Culturally Responsive Therapy Chapter 3 Culturally Responsive Therapy Diverse World with a myriad of cultural, ethnic, religious differences. All must be taken account.

Multicultural Standards of Practice American Psychological Association 6 Guidelines in Providing Sound Psychological Practice Therapists are cultural being with own assumptions, biases that may be detrimentally influence interactions. Must acknowledge importance of cross-cultural knowledge Apply constructs of multiculturalism Research must recognize diversity as a factor Apply cultural awareness in clinical practice Support culturally informed policy in organizations.

Standards of Practice Association for Multicultural Counseling Cultural Self-Awareness: what is your world view, assumptions, values, norms? Knowledge of Client Worldview: How are you similar or different? How does this impact rapport and treatment? Culturally Competent Skills: What experience do you have with grappling with culturally relevant issues?

Basic Considerations Culture: Shared Ideas, Symbols, Values & Beliefs Between Members of a Group Multiculturalism is the intersection of identities and a confluence of cultures Collectivism & Individualism - A cultural norm that affects client perceptions/choices View of illness? Help seeking behavior?

Interpersonal Therapy Symptoms evaluated in the context of the personal relationship, Environment Particularly useful for collectivistic cultures Examine Behaviors in Context More thorough understanding of symptom etiology and maintenance When applied with cultural adaptations that allow therapist to be culturally responsive

The Treatment Process Phase 1: Diagnostic Formulation and Diagnosis Education Identify the Cultural Context Assess Ethnic Identity Development Multicultural Interview Assess Acculturation Level Acculturation: process of change from one culture to another Assimilation- Adopt characteristics/values of majority culture Separation: reject majority, retain native cultural norms Individualism: reject both majority/native; new – exp: Chicano Integration: bicultural adaptation of many cultures

The Treatment Process WHO AM I? WHAT AM I? Ethnic Identity Development: Atkinson, Morten, & Sue Model Conformity Dissonance: events challenge self-concept Resistance/Immersion Integration/Transcendence (Sexual Identity Development Models are similar) Q: Which acculturative style and Ethnic identity stage is most stressful?

Acculturative Stress Assess Gender Role Conflict Adaptability of coping Stress related to conflicting roles Rewards and supports Q: How would someone with a assimilated acculturation style deal with gender role conflict? Integrative? separated?individualized?

Treatment Process Phase 2: Facilitated Problem Solving Explore Ethnic & Sexual Identity in Tx Address coping with Acculturation stress Address coping with racial & sexual discrimination Dynamics of Social Interactions Communication Analysis

The Treatment Process (Cont’d) Phase 3: Termination Between 2-4 Sessions Long Identifying Successes, work left to be done What was accomplished in therapy? What interventions worked and why? What coping styles were effective/ineffective? What new insights were learned? What areas are still in need of attention? What’s the plan for after termination?

Cultural Norms Special Considerations: African Americans: flexible family roles , kinship and community bonds, spirituality, parental engagement, racial identity development What might we see if client is depressed? Or coping with abuse?

Cultural Norms American Indian/Alaska Natives: extended family is basic unit for family structure, interdependence What should a therapist consider if client presents with psychosis?

Cultural Norms Asian Americans: Diverse, nongeneralizable,family, patriarchal, hierarchical, collectivist, value of achievement How might a child client present with learning difficulties? Middle-Eastern: religiously diverse, patriarchal, discrimination, marginalization What would you need to consider when evaluating a second generation Jordanian adolescent?

Cultural Norms Religiosity : Varies in importance across cultures Premarital Sex Co-ed Interactions Dress Restrictions

Case Discussion Aisha is a 14 year old Syrian girl who arrived with her mother and younger brother as refugees. Her mother shared with you that Aisha’s school counselor recommended that she seek out therapy. Aisha tells you that she is having difficulty focusing in class. She has constant worries about the welfare of her mother and brother while at school. She feels she can’t relate to the kids in school and feels generally unmotivated. Lately, she has also been sleeping excessively, rarely talking to her family. Mother also mentions that Aisha tends to pick at her skin and scabs on her arms and legs until bloody. Questions for class: What further information do you want to find out? What are your hypothesis as to what may be affecting Aisha? What is she dealing with and how is she coping?

Case Discussion Miguel is Mexican-American 16 year-old, born in the US to undocumented immigrants. He arrived to see you in a school counseling office because teachers were concerned about a recent significant decline in his academic performance. He attends a school that is predominantly Anglo and East-Asian. His friends are all White and he shares a lot of the same interests, habits, and values with his peers. However, recently, he has been hearing negative comments from peers and their parents about Mexican immigrants creating a lot of confusion/rejection. What is his acculturation level? Ethnic Identity Development? How might that help understand his symptoms? What is the best approach to treatment?