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Multicultural Key Strategies Multicultural Skills Training Team
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Creating a Culturally-Sensitive Multicultural Skills Training:
Operationalizing a Treatment, Training, and Research Model
TR1. Viewing Psychotherapy as a Cultural Encounter a. Literature: Generic characteristics of therapy may clash with cultural values of clients. Culture affects who clients and therapists are and the choices each make (Sue et al., 1998). b. Marker: IF the therapist is considering introducing an assessment or intervention strategy, THEN it may be helpful to consider cultural factors before making and explaining choices to the client. c. Consequence: IF the therapist attends to the cultural values and needs of the client, THEN the therapist is more likely to communicate sensitivity, promote the therapeutic alliance, keep the client engaged, acquire valid assessment information, deliver valid treatment. d. Example: “Today I thought we'd try to work on a metaphor to help you let go of painful emotions. You mentioned that your family `aumakua (family god) is the shark. Would this be a useful image for a metaphor?” TR2. Affirming Clients' Uniqueness and Diversity a. Literature: Oppressed clients tend to despise their group and themselves. Helping clients to accept themselves often results in progressive acceptance of therapists (Allport, 1954). b. Marker: IF the client discloses cultural or personal values and communicates uncertainty or shame, THEN it is particularly important for the therapist to affirm the client's uniqueness and diversity through unconditional positive regard. c. Consequences: IF the therapist communicates in-the-moment acceptance of the client, THEN a safe environment for disclosure will be created and the therapeutic alliance will be strengthened. d. Example: “I understand that Pidgin-English is often viewed as a sign of ignorance by some cultural groups, and I support your personal preferences, but I want you to know that I view you as intelligent regardless of what language you choose to use with me.” TR3. Orienting Clients to Psychotherapy a. Literature: “Culturally skilled counselors take responsibility for educating their clients to the processes of psychological intervention such as goals, expectations, legal rights, and the counselor's orientation” (Sue et al., 1998, p. 42). b. Marker: IF a client elects to proceed with therapy and/or raises concerns or questions about therapy, THEN the therapist may spend time orienting the client to the specifics of therapy. c. Consequence: IF the therapist takes the time to properly orient the client to therapy, THEN the therapist is likely to alleviate the client's anxiety about therapy, increase the likelihood of a good fit, and communicate ethical integrity and professionalism. d. Example: “We've agreed that we are going to work together on reducing your aggressive behavior, which I know is not easy. I am committed to doing my very best to help you with that. At the same time, I am legally bound to warn anyone you threaten to harm.” TR4. Creating a Culturally Appropriate Collaborative Alliance a. Literature: Culturally sensitive therapists match their styles/stances to individual clients: warm vs. tepid; passive vs. confrontational; informal vs. formal; self-disclosing vs. enigmatic; collaborative vs. prescriptive, etc. (Lazarus, 1993). b. Marker: IF the client responds in a reciprocal fashion, seems comfortable with open-ended questions, and is more highly acculturated, THEN the therapist may explore a more collaborative approach. c. Consequence: IF the therapist adjusts the degree of collaboration to fit the client's needs and expectations, THEN the therapeutic alliance is likely to be strengthened. d. Example: “I am impressed by your openness and motivation. When we talked about practicing distress tolerance strategies, you mentioned pule (prayer) and hiuwai (cleansing). Can you think of ways to incorporate these concepts into between-session activities?” TR5. Anticipating and Responding to Clients' Internal Dialogue a. Literature: Anticipate resistance, deal with negative affect before proceeding with content. Culturally skilled therapists recover from mistakes with increased rather than diminished rapport (Pederson, 2000). b. Marker: IF the therapist notices verbal or nonverbal cues on the part of the client that may indicate potential problems, THEN the therapist may choose to openly acknowledge such cues (after asking permission) or shift approaches. c. Consequence: IF the therapist effectively attends to the client's internal dialogues, THEN the client is likely to feel understood and validated, thereby opening further lines of communication. d. Example: “Kawika, is it okay if I point out something I just noticed? <affirmative response> When I mentioned your Tutu earlier, you became extra quiet. I know she meant a great deal to you. Was it uncomfortable when I asked about your grandmother?” TR6. Illuminating Differences and Similarities a. Literature: Culturally skilled therapists recognize sources of discomfort with cultural differences (Arredondo et al., 1996). Client-systems matches enhance the probability of favorable change (Sue, Akutsu, & Higashi, 1985). b. Marker: IF comparisons between the therapist and client are being made either implicitly or explicitly, THEN it may be helpful to illuminate differences and similarities to clarify misconceptions. c. Consequences: IF the therapist illuminates actual similarities, THEN the client may feel a sense of affiliation and understanding. IF the therapist illuminates actual differences, THEN the client may have a corrective multicultural experience. d. Example: “You and I have had many candid discussions about your past, and you are making steady progress with your anger management. How has it felt to talk to a female therapist about your aggressive history?”
Copyright © 2004
Winter Hamada.
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