TransCultural Awareness Institute

Offie C. Wortham, PhD

Abstract

This paper is the result of a number of perplexing experiences of the author in some graduate classes at Marist College. In this paper he will attempt to forcefully make the argument that counselors-in-training should be educated to see and treat all clients first as individuals, and second as members of an ethnic or racial group. The problem, as the author and others see it, is that people-of-color are all to often seen as members of an homogeneous group, without recognizing the vast differences that exist in the background, experiences, and psychological makeup of the individuals within their identified ethnic or racial group.

The author prefers the term "ethnic group" to "race" because it is descriptive (with regard to nationality and/or culture) and without the problems associated with defining race. It is unfortunate that the government continues to force individuals to specify their so-called "race" or ethnicity. The word "race" has now become pervasive and meaningless, and it contributes a great deal to how people attempt to identify themselves. Jews, for an instance, are not a race, but an ethnic group and a "socially supposed race," they share a common ancestry and a common cultural heritage. This is not something that can be said of those who are labeled "Black" or African American. Most of these people are biologically more European or American Indian than they are descendents of peoples of Africa. But because of the racism and conditioning during the past few hundred years, the self-identity of over 10% of this nation is Black.

Counseling Ethnic and Racial Minorities

Prior to 1970 the therapist was supposed to be colorblind, but we have since found out that ethnic/cultural identity systems can sometimes be useful in understanding people. These systems, however, should not be used rigidly to classify a person as a part of a group in the treatment processes.

The word "race" first appeared around the year 1700. The first definition was based solely on physical or biological characteristics and it was used by racist to show the superiority of one group over another, and to tell the differences between members of a common species. However, there are more similarities between groups than there are differences, and more differences within so-called racial groups than between them. The biological definition of race has led to ideological racism and this has provided the basis for discrimination and oppression of people who were considered inferior and undesirable.

Cultural competence in the assessment practice requires relevant information on the clients cultural orientation that is obtained prior to the onset of assessment services. "Reducing stereotyping and bias in understanding their input on the treatment process involves awareness of the client's individualized linguistic and sociocultural background." (Malgady, 1996).

The fourth edition of the American Psychiatric Associations's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; 1994) reflects an increasing recognition of the importance of considering the cultural diversity of clients in rendering psychiatric diagnoses. But here again, although we have the awareness that all people are not the same, we also have the same problem of generalizing about people as being part of an homogeneous group written by Dana (1987)"

Within each ethnic minority group, standard psychological assessment will be suitable for some members but inappropriate for others because of their varying degrees of assimilation. Moreover, the percentages of persons who are assimilated differ greatly among ethnic minority groups. As a result, it is always mandatory to distinguish those individuals within each minority population who are assimilated and for whom standard psychological assessment is appropriate. (p. 83)

It is important to remember that cultural background, degree of acculturation, and experience within the majority culture provide a frame-work through which current experience and information are processed and behavior is produced. Any operational definition of socio-economic-status (SES) needs to be multi-dimensional and involve consideration of the individual's economic resources, social prestige, educational background, and social influence." When SES is controlled, it has been found that "…the differences between ethnic groups and whites on standard measures of psychological functioning disappear, mental health service utilization rates are similar, and little difference in treatment outcome is found." (Briones, 1990) People-of-color are expected to acculturate, but, some people hope, never completely assimilate.

According to something called the "Cross Model," there are a series of steps that a person of "partially-African descent" can go through in this country. This is important for the counselor, and the client. For where a person is on this continuum will have great significance on how well they will, or will not relate to the counselor, or the treatment program: "The Negro-to-Black Conversion Experience"….
1) Pre-encounter - Programmed as non-black, or anti-black
2) Encounter - Begins to validate self as a Black person
3) Immersion - Rejects all non-black values. Total immersion in being Black
4) Internalization - Gains a sense of inner security and begins to focus on "…things other than self and their own ethnic or racial group.

Finally, I came across the Minority Identity Development Model (MID) by Sue, who is considered by some as the most experienced expert in the nation on multicultural counseling. His model, which I think is excellent, was put together by a multi-ethnic group of experts in the field. They say that "…the counselor must not only lose sight of reference group identities, but must also recognize client's uniqueness as well as features common to the universal human experience. To avoid, deny, or lose sight of the totality of these experiences is to miss the "total person." (see Sue, P. 118)

There are Five Stages in the model:
1) Conformity Stage - They like the dominate culture more than their own.
· High desire to assimilate and acculturate
· Negative self-image
· More you resemble dominate group the better you are
· People in dominant group are role models
· View other members of your group in the same way they are viewed by the dominant group
2) Dissonance Stage
· Begin to experience a breakdown in denial system
· Attitude toward self improves. Aware of minority strengths. New pride.
· Begin to appreciate culture of others in the same minority group
· Questions system of minority stratification held by dominant group
· Begins to view values of the dominant group as not good for them
3) Resistance and Immersion Stage - Completely endorses the minority-held views and rejects the dominant society and culture. Has a desire to eliminate oppression from the dominant group is important.
· Self-Appreciating attitude
· Strong sense of identification with their group. New stratification is with other minority groups with similar values
· Growing sense of camaraderie with other ethnic groups
· Totally rejects dominant society and their culture and experiences, and has a sense of distrust and dislike for all members of the dominant group
4) Introspection Stage - Becomes more autonomous and questions group values previously held.
· Experiences some conflicts
· Moves for own identity from the group
· Moves away from "culturocentrism" toward identity with others than the oppressed
· Moves toward dominant group members and there is a conflict between complete distrust and selective trust and distrust. Sees some good here and is not sure to adopt new values.
5) Synergistic Stage - Sense of self-fulfillment with regard to cultural identity. No more conflicts. Cultural values of others are examined, (from other cultures) and are accepted or rejected on the basis of experience gained in earlier stages of identity development. Want to eliminate all forms of oppression.
· Strong sense of self-worth
· Strong sense of pride in the group without having to accept group values unequivocally. Each member of the group is an individual.
· Strong sense of respect for the group's cultural values.
· Selective trust and liking for those in the dominant group who seek to eliminate repressive activities of the group. Openness to the constructive elements of the dominant culture.
This model is similar in some ways to the Cross Model presented earlier. It is more detailed and is probably an elaboration.

An excellent book that should be required reading for all future psychologists and counselors is Psychological Interventions and Cultural Diversity by Joseph F. Aponte and associates. Aponte stresses that students in most of the doctoral programs who will use the standard battery of tests are not trained to administer these tests to ethnic minority clients. The result, he claims, is that "training in standard psychological assessment is deficient for practice with ethnic minority populations."
A major deficiency in Standard Psychological Assessment for Cross-Cultural Practice is the ”Unquestioning acceptance of a psychometric paradigm applied in the U.S. by White male psychologists." This group has an Eurocentric world view - from early childhood socialization or assimilation as an adult.” World view embraces shared group or individual identity components, consensual values and beliefs, and common language.” (Aponte) The prevailing view is that most therapists still operate under the hypothesis that there is no significant difference between ethnic groups in terms of how individuals should be counseled. “When bad stereotypes about these groups apply, members of these groups can fear being reduced to that stereotype. Therapists, like all human beings, carry into clinical relationships, preconceptions, assumptions, and stereotypes that can blind them to the real potential of their patients to respond favorably to treatment. We must also remember that minority therapist can be as susceptible to having the same stereotypes as non-minority therapists. Many therapists have only a superficial knowledge of the sub-culture of their clients. These therapists will generally cast the patient into the mold of the generalized member of a particular culture and completely lose sight of the individual. What we wind up with is the treatment of the individual patient as a member of a class or a category, rather than as a real human being who is also a member of a specific social, cultural, racial, or ethnic sub-group.
There are several kinds of bias that the therapist may have: (Aponte)

1. Distortion - “melting pot theories” that all Americans should be assimilated. To clean this up we need “ethorelativism” this is vital for human services that are responsive to individual differences. Training for this is a necessary component of professional training for culturally compentent assessment.

2. Pathologization - Interpretations that make people look more disturbed than in fact they are. In DSM-IV there is a possibility of stereotyping in the absence of accepted diagnostic procedures for establishing cultural orientation.

3. Caricature - Is a distortion of personality and/or psychopathology that occurs as a result of stereotyping.

Many clients and therapists are ethnocentric. This means that their view of things is that their own group is the center of everything and that all other groups are scaled down and rated with reference to it. If a person is a member of the dominant culture, and wants an individual or group to acculturate into your culture, you are saying that your culture is superior to their sub-culture. To believe this way is a characteristic of racism, of which there are three major types: (Aponte)
· Individual - consists of personal attitudes, beliefs, and behaviors
· Institutional - social policies, laws, regulations
· Cultural - society beliefs and customs that promote the idea that the dominant culture is superior in all ways.
Ethnocentrism and racism inevitably result in prejudice, which refers to negative attitudes, thoughts, and beliefs toward an entire category of people. Since prejudice is an attitude or belief, it is not always evident in a person's behavior. "Counselors who unconsciously treat clients differently based on their racial/ethnic background may be doing so as the result of the unrecognized prejudices."(P. 11…Atkinson)
In the future we will need to focus on identifying those characteristic of traditional approaches that apply to all cultures. The diversity of subcultures within ethnic groups creates many problems for proponents of ethnic-specific norms for psychological tests and culture-specific diagnostic procedures or criteria. If the importance of sub-cultural identity was determined as an important factor to be considered in therapy, we would eventually have separate test forms (differing in item content, language idioms, and norms) and different diagnostic criteria might be required for each distinct minority subculture. "The failure to incorporate culture-specific tests into the assessment curriculum has further reduced the likelihood of providing acceptable services for these populations. In the absence of cultural competence, the practice of standard psychological assessment has unforeseen consequences. These may include not only faulty diagnosis, but also caricature and distortion in personality description by minimizing differences and stereotyping client behaviors." (Aponte)
More therapist need to be aware of the major modes of acculturation utilized by members of ethnic minority groups:
· Assimilation: Relinquish ethnic and assume majority identity
· Integration: Maintain ethnic and incorporate majority identity
· Marginalization -Lack of identification with both ethnic and majority groups.
There are also five possible cultural orientations that are important to distinguish:
1) Traditional Orientation - a retention of an original culture
2) Nontraditional - assimilation into the dominant culture
3) Bicultural- retained many aspects of their original culture while simultaneously functioning in a manner acceptable to and understood within the dominant culture
4) Transitional - where one begins to question traditional religion and values
5) Marginality - rejects substantial segments of both the original and the dominant society cultures.
We must always consider the patient's degree of assimilation by and acculturation into the majority group. (Up to 77% of black college students are estimated to be culturally assimilated, which usually takes three generations.) The counselor needs to understand both the client's cultural heritage and the degree to which the client identifies with his/her cultural heritage.
Ramierez points out in his work with Hispanics that we must sensitize the counselors to the life experiences and the with-in group differences of their clients. And the counselors must also aware how counseling has generally failed to meet the mental health needs of racial and ethnic minorities in the past, and that there are new directions for counseling minorities being developed.

How to deal with these issues: (Aponte)

1) Introduce the topic of race/ethnicity and its possible impact at the onset
2) Hopefully, it will lead to an exploration of the patients attitudes about and difficulties with ethnic conflict and ethnic identity, if there are any.
3) Or, you could wait for them to bring it up.
Haley, 1976, Suggested several important stages in the first interview. I believe this is important in an orientation to work with each client as a distinct individual instead of as a member of any stereotyped group. His first stage is the Social or Joining Stage. The purpose here is to develop trust and rapport. This is followed by the Problem, Interaction and Goal-Setting Stages, where one gathers information about the presenting problem and how it is affected by the values of the family and the therapist. Each of the stages are affected by the family's historical experience, social support network, value system, and means of communication. (Sue, 1996)
It can easily be argued that American "racial" categories are meaningless, too constrictive, illogical, and confusing, and may have adverse effects on ethnic group members, but for the social scientist this categorization is still required for heuristic purposes. There is a strong feeling among many individuals that there is a rich diversity in individual differences that exists within each of these groups, as well as across groups, that must be recognized and supported. According to one source, it is estimated that about 40% of the clients in the mental health service system will be members of ethnic minority groups in the year 2000. (Sue)
Sue has predicted that assessment during the next century will emphasize individual differences, using new types of tests to measure mental abilities and personality in the form of “specific psychological styles and predispositions,” within the general non-pathological population.” The sooner this prediction comes true, the sooner we will have moved into a new and enlightened era of counseling with all human beings, regardless of what label they are designated, by themselves or others.


References
Abreu, Jose M. (1996). Conscious and non-conscious African American stereotypes: Impact on first impression and diagnostic ratings by therapists. Journal of Counseling & Clinical Psychology, 1999 Jun Vol 67(3) 387-393.
Aponte, Joseph F. Robin Young Rivers, Julian Whole. (1995). Psychological Interventions and Cultural Diversity. Needham, Mass.: Simon & Shuster,
Atkinson, Donald R., and associates. (1993). American Minorities: A Cross-Cultural Perspective. Dubuque, IA: W. C. Brown.
Briones, D.F., and associates. (1990). Socioeconomic status, ethnicity, psychological distress, and readiness to utilize a mental health facility. American Journal of Pschiatry, 147, 1333- 1340.
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Gaw, Albert C. (Ed.). (1993a). Culture, ethnicity, and mental illness. Washington, DC: American Psychiatric Press.
Malgady, R. G. (1996). The Question of Cultural Bias in Assessment and Diagnosis of Ethnic Minority Clients: Let’s Reject the Null Hypothesis. Professional Psychological Research and Practice. Feb. 1996 Vol. 27, No 1, 73-77.
Malgady, R.G., Rogler, L. H., Costantino, G. (1987). Ethnocultural and linguistic bias in mental health evaluation of Hispanics. American Psychologist, 42,228-234.
Ramierez, M. (1991). Psychotherapy and Counseling With Minorities. New York: Pergamon Press.
Ryan, C., Judd, C. M. (1996). Effects of Racial Stereotypes on Judgments of Individuals: Moderating Role of Perceived Group Variability. Journal of Experimental Social Psychology, Vol. 32, No. 1, Jan 1996, pp. 71-103.
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Sue, D. W., Ivey, A. E., Pedersen, P. B. (1996). A Theory of Multicultural Counseling and Therapy. Pacific Grove, CA: Brooks/Cole Publishing Company.
Wolsko, C., Park, B., Judd, & C. M., Wittenbrink. (2000). Framing interethnic ideology: Effects of multicultural and color-blind perspectives on judgments of groups and individuals. Journal of Personality & Social Psychology, 2000 Apr Vol. 78(4) 635-654.


"African Americans have complex networks involving immediate kin, several generations of relatives, and close friends residing in the same household." (Briones, 1990, page 30) "..a denial of one's ethnic identity can be seen as an indicator of psychopathology." (Aponte) These are the types of generalizations, which he as a person of partially-African descent cannot relate to, that has prompted the writing of this paper.