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.

Being a multiculturally oriented clinical interviewer involves an orientation toward diversity that is open, af?rming, and appropriately curious. The following information on cultural groups provides barely enough information to whet the appetite and acknowledge basic potential cultural differences among clients. The old adage “The map is not the territory” is especially pertinent here, as these descriptions are meant to simply orient the interviewer. The actual cultural landscape will be unique to the individual and will most likely look quite different from the following map.

THE BIG FOUR In the introduction to Growing up Latino , Ilan Stavans writes: Today, at the center of the con?ict is the Hispanic, the man, woman, or child who speaks Castilian Spanish as his or her mother tongue, or whose ancestors did so. We in the United States often perceive Hispanics as a monolithic or amorphous group. They have divided loyalties, we say, and live between two cultures and two languages. But this is a narrow definition, a ?gment that Americans have created to ?ll our need to make these diverse peoples into a single one that we can then understand.

Multicultural and Diversity Issues 375Stavans was writing about Hispanics, but he could have inserted any of the larger or smaller minority groups in the United States and been equally accurate. Our groupings are huge, with an astonishing amount of diversity within each one. The same can be said for what is often referred to as White culture, or the dominant culture. We would be hard pressed to de?ne White . Would we include Italian Americans? Would we include Jewish Americans? Does the word Anglo communicate more accurately than White? Even if we said “persons of Western European descent,” it would not be clear as to who would be in and who would be out. In what century must the descendence begin to ?t this category? With apologies for these obvious gross generalizations, we make divisions to compare and contrast very broad differences between cultures. For example, we use the word White to refer to the dominant Caucasian culture in the United States. However, we readily acknowledge that our generalities are so broad as to be of limited usefulness. We hope this section stimulates your desire to develop your cultural competency.

The third characteristic of cultural competency is culture speci?c expertise. Culturespeci?c expertise involves the continuous acquisition of information about cultural groups, including sociopolitical dynamics, as well as effective interventions and techniques geared toward speci?c cultural groups. It has been argued that mental health professionals cannot know every nuance of every culture on the face of the earth. Of course, this is true. However, this fact does not excuse cultural ignorance. Learning about the life experiences and belief systems of other humans never ends. Competent mental health professionals seize every opportunity to increase their understanding of the diversity of life around them. Therefore, in some ways, multiculturalism is an attitude or philosophy as much as it is an applied ?eld.

The next section of this chapter contains basic, noncomprehensive coverage of concerns speci?c to groups of people identi?ed by race and/or cultural background. In addition, brief sections addressing persons with different sexual orientations, persons with handicapping conditions, and persons with deep religious convictions are included. An argument could be made for including women, the elderly, and other groups who have experienced oppression or do not ?t the mold of young, White, and male . There are many ways people ?nd themselves grouped together and many ways these groupings affect identity formation, functioning in the world, and quality of life in the dominant culture. As D. W.

Sue et al. state: Each client has multiple cultural identities which most likely do not progress or expand at the same rate. For example, a man may be quite aware of his identity as a Navaho but less aware of himself as a heterosexual or Vietnam veteran. As such, comprehensive multicultural therapy may focus on helping him and others like him become ever more aware of the impact of cultural issues on their being.

Cultural Competence

Self awareness is only the beginning of multicultural awareness and competence. Many variables are included in cultural competence. Speci?cally, three critical characteristics have been identi?ed as essential for cultural competence: scienti?c mindedness, skills in dynamic sizing, and pro?ciency with a particular cultural group .

Scienti?c mindedness requires forming and testing hypotheses, rather than making faulty assumptions and/or conclusions about the status of ethnoculturally different Multicultural and Diversity Issues

Counselor as a Cultural Being

Being aware of yourself as a cultural being has been described as a prerequisite for competent multicultural counseling. In fact, the ?rst multicultural competency discussed by D. W. Sue, Arredondo, and McDavis states, “Culturally skilled examiners have moved from being culturally unaware to being aware and sensitive to their own cultural heritage and to valuing and respecting differences” .

For this activity, you should work with a partner.

A. Describe yourself as a cultural being to your partner. What is your ethnic/cultural heritage? How did you come to know your heritage? How is your heritage manifested in your life today? What parts of your heritage are you especially proud of ? Is there anything about your heritage that you are not proud of ? Why? B. What do you think constitutes a “mentally healthy” individual? Can you think of times when there are exceptions to your understanding of this? C. Has there ever been a time in your life when you experienced racism or discrimination? Describe this experience to your partner. What were your thoughts and feelings related to this experience? D. Can you relate a time when your own thoughts about people who are different from you affected how you treated them? Would you do anything differently now? E. How would you describe the “American culture”? What parts of this culture do you embrace? What parts do you reject? How does your internalization of American culture impact what you think constitutes a “mentally healthy individual”? At the conclusion of the activity, take time to re?ect and possibly make a few journal entries about anything you may have learned about your cultural identity.

The Imperative of Cultural Competence

The 2000 U.S. census indicates steady population growth of cultural and ethnic minorities over the past several decades . Of the 281 million people living in the United States, approximately 80 million identify themselves as other than White, or of Hispanic origin . The census shows that diversity is increasing in nearly every state, making it more likely that mental health professionals in every setting will work with clients of different ethnocultural backgrounds than themselves. This is an exciting and daunting possibility; exciting for the richness that a diverse population extends to our communities, and for the professional and personal growth that accompanies cross cultural interactions; daunting because of the increased responsibility of having to employ culturally relevant approaches in our work. Hall makes a case for the idea of “cultural malpractice” for those who practice with inadequate knowledge of cultural dynamics and warns that without signi?cant changes in the way cultural issues are addressed, psychology will become obsolescent. The imperative is clear, especially in the context of the clinical interview.

To remain a viable helping resource for our whole population, we must have the necessary knowledge and understanding of culture as it impacts mental health.

Interviewer, Know Thyself You say you’re White, that you’re American. Don’t you know that MEANS something? Where I come from, being Black MEANS something!” -Victor; from the movie The Color of Fear Culture can be generally understood as the medium in which all human development takes place. Everything we value, know to be real, and assume to be “normal” is in?uenced by our past and present cultures. From a counseling perspective, answers to overarching questions such as, “What constitutes a healthy personality?” or “What should a person be or become” are largely in?uenced by the counselor’s culture of origin . For these reasons, the best place to begin in our quest to be culturally competent interviewers is with a thorough examination of ourselves as cultural beings. What does it mean to be from the culture we are from? According to D. W. Sue, Arredondo, and McDavis , increasing awareness of your own culture is a precondition for moving from an ethnocentric, culturally encapsulated perspective to a truly multicultural perspective. When we have the ability to un372 Interviewing Special Populationsderstand how our thinking, feeling, and knowing are in?uenced by our culture, we begin to obtain the capacity to understand another’s perspective without imposing our own. D. W. Sue et al. de?nes speci?c parameters for practicing in a culturally competent manner .

-Thomas Merton, A Thomas Merton Reader Many counselors may be continuing to suffer from cultural encapsulation and the selfreference criterion in their counseling practice.

-Paul Pedersen, Counseling across Cultures Counseling has been used as an instrument of oppression as it has been designed to transmit a certain set of individualistic cultural values. Traditional counseling has harmed minorities and women. Counseling and therapy have been the handmaiden of the status quo.

-Derald Wing Sue

We live in a multicultural society and, consequently, no matter what our own ethnocultural background may be, we occasionally work professionally with people who are much different from ourselves. This fact makes it crucial for us to broaden our perspectives and increase our cultural sensitivity. After reading this chapter, you will know:

• About the imperative of cultural competence and the importance of understanding your cultural biases and cultural self.

• Basic issues in interviewing clients with American Indian, African American,

Hispanic American, and Asian American ethnocultural backgrounds.

• Basic issues to address when interviewing gay, lesbian, transgendered, disabled, or religiously committed clients.

• The importance of context to understanding client ethnocultural orientation,

family environment, community environment, communication style, and language usage.

• Different culture bound syndromes and matters of etiquette to consider when

interviewing minority clients.

CHAPTER OBJECTIVESRELATIONSHIP IN THE CONTEXT OF DIVERSITY Throughout this text, we emphasize the importance of the therapeutic relationship. We believe that relationship is foundational to everything mental health professionals do- including clinical interviewing. Many mental health professionals emphasize the centrality of a therapeutic relationship in doing effective multicultural counseling . But what are essential components of such a relationship? What are helpful but optional components? Toward what should we be striving, as we become more multiculturally sensitive interviewers? How can we avoid cultural arrogance, the self referencing syndrome, and counseling as oppression when working with diverse clients? This chapter provides food for thought and pieces of the puzzle, but obtaining the answers to these profound questions is a life long endeavor.

In case we have not made our biases and values clear, consider this: Even with respect to diagnosis and treatment planning, mental health work is about human relationships. If, in the process of diagnosing or formulating, planning, and goal setting, we lose contact with our clients as unique human beings, we risk missing their real needs and causing damage. If, in this same process, we lose contact with ourselves as unique, complex human beings as well as professionals, we diminish our work and the potential of our profession.

300 Structuring and AssessmentDiagnosis and Treatment Planning Cultural Issues in Treatment Planning: A Case Example Often, client cultural issues take center stage in treatment planning. The following very brief example is adapted and summarized from “The Case of Dolores” .

Dolores, a 43 year old American Indian woman, came to counseling because she was suffering from sadness, inability to concentrate, insomnia, and anhedonia. These depressive symptoms were associated with two major concerns. First, Dolores was very upset because her husband of 23 years, Gabe, was suffering from a serious gambling addiction but was refusing to go to treatment. Second, Dolores was worried that, because of her diminished functioning and her husband’s gambling, she might lose custody of her adopted daughter, Sage.

Even with the minimal information provided in this example, several cultural issues rise to the fore. Speci?cally, because Dolores’s major concerns center around family issues, it is important to explore the onset and duration of her concerns in the context of familism-as Dolores’s symptoms might be more directly associated with her family identity than with her “self.” Additionally, it could be that the decision to come to counseling was producing nearly as much stress as her family situation because some American Indian tribes consider it disloyal to say negative things about other family members. Consequently, Dolores’s feelings about counseling and what it says about her Indian identity may be a major focus of treatment-especially if she is seeing a counselor from the dominant culture.

In this case, it was obvious after conducting a thorough interview that the client was behaving in an unusual and disturbing manner. His behavior was rationally unjusti?able , statistically infrequent , disturbing , and maladaptive .

Now we are left with a ?nal question regarding the justi?ability of the man’s behavior. Namely, is his behavior culturally justi?ed or sanctioned? Think about this standard. Can you think of any cultural situations that might adequately justify this man’s rather controlling behaviors? We take up the issue of judging mental disorders in their cultural context to a greater extent in Individual and Cultural Highlight 6.2 and Chapter 13.

An Overview of the Interview Process Exploring Society’s Contributions to Client Problems That client problems must be viewed in their social and cultural context is an unarguable fact. Articulating this point for families in particular, Goldenberg and Goldenberg describe the discoveries made by renowned family therapist Salvador Minuchin .

As Minuchin and his coworkers began to accumulate research and clinical data and to rede?ne the problem in family terms, successful interventions involving the entire family became possible. Later research expanded to include asthmatic children with severe, recurrent attacks as well as anorectic children; the additional data con?rmed for Minuchin that the locus of pathology was in the context of the family and not simply in the af?icted individual .

Minuchin argued the importance of seeing individual client symptoms from the family systems perspective. In contrast, the DSM IV TR, although including a section on cultural issues with each major diagnostic category, continues to de?ne mental disorders as residing exclusively in the individual .

But when I see a fat lady eat, I move down a couple of rungs on the ladder of human understanding. I want to tear the food away. To push her face into the ice cream.

“Stop stuf?ng yourself! Haven’t you had enough, for Chrissakes?” I’d like to wire her jaws shut! Poor Betty-thank God, thank God-knew none of this as she innocently continued her course toward my chair, slowly lowered her body, arranged her folds and, with her feet not quite reaching the ?oor, looked up at me expectantly.

Your client’s cultural background may trigger inappropriate countertransference reactions. These reactions may range from traditional discrimination to guilt and pity to competition .

There are many examples of cultural countertransference in the research literature. For example, a recent study showed that hospital staff in the United Kingdom are more likely to restrain patients from other races than they are to restrain patients from their own race . Similarly, mental health professionals from the United States have been found to overdiagnose psychotic disorders in patients of African American descent .

As you read this section, you may ?nd yourself wondering: “What’s the difference between countertransference and racism?” That’s an excellent question.

What do you think the differences might be? INDIVIDUAL AND CULTURAL HIGHLIGHT 5.1our early environment. These internalizations serve as the basis for how we feel about ourselves and how we interact with others . If we internalize “bad objects” , we may experience disturbing self perceptions and interpersonal relationships. Psychotherapy involves a relationship that can replace maladaptive or bad internalizations with more adaptive or good internalizations, derived from a relatively healthy psychotherapist. Strupp states: “[I have] stressed the importance of the patient’s identi?cation with the therapist, which occurs in all forms of psychotherapy. Since the internalization of