Tag Archives: Diversity

ACA Ethical Statement – Multiculturalism


In my opinion, having an awareness of multiculturalism and diversity are a foremost in my mind as being important to our success at developing healthy working relationships with clients.  The word culture appears 8 times in the American Counseling Association (ACA) Code of Ethics.  Specifically, it suggests that “counselors recognize that culture affects the manner in which clients’ problems are defined.  Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders.”  (ACA, 2005, p. 19)  Ivey, Ivey & Zalaquett (2010) broadly define multiculturalism and diversity to include “race/ethnicity, gender, sexual orientation, language, spiritual orientation, age, physical ability/disability, socioeconomic status, geographical location, and other factors.”  (Ivey, Ivey, & Zalaquett, 2010, p. 43)  Given this broad contextual definition of culture, and the mandate of the ACA, we can deduce that multiculturalism should be an integral part of every counseling interaction we undertake.

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Some would suggest that the only alternative is functioning as a culturally encapsulated counselor who defines reality according to one set of cultural assumptions, shows insensitivity to cultural variations, makes little effort to accommodate the behavior of others, and resists adaptation and rejects alternatives.  (Corey, Schneider-Corey, & Callanan, 2007, p. 117)  While it is suitable difficult to criticize multiculturalism in moderation, at its extremes I would suggest that multiculturalism can be detrimental.  Specifically, cultural relativism presents a dimension of diversity that, when examined closely, undermines the validity and the usefulness of some multicultural pursuits.  The influential American anthropologist Ruth Benedict, in her seminal work entitled Patterns of Culture (1934), described cultural relativism:

No man ever looks at the world with pristine eyes.  He sees it edited by a definite set of customs and institutions and ways of thinking.  Even in his philosophical probings he cannot go behind these stereotypes…  The life-history of the individual is first and foremost an accommodation to the patterns and standards traditionally handed down in his community.  From the moment of his birth the customs into which he is born shape his experience and behavior.  By the time he can talk, he is the little creature of his culture, and by the time he is grown and able to take part in its activities, its habits are his habits, its beliefs his beliefs, its impossibilities his impossibilities.  Every child that is born into his group will share them with him, and no child born into one on the opposite side of the globe can ever achieve the thousandth part.  (Benedict, 1934, p. 2-3)

To most, that makes sense, and I wager that most would agree with the above statement.  However, consider this.  “If all morality is relative, then what moral objection could one make to the Nazi holocaust, to the economic deprivation of a Latin American underclass, or to a militaristic nation’s unleashing nuclear devastation on others?  And what would be wrong with conducting painful experiments on young children, using them for case studies on the long-term psychological effects of mutilation?  In a world where no moral court of appeals exists, might makes right.  The only appeal can be to power.”  (Holmes, 1984, p. 17, 18)

Making cultures equally valuable makes them equally valueless.  The point, if there is one, is that we need to seek out and obtain a balance between multiculturalism and ethnocentrism.  If we go too far in either extreme, we do so at our own peril.

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References

American Counseling Association. (2005). ACA code of ethics. Retrieved from http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf-848c-f98489937dda

Benedict, R. (1934). Patterns of culture. Boston: Houghton Mifflin.

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Holmes, A. F. (1984). Ethics. Downers Grove, IL: InterVarsity Press.

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing & counseling (7th ed.). Belmont, CA: Brooks/Cole.

Ponton, R. F., & Duba, J. D. (2009, Winter). The ACA code of ethics: Articulating counseling’s professional covenant. Journal of Counseling and Development : JCD, 87(1), 117-121. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1618074141&sid=2&Fmt=2&clientId=4683&RQT=309&VName=PQD

Intentional Interviewing


Within the context of the therapeutic exchange, the word ‘intentional’ in ‘intentional interviewing’ seems to suggest that every motion (think micro-skills) a therapist makes should be motivated by a sense of purpose.  Beyond a results driven goal-oriented structure, Ivey, Ivey, and Zalaquett (2010) seem to be proponents of a ‘structured interview’ that remains flexible enough to account for ‘the unexpected,’ and semi-structured enough to account for the multicultural variation of clients.  Given a broad interpretation of culture that could literally represent any number of demographic variables including “age, gender, place of residence; status variables such as social, educational, and economic background; formal and informal affiliations; and the ethnographic variables of nationality, ethnicity, language, and religion;” it is literally impossible for two people to match on every variable.  (Corey, Schneider-Corey, & Callanan, 2007, p. 115)  As a result, I am inclined to suggest that every counseling session should invariably be built on a foundation that advances diversity and diminishes stereotypical generalizations.

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This structured interviewing process is founded on a 5 step process that includes building the relationship, identifying a story and strengths, goals, restory, and action.  The relationship is of paramount importance to the establishment and maintenance of a working alliance between the therapist and the client.  The foundation of the relationship building process is listening.  “It is consistently estimated that 30% of successful counseling and therapy outcome is due to relationship or common factors consisting of caring, empathy, acceptance, affirmation, and encouragement.”  (Ivey et al., 2010, p. 19)  None of the above common factors are possible without listening.  Personally, I think 30% is modest.

The story and strengths portion of the interview will be variably determined by the underlying system or theory that is being employed by the therapist.  This is an attempt to determine “where the client is at” as determined by the underlying theoretical premise(s) to which we subscribe.  The authors suggest we be sensitive to themes that would allow us to draw out, identify, and accentuate one or more strengths of the client.  This may be as mundane as acknowledging that the client has sufficient insight to recognize that they needed help, or it may manifest as highlighting adaptive coping mechanisms within the context of the stories told.

Once we have determined “where the client is at,” it is important that we allow the client to verbalize “where they would like to be.”  I have chosen my words carefully because the notion of client autonomy and self determination is paramount to the goal setting process.  Furthermore, this process of goal identification proves useful in focusing motions on the objective.  Ideally, the stories we attempt to cultivate should be relevant to the verbalized goal.  The alternative is a meandering experience without a focal point.

Restory is an element of the equation that I consider to be more of an art than a science.  Restory represents a process whereby we reinterpret and reframe events in an attempt to “help clients generate new ways to talk about themselves.”  (Ivey et al., 2010, p. 19)  I liken this portion of the interview to the ‘trial close’ in a sales presentation.  This is a critical element because there is a process of ‘trial and error’ on the part of the therapist whereby we attempt to find a ‘trigger’ in the client that will serve as a catalyst.  Just as no single type of close works on every customer, no single theoretical solution is going to work for every client.  As a result, Ivey and associates suggest we keep an open theoretical stance and remain flexible in our endeavor to find a personalized solution for the each individual client.

Action… action is ‘the test’ to attempt to see if our proposed solution is ‘close enough to the target’ to be effective.  I stress ‘close enough to the target’ because more often than not the colloquial maxim ‘there’s more than one way to skin a cat’ holds up.  If we are successful the client will generalize concepts explored in therapy to the ‘real world’ and subsequently make progress toward his or her stated goal.

There is one specific aspect about this process that I feel the authors have neglected… perhaps this aspect is addressed later in the text, or in another section, but where do ‘implications’ fit into the mix?  In my view, it is absolutely necessary for us to have the client identify the implications of both action and inaction, be they positive or negative.  Through this process, we leverage the relationship to position the action as a solution to the predicament.  In this process, I believe it is imperative that we ask the question ‘What if you choose to try XXXX?’ or ‘What if you choose to do nothing?’  Without a client realizing the implications of the choice, there’s no point in taking the action.  Just food for thought…

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References

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing & counseling (7th ed.). Belmont, CA: Brooks/Cole.

Roles of Cross Cultural Influences in Diagnosis


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Before we can begin exploring deviations from the norm as it relates to a specific culture, it is extremely important that we define exactly what is meant by the word culture.  Culture is defined as the customary beliefs, social forms, and material traits of a racial, religious, or social group.  It could also be defined as the set of shared attitudes, values, goals, and practices that characterizes an institution or organization. (culture, 2010)

As with any definition, it comes with limitations.    Given the changing nature of our social world and given the efforts of individuals to adapt to such changes, culture can best be viewed as an ongoing process, a system or set of systems in flux. (Lopez & Guarnaccia, 2000, p. 574)  Constant change is the rule with and within any given subset or group of people.  Any generalization regarding a population should come with a specific guideline as to whom it would apply, and more specifically, over what period of time the cultural generalization encompasses.   Attempts to freeze culture into a set of generalized value orientations or behaviors will continually misrepresent what culture is. (Lopez & Guarnaccia, 2000, p. 574)  While the representation may prove valid for a period of time, it is inevitable that the research will date itself; thereby propagating the perpetual need for new and innovative research.

A related limitation of the values-based definition of culture is that it depicts people as recipients of culture from a generalized “society” with little recognition of the individual’s role in negotiating their cultural worlds.  A viable definition of culture acknowledges the agency of individuals in establishing their social worlds. (Lopez & Guarnaccia, 2000, p. 574)  Simply because I am a white male from Omaha doesn’t necessarily mean that I have assumed all the traits that could be used to label or otherwise describe that general population.  Exceptions are abundant in every generalization about a specific populace.

An important component of this perspective is the examination of intra-cultural diversity.  In particular, social class, poverty, and gender continue to affect different levels of mental health both within and across cultural groups. (Lopez & Guarnaccia, 2000, p. 575)  In order to be truly inclusive of all the various aspects a culture has to offer, we would have to adopt a multi-layered approach to our cultural studies.  We all wear many hats, and it is a disservice to not examine all of them.  Similarly, it is unfair to assume that those intra-cultural differences affect different cultural populations the same.

Culture is linked to the way emotions, mental distress, social problems, and physical illness are perceived, experienced, and expressed.  Beliefs about what constitutes illness and what can be done about it vary considerably across cultures.  (Bhui & Dinos, 2008, p. 411)  We have established that in some cases a diagnosis has the potential to become a self-fulfilling prophecy.  Even a correct diagnosis may have a negative impact on a specific client.  The cultural connotations associated with a specific diagnosis can play a role in the effect it has on your individual client.  Before we diagnose, need to consider the socio-cultural context of the illness.  For example, a mental health diagnosis may have real implications for a member of the US Armed Forces.

As immigration into the United States continues to accelerate, we must ready ourselves for the influx of clients from the underdeveloped, or the developing world.  Mental health diagnostic constructs and subsequent treatment practices designed in developed countries are often used in the provision of care in the developing world and in care practices for ethnic minorities, asylum seekers, and refugees.  However, there are concerns about the limitations of using mono-cultural outcome measures in these culturally diverse contexts. (Bhui & Dinos, 2008, p. 411)  Our interview process is currently dependant on interviewing and subsequently interpreting the responses from our clients.  Given the complexities of our global community, it is suitably difficult to make underlying cultural assumptions.

In closing, while there are definitive benefits to the standardization of diagnosis techniques, we need to understand and appreciate that those standard one size fits all solutions may not always been the most appropriate way to proceed with accessing the mental state of a culturally diverse client.

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References

Bhui, K., & Dinos, S. (2008, Dec). Health beliefs and culture: Essential considerations for outcome measurement. Disease Management & Health Outcomes, 16(6), 411-419. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=36400847&site=ehost-live

Lopez, S. R., & Guarnaccia, P. J. (2000). Cultural psychopathology: Uncovering the social world of mental illness. Annual Review of Psychology, 51(1), 571-598. Retrieved from http://web.ebscohost.com.ezproxy.bellevue.edu/ehost/pdf?vid=6&hid=113&sid=f275d2f9-b3c8-458b-9968-29981a5cf4c1@sessionmgr114

culture. (2010). In Merriam-Webster Online Dictionary.  Retrieved March 16, 2010, from http://www.merriam-webster.com/dictionary/culture

Matching yourself with a therapist… important or irrelevant?


The word culture can be interpreted broadly.  It can include demographic variables such as age, gender, and place of residence; status variables such as social, educational, and economic background; formal and informal affiliations; and the ethnographic variables of nationality, ethnicity, language, and religion.  (Corey, Schneider-Corey, & Callanan, 2007, p. 115)  Given this broad based definition, it is literally impossible for us to consider every interaction as anything less than multi-cultural.  No single person is capable of sharing all the traits that contribute to our cultural identity, and as a result, any attempt to match ourselves with our clients (or clients to ourselves) is an exercise in futility.  It is impossible to match client and therapist in all areas of potential diversity, which means that all encounters with clients are diverse, at least to some degree.  (Corey et al., 2007, p. 141)  It’s a safe to assume that while you may share commonalities in one specific variable, like age for example, you likely do not share one or more demographic variables that contribute to the definition of culture.

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I would suggest we tread lightly when generalize about any single group in effort to “match” ourselves to our clients… or try to match ourselves to a potential therapist.  In doing so, we not only do injustice to our clients but we do injustice to ourselves and our own personal growth.  In my own personal journey to becoming a counselor, and indeed throughout my life, I am amazed and humbled by the differences among us.  Every time we meet someone, the potential is there to see the world through a new set of eyes.  I aspire to find as many opportunities as I can to walk in another man’s shoes, and to see through her eyes, so that I can understand more fully what it really means to be human.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.