1. CHAPTER 1: The Culturally Competent Counselor
Developing Multicultural Counseling Competence: A Systems Approach
Second Edition
Danica G. Hays and Bradley T. Erford

2. Historical Shifts
Counseling geared toward white, middle-upper class individuals
Forces: Psychodynamic, Behaviorism, Existentialism/Humanism
Increasing diversity in the United States
Forces: multiculturalism, social advocacy

3. U.S. Demographics (2010) Increased diversity Aging Trends
Vary by racial and ethnic groups
Increasing birth rates
Immigration trends
Historical patterns
Projected patterns

4. U.S. Demographics (2010) Cont.
U.S. Population = approximately 309 million
White (72.4%; 63.7% non-Hispanic/Latino)
Black/African American (12.6%)
Asian American (4.8%)
Other races (e.g., Native American, Alaska Native, Native Hawaiian = 5.2%)
16.9% identify as Hispanic/Latino
11% foreign-born (majority from Latin America)

5. U.S. Demographics (2010) Cont.
Median household income
Poverty rates
Gender data
Racial and ethnic group data

6. What is Multicultural Counseling?
The integration of cultural identities within the counseling process
Cultural Identity
Subgroups (e.g., race, ethnicity, gender, sexual identify, SES, disability, spirituality, age, etc.)
Role of “American” culture
Acknowledgement of cultural identity in counseling impacts one’s counseling experience.

7. Culture …the totality of the human experience for social contexts.
biological, psychological, historical, political events
behaviors, feelings, attitudes, feelings, and cognitions
organizes a group as a whole
worldview, individualism-collectivism, race, ability status, spirituality
universal, group, and individual cultures
cultural encapsulation/ethnocentrism

8. Individualism & Collectivism
Individuals guide their decisions by how they benefit/reflect upon themselves, others, or both.
Individualism defined – competitiveness, self-disclosure, agency, independence, self-promotion
Collectivism defined – cooperation, “saving face,” interdependence

9. Race & Ethnicity Two of the major classification systems
Race defined – arbitrary, socially constructed classification system based on physical distinctions
Ethnicity defined – shared characteristics of culture, religion, and language
Nationality defined – common component of ethnicity; one’s nation of origin

10. Generational Status
Generational status defined – clusters of particular age groups with typical ranges of 15 to 20 years
Living Generations:
GI (government issue)
Silent
Baby boomer
Generation X
Generation Y
Generation Z 2000+
The role of age and generational status may vary among cultures.

11. Gender Gender defined – expression of social categories
Gender roles defined – social categories that describe behaviors deemed appropriate for males and females
Masculinity
Femininity
Androgyny defined – blending of masculinity and femininity for both males and females
Benefits and challenges of social norms

12. Sexual Orientation
Sexual orientation defined – sexual/affectional attraction to the same, or opposite gender, or both
Sexual identity defined – degree of identification with a particular sexual orientation
Heterosexual, gay, lesbian, bisexual, questioning
Continuum of gender and sexual orientation

13. Socioeconomic Status
Indicated by: household income, occupational status, education level, use of public assistance, and access to healthcare
Lower SES tend to have negative mental health outcomes.
Intersection of SES, race, ethnicity, & gender is an important multicultural counseling component.

14. Disability
Disability defined – mental or physical impairment that affects at least one of an individual’s daily activities
Ableism – negative consequences experienced by those with disabilities
Legislation has allowed for increased protection and appropriate treatment:
U.S. Rehabilitation Act (1973), American Disabilities Act (1990), Individuals with Disabilities Education Improvement Act (2004)

15. Spirituality
Spirituality defined – connections individuals have with themselves & the universe as a whole
provides direction, meaning, purpose for individuals
Religion – behaviors & practices of faith; organizing construct of spirituality
Buddhism, Christianity, Confucianism, Hinduism, Islam, Judaism, Taoism

16. Advocacy, Privilege, & Oppression
Advocacy defined – promoting an idea, policy, or cause that betters the lives of those who have less power, access, advantage, or social status
Sense of responsibility to change the status quo
Individual & systemic interventions to empower individuals
Assumed power differential/privilege

17. Advocacy, Privilege, & Oppression Continued
Privilege defined – often unconscious & unearned power, access to resources, advantage, & social position based on cultural membership
White, male, heterosexual, higher SES, able- bodied, Christian
Privilege creates oppression
Oppression defined – lack of power, inaccessibility, disadvantage, minority social status
Racial & ethnic minority groups, females, sexual minorities, less able-bodied, lower SES, religious minorities

18. Worldview
Worldview defined – an individual’s conceptualization of their relationship with the world
Locus of responsibility & locus of control guide behavior and motivation
Sue (1978) Combinations
IR-IC
IR-EC
ER-IC
ER-EC

19. Worldview
Klockholn & Strodbeck’s theoretical model (1961) – 5 Components of worldview
Human relationship – good, bad, combination
Relationship to nature – harmony, power over, or power in
Sense of time – past, present, or future oriented
Activity – being, being-in-becoming, doing
Social relationships- Lineal-hierarchical, Collateral-mutual, and Individualistic
Impact on counselor/client relationship

20. Verbal Communication Primary tool used in counseling
Power is embedded in language; those who do not speak the majority language are marginalized
Language barriers
Feelings of frustration/invalidation
Use of metaphors from the client’s culture to deepen levels of understanding
Preferences for expression in native languages
Counselors should be aware of resources in the community
Counselors may employ interpreters or learn a second language

21. Nonverbal Communication
85% of communication is nonverbal
Facial expressions
Proxemics – use of personal physical distance
Kinesics – body movements, positions, postures
Paralanguage – verbal cues other than words
Often ambiguous and culturally bound
Counselors should be aware of own nonverbal behaviors

22. Emotional Expression
Universal experiences: anger, sadness, gladness, fright, surprise, disgust
Expression & causes of emotions vary among and within culture
Socialization influences the way emotions are experienced
Use norms from within the client’s culture to determine if expression is pathological
Include the client’s beliefs regarding the origin of emotions in the counseling process

23. Communication Patterns
Ideally, communication patterns between counselor & client are characterized by openness & honesty.
Counselor should:
consistently check with the client to ensure accurate interpretation & understanding.
engage in a self-reflective process.
respond based on the client’s frame of reference.
self-disclose appropriately to promote trust.

24. Culture & Context
Culturally based contextual factors affect the counseling process.
Discrimination, immigration, acculturation, violence, trauma
Incongruence between traditional counseling processes and culturally diverse clients’ mental health needs & general attitudes towards counseling.
Contextual factors may increase diverse clients’ risk of mental health problems due to limited resources & support in U.S. society.

25. Prejudice & Discrimination
Prejudice defined – prematurely holding a belief/attitude without appropriate examination or consideration of actual data; positive or negative
Discrimination defined – covert & overt behaviors based on generalizations held about individuals based on their cultural group membership.
Both prejudice and discrimination:
Are based on stereotypes
Include racism, sexism, classism, heterosexism
Pervade individual, institutional, & cultural practices
Impart economic, social, political, mental, & physical costs.
Affect social support, occupational status, SES
Encourage maladaptive coping responses, serves as a catalyst for depression, suicide, substance abuse, violence, anxiety, disorders, stress
Can fuel medical complications: hypertension, heart disease, cancer

26. Immigration
Immigration defined – process by which foreign-born individuals settle in a new country
Most racial/ethnic groups were immigrants at some point.
Exceptions: Native Americans, Aleuts, Native Hawaiians
Examine reasons for entry to the U.S., length of time in the U.S., information about the cultural climate of the country of origin, & the historical and present degrees of prejudice/discrimination faced by client’s family.

27. Acculturation
Acculturation defined – degree to which immigrants identify with & conform to a new culture of a host society
Can identify with both homeland & host culture, embracing one culture over another, or rejecting both cultures.
Models of Acculturation: Assimilation, Separation, Integration, Biculturalism, and Marginalization
Largely determined by number of years in process, country of origin, age at onset of acculturation process, & ethnic identity
Many stressors attributed to acculturation

28. Violence & Trauma Relate across cultural identities
Linked to mental health problems: PTSD & depression
Often make immigration and acculturation processes more difficult
Often occurs in lower SES communities, among women, and among gay, lesbian, and bisexual individuals.

29. Culture & the Counseling Process
Culturally diverse clients underuse counseling services & prematurely terminate counseling.
Differences between counseling & cultural values
Stigmatizing process
Mistrustful of counselors, who tend to be predominately White
Counseling services tend to be inaccessible to culturally diverse clients.

30. Developing Multicultural Counseling Competence
All counselors need to:
become more self-aware of values and biases.
understand how various forms of oppression influence counseling.
appreciate other cultural norms and value systems.
skillfully employ culturally-appropriate assessments & interventions.
Multicultural Counseling Competency Standards & Guidelines (Sue et al., 1992).

31. A Systems Approach Individual
Race, ethnicity, gender, SES, spirituality, disability, sexual orientation, acculturation, racial identity development, spiritual identity development
Family
Plays a significant role in cultural identity.
Counselors should understand how the family affects the clients’ worldviews and behaviors.
Violence & trauma within families

32. A Systems Approach Community
Schools, mental health/social services, spiritual institutions, legal & economic resources, within- & between-group cultural diversity
Client & family experiences are embedded within the community values, resources & practices
Counselors are encouraged to increase their knowledge to connect clients to the community
Historical
Culturally based events for a community that impact a client
Racist acts, economy of a community, immigration patterns, civil rights events, historic discrimination

33. Social Justice and Advocacy
Goal is to promote equal access to resources and to promote environmental changes that result in optimal mental health for all
Counselors must advocate for social justice by empowering clients, advocating for fair and equal treatment of all clients, conducting preventative workshops, working with community organizations, and advocating for policy changes at institutional and societal levels.

34. Etic vs. Emic Debate
Within the multicultural counseling literature, a debate over how broadly to conceptualize cultural differences exists:
Etic approach – focuses on universal qualities common to all cultures & aspects of counseling that are generalizable across cultures.
Emic approach – emphasizes “divergent attitudes, values, & behaviors arising out of specific cultures” (Ridley, Li, & Hill, 1998, p. 835) and calls for culturally-specific counseling interventions.
Majority of research supports the emic approach

35. Within Group & Between Group Differences
There are more within-group differences than between-group differences
Counselors should consider a client’s cultural identity & context, as well as individual attributes
All clients possess multiple levels of cultural identity
Counselors should strive to validate & relate to which identity is most salient for the client at the present time

36. Underutilization of Services
Culturally diverse clients underuse & prematurely terminate counseling services
Values inherent in counseling may not be congruent with values in an individual’s culture
Culturally diverse clients may perceive counseling to be stigmatizing
Clients may be mistrustful of counselors

37. Conflicting Cultural Values
Counseling values mirror those of the dominant U.S. culture:
Individualism, preference for increased self- awareness, self-disclosure & emotional expression, linear time orientation, & goal directedness
Non-western cultures may have different values:
Collectivism, interdependence, limited disclosure, & circular time orientation
Traditional counseling theories tend to minimize a systems approach

38. Social Stigma
Some cultures view mental illness as something to be discussed only within a specific community
The way normality and abnormality are defined in counseling
Western ideas may not be appropriate for conceptualizing clients from culturally diverse backgrounds leading to misdiagnosis

39. Mistrust of the Counseling Profession
Culturally diverse clients tend to be mistrustful of counselors, who tend to be predominately White
Historical racist, sexist, classist, heterosexist undertones in counseling
Limited levels of awareness of the roles privilege & oppression play in both the counseling relationship & the clients’ daily lives

40. Inaccessibility of Services
Tend towards a lack of mental health services in communities where people of color & lower SES groups reside
Counseling is often unavailable for non-English speaking clients
Traditional counseling may be cost-prohibitive for certain diverse groups

41. Resistance to Multiculturalism
Racism, sexism, classism, heterosexism, ethnocentrism, & ageism exist within the counseling profession and prevent change
Competent multicultural practices require effort and change
Not all treatments look like traditional, empirically supported treatments that counselors may be comfortable using
Some counselors may be unwilling to relinquish the power associated with the expert role