1. By Naveen Jonathan, Ph.D., LMFT Wednesday, December 4, 2013

2.  Activity:  Consider the areas that make you a diverse individual. What are these elements that make up who you are? Make a list of these elements.

3. Multiculturalism: Depends on context which it is used Concept is constantly changing In the US: Social/Political movement/position that holds differences between individuals and groups to be a potential source of strength and renewal rather than of strife. Values diverse perspectives people develop and maintain through varieties of experiences Upholds the ideals, equity and freedom and includes respect for individuals/groups

4. Diversity – The state of being diverse. Diverse is defined as differing from one another. It is composed of distinct or unlike elements/qualities. Common questions to consider: What are the pros and cons of diversity? Who decides how a person is different from another/has unlike elements/qualities, etc.? Why does one’s differing from another cause so much heat/passion/debate?

5. Ethnicity – A group of human whose members identify with each other through a common heritage. It is also based on recognition from others of the group’s distinctiveness and the recognition of common cultural, linguistic, religious, behavioral traits as indicators to other groups. “concept of a group’s people hood” Refers to commonalities of: Ancestry History Shared values Customs

6. Social location in society Migration Availability of resources Dominant definition of belonging Extent of privilege/oppression Relate to each other in cultural groups Acceptance of cultural heritage Preserve cultural traditions Relate to various cultures Worldviews/Values

7. Do not sufficiently address diversity/ethnicity issues. Focus on Traditional family model DSM

8. Experience Labels Communicate about problem Beliefs about the problem Attitudes towards help Desires/Expectations of treatment

9. Individual Others Partnership between Individual & Others Important: We do not want to perpetuate the oppression that our clients have faced.

10. The exercise of authority or power in a burdensome, cruel, or unjust manner. Individuals who are oppressed can feel heavily burdened, mentally or physically, by troubles, adverse conditions and anxiety. Therapy Sessions: Microcosm of race relations Biases of forebears Clash of worldviews Important to identify true mental health disorder or reactions to oppression/survival mechanisms

11. Playing it cool Increased vigilance and sensitivity The ability to read nonverbal communication Distrust in larger overall societal experience can appear in the therapeutic process Lack in the counseling process

12. A culturally effective therapist is one who: Can view these behaviors in a nonjudgmental manner Can avoid personalizing any potential hostility expressed towards them Can adequately resolve challenges to their credibility

13. These are brief and commonplace verbal or behavioral indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults that potentially have a harmful or unpleasant psychological impact on the target person/group Microaggressions can also be delivered through the physical surrounds of target groups where they are made to feel unwelcome, isolated, unsafe, and alienated

14. Microassaults: Conscious and intentional actions or slurs, such as using racial epithets, displaying swastikas, or deliberately serving a white person before a person of color in a restaurant

15.  Microinsults: Verbal and nonverbal communications that subtly convey rudeness and insensitivity and demean a person’s racial heritage or identity. An example is an employee who asks a colleague of color how they got their job, implying that they may have landed it through an affirmative action or quota system.

16.  Microinvalidations: Communications that subtly exclude, negate or nullify the thoughts, feelings or experiential reality of a person of color. For instance, white people often ask Asian-Americans where they were born, conveying the message that they are perpetual foreigners in their own land.

17. They tend to be subtle, unintentional and indirect. Often occur in situations where they are alternative explanations. Represent unconscious and ingrained beliefs and attitudes Are more likely to occur when people pretend not to notice differences, thereby denying that race, gender or sexual orientation had anything to do with their actions. Unintentional microaggressions by therapists may contribute to premature dropout from treatment and poor treatment outcomes for cultural minorities and women.

18. Ableism Social Class Age Cultural Competence = A consistent readiness to identify the cultural dimensions of our own lives, and the impact of those dimensions on our work with clients (McAulife et al., 2007).

19. The world is not an even playing field – some people who share group membership experience daily oppression that others don’t. Despite legal advances, virulent, life-threatening oppression is all around us. With the best of intentions therapists unwittingly perpetuate this oppression in our relationships with others or our own and different groups. Certain kinds of conversations/interactions may interrupt oppression and make it visible, clearing a space for unlearning old oppressive ways of being and creating new, authentic ways of being in relationship with one another. The best judges of injustice are the groups that have been unjustly treated.

20. Expectations based on one’s own culture and privileges can lead to unconscious undermining of the client’s experience. Listening to and valuing other’s experiences requires the therapist to make changes as an individual. This will diminish defensiveness in the therapist. Promoting genuineness is the pathway to being able to practice good cross- cultural counseling. Feeling centered and not defensive allows the therapist to respond with interest instead of fear and anger and promotes an attitude of relationship building.

21. Being aware of one’s own culture, values and biases. Being aware of and working at controlling one’s own biases and how these may affect interactions with others. Culture-specific knowledge. Knowledge of institutional barriers that prevent some populations from accessing resources.

22. Ability to build strong cross-cultural relationships and to be at ease with difference. Flexibility and ability to adapt to diverse environments Ability and willingness to be an ally to individuals who are different from oneself. Effective communication skills across differences Able to mediate cross-cultural conflicts.

23. “An African-American therapist was seeing a married, male client in his 30’s who had recently immigrated to the United States with his family from Kenya. The assessment and two therapy sessions had gone well, and the therapist experienced a sense of mutual respect between them; because of their common African heritage, she also assumed that she held a deep understanding of his experiences in the U.S. However, the therapist found herself becoming increasingly annoyed that the client called her a couple of times between each session to confirm some agreement or arrangement that the therapist had considered firm from their in-session discussion”. (Hays, 2007) The therapist wonders: Are these obsessive tendencies? Does the client consider her unreliable – is he paranoid? She asks him about this need in the third session.

24. Age Developmental Disability Disability Acquired Later in Life Religion Ethnicity Socioeconomic Status Sexual Orientation Indigenous Heritage National Origin Gender

25. Complete, 4 then 3 then 1 then 2 in that order – WHY?? Start here  Axis IV  Axis III  Axis I  Axis II Axis VI Age Developmental or acquired Disabilities Religion Ethnicity Socioeconomic Status Sexual Orientation Indigenous Heritage National Origin Gender

26.  Your client, Tiffany, a 15-year-old girl of Haitian heritage, is in treatment with you. Her father is very angry and disappointed with her. He says that he has worked very hard in this country to raise his children and Tiffany presents this way. Tiffany wants you to act as go-between between her and her father, explaining her symptomology. Her father tell, you have no right to tell him what to do and that his daughter needs to snap out of it.

27. Fill out ADDRESSING format for Tiffany. In the case of Tiffany, the following historical understanding of Haitian History and culture would be important for the counselor to possess in order to understand his reality and make hypotheses about the sources of his distress What does the following historical information add to your assessment of Tiffany?

28. Haitian Culture and History: History US occupation, Oppressive regimes 1 st wave of immigration, educated elite, 1950’s 2 nd wave mid 1960’s-1971, middle class 3 rd wave 1980’s, poor and illiterate, led to HIV stigma because of several highly publicized cases Culture Class/skin divisions inside/outside the country are strong Fluency in French and lighter skin (alignment with colonial values) are associated with higher social status. In the US, French-fluent immigrants do not have an advantage In Haiti – Tiffany’s family held privilege and status, in US, same identity has a different meaning. Most salient aspects for her family in Haiti (gender and social class) eclipsed by ethnic identity.

29. A particular cultural dimension may have different meanings in the dominant culture, another in the minority culture, and another person-specific meaning for the individual. Information about person-specific meanings will usually come from the client Information about culture-specific meanings (“Knowledge”) is part of the therapist’s own personal learning and should happen outside the therapeutic relationship. Therapists depend on knowledge gained outside the therapeutic relationship to continually generate hypotheses These hypotheses must be continuously revised in light of client specific information.

30. Use multiple sources Family/Significant others Requires trust and caution, client and context- specific Other providers Tap into clients longer-term relationships with other providers Behavioral observations Consider clients age and development in relations to historical events Consider Acculturation Problems with current approach: time, linearity, who/who not to do it with? Language

31. Three interrelated categories of cultural strengths and supports (Hays 2007): Personal strengths Interpersonal supports Physical/environmental sources of support and strength Focus on exceptions to the problem as sources of information about avenues for treatment

32. Victim-blaming (not considering culture and oppressive environment) Over-generalizing (not considering the individual) Failing to identify and help client challenge internalized oppression Valuing: Client compliance rather than client feedback Therapist neutrality rather than partiality Verbal over non-verbal communication Individuation/autonomy over inter-dependence Intra vs Inter-Generational Bonds

33.  Principle 1: Empathy and Normalization  Builds rapport  Increases comfort with disclosure  Lessens shame and self-blame, avoids victim-blaming  Principle 2: Problem-Solving Strategies  Support clients in pragmatic relief from stressors  Principle 3: Supporting Self-Care  Connect client with supportive others outside therapy  Increase sense of importance of self care (even in cultural contexts where clients ability to serve others is primary)  Avoid:  Victim-blaming, looking for only internal explanations and solutions  Assumptions about class and culture  Therapist-centered treatment goals

34.  SAMSHA (2002):  Alaskan/Native American  African-American  Latino  Asian/Pacific Islander

35.  “Eating Disorders Don’t Discriminate”:  Gender – Men  Race/Ethnicity/Culture  LGBT  Older Adults

36.  Cultural Formulation Interview

37.  Thank you!  Naveen Jonathan, Ph.D., LMFT  (714) 997-6932  jonathan@chapman.edu jonathan@chapman.edu