Multicultural Therapy

Carolyn R. Fallahi, Ph. D.

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The need for cultural competence

There is a need for cultural

competence within therapy.
Traditional approaches have failed to
meet the needs of minorities.
A large percentage of the population of
the United States is composed of people
whose racial/ethnic background is
something other than white.

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Minority Groups

Most minority groups are:

Without underrepresented in traditional
clinical/counseling populations.
There aren’t a lot of faculty members
who are minorities.
Racial & Gender domination perpetuates
these issues.
Mostly white, middle-class males who
are the teachers & administrators.
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What do we see with minority
patients?
More negative psychiatric diagnoses.
Substandard treatment.
Inferior & differential counseling
services for differing racial & ethnic
patients.
Underutilization of mental health
services. Why? Lack of minority
therapists?
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What are the issues with
multicultural therapy?
Lack of attention & emphasis on
social injustices & problems
encountered by minorities.
Sue & Smith: underrepresentation of
minority groups in professional
counseling training programs
reinforces the perception that therapy
is generally irrelevant to their needs.

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Recurring Issue
Discomfort of White Therapist working with
someone different from them.
This plays out in:
Negative stereotyping.
Lack of knowledge about the group of which the
patient is a member.
Generalized anxiety about working with
different populations.
Need: major reform in graduate programs.

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Multicultural Education Models
Are we creating an environment in
which we can foster cross-cultural
awareness & understanding?
Theories exposed to are monocultural.
No research in the area of cross-cultural
awareness development.
Theoretical models imply that
psychosocial development is uniform for
all members of society, regardless of
cultural or racial background.
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Why aren’t these theories enough?

Sociopolitical factors such as SES,

class, & power are largely ignored.
Selected variables of the authors’
culture, such as individualism are
emphasized.
Many variables have limited
applicability in pluralistic societies.

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What do the contemporary White
Western Theories & Models
emphasize?
Tendency to assume that
psychosocial development occurs in a
similarly orderly & uninterrupted
progression for all.
Ethnic & racial awareness & identity
have not been considered noteworthy
or integral within psychosocial
development process.

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Contemporary White Models
Cultural biases & taboos of a given
author’s society, including those relating to
racism, prejudice, and discrimination have
been built into the theories.
Members of society who do not represent
the dominant culture find that the models
do not “fit” their life experiences.
Theories of deviance, deprivation,
disadvantage, and abnormality are based
on the experiences of various groups &
how they differ from the model.
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Contemporary White Models

The research has incorporated biases

inherent in monocultural theoretical
models.

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Multicultural Research

High-status & low-status group – how

do individuals become aware of this?
Psychosocial development of minority
groups. This new research is
beginning to take sociopolitical factors
into account.
Quest for self-identity.

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Oppression
Oppression is a common approach.
Uncomfortable & “radical framework” for
some.
Dominant force.
Less familiar to therapists, both
cognitively & experimentally.
Oppression, as a common experience, is
the approach that provides a schema to
the experiences of Asians, Latinos,
African Americans, etc.
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Cross-cultural Training Models

Need to emphasize:
Competency: requires that the therapist
be culturally aware, in touch with his/her
own biases about minority patients,
comfortable with such differences, &
sensitive to circumstances that may
require the referral to circumstances that
may require referral to same-culture
therapist.

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Cross-cultural Training Models
Second competency area: command of
knowledge, such as information sets, that
the culturally skilled therapist should have.
Understanding of the effects that the
sociopolitical system within the U.S. has an
oppressed persons, culture specific knowledge
about the particular group being counseled, an
understanding of the institutional barriers to the
use of mental health services by nondominant
groups.

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Future Clinicians

Gain knowledge of specific minority

groups.
Focus on concerns such as value
changes, acculturation, generational
differences, parental pressures,
dating, & religious issues.
Supervision on these issues.

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Third Competency
Therapeutic skills: should have a wide
repertoire of verbal & nonverbal responses,
the ability to send messages accurately &
appropriately, and the ability to use
appropriate institution intervention.
Assume a universalist approach or a
culture-specific approach? This is a
controversy that has not yet been settled.

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The distinction between cultural &
individual differences.
A person should be seen as an individual &
as a member of his/her own cultural group.
Locke: you need to take into account the
differences within a person’s culture in the
context of the dominant culture.
Each culture is both dynamic & subjective,
& his training stresses “learning to work in
different cultures rather than merely
learning about cultures”.

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Therapists trained from the Euro-
North American cultural belief
system
Value self-disclosure, highly verbal, & goal-
oriented patients.
Issues of self-disclosure? How we interpret
self-disclosure or lack there of …. Need to
take background into account.
Does the patient feel safe to share?
If the therapist doesn’t see self-disclosure,
consider it resistant & nonproductive?

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Other Issues
Lack of role models in terms of therapists,
faculty, & administrators, the traditional
white majority student population attending
programs will continue.
Traditionally: therapy has been willing to
accept culturally different people if they are
willing to become acculturated and reject
their cultural distinctiveness.
Some of the negative programs based on
the melting pot philosophy.

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A strong conceptual framework
Sociopolitical ramifications of therapy:
Oppression
Discrimination
Racism
****Programs have to help trainees become
aware of themselves as cultural beings.
The culturally different patient becomes the
object to be analyzed & studied.
Focus on the stereotypes of the therapist.

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Barriers to effective multicultural
counseling instruction
Melting pot myth
Incongruent student
expectations about therapy
Overemphasis on verbal
disclosure
Overemphasis on abstract
& non-problem-solving
strategies.
Ethnocentric worldview
Ignorance of self-racism &
cultural identity of others
Monolingual orientation
Overemphasis on long-
range goals & the future.
Lack of understanding of
the whole person
Lack of understanding of
social focus
Lack of appreciation for
nonverbal communication
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Emphasize
Culture
Race
Ethnicity
Dominant culture
Bi-culturalism
Melting pot myth
Pluarlism
Oppression
Cultural invasion
Issues relating to power & internalized racism
Marginality
Lived experiences & contradictions
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Becoming Culturally Competent

Ethnocentricity: a major obstacle to

becoming culturally competent.
Relatively few US scholars cite
international journals.
Only 60% US Scientists feel that being
connected to international scholars is
important.

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Becoming Culturally Competent
Xenophobia: unreasonable fear,
distrust, hatred of strangers or
foreigners or anything perceived as
different.
Difficulty accepting others’
worldviews.
Accepting differences across cultures
as simply differences.
Universality assumptions.
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Becoming Culturally Competent

Personality styles.
Reality is defined according to one’s
cultural assumptions. People become
insensitive to cultural variations among
individuals & assume that their own
view is the only right one.
So????? How do we increase global
competence & collaboration?

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Enhance Cross-Cultural Awareness
& Knowledge
Increase our awareness & knowledge on a
number of cross-cultural issues.
Encourage study-abroad programs.
Cultural immersion program.
Require coursework.
Require competency in a second language.
Integrate cross-cultural issues &
knowledge in our therapy curriculum.

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Enhance Competency

Promote cross-cultural research &

supervision & consultation.

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Addressing Racism: Derald Wing
Sue
Why do we hold prejudices or
stereotypes?
Need to understand our world
Too much information – need to
categorize
Makes us feel better about ourselves

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John Duckitt – History of
Psychology & Prejudice
Prior to the 1920s – notion of race
inferiority & white superiority.
Race theories dominated
psychological thinking.
Black inferiority was thought of as due
to evolution or genetics.
Seen as intellectually inferior.
Prejudice was seen as a natural
response to “inferior” races.
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1920s- 1930s

In the 1920s, empirical data did not

settle the controversy over African
Americans.
Movement switched to: where those
preconceived attitudes came from.

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1930s & 1940s

Psychodynamic explanation –
prejudice & discrimination was not
right.
Irrational & unjustified.
Why so prevalent?
Defense mechanisms.
Same explanation applied to the rise of
Nazism & anti-Semitism in Germany.

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1950s

The prejudiced personality

Holocaust & massive genocide
Demented disturbed personality
Pathological personality structure, e.g.
authoritarian personality – more prone to
prejudice.

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1960s & 1970s
Movement from the individual to a more
sociocultural perspective.
Prejudice could be understood as a social or
cultural norm.
Normative approach
Consensus model of race relations, Black/white
relations.
Socialization & conformity
Racial integration
Conflict, power, & domination were nearly
totally neglected.

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1980s

Ingroup – outgroup research

The new image of prejudice:
inevitable outcome of cognitive
categorization.
Realization: we as humans have the
potential & propensity for prejudice.
Social & intergroup dynamics add to
this.
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Guthrie & Even the Rat was White

Extraordinary dedication to the field of

racism within psychology.
Eugenics: the study of hereditary
improvements of human race by
controlled selective breeding.
Sterilization
PhysicalAnthropologists & cultural
Anthropologists.
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The role of psychology

1973: Henry Garrett, past APA

president:
Argument against racial integration
writing that the Black man ‘s brain “on
the average is smaller….less fissured
and less complex than the white brain.”
Skull capacity differences among
humans.
The issue of IQ.
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Are you a Racist?

Overt bigotry versus more subtle

bigotry.
Prejudice versus discrimination.
People of color make up over 1/3rd of
the population & 45% in our public
schools.
2030 & 2050 racial/ethnic minority =
numerical majority.
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The average American

Not aware of race issues.

Minimize the impact of racism.
What’s involved? Fear.
Stereotypes serve the function of
making you feel better about yourself
or about members of a group.
Cultural genocide.

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Do you oppress?

Modern or contemporary racism.

Modern racism is unconscious, indirect,
subtle, & unintentional.
Failure to help versus conscious desire
to hurt.
Dovidio Study
Are these stereotypes harmful?

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African Americans

Black? African American? Ask.

Issues of poverty.
Less likely to be employed in managerial
& professional jobs.
Black women more likely to complete
college degree.
26% poverty for Afr Ams versus 8%for
Whites.
Vast inequities.
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Issues
Long history of traumatic events including
slavery, racism, & history of other individual
& social problems.
Indicators of the cumulative effects of
trauma – evidenced in health, income,
education, & occupational success.
In a therapeutic situation: develop
awareness of how oppressive experiences
like racism & discrimination influence help-
seeking behaviors & overall psychological
functioning.
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Cook & Wiley (2000)

Afr Ams will share their experiences

of oppression in psychotherapy.
Limited knowledge of the history of
racism & oppression.
Need increased cultural empathy to
validate their experiences.

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Social relationships & strengths

Religion & spirituality

Need to assess religion & spirituality
Harmony & balance – emphasis on
the family, community, & nation
versus emphasis on the individual.
Interdependence
Traditional therapy

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Family Dynamics

48% married-couple families.

45% maintained by single women with
no spouse.
Extended kinship networks
The role of the church
Different parental-child systems.
The legacy of broken families
continued following slavery
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Gender Issues

Identity linked to ability to provide for

family.
Success related to discrimination.

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Latinos & Latinas

The link between physical &

emotional = Medical services.
High tolerance for psychopathology.
Language barriers, sociocultural
factors.
Lack of bilingual & bicultural
therapists and a lack of cultural
sensitivity.
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Issues in Therapy
The terms used to identify.
High rates of undereducation.
Misplaced in special education
classes, non-college tracks,
monolingual teachers, culturally
insensitive teachers, low achievement
expectations.
Underemployed: 7% unemployed
versus 3.4% Whites.
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Other Issues

Religion
Oppression & racism
Acculturation
Family dynamics
Time orientation
Elderly versus Youth
Family & support system

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The Dynamics of Therapy

Family – strength & liability.

Great value placed on manners,
courtesy, harmonious relationships
Conflict, direct argument, &
contradiction considered rude.
Gender roles
Youth
Parent & child relationships
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Other issues

Religion
Gender & sexual norms
Boys versus girls
Homophobia
Interdependent & cooperative

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Other Problems
Physical & emotional difficulties of aging.
Cultural alienation
Racial discrimination
Language barriers
Lack of health insurance
Limited financial resources
Different cultural customs & beliefs
poverty

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Native Americans

How do we refer to Native

Americans?
Experiences shared by Native
Americans.
Loss of tribal lands to US Government
Problems with assimilation
General lack of respect for their
humanity
Cultural genocide

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Problem Areas

Life expectancy
High rates of employment
School dropout
Teen pregnancy
Alcoholism
Poverty

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Therapy Issues

Present orientation to time

Indian time
Noninterference
Direct confrontation
Healing process
Talking circles

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Educational Concerns

57% obtain a high school degree

English
Low self-esteem
Cultural value differences
Health problems
Chronic poverty
Few positive career models

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Alcoholism

52-80%
Lower tolerance?
Underuse of mental health services

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Asian Americans
Family dynamics
Confucius laid the general template for Asian
families centuries ago.
A vertical structure
Father at its head
Mother deferential & supportive
Children obedient to and respectful towards
both
Family values: duty, work, achievement
Methods used: shame, guilt, appeal to duty,
honor

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Parenting

Children are expected to not

embarrass, shame, or dishonor
Authoritarian parenting
Other parenting differences.
Collectivist values of
interdependence, conformity &
harmony.
Direct confrontations are avoided.
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Family

Emotional expression considered in

bad form.
Love & affection not expressed
openly
Indirect communication
Older generation parents &
acculturated children
Marriage issues
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Family

Strong negative stereotypes for

marrying a non-Asian.
Interracial marriage = betrayal

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Therapy Issues
Problems: enmeshment
Codependence
Lack of individuation
Social anxiety
Psychopathological labels
Enormous pressure to excel
academically
Parental emphasis on work ethic
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Therapy Issues

Elderly – revered & respected

Parents’ children expected to fulfill
their needs, care for them, treat them
with reverence, & obey their wishes &
plans.
High rate of suicide.
Unequal treatment of girls & boys

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Therapy Issues

Conflicts over family

Family responsibility & obligations
Emphasis on autonomy, overt
masculinity, & self-reliance (American
values)
Gender issues
Homosexual & transgender Asians
How view mental health problems
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