1. CULTURAL ISSUES IN PSYCHOTHERAPY
Training Seminar

2. THEMES FOR CULTURALLY COMPETENT PSYCHOTHERAPY
Historical and political issues
Migration experiences and issues
Generational issues (1st, 2nd, 3rd)
Regional issues (urban vs. rural socialization)
Racial and cultural identity issues
Language (mono-, bi-, multilingual)
Worldview (individalism vs. collectivism)
Kinship influences
Gender role socialization
Religious/Spiritual influences
Cultural idioms of distress

3. PITFALLS OF CONSIDERING CULTURAL ISSUES IN THERAPY
Assumptions about cultural universality
Renewed forms of intolerance
Questions of perceived vs. actual competency
Risk of unethical conduct in interactions
Perceived value of therapy by ethnic minorities
Sociopolitical barriers and perceptions
Lack of translation from theory to practice

4. COMPETENCY DIMENSIONS
Cultural awareness and beliefs
Personal biases & individual values
Needs of self and others
Cultural knowledge
Cultures, ethnicities, nationalities, worldviews
Differences and similarities
Cultural skills
Therapeutic techniques or strategies
Alliance building
Credibility and expertise
( Sue, 2006)

5. BROACHING RACE AND CULTURAL ISSUES
Def: Counselor’s ability to consider the relationship of race and cultural factors to the client’s presenting problem
Broaching behavior
Therapeutic benefits of broaching
Day-Vines, et al., 2007

6. CONTINUUM OF BROACHING
Avoidant – has a race neutral perspective; minimalistic
Isolating – simplistic and superficial style
Continuing/incongruent – limited skill set
Integrated/congruent – explores frequently
Infusing – has enduring commitment
Day-Vines, et al., 2007

7. ETHNOCENTRIC MONOCULTURALISM (“Encapsulated Counselor”)
Belief in superiority
Belief in inferiority of others
Power to impose standards
Manifestation in institutions
The invisible veil

8. THE RELATIONSHIP BETWEEN ETHNIC IDENTITY AND ACCULTURATION
High Acculturation
&
Strong Ethnic Identity
Low Acculturation
Weak Ethnic Identity

9. GENERAL MULTICULTURAL CONSIDERATIONS
It is necessary to use a strength-based approach to treatment
Be open to deviation from traditional Western approaches e.g. allow the client to ask you questions about yourself
Note that racial, ethnic, and gender match are not necessarily salient for effective treatment to occur
Have some cultural knowledge regarding client’s ethnic origin and affirm this
Be attentive and flexible to how you open and close sessions
Get in the habit of asking clients if they would like to return to treatment. Do not assume their position and schedule the next session!

10. CASE STUDIES

11. Case Study of Hala
Hala is a 28 year-old Arab American female who is a graduate student at FIU. She is coming to CAPS because it has becoming increasingly difficult for her to cope with stress and anxiety in her life. She indicated that this has been caused by her parents’ rejection of her choice of a marriage partner. Hala’s primary complaint is her inability to get over her parent’s disapproval of her plans to marry an Arab man who is of the Christian faith. Hala was raised in and continues to follow Islam. Despite the fact that she only sees this young man once a year because he lives and works in Syria, Hala stated that she loved him dearly and wants to marry him.

12. The Case of Nydya
Nydya is a 22 year old Puerto Rican woman, who at the age of 2 immigrated with her family to the US. She is seeking counseling because her White American fiancé made his first visit to meet her family. She came to you because she heard that you are Puerto Rican and believes that you will be able to help her sort out the tension and fears that she experienced after her fiancés visit.
While in PR her fiancé quickly identified some of the darker complected members in Nydya’s family as Black and was quite taken aback by this observation. He had assumed that because Nydya is phenotypically White all of her siblings were white. He asked her what she was: was she Black or White? This probing caused Nydya some panic and anxiety. She was concerned about her fiance’s preoccupation with her racial identity; she was also uncertain about her racial/ethnic identity at this point.

13. The Case of Grace
Grace is an 18 year old Korean American female who is a freshman at FIU majoring in Economics and is a straight A student. She came to CAPS after a series of panic attacks. She did not share these episodes with her family because she did not want to worry them. At intake Grace reported that she has been generally feeling anxious for many years and that the symptoms of anxiety worsened since her older brother’s death a year ago in an automobile accident – he was her parents’ pride and in medical school. Her brother’s death greatly affected her family such that her father was hospitalized because his heart condition deteriorated because of the death. As a result the family has been careful to avoid any subject that might upset him. Grace was left to work out her grief alone and to deal with the pressure that she now has to take the role of a first born. Her father began talking to her about choosing premed as her college major.

14. CULTURAL CONSIDERATIONS FOR HISPANICS
Collectivism
Role of family – familism
Acculturation issues
Ethnic identity development
Gender role socialization
Interactive culture strain

15. FACTORS AFFECTING MENTAL HEALTH OF AFRICAN AMERICANS
Limited access and glass ceiling
Exclusion and isolation
Powerlessness
Voicelessness and invisibility
Token status
Second guessing
Pigeonholing
Guilt by association
Identity conflict issues
Allegiance issues
Survival conflict and guilt issues
Achievement ideology issues
(From Multicultural Issues in Counseling. Lee, 1996)

16. CULTURAL CONSIDERATIONS FOR AFRICAN AMERICANS
Historical influences
Afrocentricity (cultural and ethnic identity)
The role of kinship networks and collective worldview
Religiosity and spirituality
Building trusting relationships
Role models and mentors
Stigmatization of mental illness
Education and socioeconomic status
Client’s personal experience as an ethnic minority
Client’s experience with racism and discrimination
Environmental stressors

17. RECOMMENDATIONS FOR PSYCHOTHERAPY
Create a safe environment in the initial session
Increase knowledge and understanding of the needs and experiences of African Americans
Examine personal biases and ideas and beliefs about working with African American clients
Consider cultural biases embedded in psychological assessment instruments
Become knowledgeable about counseling models shown to be effective
Increase correspondence with clients’ medical doctors
Refer clients to additional sources of support and alternative counseling resources

18. CHALLENGES AND BARRIERS
A need to thoroughly examine conscious and unconscious attitudes about race and the legacy of race in the US
Keep at arm’s length assumptions of cultural homogeneity and offer contextually based mental health care
Counselor’s race – some clients seek ethnic matching counselors
Counselors’ reluctance to broach racial issues
Clients’ doubts about cultural competency of counselors
Racial identity stage factors – difficulty to help clients develop a positive racial identity
Lack of resources and competency training that can effectively improve mental health

19. CULTURAL CONSIDERATIONS FOR ASIAN AMERICANS
Academic and career orientation
Filial piety – attitude towards parents
Role of family bonds and unity
Family roles and status
Control of emotions

20. CULTURAL CONSIDERATIONS FOR AMERICAN INDIANS
Impact of history
Identity issues and worldviews
Urban and rural differences
Intergenerational differences
Differences in understanding and explaining disease
Cultural Perspective
Being versus doing
Present time orientation
Importance of tribe, family, and elders
Spirituality
Harmony, balance, and holism

21. SYNERGETIC PSYCHOTHERAPY WITH NATIVE AMERICANS
Address openly issues of ethnic dissimilarity
Consider ethnic identity and acculturation
Allow for schedule flexibility
Be open to participation of family members and tribal elders
Incorporate the creative arts
Integrate natural healing practices
Allow time for trust to develop
Respect the use of silence
Incorporate spirituality and humor in treatment

22. CULTURAL CONSIDERATIONS FOR INDIVIDUALS OF ARABIC DESCENT
Suitable approaches are those that are short-term, concrete, structured, and goal-oriented
Men tend to explain mental health symptoms as caused by god’s will while women attribute their symptoms to sorcery
Mental illness is attributed to supernatural powers and can be exemplified in the “evil eye” phenomenon
Warding off the envy associated with the evil eye occurs in the form of various decorations for dwellings that include the depiction of an eye, or medals, or charms worn or placed on children.
Within patriarchal structure, it is important that appropriate rapport and joining occurs with the members of the family who are in authority.
Handshakes with a woman might be considered improper by a pious Muslim, while handshakes between a male and Muslim female might be considered the woman’s choice.
(A. Krenawi & J. Graham, 2000)

23. CULTURAL CONSIDERATIONS FOR MULTIRACIAL INDIVIDUALS
Develop a worldview for therapy that is based on multicultural competence
Broaching racial issues and creating a safe and supportive environment to address these concerns
Do not assume that the way a client looks signifies his or her personal affiliation even when the client is monoracial
Actively consider how a client’s experiences and perceptions may differ as a result of his/her ethnic/racial identification and racial ambiguity
Expect pessimism about the world and the intentions of others. When clients can “pass” as a race other their own they are privy to racist or discriminatory conversations
Help the client accept that she/he is not personally responsible for changing other peoples’ perceptions

24. CULTURAL CONSIDERATIONS FOR MULTIRACIAL INDIVIDUALS
Do not assume that the client’s race of origin is a “safe haven” since client experiences vary
Develop knowledge of cultural groups or organizations that focus on multiculturalism.
Encourage clients to explore positive aspects of their identity outside of the single domain of ethnicity or race.
Help the client to learn how to integrate his/her multiple identities into a unified whole in a way that is comfortable
Explore meaning and implication of sexualization of women of color and perception of them as sexual and exotic.

25. Questions?