as recent losses, financial stressors, and family issues Show older adults respect and give them as much autonomy as possible regardless of the issues involved or mental status. Identify medical conditions and prescription and over-the-counter medications because mental conditions are often a result of physical problems or drug interactions or side effects

246 Guidelines for Clinical Practice
Presume competence in older adult clients unless the contrary is obvious If necessary, slow the pace of therapy to accommodate cognitive slowing Provide information in a manner that approximates the client’s level of reading and comprehension, using alternative methods such as simplified visuals or videotapes if necessary Involve older adults in decisions as much as possible Use multiple assessments and include relevant sources (client, family members, significant others, and health care providers) Determine the role of family caregivers, educate them about the disorder, and help them develop strategies to reduce burnout

247 Guidelines for Clinical Practice
When working with an older couple, help negotiate issues regarding time spent alone and together (especially after retirement Recognize that it is important to help individuals who are alone establish support systems in the community Help the older adult develop a sense of fulfillment in life by discussing the positive aspects of their experiences Determine the older adult’s views of the problem, belief system, stage of life issues, educational background, and social and ethnic influences Assist in interpreting the impact of cultural issues such as ethnic group membership, gender, and sexual orientation on their lives For adults very close to the end of their lives, help them deal with a sense of attachment to familiar objects by having them decide how heirlooms, keepsakes, and photo albums will be distributed and cared for


249 Sexism Women continue to face barriers in many career tracks—especially math and science Teachers continue to discriminate against women in classroom setting Stereotypes against women inhibit their performance Women also continue to receive about 75% of what men earn

250 Economic Issues Women continue to be overrepresented in lower wage jobs (e.g. cashier, secretary, nurse’s aid, and teaching) Mental health professions need to become aware of economic issues faced by women and work to assist them as needed

251 Barriers to Career Choices
College women perceive more obstacles to their career choices than do men—for women of color—it is worse When a women does not behave in a stereotypically feminine manner—she is less liked by others Women continue to face difficulties in the workplace (e.g. harassment, lack of mentorship, tokenism, etc.)

252 Discrimination and Victimization
Over 70% of women office workers have reported harassment at their place of employment Approximately 20% of female students report being physically or sexually abused by their dating partner As a result of abuse, many women are depressed

253 Counselor Bias One study revealed that therapists were not aware of it, but, they were subtly conveying gender role expectations to women Biases can also exist in diagnostic categories (e.g. Histrionic, Borderline, and Dependent personality disorders) Codependency may reflect a sense of connectedness and nurturance rather than being pathological

254 Feminist Identity Theory
Feminist therapists believe that the patriarchal aspect of U.S. society is responsible for many of the problems faced by women Feminist identity theory posits an evolution of consciousness of societal subjugation of women: Passive-acceptance—the women accepts traditional gender roles and believes that men are superior to women Revelation—events of sexism occur in a way that cannot be ignored or denied Embeddedness-emanation—formation of close relationships with other women Synthesis—a positive feminist identity is fully developed Active-commitment—the woman is now interested in turning her attention towards making societal changes

255 Therapy for Women It is important for counselors to be aware of bias in the counseling process One study revealed that therapists were not aware of it, but, they were subtly conveying gender role expectations to women Biases can also exist in diagnostic categories (e.g. Histrionic, Borderline, and Dependent personality disorders) Codependency may reflect a sense of connectedness and nurturance rather than being pathological

256 Guidelines for Clinical Practice
Possess up-to-date information regarding the biological, psychological, and sociological issues that impact women--for example, knowledge about menstruation, pregnancy, birth, infertility and miscarriage, gender roles and health, and discrimination, as well as their impact on women, is important Recognize that most counseling theories are male-centered and require modification when working with women--for example, cognitive approaches can focus on societal messages Attend workshops to explore gender-related factors in mental health and be knowledgeable about issues related to women

257 Guidelines for Clinical Practice
Maintain awareness of all forms of oppression and understand how they interact with sexism Employ skills that may be particularly appropriate for the needs of women, such as assertiveness training, gender role analysis, and consciousness-raising groups Assess sociocultural factors to determine their role in the presenting problem Help clients realize the impact of gender expectations and societal definitions of attractiveness on the mental health of women so that they do not engage in self-blame Be ready to take an advocacy role in initiating systems-level changes as they relate to sexism in education, business, and other endeavors Assess for the possible impact of abuse or violence in all women


259 Discrimination Discrimination is rampant against people with disabilities—they receive lower pay and have more difficulty finding employment The Americans with Disabilities Act (ADA) was signed into law in 1990 extending federal mandate of nondiscrimination toward individuals with disabilities to the state and local governments and the private sector

260 Disabilities 21 million families in the U.S have at least one member with a disability It includes individuals with mental retardation, hearing impairment or loss, learning disabilities, psychiatric disorders, and more HIV has recently been added as a disability

261 Myths about People with Disabilities
Most people are in wheelchairs People with disabilities are a drain on the economy The greatest barriers to people with disabilities are physical ones Businesses dislike the ADA Government health insurance covers people with disabilities

262 Models of Disability Moral model Medical model Minority model
The following are three models of disability affecting the way the condition is perceived: Moral model Medical model Minority model Three models of disability affecting the way the condition is perceived is presented here: Moral model—douse on the “defect” as representing some sort of sin or moral lapse Medical model—the disability represents a defect or loss of function that resides in the individual and action is taken to rehabilitate the condition Minority model—Disability is seen as an external problem involving an environment that fails to accommodate the needs of individuals with disabilities

263 Recommendations Treat people regardless of disability status with the same expectations Gather information about your client’s disability—do not solely rely on them to educate you A client’s disability may not be the focus of treatment

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