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OBSTACLES TO CULTURAL COMPETENCE UNDERSTANDING RESISTANCE TO MULTICULTURAL TRAINING

Chapter Objectives

1. Acknowledge and understand personal resistance to multicultural training.

2. Identify how emotional reactions to topics of prejudice, discrimination, and oppression can act as obstacles to cultural competence.

3. Understand worldview differences between majority and socially devalued group members in this society.

4. Make sense of why majority group members often react differently from marginalized group members when issues of racism, sexism, or heterosexism are discussed.

5. Be cognizant of how worldviews may influence the ability to understand, empathize, and work effectively with diverse clients.

6. Realize that becoming an effective multicultural counselor is more than an intellectual exercise and is a lifelong journey.

Reading and digesting the content of this book may prove difficult and filled with powerful feelings for many of you. Students who have taken a course on multicultural counseling/therapy or multicultural mental health issues have almost universally felt both positive and negative feelings that affect their ability to learn about diversity issues. It is important not to allow those emotions to go unacknowledged, or to avoid exploring the psychological meanings they may have for you. As you begin your journey to becoming a culturally competent counselor/mental health professional, the road will be filled with obstacles to self-exploration, to understanding yourself as a racial/cultural being, and to understanding the worldview of those who differ from you in race, gender, ethnicity, sexual orientation, and other sociodemographic characteristics.

The subject matter in this book and course requires you to explore your biases and prejudices, a task that often evokes defensiveness and resistance. It is important to recognize personal resistance to the material, to explore its meanings, and to learn about yourself and others. Sometimes what is revealed about you may prove disturbing, but having the courage to continue is necessary to becoming a culturally competent counselor or therapist. This chapter is specifically written to help readers understand and overcome their emotive reactions to the substance of the text, and the course you are about to take. Let us begin by sharing reactions from four past students to reading Counseling the Culturally Diverse and discuss their meaning for the students, and the implications for mental health practice.

Reactions to Reading Counseling the Culturally Diverse

Reaction #1

1. White Female Student: “How dare you and your fellow caustic co-author express such vitriol against my people? You two are racists, but of a different color. . .I can't believe you two are counselors. Your book does nothing but to weaken our nationalism, our sense of unity and solidarity. If you don't like it here, leave my country. You are both spoiled hate-mongers who take advantage of our educational system by convincing others to use such a propagandistic book! Shame on you. Your book doesn't make me want to be more multicultural, but take ungrateful people like you and export them out of this great land of mine.” (Name withheld)

2. Analysis: This response reveals immense anger at the content of CCD, and especially at the authors, whom she labels “hate mongers” and “racists.” It is obvious that she feels the book is biased and propagandistic. The language of her words seems to indicate defensiveness on her part as she easily dismisses the material covered. More important, there is an implicit suggestion in the use of “people like you” and “land of mine” that conveys a perception that only certain groups can be considered “American” and others are “foreigners.” This is similar to statements often made to people of color: “If you don't like it here, go back to China, Africa or Latin America.” Likewise, the implication is that this land does not belong to persons of color who are U.S. Citizens, but only to White Americans.

Reaction #2

1. White Male Student: “I am a student in the field of Professional Counseling and feel compelled to write you because your text is required reading in our program. I am offended that you seem to think that the United States is the only perpetrator of prejudice and horrific acts. Excuse me sir, but racism and oppression are part of every society in the world ad infinitum, not just the United States. I do not appreciate reading biased material that does not take into account all forms of prejudice including those from minorities. You obviously have a bone to grind with White people. Minorities are equally racist. Why do you take such pleasure in attacking whites when we have done so much to help you people?” (Anonymous)

2. Analysis: Similar to the first response, the male student is also angry and offended about the content. There is a strong feeling of defensiveness, however, that emanates from his narrative. It appears he feels unjustly accused of being bigoted and that we are implying that only U.S. society and not others are racist. To make himself feel less guilty, he emphasizes that “every society” oppresses “minority” constituents and it is not Whites alone who are prejudiced. These are actually accurate statements, but they mask the defensiveness of the student, and have the goal of exonerating him and other Whites for being prejudiced. If he can get other groups to admit they too are racist, then he feels less guilt and responsibility for his own beliefs and actions.

Reaction #3

1. Latina Student: “I am currently embarking on the journey of becoming a Marriage and Family Therapist at a California State University. I just want to thank you for writing Counseling the Culturally Diverse. This book has spoken to me and given me so much knowledge that is beyond words to express. Finally, there is someone willing to tell it like it is. You have truly made an impact in my life because, being an ethnic minority, I could empathize with many of the concepts that were illustrated. Although some White classmates had difficulty with it, you truly validated much of my experiences. It reaffirmed how I see the world, and it felt good to know that I am not crazy! Once again thanks for writing the book.” (Name withheld)

2. Analysis: The reaction from the Latina student is diametrically opposite to that of her White counterparts. She reacts positively to the material, finds the content helpful in explaining her experiential reality, feels validated and reaffirmed, and realizes that she is “not crazy.” In other words, she finds the content of the book truthful and empathetic to her situation. The important question to ask is, “Why does she react so differently from the two White students?” After all, the content of the book remains the same, but the perceptions appear worlds apart.

Reaction #4

1. African American Male Student: “When I first took this course (multicultural counseling) I did not have much hope that it would be different from all the others in our program, White and Eurocentric. I felt it would be the typical cosmetic and superficial coverage of minority issues. Boy was I wrong. I like that you did not ‘tip toe' around the subject. Your book Counseling the Culturally Diverse was so forceful and honest that it made me feel liberated . . . I felt like I had a voice, and it allowed me to truly express my anger and frustration. Some of the white students were upset and I could see them squirming in their seats when the professor discussed the book. I felt like saying ‘good, it's about time Whites suffer like we have. I have no sympathy for you. It's about time they learned to listen.' Thank you, thank you, and thank you for having the courage to write such an honest book.” (Name withheld)

2. Analysis: Like the Latina student, the African American male finds the book compelling, honest, and truthful. He describes how it makes him feel liberated, provides him with a voice to describe his experiences, and taps into and allows him to express his anger and frustration, and he thanks the authors for writing CCD. He implies that most courses on multicultural psychology are taught from a EuroAmerican perspective, but the book content “tells it like it is.” Additionally, the student seems to take pleasure in observing the discomfort of White students, expresses little sympathy for their struggle in the class, and enjoys seeing them being placed on the defensive. (We will return to the meaning of this last point shortly.)

Reading Counseling the Culturally Diverse: Theory and Practice (CCD) is very likely to elicit strong emotions among readers. These four reactions, two by White students and two by readers of color, reveal the range of emotions and reactions likely to be expressed in classes that use the text. Over the last 35 years we have received literally hundreds of emails, letters, and phone calls from students, trainees, professors, and mental health professionals reacting strongly to the content and substance of CCD. Many of the readers praise the book for its honest portrayal of multicultural issues in mental health practice. Indeed, it has become the most widely used and cited text in multicultural psychology, considered a classic in the field (Ponterotto, Fingerhut, & McGuinness, 2013; Ponterotto & Sabnani, 1989), and now forms the knowledge base of licensing and certification exams for counseling and mental health professionals.

Despite the scholarly status that CCD has achieved, some readers (generally those from the majority group) find the substance of the book difficult to digest and have reacted very strongly to the content. According to instructors of multicultural counseling/therapy classes, the powerful feelings aroused in some students prevent them from being open to diversity issues, and from making classroom discussions on the topic a learning opportunity. Instead, conversations on diversity become “shouting matches” or become monologues rather than dialogues. These instructors indicate that the content of the book challenges many White students about their racial, gender, and sexual orientation realities, and that the book's writing style (passionate, direct, and hard-hitting) also arouses deep feelings of defensiveness, anger, anxiety, guilt, sadness, hopelessness, and a multitude of other strong emotions in many. Unless properly processed and understood, these emotions act as roadblocks to exploring issues of race, gender, and sexual orientation. Learning about multicultural psychology is much more than an intellectual exercise devoid of emotions.

It would be a mistake, however, to conclude from these examples that White students and students of color respond uniformly in one way. As we will explore in future chapters, many White students react positively to the book and some students of color report negative reactions. But, in general, there are major worldview differences and reactions to the material between the two groups. For example, many socially marginalized group members find solace in the book; they describe a deep sense of validation, release, elation, joy, and even feelings of liberation as they read the text. What accounts for these two very different reactions?

For practicing professionals and trainees in the helping professions, understanding the differing worldviews of our culturally diverse clients is tantamount to effective multicultural counseling. But understanding our own reactions to issues of diversity, multiculturalism, oppression, race, gender, and sexual orientation is equally important to our development as counselors/therapists (Todd & Abrams, 2011). As we will shortly see, that understanding can be quite anxiety provoking, especially when we are asked to confront our own biases, prejudices, and stereotypes. The old adage “counselor or therapist, know thyself” is the basic building block to cultural competence in the helping professions. Let us take a few moments here to dissect the reactions of the four readers in our opening narratives and attempt to make meaning of them. This is a task that we encourage you to personally take throughout your educational journey as well. Likewise, as a counselor or therapist working with culturally diverse clients, understanding differences in worldviews is an important first step to becoming culturally competent.

Emotional Self-Revelations and Fears: Majority Group Members

It is clear that the two White students are experiencing strong feelings to the content of CCD. As you will shortly see, the book's subject matter (a) deals with prejudice, bias, stereotyping, discrimination, and bigotry; (b) makes a strong case that counseling and psychotherapy may serve as instruments of cultural oppression rather than therapeutic liberation (Sue, 2015; Wendt, Gone, & Nagata, 2015); (c) indicates that well-intentioned mental health professionals are not immune from inheriting the racial and gender biases of the larger society; and (d) suggests therapists and trainees may be unconsciously biased toward clients from marginalized groups (Ratts & Pedersen, 2014).

Although supported by the research literature and by clinical observations and reports, these assertions can be quite disturbing to members of the majority group. If you are a majority group member and beginning the journey to cultural competence, it is possible that you may share similar reactions to those of the students. Both White students, for example, are reacting with anger and resentment; they believe that the authors are unjustly accusing U.S. Society and White Americans of racism, and claim the authors are themselves “racist” but of a different color. They have become defensive and are actively resisting and rejecting the content of the book. If these feelings persist throughout the course unabated, they will act as barriers to learning and further self-exploration. But what do these negative reactions mean to the students? Why are they so upset? Dr. Mark Kiselica (Sue & Sue, 2013, pp. 8–9), a White psychologist and now provost of a college in New York, writes about his own negative emotional reactions to reading the book during his graduate training. His personal and emotional reactions to the book provide us with some clues.

I was shaken to my core the first time I read Counseling the Culturally Different (now Counseling the Culturally Diverse). . . .At the time, I was a doctoral candidate at The Pennsylvania State University's counseling psychology program, and I had been reading Sue's book in preparation for my comprehensive examinations, which I was scheduled to take toward the end of the spring semester. . .

I wish I could tell you that I had acquired Sue's book because I was genuinely interested in learning about multicultural counseling. . .I am embarrassed to say, however, that that was not the case. I had purchased Sue's book purely out of necessity, figuring out that I had better read the book because I was likely to be asked a major question about cross-cultural counseling on the comps. During the early and middle 1980s, taking a course in multicultural counseling was not a requirement in many graduate counseling programs, including mine, and I had decided not to take my department's pertinent course as an elective. I saw myself as a culturally sensitive person, and I concluded that the course wouldn't have much to offer me. Nevertheless, I understood that. . .the professor, who taught the course, would likely submit a question to the pool of materials being used to construct the comps. So, I prudently went to the university bookstore and purchased a copy. . . .because that was the text. . . .used for his course.

I didn't get very far with my highlighting and note-taking before I started to react to Sue's book with great anger and disgust. Early on in the text, Sue blasted the mental health system for its historical mistreatment of people who were considered to be ethnic minorities in the United States. He especially took on White mental health professionals, charging them with a legacy of ethnocentric and racist beliefs and practices that had harmed people of color and made them leery of counselors, psychologists, and psychiatrists. It seemed that Sue didn't have a single good thing to say about White America. I was ticked off at him, and I resented that I had to read his book. However, I knew I had better complete his text and know the subject matter covered in it if I wanted to succeed on the examinations. So, out of necessity, I read on and struggled with the feelings that Sue's words stirred in me.

I was very upset as I read and reread Sue's book. I felt that Sue had an axe to grind with White America and that he was using his book to do so. I believed that his accusations were grossly exaggerated and, at least to some extent, unfair. And I felt defensive because I am White and my ancestors had not perpetrated any of the offenses against ethnic minorities that Sue had charged. I looked forward to the day when I would be relieved of him and his writings.

Becoming culturally competent in counseling/mental health practice demands that nested or embedded emotions associated with race, culture, gender, and other sociodemographic differences be openly experienced and discussed. It is these intense feelings that often block our ability to hear the voices of those most oppressed and disempowered (Sue, 2011). How we, as helping professionals, deal with these strong feelings can either enhance or impede a deeper understanding of ourselves as racial/cultural beings and our understanding of the worldviews of culturally diverse clients. Because Mark did not allow his defensiveness and anger to get the best of him, he was able to achieve insights into his own biases and false assumptions about people of color. The following passage reveals the internal struggle that he courageously fought and the disturbing realization of his own racism.

I tried to make sense of my emotions—to ascertain why I was drawn back to Sue's book again and again in spite of my initial rejection of it. I know it may sound crazy, but I read certain sections of Sue's book repeatedly and then reflected on what was happening inside of me. . . .I began to discover important lessons about myself, significant insights prompted by reading Sue's book that would shape the direction of my future. . . . I now realized that Sue was right! The system had been destructive toward people of color, and although my ancestors and I had not directly been a part of that oppressive system, I had unknowingly contributed to it. I began to think about how I had viewed people of color throughout my life, and I had to admit to myself that I had unconsciously bought into the racist stereotypes about African Americans and Latinos. Yes, I had laughed at and told racist jokes. Yes, I had used the “N” word when referring to African Americans. Yes, I had been a racist.

Sue's book forced me to remove my blinders. He helped me to see that I was both a product and an architect of a racist culture. Initially, I didn't want to admit this to myself. That is part of the reason I got so angry at Sue for his book. “His accusations don't apply to me!” was the predominant, initial thought that went through my mind. But Sue's words were too powerful to let me escape my denial of my racism. It was as though I was in a deep sleep and someone had dumped a bucket of ice-cold water onto me, shocking me into a state of sudden wakefulness: The sleep was the denial of my racism; the water was Sue's provocative words; and the wakefulness was the painful recognition that I was a racist. (Sue & Sue, 2013, pp. 9–10)

Years later, Mark Kiselica (1999) talks about his racial awakening and identifies some of the major fears many well-intentioned Whites struggle with as they begin studying racism, sexism, or heterosexism on a personal level. This passage, perhaps, identifies the major psychological obstacle that confronts many Whites as they process the content and meaning of the book.

You see, the subjects I [White psychologist] am about to discuss—ethnocentrism and racism, including my own racism—are topics that most Whites tend to avoid. We shy away from discussing these issues for many reasons: We are racked with guilt over the way people of color have been treated in our nation; we fear that we will be accused of mistreating others; we particularly fear being called the “R” word—racist—so we grow uneasy whenever issues of race emerge; and we tend to back away, change the subject, respond defensively, assert our innocence and our “color blindness,” denying that we could possibly be ethnocentric or racist.” (p. 14)

It is important to note Kiselica's open admission to racist thoughts, feelings, and behaviors. As a White psychologist, he offers insights into the reasons why many White trainees fear open dialogues on race; they may ultimately reveal unpleasant secrets about themselves. In his own racial/cultural awakening, he realizes that discussing race and racism is so difficult for many Whites because they are racked with guilt about how people of color have been treated in the United States and are fearful that they will be accused of being a racist and be blamed for the oppression of others. Maintaining one's innocence by rejecting and avoiding racial topics are major strategies used to hold on to one's self-image as a good, moral, and decent human being who is innocent of racial bias and discrimination.

Kiselica's reflection is a powerful statement that addresses a major question: Can anyone born and raised in our society not inherit the racial biases of our ancestors and institutions? When we pose this question to our students, surprisingly an overwhelming number say “no.” In other words, on an intellectual level they admit that people are products of their social conditioning and that escaping internalizing biases and prejudices is impossible. Yet when racial biases are discussed, these same students have great difficulty entertaining the notion that they have personally inherited racial biases and benefited from the oppression of others, because “racism resides in others, not me!”

Mark's honesty in confronting his own racism is refreshing, and his insights are invaluable to those who wish to become culturally competent counselors and allies in the struggle for equal rights (Chao, Wei, Spanierman, Longo, & Northart, 2015). He is a rarity in academic circles, even rarer because he was willing to put his words on paper for the whole world to read as a means to help others understand the meaning of racism on a human level. Mark's courageous and open exploration of his initial reactions to CCD indicates what we have come to learn is a common, intensely emotional experience from many readers. Because CCD deals openly, honestly, and passionately with issues of racism, sexism, and homophobia and challenges our belief that we are free of biases, it is likely to evoke defensiveness, resentment, and anger in readers. In Mark's case, he did not allow these reactions to sabotage his own self-exploration and journey to cultural competence. And we hope you will not allow your emotional “hot buttons” to deter you from your journey to cultural competence as well.

Emotional Invalidation versus Affirmation: For Marginalized Group Members

It is clear that the same subject matter in CCD often arouses a different emotional response from marginalized group members; for the two students of color, for example, they felt heard, liberated, and validated. They describe the book content as “honest” and “truthful,” indicating that their lived experiences were finally validated rather than silenced or ignored. One of the more interesting comments is made by the Latina student that “it felt good to know that I am not crazy.” What did she mean by that? Many people of color describe how their thoughts and feelings about race and racism are often ignored, dismissed, negated, or seen as having no basis in fact by majority group members. They are told that they are misreading things, overly sensitive, unduly suspicious or even paranoid when they bring up issues of bias and discrimination; in other words, they are “crazy” to think or feel that way.

As can be seen from the students of color, many marginalized group members react equally strongly as their White counterparts when issues of oppression are raised, especially when their stories of discrimination and pain are minimized or neglected. Their reality of racism, sexism, and homophobia, they contend, is relatively unknown or ignored by those in power because of the discomfort that pervades such topics. Worse yet, many well-intentioned majority persons seem disinclined to hear the personal stories of suffering, humiliation, and pain that accrue to persons of color and other marginalized groups in our society (Sue, 2015). The following quote gives some idea of what it is like for a Black man to live his life day in and day out in a society filled with both covert and overt racist acts that often are invisible to well-intentioned White Americans.

I don't think white people, generally, understand the full meaning of racist discriminatory behaviors directed toward Americans of African descent. They seem to see each act of discrimination or any act of violence as an “isolated” event. As a result, most white Americans cannot understand the strong reaction manifested by blacks when such events occur. . . .They forget that in most cases, we live lives of quiet desperation generated by a litany of daily large and small events that, whether or not by design, remind us of our “place” in American society. [Whites] ignore the personal context of the stimulus. That is, they deny the historical impact that a negative act may have on an individual. “Nigger” to a white may simply be an epithet that should be ignored. To most blacks, the term brings into sharp and current focus all kinds of acts of racism—murder, rape, torture, denial of constitutional rights, insults, limited opportunity structure, economic problems, unequal justice under the law and a myriad of. . .other racist and discriminatory acts that occur daily in the lives of most Americans of African descent. (Feagin & Sikes, 2002, pp. 23–24)

The lived experience of people of color is generally invisible to most White Americans, as this quotation portrays. As we will discuss in Chapter 6 , racial, gender, and sexual orientation microaggressions are experienced frequently by people of color, women, and LGBTQ persons in their day-to-day interactions with well-intentioned members of the dominant society (Velez, Moradi, & DeBlaere, 2015). Microaggressions are the everyday slights, put-downs, invalidations, and insults directed to socially devalued group members by well-intentioned people who are unaware that they have engaged in such biased and harmful behaviors. A lifetime of microaggressions can have a major harmful impact on the psychological well-being of victims. Note the following narrative provided by an African American man as he describes his day-to-day experiences with microaggressions that label him a dangerous person, a lesser human being, and a potential criminal.

It gets so tiring, you know. It sucks you dry. People don't trust you. From the moment I [African American male] wake up, I know stepping out the door, that it will be the same, day after day. The bus can be packed, but no one will sit next to you. . . I guess it may be a good thing because you always get more room, no one crowds you. You get served last . . . when they serve you, they have this phony smile and just want to get rid of you . . . you have to show more ID to cash a check, you turn on the TV and there you always see someone like you, being handcuffed and jailed. They look like you and sometimes you begin to think it is you! You are a plague! You try to hold it in, but sometimes you lose it. Explaining doesn't help. They don't want to hear. Even when they ask, “Why do you have a chip on your shoulder?” Shit . . . I just walk away now. It doesn't do any good explaining. (Sue, 2010, p. 87)

Here it is important to note the strong and powerful negative emotions and sense of hopelessness that pervades this narrative. The Black man expresses strong anger and resentment toward Whites for how he perceives they are treating him. His daily experiences of racial slights have made him believe that trying to explain to Whites Americans about these indignities would do little good. In fact, he expresses pessimism, rightly or wrongly, that Whites simply do not understand, and worse yet, they do not care to hear his thoughts and feelings about race and racism. He feels hopeless and frustrated about making White Americans understand, and states, “Shit . . . I just walk away now. It doesn't do any good explaining.” Although he does not directly mention it, one can surmise that he is also tired and drained at having to constantly deal with the never-ending onslaught of microaggressions. For some people of color, the sense of hopelessness can lead to simply giving up.

Dr. Le Ondra Clark, now an African American psychologist in California, describes her experiences of being one of the few Black students in a graduate program and the feeling of affirmation that flooded her when taking a multicultural counseling course and using CCD as the textbook.

I, a native of Southern California, arrived at the University of Wisconsin, Madison, and was eager to learn. I remember the harsh reality I experienced as I confronted the Midwest culture. I felt like I stood out, and I learned quickly that I did. As I walked around the campus and surrounding area, I remember counting on one hand the number of racial and ethnic minorities I saw. I was not completely surprised about this, as I had done some research and was aware that there would be a lack of racial and ethnic diversity on and around campus. However, I was baffled by the paucity of exposure that the 25 members of my master's cohort had to racial and ethnic minority individuals. I assumed that because I was traveling across the country to attend this top-ranked program focused on social justice, everyone else must have been as well. I was wrong.

The majority of my cohort was from the Midwest, and their experiences varied greatly from mine. For example, I remember sitting in my Theories of Counseling course during the first week of the semester. The instructor asked each of us to share about our first exposure to individuals who were racially and ethnically different from ourselves. I thought this was a strange question. . . .I was quite surprised as I listened to what my cohort members shared. I listened to several members share that their first exposure to someone different from them had not occurred until high school and, for some, college. When it came time for me to share, I remember stating that, as a racial and ethnic minority, I had never been in a situation where there was not some type of racial and ethnic diversity. Just sharing this made me feel distant from my cohort, as our different cultural experiences were now plainly highlighted. I remember thinking to myself, “Where am I?” For the first time in my life, I felt as if I was a foreigner, and I badly needed something or someone to relate to.

I did not begin to feel comfortable until I attended the Multicultural Counseling course later that week. Students were assigned a number of textbooks as part of this course, including CCD. . . . I never imagined a textbook would bring me so much comfort. I vividly remember reading each chapter and vigorously taking notes in the margins. I also remember the energy I felt as I wrote about my reactions to the readings each week. I felt like the book legitimized the experiences of racial and ethnic minorities and helped me understand what I was encountering in my Midwest surroundings. It became a platform from which I could explain my own experience as a racial and ethnic minority from Southern California who was transplanted to the Midwest. The personal stories, concepts, and theories illustrated in CCD resonated with me and ultimately helped me overcome my feelings of isolation. CCD provided me with the language to engage in intellectual discourse about race, ethnicity, social class, privilege, and disparities. I remember the awareness that swept over the class as we progressed through the textbook. . .I felt that they were beginning to view things through my cultural lens, and I through theirs. We were gaining greater understanding of how our differing cultural realities had shaped us and would impact the work we conducted as therapists. (Sue & Sue, 2013, pp. 17–18)

Le Ondra's story voices a continuing saga of how persons of color and many marginalized individuals must function in an ethnocentric society that unintentionally invalidates their experiences and enforces silence upon them. She talks about how the text provided a language for her to explain her experiences and how she resonated with its content and meaning. To her, the content of the book tapped into her experiential reality and expressed a worldview that is too often ignored or not even discussed in graduate-level programs. Le Ondra found comfort and solace in the book, and she has been fortunate in finding significant others in her life that have validated her thoughts, feelings, and aspirations and allowed her to pursue a social justice direction in counseling. As a person of color, Le Ondra has been able to overcome great odds and to obtain her doctorate in the field without losing her sense of integrity or racial/cultural identity.

A Word of Caution

There is a word of caution that needs to be directed toward students of marginalized groups as they read CCD and find it affirming and validating. In teaching the course, for example, we have often encountered students of color who become very contentious and highly outspoken toward White classmates. There are two dangers here that also reveal resistance from students of color to multicultural training. A good example is provided in the reaction of the African American student in the fourth scenario. First, it is clear that the student seems to take delight in seeing his White classmates “squirm” and be uncomfortable. In this respect, he may be taking out his own anger and frustration upon White classmates, and his concern has less to do with helping them understand than hurting them. It is important to express and understand one's anger (it can be healing), but becoming verbally abusive toward another is counterproductive to building rapport and mutual respect. As people of color, for example, we must realize that our enemies are not White Americans, but White supremacy! And, by extension, our enemy is not White Western society, but ethnocentrism.

Second, because the book discusses multicultural issues, some students of color come to believe that multicultural training is only for White students; the implicit assumption is that they know the material already and are the experts on the subject. Although there is some truth to this matter, such a perspective prevents self-exploration and constitutes a form of resistance. As will be seen in Chapter 3 , people of color, for example, are not immune from prejudice, bias, and discrimination. Further, such a belief prevents the exploration of interethnic/interracial misunderstandings and biases toward one another. Multicultural training is more than White–African American, White–Latino/a American, White–Asian American, White–Native American, and so on. It is also about African American–Asian American, Asian American–Native American, and Latino/a–Native American relationships; and it includes multiple combinations of other sociodemographic differences like gender, sexual orientation, disability, religious orientation, and so forth. Race, culture, ethnicity, gender, and sexual orientation/identity are about everyone; it is not just a “minority thing.”

Reflection and Discussion Questions

Look at the opening quotes by the four students, then answer these questions.

1. In what ways are the reactions of the White students different from those of students of color? Why do you think this is so?

2. Which of the four reactions can you relate to best? Which reaction can you empathize least with? Why?

3. As you continue reading the material in this text, you are likely to experience strong and powerful reactions and emotions. Being able to understand the meaning of your feelings is the first step to cultural competence. Ask yourself, why am I reacting this way? What does it say about my worldview, my experiential reality, and my ability to relate to people who differ from me in race, gender, and sexual orientation?

4. As a White counselor working with culturally diverse clients, would you be able to truly relate to the worldview being expressed by people of color?

5. As a counselor of color working with White clients, what challenges do you anticipate in the therapeutic relationship with them?

6. What do you think “understanding yourself as a racial/cultural being” means?

Recognizing and Understanding Resistance to Multicultural Training

As a counselor or therapist working with clients, you will often encounter psychological resistance or, more accurately, client behaviors that obstruct the therapeutic process or sabotage positive change (Ridley & Thompson, 1999). In therapy sessions, clients may change the topic when recalling unpleasant memories, externalize blame for their own failings, not acknowledge strong feelings of anger toward loved ones, or be chronically late for counseling appointments. All of these client behaviors are examples of resistance or avoidance of acknowledging and confronting unpleasant personal revelations. Oftentimes, these represent unconscious maneuvers to avoid fearful personal insights, to avoid personal responsibility, and to avoid painful feelings. In most cases, resistance masks deeper meanings outside the client's awareness; tardiness for appointments is unacknowledged anger toward therapists, and changing topics in a session is an unconscious deflection of attention away from frightening personal revelations. In many respects, multicultural training can be likened to “therapy” in that trainees are analogous to clients, and trainers are comparable to therapists helping clients with insights about themselves and others.

As we shall see in Chapter 2 , the goal of multicultural training is cultural competence. It requires trainees to become aware of their own worldviews, their assumptions of human behavior, their misinformation and lack of knowledge, and most importantly, their biases and prejudices. Sometimes this journey is a painful one, and trainees will resist moving forward. For trainers or instructors, the job is to help trainees in their self-exploration of themselves as racial/cultural beings, and the meaning it has for their future roles as multicultural counselors. For trainees, being able to recognize, understand, and overcome resistance to multicultural training is important in becoming a culturally competent counselor or therapist.

In the next few sections, we focus upon identifying how resistance manifests itself in training and propose reasons why many well-intentioned trainees find multicultural training disconcerting and difficult to undertake. By so doing, we are hopeful that trainees will attend to their own reactions when reading the text or when participating in classroom dialogues on the subject. Ask yourself the following questions as you continue reading in the next sections and throughout the book.

Reflection and Discussion Questions

1. What type of reactions or emotions am I feeling as I study the material on multicultural counseling? Am I feeling defensive, angry, anxious, guilty, or helpless? Where are these feelings coming from? Why am I feeling this way, and what does it possibly mean?

2. Does having a different point of view mean I am resisting the multicultural material? List all those reasons that support your stance. List all those reasons that do not support it.

3. How applicable are the resistances outlined in the following sections to me?

4. In what ways may these emotions affect my ability to understand the worldview of clients who differ from me, and how might that affect my work?

In work with resistance to diversity training, research reveals how it is likely to be manifested in three forms: cognitive resistance, emotional resistance, and behavioral resistance (Sue, 2015). Recognizing the manifestation and hidden meanings of resistance is one of the first priorities of multicultural training for both trainees and trainers. For trainees it is finding the courage to confront their own fears and apprehensions, to work through the powerful emotions they are likely to experience, to explore what these feelings mean for them as racial/cultural beings, to achieve new insights about themselves, and to develop multicultural skills and behaviors in their personal lives and as mental health professionals. For trainers it means understanding the nature of trainee resistance, creating a safe but challenging environment for self-exploration, and using intervention strategies that facilitate difficult dialogues on race, gender, sexual orientation, and other topics in the area of diversity.

Cognitive Resistance—Denial

To date, my biggest discovery is that I didn't really believe that people were being discriminated against because of their race. I could hear them say it, but in my head, I kept running a parallel reason from the White perspective. A Chinese lady says that her party had to wait longer while Whites kept getting seated in front of them. I say, other people had made reservations. A black man says that the receptionist was rude, and made him wait longer because he's Black. I say she had a bad day, and the person he was there to see was busy. A Puerto Rican couple says that the second they drove into Modesto. . .a cop started tailing them, and continued to do so until they reached their hotel, which they opted to drive right on by because they didn't feel safe. I say, there's nothing to be afraid of in Modesto. It's a nice little town. And surely the cop wasn't following you because you're Puerto Rican. I bet your hotel was on his way to the station. I know that for every story in which something bad happens to someone because of their race, I can counter it with a White interpretation. And while I was listening with a sympathetic ear, I silently continued to offer up alternative explanations, benign explanations that kept my world in equilibrium. (Rabow, Venieris & Dhillon, 2014, p. 189)

This student account reveals a pattern of entertaining alternative explanations to the stories told by persons of color about their experiences of prejudice and discrimination. Although the author describes “listening sympathetically,” it was clear that he or she silently did not believe that these were instances of racism; other more plausible and “benign” explanations could account for the events. This is not an atypical response for many White trainees when they listen to stories of discrimination from classmates of color (Young, 2003). Because of a strong belief that racism is a thing of the past, that we live in a post-racial society, and that equal access and opportunity are open to everyone, people of color are seen as exaggerating or misperceiving situations. When stories of prejudice and discrimination are told, it directly challenges these cherished beliefs. The student's quote indicates as much when he says that his “benign explanations” preserves his racial reality (“kept my world in equilibrium”).

The fact that the student chose not to voice his thoughts is actually an impediment to learning and understanding. In many classrooms, teachers have noted how silence is used by some White students to mask or conceal their true thoughts and feelings about multicultural issues (Sue, 2010; Sue, Torino, Capodilupo, Rivera, & Lin, 2010; van Dijk, 1992). Denial through disbelief, unwillingness to consider alternative scenarios, distortion, fabrication, and rationalizations are all mechanisms frequently used by some trainees during racial conversations to prevent them from thinking about or discussing topics of race and racism in an honest manner (Feagin, 2001; Sue, Rivera, Capodilupo, Lin, & Torino, 2010; van Dijk, 1992). In our teaching in multicultural classes, we have observed many types of denials that work against honest diversity discussions. There are denials that students are prejudiced, that racism still exists, that they are responsible for the oppression of others, that Whites occupy an advantaged and privileged position, that they hold power over people of color, and even denial that they are White (Feagin & Vera, 2002; McIntosh, 2002; Sue, 2010; Tatum, 1992; Todd & Abrams, 2011). This latter point (Whiteness and White privilege) is an especially “hot topic” that will be thoroughly discussed in Chapter 12 . As a trainee in this course, you will be presented with opportunities to discuss these topics in greater detail, and explore what these denials may mean about you and your classmates. We hope you will actively participate in such discussions, rather than passively dealing with the material.

Emotional Resistance

Emotional resistance is perhaps the major obstacle to multicultural understanding because it blocks a trainee's ability to acknowledge, understand, and make meaning out of strong and powerful feelings associated with multicultural or diversity topics. The manifestation and dynamics of emotional resistance are aptly described by Sara Winter (1977, p. 24), a White female psychologist. She also provides some insights as to why this occurs; it serves to protect people from having to examine their own prejudices and biases.

When someone pushes racism into my awareness, I feel guilty (that I could be doing so much more); angry (I don't like to feel like I'm wrong); defensive (I already have two Black friends. . .I worry more about racism than most whites do—isn't that enough); turned off (I have other priorities in my life with guilt about that thought); helpless (the problem is so big—what can I do?). I HATE TO FEEL THIS WAY. That is why I minimize race issues and let them fade from my awareness whenever possible.

The Meaning of Anxiety and Fear

Anxiety is the primary subjective emotion encountered by White trainees exposed to multicultural content and its implications. In one study, it was found that when racial dialogues occurred, nearly all students described fears of verbal participation because they could be misunderstood, or be perceived as racist (Sue et al., 2010). Others went further in describing having to confront the realization that they held stereotypes, biases, and prejudices toward people of color. This insight was very disturbing and anxiety-provoking to them because it directly challenged their self-image of themselves as good, moral, and decent human beings who did not discriminate. Facing this potential awareness creates high levels of anxiety, and often results in maneuvers among students to avoid confronting their meanings.

I have a fear of speaking as a member of the dominant group. . .My feelings of fear stem from not wanting to be labeled as being a racist. I think that fear also stems from the inner fear that I do not want to know what happens to people of color every day. I may not directly be a racist, but not reacting or speaking up to try to change things is a result of my guilt. . . .This is a frightening prospect because I do not want to see the possibility that I have been a racist. Awareness is scary. (Rabow et al., 2014, p. 192)

In the above quote, the student talks about “fear” being a powerful force in preventing him or her from wanting to learn about the plight of people of color. The strong emotions of guilt and fear, and possibly “being racist” are too frightening to consider. For many students, these feelings block them from exploring and attempting to understand the life experience of people of color. In one major study, for example, silence or not participating in diversity discussions, denials of personal and societal racism, or physically leaving the situation were notable avoidant ploys used by students. The apprehensions they felt affected them physically as well (Sue et al., 2010; Sue, Torino, et al., 2010). Some students described physiological reactions of anxiety like a pounding heart, dry mouth, tense muscles and perspiration. One student stated, “I tried hard to say something thoughtful and it's hard for me to say, and my heart was pounding when I said it.” Others described feeling intimidated in the discussions, stammering when trying to say something, being overly concerned about offending others, a strong sense of confusion as to what was going on, censoring thoughts or statements that could be misunderstood, reluctance in expressing their thoughts, being overwhelmed by the mix of emotions they felt, and the constriction they heard in their own voices.

These thoughts, feelings, and concerns blocked participants from fully participating in learning and discussing diversity issues because they became so concerned about themselves (turning inward) that they could not freely be open and listen to the messages being communicated by socially devalued group members. Indeed, their whole goal seemed to be to ward off the messages and meanings being communicated to them, which challenged their worldviews, and themselves as racial beings, and highlighted their potential roles as oppressors.

The Meaning of Defensiveness and Anger

Although defensiveness and anger are two different emotions, studies seem to indicate a high relationship between the two (Apfelbaum, Sommers, & Norton, 2008; Sue, Torino, et al., 2010; Zou & Dickter, 2013). One represents a protective stance and the other an attempt to strike back at the perpetrator (in many cases statements by people of color). In the opening quotes for this chapter, note that both White students became angry at the authors and accused them of being racist and propagandistic. In absorbing diversity content, many White students described feeling defensive (unfairly accused of being biased or racist, blamed for past racial injustices, and responsible for the current state of race relations). “I'm tired of hearing ‘White people this. . .White people that'. . .why are we always blamed for everything?”

When the text discusses bias and bigotry, or when classmates of color bring up the issue, for example, some White students seem to interpret these as a personal accusation, and rather than reach out to understand the content, respond in a defensive and protective posture. In many cases, even statements of racial facts and statistics, such as definitions of racism, disparities in income and education, segregation of neighborhoods, hate crime figures, and so forth, arouse defensiveness in many White students. Their defense response to a racial dialogue is seen as protection against (a) criticism (“You just don't get it!”), (b) revealing personal shortcomings (“You are racist!”), or (c) perceived threat to their self-image and egos (“I'm not a racist—I'm a good person.”). Because of this stance, we have observed that many White students who feel attacked may engage in behaviors or argumentative ploys that present denials and counterpoints because they view the racial dialogue as a win-lose proposition. Warding off the legitimacy of the points raised by people of color becomes the primary goal rather than listening and attempting to understand the material or point of view.

When White students feel wrongly accused, they may respond with anger and engage in a counterattack when a racial topic arises. It appears that anger stems from two sources: (a) feeling unfairly accused (defensiveness) and/or (b) being told the substance or stance they take is wrong. Many White students may feel offended and perceive the allegations as a provocation or an attack that requires retaliation. Anger may be aroused when students feel offended (“How dare you imply that about me?”) or wronged (“I am deeply hurt you see me that way”), or that their good standing is denied (“Don't associate me with racists!”). Unlike defensiveness, which defends one's own stance, anger turns its attention to attacking the threatening behavior of others. Given the choice of the fight-or-flight response, some White students make a choice to take verbal action in stopping the threatening accusations. The strategy used is to discredit the substance of an argument and/or to derogate the communicator, often through a personal attack (“he or she is just an angry Black man or woman”). In many respects, anger and defensiveness may become so aroused that one loses control of one's self-monitoring capacities and the ability to accurately assess the external environment. These latter two abilities are extremely important for effective multicultural counseling.

The Meaning of Guilt, Regret, and Remorse

When discussing diversity issues, many White trainees admit to feeling guilty, although most tend to say that they “are made to feel guilty” by people of color, especially when unjustly accused (Sue, 2003). This statement actually suggests a distancing strategy in localizing guilt as external to oneself rather than one rightfully residing and felt internally. Guilt as an emotion occurs when we believe we have violated an internal moral code, and have compromised our own standards of conduct. The question becomes, why should White trainees feel guilty when topics of race, racism, or Whiteness are discussed? If indeed they are not racist, not responsible for the racial sins of the past, and not responsible for current injustices, then neither would they feel guilt nor could they be made to feel guilty.

Some have coined the term “White guilt” to refer to the individual and collective feelings of culpability experienced by some Whites for the racist treatment of people of color, both historically and currently (Goodman, 2001; Spanierman, Todd, & Anderson, 2009; Tatum, 1992). In diversity discussions, many White trainees find guilt extremely uncomfortable because it means that they have violated a moral standard and are disinclined to acknowledge their violation. What is that moral standard? Being a good, moral, and decent human being who does not discriminate, being a nonracist, living a life that speaks to equality and justice, and being a humane person who treats everyone with respect and dignity are the positive standards that are being breached. Compromising these moral standards and beliefs and acting in ways that violate them bring on bad feelings of guilt and remorse.

Behavioral Resistance

All the white people I know deplore racism. We feel helpless about racial injustice in society, and we don't know what to do about the racism we sense in our own groups and lives. Persons of other races avoid our groups when they accurately sense the racism we don't see. . . . Few white people socialize or work politically with people of other races, even when our goals are the same. We don't want to be racist—so much of the time we go around trying not to be, by pretending we're not. Yet white supremacy is basic in American social and economic history, and this racist heritage has been internalized by American white people of all classes. We have all absorbed white racism; pretense and mystification only compound the problem. . . .We avoid black people because their presence brings painful questions to mind. Is it OK to talk about watermelon or mention “black coffee?” Should we use black slang and tell racial jokes? How about talking about our experiences in Harlem, or mentioning our black lovers? Should we conceal the fact that our mother still employs a black cleaning lady?. . .We're embarrassedly aware of trying to do our best, but to “act natural” at the same time. No wonder we're more comfortable in all-White situations where these dilemmas don't arise. (Winter, 1977, p. 1)

Although helplessness and hopelessness can rightly be classified as emotions, they also border on providing direct excuses for inaction. Students studying diversity topics often describe two emotions that vary from helplessness (feeling powerless) to hopelessness (despair) when diversity topics are discussed. These feelings are expressed in the quote above by the author when she realizes the vastness and magnitude of individual, institutional and societal racism; how they make themselves felt in all facets of human life; and how deeply racism is ingrained in the individual psyches of people and in the entire nation. Like many students who read CCD and take this course, the author's denial of her own biases has begun to crumble, and her self-awareness places her in a very uncomfortable position. Trainees who have come to recognize and own their biased beliefs and prejudices, their roles in perpetuating racism, the pain their obliviousness has inflicted on people of color, and their privileged and advantaged position in society may feel overwhelmed by the magnitude of the problem. This may cause paralysis or inaction. Taking steps to make the “invisible” visible and to eradicate bias and discrimination requires concrete action. As long as the person feels helpless and hopeless, inaction will result.

Although guilt continues over realizing their potential culpability over past deeds, it is compounded by the knowledge that continued inaction on their part allows for the perpetuation of racism in the self and others. Thus taking action is a means to alleviate feelings of guilt. The emotions of helplessness and hopelessness make themselves felt in two different arenas: one is internal (personal change) and the other is external (system change). In becoming aware of one's racial/cultural identity, for example, White students at this juncture of development may begin to ask two primary questions:

First is the question, “How does one change?” What needs to be changed? How does one become a nonracist or an unbiased person? How do I break the shackles of social conditioning that have taught me that some groups are more worthy than others, and that other groups are less worthy? Many trainees often make these comments: “I don't know where to begin.” “If I am not aware of my racism, how do I become aware of it?” “Tell me what I must do to rid myself of these prejudices.” “Should I attend more workshops?” “I feel so confused, helpless, impotent, and paralyzed.”

The second question is “What must I do to eradicate racism in the broader society?” While self-change requires becoming a nonracist person, societal change requires becoming an antiracist one. Impacting an ethnocentric mental health delivery system falls into this category. This role means becoming an advocate and actively intervening when injustice makes its presence felt at the individual level (for example, objecting to a racist joke or confronting friends, neighbors, or colleagues about their prejudices) and at the institutional level (for example, opposing biased mental health practices, supporting civil rights issues, making sure a multicultural curriculum is being taught in schools, or openly supporting social justice groups).

Helplessness that is felt by White students in diversity studies, unless adequately deconstructed as to what it means, can easily provide an excuse or rationalization for inaction. What good would it do? I'm only one person, how can I make any difference? The problem is so big, whatever I do will only be a drop in the bucket. Feeling helpless and hopeless are legitimate feelings unless used as an excuse to escape responsibility for taking any form of action. Helplessness is modifiable when these students are provided options and strategies that can be used to increase their awareness and personal growth, and when they are provided with the tools to dismantle racism in our society. Hopefully, this course and the readings will provide you with suggestions of where to begin, especially in mental health practice.

Hopelessness is a feeling of despair and of giving up, a self-belief that no action will matter and no solution will work. Helplessness and hopelessness associated with the need for change and action can be paralytic. The excuse for inaction, and thus the avoidance of racial exploration, does not necessarily reside simply in not knowing what to do, but in very basic fears eloquently expressed by Tatum (2002):

Fear is a powerful emotion, one that immobilizes, traps words in our throats, and stills our tongues. Like a deer on the highway, frozen in the panic induced by the lights of an oncoming car, when we are afraid it seems that we cannot think, we cannot speak, we cannot move. . . .What do we fear? Isolation from friends and family, ostracism for speaking of things that generate discomfort, rejection by those who may be offended by what we have to say, the loss of privilege or status for speaking in support of those who have been marginalized by society, physical harm caused by the irrational wrath of those who disagree with your stance? (pp. 115–116)

In other words, helplessness and hopelessness are emotions that can provide cover for not taking action. It allows many of us to not change for fear that our actions will result in the negative consequences expressed above. Becoming a multiculturally competent counselor or therapist requires change.

Cultural Competence and Emotions

There are many other powerful emotions often experienced by students during the journey to cultural competence. They include sadness, disappointment, humiliation, blame, invalidation, and so on. These feelings, along with those already discussed, can make their appearance in dialogues on multiculturalism or diversity. The unpleasantness of some emotions and their potentially disturbing meanings makes for avoidance of honest multicultural dialogues and hence a blockage of the learning process. Rather than seeing emotions as a hindrance and barrier to mutual understanding, and rather than shutting them down, allowing them to bubble to the surface actually frees the mind and body to achieve understanding and insight. The cathartic relationship between memories, fears, stereotypic images, and the emotional release of feelings is captured in this passage by Winter (1977, p. 28), who describes her own racial awakening:

Let me explain this healing process in more detail. We must unearth all the words and memories we generally try not to think about, but which are inside us all the time: “nigger,” “Uncle Tom,” “jungle bunny,” “Oreo”; lynching, cattle prods, castrations, rapists, “black pussy,” and black men with their huge penises, and hundreds more. (I shudder as I write.). We need to review three different kinds of material: (1) All our personal memories connected with blackness and black people including everything we can recall hearing or reading; (2) all the racist images and stereotypes we've ever heard, particularly the grossest and most hurtful ones; (3) any race-related things we ourselves said, did or omitted doing which we feel bad about today. . . Most whites begin with a good deal of amnesia. Eventually the memories crowd in, especially when several people pool recollections. Emotional release is a vital part of the process. Experiencing feelings seems to allow further recollections to come. I need persistent encouragement from my companions to continue.

We are aware that the content of this chapter has probably already pushed hot emotional buttons in many of you. For trainees in the dominant group, we ask the following questions: Are you willing to look at yourself, to examine your assumptions, your attitudes, your conscious and unconscious behaviors, the privileges you enjoy as a dominant group member, and how you may have unintentionally treated others in less than a respectful manner? For socially marginalized group members, we ask whether you are willing to confront your own biases and prejudices toward dominant group members, be honest in acknowledging your own biases toward other socially devalued group members, and work to build bridges of mutual understanding and respect for all groups.

Trainees who bravely undertake the journey to cultural competence eventually realize that change is a lifelong process, and that it does not simply occur in a workshop, classroom, or singular event. It is a monumental task, but the rewards are many when we are successful. A whole body of literature supports the belief that encountering diverse points of view, being able to engage in honest diversity conversations, and successfully acknowledging and integrating differing perspectives lead to an expansion of critical consciousness (Gurin, Dey, Hurtado, & Gurin, 2002; Jayakumar, 2008). On a cognitive level, many have observed that cross-racial interactions and dialogues, for example, are a necessity to increase racial literacy, expand the ability to critically analyze racial ideologies, and dispel stereotypes and misinformation about other groups (Bolgatz, 2005; Ford, 2012; Pollock, 2004; Stevens, Plaut, & Sanchez-Burks, 2008). On an emotional level, trainees of successful diversity training report less intimidation and fear of differences, an increased compassion for others, a broadening of their horizons, appreciation of people of all colors and cultures, and a greater sense of belonging and connectedness with all groups (APA Presidential Task Force, 2012; Bell, 2002; President's Initiative on Race, 1999; Sue, 2003).

In closing, we implore you not to allow your initial negative feelings to interfere with your ultimate aim of learning from this text as you journey toward cultural competence. Sad to say, this empathic ability is blocked when readers react with defensiveness and anger upon hearing the life stories of those most disempowered in our society. We have always believed that our worth as human beings is derived from the collective relationships we hold with all people; that we are people of emotions, intuitions, and spirituality; and that the lifeblood of people can be understood only through lived realities. Although we believe strongly in the value of science and the importance psychology places on empiricism, Counseling the Culturally Diverse is based on the premise that a profession that fails to recognize the heart and soul of the human condition is a discipline that is spiritually and emotionally bankrupt. As such, this book not only touches on the theory and practice of multicultural counseling and psychotherapy, but also reveals the hearts and souls of our diverse clienteles.

Implications for Clinical Practice

1. Listen and be open to stories of those most disempowered in this society. Counseling has always been about listening to our clients. Don't allow your emotional reactions to negate their voices because you become defensive.

2. Know that although you were not born wanting to be racist, sexist, or heterosexist, or to be prejudiced against any other group, your cultural conditioning has imbued certain biases and prejudices in you. No person or group is free from inheriting the biases of this society.

3. Understand and acknowledge your intense emotions and what they mean for you. CCD speaks about unfairness, racism, sexism, and prejudice, making some feel accused and blamed. The “isms” of our society are not pleasant topics, and we often feel unfairly accused.

4. It is important that helping professionals understand how they may still benefit from the past actions of their predecessors and continue to reap the benefits of the present social/educational arrangements.

5. Understand that multicultural training requires more than book learning. In your journey to cultural competence, it is necessary to supplement your intellectual development with experiential reality.

6. Don't be afraid to explore yourself as a racial/cultural being. An overwhelming number of mental health practitioners believe they are good, decent, and moral people. Because most of us would not intentionally discriminate, we often find great difficulty in realizing that our belief systems and actions may have oppressed others.

7. Open dialogue—to discuss and work through differences in thoughts, beliefs, and values—is crucial to becoming culturally competent. It is healthy when we are allowed to engage in free dialogue with one another. To a large extent, unspoken thoughts and feelings serve as barriers to open and honest dialogue about the pain of discrimination and how each and every one of us perpetuates bias through our silence or obliviousness.

8. Finally, continue to use these suggestions in reading throughout the text. What emotions or feelings are you experiencing? Where are they coming from? Are they blocking your understanding of the material? What do these reactions mean for you personally and as a helping professional?

Summary

Students who take a course on multicultural counseling and mental health issues have almost universally felt both positive and negative feelings that affect their ability to learn about diversity issues. Those from marginalized groups often feel validated by the content while majority group members often feel a range of emotions like defensiveness, anxiety, anger, and guilt. It is important not to allow these nested or embedded emotions to go unacknowledged, or to avoid exploring the psychological meanings they may have for trainees. The journey to becoming culturally competent therapists is filled with obstacles to self-exploration, to understanding oneself as a racial/cultural being, and to understanding the worldview of those who differ from others in terms of race, gender, ethnicity, sexual orientation and other sociodemographic dimensions. The subject matter in this book requires students to explore their biases and prejudices, a task that often evokes strong resistance from both majority and oppressed group members.

It is important to recognize personal resistance to the material, to explore its meaning, and to learn about yourself and others. Sometimes what is revealed about you may prove disturbing, but having the courage to continue is necessary to becoming a culturally competent counselor or therapist. Recognizing the manifestation and hidden meanings of resistance is one of the first priorities of multicultural training for both trainees and trainers. For trainees it is finding the courage to confront their own fears and apprehensions, to work through the powerful emotions they are likely to experience, to explore what these feelings mean for them as racial/cultural beings, to achieve new insights about themselves, and to develop multicultural skills and behaviors in their personal lives and as mental health professionals. For trainers it means understanding the nature of trainee resistance, creating a safe but challenging environment for self-exploration, and using intervention strategies that facilitate difficult dialogues on race, gender, sexual orientation, and other sociodemographic dimensions. This chapter is specifically written to help readers understand and overcome their emotive reactions to the substance of the text and the course they are about to take.

Glossary Terms

Antiracist

Behavioral resistance (to multicultural training)

Cognitive resistance (to multicultural training)

Cultural competence

Emotional affirmation

Emotional invalidation

Emotional resistance (to multicultural training)

Emotional self-revelation

Microaggressions

Multiculturalism

Nested/Embedded emotions

Nonracist

Self-reflection

Worldview

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THE SUPERORDINATE NATURE OF MULTICULTURAL COUNSELING AND THERAPY

Chapter Objectives

1. Compare and contrast similarities and differences between “traditional counseling/clinical practice” and culturally sensitive counseling.

2. Understand the Etic and Emic orientation to multicultural counseling.

3. Become cognizant of differences between counseling/clinical competence and multicultural counseling competence.

4. Identify Eurocentric assumptions inherent in our standards of clinical practice.

5. Discuss and understand the characteristics of the three levels of personal identity.

6. Develop awareness of possible differences in counseling culturally diverse clients who differ in race, gender, sexual orientation, and other group identities.

7. Provide examples of ways that other special populations may constitute a distinct cultural group.

8. Define multicultural counseling and therapy, cultural competence, and cultural humility.

9. Explain how cultural humility is different from cultural competence.

The following is the third counseling session between Dr. D. (a White counselor) and Gabriella, a 29-year-old single Latina, who was born and raised in Brazil but came to the United States when she was 10 years old.

Dr. D:	So how did it go last week with Russell (White boyfriend of 6 months).
Gabriella:	Okay, I guess (seems withdrawn and distracted).
Dr. D:	You don't sound too sure to me.
Gabriella:	What do you mean?
Dr. D:	Well, from the last session, I understood that you were going to talk to him [Russell] about your decision to live together, but that you wanted to clarify what moving into his apartment meant for him.
Gabriella:	I didn't get a chance to talk about it. I was going to bring it up, but I had another attack, so I didn't get a chance. It was awful (begins to fidget in the chair)! Why does this always happen to me?
Dr. D:	Tell me what happened.
Gabriella:	I don't know. I had a disagreement with him, a big stupid argument over Jennifer Lopez's song “Booty”.
Dr. D:	“Booty”?
Gabriella:	Yeah, he kept watching the video over and over on the computer. He loves the song, but I find it vulgar.
Dr. D:	Lots of songs press the limits of decency nowadays. . . .Tell me about the attack.
Gabriella:	I don't know what happened. I lost control and started screaming at him. I threw dishes at him and started to cry. I couldn't breathe. Then it got really bad, and I could feel the heat rise in my chest. I was scared to death. Everything felt unreal and I felt like fainting. My mother used to suffer from similar episodes of ataques. Have I become like her?. . . .God I hope not!
Dr. D:	Sounds like you had another panic attack. Did you try the relaxation exercises we practiced?
Gabriella:	No, how could I? I couldn't control myself. It was frightening. I started to cry and couldn't stop. Russell kept telling me to calm down. We finally made up and got it on.
Dr. D:	I'm glad things got smoothed over. But you always say that you have no control over your attacks. We've spent lots of time on learning how to manage your panic attacks by nipping them in the bud. . . before they get out of control. Maybe some medication might help.
Gabriella:	Yes, I know, but it doesn't seem to do any good. I just couldn't help it.
Dr. D:	Did you try?
Gabriella:	Do you think I enjoy the attacks (shouts)? How come I always feel worse when I come here? I feel blamed. . .Russell says I'm a typical emotional Latina. What am I to do? I come here to get help, and I just get no understanding (stated with much anger).
Dr. D:	You're angry at me because I don't seem to be supportive of your predicament, and you think I'm blaming you. But I wonder if you have ever asked yourself how you contribute to the situation as well. Do you think that fighting over a song is the real issue here?
Gabriella:	Maybe not, but I just don't feel like you understand.
Dr. D:	Understand what?
Gabriella:	Understand what it is like to be a Latina woman dealing with all those stereotypes. My parents don't want me living with Russell. . .they think he benefits from having sex with no commitment to marriage, and that I'm a fool. They think he is selfish and just wants a Latina. . . .like a fetish. . . .
Dr. D:	I think it's more important what you think and want for yourself, not what your parents would like you to do. Be your own person. And we've talked about cultural differences before, in the first session, remember? Cultural differences are important, but it's more important to recognize that we are all human beings. Granted, you and I are different from one another, but most people share many more similarities than differences.
Gabriella:	Yes, but can you really understand what's it like to be a Latina, the problems I deal with in my life? Aren't they important?
Dr. D:	Of course I can. And of course they [differences] are. . .but let me tell you, I've worked with many Latinos in my practice. When it comes right down to it, we are all the same under the skin.
Gabriella:	(period of silence)
Dr. D:	Now, let's go back and talk about your panic attacks and what you can do to prevent and reduce them.

Reflection and Discussion Questions

1. What are your thoughts and feelings about the counseling encounter between Dr. D. and Gabriella?

2. Do you think that Dr. D. demonstrated cultural awareness? Is this an example of “good counseling”? If not, why not?

3. When Gabriella described her episodes as ataques, do you know what is meant?

4. What are the potential counseling and cultural issues in this case?

5. Is it important for the counselor to know what the song “Booty” is about?

6. When the parents suggest that their daughter might be a “fetish,” what could they possibly mean? Is it important?

7. What images of Latinas exist in our society? How might they affect Gabriella's relationship with Russell?

8. If you were the counselor, how would you have handled the situation?

Culturally competent care has become a major force in the helping professions (American Psychological Association, 2003; Arredondo, Toporek, Brown, Jones, Locke, Sanchez, & Stadler, 1996; CACREP, 2015; Cornish, Schreier, Nadkarni, Metzger, & Rodolfa, 2010; D. W. Sue, Arredondo, & McDavis, 1992). The therapy session between Dr. D. and Gabriella illustrates the importance of cultural awareness and sensitivity in mental health practice. There is a marked worldview difference between that of the White therapist and the Latina client. In many cases, these differences reflect the therapist's (a) belief in the universality of the human condition, (b) belief that disorders are similar and cut across societies, (c) lack of knowledge of Latina/o culture, (d) task orientation, (e) failure to pick up clinical clues provided by the client, (f) not being aware of the influence of sociopolitical forces in the lives of marginalized group members, and (g) lack of openness to professional limitations. Let us briefly explore these factors in analyzing the previous transcript.

Culture-Universal (Etic) versus Culture-Specific (Emic) Formulations

First and foremost, it is important to note that Dr. D. is not a bad counselor per se, but like many helping professionals is culture-bound and adheres to EuroAmerican assumptions and values that encapsulate and prevent him from seeing beyond his Western therapeutic training (Comas-Diaz, 2010). One of the primary issues raised in this case relates to the etic (culturally universal) versus emic (culturally specific) perspectives in psychology and mental health. Dr. D. operates from the former position. His training has taught him that disorders such as panic attacks, depression, schizophrenia, and sociopathic behaviors appear in all cultures and societies; that minimal modification in their diagnosis and treatment is required; and that Western concepts of normality and abnormality can be considered universal and equally applicable across cultures (Arnett, 2009; Howard, 1992; Suzuki, Kugler, & Aguiar, 2005). Many multicultural psychologists, however, operate from an emic position and challenge these assumptions. In Gabriella's case, they argue that lifestyles, cultural values, and worldviews affect the expression and determination of behavior disorders (Ponterotto, Utsey, & Pedersen, 2006). They stress that all theories of human development arise within a cultural context and that using the EuroAmerican values of normality and abnormality may be culture-bound and biased (Locke & Bailey, 2014). From this case, we offer six tentative cultural/clinical observations that may help Dr. D. in his work with Gabriella.

Cultural Concepts of Distress

It is obvious that Dr. D. has concluded that Gabriella suffers from a panic disorder and that her attacks fulfill criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, American Psychiatric Association, 2013). When Gabriella uses the term ataques to describe her emotional outbursts, episodes of crying, feeling faint, somatic symptoms (“heat rising in her chest”), feeling of depersonalization (unreal) and loss of control, a Western-trained counseling/mental health professional may very likely diagnose a panic attack. Is a panic attack diagnosis the same as ataques? Is it simply a Latin American translation of an anxiety disorder? We now recognize that ataque de nervios (“attack of the nerves”) is a cultural syndrome, occurs often in Latin American countries (in individuals of Latina/o descent), and is distinguishable from panic attacks (American Psychiatric Association, 2013). Cultural syndromes that do not share a one-to-one correspondence with psychiatric disorders in DSM-5 have been found in South Asia, Zimbabwe, Haiti, China, Mexico, Japan, and other places. Failure to consider the cultural context and manifestation of disorders often result in inaccurate diagnosis and inappropriate treatment (D. Sue, Sue, Sue, & Sue, 2016). Chapter 10 will discuss these cultural syndromes and treatments in greater detail.

Acknowledging Group Differences

Dr. D. seems to easily dismiss the importance of Gabriella's Latina/o culture as a possible barrier to their therapeutic work together. She wonders aloud, for example, whether he can understand her as a Latina (being a racial/cultural being), and the unique problems she faces as a person of color. Dr. D. attempts to reassure Gabriella that he can in several ways. He stresses (a) that people are more similar than different, (b) that we are all “human beings,” (c) that he has much experience in working with Latinos, and (d) that everyone is the “same under the skin.” Although there is much truth to these statements, he has unintentionally negated the racialized experiences of Gabriella, and the importance that she places on her racial/ethnic identity. In multicultural counseling, this response often creates an impasse to therapeutic relationships (Arredondo, Gallardo-Cooper, Delgado-Romero, & Zapata, 2014). Note the long period of silence by Gabriella, for example, after Dr. D's response. He apparently misinterprets the silence as agreement. We will return to this important point shortly.

Being Aware of Collectivistic Cultures

It is obvious that Dr. D. operates from an individualistic approach and values individualism, autonomy, and independence. He communicates to Gabriella that it is more important for her to decide what she wants for herself than being concerned about her parents' desires. Western European concepts of mental health stress the importance of independence and “being your own person” because it leads to healthy development and maturity, rather than dependency (in Gabriella's case “pathological family enmeshment”). Dr. D. fails to consider that in many collectivistic cultures such as Latino or Asian American, independence may be considered undesirable and interdependence is valued (Ivey, Ivey, & Zalaquett, 2014; Kail & Cavanaugh, 2013). When the norms and values of Western European concepts of mental health are imposed universally upon culturally diverse clients, there is the very real danger of cultural oppression, resulting in “blaming the victim.”

Attuning to Cultural and Clinical Clues

There are many cultural clues in this therapeutic encounter that might have provided Dr. D. with additional insights into Latina/o culture and its meaning for culturally competent assessment, diagnosis, and treatment. We have already pointed out his failure to explore more in depth Gabriella's description of her attacks (ataques de nervios), and her concern about her parents' approval. But many potential sociocultural and sociopolitical clues were present in their dialogue as well. For example, Dr. D. failed to follow up on why the song “Booty” by Jennifer Lopez precipitated an argument, and what the parents' use of the term “fetish” shows us about how Russell may view their daughter.

The 4-minute music video Booty shows Jennifer Lopez and Iggy Azalea with many anonymous beauties grinding their derrieres (booties) in front of the camera while chanting “Big, big booty, big, big booty” continuously. It has been described as provocative, exploitative and “soft porn.” Nevertheless, the video has become a major hit. And while Dr. D. might be correct in saying that the argument couldn't possibly be over a song (implying that there is a more meaningful reason), he doesn't explore the possible cultural or political implications for Gabriella. Is there meaning in her finding the song offensive and Russell's enjoyment of it? Is there a relationship between the sexiness of big butts to the terms “fetish” and “emotionality” that upset Gabriella? We know, for example, that Latina and Asian women are victims of widespread societal stereotyping that objectifies them as sex objects. Could this be something that Gabriella is wrestling with? At some level, does she suspect that Russell is only attracted to her because of these stereotypes, as her parents' use of the word “fetish” implies? In not exploring these issues, or worse yet, not being aware of them, Dr. D. may have lost a valuable opportunity to help Gabriella gain insight into her emotional distress.

Seeing the Forest through the Trees

These important questions are left unanswered because the therapist fails to see the forest through the trees. Dr. D. appears to suffer from “tunnel vision” and seems more task oriented than people oriented. His major goal seems to be “identify the problem (panic attacks) and solve it (relaxation exercises, medication, etc.).” Who Gabriella is as a flesh and blood person seems less important than the problem. In its attempt to mimic the physical sciences, the discipline of mental health practice has often stressed the importance of objectivity, rational thinking, and problem solving—identify the problem and solve it. Although valuable in many respects, this approach may clash with the Latina/o concept of personalismo, in which people relationships are equally if not more important than tasks. Many Latina/o, for example, have described Western-trained counselors or therapists as “remote,” “aloof,” or “cold” (Arredondo et al. 2014; Comas-Diaz, 2010). There are some indications that Gabriella may view Dr. D. in this manner. His task orientation regardless of what she does or says makes her concerns remain invisible; he fails to explore the many clues provided to him by Gabriella. For example, he mistakes her silence for agreement, fails to inquire into the video-song, Booty, dismisses her cultural concerns in favor of finding solutions, and implies that she is responsible for her plight. An interesting observation of how his rigid goal-directness blinds him to what Gabriella says is seen in the description of the aftermath of her attack: “We finally made up and got it on.” The therapist interprets the statement as Gabriella and Russell “smoothing things over,” but is there more to this statement? What does she mean by “got it on”?

Balancing the Culture-Specific and Culture-Universal Orientations

Throughout our analysis of Dr. D., we have made the point that culture and life experiences affect the expression of abnormal behavior and that counselors need to attune to these sociodemographic variables. Some have even proposed the use of culture-specific strategies in counseling and therapy (Ivey, Ivey, & Zalaquett, 2014; Parham, Ajamu, & White, 2011). Such professionals point out that current guidelines and standards of clinical practice are culture bound and often inappropriate for racial/ethnic minority groups. Which view is correct? Should treatment approaches be based on cultural universality or cultural relativism? Few mental health professionals today embrace the extremes of either position, although most gravitate toward one or the other.

Proponents of cultural universality focus on disorders and their consequent treatments and minimize cultural factors, whereas proponents of cultural relativism focus on the culture and on how the disorder is manifested and treated within it. Both views have validity. It would be naive to believe that no disorders cut across different cultures or share universal characteristics. Likewise, it is naive to believe that the relative frequencies and manners of symptom formation for various disorders do not reflect the dominant cultural values and lifestyles of a society. Nor would it be beyond our scope to entertain the notion that various diverse groups may respond better to culture-specific therapeutic strategies. A more fruitful approach to these opposing views might be to address the following two questions: (a) What is universal in human behavior that is also relevant to counseling and therapy? and (b) What is the relationship between cultural norms, values, and attitudes, on the one hand, and the manifestation of behavior disorders and their treatments, on the other?

The Nature of Multicultural Counseling Competence

Clinicians have oftentimes asserted that “good counseling is good counseling” and that good clinical practice subsumes cultural competence, which is simply a subset of good clinical skills. In this view, they would make a strong case that if Dr. D. had simply exercised these therapeutic skills, he would have worked effectively with Gabriella. Our contention, however, is that cultural competence is superordinate to counseling competence. How Dr. D. worked with Gabriella contains the seeds of a therapeutic bias that makes him susceptible to cultural errors in therapy. Traditional definitions of counseling and psychotherapy are culture bound because they are defined from a primarily White Western-European perspective (Gallardo, 2014). Let us briefly explore the rationale for our position.

The Harm of Cultural Incompetence

Although there are disagreements over the definition of cultural competence, many of us know cultural incompetence when we see it; we recognize it by its horrendous outcomes or by the human toll it takes on our marginalized clients. For some time now, multicultural specialists have described Western-trained counseling/mental health professionals in very unflattering terms: (a) They are insensitive to the needs of their culturally diverse clients; do not accept, respect, and understand cultural differences; are arrogant and contemptuous; and have little understanding of their prejudices (Ridley, 2005; Thomas & Sillen, 1972); (b) clients of color, women, and gays and lesbians frequently complain that they feel abused, intimidated, and harassed by nonminority personnel (Atkinson, Morten, & Sue, 1998; President's Commission on Mental Health, 1978); (c) discriminatory practices in mental health delivery systems are deeply embedded in the ways in which the services are organized and in how they are delivered to minority populations and are reflected in biased diagnoses and treatment, in indicators of dangerousness, and in the type of people occupying decision-making roles (Parham et al., 2011; Cross, Bazron, Dennis, & Isaacs, 1989); and (d) mental health professionals continue to be trained in programs in which the issues of ethnicity, gender, and sexual orientation are ignored, regarded as deficiencies, portrayed in stereotypic ways, or included as an afterthought (Ponterotto et al., 2006; Ratts & Pedersen, 2014).

From our perspective, counseling/mental health professionals have difficulty functioning in a culturally competent manner. Rather, they have functioned in a monoculturally competent manner with only a limited segment of the population (White, male, and straight Euro-Americans), but even that has become a topic of debate (Ridley & Mollen, 2011). We submit that much of the current therapeutic practice taught in graduate programs derives mainly from clinical experience and research with middle- to upper-class Whites (Ridley, 2005). Even though our profession has advocated moving into the realm of evidence-based practice (EBP), little evidence exists that they are applicable to racial/ethnic minorities (Atkinson, Bui, & Mori, 2001; D. W. Sue, 2015). A review of studies on EBP reveals few, if any, on racial minority populations, which renders assumptions of external validity questionable when applied to people of color (Atkinson et al., 1998; Hall, 2001; S. Sue, 1999). If we are honest with ourselves, we can conclude only that many of our standards of professional competence are derived primarily from the values, belief systems, cultural assumptions, and traditions of the larger (Eurocentric) society. We will, however, in Chapter 9 attempt to summarize multicultural evidence-based practices that have recently begun to work their way into the scientific literature.

The Superordinate Nature of Cultural Competence

As we have discussed, values of individualism and psychological mindedness and using rational approaches to solve problems have much to do with how competence is defined. Many of our colleagues continue to hold firmly to the belief that “good counseling is good counseling,” dismissing in their definitions the centrality of culture. The problem with traditional definitions of counseling, therapy, and mental health practice is that they arose from monocultural and ethnocentric norms that excluded other cultural groups. Mental health professionals must realize that “good counseling” uses White EuroAmerican norms that exclude most of the world's population. In a hard-hitting article, Arnett (2009) indicates that psychological research, which forms the knowledge base of our profession, focuses on Americans who constitute only 5 percent of the world's population. He concludes that the knowledge of human behavior neglects 95 percent of the world's population and is an inadequate representation of humanity. Thus it is clear to us that the more superordinate and inclusive concept is that of multicultural counseling competence, not merely clinical or counseling competence. Standards of helping derived from such a philosophy and framework are inclusive and offer the broadest and most accurate view of cultural competence.

A Tripartite Framework for Understanding the Multiple Dimensions of Identity

All too often, counseling and psychotherapy seem to ignore the group dimension of human existence. For example, a White counselor who works with an African American client might intentionally or unintentionally avoid acknowledging the racial or cultural background of the person by stating, “We are all the same under the skin” or “Apart from your racial background, we are all unique.” We have already indicated possible reasons why this happens, but such avoidance tends to negate an intimate aspect of the client's group identity (Apfelbaum, Sommers, & Norton, 2008; Neville, Gallardo & Sue, in press). Dr. D.'s responses toward Gabriella seem to have had this effect. These forms of microinvalidations will be discussed more fully in Chapter 6 . As a result of these invalidations, a client of color might feel misunderstood and resentful toward the helping professional, hindering the effectiveness of the counseling. Besides unresolved personal issues arising from counselors, the assumptions embedded in Western forms of therapy exaggerate the chasm between therapists and culturally diverse clients.

First, the concepts of counseling and psychotherapy are uniquely EuroAmerican in origin, as they are based on certain philosophical assumptions and values that are strongly endorsed by Western civilizations. On the one side are beliefs that people are unique and that the psychosocial unit of operation is the individual; on the other side are beliefs that clients are the same and that the goals and techniques of counseling and therapy are equally applicable across all groups. Taken to its extreme, this latter approach nearly assumes that persons of color, for example, are White, and that race and culture are insignificant variables in counseling and psychotherapy (D. W. Sue, 2010). Statements such as “There is only one race, the human race” and “Apart from your racial/cultural background, you are no different from me” are indicative of the tendency to avoid acknowledging how race, culture, and other group dimensions may influence identity, values, beliefs, behaviors, and the perception of reality (Lum, 2011; D. W. Sue, 2015). Indeed, in an excellent conceptual/analytical article proposing a new and distinct definition of counseling competence, Ridley, Mollen, and Kelly (2011) conclude that “counseling competence is multicultural counseling competence” and that “competent counselors consistently incorporate cultural data into counseling, and they must be careful never to relegate cultural diversity to the status of a sidebar” (p. 841).

Second, related to the negation of race, we have indicated that a most problematic issue deals with the inclusive or exclusive nature of multiculturalism. A number of psychologists have indicated that an inclusive definition of multiculturalism (one that includes gender, ability/disability, sexual orientation, and so forth) can obscure the understanding and study of race as a powerful dimension of human existence (Carter, 2005; Helms & Richardson, 1997). This stance is not intended to minimize the importance of the many cultural dimensions of human identity but rather emphasizes the greater discomfort that many psychologists experience in dealing with issues of race rather than with other sociodemographic differences (D. W. Sue, Lin, Torino, Capodilupo, & Rivera, 2009). As a result, race becomes less salient and allows us to avoid addressing problems of racial prejudice, racial discrimination, and systemic racial oppression. This concern appears to have great legitimacy. We have noted, for example, that when issues of race are discussed in the classroom, a mental health agency, or some other public forum, it is not uncommon for participants to refocus the dialogue on differences related to gender, socioeconomic status, or religious orientation.

On the other hand, many groups often rightly feel excluded from the multicultural debate and find themselves in opposition to one another. Thus enhancing multicultural understanding and sensitivity means balancing our understanding of the sociopolitical forces that dilute the importance of race, on the one hand, and our need to acknowledge the existence of other group identities related to social class, gender, ability/disability, age, religious affiliation, and sexual orientation, on the other (Anderson & Middleton, 2011; D. W. Sue, 2010).

There is an old Asian saying that goes something like this: “All individuals, in many respects, are (a) like no other individuals, (b) like some individuals, and (c) like all other individuals.” Although this statement might sound confusing and contradictory, Asians believe these words to have great wisdom and to be entirely true with respect to human development and identity. We have found the tripartite framework shown in Figure 2.1 (D. W. Sue, 2001) to be useful in exploring and understanding the formation of personal identity. The three concentric circles illustrated in Figure 2.1 denote individual, group, and universal levels of personal identity.

Figure 2.1 Tripartite Development of Personal Identity

Individual Level: “All Individuals Are, in Some Respects, Like No Other Individuals”

There is much truth in the saying that no two individuals are identical. We are all unique biologically, and recent breakthroughs in mapping the human genome have provided some startling findings. Biologists, anthropologists, and evolutionary psychologists had looked to the Human Genome Project as potentially providing answers to comparative and evolutionary biology that would allow us to find the secrets to life. Although the project has provided valuable answers to many questions, scientists have discovered even more complex questions. For example, they had expected to find 100,000 genes in the human genome, but only about 20,000 were initially found, with the possible existence of another 5,000—only two or three times more than are found in a fruit fly or a nematode worm. Of those 25,000 genes, only 300 unique genes distinguish us from the mouse. In other words, human and mouse genomes are about 85 percent identical! Although it may be a blow to human dignity, the more important question is how so relatively few genes can account for our humanness.

Likewise, if so few genes can determine such great differences between species, what about within the species? Human inheritance almost guarantees differences because no two individuals ever share the same genetic endowment. Further, no two of us share the exact same experiences in our society. Even identical twins, who theoretically share the same gene pool and are raised in the same family, are exposed to both shared and nonshared experiences. Different experiences in school and with peers, as well as qualitative differences in how parents treat them, will contribute to individual uniqueness. Research indicates that psychological characteristics, behavior, and mental disorders are more affected by experiences specific to a child than are shared experiences (Bale et al., 2010; Foster & MacQueen, 2008).

Group Level: “All Individuals Are, in Some Respects, Like Some Other Individuals”

As mentioned earlier, each of us is born into a cultural matrix of beliefs, values, rules, and social practices. By virtue of social, cultural, and political distinctions made in our society, perceived group membership exerts a powerful influence over how society views sociodemographic groups and over how its members view themselves and others. Group markers such as race and gender are relatively stable and less subject to change. Some markers, such as education, socioeconomic status, marital status, and geographic location, are more fluid and changeable. Although ethnicity is fairly stable, some argue that it can also be fluid. Likewise, debate and controversy surround the discussions about whether sexual orientation is determined at birth and whether we should be speaking of sexuality or sexualities (D. Sue et al., 2016). Nevertheless, membership in these groups may result in shared experiences and characteristics. Group identities may serve as powerful reference groups in the formation of worldviews. On the group level of identity, Figure 2.1 reveals that people may belong to more than one cultural group (e.g., an Asian American female with a disability), that some group identities may be more salient than others (e.g., race over religious orientation), and that the salience of cultural group identity may shift from one to the other depending on the situation. For example, a gay man with a disability may find that his disability identity is more salient among the able-bodied but that his sexual orientation is more salient among those with disabilities.

Universal Level: “All Individuals Are, in Some Respects, Like All Other Individuals”

Because we are members of the human race and belong to the species Homo sapiens, we share many similarities. Universal to our commonalities are (a) biological and physical similarities, (b) common life experiences (birth, death, love, sadness, and so forth), (c) self-awareness, and (d) the ability to use symbols, such as language. In Shakespeare's Merchant of Venice, Shylock attempts to acknowledge the universal nature of the human condition by asking, “When you prick us, do we not bleed?” Again, although the Human Genome Project indicates that a few genes may cause major differences between and within species, it is startling how similar the genetic material within our chromosomes is and how much we share in common.

Reflection and Discussion Questions

1. Select three group identities you possess related to race, gender, sexual orientation, disability, religion, socioeconomic status, and so forth. Of the three you have chosen, which one is more salient to you? Why? Does it shift or change? How aware are you of other sociodemographic identities?

2. Using the tripartite framework just discussed, can you outline ways in which you are unique, share characteristics with only certain groups, and share similarities with everyone?

3. Can someone truly be color-blind? What makes seeing and acknowledging differences so difficult? In what ways does a color-blind approach hinder the counseling relationship when working with diverse clients?

Individual and Universal Biases in Psychology and Mental Health

Psychology—and mental health professionals in particular—have generally focused on either the individual or the universal levels of identity, placing less importance on the group level. There are several reasons for this orientation. First, our society arose from the concept of rugged individualism, and we have traditionally valued autonomy, independence, and uniqueness. Our culture assumes that individuals are the basic building blocks of our society. Sayings such as “Be your own person, (à la Dr. D.),” “Stand on your own two feet,” and “Don't depend on anyone but yourself” reflect this value. Psychology and education represent the carriers of this value, and the study of individual differences is most exemplified in the individual intelligence testing movement that pays homage to individual uniqueness (Suzuki et al., 2005).

Second, the universal level is consistent with the tradition and history of psychology, which has historically sought universal facts, principles, and laws in explaining human behavior. Although this is an important quest, the nature of scientific inquiry has often meant studying phenomena independently of the context in which human behavior originates. Thus therapeutic interventions from which research findings are derived may lack external validity (Chang & Sue, 2005).

Third, we have historically neglected the study of identity at the group level for sociopolitical and normative reasons. As we have seen, issues of race, gender, sexual orientation, and disability seem to touch hot buttons in all of us because they bring to light issues of oppression and the unpleasantness of personal biases (Lo, 2010; Zetzer, 2011). In addition, racial/ethnic differences have frequently been interpreted from a deficit perspective and have been equated with being abnormal or pathological (Guthrie, 1997; Parham et al., 2011). We have more to say about this in Chapter 4 .

Disciplines that hope to understand the human condition cannot neglect any level of our identity. For example, psychological explanations that acknowledge the importance of group influences such as gender, race, culture, sexual orientation, socioeconomic class, and religious affiliation lead to more accurate understanding of human psychology. Failure to acknowledge these influences may skew research findings and lead to biased conclusions about human behavior that are culture bound, class bound, and gender bound.

Thus it is possible to conclude that all people possess individual, group, and universal levels of identity. A holistic approach to understanding personal identity demands that we recognize all three levels: individual (uniqueness), group (shared cultural values and beliefs), and universal (common features of being human). Because of the historical scientific neglect of the group level of identity, this text focuses primarily on this category.

Before closing this portion of our discussion, we would like to add a caution. Although the concentric circles in Figure 2.1 might unintentionally suggest a clear boundary, each level of identity must be viewed as permeable and ever-changing in salience. In counseling and psychotherapy, for example, a client might view his or her uniqueness as important at one point in the session and stress commonalities of the human condition at another. Even within the group level of identity, multiple forces may be operative. As mentioned earlier, the group level of identity reveals many reference groups, both fixed and nonfixed, that might impact our lives. Being an elderly, gay, Latino male, for example, represents four potential reference groups operating on the person. The culturally competent helping professional must be willing and able to touch all dimensions of human existence without negating any of the others.

The Impact of Group Identities on Counseling and Psychotherapy

Accepting the premise that race, ethnicity, and culture are powerful variables in influencing how people think, make decisions, behave, and define events, it is not far-fetched to conclude that such forces may also affect how different groups define a helping relationship (Herlihy & Corey, 2015). Multicultural psychologists have long noted, for example, that different theories of counseling and psychotherapy represent different worldviews, each with its own values, biases, and assumptions about human behavior (Geva & Wiener, 2015). Given that schools of counseling and psychotherapy arise from Western European contexts, the worldview that they espouse as reality may not be shared by racial/ethnic minority groups in the United States, or by those who reside in different countries (Parham et al., 2011). Each cultural/racial group may have its own distinct interpretation of reality and offer a different perspective on the nature of people, the origin of disorders, standards for judging normality and abnormality, and therapeutic approaches.

Among many Asian Americans, for example, a self-orientation is considered undesirable, whereas a group orientation is highly valued (Kim, 2011). The Japanese have a saying that goes like this: “The nail that stands up should be pounded back down.” The meaning seems clear: Healthy development is considering the needs of the entire group, whereas unhealthy development is thinking only of oneself. Likewise, relative to their EuroAmerican counterparts, many African Americans value the emotive and affective quality of interpersonal interactions as qualities of sincerity and authenticity (West-Olatunji & Conwill, 2011). EuroAmericans often view the passionate expression of affect as irrational, impulsive, immature, and lacking objectivity on the part of the communicator. Thus the autonomy-oriented goal of counseling and psychotherapy and the objective focus of the therapeutic process might prove antagonistic to the worldviews of Asian Americans and African Americans, respectively.

It is therefore highly probable that different racial/ethnic minority groups perceive the competence of the helping professional differently than do mainstream client groups. Further, if race/ethnicity affects perception, what about other group differences, such as gender and sexual orientation? Minority clients may see a clinician who exhibits therapeutic skills that are associated primarily with mainstream therapies as having lower credibility. The important question to ask is, “Do such groups as racial/ethnic minorities define cultural competence differently than do their Euro-American counterparts?” Anecdotal observations, clinical case studies, conceptual analytical writings, and some empirical studies seem to suggest an affirmative response to the question (Fraga, Atkinson, & Wampold, 2002; Garrett & Portman, 2011; Guzman & Carrasco, 2011; McGoldrick, Giordano, & Garcia-Preto, 2005; Nwachuku & Ivey, 1991).

What Is Multicultural Counseling/Therapy?

In light of the previous analysis, let us define multicultural counseling/therapy (MCT) as it relates to the therapy process and the roles of the mental health practitioner:

Multicultural counseling and therapy can be defined as both a helping role and a process that uses modalities and defines goals consistent with the life experiences and cultural values of clients; recognizes client identities to include individual, group, and universal dimensions; advocates the use of universal and culture-specific strategies and roles in the healing process; and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems. (D. W. Sue & Torino, 2005)

This definition often contrasts markedly with traditional views of counseling and psychotherapy. A more thorough analysis of these characteristics is described in Chapter 7 . For now, let us extract the key phrases in our definition and expand their implications for clinical practice.

1. Helping role and process. MCT broadens the roles that counselors play and expands the repertoire of therapy skills considered helpful and appropriate in counseling. The more passive and objective stance taken by therapists in clinical work is seen as only one method of helping. Likewise, teaching, consulting, and advocacy can supplement the conventional counselor or therapist role.

2. Consistent with life experiences and cultural values. Effective MCT means using modalities and defining goals for culturally diverse clients that are consistent with their racial, cultural, ethnic, gender, and sexual orientation backgrounds. Advice and suggestions, for example, may be effectively used for some client populations.

3. Individual, group, and universal dimensions of existence. As we have already seen, MCT acknowledges that our existence and identity are composed of individual (uniqueness), group, and universal dimensions. Any form of helping that fails to recognize the totality of these dimensions negates important aspects of a person's identity.

4. Universal and culture-specific strategies. MCT believes that different racial/ethnic minority groups might respond best to culture-specific strategies of helping. For example, research seems to support the belief that Asian Americans and Latino/a Americans are more responsive to directive/active approaches (Guzman & Carrasco, 2011; Kim, 2011) and that African Americans appreciate helpers who are authentic in their self-disclosures (Parham et al., 2011). Likewise, it is clear that common features in helping relationships cut across cultures and societies as well.

5. Individualism and collectivism. MCT broadens the perspective of the helping relationship by balancing the individualistic approach with a collectivistic reality that acknowledges our embeddedness in families, relationships with significant others, communities, and cultures. A client is perceived not just as an individual, but as an individual who is a product of his or her social and cultural context.

6. Client and client systems. MCT assumes a dual role in helping clients. In many cases, for example, it is important to focus on individual clients and to encourage them to achieve insights and learn new behaviors. However, when problems of clients of color reside in prejudice, discrimination, and racism of employers, educators, and neighbors or in organizational policies or practices in schools, mental health agencies, government, business, and society, the traditional therapeutic role appears ineffective and inappropriate. The focus for change must shift to altering client systems rather than individual clients.

What Is Cultural Competence?

Consistent with the definition of MCT, it becomes clear that culturally competent healers are working toward several primary goals (American Psychological Association, 2003; D. W. Sue et al., 1992; D. W. Sue et al., 1998). First, culturally competent helping professionals are ones who are actively in the process of becoming aware of their own values, biases, assumptions about human behavior, preconceived notions, personal limitations, and so forth. Second, culturally competent helping professionals are ones who actively attempt to understand the worldview of their culturally diverse clients. In other words, what are the client's values and assumptions about human behavior, biases, and so on? Third, culturally competent helping professionals are ones who are in the process of actively developing and practicing appropriate, relevant, and sensitive intervention strategies and skills in working with their culturally diverse clients. These three attributes make it clear that cultural competence is an active, developmental, and ongoing process and that it is aspirational rather than achieved. Let us more carefully explore these attributes of cultural competence.

Competency 1: Therapist Awareness of One's Own Assumptions, Values, and Biases

In almost all human service programs, counselors, therapists, and social workers are familiar with the phrase “Counselor, know thyself.” Programs stress the importance of not allowing our own biases, values, or hang-ups to interfere with our ability to work with clients. In most cases, such a warning stays primarily on an intellectual level, and very little training is directed at having trainees get in touch with their own values and biases about human behavior. In other words, it appears to be easier to deal with trainees' cognitive understanding of their own cultural heritage, the values they hold about human behavior, their standards for judging normality and abnormality, and the culture-bound goals toward which they strive.

As indicated in Chapter 1 , what makes examination of the self difficult is the emotional impact of attitudes, beliefs, and feelings associated with cultural differences, such as racism, sexism, heterosexism, able-body-ism, and ageism. For example, as a member of a White EuroAmerican group, what responsibility do you hold for the racist, oppressive, and discriminating manner by which you personally and professionally deal with persons of color? This is a threatening question for many White people. However, to be effective in MCT means that one has adequately dealt with this question and worked through the biases, feelings, fears, and guilt associated with it. A similar question can be asked of men with respect to women and of straights with respect to gays.

Competency 2: Understanding the Worldviews of Culturally Diverse Clients

It is crucial that counselors and therapists understand and can share the worldviews of their culturally diverse clients. This statement does not mean that providers must hold these worldviews as their own, but rather that they can see and accept other worldviews in a nonjudgmental manner. Some have referred to the process as cultural role taking: Therapists acknowledge that they may not have lived a lifetime as a person of color, as a woman, or as a lesbian, gay, bisexual, or transgendered person (LGBT). With respect to race, for example, it is almost impossible for a White therapist to think, feel, and react as a racial minority individual. Nonetheless, cognitive empathy, as distinct from affective empathy, may be possible. In cultural role taking, the therapist acquires practical knowledge concerning the scope and nature of the client's cultural background, daily living experience, hopes, fears, and aspirations. Inherent in cognitive empathy is the understanding of how therapy relates to the wider sociopolitical system with which minorities contend every day of their lives.

Competency 3: Developing Culturally Appropriate Intervention Strategies and Techniques

Effectiveness is most likely enhanced when the therapist uses therapeutic modalities and defines goals that are consistent with the life experiences and cultural values of the client. This basic premise will be emphasized throughout future chapters. Studies have consistently revealed that (a) economically and educationally marginalized clients may not be oriented toward “talk therapy”; (b) self-disclosure may be incompatible with the cultural values of Asian Americans, Hispanic Americans, and American Indians; (c) the sociopolitical atmosphere may dictate against self-disclosure from racial minorities and gays and lesbians; (d) the ambiguous nature of counseling may be antagonistic to life values of certain diverse groups; and (e) many minority clients prefer an active/directive approach over an inactive/nondirective one in treatment. Therapy has too long assumed that clients share a similar background and cultural heritage and that the same approaches are equally effective with all clients. This erroneous assumption needs to be challenged.

Because groups and individuals differ from one another, the blind application of techniques to all situations and all populations seems ludicrous. The interpersonal transactions between the counselor and the client require different approaches that are consistent with the client's life experiences (Choudhuri, Santiago-Rivera, & Garrett, 2012; Ratts & Pedersen, 2014). It is ironic that equal treatment in therapy may be discriminatory treatment! Therapists need to understand this. As a means to prove discriminatory mental health practices, racial/ethnic minority groups have in the past pointed to studies revealing that minority clients are given less preferential forms of treatment (medication, electroconvulsive therapy, etc.). Somewhere, confusion has occurred, and it was believed that to be treated differently is akin to discrimination. The confusion centered on the distinction between equal access and opportunities versus equal treatment. Racial/ethnic minority groups may not be asking for equal treatment so much as they are asking for equal access and opportunities. This dictates a differential approach that is truly nondiscriminatory. Thus to be an effective multicultural helper requires cultural competence. In light of the previous analysis, we define cultural competence in the following manner:

Cultural competence is the ability to engage in actions or create conditions that maximize the optimal development of client and client systems. Multicultural counseling competence is defined as the counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds), and on an organizational/societal level, advocating effectively to develop new theories, practices, policies, and organizational structures that are more responsive to all groups. (D. W. Sue & Torino, 2005)

This definition of cultural competence in the helping professions makes it clear that the conventional one-to-one, in-the-office, objective form of treatment aimed at remediation of existing problems may be at odds with the sociopolitical and cultural experiences of the clients. Like the complementary definition of MCT, it addresses not only clients (individuals, families, and groups) but also client systems (institutions, policies, and practices that may be unhealthy or problematic for healthy development). Addressing client systems is especially important if problems reside outside rather than inside the client. For example, prejudice and discrimination such as racism, sexism, and homophobia may impede the healthy functioning of individuals and groups in our society.

Second, cultural competence can be seen as residing in three major domains: (a) attitudes/beliefs component—an understanding of one's own cultural conditioning and how this conditioning affects the personal beliefs, values, and attitudes of a culturally diverse population; (b) knowledge component—understanding and knowledge of the worldviews of culturally diverse individuals and groups; and (c) skills component—an ability to determine and use culturally appropriate intervention strategies when working with different groups in our society. Box 2.1 provides an outline of cultural competencies related to these three domains.

Box 2.1 Multicultural Counseling Competencies

1. Cultural Competence: Awareness

1. Moved from being culturally unaware to being aware and sensitive to own cultural heritage and to valuing and respecting differences.

2. Aware of own values and biases and of how they may affect diverse clients.

3. Comfortable with differences that exist between themselves and their clients in terms of race, gender, sexual orientation, and other sociodemographic variables. Differences are not seen as deviant.

4. Sensitive to circumstances (personal biases; stage of racial, gender, and sexual orientation identity; sociopolitical influences; etc.) that may dictate referral of clients to members of their own sociodemographic group or to different therapists in general.

5. Aware of their own racist, sexist, heterosexist, or other detrimental attitudes, beliefs, and feelings.

2. Cultural Competence: Knowledge

1. Knowledgeable and informed on a number of culturally diverse groups, especially groups with whom therapists work.

2. Knowledgeable about the sociopolitical system's operation in the United States with respect to its treatment of marginalized groups in society.

3. Possess specific knowledge and understanding of the generic characteristics of counseling and therapy.

4. Knowledgeable of institutional barriers that prevent some diverse clients from using mental health services.

3. Cultural Competence: Skills

1. Able to generate a wide variety of verbal and nonverbal helping responses.

2. Able to communicate (send and receive both verbal and nonverbal messages) accurately and appropriately.

3. Able to exercise institutional intervention skills on behalf of clients when appropriate.

4. Able to anticipate the impact of their helping styles and of their limitations on culturally diverse clients.

5. Able to play helping roles characterized by an active systemic focus, which leads to environmental interventions. Not restricted by the conventional counselor/therapist mode of operation.

Sources: D. W. Sue et al. (1992), and D. W. Sue et al. (1998). Readers are encouraged to review the original 34 multicultural competencies, which are fully elaborated in both publications.

Third, in a broad sense, this definition is directed toward two levels of cultural competence: the personal/individual and the organizational/system levels. The work on cultural competence has generally focused on the micro level, the individual. In the education and training of psychologists, for example, the goals have been to increase the level of self-awareness of trainees (potential biases, values, and assumptions about human behavior); to acquire knowledge of the history, culture, and life experiences of various minority groups; and to aid in developing culturally appropriate and adaptive interpersonal skills (clinical work, management, conflict resolution, etc.). Less emphasis is placed on the macro level: the profession of psychology, organizations, and the society in general (Lum, 2011; D. W. Sue, 2001). We suggest that it does little good to train culturally competent helping professionals when the very organizations that employ them are monocultural and discourage or even punish psychologists for using their culturally competent knowledge and skills. If our profession is interested in the development of cultural competence, then it must become involved in impacting systemic and societal levels as well.

Fourth, our definition of cultural competence speaks strongly to the development of alternative helping roles. Much of this comes from recasting healing as involving more than one-to-one therapy. If part of cultural competence involves systemic intervention, then such roles as consultant, change agent, teacher, and advocate supplement the conventional role of therapy. In contrast to this role, alternatives are characterized by the following:

· Having a more active helping style

· Working outside the office (home, institution, or community)

· Being focused on changing environmental conditions, as opposed to changing the client

· Viewing the client as encountering problems rather than having a problem

· Being oriented toward prevention rather than remediation

· Shouldering increased responsibility for determining the course and the outcome of the helping process

It is clear that these alternative roles and their underlying assumptions and practices have not been historically perceived as activities consistent with counseling and psychotherapy.

Cultural Humility and Cultural Competence

Can anyone ever be completely culturally competent in working with diverse clients? Are the awareness, knowledge, and skills of cultural competence the only areas sufficient to be an effective multicultural helping professional? The answers to these questions are extremely important not only to the practice of counseling/therapy, but to the education and training of counselors and therapists. The answer to the first question is an obvious “no.” It is impossible for anyone to possess sufficient knowledge, understanding, and experience of the diversity of populations that inhabit this planet. Indeed, those who have developed and advocated multicultural counseling competencies have repeatedly stressed that “cultural competence” is an aspirational goal, that no single individual can become completely competent, and that the journey toward cultural competence is a lifelong process (D. W. Sue et al., 1992; Cornish et al., 2010).

With respect to the second question, it appears that the dimensions of awareness, knowledge, and skills may be necessary, but not sufficient conditions to work effectively with diverse clients. Other attributes, like openness to diversity (Chao, Wei, Spanierman, Longo, & Northart, 2015) and cultural humility seem central to effective multicultural counseling (Gallardo, 2014). The concept of cultural humility was first coined in medical education, where it was associated with an open attitudinal stance or a multicultural open orientation to diverse patients, and found to be quite different from cultural competence (Tervalon & Murray-Garcia, 1998). The term has found its way into the field of multicultural counseling, where it also refers to an openness to working with culturally diverse clients (Hook, Davis, Owen, Worthington, & Utsey, 2013; Owen et al., 2014). But exactly how does it differ from cultural competence and what evidence do we have that it is an important component?

Cultural humility appears more like a “way of being” rather than a “way of doing,” which has characterized cultural competence (Owen, Tao, Leach, & Rodolfa, 2011). In the former, we are referring to the virtues and dispositions inherent in the attitudes that counselors hold toward their clients, while the latter refers more to the acquisition of knowledge and skills used in working with clients. The attitudinal components of respect for others, an egalitarian stance, and diminished superiority over clients means an “other-orientation” rather than one that is self-focused (concern with one's expertise, training, credentials, and authority). Recall again the therapeutic encounter between Dr. D. and Gabriella. When asked by Gabriella whether he could understand what it's like to be Latina, and the unique issues she must cope with, his response was “Of course I can” and “I've worked with many Latinos in my practice.” In many respects, the definition of cultural humility is humbleness; thus therapists acknowledging that they may be limited in their knowledge and understanding of clients' cultural concerns may actually strengthen the therapeutic relationship. Dr. D.'s response, however, suggests he is self-oriented (“I am the therapist and I know best”), while cultural humility would entertain the possibility that the therapist may not understand. A therapeutic response that would indicate cultural humility would be: “I hope I can, let's give it a try, okay?” Hook et al. (2013) make the following observations about cultural humility:

Culturally humble therapists rarely assume competence (i.e., letting prior experience and even expertness lead to overconfidence) for working with clients just based on their prior experience working with a particular group. Rather, therapists who are more culturally humble approach clients with respectful openness and work collaboratively with clients to understand the unique intersection of clients' various aspects of identities and how that affects the developing therapy alliance. (p. 354)

Although cultural humility may appear difficult to define and measure, researchers have been able to begin construction of an instrument to quantify it (Hook et al., 2013; Owen et al., 2014). In a therapeutic context, cultural humility of therapists was (a) considered very important to many socially marginalized clients, (b) correlated with a higher likelihood of continuing in treatment, (c) strongly related to the strength of the therapeutic alliance, and (d) related to perceived benefit and improvement in therapy. Thus cultural humility as a dispositional orientation may be equally important as cultural competence (awareness, knowledge, and skills) in multicultural counseling and therapy.

Social Justice and Cultural Competence

Recently, the Multicultural Counseling Competencies Revision Committee of the American Counseling Association (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015) has presented an important draft document, Multicultural and Social Justice Counseling Competencies (MSJCC) that proposes to revise the multicultural counseling competencies devised by D. W. Sue et al. (1992). As indicated in Chapter 4 , at the heart of the revision is integration of social justice competencies with multicultural competencies. Acknowledging that multiculturalism leads to social justice initiatives and actions, they propose a conceptual framework that includes quadrants (privilege and oppressed statuses), domains (counselor self-awareness, client worldview, counseling relationships, and counseling and advocacy interventions), and competencies (attitudes and beliefs, knowledge, skills, and action).

Perhaps the most important aspect of the proposed MSJCC is seen in the quadrants category, where they identify four major counseling relationships between counselor and client that directly address matters of power and privilege: (1) privileged counselor working with an oppressed client, (2) privileged counselor working with a privileged client, (3) oppressed counselor working with a privileged client, and (4) oppressed counselor working with an oppressed client. In other words, when applied to racial/ethnic counseling/therapy, various combinations can occur: (a) White counselors working with clients of color, (b) counselors of color working with White clients, (c) counselors of color working with clients of color, and (d) White counselors working with White clients. Analysis and research regarding these dyadic combinations have seldom been addressed in the multicultural field. Further, little in the way of addressing counseling work with interracial/interethnic combinations is seen in the literature. We address this topic in the next chapter. We will also cover the issues raised in the MSJCC framework more thoroughly in Chapters 3 , 4 , and 5 . In Chapter 3 we focus on enumerating the quadrants of power and privilege relationships between counselor and client, in Chapter 4 we address the importance of social justice advocacy and action on behalf of the client, and in Chapter 5 we deal with individual and systems level work.

Reflection and Discussion Questions

1. If the basic building blocks of cultural competence in clinical practice are awareness, knowledge, and skills, how do you hope to fulfill competency one, two, and three? Can you list the various educational and training activities you would need in order to work effectively with a client who differs from you in terms of race, gender, or sexual orientation?

2. What are your thoughts regarding cultural humility? How important is this attitude or stance in your work with culturally diverse clients?

3. Look at the six characteristics that define alternative roles for helping culturally diverse clients. Which of these roles are you most comfortable playing? Why? Which of these activities would make you uncomfortable? Why?

Implications for Clinical Practice

1. Know that the definition of multiculturalism is inclusive and encompasses race, culture, gender, religious affiliation, sexual orientation, age, disability, and so on.

2. When working with diverse populations, attempt to identify culture-specific and culture-universal domains of helping.

3. Be aware that persons of color, gays/lesbians, women, and other groups may perceive mental illness/health and the healing process differently than do EuroAmerican men.

4. Do not disregard differences and impose the conventional helping role and process on culturally diverse groups, as such actions may constitute cultural oppression.

5. Be aware that EuroAmerican healing standards originate from a cultural context and may be culture-bound. As long as counselors and therapists continue to view EuroAmerican standards as normative, they may judge others as abnormal.

6. Realize that the concept of cultural competence is more inclusive and superordinate than is the traditional definition of clinical competence. Do not fall into the trap of thinking “good counseling is good counseling.”

7. If you are planning to work with the diversity of clients in our world, you must play roles other than that of the conventional counselor.

8. Use modalities that are consistent with the lifestyles and cultural systems of clients.

9. Understand that one's multicultural orientation, cultural humility, is very important to successful multicultural counseling.

Summary

Traditional definitions of counseling, therapy, and mental health practice arise from monocultural and ethnocentric norms that may be antagonistic to the life styles and cultural values of diverse groups. These Western worldviews reflect a belief in the universality of the human condition, a belief that disorders are similar and cut across societies, and a conviction that mental health concepts are equally applicable across all populations and disorders. These worldviews also often fail to consider the different cultural and sociopolitical experiences of marginalized group members. As a result, counseling and therapy may often be inappropriate to marginalized groups in our society, resulting in cultural oppression. The movement to redefine counseling/therapy, and identify aspects of cultural competence in mental health practice has been advocated by nearly all multicultural counseling specialists.

Multicultural counseling and therapy is defined as both a helping role and a process that uses modalities and defines goals consistent with the life experiences and cultural values of clients; recognizes client identities to include individual, group, and universal dimensions; advocates the use of universal and culture-specific strategies and roles in the healing process; and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems. Thus cultural competence is the ability to engage in actions or create conditions that maximize the optimal development of client and client systems.

On a personal developmental level, multicultural counseling competence is defined as the counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds); on an organizational/societal level, it is defined as advocating effectively to develop new theories, practices, policies, and organizational structures that are more responsive to all groups. Another attribute, cultural humility seems central to effective multicultural counseling. Cultural humility appears more like a “way of being” rather than a “way of doing.” The attitudinal components of respect for others, an egalitarian stance, and diminished superiority over clients means an “other-orientation” rather than one that is self-focused. Finally, it appears that there is a strong need to integrate social justice competencies with that of cultural competence. Becoming culturally competent is a lifelong journey but promises much in providing culturally appropriate services to all groups in our society.

Glossary Terms

Awareness

Collectivism

Cultural competence

Cultural humility

Cultural incompetence

Cultural relativism

Culture-bound syndromes

Emic (culturally specific)

Etic (culturally universal)

Group level of identity

Individual level of identity

Knowledge

Multicultural counseling/therapy

Multiculturalism

Personalismo

Skills

Social justice

Universal level of identity

Worldview

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THE POLITICAL AND SOCIAL JUSTICE IMPLICATIONS OF COUNSELING AND PSYCHOTHERAPY

Chapter Objectives

1. Understand how the sociopolitical climate affects the manifestation, etiology, diagnosis, and treatment of psychological disturbances in socially devalued groups in our society.

2. Learn why traditional counseling/mental health practice may represent cultural oppression for marginalized groups.

3. Become knowledgeable about how the educational and mental health field has historically portrayed persons of color.

4. Understand the racial realities (worldviews) of people of color and those of White Americans.

5. Know how these differences may pose problems in race relations and multicultural counseling/therapy.

6. Learn how systemic factors (institutional policies, practices, and regulations) affect mental health and counseling practices.

7. Define and describe social justice counseling and the importance it plays in the mental health professions.

An Open Letter to Brothers and Sisters of Color

In 1997, I, Derald Wing Sue, was privileged to testify before President Clinton's Race Advisory Board on the President's Initiative on Race (1998) about the impact of racism on people of color. The televised public testimony evoked strong negative reactions from primarily White viewers, who claimed my colleagues and I were simply exaggerating, and that racism was now a thing of the past. In reaction to those criticisms, I published an open letter to brothers and sisters of color in 2003. A brief portion is reproduced here.

Dear Brothers and Sisters of Color:

I write . . . to you and to those White folks who have marched with us against racism and shown that their hearts are in the right place. Throughout our people's histories, we have had to contend with invalidation, oppression, injustice, terrorism, and genocide. Racism is a constant reality in our lives. It is a toxic force that has sought to

· strip us of our identities,

· take away our dignity,

· make us second-class citizens,

· destroy our peoples, cultures, and communities,

· steal our land and property,

· torture, rape, and murder us,

· imprison us on reservations, concentration camps, inferior schools, segregated neighborhoods, and jails,

· use us as guinea pigs in medical experiments, and

· blame our victimization upon the faults of our own people.

Attempts to express these thoughts have generally been met with disbelief and/or incredulity by many of our well-intentioned White brothers and sisters. We have been asked, “Aren't you distorting the truth? Where is your proof? Where is your evidence?”

When we attempt to provide it, we are interrogated about its legitimacy, told that we are biased or paranoid, and accused of being dishonest in how we present the facts. After all, they say, “Our nation is built upon life, liberty, and the pursuit of happiness. It was founded upon the principles of freedom, democracy, and equality.” Yet, these guiding principles seem intended for Whites only! In the classic book, Animal Farm (Orwell, 1945), when the issue of inequality arose, the character in a position of power justified the treatment by stating, “Some are more equal than others.” Rather than offer enlightenment and freedom, education and healing, and rather than allowing for equal access and opportunity, historical and current practices in our nation have restricted, stereotyped, damaged, and oppressed persons of color.

For too long people of color have not had the opportunity or power to express their points of view. For too long our voices have not been heard. For too long our worldviews have been diminished, negated, or considered invalid. For too long we have been told that our perceptions are incorrect, that most things are well with our society, and that our concerns and complaints are not supported. For too long we have had to justify our existence, and to fight for our dignity and humanity. No wonder that we are so tired, impatient, and angry. Yet, as people of color, we cannot let fatigue turn into hopelessness, nor anger into bitterness. Hopelessness is the forerunner to surrender, and bitterness leads to blind hatred. Either could spell our downfall!

(D. W. Sue, 2003, pp. 257–259)

Impact of Political Oppression

Multicultural counseling/therapy means understanding the worldviews and life experience of diverse groups in our nation. To be culturally competent means to understand the history of oppression experienced by marginalized groups in our society. The stories of discrimination and pain of the oppressed are often minimized and neglected. Many, for example, contend that the reality of racism, sexism, and homophobia is relatively unknown or ignored by those in power because of the discomfort that pervades such topics. Vernon E. Jordan, Jr., an African American attorney and former confidant of President Bill Clinton, made this point about racism in startling terms. In making an analogy between the terrorist attacks of September 11, 2001, and the racism directed at African Americans, Jordan stated:

None of this is new to Black people. War, hunger, disease, unemployment, deprivation, dehumanization, and terrorism define our existence. They are not new to us. Slavery was terrorism, segregation was terrorism, and the bombing of the four little girls in Sunday school in Birmingham was terrorism. The violent deaths of Medgar, Martin, Malcolm, Vernon Dahmer, Chaney, Shwerner, and Goodman were terrorism. And the difference between September 11 and the terror visited upon Black people is that on September 11, the terrorists were foreigners. When we were terrorized, it was by our neighbors. The terrorists were Americans. (Excerpted from a speech by Vernon E. Jordan, June 2002)

Likewise, in speaking about the history of psychological research conducted on ethnic minority communities by White social scientists, the late Charles W. Thomas (1970), a respected African American psychologist, voiced his concerns even more strongly:

White psychologists have raped Black communities all over the country. Yes, raped. They have used Black people as the human equivalent of rats run through Ph.D. experiments and as helpless clients for programs that serve middle-class White administrators better than they do the poor. They have used research on Black people as green stamps to trade for research grants. They have been vultures. (p. 52)

To many people of color, the “Tuskegee experiment” represents a prime example of the allegation by Thomas. The Tuskegee experiment was carried out from 1932 to 1972 by the U.S. Public Health Service; more than 600 Alabama Black men were used as guinea pigs in the study of what damage would occur to the body if syphilis were left untreated. Approximately 399 were allowed to go untreated, even when medication was available. Records indicate that 7 died as a result of syphilis, and an additional 154 died of heart disease that may have been caused by the untreated syphilis! In a moving ceremony in 1997, President Clinton officially expressed regret for the experiment to the few survivors and apologized to Black America.

Likewise, in August 2011, a White House bioethics panel heard about American-run venereal disease experiments conducted on Guatemalan prisoners, soldiers, and mental patients from 1946 to 1948: The United States paid for syphilis-infected Guatemalan prostitutes to have sex with prisoners. Approximately 5,500 Guatemalans were enrolled, 1,300 were deliberately infected, and 83 died (McNeil, 2011). The aim of the study was to see whether penicillin could prevent infection after exposure. When these experiments came to light, President Obama apologized to President Alvaro Colom of Guatemala. Dr. Amy Gutman, the chairwoman of the bioethics panel and president of the University of Pennsylvania, described the incident as a dark chapter in the history of medical research. Experiments of this type are ghastly and give rise to suspicions that people of color are being used as guinea pigs in other medical and social experiments as well.

Reflection and Discussion Questions

1. Are these beliefs by people of color accurate?

2. Aren't they simply exaggerations from overly mistrustful individuals?

3. Aren't people of color making a mountain out of a molehill?

4. As indicated in Chapter 1 , what might be emotional roadblocks you are now feeling? What meaning do you impute to them?

5. What has all this to do with counseling and psychotherapy?

Because the worldviews of culturally diverse clients are often linked to the historical and current experiences of oppression in the United States (American Psychological Association Presidential Task Force on Preventing Discrimination and Promoting Diversity 2012; Ponterotto, Utsey, & Pedersen, 2006), it is necessary to understand the worldview of culturally diverse clients from both a cultural and a political perspective (Ridley, 2005). Clients of color, for example, are likely to approach counseling and therapy with a great deal of healthy skepticism regarding the institutions from which therapists work and even the conscious and unconscious motives of the helping professional.

The main thesis of this book is that counseling and psychotherapy do not take place in a vacuum, isolated from the larger sociopolitical influences of our societal climate (Constantine, 2006; Katz, 1985; Liu, Hernandez, Mahmood, & Stinson, 2006). Counseling people of color, for example, often mirrors the nature of race relations in the wider society as well as the dominant-subordinate relationships of other marginalized groups (lesbian, gay, bisexual, and transgendered [LGBT] people; women; and the physically challenged). It serves as a microcosm, reflecting Black–White, Asian–White, Hispanic–White, and American Indian–White relations. But as we saw in Chapter 3 , it also mirrors interethnic/interracial relations as well.

We explore the many ways in which counseling and psychotherapy have failed with respect to providing culturally appropriate mental health services to disempowered groups in our society. We do this by using people of color as an example of the damaging oppressor–oppressed relationships that historically characterize many other marginalized groups. Many readers may have a very powerful negative reaction to the following material. However, only by honestly confronting these unpleasant social realities and accepting responsibility for changing them will our profession be able to advance and grow (D. W. Sue, 2010a; D. W. Sue, 2015). Jones (2010) cites an African proverb: “The true tale of the lion hunt will never be told as long as the hunter tells the story.” In other words, the story of racial, ethnic, and cultural groups (people of color) is largely a hunter's story (White Americans). To learn about the hunter (White Americans) and the hunt (balanced history), the story of the lion must be told regardless of how unpleasant.

The Education and Training of Counseling/Mental Health Professionals

While national interest in the mental health needs of people of color has increased, the human service professions have historically neglected this population. Evidence reveals that these groups, in addition to the common stresses experienced by everyone else, are more likely to encounter problems such as immigrant status, poverty, cultural racism, prejudice, and discrimination (Choudhuri, Santiago-Rivera, & Garrett, 2012; West-Olatunji & Conwill, 2011). Yet studies continue to reveal that American Indians, Asian Americans, African Americans, and Latino/Hispanic Americans tend to underutilize traditional mental health services in a variety of contexts (Kearney, Draper, & Baron, 2005; Owen, Imel, Adelson, & Rodolfa, 2012; Wang & Kim, 2010).

Some researchers have hypothesized that people of color underutilize and prematurely terminate counseling/therapy because of the biased nature of the services themselves (Kearney et al., 2005). The services offered are frequently antagonistic or inappropriate to the life experiences of culturally diverse clients; they lack sensitivity and understanding, and they are oppressive and discriminating toward clients of color (Cokley, 2006). Many believed that the presence of ill-prepared mental health professionals was the direct result of a culture-bound and biased training system (Mio, 2005; Utsey, Grange, & Allyne, 2006).

Most graduate programs continue to give inadequate treatment to the mental health issues of persons of color (Ponterotto & Austin, 2005; Utsey et al., 2006). Cultural influences affecting personality formation, career choice, educational development, and the manifestation of behavior disorders are infrequently part of mental health training or are treated in a tangential manner (Parham, Ajamu, & White, 2011; Vazquez & Garcia-Vazquez, 2003). When the experiences of socially devalued groups are discussed, they are generally seen and analyzed from the White, EuroAmerican, middle-class perspective. In programs where these experiences have been discussed, the focus tends to be on pathological lifestyles and/or maintenance of false stereotypes. The result is twofold: (a) professionals who deal with mental health problems of people of color lack understanding and knowledge about ethnic values and their consequent interaction with a racist society, and (b) mental health practitioners are graduated from our programs believing that persons of color are inherently pathological and that therapy involves a simple modification of traditional White models.

This ethnocentric bias has been highly destructive to the natural help-giving networks of ethnic/racial communities (Duran, 2006). Oftentimes mental health professionals operate under the assumption that groups of color never had such a thing as “counseling” and “psychotherapy” until it was “invented” and institutionalized in Western cultures. For the benefit of those people, the mental health movement has delegitimized natural help-giving networks that have operated for thousands of years by labeling them as unscientific, supernatural, mystical, and not consistent with “professional standards of practice.” Mental health professionals are then surprised to find that there is a high incidence of psychological distress in communities of color, that their treatment techniques do not work, and that some culturally diverse groups do not utilize their services.

Contrary to this ethnocentric orientation, we need to expand our perception of what constitutes valid mental health practices. Equally legitimate methods of treatment are nonformal or natural support systems (e.g., family, friends, community self-help programs, and occupational networks), folk-healing methods, and indigenous formal systems of therapy (Gone, 2010; Moodley & West, 2005). Instead of attempting to destroy these practices, we should be actively trying to find out why they may work better than Western forms of counseling and therapy (Trimble, 2010). We cover indigenous healing in Chapter 10 .

Definitions of Mental Health

Counseling and psychotherapy tend to assume universal (etic) applications of their concepts and goals to the exclusion of culture-specific (emic) views (Choudhuri et al., 2012). Likewise, graduate programs have often been accused of fostering cultural encapsulation, a term first coined by Wrenn (1962). The term refers specifically to (a) the substitution of modal stereotypes for the real world, (b) the disregarding of cultural variations in a dogmatic adherence to some universal notion of truth, and (c) the use of a technique-oriented definition of the counseling process. The results are that counselor roles are rigidly defined, implanting an implicit belief in a universal concept of “healthy” and “normal.”

If we look at criteria used by the mental health profession to judge normality and abnormality, this ethnocentricity becomes glaring. Several fundamental approaches that have particular relevance to our discussion have been identified (D. Sue, Sue, Sue, & Sue, 2016): (a) normality as a statistical concept, (b) normality as ideal mental health, and (c) abnormality as the presence of certain behaviors (research criteria).

Normality as a Statistical Concept

First, statistical criteria equate normality with those behaviors that occur most frequently in the population. Abnormality is defined in terms of those behaviors that occur least frequently. Despite the word statistical, however, these criteria need not be quantitative in nature: Individuals who talk to themselves, disrobe in public, or laugh uncontrollably for no apparent reason are considered abnormal according to these criteria simply because most people do not behave in that way. Statistical criteria undergird our notion of a normal probability curve, so often used in IQ tests, achievement tests, and personality inventories. Statistical criteria may seem adequate in specific instances, but they are fraught with hazards and problems. For one thing, they fail to take into account differences in time, community standards, and cultural values. If deviations from the majority are considered abnormal, then many ethnic and racial minorities that exhibit strong cultural differences from the majority have to be so classified. When we resort to a statistical definition, it is generally the group in power that determines what constitutes normality and abnormality. For example, if African Americans were to be administered a personality test and it was found that they were more suspicious than their White counterparts, what would this mean?

Some psychologists and educators have used such findings to label African Americans as paranoid. Statements by Blacks that “The Man” is out to get them may be perceived as supporting a paranoid delusion. This interpretation, however, has been challenged by many Black psychologists as being inaccurate (Grier & Cobbs, 1968, 1971; Parham et al., 2011). In response to their heritage of slavery and a history of White discrimination against them, African Americans have adopted various behaviors (in particular, behaviors toward Whites) that have proved important for survival in a racist society. “Playing it cool” has been identified as one means by which Blacks, as well as members of other groups of color, may conceal their true thoughts and feelings. A Black person who is experiencing conflict, anger, or even rage may be skillful at appearing serene and composed. This tactic is a survival mechanism aimed at reducing one's vulnerability to harm and to exploitation in a hostile environment.

Personality tests that reveal Blacks as being suspicious, mistrustful, and paranoid need to be understood from a larger sociopolitical perspective. Marginalized groups who have consistently been victims of discrimination and oppression in a culture that is full of racism have good reason to be suspicious and mistrustful of White society. In their classic book Black Rage, Grier and Cobbs (1968) point out how Blacks, in order to survive in a White racist society, have developed a highly functional survival mechanism to protect them against possible physical and psychological harm. The authors perceive this “cultural paranoia” as adaptive and healthy rather than dysfunctional and pathological. Indeed, some psychologists of color have indicated that the absence of a paranorm (healthy suspiciousness and vigilance of others' motives) among people of color may be more indicative of pathology than its presence. The absence of a paranorm may indicate either poor reality testing (denial of oppression/racism in our society) or naiveté in understanding the operation of racism.

Normality as Ideal Mental Health

Second, humanistic psychologists have proposed the concept of ideal mental health as the criteria of normality (Cain, 2010). Such criteria stress the importance of attaining some positive goal like consciousness-insight, self-actualization/creativity, competence, autonomy, resistance to stress, and psychological mindedness. The biased nature of such approaches is grounded in the belief in a universal application (all populations in all situations) and reveals a failure to recognize the value base from which the criteria are derived. The particular goal or ideal used is intimately linked with the theoretical frame of reference and values held by the practitioner (psychodynamic, humanistic/existential, or cognitive/behavioral). For example, the psychoanalytic emphasis on insight as a determinant of mental health is a value in itself (London, 1988).

It is important for the mental health professional to be aware, however, that certain socioeconomic groups and people of color may not particularly value insight. Furthermore, the use of self-disclosure as a measure of mental health tends to neglect the earlier discussion presented on the paranorm. One characteristic often linked to the healthy personality is the ability to talk about the deepest and most intimate aspects of one's life: to self-disclose. This orientation is very characteristic of our counseling and therapy process, in which clients are expected to talk about themselves in a very personal manner. The fact that many people of color are initially reluctant to self-disclose can place them in a situation where they are judged to be mentally unhealthy and, in this case, paranoid (Parham, 2002).

Definitions of mental health such as competence, autonomy, and resistance to stress are related to White middle-class notions of individual maturity (Ahuvia, 2001; Triandis, 2000). The mental health professions originated from the ideological milieu of individualism (Ivey, D'Andrea, Ivey, & Simek-Morgan, 2007). Individuals make their lot in life. Those who succeed in society do so because of their own efforts and abilities. Successful people are seen as mature, independent, and possessing great ego strength. Apart from the potential bias in defining what constitutes competence, autonomy, and resistance to stress, the use of such a person-focused definition of maturity places the responsibility on the individual. When people fail in life, it is because of their own lack of ability, interest, or maturity, or some inherent weakness of the ego. If, on the other hand, we see minorities as being subjected to higher stress factors in society and placed in a one-down position by virtue of racism, then it becomes quite clear that the definition will tend to portray the lifestyle of minorities as inferior, underdeveloped, and deficient. Ryan (1971) was the first to coin the phrase “blaming the victim” to refer to this process. Hence a broader system analysis would show that the economic, social, and psychological conditions of people of color are related to their oppressed status in America.

Abnormality as the Presence of Certain Behaviors

Third, an alternative to the previous two definitions of abnormality is a research one. For example, in determining rates of mental illness in different ethnic groups, “psychiatric diagnosis,” “presence in mental hospitals,” and scores on “objective psychological inventories” are frequently used (D. Sue et al., 2016). Diagnosis and hospitalization present a circular problem. The definition of normality/abnormality depends on what mental health practitioners say it is! In this case, the race or ethnicity of mental health professionals is likely to be different from that of clients of color. Bias on the part of the practitioner with respect to diagnosis and treatment is likely to occur (Constantine, Myers, Kindaichi, & Moore, 2004). The inescapable conclusion is that clients of color tend to be diagnosed differently and to receive less preferred modes of treatment (Paniagua, 2005).

Furthermore, the political and societal implications of psychiatric diagnosis and hospitalization were forcefully pointed out nearly 40 years ago by Laing (1967, 1969) and Szasz (1970, 1971). Although it appears that minorities underutilize outpatient services, they also appear to face greater levels of involuntary hospital commitments (Snowden & Cheung, 1990). Laing believes that individual madness is but a reflection of the madness of society. He describes schizophrenic breakdowns as desperate strategies by people to liberate themselves from a “false self” used to maintain behavioral normality in our society. Attempts to adjust the person back to the original normality (sick society) are unethical. Szasz states this opinion even more strongly:

In my opinion, mental illness is a myth. People we label “mentally ill” are not sick, and involuntary mental hospitalization is not treatment. It is punishment. . . . The fact that mental illness designates a deviation from an ethnical rule of conduct, and that such rules vary widely, explains why upper-middle-class psychiatrists can so easily find evidence of “mental illness” in lower-class individuals and why so many prominent persons in the past fifty years or so have been diagnosed by their enemies as suffering from some types of insanity. Barry Goldwater was called a paranoid schizophrenic. . . . Woodrow Wilson, a neurotic. . . . Jesus Christ, according to two psychiatrists. . .was a born degenerate with a fixed delusion system. (1970, pp. 167–168)

Szasz (1987, 1999) views the mental health professional as an inquisitor, an agent of society exerting social control over those individuals who deviate in thought and behavior from the accepted norms of society. Psychiatric hospitalization is believed to be a form of social control for persons who annoy or disturb us. The label mental illness may be seen as a political ploy used to control those who are different, and therapy is used to control, brainwash, or reorient the identified victims to fit into society. It is exactly this concept that many people of color find frightening. For example, many Asian Americans, American Indians, African Americans, and Hispanic/Latino Americans are increasingly challenging the concepts of normality and abnormality. They believe that their values and lifestyles are often seen by society as pathological and thus are unfairly discriminated against by the mental health professions (Constantine, 2006).

In addition, the use of “objective” psychological inventories as indicators of maladjustment may also place people of color at a disadvantage. Many are aware that the test instruments used on them have been constructed and standardized according to White middle-class norms. The lack of culturally unbiased instruments makes many feel that the results obtained are invalid. Indeed, in a landmark decision in the State of California (Larry P. v. California, 1986), a judge ruled in favor of the Association of Black Psychologists' claim that individual intelligence tests, such as versions of the WISC, WAIS, and Stanford Binet, could not be used in the public schools on Black students. The improper use of such instruments can lead to an exclusion of minorities from jobs and promotion, to discriminatory educational decisions, and to biased determination of what constitutes pathology and cure in counseling/therapy (Samuda, 1998).

Further, when a diagnosis becomes a label, it can have serious consequences. First, a label can cause people to interpret all activities of the affected individual as pathological. No matter what African Americans may do or say that breaks a stereotype, their behaviors will seem to reflect the fact that they are less intelligent than others around them. Second, the label may cause others to treat individuals differently, even when they are perfectly normal. Third, a label may cause those who are labeled to believe that they do indeed possess such characteristics (Rosenthal & Jacobson, 1968) or that the threats of being perceived as less capable can seriously impair their performance (Steele, 2003).

Curriculum and Training Deficiencies

It appears that many of the universal definitions of mental health that have pervaded the profession have primarily been due to severe deficiencies in training programs. Educators (Chen, 2005; Mio & Morris, 1990; D. W. Sue, 2010b) have asserted that the major reason for ineffectiveness in working with culturally diverse populations is the lack of culturally sensitive material taught in the curricula. It has been ethnocentrically assumed that the material taught in traditional mental health programs is equally applicable to all groups. Even now, when there is high recognition of the need for multicultural curricula, it has become a battle to infuse such concepts into course content (Vera, Buhin, & Shin, 2006). As a result, course offerings continue to lack a non-White perspective, to treat cultural issues as an adjunct or add-on, to portray cultural groups in stereotypic ways, and to create an academic environment that does not support their concerns, needs, and issues (Turner, Gonzalez, & Wood, 2008).

Further, a major criticism has been that training programs purposely leave out antiracism, antisexism, and antihomophobia curricula for fear of requiring students to explore their own biases and prejudices (Carter, 2005; Vera et al., 2006). Because multicultural competence cannot occur without students or trainees confronting these harmful and detrimental attitudes about race, gender, and sexual orientation, the education and training of psychologists remain at the cognitive and objective domain, preventing self-exploration (D. W. Sue, 2015). This allows students to study the material from their positions of safety. An effective curriculum must enable students to understand feelings of helplessness and powerlessness, low self-esteem, and poor self-concept and how they contribute to low motivation, frustration, hate, ambivalence, and apathy. Each course should contain (a) a consciousness-raising component, (b) an affective/experiential component, (c) a knowledge component, and (d) a skills component. Importantly, the American Psychological Association (2006) recommended that psychology training programs at all levels provide information on the political nature of the practice of psychology and that professionals need to “own” their value positions.

Counseling and Mental Health Literature

Many psychologists have noted how the social science literature, and specifically research, has failed to create a realistic understanding of various ethnic groups in America (Cokley, 2006; Guthrie, 1997). In fact, certain practices are felt to have done great harm to persons of color by ignoring them, maintaining false stereotypes, and/or presenting a distorted view of their lifestyles. Mental health practice may be viewed as encompassing the use of social power and functioning as a handmaiden of the status quo (Halleck, 1971; Katz, 1985). Social sciences are part of a culture-bound social system, from which researchers are usually drawn; moreover, organized social science is often dependent on the status quo for financial support. People of color frequently see the mental health profession in a similar way—as a discipline concerned with maintaining the status quo (Ponterotto, Utsey, & Pedersen, 2006). As a result, the person collecting and reporting data is often perceived as possessing the social bias of his or her society (Ridley, 2005).

Social sciences, for example, have historically ignored the study of Asians in America (Hong & Domokos-Cheng Ham, 2001; Nadal, 2011). This deficit has contributed to the perpetuation of false stereotypes, which has angered many younger Asians concerned with raising consciousness and group esteem. When studies have been conducted on people of color, research has been appallingly unbalanced. Many social scientists (Cokley, 2006; Jones, 2010) have pointed out how “White social science” has tended to reinforce a negative view of African Americans among the public by concentrating on unstable Black families instead of on the many stable ones. Such unfair treatment has also been the case in studies on Latinos that have focused on the psychopathological problems encountered by Mexican Americans (Falicov, 2005). Other ethnic groups, such as Native Americans (Sutton & Broken Nose, 2005) and Puerto Ricans (Garcia-Preto, 2005), have fared no better. Even more disturbing is the assumption that the problems encountered by people of color are due to intrinsic factors (racial inferiority, incompatible value systems, etc.) rather than to the failure of society (D. W. Sue, 2003). Although there are many aspects of how persons of color are portrayed in social science literature, two seem crucial for us to explore: (a) people of color and pathology and (b) the role of scientific racism in research.

Pathology and Persons of Color

When we seriously study the “scientific” literature of the past relating to people of color, we are immediately impressed with how an implicit equation of them with pathology is a common theme. The historical use of science in the investigation of racial differences seems to be linked with White supremacist notions (Jones, 1997, 2010). The classic work of Thomas and Sillen (1972) refers to this as scientific racism and cites several historical examples to support their contention:

· Census figures (fabricated) from 1840 were used to support the notion that Blacks living under unnatural conditions of freedom were prone to anxiety.

· Influential medical journals presented fantasies as facts, supporting the belief that anatomical, neurological, or endocrinological aspects of Blacks were always inferior to those of Whites.

· The following misconceptions were presented as facts:

· Mental health for Blacks was contentment with subservience.

· Psychologically normal Blacks were faithful and happy-go-lucky.

· Black persons' brains were smaller and less developed.

· Blacks were less prone to mental illness because their minds were so simple.

· The dreams of Blacks were juvenile in character and not as complex as those of Whites.

More frightening, perhaps, is a survey that found that many of these stereotypes continue to be accepted by White Americans: 20% publicly expressed a belief that African Americans are innately inferior in thinking ability, 19% believe that Blacks have thicker craniums, 23.5% believe they have longer arms than Whites, 50% believe Blacks have achieved equality, and 30% believe problems of Blacks reside in their own group (Astor, 1997; Babbington; 2008; Pew Research Center, 2007; Plous & Williams, 1995). One wonders how many White Americans hold similar beliefs privately but because of social pressures do not publicly voice them.

Furthermore, the belief that various human groups exist at different stages of biological evolution was accepted by G. Stanley Hall. He stated explicitly in 1904 that Africans, Indians, and Chinese were members of adolescent races and in a stage of incomplete development. In most cases, the evidence used to support these conclusions was fabricated, extremely flimsy, or distorted to fit the belief in non-White inferiority (A. Thomas & Sillen, 1972). For example, Gossett (1963) reports that when one particular study in 1895 revealed that the sensory perception of Native Americans was superior to that of Blacks and that of Blacks was superior to that of Whites, the results were used to support a belief in the mental superiority of Whites: “Their reactions were slower because they belonged to a more deliberate and reflective race than did the members of the other two groups” (p. 364). The belief that Blacks are “born athletes,” as opposed to scientists or statesmen, derives from this tradition. The fact that Hall was a well-respected psychologist, often referred to as “the father of child psychology,” and first president of the American Psychological Association did not prevent him from inheriting the racial biases of the times.

The Genetically Deficient Model

The portrayal of people of color in literature has generally taken the form of stereotyping them as deficient in certain desirable attributes. For example, de Gobineau's (1915) The Inequality of the Human Races and Darwin's (1859) On the Origin of Species by Natural Selection were used to support the belief in the genetic intellectual superiority of Whites and the genetic inferiority of the “lower races.” Galton (1869) wrote explicitly that African “Negroes” were “half-witted men” who made “childish, stupid, and simpleton-like mistakes,” while Jews were inferior physically and mentally and only designed for a parasitical existence on other nations of people. Terman (1916), using the Binet scales in testing Black, Mexican American, and Spanish Indian families, concluded that they were uneducable.

The genetically deficient model is present in the writings of educational psychologists and academicians. In 1989, Professor Rushton of the University of Western Ontario claimed that human intelligence and behavior were largely determined by race, that Whites have bigger brains than Blacks, and that Blacks are more aggressive (Samuda, 1998). Shockley (1972) has expressed fears that the accumulation of weak or low intelligence genes in the Black population will seriously affect overall intelligence. Thus he advocates that people with low IQs should not be allowed to bear children—they should be sterilized. Allegations of scientific racism can also be seen in the work of Cyril Burt, eminent British psychologist, who fabricated data to support his contention that intelligence is inherited and that Blacks have inherited inferior brains. Such an accusation is immensely important when one considers that Burt is a major influence in American and British psychology, is considered by many to be the father of educational psychology, was the first psychologist to be knighted, and was awarded the American Psychological Association's Thorndike Prize, and that his research findings form the foundation for the belief that intelligence is inherited.

A belief that race and gender dictate intelligence continues to be expressed in modern times and even by our most educated populace. In 2005, then–Harvard President Larry Summers (former director of President Obama's National Economic Council) suggested that innate differences between the sexes might help explain why relatively few women become professional scientists or engineers. His comments set off a furor, with demands that he be fired. Women academicians were reported to have stormed out of the conference in disgust as Summers used “innate ability” as a possible explanation for sex differences in test scores. Ironically, Summers was lecturing to a room of the most accomplished women scholars in engineering and science in the nation.

The questions about whether there are differences in intelligence between races are both complex and emotional. The difficulty in clarifying these questions is compounded by many factors. Besides the difficulty in defining race, questionable assumptions exist regarding whether research on the intelligence of Whites can be generalized to other groups, whether middle-class and lower-class ethnic minorities grow up in environments similar to those of middle- and lower-class Whites, and whether test instruments are valid for both minority and White subjects. More important, we should recognize that the average values of different populations tell us nothing about any one individual. Heritability is a function of the population, not a trait. Ethnic groups all have individuals in the full range of intelligence, and to think of any racial group in terms of a single stereotype goes against all we know about the mechanics of heredity. Yet much of social science literature continues to portray people of color as being genetically deficient in one sense or another.

The Culturally Deficient Model

Well-meaning social scientists who challenged the genetic deficit model by placing heavy reliance on environmental factors nevertheless tended to perpetuate a view that saw people of color as culturally disadvantaged, deficient, or deprived. Instead of a biological condition that caused differences, the blame now shifted to the lifestyles or values of various ethnic groups. The term cultural deprivation was first popularized by Riessman's widely read book, The Culturally Deprived Child (1962). It was used to indicate that many groups perform poorly on tests or exhibit deviant characteristics because they lack many of the advantages of middle-class culture (education, books, toys, formal language, etc.). In essence, these groups were culturally impoverished!

While Riessman was well-intentioned in trying to not attribute blame to “genes” and intended to improve the condition of African Americans in America, some educators strenuously objected to the term. First, the term culturally deprived means to lack a cultural background (e.g., enslaved Blacks arrived in America culturally naked), which is incongruous, because everyone inherits a culture. Second, such terms cause conceptual and theoretical confusions that may adversely affect social planning, educational policy, and research; for example, the oft-quoted Moynihan Report (Moynihan, 1965) asserts that “at the heart of deterioration of the Negro society is the deterioration of the Black family. It is the fundamental source of the weakness in the Negro community” (p. 5). Action was thus directed toward infusing White concepts of the family into those of Blacks. Third, cultural deprivation is used synonymously with deviation from and superiority of White middle-class values. Fourth, these deviations in values become equated with pathology, in which a group's cultural values, families, or lifestyles transmit the pathology. Thus the term “cultural deprivation” provides a convenient rationalization and alibi for the perpetuation of racism and the inequities of the socioeconomic system.

The Culturally Diverse Model

Many now maintain that the culturally deficient model serves only to perpetuate the myth of people of color inferiority. The focus tends to be one of blaming the person, with an emphasis on pathology and a use of White middle-class definitions of desirable and undesirable behavior. The social science use of a common, standard assumption implies that to be different is to be deviant, pathological, or sick. Is it possible that intelligence and personality scores for minority children really measure how Anglicized a child has become? To arrive at a more accurate understanding, people of color should no longer be viewed as deficient, but rather as culturally diverse. The goal of society should be to recognize the legitimacy of alternative lifestyles, the advantages of being bicultural (capable of functioning in two different cultural environments), and the value of differences.

Reflection and Discussion Questions

1. What reactions are you experiencing in learning that the history of the mental health movement was filled with racist formulations? As a White trainee, what thoughts and feelings are you experiencing? As a trainee of color (or a member of a marginalized group), what thoughts and feelings do you have?

2. Go back to Chapter 1 and reread the reactions to this book. Do the reactions in that chapter provide insights about your own thoughts and feelings?

3. Given the preceding discussion, in what ways may counseling and psychotherapy represent instruments of cultural oppression? How is this possibly reflected in definitions of normality and abnormality, the goals you have for therapy, and the way you conduct your practice with marginalized groups in our society?

The Need to Treat Social Problems—Social Justice Counseling

Case Study

Daryl

Daryl Cokely (a pseudonym) is a 12-year-old African American student attending a predominantly White grade school in Santa Barbara, California. He was referred for counseling by his homeroom teacher because of “constant fighting” on the school grounds, inability to control his anger, and exhibiting “a potential to seriously injure others.” In addition, his teachers reported that Daryl was doing poorly in class and was inattentive, argumentative toward authority figures, and disrespectful. He appeared withdrawn in his classroom and seldom participated, but when Daryl spoke, he was “loud and aggressive.” Teachers would often admonish Daryl “to calm down.”

The most recent problematic incident, an especially violent one, required the assistant principal to physically pull Daryl away to prevent him from seriously injuring a fellow student. He was suspended from school for 3 days and subsequently referred to the school psychologist, who conducted a psychological evaluation. Daryl was diagnosed with a conduct disorder, and the psychologist recommended immediate counseling to prevent the untreated disorder from leading to more serious antisocial behaviors. He worried that Daryl was on his way to developing an antisocial personality disorder. The recommended course of treatment consisted of medication and therapy aimed at eliminating Daryl's aggressive behaviors and “controlling his underlying hostility and anger.”

Daryl's parents, however, objected strenuously to the school psychologist's diagnosis and treatment recommendations. They described their son as a “normal child” when at home and not a behavior problem before moving from Los Angeles to Santa Barbara. They described him as feeling isolated, having few friends, being rejected by classmates, feeling invalidated by teachers, and feeling “removed” from the content of his classes. They also noted that all of the “fights” were generally instigated through “baiting” and “name-calling” by his White classmates, that the school climate was hostile toward their son, that the curriculum was very Eurocentric, and that school personnel and teachers seemed naive about racial or multicultural issues. They hinted strongly that racism was at work in the school district and enlisted the aid of the only Black counselor in the school, Ms. Jones. Although Ms. Jones seemed to be understanding and empathic toward Daryl's plight, she seemed reluctant to intercede on behalf of the parents. Being a recent graduate from the local college, Ms. Jones feared being ostracized by other school personnel.

The concerns of Daryl's parents were quickly dismissed by school officials as having little validity. In fact, the principal was quite incensed by these “accusatory statements of possible racism.” He indicated to the parents that “your people” do not have a history of academic pursuit and that discipline in the home was usually the culprit. School officials contended that Daryl needed to be more accommodating, to reach out and make friends rather than isolating himself, to take a more active interest in his schoolwork, and to become a good citizen. Further, they asserted that it was not the school climate that was hostile, but that Daryl needed to “learn to fit in.” “We treat everyone the same, regardless of race. This school doesn't discriminate,” stated the principal. He went on to say, “Perhaps it was a mistake to move to Santa Barbara. For the sake of your son, you should consider returning to L.A. so he can better fit in with his people.” These statements greatly angered Daryl's parents.

Adapted from D. W. Sue & Constantine, 2003, pp. 214–215.

If you were a counselor, how would you address this case? Where would you focus your energies? Traditional clinical approaches would direct their attention to what they perceive as the locus of the problem—Daryl and his aggressive behavior with classmates, his inattentiveness in class, and his disrespect of authority figures. This approach, however, makes several assumptions: (a) that the locus of the problem resides in the person, (b) that behaviors that violate socially accepted norms are considered maladaptive or disordered, (c) that remediation or elimination of problem behaviors is the goal, (d) that the social context or status quo guides the determination of normal versus abnormal and healthy versus unhealthy behaviors, and (e) that the appropriate role for the counselor is to help the client “fit in” and become “a good citizen.”

But as we have just seen, mental health assumptions and practices are strongly influenced by sociopolitical factors. An enlightened approach that acknowledges potential oppression in the manifestation, diagnosis, etiology, and treatment is best accomplished by taking a social justice approach (Flores et al, 2014; McAuliffe & Associates, 2013). In the new proposed ACA Multicultural and Social Justice Counseling Competencies (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015), a strong case is made that multiculturalism is intimately related to social justice and counselors must engage in actions that require both individual- and systems-level work. Such an approach might mean challenging the traditional assumptions of therapy and even reversing them as follows:

1. The locus of the problem may reside in the social system (other students, hostile campus environment, alienating curriculum, lack of minority teachers/staff/students, etc.) rather than in the individual.

2. Behaviors that violate social norms may not be disordered or unhealthy.

3. The social norms, prevailing beliefs, and institutional policies and practices that maintain the status quo may need to be challenged and changed.

4. Although remediation is important, the more effective long-term solution is prevention.

5. Organizational change requires a macrosystems approach involving other roles and skills beyond the traditional clinical ones.

Along with these five assumptions, implementing social justice counseling means recognition that interventions can occur at four different foci, as illustrated in Figure 4.1 on page 129. A basic premise of social justice counseling is that culturally competent helping professionals must not confine their perspectives to just individual treatment but must be able to intervene effectively at the professional, organizational, and societal levels as well.

The Foci of Counseling Interventions: Individual, Professional, Organizational, and Societal

Focus 1: Individual

To provide culturally effective and sensitive counseling/mental health services, helping clients acquire changes in personal beliefs, attitudes, emotions, and behaviors has always been a major goal in counseling and therapy. This is especially true when attempting to help clients achieve new insights and to have them acquire new and adaptive behaviors. Most traditional forms of counseling and psychotherapy fall within this category.

Focus 2: Professional

It is clear that our profession has developed from a Western European perspective. As a result, how we define psychology (the study of mind and behavior) may be biased and at odds with different cultural groups. Further, if the professional standards and codes of ethics in mental health practice are culture bound, then they must be changed to reflect a multicultural worldview. As we will see in future chapters, oftentimes it is these professional codes of conduct that require change in order to help a diverse population.

Focus 3: Organizational

Since clients often work for and are influenced by organizations, it is important to realize that institutional practices, policies, programs, and structures may, especially if they are monocultural, be oppressive to certain groups. If organizational policies and practices deny equal access and opportunity for different groups or oppress them (redlining in home mortgages, laws against domestic partners, inequitable mental health care, etc.), then those policies and practices should become the targets for change. In other words, the causes of disorders may not reside in the individual, but in systems of organizational oppression.

Focus 4: Societal

If social policies (racial profiling, misinformation in educational materials, inequities in health care, etc.) are detrimental to the mental and physical health of minority groups, for example, does not the mental health professional have a responsibility to advocate for change? Our answer, of course, is affirmative.

* * *

Often, psychologists treat individuals who are the victims of failed systemic processes. Intervention at the individual level is primarily remedial when a strong need exists for preventive measures. Because psychology concentrates primarily on the individual, it has been deficient in developing more systemic and large-scale change strategies. Using the case of Daryl, let us illustrate some social justice principles as they apply to multicultural counseling.

Principle 1: A Failure to Develop a Balanced Perspective between Person and System Focus Can Result in False Attribution of the Problem.

It is apparent that school officials have attributed the locus of the problem—that he is impulsive, angry, inattentive, unmotivated, disrespectful, and a poor student—to reside in Daryl. He is labeled as having a conduct disorder with potential antisocial personality traits. Diagnosis of the problem is internal; that is, it resides in Daryl. When the focus of therapy is primarily on the individual, there is a strong tendency to see the locus of the problem as residing solely in the person (Cosgrove, 2006; Ratts & Pedersen, 2014) rather than in the school system, curriculum, or wider campus community. As a result, well-intentioned counselors may mistakenly blame the victim (e.g., by seeing the problem as a deficiency of the person) when, in actuality, the problem may reside in the environment (prejudice, discrimination, racial/cultural invalidation, etc.) (Metzl & Hansen, 2014).

Figure 4.1 Levels of Counseling Interventions

We would submit that it is highly probable that Daryl is the victim of (a) a monocultural educational environment that alienates and denigrates him (Davidson, Waldo, & Adams, 2006); (b) a curriculum that does not deal with the contributions of African Americans or portrays them in a demeaning fashion; (c) teaching styles that may be culturally biased (Cokley, 2006); (d) a campus climate that is hostile to minority students (perceives them as less qualified) (D. W. Sue et al., 2011); (e) support services (counseling, study skills, etc.) that fail to understand the minority student experience; and (f) the lack of role models (presence of only one Black teacher in the school) (Alexander & Moore, 2008). For example, would it change your analysis and focus of intervention if Daryl gets into fights because he is teased mercilessly by fellow students who use racial slurs (nigger, jungle bunny, burr head, etc.)? In other words, suppose there is good reason that this 12-year-old feels isolated, rejected, devalued, and misunderstood.

Principle 2: A Failure to Develop a Balanced Perspective between Person and System Focus Can Result in an Ineffective and Inaccurate Treatment Plan Potentially Harmful to the Client.

Failure to understand how systemic factors contribute to individual behavior can result in an ineffective and inaccurate treatment plan; the treatment itself may be potentially harmful (Ali & Sichel, 2014). A basic premise of a broad ecological approach is the assumption that person–environment interactions are crucial to diagnosing and treating problems (J. Goodman, 2009; L. A. Goodman et al., 2004). Clients, for example, are not viewed as isolated units but as embedded in their families, social groups, communities, institutions, cultures, and major systems of our society (Vera & Speight, 2003). Behavior is always a function of the interactions or transactions that occur between and among the many systems that comprise the life of the person. For example, a micro level of analysis (the individual) may lead to one treatment plan, whereas a macro analysis (the social system) would lead to another (Toporek & Worthington, 2014). In other words, how a helping professional defines the problem affects the treatment focus and plan. If Daryl's problems are due to internal and intrapsychic dynamics, then it makes sense that therapy be directed toward changing the individual. The fighting behavior is perceived as dysfunctional and should be eliminated through Daryl's learning to control his anger or through medication that may correct his internal biological dysfunction.

But what if the problem is external? Will having Daryl stop his fighting behavior result in the elimination of teasing from White classmates? Will it make him more connected to the campus? Will it make him feel more valued and accepted? Will he relate more to the content of courses that denigrate the contributions of African Americans? Treating the symptoms or eliminating fighting behavior may actually make Daryl more vulnerable to racism.

Principle 3: When the Client Is an Organization or a Larger System and Not an Individual, a Major Paradigm Shift Is Required to Attain a True Understanding of Problem and Solution Identification.

Let us assume that Daryl is getting into fights because of the hostile school climate and the invalidating nature of his educational experience. Given this assumption, we ask the question “Who is the client?” Is it Daryl or the school? Where should we direct our therapeutic interventions? In his analysis of schizophrenia, R. D. Laing (1969), an existential psychiatrist, once asked the following question: “Is schizophrenia a sick response to a healthy situation, or is it a healthy response to a sick situation?” In other words, if it is the school system that is dysfunctional (sick) and not the individual client, do we or should we adjust that person to a sick situation? In this case, do we focus on stopping the fighting behavior? Or if we view the fighting behavior as a healthy response to a sick situation, then eliminating the unhealthy situation (teasing, insensitive administrators and teachers, monocultural curriculum, etc.) should receive top priority for change (Lee, 2007). In other words, rather than individual therapy, social therapy may be the most appropriate and effective means of intervention. Yet mental health professionals are ill-equipped and untrained as social change agents (Ali & Sichel, 2014; Lopez-Baez & Paylo, 2009).

Principle 4: Organizations Are Microcosms of the Wider Society from Which They Originate. As a Result, They Are Likely to Be Reflections of the Monocultural Values and Practices of the Larger Culture.

As we have repeatedly emphasized, we are all products of our cultural conditioning and inherit the biases of the larger society (D. W. Sue, 2015). Likewise, organizations are microcosms of the wider society from which they originate. As a result, they are likely to be reflections of the monocultural values and practices of the larger culture. In this case, it is not far-fetched to assume that White students, helping professionals, and educators may have inherited the racial biases of their forebears. Further, multicultural education specialists have decried the biased nature of the traditional curriculum. Although education is supposed to liberate and convey truth and knowledge, we have seen how it has oftentimes been the culprit in perpetuating false stereotypes and misinformation about various groups in our society. It has done this, perhaps not intentionally, but through omission, fabrication, distortion, or selective emphasis of information, designed to enhance the contributions of certain groups over others (Cokley, 2006). The result is that institutions of learning become sites that perpetuate myths and inaccuracies about certain groups in society, with devastating consequences to students of color. Further, policies and practices that claim to “treat everyone the same” may themselves be culturally biased. If this is the institutional context from which Daryl is receiving his education, little wonder that he exhibits so-called problem behaviors. Again, the focus of change must be directed at the institutional level.

Principle 5: Organizations Are Powerful Entities That Inevitably Resist Change and Possess Many Ways to Force Compliance among Workers. Going against the Policies, Practices, and Procedures of the Institution, for Example, Can Bring about Major Punitive Actions.

Let us look at the situation of Ms. Jones, the Black teacher. There are indications in this case that she understands that Daryl may be the victim of racism and a monocultural education that invalidates him. If she is aware of this factor, why is she so reluctant to act on behalf of Daryl and his parents? First, it is highly probable that, even if she is aware of the true problem, she lacks the knowledge, expertise, and skill to intervene on a systemic level. Second, institutions have many avenues open to them, which can be used to force compliance on the part of employees. Voicing an alternative opinion against prevailing beliefs can result in ostracism by fellow workers, a poor job performance rating, denial of a promotion, or even an eventual firing (D. W. Sue et al., 2011). This creates a very strong ethical dilemma for mental health workers or educators when the needs of their clients differ from those of the organization or employer. The fact that counselors' livelihoods depend on the employing agency (school district) creates additional pressures to conform. How do counselors handle such conflicts? Organizational knowledge and skills become a necessity if the therapist is to be truly effective (Toporek, Lewis, & Crethar, 2009). So even the most enlightened educators and counselors may find their good intentions thwarted by their lack of systems intervention skills and their fears of punitive actions.

Principle 6: When Multicultural Organizational Development Is Required, Alternative Helping Roles That Emphasize Systems Intervention and Advocacy Skills Must Be Part of the Repertoire of the Mental Health Professional.

Alternative helping roles that emphasize systems intervention must be part of the repertoire of the mental health professional. Because the traditional counseling/ therapy roles focus on one-to-one or small-group relationships, they may not be productive when dealing with larger ecological and systemic issues. Competence in changing organizational policies, practices, procedures, and structures within institutions requires a different set of knowledge and skills that are more action oriented. Among them, consultation and advocacy become crucial in helping institutions move from a monocultural to a multicultural orientation (Davidson et al., 2006). Daryl's school and the school district need a thorough cultural audit, institutional change in the campus climate, sensitivity training for all school personnel, increased racial/ethnic personnel at all levels of the school, revamping of the curriculum to be more multicultural, and so on. This is a major task that requires multicultural awareness, knowledge, and skills on the part of the mental health professional.

Principle 7: Although Remediation Will Always Be Needed, Prevention Is Better.

Conventional practice at the micro level continues to be oriented toward remediation rather than prevention. Although no one would deny the important effects of biological and internal psychological factors on personal problems, more research now acknowledges the importance of sociocultural factors (inadequate or biased education, poor socialization practices, biased values, and discriminatory institutional policies) in creating many of the difficulties encountered by individuals (Flores et al., 2014). As therapists, we are frequently placed in a position of treating clients who represent the aftermath of failed and oppressive policies and practices. We have been trapped in the role of remediation (attempting to help clients once they have been damaged by sociocultural biases). Although treating troubled clients (remediation) is a necessity, our task would be an endless and losing venture unless the true sources of the problem (stereotypes, prejudice, discrimination, and oppression) are changed. Would it not make more sense to take a proactive and preventive approach by attacking the cultural and institutional bases of the problem?

Reflection and Discussion Questions

1. Exactly how do organizational policies and practices oppress?

2. What do you need to know in order to effectively be a social-change agent?

3. Is organizational change difficult?

4. If individual counseling/therapy is ineffective in systems intervention, what alternative roles would you need to play?

Social Justice Counseling

The case of Daryl demonstrates strongly the need for a social justice orientation to counseling and therapy (Neville, 2015). Indeed, multicultural counseling/therapy competence is intimately linked to the values of social justice (Koch & Juntunen, 2014; Ratts et al., 2015). If mental health practice is concerned with bettering the life circumstances of individuals, families, groups, and communities in our society, then social justice is the overarching umbrella that guides our profession. The welfare of a democratic society very much depends on equal access and opportunity, fair distribution of power and resources, and empowering individuals and groups with a right to determine their own lives (Ratts & Hutchins, 2009). J. M. Smith (2003) defines a socially just world as having access to

adequate food, sleep, wages, education, safety, opportunity, institutional support, health care, child care, and loving relationships. “Adequate” means enough to allow [participation] in the world. . .without starving, or feeling economically trapped or uncompensated, continually exploited, terrorized, devalued, battered, chronically exhausted, or virtually enslaved (and for some reason, still, actually enslaved). (p. 167)

Bell (1997) states that the goal of social justice is

full and equal participation of all groups in a society that is mutually shaped to meet their needs. Social justice includes a vision of society in which the distribution of resources is equitable and all members are physically and psychologically safe and secure. (p. 3)

Given these broad descriptions, we propose a working definition of social justice counseling/therapy:

Social justice counseling/therapy is an active philosophy and approach aimed at producing conditions that allow for equal access and opportunity; reducing or eliminating disparities in education, health care, employment, and other areas that lower the quality of life for affected populations; encouraging mental health professionals to consider micro, meso, and macro levels in the assessment, diagnosis, and treatment of client and client systems; and broadening the role of the helping professional to include not only counselor/therapist but advocate, consultant, psychoeducator, change agent, community worker, and so on.

Thus social justice counseling/therapy has the following goals:

1. Aims to produce conditions that allow for equal access and opportunity;

2. Reduces or eliminates disparities in education, health care, employment, and other areas, that lower the quality of life for affected populations;

3. Encourages mental health professionals to consider micro, meso, and macro levels in the assessment, diagnosis, and treatment of clients and client systems;

4. Broadens the role of the helping professional to include not only counselor/therapist but advocate, consultant, psychoeducator, change agent, community worker, and so on.

Advocacy for Organizational Change

All helping professionals need to understand two things about mental health practice: (a) They often work within organizations that may be monocultural in policies and practices, and (b) the problems encountered by clients are often due to organizational or systemic factors. This is a key component of the ecological or person-in-environment perspective (Fouad, Gerstein, & Toporek, 2006). In the first case, the policies and practices of an institution may thwart the ability of counselors to provide culturally appropriate help for their diverse clientele. In the second case, the structures and operations of an organization may unfairly deny equal access and opportunity (access to health care, employment, and education) for certain groups in our society. It is possible that many problems of mental health are truly systemic problems caused by racism, sexism, and homophobia. Thus understanding organizational dynamics and possessing multicultural institutional intervention skills are part of the social justice framework (Pieterse, Evans, Risner-Butner, Collins, & Mason, 2009). Making organizations responsive to a diverse population ultimately means being able to help them become more multicultural in outlook, philosophy, and practice.

Social justice counseling (a) takes a social change perspective that focuses on ending oppression and discrimination in our society (e.g., within organizations, communities, municipalities, governmental entities); (b) believes that inequities that arise within our society are due not necessarily to misunderstandings, poor communication, lack of knowledge, and so on, but to monopolies of power; and (c) assumes that conflict is inevitable and not necessarily unhealthy. Diversity trainers, consultants, and many industrial-organizational (I/O) psychologists increasingly endorse multicultural change, based on the premise that organizations vary in their awareness of how racial, cultural, ethnic, sexual orientation, and gender issues impact their clients or workers. Increasingly, leaders in the field of counseling psychology have indicated that the profession should promote the general welfare of society; be concerned with the development of people, their communities, and their environment; and promote social, economic, and political equity consistent with the goals of social justice (Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006).

Thus social justice counseling includes social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully (Goodman et al., 2004). If mental health professionals are concerned with the welfare of society, and if society's purpose is to enhance the quality of life for all persons, then these professionals must ultimately be concerned with the injustices and obstacles that oppress, denigrate, and harm those in our society (Warren & Constantine, 2007). They must be concerned with issues of classism, racism, sexism, homophobia, and all the other “isms” that deny equal rights to everyone. As mentioned previously, counselors/therapists practice at three levels: micro—where the focus is on individuals, families, and small groups; meso—where the focus is on communities and organizations; and macro—where the focus is on the larger society (e.g., statutes and social policies).

Advocacy Counseling Roles

To achieve these conditions is truly an uphill battle. But, just as the history of the United States is the history of racism, it is the history of antiracism as well. There have always been people and movements directed toward the eradication of racism, including abolitionists, civil rights workers, private organizations (Southern Poverty Law Center, NAACP, and B'nai Brith), political leaders, and especially people of color. Racism, like sexism, homophobia, and all forms of oppression, must be on the forefront of social justice work. Efforts must be directed at social change in order to eradicate bigotry and prejudice. In this respect, psychologists must use their knowledge and skills to (a) impact the channels of socialization (e.g., education, media, groups, organizations) to spread a curriculum of multiculturalism, and (b) aid in the passage of legislation and social policy (e.g., affirmative action, civil rights voting protections, sexual harassment laws) (Goodman, 2009; Lopez-Baez & Paylo, 2009; Ratts, 2010). To accomplish these goals, we need to openly embrace the systems intervention roles identified by Atkinson, Thompson, and Grant (1993): advocate, change agent, consultant, adviser, facilitator of indigenous support systems, and facilitator of indigenous healing methods. In closing, we include the words of Toporek (2006, p. 496) about the social justice agenda and its implications for psychologists:

The vastness of social challenges facing humanity requires large-scale intervention. Although the expertise of counseling psychologists is well suited to individual empowerment and local community involvement, likewise, much of this expertise can, and should, be applied on a broad scale. Public policy decisions such as welfare reform, gender equity, same-sex marriage and adoption, and homelessness must be informed by knowledge that comes from the communities most affected. Counseling psychologists, with expertise in consulting, communicating, researching, and direct service, are in a unique position to serve as that bridge.

Implications for Clinical Practice

1. The mental health profession must take the initiative in confronting the potential political nature of mental health practice. The practice of counseling/therapy and the knowledge base that underlies the profession are not morally, ethically, and politically neutral.

2. We must critically reexamine our concepts of what constitutes normality and abnormality, begin mandatory training programs that deal with these issues, critically examine and reinterpret past and continuing literature dealing with socially marginalized groups in society, and use research in such a manner as to improve the life conditions of the researched populations.

3. The study of marginalized group cultures must receive equal treatment and fair portrayal at all levels of education.

4. The education and training of psychologists have, at times, created the impression that its theories and practices are apolitical and value free.

5. Psychological problems of marginalized group members may reside not within but outside of our clients.

6. Too much research has concentrated on the mental health problems and pathologies of groups of color, while little has been done to determine the advantages of being bicultural and the strengths and assets of these groups.

7. Psychological disturbances and problems in living are not necessarily caused by internal attributes (low intelligence, lack of motivation, character flaws, etc.) but may result from external circumstances, such as prejudice, discrimination, and disparities in education, employment, and health care.

8. Social justice counseling may dictate social and political actions that seek to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs.

9. Social justice advocacy dictates playing roles that involve advocating on behalf of clients who are victimized by the social system that creates disparities in health care, education, and employment.

Summary

Mental health practice is strongly influenced by historical and current sociopolitical forces that impinge on issues of race, culture, and ethnicity. The therapeutic session is often a microcosm of race relations in our larger society; therapists often inherit the biases of their forebears; and therapy represents a primarily EuroAmerican activity. These failures can be seen in (a) the education and training of mental health professionals, (b) biased mental health literature, and (c) an equation of pathology with differences. The genetic and culturally deficient models have perpetuated these failures by graduating mental health practitioners from programs believing that people of color are lacking the right genes or the right White middle class values to succeed in this society. The culturally diverse model, however, no longer views people of color as deficient, but recasts differences as alternative lifestyles and addresses the advantages of being bicultural and the inherent value of differences.

Social justice counseling recognizes that problems do not necessarily reside in individuals but may be externally located in organizations and the social system. As a result, mental health professionals must be prepared to direct their foci of interventions to the individual, professional, organizational, and societal levels. Specifically, when organizational interventions are required, seven principles are identified. Students are encouraged to study them thoroughly. All stress the importance of understanding how systemic factors (person–environment interactions) contribute to individual behavior, and are necessary for accurate assessment, diagnosis, and treatment. Clients are not viewed as isolated units but as embedded in their families, social groups, communities, institutions, cultures, and in major systems of our society.

If mental health practice is concerned with bettering the life circumstances of individuals, families, groups, and communities in our society, then social justice is the overarching umbrella that guides our profession. The welfare of a democratic society very much depends on equal access and opportunity, fair distribution of power and resources, and empowering individuals and groups with a right to determine their own lives. To accomplish this goal, therapists must be prepared to treat social and systemic problems and play alternative helping roles that have not traditionally been considered therapy. Advocacy roles in counseling fall into this category.

Glossary Terms

Abnormality

Antiracism

Cultural encapsulation

Culture-bound training

Cultural paranoia

Cultural deprivation

Culturally deficient model

Culturally diverse model

Etic

Emic

Ethnocentricity

Genetically deficient model

Levels of intervention

Paranorm

Scientific racism

Social justice counseling

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RACIAL/CULTURAL IDENTITY DEVELOPMENT IN PEOPLE OF COLOR COUNSELING IMPLICATIONS

Chapter Objectives

1. Learn the important factors that are influential in the development of racial/cultural identity in people of color.

2. Become familiar with racial identity development in various groups of color.

3. Describe how sociopolitical forces influence the identity development of people of color.

4. Define the developmental levels of racial consciousness and describe how they affect the attitudes, beliefs, and behaviors toward oneself, toward members of one's own group, and toward majority group members.

5. Become knowledgeable about how the racial consciousness of people of color impacts the counseling/therapy situation.

6. Describe the various common characteristics of clients at each of the following levels of identity formation: conformity, dissonance, resistance and immersion, introspection, and integrative awareness.

7. Discuss the therapeutic challenges likely to confront a counselor or therapist working with clients at each of the five levels of identity development.

Case Study

Sansei (Third-Generation) Japanese American Female

For nearly all my life I have never seriously attempted to dissect my feelings and attitudes about being a Japanese American woman. Aborted attempts were made, but they were never brought to fruition, because it was unbearably painful. Having been born and raised in Arizona, I had no Asian friends. I suspect that given an opportunity to make some, I would have avoided them anyway. That is because I didn't want to have anything to do with being Japanese American. Most of the Japanese images I saw were negative. Japanese women were ugly; they had “cucumber legs,” flat yellow faces, small slanty eyes, flat chests, and were stunted in growth. The men were short and stocky, sneaky and slimy, clumsy, inept, “wimpy looking,” and sexually emasculated. I wanted to be tall, slender, large eyes, full lips, and elegant looking; I wasn't going to be typical Oriental!. . .

At Cal [University of California, Berkeley], I've been forced to deal with my Yellow-White identity. There are so many “yellows” here that I can't believe it. I've come to realize that many White prejudices are deeply ingrained in me; so much so that they are unconscious. . . .To accept myself as a total person, I also have to accept my Asian identity as well. But what is it? I just don't know. Are they the images given me through the filter of White America, or are they the values and desires of my parents?

Yesterday, I had a rude awakening. For the first time in my life I went on a date with a Filipino boy. I guess I shouldn't call him a “boy,” as my ethnic studies teacher says it is derogatory toward Asians and Blacks. I only agreed to go because he seemed different from the other “Orientals” on campus. (I guess I shouldn't use that word either.) He's president of his Asian fraternity, very athletic and outgoing. . . .When he asked me, I figured, “Why not?” It'll be a good experience to see what it's like to date an Asian boy. Will he be like White guys who will try to seduce me, or will he be too afraid to make any move when it comes to sex?. . .We went to San Francisco's Fisherman's Wharf for lunch. We were seated and our orders were taken before two other White women. They were, however, served first. This was painfully apparent to us, but I wanted to pretend that it was just a mix-up. My friend, however, was less forgiving and made a public fuss with the waiter. Still, it took an inordinate amount of time for us to get our lunches, and the filets were overcooked (purposely?). My date made a very public scene by placing a tip on the table, and then returning to retrieve it. I was both embarrassed but proud of his actions.

This incident and others made me realize several things. For all my life I have attempted to fit into White society. I have tried to convince myself that I was different, that I was like all my other White classmates, and that prejudice and discrimination didn't exist for me. I wonder how I could have been so oblivious to prejudice and racism. I now realize that I cannot escape from my ethnic heritage and from the way people see me. Yet I don't know how to go about resolving many of my feelings and conflicts. While I like my newly found Filipino “male” friend (he is sexy), I continue to have difficulty seeing myself married to anyone other than a White man. (Excerpts from a Sansei student class journal)

Racial Awakening

Oriental, Asian, or White?

This Sansei (third-generation) Japanese American female is experiencing a racial awakening that has strong implications for her racial/cultural identity development. Her previous belief systems concerning White Americans and Asian Americans are being challenged by social reality and the experiences of being a “visible racial/ethnic minority.” First, a major theme involving societal portrayals of Asian Americans is clearly expressed in the student's beliefs about racial/cultural characteristics: She describes the Asian American male and female in highly unflattering terms. She seems to have internalized these beliefs and to be using White standards to judge Asian Americans as being desirable or undesirable. For this student, the process of incorporating these standards has not only attitudinal but behavioral consequences as well. In Arizona, she would not have considered making Asian American friends even if the opportunity presented itself. In her mind, she was not a “typical Oriental”; she disowned or felt ashamed of her ethnic heritage, and she even concludes that she would not consider marrying anyone but a White male.

Denial Breakdown

Second, her denial that she is an Asian American is beginning to crumble. Being immersed in the student body on a campus in which there are many fellow Asian Americans in attendance forces her to explore ethnic identity issues—a process she has been able to avoid while living in a predominantly White area. In the past, when she encountered prejudice or discrimination, she had been able to deny it or to rationalize it away. The differential treatment she received at a restaurant and her male friend's labeling it as “discrimination” makes such a conclusion inescapable. The shattering of illusions is manifest in her realization that (a) despite her efforts to “fit in,” it is not enough to gain social acceptance among many White Americans; (b) she cannot escape her racial/cultural heritage; and (c) she has been brainwashed into believing that one group is superior over another.

The Internal Struggle for Identity

Third, the student's internal struggle to cast off the cultural conditioning of her past and the attempts to define her ethnic identity are both painful and conflicting. We have clear evidence of the internal turmoil she is undergoing when she (a) refers to her “Yellow-White” identity; (b) writes about the negative images of Asian American males but winds up dating one; (c) uses the terms “Oriental” and “boy” (in reference to her Asian male friend) but acknowledges their derogatory racist nature; (d) describes Asian men as “sexually emasculated” but sees her Filipino date as “athletic,” “outgoing,” and “sexy”; (e) expresses embarrassment at confronting the waiter about discrimination but feels proud of her Asian male friend for doing so; and (f) states that she finds him attractive but could never consider marrying anyone but a White man. Understanding the process by which racial/cultural identity develops in persons of color is crucial for effective multicultural counseling/therapy.

Locus of the Problem

Fourth, it is clear that the Japanese American female is a victim of ethnocentric monoculturalism. As we mentioned previously, the problem being experienced by the student does not reside in her but in our society. It resides in a society that portrays racial/ethnic characteristics as inferior, primitive, deviant, pathological, or undesirable. The resulting damage strikes at the self-esteem and self/group identity of many culturally different individuals in our society; many, like this student, may come to believe that their racial/cultural heritage or characteristics are burdens to be changed or overcome. Understanding racial/cultural identity development and its relationship to therapeutic practice are the goals of this chapter.

Racial/Cultural Identity Development Models

The historic work on racial/cultural identity development among minority groups has led to major breakthroughs in the field of multicultural counseling/therapy (Atkinson, Morten, & Sue, 1998; Cross, 1971, 1995; Cross, Smith, & Payne, 2002; Helms, 1984, 1995; Horse, 2001; J. Kim, 1981; Ruiz, 1990). Most would agree that Asian Americans, African Americans, Latino/Hispanic Americans, and American Indians have distinct cultural heritages that make each different from the other. Yet such cultural distinctions can lead to a monolithic view of minority group attitudes and behaviors. The erroneous belief that all Asians are the same, all Blacks are the same, all Latinas/os are the same, or all American Indians are the same has led to numerous therapeutic problems.

First, therapists may often respond to culturally diverse clients in a very stereotypic manner and fail to recognize within-group or individual differences. For example, research indicates that Asian American clients seem to prefer and benefit most from a highly structured and directive approach, rather than an insight/feeling-oriented one (Hong & Domokos-Cheng Ham, 2001; B.S.K. Kim, 2011; Sandhu, Leung, & Tang, 2003). Although such approaches may generally be effective, they are often blindly applied without regard for possible differences in client attitudes, beliefs, and behaviors. Likewise, conflicting findings in the literature regarding whether people of color prefer therapists of their own race seem to be a function of our failure to make such distinctions. Preference for a racially or ethnically similar therapist may really be a function of the cultural/racial identity of the individual (within-group differences) rather than of race or ethnicity per se.

Second, the strength of racial/cultural identity models lies in their potential diagnostic value. Premature termination rates among clients of color may be attributed to the inappropriateness of transactions that occur between the helping professionals and culturally diverse clients. Research suggests that reactions to counseling, the counseling process, and counselors are influenced by cultural/racial identity and are not simply linked to minority group membership. The high failure-to-return rate of many clients seems to be intimately connected to the mental health professional's inability to assess the cultural identity of clients accurately (Ivey, D'Andrea, & Ivey, 2011).

A third important contribution derived from racial identity models is their acknowledgment of sociopolitical influences in shaping identity (à la the Sansei student). Early models of racial identity development all incorporated the effects of racism and prejudice (oppression) upon the identity transformation of their victims. Vontress (1971), for instance, theorized that African Americans moved through decreasing levels of dependence on White society to emerging identification with Black culture and society (Colored, Negro, and Black). Other similar models for African Americans have been proposed (Cross, 1971; Jackson, 1975; Thomas, 1970, 1971). The fact that other marginalized groups, such as Asian Americans (J. Kim, 2012; S. Sue & Sue, 1971), Latinas/os (Ferdman & Gallegos, 2012), Native Americans (Horse, 2012), women (Downing & Roush, 1985; McNamara & Rickard, 1989), lesbians/gays (Cass, 1979), and individuals with disabilities (Olkin, 1999), have similar processes may indicate experiential validity for such models as they relate to various oppressed groups.

Black Identity Development Models

Early attempts to define a process of minority identity transformation came primarily through the works of Black social scientists and educators (Cross, 1971; Jackson, 1975; Thomas, 1971. Although there are several Black identity development models, the Cross model of psychological nigrescence (the process of becoming Black) is perhaps the most influential and well documented (Cross, 1971, 1991, 1995). The original Cross model was developed during the civil rights movement and delineates a five-stage process in which Blacks in the United States move from a White frame of reference to a positive Black frame of reference: preencounter, encounter, immersion-emersion, internalization, and internalization-commitment.

· The preencounter stage is characterized by African Americans' consciously or unconsciously devaluing their own Blackness and concurrently valuing White values and ways. There is a strong desire to assimilate and acculturate into White society. Blacks at this stage evidence self-hate, low self-esteem, and poor mental health (Vandiver, 2001).

· In the encounter stage, a two-step process begins to occur. First, the individual encounters a profound crisis or event that challenges his or her previous mode of thinking and behaving; second, the Black person begins to reinterpret the world, resulting in a shift in worldviews. Cross points out how the slaying of Martin Luther King Jr. was such a significant experience for many African Americans. More recently, the shooting of Michael Brown in Ferguson, Missouri, and the choking death of Eric Gardner in New York in 2014 are examples of such events. The person experiences both guilt and anger over being brainwashed by White society.

· In the third stage, immersion-emersion, the person withdraws from the dominant culture and becomes immersed in African American culture. Black pride begins to develop, but internalization of positive attitudes toward one's own Blackness is minimal. In the emersion phase, feelings of guilt and anger begin to dissipate with an increasing sense of pride.

· The next stage, internalization, is characterized by inner security, as conflicts between the old and new identities are resolved. Global anti-White feelings subside as the person becomes more flexible, more tolerant, and more bicultural/multicultural.

· The last stage, internalization-commitment, speaks to the commitment that such individuals have toward social change, social justice, and civil rights. It is expressed not only in words but also in actions that reflect the essence of their lives.

Cross's original model makes a major assumption: The evolution from the preencounter stage to the internalization stage reflects a movement from psychological dysfunction to psychological health (Vandiver, 2001).

Confronted with evidence that these stages may mask multiple racial identities, questioning his original assumption that all Blacks at the preencounter stage possess self-hatred and low self-esteem, and aware of the complex issues related to race salience, Cross (1991) revised his theory of nigrescence in his book Shades of Black. His changes, which are based on a critical review of the literature on Black racial identity, have increased the model's explanatory powers and promise high predictive validity (Vandiver, Fhagen-Smith, Cokley, Cross, & Worrell, 2001; Worrell, Cross, & Vandiver, 2001). In essence, the revised model contains nearly all the features from the earlier formulation, but it differs in several significant ways.

First, Cross introduces the concept of race salience, the degree to which race is an important and integral part of a person's approach to life. The Black person may function with “race” consciousness playing either a large role in his or her identity or a minimal one. In addition, salience for Blackness can possess positive (pro-Black) or negative (anti-Black) valence. Instead of using the term “pro-White” in describing the preencounter stage, Cross now uses the term race salience. Originally, Cross believed that the rejection of Blackness and the acceptance of an American perspective were indicative of only one identity, characterized by self-hate and low self-esteem. His current model now describes two identities: (a) preencounter assimilation and (b) preencounter anti-Black. The former has low salience for race and a neutral valence toward Blackness, whereas the latter describes individuals who hate Blacks and hate being Black (high negative salience). In other words, it is possible for a Black person at the preencounter stage who experiences the salience of race as very minor and whose identity is oriented toward an “American” perspective not to be filled with self-hate or low self-esteem.

The sense of low self-esteem, however, is linked to the preencounter anti-Black orientation. According to Cross, such a psychological perspective is the result of miseducation and self-hatred. The miseducation is the result of the negative images of Blacks portrayed in the mass media; among neighbors, friends, and relatives; and in the educational literature (Blacks are unintelligent, criminal, lazy, and prone to violence). The result is an incorporation of such negative images into the personal identity of the Black person. Interestingly, the female Sansei student described earlier in this chapter, though Japanese American, would seem to possess many of the features of Cross's preencounter anti-Black identity.

Second, the immersion-emersion stage once described one fused identity (anti-White/pro-Black) but is now divided into two additional ones: anti-White alone and anti-Black alone. While Cross speaks about two separate identities, it appears that there are three possible combinations: anti-White, pro-Black, and an anti-White/pro-Black combination.

Third, Cross has collapsed the fourth and fifth stages (internalization and internalization-commitment) into one: internalization. He observed that minimal differences existed between the two stages except in the characteristic of “sustained interest and commitment.” This last stage is characterized by Black self-acceptance and can be manifested in three types of identity: (a) Black nationalist (high Black positive race salience), (b) biculturalist (Blackness and fused sense of Americanness), and (c) multiculturalist (multiple identity formation, including race, gender, sexual orientation, etc.).

Although Cross's model has been revised significantly and the newer version is more sophisticated, his original 1971 nigrescence theory continues to dominate the racial identity landscape. Unfortunately, this has created much confusion among researchers and practitioners. We encourage readers to familiarize themselves with his most recent formulation (Cross, 1991, 1995).

Asian American Identity Development Models

Asian American identity development models have not advanced as far as those relating to Black identity. One of the earliest heuristic “type” models was developed by S. Sue and Sue (1971) to explain what they saw as clinical differences among Chinese American students treated at the University of California, Berkeley, Counseling Center: (a) traditionalist—a person who internalizes conventional Chinese customs and values, resists acculturation forces, and believes in the “old ways”; (b) marginal person—a person who attempts to assimilate and acculturate into White society, rejects traditional Chinese ways, internalizes society's negativism toward minority groups, and may develop racial self-hatred (à la the Sansei student); and (c) Asian American—a person who is in the process of forming a positive identity, who is ethnically and politically aware, and who becomes increasingly bicultural. Other similar models have been proposed for other groups such as Japanese Americans (Kitano, 1982).

These early type models suffered from several shortcomings (Lee, 1991). First, they failed to provide a clear rationale for why an individual develops one ethnic identity type over another. Although they were useful in describing characteristics of the type, they represented static entities rather than a dynamic process of identity development. Second, the early proposals seem too simplistic to account for the complexity of racial identity development. Third, these models were too population specific, in that they described only one Asian American ethnic group (Chinese American or Japanese American), and one wonders whether they are equally applicable to Korean Americans, Filipino Americans, Vietnamese Americans, and so on. Last, with the exception of a few empirical studies (Lee, 1991; D. W. Sue & Frank, 1973), testing of these typologies is seriously lacking.

In response to these criticisms, theorists have begun to move toward the development of stage/process models of Asian American identity development (J. Kim, 1981; Lee, 1991; Sodowsky, Kwan, & Pannu, 1995). Such models view identity formation as occurring in stages, evolving from less healthy to more healthy identities. With each stage there exists a constellation of traits and characteristics associated with racial/ethnic identity. These models also attempt to explain the conditions or situations that might retard, enhance, or impel the individual forward.

After a thorough review of the literature, J. Kim (1981) used a qualitative narrative approach with third-generation Japanese American women to posit a progressive and sequential stage model of Asian American identity development: (a) ethnic awareness, (b) White identification, (c) awakening to social political consciousness, (d) redirection to Asian American consciousness, and (e) incorporation. Her model integrates the influence of acculturation, exposure to cultural differences, environmental negativism to racial differences, personal methods of handling race-related conflicts, and the effects of group or social movements on the Asian American individual.

1. The ethnic awareness stage begins around the age of three to four, when the child's family members serve as the significant ethnic group model. Positive or neutral attitudes toward one's own ethnic origin are formed, depending on the amount of ethnic exposure conveyed by the caretakers.

2. The White identification stage begins when children enter school, where peers and the surroundings become powerful forces in conveying racial prejudice that negatively impacts their self-esteem and identity. The realization of “differentness” from such interactions leads to self-blame and a desire to escape racial heritage by identifying with White society.

3. The awakening to social political consciousness stage means the adoption of a new perspective, often correlated with increased political awareness. J. Kim (1981) believed that significant political events such as the civil rights and women's movements often precipitate this new awakening. The primary result is an abandoning of identification with White society and a consequent understanding of oppression and oppressed groups.

4. The redirection stage means a reconnection or renewed connection with one's Asian American heritage and culture. This is often followed by the realization that White oppression is the culprit for the negative experiences of youth. Anger against White racism may become a defining theme, with concomitant increases of Asian American self-pride and group pride.

5. The incorporation stage represents the highest form of identity evolution. It encompasses the development of a positive and comfortable identity as Asian American and consequent respect for other cultural/racial heritages. Identification with a stance for or against White culture is no longer an important issue.

Latino/ Hispanic American Identity Development Models

Although a number of ethnic identity development models have been formulated to account for Latino/a identity (Bernal & Knight, 1993; Casas & Pytluk, 1995; Szapocznik, Santisteban, Kurtines, Hervis, & Spencer, 1982), the one most similar to those of African Americans and Asian Americans was proposed by Ruiz (1990). His model was formulated from a clinical perspective via case studies of Chicano/Latino subjects. Ruiz made several underlying assumptions. First, he believed in a culture-specific explanation of identity for Chicano, Mexican American, and Latina/o clients. Although models of the development of other ethnic groups or the more general models were helpful, they lacked the specificity of referring to Latina/o cultures. Second, the marginal status of Latinos is highly correlated with maladjustment. Third, negative experiences of forced assimilation are considered destructive to an individual. Fourth, having pride in one's cultural heritage and ethnic identity is positively correlated with mental health. Last, pride in one's ethnicity affords the Hispanic greater freedom to choose freely. These beliefs underlie Ruiz's five-stage model.

1. Causal stage: During this period messages or injunctions from the environment or significant others ignore, negate, or denigrate the ethnic heritage of the person. Affirmation about one's ethnic identity is lacking, and the person may experience traumatic or humiliating experiences related to ethnicity. There is a failure to identify with Latina/o culture.

2. Cognitive stage: As a result of negative/distorted messages, three erroneous belief systems about Chicano/Latina/o heritage become incorporated into mental sets: (a) Ethnic group membership is associated with poverty and prejudice; (b) assimilation to White society is the only means of escape; and (c) assimilation is the only possible road to success.

3. Consequence stage: Fragmentation of ethnic identity becomes very noticeable and evident. The person feels ashamed and is embarrassed by ethnic markers, such as name, accent, skin color, cultural customs, and so on. The unwanted self-image leads to estrangement and rejection of one's Chicano/Latina/o heritage.

4. Working-through stage: Two major dynamics distinguish this stage. First, the person becomes increasingly unable to cope with the psychological distress of ethnic identity conflict. Second, the person can no longer be a “pretender” by identifying with an alien ethnic identity. The person is propelled to reclaim and reintegrate disowned ethnic identity fragments. Ethnic consciousness increases.

5. Successful resolution stage: This last stage is exemplified by greater acceptance of one's culture and ethnicity. There is an improvement in self-esteem and a sense that ethnic identity represents a positive and success-promoting resource.

The Ruiz model has a subjective reality that is missing in many of the empirically based models. This is expected, since it was formulated based on the study of a clinical population. It has the added advantage of suggesting intervention focus and direction for each of the stages. For example, the focus of counseling in the causal stage is disaffirming and restructuring of the injunctions; for the cognitive stage, it is the use of cognitive strategies attacking faulty beliefs; for the consequence stage, it is reintegration of ethnic identity fragments in a positive manner; for the working-through stage, ethnocultural identification issues are important; and for the successful resolution stage, the promotion of a positive identity becomes important.

A Racial/Cultural Identity Development Model

In the past several decades, Asian Americans, Latinas/os, and American Indians have experienced sociopolitical identity transformations so that a Third World consciousness has emerged, with the awareness of cultural oppression as the common unifying force. As a result of studying these models and integrating them with their own clinical observations, Atkinson et al. (1998) proposed a five-stage Minority Identity Development model (MID) in an attempt to pull out common features that cut across the population-specific proposals. D. W. Sue and Sue (1990, 1999) later elaborated on the MID, renaming it the Racial/Cultural Identity Development model (R/CID), to (a) encompass a broader population, and (b) avoid the disempowering term “minority.” As discussed shortly, this model may be applied to White identity development as well.

The R/CID model proposed here is not a comprehensive theory of personality, but rather a conceptual framework to aid therapists in understanding their culturally diverse clients' attitudes and behaviors. Five levels of development that oppressed people experience as they struggle to understand themselves in terms of their own culture, the dominant culture, and the oppressive relationship between the two cultures are described: conformity, dissonance, resistance and immersion, introspection, and integrative awareness. At each level of identity there are four corresponding beliefs and attitudes, the understanding of which may help therapists better understand their clients. These attitudes/beliefs are an integral part of identity, and are manifest in how a person views (a) the self, (b) others of the same minority, (c) others of another minority, and (d) majority individuals. Table 11.1 outlines the R/CID model and the interaction of phases with the attitudes and beliefs.

Conformity Phase

Similar to individuals in the preencounter stage (Cross, 1991), persons of color are distinguished by their unequivocal preference for dominant cultural values over those of their own culture. White Americans in the United States represent their reference group, and the identification set is quite strong. Lifestyles, value systems, and cultural/physical characteristics that most resemble those of White society are highly valued, whereas those most associated with their own group of color may be viewed with disdain or may hold low salience for the person. We agree with Cross that individuals at this stage can be oriented toward a pro-American identity without subsequent disdain or negativism toward their own group. Thus, it is possible for a Chinese American to feel positive about U.S. culture, values, and traditions without evidencing disdain for Chinese culture or feeling negatively about oneself (absence of self-hate). Nevertheless, we believe that such individuals represent a small proportion of persons of color at this stage. Research on their numbers, on how they have handled the social-psychological dynamics of majority-minority relations, on how they have dealt with their marginalized status, and on how they fit into the models (progression issues) needs to be conducted.

TABLE 11.1 The Racial/Cultural Identity Development Model

Source: From D. R. Atkinson, G. Morten, and D. W. Sue, Counseling American minorities: A cross cultural perspective, 5th ed. Copyright © 1998 McGraw-Hill, Boston, MA. All rights reserved. Reprinted by permission.

Phases of Minority Development Model	Attitude Toward Self	Attitude Toward Others of the Same Group	Attitude Toward Others of a Different Marginalized Group	Attitude Toward Dominant Group
Stage 1—Conformity	Self-depreciating or neutral due to low race salience	Group-depreciating or neutral due to low race salience	Discriminatory or neutral	Group-appreciating
Stage 2—Dissonance	Conflict between self-depreciating and group-appreciating	Conflict between group-depreciating views of minority hierarchy and feelings of shared experience	Conflict between dominant-held and group-depreciating	Conflict between group-appreciating and group- depreciating
Stage 3—Resistance and immersion	Self-appreciating	Group-appreciating experiences and feelings of culturocentrism	Conflict between feelings of empathy for other minority	Group-depreciating
Stage 4—Introspection	Concern with basis of self-appreciation	Concern with nature of unequivocal appreciation	Concern with ethnocentric basis for judging others	Concern with the basis of group depreciation
Stage 5—Integrative awareness	Self-appreciating	Group-appreciating	Group-appreciating	Selective appreciation

We believe that the conformity phase continues to be most characterized by individuals who have bought into majority societal definitions about their marginalized status in society. Because the conformity phase represents, perhaps, the most damning indictment of White racism and because it has such a profound negative impact on persons of color, understanding its sociopolitical dynamics is of utmost importance for the helping professional. Those in the conformity phase are really victims of larger social-psychological forces operating in our society. The key issue here is the dominant–subordinate relationship between two different cultures (Atkinson et al., 1998; Freire, 1970). It is reasonable to believe that members of one cultural group tend to adjust themselves to the group possessing the greater prestige and power in order to avoid feelings of inferiority. Yet it is exactly this act that creates ambivalence in the individual. The pressures for assimilation and acculturation (melting-pot theory) are strong, creating possible culture conflicts. These individuals are victims of ethnocentric monoculturalism: (a) belief in the superiority of one group's cultural heritage—its language, traditions, arts-crafts, and ways of behaving (White) over all others; (b) belief in the inferiority of all other lifestyles (non-White); and (c) the power to impose such standards onto the less powerful group.

Internalized racism has been the term used to describe the process by which persons of color absorb the racist messages that are omnipresent in our society and internalize them (Kohli, 2013; Pyke, 2010). Constantly bombarded on all sides by reminders that Whites and their way of life are superior and that all other lifestyles are inferior, many begin to wonder whether they themselves are somehow inadequate, whether members of their own group are not to blame, and whether subordination and segregation are not justified. Clark and Clark (1947) first brought this to the attention of social scientists by stating that racism may contribute to a sense of confused self-identity among Black children. In a study of racial awareness and preference among Black and White children, they found that (a) Black children preferred playing with a White doll over a Black one, (b) the Black doll was perceived as being “bad,” and (c) approximately one-third, when asked to pick the doll that looked like them, picked the White one.

It is unfortunate that the inferior status of people of color is constantly reinforced and perpetuated by the mass media through television, movies, newspapers, radio, books, and magazines. This contributes to widespread stereotypes that tend to trap them: Blacks are superstitious, childlike, ignorant, fun loving, dangerous, and criminal; Hispanics are dirty, sneaky, and criminal; Asian Americans are sneaky, sly, cunning, and passive; Indians are primitive savages. Such portrayals cause widespread harm to the self-esteem of minorities who may incorporate them. The incorporation of the larger society's standards may lead group members to react negatively toward their own racial and cultural heritage. They may become ashamed of who they are, reject their own group identification, and attempt to identify with the desirable “good” White minority. In the Autobiography of Malcolm X (Haley, 1966), Malcolm X relates how he tried desperately to appear as White as possible. He went to painful lengths to straighten and dye his hair so that he would appear more like White males. It is evident that many marginalized group members do come to accept White standards as a means of measuring physical attractiveness, attractiveness of personality, and social relationships. Such an orientation may lead to the phenomenon of internalized racism or racial self-hatred, in which people dislike themselves for being Asian, Black, Hispanic, or Native American. People at the conformity stage seem to possess the following characteristics:

1. Attitudes and beliefs toward the self (self-depreciating attitudes and beliefs): Physical and cultural characteristics identified with one's own racial/cultural group are perceived negatively, as something to be avoided, denied, or changed. Physical characteristics (black skin color, “slant-shaped eyes” of Asians), traditional modes of dress and appearance, and behavioral characteristics associated with the minority group are a source of shame. There may be attempts to mimic what is perceived as White mannerisms, speech patterns, dress, and goals. Low internal self-esteem is characteristic of the person.

2. Attitudes and beliefs toward members of the same group (group-depreciating attitudes and beliefs): Majority cultural beliefs and attitudes about the minority group are also held by the person in this stage. These individuals may have internalized the majority of White stereotypes about their group. In the case of Hispanics, for example, the person may believe that members of his or her own group have high rates of unemployment because “they are lazy, uneducated, and unintelligent.” Little thought or validity is given to other viewpoints, such as unemployment's being a function of job discrimination, prejudice, racism, unequal opportunities, and inferior education. Because persons in the conformity stage find it psychologically painful to identify with these negative traits, they divorce themselves from their own group. The denial mechanism most commonly used is, “I'm not like them; I've made it on my own; I'm the exception.”

3. Attitudes and beliefs toward members of different marginalized groups (discriminatory): Because the conformity-stage person most likely strives for identification with White society, the individual shares similar dominant attitudes and beliefs not only toward his or her own group but toward other marginalized groups as well. Groups most similar to White cultural groups are viewed more favorably, whereas those most different are viewed less favorably. For example, Asian Americans may be viewed more favorably than African Americans or Latino/Hispanic Americans in some situations. Although stratification probably exists, we caution readers that such a ranking is fraught with hazards and potential political consequences. Such distinctions often manifest themselves in debates over which group is more oppressed and which group has done better than the others. Such debates are counterproductive when used to (a) negate another group's experience of oppression, (b) foster an erroneous belief that hard work alone will result in success in a democratic society, (c) shortchange a marginalized group (i.e., Asian Americans) from receiving the necessary resources in our society, and (d) pit one marginalized group against another (divide and conquer) by holding up one group as an example to others.

4. Attitudes and beliefs toward members of the dominant group (group-appreciating attitude and beliefs): This stage is characterized by a belief that White cultural, social, and institutional standards are superior. Members of the dominant group are admired, respected, and emulated. White people are believed to possess superior intelligence. Some individuals may go to great lengths to appear White. Consider again the example from the Autobiography of Malcolm X, in which the main character would straighten his hair and primarily date White women. Reports that Asian women have undergone surgery to reshape their eyes to conform to White female standards of beauty may typify this dynamic.

Dissonance Phase

No matter how much one attempts to deny his or her own racial/cultural heritage, an individual will encounter information or experiences that are inconsistent with culturally held beliefs, attitudes, and values. An Asian American who believes that Asians are inhibited, passive, inarticulate, and poor in people relationships may encounter an Asian person who seems to break all these stereotypes (e.g., the Sansei student). A Latina/o who feels ashamed of his or her cultural upbringing may encounter another Latina/o who seems proud of his or her cultural heritage. An African American who believes that race problems are due to laziness, untrustworthiness, or personal inadequacies of his or her own group may suddenly encounter racism on a personal level. Denial begins to break down, which leads to a questioning and challenging of the attitudes/beliefs of the conformity stage. This was clearly what happened when the Sansei student encountered discrimination at the restaurant.

In all probability, movement into the dissonance stage is a gradual process. Its very definition indicates that the individual is in conflict between disparate pieces of information or experiences that challenge his or her current self-concept. People generally move into this stage slowly, but a traumatic event may propel some individuals to move into dissonance at a much more rapid pace. Cross (1971) stated that a monumental event such as the assassination of a major leader like Martin Luther King Jr. can often push people quickly into the ensuing stage.

1. Attitudes and beliefs toward the self (conflict between self-depreciating and self-appreciating attitudes and beliefs): There is now a growing sense of personal awareness that racism does exist, that not all aspects of their own culture or majority culture are good or bad, and that one cannot escape one's cultural heritage. For the first time the person begins to entertain the possibility of positive attributes in their own group's culture and, with it, a sense of pride in self. Feelings of shame and pride are mixed in the individual, and a sense of conflict develops. This conflict is most likely to be brought to the forefront quickly when other members of the group may express positive feelings toward the person: “We like you because you are Asian [or Black, American Indian, or Latino].” At this stage, an important personal question is being asked: “Why should I feel ashamed of who and what I am?”

2. Attitudes and beliefs toward members of the same group (conflict between group-depreciating and group-appreciating attitudes and beliefs): Dominant-held views of their own group's strengths and weaknesses begin to be questioned as new, contradictory information is received. Certain aspects of their culture begin to have appeal. For example, a Latino who values individualism may marry, have children, and then suddenly realize how Latina/o cultural values that hold the family as the psychosocial unit possess positive features. Or a person may find certain members of his or her group to be very attractive as friends, colleagues, lovers, and so forth.

3. Attitudes and beliefs toward members of a different marginalized group (conflict between dominant-held views of minority hierarchy and feelings of shared experience): Stereotypes associated with other marginalized groups are questioned, and a growing sense of comradeship with other oppressed groups is felt. It is important to keep in mind, however, that little psychic energy is associated with resolving conflicts with other marginalized groups. Almost all energies are expended toward resolving conflicts toward the self, one's own group, and the dominant group.

4. Attitudes and beliefs toward members of the dominant group (conflict between group-appreciating and group-depreciating attitudes): The person experiences a growing awareness that not all cultural values of the dominant group are beneficial. This is especially true when the person experiences personal discrimination. Growing suspicion and some distrust of certain members of the dominant group develop.

Resistance and Immersion Phase

The primary orientation of individuals in this phase is the tendency to endorse minority-held views completely and to reject values of the dominant society and culture. Desire to eliminate oppression becomes an important motivation of the individual's behavior. During the resistance and immersion stage, the three most active types of affective feelings are guilt, shame, and anger. There are considerable feelings of guilt and shame that in the past the individual has sold out his or her own racial and cultural group. The feelings of guilt and shame extend to the perception that during this past “sellout,” one has been a contributor to and participant in the oppression of one's own group and other marginalized groups. This is coupled with a strong sense of anger at the oppression, and feelings of having been brainwashed by forces in White society. Anger is directed outwardly in a very strong way toward oppression and racism. Movement into this stage seems to occur for two reasons. First, a resolution of the conflicts and confusions of the previous stage allows greater understanding of social forces (racism, oppression, and discrimination) and one's own role as a victim. Second, a personal questioning of why people should feel ashamed of themselves develops. The answer to this question evokes feelings of guilt, shame, and anger.

1. Attitudes and beliefs toward the self (self-appreciating attitudes and beliefs): The individual at this stage is oriented toward self-discovery of one's own history and culture. There is an active seeking out of information and artifacts that enhance that person's sense of identity and worth. Cultural and racial characteristics that once elicited feelings of shame and disgust become symbols of pride and honor. The individual moves into this stage primarily because he or she asks the question, “Why should I be ashamed of who and what I am?” The original low self-esteem engendered by widespread prejudice and racism that was most characteristic of the conformity stage is now actively challenged in order to raise self-esteem. Phrases such as “Black is beautiful” represent a symbolic relabeling of identity for many Blacks. Racial self-hatred begins to be actively rejected in favor of the other extreme: unbridled racial pride.

2. Attitudes and beliefs toward members of the same group (group-appreciating attitudes and beliefs): The individual experiences a strong sense of identification with and commitment to his or her group as enhancing information about the group is acquired. There is a feeling of connectedness with other members of the racial and cultural group, and a strengthening of the new identity begins to occur. Members of one's group are admired, respected, and often viewed now as the new reference group or ideal. Cultural values of the group are accepted without question. As indicated, the pendulum swings drastically from original identification with White ways to identification in an unquestioning manner with the group's ways. Persons in this phase are likely to restrict their interactions as much as possible to members of their own group.

3. Attitudes and beliefs toward members of a different marginalized group (conflict between feelings of empathy for other marginalized group experiences and feelings of culturocentrism): Although members at this stage experience a growing sense of comradeship with persons from other socially devalued groups, a strong culturocentrism develops as well. Alliances with other groups tend to be transitory and based on short-term goals or some global shared view of oppression. There is less of an attempt to reach out and understand other racial-cultural groups and their values and ways, and more of a superficial surface feeling of political need. Alliances generally are based on convenience factors or are formed for political reasons, such as combining together as a large group to confront an enemy perceived to be larger.

4. Attitudes and beliefs toward members of the dominant group (group depreciating attitudes and beliefs): The individual is likely to perceive the dominant society and culture as an oppressor and as the group most responsible for the current plight of minorities in the United States. Characterized by both withdrawal from the dominant culture and immersion in one's cultural heritage, this stage also gives rise to considerable anger and hostility directed toward White society. There is a feeling of distrust and dislike for all members of the dominant group in an almost global anti-White demonstration and feeling. White people, for example, are not to be trusted because they are the oppressors or enemies. In extreme form, members may advocate complete destruction of the institutions and structures that have been characteristic of White society.

Introspection Phase

Several factors seem to work in unison to move the individual from the resistance and immersion phase into the introspection phase. First, the individual begins to discover that this level of intensity of feelings (anger directed toward White society) is psychologically draining and does not permit one to really devote more crucial energies to understanding oneself or one's own racial-cultural group. The resistance and immersion phase tends to be a reaction against the dominant culture and is not proactive in allowing the individual to use all energies to discover who or what he or she is. Self-definition in the previous stage tends to be reactive (against White racism), and now a need for positive self-definition in a proactive sense emerges.

Second, the individual experiences feelings of discontent and discomfort with group views that may be quite rigid in the resistance and immersion phase. Often, in order to please the group, the individual is asked to submerge individual autonomy and individual thought in favor of the group good. Many group views may now be seen as conflicting with individual ones. A Latina/o individual who may form a deep relationship with a White person may experience considerable pressure from his or her culturally similar peers to break off the relationship because that White person is the “enemy.” However, the personal experiences of the individual may, in fact, not support this group view.

It is important to note that some clinicians often confuse certain characteristics of the introspective stage with parts of the conformity stage. A person in the introspective stage who speaks against the decisions of his or her group may often appear similar to the conformity-stage person. The dynamics are quite different, however. While the conformity-stage person is motivated by global racial self-hatred, the introspective person has no such global negativism directed at his or her own group.

1. Attitudes and beliefs toward the self (concern with basis of self-appreciating attitudes and beliefs): Although the person originally, in the conformity phase, held predominant majority group views and notions to the detriment of his or her own group, the person now feels that he or she has too rigidly held onto the group views and notions in order to submerge personal autonomy. The conflict now becomes quite great between responsibility and allegiance to one's own group and notions of personal independence and autonomy. The person begins to spend more and more time and energy trying to sort out these aspects of self-identity and begins increasingly to demand individual autonomy.

2. Attitudes and beliefs toward members of the same group (concern with the unequivocal nature of group appreciation): Although attitudes of identification are continued from the preceding resistance and immersion stage, concern begins to build up regarding the issue of group-usurped individuality. Increasingly, the individual may see his or her own group taking positions that might be considered quite extreme. In addition, there is now increasing resentment over how one's group may attempt to pressure or influence the individual into making decisions that may be inconsistent with the person's values, beliefs, and outlooks. Indeed, it is not unusual for a minority group to make it clear to individual members that if they do not agree with the group, they are against it. A common ploy used to hold members in line is exemplified in questions such as “How Asian are you?” and “How Black are you?”

3. Attitudes and beliefs toward members of a different marginalized group (concern with the ethnocentric basis for judging others): There is now greater uneasiness with culturocentrism, and an attempt is made to reach out to other groups to find out what types of oppression they experience and how this has been handled. Although similarities are important, there is now a movement toward understanding potential differences in oppression that other groups might have experienced.

4. Attitudes and beliefs toward members of the dominant group (concern with the basis of group depreciation): The individual experiences conflict between attitudes of complete distrust for the dominant society and culture and attitudes of selective trust and distrust according to the dominant individual's demonstrated behaviors and attitudes. Conflict is most likely to occur here because the person begins to recognize that there are many elements in U.S. American culture that are highly functional and desirable, yet feels confusion about how to incorporate these elements into one's own culture. Would acceptance of certain White cultural values make the person a sellout to his or her own race? There is a lowering of intense feelings of anger and distrust toward the dominant group and a continued attempt to discern elements that are acceptable.

Integrative Awareness Phase

Persons in this stage have developed an inner sense of security and now can own and appreciate unique aspects of their culture as well as those of U.S. culture. One's own culture is not necessarily in conflict with White dominant cultural ways. Conflicts and discomforts experienced in the previous stage become resolved, allowing greater individual control and flexibility. There is now the belief that there are acceptable and unacceptable aspects in all cultures and that it is very important for the person to be able to examine and to accept or reject those aspects of a culture that are not seen as desirable. At the integrative awareness stage, the person has a strong commitment and desire to eliminate all forms of oppression.

1. Attitudes and beliefs toward the self (self-appreciating attitudes and beliefs): The individual develops a positive self-image and experiences a strong sense of self-worth and confidence. Not only is there an integrated self-concept that involves racial pride in identity and culture, but the person develops a high sense of autonomy. Indeed, the client becomes bicultural or multicultural without a sense of having “sold out one's integrity.” In other words, the person begins to perceive his or her self as an autonomous individual who is unique (individual level of identity), a member of one's own racial-cultural group (group level of identity), a member of a larger society, and a member of the human race (universal level of identity).

2. Attitudes and beliefs toward members of same group (group-appreciating attitudes and beliefs): The individual experiences a strong sense of pride in the group without having to accept group values unequivocally. There is no longer the conflict over disagreeing with group goals and values. Strong feelings of empathy with the group experience are coupled with awareness that each member of the group is also an individual. In addition, tolerant and empathic attitudes are likely to be expressed toward members of one's own group who may be functioning in a less adaptive manner to racism and oppression.

3. Attitudes and beliefs toward members of a different marginalized group (group-appreciating attitudes): There is now literally a reaching out toward different oppressed groups in order to understand their cultural values and ways of life. There is a strong belief that the more one understands other cultural values and beliefs, the greater is the likelihood of understanding among the various ethnic groups. Support for all oppressed people, regardless of similarity to the individual's minority group, tends to be emphasized.

4. Attitudes and beliefs toward members of the dominant group (attitudes and beliefs of selective appreciation): The individual experiences selective trust and liking for and from members of the dominant group who seek to eliminate oppressive activities of the group. The individual also experiences openness to the constructive elements of the dominant culture. The emphasis here tends to be on the fact that White racism is a sickness in society and that White people are also victims who are in need of help.

Counseling Implications of the R/CID Model

Let us first point out some broad general clinical implications of the R/CID model before discussing specific meanings within each of the phases. First, an understanding of cultural identity development should sensitize therapists and counselors to the role that oppression plays in an individual's development. In many respects, it should make us aware that our role as helping professionals should extend beyond the office and should include dealing with the many manifestations of racism. Although individual therapy is needed, combating the forces of racism means a proactive approach for both the therapist and the client. For the helping professional, social justice advocacy and systems intervention are often the answers. For culturally diverse clients, it means the need to understand, control, and direct those forces in society that negate the process of positive identity. Thus a wider sociocultural approach to therapy is mandatory.

Second, the model will aid counselors in recognizing differences between members of the same minority group with respect to their cultural identity. It serves as a useful assessment and diagnostic tool for therapists to gain a greater understanding of their culturally diverse clients. In many cases, an accurate delineation of the dynamics and characteristics of the phases may result in better prescriptive treatment. Counselors who are familiar with the sequence of identity development are better able to plan intervention strategies that are most effective for culturally diverse clients. For example, a client experiencing feelings of isolation and alienation in the conformity phase may require an approach different from the one he or she would require in the introspection phase.

Third, the model allows helping professionals to realize the potentially changing and developmental nature of cultural identity among clients. If the goal of multicultural counseling/therapy is to move a client toward the integrative awareness stage, then the therapist is able to anticipate the sequence of feelings, beliefs, attitudes, and behaviors likely to arise. Acting as a guide and providing an understandable end point will allow the client to understand more quickly and work through issues related to his or her own identity. We now turn our attention to the R/CID model and its implications for the counseling process.

Conformity Phase: Counseling Implications

For the vast majority of those in the conformity phase, several therapeutic implications can be derived. First, persons of color are most likely to prefer a White counselor or therapist over those from other groups. This flows logically from the belief that Whites are more competent and capable than are members of their own race. Such a racial preference can be manifested in the client's reaction to a counselor of color via negativism, resistance, or open hostility. In some instances, the client may even request a change in counselor (preferably to someone White). Likewise, the conformity individual who is seen by a White therapist may be quite pleased about it. In many cases, the client, in identifying with White culture, may be overly dependent on the White therapist. Attempts to please, appease, and seek approval from the helping professional may be quite prevalent.

Second, most conformity individuals will find that attempts to explore issues of race, racism, or cultural identity or to focus upon feelings are very threatening. Clients in this stage generally prefer a task-oriented, problem-solving approach because an exploration of identity may eventually touch upon feelings of low self-esteem, dissatisfaction with personal appearance, vague anxieties, and racial self-hatred, and may challenge the client's self-deception that he or she is not like the other members of his or her own race.

Whether you are White or a counselor of color working with a conformity individual, the general goal may be the same. There is an obligation to help the client sort out conflicts related to racial/cultural identity through some process of reeducation. Somewhere in the course of counseling or therapy, issues of cultural racism, majority–minority group relations, racial self-hatred, and racial cultural identity need to be dealt with in an integrated fashion. We are not suggesting a lecture or a solely cognitive approach, to which clients at this stage may be quite intellectually receptive, but exercising good clinical skills that take into account the client's socioemotional state and readiness to deal with feelings. Only in this manner will the client be able to distinguish the difference between positive attempts to adopt certain values of the dominant society and a negative rejection of one's own cultural value (an ability characteristic of the integrative awareness stage).

Although the goals for the White and counselor of color are the same, the way a therapist works toward them may be different. For example, a counselor of color will likely have to deal with hostility from the racially and culturally similar client. As we saw in Chapter 3 , a therapist of color working with a client of his or her own race or any person of color may symbolize all that the client is trying to reject. Because therapy stresses the building of a coalition, establishment of rapport, and to some degree a mutual identification, the process may be especially threatening. The opposite may be true of work with a White counselor. The client of color may be overeager to identify with the White professional in order to seek approval.

Rather than being detrimental to multicultural counseling/therapy, these two processes can be used quite effectively and productively. If the therapist of color can aid the client in working through his or her feelings of antagonism and if the majority therapist can aid the client in working through his or her need to overidentify, then the client will be moved closer to awareness and away from self-deception. In the former case, the therapist can take a nonjudgmental stance toward the client and provide a positive person of color role model. In the latter, the White therapist needs to model positive attitudes toward cultural diversity. Both need to guard against unknowingly reinforcing the client's self-denial and rejection.

Dissonance Phase: Counseling Implications

As individuals become more aware of inconsistencies between dominant-held views and those of their own group, a sense of dissonance develops. Preoccupation and questions concerning self, identity, and self-esteem are most likely brought in for therapy. More culturally aware than their conformity counterparts, dissonance clients may prefer a counselor or therapist who possesses good knowledge of the client's cultural group, although there may still be a preference for a White helper. However, the fact that minority helping professionals are generally more knowledgeable of the client's cultural group may serve to heighten the conflicting beliefs and feelings of this stage. Since the client is so receptive toward self-exploration, the therapist can capitalize on this orientation in helping the client come to grips with his or her identity conflicts.

Resistance and Immersion Phase: Counseling Implications

Clients at this stage are likely to view their psychological problems as products of oppression and racism. They may believe that only issues of racism are legitimate areas to explore in therapy. Furthermore, openness or self-disclosure to therapists not of one's own group is dangerous because White counselors or therapists are “enemies” and members of the oppressing group.

Clients in the resistance and immersion stage believe that society is to blame for their present dilemma and actively challenge the establishment. They are openly suspicious of institutions such as mental health services because they view them as agents of the establishment. Very few of the more ethnically conscious and militant minorities will use mental health services because of its identification with the status quo. When they do, they are usually suspicious and hostile toward the helping professional. A therapist working with a client at this stage of development needs to realize several important things.

First, he or she will be viewed by the client as a symbol of the oppressive society. If you become defensive and personalize the attacks, you will lose effectiveness in working with the client. It is important not to be intimidated or afraid of the anger that is likely to be expressed; often, it is not personal and is quite legitimate. White guilt and defensiveness can serve only to hinder effective multicultural counseling/therapy. It is not unusual for clients at this stage to make sweeping negative generalizations about White Americans. The White therapist who takes a nondefensive posture will be better able to help the client explore the basis of his or her racial tirades.

In general, clients at this stage prefer a therapist of their own race. However, the fact that you share the same race or culture as your client will not insulate you from the attacks. Again, as outlined in Chapter 3 , therapists of color working with a same-race client at the stage of resistance can encounter unique challenges. For example, an African American client may perceive the Black counselor as a sellout of his or her own race, or as an Uncle Tom. Indeed, the anger and hostility directed at the therapist may be even more intense than that directed at a White one.

Second, realize that clients in this stage will constantly test you. In earlier chapters we described how minority clients will pose challenges to therapists in order to test their trustworthiness (sincerity, openness, and nondefensiveness) and expertise (competencies). Because of the active nature of client challenges, therapy sessions may become quite dynamic. Many therapists find that this stage is frequently the most difficult to deal with because counselor self-disclosure is often necessary for establishing credibility.

Third, individuals at this phase are especially receptive to approaches that are more action-oriented and aimed at external change (challenging racism). Also, group approaches with persons experiencing similar racial/cultural issues are well received. It is important that the therapist be willing to help the culturally different client explore new ways of relating to both minority and White persons.

Introspection Phase: Counseling Implications

Clients at the introspection phase may continue to prefer a counselor of their own race, but they are also receptive to help from therapists of other cultures as long as the therapists understand their clients' worldview. Ironically, clients at this stage may, on the surface, appear similar to conformity persons. Introspection clients are in conflict between their need to identify with their own group and their need to exercise greater personal freedom. Exercising personal autonomy may occasionally mean going against the wishes or desires of their own group. This is often perceived by marginalized members and their group as a rejection of their own cultural heritage. This is not unlike conformity persons, who also reject their racial/cultural heritage. The dynamics within the two groups, however, are quite dissimilar. It is very important for therapists to distinguish the differences. The conformity person moves away from his or her own group because of perceived negative qualities associated with it. The introspection person wants to move away on certain issues but perceives the group positively. Again, self-exploration approaches aimed at helping the client integrate and incorporate a new sense of identity are important. Believing in the functional values of White American society does not necessarily mean that a person is selling out or going against his or her own group.

Integrative Awareness Phase: Counseling Implications

Clients at this stage have acquired an inner sense of security around their self-identity. They have pride in their racial/cultural heritage but can exercise a desired level of personal freedom and autonomy. Other cultures and races are appreciated, and there is a development toward becoming more multicultural in perspective. Although discrimination and oppression remain a powerful part of their existence, persons at the integrative awareness phase possess greater psychological resources to deal with these problems. Being action- or systems-oriented, clients respond positively to the designing and implementation of strategies aimed at community and societal change. Preferences for therapists are based not on race, but on the ability to share, understand, and accept their worldviews. In other words, attitudinal similarity between therapist and client is a more important dimension than membership-group similarity.

Value of R/CID Framework

The R/CID framework is a useful heuristic tool for counselors who work with culturally diverse populations. The model reminds therapists of several important clinical imperatives: (a) Within-group differences are very important to acknowledge in clients of color because not all members of a racial/cultural group are the same. Depending on their levels of racial consciousness, the attitudes, beliefs, and orientations of clients of color may be quite different from one another. (b) A culturally competent counselor needs to be cognizant of and to understand how sociopolitical factors influence and shape identity. Identity development is not solely due to cultural differences but to how the differences are perceived in our society. (c) The model alerts clinicians working with clients of color to certain likely challenges associated with each stage or level of racial/cultural consciousness. Not only may it serve as a useful diagnostic tool, but it provides suggestions of what may be the most appropriate treatment intervention. (d) Other socially marginalized or devalued groups undergo similar identity processes. For example, formulations for women, LGBT groups, those with disabilities, and so forth, can now be found in the psychological literature. Mental health professionals hoping to work with these specific populations would be well served to become familiar with these models as well.

One important aspect relatively untouched in the clinical and research literature is the racial identity development of helping professionals. We have spent considerable time describing the identity development of people of color from the perspective of clients. We have, however, in Chapter 3 indicated that the level of racial consciousness of the minority therapist may impact that of the client of color. In the next chapter we address the issue of White identity development and discuss how it may impact clients of color. But it is equally important for counselors of color to consider their own racial consciousness and how it may interact with a client from their own group. We present several questions for you to consider in the following reflection and discussion questions.

Reflection and Discussion Questions

1. What types of conflict and/or challenge confront a therapist of color at the conformity stage when working with a client of color at the resistance and immersion stage? How would they perceive one another? How may they respond to one another? What therapeutic issues are likely to arise? What needs to be done in order for the therapist to be helpful?

2. Can you discuss other stage combinations and their implications for therapists and clients of color working with one another?

3. Does a counselor of color have to be at the integrative awareness stage to be helpful to clients of color?

Research on racial/cultural identity development has slowed considerably since the 1990s (Ponterotto & Mallinckrodt, 2007; Yoon, 2011), and little change in the models presented in this chapter has occurred. In some respects, this reflects the widespread acceptance of the importance of identity development and how much it has become a part of the social-psychological and mental health landscape (Wijeyesinghe & Jackson, 2012). On the other hand, this slowing of research also reflects the considerable confusion about the theory and measurement of racial/cultural identity. Indeed, a special issue of the Journal of Counseling Psychology in 2007 (Cokley, 2007; Helms, 2007) discussed in detail the conceptual and methodological challenges confronting the field. Although many measures have been developed in an attempt to assess and/or test the conceptual models, most have proven limited because of the sometimes nuanced aspects of measurement. It is clear that we have encountered an impasse that can be broken only through the development of more sophisticated and better measures of racial and ethnic identity.

Implications for Clinical Practice

1. Be aware that the R/CID model should not be viewed as a global personality theory with specific identifiable phases that serve as fixed categories. The process of cultural identity development is dynamic, not static.

2. Do not fall victim to stereotyping in using these models. Most clients of color may evidence a dominant characteristic, but there are mixtures from other stages as well.

3. Know that identity development models are conceptual aids and that human development is much more complex.

4. Know that a number of issues and questions still exist. Is cultural identity development primarily a linear process? Do individuals always start at the beginning of these stages? Is it possible to skip stages? Can people regress?

5. Be careful of the implied value judgments given in almost all development models. They assume that some cultural resolutions are healthier than others. For example, the R/CID model obviously does hold the integrative awareness stage as a higher form of healthy functioning.

6. Be aware that racial/cultural identity development models seriously lack an adequate integration of gender, class, sexual orientation, and other sociodemographic group identities.

7. Know that a great deal of evidence is mounting that suggests that although identity may sequentially move through identifiable stages, affective, attitudinal, cognitive, and behavioral components of identity may not move in a uniform manner. It is entirely possible that the emotions and affective elements associated with certain stages do not have a corresponding one-to-one behavioral impact.

8. Begin to look more closely at the possible therapist and client stage combinations. As mentioned earlier, therapeutic processes and outcomes are often the function of the identity stage of both therapist and client. White identity development of the therapist can either enhance or retard effective therapy.

Summary

In the past several decades, work on racial/cultural identity development among marginalized groups has led to major breakthroughs in the field of multicultural counseling/therapy. Racial identity development models have proven helpful in many respects. First, they reveal major within-group differences that occur depending on one's level of identity. Second, research suggests that reactions to counseling, the counseling process, and counselors are influenced by cultural/racial identity and are not simply linked to minority group membership. Third, they clarify the impact of sociopolitical forces in shaping racial identity. And fourth, identity development models that discuss the oppressor–oppressed relationship seem equally applicable to other marginalized groups, such as women, lesbians/gays, and individuals with disabilities.

The R/CID model proposed is a conceptual framework to aid therapists in understanding their culturally diverse clients' attitudes and behaviors. Five levels of development that oppressed people experience as they struggle to understand themselves in terms of their own culture, the dominant culture, and the oppressive relationship between the two cultures are described: conformity, dissonance, resistance and immersion, introspection, and integrative awareness. At each level of identity, four corresponding beliefs and attitudes, the understanding of which may help therapists better understand their clients, are discussed. These attitudes/beliefs are an integral part of identity, and are manifest in how a person views (a) the self, (b) others of the same minority, (c) others of another minority, and (d) majority individuals.

Each specific level of racial identity offers unique challenges for the counselor. Clients in the conformity phase are dealing with internalized racism and may not respond well to therapists of color; dissonance clients are dealing with racial inconsistencies in their previous belief systems; resistance and immersion clients are likely to reveal strong anger about racism; introspection clients struggle with group loyalties and self-autonomy; and integrative awareness clients are self-secure and motivated toward multicultural integration. A culturally competent counselor needs to be cognizant of and to understand how sociopolitical factors influence and shape identity. Identity development is not solely due to cultural differences but to how the differences are perceived in our society.

Glossary Terms

Active commitment

Asian American identity development models

Black identity development models

Conformity

Dissonance

Encounter

Identity synthesis

Immersion-emersion

Integrative awareness

Internalization

Internalization-commitment

Internalized racism

Introspection

Latino/Hispanic American identity development models

Marginal person

Nigrescence

Preencounter

R/CID model

Race salience

Racial awakening

Redirection

Resistance and immersion

Traditionalist

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WHITE RACIAL IDENTITY DEVELOPMENT COUNSELING IMPLICATIONS

Chapter Objectives

1. Acquire understanding of what it means to be White. Be able to discern differences between how Whites and people of color see the meaning of “Whiteness.”

2. Analyze resistance by White Americans to identifying themselves as “White.”

3. Learn the meaning of nested or embedded emotions experienced by Whites as they come to accept their Whiteness.

4. Define White privilege.

5. Understand how Whiteness advantages Whites and disadvantages people of color.

6. Describe and discuss the various developmental levels of White racial identity development.

7. Learn how the level of White racial consciousness may affect the counseling process.

8. Understand how White racial identity development may influence the definition of normality-abnormality, assessment, diagnosis, and treatment of culturally diverse clients.

9. Learn what a White person needs to do in order to develop a nonracist and antiracist White identity.

10. Learn what White helping professionals need to do in order to prevent their Whiteness from negatively impacting clients of color.

As a person of color, I have often wondered how White people identify themselves as racial/cultural beings. At times, I noted that White trainees often seemed to believe race was confined to persons of color and did not apply to them. To explore this phenomenon more deeply, I asked people in downtown San Francisco “What does it mean to be White?” These were some of the responses I received (Sue, 2003, pp. 115–117).

42-Year-Old White Male Businessperson

1. Q: What does it mean to be White?

2. A: Frankly, I don't know what you're talking about!

3. Q: Aren't you White?

4. A: Yes, but I come from Italian heritage. I'm Italian, not White.

5. Q: Well then, what does it mean to be Italian?

6. A: Pasta, good food, love of wine (obviously agitated). This is getting ridiculous!

26-Year-Old White Female College Student

1. Q: What does it mean to be White?

2. A: Is this a trick question? . . . I've never thought about it. . . Well, I know that lots of Black people see us as being prejudiced and all that stuff. I wish people would just forget about race differences and see one another as human beings. People are people and we should all be proud to be Americans.

34-Year-Old White Female Stockbroker

1. Q: What does it mean to be White?

2. A: I don't know (laughing), I've never thought about it.

3. Q: Are you White?

4. A: Yes, I suppose so (seems very amused).

5. Q: Why haven't you thought about it?

6. A: Because it's not important to me.

7. Q: Why not?

8. A: It doesn't enter into my mind because it doesn't affect my life. Besides, we are all individuals. Color isn't important.

39-Year-Old Black Male Salesperson

1. Q: What does it mean to be White?

2. A: Is this a school exercise or something? Never expected someone to ask me that question in the middle of the city. Do you want the politically correct answer or what I really think?

3. Q: Can you tell me what you really think?

4. A: You won't quit, will you (laughing)? If you're White, you're right. If you're Black, step back.

5. Q: What does that mean?

6. A: White folks are always thinking they know all the answers. A Black man's word is worth less than a White man's. When White customers come into our dealership and see me standing next to the cars, I become invisible to them. Actually, they may see me as a well-dressed janitor (laughs), or actively avoid me. They will search out a White salesman. Or, when I explain something to a customer, they always check out the information with my White colleagues. They don't trust me. When I mention this to our manager, who is White, he tells me I'm oversensitive and being paranoid. That's what being White means. It means having the authority or power to tell me what's really happening even though I know it's not. Being White means you can fool yourself into thinking that you're not prejudiced, when you are. That's what it means to be White. (Sue, 2003, pp. 118–119).

Reflection and Discussion Questions

1. Is this a fair or unfair question?

2. Can you discern any common responses among the three given by White pedestrians? In what ways do they differ?

3. How do Whites view themselves as racial/cultural beings?

4. What seems to prevent these three individuals from viewing themselves as White?

5. If asked what it means to be White, would people of color also find difficulty answering the question? Why or why not?

6. How does the Black salesman's response differ from his White counterparts?

7. Which perception is the most accurate? Why?

Research on Whiteness, White privilege, and White racial identity development point to one of the greatest barriers to racial understanding for White Americans: the invisibility of their Whiteness (Bell, 2003; Helms, 1990; Spanierman, Poteat, Beer, & Armstrong, 2006; Tatum, 1992; Todd & Abrams, 2011). Just as ethnocentric monoculturalism and implicit bias achieve their oppressive powers through invisibility, so too does Whiteness (Boysen, 2010; Sue, 2004). During racial interactions or conversations, many Whites appear oblivious to the meaning of their Whiteness, how it intrudes and disadvantages people of color, and how it affects the way they perceive the world (Bell, 2002; Sue, 2013).

It appears that the denial and mystification of Whiteness for White EuroAmericans are related to two underlying factors. First, most people seldom think about the air that surrounds them and about how it provides an essential life-giving ingredient, oxygen. We take it for granted because it appears plentiful; only when we are deprived of it does it suddenly become frighteningly apparent. Whiteness is transparent precisely because of its everyday occurrence—its institutionalized normative features in our culture—and because Whites are taught to think of their lives as morally neutral, average, and ideal (Sue, 2004). To people of color, however, Whiteness is not invisible because it may not fit their normative qualities (e.g., values, lifestyles, experiential reality). Persons of color find White culture quite visible because even though it is nurturing to White EuroAmericans, it may invalidate the lifestyles of multicultural populations.

Second, EuroAmericans often deny that they are White, seem angered by being labeled as such, and often become very defensive (e.g., saying, “I'm not White; I'm Irish,” “You're stereotyping, because we're all different,” or “There isn't anything like a White race”). In many respects, these statements have validity. Nonetheless, many White Americans would be hard pressed to describe their Irish, Italian, German, or Norwegian heritage in any but the most superficial manner. One of the reasons is related to the processes of assimilation and acculturation. Although there are many ethnic groups, being White allows for assimilation. While persons of color are told to assimilate and acculturate, the assumption is that there exists a receptive society. People of color are told in no uncertain terms that they are allowed only limited access to the fruits of our society.

Third, the accuracy of whether Whiteness defines a race is largely irrelevant. What is more relevant is that Whiteness is associated with unearned privilege—advantages conferred on White Americans but not on persons of color. It is our contention that much of the denial associated with being White is related to the denial of White privilege, which is unmasked by this Black salesman when asked “What does it mean to be White?”

The response given by the Black salesman is markedly different from those of the other three responders by its specificity, clarity, and perspective. In essence, he believes being White means (a) having the power to define reality, (b) possessing unconscious stereotypes that people of color are less competent and capable, (c) deceiving the self that one is not prejudiced, and (d) being oblivious to how Whiteness disadvantages people of color and advantages White people. This worldview is in marked contrast to the White respondents who would rather not think about their Whiteness, are uncomfortable or react negatively to being labeled “White,” deny its importance in affecting their lives, and seem to believe that they are unjustifiably accused of being bigoted by virtue of being White. Strangely enough, “whiteness” is most visible when it is denied, evokes puzzlement or negative reactions, and equated with normalcy. Few people of color react negatively when asked what it means to be Black, Asian American, Latino or a member of their race. Most could readily inform the questioner about what it means to be a person of color.

Understanding the Dynamics of Whiteness

Our analysis of the responses from both Whites and the person of color leads us to the inevitable conclusion that part of the problem of race relations (and by inference multicultural counseling and therapy) lies in the different worldviews of both groups. It goes without saying that the racial reality of Whites is radically different from that of people of color (Sue, 2010). Which group, however, has the more accurate assessment related to this topic? The answer seems to be contained in the following series of questions: If you want to understand oppression, should you ask the oppressor or the oppressed? If you want to learn about sexism, do you ask men or women? If you want to understand homophobia, do you ask straights or gays? If you want to learn about racism, do you ask Whites or persons of color? It appears that the most accurate assessment of bias comes not from those who enjoy the privilege of power, but from those who are most disempowered (Hanna, Talley, & Guindon, 2000; Sue, 2015). Taking this position, the following conclusions are made about the dynamics of Whiteness.

First, it is clear that most Whites perceive themselves as unbiased individuals who do not harbor racist thoughts and feelings; they see themselves as working toward social justice and possessing a conscious desire to better the life circumstances of those less fortunate than they. Although these are admirable qualities, this self-image serves as a major barrier to recognizing and taking responsibility for admitting and dealing with one's own prejudices and biases. To admit to being racist, sexist, or homophobic requires people to recognize that the self-images they hold so dear are based on false notions of the self.

Second, being a White person in this society means chronic exposure to ethnocentric monoculturalism as manifested in White supremacy (Hays, 2014). It is difficult, if not impossible, for anyone to avoid inheriting the racial biases, prejudices, misinformation, deficit portrayals, and stereotypes of their forebears (Cokley, 2006). To believe that one is somehow immune from inheriting such aspects of White supremacy is to be naive or to engage in self-deception. Such a statement is not intended to assail the integrity of Whites but to suggest that they also have been victimized. It is clear to us that no one was born wanting to be racist, sexist, or homophobic. Misinformation is not acquired by free choice but is imposed upon White people through a painful process of cultural conditioning (Gallardo & Ivey, 2014). In general, lacking awareness of their biases and preconceived notions, counselors may function in a therapeutically ineffective manner.

Third, if White helping professionals are ever able to become effective multicultural counselors or therapists, they must free themselves from the cultural conditioning of their past and move toward the development of a nonracist White identity. Unfortunately, many White EuroAmericans seldom consider what it means to be White in our society. Such a question is vexing to them because they seldom think of race as belonging to them—nor of the privileges that come their way by virtue of their white skin (Toporek & Worthington, 2014). Katz (1985) points out a major barrier blocking the process of White EuroAmericans investigating their own cultural identity and worldview:

Because White culture is the dominant cultural norm in the United States, it acts as an invisible veil that limits many people from seeing it as a cultural system. . . .Often, it is easier for many Whites to identify and acknowledge the different cultures of minorities than accept their own racial identity. . . .The difficulty of accepting such a view is that White culture is omnipresent. It is so interwoven in the fabric of everyday living that Whites cannot step outside and see their beliefs, values, and behaviors as creating a distinct cultural group. (pp. 616–617)

As we witnessed in Chapter 6 , the invisible veil allows for racial, gender, and sexual orientation microaggressions to be delivered outside the level of awareness of perpetrators. Ridley (1995) asserts that this invisible veil can be unintentionally manifested in therapy with harmful consequences to clients of color:

Unintentional behavior is perhaps the most insidious form of racism. Unintentional racists are unaware of the harmful consequences of their behavior. They may be well-intentioned, and on the surface, their behavior may appear to be responsible. Because individuals, groups, or institutions that engage in unintentional racism do not wish to do harm, it is difficult to get them to see themselves as racists. They are more likely to deny their racism. (p. 38)

The conclusion drawn from this understanding is that White counselors and therapists may be unintentional racists: (a) They are unaware of their biases, prejudices, and discriminatory behaviors; (b) they often perceive themselves as moral, good, and decent human beings and find it difficult to see themselves as racist; (c) they do not have a sense of what their Whiteness means to them; and (d) their therapeutic approaches to multicultural populations are likely to be more harmful (unintentionally) than helpful. These conclusions are often difficult for White helping professionals to accept because of the defensiveness and feelings of blame they are likely to engender. Nonetheless, we ask White therapists and students not be turned off by the message and lessons of this chapter. We ask you to reread Chapter 1 where we discussed the emotive reactions likely to impede learning. And, we ask you to continue your multicultural journey in this chapter as we explore the question, “What does it mean to be White?”

Models of White Racial Identity Development

A number of multicultural experts in the field have begun to emphasize the need for White therapists to deal with their concepts of Whiteness and to examine their own racism (Gallardo & Ivey, 2014; Ponterotto, Utsey, & Pedersen, 2006; Todd & Abrams, 2011). These specialists point out that while racial/cultural identity development for minority groups proves beneficial in our work as therapists, more attention should be devoted toward the White therapist's racial identity. Since the majority of therapists and trainees are White middle-class individuals, it would appear that White identity development and its implication for multicultural counseling/therapy would be important aspects to consider, both in the actual practice of clinical work and in professional training.

For example, research has found that the level of White racial identity awareness is predictive of racism and internal interpersonal characteristics (Miville, Darlington, Whitlock, & Mulligan, 2005; Perry, Dovidio, Murphy, & van Ryn, 2015; Pope-Davis & Ottavi, 1994; Spanierman, Todd, & Anderson, 2009; Vinson & Neimeyer, 2000, 2003; Wang et al., 2003): (a) the less aware subjects were of their White identity, the more likely they were to exhibit increased levels of racism; (b) the higher the level of White identity development, the greater the reported multicultural counseling competence, more positive opinions toward minority groups, and better therapeutic alliances; (c) higher levels of mature interpersonal relationships and a better sense of personal well-being were associated with higher levels of White identity consciousness; and (d) as a group, women were more likely than men to exhibit higher levels of White consciousness and were less likely to be racially biased.

It was suggested that this last finding was correlated with women's greater experiences with discrimination and prejudice. Evidence also exists that multicultural counseling/therapy competence is correlated with White racial identity attitudes (Neville, Awad, Brooks, Flores, & Bluemel, 2013). Other research suggests that a relationship exists between a White EuroAmerican therapist's racial identity and his or her readiness for training in multicultural awareness, knowledge, and skills (Falender, Shafranske, & Falicov, 2014; Utsey, Gernat, & Hammar, 2005). Since developing multicultural sensitivity is a long-term developmental task, the work of many researchers has gradually converged toward a conceptualization of the stages/levels/statuses of consciousness of racial/ethnic identity development for White EuroAmericans. A number of these models describe the salience of identity for establishing relationships between the White therapist and the culturally different client, and some have now linked stages of identity with stages for appropriate training.

The Hardiman White Racial Identity Development Model

One of the earliest integrative attempts at formulating a White racial identity development model is that of Rita Hardiman (1982). Intrigued with why certain White Americans exhibit a much more nonracist identity than do other White Americans, Hardiman studied the autobiographies of individuals who had attained a high level of racial consciousness. This led her to identify five White developmental stages: (a) naiveté—lack of social consciousness, (b) acceptance, (c) resistance, (d) redefinition, and (e) internalization.

1. The naiveté stage (lack of social consciousness) is characteristic of early childhood, when we are born into this world innocent, open, and unaware of racism and the importance of race. Curiosity and spontaneity in relating to race and racial differences tend to be the norm. A young White child who has almost no personal contact with African Americans, for example, may see a Black man in a supermarket and loudly comment on the darkness of his skin. In general, awareness and the meaning of race, racial differences, bias, and prejudice are either absent or minimal. The negative reactions of parents, relatives, friends, and peers toward issues of race, however, begin to convey mixed signals to the child. This is reinforced by the educational system and mass media, which instill racial biases in the child and propel him or her into the acceptance stage.

2. The acceptance stage is marked by a conscious belief in the democratic ideal—that everyone has an equal opportunity to succeed in a free society and that those who fail must bear the responsibility for their failure. White EuroAmericans become the social reference group, and the socialization process consistently instills messages of White superiority and minority inferiority into the child. The underemployment, unemployment, and undereducation of marginalized groups in our society are seen as support for the belief that non-White groups are lesser than Whites. Because everyone has an equal opportunity to succeed, the lack of success of minority groups is seen as evidence of some negative personal or group characteristic. Victim blaming is strong, as the existence of oppression, discrimination, and racism is denied. Hardiman believes that although the naiveté stage is brief in duration, the acceptance stage can last a lifetime.

3. In the resistance stage, the individual begins to challenge assumptions of White superiority and the denial of racism and discrimination. The White person's denial system begins to crumble because of a monumental event or a series of events that not only challenge but also shatter the individual's denial system. A White person may, for example, make friends with a coworker of color and discover that the images he or she has of “these people” are untrue. The person may have witnessed clear incidents of unfair discrimination toward persons of color and may now begin to question assumptions regarding racial inferiority. In any case, the racial realities of life in the United States can no longer be denied. The person becomes conscious of being White, is aware that he or she harbors racist attitudes, and begins to see the pervasiveness of oppression in our society. Feelings of anger, pain, hurt, rage, and frustration are present. In many cases, the White person may develop a negative reaction toward his or her own group or culture. Although those at this stage may romanticize people of color, they cannot interact confidently with them because they fear that they will make racist mistakes. This discomfort is best exemplified in a passage by Sara Winter (1977, p. 1):

We avoid Black people because their presence brings painful questions to mind. Is it OK to talk about watermelons or mention “black coffee”? Should we use Black slang and tell racial jokes? How about talking about our experiences in Harlem, or mentioning our Black lovers? Should we conceal the fact that our mother still employs a Black cleaning lady?. . .We're embarrassedly aware of trying to do our best but to “act natural” at the same time. No wonder we're more comfortable in all-White situations where these dilemmas don't arise.

4. In the redefinition stage, asking the painful question of who one is in relation to one's racial heritage, honestly confronting one's biases and prejudices, and accepting responsibility for one's Whiteness are the culminating characteristics. New ways of defining one's social group and one's membership in that group become important. The intense soul-searching is most evident in Winter's 1977 personal journey as she writes,

In this sense we Whites are the victims of racism. Our victimization is different from that of Blacks, but it is real. We have been programmed into the oppressor roles we play, without our informed consent in the process. Our unawareness is part of the programming: None of us could tolerate the oppressor position, if we lived with a day-to-day emotional awareness of the pain inflicted on other humans through the instrument of our behavior. . . .We Whites benefit in concrete ways, year in and year out, from the present racial arrangements. All my life in White neighborhoods, White schools, White jobs, and dealing with White police (to name only a few), I have experienced advantages that are systematically not available to Black people. It does not make sense for me to blame myself for the advantages that have come my way by virtue of my Whiteness. But absolving myself from guilt does not imply forgetting about racial injustice or taking it lightly (as my guilt pushes me to do). (p. 2)

There is realization that Whiteness has been defined in opposition to people of color—namely, by standards of White supremacy. By being able to step out of this racist paradigm and redefine what her Whiteness meant to her, Winter is able to add meaning to developing a nonracist identity. She no longer denies being White, honestly confronts her racism, and understands the concept of White privilege.

5. The internalization stage is the result of forming a new social and personal identity. With the greater comfort in understanding oneself and the development of a nonracist White identity come a commitment to social action as well. The individual accepts responsibility for effecting personal and social change without always relying on persons of color to lead the way. As Winter 1977 explains,

To end racism, Whites have to pay attention to it and continue to pay attention. Since avoidance is such a basic dynamic of racism, paying attention will not happen naturally. We Whites must learn how to hold racism realities in our attention. We must learn to take responsibility for this process ourselves, without waiting for Blacks' actions to remind us that the problem exists, and without depending on Black people to reassure us and forgive us for our racist sins. In my experience, the process is painful but it is a relief to shed the fears, stereotypes, immobilizing guilt we didn't want in the first place. (p. 2)

The Helms White Racial Identity Development Model

Working independently of Hardiman, Janet Helms (1984, 1990, 1994, 1995) created perhaps the most elaborate and sophisticated White racial identity model in the field. Not only has her model led to the development of an assessment instrument to measure White racial identity, but it also has been scrutinized empirically (Carter, 1990; Helms & Carter, 1990) and has generated much research and debate in the psychological literature. Like Hardiman (1982), Helms assumes that racism is an intimate and central part of being a White American. To her, developing a healthy White identity requires movement through two phases: (a) abandonment of racism and (b) defining a nonracist White identity (Helms, 2015).

Six specific racial identity statuses are distributed equally in the two phases: contact, disintegration, reintegration, pseudo-independence, immersion/emersion, and autonomy. Originally, Helms used the term stages to refer to the six; but because of certain conceptual ambiguities and the controversy that ensued, she has abandoned its usage.

1. Contact status: People in this status are oblivious to and unaware of racism, believe that everyone has an equal chance for success, lack an understanding of prejudice and discrimination, have minimal experiences with persons of color, and may profess to be color-blind. Such statements as “People are people,” “I don't notice a person's race at all,” and “You don't act Black” are examples. Although there is an attempt to minimize the importance or influence of race, there is on both a conscious and an unconscious level a definite dichotomy between persons of color and Whites regarding stereotypes and the superior/inferior dimensions of the races. Because of obliviousness and compartmentalization, it is possible for two diametrically opposed belief systems to coexist: (a) Uncritical acceptance of White supremacist notions relegates minorities into the inferior category with all the racial stereotypes, and (b) there is a belief that racial and cultural differences are unimportant. This allows Whites to avoid perceiving themselves as dominant group members or as having biases and prejudices. Such an orientation is aptly stated by Peggy McIntosh (1989) in her own White racial awakening:

My schooling gave me no training in seeing myself as an oppressor, as an unfairly advantaged person, or as a participant in a damaged culture. I was taught to see myself as an individual whose moral state depended on her individual moral will. . . .Whites are taught to think of their lives as morally neutral, normative, and average, and also ideal, so that when we work to benefit others, this is seen as work which will allow “them” to be more like “us.” (p. 8)

2. Disintegration status: Although in the previous status the individual does not recognize the polarities of democratic principles of equality and the unequal treatment of minority groups, such obliviousness may eventually break down. The White person becomes conflicted over irresolvable racial moral dilemmas that are frequently perceived as polar opposites: believing one is nonracist, yet not wanting one's son or daughter to marry a minority group member; believing that all men are created equal, even though society treats people of color as second-class citizens; and not acknowledging that oppression exists and then witnessing it (e.g., the killing of Michael Brown and Eric Garner in 2014). Conflicts between loyalty to one's group and humanistic ideals may manifest themselves in various ways. The person becomes increasingly conscious of his or her Whiteness and may experience dissonance and conflict, resulting in feelings of guilt, depression, helplessness, or anxiety. Statements such as “My grandfather is really prejudiced, but I try not to be” and “I'm personally not against interracial marriages, but I worry about the children” are representative of personal struggles occurring in the White person.

Although a healthy resolution might be to confront the myth of meritocracy realistically, the breakdown of the denial system is painful and anxiety provoking. Attempts at resolution, according to Helms, may involve (a) avoiding contact with persons of color, (b) not thinking about race, and (c) seeking reassurance from others that racism is not the fault of Whites.

3. Reintegration status: This status can best be characterized as a regression in which the pendulum swings back to the most basic beliefs of White superiority and minority inferiority. In their attempts to resolve the dissonance created from the previous process, there is a retreat to the dominant ideology associated with race and one's own socioracial group identity. This ego status results in idealizing the White EuroAmerican group and the positives of White culture and society; there is a consequent negation and intolerance of minority groups. In general, a firmer and more conscious belief in White racial superiority is present. Racial/ethnic minorities are blamed for their own problems.

I'm an Italian grandmother. No one gave us welfare or a helping hand when we came over [immigrated]. My father worked day and night to provide us with a decent living and to put all of us through school. These Negroes are always complaining about prejudice and hardships. Big deal! Why don't they stop whining and find a job? They're not the only ones who were discriminated against, you know. You don't think our family wasn't? We never let that stop us. In America everyone can make it if they are willing to work hard. I see these Black welfare mothers waiting in line for food stamps and free handouts. You can't convince me they're starving. Look at how overweight most of them are. . . . Laziness—that's what I see. (Quoted from a workshop participant)

4. Pseudo-independence status: This status initiates the second phase of Helms's model, which involves defining a nonracist White identity. As in the Hardiman model, a person is likely to be propelled into this phase because of a painful or insightful encounter or event that jars the person from the reintegration status. The awareness of visible racial/ethnic minorities, the unfairness of their treatment, and a discomfort with their racist White identity may lead individuals to identify with the plight of persons of color. However, the well-intentioned White person at this status may suffer from several problematic dynamics: (a) Although intending to be socially conscious and helpful to minority groups, the White individual may unknowingly perpetuate racism by helping minorities adjust to the prevailing White standards; and (b) identifying with minority individuals is based on how similar they are to him or her, and the primary mechanism used to understand racial issues is intellectual and conceptual.

5. Immersion/emersion status: If the person is reinforced to continue a personal exploration of him- or herself as a racial being, questions become focused on what it means to be White. Helms states that the person searches for an understanding of the personal meaning of racism and the ways in which one benefits from White privilege. There is an increasing willingness to confront one's own biases, to redefine Whiteness, and to become more active in directly combating racism and oppression. This status is different from the previous one in two major ways: It is marked by (a) a shift in focus from trying to change people of color to changing the self and other Whites and (b) an increasing experiential and affective understanding that was lacking in the previous status. The ability to achieve this affective/experiential upheaval leads to a euphoria, or even a feeling of rebirth, and is a necessary condition to developing a new, nonracist White identity. Winter (1977) states,

Let me explain this healing process in more detail. We must unearth all the words and memories we generally try not to think about, but which are inside us all the time: “nigger,” “Uncle Tom,” “jungle bunny,” “Oreo,” lynching, cattle prods, castrations, rapists, “black pussy,” and black men with their huge penises, and hundreds more. (I shudder as I write.) We need to review three different kinds of material: (1) All our personal memories connected with blackness and black people, including everything we can recall hearing or reading; (2) all the racist images and stereotypes we've ever heard, particularly the grossest and most hurtful ones; (3) any race-related things we ourselves said, did, or omitted doing which we feel bad about today.

. . . Most whites begin with a good deal of amnesia. Eventually the memories crowd in, especially when several people pool recollections. Emotional release is a vital part of the process. Experiencing feelings seems to allow further recollections to come. I need persistent encouragement from my companions to continue. (p. 3)

6. Autonomy status: Increasing awareness of one's own Whiteness, reduced feelings of guilt, acceptance of one's role in perpetuating racism, and renewed determination to abandon White entitlement lead to an autonomy status. The person is knowledgeable about racial, ethnic, and cultural differences; values the diversity; and is no longer fearful, intimidated, or uncomfortable with the experiential reality of race. Development of a nonracist White identity becomes increasingly strong. Indeed, the person feels comfortable with his or her nonracist White identity, does not personalize attacks on White supremacy, and can explore the issues of racism and personal responsibility without defensiveness. A person in this status “walks the talk” and actively values and seeks out interracial experiences.

Helms's model is by far the most widely cited, researched, and applied of all the White racial identity formulations. Part of its attractiveness and value is the derivation of “defenses,” “protective strategies,” or what Helms (1995) formally labels information-processing strategies (IPSs), which White people use to avoid or assuage anxiety and discomfort around the issue of race. Table 12.1 lists examples of IPS statements likely to be made by White people in each of the six ego statuses. Understanding these strategic reactions is important for White American identity development, for understanding the barriers that must be overcome in order to move to another status, and for potentially developing effective training or clinical strategies.

TABLE 12.1 White Racial Identity Ego Statuses and Information-Processing Strategies

Source: Helms, 1995, p. 185.

1. Contact status: Satisfaction with racial status quo, obliviousness to racism and one's participation in it. If racial factors influence life decisions, they do so in a simplistic fashion. Information-processing strategy. IPS: Obliviousness.

Example: “I'm a White woman. When my grandfather came to this country, he was discriminated against, too. But he didn't blame Black people for his misfortunes. He educated himself and got a job. That's what Blacks ought to do. If White callers [to a radio station] spent as much time complaining about racial discrimination as your Black callers do, we'd never have accomplished what we have. You all should just ignore it” (quoted from a workshop participant).

2. Disintegration status: Disorientation and anxiety provoked by irresolvable racial moral dilemmas that force one to choose between own-group loyalty and humanism. May be stymied by life situations that arouse racial dilemmas. IPS: Suppression and ambivalence.

Example: “I myself tried to set a nonracist example [for other Whites] by speaking up when someone said something blatantly prejudiced—how to do this without alienating people so that they would no longer take me seriously was always tricky—and by my friendships with Mexicans and Blacks who were actually the people with whom I felt most comfortable” (Blauner, 1993, p. 8).

3. Reintegration status: Idealization of one's socioracial group, denigration and intolerance of other groups. Racial factors may strongly influence life decisions. IPS: Selective perception and negative out-group distortion.

Example: “So what if my great-grandfather owned slaves. He didn't mistreat them; and besides, I wasn't even here then. I never owned slaves. So I don't know why Blacks expect me to feel guilty for something that happened before I was born. Nowadays, reverse racism hurts Whites more than slavery hurts Blacks. At least they got three square [meals] a day. But my brother can't even get a job with the police department because they have to hire less-qualified Blacks. That [expletive] happens to Whites all the time” (quoted from a workshop participant).

4. Pseudo-independence status: Intellectualized commitment to one's own socioracial group and deceptive tolerance of other groups. May make life decisions to “help other racial groups.” IPS: Reshaping reality and selective perception.

Example: “Was I the only person left in America who believed that the sexual mingling of the races was a good thing, that it would erase cultural barriers and leave us all a lovely shade of tan?. . .Racial blending is inevitable. At the very least, it may be the only solution to our dilemmas of race” (Allen, 1994, p. C4).

5. Immersion/emersion status: Search for an understanding of the personal meaning of racism and the ways by which one benefits and a redefinition of Whiteness. Life choices may incorporate racial activism. IPS: Hypervigilance and reshaping.

Example: “It's true that I personally did not participate in the horror of slavery, and I don't even know whether my ancestors owned slaves. But I know that because I am White, I continue to benefit from a racist system that stems from the slavery era. I believe that if White people are ever going to understand our role in perpetuating racism, then we must begin to ask ourselves some hard questions and be willing to consider our role in maintaining a hurtful system. Then we must try to do something to change it” (quoted from a workshop participant).

6. Autonomy status: Informed positive socioracial group commitment, use of internal standards for self-definition, capacity to relinquish the privileges of racism. May avoid life options that require participation in racial oppression. IPS: Flexibility and complexity.

Example: “I live in an integrated [Black-White] neighborhood, and I read Black literature and popular magazines. So I understand that the media presents a very stereotypic view of Black culture. I believe that if more of us White people made more than a superficial effort to obtain accurate information about racial groups other than our own, then we could help make this country a better place for all peoples” (quoted from a workshop participant).

The Helms model, however, is not without its detractors. In an article critical of the Helms model and of most “stage” models of White racial identity development, Rowe, Bennett, and Atkinson (1994) raised some serious objections.

First, they claim that Helms's model is erroneously based on racial/ethnic minority identity development models (discussed in the previous chapter). Because minority identity development occurs in the face of stereotyping and oppression, it may not apply to White identity, which does not occur under the same conditions.

Second, they believe that too much emphasis is placed on the development of White attitudes toward minorities and that not enough is placed on the development of White attitudes toward themselves and their own identity.

Third, they claim that there is a conceptual inaccuracy in putting forth the model as developmental via stages (linear) and that the progression from less to more healthy seems to be based on the author's ethics.

Last, Rowe (2006) attacks the Helms model of White racial identity development because it is based upon the White Racial Identity Attitude Scale (Helms & Carter, 1990), which he labels as “pseudoscience” because he asserts that the psychometric properties are not supported by the empirical literature. It is important to note that the critique of the Helms (1984) model has not been left unanswered. In subsequent writings, Helms (1994) has disclaimed the Rowe et al. (1994, 1995) characterization of her model and has attempted to clarify her position. The continuing debate has proven beneficial in adding greater clarity to the issues of White racial identity development and has resulted in increased research.

The Process of White Racial Identity Development: A Descriptive Model

Although there are differences in the models, it appears important for Whites to view their developmental history in order to gain a sense of their past, present, and future as they struggle with racial identity development. In our work with White trainees and clinicians, we have observed some very important changes through which they seem to move as they work toward multicultural competence (Sue, 2011). We have been impressed with how Whites seem to go through parallel racial/cultural identity transformations. This is especially true if we accept the fact that Whites are as much victims of societal forces (i.e., they are socialized into racist attitudes and beliefs) as are their counterparts (Sue, 2003). No child is born wanting to be a racist! Yet White people do benefit from the dominant–subordinate relationship in our society. It is this factor that Whites need to confront in an open and honest manner.

Using the formulation of our past work (Sue & Sue, 1990), we propose a seven-step process that integrates many characteristics from the other formulations. Furthermore, we make some basic assumptions with respect to those models:

1. Racism is an integral part of U.S. life, and it permeates all aspects of our culture and institutions (ethnocentric monoculturalism).

2. Whites are socialized into the society and therefore inherit all the biases; stereotypes; and racist attitudes, beliefs, and behaviors of the larger society.

3. How Whites perceive themselves as racial beings follows an identifiable sequence that can occur in a linear or nonlinear fashion.

4. The status of White racial identity development in any multicultural encounter affects the process and outcome of interracial relationships.

5. The most desirable outcome is one in which the White person not only accepts his or her Whiteness but also defines it in a nonracist and antiracist manner.

Seven-Step Process

The seven phases of white racial identity development and their implications for White Americans are described in the following. We encourage Whites to use this information to explore themselves as racial/cultural beings and to think about their implications for work with culturally diverse clients.

1. Naiveté phase : This phase is relatively neutral with respect to racial/cultural differences. Its length is brief and is marked by a naive curiosity about race. As mentioned previously, racial awareness and burgeoning social meanings are absent or minimal, and the young child is generally innocent, open, and spontaneous regarding racial differences. Between the ages of three and five, however, the young White child begins to associate positive ethnocentric meanings to his or her own group and negative ones to others. The child is bombarded by misinformation through the educational channels, mass media, and significant others in his or her life, and a sense of the superiority of Whiteness and the inferiority of all other groups and their heritage is instilled. The following passage describes one of the insidious processes of socialization that leads to propelling the child into the conformity stage.

It was a late summer afternoon. A group of White neighborhood mothers, obviously friends, had brought their four- and five-year-olds to the local McDonald's for a snack and to play on the swings and slides provided by the restaurant. They were all seated at a table watching their sons and daughters run about the play area. In one corner of the yard sat a small Black child pushing a red truck along the grass. One of the White girls from the group approached the Black boy and they started a conversation. During that instant, the mother of the girl exchanged quick glances with the other mothers, who nodded knowingly. She quickly rose from the table, walked over to the two, spoke to her daughter, and gently pulled her away to join her previous playmates. Within minutes, however, the girl again approached the Black boy and both began to play with the truck. At that point, all the mothers rose from the table and loudly exclaimed to their children, “It's time to go now!” (Taken from Sue, 2003, pp. 89–90)

2. Conformity phase : The White person's attitudes and beliefs in this phase are very ethnocentric. There is minimal awareness of the self as a racial being and a strong belief in the universality of values and norms governing behavior. The White person possesses limited accurate knowledge of other ethnic groups, but he or she is likely to rely on social stereotypes as the main source of information. Consciously or unconsciously, the White person believes that White culture is the most highly developed and that all others are primitive or inferior. The conformity phase is marked by contradictory and often compartmentalized attitudes, beliefs, and behaviors. A person may believe simultaneously that he or she is not racist but that minority inferiority justifies discriminatory and inferior treatment, and that minority persons are different and deviant but that “people are people” and differences are unimportant. As with their marginalized counterparts at this phase, the primary mechanism operating here is one of denial and compartmentalization. For example, many Whites deny that they belong to a race that allows them to avoid personal responsibility for perpetuating a racist system. Like a fish in water, Whites either have difficulty seeing or are unable to see the invisible veil of cultural assumptions, biases, and prejudices that guide their perceptions and actions. They tend to believe that White EuroAmerican culture is superior and that other cultures are primitive, inferior, less developed, or lower on the scale of evolution.

It is important to note that many Whites in this phase of development are unaware of these beliefs and operate as if they are universally shared by others. They believe that differences are unimportant and that “people are people,” “we are all the same under the skin,” “we should treat everyone the same,” “problems wouldn't exist if minorities would only assimilate,” and discrimination and prejudice are something that others do. The helping professional with this perspective professes color-blindness, views counseling/therapy theories as universally applicable, and does not question their relevance to other culturally different groups. The primary mechanism used in encapsulation is denial—denial that people are different, denial that discrimination exists, and denial of one's own prejudices. Instead, the locus of the problem is seen to reside in marginalized groups. Socially devalued groups would not encounter problems if they would only assimilate and acculturate (melting pot), value education, or work harder.

3. Dissonance phase : Movement into the dissonance phase occurs when the White person is forced to deal with the inconsistencies that have been compartmentalized or encounters information/experiences at odds with denial. In most cases, individuals are forced to acknowledge Whiteness at some level, to examine their own cultural values, and to see the conflict between upholding humanistic nonracist values and their contradictory behavior. For example, a person who may consciously believe that all people are created equal and that he or she treats everyone the same suddenly experiences reservations about having African Americans move next door or having one's son or daughter involved in an interracial relationship. These more personal experiences bring the individual face-to-face with his or her own prejudices and biases. In this situation, thoughts that “I am not prejudiced,” “I treat everyone the same regardless of race, creed, or color,” and “I do not discriminate” collide with the denial system. Additionally, some major event (e.g., the assassination of Martin Luther King Jr.) may force the person to realize that racism is alive and well in the United States.

The increasing realization that one is biased and that EuroAmerican society does play a part in oppressing minority groups is an unpleasant one. Dissonance may result in feelings of guilt, shame, anger, and depression. Rationalizations may be used to exonerate one's own inactivity in combating perceived injustice or personal feelings of prejudice; for example, “I'm only one person—what can I do?” or “Everyone is prejudiced, even minorities.” As these conflicts ensue, the White person may retreat into the protective confines of White culture (encapsulation of the conformity phase) or move progressively toward insight and revelation (resistance and immersion phase).

Whether a person regresses is related to the strength of positive forces pushing the individual forward (support for challenging racism) and negative forces pushing the person backward (fear of some loss) (Sue, 2011; Todd & Abrams, 2011). For example, challenging the prevailing beliefs of the times may mean risking ostracism from White relatives, friends, neighbors, and colleagues. Regardless of the choice, there are many uncomfortable feelings of guilt, shame, anger, and depression related to the realization of inconsistencies in one's belief systems. Guilt and shame are most likely related to the recognition of the White person's role in perpetuating racism in the past. Guilt may also result from the person's being afraid to speak out on the issues or to take responsibility for his or her part in a current situation. For example, the person may witness an act of racism, hear a racist comment, or be given preferential treatment over a minority person but decide not to say anything for fear of violating racist White norms. Many White people rationalize their behaviors by believing that they are powerless to make changes. Additionally, there is a tendency to retreat into White culture. If, however, others (which may include some family and friends) are more accepting, forward movement is more likely.

4. Resistance and immersion phase : The White person who progresses to this phase will begin to question and challenge his or her own racism. For the first time, the person begins to realize what racism is all about, and his or her eyes are suddenly open. Racism is seen everywhere (e.g., advertising, television, educational materials, interpersonal interactions). This phase of development is marked by a major questioning of one's own racism and that of others in society. In addition, increasing awareness of how racism operates and its pervasiveness in U.S. culture and institutions is the major hallmark of this level. It is as if the person awakens to the realities of oppression; sees how educational materials, the mass media, advertising, and other elements portray and perpetuate stereotypes; and recognizes how being White grants certain advantages denied to various minority groups.

There is likely to be considerable anger at family and friends, institutions, and larger societal values, which are seen as having sold him or her a false bill of goods (democratic ideals) that were never practiced. Guilt is also felt for having been a part of the oppressive system. Strangely enough, the person is likely to undergo a form of racial self-hatred at this phase. Negative feelings about being White are present, and the accompanying feelings of guilt, shame, and anger toward oneself and other Whites may develop. The White liberal syndrome may develop and be manifested in two complementary styles: the paternalistic protector role or the overidentification with another minority group (Helms, 1984; Ponterotto, 1988). In the former, the White person may devote his or her energies in an almost paternalistic attempt to protect minorities from abuse. In the latter, the person may actually want to identify with a particular minority group (e.g., Asian, Black) in order to escape his or her own Whiteness. The White person will soon discover, however, that these roles are not appreciated by minority groups and will experience rejection. Again, the person may resolve this dilemma by moving back into the protective confines of White culture (conformity phase), again experience conflict (dissonance), or move directly to the introspective phase.

5. Introspective phase : This phase is most likely a compromise of having swung from an extreme of unconditional acceptance of White identity to a rejection of Whiteness. It is a state of relative quiescence, introspection, and reformulation of what it means to be White. The person realizes and no longer denies that he or she has participated in oppression and benefited from White privilege or that racism is an integral part of U.S. society. However, individuals at this phase become less motivated by guilt and defensiveness, accept their Whiteness, and seek to redefine their own identity and that of their social group. This acceptance, however, does not mean a less active role in combating oppression. The process may involve addressing the questions, “What does it mean to be White?” “Who am I in relation to my Whiteness?” and “Who am I as a racial/cultural being?”

The feelings or affective elements may be existential in nature and involve feelings of disconnectedness, isolation, confusion, and loss. In other words, the person knows that he or she will never fully understand the minority experience but feels disconnected from the EuroAmerican group as well. In some ways, the introspective phase is similar in dynamics to the dissonance phase, in that both represent a transition from one perspective to another. The process used to answer the previous questions and to deal with the ensuing feelings may involve a searching, observing, and questioning attitude. Answers to these questions involve dialoging and observing one's own social group and actively creating and experiencing interactions with various minority group members as well.

6. Integrative awareness phase : Reaching this level of development is most characterized as (a) understanding the self as a racial/cultural being, (b) being aware of sociopolitical influences regarding racism, (c) appreciating racial/cultural diversity, and (d) becoming more committed toward eradicating oppression. A nonracist White EuroAmerican identity is formed, emerges, and becomes internalized. The person values multiculturalism, is comfortable around members of culturally different groups, and feels a strong connectedness with members of many groups. Most important, perhaps, is the inner sense of security and strength that needs to develop and that is needed to function in a society that is only marginally accepting of integrative, aware White persons.

7. Commitment to antiracist action phase : Someone once stated that the ultimate White privilege is the ability to acknowledge it but do nothing about it. This phase is most characterized by social action. There is likely to be a consequent change in behavior and an increased commitment toward eradicating oppression. Seeing “wrong” and actively working to “right” it requires moral fortitude and direct action. Objecting to racist jokes; trying to educate family, friends, neighbors, and coworkers about racial issues; and taking direct action to eradicate racism in the schools and workplace and in social policy (often in direct conflict with other Whites) are examples of actions taken by individuals who achieve this status. Movement into this phase can be a lonely journey for Whites because they are oftentimes isolated by family, friends, and colleagues who do not understand their changed worldview. Strong pressures in society to not rock the boat, threats by family members that they will be disowned, avoidance by colleagues, threats of being labeled a troublemaker or not being promoted at work are all possible pressures for the White person to move back to an earlier phase of development. To maintain a nonracist identity requires Whites to become increasingly immunized to social pressures for conformance and to begin forming alliances with persons of color or other liberated Whites who become a second family to them. As can be seen, the struggle against individual, institutional, and societal racism is a monumental task in this society.

Developing a Nonracist and Antiracist White Identity

I sometimes visualize the ongoing cycle of racism as a moving walkway at the airport. Active racist behavior is equivalent to walking fast on the conveyor belt. The person engaged in active racist behavior has identified with the ideology of White supremacy and is moving with it. Passive racist behavior is equivalent to standing still on the walkway. No overt effort is being made, but the conveyor belt moves the bystanders along to the same destination as those who are actively walking. Some of the bystanders may feel the motion of the conveyor belt, see the active racists ahead of them, and choose to turn around, unwilling to go to the same destination as the White supremacists. But unless they are walking actively in the opposite direction at a speed faster than the conveyor belt – unless they are actively antiracist – they will find themselves carried along with the others. (Tatum, 1997, pp 11–12)

What does this metaphor of racism tell about the difference between active and passive racism? What is the “destination” of the walkway? If it represents our society, can you describe what that destination looks like? What does the conveyor belt symbolize? Are you on the conveyor belt? Which direction are you traveling? Do you even feel the movement of the belt? What would it take for you to reverse directions? More importantly, how can you stop the movement of the conveyor belt? What changes would need to occur for you at the individual level to reverse directions? What changes would need to happen at the institutional and societal levels to stop or reverse the direction of the conveyor belt?

As repeatedly emphasized in earlier chapters, White supremacy must be seen through a larger prism of individual, institutional, and societal racism. All these elements conspire in such a manner as to avoid making the “invisible” visible, and thus directly or indirectly discourage honest racial dialogue and self-exploration. Let us briefly return to the “walkway” metaphor provided by Tatum (1997) in her classic book, Why Are All the Black Kids Sitting Together in the Cafeteria?

First, the walkway metaphor is a strong and powerful statement of the continuous and insidious nature of racism; it is ever-present, dynamic, and oftentimes invisible as it takes us on a journey to White supremacist notions, attitudes, beliefs, and behaviors. The visible actions of White supremacists moving quickly on the belt represent the overt racism that we're aware of; these forms we consciously condemn. The conveyor belt represents the invisible forces of society or the biased institutional policies, practices, and structures that control our everyday lives. From the moment of birth, we are placed on the conveyor belt, culturally conditioned, and socialized to believe that we are headed in “the right direction.” For many White people, the movement of the belt is barely noticeable, and its movement remains hidden from conscious awareness. This allows White people to remain naïve and innocent about the harm their inaction imparts on people of color.

Second, as indicated by Tatum (1997), one need not be actively racist in order to be racist. The pace by which one walks with the flow of the conveyor belt determines the degree to which one consciously or unconsciously harbors White supremacist notions: (a) “active racists” who are aware and deliberate in beliefs and actions move quickly, (b) those slowly strolling may be unintentional racists, unaware of their biases and the direction they are taking, and (c) “passive racists” may choose not to walk at all. Despite choosing not to walk in the direction of the walkway, passive racists are, nevertheless, being moved in a direction that allows for racism to thrive. On a personal level, despite beliefs of justice, equity, and fairness, inaction on the walkway ultimately means that these individuals are also responsible for the oppression of others.

Third, most people of color are desperately trying to move or run in the opposite direction. The voices of people of color are filled with attempts to make well-intentioned Whites aware of the direction they are taking and aware of the harm they are inflicting on people of color. But they are hindered by many obstacles; well-intentioned White Americans who tell them they are going the wrong way and don't believe them; institutional policies and practices that put obstacles in their retreating path (institutional racism); and punishment from society for “not obeying the traffic rules”—a one-way street of bias and bigotry.

Fourth, despite limited success in battling the constant forces of racism, people of color are also slowly but surely being swept in a dangerous direction that has multiple implications for their psychological health, physical well-being, and standard of living. Walking at a fast pace or running in the opposite direction are never-ending activities that are exhausting and energy depleting for people of color. Worse yet, they are being trampled by the large numbers of well-intentioned White Americans moving in the opposite direction. Giving up or ultimately being swept to the end of the walkway means a life of oppression and subordination.

Last, the questions being posed to trainees are challenging. How do we motivate White Americans to (a) notice the subtle movement of the walkway (making the invisible visible), (b) discern the ominous direction it is taking (White racial supremacy), (c) take action by moving in the opposite direction (antiracism), and (d) stop the conveyor belt and/or reverse its direction (institutional and societal change)?

As indicated in the White racial identity development sections, becoming nonracist means soul searching, individual change, and working on the self; becoming antiracist, however, means taking personal action to end external racism that exists systemically and in the action of others. The invisibility of White privilege and Whiteness allow for denying the pain and suffering experienced by people of color, but more importantly, it absolves White Americans of personal responsibility for perpetuating injustice, and allows them to remain passive and inactive.

Principles of Prejudice Reduction

Although White racial identity development models tell us much about the characteristics most likely to be exhibited by individuals as they progress through these phases, they are very weak in giving guidance about how to develop a nonracist White identity (Helms, 2015). Possible answers seem to lie in the social-psychological literature about the basic principles or conditions needed to reduce prejudice through intergroup contact first formulated by Gordon Allport (1954) in his classic book The Nature of Prejudice. His work has been refined and expanded by other researchers and scholars (Aboud, 1988; Amir, 1969; Cook, 1962; Gaertner, Rust, Dovidio, Bachman, & Anastasio, 1994; Jones, 1997). Sue (2003) has summarized these findings into the basic principles of prejudice reduction: (1) having intimate and close contact with others, (2) cooperation rather than competition on common tasks, (3) sharing mutual goals, (4) exchanging accurate information rather than stereotypes, (5) sharing an equal status relationship, (6) support for prejudice reduction by authorities and leaders, and (7) feeling a sense of connection and belonging with one another. To this we might add the contributions of White racial identity development theorists, who have indicated the importance of understanding oneself as a racial/cultural being. It has been found, for example, that a person's level of White racial awareness is predictive of his or her level of racism (Pope-Davis & Ottavi, 1994; Wang et al., 2003); the less aware that participants in research projects were of their White racial identity, the more likely they exhibited increased levels of racism.

The seven basic principles outlined above arose primarily through studies of how to reduce intergroup conflict and hostility, but several seem consistent with reducing personal prejudice through experiential learning and the acquisition of accurate information about other groups. Translating these principles into roles and activities for personal development has come from recommendations put forth by the American Psychological Association, Presidential Task Force on Preventing Discrimination and Promoting Diversity (2012), from the President's Initiative on Race (1998, 1999), from educators and trainers (Ponterotto et al., 2006; Young & Davis-Russell, 2002), and from studies on difficult racial dialogues (Sue, Lin, Torino, Capodilupo, & Rivera, 2009; Sue, Rivera, Capodilupo, Lin, & Torino, 2010).

Sue (2003) outlines five basic learning situations and activities, or principles, most likely to enhance change in developing a nonracist White identity.

Principle 1: Learn about People of Color from Sources within the Group

· You must experience and learn from as many sources as possible (not just the media or what your neighbor may say) in order to check out the validity of your assumptions and understanding.

· If you want to understand racism, White people may not be the most insightful or accurate sources. Acquiring information from persons of color allows you to understand the thoughts, hopes, fears, and aspirations from the perspective of people of color. It also acts as a counterbalance to the worldview expressed by White society about minority groups.

Principle 2: Learn from Healthy and Strong People of the Culture

· A balanced picture of racial/ethnic groups requires that you spend time with healthy and strong people of that culture. The mass media and our educational texts (written from the perspectives of EuroAmericans) frequently portray minority groups as uncivilized or pathological, or as criminals or delinquents.

· You must make an effort to fight such negative conditioning and ask yourself what are the desirable aspects of the culture, the history, and the people. This can come about only if you have contact with healthy representatives of that group.

· Since you seldom spend much intimate time with persons of color, you are likely to believe the societal projection of minorities as being law breakers and unintelligent, prone to violence, unmotivated, and uninterested in relating to the larger society.

· Frequent minority-owned businesses, and get to know the proprietors.

· Attend services at a variety of churches, synagogues, temples, and other places of worship to learn about different faiths and to meet religious leaders.

· Invite colleagues, coworkers, neighbors, or students of color to your home for dinner or a holiday.

· Live in an integrated or culturally diverse neighborhood, and attend neighborhood organizational meetings and attend/throw block parties.

· Form a community organization on valuing diversity, and invite local artists, authors, entertainers, politicians, and leaders of color to address your group.

· Attend street fairs, educational forums, and events put on by the community.

Principle 3: Learn from Experiential Reality

· Although listening to readings, attending theater, and going to museums are helpful to increase understanding, you must supplement your factual understanding with the experiential reality of the groups you hope to understand. These experiences, however, must be something carefully planned to be successful.

· It may be helpful to identify a cultural guide: someone from the culture who is willing to help you understand his or her group; someone willing to introduce you to new experiences; someone willing to help you process your thoughts, feelings, and behaviors. This allows you to more easily obtain valid information on issues of race and racism.

Principle 4: Learn from Constant Vigilance of Your Biases and Fears

· Your life must become a “have to” in being constantly vigilant to manifestations of bias in both yourself and the people around you.

· Learn how to ask sensitive racial questions of your minority friends, associates, and acquaintances. Persons subjected to racism seldom get a chance to talk about it with a nondefensive and nonguilty person from the majority group.

· Most minority individuals are more than willing to respond, to enlighten, and to share if they sense that your questions and concerns are sincere and motivated by a desire to learn and serve the group.

Principle 5: Learn from Being Committed to Personal Action against Racism

· Dealing with racism means a personal commitment to action. It means interrupting other White Americans when they make racist remarks, tell racist jokes, or engage in racist actions, even if this is embarrassing or frightening.

· It means noticing the possibility for direct action against bias and discrimination in your everyday life: in the family, at work, and in the community.

· It means taking initiative to make sure that minority candidates are fairly considered in your place of employment, advocating to your children's teachers to include multicultural material in the curriculum, volunteering in community organizations to have them consider multicultural issues, and contributing to and working for campaigns of political candidates who will advocate for social justice.

· The journey to developing a White nonracist identity is not an easy path to travel. Remember, racial identity and cultural competence are intimately linked to one another. Becoming a culturally competent helping professional involves more than “book learning”; it requires both experiential learning and taking personal action. Are you ready for the challenge?

Reflection and Discussion Questions

1. Do these suggestions and strategies make sense to you? Are there others that come to mind?

2. What would make it difficult for you to personally implement these suggestions? What barriers stand in the way? For example, what would make it difficult for you to interrupt a stranger or even a family member when a racist or sexist joke is made?

3. Have you ever been in a situation where you were the only White person in an activity or event full of Black, Asian, or Latino/a people? What feelings did you have? How did you think? Were you uncomfortable or fearful?

4. What would you need in the way of support or personal moral courage to move toward developing a White nonracist identity?

Implications for Clinical Practice

1. Ultimately, the effectiveness of White therapists is related to their ability to overcome sociocultural conditioning and to make their Whiteness visible.

2. Accept the fact that racism is a basic and integral part of U.S. life and permeates all aspects of our culture and institutions. Know that as a White person you are not immune.

3. Understand that the level of White racial identity development in a cross-cultural encounter (e.g., working with minorities, responding to multicultural training) affects the process and outcome of an interracial relationship (including counseling/therapy).

4. Work on accepting your own Whiteness, but define it in a nondefensive, nonracist, and antiracist manner.

5. Spend time with healthy and strong people from another culture or racial group.

6. Know that becoming culturally aware and competent comes through lived experience and reality.

7. Attend cultural events, meetings, and activities led by minority communities. This allows you to hear from church leaders, to attend community celebrations, and to participate in open forums so that you may sense the strengths of the community, observe leadership in action, personalize your understanding, and develop new social relationships.

8. When around persons of color, pay attention to feelings, thoughts, and assumptions that you have when race-related situations present themselves.

9. Dealing with racism means a personal commitment to action.

Summary

“What does it mean to be White?” is often an uncomfortable and perplexing question for White Americans. Exploring the basis of this discomfort and its meaning is important for cultural competence in mental health practice. Being a White person in this society means chronic exposure to ethnocentric monoculturalism as manifested in White supremacy. Research suggests that it is nearly impossible for anyone to avoid inheriting the racial biases, prejudices, misinformation, deficit portrayals, and stereotypes of their forebears. If White helping professionals are ever able to become effective multicultural counselors or therapists, they must free themselves from the cultural conditioning of their past and move toward the development of a nonracist and antiracist White identity.

White racial identity development models have been found to be helpful in describing how majority group members go through a process of racial awakening that has direct meaning to multicultural counseling. Two of the influential models are those presented by Rita Hardiman and Janet Helms. It has been found that the level of White racial identity awareness is predictive of racism and internal and interpersonal characteristics. The less aware subjects studied were of their White identity, the more likely they were to exhibit higher levels of racism, while the greater their White identity development, the greater their levels of multicultural counseling competence, the higher their positive opinions toward diverse groups, and the better their ability to form therapeutic alliances with clients of color.

A descriptive model of White racial identity development identifies a seven-phase process by which Whites become increasingly aware of themselves as racial/cultural beings: (1) naiveté, (2) conformity, (3) dissonance, (4) resistance and immersion, (5) introspective, (6) integrative awareness, and (7) commitment to antiracist action. Becoming nonracist means soul searching, individual change, and working on the self; becoming antiracist, however, means taking personal action to end external racism that exists systemically and in the actions of others. Five basic principles are provided to facilitate racial/cultural awareness. Learn (1) from the groups you hope to understand, (2) from healthy and strong people of the culture, (3) from experiential reality, (4) from constant vigilance of fears and biases, and (5) from being committed to anti-bias action.

Glossary Terms

Antiracist white identity

Commitment to antiracist action phase

Conformity phase

Dissonance phase

Ego statuses

Hardiman White racial identity development

Helms White racial identity development

Information processing strategies

Integrative awareness phase

Introspective phase

Naiveté phase

Nonracist white identity

Resistance and immersion phase

Unintentional racism

White privilege

White racial identity development

White racial identity development descriptive model

White supremacy

Whiteness

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COUNSELING LATINAS/OS

Diane M. Sue and David Sue

Chapter Objectives

1. Learn the demographics and characteristics of Latinas/os.

2. Identify counseling implications of the information provided for Latinas/os.

3. Provide examples of strengths that are associated with Latinas/os.

4. Know the special challenges faced by Latinas/os.

5. Understand how the implications for clinical practice can guide assessment and therapy with Latinas/os.

Nearly a quarter of Americans say Hispanics face a lot of discrimination in society today, making them the racial/ethnic group the public sees as most often subjected to discrimination. (Pew Research Center, 2010a)

It was sometimes hard to adjust. When I went outside, I was in America but inside my house, it was Mexico. My father was the leader of the house. It wasn't that way for some of my American friends. (Middleton, Arrendondo, & D'Andrea, 2000, p. 24)

Even the most patriotic of us Mexican-Americans has a couple of members in our family who are here illegally. We also think there is nothing wrong with them being here illegally because we know they're just trying to build a better life for themselves. . . illegal immigrant isn't some random statistic that conservative pundits always seem to bitch about stealing lucrative ‘merican' jobs like picking strawberries and working as dishwasher at Denny's (Felix, 2014).

In this chapter, we use the term Latinas/os in reference to individuals living in the United States with ancestry from Mexico, Puerto Rico, Cuba, the Dominican Republic, and Central or South American Spanish-speaking countries. However, people vary in preference for the terms used for self-identification. For example, more than half of the Latina/o youth (ages 16 to 25) in one sample self-identified first by their family's country of origin (i.e., Mexican, Cuban), while approximately 20% self-identified as “Hispanic” or “Latina/o,” and 24% self-identified as “American.” Among youth who are third-generation or higher, about half chose “American” as their first term of self-description (Pew Research Center, 2009). The U.S. Census uses the term Hispanic as an ethnic descriptor rather than the term Latina/o.

Throughout Latin America, the immigration of European, African, and Asian populations and subsequent mixture with indigenous groups has resulted in a wide range of phenotypes. Thus the physical traits of Latinas/os vary greatly and include characteristics of indigenous groups, Africans, Asians, and fair-skinned Europeans. Latinas/os are currently the largest minority group in the United States, comprising 17.1% of the total U.S. population (U.S. Census Bureau, 2015). Because of immigration patterns and high birthrates (one in four infants born in the United States is Latina/o), more than half of the growth in the total U.S. population between 2000 and 2010 resulted from increases in this population.

According to the U.S. Census Bureau (2014), there are 54.6 million Latina/o Americans, of whom 64% are of Mexican origin, 9.4% are from Puerto Rico or of Puerto Rican descent, 3.7% have Cuban ancestry, and 16% originate from Central and South America.

Approximately 37% of Latinas/os are immigrants, including the 11% of foreign-born individuals who have become U.S. citizens. However, approximately one-fourth of the Latina/o adults are undocumented immigrants; about two-thirds of all undocumented immigrants are from Mexico (Marrero, 2011). It is not surprising that nearly half of all Latina/o American adults express concern that they, a family member, or a close friend will be deported (Lopez, Taylor, Funk, & Gonzalez-Barrera, 2013). Those who are undocumented occupy the lowest rung of the labor pool and are often taken advantage of because they have no legal status.

Although Latina/o groups share many characteristics, there are many between-group and within-group differences. Many are strongly oriented toward their ethnic group, whereas others are quite acculturated to mainstream values. About three-fourths of U.S.-born Latinas/os are third-generation or higher, with many descended from the large wave of Latin Americans who began immigrating in the 1960s. In certain states and cities, they make up a substantial percentage of the population. Mexican Americans are the dominant Latina/o group in metropolitan areas throughout the United States. Most Puerto Ricans reside in the Northeast, and most Cubans live in Florida (Lopez & Dockterman, 2011). Median wealth of White households is more than 10 times that of Latina/o households (Pew Research Center, 2014b). Members of this group have high unemployment, are overrepresented among the poor, and often live in substandard housing. Many hold semiskilled or unskilled occupations (U.S. Census Bureau, 2010b).

Characteristics and Strengths

In the following sections we describe the characteristics, values, and strengths of Latina/o individuals and consider their implications in treatment. These are generalizations and their applicability needs to be assessed for each client or family.

Cultural Values and Characteristics

The development and maintenance of interpersonal relationships are central to the Latina/o culture (Kuhlberg, Pena, & Zayas, 2010). There is typically deep respect and affection among a large network of family and friends. Family unity, respect, and tradition (familismo) are an important aspect of life. Cooperation among family members is stressed. For many, the extended family includes not only relatives but also close friends and godparents. Each member of the family has a role: mother (self-denial), father (responsibility), children (obedience), grandparents (wisdom), and godparents (resourcefulness) (Lopez-Baez, 2006).

Implications

Familismo refers not only to family cohesiveness and interdependence but also to loyalty and placing the needs of close friends and family members before personal needs (Baumann, Kuhlberg, & Zayas, 2010). Counselors can inquire about clients' connectedness with extended and nuclear family members and the value placed on familismo. Because of these strong familial and social relationships, Latinas/os often wait until resources from extended family and close friends are exhausted before seeking help. Even in cases of severe mental illness, many delay obtaining assistance (Kouyoumdjian, Zamboanga, & Hansen, 2003).

Although there are many positive features of the extended family, emotional involvement and obligations with numerous family and friends can function as a source of stress, particularly when decisions are made that affect the individual negatively (Aguilera, Garza, & Muñoz, 2010). Problem definition may need to incorporate the perspectives of both nuclear and extended family members, and solutions may need to bridge cultural expectations and societal demands. Additionally, family responsibilities sometimes take precedence over outside concerns, such as school attendance or work obligations. For example, older children may be kept home to care for ill siblings, attend family functions, or work (Headden, 1997). Under these circumstances, problematic behaviors (i.e., absenteeism) can be addressed by framing them as a conflict between cultural and societal expectations.

Family Structure

Latinas/os often live in households having five or more members (U.S. Census Bureau, 2010a). Traditional oriented families are hierarchical in form, with special authority given to parents, older family members, and males. Within the family, sex roles are clearly delineated. The father is typically the primary authority figure (Lopez-Baez, 2006). Children are expected to be obedient and are typically not involved in family decisions; parents may expect adolescents to work to help meet family financial obligations (Lefkowitz, Romo, Corona, Au, & Sigman, 2000).

Parents reciprocate by providing for children through young adulthood and even after marriage. This type of reciprocal relationship is a lifelong expectation. Older children are expected to care for and protect their younger siblings; older sisters often function as surrogate mothers. Also, in traditionally oriented marriages, emphasis is placed on social activities involving extended family and friends rather than on activities as a couple (Negy & Woods, 1992).

Implications

Assessment of family structure should consider the family hierarchy and the ways that decisions are made within the family unit. Conflicts among family members often involve differences in acculturation and conflicting views of roles and expectations for family members, as well as clashes between cultural values and mainstream societal expectations (Baumann et al., 2010). In less acculturated families, counselors may find success by helping family members reframe these issues as responses to acculturation stress; they can then negotiate conflicting cultural norms and values. Counselors can help clients consider ways in which they can demonstrate their allegiance to the family without significantly compromising their own acculturation. One such approach is demonstrated in the following case:

During family therapy, a Puerto Rican mother indicated to her son, “You don't care for me anymore. You used to come by every Sunday and bring the children. You used to respect me and teach your children respect. Now you go out and work, you say, always doing this or that. I don't know what spirit [que diablo] has taken over you.” (Inclan, 1985, p. 332)

In response, the son explained that he was sacrificing and working hard because he wanted to be a successful provider and someone of whom his children could be proud. The son has adopted future-oriented, mainstream U.S. values, stressing hard work and individual achievement. The mother was disappointed because she believed her son should spend time with her, encourage the family to gather together, and prioritize the family over individual desires. This clash in values was at the root of the problem.

In working with this family, the therapist provided alternative ways of viewing the conflict. He explained how our views are shaped by the values that we hold. He asked the mother about her socialization and early childhood values. The son expressed how difficult it was to lose his parents' respect but also his belief that he needed to work hard and focus on the future in order to succeed in the United States. The therapist pointed out that different adaptive styles may be necessary for different situations and that what “works best” may be dependent on the social context. Both mother and son acknowledged that they demonstrate love and affection in different ways. As a result of the sessions, mother and son better understood the nature of their conflicts and were able to improve their relationship.

Gender Role Expectations

Latinas/os often experience conflicts over gender roles. In traditional culture, men are expected to be strong, dominant, and the provider for the family (machismo), whereas women are expected to be nurturing, modest, virtuous, submissive to the male, and self-sacrificing (marianismo) (Deardorff et al., 2013). As head of the family, the father expects family members to be obedient. Individuals with greater ethnic identity are more likely to subscribe to traditional male and female roles. Areas of possible gender role conflict for males (especially among immigrants) include the following (Avila & Avila, 1995; Constantine, Gloria, & Baron, 2006):

1. Lack of confidence in areas of authority. Latino men may lack confidence interacting with agencies and individuals outside of the family; this can result in feelings of inadequacy and concern about diminished authority, especially if the wife or children are more fluent in English.

2. Feelings of isolation and depression because of the need to be strong. Talking about concerns or stressors may be seen as a sign of weakness. This difficulty discussing feelings can produce isolation and anger or depression.

3. Conflicts over the need to be consistent in his role. As ambiguity and stress increase, there may be more rigid adherence to traditional roles.

For women, conflicts may involve (a) expectations associated with traditional roles, (b) anxiety or depression over not being able to live up to these standards, and (c) inability to express feelings of anger (Lopez-Baez, 2006). Latina immigrants are often socialized to feel inferior and to expect suffering or martyrdom. With greater exposure to the dominant culture, such views may be questioned. Certain roles may change more than others. Some women may be very modern in their views regarding education and employment but remain traditional in the area of sexual behavior and personal relationships. Others remain very traditional in all areas. Cultural differences between partners are associated with strained marital relationships while couples with cultural similarity have a more positive marital experience (Cruz et al., 2014).

Implications

Therapists should explore the client's degree of adherence to traditional gender norms, as well as the gender role views among family members. It is important to consider the potential impact of acculturation on marital relationships, particularly when women function independently in the work setting or when dealing with schools and other agencies. For both men and women, role conflict is likely to occur if the man is unemployed, if the woman is employed, or both.

When dealing with gender role conflicts, counselors who believe in equal relationships must be careful not to impose their views on clients. Instead, if a Latina client desires greater independence, the counselor can help her consider the consequences of change, including potential problems within her family and community, and work toward this goal within a cultural framework. It is helpful to frame conflicts in gender roles as an external issue involving differing expectations between cultural and mainstream values and to encourage problem solving to deal with the different sets of expectations.

Spiritual and Religious Values

Mrs. Lopez, age 70, and her 30-year-old daughter sought counseling because they had a very conflictual relationship. . . .The mother was not accustomed to a counseling format. . . .At a pivotal point in one session, she found talking about emotional themes overwhelming and embarrassing. . . .In order to reengage her, the counselor asked what resources she used when she and her daughter quarreled. She. . .prayed to Our Lady of Guadalupe. (Zuniga, 1997, p. 149)

The therapist subsequently employed a culturally adapted strategy of having Mrs. Lopez use prayer and spiritual guidance to understand her daughter and to find solutions to their conflicts. This use of a cultural perspective allowed the sessions to continue. Religion (often, but not always, Catholicism) is important to many Latinas/os, although less so among younger individuals (Pew Research Center, 2014a). Prayers requesting guidance from patron saints can be a source of comfort in times of stress. Latinas/os often believe that life's misfortunes are inevitable and feel resigned to their fate (fatalismo). Consequently, they may take a seemingly passive approach to problems and lack experience assertively addressing challenges. Also, some Latina/o groups believe that evil spirits cause mental health problems and rely on indigenous healing practices.

Implications

During assessment, it is important to consider religious or spiritual beliefs and to explore the spiritual meanings of presenting problems. If there is a strong belief in fatalism, instead of attempting to change this view, the therapist can acknowledge this attitude and help the individual or family determine the most adaptive response to the situation. A therapist might say, “Given that the situation is unchangeable, how can you and your family deal with this?” with the aim of helping the client develop problem-solving skills within certain parameters. The strong reliance on religion can be a resource (e.g., evoking God's support through prayer to facilitate problem solving). Fatalism can be countered by stressing “Ayudate, que Dios te ayudara,” which is the equivalent of “God helps those who help themselves” (Organista, 2000). Indigenous healing practices can also be incorporated into the therapeutic process.

Educational Characteristics

Peer pressure to drop out can be nearly overwhelming in the Latina/o community, as DeAnza Montoya, a pretty Santa Fe teen, can attest. In her neighborhood, it was considered “Anglo” and “nerdy” to do well in school. . . “In school they make you feel like a dumb Mexican,” she says, adding that such slights only bring Latinas/os closer together. (Headden, 1997, p. 64)

Many Latina/o students do not fare well in the public school system and have a high likelihood of dropping out of school; this is particularly true among first-generation (immigrant) youth and those who are third-generation or higher (Pew Research Center, 2009). Approximately 41% of adults do not have a regular high school diploma, including 52% of those who are foreign-born. Additionally, the vast majority (90%) of youth who drop out of high school never attain a General Educational Development (GED) credential and thus are not eligible to attend college or vocational programs or to enter the military (Fry, 2010).

A number of problems contribute to the high dropout rate of Latina/o students. Educational difficulties may be related to limited English proficiency. Spanish is the primary language spoken in over half of the households; others speak Spanish on a more limited basis. Although most second-generation Latinas/os are bilingual (exposed to Spanish in the home and to English in school), their command of both English and Spanish may be marginal. The high pregnancy rate for Latina girls also contributes to school dropout rates. Although teen pregnancy among 15- to 19-year-old Latinas is decreasing, the birth rate (70 live births per 1,000 women in this age group) is significantly higher than for other groups (Hamilton, Martin, & Ventura, 2009). In some schools there is peer pressure against “acting White” or doing well academically. Higher grades in Latina/o youth are associated with a decrease in peer popularity and could explain underperformance in schools (Fryer, 2006).

However, there are some grounds for optimism about education. Many Latina/o youth value education and are optimistic about the future and performing better in school (Pew Research Center, 2009). In 2013, 79% completed high school which is an all-time high and the dropout rate has gone down to 14% in 2013 as compared to 32% in 2000. College attendance is also increasing among Latina/o young people: 18% were in college in 2013 versus 12% in 2009. Although there is improvement, Latina/o young adults continue to lag substantially behind White youth in obtaining a bachelor's degree (9% versus 69%) (Fry, 2014).

Implications

Although teachers often attempt to accommodate Latina/o cultural learning styles and adapt lessons for students with limited English skills, the move against bilingual education and the rapid immersion of Spanish-speaking students in English can exacerbate academic difficulties. Many immigrant parents do not realize they have the right to question school decisions. Difficulty communicating with Spanish-speaking parents compounds the problem. Some parents are unable to attend conferences because of work requirements, and this may be interpreted as a lack of caring about the child's education. To engage parents, conferences can be scheduled at flexible hours and interpreters be made available. Face-to-face communication or other personal contact is more successful than written material (even if written in Spanish) since many parents have limited literacy skills. Trust develops slowly, and it is important to identify and support the family's strengths rather than focusing on its shortcomings (Espinosa, 1997). Altering instructional strategies to fit cultural values (i.e., cooperation) is also important. Latina/o students often have high educational expectations but don't know how to apply for financial assistance and are unaware of university application procedures. Providing information regarding resources and help through this process can increase the chances for a college education (Gonzalez, Stein, Shannonhouse, & Prinstein, 2012).

Cultural Strengths

Cinthya grew up in poverty. She is now attending Columbia University working on her public health degree. Asked how she persevered against the odds, Cinthya speaks with emotion and credits her success to her family. “It's my parents,” she said. “They have sacrificed so much to give us the opportunity to go to school, to grow.” (New Journalism on Latina/o Children, 2010, p. 1)

Most Latina/o children grow up in two-parent families, often supported by a strong kinship system. Familismo and the related sense of connectedness and loyalty among immediate and extended family can be a source of significant social and emotional support for individuals and families (Kuhlberg et al., 2010). Traditional Latina/o values place a great deal of emphasis on creating a harmonious atmosphere and accord within the family system. Personalismo refers to a personalized communication style that is characterized by interactions that are respectful, interdependent, and cooperative. Simpatico refers to the relational style displayed by many Latinas/os—a style emphasizing social harmony and a gracious, hospitable, and personable atmosphere (Holloway, Waldrip, & Ickes, 2009). Cultural identity and values can serve as a protective asset against stress by promoting a sense of belonging (Ai, Aisenberg, Weiss, & Salazar, 2014) while a strong system of spiritual and religious beliefs can be nurtured as a source of strength when dealing with personal or family issues.

Specific Challenges

In the following sections we consider challenges often faced by Latina/o individuals and reflect on their implications in treatment.

Stigma Associated with Mental Illness

Depressive symptoms are common among Latinas, with 53% reporting moderate to severe symptoms versus 37% of White women (Diaz-Martinez, Interian, & Waters, 2010). Mexican American males and Puerto Ricans of both genders have high rates of weekly alcohol consumption and binge-drinking; additionally, alcoholism among these groups is more likely to be chronic (Chartier & Caetano, 2010). Statistics such as these confirm the need for mental health support. However, the cultural stigma associated with mental illness, including fear that psychiatric medications can cause addiction, results in reluctance to seek treatment. Latina/o immigrants are also more likely than members of the majority culture to fear embarrassment or social discrimination from family, friends, and employers if they acknowledge psychological distress, and are more likely to express psychological distress via somatic symptoms.

“When Latino think of mental illness, they just think one thing: loco,” says Clara Morato, whose son, Rafaelo, was diagnosed with bipolar disorder at age 18 (Dichoso, 2010, p. 1). Machismo may also be a barrier to seeking treatment, owing to concerns about lost time from work (Vega, Rodriguez, & Ang, 2010). Additionally, Latinas/os underutilize resources for their children. Although most young children are citizens, one or both parents may be undocumented and, therefore, reluctant to seek assistance (Capps, Fix, Ost, Reardon-Anderson, & Passel, 2005). Many Latinas/os are afraid to sign up for programs such as the Affordable Care Act over concern that their undocumented family members will get discovered, and deported. This results in the inability to pay for mental health treatment (Dembosky, 2014).

Implications

Clinicians can anticipate and help counteract the stigma associated with mental illness by taking the time to build rapport and provide psychoeducation about therapeutic approaches (Vega et al., 2010). Comas-Diaz (2010), a Puerto Rican multicultural therapist, advocates exploring the client's heritage, history of cultural translocation, and views about counseling early in therapy and encourages a flexible therapeutic style that might include roles familiar to the client, such as healer, advisor, coach, teacher, guide, advocate, consultant, and mentor. Developing a culturally relevant therapeutic alliance, providing psychoeducation about how treatment is conducted and how goals are developed in a collaborative manner, and using a flexible, culture-centered approach can help clients overcome their fear of the stigma associated with seeking help and their reluctance to participate openly in treatment.

Acculturation Conflicts

As with many ethnic minority groups, Latinas/os are frequently faced with societal values distinctly different from their own. Additionally, the severing of ties to family and friends, the loss of supportive resources, language inadequacy, unemployment, and culture conflict all function as stressors for recent immigrants. Some maintain their traditional orientation, whereas others assimilate and exchange their native cultural practices and values for those of the host culture. Differences in acculturation between family members can produce stress within the family unit as seen in the following case:

Juan, a 46-year-old Latino, was born in Mexico and has lived in the United States for 10 years. He works as a cook, has been married for over 20 years, and has five children. Juan has frequent conflicts with his wife and children, believing that they want freedom from him and that they have become too “Americanized.” He strongly believes in the cultural values of familismo (family connectedness), machismo (being head of the family, with responsibility for providing for the family), and respecto (respect) from his children. As husband and father, he believes that he should set the rules in the family and that his wife and children should respect his rules. Juan often feels stressed, angry, hopeless, and depressed and has had suicidal thoughts and thoughts of hurting his wife. When angry, he resorts to threats and physical violence. (Santiago-Rivera et al., 2008)

Juan's therapist recognized that traditional cognitive behavior therapy (an evidence-based treatment for depression) might not adequately address the environmental stressors, acculturation conflicts, and feeling of isolation and powerlessness Juan was experiencing. Instead, the therapist modified another evidence-based treatment (behavioral activation therapy). He encouraged Juan to participate in free or low-cost activities (e.g., socializing with and attending church services with his wife and children), thus enhancing family relationships and building social networks within the community. Differences between Juan's upbringing in Mexico and the American culture faced by his children were also discussed in therapy, increasing Juan's understanding of issues faced by his wife and children. At the end of therapy, Juan was no longer depressed and reported improved relationships with his wife and children (Santiago-Rivera et al., 2008).

Those who either completely reject or accept the values of the host culture appear to experience greater stress than those who partially accept them (Miville, Koonce, Darlington, & Whitlock, 2000). Miranda and Umhoefer (1998a, 1998b) found that both highly and minimally acculturated Mexican Americans score high on social dysfunction, alcohol consumption, and acculturative stress. They concluded that a bicultural orientation (i.e., maintaining some components of the native culture while incorporating practices and beliefs of the host culture) may be the “healthiest” resolution for acculturation; those with bicultural values are able to accept and negotiate aspects of both cultures. Some of the issues involved in acculturation conflict are evident in the following case:

A Latino teenager, Mike, was having difficulty knowing “who he was” or what group he belonged with. His parents had given him an Anglo name to ensure his success in American society. They only spoke to him in English because they were fearful that he might have an accent. During his childhood, he felt estranged from his relatives because his grandparents, aunts, and uncles could speak only Spanish. At school, he did not fit in with his non-Latino peers, but also felt different from the Mexican American students who would ask him why he was unable to speak Spanish. Mike's confusion over his ethnic identity resulted in significant distress. (Avila & Avila, 1995)

During their early teen years, Latina/o children begin to have questions about their identity and question whether they should adhere to mainstream or traditional values. The representation of Latinas/os on English-language channels often involves characters who behave criminally or are violent. The mixed heritage of many Latina/o Americans raises additional identity questions. Should those of Mexican heritage call themselves “Mexican,” “American,” “Mexican American,” “Chicano,” “Latina/o,” or “Hispanic”? What about those with indigenous, Asian, or African ancestry? An ethnic identity provides a sense of belonging and group membership. Many Latina/o youngsters undergo the process of searching for an identity. This struggle in combination with acculturative stresses may contribute to problems such as substance abuse, aggressive behavior, delinquency, low self-esteem, and an increased risk for suicide (Smokowski, Rose, & Bacallao, 2010). Retention of one's culture may be related to positive mental health. Mexican American students who maintained their ethnic identity and heritage had higher levels of self-esteem and life satisfaction. Cultural retention may help prevent problem behaviors (Navarro, Ojeda, Schwartz, Piña-Watson, & Luna, 2014).

Implications

The client's degree of acculturation has important implications for treatment, especially during initial therapy sessions, and can influence both perceptions of and responses to counseling. For example, individuals with minimal acculturation may have difficulty being open and self-disclosing or discussing their issues in depth and may believe that counseling will take only one session (Dittmann, 2005). Acculturation can be assessed by inquiring about the client's background, generational status, residential history, reasons for immigration, primary language, religious orientation and strength of religious beliefs, extent of support from extended family, and other factors related to acculturation. The therapist needs to determine the client's degree of adherence both to traditional values and to those of the majority culture. Second-generation Latina/o Americans are often marginal in both native and majority cultures. They are often bilingual (exposed to Spanish at home and English at school) but frequently have less-than-optimal use of either language. The therapeutic alliance can be enhanced by beginning the counseling relationship in a more formal manner and working to build trust before beginning comprehensive exploration of the presenting problem or extensive interviewing regarding sensitive topics.

Ethnic identity issues should be recognized and incorporated during assessment and treatment of youth and adults. Conflicts between mainstream values and ethnic group values can be discussed, and clients can help brainstorm methods for bridging these differences. It should be stressed that ethnic identity is part of the normal development process. In many cases, a bicultural perspective may be the most functional, since such a perspective does not involve the wholesale rejection of either culture.

Counselors should also inquire about potential acculturation conflicts, including their impact on client symptoms or family conflicts. Although values such as familismo can be a source of strength for youth, distress may feel unbearable when there is parent–child discord (Hernandez, Garcia, & Flynn, 2010). Identification with core cultural values appears to serve as a protective factor against risky behavior such as substance abuse and to serve as a source of strength for children and adolescents (Dettlaff & Johnson, 2011). Counselors can help youth explore and retain their cultural values and ethnic identity to bolster self-esteem and life satisfaction (Ai et al., 2014).

Research attempting to identify the risk factors accounting for the high incidence of suicide attempts among Latinas, particularly among girls whose mothers place high value on familismo, suggests that although familismo can be a protective factor with respect to emotional and behavioral health, conflicts that result from adolescent strivings for autonomy and resultant parent–child discord can be a risk factor, particularly for those accustomed to close parent–child relationships and harmony in the family unit (Kuhlberg et al., 2010). Adolescents may question family obligations and parental rules and desire input into decisions. Such behavior may be viewed as disrespectful by parents and extended family.

Females may feel overprotected by parents and question their rules or expectations, such as staying at home to care for others and being monitored on dates or forbidden to date; such acculturation conflict may be particularly distressing to girls, since gender socialization for females emphasizes their role in maintaining harmonious relationships. Mother–daughter conflicts are exacerbated when the family orientation is traditional and the daughter has a high mainstream cultural involvement (Derlan, Umaña-Taylor, Toomey, Updegraff, & Jahromi, 2015). Both biculturalism and familismo are related to higher self-esteem and greater flexibility in negotiating both cultures among Latina/o adolescents (Smokowski et al., 2010). Effective interventions for parent–child conflict include enhancing bicultural understanding and promoting adaptive interpersonal behaviors (e.g., improved communication, increased parental affection, and emotional connection) (Kuhlberg et al., 2010).

Racism and Discrimination

Arizona state law allows the state superintendent of Public Education to disallow any ethnic studies class that “promotes resentment towards a race or class of people. . .(or) advocates ethnic solidarity instead of treatment of pupils as individuals.” (Martinez & Gutierrez, 2010, p. 1)

Because of anti-immigration rhetoric, Latinas/os are now seen as the ethnic group suffering from the most discrimination. Almost 80 percent of Latinas/os believe that there is “a lot” or “some” discrimination against their group. (Pew Research Center, 2010b)

Stressors such as racism and discrimination can lead to emotional difficulties, particularly when combined with acculturation conflicts. Legislators in Arizona and Alabama recently enacted some of the broadest measures against undocumented immigrants in U.S. history. Such recent legislation includes making it a crime for noncitizens to be without documents (i.e., a visa or immigration forms) authorizing their presence in the United States and requiring law enforcement officers and other officials (including school personnel) to verify immigration status. These laws (supported by the majority of U.S. citizens) have been heavily criticized for promoting racial profiling.

Additionally, Arizona has implemented a state law banning any ethnic studies classes that “advocate ethnic solidarity instead of treatment of pupils as individuals” and not allowing instructors with “heavy accents” to teach English classes (Martinez & Gutierrez, 2010; Navarrette, 2011). Latina/o adolescents are particularly vulnerable to the effects of acculturation conflict and societal racism. Perceived discrimination among Mexican American adolescents increased psychological distress and such behaviors as drug use, fights, and sexual promiscuity (Flores, Tschann, Dimas, Pasch, & deGroat, 2010). Many youth attempt to deal with family distress, discrimination, and feelings of hopelessness by involvement in gang activities (Baca & Koss-Chioino, 1997).

Implications

Clinicians must assess not only intrapsychic issues but also the degree to which external conditions are involved in mental health issues. Thus it is important to be sensitive to sociopolitical issues (e.g., anti-immigrant sentiments) and client experiences with disenfranchisement and discrimination. For example, highly educated Latinas/os report demoralizing situations in which their academic success is questioned or they are assumed to be less qualified than they actually are (Rivera, Forquer, & Rangel, 2010). Additionally, many clients may be dealing with issues related to unemployment and poverty, including stressful interactions with bureaucracies (Vasquez, 1997).

Careful assessment of the source of emotional distress is necessary before appropriate action can be taken. This should be done early in the treatment process, as illustrated by the case of a migrant worker in his mid-50s who was fearful of leaving his home because he heard threatening voices. In working with him, Ruiz (1981) initiated an analysis of possible external causes, suggesting that the client undergo a complete physical examination, with special attention to exposure to pesticides and other agricultural chemicals that might result in mental symptoms. Additionally, interviews revealed that the client was quite anxious owing to fears of deportation, suspiciousness of outside authorities, and recent encounters with creditors.

Linguistic Issues

Considerable evidence suggests that assessment results can be influenced by linguistic differences or misunderstandings. Assessments should always be conducted in the primary language of the client and interpreted within a sociocultural context.

Implications

It is essential that clinicians consider the validity of tests for Latina/o clients and the influence of cultural or social factors as well as language barriers, discrimination, immigration stress, and poverty. Because of the lack of bilingual counselors, problems in diagnosis can occur with clients who are not proficient in English. For example, Marcos (1973) reported that Mexican American clients were considered to have greater psychopathology when interviewed in English than when interviewed in Spanish. However, interpreters themselves may present difficulties in the counseling process, such as distortions in communication.

Implications for Clinical Practice

Several writers (Bean, Perry, & Bedell, 2001; Paniagua, 1994; Velasquez et al., 1997) have made suggestions about initial counseling sessions with Latina/o clients.

1. Assess the acculturation level of the client and family members and modify your interactions and assessment accordingly.

2. It is important to engage in a respectful, warm, and mutual introduction with the client. Less acculturated clients may expect a more formal relationship and see the counselor as an authority figure. Paniagua (1994) recommends interviewing the father for a few minutes during the beginning of the first session, showing recognition of the father's authority and sensitivity to cultural factors in counseling.

3. Determine whether a translator is needed. Be careful not to interpret slow speech or long silences as indicators of depression or cognitive dysfunction. The client may be struggling with English communication skills.

4. Give a brief description of what counseling is and the role of each participant. Such information is particularly important for less acculturated clients, who may expect to meet for only one or two sessions or expect to have medication prescribed.

5. Explain the notion of confidentiality. Even immigrants with legal status have inquired about whether the information shared during counseling would “end up in the hands of the Border Patrol or other immigration authorities” (Velasquez et al., 1997, p. 112). Immigrant families may also be uncertain about the limits of confidentiality, especially as it applies to child abuse or neglect issues. Physical discipline is used in some families. Parents may be fearful about how their child-rearing practices will be perceived.

6. Have clients state in their own words the problem or problems as they see them. Determine the possible influence of religious or spiritual beliefs. Use paraphrasing to summarize and clarify the problem.

7. Consider whether there are cultural or societal aspects to the problem. What are the impacts of racism, poverty, and acculturative stress on the problem?

8. Determine the positive assets and resources available to the client and his or her family. Have they, other family members, or friends successfully dealt with similar problems?

9. Help the client prioritize the problems and decide on the goals and expectations for therapy.

10. Discuss possible negative consequences of achieving the indicated goals for the individual and the family.

11. Discuss the possible participation of family members in therapy. Within the family, determine the hierarchical structure, as well as the degree of acculturation of the different members.

12. Assess possible problems from external sources, such as the need for food, shelter, or employment, or stressful interactions with agencies. Provide necessary assistance in developing and maintaining environmental supports.

13. Explain the treatment to be used, why it was selected, and how it will help achieve the goals (culturally adapted evidence-based therapies should be considered). Consistently evaluate the client's or family's response to the therapeutic approach you have chosen.

14. With the client's input, determine a mutually agreeable length of treatment. It is better to offer time-limited, solution-based therapies.

15. Remember that personalismo is a basic cultural value for many Latinas/os. Although initial meetings may be quite formal, once trust has developed, clients often develop a close personal bond with the counselor, may treat the counselor as a close friend or family member, and may give gifts or extend invitations to family functions. These behaviors are culturally based and not evidence of dependency or a lack of boundaries.

16. When there are acculturation conflicts, have clients identify external demands rather than merely focusing on intrapsychic or relational issues.

Summary

The term “Latina/o” refers to a diverse group of people whose country of origin includes Mexico, Puerto Rico, Cuba, and other Spanish-speaking countries. As with other groups of color, their standard of living is far below that of their White counterparts and they have been subjected to continual racism and bias. Understanding major differences in family structure (familismo), gender role expectations (machismo and marianismo), spiritual and religious values, educational characteristics, and cultural strengths of this group is important for culturally competent practice. Counselors must anticipate specific challenges they face such as mental illness stigma, acculturation conflicts, linguistic issues, and racism/discrimination. Sixteen clinical implications for counselor practice are identified.

Glossary Terms

Acculturation

Bicultural orientation

Extended family

Familismo

Fatalismo

Latina/o Americans

Machismo

Marianismo

Personalismo

Respecto

Simpatico

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