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Religious and Spiritual Matters

Do accept the client’s beliefs regarding the sources of distress: ancestral disapproval, the evil eye, God’s wrath, or trouble because of misbehavior in another life. A strong relationship of trust must be established before one can determine the adaptive and maladaptive aspects of such beliefs and thereby work within the frame toward healing or growth.

Don’t assume you are being told the whole story regarding faith or belief systems early on.

Most are powerful and quite private and will not be easily or fully shared.

Do take advantage of any possible link to meaningful spiritual or religious beliefs or connections that may help address the current distress.

Don’t hesitate to allow input into the problem from religious or spiritual persons respected by the client.CULTURE BOUND SYNDROMES Because theories of human functioning are culture bound, our current diagnostic system for mental health problems is heavily culturally in?uenced . In addition, the manifestation of mental angst and distress occurs through different culturally speci?c symptom complexes that change over time. For example, in contrast to Freud’s era , not many women in the United States currently have vapors or fainting spells; however, eating disorders were almost unheard of a hundred years ago. Posttraumatic stress symptoms re?ect at least some common human responses to trauma across cultures, but the name of the disorder has varied over many centuries. In addition, to some extent, what is actually considered traumatic is culturally speci?c, and what to do in the face of trauma constitutes culturally informed advice.

Open Inquiry

Do ask about tribal, ethnic, or background differences that are obvious or are made obvious by information provided by the client.

Don’t insist on a more thorough exploration of these differences than is offered.

Do realize that acculturation and cultural identity are ?uid and developmental.

Don’t assume all members of a given family group or couple have the same levels of cultural identity or the same experiences interfacing with the dominant culture.

Family

Do recognize that for many or most nondominant cultures in the United States, the role of family is central. The concept of family is often broader, more inclusive, and more de?nitive in a given individual’s sense of identity. Therefore, be attuned to matters of family with heightened awareness and sensitivity.

Don’t impose either your own de?nition of family or the de?nition of family you’ve read about with regard to the client’s culture. Simply be open to the client’s sense of family.

Do graciously allow family members to attend some part of an initial interview if they so request.

Don’t de?ne family strictly along biological lines.

Communication Styles

Do remember that patterns of eye contact, direct verbalization of problem areas, storytelling, and note taking all have culturally determined norms that vary widely.

Don’t assume a chatty or overly familiar style, even if that is your predominant style. Strive to demonstrate respect.

Do ask for clari?cation if something is not clear.

Don’t ask for clari?cation in a manner that suggests your lack of clarity is the client’s problem.

Although many attempts have been made to address cultural bias in assessment instruments, such biases still exist .

Unfortunately, although culture speci?c or culturally fair testing procedures are sometimes available, such approaches limit valuable information available to the interviewer. Culture speci?c assessment limits the person’s experience to membership of a particular group, thus missing the uniqueness of the individual; culturally fair assessment instruments tend to wash out the cultural in?uences, thus neglecting the impact culture has on a person’s life . While speci?c information regarding instrumentation is beyond the scope of this article, an interviewer working with a culturally different client should consider the following general questions: Are there other, less culturally bound options to obtain the necessary information? Are there ways to accommodate or ameliorate the cultural differences? Will the use of this assessment procedure help me to understand the individual’s experience as a unique cultural being? Additional guidelines for interviewing culturally different clients are provided in Table 13.1.

Multicultural and Diversity Issues 395396 Interviewing Special Populations Table 13.1. The Dos and Don’ts of Initial Sessions with Multicultural Clients The following are suggestions for interviewers working with clients who come from cultural, racial, ethnic, religious, or life experience backgrounds different from themselves. The applicability and relevance of each suggestion must be evaluated with the particular clinical situation at hand. Our intention is to provide a thought provoking checklist.

How do language differences affect the ability of the interviewer to communicate with the client? Ask: “What language would you prefer to use in counseling? Are you able to understand my ?” Or, if you cannot speak any other languages, ask: “How comfortable are you with my English?” INTERVIEWING CONTEXT AND PROCEDURES Thus far, we have discussed counselor awareness of himself or herself as a cultural being, and the importance of knowing the cultural characteristics of the client-whether those are attributable to group, universal, or individual in?uences. We have also covered the importance of broad contextual elements as they interact with the individual as a unique ethnocultural being. What has been left out until now is how the actual interviewing context and procedures might impact the interviewing process.

For many people raised in many cultures, consulting with a mental health professional comes as a last resort. Seeing an outsider for personal problems goes against traditional problem solving strategies. This means that clients from another culture may experience an enormous amount of stress or anxiety because of the counseling process-in addition to the stress that brought them in. Moreover, they have expectations for counseling that may or may not match the abilities or styles of the interviewer.

Therefore, extra care should be taken to ensure that clients feel welcome, to establish credibility, and to build trust . At the very least, the counselor must ensure that clients feel and believe their interests are being served without threatening their worldview.

Using standardized assessment instruments may produce anxiety, confusion, or anger in ethnoculturally different clients. For all the reasons described, standardized assessment procedures may be inappropriate for the ethnoculturally different client. In the past, testing procedures used to aid in diagnosis and treatment have been misused.

Successful adaptation to a context is greatly enhanced when an individual is reasonably sure that the messages he or she sends and gets are received and interpreted in the way they were intended.

Another component of communication style involves how a person handles misunderstandings. A person willing to ask for clari?cation is less likely to experience communication breakdowns than one who is not. However, some people might feel it is disrespectful to ask, or may feel ashamed or embarrassed for not understanding. For these reasons, the interviewer might consider observing for the following issues: What are the person’s sensitivities to nonverbal cues ? How does the client use his or her voice? What are the intonations, in?exions, voice level, and rate of speech? How are the client’s verbal tracking skills? Will the client ask for clari?cation if he or she doesn’t understand something? Are there any attitudes associated with asking for clari?cation ? The ?nal domain of cultural context involves language usage. It differs from communication style primarily because it is concerned with the content of what was spoken, rather than the qualitative style. Language usage is the “what,” whereas communication style is the “how.” According to Castillo and associates , language is associated with cultural, social, and cognitive variables. Not only does it involve the ability to communicate, but also it affects perceptions of others about the language user. For example, people can be either positively or negatively evaluated according to which language they speak . People are also positively or negatively evaluated based on how well they speak their newly acquired language. Additionally, Swartz Kulstad and Martin report that potential for ethnocultural con?ict increases whenever people entering a new environment are not able to understand the language. A person’s ability to communicate effectively is a good predictor of ability to successfully adapt to a given environment. Therefore, it is extremely important to understand not only the language that a person speaks in any given context, but also the level of pro?ciency and comprehension. Here are some questions for the interviewer to consider: What is the client’s preferred language? What is the language pro?ciency? Ask: “What languages do you speak? Which do you prefer to use at home, at 394 Interviewing Special Populationswork/school, or with friends?” Keep in mind that direct questioning may not be the best way to evaluate language pro?ciency.

Where is the client’s community? How many people of similar ethnocultural backgrounds live there? How does this community compare with the former community ? If the client is an immigrant, what were the conditions of his or her arrival? Is he or she in the United States legally? Ask: “How would you describe your community? How is it similar or different from your home community? How did you come to this country?” How are the client or the client’s parents employed? What is their socioeconomic status ? Ask: “What do you do for a living? How are you and your family doing ?nancially?” What parts of the community does the client perceive to be supportive? Is he or she a member of a spiritual community and, if so, what is the level of involvement? How does he or she view institutions such as government, schools, and so on? Ask: “Where do you go, or whom do you see when you need help with something? How important is spirituality to you? Do you practice any particular faith? How often do you visit with your children’s teachers? Are you comfortable visiting with your children’s teachers? How do you feel when you see a police of?cer?” Multicultural and Diversity Issues 3934. Are there any observable signs of racism, discrimination, or prejudice in his or her community? Does the client feel welcome or valued in the community? Ask: “Have you experienced prejudice or any racist behaviors in your community? What would you like me to know about these incidents?” The fourth domain of culture and context is communication style. It includes the extent to which a person is able to send and receive accurate information as he or she interacts with his or her environment. Certainly, a great potential for dif?culty exists in this domain because interpretation of verbal and nonverbal information is so dependent on cultural background. For example, direct eye contact can be interpreted as hostile and disrespectful behavior from the perspective of some cultures, while avoiding direct eye contact can be interpreted as resistant or disrespectful in others. In the same way, inability to adequately express yourself verbally to another presents dif?culties.

If they exist, what importance does the client place on meeting family expectations? Ask: “How would you describe the kind of life your family wants for you? What kind of life do you want for your own children? Have you ever done something that disappointed your parents? Would you tell me about it? Have you ever argued with your parents? What happened? What happens when your children argue with you?” What are the discrepancies between family expectations and those of the other systems the client interacts with? Ask: “I’m wondering if you ever feel as if you have to act differently at work than you do at home or with your neighborhood friends. What happens when you act as you do at work when you’re home?” Community environment is the third domain of culture and context. This domain involves structural aspects of the community where the client currently lives . For those who have recently immigrated, it also involves comparisons with former community environments and conditions under which migration occurred . For example, Sandhu, Portes, and McPhee reported less stress involved with voluntary migration as opposed to those who were forced to migrate, whereas involuntary minorities may view engagement with the dominant community as a threat to their identity, and thus resist accessing supportive structures .

The sociopolitical climate must also be considered in assessment of community environment. There is always the possibility that racism , bias, and discrimination contribute to community related stress.

Here are some things to listen for and ask about as you gauge your client’s community environment.

The second domain identi?ed by Swartz Kulstad and Martin is family environment. Because the family is a signi?cant mechanism through which culture is transmitted, and because it is also the primary source of support for most individuals, gaining information about family dynamics is crucial. We know Russian immigrants who came to the United States during World War II who forbade their children to speak anything but English. They gave their children popular English names and pushed them full speed into the culture. We know Laotian refugees determined that their children have the best of both: to excel at all things American and yet retain all things Laotian. We also know Iranian families in deep con?ict because their children have rejected their original cultural values. In all these cases, there is variance in the degree of dependence on the family or adherence to family expectations concerning family roles and hierarchies, communication styles, individuation, and maintenance of culture. In a sense, the family can become a source of great support for an individual, while at the same time, be a cause of great stress as that individual seeks to reconcile family environmental expectations with other systems in which he or she interacts .

Listening to your client along the family dimension might involve covering the following: What is the nature of the overall family environment? Is there a strong nuclear and/or extended family? What is the proximity to, or availability of, family sup392 Interviewing Special Populationsport? What is the level of dependence on the family for support? Ask: “Tell me about your family. How did you grow up? What kinds of things did your parents do? How often does your whole family get together? What happens when all the grandparents and aunts and uncles get together?” Listen for subtle or overt expectations for conformity to family beliefs and values.

Because it is a ?uid, value laden, and con?icted process for many people, directly asking about ethnocultural orientation is not generally advisable. There are many formal instruments to measure acculturation ; and should this issue be central, it can be gradually addressed directly.

However, in the initial interview, it is best to simply explore how strong the connections to the various cultures are and what emotions are attached to those connections.

Multicultural and Diversity Issues 391An informal assessment of ethnocultural orientation can be obtained by listening as information emerges during the session or by asking for speci?c information. For example: Listen for the sense of connection to the culture historically. Ask: “Did you grow up on the reservation ?” or “I know everyone’s different, so I’m wondering for you personally, do you feel much connection with your culture?” Listen for the relationship between the client and other members of the culture.

Does the client go to cultural events? Are original cultural practices a regular part of life? Does he or she speak the original language? Ask: “What kinds of things do you celebrate?” or “Do you attend very often?” and “What language do you prefer to speak at home? with friends? at work?” Listen for methods or style of coping with environmental demands Ask: “Is there anything about your work that challenges you? How do you handle the challenges?” Listen for how the person envisions life in the future. Will he or she play a role in traditional cultural ceremonies or practices? Will he or she seek a bicultural stance in life? Ask: “What things about your culture do you appreciate or not appreciate? What things about the Western culture do you appreciate, or not appreciate? How would you like your life to be in the future in terms of your culture?” The client’s cultural orientation to the past, present, and future can be very informative with regard to engagement with the dominant culture . The more culturally oriented and embedded the client is, the more important it is for the professional to seek appropriate cultural input and education to be of assistance in a culturally sensitive manner.

To address this need, Swartz Kulstad and Martin identi?ed ?ve primary domains of culture and context. Taken together, the ?ve domains provide a nice structure for building a better understanding of client issues .

Ethnocultural orientation is the ?rst domain of culture and context . Ethnocultural orientation is a multidimensional domain that includes gauging the extent to which a person af?liates with his or her culture of origin and the dominant culture. This concept has also been referred to as acculturation . People born in another country who reside in the United States for more than a visit are no doubt challenged with trying to reconcile their beliefs, values, and understanding of social norms with what is required in their new home. A few words of the language creep in. The availability of familiar homeland foods is limited.

The entertainment re?ects and teaches the dominant culture. Obedience to the laws, education for the children, employment, housing-all require an active connection to, and understanding of, the dominant culture.

Even with the decision to engage the dominant culture, some individuals experience great stress when traditional ways of dealing with life situations do not yield predictable results. Integration requires fundamental shifts in a person’s identity and behavior, thus threatening a sense of continuity and equilibrium. However, according to SwartzKulstad and Martin , people who successfully adapt at the psychosocial level and exhibit positive mental health in a dominant culture are able to act within the expected standards of the dominant society while maintaining a clear sense of their beliefs and values. At the same time, they are able to maintain salient aspects of their culture of origin in such a way that they do not lose traditional psychosocial support systems. In other words, adaptation to the dominant culture does not require abandonment of the culture of origin, but rather ?exibility in being able to employ positive aspects of both cultures in the process of adapting to a new environment.