HW

C H A P T E R 4 Understanding Diversity

Learning Objectives 1. Describe the components of a multicultural perspective on helping. 2. Explain the concept of cultural tunnel vision. 3. Discuss a range of cultural values and assumptions in the helping process. 4. Describe the ethical issues in working with people with disabilities. 5. Discuss the steps for acquiring competence in multicultural counseling. 6. List several social justice competencies. 7. Describe several components of multicultural training. Focus Questions 1. How much thought have you given to your own cultural background, and how has it influenced you? 2. How prepared are you to work with client populations that differ from you significantly in a number of ways (age, gender, culture, race, ethnicity, sexual orientation, socioeconomic status, and educational background)? 3. What values do you hold that could make it difficult for you to work with clients who have a different worldview? What biases and assumptions do you hold about individuals who look, think, feel, and behave differently from you? 4. How might you respond if a client wondered out loud if you will be able to help him because of differences in worldview or culture? 5. How much involvement have you had with people with disabilities? How do you generally feel in their presence? What personal characteristics or experience do you have that could facilitate your work with this population? 6. What are some societal stereotypes pertaining to people with disabilities? How could you work to change these beliefs in your community? 7. What can you do to increase your knowledge and awareness of diverse cultural groups? As you learn about different cultural groups, how can you avoid stereotyping individual members within these groups? 8. How do you relate to the idea of cultural competence being a process that continues throughout your career rather than a goal that can be achieved

within a short time frame?

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9. How prepared are you to advocate for clients who have been oppressed or marginalized in society? What are the most challenging aspects for you in assuming the role of social advocate?

10. What are the first steps you could take to expand your current attitudes and worldview?

Aim of the Chapter Most helpers encounter a wide variety of clients in their work. At this point in your development as a helper, it is imperative that you are open to learning how to establish contact with individuals who differ from you in various ways. You do not need to share the same worldview or the same background as your client, nor is it necessary for you to experience the same life circumstances to form an effective therapeutic alliance. However, it is necessary for you to have a range of experiences upon which to draw in understanding the human condition. Universal human themes link people together, but it is crucial to acknowledge our differences as well.

Your openness to learn from the lessons that life has presented to you, your respect for contrasting perspectives, your interest in understanding the diverse worldviews of the clients you will meet, and your willingness to advocate for those who have been oppressed are critical attitudes and skills. Even if you have grown up in a monocultural context, you can learn about people with a worldview different from your own. Through concerted efforts on your part, it is possible to expand your current attitudes and views.

To function effectively as a helper, you must familiarize yourself with your clients’ cultural attitudes and realize how cultural values operate in the helping process (see Chapter 3). By understanding how your own cultural background has contributed to who you are, you have a basis for understanding other viewpoints. All helpers need to seriously consider these issues, regardless of their racial, ethnic, or cultural background.

You will probably take a course in cultural diversity, which is likely to emphasize the changing demographics in society and the urgent need for helpers to develop cultural competence. In that course, you will surely be expected to examine the ways in which many members of society have been marginalized and discriminated against. It is also likely that you will explore the critical concepts of power and privilege in a personal way and that you will learn how to broach differences in your conversations with clients. Although exploring these themes and topics may at times take you out of your comfort zone, it can be enlightening and can help broaden your vision of the world. By honoring cultural diversity, you can formulate alternative perspectives and develop appropriate tools for working with diverse client populations.

A Multicultural Perspective on Helping We look at multicultural helping from a broad perspective and do not limit our consideration of this topic to race and ethnicity. Pedersen (2000) defines cultural groups by ethnographic variables (nationality, ethnicity, language, and

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religion), demographic variables (age, gender, and place of residence), status variables (educational and socioeconomic background), and formal and informal affiliations. According to Pedersen, the multicultural perspective provides a conceptual framework that both recognizes the complex diversity of a pluralistic society and suggests bridges of shared concern that link all people, regardless of their differences. This perspective looks at both the unique dimensions of a person and the common themes we share with those who are different.

Multicultural counseling “can be operationally defined as the working alliance between counselor and client that takes the personal dynamics of the counselor and client into consideration alongside the dynamics found in the cultures of both of these individuals” (Lee, 2019b, p. 5). Effective multicultural counseling defines contextual goals consistent with the life experiences and cultural values of clients and balances the importance of individualism versus collectivism in assessment, diagnosis, and treatment (Sue & Sue, 2016).

In this chapter, we deal with both multiculturalism and diversity perspectives. Multiculturalism puts the focus on ethnicity, race, and culture. We interpret the word culture broadly to include differences in gender, age, religion, economic status, nationality, physical capacity or disability, and affectional or sexual orientation. Diversity refers to individual differences on a number of variables that place clients at risk for discrimination. Both multiculturalism and diversity have been politicized in the United States in ways that have often been divisive, but these terms can equally represent positive assets in a pluralistic society. Cultural pluralism recognizes the complexity of cultures and values the many forms of diversity.

When you become a helper, you will encounter many individuals from cultures different from your own. You may consult textbooks, websites, and other sources about your clients’ culture to be prepared to work effectively with them. It may surprise you to learn that your path to becoming a culturally competent helper begins with an exploration of how your own cultural heritage and values might affect the counseling process. Lee (2019b, p.10) describes the conceptual framework of multicultural counseling competency by addressing three key questions: 1. “Who am I as a cultural being?” 2. “What do I know about cultural dynamics and how they may

influence my client’s worldview?” 3. “How do I promote client mental health and well-being in a

culturally competent manner?” Becoming and remaining multiculturally competent entails a great deal

of work, study, and clinical experience. Lee (2019a, pp. 18–19) identifies some guidelines for facilitating a working alliance between counselor and client in the helping process: • Consider cultural factors in any counseling interaction. • Examine and evaluate your cultural baggage, your cultural

privilege, your biases, and the relevance of your theoretical orientation in working with diverse clients.

• Avoid stereotypes or adopting a monolithic perspective. • Be open to learning about other cultures; be willing to learn from

culturally diverse clients. • Be willing to make a commitment to advocacy and social justice.

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The Need for a Multicultural Emphasis In the past few decades, we have seen an increased awareness on the part of the helping professions to address the special issues involved in working with people of various cultures. Because of the changing demographics in the United States, a conceptual framework is needed to help professionals deliver competent services to clients from culturally diverse backgrounds (Lee, 2019b). Cultural factors are an integral part of the helping process, and culture influences the interventions we make with our clients. Whether we are aware of it or not, Pedersen (2008) claims that culture controls our lives and defines reality for each of us. Adopting a multicultural perspective enables us to think about diversity without polarizing issues into “right” or “wrong.” Depending on the cultural perspective from which a problem is considered, there can be several appropriate solutions. In some cases, a similar problem may have very different solutions depending on the client’s culture. For example, helpers may encourage some clients to express feelings of hurt to parents but respect other clients’ practice of restraint in self-expression so as not to offend their elders.

An effective multicultural counselor respects the needs and strengths of diverse client populations and recognizes the experiences of these clients. However, it would be a mistake to perceive individuals as simply belonging to a group. The differences between individuals within the same group are often greater than the differences between groups. Pedersen (2000) indicates that individuals who share the same ethnic and cultural background are likely to have sharp differences. Not all Native Americans have the same experiences, nor do all African Americans, all Asian Americans, all Euro- Americans, all women, all older adults, or all people with physical or intellectual disabilities. Helpers, regardless of their cultural background, must be prepared to deal with the complex differences among individuals from a variety of groups.

Pedersen (2000) believes multicultural awareness can increase the quality of your life, and it can also make your job easier. Adopting a perspective that cultural differences are positive attributes that add to relationships will expand your ability to work with diverse client groups. We hope you will view the tapestry of culture woven into the fabric of all helping relationships not as a barrier to break through but as a garment that provides comfort in your clients’ search for meaning.

Ethical Dimensions in Multicultural Practice Recognizing diversity in our society and embracing a multicultural approach in the helping relationship have become fundamental tenets of professional codes of ethics, and the ethics codes specify that discrimination by helping professionals is unethical. Most ethics codes mention the practitioner’s responsibility to recognize the special needs of diverse client populations. Lee (2015) maintains that counselors must address diversity in a way that is both culturally responsive and ethically responsible. Those counselors who are unaware of cultural dynamics and their impact on client behavior are at risk of practicing unethically.

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Becoming an ethical and effective helper in a multicultural society is

a continuing process. Effective multicultural counseling evolves from three primary practices. First, helpers must be aware of their own assumptions, biases, and values about human behavior, and of their own worldview. Second, helpers need to become increasingly aware of the cultural values, biases, and assumptions of diverse groups in our society, and come to an understanding of the worldview of culturally different clients in nonjudgmental ways. Third, with this knowledge helpers will begin to develop culturally appropriate, relevant, and sensitive strategies for intervening with individuals and with systems (Lee, 2019b; Sue & Sue, 2016).

Discrimination in providing services is often linked to racial and cultural factors, socioeconomic class, and gender, and discrimination and misdiagnosis can be due to biased attitudes on the part of practitioners (Dolgoff, Loewenberg, & Harrington, 2009). For example, people in lower socioeconomic classes consistently receive more severe diagnoses than do individuals in higher socioeconomic classes. Discrimination involves more than simply refusing to offer services to certain client groups; it can take any one of these forms: • Being unaware of one’s own biases and how they can

inadvertently be communicated to clients. • Being unaware that some of the theories studied during a training

program may be culture bound. • Being unaware of differences in cultural definitions of health and illness. Lack of awareness can lead helpers to engage in unintentional racism, which can be extremely damaging to clients.

Unfortunately, many people of color are subjected to racial microaggressions: “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults” (Sue et al., 2007, p. 271). These “racial microaggressions are not limited to White–Black, White–Latino, or White–Person of Color interactions. Interethnic racial microaggressions occur between people of color as well” (p. 284). Microaggressions related to a person’s gender, sexual orientation, or disability may have equally powerful and potentially destructive effects. For example, consider the counselor who continues to steer the conversation to the societal challenges faced by her client with cerebral palsy when the client has come for help in addressing anxiety related to his relationships, conflicts with a sibling or parent, or grieving the loss of a loved one.

Cultural differences are real, and they influence all human interactions. All counseling is multicultural in nature, as both client and counselor bring their unique histories and culture into the counseling process (Lee, 2019b). Clinicians may misunderstand clients of a different gender, race, ethnicity, age, social class, or sexual orientation. If practitioners fail to integrate these diversity factors into their practice, they are infringing on the client’s cultural autonomy and basic human rights, which will reduce the chance of establishing an effective helping relationship. It is important to be able to deal with all aspects of diversity. For some clients, religious values are important. Other clients may focus on gender or age discrimination. By paying attention to what a client is saying, helpers can discover which aspects of a client’s identity are most salient for this person at this time.

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Cardemil and Battle (2003) believe that openly discussing race and ethnicity is one way to actively include a multicultural element in counseling, and a way to strengthen the therapeutic alliance and promote better therapeutic outcomes. For example, the counselor might say: “Today we have been talking about your sense that many of your coworkers are prejudiced. What has this conversation with me been like for you? What has it been like for you to share experiences of discrimination with a White therapist who hasn’t had those kinds of experiences?” (p. 282). Day-Vines and colleagues (2007) refer to this as broaching behavior and stress the importance of having “a consistent and ongoing attitude of openness with a genuine commitment by the counselor to continually invite the client to explore issues of diversity” (p. 402). Race may contribute to the client’s presenting problem, and acknowledging this can be instrumental in establishing a working therapeutic relationship.

Overcoming Cultural Tunnel Vision Our work with students in a human services training program has shown us that students often struggle with cultural tunnel vision. Many students are unaware of the difficulty of dealing with clients who have a cultural background different from their own. They may have limited cultural experiences, and in some cases, they see it as their role to transmit their values to their clients. Some make inappropriate generalizations about a particular group of clients. For example, some students-in-training may assert that certain groups of people are unresponsive to psychological intervention because of a lack of motivation to change. This perceived lack of motivation might reflect cultural differences, the clients’ ambivalence about change, or hesitance to seek support from someone outside their family system. Clients also may distrust the professional helping process due to past experiences with discrimination and oppression.

It is worth repeating that all helping relationships are multicultural. Both those providing help and those receiving help bring to their relationship attitudes, values, and behaviors that can vary widely. One mistake is to deny the importance of these cultural variables; another mistake is to overemphasize such cultural differences to the extent that helpers lose their spontaneity and thus fail to be present for their clients. We need to understand and accept clients who have a different set of assumptions about life, and we need to be alert to the likelihood of imposing our own worldview. In working with clients with different cultural experiences, it is important that we resist making value judgments for them.

The culturally encapsulated counselor, a concept introduced by Wrenn (1962, 1985), exhibits the characteristics common to cultural tunnel vision. Think about how broad your own vision is as you consider these traits of culturally encapsulated counselors: • Define reality according to one set of cultural assumptions • Show insensitivity to cultural variations among individuals • Accept unreasoned assumptions without proof or ignore proof

because that might disconfirm their assumptions • Fail to evaluate other viewpoints and make little attempt to

accommodate the behavior of others • Remain trapped in one way of thinking, resist adaptation, and reject alternatives

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Encapsulation is a potential trap that all helpers are vulnerable to

falling into. If we accept the idea that certain cultural values are supreme, our refusal to consider alternatives limits us. If we possess cultural tunnel vision, we are likely to misinterpret patterns of behavior displayed by clients who are culturally different from us. Because of this lack of understanding, we may label certain client behaviors as resistant, we may make an inaccurate diagnosis of a particular behavior as maladaptive, or we may impose our value system on the client. For example, some Latinas might resist changing what we could view as dependency on their husband. If we work with Latina clients, we need to appreciate that Latino tradition tells these women that it is never appropriate to leave one’s husband, even if he is unfaithful. If we are unaware of this traditional value, we could make the mistake of pushing such women to take an action that will violate their belief system.

Case example: Looking through a narrow lens. Marcia, a school counselor, personally believes that students develop

healthier self-esteem when they engage in sports and have a balanced course load that does not consume too much time outside of the

classroom. Min-jun and his family recently moved to the United States from South Korea so the children could prepare for admission to a top

U.S. university. During their first meeting, Min-jun informs Marcia that he would like to take a large number of Advanced Placement (AP) courses

and join some academic clubs. He is not interested in participating in sports as an extracurricular activity. Marcia strongly discourages Min-

jun from taking so many AP courses and suggests that he join the baseball or soccer team rather than focus so heavily on academic clubs. Min-jun

defers to Marcia’s authority and politely agrees to her recommendations, but he leaves her office feeling concerned about how well prepared he

will be to get into a top university. Your stance. If you were in Min-jun’s situation, how might you feel if your school counselor imposed an agenda

on you that did not take your cultural values into consideration? What might you be inclined to say to Marcia if she was your colleague and you

noticed that she was basing her recommendations largely on her own assumptions and life experiences?

Discussion. Although Marcia’s intentions are good and her recommendations are meant to help bolster Min-jun’s self-esteem and promote his development as a well-rounded individual, she is not taking this student’s cultural context into account. It is important to note that Min- jun’s family relocated to the United States so that he and his sister could avail themselves of academic opportunities, which reflects the family’s value on education. Marcia is also failing to take into account how competitive college admissions have become at top tier universities where Min-jun plans to apply. Given Min-jun’s respect for authority, it is unlikely that he will challenge Marcia’s recommendations.

Honoring Clients’ Cultural Values Culture is a vital part of who we are as human beings. Conveying the message to clients (either explicitly or implicitly) that they need to abandon this vital part of themselves and embrace the dominant culture is antithetical to what we stand for as helpers. Harboring an agenda for clients to conform to cultural standards

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that conflict with their own values is insensitive, if not unethical, and could lead clients to terminate from counseling prematurely. A particular behavior may be acceptable in one culture but unacceptable, or perhaps even illegal, in another culture (e.g., particular child-rearing practices); helpers need to remain nonjudgmental when assisting clients who are navigating these issues.

Chung and Bemak (2012) coined the term political countertransference to describe a helper’s personal reaction to the political context in which he or she works with clients. For example, a helper may have a strong personal reaction to a highly charged political issue such as terrorism, abortion, immigration reform, shutdown of the government, or gay marriage. Helpers must monitor their reactions and be aware of the potential impact of their political countertransference on their clients. This awareness is particularly important during this time of polarization around multiple political issues in our society.

Realize that there is no sanctuary from cultural bias. We tend to carry our biases around with us, yet we often do not recognize this fact. It takes a concerted effort and vigilance to monitor our biases and value systems so that they do not interfere with establishing and maintaining successful helping relationships.

Cultural Values and the Helping Process Many of the theories and practices of the helping process discussed in Chapters 6 and 7 are grounded in core value orientations of mainstream American culture. Hogan (2013) characterizes these underlying values as emphasizing the patriarchal nuclear family; keeping busy; measurable and visible accomplishments; individual choice, responsibility, and achievement; self-reliance and self- motivation; change and novel ideas; competition; direct communication; materialism; and equality, informality, and fair play. The degree to which these value orientations fit clients from other cultures needs to be carefully considered by human services practitioners.

Some writers in the multicultural field are critical of the strong individualistic bias of contemporary theories and the lack of emphasis on broader social contexts such as families, groups, and communities (Chung & Bemak, 2012; Zalaquett, Ivey, & Ivey, 2019). Intervention strategies based on Western assumptions may not be congruent with the values of some clients and may perpetuate forms of injustice and institutional racism. Clients from oppressed groups may be slow to form trusting relationships with counselors, and mental health professionals may have difficulty identifying with these clients if they ignore the history or context of this distrust. Seeking professional help is not typical for people from certain cultural backgrounds, and helpers need to expand their perception of mental health practices to include support systems such as family, friends, community, self-help programs, faith healing practices, and occupational networks. Mental health providers must be willing to redefine their professional roles and adapt their practices to better suit the client’s worldview, life experiences, and cultural identity (Chung & Bemak, 2012).

Some time ago we presented a series of workshops in Hong Kong for human services professionals. This gave us the opportunity to rethink the relevance of applying some of our approaches to working with Chinese clients. Almost all the participants in these workshops were Chinese, but some of them had obtained

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their graduate training in social work or counseling in the United States. These professionals struggled with retaining values basic to their Chinese heritage while integrating the counseling approaches they had studied in the United States.

In talking with these practitioners, we learned that they pay more attention to the family than to individuals’ interests in their interventions. Many told us that they had to demonstrate patience and understanding with their clients. They saw it as essential to form a trusting relationship before engaging in confrontation. Although this necessity applies to counseling in general, it seems especially important for clients from diverse cultural groups.

Case example: Considering cultural differences.* A counselor, Doug, receives a telephone request from the oldest male in a traditional extended family that had recently migrated from a northern state in India. Kishore is requesting counseling concerning his younger sister, who is having difficulty adjusting to their new country and has recently tried to run away from her family. He states that there is disagreement between his sister, Savita, and the rest of her family about whom she should marry. Doug’s usual practice would be to respond positively to the inquiry but to insist on the potential client speaking directly to him to arrange an appointment.

Doug wonders what he should do in these circumstances, particularly in view of the cultural differences. It becomes clear that the brother intends to attend the counseling sessions with his younger sister, Savita. This is contrary to Doug’s usual practice of seeing clients alone. He hesitates before deciding whether to accept these arrangements.

Your stance. If you were the counselor in this situation, how would you respond to this phone call? Consider these issues in forming your opinion: • What are the indications of cultural differences between the

counselor and the prospective clients? • Who is the client? • How far should the counselor go in adapting his usual practices to

respond to these cultural differences? • How does the available ethical guidance from your professional

counseling organization help or hinder you in responding to these circumstances? Discussion. This case study directs attention to potential tensions

between cultural competence and meeting other ethical requirements. The ethical guidance issued by most professional associations requires cultural sensitivity and competence and warns against prejudice. However, the ethics codes seldom offer more precise instructions on how to achieve these requirements, nor do they provide advice on how to resolve conflicts between any adaptations made in response to cultural differences and other ethical requirements.

The most significant cultural feature of this case is that Kishore is reaching out beyond the family for help. Typically, within his culture problems are resolved or contained within the family, and there is great reluctance to communicate the private business of the family to outsiders. If the problem is of such significance

*We thank Tim Bond, University of Bristol, UK, and Lina Kashyap, Tata Institute of Social Sciences, Mumbai, India, for contributing this case study.

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that it justifies breaking the family’s privacy, the counselor should recognize the seriousness of this request and the family’s sense of concern and vulnerability in requesting help in this way. They are taking a major step outside their cultural norms. One of the first challenges for the counselor is to recognize the scale of risk that the family is taking and the significance of responding in a culturally appropriate way in order to offer a sense of reassurance and safety.

The second culturally significant feature is that the request for counseling is from the oldest male, who has responsibility for the well- being of all family members. This creates new challenges for the counselor who will need to balance being respectful of the oldest male’s responsibility while working with other members of the family who will also be expected to defer to the oldest male. Kishore’s desire to be present in the counseling sessions may be interpreted as his way of communicating his care and concern for his sister or as a way of exercising control. It is unlikely that this will become clear in an initial phone call, and it may take several sessions before the balance between care and control and the nature of the relationship between brother and sister becomes apparent.

As the counselor, Doug is faced with a critical decision about whether to start his work on the basis suggested by the brother or to attempt to ensure that Savita both wants counseling and is seen on her own to ascertain her wishes. The first might be more culturally appropriate for his client, and the second more respectful of a sense of individual autonomy and women’s rights. As Doug has little information about Savita’s views about her situation, he may decide to offer an initial meeting with both of them to discuss their situation and to agree on how he will work with them. A single meeting may not be sufficient to enable Savita to speak freely; her cultural background may encourage reticence over speaking freely, or even at all, in the presence of men. A tradition of modesty may discourage her from making eye contact with a stranger who is male. Doug will have to be sensitive and patient to win her trust sufficiently for her to communicate her views. He may want to keep an open mind as to whether a female counselor would be more appropriate if Savita is to become the primary client.

Doug’s multicultural competence may be tested in other ways. Actions can be as important as words in providing a sense of security across cultural differences. One of the ways in which he might open the meeting would be to offer a cup of tea or water as a culturally appropriate way of demonstrating a respectful welcome, even if offering refreshments is not his normal practice with clients.

At some point Doug will need to decide who constitutes the “client.” This is both an ethically and professionally significant decision that cannot be made without taking cultural values into account. Professional ethical guidance for counselors tends to be based on assumptions about nuclear families and the rights of all family members to be autonomous. The basic unit of ethical concern is the individual. These are culturally specific assumptions characteristic of North America and some areas of Europe, including Britain. In extended family systems, the basic unit of ethical concern may be the family as a whole rather than any individual within it. From this perspective, it could be a mistake to understand the request for help in personal terms relating to the two named individuals. Instead, it may be better understood as a request on behalf of the whole family, including other significant unnamed people such as the mother or an older sister.

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Deciding how to interpret the request and its implications for establishing how to deliver the counseling is likely to be one of the primary tasks of the initial assessment. It is also ethically significant. Should the counselor work with the autonomy of the family as whole, even if this is at the expense of individual autonomy, or prioritize individual autonomy at the expense of family identity? How the counselor should position himself with respect to existing family structures and gender relationships is another challenging issue that will require careful consideration throughout the counseling relationship. When a counselor is working with people from an unfamiliar cultural background, there is a strong case for obtaining appropriate cultural mentoring in addition to any external therapeutic support or supervision. Some professional bodies strongly recommend or require this additional cultural mentoring.

The decision about who is the client will determine how the counselor approaches issues of informed consent, whose consent ought to be sought, and the management of confidentiality between family members. The emphasis on consent that is characteristic of most professional ethics codes may fail to convey the level of respect that is the intended ethical purpose of this practice. Many counselors would consider it to be good practice to discuss these issues with the prospective clients to determine their wishes before making a final decision about how to proceed. The extent to which such discussions are possible and desirable will depend on the degree of urgency and purpose for which counseling is being sought.

Many of the helping professions express doubts about how far an ethical principle founded on respect for individual autonomy can adequately address the needs of people from a collectivist culture. Could a professional ethic that emphasizes the principle of respect for individual autonomy in itself be culturally insensitive and exclude people who hold other cultural values?

Examining Your Cultural Assumptions Culturally learned basic assumptions, whether we are aware of them or not, significantly influence the ways in which we perceive and think about reality and how we act. A willingness to examine such assumptions opens doors to seeing others from their vantage point rather than from a preconceived perspective. Helpers often unwittingly make cultural assumptions on a variety of topics. Review the basic cultural assumptions that influence you and determine how you might be imposing your views. What forces have shaped your basic assumptions? Are you open to considering the relevance of such assumptions in working with clients who are different from you? Reflect on how your understanding of these issues is likely to influence your work with clients. Assumptions about self-disclosure. Self-disclosure is highly valued in counseling, and most helpers assume that no effective helping can occur unless clients reveal themselves in the helping relationship. One way to facilitate meaningful disclosure on the part of clients is for helpers to model appropriate self-disclosure. Ivey, Ivey, and Zalaquett (2018) comment that helper self- disclosure can increase client self-disclosure, create trust between counselor and client, and establish a more equal relationship in the interview.

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Unless clients work through the obstacles to some level of

disclosure, they may not be able to participate fully in the helping relationship. However, you can recognize and appreciate that some of your clients will struggle in letting you know the nature of their problems. This struggle in itself is a useful focus for exploration. Rather than expecting such clients to disclose freely, you can demonstrate respect for their values and at the same time ask them what they want from you and why they are seeking counseling. With your support and encouragement, clients can sort through their values and socialization pertaining to self-disclosure and decide the degree to which they want to change.

Some forms of helping place less stress on verbal disclosure, such as music therapy, occupational and recreational therapy, and other forms of activity therapy. Helpers can also assume an advocacy role for the client in the system, can help clients build on their natural sources of support, or can teach clients to use the resources within the community. As you will see in Chapter 12, a number of community-based interventions may be more appropriate for some clients than traditional approaches to helping. Assumptions about nonverbal behavior. Clients can disclose themselves in many nonverbal ways, but cultural expressions are prone to misinterpretation. Personal space requirements, eye contact, handshaking, dress, formality of greeting, perspective on time, and so forth all vary among cultural groups. Mainstream Americans often feel uncomfortable with silence and tend to fill in quiet gaps with words. In some cultures, in contrast, silence indicates a sign of respect and politeness. You could misinterpret a quiet client’s behavior if you did not realize that the client might be waiting for you to ask questions. It is good to keep in mind that there are no universal meanings of nonverbal behaviors.

You may have been systematically trained in a range of microskills: attending, open communication, observation, hearing clients accurately, noting and reflecting feelings, and selecting and structuring, to mention a few (Ivey et al., 2018). Although these behaviors are aimed at creating a positive therapeutic relationship, individuals from certain ethnic groups may have difficulty responding positively or understanding the intent of the counselor’s attitudes and behavior. The helper whose confrontational style involves direct eye contact, physical gestures, and probing personal questions may be seen as offensively intrusive by clients from some other cultures.

In American middle-class culture, direct eye contact is usually considered a sign of interest and presence, and a lack thereof is interpreted as evasiveness. It is common for individuals to maintain more eye contact while listening and less while talking. Some research indicates that African Americans may reverse this pattern by looking more when talking and slightly less when listening. Among some Native American and Latino groups, eye contact by the young is a sign of disrespect. Some cultural groups generally avoid eye contact when talking about serious subjects (Ivey et al., 2018). Clearly, helpers who pathologize a client’s lack of eye contact may not be understanding or respecting important cultural differences. Helpers must acquire knowledge of a wide range of cultural differences to reduce the probability of miscommunication, misdiagnosis, and misinterpretation of nonverbal behaviors.

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Assumptions about trusting relationships. Many, but not all, Americans of European background tend to form quick relationships and to talk easily about their personal life. This characteristic is often reflected in a helper’s style, and the helper may expect the client to approach their relationship in an open and trusting manner. Doing this is very difficult for some clients, however, especially given that they are expected to talk about themselves in personal ways to a stranger. It may take some time to develop a meaningful working relationship with a client who is culturally different from you.

Assumptions about self-actualization. Helping professionals commonly assume that it is important for the individual to become self- actualized. But some clients are more concerned about how their problems or changes are likely to affect others in their life. In collectivistic cultures the individual exists in relation to others, and one of the guiding principles is achievement of collective goals. Likewise, Native Americans judge their worth primarily in relation to how their behavior contributes to the harmonious functioning of their tribe. Emphasis is on social relatedness and the interconnectedness of all things. Shared experiences are used as a means of healing individuals, which occurs only in the context of relationship with others (McWhirter & Robbins, 2014).

Assumptions about directness and assertiveness. Although some cultures prize directness, other cultures see being direct as a sign of rudeness and as something to be avoided. If you are not aware of this cultural difference, you could make the mistake of interpreting a lack of directness as a sign of being unassertive rather than as a sign of respect. Getting to the point immediately is valued in some cultures, but other cultures value less direct styles of communication. It is easy to put the responsibility on the client when the therapy interventions do not work. However, if therapists cannot connect to clients using the techniques in which they were trained, it is their responsibility to find other ways to work with their clients.

If you are operating from an individualistic orientation, you are likely to assume that your clients are better off if they can behave in assertive ways, such as telling people what they think, feel, and want. It is critical to recognize that being direct and assertive is just one way of being; counselors should avoid assuming that assertive behavior is the norm and is desirable for everyone. Certain clients might be offended if it were automatically assumed that they would be better off if they were more assertive. For example, assume that you are working with a woman who rarely asks for what she wants, allows others to decide her priorities, and almost never denies a request or demand from anyone in her family. If you worked hard at helping her become an assertive woman, it could very well create conflicts within her family system. If she changed her role, she might no longer fit in her family or in her culture. Therefore, it is crucial that both you and your clients consider the consequences of examining and modifying cultural values.

One way to respect your clients is to listen to what they say they value. Ask your clients what behaviors are and are not working in their lives. If clients tell you that being indirect or unassertive is problematic for them, then this should

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be explored. However, if such behaviors are not posing difficulty for them, you need to monitor how your biases may be operating when you attempt to change clients in directions that they are not interested in pursuing. Asking your clients what they want from you is a way of decreasing the chances that you will impose your cultural values on them. On this point, consider the following case.

Case example: Is listening to your client enough? Mac, a successful psychologist, has concerns about much of the multicultural movement. He sees it as more trendy than useful. “I do not impose my values. I do not tell clients what to do. I listen, and if I need to know something, I ask. How am I to know whether a Japanese American client is more American than Japanese or vice versa unless I ask him? My belief is that the client will tell you all you need to know.”

Your stance. What is your reaction to Mac’s attitude? How would you determine the level of acculturation of a client of yours? What is your reaction to Mac expecting his client to educate him on culture issues?

Discussion. We react not so much to what Mac says as to what is implied by what is said. Certainly, it is important for clients to tell counselors what they need to know. However, Mac seems to downplay the necessity for ongoing education and sensitivity to cultural issues, which might enable him to ask more effective questions. It is not the responsibility of Mac’s clients to educate him. Listening to our clients is not enough; we also need to be formally and informally educated.

Challenging Your Stereotypical Beliefs Although you may assume you are without bias, stereotypical beliefs could well affect your practice. Stereotyping involves assuming that the behavior of an individual will reflect or be typical of that of most members of his or her cultural group. This assumption leads to statements such as these: “Asian American clients are emotionally repressed.” “African American clients are suspicious and will not trust professional helpers.” “White people are arrogant.” “Native Americans have very low motivation.” Lee (2019b) emphasizes the importance of challenging stereotypical beliefs. “An important component of any cross-cultural encounter is the ability to get beyond stereotypes and ensure that one sees people as individuals within a cultural context” (p. 9).

Sue (2005) contends that modern racism is often subtle, indirect, and unintentional, which allows people to remain oblivious to its existence. According to Sue, racism frequently operates outside the level of conscious awareness. Helpers who view themselves as being without any stereotypes, biases, and prejudices are most likely underestimating the impact of their socialization. Such helpers can be even more dangerous than those who are more open about their biases and prejudices.

According to Pedersen (2000), this form of racism emerges unintentionally from well-meaning and caring professionals who are no more or less culturally biased than segments of the general public. He believes that unintentional racists must be challenged either to become intentional racists or to modify their attitudes and behaviors. The key to changing the unintentional racist lies in examining basic underlying assumptions, such as those we described earlier.

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In addition to cultural stereotypes, some stereotypes are associated with special populations, such as people with disabilities, older people, and people who are homeless. Statements that lump together individuals within a group reflect a myth of uniformity. In your professional work, you need to realize that there are variations within cultural groups and that such differences may be at least as important as those among different groups. In your attempt to be culturally sensitive, be careful to avoid further stereotyping of certain groups.

Although cultural differences both among and within groups may be obvious, it is important not to go to the extreme of focusing exclusively on the differences that can separate us. In working with mental health professionals in foreign countries, we have become even more convinced that there are some basic similarities among the peoples of the world. Universal experiences can bind people together. Although personal circumstances differ, most people experience the pain of making decisions and attempting to live with integrity in the world. It is essential to be respectful of the real cultural differences that exist, and it is equally important that we not forget the common denominators of all people.

Expanding Your Awareness of Cultural Assumptions and Values Try to identify some of your cultural assumptions and values as you think about these questions: • As a helper, is it necessary that you share the cultural background

of your client to be effective? • How might your own experiences with discrimination help or hinder

you in working with clients who have been discriminated against? • What stereotypes are you aware of having? • Will your values help or hinder you in forming a helping

relationship with individuals who do not share your values? Understanding People With Disabilities* Part of understanding diversity involves understanding how ability and disability are relevant factors in the delivery of human services. In ways similar to people of color, people with disabilities have to face prejudice, hostility, lack of understanding, and discrimination on the basis of their physical appearance and perceived emotional or mental abilities. DePoy and Gilson (2004) point out that diversity categories such as race, ethnicity, and gender fall under a similar analytic lens. Individuals without disabilities frequently view people with disabilities through the same distorted spectacles with which they see others who differ from them. The clarity of a helper’s vision can be impaired by myths, misconceptions, prejudices, and stereotypes about people with disabilities.

It is important to recognize the potential of people with disabilities. Helpers’ attitudes are a key factor in successfully intervening in the lives of people with disabilities. Dispelling myths and misconceptions when helping people with

*We want to acknowledge Mark Stebnicki, professor in the Department of Addictions and Rehabilitation at East Carolina University, for his consultation with us and helpful input in revising this section on understanding people with disabilities.

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disabilities achieve their goals can be just as necessary as when working with people who have addiction issues, intense marital conflicts, or are survivors of extraordinary, stressful, and traumatic events.

Examining Stereotypes Pertaining to Physical Disabilities People with physical disabilities do not want to be labeled with language such as “crippled,” “afflicted,” “special,” or “handicapped.” Many advocates believe that the environment itself, both physical and social, and others’ negative attitudes toward people with disabilities are the real handicapping conditions (Smart, 2019). Historically, much of the language used to refer to “the disability experience,” as portrayed in the print and electronic media, has communicated a condescending attitude toward people with disabilities. For example, the term mental retardation began as a medical term and appeared in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000), but over time it was repeatedly misused in our society in a hurtful and derogatory way. In response to this, Rosa’s Law was passed to replace the old designation with the term intellectual disability. The revised DSM-5 (American Psychiatric Association, 2013a) now places “intellectual disabilities” under the category of Neurodevelopmental Disorders. People with spinal cord injuries also have been stereotyped as being “physically or mentally deficient” in some way, which has profound implications for socialization, employment outlook, self- esteem, and basic independent functioning (Marini, 2007). Overall, people with disabilities remain the most disenfranchised group in almost every society, regardless of their ethnicity. People with disabilities are often unemployed and underemployed, and many live below the poverty line (Olkin, 2016). Olkin states that people with disabilities generally report psychosocial issues more than physical barriers as major impediments in living with a disability. People with disabilities are often underserved in the counseling field, but this is beginning to change as awareness and advocacy efforts improve. One growing trend in some states is to provide community-based counseling for people with severe disabilities, bringing the services to people who otherwise could not access therapy in traditional office settings.

Individuals without disabilities often try to hide their feelings of awkwardness in the presence of a person with a disability through exaggerated attention and kindness. Helpers may have learned a variety of negative messages about disability, and they may experience some initial discomfort. It is essential for helpers to demonstrate a willingness to examine their own attitudes when they are working with people who have any kind of disability. A critical aspect of self- awareness is to recognize, understand, and manage one’s countertransference in working with clients with disabilities (Olkin, 2016).

Although people with disabilities share some common concerns, there is considerable diversity among people with physical disabilities. As with any special population with which you work, it is important that you identify your assumptions. For example, you could assume that certain careers might be out of reach for a client with a disability. But to make this assumption without

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checking it out with your client is tantamount to limiting his or her options. Smart (2019) notes that many of our assumptions about individuals with disabilities are inaccurate and may impede the helping process because they may further stereotype the client. This would be a good time for you to reflect on any stereotypes that you may have toward people with disabilities and to scrutinize some of your assumptions.

A major role of practitioners who work with people with disabilities is to help these individuals to understand the prejudice and discrimination that surrounds disability. According to Palombi (Cornish, Gorgens, Monson, Olkin, Palombi, & Abels, 2008), people with disabilities often experience many of the same prejudices and kinds of discrimination as other underrepresented groups. Attitudinal barriers by people without disabilities are much greater than barriers to employment or even physical and architectural barriers. For instance, people with chronic medical or physical conditions (e.g., cerebral palsy, multiple sclerosis) who have articulation, speech, or communication difficulties are often perceived as having an intellectual disability. A visible physical disability may also be perceived by professionals as a mental or physical incapacity, requiring a heavy reliance on personal caregivers and overall dependence rather than independence.

Professional helpers need to understand the ultimate harmful costs to the individual because many people with disabilities integrate negative societal stereotypes and attitudes into their self-esteem and self-concept. It is crucial that helpers recognize their own biases and address them; failing to do so may result in perpetuating attitudinal barriers based on ignorance, false beliefs, and prejudice (Cornish et al., 2008). Helpers need to be able to assist their clients who have a disability develop an understanding of the impact that societal stereotypes have on their view of themselves.

Pushing Through Perceived Limitations If you work with people with disabilities, you must develop attitudes and intervention skills that will enable your clients to recognize the strengths and resources they possess. The kinds of help people with disabilities need may encompass a broad range of services. Primarily, these individuals could benefit from psychosocial adjustment services with the intention of optimizing their level of independent functioning, developing positive coping skills, cultivating resiliency strategies, and achieving optimal levels of wellness. Some clients may need help finding community resources to enable them to participate fully in the workforce. Others may need counseling to overcome the anxiety and depression that is often present when it looks like all of life has been turned on its head in a single moment. The rehabilitation plan should be highly individualized and presented in such a way that each person can reach his or her optimal level of medical, physical, psychological, emotional, vocational, and social functioning. People with disabilities often have complex issues; it is best not to judge these clients or their needs based on your first meetings with them. Although many people with disabilities do want and need counseling that addresses the impacts of their disability, it is a mistake to assume this. For example, a 27-year-old woman who has been blind since birth may feel offended if the counselor

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continues to focus on her blindness; she adjusted to this condition as a child. The helper who focuses on the disability may be the one who is blind to the totality of the human being in front of her. Actively listen to the client’s presenting concern because it could have little to do with her disability. She has other attributes as well, such as being a mother, a child, or a sibling; having a job or career; and being a partner. The disability is but one aspect of the person’s life, and it may not be a significant concern when counseling this client.

Smart (2019) indicates that individuals with disabilities are becoming advocates for themselves and asserting their rights to counseling services in all specialty areas and practice settings. To provide ethical and effective services to individuals with disabilities, Smart believes that obtaining a broad knowledge of the disability experience is essential. Cornish and her colleagues (2008) state that professionals are not being adequately trained to provide services to clients with disabilities despite the likelihood that they will work with this population, and they may not be able to provide ethical and competent care. Practitioners must engage in self-reflection to accurately determine whether they are competent to provide services to people with disabilities.

Mackelprang and Salsgiver (2009) provide these guidelines for practice with people with disabilities: • Operate on the assumption that people are capable or potentially capable. • Critically evaluate the assumption that the problem with disability

lies with the person and that individuals with disabilities must be changed before they can function adequately in society.

• Recognize that people with disabilities often face discrimination and oppression, as do other minority groups. Realize that your interventions might well involve political advocacy and actions on your part to eliminate policy barriers that prevent individuals from accessing society’s benefits.

• Empower people with disabilities with interventions based on the assumption that these individuals have the right to control their own lives. (pp. 436–438) When working with people with disabilities, use people-first language

(e.g., a client with cerebral palsy spastic quadriplegia, not the quadriplegic client), keep abreast of current terminology used for disabilities to demonstrate respect (e.g., intellectual disability rather than mental retardation), seek knowledge about disability etiquette (e.g., wheelchairs are often considered an extension of the individual, and it is rude to lean on the wheelchair or hang things from the handles without permission), and avoid mentioning the disability at all unless it is pertinent to the current situation because no single attribute defines a person. It is of the utmost importance to ask clients directly about their experience and their preferences when referring to their disability.

Case example: Challenging our perceptions. I (Marianne) gave a talk to people with disabilities at a residential facility. The kinds of questions they raised were not any different from those of other groups that I have addressed, and many of the residents emphasized that they were no different from people without disabilities. Later, I asked a staff member at this institution to ask a few residents this question: “What would you like to tell

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helpers in training about yourself to assist them in better dealing with special populations?” Some of the residents gave these responses: • “I would like them to know that I want to be treated as a normal person

even though I am in a wheelchair. Look at the person, not at the wheelchair. Don’t be afraid of us.”

• “I’m a very good person. I’m a very smart person. I have a disability, but I also have intelligence.”

• “I can think and feel just like a normal person.” The staff member said a great deal in very few words in a letter to me

about her perceptions of the people she helps:

They have lived in institutions for most of their adult lives. They say they are no different from people without disabilities, but I think that they have enormous hearts. The people I have known have no prejudice and are very loving and giving. They also have a greater appreciation for the very simple things in life that most of us take for granted each day. They are unique individuals and I feel fortunate to have worked with them.

Your stance. Consider your own attitudes and assumptions about people you meet who have disabilities. Do you go out of your way to “help” these individuals? Do you conveniently “avoid” getting too close to them? How might your own reactions affect your work as a helper with this population?

Discussion. Societal attitudes are slowly changing as well-known individuals demonstrate a basic truth—having a disability does not mean that the person is disabled. Most of us are familiar with the Special Olympics, in which people with physical disabilities participate at the highest levels. Indeed, many people who are not so well known are challenging themselves to reach phenomenal goals in their daily lives. Such individuals continue to teach us about ourselves and the capacity of the human spirit to overcome any obstacle. And what about clients who have a disability but who lack hope and want to give up? If helpers accept their hopelessness and despair, they will be of little therapeutic value to their clients. Human services professionals need to discover their clients’ strengths and work toward empowerment.

Multicultural Counseling Competencies The helping professions continue to emphasize a monocultural approach to training and practice, leaving many helpers ill prepared to deal effectively with cultural diversity (Sue & Sue, 2016). Although referral is sometimes an appropriate course of action, it should not be viewed as a solution to the problem of inadequately trained practitioners. Lee (2015) contends that unethical conduct with culturally diverse clients is often due to a lack of counselor competence. Lee adds that cultural ignorance should not be an excuse for unethical counseling practice. Students in the mental health professions, regardless of their racial or ethnic background, should receive training in multicultural helping. Although it is unrealistic to expect you to have an in-depth knowledge of all cultural backgrounds, it is feasible to have a comprehensive grasp of general principles for working successfully with cultural diversity. If you are open to the values inherent in a diversity perspective, you will find ways to avoid getting trapped

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in provincialism, and you will be able to challenge the degree to which you may be culturally encapsulated (see Wrenn, 1985).

Sue and his colleagues (1982; Sue, Arredondo, & McDavis, 1992) developed a conceptual framework for multicultural counseling competencies and standards in three areas. The first area deals with the helper’s beliefs and attitudes about race, culture, gender, and sexual orientation. The second dimension involves knowledge and understanding of the worldview of the helper and specific knowledge of the diverse groups with whom he or she works. The third area deals with skills and intervention strategies needed to serve diverse client groups. Arredondo and her colleagues (1996) operationalized these competencies, and Sue and his colleagues (1998) extended multicultural counseling competencies to individual and organizational development. Sue and Sue (2016) have summarized the multicultural competencies as they apply to practice. These multicultural competencies have been endorsed by the Association for Multicultural Counseling and Development (AMCD), by the American Counseling Association (ACA), by the Association for Counselor Education and Supervision (ACES), and by the American Psychological Association (APA). The most recent version of the competencies, Multicultural and Social Justice Counseling Competencies, was developed by the Multicultural Counseling Competencies Revisions Committee (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2016). This document provides a framework for the effective delivery of services to diverse client populations. The American Psychological Association (2017b) also developed a diversity document, Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality.

The essential attributes of culturally skilled helpers, compiled from these sources, are presented next. You can use this checklist to identify areas of multicultural competence you now possess as well as areas in which you need to acquire additional knowledge and skills.

Beliefs and Attitudes of Culturally Skilled Helpers Put a check mark in the box before each of the beliefs and attitudes in this section that you think you already hold or each area of awareness that you already possess.

With respect to beliefs and attitudes, culturally skilled helpers … • become aware of their own personal culture and how they

might come across to those who differ from them in a multitude of ways.

• are aware of how their own cultural heritage, gender, class, ethnic identity, sexual orientation, disability, and age shape their values, assumptions, and biases related to identified groups.

• gain awareness of their personal and culture biases toward individuals or groups other than their own.

• do not allow their personal biases, values, or problems to interfere with their ability to work with clients who are different from them.

• believe that cultural self-awareness and sensitivity to one’s own cultural heritage are essential for any form of helping.

• are aware of their negative and positive emotional reactions toward others that may prove detrimental to establishing collaborative helping relationships.

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• have moved from being culturally unaware to

knowing their cultural heritage. • learn about the ways in which they are both alike and

different from the person they are helping. • seek to examine and understand the world from the

vantage point of their clients. • become aware of how any aspect of diversity (age,

disability, race, ethnicity) can become a target of negative behaviors.

• are able to recognize the limits of their multicultural competence and expertise.

• respect clients’ religious and spiritual beliefs and values. • recognize their sources of discomfort with differences

that exist between themselves and others. • welcome diverse value orientations and diverse

assumptions about human behavior and, thus, have a basis for sharing the worldview of their clients as opposed to being culturally encapsulated.

• do not maintain that their cultural heritage is superior and are able to accept and value the many forms of diversity.

• are able to identify and understand the central cultural constructs of their clients and to avoid applying their own cultural constructs inappropriately to people with whom they work.

• respect indigenous helping practices and respect help- giving networks within the community.

• monitor their functioning through consultation, supervision, and further training or education.

• understand that mainstream Western helping strategies might not fit all people or all problems and realize how they may need to adapt their interventions to the needs of their clients.

Knowledge of Culturally Skilled Helpers Put a check mark in the box before each type of knowledge in this section that you think you already possess.

With respect to knowledge areas, culturally skilled helpers … • possess knowledge about their own racial and cultural

heritage and how it affects them personally and in their work. • possess knowledge and understanding about how

oppression, racism, prejudice, discrimination, and stereotyping affect them personally and professionally.

• do not impose their values and expectations on clients from differing cultural backgrounds and avoid stereotyping clients.

• strive to understand the worldviews, values, and beliefs of those with whom they work.

• understand the basic values underlying the helping process and know how these values may clash with the cultural values of diverse groups of people.

• are aware of the institutional barriers that prevent some individuals from utilizing the mental health services available in their communities.

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• have knowledge of the potential bias in assessment instruments and

use procedures and interpret findings keeping in mind the cultural and linguistic characteristics of clients.

• possess specific knowledge and information about the particular individuals with whom they are working.

• are knowledgeable about communication style differences and how their style may clash with or foster the helping process with people from different cultural groups.

• are knowledgeable about the community characteristics and the resources in the community as well as those in the family.

• learn about the basics of family structure and gender roles of groups with whom they work.

• understand how people in various cultures feel about asking for professional help.

• have knowledge about sociopolitical influences that impinge upon the lives of ethnic and racial minorities, including immigration issues, poverty, racism, stereotyping, stigmatization, and powerlessness.

• view diversity in a positive light, which enables them to meet and resolve the challenges that arise in their work with a wide range of client populations.

• know how to help clients make use of indigenous support systems. In areas where they are lacking in knowledge, they seek resources to assist them.

Skills and Intervention Strategies of Culturally Skilled Helpers Put a check mark in the box before each of the skill areas in this section that you think you already possess.

With respect to specific skills, culturally skilled helpers … • take responsibility for educating their clients to the way the

helping process works, including matters such as goals, expectations, legal rights, and the helper’s orientation.

• familiarize themselves with relevant research and the latest findings regarding mental health and mental disorders that affect diverse client populations.

• are willing to seek out educational, consultative, and training experiences to enhance their ability to work with culturally diverse client populations.

• assess their level of cross-cultural and personal-cultural competence and do what they can to become a culturally competent helper.

• are open to seeking consultation with traditional healers or religious and spiritual leaders to better serve culturally different clients, when appropriate.

• use methods and strategies and define goals consistent with the life experiences and cultural values of their clients and modify and adapt their interventions to accommodate cultural differences.

• establish rapport with and convey empathy to clients in culturally sensitive ways.

• have the ability to design and implement nonbiased and effective interventions for clients from identified groups.

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• are able to initiate and explore issues of difference

between themselves and their clients, when it is appropriate.

• are not limited to only one approach in helping but recognize that helping strategies may be culture bound.

• are able to send and receive both verbal and nonverbal messages accurately and appropriately.

• are able to exercise institutional intervention skills on behalf of their clients.

• become actively involved with individuals outside of the office (community events, celebrations, and neighborhood groups) to the extent possible.

• are committed to understanding themselves as racial and cultural beings and are actively seeking a nonracist identity.

• actively pursue and engage in professional and personal-growth activities to address their limitations.

• consult regularly with other professionals regarding issues of culture to determine whether or where referral may be necessary.

Reflection questions. Now that you have completed the checklist, summarize and think about the implications of your current level of awareness, knowledge, and skills. As a way to assess your present level of multicultural competence, reflect on the following questions: • Are you familiar with how your own culture has a present influence

on the way you think, feel, and act? What steps could you take to broaden your base of understanding, both of your own culture and of other cultures?

• Are you able to identify your basic assumptions, especially as they apply to diversity in culture, ethnicity, race, gender, class, religion, disability, age, and sexual orientation? To what degree are you clear about how your assumptions are likely to affect your practice as a helper?

• How open are you to being flexible in applying the techniques you use with clients?

• How prepared are you to understand and work with clients of different cultural backgrounds?

• To what degree are you now able to differentiate your own cultural perspective from that of a person from another culture?

• To what degree is your academic program preparing you to gain the awareness, knowledge, and skills you will need to work with diverse client populations?

• What kinds of life experiences have you had that will better enable you to understand and counsel people who have a different worldview?

• Can you identify any areas of your personal-cultural biases that could inhibit your ability to work effectively with people who are different from you? If so, what steps might you take to challenge your biases?

Recognizing Your Own Limitations As a culturally skilled helper, you have the ability to recognize the limits of your multicultural competency and expertise. It is not realistic to expect that you will know everything about the cultural background of people with whom you will work. There is much to be said for letting your clients teach you about relevant aspects of their culture. Ask clients to provide you with the information

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you will need to work effectively with them. In working with culturally diverse individuals, it helps to assess the degree of acculturation and identity development that has taken place. This is especially true for individuals who have had the experience of living in another culture. They often have allegiance to their own home culture but find certain characteristics of their new culture attractive. They may experience conflicts when integrating the values from the two cultures in which they live. These core struggles can be productively explored in the context of a collaborative helping relationship.

We encourage you to accept your limitations and to be patient with yourself as you expand your vision of how your culture continues to influence the person you are today. It is not helpful to overwhelm yourself with all that you do not know or to feel guilty over your limitations or parochial views. You will not become a more effective and culturally skilled helper by expecting to be completely knowledgeable about the cultural backgrounds of all your clients, by thinking that you should have a complete repertoire of skills, or by demanding perfection. Instead, recognize and appreciate your efforts toward becoming a more diversity-competent helper.

Cultural Competence as a Lifelong Learning Process Acquiring cultural competence is a lifelong learning process that includes formal training, self-reflection, and questioning what is occurring in cross- cultural therapeutic partnerships. Cultural competency involves more than self- awareness and knowledge; it entails acquiring skills for effective multicultural intervention. Counselors entering cross-cultural helping relationships need to develop techniques and skills consistent with the life experiences and cultural values of their clients (Lee, 2019b). Culturally competent helpers are continually developing attitudes and beliefs, knowledge, and skills that enable them to work more effectively with diverse clients. They realize that they can never say they have achieved an ultimate level of competency (Corey, Corey, & Corey, 2019). Culturally competent practitioners adapt and incorporate various therapeutic approaches to address the multiple facets of each client’s unique needs and life experiences. They are attuned to both interpersonal and intrapersonal factors that foster the therapeutic relationship (Chu, Leino, Pflum, & Sue, 2016). For an in-depth discussion of becoming a culturally competent practitioner, see Multicultural and Social Justice Counseling Competencies: A Blueprint for the Profession (Lee, 2019c).

Social Justice Competencies Understanding that oppression and discrimination operate in the lives of our clients is fundamental to ethical practice, and we must translate this awareness into various forms of social action. We can play a significant role in making society a better place by challenging systemic inequities. The social justice perspective is based on the premise that oppression, discrimination, privilege, and social inequities do exist and have a negative impact on the lives of many people from diverse cultural groups. Broadly constructed, social justice

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involves access and equity to ensure full participation in the life of a society, particularly for those who have been systematically excluded on the basis of race/ethnicity, gender, age, physical or mental disability, education, sexual orientation, socioeconomic status, or other characteristics of background or group membership. For us to be able to effectively work with a range of people from diverse backgrounds, it is critical that we acquire competencies in the social justice perspective, and that we also incorporate these competencies into our practice. Lee (2018b) conceives of social justice as “a shared journey, that first and foremost needs to take place inward with self-reflection, self-awareness, self- empowerment, and self-change, in order to create the fertile ground upon which social change can blossom” (p. 249).

The social justice perspective reflects a valuing of fairness and equal treatment for marginalized and devalued individuals and groups of people who do not share equally in society. Counseling practices rooted in social justice aim to challenge inherent inequities in social systems. Social justice goes beyond raising awareness and focuses on issues of oppression, privilege, power relations, and social inequities. Counselors as agents of social change possess the awareness, knowledge, and skills to intervene, not only at the individual level but also at the systemic level (Lee, Baldwin, Mamara, & Quesenberry, 2018).

Chung and Bemak (2012) refer to social justice work as a fifth force; it entails a paradigm shift beyond the individual and represents a proactive concern with advocacy and social change. For instance, a helper who is invested in social justice may become active in a local organization that addresses the issue of voter suppression during election time. “Being an advocate requires the core counseling skills and multicultural competencies, along with energy, commitment, motivation, passion, persistence, tenacity, flexibility, patience, assertiveness, organization, resourcefulness, creativity, a multisystems and multidisciplinary perspective, and the ability to deal with conflict and negotiate and access systems” (p. 175).

Sustained efforts on a large-scale need to be made in advocating for oppressed groups, but you can also promote social justice in small ways in everyday life. Although acquiring multicultural and social justice competencies and working toward social change might seem like an ambitious undertaking, each of us can take small steps toward bringing about social change. For example, when a coworker in the break room or a “friend” on Facebook makes an insensitive comment about someone from a marginalized group, you have an opportunity to be a social justice advocate by commenting on the biased remarks you are hearing. Counseling for social justice is the next logical evolutionary step from multicultural counseling. Social justice work involves a move from understanding the experiences of oppressed groups toward social action with the goal of achieving social equity for marginalized or disenfranchised individuals (Lee et al., 2018). Developing social justice competence, like multicultural competence, is not achieved once and for all. It is best to think of competence in these areas as part of a lifelong journey in developing attitudes and behaviors that will equip you to best serve a wide range of client groups.

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LO7 Multicultural Training The standards established by the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2016) require that training programs provide curricular and experiential offerings in multicultural and pluralistic trends, including characteristics within and among diverse groups nationally and internationally. Social justice principles, concepts, and practices should be infused throughout the training curriculum. CACREP standards call for supervised practicum experiences that include people from the environments in which the trainee is preparing to work. It is expected that trainees will study ethnic groups, subcultures, the changing roles of women, sexism, urban and rural societies, cultural mores, spiritual issues, and differing life patterns. Lee (2018c) emphasizes that students must be provided with opportunities to acquire multicultural and social justice competencies. This competence is predicated on (1) counselor self-awareness, (2) an understanding of the client’s worldview, (3) an understanding of how privilege affects the counseling relationship, and (4) developing advocacy intervention skills at the individual, group, institutional, and societal levels.

To enable helpers to utilize a multicultural perspective in their work, we support specialized training through formal courses and supervised field experiences with diverse client populations. We believe a self- exploratory class should be required for trainees in the helping professions to help them better identify their cultural and ethnic blind spots. In addition to enabling students to learn about cultures other than their own, such a course could offer opportunities for trainees to learn more about their own race, ethnicity, and culture.

A good program should include at least one course dealing exclusively with multicultural issues and people from diverse backgrounds. However, reliance on a single course designed to address the interface of professional ethics, multicultural counseling competence, and social justice counseling issues is not adequate for assisting counselors with the demands they will face (Bemak & Chung, 2007). In addition to a separate course, a broad range of ethical decision-making skills related to multicultural counseling should be integrated throughout the curriculum and infused in all aspects of the training program. For example, a fieldwork or internship seminar can introduce ways that helping strategies can be adapted to the special needs of diverse client populations and show how some techniques may be quite inappropriate for culturally different clients. The integration of multiculturalism and gender awareness can certainly be a thread running through relevant formal courses. In addition, there could be at least one required field placement or internship in which trainees have multicultural experiences. Ideally, the supervisor at this agency will be well versed in the cultural variables of that particular setting and also be skilled in cross-cultural understanding. Further, trainees should have access to both individual and group supervision on campus from a faculty member.

Supervised experience, along with opportunities for trainees to discuss what they are learning, is the core of a good program. We encourage you to select supervised field placements and internships that will challenge you to work on gender issues, cultural concerns, developmental issues, and lifestyle differences. You will not learn to deal effectively with diversity by working exclusively with

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clients with whom you are comfortable and whose culture is familiar to you. You can learn a great deal by going out into the community and interacting with diverse groups of people who face myriad problems. Through well-selected internship experiences, you will not only expand your own consciousness but will increase your knowledge of diverse groups. This will provide a basis for acquiring intervention skills.

An effective multicultural training program includes the components of awareness, knowledge, skill development, and experiential interaction, all of which are integrated in actual practice. As you have seen, awareness of personal attitudes and of attitudes toward diverse client populations is integral to becoming an effective helper. From a knowledge perspective, helpers need to understand what makes a diverse population unique. They need to know what behavior is acceptable within the diverse population and how this behavior differs from that of other groups.

Skill development is a necessary but not sufficient component of learning to work with diverse populations. The skills themselves are not unique, but the ways in which these skills are applied to particular clients should be the focus of training. Effective training will pay sufficient attention to each of these domains. If any of them are neglected, helpers are at a disadvantage.

Training programs have come a long way in the past several years, but they still have some way to go to equip helpers with the knowledge and skills required to meet the needs of diverse clients. As a student, you can take some small, yet significant steps toward recognizing and examining the impact of your own cultural background and learning about cultures different from your own. Deciding to act upon even a few of the suggestions given in this chapter is one way to move in the direction of becoming a culturally skilled helper.

By Way of Review • Multiculturalism recognizes and values diversity in helping

relationships and calls on helpers to develop strategies that are culturally appropriate.

• A multicultural perspective considers specific values, beliefs, and actions related to race, ethnicity, gender, age, ability, religion, language, socioeconomic status, sexual orientation, political views, and geographic region. Multicultural counseling, broadly conceptualized, considers the personality dynamics and cultural backgrounds of both helper and client in establishing a context in which they can interact meaningfully.

• To function effectively with clients of various cultures, helpers need to know and respect specific cultural differences and realize how cultural values operate in the helping process.

• Be aware of any tendencies toward cultural tunnel vision. If you have limited cultural experiences, you may have difficulties relating to clients who have a different view of the world. You are likely to misinterpret many patterns of behavior displayed by these clients.

• Broaching the topic of race and ethnicity is one way to actively include a multicultural element in counseling; it can strengthen the therapeutic alliance and promote better therapeutic outcomes.

By Way of Review

• Many diverse clients have come to distrust helpers associated with

the establishment or with social service agencies because of a history of unequal treatment.

• It is important to pay attention to ways in which you can express unintentional racism through your attitudes and behaviors. One way to change this form of racism is by making your assumptions explicit.

• Microaggressions related to a person’s gender, sexual orientation, or disability can be as powerful and potentially destructive as are racial microaggressions.

• Helpers must be committed to continually monitoring their political countertransference so their biases and assumptions do not contaminate the therapeutic process.

• In working with people from other cultures, avoid stereotyping and critically evaluate your assumptions about the use of self-disclosure, nonverbal behavior, trusting relationships, self-actualization, and directness and assertiveness.

• Helpers must demonstrate a willingness to examine their own attitudes when working with people who have any kind of disability.

• Many individuals with disabilities are able to achieve a high degree of success; keep your focus on clients’ potential rather than their perceived limitations.

• Effective multicultural helpers have been identified in terms of the specific knowledge, beliefs and attitudes, and skills they possess.

• Social justice, the fifth force in the helping professions, addresses issues of oppression, privilege, and social inequities. Helping professionals need to take an active stance in addressing social justice issues that are manifested in society by acquiring social justice competencies.

• Acquiring and refining multicultural and social justice competencies should be thought of as a lifelong developmental process that requires ongoing self- reflection, training, and education.

• Helpers who view differences as positive attributes will be most likely to meet and resolve the challenges that arise in multicultural helping situations.

What Will You Do Now? 1. If your program does not require a course on cultural diversity,

consider taking such a course as an elective. You might also ask if you can sit in on some class sessions in various courses that deal with specific populations. For example, in one university these are a few of the courses offered: The Black Family, The Chicano Family, American Indian Women, The African Experience, The Chicano and Contemporary Issues, Afro-American Music Appreciation, The White Ethnic in America, Women and American Society, The Chicano Child, and Barrio Studies.

2. On your campus you will probably find a number of student organizations for particular cultural groups. Approach some members of one of these organizations for information about the group. See if you can attend one of their functions to get a better perspective on their culture.

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3. Think of ways to broaden your cultural horizons. Go to a

restaurant, social event, faith-based service, concert, play, or movie that will expose you to a culture that you are unfamiliar with or that you would like to learn more about. If possible, attend this activity with a person from a cultural background that is different from your own. Ask this person to teach you about salient aspects of his or her culture.

4. If your grandparents originally came from another country, interview them about their experiences growing up in their culture. If they are bicultural, ask them about any experiences with combining both cultures. What have been their experiences in assimilation? Have they retained their original cultural identity? What do they most value in both cultures? Do what you can to discover the ways in which your cultural roots have some influence on your thinking and behavior today. In Chapter 2 you were introduced to the importance of discovering how your family of origin continues to influence you. This exercise can help you develop a richer appreciation of your cultural heritage.

5. Helpers are likely to encounter clients with a variety of disabilities. Some broad types of disabilities include mobility disabilities, visual disabilities, deafness, developmental disabilities, psychiatric disabilities, and cognitive disabilities. In groups of three or four, select a broad category and research the kinds of help available in your community for people with this type of disability. What additional services would benefit this population? Present your findings in class.

6. For the full bibliographic entry for each of the sources listed here, consult the References at the back of the book. For a good overview of counseling strategies and issues for various ethnic and racial groups, consult Atkinson (2004). See Chung and Bemak (2012) for an excellent treatment of the social justice perspective in the helping professions. See Lee (2018a) for various perspectives on counseling for social justice. See Lee (2019c) for a useful treatment of multicultural issues in counseling. See Ratts and Butler (2019) for a treatment of multicultural and social justice competencies. Sue and Sue (2016) have written a comprehensive text on counseling diverse client populations, and they provide a framework for developing cultural competency in the areas of cultural awareness, knowledge acquisition, and skill development.

Ethics in Action Video Exercises 7. In video role play 3, Challenging the Counselor: Culture Clash, the

client (Sally) directly questions the counselor’s background. She says that she didn’t expect the counselor (Richard) to be so young and seemingly inexperienced. She presses him further about whether he knows much about the Chinese culture.

Assume you are the counselor, and your client directly questions you about your background, wondering if you are able to understand her life experience and thus help her. When you consider the range of differences between you and your client, what specific differences concern you the most?

By Way of Review

Role-play a situation where a clash between you and a client might develop (such as a difference in age, race, sexual orientation, or culture).

8. In video role play 6, Multicultural Issues: Seeking More From Life, the client (Lucia) is presenting her struggle, which can be understood only to the extent that the counselor (Janice) understands her client’s cultural values. In this case, Lucia is struggling with a decision of what she wants to do with her life. Her parents would like her to stay at home and take care of her children. She asks Janice how she might be able to help her. The counselor lets Lucia know that the most important thing is that she is at peace with whatever decision she makes. This situation can be role-played in class or in a small group and used as a springboard for discussion of what it takes for a counselor to be able to ethically and effectively counsel diverse clients.

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