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On the last track we discussed acculturative stress, as well as compared acculturative stress to "Culture Shock."
On this track we will discuss three common counseling microskills. We will also discuss the ethical need for modifying these three common counseling microskills in treating culturally different clients. Sound interesting?
Obviously there are a number of common counseling microskills that generally serve to accomplish the first leg of the therapy process, which is getting the client’s story in order to begin the development of a working alliance.
Ethics - Three Counseling Microskills for Treating Culturally Different Clients
However, probably like you, I have found that attending behaviors are culturally based. Obviously, in the dominant culture, an open posture and eye contact are signs of nondefensiveness. These two behaviors can be quite conducive in establishing an effective counseling relationship. However, of course, this does not apply to all cultures. A short case study will illustrate this.
Junji (june’-jee), age 12, had gotten in trouble in school. Junji kept talking to a student in the next desk during a math class. After several requests to stop and threats of punishment, the math teacher sent Junji to the assistant principal for discipline. The school counselor had also been summoned and observed the interaction. As the assistant principal, Charles, tried to communicate with Junji regarding his punishment, he noticed that Junji would not make eye contact and looked down frequently.
Charles was soon becoming frustrated with Junji regarding what he felt was a lack of respect, due to his lack of eye contact. Charles demanded that Junji look up when he was being spoken to. Do you see the problem with the way Charles tried to communicate with Junji? Obviously, in Asian cultures, direct eye contact is a sign of disrespect. A lowered head is, in fact, the common sign of respect in Asian cultures. How would you have handled communication with Junji? How would you have conveyed this to the assistant principal?
Celestina, 32 years old and of Puerto Rican descent, originally sought therapy to help her cope with the death of her sister, Marisol (mar-ee’-soul). Following Marisol’s death, Celestina was sure that evil spirits were trying to control her. How would you deal with a client claiming that he or she was influenced by evil spirits? Instinctively I thought to categorize Celestina as paranoid with poor reality testing.
However, I knew that Puerto Ricans have a common tradition called "espiritismo" (es-peer-eat-ees’-moh). Espiritismo is a worldview that understands one’s fate as determined by good and evil spirits existing outside oneself and warring with each other.
Can you see how treatment for paranoia and poor reality testing would have been inappropriate for Celestina? In Celestina’s case, the counseling microskill of clarification helped me to confirm the world view of espiritismo instead of incorrectly diagnosing the behavior. As you can see, when working cross-culturally, you, as the therapist, have the clinical and ethical obligation to use clarification to gain as much knowledge as possible about your culturally different client’s background.
Microskill #3: Reflection
For some clients from nondominant cultures, therapists are expected to be experts whose role is to tell the client what to do. Thus, counseling a client of another culture can be an ethical challenge as you negotiate a stance between empowering the client and not alienating the client. In addition reflection has a second dimension, which is the tendency to employ its use for facilitating the expression of affect on the part of the client. In some cultures, such as the Hispanic culture, emotional expression is highly valued. However, I have found that in other cultures, like the Asian culture, emotional expression is seen as a sign of weakness.
Thus using reflection in treating a Hispanic client may be appropriate, while using the same microskill in treating an Asian American may be culturally insensitive. Make sense?
What counseling mircoskills do you use in treating your culturally different client? The NBCC Code of Ethics states, "Through an awareness of the impact of stereotyping and unwarranted discrimination, that is, biases based on age, disability, ethnicity, gender, race, religion, or sexual orientation, certified counselors guard the individual rights and personal dignity of the client in the counseling relationship."
Do you use any of the three microskills of attending behaviors, clarification, and reflection that we discussed on this track? Do you take into account the importance of different attending behaviors when dealing with Asian American clients like Junji? Do you use clarification to better understand the cultural background and worldviews of your Hispanic clients like Celestina? What are the ethical implications of using the reflection microskill with your culturally different client?
On this track, we have discussed three common counseling microskills. These three common counseling microskills were attending behaviors, clarification, and reflection. We also discussed the ethical concerns raised by using these microskills in an unmodified manner with clients of a different culture.
On the next track we will discuss transference and countertransference as they relate to cross-cultural counseling. Regarding transference, we will discuss the traditional analytical framework of the primary caretaker as used in traditional counseling experiences, and compare it to the more appropriate cultural framework that may be necessary in cross-cultural counseling experiences. Regarding countertransference, we will discuss the importance of the therapist’s ability to recognize countertransference as well as the importance of admitting one’s own racist attitudes and ethnic stereotypes.
- Carter, R.T. & Qureshi, A. A typology of philosophical assumptions in multi-cultural counseling and training. In J.G. Ponterotto, J.M. Casas L.A. Suzuki & C.m. Alexander (Eds.), Handbook of multicultural counseling (pp. 239-262). Thousand Oaks, CA: Sage. 1995.
Ethics CEU QUESTION 5
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