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Alaskan Cross-Culture: Native Behavioral Health
Validation of client identity and worldviews. Many practioners have noted that cultures are distinguished by distinctive sets of values end worldviews(Carter, 1991;Ibrahim, 1985, 1991;Sue&Sue, 1990). These perspectives help to shape clients' experience, forming a crucial part of racial and cultural identity (Helms, 1985, 1990; Parham, 1990). Recognizing that the dominant culture often devalues client worldviews and impairs the process of identity development, multicultural counselors are especially concerned with client validation and empowerment (Sue & Sue, 1990). This means that therapists must possess an awareness and knowledge of cultural differences, as well as skills that enable them to work within client frameworks (Pedersen, 1988; Sue et al., 1992).
Attention to the social context of presenting complaints. Many multicultural perspectives emphasize the role of "difference" in the genesis of client problems (Ramirez, 1991; Sue & Sue, 1990). Clients from ethnic and racial minorities have typically experienced expressions of prejudice, ranging from separatism and antilocution to discrimination and physical attack (Ponterotto, 1991). Indeed, multicultural counselors emphasize that it is the lack of fit between the minority client and the dominant culture--and not deficits internal to the client--that often generate presenting complaints (Ramirez, 1991). For this reason, multicultural therapists often function as social ecologists (Aubrey & Lewis, 1988; Conyne, 1987), addressing the needs of social systems as well as individuals (Herr, 1991).
Attentiveness to client distrust. Vontress (1988) noted:
Such distrust may, in fact, account for why mental health utilization rates are lower and dropout rates are higher among minority clients (Poster, Craine, & Atkinson, 1991). An important skill of multicultural counseling is the ability to work nondefensively with this distrust and to build an effective therapeutic alliance (Pedersen, 1988). Ramirez (1991) described the multicultural counselor's stance as one of empathy projection "trying to understand the point of view and the feelings of someone whose values and cognitive styles may be very different from those of the therapist" (p. 54).
Brief and Multicultural Counseling: Diverging Assumptions
Locus of client problem. An overview of the major approaches to brief therapy reveals that they tend to be derived from mechanistic and organismic developmental models that stress the acquisition of skills and insights (see Lyddon, 1989, for a review of developmental counseling models). These approaches view problems as internal to clients, resulting from the learning of maladaptive behaviors and cognitions and the disowning of important facets of the self. Multicultural approaches, conversely, are derived from contextualist models of development (Steenbarger, 1991) that posit problems as a function of poor person environment fit. Thus, client problems are not intrapsychic in this view, but instead are derived from a fundamental tension between the demands and resources of the environment and the needs of the individual (Herr, 1991). As Ivey (1985) noted, multicultural approaches inevitably address person and environment, including strategies for social as well as individual change. Brief therapies, in their relatively individualistic, intrapsychic conceptualizations, run the risk of disempowering clients by denying social causation and by blaming victims (Ivey, 1985; Pedersen, 1987).
Criteria of client inclusion. Brief therapies tend to target "high functioning" individuals who display circumscribed complaints of recent onset and who are capable of forming a rapid therapeutic alliance (Steenbarger, 1992a). Multicultural approaches, however, draw no such inclusive boundaries and, indeed, assume that clients will not be able to form a ready alliance because of past experiences with prejudice and oppression (Sue & Sue, 1990). Whereas brief therapies tend to view difficulties in alliance formation in terms of client "pathology," multicultural approaches link these to such contextual factors as economic status and social class (Vontress, 1988). This difference may help to account for the observed tendencies of helping agencies to exclude minority clients from desirable forms of psychological treatment (Atkinson, 1985).
Therapeutic methods. Brief therapies, by their very nature, tend to be time bound, stressing the rapid creation of a change focus and an active, catalyzing, hands-on approach to change (Koss & Butcher, 1986; Steenbarger, 1992a). Multicultural counseling, on the other hand, does not necessarily adhere to Western conceptualizations of time (Carter, 1991; Sue & Sue, 1990), emphasizing being as well as doing (Vontress, 1985). Indeed, whereas brief approaches often seek an alliance within the first few sessions, multicultural models devote significant time to exploring client worldviews (Ibrahim, 1985). Similarly, although many brief therapies tend to be challenging and confrontational (Steenbarger, 1992a), multicultural modalities stress a matching of counselor-client communications as a primary intervention strategy (Pedersen, 1988; Sue & Sue, 1990).
Therapeutic aims. A distinctive theme linking the brief therapies is that deficient aspects of client worldviews--cognitions, self-schemata, and interactional patterns--are responsible for presenting complaints. The role of the helping relationship is to challenge these views and generate more adaptive patterns of action and understanding (Steenbarger, 1992a). Alternatively, multicultural therapies seek to validate client worldviews as part of the cultivation of a multicultural identity (Helms, 1986; Parham, 1989; Pedersen, 1988). Thus, symptom relief and pattern change are less central to multicultural counseling than are empowerment and identity development.
Reflection Exercise #4
Peer-Reviewed Journal Article References:
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