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

2. 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.

3. 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?

4. 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?

5. 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

6. 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

7. 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?

8. 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?

9. 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

10. 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?

11. 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?

12. 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?

13. 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?

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

15. 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?

16. 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?