Assignment: Multicultural Case Study: Part Two

MDWELLONS

MulticulturalAssessment.pdf

Home >Psychology homework help >Assignment: Multicultural Case Study: Part Two

Multicultural Assessment: Understanding Lives in Context

I am I plus my circumstances.

—Jose Ortega y Gasset (1961)

Paolo: You think you understand, but you don’t. [Turns his body away

from his wife and continues speaking.] You’re not Italian.

Karen: You always say that when you don’t agree with me. [Her face

reddens.]

Lillian: Can you tell us more?

Karen: I know that Paolo and I have cultural differences. [Takes a tissue

and continues.] But I mean something else. [Places the tissue on her lap.]

I’m talking about our problems as a couple.

Paolo: What? [Leans forward in his chair.]

Karen: [Slapping the arm of her chair with every word she utters.] You –

don’t – have – time – for – us. We’re always with your family.

Paolo: I don’t get it. [Lowers his voice.] My family is your family.

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 57

Co py

ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

Karen: I married you, not the Verdis.

Paolo: You’re wrong. [Voice echoes throughout the office.] You married the Verdis. The whole clan.

How do you feel about Paolo and Karen’s couples’ session? What are

the issues Lillian must deal with? How would you approach Paolo and

Karen if they were your clients? Is there a cultural conflict? If so, what do

you think it is?

This clinical vignette illustrates a cultural difference regarding family

boundaries. Karen, a White American woman whose ancestry is British,

seems to perceive the couple as a separate unit. Conversely, Paolo—an

Italian American—sees the couple as part of his family of origin. This dif-

ference demonstrates the contrast between individualistic and collectivist

worldviews.

As readers may remember from Chapter 1, the essential difference

between the individualistic and the sociocentric perspective is the relative

importance people assign to context. In other words, Paolo’s sociocentric

view of marriage as part of his extended family contrasts with Karen’s indi-

vidualistic perception.

Regardless of a clinician’s worldview orientation, he or she can benefit

from paying attention to clients’ multiple contexts. To achieve this goal, you

can complement the explanatory model of distress (see Chapter 2) with a

process-oriented clinical assessment. In this chapter, I discuss multicultural

assessment. Although there is some overlap between the previous chapter

and this one, I emphasized initial engagement and cross-cultural commu-

nication in Chapter 2, whereas here I emphasize gathering and analyzing

information for assessment and treatment. Nonetheless, the tools presented

in this chapter will yield information useful for engagement, and the tools

used in engagement will strengthen assessment.

MULTICULTURAL ASSESSMENT: A PROCESS-ORIENTED APPROACH

A multicultural clinical assessment is a process-oriented approach that

examines the multiple contexts in people’s lives. This clinical process can

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 58 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

be used for both evaluation and treatment. Engaging in a multicultural

assessment conveys genuine interest in a client and thus fosters a culturally

holding environment. Of course, not all of the contexts may be relevant to

a client’s current circumstances. As with any multicultural strategy, remem-

ber to rely on clinical judgment when conducting a multicultural assess-

ment. I recommend that you ask your clients to have a physical examination.

Because many multicultural individuals are referred to mental health treat-

ment by their internist, your clients may have already undergone a physical

evaluation. Such an examination is helpful in identifying physical condi-

tions, such as thyroid malfunctioning, that may mimic mental health prob-

lems. Moreover, you will be exploring your clients’ health status in a holistic

multicultural assessment.

Individuals’ circumstances may be explored throughout the evaluation

and treatment phases. Indeed, some culturally different clients require an

extended time to share their stories (Mollica & Lavalle, 1988) and for cli-

nicians to earn clients’ trust and demonstrate cultural credibility. The use

of a multicultural assessment demonstrates cultural integrity on the part of

the clinician and enhances the emergence of a therapeutic alliance.

Exhibit 3.1 lists overlapping areas that you may want to consider when

using a multicultural assessment. This is not an exhaustive list. Moreover,

many contextual areas relevant to assessment are not mutually exclusive.

Some of the diversity variables acquire more prominence than others for

certain individuals. For example, although gender may be a pivotal vari-

able for most women, the ethnic/racial–gender interaction achieves cen-

trality in the lives of many women of color. Clinicians can elicit the

contextual information throughout several evaluation sessions as well as

during the treatment phase.

MULTICULTURAL ASSESSMENT DOMAINS

The multicultural assessment examines the contextual areas through four

domains: ethnocultural heritage, journey, self-adjustment, and relations

(Jacobsen, 1988). In the following sections, I discuss the four domains

separately.

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 59 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL CARE

Exhibit 3.1

Multicultural Clinical Assessment Areas

Ability and Disability Status

� Cultural beliefs around disability

� Family beliefs, attitudes

Acculturation

� Assimilation

� Biculturalism

� Culture shock stages

� Transculturation

Age

� Age cohort

� Cultural meaning of age

� Interaction of age with gender, ethnicity, race, class, and other

variables

Biocultural

� Health status

� Medical history

� Illnesses, genetic predisposition to illness

� Nutrition, common foods, vitamins, herbs

� Physical activity

� Substance use or abuse

� Traditional healing practices

Development

� Cultural meaning of developmental stages: infancy, childhood,

adolescence, menarche, adulthood, menopause, old age

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 60 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL ASSESSMENT

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

Discrimination

� Anti-immigration movement, classism, racism, heterosexism,

ageism, ableism, sizeism, colorism, xenophobia

� Historical and contemporary oppression

� Microaggressions

Education

� Education level

� Occupation, avocation

� Professional status

Ethnicity

� Ethnic identity and identification

� Ethnocultural heritage

� History of (im)migration and generations from (im)migration

� Acculturation and transculturation

� Languages spoken by client, family of origin, and current family

Family

� Adoption and foster parenting

� Family of origin and multigenerational history

� Family life-cycle development and stages

� Family structure (patriarchal, matriarchal, egalitarian; nuclear,

extended; traditional; reconstituted)

� Non–blood-related extended family members, such as padrino,

madrina (godparents), doula (person who mothers the mother

by providing specialized maternal infant care, including emo-

tional and practical support)

(continued)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 61 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL CARE

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

� Gender and family roles (hierarchies, responsibilities) (What

are the cultural specifications for being a mother, father, grand-

parent, etc.?)

Folk Beliefs

� Culture-bound syndromes

� Anger management and cultural expressions of anger (i.e.,

amok, mal de pelea, and hwa-byung; see Chapter 8 for a discus-

sion of culture-bound syndromes)

Health-Related Folk Beliefs

� Use of folk healers, complementary and alternative medicine

Gender

� Cultural roles of male, female; interaction of gender, ethnicity,

and race

Geographic Location

� Presence and impact of ethnic group members vary according

to locale (e.g., Mexican Americans in California, Polish and Pol-

ish Americans in Chicago)

Geopolitics and History

� Ethnic group’s politicohistory

� Ethnic group’s relationship with dominant group (including

wars and political conflict)

� Ethnic group’s relationship with other ethnic groups

� Historical era

� Sociohistory

� Political ideology

� Wars (including civil war)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 62 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL ASSESSMENT

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

Health and Mental Health Beliefs

� Attitudes around mental health or illness

� Attitudes toward, and expectations for, mental health treatment

� Beliefs, customs, and attitudes surrounding death

� Meaning of pain and suffering

Immigration and Migration

� Age of immigration

� Asylum experience

� Culture shock stages

� International living experiences

� Refugee experience

� Type of immigration (voluntary, involuntary)

� Ulysses syndrome

Language

� Accent

� Bilingualism, multilingualism, dialects

� Languages spoken at home

� Language fluency

� Nonstandard English

� Speech difficulties (e.g., stammering)

Lifestyle

� Health-maintenance behaviors, exercise, vitamin and herb

supplements

� Recreation, avocations (e.g., mountain climbing), and hobbies

� Risk-taking behaviors; sensation seeking

� Special roles

(continued)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 63 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL CARE

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

Marital Status

� Marriages (heterosexual, same sex, common law liaisons, sexual

partnerships)

� Divorce, singlehood, separation, widowhood, political widowhood

National Origin

� Legal status (alien, resident, naturalized, native born)

� Citizenship (single, dual)

Oppression

� Ableism

� Ageism

� Elitism

� Functional and dysfunctional reactions

� Heterosexism

� Homophobia

� Institutional

� Internalized oppression

� Racism

� Religious (e.g., anti-Semitism, anti-Islam, anti-Catholicism, cult)

� Sexism

� Sizeism (discrimination due to body size)

Pets

� Past and current pets

� Reaction to pet’s death

Physical Appearance

� Attractiveness (self and other, cultural group and mainstream

group perception)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 64 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL ASSESSMENT

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

� Minority status may increase as individuals deviate from the

White European American phenotype

� Distinctive physical characteristics (e.g., birthmarks, tattoos)

� Hair texture

� Size and body type

Politics and Ideology

� Political groups

� Ideology

Race

� Interaction of race, gender, age, sexual orientation, class

� Phenotypical characteristics

� Skin color, hair texture, facial features

� Racial history (individual and collective)

� Racial socialization

Religion and Spirituality

� Folk beliefs

� Religions raised and practicing

� Spiritual beliefs

� Effect of religion or spirituality on health and well-being

� Ecstatic experiences, paranormal experiences

� Psychospiritual journey

� Relationship with the divine

Sexual Orientation

� Asexual, heterosexual, gay/lesbian, bisexual, transgender

� Internalized oppression

(continued)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 65 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL CARE

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

Sexuality

� History, including partners, and other pertinent information

� Reproductive history (abortion, miscarriages, stillborn,

offspring)

Socioeconomic Class

� Current socioeconomic status (SES)

� SES of family of origin

� Changes in socioeconomic class

� Financial health

� Financial history (Great Depression, culture of poverty)

Strengths

� Cultural resilience

� Cultural strengths

� Talents, gifts, special abilities

Stress

� Types of stress (acculturative, racial or ethnic, financial, ecologi-

cal—inner-city living)

� Life stressors

� Stress management

Trauma

� Abuse (bullying, emotional, domestic, physical, verbal)

� Collective

� Combat trauma

� Cultural or historical

� Individual (crime, accident, insidious, natural catastrophes)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 66 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL ASSESSMENT

Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

� Gender (sexual, incest, battered spouse syndrome, forced pros-

titution, sexual abduction, trafficking, tortuous inducement of

abortion of pregnant imprisoned females)

� Ethnoracial (prejudice, discrimination, microagression, victim-

ization, scapegoating, hate crime)

� Political (e.g., refugee trauma, repression, persecution, torture)

� Racial terrorism

� Survivor syndrome

Work and Employment

� Attitude toward work

� Employment and unemployment history

� Impostor syndrome

� Glass ceiling experiences

� Promotions, demotions, etc.

Ethnocultural Heritage

Exploration of clients’ ethnocultural heritage elicits ancestry, history,

genetics, biology, and sociopolitical legacy. More specifically, clinicians

obtain contextual information on clients’ maternal and paternal cultures

of origin, religions, social class, gender and family roles, languages, and

other variables. As you examine your clients’ multiple contexts, make sure

to consider the larger historical and sociopolitical factors that inform their

lives. In addition to eliciting collective narratives, you can assess genera-

tional experiences such as disconnection; dislocation; and trauma, includ-

ing sociopolitical trauma, such as a group history of slavery, colonization,

the Holocaust, and others. Moreover, you can inquire about history of

collective formative events. These may include natural disasters, political

violence, terrorism, and social cataclysms, such as the Great Depression,

that tend to lead to an enduring and distinguishing membership affiliation

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 67 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

(Elder, 1979). Such affiliation engenders feelings of shared participation

in social experiences that create firm bonds, distinguishing persons who

have endured these events from those who have not. For example, a bond-

ing experience for many baby boomers is the Vietnam War. Likewise, cli-

nicians can explore experiences with collective oppression and trauma.

For instance, whereas many women feel connected by experiences of sex-

ism, many people of color feel bonded by experiences of racism, and many

women of color are “branded” by sexist racism. Moreover, having lived

through collective bonding events tends to shape responses to subsequent

events. These bonding experiences can lead to sympathetic trauma or feel-

ing secondhand (vicarious) trauma if one witnesses a trauma inflicted

upon a person of one’s cultural group. To illustrate, many African Amer-

icans experienced traumatic responses to the televised incident in which

White policemen were beating African American Rodney King (Shorter-

Gooden, 1996). Their sympathetic trauma was akin to a realization that

“it could happen to me.” This type of indirect trauma goes beyond psy-

chological identification and empathy for the pain of others and relates to

the fact that one’s membership in an ethnic group predisposes him or her

to potentially become a victim of a hate crime.

It is important to explore the presence of historical and contemporary

cultural trauma. Cultural trauma refers to the victimization that individ-

uals and groups may experience because of their culture, including their

ethnicity, race, gender, sexual orientation, class, religion, or political ide-

ology, and their interaction with other diversity characteristics. These

events can have long-standing effects on individuals and groups. For

example, individuals with a history of colonization may experience post-

colonization stress disorder (PCSD). PCSD results from a historical and

generational accumulation of oppression, the struggle with racism, cul-

tural imperialism, and the imposition of mainstream culture as dominant

and superior (Comas-Díaz, 2000; Duran & Duran, 1995). As a form of

posttraumatic stress disorder, however, PCSD is an entity unto itself. Con-

temporary exposure to racism, xenophobia, homophobia, hate crimes,

and other forms of oppression causes cultural trauma. Moreover, many

individuals experience cultural trauma individually, collectively, vicari-

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 68 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

ously, intergenerationally, or all of these ways. The following vignette

illustrates the usefulness of exploring clients’ ethnocultural heritage.

An upper-middle-class married woman, Laura sought treatment for

anxiety after Sister Mary, her spiritual advisor, suggested psychotherapy

to her. Laura’s symptoms included sweaty palms, heart palpitations, nerv-

ousness, and dizziness during social interactions with her husband’s col-

leagues. As an attorney, Laura did not experience dysfunctional symptoms

in her professional role. Her husband, John, was a White philanthropist

who could trace his ancestral origins back to the Mayflower. Laura’s clini-

cian, Dr. Cross, was a psychologist with cross-cultural experience (he

spent a year in Sicily as an American field student) and a White American

man of British ancestry. After completing a clinical assessment, Dr. Cross

decided to conduct a multicultural assessment to further explore the

source of Laura’s anxiety. In exploring Laura’s ethnocultural heritage, he

found out that her mother, Clara, was a Mexican sculptor who grew up in

a working class neighborhood in Arizona, where she suffered severe eth-

nic and gender discrimination. Laura’s father, Don, a lawyer who is a

White American and whose ancestry is British, met Clara at an art exhibi-

tion. In discussing her maternal ethnocultural heritage, Laura realized that

she felt like an impostor and harbored fears of being “found out” as half

Mexican. Consequently, she was able to identify the dread of being

rejected by her husband’s social and business circle as the source of her

anxiety. Laura was a tall, blonde, fair-skinned woman who many believed

“did not look stereotypically Mexican.” Even though Laura did not report

being the victim of direct ethnic prejudice, her mother’s stories about

being called a “wetback” (a pejorative term used to designate Mexicans

without a legal residence status) were vivid in her mind and in her night-

mares. It appeared that Laura was experiencing an intergenerational

trauma (Danieli, 1998) arising from her mother’s exposure to racism and

xenophobia in Arizona. The succession of traumatic events and oppression

that members of a cultural group endure, historical trauma has intergener-

ational effects (Evans-Campbell, 2008). Unfortunately, the intergenera-

tional trauma continues to affect subsequent generations because when

the cultural trauma is not resolved, it becomes internalized.

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 69 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

Sociopolitical Timelines

To explore the effects of history and cultural trauma on clients, clinicians

can chart a sociopolitical timeline. This process helps individuals to con-

nect their history to the present and to envision a future.

You can complement the examination of the effects of sociopolitical

and historical factors through the exploration of your client’s sociopolit-

ical timeline. A timeline helps to identify your client’s personal, family and

historical events.

Laura’s sociopolitical timeline is as follows:

� April 25, 1846: Mexican American War begins

� January 1848: Peace agreement and Treaty of Guadalupe Hidalgo

� 1950: Clara, Laura’s mother is born

� 1955: Clara immigrated to the United States

� 1964: Civil Rights Act

� 1960s: Chicano movement

� 1970s: Women’s movement

� 1975: Laura’s parents are married

� 1980: Laura is born

� 2008: Barack Obama, the first person of color (mixed race, White and

Black African), is elected president of the United States

� April 28, 2010: Arizona anti-immigration law (see Arizona State

Senate, 2010)

Biocultural and Ecological Contexts

The meaning of pain and suffering has cross-cultural variations. Conse-

quently, when you delineate your client’s ethnocultural heritage, you can

explore biocultural variables—the physical factors grounded in a cultural

context. For a more detailed discussion of ethnopsychopharmacology, or

the physiological, ethnic, and gender differences in drug metabolism, see

Chapter 7. When you adopt a physical health mode during the first stage

of the assessment, you can examine your client’s health and illness belief

systems. For instance, a belief in mind–body–spirit unity is relevant to an

understanding of culture-bound syndromes as coping skills, particularly

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 70 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

anger management. To illustrate, mal de pelaa among Latinos and hwa-

byung among Koreans are syndromes related to anger management within

a culturally specific context (American Psychiatric Association, 2000). I

discuss culture-bound syndromes in Chapter 8.

When you promote health as a holistic construct, you help to cement

a multicultural therapeutic alliance. Assessing biological functioning is

congruent with culturally diverse clients who are familiar with the U.S.

medical or public health model. Moreover, you can explore your clients’

biocultural genetic predispositions to illnesses. As an illustration, one in

four Ashkenazi Jews carries a genetic predisposition to develop Tay-Sachs

disease, Canavan disease, Niemann-Pick disease, Gaucher disease, famil-

ial dysautonomia, Bloom syndrome, Fanconi anemia, cystic fibrosis, and

mucolipidosis IV (see Jewish Virtual Library, 2011). Likewise, lower rates

of Alzheimer’s dementia are present in African Americans, Japanese (with

autopsy confirmation), and Cree Indians than in White populations

(Sakauye, 1996). As a clinical implication of these findings, if a Japanese

American presents with Alzheimer’s-related symptoms, clinicians may

want to explore the existence of other types of disorders, such as multi-

infarct dementia.

Exploring a client’s biocultural background can provide useful infor-

mation. For example, Laura reported that her maternal uncle had died of

diabetes-related complications. After learning about Laura’s maternal

Mexican ancestry, Dr. Cross inquired about Laura’s propensity to develop

diabetes. A physical exam revealed that Laura had a prediabetic condition.

Similarly, clinicians can gather information following a wellness per-

spective. Many sociocentric individuals view wellness as a balance among

the physical, emotional, relational, cognitive, ecological, and spiritual

dimensions. Therefore, you can examine clients’ lifestyle through ques-

tions about nutrition (special foods), physical activity, ability or disability

status, use of alternative medicine, intake of vitamins and herbs, relaxation

practices, spiritual practices, use or abuse of substances, and others. In

addition, you can explore clients’ ecological contexts, such as living in the

northern latitude and being susceptible to seasonal affective disorder, as well

as being exposed to higher than normal lithium soil quantities in the U.S.

Southwest. Along these lines, you can examine your clients’ environmental

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 71 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

circumstances. For example, Caspi, Taylor, Moffitt, and Plomin (2000)

found that lower income neighborhoods are associated with children’s

development of behavioral problems. Living in high-density areas forces

inner-city individuals to endorse specific survival adaptations—behaviors

that become dysfunctional when living in low-crime areas. Although one’s

clients may not reside in a lower income neighborhood, they may be

vicariously affected by having significant others who do.

Multigenerational Genograms

You can diagram clients’ ethnocultural heritage with the use of multi-

generational genograms (McGoldrick, Gerson, & Petry, 2008; McGoldrick,

Gerson, & Shellenberger, 1999). Similar to family trees, genograms present

family relationships, issues, and concerns in a multigenerational format. A

multigenerational genogram recognizes the centrality of a collective iden-

tity, highlighting the connections with intergenerational and historical

linkages. It is important to earn a client’s trust and credibility before

attempting to do a genogram.

When you diagram a genogram, you can use symbols to organize and

understand a client’s family history and dynamics from a nuclear to an

extended genealogical perspective (McGoldrick et al., 1999, 2008). A multi-

generational genogram goes back at least three generations and helps you

to map a client’s patterns and dynamics in a collective context (McGoldrick

et al., 1999). See Genopro (n.d.), for basic genogram symbols; see also

McGoldrick et al. (1999, 2008).

Cultural Genograms

Genograms are particularly useful when you compare your own geneol-

ogy with your client’s. As a clinical tool, a genogram helps one examine

clinician–client similarities and differences. As part of your clinical train-

ing or personal therapy, you may have already completed your own

genogram. However, when working with multicultural clients, you should

diagram your own cultural genogram. Note that clinicians should make

sure that they have earned enough cultural credibility before introducing

this multicultural tool.

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 72 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

Cultural genograms place individuals within their collective contexts,

including but not limited to genealogical, biological, developmental, his-

torical, political, economical, sociological, ethnic, and racial influences

(Hardy & Laszloffy, 1995). In short, cultural genograms emphasize the role

of context in the lives of individuals. Hardy and Laszloffy (1995) advanced

the concept of the cultural genogram as an extended genealogical tool to

map contextual relationships among heritage, affiliation, history, collective

trauma, ecology, place, community, racial socialization, experiences with

oppression, ingroup dynamics, outgroup dynamics, relationship with

dominant society, relationship with members of other racial ethnic groups,

politics, identity, immigration, translocation, adaptation, acculturation,

transculturation, ethnic/racial identity development, and many other con-

textual factors. In particular, cultural genograms examine the management

of cultural differences and similarities. Because of the emphasis on ethno-

cultural heritage, it is important to go at least five generations back when

completing a cultural genogram. In addition to the regular information

obtained through a genogram, cultural genograms (Comas-Díaz, 2011b;

Hardy & Laszloffy, 1995) chart culture-specific information such as

� activities of daily life;

� birth, marriage, death, and developmental milestone rituals;

� meaning of cultural similarities and difference;

� meaning of leisure;

� ethnocultural heritage;

� cultural translocation;

� cultural adaptation, acculturation, and transculturation;

� dual consciousness, biculturalism, and multiculturalism;

� communication style;

� cultural–racial/ethnic identity development;

� soul wounds;

� historical and contemporary trauma;

� racial socialization;

� gender racial socialization;

� experience with oppression and privilege;

� internalized oppression and privilege;

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 73 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

� orientation to time;

� sense of agency;

� ingroup/outgroup member dynamics;

� relations with dominant society members;

� spirituality and faith;

� geopolitics, ecological influences; and

� psychopolitical influences.

Clinicians should not expect to complete a cultural genogram in a sin-

gle session. Allow yourself enough time to let clients’ cultural genealogi-

cal stories emerge. Both an assessment and a treatment instrument, a

cultural genogram promotes clients’ self-healing because it allows them to

reconnect with their cultural heritage. Use your clinical judgment when

conducting a cultural genogram with your multicultural clients. Informa-

tion on cultural genograms is in Hardy and Laszloffy (1995).

Clinicians should complete their own cultural genogram. Figure 3.1

shows an example. The client in this cultural genogram, Marcia, is dis-

cussed in Chapter 7.

Journey

As you examine your clients’ ethnocultural legacies, you lay down the foun-

dation for unearthing their journey. To elicit such a journey, you can assess

your clients’ translocations, family sagas, and trauma histories. Psychology

of place elucidates the relevance of the journey because one’s location

affects one’s sense of attachment, familiarity, and identity (Fullilove, 1996).

In assessing your clients’ translocation story you can explore their family,

clan, tribe, and when pertinent, national history. Such narrative sharpens

the understanding of the role of cultural, historical, and geopolitical con-

texts on individuals and groups. The family saga includes the ancestral, cul-

tural, and personal stories that reveal the cultural schema. When you elicit

the family saga, you explore the circumstances that led your clients or their

multigenerational families, or both, through cultural translocation. A cul-

tural translocation refers to a geographical, developmental, psychological,

socioeconomic, sociopolitical, and historical transition. Although most

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 74 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL ASSESSMENT

Figure 3.1

Example of a cultural genogram. Please note that “Red slaves” are people who were kid- napped from Goajira (Venezuela) and forced into slavery (see Regional Office for Cul- ture in Latin America and the Caribbean, n.d.). The genogram information here follows the genogram formulation by McGoldrick and colleagues (1999, 2008; standard genogram symbols can be viewed at http://courses.wcupa.edu/ttreadwe/courses/ 02courses/standardsymbols.htm). The essential differences between a genogram and a cultural genogram are that the latter goes back at least five generations, emphasizes eth- noracial identity, acknowledges the sociopolitical and historical contexts, and recognizes sociocentric cultural values. Here, some genogram symbols were modified to reflect racial-ethnic identification and collectivistic cultural values, and “universal” symbols were added to simplify the diagram.

Marcia’s Cultural Genogram

Fifth-generation unknown Fifth-generation unknown Fourth-generation unknown Fourth-generation unknown Paternal great-grandparents Maternal great-grandparents North Carolina Aruba

? ? ? ? ? ?

Father Mother Uncle Aunt Ray Vivian

// “Uncle” Doug Marcia Bob (Vietnam War)

church singing

Dora (nonbiological

cousin) - - - - - - - - - - - / - - - - - - - - - - - - - - Al Kecia Sam (car accident)

(cat) Sally 6 years old

(continued)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 75 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

people go through transitions while leaving the parental home, commit-

ting to a romantic relationship, getting or changing jobs, becoming parents

(or not), getting divorced, coping with losses, and other relational experi-

ences, a cultural journey refers to a significant transition that bears pro-

found effects.

A classic example of a cultural journey is immigration. Many cultur-

ally diverse individuals have a collective or personal history of immigra-

tion, or both. Certainly, immigration entails a cultural adjustment (P. S.

Adler, 1975) that can engender a developmental milestone (Akhtar, 1995).

Indeed, immigration changes individuals’ sense of affiliation because the

old ways of connecting may no longer be efficient, requiring the person’s

creation of new ways of relating (Akhtar, 1995, 1999; Espin, 1987). Imag-

ine visiting a foreign country and not speaking the national language. This

MULTICULTURAL CARE

LEGEND

Cultural symbols Marcia Mixed-race woman or girl African American man or boy Mixed-race man or boy

Venezuelan Red slave Native American woman or girl Deceased

Person has lived in 2 cultures Physical disability Family secret

Christian Church Conflict

Music Alcohol abuse

Pet (cat, dog) Color (Marcia used the following colors)

Orange - self-designation Gold - daughter Kecia Blue - son Al Pink - granddaughter Sally Reddish brown - paternal Cherokee great-grandmother Red - maternal great-grandfather Red slave Venezuelan

Emotional relationship symbols ___________ Good ____ ____ Basically good, some powerful arguments

Conflicted Close or Enmeshed

Relationship

Married

Cohabiting

- - - - - - - - - - - - - - - - -

Common law marriage

Divorced

Separated

Sexual abuse

Figure 3.1 (Continued)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 76 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

temporal experience may be similar to interacting with the nation’s super-

ficial culture iceberg. In contrast, a multicultural client’s immigration

entails coping with the mainstream’s deep culture iceberg.

To have a complete picture of a client’s journey, you need to explore

the type of translocation (voluntary or forced, during war or peace)

involved. In addition, you can examine whether your client had a refugee

experience (Marsella, Bornemann, & Orley, 1994) or whether the immi-

gration was legal or undocumented. Moreover, you can explore whether

the translocation was recent or generations ago. The thoughts and feelings

regarding the transition also provide a blueprint for understanding your

clients’ adaptation to the host environment. For instance, many migrants

have a family saga of escaping from starvation or political repression, a

search for adventure, or being members of a displaced elite who escaped

their country of origin. Yet, for others, as in the case of many African

Americans, their family saga translocation is one of historical slavery and

oppression. Likewise, you can explore the posttranslocation circum-

stances. For example, you can examine whether family members stayed

together and whether they have a sense of family unity. Moreover, you can

inquire about the relationship of the family with their ethnocultural group

and examine how they have fared emotionally, socially, and financially.

Clinicians can assist clients’ articulation of identity by exploring their

family saga. This process promotes healing because cultural, family, ances-

tral, and personal storytelling are powerful multicultural therapeutic tools

(Deveaux, 1995). Moreover, as you go about gathering family and ances-

tral stories, you can activate and facilitate clients’ family saga inquiry when

you ask about the perspectives of others. To illustrate, for many indige-

nous people and people of color, ancestry is important for both individ-

ual and collective identity, and because ancestors can represent spiritual

guides who aid in times of crises. Similarly, many clients perceive their

land or environment as a significant dimension in their life.

Separation from significant others, culture, place, or all three, can lead

to disconnection. A particular form of disconnection, translocation—

moving from one environment (physical, emotional, cultural) to another—

involves an implicit dislocation, loss, uprootness, separation, and grief. The

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 77 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

psychology of place and displacement advanced by Fullilove (1996) helps

to explain the effects of translocation. Fullilove asserted that individuals

require a “good enough environment,” which they are linked to through

attachment, familiarity, and identity. Displacement threatens these psy-

chological processes, resulting in disorientation, cultural fatigue, adjust-

ment, dislocation, and even trauma.

Another area to explore during the saga stage is the presence of histor-

ical, cultural, and individual trauma. For example, a significant number of

immigrant children relocate without their parents because the adults immi-

grate first to send money to their families back home (Suárez-Orozco &

Suárez-Orozco, 2001). In addition to coping with grief, many immigrant

children struggle with feelings of parental abandonment and rejection.

Therefore, examining the age and context of immigration is crucial to

assessment. For instance, several kinds of immigrants, particularly refugees,

may have experienced trauma in the form of political repression and tor-

ture; witnessing violence, sexual, and domestic abuse; forced prostitution;

and many other types of oppression. Of course, not all trauma stories are

related to translocation; nonetheless, these are problems encountered in dis-

location. However, I recommend that clinicians use clinical judgment and

ascertain the existence of trauma. Although the adaptation to a new envi-

ronment is mediated by various factors, including the cultural similarities

between the original culture and the host culture, many immigrants and

culturally diverse people experience a range of trauma-related symptoms.

These symptoms may include guilt and survivor’s guilt regarding relation-

ships left behind either in their countries of origin or in the ethnic commu-

nities. For instance, the development of new relationships in the host

country or dominant society at times may be experienced as a betrayal of

those who live in their original communities (Espin, 1987).

Regardless of the nature of a client’s journey, a cultural translocation

evokes a sense of displacement that can result in loss, dislocation, accul-

turation, and adjustment difficulties. Adjusting to the mainstream society

and functioning in two different cultures can be stressful and distressing.

Unlike most mainstream clients, culturally diverse individuals’ lives tend

to have cumulative effects that are shaped by life stressors. For instance, as

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 78 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

a regular move may reenact an immigrant’s original translocation, it may

lead a refugee to relive dislocation related traumatic experiences.

Mapping the Journey: Culturagram

You can map your clients’ journey by examining their cultural transitions

and identifying the multigenerational family translocations, their interac-

tion with developmental stages, and the family sociocultural evolution in

a changing society (Ho, 1987). Moreover, you can uncover the transloca-

tion effects at the personal, family, and communal levels. As you collect

demographic, psychological, social and cultural data, you assess clients’

transitional position and family cultural homeostasis. Examining clients’

translocations helps to affirm their ethnic and gender identity through the

use of cultural heritage, photographs, folklore, art, literature, and music.

Besides examining the family and individual transition, I suggest that

clinicians inquire about other societal and global transitions, such as wars,

sociopolitical, and economic events (e.g., the Great Depression, Black

Monday, September 11,the election of Barack Obama as the first president

of color of the United States) and explore their interaction with clients’

lives. A culturagram maps a client’s (and his or her family’s) journey or

cultural translocation (Congress, 1994, 2002). This tool helps clinicians to

examine in more detail issues such as reasons for relocation; type and nature

of journey (immigration, migration, refugee, international sojourn); age at

immigration (younger immigrants tend to adapt faster than older individ-

uals); legal status; languages spoken both at home and in the community;

length of time in the community; health beliefs; impact of crisis events;

holidays and special events; adherence to cultural, spiritual, and religious

organizations; values about education and work; and values regarding

family structure, power, hierarchy, rules, subsystems, and boundaries,

among others. A main function of the culturagram is to contextualize

clients’ translocation and illuminate the journey’s implications for their

lives (Congress, 1994, 2002). As with all multicultural clinical tools, use

clinical judgment to infuse a richer interpretation into the culturagram.

Figure 3.2 shows an example. The client in this culturagram, Marcia, is

discussed in Chapter 7.

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 79 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

As you examine your clients’ journey, you can assess their cognitive

and emotional perception of their family’s cultural identity in the host

society since the translocation. For example, you can explore the family’s

reaction to the journey, including the diverse rates of acculturation of

family members. In other words, you explore the place carved by the fam-

ily after the transition. In addition, you can assess clients’ cognitive and

emotional perception of their family saga. Certainly, clients’ internaliza-

tion of their cultural journey provides a blueprint of their entry into the

world. In other words, a client’s adjustment to the journey may be differ-

ent from that of her or his family members.

MULTICULTURAL CARE

Figure 3.2

Example of a culturagram. PTSD = posttraumatic stress disorder; IBS = irritable bowel syndrome.

Trauma Impact Child sexual abuse,

PTSD, IBS

Oppression Racism, sexism, sizism,

colorism

Religious Cultural Contact

Church choir, community advocacy,

Aruba’s Carnival

Education/Work Values College education,

learning and teaching, early retirement Family Values

Familism, egalitarianism,

transpersonality

Legal Status Marcia, Al, Kecia, and

Sally: U.S. citizens Vivian: Aruba citizen

Relocating Reasons Father’s work,

Marcia’s education

Health Beliefs Spiritual healing,

Qi gong, Alcoholics Anonymous

12 steps.

Languages Marcia, Al, and Kecia: English and Ebonics

Vivian: Papiamento and English

Time in Community Marcia, born in Aruba,

moved to U.S. at 1 year old, raised in North

Carolina, moved to D.C. for college, lived in D.C.

adult life, 2 visits to Aruba.

Family Marcia (57)

Al (35) Kecia (32) Sally (6)

Dora (57) Vivian (70)

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 80 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

Cultural Self-Assessment: Mapping Clinicians’ Journeys

Clinicians can use culturagrams to chart their own cultural locations and

to examine similarities and differences vis-à-vis their clients’ journeys. If

you do not have a personal history of immigration, map your ancestors’

journey saga. Native Americans (or descendants of the Hispano popula-

tion that has always lived in what is now the Southwest United States) can

map their ancestors’ journey of being emigrants in their own land.

Self-Adjustment

A significant cultural translocation such as immigration can act as a psy-

chological individuation (Akthar, 1995). Therefore, you can examine your

clients’ self -adjustment to their journey. Self-adjustment relates to clients’

own perceived adaptation to the context, situation, or host culture as indi-

viduals and is distinct from their family’s adjustment. Regardless of their

worldview, culturally diverse people tend to experience an individual

adaptation (separate from that of their family, peers, or both) to cultural

translocation. For instance, a client may have what Achotegui (2004)

termed Ulysses syndrome, a type of depression with somatic reactions that

some immigrants living away from loved ones may experience as part of

their cultural adjustment. For example, Steve, the Filipino man referred

to Dr. Perez in Chapter 2, seems to illustrate a case of Ulysses syndrome.

In assessing a client’s adaptation, you can review the client’s interac-

tions with members of his or her own ethnocultural group, as well as with

members of other cultural groups. When you explore the self-adjustment

domain, you can examine the client’s connection and his or her dis-

connection story. Exploring the disconnection story could be useful in

identifying areas in which the individual feels separate from the family,

peers, and perhaps the rest of the world.

You can assess clients’ acculturation level, which is part of their self-

adjustment. How individuals adapt to cultural translocation can take

diverse forms, ranging from assimilation, acculturation, biculturalism,

and transculturation.

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 81 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

Brief Clinical Assessment of Acculturation

Freddy Paniagua (1994, p. 11) described the use of a brief acculturation

scale that is useful in clinical settings. This acculturation scale—based on

the work of Burnam and colleagues (1987); Cuellar, and colleagues

(1980); as well as Suinn and his associates, (1987)—can help you to assess

three acculturation variables: generation, language, and social activity.

According to this scale, Laura’s score is consistent with high acculturation.

Acculturative Stress

In assessing a client’s acculturation levels, remember to explore his or her

acculturative stress. Generational acculturation conflicts frequently involve

parents wanting to preserve traditional cultural beliefs in their children

and the stress their offspring experience as they are pressured by the dom-

inant culture and thus feel alienated from their parents. Moreover, racial,

gender, and personal characteristics intervene in an individual’s reaction

to acculturative stress. For example, Latinos with the darkest skin tend to

be less acculturated than those with lighter skins (L. A. Vázquez, Garcia-

Vasquez, Bauman, & Sierra, 1997). Furthermore, acculturative stress can

bear intergenerational effects. For example, Laura, the fair-skinned, half-

Mexican woman from the clinical vignette in this chapter, experienced

intergenerational trauma due to her mother’s exposure to racism and

xenophobia.

As you explore your clients’ self-adjustment, you can assess their

strengths. More specifically, you can help clients to analyze the function-

ality of their behaviors—including coping skills—in diverse contexts. An

important aspect of assessing clients’ strengths is to pay attention to their

adaptive functioning. For example, many individuals develop cultural

resilience in connection to their collective survival and as a response to

historical and cultural trauma. Cultural resilience refers to the host of

strengths, values, and practices that promote coping mechanisms and adap-

tive reactions to traumatic oppression (Elsass, 1992). It fosters resource-

fulness, flexibility, and creativity. Along these lines, you can ask clients

about their talents, gifts, special abilities, avocations, artistic expressions,

and other strengths. Research has documented, for example, that expo-

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 82 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

sure to multicultural experiences is associated with increased creativity

(Leung, Maddux, Galinksy, & Chiu, 2008). Moreover, you can use clients’

strengths in clinical interventions.

When you explore your clients’ self-adjustment, you help them to

contrast their cultural identity with that of their family, group, and com-

munity. Generational acculturation conflicts between parents and off-

spring further nurture clients’ self-adjustment and cultural identity

development. I expand the discussion of the development of cultural iden-

tity in Chapter 4.

Relations

The examination of relationships is essential to multicultural assessment

because affiliation is at the center of a sociocentric individual’s life. A rela-

tional perspective grounds clients to place and time. The domain of rela-

tions refers to all relationships—with family, loved ones, confidants,

ancestors, and others. Moreover, the American Indian concept of “all my

relations” includes individuals’ relationships (or lack of) with spirituality

or higher power(s). You may want to include pets (and in some cases, ani-

mal spirit guides or totems) among clients’ significant others. Indeed, rela-

tionships with animals or pets are significant for many people. For clients

who experienced cultural translocation, an animal or a pet can be a tran-

sitional object from one culture to another. As you examine your client’s

relationships with their pets, consider what resources are available for pet

bereavement.

The relations domain pays special attention to the self and other rela-

tionship. When appropriate, and with the client’s consent, you can invite

family members and significant others to participate in the multicultural

assessment.

Multicultural Interpersonal Inventory

To further assess the relationship domain, I suggest that clinicians use a

multicultural interpersonal inventory based on interpersonal psycho-

therapy (Klerman, Weissman, Rounsanville, & Chevron, 1984). This tool

MULTICULTURAL ASSESSMENT

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 83 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

examines individuals’ relationships in a cultural context. Let us explore

Laura’s interpersonal inventory.

Dr. Cross: Who or what are you close to?

Laura: Besides my husband, John, there is Nana Blanca, the woman who

helped Mami raise me. There’s also Sister Mary, my spiritual advisor, and

Pat. But I am mostly close to Pat.

Dr. Cross: Who’s Pat?

Laura: My best friend. We grew up in the same neighborhood, went to

school and college together.

Dr. Cross: When you are with Pat, how do you feel?

Laura: Great. She’s my confidant.

Dr. Cross: What do you treasure most in your relationship with Pat?

Laura: Her loyalty. By the way, she gave me Coco.

Dr. Cross: Who’s Coco?

Laura: My beautiful poodle.

Dr. Cross: That’s nice of Pat. If you could change one thing about your

relationship with Pat, what would it be?

Laura: Let me think. This is hard. Maybe that she is too supportive and

does not give me criticism.

Dr. Cross: Have you ever asked Pat to give you critical feedback?

Laura: Ah-ha.

Dr. Cross: What happened?

Laura: She couldn’t do it.

Dr. Cross: How’s that for you?

Laura: Well, she is loyal, that’s one of the reasons I love her.

An interpersonal inventory can provide rich clinical information.

Clinicians can diagram clients’ multicultural interpersonal inventory fol-

lowing a genogram format. Figure 3.3 illustrates Laura’s multicultural

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 84 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

interpersonal inventory. I based this inventory on Klerman et al.’s (1984)

interpersonal psychotherapy, McGoldrick et al.’s (1999, 2008) genogram

formulation, and Hardy and Laszloffy’s (1995) cultural genogram model

(see Figure 3.1 for an example of a cultural genogram). I also created some

unique genogram symbols to reflect racial–ethnic identification and col-

lectivistic values.

MULTICULTURAL ASSESSMENT

Figure 3.3

This inventory (based on Klerman et al., 1984) was diagrammed following an adaptation of the genogram formulation by McGoldrick and colleagues (1999, 2008). Additionally, the cultural genogram model was used to inform the interpersonal inventory (see Figure 3.1 for an example of a cultural genogram). As a result, some of the genogram’s symbols were modified to reflect racial-ethnic identification and collectivistic values and symbols were added to represent specific meanings.

Laura’s Multicultural Interpersonal Inventory

Paternal grandparents Maternal grandparents

John Ann

(cardiac attack) Gil Lola

(cancer)

Don Clara Carlos

(diabetes)

John (husband)

Pat (confidant)

Mary (advisor)

Blanca (nana)

Coco (pet)

Bill (mentor)

Jose/Maria (godparents)

Laura (client)

LEGEND Symbols

Mixed-race woman or girl Mixed-race man or boy White man White woman Deceased

Emotional relationship symbols ___________ Good

Close or enmeshed

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 85 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

Therapeutic Relationship

Most theoretical and clinical orientations recognize the therapeutic rela-

tionship as a core factor in clinical practice. The development of an effec-

tive therapeutic relationship is of utmost relevance in becoming a

multicultural caring clinician. When you examine your clients’ relations,

you can obtain a blueprint of their expectations regarding their clinician.

Above and beyond obtaining a wealth of information that is crucial for

therapeutic interventions, a multicultural assessment frequently opens

new channels for the recognition of self in the culturally different other.

Feel free to conduct your own multicultural assessment to determine

specific areas of real and or potential overlap with your clients. I discuss

the multicultural therapeutic relationship in more detail in Chapter 5.

CONCLUSION

Clinicians are aware of the complexities in human life. Examining the

multiple and interactive contexts of individuals’ lives is culturally compe-

tent clinical care. A multicultural clinical assessment is a process-oriented

method of examining people’s lives in context. As part of the assessment,

clinicians can use multicultural clinical tools such as cultural genograms,

sociopolitical timelines, culturagrams, multicultural relationship inven-

tories, and psychospiritual assessments (I discuss this tool in Chapter 4).

People’s lives evolve out of multiple contexts and circumstances. The multi-

cultural assessment recognizes the complexities in human life.

MULTICULTURAL CARE

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 86 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .

MULTICULTURAL ASSESSMENT

MULTICULTURAL CLINICAL STRATEGIES

� Use a process-oriented clinical assessment.

� Examine clients’ multiple contexts and cohort experiences.

� Conduct a cultural genogram.

� Diagram a culturagram.

� Conduct a multicultural interpersonal inventory.

� Identify clients as partners in assessment and treatment.

� Capitalize on clients’ strengths and mitigate weaknesses.

� Complete one’s own multicultural assessment and determine

specific areas of real or potential overlap with the client’s.

12706-04_Ch03-rev.qxd 11/8/11 3:41 PM Page 87 Co

py ri gh

t Am

er ic

an P sy

ch ol og ic al A ss oc ia ti on . No t fo r fu

rt he

r di

st ri

bu ti

on .