Cultural competency and gender roles in cross-cultural counseling relationships

Racial Identity

Complexities and Potential in Cross-Cultural Counseling

In 1897 the French sociologist Emile Durkheim wrote about the influence of culture on suicide rates among different groups. He found that while suicide seems to be the most private and most individualistic choice that a person can make (what could be more private than the dialogue that an individual has with eternity, after all) cultural values still hold sway. His research has been criticized over the decades, but its central point remains valid. Culture seeps into every level of both our conscious and unconscious behaviors, and therefore must be attended to in every aspect of the therapeutic process. However, while at least most therapists as well as most of those individuals studying to become therapists are certainly aware of this fact, this awareness does not necessarily translate into sufficient care taken to minimize the harm that cross-cultural misunderstandings or blindnesses that can occur between a therapist and a client.

Before proceeding to examine some of the specific topics that this chapter will address, it will be useful to make a few general comments about the ways in which cross-cultural counseling provides challenges that no other variety of counseling does. There are several primary reasons for this. The first is that when the counselor and the client come to the relationship with different world views there will necessary be friction, in no small part because the two are unlikely to have considered the precise nature of those differences.

Most of us believe that our culture is the "normal" one, even the best and most correct one. Culture for the individual is very similar to water to a fish in that it is both vital and invisible. Each one of us from nearly the moment of birth onward is both implicitly and explicitly taught what is acceptable and what is not according to the culture in which s/he lives. This inculcation has occurred for both client and therapist, and the best way to create the most productive and, indeed, therapeutic, relationship is for both parties in the consulting room to understand the ways in which their own cultural perspective can be used in aid of the therapeutic process rather than to let these differences impede the ongoing relationship that is central to any productive therapeutic relationship.

A general example of this phenomenon would be different understandings of proper gender roles. If the therapist has a Western feminist perspective on gender roles within a heterosexual marriage, she will be inclined to see extreme gender differences that privilege the husband as being problematic. If she brings this up to the couple and they both state that this is the way in which they both conceive of the best marriages to be structured, the therapist may not believe this claim and may continue to try to push both of the clients into a more equal marriage. (Of course, it is also possible that there are differences between the couple on the way in which a marriage should be constructed, and in this case the therapist should -- gently -- help the couple to understand the nature of these differences.)

The above is just one of the many potential conflicts that can arise in cross-cultural counseling. Sue et al. (1996) summarize this as they put forth an entirely new model for multicultural counsel. Not only does multicultural counseling require changes in the daily, ongoing interactions between therapist and client, but these interactions have to be connected to a new theoretical model since multicultural counseling can be considered to be radically different from previous models of counseling.

Sue et al. (1996) argue that all of the then-current theories about counseling practices. Those practices, they wrote, were embedded in a theoretically with both implicit and explicit beliefs garnered from dominant culture. The authors posit that a truly effective between a therapist and a client from dramatically different cultures cannot be established without the therapist's performing an "assumption audit" that allows the therapist to begin to construct for herself a theoretical model that is more flexible.

Pederson (1994) provides a sufficiently broad definition go cover all of the aspects of multicultural counseling:

[E]thnographic variables such as ethnicity, nationality, religion and language; demographic variables such as age, gender and place of residence; status variables such as social, educational and economic; and affiliations including both formal affiliations to family or organizations and informal affiliations to ideas and a lifestyle' (p. 229).

A counselor who can incorporate these concerns will be able to create a close and valuable connection with his/her clients. A counselor who does not incorporate such considerations will be able to establish a relationship with clients from groups that tend not to enter therapy (Bimrose, 1996, p. 238).

Sue et al. (1996) wrote one of the first comprehensive theoretical models of multicultural counseling and so were responsible for setting forth the major principles that many therapists (as well as counseling programs) have since adopted. Their list of requirements for the most effective model of multicultural counseling is sufficiently long and detailed that it can seem intimidating to the individual beginning a career in counseling. These requirements, which are based on already-common models of culture and cultural identity formation that have been developed primarily within the context of anthropological rather than psychological research, include the following:

Culture is inevitably complex; this does not mean that it is chaotic. All cultures have an underlying order.

Modern society is becoming increasingly diverse, in large measure because of the forces of globalization. This will require all therapists to work with clients who are different from them culturally, ethnically, or racially.

Current training methods for therapists neglect to provide them with the tools needed to work with a diverse clientele.

A multicultural perspective should be considered to be as central as counseling as other orientations such as cognitive and psychodynamic approaches.

Not all cultures are defined by an individualistic perspective.

All learning about self- and group-identity occurs within their cultural context.

Every individual's cultural identity is dynamic and changes over time.

Whenever these conflicts do arise, it is the responsibility of the therapist to teach herself about the client's culture on her own, rather than require the client to become the teacher. (Although, inevitably, the client will tell the therapist things that help her come to a greater and more fundamental understanding of the way in which the lived-culture feels.) As the therapist becomes increasingly knowledgeable about the client's culture, she can use this knowledge to become far more effective with the client. And, by sometimes gently elaborating the differences between both their cultural perspectives, the therapist can help the client begin to question his/her assumptions in ways that can be helpful to the client.

When we look at the ways in which a therapist works with members of a specific ethnic/racial group, we can see the multiplicity of complexities that can arise. For the purpose of this paper, and to provide examples of therapeutic assumptions and practices, the hypothetical therapist is a white woman in her late forties. A committed Baptist, she considers herself to be racially tolerate because her church has a congregation that includes both African-Americans and Euro-Americans. She does not regularly interact with members of other races.

Because the therapist's experience with African-Americans takes place primarily within the context of church activities, she believes that African-American clients share her religious and moral views. She also believes that they share her understanding of what makes a well-adjusted family since her own views on this subject are for the most part on her religious beliefs. Because of her own concept of marriage, she frequently challenges her African-American clients who live in homes headed by single mothers. Not only does the therapist believe that all families should have two parents but she also believes that the husband should be the head of the household. As a consequence, her African-American clients often feel that she is scolding them rather than listening to them and that she entirely dismisses the strengths of the ways in which African-American extended families and communities are structured.

Her African-American clients also conclude that the therapist has little understanding of what it is like to be a racial minority in the United States, and moreover has little interest in learning about the clients' experiences. The clients would be much better served if the therapist were open in this case about their differing experiences by acknowledging this and by asking the client to be as straightforward as possible in helping the therapist understand the experience of belonging to a racial minority.

As is true for all of the groups of clients that are being discussed in this chapter, we must remember that we are making broad generalizations about both the therapist and the client. There are important differences between therapists in terms of their own experiences and perspective; this is, of course, even more true for a group of clients. One thing that each therapist working in a cross-cultural context must remember is not to generalize: A male, highly educated Muslim African-American who grew up in Ontario will have a fundamentally different view of the world and of what it means to be black than does a young African-American Southern Baptist woman working to come to turns with the fact that she is gay.

African-Americans are -- because of a complex and iterative series of social, economic, and cultural conditions -- generally less educated, less wealthy, and less healthy than white or Asian-American individuals. Reponses to the feelings of anger and/or hopelessness that result from ongoing poverty and lack of opportunities in some African-Americans is linked to a high level of drug and alcohol abuse, gang membership and violence, and involvement in the criminal justice system. Any one of these can lead to early death, especially for young black men. A therapist who does not understand the social stresses faced by her African-American client may, at least unconsciously, blame her client's own behavior instead (Jones, 1985).

Most African-Americans are not addressing acculturation or immigration issues because they are likely to have been in the United States for many generations.

Counseling American Indians

The proviso in the above section on not treating all African-American clients as if they had the same experiences and reference points must be multiplied many fold for counseling with American Indians, many of whom will see themselves as belonging to different ethnicities and possible races than members whose families have other tribal affiliations. The entire idea of American Indians as a single race is one that has arisen from government designations and not from the perspectives of any individuals in American Indian communities. To designate a Navajo man who grew up on the tribe's reservation and converted to Judaism on his marriage because Navajo men follow their wives' faith is likely to have very little in common with a rich Seminole woman who is receiving substantial payments from tribal gambling.

African-Americans generally consider themselves to be black, despite the fact that family history and the wide range of phenotype make it clear that most African-Americans are multiracial. However, for American Indians, the definition of race and ethnicity is far more complicated and nuanced and bound up with legalities in ways that are disjointed from the experiences of African-Americans. (African-Americans were previously "graded" by how much "African blood" each had, but this practice is no longer common.) Individuals are told by their tribal governments whether or not they "count" as an Indian due to a range of criteria, criteria that can change over time. Thus a person whose ancestry does not come entirely from one Indian group is subject to being told that s/he is no longer the race long affiliated with.

The legal shakiness of their ethnic identity (which has been greatly exacerbated by the wealth brought to the members of certain tribes by Indian gaming) is one of the reasons that drug and especially alcohol use are extremely high for many American Indians, as is suicide. Other conditions, including poverty and lack of opportunities for education and jobs, common to the lives of many American Indians also substantially increase the stress under which they live.

Our therapist could find herself making a number of mistakes in working with an American Indian client. Among the most likely to occur are not being careful to differentiate among different American Indian groups and romanticizing the conditions under which American Indians lives. (This latter is a continuation of the historical trend of characterizing American Indians as the Noble Savage.) She is also unlikely (as was the case with her African-American clients) to be able to establish an effective relationship with American Indian clients.

To be effective, this therapist must consider the following when working with American Indian clients:

American Indian social and psychological perspectives concerning the process and theory of counseling are contrasted with the individualistic focus, style, and outcomes of therapy as practiced in America today….The under use of mental health services by American Indian is associated with the tension surrounding power differentials in counseling relationships and perceived conflicting goals for acculturation between counselors and Indian clients. LaFromboise, Trimble, & Mohatt, 1990, p. 628)

Counseling Latino/as

Latinos are an increasing part of the American population, which ensures that many therapists (especially those working in the Southwestern and Western parts of the country) are likely to work with Latino clients. Latino clients too are often committed to a family-oriented perspective rather than an individualistic one, which can make it difficult for a therapist to untangle needs when those of the client are different from other family members. When a client believes that his/her health or happiness should be subsumed to that of the family, the client and the therapist may become engaged in a psychic struggle over what health and happiness mean given that in any family there are conflicting vectors.

Latino/s clients are often from families that have recently immigrated to the United States and many of their families are likely to have members who are undocumented. This leads to a situation in which a shadowy legal status creates high degrees of uncertainty and stress, which in turn can lead to drug use. Even when all members of a family are in the United States legally, there are the stresses faced by immigrant families along intergenerational lines.

Because there are so many Latino/as in the United States, many of them can live in neighborhoods where they are the majority ethnic group. This makes the pressures to become "American" or to retain their original identity more complex than it is for other immigrant groups, and can increase pressure on those members of a family who wish to become more American. This tends to be the young women in families that value patriarchal family structures. These young women may wish for greater sexual freedom, which in turn may affect their relationship with their Catholic faith.

For many Latino/as, the language with which they are most comfortable is Spanish, which also affects their relationship with therapists. Since there are relatively fewer Spanish-speaking therapists, there may be no counselor who literally speaks "their language." Our hypothetical therapist does not speak Spanish; moreover, she thinks that all immigrants should learn English and that those who speak another language are in part responsible for their own alienation from society. Because Latino/as are such a large immigrant group, the therapist cannot understand how Latino/as face racism, especially in a context where many people assume that they are illegally in the country (Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002, pp. 43-6).

Jewish-Americans and Arab-Americans

These two groups of clients have a very different relationship with the process of therapy despite key similarities between the two groups. Both are viewed as foreign by many Americans, no matter how many generations their families may have lived in the United States. Most Arabs (as well as Jews of course) belong to a minority religion, which makes them suspect by many who believe that America is a Christian country.

The longer a family has been in the United States, the more likely they are to face the stresses of immigration. Thus more Arab-American families will face issues around immigration and acculturation. How stressful this situation is in many ways dependent on where the family came from initially and how religious they are. Conservative Jews and Muslims both hold views of family life and gender that are generally far more conservative than the views held by other American groups, which is likely to cause considerable stress. Arab-Americans may be less inclined to react to this stress by drinking or using drugs because of religious prohibitions.

Arab-Americans face extremely high levels of suspicion, regardless of their country of origin or religion because they are often associated with Islamist terrorism. Having to live a marginalized life is extremely stressful. This is true for Orthodox Jews as well, since they can (like observant conservative Muslims) be distinguished by their clothing. More liberal Jews are likely to be less stressed by minority status since they can "pass" as "normal" Americans because they are not usually visually identifiable by race or ethnicity. Arab-Americans are much more easily identified by others, and thus face a more perilous daily existence.