Capella Unit 7 Looking Into the Clinician Mirror Article Personal Reflection

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Capella Unit 7 Looking Into the Clinician Mirror Article Personal Reflection

side, write the acronym ADDRESSING vertically, leaving space to the right of and below each letter. Next, record a brief description of the influences you consider salient for yourself in each category. If current influences are different from those that influenced you growing up, note the salient influences and identities in relation first to your upbringing, and then to your current contexts. Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment Also, fill in every category, even those for which you hold a dominant cultural identity, because this too is meaningful information. These categories are not mutually exclusive, so there may be some overlap between them. For example, if you are an American Indian, you may note this under ethnicity and/or under Indigenous heritage, depending on how you identify. Similarly, Jewish heritage might be noted under ethnicity and/or religion and spiritual orientation. Table 3.1 illustrates this process using the therapist, Olivia, as an example. Under age and generational influences, Olivia wrote, “52 years old; third-generation U.S. American; member of politically active generation of Chicanos and Chicanas in California; first generation affected by post-civil rights academic and employment opportunities in the TABLE 3.1 The Therapist’s Cultural Self-Assessment: Example of Olivia Cultural influences Olivia’s self-assessment *Age and generational influences 52 years old; third-generation U.S. American; member of politically active generation of Chicanos and Chicanas in California; first generation affected by post-civil rights academic and employment opportunities in the 1970s. No developmental disability. Chronic knee problems since early adulthood, including multiple surgeries; sometimes I use crutches to walk. Mother is a practicing Catholic, father nonpracticing Presbyterian; my current beliefs are a mixture of Catholic and secular; I do not attend mass. Mother and father both of mixed Mexican (Spanish and Indian) heritage, both born in the United States; my own identity is Chicana; I speak Spanish, but my primary language is English. Parents urban, working, lower-middle-class members of an ethnic minority culture; however, my identity is as a university-educated Chicana; I identify with workingclass people, although my occupation and income are middle class. Heterosexual; I have one friend who is lesbian. My maternal grandmother was Indian and immigrated to the United States from Mexico with my grandfather when they were young adults; what I know about this part of my heritage came from her, but she died when I was 10 years old. United States, but deep understanding of the immigration experience from my grandparents. Woman, Chicana, divorced, mother of two children. *Developmental disability Disability acquired later in life *Religion and spiritual orientation Ethnic and racial identity *Socioeconomic status *Sexual orientation Indigenous heritage *National origin Gender Note. *Connotes dominant cultural identity. 43 Copyright American Psychological Association. Not for further distribution. 44 S E L F – A S S E S S M E N T 1970s.” On the line for disabilities, she wrote, “Chronic knee problems since early adulthood, including multiple surgeries; sometimes I use crutches to walk.” She continued through the list, with some overlap between categories, providing a general sketch of both minority and dominant cultural influences and identities salient for her. The degree to which this exercise is helpful depends on how far one takes the exploration of these influences and identities. For instance, in the first area, age and generational influences, simply recognizing your age is not particularly informative. However, exploring the generational influences—including historical and sociocultural contexts related to your age and particular developmental phases—offers a rich source of material regarding the meanings of these influences and identities (Rogler, 2002). The following general questions can help to elicit the meanings of age and generational influences in your self-evaluation: i When I was born, what were the social expectations for a person of my identity? i When I was a teenager, what were the norms, values, and gender roles supported within my family, by my peers, in my culture, and in the dominant culture? i How was my view of the world shaped by the social movements of my teenage years? i When I was a young adult, what educational and occupational opportunities were available to me? And now? i What generational roles make up my core identity (e.g., auntie, father, adult child, grandparent)? The specific details of these questions are shaped by your particular identity, experiences, and contexts. Returning to the example of Olivia, her specific questions were the following: i When I was born (1955), what were the social expectations for a Chicana growing up in California? i When I was a teenager (late 1960s-early 1970s), what were the norms, values, and gender roles supported within my family, by my peers, in Chicana culture, and in the dominant culture? i How was my view of the world shaped by the social movements of my teenage years (e.g., protests by Chicano farm workers, the Civil Rights movement, the Women’s Liberation movement, and the Vietnam War)? i When I was a young adult (1970s), what were the educational and occupational opportunities available to me? i Currently, how has the growing population and solidarity of Latinos in the United States, plus the anti-immigrant backlash (since 2000), affected my identity and opportunities? Cultural Self-Assessment Copyright American Psychological Association. Not for further distribution. The initial part of this work is individual, but the development of questions aimed at exploring the meaning of diverse influences can be facilitated by participation in a group aimed at increasing self-awareness (see Aponte, 1994, regarding the importance of groups in cross-cultural training). With large groups, I find it most helpful to divide into triads. Individuals in these smaller groups can help you explore the questions, and returning to the large group provides opportunities to share insights and obtain feedback from a broader range of perspectives. How Privilege and Culture Affect Your Work In the ongoing process of cultural self-assessment, an understanding of the role of privilege in relation to one’s own identity and opportunities is essential. The next exercise can help you recognize the ways in which privilege affects you. The focus is on privilege (rather than oppression) because I have found that therapists’ areas of privilege are usually the areas they are less knowledgeable about and less aware of. In contrast, people are usually very aware of the areas in which they feel oppressed, because they have spent more time thinking about their experiences of oppression. So, for this next step, return to your ADDRESSING outline. Look back over each category and next to the areas in which you hold a dominant cultural identity, put a little star (*). (Look again at Table 3.1 to see the stars next to Olivia’s dominant cultural influences.) For example, if you are between 30 and 60 years of age, put a star next to *age and generational influences. If you do not have a disability (i.e., if you are a member of the nondisabled majority), put a star next to *developmental disabilities or *disabilities acquired later in life. If you grew up in a secular or Christian home, put a star next to *religion and spiritual orientation. Continue on down the list, starring *ethnic and racial identity if you are of European American heritage, *socioeconomic status if you were brought up in a middle- or upper-class family or are currently of middle- or upper-class status, *sexual orientation if you are heterosexual, *Indigenous heritage if you have no Indigenous heritage, *national origin if you live in the country in which you were born and grew up, and *gender if you are male. Now look at your ADDRESSING self-description with attention to the stars. Every individual has a different constellation. However, because a majority of therapists in North America hold membership in dominant ethnic, educational, and socioeconomic groups (e.g., only 8% of mental health providers are of ethnic minority identities; Puryear Keita, 2006), 45 Copyright American Psychological Association. Not for further distribution. 46 SELF-ASSESSMENT when I do this exercise in the United States, people are often surprised by how many stars—that is, how much privilege—they have. This is true even for therapists who hold a minority identity in one area but are privileged in others (e.g., generational status, educational level, socioeconomic status, sexual orientation, or physical abilities). As you may notice, this task of recognizing the areas in which we hold privilege is not a simple one. Privilege can change over time—for example, for a person who grew up in poverty but now lives a middleclass lifestyle. Privilege also varies depending on context. For example, a middle-class older Chinese man living in British Columbia may experience little privilege in relation to the dominant Anglo majority. However, within the Chinese Canadian community in Vancouver, the same man’s age, gender, and socioeconomic standing may give him significant privilege. In fact, he may be seen as quite powerful in his particular community. Perceiving one’s own privileges can be as difficult as seeing one’s own assumptions. As Akamatsu (1998) noted, the underlying duality—the coexistence of one’s own privileged and targeted positions—is not easy to apprehend emotionally. It requires a more complex view of identity, in which contradictory experiences of advantage and disadvantage form ragged layers. This demands a particular sort of “both-and” holding that relies on the ability to “contain opposites.” (p. 138) Values As systems of privilege work to maintain the status quo, they also reinforce the values of powerful groups. Because the field of psychology is a privileged profession, its values are often synonymous with those of the dominant culture (Moghaddam, 1990). Many therapists, although recognizing that biases occur in the larger culture, fail to see the biases in their own theoretical orientations and believe that their particular approaches are relatively value-free (Kantrowitz & Ballou, 1992). These therapists are vulnerable to making assumptions without being aware that they are doing so. On the other end of the continuum are therapists who believe that their political and social values are “the healing elements of their therapies”; problems arise when these therapists believe that their views concerning social roles and personal morality are the “therapeutically correct standards for healthy functioning” (Aponte, 1994, p. 170). Not surprisingly, there is evidence that clinicians’ personal beliefs and lifestyles are reflected in their values concerning therapy. In one study (Jensen & Bergin, 1988), religiously oriented therapists rated religious values as more important in mental health than did less religious therapists. Practitioners in their first marriage valued marriage more Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment highly. Psychiatrists and older therapists “valued self-maintenance and physical fitness more than did nonphysicians and younger professionals,” and psychodynamically oriented practitioners believed that “selfawareness and growth values were more salient to mental health and psychotherapy than did behavior therapists” (Bergin, Payne, & Richards, 1996, p. 306). Because the psychotherapy field is so dominated by European American practitioners, European American values are often simply not perceived. Take the example of individualism. A random sample of 229 psychologists (96% were non-Hispanic White) clearly endorsed individualistic values over others (Powers, Tredinnick, & Applegate, 1997, p. 214). This emphasis contrasts sharply with the greater weight given to interdependence, group cohesion, and harmonic relationships in other cultures (S. C. Kim, 1985; Matheson, 1986). Furthermore, individualistic values influence the concepts used to measure success in therapy—for example, “self-awareness, ^/-fulfillment, and .se//-discovery” (italics added; Pedersen, 1987, p. 18). Although family systems theories offer a potential solution to this individual focus, they, too, suffer from European American biases. For example, the value placed on the individuation of family members may lead a therapist to diagnose an East Indian family as “enmeshed” despite the normality of their behavior within an Indian context (see Rastogi & Wampler, 1998). Self-disclosure and emotional expressiveness are similarly valued by the field and often seen as central for progress in therapy. However, many clients are cautious about sharing personal information. Among Asian Americans, such reserve may be viewed as a culturally appropriate sign of maturity and self-control rather than as pathological resistance (S. C. Kim, 1985). For Arab and Muslim people, a reluctance to self-disclose may reflect values that emphasize the importance of family over the individual and a desire to protect the family’s reputation (Abudabbeh & Hays, 2006; Ali, Liu, & Humedian, 2004). Similarly, among Orthodox Jewish people, avoidance of self-disclosure may represent a culturally appropriate attempt to avoid speaking poorly of one’s family (Paradis, Cukor, & Friedman, 2006). And the reluctance of gay and lesbian elders to openly identify as such is often related to social contexts that required (and still require) caution for safety reasons (Baron & Cramer, 2000). Although behavioral change is often the goal of psychotherapy, clients of minority cultures and religions (and even some clients of dominant groups) may be more interested in obtaining emotional support or developing patience. Helping clients with the process of letting go of the need to control events is not a process of passivity, resignation, dependency on authoritarian direction, or obedience to some guru. It is rather a turning loose of the uncontrollable and the unnecessary, a positive spiritual realignment of one’s life and a joining of one’s 47 48 SELF-ASSESSMENT Copyright American Psychological Association. Not for further distribution. resources with healing and life-enhancing processes of reality. (E.W.Kelly, 1995, p. 221) To engage therapists with the exploration of personal values in a group context, I ask members of the triads to first answer the question, “What do you value?” Common answers for therapists are hard work, education, family relationships, community, honesty, and a spiritual orientation to life. You may share some of these values but also hold others that are related to your particular cultural identity, family, and experiences. I remember asking the question of one triad that coincidentally consisted of three women of Scandinavian backgrounds. They laughingly said that they were all taught, “Work hard, save your money, and don’t enjoy it!” Although humorous, they went on to talk about how this message affected their lives in the form of a certain seriousness and stoicism that was helpful to them in some situations but unhelpful in others. A second question for consideration is, “How does a particular value affect your work with clients who may not share this value?” Note the difference between clinically necessary judgments and judgmentalism; whereas the former facilitates the therapeutic relationship, the latter works against it. The challenge in this question is for one to begin to see value differences less judgmentally and more with an attitude of interest in understanding oneself and others. For instance, the value that many therapists place on hard work (in school and employment) may not be rewarded in the culture of a client who comes from an extremely harsh environment in which there are few jobs, low pay, and no opportunities for advancement (Aponte, 1994; Boyd-Franklin, 1989). The person who works hard in such a situation may even be seen as identifying with the dominant culture and be punished for trying to separate him- or herself from the minority group. Often, what appears to be a value conflict between a therapist and client is instead related to differences in the degree to which something is valued. For example, in working with families, therapists may need to consider the extent to which family cohesion is valued over individual desires and goals (and vice versa). Both are important in most families; the differences are primarily in the degree to which one is valued over the other. Recognizing the shared aspect of these values (i.e., the middle ground) can help therapists and clients of different belief systems work together more effectively. In addition, thinking about one’s own possible negative assumptions regarding differences can help. Returning to the example of the East Indian family, the therapist might think to herself: “I value independence and egalitarian interactions, but this family does not. This family is enmeshed, authoritarian, and patriarchal.” Such a black-and-white conceptualization focuses on differences as negative. It also ignores the possibility that the family does value independence and equality but that other values have a higher priority or that Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment value priorities vary depending on the situation. A more open-minded and accurate reframe would be, “I value independence over interdependence, and I place a higher priority on egalitarian interactions than on respect for authority in most situations. This family places a higher value on respect for the wisdom and decisions of elders. They place a high value on interdependence, family cohesion, and the preservation of cultural and religious traditions.” Note the positive connotation of the terms in the latter description. (See Tewari, Inman, & Sandhu, 2003, regarding values in South Asian families.) The following are a few more examples of judgmental statements with their positive reframes: Judgmental: I am open. She is closed. Positive: I am more open regarding feelings and personal information. She is more reserved. Judgmental: I work hard. He is lazy. Positive: I place a high priority on my work. He places a high priority on enjoying and appreciating life. Judgmental: I value free choice. She is resigned to fate. Positive: I value free choice. She places a higher priority on patience and acceptance. Judgmental: I value change. He is resistant. Positive: I place a high priority on behavioral change. He is cautious regarding change and has reasons for preferring patience. Judgmental: I am honest. She is dishonest. Positive: I value openness and honesty regarding my feelings and opinions. She considers emotional restraint a sign of self-control and maturity and values harmony between people over open selfdisclosure that could offend someone. The Case of Don To give you a better idea of how this process of self-exploration and selfquestioning can work, consider the responses to the following questions given by one therapist. People would generally see Don as a middle-aged, middle-class White man; however, his identity is much more complex when considered via the ADDRESSING framework. His example is a good one for illustrating the point that cultural influences affect all people in complex ways, regardless of their identities. Table 3.2 summarizes the ADDRESSING influences in Don’s life. The following interview provides the background for understanding the meaning of Don’s self-description in Table 3.2. 49 50 SELF-ASSESSMENT TABLE 3.2 Copyright American Psychological Association. Not for further distribution. The Therapist’s Cultural Self-Assessment: Example of Don Cultural influences Don’s self-assessment *Age and generational influences Late 1940s, post-World War II baby boomer; I identify with the sense of hopefulness of my generation and a shared history of political and social upheaval in my early adult years (grew up near Berkeley, CA). No current disability, but I once had cataracts on both eyes that hindered my work for 1 year; also, I was the primary caregiver for parents both who had a heart attack and/or a stroke in their 50s. Grew up in a fairly religious Irish Roman Catholic family; currently a “recovered” Catholic with a strong sense of spirituality as well as a belief in reincarnation, Buddhist philosophy, and earth-based spiritualities. One-half Irish, one-quarter French Canadian, one-quarter Seneca Indian; adopted at birth and reared in Irish American family; as an adult, reconnected to Native heritage through legal search, academic study, professional work, and social relationships. Adopted into a middle-class family that made it into upper middle class; currently upper middle class. Gay, with some bisexual leanings; was married to a woman in my early 20s, had a child with her, then divorced; currently with a male partner and politically active in the gay community. See ethnic and racial identity. Born and reared in United States; English is first language. Male; roles as son, brother, father, and partner. *Developmental disabilities *Disabilities acquired later in life *Religion and spiritual orientation *Ethnic and racial identity *Socioeconomic status Sexual orientation Indigenous heritage *National origin *Gender Note. *Connotes dominant cultural identity. Interviewer: How have these cultural influences shaped who you are, how you see yourself, and how clients see you? Don: Well, clearly they’ve all influenced me in a great way. I think the most significant factor in my life would probably be having been … adopted; I’m hesitating, because the word that comes to mind is abandoned, and I do think that’s a significant piece, because the abandonment stuff has been pretty big in my life. I was adopted by my Irish Catholic family at the age of 10 months. My sister was also adopted, but she was 100% Irish. I’ve known my whole life that I was adopted, but I did not find out more about my background until high school. Then, much later, I did a legal search, not to get in contact with my biological parents, Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment but because I wanted more of a cultural identity, more of a sense of who I was. And that’s how I found out about the French Canadian and Seneca piece. [As for the meaning of this for me,] it’s a mixed blessing. Because I found it out as an adult, with a fair amount of education behind me and an interest already in diversity, the first thing that it did was that it slapped me in the face with my own prejudice. What I felt was a lot of pain because I realized how much I had bought into stereotypes growing up. I lived in a family with a father who was pretty bigoted, my mother less so, but still influenced by her culture. I was raised in a pretty privileged, White, upper-middle-class environment on the East Coast, in the Midwest, in the South, and then in California. I went to junior high and high school in Oakland, and that was very diverse; the schools were about 60% students of color. That introduced me to a whole lot more. But I still lived in a White neighborhood. In finding out more about my ethnic heritage, I had fairly avoidant behaviors, particularly around Native Americans. One, because growing up in the East and Midwest, I didn’t see them; even in California, the Native population was not very visible. Seattle is the first city I’ve lived in where there is a much larger Native population that is urban. I also had a painful awareness of how I had these internalized stereotypes of people who were lazy, who were drunk, who didn’t parent very well. And then having to discover that there was a part of me that fit into that group was really hard, and it still is. I’ve never felt a part of my family, so to some degree I feel more connected now that I have a sense of my ethnic heritage. But I still feel pretty isolated from a community. Through my adoptive family, I can connect to my Celtic heritage, but there’s still this other half of me. I’m trying to find ways to connect with that in more meaningful ways. I battle with feeling like an outsider because, basically, I am. I have been putting out feelers to the Seneca tribe, which is one of the more decimated groups of the Iroquois Nation. They are primarily in upper New York State, Ontario, and Quebec. But they’ve lost their land and don’t really have a place. I’ve also made some strong connections in the Seattle community. I completed the Native American mental health specialist certification and did a lot of work 51 Copyright American Psychological Association. Not for further distribution. 52 SELF-ASSESSMENT Interviewer: Don: Interviewer: Don: Interviewer: Don: with the Seattle Indian Health Board, which gave me more of a sense of how to work. I have also spent a lot of time in some rural areas of Mexico, particularly with Zapotec Indians. I did observations with their healers, studying with a translator, as part of my dissertation work. I had these interests even before I knew the details of my heritage. But it was still pretty painful for me to see that, despite all of that, there was still part of me that avoided Indian people. I don’t have this problem when I’m someplace else. But in my own home community, I really have to push myself to change that. It’s still a struggle in that I generally want to feel connected, but I also feel like a fraud, because I was not raised with the identity. And clearly the other piece for me is that I look White. How do these influences affect your comfort level in certain groups and your feelings about particular clients? There’s a double-edged sword. On one hand, they allow me to feel fairly comfortable about being with people I don’t know. I resort back to being the quiet observer at the beginning before I move in. The flip side of it is that I can get so introspective and so conscious about how I can best connect that I get in the way of opportunities that are available. It’s the fraud thing. I would hate for any person or group of people to think that I’m coopting them or attempting for all the wrong reasons to be a part of them. What is the relationship between your visible identity and your self-identification? Today, they are much more congruent. But I would say historically, I was really good at having a facade of being personable and present, when internally I experienced myself differently. I did a really good job of acting. But I didn’t feel as confident inside. How has your self-identification been influenced by your cultural context? A lot. I think there’s a cultural thing with being an adult adoptee. It comes out in the part of me that realizes the male White privilege I have and how uncomfortable I can feel about that sometimes. Even though I realize it’s somewhat uncontrollable. And adding to it is the recognition that I had all of that, and then finding out that I’m not really that at some level, or not all of me. I Cultural Self-Assessment mean, in the purest sense, I’m not this White middleclass straight male. And that’s a whole thing that we haven’t even touched on—the gay aspect. Copyright American Psychological Association. Not for further distribution. Interviewer: Was there a parallel between the time that you began to recognize that you were gay and the time that you started to learn about your ethnic identity? Don: The gay part happened much earlier. I mean, I knew, but I didn’t have a word for it. But I knew that I was attracted to other boys at about age 6 to 8. Certainly, culturally, it was not just my family, but also the world around me. I didn’t really get it—that there were gay people—until I was in college. And that says something about the interaction between the social and family system. I mean, I grew up in the Bay Area, and I had no clue until I moved here. And I spent lots of time in San Francisco, and so, like, where was I? I have no idea. I dated women, and I had these full-blown attractions to men. And I was comfortable about it, but I knew I couldn’t talk about it. I think the hard thing now in my life is that although I feel so much more congruent, I am more aware when I act in opposition to this desire to be authentic. I don’t have to or want to hide parts of myself. There are certainly places and situations where I come up against that—hiding myself—where it feels very clear that I should keep my mouth shut, for safety. However, I am no longer willing to consciously lie. Now, I might find creative ways around it that feel safe. Still, being more conscious means being aware of my discomfort. But that’s contemporary, and it’s been true for the past 10 to 15 years. Previous to that, it was a real struggle. I mean, my homophobic stuff played itself out in terms of finding ways to avoid having to deal with it. I didn’t want to lie, but I didn’t want to get in trouble either and I could pass as straight really well. To me, it was particularly evident not so much in my own life and how it had an impact on me, but in the sense that I wouldn’t say anything when other people were making jokes or cracks. And now I feel ashamed that I didn’t say something—which I’m no longer willing to do, about anybody. And that’s true in terms of my ethnic relations stuff, too. If I have anything in my life that haunts me now, that’s it—that for a long chunk of time I didn’t stand up and say, “This is not OK.” 53 54 SELF-ASSESSMENT Interviewer: What kind of assumptions are clients likely to make about you based on your visible identity, your sociocultural context, and what you choose to share about yourself? Copyright American Psychological Association. Not for further distribution. Don: I think that my clients are attracted to me because they experience me as being genuine, which includes being willing to talk about my experience openly. And at the same time, I’m willing to say, “I need to learn more about this.” So when I’m working with someone who has such a different experience from me, I’m pretty open about the fact that I don’t know what those experiences are, and I really want to understand. I think that’s why I’ve had a fair amount of success with diverse clients. Interviewer: When clients first meet you, and know nothing about you, do you have an awareness of how they perceive you? Don: I suspect that they perceive me as this middle-aged— oh, I don’t like to say that word—this youthful, middleaged, White guy and assume that I’m straight. I think that once we’ve chatted for a little while, they have a sense of me that’s deeper. And it’s not so much about whether my exterior has changed, but their sense of my being that’s shifted. Interviewer: How might your areas of privilege affect your work (e.g., your clinical judgments, theoretical preferences, view of clients, beliefs about health care)? Don: The biggest piece for me, and I try to keep really conscious of this, is the biases that come out of the givens of my life. It’s something that I always have to pay attention to in terms of the expectations I have of people. In other words, when someone is clearly different from me, it’s much easier for me to step out of my biases, because I think I’m more conscious of them. I actually struggle more with people who look like me, or are more like me, because then it’s easier to make assumptions that I shouldn’t make about their experience. On one level, I really do believe that we all have the capacity to do whatever we want to do. And I think that there are tremendous obstacles based on history and all these “isms” we’re talking about. But underneath that, I still really believe the idea that we can all transcend ourselves in some way, even if it’s just our attitude. So sometimes I have to be care- Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment ful that I’m not leaving things out, like the obstacles; that has happened, and I have to catch myself that I don’t make these assumptions. The other thing to pay attention to is values with people of particular backgrounds. The biggest place I get caught is between the value of the group versus the value of the individual, to stay conscious of not placing importance on the individual only. I’ve also been in situations where there’s so much value placed on the group that the individual gets lost. It’s not that it’s right or wrong; it’s just priorities. Interviewer: How about in terms of your theoretical preferences? Don: I can’t help but assume that because I was raised in this Western culture as a White male, that’s influenced me to some degree. I’ve certainly known that early on, for me, a cognitive-behavioral training program was attractive because it was rational. It was about changing thinking, and that made sense to me. Even though that’s not how I operate very well, but I got caught in it, and I was good at it. I also think that my later attraction to existentialism was influenced by Western culture, which values the individual more than the group. And I think that I was attracted to Zen Buddhism for the same reason. Zen Buddhism is a very rational, individually oriented kind of thing, and I think it’s also larger than that. It’s about the individual within a group context. When I talk to people who were raised in Buddhist cultures, they have a very different slant on it than I do, yet this doesn’t diminish the usefulness of this perspective for me. I also have a firm belief that both of these theoretical leanings have lots of room to be widened. I think that there are elements of each that address societies and groups and not just the individual. But that has to be conscious, something you do with it, which is most of the work I’m trying to do now. Clearly, I’m still influenced by my experience, which I can’t change. And that’s the other big thing I’ve come to realize: I can’t leave behind my context, so how do I adapt it? I think it’s a trend now to want to throw it out, because it’s “bad,” but I can’t. We see this now in how many Westerners attempt to co-opt Eastern thought without truly understanding the context. In the process, they have once again done this Western dualistic split— Eastern is good, Western is not. 55 Copyright American Psychological Association. Not for further distribution. 56 S E L F – A S S E S S M E N T I can change what I think about things, but I can’t change who I am. So I have a hard time with folks out there throwing everything off of their Euro/White, Christian culture and trying to be something they’re not. I think we can learn from lots of other things, but we’re always going to interpret it in a Western way. We can live in another country for years, and there’s still going to be a way in which we perceive things. I think that’s one of the reasons why both Zen Buddhism and existentialism offer me so much, because the one thing they do similarly and really well is that they hold the paradox. To me that’s so essential. It’s not about leaving one behind and moving to another, or either-or. It’s about both-and. It is clear that Don is a person who had thought deeply about cultural influences on himself before the interviewer asked him these questions. But even when one is highly experienced in the area of diversity, there are always areas in which one can learn more. Now that you have read Don’s responses, try answering the same questions in relation to yourself. If you can talk about your answers with a friend or a culturally diverse group of people, all the better. i How have cultural influences shaped who I am, how I see myself, and how clients see me? i How do these influences affect my comfort level in certain groups and my feelings about particular clients? ” What is the relationship between my visible identity and my selfidentification, and how is this influenced by my cultural context? i What kinds of assumptions are clients likely to make about me based on my visible identity, my sociocultural context, and what I choose to share about myself? i How might my areas of privilege affect my work (e.g., my clinical judgments, theoretical preferences, view of clients, beliefs about health care)? (The concept of countertransference in relation to particular clients is discussed in chap. 4 of this volume.) Seeking New and Diverse Sources of Information Carefully considering the questions and ideas outlined so far, you may come to recognize the key gaps in your experience and knowledge base regarding particular groups. The next step is to begin to search Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment for information that will educate you about the groups with which you have less experience. This search can lead to books, magazines, newspapers, films, theater, workshops, and culture-specific community events. Of course, most people already use these sources of information; what turns them into culture-specific learning opportunities is how one thinks about them and the questions one asks—that is, one’s critical thinking. Critical thinking about one’s sources of information involves questions that challenge the information itself and simultaneously expand one’s perceptions, beliefs, and attitudes (Brookfield, 1987). For example, when you read newspaper articles about ethnic minority cultures, do you read between the lines for information about the authors’ identities and political orientations? Does it occur to you that many articles about minority cultures are written by members of dominant groups, often without comment from members of the group being discussed? If an article was written by a minority group member, do you assume that the person’s opinion represents those of the entire group? The following questions may help you think critically about information sources: i Who are the authors, producers, or editors of this information and what are their identities, political orientations, and alignments? i Are people of minority identities and views represented? i Is this information directly from people of minority groups, or only about them? • Where can I obtain information from more direct or alternative sources? The views and experiences of people of minority cultures are routinely excluded from the mainstream media. Consider the number of popular films that focus on the love story of a person who has a disability, a hero who is Hindu, or the lives of ethnic minority elders. When minority groups are discussed, it is often from the perspective of members of the dominant culture. For example, despite the plethora of films about the Vietnam War, I have yet to see one written and directed by a Vietnamese person. Similarly, how many U.S. newspaper articles about Iraq are written by an Iraqi? To counter such imbalances, look for information from publications and other media emanating from minority communities themselves (e.g., Mouth Magazine []; Able [http://]; The American Association of Retired Persons [AARP] Magazine; The Advocate; National Public Radio/Alaska Public Radio Network program Native News}. In cities and even in many smaller communities, minority groups often publish their own newsletters and newspapers. Large newsstands and bookstores sell magazines and 57 Copyright American Psychological Association. Not for further distribution. 58 S E L F – A S S E S S M E N T newspapers from various countries that provide news and perspectives on events often completely ignored by U.S. reporters. Films from Asia, Latin America, and India are available in many video stores. And another enormous resource for psychologists is the large and growing psychological literature on people of diverse minority groups. However, regarding the multicultural research base, there continues to be gaps; one of the most obvious is the paucity of information regarding social class and people of lower socioeconomic status (SES; Robinson & Howard-Hamilton, 2000; L. Smith, 2005). There are several reasons for this neglect. For one, people of lower SES have historically been labeled as poor candidates for psychotherapy (Jones, 1974). The disinterest in investigating this stereotype and in developing approaches, if indicated, that are more effective may be related to dominant cultural beliefs about the poor. As Lott (2002) noted, poor people tend to be seen as “lesser in values, character, motivation, and potential” (p. 108). Such beliefs justify the exclusion, separation, and devaluation of poor people. By education, occupation, and income, therapists (of both minority and dominant ethnic identities) are usually middle- or upper-middle class, and hold values consistent with this status (Acosta, Yamamoto, Evans, & Wilcox, 1982; Robinson & Howard-Hamilton, 2000). As Aponte (1994) noted, today’s therapeutic models often carry strong social messages and philosophies “that reflect the world of the intellectual and the academic” (p. 246) and contrast sharply with the traditional customs, lifestyles, and religious beliefs that many clients of lower SES hold. These differences can make it difficult for some therapists to understand and effectively help clients of lower SES (Acosta et al., 1982). Recognizing the need for greater attention to poverty, classism, and the poor population, the American Psychological Association (APA, 2000b) adopted the Resolution on Poverty and Socioeconomic Status. In recent years, a few articles and book chapters have also been published that may be helpful to therapists (for overviews, see C. Campbell, Richie, & Hargrove, 2003; Lott, 2002; P. Minuchin, Colapinto, & Minuchin, 2007; Payne, 2003; L. Smith, 2005). For a wider range of information on this topic, it is useful to look beyond the field of psychology to the areas of political science, history, sociology, anthropology, social work, and some forms of literature: Regarding the latter, novels can provide a rich description of the experiences of people living in poverty (e.g., see Gaines, 1997; Gibbons, 1998; Hogan, 1995; Mistry, 2001). To learn from—not simply about—people of diverse minority groups, knowledge of culture-specific organizations is also important. Examples of resources therapists should be familiar with include religious institutions (e.g., mosques, synagogues, churches, temples, meeting houses); Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment support groups; educational institutions; recreational centers for elders and people with disabilities and their families; culture-specific community organizations; language-specific social services; gay, lesbian, bisexual, and transgender counseling services and political action groups; university and community women’s centers; and community support groups and activities for parents and children. Some specific organizations include the Association of Multiethnic Americans (http://www., the Biracial Family Network (, the National Family Caregivers Support Program ( prof/aoaprog/caregiver/caregiver.asp), the National Gay and Lesbian Taskforce (, Parents and Friends of Lesbians and Gays (, and the American Association of People with Disabilities ( Relationships and the Influence of Sociocultural Contexts As a field, psychology is oriented toward individualistic work. However, to increase one’s cross-cultural competence, individually oriented work (e.g., introspection, self-questioning, reading, some forms of research) is necessary but not sufficient (Pedersen, Fukuyama, & Heath, 1989). Equally important are therapists’ relationships with people of diverse identities and an understanding of how people in their social networks influence their identities and worldviews (Kim-Ju & Liem, 2003). Interpersonal relationships can help to increase self-awareness of one’s limitations and biases. However, if the people around therapists hold similar identities and share the same privileges, then they may rarely question the “universal nature” of their beliefs and become what Wrenn (1962) referred to as “culturally encapsulated counselors.” Because the therapist’s role in itself confers authority and power (Holiman & Lauver, 1987), therapeutic practice—even with clients of diverse identities—will not necessarily increase one’s self-awareness. As therapists, we need to look outside the therapy setting to individuals and groups who differ from us, and who can facilitate our self-assessment process. Here is another exercise. Take a minute to consider the people with whom you choose to spend most of your time. It can be helpful to make a list of these individuals (e.g., your partner, spouse, friends, coworkers, fellow students, and particular family members). Now look back at 59 60 S E L F – A S S E S S M E N T TABLE 3.3 Recognizing the Influence of Sociocultural Contexts Confidantes’ names Copyright American Psychological Association. Not for further distribution. Cultural influences: Are my confidantes different from me in Jan Habib Max Jos6 Nadya Age and generational influences? Developmental disabilities? Disabilities acquired later in life? Religion and spiritual orientation? Ethnic and racial identity? Sexual orientation? Socioeconomic status? Indigenous heritage? National origin? Gender? the ADDRESSING outline and the cultural influences you starred as areas of privilege. Think about the individuals in your intimate circle and ask yourself, “How many in my circle differ from me in these areas of privilege?” (See Table 3.3 as a guide). If you are in your 30s, do you have any close friends who are in their 60s? If you do not have a disability, do you have any close relationships with people who do? If you grew up in a Christian or agnostic home, do you have any intimates who are Muslim, Buddhist, or Jewish? If you are heterosexual, is anyone in your closest circle gay, lesbian, bisexual, or transgender? If you are of European American heritage, do you have any confidantes of ethnic minority cultures? Of course, everyone’s situation is different, but for many people, this exercise highlights the homogeneity of their social circles. This homogeneity is particularly common when one belongs to a majority group. Research suggests that people tend to be attracted to those they perceive as similar to themselves, particularly with regard to mates (see Kail & Cavanaugh, 2000). (Although interracial partnerships are increasing in the United States, they still constitute only 6% of marriages and 10%-12% of gay and lesbian partnerships; U.S. Census Bureau, 2000b.) There is some evidence that people of ethnic minority identities marry outside their groups more often than do European Americans. For example, by the 1990s, between 54% and 80% of Asian American women married non-Asians (Kitano, Fujino, & Takahashi, cited in Hall, 2003). Perhaps because they are fewer in number, minority members often have no choice but to develop relationships with people who are Copyright American Psychological Association. Not for further distribution. Cultural Self-Assessment different from themselves. In contrast, people of majority groups can more easily find friends and partners of their own cultures because there are more of them (Mclntosh, 1998). Direct personal experience with people who differ culturally from oneself is an important element in gaining cross-cultural sensitivity and understanding (Mio, 1989). But it is not enough to simply be around people of diverse backgrounds. Traveling to different countries, eating in ethnic restaurants, and attending cultural events can set the stage for interaction, but deeper learning comes from relationships between people that are sustained over time. In addition, it is important to remember that power differentials can affect what and how much is shared in a relationship. Relationships with people who are in a less powerful position than oneself (e.g., clients, students, support staff) may involve learning, but power differences generally mean that one person is in a more vulnerable position and thus less able to speak freely. One can better learn from peer-level, intimate relationships in which both parties hold enough power to honestly and safely share their feelings and thoughts. The development of such relationships is a natural outgrowth of the personal work I have described so far. However, if members of dominant cultural identities are not engaged in this personal work, their attempts to develop relationships with people of minority identities may backfire. Choosing to develop a friendship because the person holds a particular identity may be offensive, because it suggests a greater interest in obtaining cultural information than in knowing the individual. Conclusion Culturally responsive practice begins with the therapist’s commitment to a lifelong process of learning about diverse people across cultures and life spans. A first step in this process is to explore the influence of one’s own cultural heritage on one’s beliefs, views, and values. Related to this work is the therapist’s need to recognize the ways in which privilege can limit one’s experiences and knowledge base. Equally important is the therapist’s willingness to seek out new sources of information that enable him or her to learn from and with (not simply about) people of diverse cultures. Forming intimate relationships with people of diverse identities is an important part of this learning. The reward for these efforts is a deeper understanding of one’s clients, an appreciation of the richness of diverse people’s experiences, and an ability to provide more effective and culturally responsive mental health services. 61 62 SELF-ASSESSMENT I/ Copyright American Psychological Association. Not for further distribution. • IQ6QS Engaging in One’s Own Cultural Self-Assessment I. Recognizing the ADDRESSING influences on one’s own life is a **rst steP ^ t^le exPi°raaon of one’s cultural heritage. 2. Recognizing the areas in which one holds privilege is key to understanding the impact of these influences on one’s work. 3. Privilege is contextual: A privileged identity in one cultural context may not be privileged in another. 4. Because privilege tends to cut people off from information and experiences related to specific minority groups, the areas in which people hold privilege are usually those in which people hold the least awareness. 5. Psychology is a privileged profession that reinforces many dominant cultural values. 6. Therapists’ personal beliefs and lifesyles are often reflected in their values concerning therapy. 7. Individually oriented work {e.g., introspection, self-questioning, reading, some forms of research) is necessary but not sufficient for increasing cross-cultural competence. 8. What turns mainstream sources of information into culturespeciflc learning opportunities is how one thinks about them and the questions one asks—that is, critical thinking. 9. Peer-level intimate relationships with people of diverse identities are a rich source of cross-cultural learning. 10. Humor is a valuable tool in reducing the conflict that often comes with cross-cultural relationships and interactions.
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Tags: Diversity Issues cultural assumptions Human behavior and diversity Personal Cultural Reflection Looking Into the Clinician Mirror



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