Racial Identity Development

You work as a manager of human service providers for a culturally diverse population. After some complaints about new human service providers hired last month, you have been asked to create a memo for the new human service providers to educate them on racial identity development.

Write a 1,200-word memo to help train new human services providers on racial identity development. Specifically, ensure your memo includes the following:

· Describes racial identity development and its five stages.

· Describes why it is important for providers to understand racial identity development when working with a culturally diverse population.

· Discusses how you would tailor your professional response and interventions to individuals based on the stage of perceived and/or assessed racial identity development.

· Includes a chart that lists the five stages of racial identity development, description of each stage, actions and phrases to avoid for each stage, and recommendations of techniques for each stage. The chart should serve as a quick reference guide for the new human services providers. This will serve as 1 page of your memo.

**You may want to review and refer back to Table 9-2 and Section 9-2, “Racial Identity Development and the Helping Process,” from your textbook in your memo. See below.

The value of these models of racial identity development to providers is twofold: They educate and sensitize providers to the importance of cultural identity in understanding the experiences of people of color. They suggest that individuals at different stages of development may exhibit very different needs and values and may feel differently about what is supportive or therapeutic in the helping situation.Various authors have differentiated the counseling needs that clients of color exhibit as they move through the five stages of racial identity development (Atkinson, Morten, and Sue, 1993; Sue and Sue, 1999). Clients at Stage 1 tend to seek help for issues unrelated to ethnic identity and generally prefer working with white providers. According to Sue and Sue (1999), Stage 1 individuals are likely to feel threatened by direct explorations of race and ethnicity and tend to feel more comfortable with a “task-oriented, problem-solving approach.” They also react differently to white and same-race providers. Stage 1 clients are likely to overidentify with and seek approval from the former and direct hostility toward the latter as a symbol of what he or she is trying to reject. Both types of therapist, however, have a similar task of bringing to consciousness the topic of race and culture. Clients at Stage 2 tend to be preoccupied with personal issues of race and identity but at the same time are torn between fading Stage 1 beliefs and an emerging awareness of race consciousness. They seek counselors knowledgeable about their cultural group and tend to do best with counseling modes that allow maximum self-exploration. Sue and Sue (1999), however, point out that the person may still be more comfortable with a white therapist, so long as he or she is culturally aware. Clients in Stage 3 are less likely to seek counseling. They tend to be absorbed in re-exploring and engaging in ethnic ways and see personal problems exclusively as the result of racism. If they must enter treatment, counselors of color are preferred. Sue and Sue (1999) offer the following suggestions in relation to Stage 3 clients: The therapist, whether white or of color, will inevitably be seen as a “symbol of the oppressive society” and thus challenged. The least helpful response for either is to become defensive and take any attacks personally. “White guilt and defensiveness” on the part of white therapists will especially exacerbate client anger. Therapists must realize that they will be continually tested and often find that honest self-disclosure about matters of race is “a necessary requirement to establish credibility.” Lastly, Sue and Sue (1999) suggest adopting strategies that are more “action oriented” and “aimed at external change” as well as group approaches when working with Stage 3 clients. Clients in Stage 4 are struggling to balance group and personal perspectives and may seek counseling to help them sort out these issues. They may still prefer a counselor from their own group, but they can begin to conceive of receiving help from a culturally sensitive outsider. Sue and Sue (1999) point out that those in Stage 4 appear in many ways similar to those in Stage 1; they tend to experience conflict between identification with their group and the need to “exercise greater personal freedom.” Unlike the Stage 1 person, however, reactions tend to be issue-specific and do not challenge their positive attachment to the group. Approaches that emphasize self-exploration are particularly helpful in integrating group identity and personal concerns of the self. Clients who have reached Stage 5, according to Atkinson, Morten, and Sue (1993), are again less in need of access to counseling. They have developed good skills at balancing personal needs and group obligations, have an openness to all cultures, and are able to deal well with racism when it is encountered. Their preference for a counselor, if needed, is most likely to be dictated by the personal qualities and attitudes of the counselor rather than by group membership.Recall that in Chapter 4, Helms’s (1995) model of white identity development was introduced. Her model, which parallels and evolved from the work just described, enumerates stages of racial consciousness development in whites and the eventual abandonment of entitlement. Just as it is useful to be able to identify the stage of identity development of individual clients of color, so too is it valuable to assess white helpers vis-à-vis Helms’s model in order to train them better and match them with appropriate clients of color. According to Sue and Sue (2015), white providers will be most effective in cross-cultural service delivery when they have successfully worked through their feelings about whiteness and privilege. Such individuals, located in the highest stages of Helms’s model, are able to experience their own ethnicity “in a non-defensive and non-racist manner.” They also warn against mismatches, especially when the white therapist is at Stage 1 of Helms’s model.A white therapist at the conformity level, for example, may cause great harm to culturally diverse clients . . . The therapist may . . . a) reinforce a conformity client’s feelings of racial self-hatred, b) prevent or block a dissonance client from looking at inconsistent feelings/attitudes/beliefs, c) dismiss and negate resistance and immersion client’s anger about racism . . . or d) perceive the integrative awareness individual as having a confused sense of self-identity. (p. 162) Assimilation and Acculturation 9-3Ethnic group members differ widely in the extent of their assimilation and acculturation. Conceptually, ethnic assimilation is the coming together of two distinct cultures to create a new and unique third cultural form. This is the myth of the “great melting pot,” taken from a play by the same name, written by Jewish playwright Israel Zangwill at the beginning of the twentieth century. It is referred to as a myth because it just never happened that way.Gordon (1964) distinguishes several forms of assimilation: Acculturation involves taking on the cultural ways of another group, usually those of the mainstream culture. Structural assimilation means gaming entry into the institutions of a society. Gordon also refers to this as “integration.” Marital assimilation implies large-scale intermarriage with majority group members. Identificational assimilation involves developing a sense of belonging and peoplehood with the host society.It is probably most accurate to say that white ethnics—Irish, Italian, Jews, Armenians, and so forth—have assimilated into American society on all these dimensions, but only to the extent that they have been willing to give up their traditional ways and values. People of color, on the other hand, were never really considered part of the great melting pot and have remained structurally separate. They have, however, acculturated in varying degrees to the dominant Northern European culture. Thus, in the United States, assimilation has always been a one-way process that is perhaps, according to Healey (1995), better described as “Americanization” or “Anglo-conformity.” Healey states:This kind of assimilation was designed to maintain the predominance of the British-type institutional patterns created during the early years of American society. Under Anglo-conformity there is relatively little sharing of cultural traits, and immigrants and minority groups are expected to adapt to Anglo-American culture as fast as possible. Historically, Americanization has been a precondition for access to better jobs, higher education, and other opportunities. (p. 40)Acculturation, again, is the taking on of cultural patterns of another group—in this case, dominant white culture. In relation to working with culturally diverse populations, acculturation has importance in two ways: It is critical to be able to assess the amount of acculturation that has taken place within any individual or family and, simultaneously, to discover to what extent and in what specific areas traditional attitudes, values, and behavior still remain. Without such a “reading,” it is impossible to know what form of helping process is most appropriate and most effective with culturally diverse clients. Just knowing that a client is Latino/a in origin tells us very little about who the person is or how he or she lives. To know where the individual falls on a continuum from traditional identification to complete acculturation offers more information. It is important, however, not to confuse group membership with the degree of acculturation that has occurred—or, as Sue and Zane (1987) warn, to “avoid confounding the cultural values of the client’s ethnic group with those of the client” (p. 8). Acculturation can create serious emotional strain and difficulties for ethnic clients. A special term, acculturative stress, has been coined to refer to such situations. Take, for example, a newly arrived Vietnamese family. The children have learned English relatively quickly in comparison to their parents. As a result, they may end up translating for and becoming the spokespeople for the family. This is not a traditional role for Vietnamese children, who are trained to be very deferential to their elders; nor is it natural within their tradition for children to be in a position to wield so much power. As the children Americanize, they feel increasingly less bound by traditional ways. The result is enormous stress on the family unit, as is usually the case when traditional cultural ways are compromised or lost as a result of immigration and acculturation. Views of Acculturation 9-4Researchers have long argued over how best to conceptualize the process of acculturation. Is it uni-dimensional or multi-dimensional? That is, does acculturation exist on a single continuum ranging from identification with the indigenous culture at one end to identification with the dominant culture at the other? Or does it make more sense to conceive of an individual’s attachment to the two groups as independent of each other, with the possibility of simultaneously retaining an allegiance to one’s traditional culture as well as to dominant American culture? The uni-dimensional view implies that as one moves toward dominant cultural patterns, there must be a simultaneous giving up of traditional ways. This approach has generated the notion of the “marginal” person, an ethnic group member who tries to acculturate into the majority but ends up in a perpetual limbo between the two cultures (Berry, 2017; Lewin, 1948; Stonequist, 1961). Such individuals have transformed themselves too much to return to traditional ways, but at the same time, they cannot gain any real acceptance in the majority culture because of their skin color. A variety of symptoms have been attributed to such marginality: feelings of inferiority, depression, hyper-self-consciousness, restlessness and anomie, and a heightened sense of race consciousness. Other writers see acculturation as bi- or multi-dimensional. Proponents of such biculturalism believe that it is possible to live and function effectively in two cultures (Berry, 2017; Cross, 1988; Oetting and Beauvais, 1990; Valentine, 1971). Unlike the marginal person who is suspended between cultures with little real connection to either, the bicultural individual feels connected to both and picks and chooses aspects of each to internalize. Thus, in this view, it is possible for an Asian American to remain deeply steeped in a traditional lifestyle while interacting comfortably in the white world, perhaps in relation to work, some socializing, and political activity outside the Asian American community. Problems with this notion arise when aspects of the two cultures are in clear conflict. For example, an immigrant Latina woman is forced to give up her traditional role and work outside the home and yet tries to remain true to traditional sex roles. Even if she is able to integrate the two, it will be very difficult for her children, not having been fully acculturated in traditional ways, to do the same (Casas and Pytluk, 1995). It should also be pointed out that biculturalism is not seen as a virtue in all ethnic communities. Some view those who have become proficient in majority ways with contempt—as “turncoats” who have rejected and turned away from their own kind. A third perspective, typified by the work of Marin (1992), suggests that the impact of acculturation can be best assessed by discovering the kinds of material that have been gained or lost through acculturation. Marin distinguishes three levels of acculturation. The superficial level involves learning and for getting facts that are part of a culture’s history or tradition. The intermediate level has to do with gaining or losing more central aspects and behaviors of a person’s social world (e.g., language preference and use, ethnicity of spouse, friends, neighbors, names given to children, and choice of media). The significant level of cultural material involves core values, beliefs, and norms that are essential to the very cultural paradigm or worldview of the person. For example, Marin (1992) points to the Latino culture’s values of “encouraging positive interpersonal relationships and discouraging negative, competitive and assertive interactions,” “familialism,” and “collectivism” (p. 239). When cultural values of this magnitude are lost or become less central, acculturation has reached a significant point, and one might wonder what remains of an individual’s cultural attachment. For many whites, traditional cultural ties progressively slipped away, generation by generation in America, according to Marin’s model. The immigrant generation tended to trade more superficial cultural material. Their children, in turn, exchanged more intermediate and core cultural material as they increasingly acculturated.Immigration and AcculturationAcculturative stress is most pronounced during periods of transition, especially during and after significant migrations (e.g., to the United States) and the exposure and necessary adjustment to a new culture. Landau (1982) points to five factors that make the transition either easier or more difficult: The reasons for the migration and whether the original expectations and hopes were met The availability of community and extended family support systems The structure of the family and whether it was forced to assume a different form after migration (e.g., moving from extended family to exclusively nuclear) The degree to which the new culture is similar to the old (the greater the difference, the more substantial the stress) The family’s general ability to be flexible and adaptiveAccording to Landau, and more recent writers McDowell, Knudson-Martin, and Bermudez (2017), when the stresses are severe, the support insufficient, and the family basically unhealthy, the family unit is likely to try to compensate in one of three ways, each leading to further stresses and a compounding of existing problems. The family may isolate itself and remain separate from its new environment. It may become enmeshed and close its boundaries to the outside world, rigidify its traditional ways, and become overly dependent on its members. Or the family may become disengaged, wherein individual family members become isolated from one another as they reject previous family values and lifestyles. Especially problematic is the situation in which family members acculturate at very different rates. Cobb et al. (2017) found that acculturation dimensions, such as ethnic identity of undocumented Latinos/as in the United States, were significantly related to experiences of everyday discrimination and increased depression. They went on to suggest that more research needs to be conducted, focused on the acculturation experiences of undocumented Latinos/as so that mental health professionals can offer more culture specific interventions (Cobb et al., 2017).Perhaps the most common and problematic consequence of acculturation is the breakdown of traditional cultural and family norms. Among Latino/a immigrants, for instance, this may take the form of challenges to traditional beliefs about male authority and supremacy, role expectations for men, and standards of conduct for females. But such changes may not be limited to newer immigrants. Carrillo (1982) suggests that these same changing patterns are evident within the Latino/a community as a whole: “Clearly, Hispanics appear to be moving away from such strict concepts of role and authority within the family, and with this movement approaching new normative behavior for males and females” (p. 260). This suggestion aligns with current research by Allison and Bencomo (2015).Carrillo (1982) goes on to warn helping professionals to exhibit caution in assessing pathology, appropriateness, and inappropriateness in relation to Latino/a sex-role behavior and provides the following example:An Hispanic man who prefers the company of other men and who behaves in an authoritative manner with his wife may be manifesting his “machismo” rather than indicating personal pathology. Such behavior among other cultural groups may imply “latent homosexuality,” or an “inferiority complex,” or that the woman is masochistic and prefers to be a “martyr.” Such is not necessarily the case among Hispanic groups. (p. 261)It is critical to be familiar with the norms of the group and subgroup of which the client is a member. This is not to say, however, that emotional problems do not develop as a result of cultural change; quite the contrary. Carrillo (1982), in fact, points out a number of problems that can emerge in relation to the individual’s “inability to accept, conform to or adhere to sex-role defined standards of conduct” (p. 258). For males, symptoms can include difficulties in relation to authority, preoccupation and anxiety over sexual potency, conflict over the need for role consistency, and depression and isolation over having to feel invincible. For females, it tends to include feelings of failure and depression over not being able to live up to the strict sex-role requirements that are placed on them, as well as the somatization (development of bodily symptoms) of their frustration and rage.Acculturation and Community BreakdownA final dynamic worth exploring is the psychological consequences of the breakdown of communal support as a result of assimilation. As acculturation proceeds and individual group members feel less attached to traditional ways, they often choose to leave the community (or ghetto) in the hope of avoiding some of the hatred and animosity that are routinely directed toward the group. Lewin (1948), drawing on observations of highly assimilated German Jews prior to World War II, suggests a very different outcome than one would predict. Specifically, he found that by leaving the ghetto, acculturated individuals put themselves at greater risk of being the objects of prejudice and racial hatred than was true when they resided within the traditional community. Lewin writes:If we compare the position of the individual Jew in the Ghetto period . . . with his situation in modern times . . . we find that he now stands much more for and by himself.With the wider spread and scattering of the Jewish group, the family or the single individual becomes functionally much more separated . . . In the ghetto he felt the pressure to be essentially applied to the Jewish group as a whole . . . Now as a result of the disintegration of the group, he is much more exposed to pressure as an individual . . . Even when the pressure on the whole group from without was weakened, that on the individual Jew was relatively increased. (pp. 153–155)A more recent example of this phenomenon is when a member of lower SES community is able to pull themselves up into a higher economic status. Throughout that process of growing, that individual may adjust themselves (i.e., change their accent, change appearance, change their clothes) to survive in a new environment. While that person chooses to sacrifice parts of their culture to survive in a new environment, he may still feel connected to their community. However, the changes cause their community to disown him, leaving that person feeling as if he does not belong in either world.In other words, with acculturation and assimilation, the ability of the community to protect the individual is weakened, and efforts to avoid racial hatred by distancing oneself from group membership are likely to prove counterproductive.In regard to acculturated individuals leaving the community, Lige, Peteet, and Brown (2017) studied the racial identity, self-esteem, and impostor phenomenon among African American students. For some of these students, going to college was not a part of their family’s culture. In some cases, it took generations for African American families to be able to send an individual to college. These college students often experience the impostor phenomenon, which is a persistent perception of incompetence, despite contrary evidence (Lige et al., 2017). They went on to find that self-esteem mediates the relationship between racial identity and the impostor phenomenon.StressA critical question that needs to be answered in order to understand the complex relationship between ethnicity and health is: How exactly does the negative impact of broad social factors, such as racism, acculturation, and poverty, get translated into the everyday physical and emotional distresses that disproportionately affect people of color?According to Myers (1982), the mechanism is stress. Put most simply, being without resources and the perpetual object of discrimination makes life more stressful and, in turn, increases the risks of disease, instability, and breakdown. Myers begins his argument by suggesting that “for many blacks, particularly those who are poor, the critical antecedents appear to be the higher basal stress level and the state of high stress vigilance at which normative functioning often occurs” (p. 128). In other words, poor African Americans tend to live a “stress-primed” state of existence (Littleton, 2016).Myers goes on to show how certain internal and external factors either increase or decrease (mediate) the subjective experience of stress and, as a result, the risk of stress-related diseases: Externally, current economic conditions set the stage for whether race- and social-class-related experiences will be sources of greater or lesser stress. Internally, individual temperament, problem-solving skills, a sense of internal control, and self-esteem reduce the likelihood that an event or situation is experienced as stressful.With these factors as a baseline, two additional conditions seem to mediate the individual’s response when a stressful situation is actually presented: The actual episodic stressful event that occurs The coping and adaptation of which the individual is capableMyers (1982) contends that for poor African Americans, episodic crises are more frequent, and because of their higher basal stress levels, such crises are more likely to be damaging and disruptive.Thus, for example, the death of a spouse or relative or the loss of a job due to economic downturns is likely to be more psychologically and economically devastating to the person who is struggling to find enough money to eat, to pay the rent, and to support three or four children than it would to someone without those basic day to day concerns. (pp. 133–134)Myers has identified substantial differences among group members in their ability to cope and in the type of coping strategies used. Street youth, for example, resort to engaging in less than legal activities as coping mechanisms for survival in the streets. For others, the “ability to remain calm, cool, and collected in the face of a crisis” is primary. Still others may turn to alcohol and drugs or religion as a means of gaming some distance. Myers believes that for African Americans as a group, stress-related illness risks are higher than for the general population. But he does point out that there are effective ways to reduce the risk:To the extent that ethnic cultural identity can be developed and stably integrated into the personality structure, to the extent that skills and competencies necessary to meet the varied demands can be obtained, to the extent that flexible, contingent response strategies can be developed, and to the extent that support systems can be maintained and strengthened, then resistances can be developed that will enhance stress tolerance and reduce individual and collective risk for disorders and disabilities. (p. 138)Daly et al. (1995) amplify on Myers’s findings by describing specific coping mechanisms within the family, at the community level, and within organizations. Then, Utsey et al. (2000) continued this line of study, focusing on life satisfaction and self-esteem among African Americans. More recently, Myers et al. (2015) found that a lifetime of cumulative adversities such as experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood traumas, and chronic stress can have deleterious consequences on the mental health of African Americans and Latino/as. Psychological Trauma 9-5Stress reactions, which Myers (1982) sees as having particular impact on people of color, serve to deplete psychic resources and ultimately lead to some kind of breakdown in functioning or illness. There are, however, stress experiences that are so extreme that they not only deplete personal resources but actually shut down an individual’s basic psychic adaptation systems. Clinically, we call these traumas or traumatic events. Comas-Díaz (2016) defined racial trauma as “events of danger related to real or perceived experience of discrimination, threats of harm and injury, and humiliating and shaming events, in addition to witnessing harm to other ethnoracial individuals because of real or perceived racism” (p. 249). According to Herman (1997/2015), “traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning . . . Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close encounter with violence and death” (p. 33). Intense trauma, which has been diagnostically labeled post-traumatic stress disorder (PTSD), involves a loss of basic safety, intense fear, helplessness, loss of control, and threat of annihilation. Turner and Richardson (2016) explained that the impact of police shootings on African American communities has increased symptoms of depression, anxiety, fear, and low self-esteem. Herman (1997/2015) distinguishes four major symptom-groups associated with trauma: Hyperarousal, in which the internal biology of self-preservation goes on permanent alert. Intrusion, in which traumatized people relive the event as if it were recurring in the present. Constriction and numbing, which involve a psychic deadening or dissociation from reality. Disconnection, which involves a shattering of the self, its attachment to others, and the meaning of human experience.Much of the research on trauma has involved victims of genocide, torture, ethnic conflict, and racism as well as women, children, and gay people. Too often, racial and ethnic animosities end in violence and hate crimes that target people of color and other minorities. It has been argued by certain authors (Brave Heart, 2004; Duran and Duran, 1995) that in some ethnic populations, PTSD is a derivative of racism and colonization. The topic of social trauma (and I refer to it and other forms of mass violence as social because it tends to involve identifiable ethnic populations and is fueled not only by personal, but also by social, cultural, and political motives) is more fully explored in Chapter 10.There are a number of important points to be made in relation to psychological trauma. The source and type of trauma dictates its impact and magnitude. Trauma resulting from natural disasters, such as floods and earthquakes, tends to be less debilitating than that caused by other human beings. “Acts of God” tend to be less personally destructive and easier to recover from psychologically than those carried out in an interpersonal context. One possible explanation is that trauma caused by human hands is experienced as more personal and purposeful and, as a result, is more likely to destroy a victim’s basic sense of attachment to others and safety in the world. Similarly, repeated and long-term abuse, as in the case of torture, captivity, and repeated child abuse, is generally more destructive and debilitating than single, isolated incidents. It is important to understand that, although the trauma experience happened in the past, it can best be understood, as Gobodo-Madikizela (2000) suggests, as “lived memory.” The victim has been reliving it, over and over again, in great detail as if it is still happening. Gobodo-Madikizela relates the experience of listening to a South African mother describing the death of her 11-year-old son: The death was so vivid to me that it was as if it were happening in the moment. Her use of tense defied the rules of grammar as she crossed and recrossed the boundaries of past and present in an illustration of the timelessness of traumatic pain . . . “He ran out. He is still chewing his bread . . . Now I am dazed. I ran . . .” And the final moment when she recalled seeing her son’s lifeless body: “Here is my son.” With a gesture of her hand, she transformed the tragic scene from one that happened more than ten years earlier to one that we were witnessing right there on the floor of her front room (pp. 88–89). Various researchers (Duran and Duran, 1995; Epstein, 1998; Fogelman, 1991; Sangalang and Vang, 2017) have suggested that social trauma can be passed on or transmitted intergenerationally within ethnic families.An individual growing up in such an environment internalizes the trauma of past generations and responds to present events and experiences in light of that traumatization. In fact, Brave Heart (2004) argues for the creation of a new diagnostic designation, historic trauma, that emphasizes the massive cumulative trauma that can occur across generations and reflects a broader range of social consequences and dysfunction than is referred to by the more limited and a historical diagnosis of PTSD. By way of evidence, Yehuda (1999) points to studies that show that children of Jewish Holocaust survivors are more vulnerable than others to the development of PTSD, including a greater degree of cumulative lifetime stress. Brave Heart (2004) explains: “This finding implies that there is a propensity among offspring to perceive or experience events as more traumatic and stressful; children of Holocaust survivors with a parent having chronic PTSD were more likely to develop PTSD in response to their own lifespan traumatic events.The traumatic symptoms of the parents, rather than the trauma exposure per se, are the critical risk factors for offspring manifesting their own trauma response” (p. 12). Historic trauma is also often associated with the destruction of traditional cultural and spiritual rituals that might have ameliorated the effect of the trauma in the first place. Substance abuse and dependence often occur with trauma. Physical pain and the disruption of healthy bodily functioning are regular occurrences in trauma. A first step in treatment involves regaining control of the body and often involves, as Herman (1997/2015) suggests, restoring biological rhythms of eating and sleep and reducing the symptoms of hyperarousal and intrusion. The psychic pain is less easily or quickly controlled, and patients regularly self-medicate in order to reduce the ongoing emotional pain. It is important to acknowledge that therapeutic work with trauma survivors is particularly challenging for a number of reasons. First, the clinical material that the trauma victim must share is not only painful for her or him to relive, but it is also very difficult for the therapist to hear and assimilate. There is in each of us a strong, unconscious tendency to avoid such disturbing material. Victims are often fearful that others, including the therapist, will not believe them. Second, it is also quite natural for the client to project feelings about the perpetrator onto the therapist. As McWilliams (2004) points out:“Because the transferences of clients with histories of traumatic abuse tend initially to be intense and relatively undiluted by observing capacities, it is hard for such individuals to take in the possibility that the therapist sincerely has their best interests at heart” (p. 253). It has been suggested that working with trauma survivors can be “traumatic” in its own right. Such trauma is referred to as vicarious traumatization. Third, trauma work is long term, highly emotional, and very draining, and it can involve frequent setbacks, re-traumatization, hospitalizations, and efforts at self-injury. Trauma in its most extreme form transforms one’s physiology, sense of self and safety, attachment to others, and sense of meaning in life. As Herman (1997/2015) emphasizes: “Because trauma affects every aspect of human functioning, from the biological to the social, treatment must be comprehensive and stage-appropriate. A form of therapy that may be useful for a patient at one stage may be of little use or even harmful to the same patient at another stage” (p. 156). Root (1992) has introduced the idea of “insidious trauma”; that is, pervasive and ongoing attacks and slights associated with one’s identity as a person of color or member of a targeted minority group devalued by the majority culture. Also related here are the concepts of racial microaggressions and implicit racism introduced in Chapter 4. Insidious trauma begins early when the child is particularly vulnerable to such emotional slights, is cumulative, and can eventually trigger full-blown complex trauma reactions that are experienced as life-threatening. Susceptibility to insidious trauma may also be exacerbated by a history of intergenerationally transmitted traumatic experience, as described earlier in this section. By way of assessment for trauma, Hays (2008) makes the following important suggestions: An assessment of trauma should be made only in light of each client’s cultural life history and minority status. A client may not report a traumatic experience until trust has developed. If a client begins to decompensate while describing a traumatic event, back off and then proceed slowly and over time. Explore and validate clients strengthens by way of empowerment to balance the exploration of traumatic experiences. Be sure not to overpathologize the clients and emphasize growth and healing. With children, be very careful of re-traumatization with play therapy. Assess for trauma at the level of community experience as well as individual and personal. Additional, valuable material on the topic of trauma can be found in Tracy Smith’s excellent article “Working with Complex Trauma in Children and Adolescents” in Chapter 7, as well as the entirety of Chapter 10.Drug and Alcohol UseThere are three important points to be made about substance use and ethnicity: First, there are numerous myths about substance abuse among people of color. Rather than reflect anything akin to empirical reality, they are based on distorted stereotypes of excessive use and abuse by people of color, especially in comparison to beliefs about the consumption patterns of whites. “All Mexicans use and sell drugs” is a typical stereotype. Recently, for example, a report was issued regarding profiles of suspected drug traffickers to be routinely stopped and searched by the Oregon State Highway Patrol. Included among the characteristics that were sufficient to initiate a search was “being Hispanic.” In reality, research shows that, with a few notable exceptions (to be discussed shortly), people of color tend to use drugs and alcohol much less frequently than do dominant-culture Americans. Second, there are real cultural differences in consumption patterns, in the meaning of drinking and substance use, and in what is socially acceptable across cultures. Like the interpretation of any cultural differences, it is dangerous to make clinical judgments about patterns of substance use by culturally diverse clients without knowledge of the norms that exist around drinking or drug use within their culture. The same consumption pattern in an Asian American male, for instance, may have very different meaning vis-à-vis possible excesses and pathology than it would for a similarly aged Native American male. Third, the meaning of recovery and abstinence is very different for people of color and dominant group members. Substance abuse among whites tends to be understood as a personal issue; for people of color, it is as much a social-cultural issue as a personal one.A good place to begin is by citing research findings on substance use and abuse in youth of color. Drug research on youth is more plentiful than similar data on adults and, in general, tends to reflect similar patterns to those of adults within the same culture. The following data are drawn from and summarized in Bernard (1991) and Beker, Isralowitz, and Singer (2014): With the exception of Native American youth, other ethnic populations exhibit use patterns that are significantly less than young whites. This fact challenges common beliefs and stereotypes about runaway abuse and addiction among minority youth. As ethnic group members acculturate, however (and this is true for youth as well as adults), research shows that use levels increase and begin to approximate those of their white counterparts. The lower use rates among less acculturated African Americans, Latinos/as, and Asian Americans may reflect protective factors that exist in traditional ethnic cultures, including emphasis on cooperation, sharing, communality, group support, interdependence, and social responsibility. These values are believed to mitigate against social alienation, which has regularly been shown to be associated with high substance abuse. It is interesting to note that complementary values (i.e., competition, individualism, self-first, and non-sharing) are more closely aligned with Northern European dominant culture and are seen as risk factors implicated in the development of substance abuse problems. It has also been found that bicultural youth (i.e., those who can move effectively between the dominant culture and their culture of origin) tend to exhibit rather low levels of drug and alcohol use. Although youth of color generally show lower rates of substance use, their use tends to lead to more behavioral and health problems. This is because there is a cumulative effect of substance abuse with other risk factors, such as poverty, unemployment, discrimination, poor health care, and general depression, which correlate highly with ethnicity. It is believed that prevention is of little use unless these other risk factors are addressed.More specific information on use and abuse patterns of youth of color by community is summarized in Tables 9-3 through 9-6. © Cengage