Section I The Multiple Dimensions of Multicultural Counseling and Therapy

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1 Derald Wing Sue, David Sue Counseling the culturally diverse : theory and practice Preface xix Section I The Multiple Dimensions of Multicultural Counseling and Therapy Part I The Affective and Conceptual Dimensions of Multicultural Counseling/Therapy 3 Chapter 1 The Multicultural Journey to Cultural Competence: Personal Narratives 5 My Personal and Professional Journey as a White Person: Reactions to Counseling the Culturally Diverse: Theory and Practice Mark S. Kiselica 6 My Personal and Professional Journey as a Person of Color: The Heart and Soul of Counseling the Culturally Diverse Derald Wing Sue 16 Being Chinese American in a Monocultural Society 18 The College and Graduate School Years 20 First Job A Counseling Psychologist 21 Going into Academia 22 Work on Multicultural Counseling and Therapy 23 Expanding Social Justice Horizons 24 Implications for Clinical Practice 26 Chapter 2 The Superordinate Nature of Multicultural Counseling and Therapy 29 Theme One: Cultural Universality versus Cultural Relativism 31 Theme Two: The Emotional Consequences of "Race" 32

2 vi Contents Theme Three: The Inclusive or Exclusive Nature of Multiculturalism 33 Theme Four: The Sociopolitical Nature of Counseling/Therapy 34 Theme Five: The Nature of Multicultural Counseling Competence 35 A Tripartite Framework for Understanding the Multiple Dimensions of Identity 36 Individual and Universal Biases in Psychology and Mental Health 40 The Impact of Group Identities on Counseling and Psychotherapy 41 What Is Multicultural Counseling/Therapy? 42 What Is Cultural Competence? 43 Competency One: Therapist Awareness of One's Own Assumptions, Values, and Biases 44 Competency Two: Understanding the Worldview of Culturally Diverse Clients 44 Competency Three: Developing Appropriate Intervention Strategies and Techniques 45 Multidimensional Model of Cultural Competence in Counseling 48 Implications for Clinical Practice 51 Part II The Political Dimensions of Mental Health Practice 53 Chapter 3 The Politics of Counseling and Psychotherapy 55 The Diversification of the United States 59 The Graying of the Workforce and Society 59 The Feminization of the Workforce and Society 60 The Changing Complexion of the Workforce and Society 61 The Education and Training of Mental Health Professionals 64 Definitions of Mental Health 66 Curriculum and Training Deficiencies 70 Counseling and Mental Health Literature 71 Minorities and Pathology 71 Relevance of Research 75 Implications for Clinical Practice 76

3 Contents vii Chapter 4 Sociopolitical Implications of Oppression: Trust and Mistrust in Counseling/Therapy 79 Effects of Historical and Current Oppression 84 Ethnocentric Monoculturalism 84 Historical Manifestations of Ethnocentric Monoculturalism 88 Therapeutic Impact of Ethnocentric Monoculturalism 91 Credibility and Attractiveness in Multicultural Counseling 93 Counseling as Interpersonal Influence 94 Psychological Sets of Clients 95 Therapist Credibility 98 Implications for Clinical Practice 102 Chapter 5 Racial, Gender, and Sexual Orientation Microaggressions: Implications for Counseling and Psychotherapy 105 By Derald Wing Sue & Christina M. Capodilupo Racism, Sexism, and Heterosexism 107 The Evolution of Racism, Sexism, and Heterosexism: Microaggressions 110 The Dynamics and Dilemmas of Microaggressions 112 Therapeutic Implications 121 Implications for Clinical Practice 124 Part III The Practice Dimensions of Multicultural Counseling/Therapy 131 Chapter 6 Barriers to Multicultural Counseling and Therapy 133 Characteristics of Counseling/Therapy 137 Generic Characteristics of Counseling/Therapy 137 Culture-Bound Values 140 Focus on the Individual 141 Verbal/Emotional/Behavioral Expressiveness 142

4 viii Contents Insight 143 Self-Disclosure (Openness and Intimacy) 145 Scientific Empiricism 146 Distinctions between Mental and Physical Functioning 146 Ambiguity 147 Patterns of Communication 147 Class-Bound Values 148 Language Barriers 151 Generalizations and Stereotypes: Some Cautions 153 Implications for Clinical Practice 154 Chapter 7 Culturally Appropriate Intervention Strategies 157 Communication Styles 160 Nonverbal Communication 162 Sociopolitical Facets of Nonverbal Communication 169 Nonverbals as Reflections of Bias 170 Nonverbals as Triggers to Biases and Fears 172 Counseling and Therapy as Communication Style 176 Differential Skills in Multicultural Counseling/Therapy 177 Implications for Multicultural Counseling/Therapy 178 Implications for Clinical Practice 181 Chapter 8 Multicultural Family Counseling and Therapy 183 Family Systems Counseling and Therapy 189 Issues in Working with Ethnic Minority Families 190 Ethnic Minority Reality 190 Conflicting Value Systems 191 Biculturalism 192 Ethnic Differences in Minority Status 192 Ethnicity and Language 195 Ethnicity and Social Class 196

5 Contents ix Multicultural Family Counseling/Therapy: A Conceptual Model 196 People-Nature Relationship 197 Time Dimension 199 Relational Dimension 201 Activity Dimension 203 Nature of People Dimension 204 Implications for Clinical Practice 205 Chapter 9 Non-Western Indigenous Methods of Healing: Implications for Counseling and Therapy 209 The Legitimacy of Culture-Bound Syndromes: Nightmare Deaths and the Hmong Sudden Death Phenomenon 211 Causation and Spirit Possession 214 The Shaman as Therapist: Commonalities 215 A Case of Child Abuse? 216 The Principles of Indigenous Healing 219 Holistic Outlook, Interconnectedness, and Harmony 222 Belief in Metaphysical Levels of Existence 223 Spirituality in Life and the Cosmos 225 Implications for Clinical Practice 228 Part IV Racial/Cultural Identity Development in Multicultural Counseling and Therapy 231 Chapter 10 Racial/Cultural Identity Development in People of Color: Therapeutic Implications 233 Racial/Cultural Identity Development Models 235 Black Identity Development Models 236 Asian American Development Models 239 Latino/Hispanic American Identity Development Models 240

6 x Contents A Racial/Cultural Identity Development Model 242 Conformity Stage 242 Dissonance Stage 246 Resistance and Immersion Stage 248 Introspection Stage 249 Integrative Awareness Stage 251 Therapeutic Implications of the R/CID Model 252 Conformity Stage: Therapeutic Implications 253 Dissonance Stage: Therapeutic Implications 254 Resistance and Immersion Stage: Therapeutic Implications 255 Introspection Stage: Therapeutic Implications 256 Integrative Awareness Stage: Therapeutic Implications 256 Implications for Clinical Practice 257 Chapter 11 White Racial Identity Development: Therapeutic Implications 259 What Does It Mean to Be White? 259 The Invisible Whiteness of Being 262 Understanding the Dynamics of Whiteness 263 Models of White Racial Identity Development 265 The Hardiman White Racial Identity Development Model 266 The Helms White Racial Identity Development Model 269 The Process of White Racial Identity Development: A Descriptive Model 276 Implications for Clinical Practice 282 Part V Social Justice Dimensions in Counseling/Therapy 285 Chapter 12 Social Justice Counseling/Therapy 287 Social Justice Counseling 292 Understanding Individual and Systemic Worldviews 293 Locus of Control 294

7 Contents xi Locus of Responsibility 296 Formation of Worldviews 297 Internal Locus of Control (IC)-Internal Locus of Responsibility (IR) 298 External Locus of Control (EC)-Internal Locus of Responsibility (IR) 300 External Locus of Control (EC)-External Locus of Responsibility (ER) 302 Internal Locus of Control (IC)-External Locus of Responsibility (ER) 303 Multicultural Organizational Development (Meso Level) 305 Culturally Competent Mental Health Agencies 306 Systemic Change (Macro Level) 309 Antiracism as a Social Justice Agenda 310 Social Justice Requires Counseling Advocacy Roles 311 Section II Multicultural Counseling and Specific Populations Part VI Counseling and Therapy Involving Minority Group Counselors/Therapists 315 Chapter 13 Minority Group Therapists: Working with Majority and Other Minority Clients 317 The Politics of Interethnic and Interracial Bias and Discrimination 318 Multicultural Counseling in Minority-Majority and Minority-Minority Relationships 321 Therapist-Client Matching 322 Communication Style Differences 324 Issues Regarding Stage of Ethnic Identity 325 Ethnic Minority and Majority Therapist Perspectives 326 Implications for Clinical Practice 327

8 xii Contents Part VII Counseling and Therapy with Racial/Ethnic Minority Group Populations 329 Chapter 14 Counseling African Americans 331 African American Values, Research, and Implications for Counseling and Therapy 332 Family Characteristics 332 Kinship Bonds and Extended Family and Friends 334 Educational Orientation 335 Spirituality 336 Ethnic or Racial Identity 337 African American Youth 337 Racism and Discrimination 340 Implications for Clinical Practice 341 Chapter 15 Counseling American Indians and Alaskan Natives 345 The American Indian and the Alaskan Native 347 Tribe and Reservation 348 American Indian/Alaskan Native Characteristics, Values, and Implications on Behavior 349 Family Structure 349 American Indian Values 349 Specific Problem Areas for American Indians/Alaskan Natives 351 Education 351 Acculturation Conflicts 352 Domestic Violence 354 Suicide 354 Alcohol and Substance Abuse 355 Implications for Clinical Practice 356

9 Contents xiii Chapter 16 Counseling Asian Americans and Pacific Islanders 359 Asian Americans: A Success Story? Traditional Asian Cultural Values, Behavior Patterns, and Implications for Therapy Collectivistic Orientation 362 Hierarchical Relationships 363 Parenting Styles 364 Emotionality 365 Holistic View on Mind and Body 366 Academic and Occupational Goals 367 Racism and Prejudice 367 Acculturation Conflicts between Parents and Children 368 Identity Issues 368 Psychotherapy Is a Foreign Concept to Many Asian Americans 369 Expectations of Counseling 370 Counseling Interventions 370 Family Therapy 371 Implications for Clinical Practice Chapter 17 Counseling Hispanic/Latino Americans 375 Traditional Hispanic Values, Characteristics, Behavior Patterns, and Implications for Therapy 377 Family Values 377 Family Structure 378 Sex Role Expectations 379 Spirituality and Religiosity 381 Acculturation Conflicts 382 Educational Characteristics 384 Immigration, Racism, Discrimination, and Other Societal Factors 385 Assessment and Linguistic Issues 386 Implications for Clinical Practice 387

10 xiv Contents Chapter 18 Counseling Individuals of Multiracial Descent 389 Facts and Figures Related to Biracial/Multiracial Populations 390 Hypodescent: The "One Drop of Blood" Rule 392 Racial/Ethnic Ambiguity, or "What Are You?" 393 The Marginal Syndrome, or Existing between the Margins 395 Stereotypes and Myths of Multiracial Individuals and Interracial Couples 397 A Multiracial Bill of Rights 399 Implications for Clinical Practice 401 Part VIII Counseling and Special Circumstances Involving Racial/Ethnic Populations 405 Chapter 19 Counseling Arab Americans 407 Characteristics of the Arab American Population 408 Facts Regarding Arab Americans and Islam 408 Stereotypes, Racism, and Prejudice 409 Religious and Cultural Background 411 Family Structure and Values 412 Acculturation Conflicts 413 Implications for Clinical Practice 413 Chapter 20 Counseling Jewish Americans 415 Experiences with Prejudice and Discrimination 417 Jewish Identity and Religion 418 Counseling and Therapy with Jewish Clients 420 Implications for Clinical Practice 421

11 Contents xv Chapter 21 Counseling Immigrants 423 Population Characteristics of Immigrants 424 Immigration Policy and Factors Influencing Receptivity to Immigrants 424 The Impact of September 11, 2001, on Immigrants 426 Cultural and Community Adjustments 427 Barriers to Seeking Treatment 428 Implications for Clinical Practice 429 Chapter 22 Counseling Refugees 431 Special Problems Involving Refugees 432 Considerations in Work with Refugees 433 Effects of Past Persecution, Torture, or Trauma 433 Culture and Health 434 Safety Issues and Coping with Loss 435 Gender Issues and Domestic Violence 436 Linguistic and Communication Issues 437 Implications for Clinical Practice 438 Part IX Counseling and Therapy with Other Multicultural Populations 441 Chapter 23 Counseling Sexual Minorities 443 Same-Sex Relationships Are Not Signs of Mental Disorders 445 GLBT Couples and Families 447 GLBT Youth 449 Identity Issues 450 Coming Out 451 Aging 452 Implications for Clinical Practice 453

12 xvi Contents Chapter 24 Counseling Older Adult Clients 455 Problems of Older Adults 457 Physical and Economic Health 457 Mental Health 458 Mental Deterioration or Incompetence 458 Family Intervention 459 Elder Abuse and Neglect 461 Substance Abuse 462 Depression and Suicide 462 Sexuality in Old Age 464 Multiple Discrimination 465 Implications for Clinical Practice 466 Chapter 25 Counseling Women 469 Problems Faced by Women 470 Economic Status 470 Barriers to Career Choices 471 Discrimination and Victimization 472 Gender Issues 473 Affective Disorders 474 Aging 475 Feminist Identity Theory 477 Therapy for Women 478 Implications for Clinical Practice 479 Chapter 26 Counseling Individuals with Disabilities 481 The Americans with Disabilities Act 485 Myths about People with Disabilities 488 Programs for Individuals with Disabilities 488

13 Contents xvii Counseling Issues with Individuals with Disabilities 490 Models of Disability 491 Life Satisfaction and Depression 492 Sexuality and Reproduction 493 Spirituality and Religiosity 494 Family Counseling 495 Implications for Clinical Practice 496 References 497 Author Index 539 Subject Index 546

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