Putting It in Practice 13.4Asian Americans are only the third largest multicultural group represented in mental health services in the United States , yet they hail from the world’s largest continent both in land mass and in population. Asia is diverse in terms of geographic features; it is even more diverse in terms of religion, custom, lifestyle, and ancestry. The major countries comprising South Asia are India, Bangladesh, and Pakistan; those making up Southeast Asia are Burma, Cambodia, Laos, Vietnam, Malaysia, Indonesia, and the Philippines. East Asia’s major countries are China, Japan, North and South Korea, and Taiwan .
The Role of the Family
Again, among Asian peoples, we ?nd stronger, more inclusive family roles than is true in most White cultures. Similar to Hispanic family structure, the father is considered the head of the household and holds the dominant role. In fact, each family member’s role, based on sex, birth order, and marital status, is ?xed and cannot be changed .Individual acts, therefore, re?ect quite directly on the family. Individualism is not viewed positively. Decisions that affect the family should be decided by the family rather than the individual. The family should be strong enough, wise enough, and have enough resources to handle problems encountered by the individual. Failing this task and seeking outside help in the form of counseling brings a shameful loss of face . Therefore, an interviewer conducting a ?rst session with an Asian American client or family must consider the fact that it took a great deal of stress to cause the client to seek help. Consequently, the situation is probably quite serious and must be approached as such.
-Christina Chao, “We Do Not Even Eat Rice the Same” 384 Interviewing Special Populations
Working with a Hispanic Client
Rosa is a 19 year old single female whose family moved from Mexico to Michigan 15 years ago. She has two sisters, ages 16 and 21, and three brothers, ages 14, 17, and 22. She and her family live in a community that is primarily Mexican American and where Catholicism is a signi?cant part of people’s lives. Rosa is living at home while she studies journalism at a local college, where she has consistently been named to the Dean’s list for academic excellence.She came to counseling because she had been feeling depressed over the last two months. She noted that she is not sleeping or eating well, and is “having a hard time just getting through each day.” She stated that it was dif?cult to come to counseling because her family would not approve of her discussing personal things with an outsider, but she came anyway because friends at her college strongly encouraged her.
When asked about her life, she burst into tears. She was thoroughly enjoying college until she noticed that her family was treating her differently. Looking back, she thought it started as soon as she began college, but the novelty of the experience helped her overlook the differences. Rosa said her brothers, especially, were keeping their distance from her and when they spoke to her, they treated her like she wasn’t like them anymore. One time she overheard her older brother accuse her of trying to be better than them. She also noticed that she couldn’t relate as well to her old friends. When they met, they often ran out of things to say after a few awkward minutes. She ?nally said, “It’s just not worth it to me-I’m going to quit college. I just don’t know who I am anymore!” How would you explore the importance of family with Rosa? What else would you need to know about her? Her friends? How would you ask? Would you consider incorporating other helping sources in your work with Rosa? Discuss these with a partner.
Gender Roles
Machismo and marianismo are central notions that tend to dictate interpersonal relationships, especially between the sexes. Machismo denotes masculinity as evidenced in physical prowess, aggression, attractiveness to women, and consumption of large quantities of alcohol, thereby commanding respect from others. This respect has many important dimensions in Hispanic culture. The term respeto refers to respect accorded persons in the culture based on age, social position, sex, and status. A person who shows appropriate respeto is seen as someone who has been well educated or well reared.Marianismo, or traditional Hispanic womanhood, is based on the Catholic worship of the Virgin Mary. It connotes obedience, timidity, sexual abstinence until marriage, emotionality, and gentleness. According to Comas D
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Personalism
Hispanic cultures are known for placing great emphasis on interpersonal relationships and valuing warmth, closeness, and honest self disclosure . These values may dictate the choice of counselor more than credentials per se. As an interviewer, you might be surprised by the level of inquiry and interest in your personal life and tastes, but the intention is not invasiveness, it is simply connection. However, it is advisable to remain more formal initially, to signal the boundaries of the relationship. Using last names and acting with deliberate respect during the ?rst interview can help this process.In addition, this personal orientation ?nds expression in the giving of gifts to the counselor during therapy. Paniagua points out: Therapists working with Hispanic clients need to recognize and acknowledge the conditions under which it is culturally appropriate to accept such gifts and those conditions under which it may be clinically appropriate to reject the gift .
The Role of the Family
Similar to other cultures discussed in this chapter, family is extremely important to Hispanic people and is more broadly de?ned than traditional White American nuclear families. Family members have most likely been consulted before an individual comes for counseling; and in many cases, involving the family directly is helpful. There is a strong emphasis on the family’s needs and the needs of the group over the needs of the individual.However, in contrast to other nondominant cultures in the United States and in contrast to White culture, role ?exibility in the family is not condoned in the Hispanic community. The father is the head of the household and is to be respected as such. The mother is the homemaker and cares for the children. The sense of family obligation, honor, and responsibility runs deep for most traditional Hispanic families .
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The people thus grouped together represent many different countries, cultures, sociopolitical histories, and reasons for being in the United States. Therefore, an important place to begin a clinical interview is to ask about the client’s country of origin.
Proclaiming their nationality is very important to Latinos: it provides a sense of pride and identity that is re?ected in the stories they tell, their music, and their poetry. Longing for their homeland is more pronounced when they are unable to return to their home either because they are here as political exiles, or as illegal aliens, or because they are unable to afford the cost of travel. In therapy, asking the question, “What is your country of origin?” and listening to the client’s stories of immigration helps to engage the therapist and gives the therapist an opportunity to learn about the country the client left behind, the culture, and the reasons for leaving.
Religion and Related Belief Systems
The Catholic Church is very in?uential in many Hispanic cultures. The priest, therefore, is often central in helping solve individual and family problems. Mental health problems are sometimes seen as being caused by evil spirits, and, therefore, the church is the logical place to seek assistance . As a result, mental health professionals may be contacted only after all other avenues in the church and community have been accessed.Sometimes in the Hispanic culture, it is believed that individuals bring on their own mental and/or physical problems by engaging in certain forms of behavior, and that others can be in?icted with such problems by mal de ojo directed at them . Such beliefs are related to a fatalism that some have identi?ed as common to many Hispanic cultures . Fatalism is a belief that a person cannot do much about his or her fate-adversity and good fortune are out of the control of the individual. In counseling, this belief can be counterproductive when the therapist is trying to encourage clients to take control and begin making changes. On the other hand, it can absolve individuals of blame for traumatic life circumstances that are indeed out of their control. It is ill advised to strongly confront Hispanics regard382 Interviewing Special Populationsing their fatalistic or external locus of control orientation. In some cases, encouragement to become or stay involved with the church may help.
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Then he said, “but you being White probably don’t understand.” He continued angrily, “There’s NO WAY you can know what it’s like to be a Black man in a White man’s business!-Hell, in a White man’s WORLD!” Take a few minutes to contemplate this scenario. What stereotypes of Black men might emerge in your mind after this interaction? How would you deal with them? What would you feel? How would you respond to Marvin? One option would be to say something like this, “You’re right, there’s no way I can truly understand what it’s like for you, but I’d like to try. Can you tell me more about being Black in your place of work?” What would a question like this accomplish? What other responses might you try? Putting It in Practice 13.3Hispanic American Cultures . . . it was the American phenomenon of ethnic turnover that was changing the urban core of Paterson, and the human ?ood could not be held back with an accusing ?nger.
“You Cuban?” the man asked my father, pointing a ?nger at his name tag on the navy uniform-even though my father had the fair skin and light brown hair of his northern Spanish family background and our name is as common in Puerto Rico as Johnson is in the United States.
“No,” my father had answered, looking past the ?nger into his adversary’s angry eyes. “I’m Puerto Rican.” “Same shit.” And the door closed.
-Judith Ortiz Cofer, Silent Dancing For the purposes of this chapter, we take our meaning for the term Hispanic from Marin and Marin , who indicate that Hispanic people are “individuals who reside in the United States and who were born in or trace the background of their families to one of the Spanish speaking Latin American nations or Spain” . This term is not perfect, in that some Mexican Americans prefer the term Latino because it does not harken back to the conqueror, Spain . However, Hispanic is the term most commonly used at present, so it is our choice for this section.
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Statistically, African Americans are poorer, have less education, suffer from more unemployment, and have more teen pregnancies as compared to White Americans. Our country has been torn by racial strife, with much of the violence and loss suffered between Whites and African Americans. We mention this because it is good to remember that a little knowledge is a dangerous thing. It is tempting to believe that because we once had an African American friend, roommate, girlfriend, or boss, we somehow know how to work with people of African descent. Such assumptions are hazardous with regard to any person from another culture, but seem especially likely between Whites and African Americans.
An example of an initial interview with an African American client is included in Putting It in Practice 13.3.
Multicultural and Diversity Issues
Working with an African American Client
Marvin was a 36 year old African American male who had been married for years and had two children, ages six and eight. He referred himself for counseling a short time after receiving a substantial promotion at the accounting ?rm where he had worked for the last ?ve years. He indicated a preference for working with an African American counselor; however, he didn’t feel he could wait for the next opening . He, therefore, reluctantly agreed to meet with a white male counselor who was about his age.Marvin appeared uneasy on meeting his counselor. He shook hands, made brief eye contact, and offered a pensive smile. He reported feeling an enormous amount of stress a few months before his promotion. Ful?lling his role as a husband and father was nearly impossible while meeting the demands of his work.
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Dating back to African practices, African American family roles tend to be more egalitarian than those in the White patriarchy, where women’s roles were limited to childbearing and homemaking . African American women are likely to work for the family’s sustenance as well as function in an equal or dominant parenting role.
Couples counseling often occurs because of child focused concerns . Also, African American women have been noted to stay in a dysfunctional relationship because of a reluctance to add further distress to the burdened lives of African American men . This reluctance to take care of themselves out of deference to “their men” can be very frustrating for counselors working with African American women.
Language
For an interviewer unaccustomed to street talk, or Black English, a client using such can be a challenge to understand. However, we do not see this issue as qualitatively different from any other bilingual challenge. Some African Americans speak perfect Standard American English and can switch to nearly indecipherable Black English at will. Some White Americans can do the same. However, it is unlikely that most White counselors easily understand street talk or Black English. You simply need to acknowledge your inability to understand and ask for help. The important 380 Interviewing Special Populationsthing to remember is that it is the interviewer’s language de?cit, not the languagespeaker’s problem. A polite attitude with a bit of a sense of humor goes a long way toward bridging language barriers that might exist. Issues of Assumptions
There are approximately 30.8 million Americans of African descent . They make up the largest non White cultural group in the United States.
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Putting It in Practice 13.2Interviewing individuals, couples, or families of African descent should involve sensitivity to family roles. The family head may be the father, the mother, or older siblings.
In addition, unrelated community members may serve important familial roles. Although a genogram can help with assessment or treatment, African American kinship systems may contain information not openly acknowledged. Hines and Boyd Franklin state, “Illegitimate births, parents’ marital status, incarcerated family members, or deaths due to AIDS, violence, or substance abuse may be
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The Role of the Family
People of African descent place great importance on nuclear family and extended kinship systems. This pattern of family relationship was true in Africa before they were brought to North America and was reinforced by the extreme conditions families faced as slaves. Every family member, no matter how remotely related biologically, is highly valued.Multicultural and Diversity Issues An Initial Interview with an American Indian Client Willard is a 26 year old, single Navajo male who grew up on the Navajo reservation in rural New Mexico. He served four years in the Navy immediately after high school and is now a junior in college majoring in mathematics and education. College administration required Willard to seek counseling after he was arrested for assault during a ?ght in the dorm, and his status in school was contingent on completion of ?ve sessions. The incident report noted that he and two other students became involved in an altercation after one of the other students made inappropriate gestures toward Willard’s girlfriend.
During his ?rst session, it was noted that he was a large, well muscled young man with long hair freely falling around his shoulders. He did not smile upon introduction. However, he did make direct eye contact. He indicated that he was aware of the conditions placed on his continued enrollment, but he was not enthusiastic about participating in counseling.
Working in small groups or dyads, consider how you might proceed with the initial interview with Willard. Begin by creating a list of items that need to be considered given the circumstances of his referral. Which of the items on your list have cultural implications? Next, consider the issues that are relevant to establishing a therapeutic relationship with Willard. How would you begin the interview? Finally, what information would you want to know about Willard that would in?uence your work with him in the future? Do stereotypes or assumptions that you might have about Native Americans in?uence anything on your list? Discuss these with your group.
