NCMHCE Review
Human Diversity
Dr. Dawn-Elise Snipes, LPC-MHSP, LMHC
Executive Director, AllCEUs Counselor Education
Host: Counselor Toolbox Podcast, NCMHCE Exam Review Podcast
Objectives
~ Explore issues related to the counseling relationships with people who are culturally different
~ Identify approaches to use with culturally diverse clients
Explore Cultural Diversity
~ Many of the problems experienced by minorities are related to prejudice and discrimination, cultural differences and other experiences associated with minority group status
~ Clients preferences for ethnically similar counselors depend on
~ Ethnic identity
~ Level of acculturation
~ Gender
~ Trust of therapist’s ethnicity
Cultural Minorities
~ Lack role models
~ May be rejected or discriminated against
Cultural Identify Development Model
~ Conformity: Preference for dominant culture and disavowing personal culture
~ Dissonance: Prefer a minority counselor and perceive their problems as stemming from their minority status
~ Resistance and Immersion: Reject the dominant culture. Prefer a racially similar culture. Perceive most problems as due to oppression
~ Introspection: Conflicts about loyalty and responsibility towards ones group and personal autonomy. More open to counselors of different backgrounds
~ Synergystic awareness: Developed a personalized cultural identity and can objectively evaluate and accept or reject the values of other cultures. Prefer counselors with similar worldviews
Counseling Culturally Diverse Clients
~ Identify the client’s cultural identities and degrees of acculturation
~ Understand the client’s worldview
~ Consider the impact of social, economic and political discrimination and prejudice
~ Remember that clients from a low SES are more concerned with immediate survival than long-range goals
~ Explore their reactions to a culturally different clinician
~ Identify their perception of the problem and role of therapy
~ Explore issues related to cultural discrimination
~ Evaluate positive resources and strengths
~ Identify biopsychosocial issues related to the presenting problem
~ Use a time limited, problem solving approach
African Americans
~ Humanitarian, people-oriented view
~ Family is extended past blood relatives
~ Family roles are flexible
~ Church is often important
~ Family therapy approaches are often the treatment of choice
American Indians
~ Begin with small-talk not defending your competence or getting to business
~ Prefer a spiritual, holistic approach
~ Place greater emphasis on the family and tribe than the individual
~ Perceive most problems as a result of disharmony in one’s life
~ Views behaviors as motivated by interconnections with others
~ Treatment often involves helping to heal the community
~ Often prefer the involvement of tribal healers
~ May benefit from fables and lessons from tribal elders which cannot be written
Asians
~ High context communication
~ Extended family often live together
~ Family may expect to participate in assessment and treatment
~ Interdependence
~ Mental illness can be seen as bringing shame on the family
~ Understate feelings and problems
~ Modesty and self-deprecation are often not signs of low S-E
~ Many mental health issues are somaticized
~ PTSD is not uncommon in refugee populations
~ Establish credibility
Hispanics
~ Interdependence
~ Uncomfortable sharing very personal information
~ Concrete, tangible, present-focused approach to life
~ May have a relatively external locus of control
~ Often somaticize
~ Place importance on personal greetings and small talk
~ Family roles are relatively inflexible and patriarchal
~ Avoid insight oriented approaches and focus more on solution-focused approaches
Sexual Orientation
~ Dealing with people to whom the client is not “out”
~ Understanding the lifestyles of people who are LGBTQ2IA
~ Help client access resources
Coming Out
~ Stage 1 – Identity Confusion: You begin to wonder about your sexual identity and experience denial and confusion.
~ Stage 2 – Identity Comparison: You accept the possibility that you may be LGBTQ2IA and face the social isolation that can occur with this new identity.
~ Stage 3 – Identity Tolerance: Your acceptance of your sexuality increases, but may feel increased isolation and alienation as your self-concept becomes increasingly different from society’s expectation of you. Begin to contact members of the community.
Coming Out
~ Stage 4 – Identity Acceptance: You have accepted your sexuality and have increasing contact with the community
~ Stage 5 – Identity Pride: You begin to feel pride in being part of the community and immerse yourself into the culture sometimes rejecting the heterosexual community.
~ Stage 6 – Identity Synthesis: The rejection of the heterosexual community and the intense pride you may have in your own sexuality decreases and there is congruence between your public self and your private self and in integration of your sexuality with all aspects of your life.
Elderly
~ Identity transition
~ Sexuality
~ Loss and bereavement
~ Acceptance of death
~ Depression
~ Cognitive decline and dementia
~ Issues in caregivers and family related to guilt, anger, resentment, anxiety
Elderly
~ Treatment
~ Identify current problems
~ Allow the person to express their feelings and thoughts
~ Identify past problem-solving approaches which could be applied here
~ Use a biopsychosocial approach
~ Sleep
~ Nutrition
~ Medications
~ Support
~ Environment
~ Mobility…
~ Reminiscence Therapy may be appropriate
People with Disabilities
~ Identify client's perception of problems
~ If issues related to disability, explore issues of adjustment, grief, pain
~ Make referrals to local support groups as appropriate
~ Help client improve quality of life
People Who are Homeless
~ Provide service outreach, engagement and coordination
~ Basic needs (nutrition, sleep, medical care, hygiene)
~ Supportive housing
~ Meaningful daily activities
Summary
~ It is important to be aware of the cultural issues impacting clients
~ Culture is about more than ethnicity
~ People may embrace multiple cultures (gender, sexual orientation, ethnicity, disability, socioeconomic status)
~ Understanding clients’ perceptions of what is causing their problems and how therapy can help is essential
~ It may also be necessary to explore the impact of working with a culturally different clinician
~ Ensure when working with clients from different cultures to use approaches that are appropriate and/or tailored to meet their needs
Case Example
~ Betty is 42 years old, a single mother with a 16 year old son. She is an executive at a local company and she has been referred to her EAP due to performance issues. She has insomnia and has been feeling depressed and anxious all the time for about 3 months. She is fatigued and has difficulty getting motivated to go to work. Her son recently was caught smoking marijuana on the school campus, and her mother was diagnosed 2 weeks ago with Parkinson’s disease and will be moving in with them next month. Betty’s mother does not know about her son’s drug issues and Betty is concerned about the responsibilities of caring for her mom.
~ What diagnoses are you thinking exist for Betty?
Case Example
Case Example