NCE

NCE STUDY – Asian American Families

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

Understanding Acculturation…

“Asian Americans represent a wide range of diversity to the extent to which they have adopted the norms of the dominant US culture and retained the norms of the traditional Asian culture” (Trihn, et al, 2009, p. 25).  While enculturation is the process of acquiring the norms and values of a particular culture, acculturation is a process of socialization that occurs when an individual is influenced by two cultures.  With acculturation, immigrants struggle to maintain values from their country of origin, while learning to adapt to the norms of the dominant culture they live in.   The process of acculturation differe greatly from family to family as well as amongst individual members.  Triton, et al, (2009) notes that a “problematic distancing occurs between immigrant parents and children” (p. 27), when varied rates of acculturation occur within each generation.  This is commonly known as a “cultural gap”, wherein “parents tend to cling to values from their culture of origin….[while] children might increasingly adopt the norms of the dominant society (Trihn, et al, 2009, p. 29).  As I have experienced personally within my own diverse extended family, children are often raised hearing mixed message and are left to “figure things out” on their own.  LaFramboise, et al, (1993) define acculturative stress as a “worsened mental health status…anxiety, depression, feelings of marginality, alienation, and identity confusion (p. 29).”  Lee, et al, (1996), describe five types of Asian Families based on the dynamics of this acculturative transition

  • TRADITIONAL FAMILIES: “consist entirely of individuals born and raised in Asia, with little exposure to Western Culture (Lee, et al, 1996, p. 275)
  • FAMILIES IN CONFLICT:  Families in conflict often immigrate to the United States with young children.  As a result, children are acculturated into American society while parents and grandparents tend to uphold traditional values.
  • BICULTURAL FAMILIES:  La Framboise, et al, (1993) defines biculturalism as an ability to operate effectively within two cultures.  As a result, well acculturated parents, who hope to instill in their children a pride and appreciation for their own ethnic identity.
  • AMERICANIZED FAMILIES: All family members adopt mainstream cultural values.  My mother has preferred to adopt this acculturative style, and as a result I know little about her home country
  • NEW MILLENNIUM FAMILIES:  These families go “beyond prior cultural expectations and are forging new identities…’integrate multiple cultures… (Lee, et al, 1996, 275)”  ‘

Values & Belief Systems…

Asian Americans comprise about 3% of the U.S. population, (4,000,000 people), (Rosenthal, 2005).  By 2050 it is estimated that this population will grow to about 8%.  Relatively little is known in literature about Asian Americans.  Rosenthal, (2005) states that “one theory for this is that very few Asian Americans have very few problems and are very successful and thus researchers are not giving this group attention that they deserve.”  What follows is a “quick and dirty” overview of key insights that should be kept in mind when counseling Asian clients..

  1. COLLECTIVIST IDENTITY:  As an American it is important to understand a collectivist identity.  Doing so requires one to set aside, (for the time being) the idea of individualism.  Seeing yourself as part of something greater than yourself is essential.  Identity is constructed based on a different point of reference.  For example, in my mother’s culture life centers around family and plays a central role in daily life.
  2. PATRIARCHAL FAMILY LIFE: The vast majority of Asian cultures have a very patriarchal structure, where the dad has a wealth of authority (Rosenthal, 2005).  However, the degree of patriarchalism that is presented in an Asian family, depends on the degree of acculturation.  Additionally, Asian countries with a greater westernized sociocultural influences tend to be more egalitarian in nature.  This is especially true in the Philippines, where my mother was raised.
  3. GUILT & SHAME:  My mother comes from a collectivist culture in which family life is central to daily living.  For example, she is still called “Nene” which means baby.   Additionally, she discusses the notion of “DUTY” as a responsibility to her family.  This notion of “duty”, while foreign to me is very important to her.  It is by fulfilling this “duty” to family members that she expresses her love as a wife, mother, sister, and daughter.  Integral in this belief system is a form of social control that parents utilize on children to encourage compliance.  Failure to respect your elders and live up to your “duty” can produce feelings of shame and guilt.
  4. COLLECTIVE TRAUMA:  Asian families often have complex migration histories that involve political upheaval and wartime experiences (Lee, et al, 1996).  For example, my mother’s family survived WW2 and eventually immigrated to the United States for a better life.  A complex history of trauma exists within their family history with lasting, profound effects.
  5. ACADEMIC PRESSURE – There is a greater pressure to succeed within Asian families.  For example, Rosenthal (2005) notes that while 41% Asian mothers say academic is critical, only 11% of white mothers hold this belief.
  6. BODILY COMPLAINTS EQUATED WITH EMOTIONAL ILLS (Rosenthal, 2005).  Rosenthal notes that oftentimes Asian cultures equate emotional problems with physical ailments.  As a result, it will be important to investigate all physical complaints thoroughly to develop an understanding of the underlying cause.
  7. LESS LIKELY TO SEEK THERAPY –  Rosenthal, (2008) also notes that Asian Americans are less likely than other demographics to seek therapy.  As a result, when thy do seek therapy, they are often extremely disturbed.  Additionally, Rosenthal (2008) states Asian Americans have a higher incidents of depression than any other minority group.
  8. STOICIM = MATURITY:  In many Asian cultures, a “lack of emotional expression represents maturity…[and] silence is seen as an act of respect.” (Rosenthal, 2008).  As a result, it will be important for therapist to “carry ball more” (Rosenthal, 2008) during therapy and lead the conversation with well-thought out questions.

ADDENDUM:  Exploratory Interview Paper.

In this paper I share the insights gained from an interview with my mother. In addition to learning about my mother’s background, I got to know more of our relationship with one another from her perspective.   I will begin by utilizing the addressing model and move on with a summary of the interview. In addition to sharing insights about my mother’s culture, I will add a bit of personal reflective commentary. At the end of this paper I have provide a transcription of the recorded interview.

Utilizing the Addressing Model

In this section, I utilize the Addressing model, as discussed in our textbook. This model acts as a framework around which to explore the influence of my mother’s culture on her own belief systems. As I have come to understand it, these cultural belief systems, affect many elements of a person’s life. In addition to defining a life perspective it also influences your identity, feelings, thoughts, and interactions with others, (Fortune, 2012; Hays, 2008). The cultural gap has between us has been an ongoing struggle.  The importance of multicultural sensitivity is vividly apparent to me. For the sake of brevity, I discuss the key areas of greatest relevance for my mother, having the biggest impact on her identity. I provide only a brief overview of details relevant to my mother’s life history within each relevant area. In a later section I share these specific arenas of life were relevant to her development in her own words.

Age and Generational Influences.

The Silent Generation. My mother was born in the Philippines in 1938, moved to the states in 1965, and has lived here since.   A member of the silent generation that preceded the baby boomers, my mother’s earliest years were in the midst of a war. While she has little memory of her earliest years of life, according to records she’s uncovered, her dad signed up for the “USAFE” (United States Army of the Far East), just one day after the bombing of Pearl Harbor. The date this occurred was December 8th, of 1941.   With her father away, her mother was left alone with a three year old and five year old.   While completely ignorant of the realities of war in my own life, I have an appreciation of the effects it had on my mother’s family.   They had to develop a toughness that served them well as the war came to a close in their survival.

Extended Family Influences. The Philippines is much more collectivist in its orientation in comparison to the United States which is clearly individualistic (Fortune, 2012; Root, 1997). The extended family is central to one’s life and identity. For example, in the United States the focus is on our own goals their achievement. In the Philippines, on the other hand, the well being of the extended family is a primary consideration (Fortune 2012; Root 1997). This can be seen in the way members of the family, will sacrifice of themselves, for the sake of the family. It can also be realized in the way family harmony and psychological-well being of the extended group takes precedence over individual insecurities and any need to vent pent up emotions (Fortune 2012).

Extended family influences go well beyond one’s degree of personal orientation toward a collective unit. According to my mother, the Philippines is very much a melting pot. While the majority of the country is Catholic, they also display influences from other religions such as Confucianism. As a result of this, it is a well-known but unspoken rule within the family that children display absolute obedience to elders. Any elders, whether strangers, older brothers, parents, uncles are to be shown respect. Finally, one interesting fact seems to illustrate to me how much membership to the family defines your identity. Within the family, siblings do not call each other by name, but by birth order.   My mother was “Nene”, as the youngest in the family, this word in Tagalog means “baby”. My aunt on the other hand was the older sister and was called “Ate”, for big sister.

Developmental Disabilities.

While my mother has no disabilities to speak of, she is a retired Clinical Cytogeneticist and worked in the Center for Developmental Disabilities at the University of South Dakota. One of her tasks was counseling parents of children with developmental disabilities. Her support was very critical when my oldest son was born with a congenital heart defect.   Very ill, needing several heart surgeries, these medical issues affected his childhood development for quite some time. Through her support and educated background, I feel I was able to handle the situation well as a parent of a sick child.

National Origin & Racial Identity.

Racial Identity. As a Filipino who immigrated to the United States in the 60’s my mother is definitely a minority in this culture. Having said this, she does make a point to note that she was raised in the Philippines, and was part of the “majority” there.   Everyone, like her was Filipino, and so race was an inconsequential issue she gave little thought to. Therefore, issues such as “Insidious Trauma”, (defined by Maria Root as “trauma associated by a devalued identity in a dominant culture,” (Hays, 2008, p115)), don’t apply to her.

This isn’t to say she didn’t experience racism, as she will note in her interview summary below. Nonetheless, she has noted a set of coping skills that many who had lived their entire lives as a minority didn’t have.   Part of the problem for many who were raised here, she notes, is the racism experienced, was throughout critical years of childhood development. Nonetheless, she also says there is more to the issue that. While the Philippines and American are both melting pots, she has stated there was a different preconceived reaction to the idea of different groups blending together. Growing up, it was know the Philippines was a melting pot was a non-issue and that everyone there was the byproduct of many blended cultures.   In fact, there are Spanish, and Chinese ancestors in her family. In contrast to this, she felt this culture seemed to hold the idea of differences between various groups as being significant in a way she didn’t understand. For example, the idea of marrying a white man and having mixed kids to her wasn’t a big deal. Despite this, in the late 60’s and early 70’s she felt people reacted sometimes to this in a manner she didn’t quite understand.

National Origin. As an immigrant, my mother’s biggest issues have been associated with attempting to honor her own values while having to learn about a whole new culture. Finding a balance between these two competing value systems is best described as “bicultural competence” (LaFramboise, et al, 1993). The greatest ambivalence she experienced was in raising her two daughters. Living in a small town in the Midwest with few minorities and foreigners, she had little support. Adding to this was the fact that she was separated from her extended family, another critical support system, unavailable to her.

Socioeconomic Status.

My mother’s socioeconomic status and background are quite intriguing to me. Currently, my mother and father are both retired doctors and upper middle class in their background. Additionally, growing up, her extended family was also considered solidly upper middle class.   For example, she notes her parents were able to afford to put two girls through medical school. Without any loan programs, advanced education, was available only to those who could afford it. She was very lucky.

On the other hand, despite this fact, there are a few unique details that differentiate the meaning of social class for my mother.   Firstly, she said, the overall standard of living was different from the United States.   This made her experiences of blending into my dad’s upper middle class background still quite difficult. She didn’t quite understand the materialistic perspective whereby your possessions defined your worth.   Her perspective is really of the need for essentials in life: food, clothing, and shelter. While she does enjoy having things, it was simply for how they reminded her of “back home”. She didn’t feel it reflected on her worth as a person.

Still, having said all this, the critical cultural differences she dealt with go much deeper. In the aftermath of the Second World War, her family lost everything, but “the clothes on their backs”.   Having to work hard and rebuild their lives, she simply states the overall life perspective on things is entirely different, and “hard to put words to”.

Religious Practices.

Spain came to the Philippines in 1400 and ruled there until the late 1800’s. As a result of Spain’s influences: (1) many words in Tagalog are of Spanish origin, (2) many last names are of Spanish origin, and (3) the primary religion practiced by 95% of the population is Catholicism.

Adherence to Catholicism as a member of the church community was vital to my mother’s family. For example, she said they all said the rosary every night. On Sundays all 24 of her cousins went to mass every Sunday, sitting in the same two pews every week with Grandma behind them to ensure they behaved. She warned them of their misbehavior with a flick on the ear.

Gender Roles.

Due to America’s influences, the Philippines has a very egalitarian view of the genders. For example, within the extended family system, the oldest child in the extended family is considered head of family, whether male or female. In fact, my mother said her family was very matriarchal in nature with the last two family heads being female.

After the Second World War, her maternal grandmother was a widow, and left as matriarch of the family until her passing. After her death, my moms own mother became family head as “Ate” of her four younger brothers and sisters. Everybody respected them both as head of the family and did as they said.

Also notable of the matriarchal vibe in the family was the fact that all family resources were devoted to equally toward both men and women pursuing advanced degrees. When you consider the fact that this occurred in the 30’s for my grandmother’s generation, its really quite remarkable.   In conclusion, its also interesting to note that the women surpassed the men in performance, with all finishing their education and even earning advanced degrees.

Cultural Assessment Interview Summary

While the previous section provides a perspective of my mother from within the Addressing Model, this section provides an overview of her life in her own words. At the end of each section I will include a few of my own personal thoughts.

Early Traumas

“I don’t remember much of my early years. I was born in 1938 and the war started in 1941 by the time the war started I was three years old…. I don’t remember much about growing up in a normal sense, such as reading books and going to bed at night since were refugees of the second world war and were living in caves alongside mountains, growing our own food…” (Johnson, 2014)

When the war came to a conclusion, my mother was about six years old.  Life for her in the aftermath of war was very different from life in America.  Nobody had anything and all people were left to rebuild their lives from search.  her parents were educated and were fortunate to find jobs.  Her mother was a schoolteacher.  Her father took advantage of the GI Bill as a former soldier of the USAFE and became an engineer.  While I have been able to talk with my mother about these experiences, I’ve come to understand that some caution needs to be taken when discussing these issues.  There is often an unspoken rule amongst my mom’s family that you aren’t to bring that stuff up, because it is too painful.  Having said that, I am grateful my mother has shared these experiences with me.  It has helped me understand how these early experiences influenced her.

Limiting Emotional Expression.

There are two key characteristics within my mom’s culture that influence how emotions are expressed:

  • RESPECT YOUR ELDERS:  As stated earlier, in my mom’s culture an authoritarian parenting style was the norm.  In the case of war, this was clearly essential for survival.  Absolute respect was essential and meant listing to mom for the sake of survival.
  • FAMILY WELL-BEING IS FIRST:  Thinking of the family collective unit first is essential during wartime.  Within my mother’s family the idea of harmonious family relations was important.  Making this a priority over personal feelings meant suppressing our own private needs for the sake of harmony and to avoid strife.

Material Loss & Gain.

In a recent conversation since our interview, my mother complained about something my sister said recently.  She allowed me to record this portion of our conversation on Skype since it was relevant to the topic at hand:

“You know what Dorene said to me? ‘Kevin and I decided we are not going to have all this stuff’, who a swish of her hand.  She waved her hand out from her chest while holding Audrey…”Stuff” as in all the things in our house.  I thought to myself: ‘Dorene I like them, I collected them.  I crocheted the afghans, I made the quilts, and sanded the refurbished furniture.  It has my guts and soul in it’  I had to say to myself ‘cool it Virginia’… Yet when you think about it, she was absolutely right in her viewpoint.  To her they are meaningless.  Nonetheless for me, understand I wanted frilly homey things.  My take on this, is that I want memories from back home, since I took none of this with me when I moved to the states.  Like my mother’s Queen Anne dining table and chairs.  I couldn’t take it with me.  I left home with two suitcases and only my memories.” (Virginia, 2014)

As I heard of the misunderstanding between my mother and sister, I couldn’t help but think of the things from within the perspective of this assignment.  My mother’s early childhood was filled with tremendous loss.  After the war, at the age of 7 she had to work with her family to rebuild their lives from nothing.  She learned to work hard, remain tough, and as a result is appreciative of what she has.  Additionally, she put much time creating things as her form of “art”.  What’s interesting is that since everybody after the war was in the same situation, nobody was better than anybody else.  The American notion that our material possessions can define our social class wasn’t relevant then.

As a result of all this, today she sees her material possessions as reflective of memories of “back home”  They also reflect all the hard work she’s endured to get to where she is.  They hold value that isn’t quite understood from an American materialistic perspective.

Social Expectations & Generational Influences.

“When you were born what were the social expectations of a person of your identity?…What generational roles make up your core identity? (Ajuoga, 2014).”

The differences between parenting styles and family structure stand at the forefront as key insights that make the Philippines different from the states.  I discuss these below alongside my mother’s struggles to raise two daughters in a foreign culture.

Parenting Styles.  Parenting styles in the United States are very different form where my mother grew up.  While she says we are more friendly, empathetic and familiar, parents are more authoritarian in the Philippines.

As a child in the Philippines you are to be seen but not heard. Crying and whining are not allowed, whether or not you are at home or in public. We are supposed to behave and remain compliant. So parents there were more authoritative and less empathetic….American parents are so much more permissive. In a way it is great at times, but you see American kids whine and whine, until they get their way. Over here kids are so much more familiar…The other thing in America because of all this permissiveness, the spinoff is kids are left disrespecting authority, and are less compliant as a result. In the Philippines kids are compliant, we comply with what our elders tell us, that’s the biggest difference. (Johnson, 2014).

Extended Family Structure.  

…I think it’s also easier in the Philippines growing up because of the extended family system. I had 24 cousins we all lived on Grandma’s piece of land, building five houses on it. It was a communal area we spilled out of the houses, and played together….The family structure in the Philippines, I think this is because we are Southeast Asian. you know of Confucianism? Philippines is a melting pot, Spain came to the Philippines in 1400, so we are Christian, but we do have a lot of Chinese, Japanese, and Indian emigrating to the Philippines. So there is also Confucianism, and it you revere your ancestors. As a matter of fact, there are names for the first-born son. My mother is firstborn, she is called “Ate”, they call her this and not Maria.   The second born is called “Eche”, that is my aunt who is a Physician. You call siblings by birth order. I was “Nene” which means baby for the youngest child. I am the youngest. You are supposed to respect your elders….” (Johnson, 2014)

The above quote points out a critical difference between American and Filipino family structures.  Family order is a critical component of one’s identity.  My mother was called “Nene”.  She was always called this whenever we visited, even as an adult.  In this respect, generational influences carry a greater weight as a component of one’s identity.

Education in Biculturalism.

I was never conflicted in my identity, I just was clueless about much regarding raising kids here. I should have kept up on what went on with your education. I should have been more on top of enforcing you to do well. You guys didn’t tell me anything. I remember a lady in church say jokingly, “I hear Dorene has a boyfriend”.   I just smiled and nodded. I only found out your sister was dating this way.   There are so many different kinds of kids and different kinds of parents.   No one child is the same. Every child has different needs, every parent has a unique set of life experiences. I think in your case you wanted to spare my feelings because I was a foreigner. You didn’t tell me what was going on.

As the quote above indicates, my mother’s greatest difficulty was in trying to figure out how to raise us in a different culture.  With a set of normative values drastically different than what she was familiar with she struggled with an ongoing internal conflict.  She wanted to remain true to her own values while helping us adjust in American Culture.  It’s interesting to note that my mother’s own acknowledgement of my struggles at the end of the quote here.  Very protective of her, I kept many of my struggles in fitting in to myself.

Norms & Values.

“When you were a teenager, what were the norms, values & gender roles supported within your family, peers, culture and in the dominant culture (Ajuoga, 2014)”

Key differences in norms between my mother’s culture and my own appear to be the greatest in the areas of dating, money and parental control.  I provide my mother’s thoughts on these areas below.

Adolescence & Dating.

“The other reality of my upbringing in the Philippines was you didn’t date until College. By the time you are in college you have some degree of maturity and did it then. We didn’t drink in high school, we did not date, we had no car, and there were no extracurricular activities in our public schools. Our society couldn’t afford them as you can here. When you go home you walk or take the bus and your mother was there. The norm was that you maintained your virginity as a girl. I was a virgin for a long time, because I was never propositioned. The boys don’t propositioned the girls.   I don’t think teenage boys that young, are knowledgeable of how to do such things…..There is a strong need in adolescence to be popular and fit in. There is a ladder, like a pecking scale. Teenagers are so insecure it seems like so much to handle at that age….As a girl, we didn’t wear makeup. In college you wear lipstick. This is when you start dating college….. There was really no bullying, because in school, if you are picked on at recess, you have many cousins and relatives to stand up for you. There is always a bigger and older cousin or sibling looking out for you. On the same note, if you are misbehaving, they will also inform adults, and you will be punished. This is because the reputation of the family is important, and protected in this respect. My mother’s family, the Gonzales family, has a good reputation in town. Among all 24 cousins, nobody got in trouble, and we were all upstanding citizens. I all these respects it’s a much safer environment. (Johnson, 2014).”

In my home my mother made the rules, my father was busy with his job much of the time and preferred to leave such issues to her.  As a result, I did suffer quite a bit of difficulty with fitting in.  I felt there existed a notion of ‘normal’ as in how I am supposed to be around my peers but yet I wasn’t taught how to be that.  I stood out.  I didn’t wear makeup, or dress like the other girls.  I was clueless in the realm of dating and didn’t experience my first kiss until my second year of college.  I was entirely on my own in figuring things out in this culture.  With American High Schools centered around fitting it, I was definitely an oddball, and bullied endlessly.

Adolescence and Money.

“there were no extracurricular activities in our public schools. Our society couldn’t afford them as you can here. When you go home you walk or take the bus and your mother was there. The norm was that you maintained your virginity as a girl….We had no money as teenagers.  We didn’t work at McDonalds. Boys and girls have no money. Many families can’t afford a car. We didn’t own a car until High School. We didn’t have a television until High School. We had crushes like everyone. It was never actualized. In the Philippines you did what your elders said and accept their wisdom. We don’t have the high school wisdom, they ‘don’t understand'” (Johnson, 2014).”

With fewer resources available, and entirely reliant of parents, adolescent life in the Philippines was very different. She would struggle with the idea of allowing us to have what we wanted.  For example, she says also makes the following comment in our interview:

“You wanted moon boots or Gloria Vanderbilt jeans, do I relent, yes or no? Just because that’s what everybody else in this culture is doing, does that mean you must as well?” (Johnson, 2014).

Her measuring stick was very different.  With the life of the average middle class family very different in the Philippines, she didn’t understand our desire for “things”.  She always had a problem with the idea that fitting in for girls meant dating and having certain clothes.

Adolescence & Rebellion.  

In the Philippines you did what your elders said and accept their wisdom. We don’t have the high school wisdom, they “don’t understand”, sums up a complaint of American kids. Even if you don’t take the advice, by asking it, they might make you their favorite. They appreciate this…On the same note, if you are misbehaving, they will also inform adults, and you will be punished. This is because the reputation of the family is important, and protected in this respect. My mother’s family, the Gonzales family, has a good reputation in town. Among all 24 cousins, nobody got in trouble, and we were all upstanding citizens. In all these respects it’s a much safer environment.” (Johnson, 2014).

When I was growing up, I remember my mother absolutely hated the Golden Girls and Rosanne.  These two television shows bothered her.  She felt everybody was so disrespectful.  There was a clear standard within our family that you are to be respectful and not allow your emotions to get away with you.  As two intellectual individuals, my parents were very stoic.  I felt they weren’t too interested int he open expression of emotion.

Social Movements in Teens.

“How was your view of the world shaped by the social movements of your teenage years (Ajouga, 2014).”

If there were any social movements which stand out for my mother it was the influence of Hollywood and the influx of American influence into her culture during the Post World-War 2 era:

“We are very westernized as a country and were very much influenced by America. I grew up with Elvis Presley, Patsy Cline, and The Everly Brothers. We saw movies and T.V. too, such as Mission Impossible, Bonanza, and I Love Lucy. American Music influenced me, because you heard it on the radio. We did have magazines, but I didn’t have television until high school. As a matter of fact, Rebecca would write celebrities and receive a signed letter from them. We didn’t have any social movements resulting from teenage angst, or youth rebellion, (Johnson, 2014).”

Educational & Occupational Opportunity.

“When you were a young adult, what educational and occupational opportunities were available to you?” (Ajuoga, 2014).  

“The reason we are compliant with our elders is because you rely on them for education as well as food, clothing, and shelter. In the Philippines it is somewhat a given that the parents pay for the child’s education, if able to at all. If you have the drive and ability, you are encouraged to go to College. Your ability to go to college is ability of your parents to pay. This is because there are no Federally Guaranteed Student Loans.   This is what’s different about America. Anybody here can get an education. Back home, if parents are well off, you stand on their shoulders as they pay your education. If not, you can have the ability, but not the resources to get a degree. It really is also an unspoken fact that when you do finish your education, you better have a marketable skill, career, and you support your elders in their old age because basically they gave up their retirement for your education.   Usually in the Philippines, the parents live in the kids’ house. Grandma then does the babysitting and usually does it for free. That also makes it difficult to get away from things, because Grandma is there to watch over everyone.   The education of your child is your form of retirement, (Johnson, 2014)”

The one thing I remember my mother always complained about growing up, is the issue of popularity in the United States.  It always distressed her how much it seemed peer group interactions influenced our identity as a person.  In her culture, education is available to those who can afford it.  As a result, in a respect, it enforces social class structures there.  Those who can afford, continue sending kids to college, so they have greater work opportunities.  Those who work can’t afford it don’t, and so consequently climbing out of poverty is quite difficult.

As a result of this, in adolescence, academic achievement is higher in importance for kids.  Children are divided into groupings in her school by academic achievement.  The ones in class number one were the high achievers and everybody looked up to them.   She also said the school displayed everyone’s grades in the town center on an announcement board for everyone to see.

Life in the States.

The entire quote below consists of my mother’s concluding remarks regarding how she transitioned to life in the states.  I have nothing to say about what is written below, other than I have a lot of respect for her.  She was quite young and yet very secure in who she was.

“When I moved here back as a resident, I had a good command of the language. the Filipino t.v. Anchors speak American Midwest English. I have trouble understanding other accents, but Midwest accents make sense to me. The thing I had trouble with were idioms such as “the cat’s meow”. I do feel my fellow residence at Baylor treated me fairly, although I was the only female, foreigner, minority in the program.   Although I do believe I imposed this upon myself, I felt I had to be twice as good to be good enough. I felt determined to prove myself. I was over prepared with a goal to do twice as good as anyone else. What did help is my older sister was already a resident at Baylor going to school. We were there together. I do remember people sometimes were surprised I was the housekeeping staff and not the physician in scrubs, so I learned to dress well and look the part. You know if I received discrimination from patients at times who didn’t want me to care for them because of my color. Oftentimes they were minorities like me, which surprised me. Nonetheless, I had to work hard to prove myself over time.   There was a time when I had trouble on the bus system. I took myself at face value, yet there were people who felt I shouldn’t sit here at a certain location on the bus. Since it wasn’t illegal to do so, I would stay there. They were the ignoramuses. I found it hurts only you if you put value upon the opinions of those people. I know who I am and stick to that identity of myself. To tell you the truth today, I don’t think of myself in terms of race, but as a person. The same goes for you, your sister or your father.   We are just a family; people.   I didn’t have the effects of being a minority growing up. While the Philippines is a melting pot country, but it was less “in your face” as an issue. In this country, it is more an issue in an “in your face manner”.   Back home, we are so diverse as people it wasn’t an issue. I, for example, have Spanish and Chinese in my family background, as do you through me….I’m being fair to each child. You give your child what they need, as they need it. Make your own way. Let go of any old gripes they aren’t worth the familial disharmony. Your successes are your own, as are your failures. I see myself as me; I am Virginia first and foremost. Race in a respect is a social construct, not genetic fact.   My identity is a choice of my own that I make it for myself irrespective of what comes at me from the race perspective, (Johnson, 2014).”

References

Ajouga, P. (2014). Re: MCC 638 Week Four Overview. Retrieved from: https://ssoblackboard.bellevue.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_328162_1%26url%3D
Fortune, B.A. (2012). Acculturation, intergenerational conflict, psychological distress and  stress in Filipino-American families. Regent University, Virginia.
Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American Psychological Association.
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.
LaFromboise, Coleman, H.L.K. & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin. 114(3) 395-412.
Lee, E, McGoldrick, Monica, Giordano, J, Pearce, J.K., (1996) Ethnicity and Family Therapy (2nd Ed.), (pp. 227-248) NY, NY: Guilford Press.
N. H. Trinh et al. (eds.), (2009).  Handbook of Mental Health and Acculturation in Asian American Families, Current Clinical Psychiatry, DOI 10.1007/978-1-60327-437-1z
Root, M. P. (1997). Filipino Americans : Transformation and Identity. Thousand Oaks: SAGE Publications.

 

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NCE STUDY – Counseling Older Adults

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

QUESTION: “How can you develop sensitivity to culturally diverse older adults?”

INCREASE KNOWLEDGE BASE:

The first idea that comes to mind, as a result of everything I’ve learned in this course, is the idea of working developing a working knowledge base. This means having a knowledge of various theories and as well as current research.   Admittedly this is not enough in and of itself. Nonetheless having a basis of knowledge to begin assessing and contextualizing client experiences can help provide essential insights to guide the counselor through the therapy process.

GAINING DIRECT EXPERIENCE:

The second idea I’ve learned from this course is the idea of learning through direct contact within those communities we hope to serve within. Naturally, you can only so much about human beings, and relevant interpersonal skills through reading and study.

ECLECTIC APPROACH & ONGOING CASE CONCEPTUALIZATION:

There is one final insight relevant to this question and it comes from two sources. The first insight comes from the following quote in our Hays textbook:

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically  choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176-177)”

alongside this notion of being somewhat flexible and using a “doing-what-works” method there is another resource I found particularly helpful from my research for our paper assignment for the Latino community. In this research titled “Counseling a Hispanic/Latino Client – Mr. X” by Delgado-Romero (2001), there is an excellent example of case conceptualization. This paper did a good job of showing how using relevant knowledge alongside directly assessed information to form a basic conceptualization of the case. This would be useful as an ongoing hypothesis testing process in a “doing-what-work” approach.

QUESTION: “What are some unique issues faced by these older adults?”

MATURATION ISSUES:

As per our readings, initial obvious issues associated with this community include physical and cognitive decline, caregiver stress, grief and bereavement, and intergenerational stress (associated with variations in acculturation and familial culure gaps), (Hays & Iwasama, 2006).  When taking time to contextualize these developmental changes, I found it helpful to look at Erickson’s lifespan Development theory which discusses Ego Integrity vs. Despair. The key developmental issue at this age occurs as one “comes to terms with life’s successes, failures, and missed, missed opportunities and realizes the dignity of own life” (Broderick & Blewitt, 2010, p10). It must be noted in mentioning factors associated with aging, that it is important to note both positive elements associated with maturity, alongside the above factors.

COHORT INFLUENCES:

In a resource titled, “Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults” is information on unique influences associated with one’s cohort, (Knight & Poon, 2008).Defined as a birth-year dependent group of individuals born within a 7 to 10 year period” (Knight & Poon, 2008), one’s cohort influences a variety of factors. In addition to the obvious influences of key historical events during one’s developmental years, other less obvious factors exist. For example, a person’s immediate sociohistorical context influences the cognitive abilities most relevantly adaptive to that environment. Additionally, differences along measures of personality are seen to coincide within different cohort groups. Influenced by sociocultural factors, and norms influencing behavior for example personality measures such as extraversion/interversion vary by cohort, (Knight & Poon.) Factors such as these influence the general maturation issues as they are experienced by the client.

CULTURAL INFLUENCES:

Finally, culture also complicates the issue of understanding the general issues associated with the maturation process.   Variations in beliefs and norms, as well as views of illness and help seeking behaviors are obvious key factors, (Hays & Iwasama, 2006). When digging deeper, and understanding the influence of culture it is important to understand the clients experiences of acculturation and enculturation. The problem is further complicated by the need to contextualize this alongside the any potential intergenerational conflicts associated with familial cultural gaps.

QUESTION: “What does research suggest as effective techniques in working with older adults?”  

Our textbook makes a point to mention that while CBT is found to be effective within this community, certain adaptations need to be made. Firstly as per the previously mentioned insights it will be essential to adapt CBT to how older ethnic adults learn and recall information, (Hays & Iwasama, 2006). Secondly, taking time to build a rapport and carefully assess the client will require the case conceptualization / eclectic approach mentioned earlier, (Hays, 2008; Delgado-Romero, 2001). The most convenient example of this is in our assigned readings in which the counselor’s method of assessing affect, shifted in focus to account for generational and cultural differences.

References 

Broderick, P.C. & Blewitt P. (2010). The Life Span: Human Development for Helping Professionals. 3rd Ed. New Jersey: Pearson.
Delgado-Romero, E.A. (2001). Counseling a Hispanic/Latino Client – Mr. X. Journal of Mental Health Counseling. 23(3). 207-221.
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.:  American Psychological Association
Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American Psychological Association
Knight, B.G. & Poon, C.Y.M. (2008) Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults Journal of Rational-Emotive Behavioral Therapy. 26:232–249

 

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NCE STUDY – Psychological Testing Bias

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

When you consider what exactly culture is, its not surprising that “culturally bound assumptions…pervade virtually all mental and physical health instruments” (Switzer, et al, 1999).   In fact, during my literature review, I came across an endless list of definitions for culture that repeatedly drove this fact home, (Thomas, 2007; Wakefield, 2006; Mclaughlin, 2002; Sternberg, 2004).

Culture permeates virtually every facet of our development as individuals. As a set of learned values, roles, and behaviors passed from one generation to the next, it consists of external and internal components that tie individuals to their culture, (Wakefield, 2006). Culture ensures its existence through its influence over our personality development by providing members with a value system, and set of social roles for its members (Wakefield, 2006). In turn, through their participation in culture, individuals ensure culture’s functional success in a society (Wakefield, 2006).

A similar interdependence can be seen between mental health, intelligence and culture. Culture provides its members with attitudes, thoughts, knowledge, and “the kinds of cognitive strategies and learning modules that individuals use” (Valencia, et al, 2001, p31). This allows people to develop a set of skills with which to adapt to the daily life, that they then pass to the next generation (Sternberg, 2004).

Most notably though is culture’s influence upon our overall mental health.   As an “internalized system of control for producing adaptive, sane behavior”, (Emmerling, et al, 2008, p40), culture also exerts an influence over our emotions, and adjustment. While well beyond the scope of this brief paper, an interesting concept drives home this fact:

“Group Emotional Competence (GEC) concerns the ability of a group to create a culture that effectively shapes the group’s experience of, and response to, emotion in the group….A group’s culture influences the cognitive processes of its members, the way they interpret events and define appropriate responses…which affect(s) the emotional responses of a group and ultimately its performance.” (Emmerling, et al, 2008, p40-41)

When taking all this into consideration, its clear that “everyone should be assessed in light of relevant sociocultural influences,” (Thomas & Hersen 2007, p55).   Multicultural sensitivity throughout any diagnostic and assessment process means considering biological and psychological factors within a sociocultural context, (Hays, 2008). In this paper I discuss the potential biases in intelligence testing, personality assessment, and mental health status exams. I conclude with a brief outline on how to address such biases.

Intelligence Testing Bias.

“Intelligence cannot be fully or even meaningfully understood outside its cultural context. Work that seeks to study intelligence contextually risks the imposition of an investigator’s view of the world on the rest of the world. Moreover, work on intelligence within a single culture may fail to do justice to the range of skills and knowledge that may constitute intelligence broadly defined and risks drawing false and hasty generalizations”(Sternberg, 2004, p325)

Intelligence Defined.

Our textbook makes a point to note that psychological testing biases have centered around a European American worldview that has been predominant in the field, (Hays, 2008).   With this in mind, Robert Sternberg provides a definition of intelligence that I quite like, (2004). Defined as “a set of skills and knowledge needed for success in life, according to one’s own definition of success, within one’s sociocultural context” (Sternberg, 2004, p326), this view of intelligence acknowledges variations relevant to it for accurate measurement. With this as a starting point, how exactly does culture influence intelligence? Additionally, how do you incorporate these insights into measures of this concept?

The Relationship of Culture & Intelligence.

As stated earlier, culture impacts intelligence by providing a knowledge base with strategies for its attainment so members can successfully thrive (Valencia, et al, 2001). In this respect, the skill and knowledge set that comprises intelligence “depends” on one’s sociocultural context. In fact, cultures define intelligence as those skills needed for adaptive success within a particular social environment, (Sternberg, 2004)

In keeping with this insight, I found it interesting through my literature review, how widely varied intelligence was perceived by different cultures.  For example, while European American standards emphasize quick response as a measure of intelligence, Ugandan culture emphasizes a slow, precise thoughtfulness, (Valencia, et al, 2001). Additionally, while Chinese schools make time for silent mental activities, American school systems promote “group discussion and verbal inquisitiveness.” (Valencia, et al, 2001, p44).

Measures of Intelligence.

 Evolution or Cultural Relativism.

Currently, measures of intelligence vary in how they attempt to reflect the relationship between intelligence and culture. In fact, testing methods vary according to whether they acknowledge cross-cultural difference and if they adapt their instrument accordingly, (Sternberg, 2004). At one extreme, there are theorists who believe that nothing exists “that cannot be measured.” (Valencia, et al, 2001, p27). Theoretical perspectives such as these hold a more evolutionary view of intelligence (Sternberg, 2004). Measures of intelligence based on this perspective view intelligence as culturally unvaried, with one singular method for measurement useful across all sociocultural contexts.

In contrast to this, other measures of intelligence based on a culturally relativistic perspective (Sternberg, 2004). Such theoretical perspectives yield a view of intelligence that “can be understood and measured only as an indigenous construct within a given cultural context.” (Sternberg, 2004).

Ultimately, the issue is one of how to assess biological and psychological characteristics of the individual within a particular sociocultural context (Hays, 2008). On the one hand, focusing on an individual outside of a sociocultural context is what creates bias in intelligence testing (Valencia, et al, 2001). On the other hand, a purely culturally relativistic position fails to acknowledge the individual doesn’t exist except as a cultural byproduct (Sternberg, 2004). With no testing method 100% ideal, I do believe the greatest remedy to this issue falls in the hands of practitioners.

Types of Intelligence.

Varied types of intelligence are posed in literature as a result of the above conundrum.   For example, while academic knowledge is the result of educational pursuits, practical knowledge is more action-oriented and directly relevant to daily life, (Hays, 2008). In contrast to this, emotional intelligence is the ability to understand, perceive emotions in others as well as yourself and then express effectively in a relationship, (Valencia, et al, 2001, p36). Still other theories propose creative intelligence, moral intelligence, and multi-faced intelligence models (Sternberg, 2006; Valencia, et al, 2001). It is clear, understanding the nature of the concept and means of measurement are critical for an accurate assessment of intelligence to occur.

Personality Measures & Bias.

Personality Defined.

In the DSM-IV-TR, personality is defined as “enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.” (Hays, 2008, p146; Wakefield, 20076). While on the surface, this definition appears useful enough, the same issues arise in how to best depict this concept (Hays, 2008).   Weighing the need for an empirically clear concept against cultural relativism and evolutionary perspectives makes the measurement of this concept difficult.

Personality & Culture.

“Personality is a uniquely important medium within which culture attempts to ensure social coordination among individuals within the culture and produce individuals who will fulfill social roles. The culture’s approach to ensuring the functional success of its members and its own reproduction expresses itself via values, which influence personality formation. Personality is in part essentially cultural and culture in part essentially consists of the purposeful shaping of personality tendencies in what amounts to the creation of a kind of mental artifact.” (Wakefield, 2006, p168)

 As this quote illustrates, the relationship between culture and personality is quite complex. Knowing how to measure personality while accounting for its relationship to culture is complicated. It seems literature holds a similar theoretical divide as was witnessed in discussions on intelligence measures above (Sternberg, 2004; Wakefield, 2006).

There are those in the field who hold an evolutionary and nature-based view of personality as innate. These perspectives uphold an empirical stance that we should focus on the individual as concrete autonomous factor for measurement, (Hays, 2008). On the other hand, some people hold a culturally relativist position. Such views point to the fact that “all personality models are based on concepts of personhood and standards of culturally appropriate behavior…in Anglo-American countries,” (Alik, 2005, p215). Further complicating this matter, is the fact that a measure’s purpose seems to change the focus of this conceptual battle.

Personality Measures & Diagnosis.

There are two primary perspectives within which to assess personality. The DSM utilizes a medical approach and defines personality within a disorder perspective. This perspective on personality focuses solely on problems and dysfunction. On the other hand, personality typology assessments focus on strengths, describing traits relevant to the individual.

 Personality Disorder Diagnosis.

In an article discussing the concepts of personality disorder and culture Jerome Wakefield (2006) provides the following definition of a mental disorder:

“The harmful dysfunction (HD) analysis of the concept of mental disorder…maintains that a mental disorder is a psychological or behavioral condition that satisfies two requirements, (1) it is negative or harmful according to cultural values; and (2) it is caused by a dysfunction (i.e. by a failure of some psychological mechanism to perform a natural function for which it was evolutionary designed.” (Wakefield, 2006 p157)

A few things can be noted about how this concept relates to personality diagnosis. In the case of the evolution versus cultural relativism debate that exists, the underlying issue that complicates matters is one of perceived blame attribution, (Wakefield, 2006).

Evolutionary empiricism. On the one hand, there are those who state a preference of some universal diagnostic criteria over cultural value judgment. Such perspectives claim changes such as these are “a politically correct concession to cultural relativism that illegitimately allows cultural values to intrude scientific definition.” (Wakefield, 2006, p162).

Cultural relativism.  On the other hand, as a counterpoint, there are those who state utilizing some element of cultural value judgment in the diagnostic process is seen as essential. Such perspectives point to the classic notion of personality as “a dynamic organization, that…is not a trait” (Wakefield, 2006, 158), but an overall structure that exists in sociocultural context. Stating it is wrong to misattribute social problems as individual dysfunction, this perspective affirms that sociocultural context is critical to the diagnosis of personality diagnosis, (Wakefield, 2006).

A conceptual solution. In my opinion, the best conceptual remedy comes when understanding how the “harmful dysfunction” definition (Wakefield, 2006), of mental disorder as it relates to personality. According to this perspective a personality disorder exists in the presence of two key factors. Firstly, an element of one’s personality must be harmful according to a cultural value-based perspective (Wakefield, 2006, p157). This standard addresses the need for sociocultural context but naturally isn’t enough by itself. A second critical element for the diagnosis of a personality disorder is the existence of a dysfunctional dimension within the individual, as defined by the DSM, (Wakefield, 2006).

Our Hays textbook adds to this insight by simply stating care needs to be made when diagnosing a personality disorder, stating the following:

“To accurately diagnose a personality disorder, the therapist needs to know the client’s culture well enough to judge whether the client’s behavior represents a marked deviation from it….Because personality disorders by definition involved disturbed interpersonal functioning, and misrepresentations of actions of others the therapist may need information from those who know the client,” (Hays, 2008, p159)

Personality Typology.

In attempting to understand the potential of cultural biases in a personality typology, two facts became clear. Firstly, it is vital to note that many popular tests such as the MBTI (Myers Briggs) and MMPI (Minnesota Multiphasic Personality Inventory) are based on a sampling that is largely Euro-American, and therefore limited in generalizability, (Hayes, 2008). Having said this other testing methods do exist to help account for this cultural bias. Nonetheless it is worth mentioning simply as a matter of further exemplifying the underlying history of bias that exists within the mental field throughout its formation.

A second notable fact in my literature review was also intriguing in helping shed light on the cultural biases through personality typology. Some of the research I uncovered, gathered results from assorted tests attempted to create a societal average or “aggregate personality” (Mccate, 2005, p5). While at first I thought the idea of this as potentially stereotyping, if not conducted thoughtfully, I read further. When reading studies of how personality traits do indeed vary across culture I began to think of how culture defines personality? Additionally, I came to wonder, what these tests actually did measure? After all, if we were to examine Hays’ definition of personality as “enduring ways of perceiving” (Hays, 2008, 146) in a context, it appears culture and personality are intertwined. It would stand to reason, then that such measures might in some respects be reflect an interaction between these two factors.

Mental Status Examination.

Consisting of patient’s subjective experience and observation, the mental status examination is an interview based evaluation of a person’s overall functioning, (Thomas, 2007, p49).   As an interview-style approach, it consists of the following components: Appearance, behavior, motor activity, orientation, attitude, speech & language, affect & mood, thought & perception, insight & judgment, attention & concentration, memory, intelligence and abstraction, (Judd & Beggs, 2005; Thomas & Hersen 2007). While an in depth discussion of each of these elements goes way beyond this assignment’s scope, when reviewing the categories above, the possibility of bias seems clear. Having had the opportunity to witness several mental status examinations in a hospital setting, the degree of bias seems to vary with practitioner. While very useful as a tool with which to diagnose, assess, and create a treatment plan, it isn’t quantifiable, without a normative standard, or defined relative to culture and environment, (Judd & Beggs, 2005). Consequently, open to much clinical judgment and interpretation, a high degree of cultural bias exists throughout the process. As stated earlier, some resistance to the inclusion of cross-cultural factors in mental health assessment and testing exists. In fact, the following quote sheds light on how this exists as a causal factor in the continuing existence of bias in assessment:

“Some experts in mainstream psychiatry believe cross-cultural factors are not relevant if a diagnostic category is valid; instead such factors, they argue, relate only to specific clinical symptom presentations….”(Johnson, 2013, p18).

From this perspective, it seems that such factors are “a nuisance variable in assessment”. (Thomas & Hersen 2007).   The problem in learning how to operationalize and measure such a concept comes in light of the fact that self-awareness is a critical component in the process. Interestingly, attitudes like this which defend empiricism against confounding variables, promote a narrowed view of individuals from a nature-based evolutionary perspective.   At the same time, this isn’t to say those who promote cultural relativism in the field are without blame as well:

“Some naïve psychologists still believe that psychological testing is a universal phenomenon that it can be made culturally fair. There are even tests that incorporate “culture-fairness” in their names. This myth has an unfortunate role in advancing xenophobic and racist agendas.” (Judd & Beggs, 2005, p198)

In the end, whether or not one embraces or refuses to acknowledge the notion of multiculturalism, the issue is one of asking questions, rather than knowing the answers. The simple skills mentioned in our Hays textbook (2008), of humility and critical thinking stand out as key skills for multicultural sensitivity.

Resolving The Potential For Bias

Defining the Problem.

“Tests originate from a European American worldview that permeates procedural norms in the research and development of such instruments. Items are chosen according to the rational analysis and judgments of a panel of experts who usually hold European American perspectives (Rogler, 1999), and instruments are validated through correlation with other instruments based on American cultural views.” (Hays, 2008, p130)

Assessor Bias.

Assessor bias can be thought of as “the homogenization of all clients through the use of the scientific method without critical thought” (Thomas, 2007, p68).   From the perspective of testing and assessment misdiagnosis, and even institutionally based discrimination, are the results. (Thomas, 2007). Issues such as confirmatory bias, (ignoring information not relevant to your predicted hypotheses), certainly highlight the importance of critical thinking and humility in counseling practice, (Hays, 2008). In fact, in a well-known study several researchers gained admission to a hospital to assess the potential of self-fulfilling prophecy in psychiatric diagnosis, (Mclaughlin, 2002). While not having any psychiatric diagnosis on admission, staff nonetheless acted to confirm their expectations based on the assumed diagnosis of researchers (Mclaughlin, 2002). When you consider such clinical errors in judgment and diagnostic bias alongside mental health’s own troubled history lacking in multicultural sensitivity, this problem more complex than one might think.

Instrument Bias.

Biases in diagnostic criterion within assessment instruments further compound assessment bias, (which occurs throughout the gathering and processing of information0.   In light of the history of psychometric testing, an overarching cultural testing bias can found in many instruments, (Valencia, et al, 2001). Issues of context arise when careful consideration isn’t made of the generalizability of an instrument’s results in light of a client’s own sociocultural background (Switzer, 1999). Examining original sample data the testing instrument is based upon is a great start.

Examining the Solution.

How can a practitioner assure that client’s be assessed in light of relevant sociocultural influences while using many of the testing instruments and diagnostic criterion existing today? What follows is an overview of all information found throughout my literature, to reduce biases discussed throughout this paper.

Reducing Instrument Bias.

When utilizing any psychometric instruments a first critical step is cautious test selection. Being aware of contextual issues, as well as the culturally loaded North Euro-American history of mental health overall throughout the utilization and interpretation of such instruments. Further evaluating the degree of reliability and validity of such instruments is also useful. For example, how well do testing instruments utilized really measure what they are purported to? Also, how generalizable are the tests results? What sampling methods were utilized?

When administering any psychometric tests it is important to be aware of the testing environment to assure the client’s comfort level. Conducting thorough clinical and sociocultural interviews to consider alongside psychometric tests helps to contextualize their results, (Hays, 2008). Finally, interpretation of results should occur holistically, considering biological, psychological factors within a sociocultural context. Including clients and family members throughout the process as valuable reference points of client’s subjective experience also bears mention (Mclaughlin, 2002). Considering these factors alongside objective assessment measures and diagnostic criterion, helps further contextualize results, (Mclaughlin, 2002)

Reducing Assessor Bias.

“Multicultural assessment is a logical and necessary extension of standard assessment in which a traditional underemphasis on sociocultural factors is remedied…multicultural clinical interviewing, in addition to its standard functions of gathering medical, psychiatric and social information, ‘ serves as the fundamental medium for gathering cultural information.” (Thomas, 2007, p66).

MAP a Modified Axis-6 Approach. Throughout my research review, the best advice I had found was from two key sources.   Starting with our Hays textbook (2008), chapter 8 is devoted to an Axis 6 approach that encompasses the utilization of the ADDRESSING model she refers to throughout, (Hays, 2008).   While clear adjustments to this process need to be made in light of the DSM-5’s new nonaxial approach. I will still do see great benefit in starting with the ADDRESSING model as a critical component in my initial interview assessments.

Adding to this advice along imilar thought lines is a “Multicultural Assessment Procedure, otherwise known as “MAP”, (Thomas, 2007, p65). Firstly, this assessment divides clinical data into two categories: covert and overt information, (Thomas, 2007, p70). Stressing the importance of an ongoing commitment to multicultural sensitivity, to uncover it, covert data can include cultural values and assumptions, repressed memories, or family conflict. Overt data can include anything clearly expressed within an initial interview in which I intend to utilize the ADDRESSING model, (Hays, 2008; Thomas, 2007).

With this data in hand, an ongoing hypothesis testing process occurs. Developing working hypotheses seeking more information to test and revise it and repeating the process, allows for the gradual development of a sound and accurate assessment decisions, (Thomas, 2007, p70). As a method which stress always asking questions, and seeking more insight, I found it quite useful.

FACTS Method. Also discussed in our assigned readings for this course, I found it blended nicely with the above suggestions. This FACTS method exists as a culturally responsive approach to the DSM (Johnson, 2013). With its empirical basis focusing on individualized dysfunction, a critical sociocultural counterpoint is quite useful. Starting with the formulating questions means keeping in mind relevant sociocultural context might have on symptom presentation (Johnson, 2013; McLaughlin, 2002). Assessing signs and symptoms in light of different diagnostic possibilities and potential comorbidities while including clients throughout the process is critical, (McLaughlin, 2002; Hays, 2008). Including client’s input throughout this process while advocating on the clients behalf with the health insurance system is also critical, (Hays 2008). Doing so allows for a culturally-responsive addressing of relevant issues and understanding how sociocultural context influences DSM-based diagnosis presentation, (Johnson 2013). Designing a treatment plan based on scientific evidence while including patient needs and concerns is a Johnson’s (2013) final suggestion.

References

Alik, J. (2005) Personality dimensions across cultures. Journal of Personality Disorders. 19(3), 212-232.
Emmerling, R.J., Shanwal, V.K., and Mandal, M.K (2008). Emotional Intelligence : Theoretical  and Cultural Perspectives. New York, NY, USA: Nova.
Geisinger, K.F. (Ed.), (2013). APA Handbook of Testing & Assessment in Psychology: Volume 1. Test Theory & Testing & Assessment in Industrial & Organizational Psychology. Washington, D.C.: American Psychological Association.
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.
Johnson, R. (2013) Forensic and Culturally Responsive Approach for the DSM-5: Just the FACTS. Journal of Theory Construction & Testing, 17(1), 18-22.
Judd, T., & Beggs, B. (2005). Cross-cultural forensic neuropsychological assessment. In Barrett, & W. George (Eds.), Race, culture, psychology, & law. (pp. 141-163). Thousand Oaks, CA: SAGE Publications, Inc. doi: http://dx.doi.org/10.4135/9781452233536.n10
McLaughlin, J.E., (2002). Reducing diagnostic bias. Journal of Mental Health Counseling. 24(3) 256-269.
Mcrate, R.R. & Terracciano, A., (2005) Personality profiles of cultures: Aggregate personality traits. Journal of Personality and Social Psychology, 89(3) pp. 407-425.
Switzer, G.E., Wisniewski, S.R., Belle, S.H., Dew, M.A., & Schultz, R. (1999). Selecting developing and evaluating research instruments. Social Psychiatry and Psychiatric Epidemiology, 34(8), 399-409.
Sternberg, R.J., (2004) Culture and Intelligence. American Psychologist. 59(5), 325-338.
Thomas, J. C., Hersen, M., Sage Reference (Online, s. (Online service), & Sage Publications. (2007). Handbook of Clinical Interviewing with Adults. Los Angeles: Sage Publications.
Valencia, R.R. & Suzuki, L.A. (2001) Intelligence Testing & Minority Students. Los Angeles, CA: Sage Publications.
Wakefield, J.C., (2006) Personality disorder as harmful dysfunction: DSM’s cultural deviance criterion reconsidered. Journal of Personality Disorders, 20(2) 157-169

 

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NCE STUDY – Culture & Rapport….

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))
“Counselors are aware of – and avoid imposing – their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselors values are inconsistent with the client’s goals or are discriminatory in nature.” (American Counseling Association, 2014, p4).

Establishing rapport is an essential skill in building a therapeutic relationship with clients. In today’s diverse culture, doing so requires a great deal of multicultural competency. When you consider how this can mean respecting diverse language styles, understanding different value systems, and even communicating respect or empathy, it becomes clear this skill is as much art as science (Hays, 2008).

In this paper, I will review a research article titled “The Relationship of Culture and Empathy in Cross-Cultural Counseling”, by Chung & Bemak (2002). It is intended to provide a theoretical model upon which to begin understanding how culture influences personality development. While I do have some misgivings about it from a theoretical perspective, I do still believe it has much insight that is applicable to my future counseling practice.

What intrigued me about this particular article is it touched upon a personal insight that has stayed with me, since I began this course. Firstly, I’m amazed at how much culture really does define us. It is actually an essential element in the formation of my own identity, value system, worldview, as well as affective style of emotive expression, (Pedersen, et al, 2008; Hays, 2008). Secondly, I’m struck by how much miscommunication can occur when divergent cultural perspectives aren’t fully recognized. In the subtlest ways, cultural differences define our system of meanings, and modes of emotional and verbal expression. When not put into a proper context, we can unknowingly, misapply our own cultural viewpoint and fail to understand what is being communicated.

The following article provides a theory of how culture and personality together affect our emotional styles in a particular culture. Again while I do have some criticisms about the theory, it is worth sharing.

Empathy & Culture

Empathy Defined.

Empathy is a key element of building an effective therapeutic relationship and establishing a solid rapport with clients.   Empathizing with someone means understanding your client as they understand themselves within the context of their own world (Nazir, et al, 2009).   In other words, empathy means putting yourself in your client’s shoes. Based on this definition, it is clear that empathy requires an understanding of your client’s viewpoint (Chung & Bemak, 2002). It also becomes quickly clear that knowledge of your client’s culture is implicitly an integral component of empathy and the establishment of rapport. It appears empathy and cultural sensitivity are indeed interconnected (Chung & Bemak, 2002). Despite this fact, empathy has historically been defined in a “Westernized Euro-American context” (Nazir, et al, 2009, p155) in the Psychology field. This paper is aimed at rectifying the problem by providing a theoretically proposed model of how culture affects personality.

Culture Defined.

Culture consists of a shared system of meanings within society that define modes of expression and communication, (Chung & Bemak, 2002; Nazir, et al, 2009). It influences how we view the world around us and sets the normative standards for behavior (Chung & Bemak, 2002; Nazir, et al, 2009). As a form of “mental programming” (Chung & Bemak, 2002, p282), it defines our value systems and preferred ways of thinking and feeling.

Within this way view of culture, authors Chung & Bemak, (2002) connect culture to personality by stating our mental programming exists at differing levels of uniqueness.   Starting with an innate evolutionary set of instincts, we have universal mental programs that exist in all humans (Chung & Bemak, 2002). Culture provides another set of mental programs relevant to a society (Chung & Bemak, 2002). Finally a personality specific to an individual exists as the result of both inherited and learned influences (Chung & Bemak, 2002).

Hofestede’s Dimensions of Cultural Variability.

With some basic conceptual definitions out of the way, this article moves on to a brief overview of a few theories. Together, it is proposed that these theories can help provide some understanding of how culture and personal are interrelated. The first of these theories is a “Hofestede’s Dimensions of Cultural Variability.” (Chung & Bemak, 2002, p283). This theory describes four dimensions of behavioral variations within culture that can be thought of as existing along a continuum, (Chung & Bemak, 2002).

Individualism & Collectivism.

Individualistic and collectivistic cultures vary in terms of the focus of identity on either individuals or community (Chung & Bemak, 2002). Collectivist cultures focus on community and consequently value harmony, tradition, sacrifice, duty (Chung & Bemak, 2002).   Individualistic cultures focus on the individual and value personal freedom of expression, responsibility, and independence (Chung & Bemak, 2002). It is interesting to note the varied mental programs in personalities that develop for each type of society. Collectivist societies, for example, would more likely promote emotional suppression and sacrifice for the sake of group harmony. Individualistic societies promoting values such as personal freedom would cultivate personality characteristics of emotional expression, and allow a more open expression of opinions.

Uncertainty Avoidance.

Cultures also vary in the degree of uncertainty avoidance. For example, a culture that defines uncertainty as bad would have individuals who are resistant to change in favor of tradition (Chung & Bemak, 2002).   Curbing uncertainty with restrictions to personal freedom and rules of behavior is often the solution (Chung & Bemak, 2002).

Power Distance.

Cultures also vary in terms of power structure and social status organization (Chung & Bemak, 2002).   “High power distance cultures” (Chung & Bemak, 2002, p284) have a more rigid power structure enforced as a basis of society. These societies promote a respect for authority, and its members engage in more formal interaction styles. (Chung & Bemak, 2002).   “Lower power distance cultures” tend to have greater social mobility, a larger middle class, and interaction is more informal (Chung & Bemak, 2002).

Masculinity vs. Feminity.

While masculine cultures promote values such as ambition, assertiveness, and performance feminine cultures promote service and caring for others (Chung & Bemak, 2002).   Again as with the other cultural dimensions, personality development of individuals these cultures reflects these differences.

Individual Mental Programming

With a discussion of culture out of the way, the article now moves to theories related to the individual. This section focuses on personality as a unique mental programing within the individual resulting from both nature and nurture (Chung & Bemak, 2002). From this perspective, personality can be thought of as a set of emotional, behavioral, and thought patterns unique to the person. (Chung & Bemak, 2002).

PSI Model of Emotions.

The PSI model of emotions discusses how people utilize motivation, thought emotion and action in the context of their lives. On the one hand what I didn’t like about this theory, is individuals appear very Pavlovian in nature. Focusing on concepts such as needs, drives, motivation, and arousal, this theory attempts to depict the mind as a system of action and regulation (Chung & Bemak, 2002). While I feel this is a tad too evolutionary in scope, there are some interesting elements that warrant mention.

Emotions as modulators of action.

This theory rejects the traditional notion of emotions as irrational, stating they play a role in decision-making, self-regulation, and motivation (Chung & Bemak, 2002). Rather than distorting our thoughts, they are thought to direct them. Noting that without emotions, humans become robots, this theory focuses on factors that influence our emotional reasoning. (Chung & Bemak, 2002).

Culture & personality as drivers of motivation.

A second element of this theory, which I appreciated, was how easily it helps show how both culture and personality drive human behavior. With these factors defining our value systems and perceived needs, culture and personality act to drive our motivations (Chung & Bemak, 2002). I would add to this by saying it would be logical to say they also direct our plans and goals in response to these needs, as the filter systems through which intake information.

Big Five Personality Theory.

In concluding this discussion on the individual, this article just briefly mentions the Big Five Model of Personality. While ignoring other personality type theories, it offers this one as a model that works well along the theory culture mentioned earlier. This theory comprises five dimensions of personality which also exist along a continuum: (1) openness to experience, (2) conscientiousness, (3) extraversion, (4) agreeableness, and (5) neuroticism.

I have to admit, I was disappointed more time was not discussed on how these factors might correlate with the cultural dimensions mentioned earlier. It would be interesting to see how cultures promoted the development of personality through the usage of such instruments.

Sadly, there isn’t much research in this area What I’ve read is largely speculative, and informal in books such as “Where In the World Do I Belong” by Brent Massey available at Amazon.

Criticisms & Conclusions.

The Positive Insights.

A Cultural Personality.

This paper concludes by providing a theory that depicts culture as a component of mental programming, alongside personality. In other words, it is internalized within us as a component of our personality (Chung & Bemak, 2002). In this respect it has great value in helping us understand how culture and personality correlate.   I would, in fact, be interested in more research that correlates cultural variants discussed with personality development and typology. Having knowledge of in Myers Briggs typology and Jungian psychology, I find this quite interesting.

Emotions Matter & Are Not Illogical.

Based on a theory, which depicts emotions as providing logic that motivates action, it attempts to understand feelings in this context. Understanding our emotions in the context of our decisions, motivations, and forms of reasoning, can only help us understand ourselves and therefore help others more effectively in a therapeutic setting.

Empathy as a Cultural Concept.

A theoretical perspective, that helps us understand empathy as a culturally based notion, is indeed relevant to future practice. If empathy means putting someone in another person’s shoes, cultural considerations are naturally integral to this. Understanding culture as a key factor influencing our personality, (and therefore emotional style), is also very useful.

Negative Criticisms

This article focused too much on a theoretical perspective that depicts individuals as functioning with a set of Pavlovian needs from an evolutionary perspective. Additionally, there was too little time spent understanding the influences of cultural dimensions on personality development.   For this reason, it’s potential to provide insights for direct application in a counseling setting aren’t as great as they could be.

Finally, I have some misgivings about one more item mentioned here.   This article proposes the development of a theory that can create “affective synthetic characters” which are representative of a cultural personality, (Chung & Bemak, 2002). While potentially beneficial to understand how culture influences personality, I’m not certain what the authors mean by “synthetic characters”. If researchers utilize some caution throughout the research process it could be useful, (much as the cultural variables are), in understanding behavior. On the other hand, if one were to use an evolutionary based theory that depicts individuals in a Pavlovian sense I have my concerns. I would worry about a reductionist and stereotypical depiction of personality under the influence of culture, being the end result.

Conclusions

Overall, while the article did have its shortcomings, I did find many of its insights useful. I am very interested in understanding how culture determines personality and the individual. As stated earlier, it seems this field involves as much art as science.   In utilizing insights from this article, the following quote seems most relevant to me:

“….The therapist then engages in ‘a continuous cycle of hypothesis formulation and hypothesis testing about the particular individual. Each item of information…suggests a hypothesis about the person, which will be either confirmed or refuted as other facts are gathered.” (Hays, 2008, 73).

In the end, it seems as if the more I learn in this class, the more I realize I have much to learn. My self-awareness grows, and I become aware that asking the questions is more important than knowing the answer.

References

American Counseling Association. (2014). Code of Ethics.   http://www.counseling.org/Resources/aca-code-of-ethics.pdf
Beadling, L. L. (2010). Mommy angst: Motherhood in american popular culture. Choice, 47(9), Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/356627939?accountid=28125
Chung, R.C.Y. & Bemak, F. (2002) The relationship of culture and empathy in cross- cultural counseling. Journal of Counseling and Development. (80) pp154-158.
Hays, P. A. (2008). Addressing Cultural Complexities in Practice. (2nd ed.). Washington, D.C.: American Psychological Association
Nazir, A, Enz, S, Lim, M.Y., Aylett, R., & Cawsey A. (2009). Culture-personality based affective model. AI & Society. 24(3) pp 281-293.
Pedersen, P.B, Crethar, H.C. & Carlson, J. (2008). Inclusive Cultural Empathy. Washington, DC: American Psychological Association.

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NCE STUDY – A Cultural Self-Assessment….

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

PART ONE – A Cultural Self-Assessment….

According to our textbook, a bias is simply a “tendency to think, act, or feel in a particular way.” (Hays, 2008, p24). Personal biases emerge as a result of our upbringing and sociocultural background, (Hays, 2008). Our life history provides us a worldview, value system, identity and cultural background that produce the very biases we carry into therapeutic relationships, (Hays, 2008). In light of this fact, a cultural self-assessment is the first step toward developing greater multicultural competency as a counselor. I start this self-assessment by utilizing the Addressing Model to provide a rough overview of my sociocultural history.  I then move on to a series of interview questions, which can help to shed light on areas of privilege, as well as value systems, and identities.

Utilizing the Addressing Model

Age and Generational Influences

My Parent’s Generation.

My mother was born in 1938 and my father was born in 1941. They are members of the “silent generation”, born just prior to the baby boom (Martin, 2004). Their earliest years of life occurred while the world was at war. My mother, from the Philippines, grew up in the middle of war. My dad, an American, was ignorant of war altogether. They were both raised to work hard, get an education, and pursue the American Dream. For my mother’s family this meant gathering resources to put both of their two daughters through medical school and then help them to immigrate to the states. For my father’s family, this meant raising their sons in a strict household, expecting them to work hard, and then put themselves to school. In the end, they all did so, earning advanced degrees.

My Generation.

I was born in 1969, and grew up in a small college town in South Dakota. Unlike many of my generation, I was spared from having to experience divorce first-hand, with divorce rates soaring to 50% in my childhood (Amato & Cheadle, 2005). With everyone in my extended family enjoying long and happy marriages, I have come to value the commitment of marriage and family.

Typical of many women in generation, I am fairly skeptical of the idea of “having it all”; a popular notion existing in westernized cultures in the aftermath feminist movement (Genz, 2010). While very appreciative of the strides made, I’ve witnessed many women struggle to keep up with home and work life in frustration. With many women in my generation have chosen to put off family, or opt out all together, I’ve chosen to put off career pursuits in favor of focusing on my family life, while my kids were young (Genz, 2010).

Developmental Disabilities

            Fortunately, I have no physical disabilities or health issues whatsoever. I’ve had the privilege of ignorance that comes with living in a healthy body, and never having to think about living with disability. (Hays, 2008). Nonetheless, I’ve found plenty of opportunity in my life to learn about living with disability. As a Hospital Tech I have had a great deal of opportunity to work with disabled individuals. As the mother to a son with a congenital defect, I’ve gained insight into experience of raising a child with special needs. I’ve developed an awareness of what it is to deal with physical disability on a daily basis. In fact, I’ve felt a great deal of satisfaction from these experiences, and wish to explore this area as a potential career path.

Religion and Spiritual Orientation

            My religious background is complicated, by the fact that my family isn’t unified in its religious beliefs. My father is an atheist, my mother is devoutly catholic, and my sister considers herself a “born-again” evangelical Christian. As an agnostic, I can see everyone’s point of view and respect each one, as right for that person. I don’t feel it is right for anyone to impose their religious beliefs on others. Nonetheless, I do find the other members of my family disagreeing on matters quite often. My sister and mother disagree with the others beliefs on the grounds that it goes against their own. My father refuses to talk about it altogether and this annoys my mother and sister.

Ethnic & Racial Identity

“The ecological model of racial identity development acknowledges that there are many different ways people of mixed racial heritage may identify themselves….These identities do not necessarily coincide with how other persons identify them. Thus the private identity may be different from the public identity assumed or validated by others.” (Root, 1998, p240).

I am a biracial individual, born to a Filipino mother and White father. A book written about my hometown, by author May-Lee Chai, titled “Hapa Girl” (2007), provides a good depiction of my childhood environment overall.   Also biracial, she was a senior in high school when I was a freshman and endured much of what I did growing up.

My racial identity can be best described as a personal knowledge I hold within.   It isn’t reflected in my phenotypic appearance and consequently is rarely acknowledged in my interaction with others. (Root, 1998). As a result, my identity as biracial is held with pride despite often being refuted and criticized by others. Additionally, because I’ve never been to the Philippines, it isn’t based on any cultural heritage. (Root, 1998) While purely American, from a cultural perspective, I claim both my Asian and American heritage from an identity viewpoint.

Socioeconomic Status

The socioeconomic status of my family of origin is solidly upper middle class. In contrast, my family of procreation would most likely be somewhere in the lower middle class. My husband comes a working class background, and had a rough home life. Adding to this, until recently, I’ve put off career pursuits in favor of family. As a result, I have experienced some downwardly mobile, in a matter of speaking. By marrying someone of a different socioeconomic class, I’m aware of the huge cultural divide between my husband’s family and my own. I feel comfortable in both worlds, yet my husband doesn’t enjoy being around my extended family, (despite getting along with my parents). A quote from a book titled “Reading Classes” by Barbara Jensen (2012) that sums up my husband’s experiences well:

“I knew I wasn’t middle class like some others in the movement, and I believed I wasn’t as smart as they were. I knew my brain worked okay, but they knew more, lots more, and I wanted what they had. They often referred to authors I had never read or even heard of. They used words I didn’t understand, and they often talked about their college experiences, worldly travel, orchestral music, and other things with which I had little opportunity and experience. They appeared to all understand one another, but sometimes I just pretended I understood, and then I felt ashamed of both not knowing and pretending.” (Jensen, 2012, p18)

Sexual Orientation & Gender

Sexual Orientation & Cisgender Status.

Regarding the issue of sexual orientation and gender identity, I happen to be a cisgendered heterosexual.  Being cisgender, I moved through life with a body that matches my gender of identification, (Levy, 2013). Being a heterosexual, I have a sexual preference that is deemed acceptable by all facets of our society (Levy, 2013). I have never felt the need to think about my sexual orientation or gender identity to the extent I have my racial identity. Any thought I do give to such matters has been purely political in nature, since I’ve always been very supportive of LGBT rights. Having said this, I do feel simply believing in equal rights isn’t enough With ignorance, can come a lack of awareness of things such as subtleties of interaction and the imposition of our biases that can indeed be felt as discriminatory, regardless of their intention, (Hays, 2008)

Being Female.

While being a female certainly implies a second-class status, it must be noted that the degree to which this is experience varies by culture. Fortunately, my sociocultural background has been one which values and empowers women.   Having said this, it would be fruitful to learn about the implications of being female in cultures other than my own, as a matter of perspective.

Indigenous Heritage & National Origin.

On the one hand, I’m an American living in the United States and have no experience living in another country. I am neither an immigrant nor of indigenous heritage. On the other hand, with a mother who emigrated from the Philippines, I’ve witnessed a bit of what it is like to balance the influences of two competing cultures. Described best as a biculturalism, or dual identity status, (Framboise, 1993), raising a family in a foreign culture was certainly problematic for my mom. From my perspective, the cultural gap that resulted did require time to work through. Having not occurred until well into my own adulthood, I have a relationship with my mother today, which is very different from that of my childhood.

Cultural Self-Assessment Interview

In this portion of the paper, I move on to a series of self-assessment interview questions. It is my intention to answer each within the Addressing Model framework. I will consider how each question applies to my sociocultural history as described within this model.

“When I was born what were the social expectations for a person of my identity?” (Ajuoga, 2014).

My biggest struggles with social expectations associated with identity, are in the areas of: (1) gender roles, (2) race identity, (3) socioeconomic class, and (4) religious affiliation. Other addressing components such as disability, sexual orientation, and indigenous heritage, have been of little concern. I will address these areas of struggle in turn, leaving female gender roles issues, for later.

Racial & Ethnic Identity. As mentioned already, I have experienced a great deal of confusion regarding my ethnic identity. My own biracial identity has been largely met with messages of disapproval, with others needing to inform me what they believe is the correct one (Root, 1998). It has taken some time, to sort through this issue as I’ve learned to let go of the idea that validation from others is ever a realistic expectation.

Religious Identity. While my mother’s family is devoutly catholic, my father’s family is predominantly agnostic and atheistic. The competing perspectives from this interfaith family background yielded an array of contradictory expectations (McCarthy, 2007). As my sister and I matured, our chosen routes diverged greatly. I came to identify myself as agnostic, while my sister has joined an evangelical church and embraced those ideals. The biggest issues in our family have come as we’ve tried to maintain a sense of integrity while also respecting others’ beliefs (McCarthy, 2007).

Socioeconomic Identity. Maria Root discusses in her work on mixed race identity, that individuals from such backgrounds can often develop negative biases against one side of their family as result of negative treatment, (Root, 1998). Within my father’s extended family I have experienced just this growing up. The ignorance and ethnocentrism they display, alongside the pride, and unwillingness to see any other perspective has been the source of much pain. As a byproduct of this experience, I’ve developed a negative bias against their upper middle class socioeconomic ideals (Root, 1998). It’s only in my adulthood, that I’ve been aware of how much I rejected this component of my identity, while embracing husband’s working class background instead, (Root, 1998). Coming to terms with this will be essential in my growth as a counselor (Hays, 2008).

 “When I was a teenager, what were the norms, values, and gender roles supported within my family, by my peers, in my culture and in the dominant culture” (Ajouga, 2014)

Overall, a great deal of conflict exists regarding norms, values, and gender role expectations within my extended family. In her article an article on biculturalism, Teresa LaFrombroise, discuss the impact of living between cultures (LaFrombroise, et al, 1993). This article mentions feelings of psychological discomfort as the initial result of a dual identity-based conscious that can have potential benefits in the long run, (LaFrombroise, et al, 1993). Having many conflicting identities, as mentioned previously, I’ve experienced much of this discomfort and have likewise developed many fruitful life lessons as a result.

Gender roles.

Within my family, gender roles brought about much confusion as a child.   Conflicting messages existed as a result of complex familial generational and cultural gaps. My dad’s family came from a traditional background, with the belief that women were supposed to stay at home. In contrast, my mother’s family was very forward thinking. Since my maternal grandparents were both teachers, it was very important their daughters go to school. Having two daughters finish medical school was a source of great pride.

These competing perspectives left me with a conflicting and contradictory array of familial gender-based role expectations. Against this backdrop, was the generational influence of being born in the aftermath of the feminist movement, (Genz, 2010). Not feeling the need to having it all, I have instead discovered a path that has worked for me.

Norms and Values.   While there were many conflicting norms and values within my extended family, this wasn’t really the biggest issue in the context of day-to-day life as a child. The greatest source of conflict existed between the values and norms my parents held me to in contrast to what was expected in my hometown. Norms and values regarding: (1) relationships and dating, (2) parental roles, (3) rules of emotional expression, as well as (4) appearance and demeanor stand at the forefront as most problematic.

In keeping with her cultural background, my mother assumed the role of matriarch, and was largely responsible for setting parental limits. My dad, busy at work most of the time, didn’t want to interfere. As a result, my mothers cultural belief systems were the standard we complied with at home. Naturally unbeknownst to them, this key factor resulted in an array of problems throughout my childhood, when it came to fitting in (Chai, 2004; Fortune, 2012).

For example, regarding the issue of appearance, my mother didn’t allow me to shave my legs or wear makeup, and I was bullied endlessly for it (Chai, 2004). In the arena of dating, I was absolutely forbidden from even considering it until we finished college, because that’s how it was for her growing up, (Fortune, 2012). Added difficulties resulted from differences in parenting role expectations between my mom’s culture and my hometown environment, (Root, 1998). Cultural differences such as these, caused many parents and teachers to misunderstand my mother. They often thought poorly of her parenting style, because it was so different from what they knew. This added to my difficulties in trying fitting in at school.

How was my view of the world shaped by the social movements of my teen years?” (Ajouga, 2014)

With a population that was mostly white, middle class, and well educated, my hometown had a very ethnocentric feel to it (Chai, 2004). At school, a large portion of my classmates came from families that called this town home for several generations. This gave many of my classmates the benefit of a large social and familial network, as well as consistent socialization, on how to follow the values and norms of the local culture (Chai, 2004).   Without this knowledge base or support system, fitting in was difficult, and I was bullied throughout much of my childhood, (Chai, 2004). As per Brene’s Brown work on shame, my personal view of the world was based on an underlying identity based on shame as she defines it:

“The definition of shame that emerged from the research is, ‘ an intensely painful or experience of believing we are flawed and therefore unworthy of acceptance, and belonging.” (Brown, 2006, p45)

“When I was a young adult, what educational opportunities were available to me? And now?” (Ajouga, 2014)

While I did enter college with many opportunities for learning, my ability to make the most of them limited by my problematic childhood history.   Nonetheless, having been born into an upper-middle class environment to two highly educated parents, provided me with many privileges I failed to appreciate at the time, (Hays, 2008). Today, after having come to terms with my past through counseling, I’m grateful for the opportunity to make the most of these privileges and pursue this degree.

“What generational rules make up my core identity (eg., auntie, father, adult child, grandparent)?” (Ajouga, 2014)

Key generational roles which are strongly associated with my identity, include my roles as a daughter and mother. In fact, I hold my role as parent before any others in my life. Having nearly lost my oldest after several open heart surgeries and then suffering a miscarriage before giving birth to my youngest, I value my time with my kids greatly. It’s been my goal in life to learn the lessons from my parents, and be there in ways they were not able to. Making sacrifices for my kids, showering them with affection and cherishing our time together are key priorities in my daily life.

Regarding my role as daughter, while I’m not as close to them as I’d wish, I do strongly identify with my duties to them. As the oldest child with a background in health care, its expected that I be there to care for them when they age.   I plan on trying my best to live up to this expectation as a show if respect and love, knowing action and not words work best a communicating such things with them.

PART ONE: Conclusion

In completing this assignment, I’m actually surprised at how much I learned about myself. Rereading my personal history has been quite enlightening, as a much-needed perspective within to contextualize the outcome of my life.   It’s cleared while my complex sociocultural history yielded much stress as a child, its also provided me with wonderful opportunities for personal growth. Inspired by this fact, I am committed to a lifelong process of learning as a counselor and plan to use these insights as I worked completing my degree.

PART TWO:  Becoming a Culturally Competent Counselor

“Every man is in certain respects; (a) like all other men, (b) like some other men, and (c) like no other men” (Leong, F.T.L., 2011, p. 150).  We are inextricably connected to culture, defining it while simultaneously existing as a byproduct of it.  (Leong, F.T.L., 2011).  It is clear that counseling can’t occur in isolation of society at large (Sue & McDavis, 1992), and that counseling interventions are never culturally neutral (Framboise, et al., 1993).  Consequently multicultural competence must be an integral component of  ethical therapeutic practice .   A multimodal approach will be needed to consider varied factors from multiple viewpoints.

Towards a Solution

A quick review of literature reflects the complexity of the issue, with a complexity of approaches encompassing an array of factors to consider from multiple perspectives.   For example, the AMCD Multicultural Counseling Competencies, includes an awareness of one’s own cultural perspective, the clients, as well as knowledge of appropriate interventions based on these factors. (Arredondo, et al., 1996).  Assessing one’s beliefs, knowledge base, and skill set, within these three areas is essential for multicultural competence (Arredondo, et al., 1996).  Adding to this perspective, is insight from an article which says our personal development can be understood from a universal, group oriented and finally individual one (Leong, F.T.L, 2011).   In keeping with the idea that the individual and society at large are mutually definitive and interrelated in a complexity of ways, this perspective can be useful from a variety of theoretical perspectives.  Additionally, it could provide useful insight when utilized alongside the ADDRESSING Model discussed in our textbook (Hays, P, 2008).

A Tentative Plan

With multicultural competence such a complex issue, a plan is essential as a general guide to the development of this skill.  In this section, I provide a tentative outline of how I plan to develop multicultural competence.  In doing so, I will utilize the Bellevue University MCC Graduate Student Disposition Rubric to organize my thoughts (Bellevue University, 2014).  Additionally, in the spirit of this assignment, I believe a more informal and honestly self-reflective discussion is essential to make the most of this exercise.

Professionalism: Maturity & Responsibility.  

“Seeks solutions independently and/or identifies faculty who can assist…uses discretion by discussing the problem with only the appropriate person(s); focuses on solutions rather than blame….is respective to constructive comments….maintains confidentiality….always displays a thorough preparation…always demonstrates behaviors that exemplify honesty, and integrity…” (Bellevue University, 2014).

Strengths.

When reflecting upon the above, I feel my work as a C.N.A./Psych Tech has prepared me fairly well overall.  Confidentiality and discretion are very familiar concepts, (Catholic Health Initiative, 2014).   Additionally, maintaining a sense of integrity is what keeps me going during even the most difficult shifts.  This concept of integrity has meant thinking of the well being of clients first, and doing right by them first and foremost.  In doing so, this has meant letting go of any ego-based need to blame someone else.  Regardless of who is to blame, I have had to learn to understand the perspective of those whom I provide care for.  Adding to this, work-oriented skill development are my personal experiences as a biracial individual.  I’ve developed an understanding of the concept of cultural relativity and feel a heightened self-awareness has been an adaptive response to this experience.  The result is a greater willingness and open-mindedness to idea of understand cultural perspectives other than my own.

Area of Growth.

Being thoroughly prepared from the standpoint of multicultural competency, will have to be an ongoing commitment.   On the one hand, I’m a very self-aware individual, in terms of my own cultural values and biases (Arredondo, et al, 1996)  Additionally, I am very willing to learn about other cultures (Arredondo, et al, 1996).  At the same time, I do need to gain greater knowledge and skills when through interpersonal work within those communities I hope to serve (Arredondo, et al, 1996; Hays, 2008).

Solutions.

Direct interaction with individuals in communities I hope to serve within will need to be a priority.  Finding volunteer work, and opportunities for exposure to other cultures will be important.

Professionalism & Valuing Others.   

“Interactions…respectful of differing opinions.  Treats others with courtesy, respect, and open-mindedness.  Listens to and shows interest in the ideas and opinions of others.  Seeks opportunities to include or show appreciation for those who may be excluded.  Demonstrates concern….” (Bellevue University, 2014).

Strengths.

When considering how this applies to multicultural competence, valuing others will start with a self awareness of my own cultural background (Arredondo, et al, 1996) Being open-minded and willing to respect other cultural perspectives will be vital (Arredondo, et al, 1996)   In these respects, I do believe I’m well on my way to expressing my desire to show I value others.  Nonetheless, a knowledge base and set of interpersonal skills is again essential to add to this attitudinal perspective.  Without it, I can have the best of intentions, but fail to meet my desired mark.

Areas of Growth.

According to an article on biculturalism by Theresa LaFramboise, a culturally competent individuals hold a strong identity, possesses a knowledge of cultural beliefs and values, is able to display sensitivity to the affective, behavioral and language components in a cultural, while negotiating their way through social relationships and institutions in that culture.  (LaFramboise, et al, 1993).  Its clear without these components, serious errors in communication can occur.   Culture can be seen as a paradigmatic foundation in a person’s life, defining not just values and beliefs, but how we feel, think, and relates to others(Hays, P., 2008).  As I’m well aware, within the familial cultural gaps existing in my own extended family, failing to understand this can relate to terrible misunderstandings.

Solutions.

As stated before, developing this skill and knowledge will mean: (1) developing a knowledge base of therapeutic interventions, (2) gaining opportunities to be exposed to other cultures.  While doing so, our Hays (2008) textbook mentions the importance of humility as a critical element to professional growth which I believe will be important throughout the learning process:

“When people are humble, they recognize that other viewpoints, beliefs, and traditions, may be just as valid as their own….people with genie humility are effective helpers, because they are realistic about what they have to offer….critical thinking skills are essential, because they involve the abilities to identify and challenge assumptions….examine contextual influences…and imagine and explore alternatives. (Hays, P., 2008, p29).

Professionalism & Networking.

“Counselor is highly active in professional organizations and views professional organizations as a valuable medium through which ideas and information can be freely and consistently shared.”  (Bellevue University, 2014).

Areas of Growth.

When reviewing the above criterion, it is clear this is an area in which much growth is needed.   I don’t honestly have a lot of opportunity for networking on the job.  I work the weekend night shift in a nursing float pool throughout the  Alegent Creighton Health System.  I also go to school, and have a family, while jet lagged from my night shift hours.

The crucial importance of networking from the perspective of multicultural competence is it provides an opportunity for others to challenge your views offering valuable counterpoints you may not consider on your own.  Without this, I’m leaving a critical opportunity for learning out of the mix, in my educational and career pursuits.

Solutions.

I intend to focus on developing strong supervisory relationships within any  internship and volunteer opportunities while earning my degree.   Getting involved in organizations opportunities as a student therapist is another goal.  Finally, taking time to talk with those in the field, has been an ongoing priority, so I can plan my career path accordingly based on any shared insights.

Professionalism: Appearance & Self Care.

“Reflects upon and revises counseling practices and expertly applies revised practices…consistently seeks out self-care and prevention of burnout…participates in various ongoing educational and staff development activities….Is a role model of professionalism through personal appearance, attire, and cleanliness.” (Bellevue University, 2014).

Areas of Growth.

As is often said amongst caretakers in the field, you have to take care of yourself before you can take care of others.  Making time to engage in adequate self care, is a critical priority in my overall life path.  As someone who spends much time caring for others, I’m at a high risk of burnout.  “Burnout is a state of physical, emotional, intellectual, and spiritual depletion characterized by feelings of helplessness and hopelessness, (Corey, et al, 2011, p69).  The critical problem with burnout and heightened stress, are their ability to rob your ability to care for others with any degree of competence.  You can’t give to others any more than you’re willing or able to give yourself (Corey, et al, 2011).   It goes without saying, that no headway will be made in attaining multicultural effectiveness, if I can’t make this criterion a priority.

Solutions.

First and foremost in my self care regimen, is the need for adequate sleep.  After having switched to a different work schedule, and paying of some lingering debt, I find I’m  able to cut down on my work hours.  As a result, I’m making time to take care of myself, and am currently exercising and eating healthier with the goal to lose weight.  Additionally, I’ve saved up some money, for a more professional wardrobe, since nursing scrubs will no longer be appropriate.

PART TWO:  Conclusion

From the outset, choosing to enter the field of therapy, has been more than a career move.  It is a new life path, and a logical extension, from my past personal life progression of personal growth.   Much of what I’ve learned through this education process, has taken on a very personally reflective quality.  My most critical steps from this point forward will involve taking action, through direct interpersonal experience, as well as consistency in effort and commitment over time.   With my greatest challenges being self care and the need for networking opportunities, these have been my biggest focuses, in moving forward.

References

Ajouga, P. (2014). Re: MCC 638 Week Two Overview. Retrieved from: https://ssoblackboard.bellevue.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_328162_1%26url%3
Amato, P. R., & Cheadle, J. (2005). The long reach of divorce: Divorce and child well-beingacross three generations. Journal of Marriage and Family, 67(1), 191-206. Retrieved from: http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/219746544?accountid=28125
Arredondo, P., Toporek, M.S., Brown S., Jones, J., Locke, D.C., J. and Stadler, H. (1996) Operationalization of the Multicultural Counseling Competencies. AMCD: Alexandria VA.
Bellevue University. (2014). MCC Graduate Student Disposition Rubric. [Class Handout]
Brown ,B., (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society. 87(1) 43-52.
Catholic Health Initiative. (2014). HIPPA & Privacy Rule.  http://www.chihealth.com/hipaaprivacyrule
Corey, G. ,Corey, M.S., & Callanan, P. (2011).  Issues and ethics in the helping professions.  (8th ed.) Belmont: CA:  Brooks & Cole.
Fortune, B.A. (2012). Acculturation, intergenerational conflict, psychological distress and stress in Filipino-American families. Regent University, Virginia.
Genz, S., (2010). Singled Out: Postfeminism’s “New Woman” and the Dilemma of Having It All.  The Journal of Popular Culture, (43)1, 97-119.
Hays, P. & Iwamasa, G. (2010) Culturally responsive cognitive-behavioral therapy. (3rd ed.) Washington, D.C. American Psychological Association.
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.
Jensen, B. (2012). Reading Classes : On Culture and Classism in America. Ithaca: ILR Press.
LaFromboise, Coleman, H.L.K. & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin. 114(3) 395-412.
Leahy, R.L. (2008) The therapeutic relationship in cognitive-behavioral therapy.  Behavioural and Cognitive Psychotherapy. 36, 769-777.
Levy, Denise L. “On the outside looking in? The experience of being a straight, cisgender qualitative researcher.” Journal of Gay & Lesbian Social Services 25.2 (2013): 197-209.
Martin, C.A. (2004) “Bridging the generation gap (s).” Nursing2013. 34(12)62-63.
McCarthy, K. (2007). “Pluralist Family Values: Domestic Strategies for Living with Religious Difference” The ANNALS of the American Academy of Political and Social Science. 612(1) 187-208.
Root, M.P.P. (1998) Experiences and processes affecting racial identity development: Preliminary results from the biracial sibling project. Cultural Diversity and Mental Health.  4(3) 237-247.
Sue, D.W., Arredondo, R. & McDavis, R.J. (1992).  Multicultural counseling competencies and standards:  A call to the profession.  Journal of Counseling & Development.  70, 477-486.
 

 

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NCE STUDY – Counseling Latino Clients

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

The term Latino/Latina is an ‘umbrella-notion’ that encompasses a wide variety of cultures that can include societies from Central American Indians, to Cuba, and Puerto Rico. Learning more about this minority group is essential when you note the wide diversity found within it. Including a variety of countries, each has its own unique culture and history.   Also notable are the varied stories of acculturation for the many subgroups and individuals in this community. A complexity of sociocultural and individual factors, blend together to determine experiences of acculturation, identity formation, and overall well-being for this minority group. As a byproduct of rich racially-mixed societies, varied socioeconomic histories, and unique degrees of political disempowerment in American society, each Latino individual and family has their own story, (Organista, 2007; Santiago-Rivera, et al, 2002).

In light of all this, I have a few concerns for my future career in counseling with this unique minority group. Understanding the issues at hand for my Latino clients will mean more than understanding factors such as sociocultural history and family background; although this is a good starting point.   I believe these factors can help a counselor to begin to understand how the process of acculturation and identity formation affect overall mental health (Organista, 2007; Santiago-Rivera, et al, 2002). When assessing these issues, it also becomes vital to note variations in value systems and worldview between counselor and client. Understanding how these factors affect ongoing dynamics during the counseling process and any intervention methods utilized, is also important.

In this paper I will begin by discussing key concerns to address during assessment to better understand the client.   I will continue with a discussion of Latino cultural values and worldview. I conclude with strategies and insights that would prevent me from making any overarching assumptions be made about my client’s cultural identity.

Understanding the Problem

“The ecological niche or unique combination of multiple contexts and partial perspectives define each individual’s and each family’s variation on major cultural themes. The ecological niche guides the evolution of values and behaviors…given its link to the social and physical environment…as well as access to power and the resources for healthy development.” (Hays & Iwasama, 2006, P73).

The concept of an ecological niche, as discussed in our Hays & Iwasama textbook (2006), sheds light on a key fact that is the source of concern for me in my future practice. Ultimately it’s the interaction of individual and sociocultural factors that influence the development and overall well-being of an individual.   In the case of the diversity in this group, this factor is that much more critical.

In his book titled “Solving Latino Psychosocial and Health Problems” Kurt Organista provides a historical background for Mexican Americans, Puerto Ricans, Cubans, and Central Americans, (2007). In this discussion the sociocultural histories of Latino communities described as influencing identity and acculturation stressors for individuals.   For example, it is interesting to note the differing degrees of adaptation to American culture between the Cuban and Central American communities, (Organista, 2007; Santiago-Rivera, et al, 2002).   Whereas the Cuban community received unprecedented support the Central American immigrants have been met with high degrees of resistance, (Organista, 2007; Santiago-Rivera, et al, 2002).   It’s also not a coincidence that these differing degrees of support vary with economic background and phenotypic appearance amongst the two groups (Organista, 2007). Examples such as this shed light on the importance of understanding within-group diversity of the Latino population.

In this section I discuss research on concepts of identity formation and process of adaptation for this varied minority group. Having an understanding of such research is a first step to effective counseling and assessment for Latino clients.

Concern One: Cultural & Ethnic Identity Formation

Viewing individuals holistically means understanding the relationship between person and their unique sociocultural context, (Santiago-Rivera, et al, 2002).   This requires more than simply taking time to learn about a clients unique sociocultural history. It also means developing a cursory understanding of identity, as a multidimensional construct with variances in progression between individuals (Organista, 2007).

Identity Defined.

Identity can be thought of as an internalized set of standards regarding beliefs about the self, or self-concept, (Santiago-Rivera, et al, 2002, p156). With this in mind, what follows is a useful definition of ethnic identity:

“Ethnic identity is defined as one of several role identities within the self-concept, eachof which varies in importance depending on the differential context of experience.” (Organista, 2007, p165-166).

With this definition in mind it seems our many roles, as reflected in the “addressing model” fit as components of a fluid ever-changing hierarchy within our self-concept, (Hays, 2008 & Organista, 2007).   It is useful to consider identity as highly personal subjective construct we develop to understand ourselves as individuals in an ever-changing sociocultural context. Understanding the identity formation process as it relates to this diversified minority is vital when you consider their consequences in the following quote:

“I believe that psychological pain is often the result of a lack of integration and that racism; prejudice and oppression are forces that can lead to disintegration of the sense of self. These negative forces can be overt, covert and internally based, or externally, which makes oppression a highly personal and difficult issue to deal with. (Delgado-Romero, 2001, p209.”

Addressing & Dimensions of Personal Identity Model.

The first theoretical perspective that intrigued me is the “Dimensions of Personal Identity Model” (Santiago-Rivera, et al, 2002).   It describes identity as having three key dimensions that appear to coincide well with the Addressing Model discussed in our Hays textbook (Hays, 2008).

  1. Dimension A” (Santiago-Rivera, et al, 2002) consists of factors are least changeable, and are usually ascribed at birth. They consist of factors such as gender, race, physical disability, sexual orientation, social class, and age.
  2. Dimension B” (Santiago-Rivera, et al, 2002) consists of factors that are more developmentally related and include factors such as income, marital status, citzenship and educational background.
  3. Dimension C” (Santiago-Rivera, et al, 2002) consists external sociocultural factors. These factors can include immigration experiences as related to the political-oriented historical context in which it occurred.

RIDM & Helms Models.

While the above model is effective in understanding identity formation as it occurs in a general sense, still other theoretical perspectives are useful in understanding how identify formation occurs for many Latinos. For example, the “Racial & Cultural Identity Developmental Model” describes five stages of identity development including conformity, dissonance, resistance, immersion, and awareness, (Delgado-Romero, 2001). Effective in describing identity development of “oppressed people experience as they try to understand themselves in terms of two cultures” (Delgado-Romero, 2001, p209) it describes identity as a subjective internal construct.   Still other models such as the Helms Racial Identity Model, (Delgado-Romero, 2001), help describe identity development as an interactive process.   With four stages of interaction (parallel, regressive, progressive, and crossed, (Delgado-Romero, 2001)) throughout identity formation process, it effectively contextualizes family dynamics and other common relational patterns. For example in the case of progressive interaction the “counselor operates from a more sophisticated ego status than the client. Energy and growth producing intercourse are the results of this type of relationship” (Delgado, 2001, p210). Conversely, a crossed interaction exists when the “ego status of counselor and client are in direct opposition”, (Delgado-Romero, 2001, p21). As you might guess the results are more problematic.

Concern Two: Acculturation & Adaptation Processes

Alongside issues of identity formation, the manner of adaptation to two sets of cultural influences exists as another important concept. Understanding a person’s overall orientation to their own culture (i.e enculturation) as well as dominant culture (i.e acculturation), (Delgado-Romero, 2001), is also vital.

Dimensions to Cultural Adaptation.

Overall there are a wide variety of potential orientations visible in clients contending with the influence of competing cultures. For example, our textbook briefly describes five models including “assimilation, acculturation, alternation, multicultural and fusion” (Hays & Iwasama, 2006, p10).

“Which form of adaptation an ethnic minority eventually experiences depends on a number of factors, including the original conditions of contact, the degree of conflict between groups, and the dominant society’s tolerance for cultural diversity.” (Organista, 2007, p8).

Further adding to the complexity of the situation are the variations seen as a result of this orientation including unique resultant social experiences, psychological mechanisms utilized and strengths/obstacles, (Hays & Iwasama, 2006, p10).   Understanding how the sociocultural history, family history and individual factors blend together into this adaptive style is also important.

Acculturation Process & Influences.

“acculturation is consistently related to higher levels of a broad array of diagnosable mental health problems…..Mental health differences between Latino groups reflects their acculturation histories, which vary considerable in terms of degree of acculturative stress and challenges to adaption.” (Hays & Iwasama, 2006, p75).

As the above quote conveys, the adaptive processes utilized in relation to American culture have a huge impact on overall well-being and warrant closer examination. Defined as “socialization into an ethnic group other than one’s own” (Delgado-Romero, 2001, p211), acculturation can be thought of as a process including three factors described as follows:

“Contact refers to the conditions under which two cultural groups meet….conflict refers to the predictable tension and fighting that results when one group attempts to dominate another…and adaptation refers to the eventual form of accommodation between groups that is intended to reduce conflict.” (Organista, 2007, p5)

The Latino Model of Ethnic identity helps to contextualize the Acculturation Process for this diverse minority, (Delgado-Romero, 2001, p211). Encompassing five stages (including causal stage, cognitive stage, consequences, working through stage, and resolution), this theory indicates marginality and forced assimilation are negatively correlated with mental health, (Delgado-Romero, 2001). Conversely, promoting a pride one’s identity and freedom of chose are key to effective adaptation (Delgado-Romero, 2001)

With this in mind, trends are visible when examining how acculturative stressors vary within differing Latino subgroups, (Organista, 2007).   As a result of such research, it is clear that acculturative stress inversely correlated with cultural and behavioral similarity, as well as socioeconomic status (Organista, 2007, p8). Additionally it is possible to correlate immigration policies and other political factors at the time of immigration with acculturation stresses (Organista, 2007)

Latino Cultural Values & Worldview

Individual worldviews and value systems exist in us as largely automated and subconscious factors we rarely consider.   In light of this fact, a lack of awareness regarding value differences between clients and ourselves can cause misunderstandings to occur.  With this in mind, what follows are value differences that I would need to be aware of during the assessment process:

  1. Individualism vs. Collectivism: Growing up in American culture my own personal value system is one that emphasizes individualism. In this respect, self-expression, personal rights, and privacy are ideals that are important. Collectivist ideals that emphasize respect, sacrifice, and emotional suppression for the sake of harmony can be easily overlooked.
  2. Verbal Expressiveness vs. Stoicism: This key difference is one that has troubled my relationship with my mother. Stoicism is a value that is often correlated with a collectivist perspective in which harmony is a priority. This can be misunderstood, easily from an American perspective which values verbal expressiveness.
  3. Personalismo vs. Task Orientation: In those instances in which I have cared for Latino clients in a hospital setting, I have been made acutely aware of these value differences. As someone who is task oriented I set about checking things off my to-do list.   This can be experienced as highly impersonal at times from a Latino values perspective. Taking time to provide personal attention, build trust, and simply converse casually, are key in building a therapeutic relationship with Latino clientele.
  4. Egalitarian vs. Traditional Gender Roles: Coming from a highly egalitarian background, it will be important to understand traditional gender roles as they relate to counseling Latino families. Being aware of this factor, gauging interactions and interventions accordingly will be vital.
  5. Science Vs. Religion: Having been raised by two doctors and being agnostic, my value system is clearly one-sided. In an attempt to engage in an honest self-assessment, I will need to further educate myself on the importance of religion in the counseling context. Participating in religious practices, relevant volunteer work and internship opportunities are possible solutions to address this issue

In concluding this section, the above listing of cultural value differences is certainly an overview of key issues and an in-depth self-assessment. This list appears to me as an example of issues that can potentially stand in the way of any culturally sensitive empathy.   Essentially defined as an ability to put yourself in another’s shoes and understand their frame of reference, empathy is definitely culturally relevant (Chung & Bemak, 2002). It entails understanding the internal world, cultural identity, and value systems of clients while simultaneously holding onto my own. Affectively communicating it and addressing issues relative to cultural context also communicate empathy. Clearly, throughout this process, value system differences need to be attended to

Counseling Strategies to Address Therapist Assumptions the Need for Eclecticism In Counseling.

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176-177)

As is well known, counseling’s history has encompassed a longstanding under-emphasis in sociocultural factors and over-emphasis in empiricism.   Consequently, many traditional theories and techniques are based on a value system that is highly Euro-American in scope. Preventing any assumptions regarding a client’s identity as a member in the Latino community requires a eclectic approach.

While I know this is a slight reiteration of previous paper assignment, there are three theoretical perspectives that provide a great start-off point for multi-culturally competent counseling. Firstly, it will be beneficial to slightly modify the Axis-6 Addressing Model approach as mentioned in our Hays-textbook (2008) for the new DSM-V. Considering sociocultural context alongside a DSM perspective can provide a critical balance of cultural relativism and empirical soundness.

Still other insights from the “MAP – Multicultural Assessment Procedure” (Thomas, 2007, p65) and the “FACTS” Method, (Johnson, 2013) are useful. The Multicultural Assessment Procedure is useful as an assessment that involves a process of continually testing and revising a working hypothesis, (Thomas, 2007).   The FACTS Method is a five part approach that involves (1) formulating questions, (2) utilizing assessment methods, (3) addressing culturally-responsive issues, and (4) providing treatment based on scientific evidence. (Johnson, 2013, p19).

Multicultural Competency & Empirically Based Insight.

In concluding this paper, I feel it is useful to mention briefly an article titled “Counseling a Hispanic/Latino Client – Mr. X.”.   It describes a hypothetical scenario of case conceptualization for a Latino client.   The article begins by providing an overview of relevant theoretical perspectives, while also describing how it is relevant to client “Mr-X”.

Starting out with the first therapy meeting, mention is made of any value-based differences between counselors and Latino clients. Cautioning against the potential for misunderstanding, attending to these differences throughout client interaction is critical, (Delgado-Romero, 2001).

Still other initial considerations in our hypothetical case scenario include addressing issues of cultural and racial identity, and family roles.   Continuing through therapy, there is a description of how identity and acculturation theories, described above, can relate to assessment and effective case conceptualization for “Mr-X”. Finally, therapy goals such as validation and education are vital to help the client understand self-development in a greater sociocultural context. Additional considerations such as providing homework that is culturally relevant are also mentioned.

To summarize, this article is effective in describing how multicultural counseling might occur in an intriguing hypothetical scenario.   I would hope to utilize a very eclectic method that would allow for culturally relevant contextualization of theoretical perspectives of issues such as identity development and acculturation. Additionally, assessing clients in this diverse minority group, would best be served when the utilization of the DSM-5 is put within a culturally relevant context.

“I am about to go to the waiting room and meet Mr. X for the first time. I am feeling nervous, yet excited, especially since I have had time to review a general racial and ethnic identity development theory….I feel that I have reviewed the variable that might be important in conceptualizing, assessing, and treating Mr. X. But an air of mystery still remains, the unknown of how we will work together. I guess that’s why counseling is still an art.” (p220)

References

Chung, R. C., & Bernak, F. (2002). The relationship of culture and empathy in cross-cultural counseling. Journal of Counseling and Development : JCD, 80(2), 154-159. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/219015671?accountid=28125

Delgado-Romero, E.A. (2001). Counseling a Hispanic/Latino Client – Mr. X. Journal of Mental Health Counseling. 23(3). 207-221.

Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.

Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American Psychological Association.

Hernandez, A.M., & Curiel, Y.S. (2012). Entre nosotros: Exploring Latino diversity in family therapy literature. Contemporary Family Therapy. 34, 516-533.

Johnson, R. (2013) Forensic and Culturally Responsive Approach for the DSM-5: Just the FACTS. Journal of Theory Construction & Testing, 17(1), 18-22.

Organista, K.C. (2007). Solving Latino Psychosocial and Health Problems: Theory, Practice, & Populations. Hoboken, N.J.: John Wiley & Sons, Inc.

Santiago-Rivera, A.L., Arredondo, P, & Gallardo-Cooper, M. (2002). Counseling Latinos and La Familia: A Practical Guide. Thousand Oaks, CA: Sage Publications, Inc.

Thomas, J. C., Hersen, M., Sage eReference (Online, s. (Online service), & Sage Publications, (2007). Handbook of Clinical Interviewing with Adults. Los Angeles: Sage Publications.

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Choosing a Theoretical Orientation…

(((I’m starting a new internship soon.  My internship supervisor gave me an assignment that involves thinking about what my theoretical approach is.  Here are my initial thoughts…)))

As I’ve worked through this Masters Program towards LMHP licensure, I can recall several instances in which i’ve been asked to define my theoretical orientation.  My own thoughts on this matter have always been “Why must I choose now?” After all, I haven’t even gotten my first job yet….

My initial thoughts are that seems best to keep open mind and allow my therapy approach to develop naturally.  However, it couldn’t hurt to begin addressing this issue but examining what counseling approaches best “resonate” with me personally.  At first glance, my immediate impression is that all theoretical orientations have their strengths and limitations.  No counseling approach exists that can in itself be considered 100% perfect.

On the one hand, there are theories that focus inward, upon mental activities. Perspectives such as the Rogerian client-centered approach, and existentialism, offer an internal subjectivist perspective.
On the other hand, you have objective and externalized approaches that put the inner world of the individual at a place of lesser importance. For example cognitive and behavioral therapies, offer a pragmatic approach, objective assessments, and a reality-based approach.

What Is The And?

An integrative structure based on the work of a number of theorists rejects an antagonist model….(and) dualistic thinking, replacing the world versus with and. Thus they proposed a three-dimensional model, with the following structure: (a) rational and affective, (b) action and insight, and (c) directive and nondirective. (Brown, 2010, p473).

The above quote summarizes my initial reactions regarding the issue of a “theoretical orientation”.  A theory that is useful can provide a dialectical balance of change and acceptance approaches.  Change-based approaches can involve pragmatic and reality based interventions that provide opportunities for direction and confrontation. Acceptance-based approaches can provide clients the Rogerian unconditional acceptance alongside empathy and the validation Lineman speaks of in DBT.

This dialectical balance of seemingly oppositional perspectives is critical, and goes well beyond a change vs. acceptance perspective.  Human beings are not islands.  We are affect our relationships and environment and change them in turn.  A theoretical orientation I need would allow me to understand my clients in a sociocultural perspective.  I would also like an approach that can help me contextualize how people are influenced and affected by significant relationships.

Overall, these considerations remind me of a question asks me often “What is the ‘and’?”  It is a subtle encouragement to seek the other side of the coin regarding matters in which I feel“stuck”.   When I address this question honestly, I inevitably learn that my beliefs and skewed perception exist as a causal of my own stickiness.  A willingness to see what I choose to ignore allows understand the solution. This life lesson is vital for professionally as well as personally.

With this in mind, what follows is a list of counseling theories that resonate with me personally….

#1. Dialectical Behavioral Therapy

As a former therapy client, I’m personally familiar with DBT as a group therapy approach.   After reading Marsha Lineman’s work, I appreciate the Hegelian dialectic approach it utilizes.

  1. Alongside cognitive behavioral techniques that promote effective emotional regulation is a mindful awareness based on Buddhist philosophy (Linehan, 1993).
  2. In addition to action-based homework assignments and rationally-oriented chain analysis to encourage change is notion of radical acceptance of things that cannot be altered (Linehan, 1993)
  3. Finally, there are techniques taught throughout the counseling process that touch upon various points of along the process of interpersonal growth (Linehan, 1993)
Click here to read a recent post I wrote on DBT

#2. Motivational Interviewing….

Motivation, Ambivalence & Resistance.

“Motivation is defined as that which moves us to action” (Salkind, 2006, p857). Working with clients who have a low motivation to change is a key challenge in the helping professions. Ambivalence and experiential avoidance are two factors frequently encountered with clients resistant to change.  Prout & Wadkins (2006) describe ambivalence as “a contradictory mix of positive and negative feelings about change” (p232). It is a complex mindset that encompasses a need for change alongside a desire to deny the problem (Prout & Wadkins, 2006).    Resistance, on the other hand, can be thought of as anything within the client that impedes progress (King, 1992).  Evidence of resistance can include excuses, limitations on change, or feelings of ambivalence (King, 1992; Prout & Wadkins, 2014).

The Stages of Change

Underlying ambivalence, resistance and low-motivation is a preference for experiential avoidance as a coping mechanism.   This experiential avoidance can be thought of as a client’s desire to avoid memories, thoughts, sensations, and emotions that are related to painful personal experience in the past (Stroshal, et al, 2004). Interestingly, while the tactics utilized to avoid such experiences are harmful from the standpoint of personal growth they still yield short-term benefits that must be addressed (Stroshal, et al, 2004).

Prout & Wadkins (2006) discuss a “Transtheoretical Stages of Change Model” (p.233) to help conceptualize the degrees of ambivalence in clients. The stages of change included in this theory consist of five stages: (1) pre-contemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance (Prout & Wadkins, 2006, p234).   It is a useful as a tool for assessing a client’s readiness to change.

An Overview of Motivational Interviewing

Motivational interviewing is a “collaborative person-centered conversation [utilized] to elicit and strengthen motivation” (Microtraining Associates, 2011). These techniques are useful with clients who are working through ambivalent feelings regarding the idea of change (Prout & Wadkins, 2006). The four principles of motivational interviewing include: “express[ing] empathy…develop[ing] discrepancy…roll[ing] with resistance…and support[ing] self-efficacy” (Prout & Wadkins, 2006, p245). Seeing these principles in action throughout the motivational interview video series has been quite helpful (Microtraining Associates, 2011).

In a video presented in class we are provided an example of motivational interviewing “in action” The client is coming to counseling at his girlfriend’s insistence and the therapist makes a comment about this fact (Sushi Productions, 2009). Based on his response, she is given an idea of his level of resistance.  What follows is an overview of insights from this video….

Assessment   During the assessment phase of the interview, the counselor is working to attain details of the client’s drinking. The counselor’s initial efforts reflect two key principles of motivational interviewing: (1) expressing empathy and (2) rolling with resistance (Prout & Wadkins, 2014).   Firstly, the counselor makes a point of refraining from any displays of judgment. Instead, she restates the situation in his words as a show of empathy.   Later the counselor states: “and your girlfriend got a bit of mileage out of that one” (Sushi Productions, 2009). This comment acknowledges the client’s feelings of resistance regarding his participation in therapy.

Working With Ambivalence:  In this portion of the session, the positive and negative aspects of the client’s drinking are discussed.   Several useful techniques can be seen in the counselor’s summary of positive aspects of drinking. For example, in a show of empathy the counselor states, “it’s kind of given that you’re going to be drinking, you know” (Sushi Productions, 2009). This statement acknowledges the client’s perspective, and reflects the therapist’s effort to “roll with resistance” (Prout & Wadkins, 2014, p245). Inconsistencies in the client’s thinking are then highlighted in a discussion of negative factors associated of drinking. It is at this point that the motivational interview focuses on developing discrepancy (Prout & Wadkins, 2014).

At a key point, the counselor takes time to review the client’s feelings of ambivalence. She does this by summarizing the negative consequences of drinking, while also acknowledging any resistance. After allowing the client time to reflect on this she asks him they begin discussing his options.

Problem Solving & Goal Setting  In this portion of the session, the therapist discusses the parameters of a problem solving exercise. They work together to list all possible options and set aside feasibility considerations for the time being. This causes the client to set aside his ambivalence and allows the counselor to highlight any inconsistencies in his thinking.

After developing discrepancy in this discussion, the counselor moves on to feasibility considerations.   The therapist then asks the client to image following through with these options. This allows a discussion on change talk to begin.   Specific strategies to enact these options are outlined, and a plan is worked through.

Normalizing Relapse  A follow-up session in this video shows a discussion on the degree of success in following through with plans. The client admits that he underestimated the efforts required to initiate his plans for change. Clearly frustrated, the counselor acknowledges his concerns, but reminds him of his successes as well. The therapist then normalizes his experience by discussing the difficulties all people have in attempting to make major life changes (Sushi Productions, 2009). This allows the client to develop a more realistic idea of the efforts involved in his plans for change.

#3. Multicultural Counseling…

Culture can be thought of as the knowledge, beliefs, behaviors, worldview, language, etc, of a social group or segment of society (Monk, 2008, p12). It is a framework with which we understand and create meaning from our life experiences.  From a multicultural perspectives each culture as a unique meaning systems that is internalized within us as an overall life perspective.   In an environment of increasing globalization misunderstandings can easily arise as individuals from different cultures interact.   Counselors are required ethically to “maintain [an] awareness and sensitivity regarding cultural meanings” (ACA Code of Ethics, 2005).

Developing cultural competency requires a dualistic focus. On one hand, a commitment to greater self-awareness is essential to see beyond our own myopic viewpoint. On the other hand, there needs to be a willingness to gain the education, and skill necessary to assess people from within a larger sociocultural context. Doing so is critical to prevent any unintentionally ethnocentrism in the therapeutic context (Corsini & Wedding, 2011).

What follows is a list of key insights regarding a multicultural perspective.  

Social Constructivist Philosophy

A core condition of constructivist approaches includes listening to the client’s story. This is more than displaying empathy, this is a profound listening from a self-aware and politically aware counselor. It is a listening that believes that the client’s understanding of events, and how they think feel and construe the impact of their lives, is the important meaning. (Cretar, et al, 2008, p31).

As an underlying philosophical perspective for the counseling theories within this paper, it is important to note a few of the peculiarities of this point of view. Also known as postmodernism, this philosophical movement has occurred within the social sciences over the last 30 years (Monk, 2008, p4). A few interesting observations can be made of this perspective:

  1. Theories of social constructivism argue against the idea of an objective truth, stating instead that we make our own meaning. (Monk, 2008, p4).
  2. Constructivists understand reality as constructed from the inside out, rather than as a matter of externalized objective fact imposed upon individuals. (Monk, 2008, p4).
  3. Whereas traditional approaches to counseling place the therapist at the center, constructivists are less directive, engaging in a collaborative process (Monk, 2008, p4).
  4. Finally, rather than focusing on symptomatology or trait-based analysis, clients are viewed holistically, as a person in context. (Monk, 2008, p4).

Social Justice Promotion.

One of the common threads that multicultural, feminist, and social counselors share is the view that clients exist within and are constantly affected by environmental systems and contexts. (Crethar, et al, 2008, p269)

Another key commonality of multicultural counseling theories, is an awareness of the potential for unintentional ethnocentrism within traditional monocultural perspectives. Desiring to gain an awareness of person-in-context, culturally competent practitioners, display an awareness of their own worldview, and desire to learn others, (Corsini, & Wedding, 2011).

Alongside this awareness, is a desire to move beyond an intrapsychic perspective and engage in a more comprehensive perspective (McMahon & Patton, 2006). The goal becomes not only to promote mental health, positive development, but encourage distributive justice, and equality (Crethar, 2008, 273). In an interactional context, this involves utilizing an inclusive cultural empathy that comprises an affective acceptance, intellectual understanding, and culturally appropriate interaction. (Pederson, et. al, 2008, p54).

Click here to read my post on culture & rapport

#4. Systems Theory

Systems Theory can be thought of as a lens through which to view the relational processes of individuals and the significant others with whom they interact in their attempts to derive meaning and construct an identity. (Curtis & McPherson, 2000, p50)

Systems Within Systems.

What is first notable about systems theory is its view of individuals as a subsystem within a larger subsystem (Arthur & McMahon, 2005). If one were to provide a diagrammatic picture of this theory, they would draw a series of concentric circles. With a picture that looks much like a target, each level, can be thought of as a subsystem within a subsystem. The individual is a system that exists within microsystems such as family, peers, or work environment. These microsystems, then exist within a larger ecosystem that can be thought of as society at large. How does this relate to counseling practice? Essentially it calls for an understanding of individuals holistically, people aren’t beings unto themselves, but parts of a larger whole (Curtis & McPherson, 2000, p50)

Interdependent Recursiveness       

What makes this theory unique is how it describes people as individuals in context. As an elemental part within a greater whole, the relationship of individuals within the larger subsystems is actually quite complex (Curtis & McPherson, 2000, p51). On the one hand, Individuals are defined by the larger subsystems they exist within. Whether these larger subsystems are families, or society as a hole, they determine our way of perceiving ourselves and the world at large. On the other hand, we also define our culture, in the way we participate and engage with others within it. Essentially what this means, is “the whole is greater than the sum of its parts” (Arthur & McMahon, 2000, 212). This notion that we are both influenced by and influence is known as an inderdependent recursiveness (Arthur & McMahon, 2000).   The thing to remember about this as counselors, is that cause and effect do not occur in a linear fashion, but rather as a circular process (Curtis & McPhearson, 2000, p51). Therefore it is truly impossible to understand a person independent of their own sociocultural environment.

Change as Morphostasis.

The final notion which is key in systems theory, is the notion of morphostasis (Curtis & McPhearson, 2000). Essentially this notion can be thought of as a sociocultural thermostat which functions to maintain a sense of stability. Much like the way organisms maintain a biological homeostasis, societies undergo morphostasis to maintain a similar stability. Through the process of feedback from within the many subsystems that comprise it, change occurs, so that stability within the larger ecosystem can be maintained.

Toward Practical Application.

With this theoretical overview out of the way, how might one begin to apply a series of abstract notions? What follows is just a sampling of two approaches.

Structural Family Therapy.

Conceived on the notion of the looking glass self, this therapy states the family is an integral part of an individual’s identity. From a systems theory perspective, this therapy enables people to examine their identities from this standpoint. This involves a collaborative examination of roles and perceptions, examining the system-based dynamics. From within this approach, problems are said to occur commonly from within key stages of development. With the therapists take an “inside role” attempting to lead structural changes within the family system (Curtis & McPherson, 2008, p55).

Strategic Approaches.

Rather than diagnosing a “problem” to solve, this perspective seems to take on the notion of systemic “stuckness” (Curtis & McPherson, 2008). With a desire to understanding the circular causality within the system, strategic therapists aim at understanding underlying systemic perceptions. Essentially, taking on the belief that things aren’t as they seem, the problem is a reframing of the situation, to readjusting a predominate worldview. “The therapist takes responsibility for the counseling process and the duty of manipulating the system’s worldview, (Curtis & McPherson, 2008, p57).

#5.  Vygotsky’s Developmental Theory

Lev Vygotsky is a developmental theorist whose views vary significantly from many of the westernized perspectives that predominate the field (Broderick, 2010). For example, while Piaget focused on the inherent biological limitations of an individual, Vygotsky describes development as occurring with a sociocultural context (Wertsch, 1985). Instead, Vygotsky provides a unique perspective, stating famously: “the mind is no longer to be located inside the head.” (Broderick, 2010, p102). This perspective stands in stark contrast to the westernized notions of development that predominated in his day.

In keeping with a social constructivist perspective, Vygotsky states asserted there is pre-existing structure within the psyche that exists independent of our environment. Instead, our internal cognitive processes are created as a result of sociocultural interaction (Glassman, 1994). For Vygotsky, conscious creation and development is a matter interpersonal interaction. What the author finds particularly intriguing about this assertion, is recent research on the brain’s neuroplasticity confirming this fact (Broderick, 2010). What follows is just a small sampling of concepts that help to illustrate the unique benefits of Vygotsky’s theory.

Zone of Proximal Development

Vgotsky’s notion of ‘the zone of proximal development’ helps to explain how he treats the process of freeing the world. The zone of proximal development is ‘the distance between the actual developmental level as determined by independent problems solving and the level of potential development as determined through problem solving under adult guidance. (Williams, 1989, p115)

The zone of proximal development defines the range between what the child is capable of independently, and what they can learn through attentive guidance. A parent is responsible for providing a degree of structural context within which mediated learning occurs (Broderick, 2010). With this concept, in contrast to other theorists, which examine human development as a matter of individuals mastering key tasks, Vygotsky paints a very different picture.

According to Vygotsky, the crucial element to understanding human development is to examine the interactional nature of person in context. That is the crucial point he attempts to make with this concept.   For example, it is the definitive actions of parent and child, are what help to determine the nature of this zone of proximal development. With parents providing what he calls a “scaffolding”, to enable learning to occur, children engaging in “bootstrapping” efforts in response (Broderick, 2010).

Mediated Learning

“mediated learning is the training given to the human organism by an experienced adult who frames, selects, focuses, and feeds back an environmental experience in such a way as to create appropriate learning sets…These mediated learning experiences are an essential aspect of development…..the principal means by which the child develops the cognitive operations for learning independently” (Wertsch, 1989, 278)

According to Vgytosky, the concept of mediated learning describes the mode of development from a sociocultural perspective (Broderick, 2010).   In contrast to many developmental theorists, Vygotsky didn’t conceive develop as an internal process (Williams, 1989). Instead the essential tools for language, were the means through which society influences our development (Wertsch, 1985). The communication that occurs within our primary interpersonal relationships in childhood, defines the nature of our inner world. This brings us to a final concept of Vygotsky’s theory that warrants mention.

Internalization

“Vygotsky argued that there is an inherent relationship between external and internal activity, but that it is a genetic or developmental relationship in which the major issue is how external processes are transformed to create internal processes…the process of internalization is not the transferal of an external activity to a preexisting internal ‘plane of consciousness’ it is the process in which this plane is formed. (Wertsch, 1985, p163)

As with many developmental theorists, Vygotsky didn’t discuss the adult developmental life course in great detail. Still, when examining his theory in closer he appears to indirectly discuss the issue in his concept of internalization. As this notion connotes, internalization refers to a process, in which externalized processes engaging with the world transform into an internalized plane of consciousness. This process of internalization occurs through language and it is how our culture is internalized, into an internal frame of consciousness. In other words, language defines our mode of understanding, and inner thought world.

#6. Others…

Honestly, the above post is a conglomeration of assignments I’ve completed throughout this program that ask me to state my theoretical perspective.  I’m still uncertain “where I stand”, and firmly believe an open-minded stance is critical.  However, the theories above do intrigue me.  For the sake of brevity, I’m simply listing links to other theoretical orientations that have intrigued me over the years.  They also provide great “explanatory value” therapeutically.

In this post I discuss “feeling stuck” using Berne’s Transactional Analysis.   
In this post, I discuss misunderstandings using Berne’s Transactional Analysis.
In this post I discuss Erikson’s Stages of Development.  

References

American Counseling Association (2005). ACA Code of Ethics. Alexandria, VA: Author.
Arthur N. & McMahon, M. (2005). Multicultural career counseling: Theoretical applications of systems theory framework. The Career Development Quarterly. 53(3). 208-222.
Broderick, P.C. & Blewitt, P. (2010). Life Span Development: Human Development for Helping Professionals. (3rd. Ed.) Boston, MA: Pearson.
Brown, J. (2010). Psychotherapy integration: Systems theory and self-psychology. Journal of Marital and Family Therapy. 36(4), 472-485.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Crethar, H.C., Rivera, E.D., & Nash, S. (2008). In search of common threads: Linking multicultural, feminist, and social justice counseling paradigms. Journal of Counseling and Development. 86(3). 269-278.
Curtis, D.F. & McPherson, R.H. (2000). The clinical utility of systems theory in counseling practice. Journal of Professional Counseling, Practice, Theory & Research. 28(1) 50-63.
Elrich, J.F. (2006). Vygotskian inner speech & Reading process. Australian Journal of Educational & Developmental Psychology. 6. 12-25.
Glassman, M. (1994). All things being equal: The two roads of Piaget and Vygotsky. Developmental Review. 14, 186-214
Linehan, M. M. (1993). Skills Training Manual For Treatment of Borderline Personality Disorder. New York Guilford Press.
McMahon & Patton (Eds). (2006). Career Counseling: Constructivist Approaches. New York: Routledge.
Monk, G., Winslade, J. & Sinclair, S. (2008). New Horizons in Multicultural Counseling. Thousand Oaks , CA: Sage Publications.
Microtraining Associates (2011). Introduction to Motivational Interviewing. Available from http://ctiv.alexanderstreet.com/View/1779393
Prout, T.A. & Wadkins, M.J. (2006).  Essential interviewing and counseling skills.  New York, NY: Springer Publishing Company.
Pederson, P.B., Crethar, H.C., & Carlson, J. (2008). Inclusive Cultural Empathy. Washington, D.C.: American Psychological Association.
Salkind, N. J. (2006). Encyclopedia of human development. Thousand Oaks, Calif: Sage Publications.
Wertsch, J.V. (1985). Culture, Communication, & Cognition: Vgytoskian Perspectives. New York: Cambridge University Press.
William, M. (1989) Vgytosky’s Social Theory of Mind. Harvard Educational Review, 59(1). 108-126.

 

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Rational Emotive Behavioral Therapy…

(((I’m starting a new internship soon.  My internship supervisor gave me an assignment that involves thinking about what my theoretical approach is.  He also mentioned briefly that his theoretical approach included motivational interviewing and Ellis’s “Rational Emotive Behavioral Therapy”.  I review this theory here from old course notes.))

Acceptance vs. Change

Albert Ellis is a clinical psychologist practiced over 60 years and founded Rational Emotive Behavioral Therapy “REBT”.   In the early years of his practice of psychoanalysis, Albert Ellis was struck by the fact that “irrational premises” (Corsini, 2011) plagued the thinking of his clients. Clearly causing much of their emotional distress, this dysfunctional thinking was largely impervious to any logical counterargument (Corsini, 2011).

As the result of these observations, Albert Ellis came to the conclusion that an individual’s belief systems were at the core of their issues (Corsini, 2011). Conceived by Ellis as being comprised of thoughts, feelings, and behaviors, these belief systems required a multidimensional approach to overcome (Corsini, 2011). It was Ellis’s assertion that cognitive therapies, emotional-affective techniques, and behavioral reconditioning together can help individuals overcome these illogical belief systems (Corsini, 2011). He termed this therapeutic process “Rational Emotive Behavioral Therapy” (Corsini, 2011). What I like about Ellis’s approach is it utilizes a combination of change-based and acceptance-based interventions much like Marsha Lineman’s DBT.

Ellis on Acceptance.

In his book “Myth of Self Esteem book“, Ellis defines esteem as a internal constructed based on an evaluation of one’s self-efficacy and self-worth (Corsini, 2011).  He also makes a point of noting that it is often based on externalized sources.  He states that when self-esteem is constructed in this way, your self-acceptance becomes conditional, based on evaluations of information from outside sources.  He claims the solution for this is an unconditional positive regard.

Ellis on Change Opportunities.

As Jeffrey Mishlove states in his interview with Albert Ellis: “Whatever happens in our life, it isn’t totally responsible for our emotions” (Mishlove, 2010). This observation is a key element of REBT’s overarching view of human nature (Corsini, 2011; Mishlove, 2010). While Ellis makes a point of clarifying that our events can help us understand the consequences of our thought process, this view alone is limiting (Mishlove, 2010). This perspective is limited without an additional consideration of how preferred thought processes determine our feelings, behaviors understanding and consequent experience (Mishlove, 2010). In fact, Ellis states that our interpretations of our events are the ultimate causal explanation for their emotional effects (Mishlove, 2010).

Belief Systems & A Solution

How To Overcome Belief Systems.

Albert Ellis stated that it was our dogmatic belief system in form of unhealthy musterbations that were the central cause of our emotional suffering (Mishlove, 2010). Comprised of behaviors, thoughts and feelings, deeply ingrained as a standard operating system within us, he felt it took a great deal of repetitive practice to overcome (Mishlove, 2010). Utilizing a Rogerian regard, he proposed that these elements could be addressed through guidance and direction (Mishlove). He felt it was important to both educate a client on the benefits of a rational belief system and encourage them to challenge their unhealthy ones (Bernard, 2009).

The Therapist’s Role In Addressing Belief Systems

In interesting article by Michael Bernard which includes an interview with Albert Ellis there is an in-depth discussion of how the therapist role in REBT (Bernard, 2009). What follows are key insights that can help provide a good overview of the therapist’s role (Bernard, 2009).

What beliefs are considered rational?

This is the first question that logically comes to mind when attempting to understand the REBT approach. The following is Albert Ellis’s core definition of a rational belief system:

….accepting yourself as a mistake- maker without putting yourself down, understanding that to be successful you sometimes have to do things that you don’t feel like doing as well as not rating people on the basis of their behavior. (Bernard, 2009, p72).

REBT therapy: An ABCDEF approach.

In his interview with Albert Ellis, Michael Bernard essentially summarizes Ellis’s approach as follows:

Ellis supports adding an ‘‘F’’ to the ABCDE model— forcefully agreeing with and applying new rational beliefs…..it’s always cognitive, emotional and behavioral. You’re giving them an idea but you’re getting them to think of it emotionally, forcefully and act on it. (Bernard, 2009, 66-74)

In keeping with this theory’s name, the specific approach to changing belief system involves cognitive, emotional as well as behavioral components. This “ABCDEF” model, according to Bernard, defines the overall process for working with clients to create change (Bernard, 2009):

  • Step one: Asking About The Activating Events (Bernard, 2009). Understanding the relevant details of the situation and life/event in question at the core of the client’s problems. (Bernard, 2009)
  • Step Two: Understand The Underlying Belief Systems (Bernard, 2009). When learning about the details of the activating event, also try to piece together the belief systems. (Bernard, 2009). What are the specific beliefs, feelings, thoughts, that related to their retelling of the story (Bernard, 2009).
  • Step Three: Understand the Consequences of the current belief system (Bernard, 2009). Understand the logical consequences of the belief system and choose together how they belief systems can be challenged (Bernard, 2009).
  • Step Four: The Doing Phase (Bernard, 2009). In recognition of the behavioral and affective components of REBT, this phase involves assigned homework, in which the client is given an opportunity to dispute irrational beliefs (Bernard, 2009).
  • Step Five & Six: Evaluation of progress & continual forceful agreement with positive rational beliefs (Bernard, 2009). This phase helps to counteract Ellis’s assertion that overcoming irrational belief systems took much practice and effort, (Mishlove, 2010)

Strengthening positives and eliminating the negatives.

One final observation regarding Ellis’s REBT theory, is its dualistic approach (Bernard, 2009). It is a directed approach that involves a dualistic goal of overcoming irrational beliefs and replacing them with positive ones (Bernard, 2009). Addressing the cognitive components underlying this goal means teaching clients the benefits of rational belief system (Bernard, 2009). Alongside this, there is the need to help them work through toward the affective and rational consequences of their irrational beliefs systems (Bernard, 2009). Since his early experiences with psychoanalysis lead him to the conclusion that reason alone was not enough, he added another key component (Bernard, 2009). By assigning homework, and encouraging follow-through, they could address the affective and behavioral components (Bernard, 2009). This was said to help further reinforce the insights of the rationality of a new belief system (Bernard, 2009>

Ellis on Relationships

Another key insight that is unique to REBT is its assertion that our inner thought world is what helps to define and further perpetuate our emotional experiences (Corsini, 2011). There are many theories, which are helpful in point to externalized factors and past events as determining factors in our emotional experiences (Corsini, 2011). While these theories are all valid and beneficial, they are limiting by themselves (Corsini, 2011). This theory provides an added dimension to understanding the cause of our experiences (Corsini, 2011). As Ellis states in this video, it is the complex interrelated system of thoughts, feelings, and behaviors that define the lives we live (Mishlove, 2010).   As a preferred way of coping and relating with the world, this belief system can become healthy when rigid and absolute (Corsini, 2011). Defining this notion as “musterbation”, he felt is was a key component in our emotional suffering, and cause of many of our problems (Mishlove, 2010).  Should’s, on the other hand, are unrealistic expectations or demands people impose on themselves or others (Metcalf, 2011).  “Awfulizing” involves the exaggeration of an unpleasant situation so that it is worse than it really is (Metcalf, 2011).

Criticisms of Ellis’s REBT

When watching the videotaped interview with Albert Ellis for this assignment, two key areas of disagreement with Ellis’s observations were found.   Springing from empirical observations and theories, that negate Ellis’s observations, my thinking on these matters diverges from his.

Developmental Psychology and Ellis

In the videotaped interview between Jeffrey Mishlove and Albert Ellis, is a bit of commentary that runs counter to observations within the field of developmental psychology (Broderick, 2010; Mishlove 2010). Specifically, Ellis seems to focus primarily on the individual as the central causal factor in one’s own lifespan development (Mishlove, 2010). On the one hand, it is certainly true generally speaking, that our ways of thinking do tend to define our experiences (Corsini, 2011). On the other hand, applying this observation to child development results in the painting of an inaccurate picture (Broderick, 2010). So what are the areas of divergence from the field of development psychology within Ellis’s theory?

In the videotaped interview for this assignment, Ellis seems to make the assertion that parents and early upbringing aren’t responsible for our development (Mishlove, 2010). He states that it is our chosen way of applying and using these early influence that exists as the central explanation for our overall developmental course (Mishlove, 2010).   While listening to this commentary, an array of contrary evidence within the field of human development can come to mind. Research on brain and child development, both point to the very real limitations on the human mind at early points in our lives (Broderick, 2010).

A child’s mind can be best defined as egoic in nature, and immediate in its overall focus (Broderick, 2010). With a level of understanding of their truth as the only truth, there is little capacity to not only consider other’s points of view, but also effectively the process abstract notions (Broderick, 2010).   Additionally, with the brain very malleable at that point, our earliest attachments and emotional experiences have long ranging effects on brain development (Broderick, 2010).

When taking in Ellis’s commentary above with this in mind, it would be wrong to apply his observation of “the self as cause”, to child development (Broderick, 2010). In reality, the matter of what causes us to develop as we do is much more complex than Ellis’ would lead you to believe (Broderick, 2010).

The Scientific Method Can Solve Our Problems.

When you think antiscientifically…then you disturb yourself, therefore we use the flexible scientific method to get you to undisturb yourself. (Mishlove, 2010). 

This quote above comes directly from the interview between Jeffrey Mishlove and Albert Ellis. In his desire to stress this as a key element in his theoretical perspective that sets it apart, he states unscientific and dogmatic perspectives are unhealthy (Broderick, 2010). The reason for using the scientific method in therapy is that, according to Ellis, it can help counteract the roles we play in creating our own experiences.

On the one hand, it is important to not take this statement alone and mischaracterize Ellis’s theory. While the scientific method is innately objective and logical nature, it is wrong to limit our description of REBT as one-sided in this manner (Corsini, 2011). Additionally, it is certainly true this theory by its very name, is multidimensional in its approach, utilizing, emotional, rational, and behavioral elements (Corsini, 2011). His utilization of a Rogerian positive regard as a key element in the therapeutic relationship, for example, helps address the affective elements of our problems (Corsini, 2011).

On the other hand, with this said, the introduction of a scientific method as a key founding principle of an approach to therapy is still troubling.   Using an objective logical in nature isn’t always the ideal way to address human concerns.   Doing so can ultimately limit our effectiveness as counselors. For example, changing your basic philosophically, rationally and affectively, doesn’t always address every elemental cause of our problems (Broderick, 2010).

Evidence of this fact can be found by again referring to our discussion early of human development (Broderick, 2010). For example, our earliest experiences, in the pre-memory stages of live, affect our brain development, and attachment styles (Broderick, 2010). These effects are very real, life lasting, and existent at subconscious levels (Broderick, 2010). Addressing them requires more than an objective or logical approach (Broderick, 2010).

When you consider the role of psychiatric diagnosis, the limit of this scientific perspective can also be seen (Broderick, 2010). The experiences of depression and anxiety based on an altered brain activity that defines a psychiatric diagnosis, exists independent of any logic or reason (Broderick, 2010). However illogical or irrational, they are still that individuals reality and can’t be altered through scientific reason alone.

References

Bernard, M. E. (2009). Dispute irrational beliefs and teach rational beliefs: An interview with
Albert Ellis. Journal of Rational – Emotive & Cognitive – Behavior Therapy, 27(1), 66-76. doi:10.1007/s10942-009-0089-x
Broderick, P.C. & Blewitt, P. (2010). Life Span Development: Human Development for Helping Professionals. (3rd. Ed.) Boston, MA: Pearson.
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

 

 

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