1. Approaching Culture Authentically in Clinical Practice
Dr. Manuel X. Zamarripa, LPC-S
Austin Community College
Institute of Chicana/o Psychology
facebook.com/ChicanoPsychology

4. Culture & Cultural Identities
Microaggressions
The Role of Bias
Individualism v Collectivism
Primary v Secondary Cultural Characteristics
Help Seeking v Help Offering Behaviors
Defensive Behaviors

5. Cultural Competence
The paradox of practicing in the era of cultural competence
Although we have standards, evidence that there are still significant gaps in training and cultural understanding.
One reason, I propose, is because the concepts of culture and diversity have become buzzwords.
We hear and talk about culture often, however, many times a deeper understanding is not acquired in terms of application to clinical practice.

6. Cultural Competence
Result is that sometimes we become desensitized to the words “culture” or diversity” so that some reactions can be “Are we talking culture again?”
Infusing culture and deepening our understanding is equal to continuing to learn and review issues of ethics, counseling skills or interventions.

7. Cultural Context (Pedersen, 2000)
ALL behaviors are learned & displayed within a cultural context
Within their particular cultural contexts,
behaviors can be measured more accurately
personal identity can be more clearly defined
the consequences of problems are better understood
counseling interviews become more meaningful 

8. Cultural Context
Cultural Context is broadly defined to include ethnographic, demographic, status, & affiliation variables
Culture-centered interventions depend on
an inclusive definition of culture
a broad definition of the counseling process
additionally, culture is recognized as
central (not marginal)
fundamental (not exotic)

9. Culturally “Different” (i.e. deficient)
Historically “Different” indicated deficit
Different meant different than the “norm”
White, middle-class, male, heterosexual
Any difference from this norm was “less desirable”

10. Cultural/Social Identities in Therapy(Hayes, 2008)
ADDRESSING Framework
Age/Generation
Developmental Disability
Disability acquired later in life
Religious and Spiritual Orientation
Ethnic and Racial Identity
Socioeconomic Status
Sexual Orientation
Indigenous Heritage
National Origin
Gender

11. Identities & Privilege
Age/Generation – between ages of
Developmental Disability – no
Disability acquired later in life - no
Religious and Spiritual Orientation – secular or Christian
Ethnic and Racial Identity – European American or White
Socioeconomic Status brought up or currently middle- or upper class status
Sexual Orientation - heterosexual
Indigenous Heritage – no meaningful indigenous heritage
National Origin if you live in the country in which you were born and grew up
Gender male

12. Cultural Encapsulation
If people around you hold similar identities AND share the same privileges, may rarely question some common beliefs. This is cultural encapsulation.
Therapeutic practice – even with diverse clientele – will not necessarily increase self- awareness.

13. Cultural Encapsulation
We need to look outside the therapy setting to individuals and groups who differ from us AND can facilitate our self-assessment process.
Think about individuals in your intimate circle: How many differ in my areas of privilege?

14. Mental Health Cultural Encapsulation
What are three to five aspects that demonstrate wellness or mental well-being?
Accuracy of communication
Directness/frankness of communication
High Context v Low Context cultures

15. Real Talk
How would your parents respond to “what is your cultural background?” “Do you think culture plays a part in your problem?”
Real Talk, Real People. Need to speak their language. Careful about therapy talk.
How do we bring forth the topic of culture? How do we address social justice issues.?

16. Bringing Culture Forth (Hays, 2008)
How would you describe yourself?
Would you tell me about your cultural heritage or background? (use follow up questions)
What was your religious upbringing? Do you have a religious or spiritual practice now?
What was your family’s economic situation growing up?

17. Bringing Culture Forth (Hays, 2008)
Do you have experience with disability, or have you been a caregiver for someone who does?
Are there ways in which your disability is part of [the presenting problem]?
What did it mean to grow up as a [girl or boy] in your culture and family?
Do you currently have a partner? Could you tell me about the significant intimate relationships you have had?

18. Values
Individualism- the notion that our behaviors and attitudes are guided by incentives that promote independence
Collectivism- the idea that decisions and what is valued as important is based on the betterment of others (e.g. community or family members)
(Hays & McLeod, 2010)

19. Values
Some concepts viewed as central to success and progress in therapy –
SELF-awareness,
SELF-fulfillment,
SELF-discovery,
SELF-disclosure and
Emotional expressiveness.
Being emotionally reserved is not often viewed as a positive sign of maturity and self-control

20. Values
"I value independence and egalitarian interactions, but this family does not"

21. Values
"I value independence over interdependence, and I place a higher priority on egalitarian interactions than on respect for authority in most situations. This family places a higher value on respect for the wisdom and decision of elders. They place a high value on interdependence, family cohesion, and the preservation of cultural and religious traditions. (Hays, 2016)"

22. Culture on a Continuum
Individualism Collectivism

23. I & C Values on a Continuum Profile
Place an “X” on each continuum to indicate your place on each value
Identity
Express distinctiveness Adopt appearance of
your social group
Self=individual characteristics Self=family characteristics
Growth/Change valued Increasing/maintaining
family traditions
Family
Immediate family Extended family
Not involved in personal decisions Equally involved
in personal decisions
Move away from family Stay with family

24. Culture on Continuum Identity Family
Growth/Change valued Increasing/maintaining family traditions
Growth/Change not valued Decreasing/discarding traditions
Family
Not involved in personal decisions Equally involved
in personal decisions
Overly involved
Opinion not valued

25. Culturally Responsive, Competency-based
Continuum of behaviors, beliefs, and contexts
For example: Traditional
Deconstruct what “traditional” means for client.
Focus on the strengths of the meaning for client.
Are there exceptions to client’s belief about this meaning.
Both/And

26. Preventing Defensive Behaviors
Defensive feelings lead to focus on justifying our own ideas, lessening concern for the client’s experience. This shift easily perceived by clients, who may then engage in self- protective behaviors (emotionally distancing selves from you).

27. Preventing Defensive Behaviors
Probably impossible to eliminate defensive feelings. May also be undesirable: emotions often serve as cues that something is wrong.
However, possible and desirable to refrain from engaging in defensive behaviors.

28. Preventing Defensive Behaviors (Hayes, 2008)
Be mindful of the physical sensations that accompany feelings of defensiveness, fear, and pain.
If possible, identify the precipitants of these sensations and feelings to help you predict defensive feelings and behaviors before they occur.
Use these physical sensations as cues to what you are feeling.
When you feel defensive sensations and feelings arise, take a deep breath, exhale slowly, and then focus for a few seconds on your breath.

29. Preventing Defensive Behaviors (Hayes, 2008)
Refrain from defensive behaviors (e.g., talking too much, emphasizing your own accomplishments, emotional distancing).
Question the need for clients’ views to match your own.
Recognize your need for additional information and experiences.
If appropriate, discuss the limitations of your knowledge and experience with the client.