Cross-Cultural Counseling: Middle Eastern, South Asian, and Native Americans

Introduction

No longer a melting pot but more like a salad bowl, the United States has always been a land of immigrants, and its diverse demographic composition today is a reflection of that ongoing process. In fact, just one group — Native Americans — can be regarded as the original inhabitants, though anthropologists argue that even these peoples likely migrated from other continents tens of thousands of years ago, making them immigrants in a sense as well. Three groups in particular stand out in the American demographic mix as being in need of thoughtful attention in cross-cultural counseling situations: Middle Eastern Americans, South Asian Americans, and Native Americans. To determine what counselors need to know in order to develop effective interventions for members of these three groups, this paper provides a review of the relevant literature, followed by a summary of the research and important findings in the conclusion.

Middle Eastern Americans

Middle Eastern Americans are perhaps the most misunderstood and maligned group of "hyphenated Americans" in recent years, particularly following the terrorist attacks of September 11, 2001. Rogers (2009) emphasizes that one of the most significant effects of the 9/11 attacks was the groundswell of negative reactions that emerged across the country. According to Rogers, "Among the most significant reactions that resulted were dramatic increases in feelings of anger toward, and workplace discrimination against, Muslims and those perceived to be from Middle Eastern cultures" (2009, p. 25). These feelings of anger were further reinforced as the beheadings of American and British citizens were widely publicized in the global media by ISIS.

These events have had significant implications for Middle Eastern Americans in the workplace. When mainstream Americans witness such events on television or other media, existing fears are reinforced and new ones are generated about people from the Middle East. Rogers (2009) reports that "Employers began implementing more visible corporate security precautions and background and security checks. Underlying all these actions and emotions was an unspoken understanding that a potential employee who fit the stereotypical description of a Muslim could harbor terrorist intentions" (p. 27).

Middle Eastern Americans are defined as the collective group of 22 Arab League States: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, the State of Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen (Nassar-McMillan & Zagzebski-Tovar, 2012). The fundamental differences between the Western world and the Arab world did not spring into full bloom on 9/11, but have rather been a source of division for centuries. According to Nassar-McMillan and Zagzebski-Tovar (2012), "Conflicts between the United States and the Arab Middle East have been characterized as rifts between east and west, capitalizing on differences rather than similarities among people and overlooking the common human elements in individuals' hopes, dreams, aspirations, and values" (p. 72). Despite the enormous volume of media coverage of the Arab world in recent years, significant misconceptions concerning Middle Eastern Americans remain firmly in place in the minds of tens of millions of Americans. Nassar-McMillan and Zagzebski-Tovar (2012) therefore emphasize that "it is important for culturally sensitive career counselors to be aware of distinctions, subtle as they may seem, in order to best understand clients who are of Arab-American descent" (p. 73).

The first distinction involves the important difference between the terms "Middle Eastern" and "Arab," which are not synonymous. The term "Middle East" as popularly conceptualized in the West refers to an enormous geographic area that is larger than the League of Arab States but does not fully encompass all of the states of the Arab League, which includes countries in Asia as well as countries in northern and sub-Saharan Africa (Nassar-McMillan & Zagzebski-Tovar, 2012). As Nassar-McMillan and Zagzebski-Tovar (2012) point out, "The Middle East, in fact, includes countries such as Afghanistan, Pakistan, and Turkey, to mention a few, that are not Arab countries by any definition" (p. 74). Nevertheless, the term "Middle East" has been used by the U.S. Census Bureau and other organizations since September 11, 2001 to refer to people from — and with ancestry from — the Middle East as well as the Arab States (Nassar-McMillan & Zagzebski-Tovar, 2012).

Another important distinction concerns the difference between the terms "Muslim" and "Arab," which are frequently used interchangeably but are, again, not synonymous (Nassar-McMillan & Zagzebski-Tovar, 2012). According to Nassar-McMillan and Zagzebski-Tovar (2012), "The motivation at times for the lack of differentiation of these two groups is, again, political, which at times can be either detrimental or beneficial to the Americans of Arab descent (AAD) population" (p. 73). Consequently, it is important for counselors to avoid assigning all clients from Arab nations a Muslim, Middle Eastern American label. As Nassar-McMillan and Zagzebski-Tovar (2012) conclude, "In counseling, it is critical to distinguish Muslim and Arab clients" (p. 74). Rather than making erroneous assumptions concerning the religious, cultural, social, and political views of clients who may appear to be of Arab descent, counselors should develop a comprehensive understanding of the facts about their individual clients. As Nassar-McMillan and Zagzebski-Tovar (2012) explain, "Some may be Muslim Arabs (or Arab Americans, or AAD), but others may be AAD but be non-Muslim, while many others still might be Muslim with countries of origin in the greater Middle East or elsewhere entirely" (p. 74).

According to the World Bank, South Asia is comprised of Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka and, with 1.4 billion people, contains half of the world's population (South Asia countries, 2014). Like the term "Middle Eastern Americans," South Asians comprise a separate group from other Asians, and it is important for counselors to avoid grouping all Asians together under a single umbrella term. As the authors of Culturally Alert Counseling emphasize, "It is particularly important that counselors, while being culturally sensitive and aware of different cultural norms and expectations, do not use these similarities among South Asians to stereotype their clients" (p. 318).

South Asian Americans

Some indication of the current status of South Asian Americans can be discerned from how this group is perceived in relation to other immigrant groups. Burke and Chauvin (2005) suggest that in contrast to other "hyphenated American" groups, "Asian immigrants have not been welcome in the United States" (p. 171). As examples, Burke and Chauvin describe the prevailing perceptions of other demographic groups in comparison: European Americans have been accepted as conquerors; African Americans are accepted as people who were severely wronged; Native Americans are accepted as the original people of the land; most Latino Americans are accepted as colonized people; but Asian Americans have not been accepted because of cultural and certain racial differences (2005, p. 171).

Among all immigrant groups, South Asians have especially been singled out as targets of exclusionary tactics by the U.S. government for more than 150 years (Burke & Chauvin, 2005). According to Burke and Chauvin, "Some authors believe that these injustices may live in the psyche of South Asian Americans and influence their trust of mainstream American society" (p. 171). Although the Asian Exclusion Act of 1924, which outlawed Asian immigration to the United States, is no longer in effect, the patterns of treatment it embodied may have a residual effect on the consciousness of South Asian Americans in ways that inevitably affect the counseling relationship. Burke and Chauvin point out that "counselors and mental health professionals must have some knowledge of the history of this cultural group in order to be able to walk with their clients on the journey toward wholeness" (2005, p. 172).

Unfortunately, there remains a profound dearth of relevant and timely literature concerning South Asian Americans and counseling (Dasgupta, 2007). The research conducted to date has largely focused on two separate issues: (a) South Asian American community attitudes toward mental illness and (b) South Asian American community attitudes toward mental health services (Dasgupta, 2007). According to Dasgupta, "A few recently published works have attempted to develop theoretical frameworks on these topics, presumably to assist in developing culturally competent therapeutic practices, and reflect themes of silence and shame in the community discourse on mental health issues" (2007, p. 82). For instance, studies have shown that stigma and shame are linked with mental health problems in India, and because many Indians have immigrated to the United States in recent decades, counselors are likely to encounter clients who "have retained some traditional Indian beliefs about mental illness" (Dasgupta, 2007, p. 83).

Moreover, South Asian Americans have also been found to hold negative views concerning Western psychological counseling and, as a group, tend to underutilize mental health care services (Dasgupta, 2007). Three major explanations have been advanced for these conditions. First, many South Asian Americans have achieved significant financial success, and community members are focused on maintaining cultural integrity and cohesion, as well as a positive external image, which requires a degree of denial of "unpleasant" issues such as mental illness. Second, a "cultural proscription" discourages South Asian Americans from discussing intimate problems and emotional difficulties with anyone outside the family, because the family is viewed as the primary and most appropriate support structure for individuals. Third, a lack of awareness and education about the complex dimensions of mental health problems has resulted in stigmatization of psychopathology within the community, such that seeking counseling is viewed as a sign that a person is mentally ill — an acknowledgment that may stigmatize both the individual and their family (Dasgupta, 2007, p. 82).

To their credit, Asian Americans in general and South Asian Americans in particular have succeeded in weathering and even overcoming these perceptions through academic endeavor, hard work, and thrift, contributing to a strong sense of self and culture even when transplanted to the United States or elsewhere. As the authors of Culturally Alert Counseling note, "Immigrants and first-generation South Asians have a strong ethnic identity wherever they are in the world and are aware of the differences between them and the host culture. They do not feel that they have to deny such differences because their ethnic pride is extremely strong" (p. 326).

Conclusion

The research showed that Middle Eastern Americans, South Asian Americans, and Native Americans have all taken very different paths to their current place in American society, with each group experiencing distinct challenges to assimilation into the mainstream. Beyond the powerful stereotypes that surround these groups, there are significant cultural realities that constrain their willingness to participate in counseling. In some cases, strong cultural prohibitions exist against seeking mental health services — stemming from fear of being labeled "insane" and the associated stigma, or from a fundamental distrust of Western authority figures and healthcare practitioners. In every instance, the research demonstrated that effective cross-cultural counseling requires significant effort on the part of counselors to learn about the cultures and values of the people they encounter in their professional practices.