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Chapter 3

Chapter 3. Culturally Responsive Therapy. Multicultural Standards of Practice. American Psychological Association 6 Guidelines in Providing Sound Psychological Practice Therapists are cultural being with own assumptions, biases that may be detrimentally influence interactions.

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Chapter 3

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  1. Chapter 3 Culturally Responsive Therapy

  2. Multicultural Standards of Practice • American Psychological Association • 6 Guidelines in Providing Sound Psychological Practice • Therapists are cultural being with own assumptions, biases that may be detrimentally influence interactions. • Must acknowledge importance of cross-cultural knowledge • Apply constructs of multiculturalism • Research must recognize diversity as a factor • Apply cultural awareness in clinical practice • Support culturally informed policy in organizations.

  3. Standards of Practice • Association for Multicultural Counseling • Cultural Self-Awareness: what is your world view, assumptions, values, norms? • Knowledge of Client Worldview: How are you similar or different? How does this impact rapport and treatment? • Culturally Competent Skills: What experience do you have with grappling with culturally relevant issues?

  4. Basic Considerations • Culture: Shared Ideas, Symbols, Values & Beliefs Between Members of a Group • Multiculturalism is the intersection of identities and a confluence of cultures • Collectivism & Individualism - A cultural norm that affects client perceptions/choices • View of illness? • Help seeking behavior?

  5. Interpersonal Therapy • Symptoms evaluated in the context of the personal relationship, Environment • Particularly useful for collectivistic cultures • Examine Behaviors in Context • More thorough understanding of symptom etiology and maintenance • When applied with cultural adaptations that allow therapist to be culturally responsive

  6. The Treatment Process • Phase 1: Diagnostic Formulation and Diagnosis Education • Identify the Cultural Context • Assess Ethnic Identity Development • Multicultural Interview • Assess Acculturation Level • Acculturation: process of change from one culture to another • Assimilation- Adopt characteristics/values of majority culture • Separation: reject majority, retain native cultural norms • Individualism: reject both majority/native; new – exp: Chicano • Integration: bicultural adaptation of many cultures

  7. The Treatment Process • WHO AM I? WHAT AM I? • Ethnic Identity Development: • Atkinson, Morten, & Sue Model • Conformity • Dissonance: events challenge self-concept • Resistance/Immersion • Integration/Transcendence (Sexual Identity Development Models are similar) • Q: Which acculturative style and Ethnic identity stage is most stressful?

  8. Acculturative Stress • Assess Gender Role Conflict • Adaptability of coping • Stress related to conflicting roles • Rewards and supports Q: How would someone with a assimilated acculturation style deal with gender role conflict? • Integrative? separated?individualized?

  9. Treatment Process • Phase 2: Facilitated Problem Solving • Explore Ethnic & Sexual Identity in Tx • Address coping with Acculturation stress • Address coping with racial & sexual discrimination • Dynamics of Social Interactions • Communication Analysis

  10. The Treatment Process (Cont’d) • Phase 3: Termination • Between 2-4 Sessions Long • Identifying Successes, work left to be done What was accomplished in therapy? What interventions worked and why? What coping styles were effective/ineffective? What new insights were learned? What areas are still in need of attention? What’s the plan for after termination?

  11. Cultural Norms • Special Considerations: • African Americans: flexible family roles , kinship and community bonds, spirituality, parental engagement, racial identity development • What might we see if client is depressed? Or coping with abuse?

  12. Cultural Norms • American Indian/Alaska Natives: extended family is basic unit for family structure, interdependence • What should a therapist consider if client presents with psychosis?

  13. Cultural Norms • Asian Americans: Diverse, nongeneralizable,family, patriarchal, hierarchical, collectivist, value of achievement • How might a child client present with learning difficulties? • Middle-Eastern: religiously diverse, patriarchal, discrimination, marginalization • What would you need to consider when evaluating a second generation Jordanian adolescent?

  14. Cultural Norms • Religiosity : Varies in importance across cultures • Premarital Sex • Co-ed Interactions • Dress Restrictions

  15. Case Discussion • Aisha is a 14 year old Syrian girl who arrived with her mother and younger brother as refugees. Her mother shared with you that Aisha’s school counselor recommended that she seek out therapy. Aisha tells you that she is having difficulty focusing in class. She has constant worries about the welfare of her mother and brother while at school. She feels she can’t relate to the kids in school and feels generally unmotivated. Lately, she has also been sleeping excessively, rarely talking to her family. Mother also mentions that Aisha tends to pick at her skin and scabs on her arms and legs until bloody.

  16. Case Discussion • Miguel is Mexican-American 16 year-old, born in the US to undocumented immigrants. He arrived to see you in a school counseling office because teachers were concerned about a recent significant decline in his academic performance. He attends a school that is predominantly Anglo and East-Asian. His friends are all White and he shares a lot of the same interests, habits, and values with his peers. However, recently, he has been hearing negative comments from peers and their parents about Mexican immigrants creating a lot of confusion/rejection.

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