This section describes thirteen multicultural psychotherapy skills that focus on the role of cultural influences and identity development. These skills embrace a broad definition of culture that includes race, ethnicity, gender, sexual orientation, religion, age, class, and physical abilities. These skills are drawn from a wide variety of approaches to multicultural counseling (Ponterotto, Casas, Suzuki, & Alexander, 1995) as well as feminist therapy (Brown & Root, 1990).
Please rate your abilities for each of these multicultural microskills in order to identify current strengths and areas that need more practice and refinement. Please use the following scale to evaluate your skills:
A: I ALREADY use this skill with comfort and success.
B: I'm okay at this skill; I would like to be BETTER.
C: I CAN'T implement this skill very well.
D: I DON'T want to include this skill in my repertoire.
MS1. ______ Clarifying the impact of cultural context and family background on thoughts, feelings, actions, and interpersonal relationships.
People cannot be fully understood by examining only internal processes and identity. A client's current worldview is shaped by past familial and cultural experiences. Both one's own internalized culture and the cultural expectations of the people in one's life affect the interaction with the world. In order to develop the most accurate picture possible of a client's issues and experiences, it is necessary for the psychotherapist to help expand their understanding of the situation to include familial, cultural, and social factors. Cultural context includes race, ethnicity, gender, sexual orientation, class, ability, and age.
MS2. ______ Celebrating diversity in order to help clients accept and express their uniqueness.
There is a great deal of pressure on people to conform to societal standards. A significant number of clients will present for psychotherapy complaining that they're “not normal” or “weird.” Celebrating diversity means reframing a client's unique characteristics as differences to be valued and appreciated rather than as pathological deviations from a societal ideal. By emphasizing that there may be many different but equally adaptive and valid worldviews coexisting within society, the client can free himself or herself of internalized oppression, stigma, and self-criticism.
MS3. ______ Facilitating the awareness and development of cultural identity in order to promote self-acceptance and empowerment.
Some clients will present for psychotherapy having little awareness of how their cultural identity affects their lives. Other clients will present specifically because of culture shock, dissonance between familial culture and mainstream society, or recent personal exposure to discrimination. In any case, the psychotherapist needs to help clients obtain full and accurate awareness of their cultural identity. For those clients who are already aware of their cultural identity, it may be necessary to help reframe and redefine this perception into a positive, accepted, empowered self-image.
MS4. ______ Recognizing how identity development impacts attributions of personal success and failure. These attributions can be either internal (e.g., internalized oppression) or external (e.g., perceptions of pervasive discrimination).
A client's cultural identity can have a strong effect on what he or she believes to be the cause of problems. For example, clients in the earliest stages of racial identity development may see little connection between their race and events in their lives, and may choose internal attributions that ignore societal factors. (e.g., “bad things are happening only because of my personal faults”). In contrast, clients in the immersion-emersion stage of identity development may subscribe to blanket external attributions (e.g., “bad things happen to me because my life is full of racists who are actively out to get me”). Clients at all stages of identity development may need help understanding how some of society's negative stereotypes about different groups may have been internalized or incorporated into self-image.
MS5. ______ Appreciating the interaction between multiple identities including race, ethnicity, gender, sexual orientation, class, ability, and age.
A client's cultural identity never depends solely on a single characteristic. Instead, cultural identity consists of multiple interacting characteristics, the salience of each shifting dramatically in the face of current context and situation. Appreciating the complexity of cultural identity and its interaction with society can help a client understand their life experiences more fully. Clients who are members of more than one oppressed group may face greater barriers than those struggling with only one source of discrimination.
MS6. ______ Highlighting the impact of societal oppression, privilege, status, and power on thoughts, feelings, and actions.
Because culture impacts clients' lives in such constant and pervasive ways, they may not be aware of its direct presence. Clients who come from the majority culture may be unaware that they benefit from many unspoken cultural privileges and may assume that these privileges are available to people of all racial and cultural backgrounds. Clients from minority or marginalized cultural backgrounds are more likely to recognize the inherent differences in privileges and power between different groups but may need help in finding adaptive coping strategies. The psychotherapist needs to make the connection between societal factors and client reactions or responses.
MS7. ______ Creating an egalitarian collaboration within the therapeutic relationship that highlights and subverts societal power dynamics.
Power dynamics are an inevitable part of human interaction, although the visibility of these dynamics can vary widely across cultures and situations. Many psychotherapy clients will have experienced a “one-down” power position by many of the laws, institutions, and expectations of mainstream society. The psychotherapy process can serve as a corrective experience in which the psychotherapist overtly acknowledge the inherent power dynamics of the situation and works collaboratively with the client to minimize these effects. In addition to facilitating rapport and trust in the therapeutic relationship, this subversion of societal power dynamics can help the client translate empowerment into their personal life.
MS8. ______ Exploring societal expectations and supporting informed decisions about which roles to embrace and which to discard.
Although some societal and cultural effects can be obvious and overt (such as blatant racism), many other factors are so faint as to be outside clients' consciousness. Subtle but powerful societal messages about stereotypes, stigma, self-worth, status, expectation, potential, and power pervade mainstream culture. Because of this, many clients internalize societal messages without being aware of it. The psychotherapist needs to help make these internalized message overt, to highlight their origin in society, and work collaboratively with the client to decide how they want to embrace or reject different societal expectations.
MS9. _____ Integrating a client's spiritual awareness or faith development into holistic growth.
Understanding and developing cultural identity means exploring all the salient parts of a client, including their spirituality. Integrating spirituality or faith development into holistic growth requires both a non-judgmental investigation of the client's current beliefs and an understanding of how the client wants their spirituality to play a part in their lives. Clients should be encouraged to be proud of whatever spiritual beliefs or faith they hold and to recognize them as a vital part of their cultural identity.
MS10. ______ Understanding your own worldview and how it impacts your role as a psychotherapist.
All people, including psychotherapists, have a unique worldview based on family, culture, and community experiences. As a result, all psychotherapists will have expectations, assumptions, and blind spots. It will be necessary for the psychotherapist to be on constant watch for how their cultural blind spots may be playing out in psychotherapy. It will also be necessary to investigate how the “culture” of mental health professionals may be playing out in the relationship with the client.
MS11. ______ Presenting options with as little bias as possible.
Because psychotherapists are human beings, they all have culturally-focused assumptions and expectations. However, working in an egalitarian style means that the psychotherapist must empower the client as much as possible, within an appropriate and ethical therapeutic relationship. Clients may need help recapturing personal power and responsibility for choice in their lives. Psychotherapists will need to present possible decisions in such a way that clients are able to choose a course of action without being pressured by the psychotherapist's own expectations and agenda. When a psychotherapist does have a strong preference or bias, they have a responsibility to own the reaction and share it with the client. This warns the client about possible bias in the presentation of the problem and separates the psychotherapist's professional power from his or her personal reactions.
MS12. ______ Illuminating differences between psychotherapist and client identity and how they impact the therapeutic relationship.
Because all people are unique, there will be inevitable differences between psychotherapist and client cultural identities. In some cases, especially when the gap in identities is small or the client's crisis is intense, these differences may have little salience in the therapeutic relationship. At other times, such as when presenting concerns revolve around cultural factors or when the focus of treatment is the client's interpersonal relationships, differences between client and psychotherapist cultural identities may have a strong impact on the psychotherapy experience. Under these circumstances, it will be necessary for the psychotherapist to explore how cultural differences might be affecting the relationship.
MS13. ______ Observing and understanding a client's nonverbal and verbal behavior from a cultural point of view.
Cultural background has a large impact on normative nonverbal and verbal behaviors. Eye contact and physical proximity have different meanings in different cultures. Formality of speech and other verbal behaviors also should be appreciated in light of a client's background. In addition to being aware of the cultural source of different behaviors, it may be helpful to adapt your own nonverbal and verbal behavior to a client's culture-based expectations. For example, if a client comes from a culture in which direct eye contact is seen as a sign of disrespect, it may be important to adjust your own eye contact accordingly.
Identifying Strengths and Areas for Growth
Now that you have had a chance to read descriptions of these thirteen multicultural skills, please complete the Identifying Strengths and Areas for Growth worksheet focusing on multicultural skills.
Written Practice
Next, please write a specific example for each of the multicultural skills described in this section. Here is an example of what a written example might look like for Multicultural Skill 1: Clarifying the impact of cultural context and family background on thoughts, feelings, actions, and interpersonal relationships:
CL: “I just can't get myself to apologize for the way I acted last week. Part of me wants to clear the air but I keep avoiding the situation.”
PS: “When we talked before about the cultural values you learned from your family, you emphasized the role of shame. Do you think you might not want to apologize because it might bring up feelings of shame?”
Role Play Practice
After writing examples of each of these multicultural skills, the next step is to practice them in a role-play. You may want to choose some of the skills that you identified as areas for growth and practice them with a classmate or colleague.
Treatment Planning
You may want to think about a specific client who would benefit from a multicultural approach and identify the skills that you would like to use. A Treatment Planning Worksheet is provided for this purpose.
Reflecting on a Single Session
You may want to identify a session in which you used a multicultural approach and identify the specific skills from the catalog that you used. A worksheet for Reflecting on a Single Session is provided for this purpose.
Copyright © 2001 Jeff E. Brooks-Harris &
Michael F. Gavetti.
Skill-Based Psychotherapy Integration: A Practicum Handbook of
Intermediate Miscroskills.
http://www2.hawaii.edu/~jharris/sbpi.html
Permission is granted to copy these materials for educational
purposes provided this copyright notice remains intact.