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Cultural Diversity: A Primer for the Human Services

By Jerry V. Diller

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Working With Culturally Diverse Clients

Chapter 3

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Experiential: Providers are more likely to be affected directly and emotionally by the helping relationship, and to realize the need for new means of acting and relating to clients

How Cross-Cultural Helping is Different

Freewheeling: The helping process must be continually adapted to the specific cultural needs of differing clients

Providers should alter techniques (e.g., general activity level, mode of verbal intervention, content of remarks, tone of voice), and be aware of approaches that are culture-bound

How Cross-Cultural Helping is Different

Bilateral: Provider should be willing to collaborate with the client to define the process itself

Culturally competent professionals adapt and adjust their efforts according to the cultural needs of their clients

How Cross-Cultural Helping is Different

Ethnicity

Race

Difference

Power

Four Systems of Psychological Dynamics

Ethnicity: Psychological dynamics and definitions of self that satisfy a need for historical connection and security, and which are informed by the value that society places on the group to which an individual belongs

Four Systems of Psychological Dynamics

Race: A socially constructed category which relies on biological differences as markers for status assignment within a social system

Often, the status assignment is based on skin color identity and is tied to the social structure which promotes a power differential between whites and people of color

Four Systems of Psychological Dynamics

Difference: Difference occurs in feelings, attitudes, perceptions, and behaviors

Providers should prepare for the negative feelings and reactions that are often associated with experiencing the self as different from others

Four Systems of Psychological Dynamics

Power: The capacity to produce desired effects on others

Contrasted with powerlessness, or the inability to produce desired effects

In the helping relationship, the helper has power and the client is potentially vulnerable

Four Systems of Psychological Dynamics

Hays’ ADDRESSING Framework

Age and generational influence

Developmental disabilities

Disabilities acquired later in life

Religion and spiritual orientation

Ethnic and racial identity

Socioeconomic status

Sexual orientation

Indigenous heritage

National origin

Gender

Information about each of these cultural dimensions should be inquired about at intake, and added to throughout the helping relationship

ADDRESSING Framework

Personal Work: Therapists can use the framework to carry out their own self-assessment. Dynamics include:

Cultural identity’s effect on personal values, beliefs, and views

Power and privilege within the role of therapist

Dominant cultural values and themes reinforced in the field of psychology

Individually oriented work is not sufficient for learning about culture and diversity.

ADDRESSING Framework in Clinical Work

Interpersonal work: Identity has both group-specific and person-specific meaning. Dynamics include:

Identities are multidimensional; finding salient cultural identities offers clues to perspective, behavior, and values

Whether the client wishes to discuss it or not, the therapist must consider the effect of cultural identity in relation to the problem

ADDRESSING Framework in Clinical Work

Interpersonal work: Identity has both group-specific and person-specific meaning. Dynamics include:

The client should not be used as a cultural guide or instructor for the therapist

In cross-cultural therapy, transference and countertransference refer to relationships, conflicts, and power imbalances that are replicated in the client-helper relationship

ADDRESSING Framework in Clinical Work

Becoming culturally competent is part of a process you have already started

It is honing skills, adapting and broadening concepts, and gaining cultural knowledge about the clients you will be working with

Preparing for Cross-Cultural Work

The clients you are working with are human beings, and this is the ultimate basis for connection

Initial task is to help clients be at ease in a manner that is personally meaningful for the client

Preparing for Cross-Cultural Work

Guard against the urge to objectify and stereotype clients in terms of their differences

By attending to differences too fully, you can lose sight of the entire person with whom you are interacting

Preparing for Cross-Cultural Work

Focusing too much on differences, and overlooking basic similarities, can turn work into a mechanical process

Differences are best bridged by paying attention to the basic joys and predicaments of being human

Preparing for Cross-Cultural Work

The dimensions below offer a good initial basis for understanding the client ethnically and culturally:

Place of birth

Number of generations in the United States

Family roles and structures

Language spoken at home

English fluency

Economic situation and status

Assessing Culturally Diverse Clients

The dimensions below offer a good initial basis for understanding the client ethnically and culturally:

Amount and type of education

Amount of acculturation

Traditions still practiced in the home

Familiarity/comfort with N. European lifestyle

Religious affiliation

Community and friendship patterns

Assessing Culturally Diverse Clients

Grieger and Ponterotto (1995) suggest six additional areas of assessment that should be useful for deciding how to adjust the helping process in relation to the client's cultural needs:

Client’s level of psychological mindedness

Family’s level of psychological mindedness

Client’s and the family’s attitudes toward helping

Client’s level of acculturation

Assessing Culturally Diverse Clients

Grieger and Ponterotto (1995) suggest six additional areas of assessment that should be useful for deciding how to adjust the helping process in relation to the client's cultural needs:

Family’s level of acculturation

Family’s attitude toward acculturation

Assessing Culturally Diverse Clients

Pinderhughes (1989) offers seven questions that can be used to further define the cultural dimensions of a presented problem:

To what extent is the problem related to issues of transition, such as migration and immigration?

To what extent is the client’s understanding of the problem based on a cultural explanation?

Is the behavior that is a problem considered normal within the culture, or is it considered dysfunctional?

Assessing Culturally Diverse Clients

Pinderhughes (1989) offers seven questions that can be used to further define the cultural dimensions of a presented problem:

To what extent is the problem a manifestation of an environmental lack of access to resources and supports?

To what extent is the problem related to culture conflict in identity, values, or relationships?

Assessing Culturally Diverse Clients

Pinderhughes (1989) offers seven questions that can be used to further define the cultural dimensions of a presented problem:

To what extent is the behavior a consequence of psychological conflict or characterological problems?

What are the cultural strengths and assets available to the client?

Assessing Culturally Diverse Clients

“Outline for Cultural Formation” (Lu, Lim, and Mezzich, 1995), appended in the DSM-IV, helps clinicians identify cultural factors in individual cases that may require special attention or alternative approaches to diagnosis and treatment

Culturally-Sensitive DSM-IV Diagnoses

Cultural identity of the individual

Cultural explanations and expressions of the individual’s illness

Cultural factors related to psychosocial environment and levels of care

Cultural elements of the relationship between the individual and the clinician

Overall cultural assessment for diagnosis and care

Culturally-Sensitive DSM-IV Diagnoses

Goals for first session (Sue and Zane 1987):

Establishing good rapport

Gaining an understanding of the client’s problem

Gaining an understanding of what he or she expects from the helping relationship

Communicating clearly what the provider can reasonably offer

Providing the client with the experience of being heard and understood, and the hope that the process can offer some immediate help

First Session with Culturally Diverse Clients

Approach goals by:

Introducing yourself by the name you wish the client to use, asking the client how they would like to be referred to individually, and how they would like you to refer to their cultural group.

Research the client’s culture prior to meeting; be open about your lack of knowledge or questions

Giving a brief and non-technical description of the helping process, describing what is expected of the client and what can be expected of you

First Session with Culturally Diverse Clients

Approach goals by:

Having clients describe in their own words what they are seeking help from; ask questions to get clarification

Sharing what you believe can be accomplished immediately and long-term; discuss possible goals, indicating if the client chooses to proceed, goals will be formed collaboratively

First Session with Culturally Diverse Clients

Approach goals by:

Discussing the client’s possible concerns, and your own if you have any

Ending the session with a formal goodbye and plans for what will transpire next

First Session with Culturally Diverse Clients

Timing is an important part of introducing race and ethnicity into therapy

It is the therapist’s duty to introduce the topic

Therapist’s ethnic identity must be brought into treatment if we want to be able to invite the client’s ethnic identity into the relationship

Talking About Race and Ethnicity

White therapists’ experience talking about issues of race and ethnicity with clients is especially difficult

Some literature speaks of white therapists becoming anti-racist, which requires taking risks and challenging White privilege and racism

Therapist self-disclosure can be used to model talking about ethnicity, which also diminishes the invisibility of whiteness

Talking About Race and Ethnicity

The therapist’s intention should be one of openness, curiosity, courage, willingness to take risks, and self awareness

Talking About Race and Ethnicity