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Immigrant & Refugee, Cultural Diversity & Ethical Boundaries: Freedom from Stereotypes
3 CEUs Cultural Diversity & Ethical Boundaries: Freedom from Stereotypes

Section 9
Clinical Social Work Practice with Ethnically Diverse Clients

Question 9 | Ethics CEU Answer Booklet | Table of Contents
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

In clinical social work the ethnicity of the clinician encounters the ethnicity of the client. Just as clinicians are affected by the client's family-of-origin issues, they also are uncomfortable to some extent with ethnic andsocial worker Cultural Ethics Boundaries psychology continuing education cultural differences. A challenge for clinicians is how to therapeutically use self with ethnically diverse clients while recognizing the effects of cultural differences.

In discussing ethnic-sensitive clinical practice, Pinderhughes (1989) consistently emphasized the importance of clinician comfort in working with clients' ethnic and cultural differences. To feel as comfortable as possible in cross-cultural work, clinicians need to be aware of and feel positive about their own ethnic and cultural identity (Pinderhughes, 1989). Pinderhughes stated that clinicians must monitor and manage their "feelings, perceptions, and attitudes mobilized as a result of one's clinical and cultural group status role" (p. 133) to practice effectively with ethnically diverse clients.

Desired outcomes of clinical social work include increases in self-esteem and empowerment for clients. Such outcomes can occur when the therapeutic discourse causes the client to have an empowered sense of self. Essential to this empowerment process is the client's feeling more connected to his or her ethnic identity. In taking a constructivist or narrative approach to clinical work with clients of color, clinicians must include ethnicity and issues of discrimination and powerlessness in the therapeutic discourse for such clients to successfully restory their lives. Howard (1991) stated that some examples of clinical work could be viewed as cross-cultural experiences in story repair. Clients develop new stories as models for future action (Laird, 1989).

Use of Self

A constructivist approach to therapy lends itself well to client empowerment and, thus, is well suited to cross-cultural clinical social work. A constructivist approach to therapy de-emphasizes therapeutic hierarchical power and control and emphasizes therapy as collaborative and empowering (Hoffman, 1988). Thus, from a constructivist perspective, the clinician does therapy with clients rather than to them.

Clinicians using a constructivist approach do not attempt to impose "reality" but rather facilitate through the therapeutic conversation the clients' construction of a more workable reality for themselves. This perspective can allow clinicians to transcend their discomfort arising from crosscultural differences with clients. According to Anderson and Goolishian (1988), a therapeutic conversation involves "a mutual search and exploration through dialogue, a two-way exchange, a crisscrossing of ideas in which new meanings are continually evolving toward the 'dissolving' of problems" (p. 372).

Coconstruction. Because reality is socially constructed, a constructivist therapist believes that there is no one truth but many possible explanations--multiple realities--for the phenomena under discussion (Cecchin, 1987). This belief allows the clinician to take a position of curiosity about which explanation fits the client rather than insisting on discovering the "truth" (Cecchin, 1987).

Lax (1992) stated that it is the clinician's job to join with clients "in the development of a new story about their lives that offers them a view that is different enough from their situation, yet not too different, to further the conversation" (p. 74). In this co-constructing process, clinicians and clients both contribute words and ideas. Clinicians continually translate the clients' words into their own and share these words with them to see if there is a match with the clients' language and interpretations (Lax, 1992).

During the therapeutic conversation the clinician may offer suggestions and ideas that build on what the client has said; the clinician presents them in a tentative way, leaving plenty of room for the client to come up with his or her own answers (Lax, 1992). The successful coconstruction of the client's story no longer includes the presenting problem.
Novelty. The clinical situation is more than an ordinary conversation between the social worker and client. The therapist must be skilled at facilitating the conversation in a therapeutic manner (Anderson & Goolishian, 1988). As a participant in the process of change, the therapist must interact with clients in a manner that results in the interruption of the problematic, repetitive patterns in which clients find themselves (Dowd & Pace, 1989; Fruggeri, 1992; Watzlawick, Weakland, & Fisch, 1974). Consequently, the clinician hears and feeds back to the client a slightly different perspective than the client's description of his or her situation; in this manner, the clinician introduces novelty to the client system (Lax, 1992).

The experience of "novelty" by the client as a result of the therapeutic conversation is integral to a constructivist approach (Anderson & Goolishian, 1992; Fruggeri, 1992). The clinician should have some guidelines for asking questions during the therapeutic conversation so that the client experiences such novelty in the coconstruction of a new reality (or a new story) that does not include the problem and the vicious cycles that maintain it.

Real (1990) pointed out "that the only behavior directly accessible to the therapist's control is the therapist's own behavior. How the therapist moves, the selections he makes, where he places his weight, so to speak, in other words his use of self, is the only tool available to him" (p.260). Given constructivism's emphasis on language and conversation in reality construction, the use of self in contributing to the process of empowering ethnically diverse clients involves bringing the issue of ethnicity into the therapeutic discourse in a way that allows the clinician to transcend any discomfort with cultural differences. The literature on operationalizing the use of self in general and with ethnically diverse clients in particular is limited. In response to a lack of literature on the operationalization of constructivist-systemic family therapy, Real (1990) developed five stances for guiding therapeutic use of self: eliciting, probing, contextualizing, matching, and amplifying. The following adaptation of Real's stances for the therapeutic use of self (found in Section 9 of the Manual) from a constructivistsystemic perspective provides a map for operationalizing such an endeavor with ethnically diverse clients.
- Greene, GJ, Jensen, C, & Jones D. Harper; A constructivist perspective on clinical social work practice with ethnically diverse clients; Social Work; March 1996; Vol. 41, Issue 2
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #5
The preceding section contained information about clinical social work practice with ethnically diverse clients.  Write three case study examples regarding how you might use the content of this section in your practice.

What do clinicians need to be aware of and feel positive about to feel as comfortable as possible in cross-cultural work?
Record the letter of the correct answer in the Answer Booklet.

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