Improving Cultural Competence
SAMHSA TIP 59
Part 3
Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs.com Counselor education
Podcast Host: Counselor Toolbox, Happiness Isnât Brain Surgery
Objectives
~ Review elements which constitute a culture
~ Define and explore the drug culture
~ Define and explore the recovery culture for addictions
~ 12-Step
~ SMART
~ Celebrate Recovery
~ Define and explore the culture of Mental Health Recovery
~ Theorize about the struggles clients experience when becoming acculturated to the recovery culture
~ Hypothesize interventions and methods which can help clients embrace the recovery culture
Worldview, Values, and Traditions
~ Culture can be seen as
~ A frame through which one looks at the world
~ A repertoire of beliefs and practices that can be used as needed
~ A narrative or story explaining who people are and why they do what they do
~ A set of instructions defining different aspects of values and traditions
~ A series of boundaries that use values and traditions to delineate one group of people from another
Continuum of Cultural Competence
~ Stage 1. Cultural Destructiveness
~ Organizational and Individual Level: Negates the relevance of culture in the delivery of behavioral health services, holding a myopic view of âeffectiveâ treatment. (Abstinence, Harm Reduction, Happiness)
~ Stage 2. Cultural Incapacity
~ Organizational and Individual Level: Expects clients to conform to generalized services. Ignores the relevance of culture while using the dominant client population and/or culture as the norm for assessment, treatment planning, and determination of services. (Therapy Groups, 12-Step Based Treatment)
Continuum contâŚ
~ Stage 3. Cultural Blindness
~ Organizational and Individual Level: At this stage, counselors uphold the belief that there are no essential differences among individuals across cultural groupsâthat everyone has trauma, mood, self-esteem and coping deficits which are causing the current state
~ Stage 4. Cultural Precompetence
~ Organizational Level: Have a basic understanding of and appreciation for the importance of sociocultural factors in the delivery of care. Counselors acknowledge a need for more training specific to the populations they serve.
Continuum contâŚ
~ Stage 5. Cultural Competence and Proficiency
~ Organizational Level: Organizations are aware of the importance of integrating services that are congruent with diverse populations. Recognize the vital need to adopt culturally responsive practices.
Cultural Identity
~ Cultural identity describes an individual's affiliation or identification with a particular group or groups.
~ Cultural identity arises through the interaction of individuals and culture(s) over the life cycle.
~ Cultural identities are not static; they develop and change across stages of the life cycle.
~ People reevaluate their cultural identities and sometimes resist, rebel, or reformulate them over time. (Remember High School; Midlife âcrisisâ)
Acculturation
~ There are many forces at work that pressure a person to alter his or her cultural identity to conform to the mainstream culture's concept of a âproperâ identity.
~ People may feel conflicted about their identitiesâwanting to fit in with the mainstream culture while also wanting to retain the values of their culture of origin. (Religion)
~ Sorting through these conflicting cultural expectations and forging a comfortable identity can be an important part of the recovery process
~ Many studies have found that increased acculturation are associated with higher rates of substance use disorders and mental health issues
Culturally Responsive Practice
~ Culturally responsive practice reminds counselors that a client's worldview shapes his or her:
~ Perspectives (How things âshould be,â What goals to strive for)
~ Beliefs (ex. Why things happen)
~ Behaviors surrounding addictive behaviors (Alcohol, illicit drugs, sex, gambling, food/eating disorders)
~ Beliefs about illness and health (East vs. West, Godâs punishment vs Natural progression)
~ Seeking help (Airing âdirty laundry,â participation in face to face vs virtual treatment, LEO/Military, elderly)
~ Counseling expectations (LEO/Military, criminally involved)
~ Communication (Openness, methods)
Family and Kinship
~ Concepts of and attitudes toward family are culturally defined and can vary in a number of ways, including
~ the relative importance of particular family ties
~ the family's inclusiveness
~ how hierarchical the family is
~ how family roles and behaviors are defined
~ In some cultural groups family is limited to the nuclear family, whereas in other groups the idea of family typically includes many other blood or marital relations
~ Family dynamics may change as the result of internal or external forces, such as acculturation
Drug and Recovery Culture
~ Have certain shared values, beliefs, customs, and traditions, and it has its own rituals and behaviors that evolve over time.
~ Members often share similar ways of dressing, socialization patterns, language, and style of communication.
~ May have a social hierarchy that gives different status to different members of the culture based on their roles within that culture
~ Localized to some extent. For example, people who use methamphetamines in Hawaii and Missouri could share certain attitudes, but they will also exhibit regional differences.
Addiction and Recovery Culture
~ Alcohol: Drinking as part of all social activities, âIâm an alcoholic not an addict.â
~ Shared values, beliefs, customs, and traditions
~ Bar culture
~ Alcohol as a reward
~ Similar ways of dressing, socialization, language
~ Social hierarchy??
~ Localized
~ New York bar scene
~ Back woods moonshine
Addiction and Recovery Culture
~ Gambling:
~ Shared values, beliefs, customs, and traditions
~ Superstitious rituals, faulty reasoning
~ Similar ways of dressing, socialization, language
~ Definite language of gambling, betting, odds
~ Social hierarchy ??
~ Localized
~ Online
~ Ponies
~ Casinos
~ Sports Bars
Addiction and Recovery Culture
~ Eating Disorders:
~ Shared values, beliefs, customs, and traditions
~ What is okay to eat, what to do after eating, acceptable appearance
~ Similar ways of dressing, socialization, language
~ Topics of discussion
~ Social hierarchy
~ Often centers around appearance and body weight
~ Extremely competitive â If she can weigh X I can do it too
~ Localized
~ Activities and behaviors may differ by locale, SES, age
Addiction and Recovery Culture
~ Shared values, beliefs, customs, and traditions
~ Centering rituals reading recovery literature including daily meditations, receiving chips, taking regular personal inventories each day.
~ Acts of personal responsibility include being honest and becoming time-conscious and punctual, creation of new rituals of daily living related to self-care while improving interpersonal skills.
~ Acts of service Carry the message of their spiritual awakening to others, thereby encouraging them to practice the 12 Steps. Acts of service recognize that people in recovery have something of value to offer those still abusing alcohol. âWalk in my footstepsâ
Addiction and Recovery Culture
~ 12-Step Recovery:
~ Similar ways of dressing, socialization, language
~ Attending meetings, telling one's story, speaking regularly by phone, and using slogans (e.g., âkeep it simple,â âpass it onâ)
~ Social hierarchy
~ Sponsors, Meeting Chairs, âOld-timersâ
Addiction and Recovery Culture
~ 12-Step Recovery (4 sub-cultures):
~ Localized (face to face vs. online participants)
~ Subcultures in 12-Step for SUBSTANCES
~ No mind altering substances at all (including medication)
~ No alcohol but recreational drugs okay (AA)
~ No illicit drugs or opiates but alcohol okay (NA)
~ No alcohol or recreational drugs but MAT okay
Addiction and Recovery Culture
~ Celebrate Recovery: Addresses all issues âhurts and hang-upsâ in one umbrella
~ Shared values, beliefs, customs, and traditions
~ Requirement of belief in Christianity
~ Similar ways of dressing, socialization, language
~ Scriptural responses to dealing with distress
~ Social hierarchy
~ Group facilitator and higher power
~ Localized??
Addiction and Recovery Culture
~ DBT Based Recovery: Learning the tools, preventing vulnerabilities, mindfulness, radical acceptance, own language
~ Shared values, beliefs, customs, and traditions
~ Emotion regulation through vulnerability prevention
~ Belief in emotional dysregulation
~ Dialectics
~ Similar ways of dressing, socialization, language
~ Vulnerabilities, wise mind, distress tolerance
~ Localized
~ Methods for IMPROVING and ACCEPT-ing the moment may differ by locale
Cultural Barriers to Seeking Treatment
~ When people with addictions or eating disorders are marginalized, they tend not to seek access to mainstream institutions
~ This can result in even stronger bonding with the harmful original culture
~ A marginalized person's behavior is seen as abnormal even if he or she attempts to act differently, thus further reducing the chances of any attempt to change behavior
~ Original culture enables its members to view their addiction or mental health issues as normal or even as status symbols
~ People may celebrate their original culture-related identity with other members of the culture
~ Social stigma also aids in the formation of oppositional values and beliefs that can promote unity among members of the original culture
Example: Illicit Drug Culture
~ Many core values of illicit drug cultures involve rejecting mainstream society and its cultural values. are:
~ Antisocial viewpointâMembers of this drug culture share a viewpoint that sees all people as basically dishonest and egocentric
~ Rejection of middle-class valuesâMembers denigrate values such as the need for hard work, security, and honesty.
~ Excitement/hedonismâMembers value immediate gratification and the intense pursuit of pleasure over more stable and lasting values.
~ Importance of outward appearancesâstrongly believe in conspicuous consumption and the importance of owning things that give an image of prosperity.
~ Valence of street addict subculturesâvalue the continued participation of others in the culture, even to the point of expecting individuals who have stopped using to continue to participate
~ Emotional detachmentâPeople involved in this drug culture value emotional aloofness and see emotional involvement with others as a weakness.
Summary
~ In a culture, people often share similar beliefs, traditions, language and may have a social hierarchy.
~ Recovery has its own culture characterized by honesty, mindfulness and a variety of tools unique to each recovery method
~ 12-Step
~ Celebrate Recovery
~ DBT
~ There are many struggles clients experience when becoming acculturated to the recovery culture, especially if they have to change people, places and things.
~ Interventions and methods which can help clients embrace the recovery culture are those in which the recovery culture meets the same needs as the original culture