Counseling the Culturally Diverse

Derald Wing Sue, PhD, is a Professor of Psychology and Education in the Department of Counseling and Clinical Psychology at Teachers College, Columbia University.David Sue, PhD, is Professor Emeritus of Psychology and an associate at the Center for Cross-Cultural Research at Western Washington University in Bellingham, Washington. Helen A. Neville, PhD, is a Professor of Educational Psychology and African American Studies at the University of Illinois at Urbana-Champaign. Laura Smith, PhD, is a Professor of Psychology and Education in the Counseling Psychology Program at Teachers College, Columbia University.

• Preface xixSection 1 The Multiple Dimensions of Multicultural Counseling and TherapyPart 1 The Affective Conceptual and Practice Dimensions of Multicultural Counseling and Therapy1 Understanding Resistance to Multicultural Training: Obstacles to Developing Cultural Competence 5Expections for the Course 6Reflection and Discussion Questions 6Reactions to the Course 7By The Numbers 8Emotional Self-Revelations and Fears: Majority Group Members 8Emotional Invalidation Versus Affirmation: Marginalized Group Members 10A Word of Caution 12Reflection and Discussion Questions 13Recognizing and Understanding Resistance to Multicultural Training 13Cognitive Resistance—Denial 14Emotional Resistance 14Did You Know? 15Behavioral Resistance 17Cultural Competence and Emotions 18Implications for Clinical Practice 19Summary 20Glossary Terms 20References 202 Multicultural Counseling and Therapy (MCT) 23Race and Culture Matter 23Reflection and Discussion Questions 25Culture-Universal (ETIC) Versus Culture-Specific (EMIC) Formulations 25Cultural Concepts of Distress 25Acknowledging Group Differences 26Being Aware of Collectivistic Cultures 26Attuning to Cultural and Clinical Clues 26Balancing the Culture-Specific and Culture-Universal Orientations 27The Nature of Multicultural Counseling Competence 27The Harm of Cultural Insensitivity 27Good Counseling is Culturally Responsive Counseling 28By The Numbers 28Understanding The Three Dimensions of Identity 28Individual Level: “All Individuals Are in Some Respects Like No Other Individuals” 29Group Level: “All Individuals Are in Some Respects Like Some Other Individuals” 30Universal Level: “All Individuals Are in Some Respects Like All Other Individuals” 30Reflection and Discussion Questions 31Individual and Universal Biases in Psychology and Mental Health 31The Impact of Group Identities on Counseling and Psychotherapy 32What is Multicultural Counseling and Therapy? 32What is Cultural Competence? 33Box 2.1: Multicultural Counseling Competencies 34Did You Know? 35Social Justice and Cultural Competence 36Reflection and Discussion Questions 36Implications for Clinical Practice 37Summary 37Glossary Terms 38References 383 Cultural Perspectives and Barriers: The Individual Interplay of Cultural Experiences 41Reflection and Discussion Questions 42Characteristics of Conventional Counseling 42Culture-Bound Values 44Focus on the Individual 44Verbal/Emotional/Behavioral Expressiveness 45Insight 45Self-Disclosure Openness and Intimacy 46Styles of Communication 47Did You Know? 48Scientific Empiricism 49Distinctions Between Mental and Physical Functioning 50Patterns of Cultural Assumptions and Multicultural Family Counseling/Therapy 50People–Nature Dimension 51Time Dimension 52Relational Dimension 53Activity Dimension 53Nature of People Dimension 54Language Barriers 55Class-Bound Values and Perspectives 56By The Numbers 56The Damaging Impact of Poverty 56Therapeutic Class Bias 57Overgeneralizing and Stereotyping 58Implications for Clinical Practice 58Summary 59Glossary Terms 60References 60Part 2 Sociopolitical and Social Justice Dimensions of Multicultural Counseling and Therapy4 Microaggressions: Implications for Counseling and Psychotherapy 67Reflection and Discussion Questions 67Reflection and Discussion Questions 68Contemporary Forms of Oppression: Racism Sexism & Heterosexism 70The Evolution of the “ISMS”: Microaggressions 71Microassault 71Microinsult 71Microinvalidation 72By The Numbers 72Reflection and Discussion Questions 72The Dynamics and Dilemmas of Microaggressions 75Dilemma 1: The Clash of Sociodemographic Realities 75Dilemma 2: The Invisibility of Unintentional Expressions of Bias 76Dilemma 3: The Perceived Minimal Harm of Microaggressions 76Dilemma 4: The Catch-22 of Responding to Microaggressions 77Did You Know? 77Therapeutic Implications 77Microinterventions: The New Therapeutic Frontier 80Implications for Clinical Practice 82Summary 82Glossary Terms 83References 835 Sociohistorical Privilege and Oppression: Implications for Counseling and Psychotherapy 86An Open Letter to Brothers and Sisters of Color 86Reflection and Discussion Questions 87Mental Health Practice and the Reproduction of Oppression 87Connecting the Dots Between Mental Health Practice and Social Justice: An Overview 89The Danger of a Single Story: Ethnocentric Monoculturalism 91Did You Know? 91Understanding Ethnocentric Monoculturalism 92Historical Manifestations of Ethnocentric Monoculturalism 94Ethnocentric Monoculturalism Sociohistorical Oppression and Mental Health 95Ethnocentric Monoculturalism and Foundational Psychotherapeutic Theory 96Definitions of Mental Health 96Connections to the Counseling and Mental Health Literature 98Pathology and Persons of Color 98By The Numbers 100Ethnocentric Monoculturalism and Mental Health Practice: Psychotherapy as a Racial-Cultural Microcosm 100Reflection and Discussion Questions 101MCT as a Social Justice Approach to Mental Health Practice 102Social Justice Advocacy and Cultural Humility 104Implications for Clinical Practice 105Summary 106Glossary Terms 106References 107PART 3 Racial Ethnic Cultural (REC) Attitudes in Multicultural Counseling and Therapy6 Racial Ethnic Cultural (REC) Identity Attitudes in People of Color: Counseling Implications 113Case Study: Alejandro: Afro-Puerto 113Racial Awakening 114Just American to Puerto Rican/Afro-Latino 114Denial Breakdown 114The Internal Struggle for Identity 114Locus of the Problem 115REC Identity Attitude Models 115Did You Know? 115William E. Cross’ Nigrescence Model: Foundational Theory 115A General Model of Rec Identity 117Conformity Status 118Dissonance Status 119Resistance and Immersion Status 120Introspection Status 121Integrative Awareness Status 123Counseling Implications of the R/CID Model 123Conformity Status 124Dissonance Status 125By The Numbers 125Resistance and Immersion Status 125Introspection Status 126Integrative Awareness Status 126Value of a General Rec Identity Framework 126Reflection and Discussion Questions 127Implications for Clinical Practice 127Summary 128Glossary Terms 128References 1287 White Racial Consciousness: Implications for Counseling and Psychotherapy 130Whiteness and Multicultural Counseling 130Reflection and Discussion Questions 131Steps Toward an Understanding of Whiteness and White Identity 132Did You Know 133Models of White Racial Identity Development 135The Hardiman White Racial Identity Development Model 135The Helms White Racial Identity Development Model 136A Descriptive Model of White Identity: Seven Positions 137By The Numbers 139An Antiracist White Identity 141White Antiracist Identifications 142Principles of Prejudice Reduction 143Principle 1: Learn About People of Color From Sources Within the Group 143Principle 2: Learn From the Examples of Healthy and Strong People of the Culture 144Principle 3: Learn From Experiential Reality 144Principle 4: Learn From Constant Vigilance of Your Biases and Fears 144Principle 5: Learn From Being Committed to Personal Action Against Racism 144Reflection and Discussion Questions 145Implications for Clinical Practice 145Summary 146Glossary Terms 146References 1468 Multicultural Counseling Competence and Cultural Humility for People of Color Counselors and Therapists 149Interracial And Interethnic Biases 150Impact On Interracial Counseling Relationships 150Racial Stereotypes Held by People of Color 150The Who-Is-More-Oppressed Game 151Interracial and Interethnic Counseling 151By The Numbers 152Reflection and Discussion Questions 152The Politics of Interracial and Interethnic Bias and Discrimination 153The Political Relationships Between Groups of Color 154African Americans and Asian Americans 154Asian Americans and Latinx Americans 155Latinx Americans and African Americans 155American Indians and Black Latinx and Asian Americans 156Reflection and Discussion Questions 156Within Group Differences Among Racial/Ethnic Groups 157Cultural Values 157Communication Styles 157Issues Regarding Stage of Ethnic Identity 158Did You Know? 158Counselors of Color and Dyadic Combinations 158Challenges Associated with Counselor of Color and White Client Dyads 159Situation 1: Challenging the Competency of Counselors of Color 159Situation 2: Needing to Prove Competence 159Situation 3: Transferring Racial Animosity toward White Clients 160Situation 4: Viewing the Counselor of Color as a Super Minority Counselor 160Situation 5: Dealing with Client Expressions of Racism 161Challenges Associated with Counselor of Color and Client of Color Dyads 162Situation 1: Overidentifying with the Client 162Situation 2: Encountering Clashes in Cultural Values 162Situation 3: Experiencing Clashes in Communication and Counseling Styles 163Situation 4: Receiving and Expressing Racial Animosity 164Situation 5: Dealing with the Racial Identity Status of Counselors and Clients 164Reflection and Discussion Questions 165Implications for Clinical Practice 165Summary 166Glossary Terms 166References 166PART 4 Western and Non-Western Perspectives in Counseling and Therapy9 Multicultural Evidence-Based Practice 171Reflection and Discussion Questions 172Empirically-Supported Therapies (ESTs) 172Reflection and Discussion Questions 175Empirically Supported Relationships (ESRs) 175Did You Know? 175The Therapeutic Alliance 176Emotional or Interpersonal Bond 178Empathy 178Positive Regard Respect Warmth and Genuineness 179Therapist Self-Disclosure 180Management of Countertransference 180Goal Consensus 180Reflection and Discussion Questions 181Evidence-Based Practice and Diversity Issues in Counseling 181By The Numbers 182Reflection and Discussion Questions 183Implications for Clinical Practice 184Summary 184Glossary Terms 185References 18510 Indigenous and Cultural Methods of Healing Among People of Color: Implications for Multicultural Counseling and Therapy (MCT) 188Worldviews and Cultural Concepts of Distress 189The Shaman and Traditional Healer as Therapist: Commonalities 190Case Study: The Nguyen Family 191A Case of Child Abuse? 191Did You Know? 193The Principles of Indigenous Healing 193Holistic Outlook Interconnectedness and Harmony 194Belief in Metaphysical Levels of Existence 194Acceptance of Spirituality in Life and the Cosmos 195By The Numbers 197Reflection and Discussion Questions 198Radical Healing Among People of Color 198Examples of Healing Practices Among People of Color 199Implications for Clinical Practice 200Summary 200Glossary Terms 201References 201PART 5 Assessment Diagnosis and Treatment Issues in Multicultural Counseling and Therapy11 Culturally Competent Assessment 207Therapist Variables Affecting Diagnosis 208Did You Know? 209Cultural Competence and Preventing Diagnostic Errors 210Cultural Self-Awareness 210Cultural Knowledge 211Culturally Responsive or Multicultural Skills 211Contextual and Collaborative Assessment 212Case Study: Erica 213Principles of Collaborative Conceptualization 213Infusing Cultural Relevance into Standard Clinical Assessments 214Cultural Formulation Interview 214Culturally Sensitive Intake Interview 215By The Numbers 216Implications for Clinical Practice 218Summary 218Glossary Terms 219References 219Section 2 Multicultural Counseling and Specific PopulationsPART 6 Counseling and Therapy with Racial/Ethnic Group Populations12 Multicultural Counseling Contexts: African Americans 225Sociohistorical Context 226Strengths and Resiliences 227Family and Community 227Religion and Spirituality 227Resourcefulness and Resilience 228Positive Racial-Ethnic Identity or Racial Pride 228Potential Challenges 228Racism and Discrimination 228Racial Socialization: When What and How to Discuss Racism 229Internalized Racism 229Challenges for Black Women 230Counseling and Applied Considerations 230Case Studies: Johnny: When Extra Familial Help Causes Disruption 231A Clinical Checklist 233Summary 234Glossary Terms 235References 23513 Multicultural Counseling Contexts: American Indians/Native Americans and Alaskan Natives 239Sociohistorical Context 240Strengths and Resliencies 241Tribal Community Structure and Relationships 242Family Structure and Relationships 242Cultural and Spiritual Values 242Specific Challenges 243Case Study: Mary 244Educational Concerns 244Acculturation Conflicts 245Alcohol and Substance Abuse 246Domestic Violence 246Suicide 247Implications for Clinical Practice 248Summary 248Glossary Terms 249References 24914 Multicultural Counseling Contexts: Asian Americans and Pacific Islanders 252Characteristics and Strengths 253Asian Americans: A Success Story? 253Case Study: Katherine 255Collectivistic Orientation 255Hierarchical Relationships 256Parenting Styles 256Emotionality 257Holistic View on Mind and Body 257Academic and Occupational Goal Orientation 258Cultural Strengths 258Specific Challenges 259Racial-Ethnic-Cultural Identity and Conflict 259Acculturation Conflicts 259Expectations Regarding Counseling 260Racism and Discrimination 261Implications for Clinical Practice 262Summary 263Glossary Terms 263References 26315 Multicultural Counseling Contexts: Latinx Communities 266Cultural Strengths 267Family and Interpersonal Relationships 267Religion and Spirituality 269Additional Cultural Strengths 270Specific Challenges 270Xenophobia Discrimination and Ethno-Racial Trauma 270Racism in the Schools 271Stigma Associated with Mental Illness 272Acculturation and Acculturative Stress 272Gender Role Conflicts 274Implications for Clinical Practice 275Summary 276Glossary Terms 277References 27716 Multicultural Counseling Contexts: Multiracial Americans 280Characteristics and Strengths 281Multiracial Population in the United States 281The “One Drop of Blood” Rule 282Strengths 283Specific Challenges 284Racial/Ethnic Ambiguity and Multiracial Identity Socialization: “What Are You?” 284Intermarriage Stereotypes and Myths 285Discrimination Racism and Microaggressions 285Racial Identity Invalidation 286A Multiracial Bill of Rights 288Implications for Clinical Practice 288Summary 290Glossary Terms 290References 29017 Multicultural Counseling Contexts: Arab Americans 293Demographic Characteristics 294Sociohistorical Context 294Potential Challenges 295Strengths and Resiliencies 296Counseling and Applied Considerations 296A Clinical Checklist 297Summary 298Glossary Terms 298References 298PART 7 Counseling and Therapy with Other Multicultural Populations18 Multicultural Counseling Contexts: Marginalized Religious Communities 303Counseling Contexts: Jewish Americans 303Characteristics and Strengths 304Spiritual and Religious Values. 304Ethnic Identity 305Gender-Related Considerations 305Cultural Strengths 305Potential Challenges 306Prejudice and Discrimination 306Counseling and Applied Considerations 307Counseling Contexts: Muslim Americans 308Characteristics and Strengths 308Spiritual and Religious Values 309Gender-Related Considerations 309Cultural Strengths 309Potential Challenges 310Counseling and Applied Considerations 311Marginalized Religious Communities: A Clinical Checklist 311Summary 312Glossary Terms 312References 31319 Counseling Contexts: Immigrants and Refugees 316Demographic Characteristics 317Sociohistorical Context 317Cultural Dimensions 318Potential Challenges 318Gender Issues and Domestic Violence 319Refugee Issues and Coping with Loss 319Strengths and Resiliencies 320Counseling and Applied Considerations 320Barriers to Seeking Treatment 321Linguistic and Communication Issues 322Counseling Refugees 323Effects of Past Persecution Torture or Trauma 323A Clinical Checklist 324Summary 326Glossary Terms 326References 32620 Multicultural Counseling Contexts: LGBTQ Communities 328Characteristics and Strengths 329SOGI Awareness 329LGBTQ Youth 331LGBTQ Couples and Families 332Strengths 333Specific Challenges 333Coming Out 333Prejudice Discrimination and Misconceptions 334Aging 336Implications for Clinical Practice 337Summary 339Glossary Terms 339References 33921 Multicultural Counseling Contexts: Older Adults 343Demographic Characteristics 343Sociohistorical Context 344Potential Challenges 345Mental Deterioration 345Elder Abuse 345Strengths and Resiliencies 346Sexuality 346Leadership 346Counseling and Applied Considerations 347Physical Limitations 347Cognitive Limitations 347Elder Abuse 348Substance Abuse 348Social Isolation Depression and Suicide 349The Benefits of Counseling and Therapy for Older Adults 350A Clinical Checklist 350Summary 351Glossary Terms 352References 35222 Multicultural Counseling Contexts: Women 355Demographic Characteristics 356Sociohistorical Context 356Potential Challenges 357Bias and Schooling 358Organizational and Workplace Bias 358Harassment and Violence 359Sexual Objectification and Its Sequellae 359Social Pressure Toward Unrealistic Body Ideals 360Caretaker Overload 360Incidence of Depression 360Strengths and Resiliencies 360Counseling and Applied Considerations 361Gender Bias and Conventional Practices 361Body Image 362Addressing Harassment and Violence 362Educational and Vocational Issues 362Depression 363A Clinical Checklist 364Summary 365Glossary Terms 365References 36523 Multicultural Counseling Contexts: Individuals Living in Poverty 369Demographic Characteristics 369Sociohistorical Context 370Potential Challenges 371Social Exclusion 371Educational Inequities 372Disparities in the Judicial System 372Classism and the Minimum Wage 373Health Care Inequities 373Strengths and Resiliencies 373Counseling and Applied Considerations 374A Clinical Checklist 375Summary 377Glossary Terms 377References 37724 Multicultural Counseling Contexts: Individuals with Disabilities 380Demographic Characteristics 380Sociohistorical Context 381Models of Disability 381Potential Challenges 382Prejudice and Discrimination 382Strengths and Resiliencies 383Counseling and Applied Considerations 384Sexuality and Reproduction 385Spirituality and Religiosity 385Family Counseling 385Environmental and Social Justice Issues 386Counselors’ Attitudes When Clients have Disabilities 387A Clinical Checklist 388Summary 390Glossary Terms 390References 390Index I-1