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Loving One’s Neighbor and Multicultural Orientation

Loving One’s Neighbor and Multicultural Orientation

Please see attached.

Required reading:   

Hook, J. N., Davis, D., Owen, J., & DeBlaere, C. (2017). Cultural Humility. American Psychological Association. https://mbsdirect.vitalsource.com/books/9781433827792

Audio Transcript: The Blessing of Pure Motivations

What is a pure heart the idea behind pure Barros me Old Testament requirement that a sacrifice be pure appear heart is devoted to Christ appear heart is cleanse on a regular basis through forgiveness of pure heart respond to the direction of the Holy Spirit a pure heart is willing to change a similar description of purity was used when Jesus called Nathaniel to join his disciples do you describe an angel as a pure man possessing no deceit on 127. The promise was that a pure heart creates clear vision so that we can see God On the one hand faith in Jesus Christ alone makes us pure or innocent before gone on the other hand we bear responsibility in keeping our hearts claimed by setting the focus of our hearts on Christ we often think of purity in heart as a description associated with personal holiness and piety purity does include these factors another namin understanding purity of heart is motivation our motivations can easily disguise themselves from our side because we naturally want to view our motives this pure and gladly when reality they may not be. Why do we do what we do motivation theories have contemplated this question for over a century some point to meet the needs they steer specific people are motivated by tunes to meet since cool social face will cognitive or effective need the goal is to achieve the feeling of these needs in some reliable and tangible way social influence can be a source of motivation the power of social influence wrath and a persistence are to be accepted and to be connected with other meaningful people peer pressure is a common form of social influence and serve as a potent source of motivation for teenagers and young adults transcendent reasons are sensitive or with privileges motivations were desired to achieve a virtue of lifestyle transcendent money vacation may or may not appeal to our desires transcendent motivation all through requires personal sacrifice and may require irrational or nonsensical actions on the part of the people the goal is to achieve something transcendental value such as the favor of God or eternal bliss drug or behind motivation is expectancy we do certain things with the expectation of a positive dishonorable predictable outcome Victor broom proposed expectancy theory for applications in the business world the premise is simple. And employee motivation is an. Come to and identify an action or effort will likely result in the desired outcome 3 superior performance in pursuing had been assigned action will increase the likelihood of obtaining the desired outcome rooms model was with application in the business world than the theory works in other areas of life to we have a goal in mind need social influence or transcendent we determine a path that will likely result in the desired outcome then we engage in any number of actions attempting to attain the goal which was early on in the quality of our performance matters wasting simply stars for a lot will set of behaviors and skills they called us to experience that is are the outcome and will likely repeat success in the future this is the foundation of habits and addictions the Bible describes how to meet our needs and healthy ways but human nature life shortcut and actually resists God's instructions because his way because his way considers the needs of others and requires say a primary concern of all in human nature itself. The problem of the verse a was the pure in heart will see God how will the pure in heart seeing dime 1st those who are in Christ are among the pure in heart and will seek to hide in the sands of eternity with God 2nd those who are pure in heart will see God's intervention and life sometimes God's intervention comes in meeting the sometimes God's intervention comes in helping people break free of one healthy behaviors and fiction they have a lot of pollen in the path and meeting the 3rd the pure in heart can see Dr Jose have learned to trust God's willingness to meet their needs and have experienced God's grace and overcoming that I saw Sickles now we serve as a resource for others Paul described this principle and saying Corinthians 1324 Praise be to God and the father of our Lord Jesus Christ the Father of compassion and the God of all comfort who come 1st us and all our troubles so that we can comfort those. In trouble with the comfort we ourselves have received from God Job illustrated the point and then jump start the experience with multiple losses and his journey in seeking God for answers Joe came to realize came to realization Joe 15 Read my years have heard of you but now my eyes have seen you imagine the resources of comfort and hope. Once authorities perience was over Jochen been a resource of hope because he was pure in heart joke you see God in others benefited from what you call how well do we see God are how pure our motivations how willing are we to serve as resources of comfort and hope for others.

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The student will post one thread of atleast 400 words. Each thread, students must support their assertions with at least 2 textbook citation, following current APA Professional Standards.

In our reading in Cultural Engagement this week, Treat (2019) discussed loving one’s neighbor, and Chediak (2019) talked about making the Gospel sweeter. Discuss how we can address core needs of encouragement, compassion, and empowerment alongside material needs as a means of loving one’s neighbor and adorning or making the Gospel sweeter. Include your faith in this discussion.

Explain in your own words why Hook et al. (2017) advocate for a shift from multicultural competence to multicultural humility. Describe what is meant by a multicultural orientation framework. Define and discuss key concepts from our reading this week in Hook et al. regarding multicultural orientation, cultural identity, and working on cultural biases, power, and privilege. Do not use subheadings. Write one paragraph on multicultural orientation and one paragraph on loving your neighbor.

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 Hook et al: Preface, Introduction, and Chapters 1 – 3

Hook, J. N., Davis, D., Owen, J., & DeBlaere, C. (2017).  Cultural Humility. American Psychological Association.  https://mbsdirect.vitalsource.com/books/9781433827792

Preface

Culture plays a complex role in our society and world. Our cultural identities enrich our lives and make our cities, workplaces, churches, and neighborhoods more exciting and engaging, but our cultural identities can also be a source of disagreement, division, and conflict. In our current cultural context, disagreements about cultural identities and worldviews dominate news coverage (e.g., the Black Lives Matter movement and its opposition; attitudes toward Syrian refugees and immigrants; disagreement and conflict about lesbian, gay, bisexual, and transgender rights).

As counseling psychologists, our hope is that the therapy context can be a place where therapists and clients can engage in deep discussion and analysis of clients’ cultural identities, beliefs, values, and attitudes, as well as the intersection between clients’ and therapists’ cultural identities. Unfortunately, many therapists struggle to understand how to meaningfully address and engage the cultural identities of clients when they come up in therapy. They may ask themselves, How do I ask about a client’s cultural background? How do I communicate that I value my client’s culture? What do I do when I make a cultural misstep or mistake? How should I proceed when I have a strong negative reaction toward a part of my client’s cultural values or worldview?

It is with these questions in mind that we set out to write this book. We wanted to write a book that would be practical—that would help therapists who were struggling to address or engage culture in the therapy room. We wanted a book that would be integrative—that would connect theory and research from multicultural counseling with the primary tasks of psychotherapy, such as developing a working alliance with a client and dealing with ruptures when they occur in therapy. Finally, we wanted a book that was respectful of various cultural identities, rather than relying on generalizations or stereotypes.

We decided to use cultural humility as the guiding theoretical framework for our writing. Humility is an interesting theoretical perspective from which to write a book because it focuses on acknowledging what we don’t know rather than the more typical approach in psychology of discussing what we (believe we) know. But when it comes to engaging culture and exploring an individual’s cultural identity, humility is a great tool and represents a worthwhile place to begin. Engaging with an attitude of humility avoids some of the common pitfalls that can disrupt relationships, such as stereotyping or making assumptions. In contrast, humility involves an openness to explore and an inherent valuing of cultural diversity.

Humility isn’t easy. In fact, we intentionally put together a writing team representing a variety of cultural identities. We knew we would have different perspectives, and we hoped this would lead to stronger ideas. The process was challenging, and the book ended up being more nuanced than the book we set out to write. But in the end, we think our experience mirrored the costs and benefits of engaging cultural identities in therapy. Engaging cultural identities can be difficult, challenging, and messy. Cultural missteps or mistakes can feel awkward and painful. But if you stick with it, commit to consistent dialogue even when uncomfortable, and engage with humility, the benefits are profound and include a deeper, richer experience of connection, learning, and growth. Thanks for taking this journey with us.

In writing this book, we want to acknowledge and thank several people. Professionally, we are thankful to our mentors who showed us the way—Ev Worthington, Karen Kitchener, and Bonnie Moradi. We are indebted to the courageous researchers and clinicians who started and maintained the multicultural counseling movement over the past several decades. In our education, we were taught to think about and value culture as an important aspect of therapy, and we are thankful to those who came before us and paved the way. Finally, we are thankful to our families, who provided us with our own cultural story to share.

Introduction – Beginning the Journey of Cultural Humility

The beginning is the most important part of the work.

—Plato, The Republic

Culture is full of rich histories and shared stories that exist within the larger sociopolitical context that influences the power, privilege, and opportunities we have in everyday life. People who share a cultural identity at some level share a similar story, although they have important differences and unique characteristics as well. Engaging with clients and their cultural identities involves understanding and honoring our cultural stories and those of our clients.

As you begin reading this book, we encourage you to think about your cultural story and how it intersects with the cultural stories of your clients. Maybe you are a therapist who would like to improve your ability to connect and work with clients from different cultural backgrounds. Perhaps you want to learn how to honor and respect the cultural identities of your clients. Or maybe you are a therapist-in-training, entering your work with clients and culture with a mix of excitement and fear. Wherever you are in your journey as a therapist, we are hopeful that you will find this book helpful. This book presents a theoretical foundation and framework for how to think about your work with diverse clients and honor their cultural identities in the therapy room. Throughout the book, we encourage you to take a close, hard look at yourself. If you are like most people, you probably have certain areas of strength for working with clients and their cultural identities, but you probably also have certain areas for growth, including struggles and biases. We encourage you to step into these areas of growth with courage, rather than retreating into your areas of comfort and avoiding the discussion. Finally, we discuss practical strategies for engaging with clients and their cultural identities, including repairing mistakes that threaten the therapeutic relationship.

Culture and Therapy

There has been a growing recognition by mental health professionals over the years that clients’ and therapists’ cultural identities are an important aspect of therapy (American Psychological Association [APA], 2003; Comas-Díaz, 2012). Historically, an assumption of most theoretical approaches was that people were more similar than different. Psychological disorders were thought to occur on the basis of a series of universal principles. According to this conceptualization, treatment followed a one-size-fits-all approach, which was typically tailored according to the type of psychological disorder (e.g., depression, anxiety, personality disorder). For example, Freud focused on internal drives toward aggression and sex, as well as defense mechanisms such as repression and projection, and he believed these principles were universal regardless of a person’s cultural identities (Freud & Strachey, 1964). Skinner described human behavior in terms of behavioral reinforcement (Skinner, 1953). Principles such as shaping and extinction were thought to work similarly for all people (and animals) regardless of clients’ cultural identities (e.g., race, ethnicity, religion, gender, sexual orientation).

Looking back, it is hard to believe that culture was not a bigger part of the conversation. Culture is now widely accepted as a potent force that underlies and shapes all human thought, emotion, and behavior (Pedersen, 1990). Throughout this book, we discuss culture in more detail. Culture involves the ways in which we think, feel, behave, and interact with others. Culture provides us with a lens or point of view with which we see the world. Culture affects almost all our decisions: where we choose to live, what we do for a living, who (or whether) we decide to marry, and whether we believe in God or a higher power.

When mental health professionals first started to think about culture, they focused on race and ethnicity. This was a good place to start because racial and ethnic differences form some of the strongest group memberships in our society. Race and ethnicity have a complex history, both in our country and around the world, and these group memberships continue to exert powerful effects on individuals today. As mental health professionals continued to work and study culture, theory and research necessarily became more complex. Mental health professionals expanded the scope of culture to include other cultural identities, including nationality, language, gender, religion, sexual orientation, socioeconomic status, disability or ability status, and size (Cornish, Schreier, Nadkarni, Metzger, & Rodolfa, 2010). They also began to explore the fact that a person’s various cultural identities were presented in conjunction with each other and exerted reciprocal effects on one another. This led to theory and research examining the intersectionality of various types of cultural identities (Cole, 2009). As such, culture, as a broader term, reflects the fact that people belong to and identify with different cultural groups. This sense of belonging to different cultural groups influences every aspect of one’s life, including beliefs, values, attitudes, and worldviews.

In examining culture in therapy, some important research on health disparities was conducted in the 1970s and 1980s (e.g., S. Sue, 1976; S. Sue, McKinney, & Allen, 1976). This work documented that racial and ethnic minority clients had worse therapy outcomes compared with White clients (S. Sue, 1977). Moreover, racial and ethnic minority clients were not seeking therapeutic services as much as White clients. When they did seek services, they had higher rates of premature termination and dropout and also reported smaller levels of symptom improvement relative to White clients. These findings disturbed many mental health professionals, who devoted their careers to thinking and writing about why therapy did not seem to be working as well for racial and ethnic minority clients and what could be done to improve the situation.

This enterprise led mental health professionals to realize that many therapists were doing a poor job of addressing cultural identities in therapy (S. Sue & Zane, 1987). This finding was not surprising; mental health professionals were just beginning to write about the idea that cultural identities might be important to explore in therapy. Thus, therapists entering the field did not have the necessary training for how to think about or address cultural identities in the therapy room.

These mental health professionals critiqued many therapeutic models and techniques. They pointed out important limitations of therapeutic models that were aimed at all people, regardless of cultural background. They worked to articulate the role of culture in shaping individuals’ beliefs, values, thoughts, feelings, behaviors, and interpersonal relationships. Likewise, they highlighted the role of culture in how clients and therapists understand some of the key variables in the therapy process, including the presenting problem, goals, interventions, and even the idea of what therapy should look like. This line of theory and research coalesced into a body of work on how to train therapists to be effective or competent in their work with culturally diverse clients (D. W. Sue, 2001; D. W. Sue, Arredondo, & McDavis, 1992; D. W. Sue et al., 1982).

Multicultural Competence

The first major model of multicultural competencies was developed by Derald Wing Sue and colleagues in the early 1980s (D. W. Sue et al., 1982). The model involved three components. First, therapists were encouraged to develop self-awareness of their own cultural background and experiences and gain a better understanding of how these identities affected others. For example, some White individuals in the United States might not necessarily think of themselves as having a “culture” because culture can be invisible for people who are members of privileged groups (i.e., groups that have greater collective bargaining power to negotiate formal structuring of institutions and subtle expression of social norms to prioritize their values and interests; McIntosh, 1988). This aspect of multicultural competencies encouraged therapists to acknowledge and explore their cultural background and to note points of connection or disconnection regarding their own and the client’s cultural background.

Second, therapists were encouraged to develop knowledge for working with various cultural groups. As we noted previously, culture has a large influence on one’s way of thinking, feeling, behaving, and interacting. Therapists were encouraged to learn all they could about various cultural groups so they could better understand and help their clients.

Third, therapists were encouraged to develop specific skills for working with culturally diverse clients. Psychologists noted that certain kinds of interventions were likely to work better or worse with clients from different cultural backgrounds. For example, encouraging a client to be more independent and to disregard the wishes of their family may be a misguided suggestion in some cultures that are more collectivistic. Also, therapists should realize that certain skills may be required to address and discuss culture and cultural identities in the therapy room.

This model of multicultural competencies has had important effects on the field of psychology and other helping professions, including medicine, psychiatry, social work, and counseling (APA, 2003). To become a therapist in almost any discipline requires completing coursework in multicultural counseling. Much of this coursework is based on D. W. Sue and colleagues’ (1982) three-part model of multicultural competence.

Although this model of multicultural competence is popular and widely disseminated in several mental health fields, it is not without its critics (Owen, 2013; Weinrach & Thomas, 2002). Most of the critiques of this model have focused on the research base supporting its use, implementation, and effectiveness. First, measures of multicultural competence have been difficult to develop and validate. For example, researchers and clinicians have questioned the validity of self-report measures of multicultural competence. Self-report measures of multicultural competencies have been linked to social desirability (Constantine & Ladany, 2000). Therapists who rate themselves as “very high” in multicultural competence may be accurate or may perhaps lack self-awareness, demonstrating a lack of humility in their overconfidence.

Given these concerns, the majority of research in this area has used client-report measures, in which the client rates the therapist on perceived multicultural competence (Tao, Owen, Pace, & Imel, 2015). Although these other-report measures seem to fare better than self-reports, they have their issues as well. Namely, some aspects of multicultural competence (e.g., the therapist’s knowledge of racial identity models) involve jargon that is likely unfamiliar to clients and may be difficult or impossible for clients to rate (see Drinane, Owen, Adelson, & Rodolfa, 2016). Furthermore, ratings of perceived multicultural competence may be confounded with measures of general competence or closeness with the therapist. Taken together, because measurement is crucial to a solid scientific foundation, the major concerns regarding measurement of multicultural competencies have undermined the confidence in this body of work.

Perhaps just as concerning, mental health professionals have noted the absence of scientific support for the hypothesis that multicultural competence, as a quality of the therapist, predicts better outcomes in therapy (Owen, Leach, Wampold, & Rodolfa, 2011). When clients rate their therapist as low in multicultural competence, this corresponds with negative outcomes in therapy. However, most studies in this area have looked at single pairings of therapists and clients, so ratings of multicultural competencies are likely mixed up with factors that are specific to the particular relationship between the therapist and client. In studies that have looked at multicultural competence as a quality of the therapist (measured by aggregating ratings across clients), this construct does not reliably predict client outcomes (Owen et al., 2011). These findings ought to make therapists question the scientific basis for models promoting multicultural competence given that there is currently no established link between this construct (as a quality of the therapist) and better therapy outcomes.

In our work with therapists-in-training, we have noted another difficulty with the dominant model of multicultural competence: The focus on competence denotes a particular end state at which the therapist-in-training reaches a certain level of knowledge or skill for their work with culturally diverse clients. This language gives the impression that therapists can “arrive” in a sense in their work with diverse clients. We have started to question the usefulness of this language for thinking about and training therapists to work with diverse clients. The language sets therapists up for having unrealistic standards that may exaggerate perfectionistic striving and evaluative concerns that undermine desired qualities and behaviors. Some therapists-in-training may become preoccupied with working toward an ill-defined state of “competence.” Given that this end state of competence remains vague, therapists who are honest with themselves about their limitations may feel anxious and fear negative evaluation from supervisors. Therapists may try to avoid appearing “incompetent,” rather than leaning into their discomfort and anxiety about cultural identities, which is an important prerequisite for growth.

These practical issues, combined with the well-established theoretical and empirical gaps in work on multicultural competence, have led us to develop a framework that focuses on therapists’ development and values regarding working with diversity. As such, for both practical and scientific reasons, we prefer the language of humility to competence. Humility encourages therapists to approach their work with culturally diverse clients with an attitude of openness, being engaged in a dynamic process of growth (Hook, Davis, Owen, Worthington, & Utsey, 2013). This process is characterized by acknowledging and owning limitations and striving to express openness and interest in the client’s salient cultural identities. There is no end state of competence. There is only humility and continued growth and development over time.

On the basis of this humility framework, we have developed an approach to integrating cultural considerations into therapy that addresses some of the limitations of the existing models of multicultural approaches to therapy. Our framework is developmental in nature and acknowledges that therapists will have struggles and growth edges. We invite therapists to be honest about their growth edges and work on them, rather than aiming to achieve an unrealistic end goal of competence. Also, our framework is flexible. Rather than focusing on specific approaches for particular cultural identities, which may be unrealistic given recent theory and research on the importance of considering the intersectionality of identities, our framework provides a general structure for how to think about respecting and integrating cultural considerations into therapy. Finally, past approaches have not done a good job of integrating theory and research on diversity issues and psychotherapy. Our framework explicitly integrates cultural considerations with theory and research on the process of psychotherapy, focusing on important topics such as developing a strong working alliance and dealing with ruptures in the alliance.

Multicultural Orientation

This shift in focus from competence to humility aligns with recent theory and research on the importance of developing a strong multicultural orientation for work with diverse clients (Owen, 2013; Owen, Tao, Leach, & Rodolfa, 2011). A multicultural orientation refers to how a therapist thinks about and values diversity, which necessarily affects the therapist’s work with diverse clients. Multicultural competence focuses on “ways of doing” therapy with diverse clients, including the effective implementation of cultural knowledge and skills. Multicultural orientation, however, focuses on “ways of being” with diverse clients and includes cultural humility, cultural comfort, and taking advantage of cultural opportunities (Owen, 2013).

Cultural humility is the bedrock of developing a strong multicultural orientation and reflects the focus and title of this book (Hook et al., 2013). Cultural humility involves an awareness of one’s limitations to understanding a client’s cultural background and experience. Cultural humility also involves an interpersonal stance that is other oriented rather than self-focused in regard to the cultural background and experience of the client. The culturally humble therapist is interested in and open to exploring the client’s cultural background and experience. The culturally humble therapist does not assume their cultural perspective is “the correct one”; rather, the culturally humble therapist recognizes that there are several valid ways of viewing the world and developing a sense of one’s beliefs and values.

The second aspect of multicultural orientation involves attending to and eliciting cultural opportunities in one’s work with clients (Owen, 2013; Owen, Tao, et al., 2016). This is also a specific expression of cultural humility. Therapists have several decision points during therapy, and many of these decisions involve deciding whether to engage a discussion about the client’s cultural background and identities. These choice points, which are guided by the therapist’s multicultural orientation, can directly or indirectly communicate to the client that the therapist views the client’s culture as an important aspect of the client’s life that should be addressed in therapy. However, avoiding or moving away from a cultural opportunity can communicate that the client’s cultural identity is unimportant or invalid.

Finally, the third aspect of multicultural orientation involves cultural comfort. This is an expression of cultural humility that involves the therapist’s sense of ease when addressing cultural topics and engaging the client in cultural discussion (Owen, 2013; Owen et al., 2017). Cultural comfort is expected to directly influence a therapist’s likelihood of initiating cultural dialogue with a client, and it is also expected to relate positively to the quality of a discussion with a client about culture. Cultural comfort can be developed through experiences both inside and outside the therapy room.

Who We Are

As authors, we bring four different sets of cultural stories and perspectives to bear on this book. Thus, here in the Introduction, we decided to share a bit about our own stories and how we became interested in multicultural counseling and cultural humility.

Josh: Looking back, I did not think too much about culture and diversity before I attended graduate school. A lot of this had to do with privilege. I belong to certain groups and communities that have historically had greater power, so their values and interests are disproportionally reflected in both the structure of formal societal institutions and more subtle social norms. As a cisgender (i.e., my gender identity matches my biological sex) White man, I did not have to think a lot about my cultural background and identity when I was younger. I grew up in a suburb of Chicago, in a town that consisted of people who mostly looked like me and believed the same things I did. I went to college at a large state university that was more diverse, but it was so big that I was able to surround myself with people who looked like me and viewed the world similarly to me. The most in touch I got with my ethnic heritage growing up was eating traditional Norwegian and Swedish foods during the holidays. I had the privilege to engage with and think about my cultural identity as much (or as little) as I wanted.

Culture became more salient for me when I entered graduate school. First, there was the professional side. I dove headfirst into multicultural counseling training, and I also began to develop relationships with supervisors, colleagues, and clients who identified with a variety of cultural identities. There was also the personal side. A lot of this had to do with my identity as a Christian and my growing awareness that relatively few psychologists also identified as religious. During my training, I struggled to align beliefs I had been taught growing up with new values I was developing as a counseling psychologist. This was not an easy process, and for a time I thought I would have to either give up my identity as a Christian or my identity as a psychologist.

My professional interests in multicultural counseling and cultural humility emerged from a mix of personal interest and some unexpected events along the way. I love hearing people’s stories, including those about their families and cultures. I am naturally curious, and I was interested in exploring how people’s cultural backgrounds influenced the problems in their lives, as well as how culture could be used as a source of support. I was interested in how or why people believed certain aspects of life were valuable and important, especially those aspects that were different from my own.

When I first got to graduate school, my advisor was on sabbatical, so I worked with a different advisor at first, which focused some of my early research on the experience of racism in African Americans, as well as cultural protective factors that buffered African Americans from the deleterious effects of race-related stress. I also spent a lot of time studying the intersection of religion and psychology—partly due to my professional interest and partly in the hope I could work out my struggles between my two seemingly conflicting identities as a person of faith and a counseling psychologist.

When I took my first faculty position, my department chair asked whether I would teach multicultural counseling. I was not sure what I was getting myself into, but I knew I was interested and passionate about the topic, so I said yes. It has been a wonderful and challenging journey over the past several years, working with students to help them navigate their struggles with cultural issues to help serve their clients. I am grateful to my students for trusting me with their process and stories; my experience teaching this class has strongly influenced my thoughts about cultural humility and working with cultural identities in therapy.

Donnie: I was home schooled through the sixth grade, in part because my parents did not trust the public school system to reflect their religious values. My mom was a devout Christian—in fact, her father and all three of her brothers were pastors. I wonder whether she would have been a pastor if that was allowed within her tradition, but as it turns out, raising her children to love Jesus was at the center of her sense of calling. When I was about 12 years old, she became depressed. As a result of several years of therapy, she explored her identities as a woman and a daughter. Over the course of her work in therapy, my mom realized she had become an expert at intuiting and responding to the needs and wants of others, for which she earned approval. But to have a greater sense of wholeness, she had to discover and honor her own interests, hopes, and dreams.

One of the ways she did this was through art. We took lessons from an artist in Atlanta who was very good. (I stopped after a few years, but my mom continued to develop into an outstanding artist.) As her four kids grew up, she also explored possibilities for a second career. She aced her GREs and got a scholarship to a counseling program near our home. Before she actualized some of these dreams, however, she was diagnosed with ovarian cancer. I was a senior in college at the time, and as soon as I graduated, I came home and worked for my dad’s small home-building company and went to school with my mom. Just before finishing her internship, she died—her life cut short at age 48.

My mom is often the first person I think about when trying to understand intersecting cultural identities. I wonder what she would have done with her life if she had grown up in a cultural environment with less strict rules related to gender roles. She got to explore and expand her identity, gifts, and talents later in her life, but I wish she had gotten to do that sooner.

My interest in multiculturalism is deeply grounded in my relationship with my mom. I feel ambivalent, which I think is OK. On the one hand, I sometimes feel sad (and even angry) that certain perspectives may have limited her options and her sense of freedom to explore her calling in life. On the other hand, I do not think she viewed her sacrifice as I have come to, which gives me pause. I received many benefits from my mother’s commitment to and integrity in how she understood what it meant to be a loving wife and mother. I wonder how to honor her commitments and the way she invested her life in line with her values. I think this intuition is somehow important for the work we do as therapists. We are not dealing just in the theoretical. Our clients come to us and trust us with their deepest dreams and disappointments.

Holding this tension is what I want to spend my life learning about. I want to learn to honor the strengths of cultural identities and systems to provide people with meaning and purpose, but I also want to be honest about how certain cultural values can sometimes exploit and stifle human flourishing. I want to understand how to listen to people’s pain related to identity and begin to explore what it might mean to flourish as a person in the face of cultural hurts and wounds. I want to learn how to build trust even when it is hard. I want to understand how to actively participate with others to develop systems in which people have a chance to develop and grow.

Jesse: Over my life, I have come to learn that I have a complex relationship with the institutions of power, privilege, inequities, and justice. My mother is an immigrant to the United States from Malaysia, and my father is from the United States (preceded by multiple generations). They met in England, and their relationship began because of the Vietnam War (my father was in the Navy). Although I am fortunate they were able to meet, the context in which that occurred has never been lost on me. Indeed, the larger sociopolitical contexts and systems continue to define the way I understand myself, others, and the world.

In my youth, there were times when I ignored the racial and ethnic teasing from my friends, and there were times where I even joined in. At times, I did not stand up for justice or the inequitable treatment of others. Those memories sit with me to this day. As I grew up, I faced situations in which individuals called me racist terms, such as sandnigger and terrorist. Although these memories are painful, it made me wonder how many other individuals are thinking the same thing but not vocalizing their views (at least in public).

As I entered graduate school, I remember learning about cultural dynamics and how they might influence the therapy process. The lessons were rife with stereotypes, surface-level exposure, and a focus on deficit-based models of learning. Moreover, the focus tended to be largely on race and ethnicity and tended to ignore the true complexity of culture—in particular, the concept of intersectionality. What was even more disconcerting to me was the lack of empirical data guiding the treatment suggestions. In addition, the treatment suggestions appeared to lack a connection to how actual therapy is conducted (not to mention missing how to conceptualize cultural exchanges based on modern empirically supported treatments). In my private practice, I tend to find a more natural way of being with clients to truly honor the complexities of cultural dynamics.

From these experiences, I have dedicated my professional and personal life to better understanding how I relate to the institutions and systems that influence the lived experiences of minority and majority identified individuals. I know I do not have the answers to these complex issues, but I am dedicated to being part of the discussion.

Cirleen: I feel like culture was a salient construct to me before I even had the words to articulate the ways in which my identities and worldview reflected my cultural experiences. I identify as a biracial Asian American cisgender woman. I would add my identities as an ally, first-generation college student, and daughter of an immigrant as salient as well. My mother emigrated from Taiwan to the United States in her mid-20s and met and married my father, a Belgian American from Ohio. I lived in four countries (Japan, Taiwan, Saudi Arabia, the United States) before I was 8 years old. The transition from Saudi Arabia to the United States was the most challenging. I went from attending an international school at which cultural and ethnic diversity were inherently present and celebrated to attending an elementary school in a small town in Florida where there were few Asian or multiracial families. I recall my younger sisters being the only other Asian children at my school. So I went from not seeing my ethnicity or biracial identity as the defining characteristic of my person to being a “chink” in a transition that was extremely painful. The one question I constantly asked myself was: “Why?” “Why did people see me so differently here?” “Why did they see something wrong with me?” and, eventually, “What was wrong with me?” I think my educational journey has been one of trying to understand these questions.

I did not plan on getting a PhD. I did not see the point in spending 5 years of my life pursuing a degree if I did not find something I was passionate about and would want to study with that level of intensity. However, I did pursue a master’s degree, and in my second year, I took my first multicultural psychology course. My diversity course with Dr. Adelbert Jenkins was an absolute awakening for me. For the first time in my life, I had language for my experience—my identity development, the complexity of my multiple ethnicities, racism, systemic oppression, and privilege. It was all there. I felt like I took my first real breath as a psychologist. I had found my passion. I wanted to do that—to explore identity, to combat oppression, to do work that would elucidate the pervasive and insidious impact of discrimination. I think on a basic level, my work as a researcher, teacher, mentor, and therapist is an answer to the question I asked as a kid—“What is wrong with me?” The answer was “Nothing!” We are all cultural beings who deserve the opportunity to develop authentically and be genuinely seen and known.

Structure and Outline of This Book

The focus on multicultural orientation has important ramifications for training and work with diverse clients, as well as the organization of this volume. The focus of this book is different from that of many texts on multicultural competence, which tend to have a chapter devoted to various types of clients (e.g., one chapter on counseling African American clients, one chapter on counseling lesbian, gay, bisexual, and transgender clients). It is not that we view developing knowledge and skills for work with specific types of clients to be unimportant. Other texts have done a good job providing baseline knowledge and skill. Also, attempting to apply knowledge and skills about general groups without a baseline value of cultural humility can easily devolve into stereotyping or other cultural problems. The existing body of work reflects valuable resources of a diverse profession, but what is needed is an approach for engaging these resources and contextualizing them to the specific needs of the client who is sitting in the therapy room. Each client has a unique identity that is based on their personality, experience, and intersecting cultural identities. Something new is needed to clarify and explore what this task requires.

Instead of focusing one chapter on various types of cultural backgrounds, we organize this book into two main sections. First, in Part I (Chapters 1–3), we present the theoretical foundation of our book, focusing on self-awareness and the importance of developing a strong multicultural orientation that values diversity in all forms. Specifically, in Chapter 1, we explore in detail the concepts of cultural humility, cultural comfort, and cultural opportunities and what they mean for us as therapists. In Chapters 2 and 3, we shift our focus to the person of the therapist and delve into the therapist’s cultural identity, background, and experiences. In Chapter 2, we invite you to explore your cultural identities, as well as the relationship or intersection between your cultural identities and systems of power and privilege. In Chapter 3, we work with you to develop a plan for working on becoming more comfortable with cultural differences, reducing your cultural biases, and exploring what to do with your experiences of power and privilege. In this section, we set the groundwork for you to develop cultural humility in your life, to better prepare you for engaging in your work with culturally diverse clients.

Then, in Part II (Chapters 4–9), we shift our focus to the therapy room and explore how cultural humility shows up in the interpersonal interactions between therapist and client. In this second section, we first present an overview of the connections between having a multicultural orientation and the various tasks of therapy, such as intake procedures, diagnosis, case conceptualization, treatment planning, and the use of interventions (Chapter 4). Then we present a detailed discussion about four core ways in which you can integrate cultural humility and the multicultural orientation model with the key processes of therapy: developing a strong working alliance with clients of various cultural identities (Chapter 5), avoiding cultural ruptures and microaggressions and repairing the therapeutic relationship if and when they do occur (Chapter 6), navigating value conflicts when they occur in therapy (Chapter 7), and understanding and addressing your limits when you face them in therapy (Chapter 8). We conclude the book by discussing cultural humility as a lifelong learning process, and we share some of our stories of continued growth (Chapter 9).

The chapters follow a similar structure. We begin with a personal story from one of the authors. Each of us is involved in teaching and training graduate students, and we focus on issues related to diversity in our teaching and training work. (When these personal stories involve work with clients, the identifying information and some details about the clients have been changed to protect client confidentiality.) Second, we describe the main content of the chapter, integrating recent research supporting the link between each topic and effective work with culturally diverse clients. Third, integrated throughout each chapter, we present practical exercises to aid in application and training. The practical exercises are designed to help you meaningfully incorporate the concepts described in each chapter into your work with clients. Our hope is that this text will actively engage you as the reader, and we encourage you to actively engage with your thoughts and feelings as you read the material and complete the exercises. At times, this engagement may bring up strong feelings or reactions, which is normal and to be expected. It may be helpful to be mindful of your environment and the psychological space you are in as you read the text and do the exercises. Finally, throughout the text, we provide several case examples1 from a variety of settings. The case examples illustrate therapists working with the concepts presented in their work with clients, in supervision, and in consultation with other colleagues. The case examples present therapists working with varying levels of cultural humility. We hope these case examples will both normalize struggles with the material in this book and provide snapshots of therapists working to develop a strong multicultural orientation and connecting with clients and their cultural identities.

Conclusion

Improving one’s therapeutic work with clients is a worthy goal. There are not many constants in the world of therapy, but one constant is that issues related to your clients’ cultural identities will come up in therapy. These issues will intersect with your cultural identities in complex ways. Cultural differences may cause struggles or misunderstandings with your clients, or they may lead to an enriched therapeutic relationship that results in increased growth. Likewise, cultural similarities may lead to overidentification with your clients, or they may result in a close bond. Our goal is to explore how to engage your clients’ cultural identities in a way that promotes connection rather than alienation. The main theme is this: Learn to get comfortable with acknowledging your limitations, owning them, and viewing them as opportunities to grow and connect with your clients at a deeper level. Becoming a better therapist is not an end state to be achieved through striving, but rather a continued process of growth in humility, openness, interest, and flexibility.

Chapter 1 Multicultural Orientation

Humility is the solid foundation of all the virtues.

—Confucius

Josh: I remember beginning to prepare to teach my first graduate course in multicultural counseling as a new faculty member. I had done some research in graduate school about the intersection of religion and therapy, as well as the experience of race-related stress in African American college students. My chair asked me whether I would consider teaching the course. I thought about for a bit, and then I said yes. Even though I tried to appear confident as I agreed to teach the course, on the inside I felt afraid and anxious.

I doubted my abilities. Sure, I had written some articles on a couple of different aspects of cultural diversity, and I was interested in culture and diversity issues, but did that make me an expert? Probably not. I wondered whether I was way out of my league. I was not sure how my students would react to having a White man as the instructor. I also felt a lot of pressure to do a good job teaching the course. I knew that effectively engaging with clients’ cultural identities was an essential aspect of being a strong clinician. I felt that, at least in some areas, I possessed a certain degree of competence, but I was not at all certain I was ready to consistently help students with a variety of identities deal with the many areas and issues that fall under the topic of multicultural counseling.

As I prepared to teach the course, I did what most beginning faculty members do—I read works by leaders in the field and gathered materials from other professors I respected. Most of the models of graduate multicultural education focused on multicultural competence. This made sense to me at first. I wanted my students to get to a place where they could competently counsel their clients. Navigating cultural identities was an important part of effective therapy, so it made sense that multicultural competence would likewise play a large role in effective therapy.

But what did multicultural competence mean? The main models of multicultural competence focused on multicultural awareness, knowledge, and skills, but which aspects were most important? My students all seemed to be in different places in their process of developing their multicultural awareness, knowledge, and skills—how much was enough to be deemed “competent”? I also started to struggle with the idea of multicultural competence. Competence seemed to focus on an end goal and achieving a certain status. But this language did not align well with my experience of growth in dealing with various aspects of culture and diversity. Often the more I learned, the more I realized I did not know. In fact, many people talk about how multicultural learning is a lifelong developmental process. I was looking for a language that captured this pursuit of ongoing learning and growth about cultural identities. In fact, when my students were worried about how they were doing (e.g., they were focused on competence and grades), they seemed less willing to share their limitations and struggles, which inhibited the learning process. I wanted my students to recognize and own their limitations instead of just trying to appear as competent as possible. These experiences led me (and others) to explore the language of humility as an alternative to competence in our research, clinical work, and training.

Multicultural Orientation Framework

This chapter outlines the multicultural orientation framework that serves as the theoretical foundation for the rest of the book. Theory guides practice. A good theory provides a framework or explanation for why we do what we do as therapists. It provides a common language for talking about clients and guides our interventions and decisions. Thus, before we get into some of the personal work of developing cultural humility, as well as practical ways to engage clients with cultural humility, it is important to discuss the theoretical foundation that guides this work. First, we critique the multicultural competency framework, which sets the stage for the development of the multicultural orientation framework that we use in this book. Second, we describe the foundational assumptions of the multicultural orientation framework. Finally, we explain the core tenets of the multicultural orientation framework. In doing so, we hope to provide you with a sense of how the multicultural orientation model can assist in the process of therapy. In addition, we highlight how cultural humility is one of the foundational aspects of this framework.

CRITIQUE OF MULTICULTURAL COUNSELING COMPETENCIES

For decades, theorists and researchers have investigated the multicultural counseling competencies of therapists (D. W. Sue et al., 1998; Whaley & Davis, 2007). A primary impetus for the multicultural competencies movement was that psychologists had mostly disregarded the needs of racial and ethnic minority clients in psychotherapy research, theoretical models, training, and practice. As mentioned in the Introduction to this volume, the multicultural competencies model defined three core aspects that professional counselors and psychologists had to demonstrate (i.e., awareness, knowledge, and skills).

Most existing models of multicultural counseling and training are based on this definition of multicultural competencies. Summarizing various multicultural competencies definitions, Whaley and Davis (2007) shared the following:

We view cultural competence as a set of problem-solving skills that includes (a) the ability to recognize and understand the dynamic interplay between the heritage and adaptation dimensions of culture in shaping human behavior; (b) the ability to use the knowledge acquired about an individual’s heritage and adaptational challenges to maximize the effectiveness of assessment, diagnosis, and treatment; and (c) internalization (i.e., incorporation into one’s clinical problem-solving repertoire) of this process of recognition, acquisition, and use of cultural dynamics so that it can be routinely applied to diverse groups. (p. 565)

The multicultural competencies have greatly shaped the field of psychology in many positive ways.

Although the multicultural competencies catalyzed a cross-disciplinary explosion of interest and scholarly research on how to work with culturally diverse clients (see Huey, Tilley, Jones, & Smith, 2014; D. W. Sue, 2010), the language itself has led to several well-known limitations. Some limitations are practical, such as some of the personal struggles Josh shared about integrating the idea of competencies in his work and training. Other limitations are based on scientific research and involve major limitations in the scientific basis of multicultural competencies. For example, profound concerns regarding the accuracy of certain measurement strategies persist (Drinane, Owen, Adelson, & Rodolfa, 2016). Likewise, there is little evidence that multicultural competencies can be reliably measured as a quality of a therapist (i.e., they seem to vary by relationship and show low convergence across clients). Also, multicultural competencies as a quality of the therapist has not been associated with better therapy outcomes (e.g., higher levels of symptom improvement; see Owen, Leach, Wampold, & Rodolfa, 2011), which suggests that adopting models that purport to increase multicultural competencies may not work to improve outcomes for culturally diverse clients.

As psychologists who have committed our careers to some of the underlying values and the mission reflected in the multicultural competencies movement, we were deeply concerned with these practical and scientific limitations, and we set out to do something about it. Accordingly, Jesse Owen and colleagues (Owen, 2013; Owen, Tao, Leach, & Rodolfa, 2011) began to reexamine what constitutes effective psychotherapy practice with clients from various cultural backgrounds.

Recent work on the intersectionality of identities led us to become increasingly convinced that we might need a theoretical change rather than just a minor tweaking of the multicultural competencies model. If cultural identities intersect with each other (e.g., Black gay cisgender man, South Korean Christian cisgender woman from a lower socioeconomic status [SES] background), and these intersections are meaningful and important, then the task of identifying multicultural competencies for specific intersections of cultural identities became difficult, if not impossible, to clarify. For example, what would it mean to assess a therapist’s multicultural competencies for a configuration of a client’s intersecting identities involving varying levels of privilege and marginalization? The main objective of our efforts was to develop a theoretical framework that appreciates the complexities of individual differences within any social identity (e.g., race, ethnicity, gender, SES) while also providing a way forward that was easily understood, therapeutically sound, and empirically testable.

Before we start this reexamination of foundational assumptions, we should first consider the meaning of multicultural competencies. We are clearly in a training era in which competencies are a prevalent and guiding force. We also place a high priority on the importance of providing effective therapy services to clients from underprivileged and marginalized groups. So the question of multicultural competence is an important one. As a thought exercise, consider the following questions related to the term competent. What does it mean to be multiculturally competent? Specifically, what actions or behaviors would a therapist have to demonstrate to be competent? How much knowledge does a therapist need to have to be deemed multiculturally competent? Does a therapist need to have a wide breadth of knowledge (e.g., information about a wide variety of cultural groups)? Or is depth of cultural knowledge equally or even more important? How much cultural self-awareness is necessary for competence? If a therapist has some cultural biases or areas of growth, are they not competent?

Also, defining how to be multiculturally competent is a complex endeavor. When Jesse was trained in multicultural counseling, he took a course in which the instructor focused each week on one of several cultural identities. For example, they spent 1 week on counseling African American clients, 1 week on counseling lesbian, gay, bisexual, and transgender clients, 1 week on counseling clients with disabilities, and so on. This information was augmented by lectures, readings, and discussions regarding privilege, power, and oppression. On the one hand, Jesse found this information helpful, and he gained a better appreciation for his assumptions and biases. On the other hand, Jesse often found the information presented to be superficial and potentially reinforcing of stereotypes.

Where the training really fell flat was in the therapy room. Jesse had learned generalized information about various groups, but he was left largely on his own to figure out how to contextualize this collection of knowledge (about himself and various groups) to each client—and no two clients were alike. Jesse suspected the course was taught this way because this is how many authors organize their textbooks on multicultural counseling (e.g., Cornish, Schreier, Nadkarni, Metzger, & Rodolfa, 2010; D. W. Sue & Sue, 2013). But he started to wonder whether our existing training models might have overlooked a fundamental aspect of what good therapists learn to do when they engage cultural issues in therapy.

There are also other related multicultural competency terms, such as culturally sensitive or culturally responsive treatments in the literature (Whaley & Davis, 2007). Although these terms are well-intentioned, there are some shortcomings in their definitions. For instance, culturally responsive treatment seems to suggest that therapists have to be reactive (or responsive) to cultural factors in session, compared with being proactive and engaging with clients regarding their cultural identity. In addition, culturally sensitive treatments propose that therapy with culturally diverse clients has to be approached cautiously or delicately. In contrast, we suggest that therapists should have a multicultural orientation that is encompassing of the entire therapy process.

The empirical approaches to understanding cultural processes in psychotherapy do not provide many answers to the question of how to be multiculturally competent. Following the manualized treatment approach, several researchers have tailored standard treatments, such as cognitive behavioral therapy, to the cultural background of clients with specific cultural identities (see Benish, Quintana, & Wampold, 2011; Huey et al., 2014, for reviews). For example, a culturally adapted treatment could take the form of using interpersonal therapy for men who never married (e.g., Waehler, 1996) or adjusting psychodynamic therapy with lesbian, gay, and bisexual individuals (e.g., Cornett, 1993). Many of these treatments focus on panethnic groups and ignore important differences or complexities within those groups (e.g., focusing on Hispanic clients without acknowledging the differences among Hispanic clients’ countries of origin). These treatments assume that therapists can learn the appropriate techniques and approaches with clients according to their social identity.

Dozens of studies comparing culturally adapted treatments (i.e., interventions that are modified to be more consistent with the cultural worldview of a particular cultural group) with standard nonadapted treatments produced results that seem equivocal. Some studies favor the culturally adapted treatments, some favor the nonadapted treatments, and some studies show no differences between treatments (for a review, see Huey et al., 2014). These results are less surprising when compared with the broader literature on psychotherapy. For example, therapists who adhere more closely to a treatment manual or who are rated as more competent (presumably because they possess more knowledge and skills; Webb, DeRubeis, & Barber, 2010) do not have better outcomes with clients. Cultural adaptation of interventions joins a variety of other seemingly good ideas that have weak empirical support.

Even if these findings on culturally adapted treatments were more promising, they focus on approaches that are more effective across therapists, rather than informing our understanding of what makes some therapists better than others when engaging with clients from various cultural backgrounds. Indeed, recent work has shown that therapists do vary in their effectiveness with clients according to their own or the client’s race or ethnicity (Hayes, McAleavey, Castonguay, & Locke, 2016; Imel et al., 2011; Owen, Imel, Adelson, & Rodolfa, 2012). For example, Black clients are more likely to drop out of therapy with some White therapists compared with other White therapists. Although multicultural competencies do not explain this variability, these findings suggest that something is happening and it has to do with the therapist (see Hayes, Owen, & Nissen-Lie, 2017). We need to understand these processes better, and what we propose in this chapter is aimed to help us do that.

Taken together, these studies highlight the importance of focusing on psychotherapy outcomes when assessing our ability to work with clients with diverse cultural identities. We assume that a framework regarding working with diversity should be evaluated on the degree to which it can explain variability in therapist outcomes with clients from particular cultural identities. Therapists can assess their strengths and weaknesses for working with clients from various cultural groups (aggregated across a large number of clients) through examining client outcomes—a potentially humbling and scary process.

At an even more vital level, what inspired the multicultural orientation framework was the lack of practical guidance for therapists when facing various questions about multicultural competencies. For example, are there specific skills that a therapist should use with an Asian American client that are different from those necessary to work with a Hispanic client? Are there different skills that should be used when working with Asian American women versus Asian American men? Or Asian American gay men who are first generation to the United States compared with upper middle class Asian American transgender women?

The challenge can feel untenable when one truly takes the influence of intersecting cultural identities on the psychotherapy process seriously. The identities under consideration grow exponentially as one integrates race and ethnicity, gender, religion and spirituality, social class, sexual orientation, ability, and other identities into one’s conceptualization, treatment plan, and interventions. The challenge is even more daunting when one considers the interaction of cultural identities with mental health symptoms. For example, what about generalized anxiety disorder treatment for Asian American cisgender men versus generalized anxiety disorder treatment for African American women who identify as genderqueer? Considering intersectionality in conjunction with different symptoms adds layers of complexity that may limit the effective applicability of the traditional model of multicultural competencies.

The challenge of this task led Jesse to explore an entirely different approach. Instead of using the language of competencies, the multicultural orientation framework uses the language of orientation. A therapist’s orientation provides a lens through which one sees the world. In a way, an orientation is its own type of identity. It involves a way of being with clients and informs one’s understanding of how change is possible. A parallel example to consider is that through training, therapists develop theoretical orientations (e.g., cognitive behavioral, psychodynamic, humanistic). The primary purpose of possessing and using a theoretical orientation is to organize how one understands a client’s personality, presenting problem, and life context, as well as to guide the therapy process. Like other theoretical orientations in psychology and therapy, the multicultural orientation framework is intended to be an orientation that can be used alongside other therapeutic models (e.g., cognitive therapy, emotion-focused therapy, psychodynamic therapy). The multicultural orientation we hope you will embrace is grounded in a belief that by attending to, infusing, and integrating the cultural dynamics that naturally occur between therapist and client into the psychotherapy process, client therapy outcomes can be enhanced.

ASSUMPTIONS OF THE MULTICULTURAL ORIENTATION FRAMEWORK

The multicultural orientation framework has three main pillars: cultural humility, cultural opportunities, and cultural comfort (Owen, 2013). These three pillars involve one’s attitudes and motivations, as well as behaviors and reactions, both within and outside the therapy space. Before we elaborate on these three pillars, we first acknowledge four foundational assumptions of the multicultural orientation framework.

First, we assume that clients and therapists cocreate cultural expressions. Wachtel (1993) noted that some therapists approach therapy with a one-person model, which focuses mainly on the client, and the person of therapist is largely ignored (except to facilitate change through techniques and relational bond). Other therapists approach therapy with a two-person model, which assumes who the therapist is can be a powerful and meaningful factor in the therapy process. In our view, the therapist is not simply a person who reflects feelings, challenges cognitive errors, and facilitates the development of insights in the client. Rather, the cultural identities of therapists can influence a variety of factors such as what clients say and do not say, how safe clients feel in the room, and so on. For example, a cisgender African American female client might relate differently to a therapist who is a cisgender African American man than to a therapist who is a cisgender African American woman. The interaction between the cultural heritages of clients and therapists can vary according to a host of factors, such as the presenting problem of the client or the personalities and socialization histories of both the therapist and client.

Take a few minutes and consider how you generally think about the therapy process, especially as it pertains to the client, the therapist, and the relationship between the therapist and client. Is there a particular metaphor you like to use to describe the client, therapist, or therapeutic relationship? For example, you might think of the therapist as a blank slate or a pillar of support. Maybe you think of the therapist as a guide who is leading the client in a process of exploration. Perhaps you think of the therapy relationship as similar to a doctor–patient relationship or an equal partnership. Take a step back and consider the metaphor you like to use. If you like to express yourself through art, draw a picture or create a work of art that reflects your metaphor. Does your metaphor reflect more of a one-person model of therapy or more of a two-person model of therapy? How might your metaphor for therapy influence how you work with clients to cocreate cultural expressions in the therapy room?

As clients and therapists cocreate cultural expressions in therapy, we assume that therapists can influence the cultural identities that are more or less salient for clients, how culturally safe the therapeutic environment feels, and the degree to which clients’ cultural heritage is integrated into the therapy process. Also, therapists vary in the degree to which they discuss the therapeutic relationship with clients. Some theoretical orientations are designed to have these interactions occur more explicitly because they are thought to be part of the mechanisms for change (e.g., psychodynamic, interpersonal; Ackerman, Hilsenroth, Baity, & Blagys, 2000; Hilsenroth, Ackerman, Clemence, Strassle, & Handler, 2002). Accordingly, we assume that effective therapy requires therapists to attend to and use these cultural interpersonal dynamics in their work with clients. How therapists go about doing so (e.g., discussions of the therapeutic relationship, self-disclosures, informing the conceptualization) varies according to the needs of the client, the comfort level of the therapist, and the theoretical beliefs of the therapist. Our approach in this book is flexible regarding theoretical approach—we do not prescribe one theoretical orientation or perspective. Further, we assume that therapists will use clinical judgment for how to integrate the material that is presented in this book with their own theoretical approach. At the same time, it is likely that, regardless of theoretical orientation, discussions of cultural beliefs and values will be front and center during some therapy sessions. How those discussions are managed (i.e., with humility and comfort) will likely be of utmost importance.

Second, we assume that multicultural orientation involves a way of being with clients rather than a way of doing therapy (Owen, 2013; Owen, Tao, et al., 2011). In other words, the multicultural orientation framework is less about the actual interventions that are implemented with clients with specific cultural identities and more about the therapist’s values regarding culture and the integration of those values throughout the therapeutic process. Values consistent with the multicultural orientation framework include engaging conversations about culture in a genuine, natural, curious, and real way. Integration of this value involves finding one’s voice in the therapy room and having cultural conversations in a manner that is congruent with one’s values and identity. Throughout this book, we provide examples of how to engage clients in cultural conversations, but these examples are intended to be guides and suggestions because you will have to find the words that work best for you.

Third, we assume that cultural processes (e.g., cultural humility) are especially important for connecting with the client’s most salient cultural identities; feeling deeply known and accepted sets the stage for effective therapy. For example, Owen, Jordan, et al. (2014) found that clients’ rating of their therapists’ cultural humility was a significant predictor of therapy outcomes only for clients for whom their cultural identity was most salient. A key feature of this assumption is that clients have the right to define for themselves what cultural identities are most salient to them personally. This is an important distinction from other approaches in which the theorists, researchers, and therapists have assumed the importance of certain cultural identities. For example, should we presume that being a racial or ethnic minority equates to a client’s racial or ethnic identity’s being a primary identity for them? It could be, but we should not assume that to be the case. Moreover, it could be that for a particular racial or ethnic minority client, sexual orientation, generational status, nationality, or gender identity is a more salient identity. In addition, like the first assumption (i.e., that clients and therapists cocreate cultural expressions), for some clients, it may be that gender identity is more salient when they are discussing issues with an individual of a particular gender (e.g., men) rather than the other (e.g., women).

Fourth, we assume that having a strong multicultural orientation motivates therapists to learn new things about their own and their clients’ cultural perspectives and worldviews. The values that underlie a multicultural orientation framework affect one’s motivational system as a therapist. Multicultural orientation values motivate one to (a) understand one’s cultural limits (e.g., gaps in knowledge, feeling uncomfortable during cultural discussions) and (b) learn and experience more about culture and diversity more broadly. Of course, some therapeutic encounters require cultural knowledge. For example, Budge (2015) described best practices in writing letters for transgender clients to obtain medical treatments. Therapists are asked to be gatekeepers in helping transgender clients to obtain gender-affirming treatments, such as gender transitioning. This level of knowledge is critical to providing adequate care for transgender clients who are seeking medical treatment. However, to state the obvious, it is impossible to know everything about every cultural group and every possible intersection of cultural identities.

Thus, the multicultural orientation framework emphasizes one’s metacognition about what one does and does not know. In addition, multicultural orientation values intrinsically motivate therapists to learn more about the dynamics of their own cultural perspective and those of other cultural groups, both in their personal and professional lives. Consider for a moment: What was the last cultural experience you had that expanded your perspective? What type of documentaries are you drawn to? How diverse is your social network? How motivated are you to learn about different cultures? What proactive things are you doing to learn more about culturally diverse others? The answers to these questions are sometimes not easy to arrive at or even evaluate. For instance, we sometimes have a tendency to surround ourselves with people who look like and think similarly to us because it can feel more comfortable. These questions are intended to highlight that we all have room to grow.

CORE PILLARS OF THE MULTICULTURAL ORIENTATION FRAMEWORK

There are three core pillars of the multicultural orientation framework: cultural humility, cultural opportunities, and cultural comfort. In this section, we describe each of these pillars in detail, offer examples of therapist and client interactions that highlight each pillar, and provide an opportunity for you to assess how you are doing with each aspect of the multicultural orientation framework.

Cultural Humility

Cultural humility encompasses the intrapersonal and interpersonal spirit inherent in the multicultural orientation framework. This aspect of the multicultural orientation framework is the foundational concept that drives the other two important parts of the model: cultural opportunities and cultural comfort. Culturally humble therapists are able to have an accurate perception of their own cultural values as well as maintain an other-oriented perspective that involves respect, lack of superiority, and attunement regarding their own cultural beliefs and values (Davis, Worthington, & Hook, 2010; Hook, Davis, Owen, Worthington, & Utsey, 2013). To date, there are data on over 2,000 clients who evaluated their therapist’s degree of cultural humility toward the cultural identities that were most salient to the client. The findings from these studies demonstrate that clients who view their therapist as more culturally humble have better therapy outcomes, including key therapeutic processes such as the working alliance (e.g., Davis et al., 2016; Hook et al., 2013; Hook, Farrell, et al., 2016; Owen, Jordan, et al., 2014).

The intrapersonal aspect of cultural humility captures how therapists are able to view themselves culturally, including their biases, strengths, limitations, areas for growth, beliefs, values, attitudes, and assumptions. In doing so, culturally humble therapists should be open to feedback from others. The use of feedback in training from supervisors, peers, and clients is commonplace. The ability to incorporate this information in a nondefensive, open stance is the hallmark of intrapersonal humility. This process of self-evaluation can be challenging, but it is critical work. Indeed, humility can be most difficult to embody during times that are most stressful. Engaging with a client in a discussion about cultural beliefs and values can be difficult. It is important to accurately gauge your reactions to various cultural issues. While doing so, attune to your true feelings, be present with the thoughts that automatically enter your mind, and resist the urge to explain or defend your reactions. For example, what is your initial reaction to a client who would like your assistance in deciding on whether she should have an abortion? Is it possible to stay neutral in such a case? What is your honest, accurate view of this issue? What are the barriers, if any, to accepting your viewpoint? What are the barriers, if any, to accepting your client’s viewpoint?

The interpersonal aspect of cultural humility describes a way of being with others that is open to and curious about others’ cultural beliefs and values rather than presumptuous or arrogant (Davis et al., 2010; Hook et al., 2013). Of course, being open to others’ values and identities does not entail unconditional acceptance. As a professional community, psychologists view some beliefs and ideologies as morally inferior (e.g., viewing certain races or ethnicities as inherently superior to others). Also, you are likely to have a personal set of values that views some beliefs and ideologies as better or worse than others. The interpersonal aspect of cultural humility involves the process by which we engage beliefs and values that are different from our own. To continue our example, did you have any initial assumptions about a person who was seeking an abortion? What do these assumptions say about your beliefs and values? Again, it is important to understand and have an accurate sense of self and then contemplate how those initial reactions might impede an open, humble stance with others.

Case Example: Laura and Cesar

Consider the following therapy example of Cesar, a 31-year-old Mexican American, heterosexual, cisgender male client, and Laura, his 33-year-old White, heterosexual, cisgender female therapist. Cesar is struggling with some symptoms of depression, as well as feeling isolated at his workplace. The following is a portion of the dialogue between Cesar and Laura. As you read, think about whether Laura is engaging with Cesar in a culturally humble manner. After you read the dialogue, you will be asked to rate the therapist on her level of cultural humility.

Laura:  You know, you mentioned earlier that you are feeling hopeless at work, but also that things might be looking up. I wonder how you are feeling about your work situation now.

Cesar:  Well, I guess I am not feeling totally hopeless—getting a good review definitely helped a lot there—but I still feel this kind of sick feeling in my stomach when I think about going to work each week. I just don’t know if it’s the right place for me, and that worries me because I had to fight really hard to get here.

Laura:  That does sound particularly hard—I know your parents are proud . . . but what was challenging this week?

Cesar:  Especially over this past week, I’ve been trying to stay upbeat and keep myself motivated. These past few months have just sucked—I can’t kick these negative feelings. Even when I’m really putting in the effort, I go to work, push through the day, and [sighs] when I get home, I just have to unwind and reboot, and it doesn’t feel like enough. It takes everything I’ve got just to tolerate my day, and then I just settle in in front of the TV, which makes my girlfriend upset, but I just don’t want to deal with it. I can’t explain it to her, but all I want to do is veg out.

Laura:  Hmm, yeah, it sounds like you are spending so much energy at work that you aren’t able to take care of yourself when you get home. Does that sound right to you?

Cesar:  Exactly, work takes it out of me, and I don’t have the motivation to work on my relationship or to spend time with my family, and that’s what I really want to do. I miss them, and I miss feeling like myself.

Laura:  So you are in survival mode, just trying to make it through? Sounds hard to keep this up. What do you think is contributing to that?

Cesar:  I think it has to do in part with my being the only Mexican man in my office. Like I feel so on edge without a feeling of community and connection with my colleagues, and it wears on me all the time. I’m on my own, and people aren’t really reaching out. It’s exhausting trying to make it all come together and being by myself.

Laura:  Well, after listening to you these past few sessions, I’m not really sure if your being Mexican has anything to do with it. . . . A lot of people experiencing depression like you are feel lonely and isolated. Don’t be so hard on yourself.

What do you think? Was the therapist culturally humble or not? What parts of the dialogue indicated that the therapist was culturally humble (or not)? Try using the scale in Exhibit 1.1 to rate your impression of the therapists’ cultural humility. It is important to know that these are just your initial reactions. We understand that it can be challenging to rate a dialogue without seeing it on video (or live), but try your best. If you are working through this book with a group or class, take some time to discuss your perspective with others. How did you come up with your scores? What statements in the dialogue led you to rate the therapist as more or less culturally humble? Was there any disagreement in the group about whether Laura was more or less culturally humble?

Cultural Opportunities

Cultural opportunities are the second pillar of the multicultural orientation framework. Cultural opportunities are markers that occur in therapy in which the client’s cultural beliefs, values, or other aspects of the client’s cultural identity could be explored (Owen, 2013; Owen, Tao, et al., 2016). Each therapy session provides multiple opportunities to explore and integrate a client’s cultural heritage, but for a variety of reasons many of these opportunities go unrealized.

Consider the example of Cesar and Laura. When Cesar mentioned that he thought his struggles might have to do with being the only Mexican man at his office, Laura had the opportunity to explore more about his cultural experience as a Mexican American man in an office in which most of his colleagues are White. Instead, Laura assumed that Cesar’s distress was rooted in his depressive symptomology and wanted to focus on the depressive symptoms instead.

There could be many reasons why Laura decided to go this route. Perhaps Cesar had displayed a pattern in the past of avoiding discussion of his depressive symptoms, and Laura wanted to encourage him to maintain focus on the depression. Maybe she felt anxious about the cultural comment and was not sure how to address it. Perhaps Laura was experiencing some racial or ethnic prejudice (unconscious or conscious) and did not want to admit that her client’s problems could have been partially caused by a difficult, stressful, and potentially racist work environment. Whatever the reason, by taking the route she did, Laura could have missed a cultural opportunity to connect with Cesar. Furthermore, by not addressing the cultural comment, Laura likely minimized Cesar’s feelings about his cultural identity. In doing so, she committed a micro-aggression, a subtle discriminatory insult to or invalidation of Cesar’s cultural identity (D. W. Sue et al., 2007).

Cultural opportunities and cultural humility work in tandem during therapy sessions. For example, Owen, Tao, et al. (2016) found that clients who reported that their therapists missed cultural opportunities reported poorer therapy outcomes. However, those negative effects were mitigated if clients viewed the therapist as high in cultural humility. These findings suggest that maintaining a culturally humble stance can offset some cultural mistakes or missteps.

Cultural opportunities arise when clients mention a cultural belief, value, or some other aspect of their cultural heritage. These moments provide natural chances for the therapist to transition to a deeper exploration of a client’s cultural identity. Other times, the therapist may initiate cultural opportunities. For example, in a session in which a client describes the loss of a family member to suicide, the therapist might say, “Sometimes when people face tragedy, they turn to religion or spirituality to cope. I am wondering if that is true for you?” In this example, the therapist relies on previous knowledge about grief and loss to create an opportunity for cultural exploration. What is nice about this intervention is the therapist does not make assumptions about the client’s cultural worldview. If the question does not fit for the client, the therapist and client can move on to more relevant clinical material. But if it does fit, it may facilitate an important discussion about a cultural identity that is important for the client.

We invite you to engage in an exercise that will help you notice cultural opportunities in your everyday life. Today, during your conversations with family, friends, and colleagues, pay particular attention to cultural opportunities that may come up. For example, make a note if someone you are talking with mentions an aspect of their cultural identity. Also, try to think about how you could link the various experiences or topics that people talk about to aspects of their cultural identity. If a cultural opportunity comes up, try to pursue the cultural opportunity and ask a question about the person’s cultural identity. Do not force the conversation in that direction; just ask a question and see where the conversation goes. At the end of the day, spend some time thinking, reflecting, and journaling about what happened. How many cultural opportunities did you notice throughout your day? Was it helpful to be more attentive to the cultural opportunities that came up?

We view cultural opportunities to be a naturally unfolding process over the course of therapy, rather than a specific rule or set of rules to which all therapists must rigidly adhere. For example, some therapists advocate for having explicit conversations about certain cultural identities in the first session. This recommendation is difficult to reconcile with research showing that some clients do not want or need therapists to address cultural concerns in therapy (Chang & Berk, 2009; Maxie, Arnold, & Stephenson, 2006). Similarly, initial evidence has suggested that discussing race or ethnicity within the first session is unrelated to therapy outcomes with racial or ethnic minority clients (Thompson & Alexander, 2006).

These findings suggest that greater nuance may be needed regarding when and how therapists decide to explore cultural opportunities. We revisit this issue in greater depth in Chapter 5, but for now, suffice it to say that perhaps it is better to look for organic ways to address cultural issues in therapy rather than force abrupt transitions that may unsettle clients and distract from the natural flow of therapy. Any given moment can provide a variety of inroads to explore the client’s cultural heritage. Within the multicultural orientation framework, the critical issue is the degree to which clients perceive their therapist is willing and motivated to explore their cultural identity (Owen, Tao, et al., 2016). As a therapist, it is important to explore your decisions about whether to engage in cultural opportunities (or not) in your sessions with clients, as well as the motivations behind them. Especially for beginning therapists, there can sometimes be a tendency to avoid discussion of cultural topics because of inexperience, anxiety, or discomfort. Thus, although we encourage therapists to engage in organic discussions of cultural opportunities, it is important to consider and challenge one’s thoughts, feelings, and motivations for not addressing cultural topics in session.

Case Examples

In the following examples, we provide client statements to which there could be multiple therapeutic responses. Specifically, these client statements afford an opportunity for the therapist to address the client’s culture or move the conversation in an alternate direction without engaging the client’s culture. We would like you first to read the client statement and then consider how you might respond. We start with an excerpt from the earlier example and provide an example response statement. After that, we provide another client example for you to try out for yourself.

Cesar:  I think it has to do in part with my being the only Mexican man in my office. Like I feel so on edge without a feeling of community and connection with my colleagues, and it wears on me all the time. I’m on my own, and people aren’t really reaching out. It’s exhausting trying to make it all come together and being by myself.

Laura—Symptom focus:  I can see it on your face; you seem exhausted just talking about this. I am wondering how this experience is affecting your ability to make changes, both in your home life and in your office.

Laura—Cultural focus:  I can see it on your face; you seem exhausted just talking about this. I am curious what it means for you to be the only Mexican man in the office.

As you can see, there is a decision to be made about the direction of the therapeutic discussion. The focus of Laura’s first comment was to check in about how the client’s level of distress was inhibiting his ability to apply what he was learning in therapy to make changes in his home and work life. It was not necessarily an error, but it did not take advantage of the cultural opportunity the client presented. Her second comment highlighted the impact of the client’s cultural identity. This approach could lead to new insights about the client’s level of distress, as well as other ways of being in the therapy room and the workplace.

Now we invite you to try this second example. The client is Kristi, a 35-year-old Chinese American, heterosexual, cisgender woman who has been married for 7 years. She has two children with her husband. Her family lives with her parents, who are immigrants from China. The client and her family identify as Christian.

Kristi:  I have been feeling very down lately. I don’t know why, but I have now been feeling more anxious since we chatted last week. I know this is only our third session, but I am just feeling nervous every day. I can’t stay focused at work, and it is really affecting my relationship with my husband. I guess I have been questioning my relationship with him . . . but I could never think about being divorced.

Therapist Statement—Symptom focus:  

_____________________________

_____________________________

Therapist Statement—Cultural focus:  

_____________________________

_____________________________

How was it to come up with a symptom-focused response, as well as a culture-focused response? Which response was easier to write? Which response felt more natural to you? Try to brainstorm some benefits and drawbacks for each response. If you were the therapist in this scenario, which one do you think you would be more likely to use? Which response would be more likely to promote a deeper connection and discussion about the client’s cultural identities?

Next, we would like you to evaluate each response using the scale in Exhibit 1.2, the cultural opportunity scale from our research. It might be hard to evaluate your own work, so you may want to complete this exercise with a peer. Try to evaluate each response using the cultural opportunity items. You can see that some responses are more or less culturally focused. You can use this rubric to help evaluate other therapist comments throughout the book.

Cultural Comfort

Cultural comfort is the third pillar of the multicultural orientation framework. Cultural comfort relates to the feelings that arise before, during, and after culturally relevant conversations in session between the therapist and client. The emotional states of feeling at ease, open, calm, and relaxed are hallmarks of cultural comfort. Discussing issues related to culture can sometimes feel difficult and uncomfortable, and some therapists may feel awkward or tense when having these discussions. Therapists with high levels of cultural comfort can moderate their anxiety when having cultural conversations and instead engage the client in a composed, relaxed, and connected manner. Owen et al. (2017) found that therapists’ cultural comfort helped explain the racial and ethnic disparities in treatment dropout within therapists’ caseloads. In other words, some therapists were better at retaining their White clients than their racial or ethnic minority (REM) clients, whereas other therapists showed the opposite pattern (see Figure 1.1). Therapists who were less culturally comfortable with REM clients had a higher rate of dropout for their REM clients than their White clients. Also, cultural comfort can interact with cultural humility—it is difficult to be culturally humble if one does not feel comfortable being open or curious about a client’s cultural heritage.

Emotional states provide important signals for therapists. Therapists who are higher in cultural comfort are more likely to have cultural conversations with their clients. They are also more likely to respond to cultural markers during sessions (i.e., cultural opportunities). In addition, their clients are more likely to discuss cultural topics because the therapists have established a safe, positive, cultural therapeutic environment (Owen, Drinane, et al., 2016; Tao, Whiteley, Noel, & Ozawa-Kirk, 2016; Tao, Whiteley, Noel, Ozawa-Kirk, & Owen, 2016). Emotional states are also signals for clients. For example, clients’ sense of emotional safety in session is paramount because many REM clients do not trust the medical and/or psychological community (Whaley & Davis, 2007). Accordingly, therapists’ cultural comfort sends a signal to clients that it is OK to discuss cultural issues in session.

Cultural discomfort can provide vital feedback to therapists about areas that are in need of further exploration and development. For example, if a therapist feels uneasy about discussing sex with a gay couple, the therapist may want to seek out consultation or supervision to figure out why the discomfort is occurring. Cultural discussions may elicit strong emotional reactions, some of which may be uncomfortable because of a lack of familiarity, conflicting values, and so on. Although it may be difficult to explore these emotions, we urge you throughout this book to lean into the discomfort rather than avoid or run away from the uneasiness. These feelings are excellent windows into new insights about the cultural dynamics between you and your client, and they also may help you identify areas for future growth. However, to benefit most thoroughly from these emotions, therapists need cultural humility to be willing and open to listening to and exploring the uncomfortable feelings. Moreover, therapists have to be aware of the cultural topics they tend to avoid because avoidance is a typical defense against discomfort.

Case Example: Graham and Adam

Consider the following supervision example between Graham, a 49-year-old White, heterosexual, cisgender male supervisor and Adam, a 25-year-old White, heterosexual, cisgender male therapist. They discuss Adam’s most recent session with Arthur, a 56-year-old White, heterosexual, cisgender male client. Arthur is a nontraditional student who returned to school after having to quit his job as a carpenter because of the physical symptoms of Parkinson’s disease.

Graham:  We haven’t talked much about your work with Arthur lately. How did your session go this past week?

Adam:  I guess it went OK.

Graham:  Just OK? How are you feeling about it?

Adam:  Well, we’re still in the beginning stages, still trying to get to know one another. But I guess it’s just been challenging because he’s really struggling with trying to get back into school, and I don’t blame him. I mean, he’s been out of school for 35 years! I couldn’t imagine doing that.

Graham:  Yeah, it does sound like a tough situation. How does his physical disability impact the goals he is working toward in therapy?

Adam:  I’m sure it has to make his schoolwork more difficult. I mean, he needed a lot of help with filling out the intake paperwork. I bet it’s difficult to take exams and take notes in class.

Graham:  How has it been to discuss those things in therapy with him?

Adam:  Well, to be honest, it hasn’t come up a whole lot thus far. We talked about it a little bit at the beginning when he was talking about his reasons for the career change and going back to school because he couldn’t maintain his manual labor job because of his disability. But lately we’ve been talking more about his goals, what types of careers he might be interested in, adjustment to college, things like that.

Graham:  Interesting. . . . I’m curious if you have any thoughts about why you haven’t talked more about his disability. It seems like it might be pretty important to what he’s presenting with in therapy.

Adam:  I don’t know. I guess, to be honest, I didn’t want to make him feel self-conscious about the disability, and I thought maybe talking about it more would draw attention to it. But maybe I’m a little uncomfortable talking about it myself.

Did you have any reactions to the dialogue between Graham and Adam? What do you make of the fact that Arthur’s disability has not come up often in therapy? How comfortable did Adam appear to be when discussing Arthur’s disability? If you were Adam’s supervisor, how could you help him to work on becoming more comfortable in his work with Arthur specifically and with disability or ability status issues more generally?

Exploring Your Cultural Comfort

Changes in cultural comfort are also important markers. Shifts in cultural comfort or discomfort within a session may indicate topics that require further exploration. Certainly, reactions within the session can guide one’s therapy, especially within certain theoretical approaches. For example, a therapist might notice a growing discomfort and tension as a client discusses his family’s attitudes toward discussing money. Beginning therapists might be tempted to ignore such shifts or seek to reduce the uncomfortable feelings, but sometimes these emotions can provide important clues to what is happening within the therapeutic relationship, and they may indicate subtle experiences of the client that deserve further exploration. The therapist might disclose noticing a shift, which could provide an opportunity to understand the client at a deeper level. In this way, therapists’ cultural comfort might inform cultural opportunities within a session, which should be met with a level of cultural humility. Accordingly, these three pillars should work in combination for the greater good of the client.

In this next exercise, we would like you to think about your level of cultural comfort with various cultural identities. Specifically, we would like you to watch a series of videos (e.g., documentary, social media clip). We encourage you to watch videos that represent new or novel cultural topics for you. If you are stuck on what type of video to watch, pick one video from several categories of various cultural identities (e.g., race, ethnicity, gender, sexual orientation, religion, disability or ability status, progressive chronic illness, SES). It would be good to watch some videos that are within your cultural comfort zone as well as some that are outside of it.

Conclusion

We hope this chapter has provided you with a new framework to understand cultural dynamics in psychotherapy. We continue to expand on these principles throughout the book, with a particular focus on cultural humility. We focus more on this aspect of the multicultural orientation framework because this pillar is truly the foundation for the framework. At this point, we have provided information regarding (a) why the multicultural orientation framework is different from the multicultural competencies approach, (b) the core assumptions of the multicultural orientation framework, and (c) the three main pillars of the multicultural orientation framework. In the next chapter, we shift our focus to self-awareness and invite you to explore your own cultural identity, as well as the relationships between your cultural identity and systems of power and privilege.

Chapter 2 Exploring Your cultural Identity.

Who in the world am I? Ah, that’s the great puzzle.

—Lewis Carroll, Alice’s Adventures in Wonderland

Jesse: My paternal grandfather had many great qualities—he served in World War II, he was a successful businessman, he was handy with construction (he even built a two-story garage), and he raised my father, just to name a few of his notable accomplishments. However, he was quite biased—racist—against racial and ethnic minorities. He is responsible for a notable memory highlighting my awareness of being a racial and ethnic minority (biracial, Malaysian—my mother is an immigrant to the United States—and European—my father’s side of the family) when I was young.

It was around the time of the first Gulf War, and we (my father, mother, older brother, and I) were sitting with my grandfather watching the news about the war. He made a remark about the Iraqi army in a negative racist term and then quickly looked over at my mother and asked, “Where are you from again?” He continued with a few more disparaging remarks, and then my mother encouraged my brother and me to go and play in the yard. What I remember the most about this experience is the steadfastness, strength, patience, and thoughtfulness of my mother. She seemed unfazed by his comments and quickly turned to protecting us. These types of events would continue throughout my life in more and less overt and intentional ways. In most situations, I try to channel my mother’s spirit of strength. Moreover, these situations have fueled my passion to not only know and understand my cultural identity but also to help eliminate the hatred that can divide us.

Cultural Humility and Self-Awareness

Mental health professionals place a high value on personal insight and self-awareness (Richardson & Molinaro, 1996; D. W. Sue, Arredondo, & McDavis, 1992). In this chapter, our goal is to help you explore and better understand your cultural identity, worldview, beliefs, values, and attitudes. Some of you might wonder what the point of self-awareness and cultural exploration is. In our view, the purpose is not just to increase your knowledge about yourself for the sake of gaining knowledge, but the hope is that as you increase your self-awareness and understanding, you will have a better sense of how your cultural identities and values affect your sense of self and your interactions with others, especially your clients. A core aspect of cultural humility involves knowing yourself well, including awareness and ownership of your strengths and limitations.

We hope you will push yourself to be as real and honest as you can when you complete the activities in this chapter. At times, you might experience discomfort, shame, anger, or sadness in exploring these topics—that is normal. At other times you might feel proud and appreciative of exploring your cultural identity—that is normal too. Regardless of the feelings that come up, we hope you sit with your feelings, avoid the temptation to run from any negative emotions you may experience, and be mindful of how your positive emotions can fuel your motivation to do more work in this area. This motivation should also lead you to have conversations with others about their experiences as well. We hope you have the courage to take risks in being vulnerable with others (assuming it is safe to do so).

Cultural self-awareness is an important component of cultural humility and developing a strong multicultural orientation (Hook, Davis, Owen, Worthington, & Utsey, 2013; Owen, 2013). An important part of cultural humility involves an awareness of your cultural identities, beliefs, and values. This is where the work of self-awareness starts. Taking time to honor where your cultural identity originates and reflecting on the roots of your cultural heritage is crucial. These foundational lived experiences of your family members provided valuable lessons and also reflect the sociopolitical environment of the times in which you grew up. Of course, these experiences and lessons teach and guide our way of being. At the same time, there are other lessons and experiences your family and you did not experience. This is a reminder that we cannot fully know the lived experiences of others. Accordingly, knowing the scope of your cultural awareness, as well the limits of your ability to truly understand the cultural experiences of others, is a key aspect of cultural humility. Understanding yourself as a cultural being, as well as how your cultural identities intersect with experiences of power, privilege, and oppression, is an important step in this process.

What does cultural self-awareness look like in practice? How much self-awareness is necessary to be effective in therapy? Should there ever be an end to self-exploration? It can be overwhelming to consider all of the origins, histories, intersecting values, and expressions within your own set of cultural identities. This becomes even more complex when you consider the interactions of your cultural identities and those of your clients. Accordingly, we want to be clear about what, why, and how cultural self-awareness can be harnessed to promote cultural humility.

We consider cultural self-awareness to contain four main components: (a) knowledge structures (e.g., knowledge of your cultural identity), (b) motivational processes (e.g., the process of learning), (c) relational experiences (e.g., how your cultural identity intersects with others and the sociopolitical systems of power, privilege, and equity), and (d) meta- and epistemic cognitions (e.g., reflective capacity). Our hope is that by better understanding your cultural identities in these four areas, you will be able to feel more secure in yourself culturally and be able to engage in cultural discussions, knowing your perspective and vantage point.

KNOWLEDGE STRUCTURES

First, the starting point to cultural self-awareness begins with increasing cultural knowledge and understanding about your particular cultural identities. However, we encourage you to go deeper than simply identifying the cultural identities that are important to you. Indeed, your cultural identities include your personal, family, and sociopolitical histories that help inform the broader contexts of your cultural heritage. Importantly, we encourage you to consider the relationships and connections between your cultural identities and your experiences of privilege, power, and oppression, as well as how your cultural identities intersect and work together to create your cultural self. In most cases, there are social norms that also inform how you understand your cultural identities, as well as how others understand your cultural identities (e.g., Mahalik, Good, & Englar-Carlson, 2003). Sometimes those social norms may feel congruent to how you view yourself; other times they will not feel congruent, and they can be a source of distress and misunderstanding. Also, we would like you to consider your most important and fundamental cultural beliefs, values, and attitudes and how these are connected or related to your cultural identities and experiences. In doing so, we encourage you to think about the development of your cultural identities. Most cultural identities change over time, some in predictable ways. Accordingly, it can be useful to read more about developmental models that describe how cultural identities can shift or develop over time (e.g., Cross, 1995; Helms, 1990; Peek, 2005; Rosario, Schrimshaw, & Hunter, 2011).

Sociocultural Identity Wheel

In this first exercise, we begin the process of cultural self-exploration by identifying the cultural identities that make up who you are. Take a look at the sociocultural identity wheel (adapted from Metzger, Nadkarni, & Cornish, 2010) in Figure 2.1. Think of this wheel as a cultural picture of your life. The center represents the essence of who you are. The six blank circles surrounding the center represent various aspects of your cultural identity. Take some time and think about the aspects of your cultural identity that are important to you. These are the cultural identities that describe who you are. Write one part of your cultural identity in each circle. If you cannot come up with six things right now, that’s OK. Just write down as many as you can. After you write down your cultural identities, think about which cultural identities are more or less salient to you. Which do you feel are core to who you are as a person, and which cultural identities are more peripheral?

When you are finished, take a few minutes and look at your cultural identity wheel. Feel free to write down any reactions or reflections you had while doing this exercise. Consider the following questions: What identities were most salient and least salient to you (and how are they expressed on a daily basis)? What meaning do you make about the saliency of your cultural identities? How have these cultural identities changed or shifted over time? What privileges, advantages, inequities, or discrimination have you experienced on the basis of your cultural identities? What messages do you receive about your cultural identities from the media? How do you think other people view your cultural identities? Did any feelings (e.g., sad, angry, scared, happy, excited) come up for you as you completed the exercise?

There are several aspects of culture that you could have used to fill out your cultural identity wheel, including race, ethnicity, gender, sexual orientation, religion, social class, age, disability or ability status, progressive chronic illness, size, and political affiliation, among others. Perhaps you included other aspects of your identity, such as your role as a mental health professional or graduate student.

As you reflect on your wheel, were there any aspects of your cultural identity that did not come to mind when you were completing the sociocultural identity wheel? Such an omission might be an indication that this aspect of your culture is not important or salient to you. However, sometimes an aspect of our cultural background is not salient to us because it represents a privileged aspect of our cultural background (McIntosh, 1988). Sometimes we are not aware of the privileged parts of our cultural identity because they just seem “normal” to us. These parts of our identity might have a big impact on us, but the impact might be invisible. For example, if you are White, did you put down “White” on your sociocultural identity wheel? Sometimes White people leave it off. If you are heterosexual, did you put down “heterosexual” on your wheel? Sometimes heterosexual people leave it off. If you are able bodied, did you put down “able bodied” on your wheel? Sometimes people who do not have a disability or progressive chronic illness do not think about it.

Next, take a look at your sociocultural identity wheel and think about how the cultural identities you listed intersect with experiences of privilege. We want you to think about your relationship with privilege. There are clear sociopolitical privileges that come with some cultural identities (e.g., White men typically have more privilege than racial minority women). However, our relationship with these institutes of privilege might cause us to see our relationship differently. For example, a White man might view his relationship with power as accepting of the power but channeling it into a mission to be an ally and to fight for social justice. This stance does not mitigate the power afforded him, but it also honors his position in society. In addition, there may be other identities that are less or more advantaged that could also influence his perspective. How would you describe your relationship with systems of power, privilege, and equity based on your salient cultural identities?

For each of your cultural identities, write a P if it represents a privileged identity in the United States, and write a D if it represents a disadvantaged identity in the United States. How did it feel to mark certain aspects of your cultural identity as privileged or disadvantaged? Did your classification of your cultural identities into privileged or disadvantaged ring true for you? Which of these labels are consistent or inconsistent with your experience? For the labels that are inconsistent, what do you make of this difference? Do you think it is possible that there is a part of you that is not in touch with your experiences of privilege or disadvantage related to a particular aspect of your cultural identity? Perhaps there are more powerful or salient aspects of your cultural identity that buffer your experience of a different cultural identity? For example, if you identify as Black but grew up in a wealthy home, your socioeconomic privilege may have buffered your racial disadvantage. Conversely, if you identify as White but grew up in a poor home, your socioeconomic disadvantage may have overshadowed your racial advantage. Spend some time thinking, reflecting, and journaling about these questions.

Case Example: Becky and Grant

Having a clear sense of your cultural identities, as well as how these identities are connected with experiences of power, privilege, and oppression, can be important in the therapy room. It can be especially helpful to consider the intersection between our identities as therapists and our clients’ identities, as seen in the following supervision case example between Becky, a 28-year-old White, heterosexual, cisgender female therapist, who is in her third year of a PhD program in clinical psychology, and Grant, a 51-year-old White, heterosexual, cisgender male supervisor, who works in the counseling center at Becky’s university. They discuss Becky’s third session with Luis, a 45-year-old Latino, heterosexual cisgender male client. The following is the dialogue between them. As you read, think about the intersection of cultural identities between the supervisor, therapist, and client.

Grant:  You mentioned before that you felt like you were struggling to connect with Luis—could you say more about how you experience that?

Becky:  Yeah, well, sometimes I feel like we’re just not on the same page. Like I try really hard during session to understand his perspective and get a sense of what he’s going through, but it’s tough. I think we both realize we’re pretty different from each other. We do our best to connect and help each other, but it doesn’t always happen.

Grant:  When you say you’re different, what do you mean by that?

Becky:  Well, there are the obvious differences between us. We have different racial/ethnic backgrounds; he’s a man and I’m a woman. But I think the biggest difference is where we are at in our life situations. He’s older, he has a wife and child, and he’s trying to balance all of that, along with work and school part time. It’s just a lot. Sometimes I feel overwhelmed just listening to him, and I’m honestly not sure what I would do in his situation. Sometimes I just don’t know how to help.

Grant:  It does sound like he has a lot going on. Is that the part you’re having trouble connecting with—that he has all these different responsibilities and is pulled in all these different directions? It sounds like maybe your experience has been different, so it’s hard to connect.

Becky:  Yeah, I mean, I’ve had my share of problems, but for the most part, things have been pretty easy. My family always had enough money, and my parents really stressed that getting an education and doing well was important, so I was able to pretty much focus on that. Even now, you know, some of my classmates have to wait tables to make ends meet. I still have support from my parents, so I’m able to focus on my schoolwork and not get too stressed out.

Grant:  So it sounds like there might be a difference between you and Luis in regard to privilege and opportunities, especially around money. It seems to be getting in the way of you connecting with Luis. I wonder what feelings come up for you when you consider your privilege in this case?

Becky:  Yeah, I feel a little awkward in session, because I don’t know how he is connecting with me . . . and I guess I feel kind of angry in general. I don’t know what to do about my privilege. It’s just something that I am not aware of on a day-to-day basis.

What did you think of this exchange between Becky and her supervisor? What cultural identities and issues were salient to you as you considered this case? What cultural processes might be helpful for Becky to consider in her relationship with her client? If you were Becky’s supervisor, what additional questions might you have asked to help her in her work with Luis?

Cultural Identity Salience

As you completed the sociocultural identity wheel exercise, you probably noticed that some of your cultural identities were more salient to you, and other cultural identities were less salient to you. The salience of various cultural identities is an important thing to consider as we work on engaging clients and their cultural identities. As noted in Chapter 1, it is important to be humble and listen to how clients describe the cultural identities that are most salient to them, rather than enforcing our own views on which cultural identities should be salient for our clients. In the following exercise, we provide one example to help you (and your clients) think about the salience of your cultural identities.

In this next exercise, we invite you to complete the Multigroup Ethnic Identity Measure (Phinney & Ong, 2007) in Exhibit 2.1 to help you understand the salience of various cultural identities in your life, as well as in the lives of your clients. Note that this measure focuses on ethnic identity, but you could ask similar questions about other aspects of your cultural identity.

After you complete the Multigroup Ethnic Identity Measure, take some time to think and reflect on your experience. Did your scores line up with how salient you view your ethnicity to be? Did you notice any differences in your scores on exploration versus commitment? Could you think of ways in which you could use questions such as these in your work with clients? Could you think of ways in which you could adapt these questions to explore other aspects of your cultural identity?

Cultural Beliefs, Values, and Attitudes

In addition to recognizing our salient cultural identities and those of our clients, it is important to explore our most important cultural beliefs, values, and attitudes. These aspects make up our cultural worldview and have a strong effect on our everyday lives and decisions. It is important to be able to understand our cultural worldview and also recognize how our cultural worldview is similar or different from that of our clients.

In this next exercise, we ask you to describe your current cultural worldview and reflect on how it is consistent (or not) with the cultural worldview of your family. Take out a blank sheet of paper. Begin journaling about the most important beliefs, values, and attitudes you learned in your family growing up. Beliefs are broad and refer to things you believe to be true about yourself, other people, and the world. Values are the things you think are most important in your life; they serve as guiding principles and affect your judgments of right and wrong (Schwartz, 1992). Attitudes are more specific and refer to thoughts or opinions on various subjects (Myers & Twenge, 2012). If you need help getting started, think about what you were taught by your parents or caregivers about the following topics: politics, money and possessions, family, romantic relationships, crisis, fun and friendship, gender roles, sexual orientation, education, work, religion, and diversity.

After you have spent some time journaling about what you were taught by your parents or caregivers when you were growing up, take out another sheet of paper, and describe what you believe currently about these topics. For example, perhaps your family valued education strongly, and you do as well. Alternatively, perhaps your family was very religious, but religion is not an important aspect of your life currently.

Take a few minutes and reflect on this exercise. Do you think your description of your beliefs, values, and attitudes do a good job of describing your cultural worldview? Does it reflect the things that are most important to you? Does it capture how you tend to view the world? What was it like to compare your current cultural worldview with the cultural worldview of your family? Was your current cultural worldview mostly consistent with the cultural worldview of your family of origin, or were there quite a few differences?

MOTIVATIONAL PROCESSES

In addition to growing in self-awareness about our cultural identities and worldview, it can be helpful to get in tune with our motivations about how we engage with culture in our professional and personal lives. We believe that cultural self-awareness at its core is a motivational process, not an outcome. Conceptually, understanding cultural self-awareness as a process raises considerations of what is activated while contemplating the self or self–other interactions. We hope that by encouraging you to begin the process of exploring your cultural identities and worldview, you will develop a natural tendency to be interested and curious about your cultural experiences, as well as the cultural experiences of others. Accordingly, we hope that the process of developing cultural self-awareness will be a lifelong endeavor. This motivational process should continue to develop with each new person we are fortunate enough to meet and develop a relationship with. At the same time, there may be some experiences in which you get protective, defensive, guarded, or prideful in your reactions. These reactions are a normal part of the process, and we encourage you to sit with them and fully explore and make meaning of them. Ultimately, we hope that by engaging in this process you will develop new motivations to be multiculturally oriented.

In this next exercise, we invite you to consider some of your motivations for engaging in cultural work and exploration. Motivation refers to the factors that activate, direct, and sustain behavior toward particular goals (Nevid, 2013). Motivation gets at why you do something. Motivation asks questions about the needs or wants that drive what you do.

To begin, think about your current degree of motivation regarding cultural exploration and engaging with others who are different from you. You cannot really “see” your motivation per se, but you can infer your level of motivation by observing your behavior in certain areas. For example, how much personal work have you done to understand your cultural identities and worldview? Do you generally hang out with people who are similar to you, or do you push yourself to engage with and understand people who are different? Take a look at your family and friends. Who are your friends on social media? Do they reflect a range of cultural identities? What about the kinds of books, documentaries, and movies you watch? Are you curious to learn about people who are different from you, or do you stay away because of your discomfort? What about the news channels you watch and listen to? If you are liberal, have you watched and listened to more conservative news outlets? If you are conservative, have you watched and listened to more liberal news outlets?

Next, think about your motivations for the current cultural work and exploration you are doing now. Why are you reading this book? Is it required reading for a course you have to take? Are you intrinsically interested in the subject matter? Do you want to improve your ability to work with culturally diverse clients? Maybe your motivation comes from a different source. Think about the needs and wants that underlie the cultural work and exploration you are doing now. What professional and personal needs and wants fuel your motivation?

As you engage in this work, be aware of your motivations. Sometimes our motivations are not truly respectful of others’ cultural identities. For instance, it can be useful to engage with others who have different cultural identities. However, it is important to understand why you are doing this and how others feel about your motivations. For instance, going to a Black Republican’s meeting can provide new insights for some individuals who hold different political and/or racial identities. At the same time, if not welcomed, trying to enter a new group for your own enlightenment can be tokenizing and selfish.

RELATIONAL EXPERIENCES

In addition to understanding our cultural identities, worldview, and motivations, the third important part of cultural self-awareness is to understand how you experience your cultural identities in relationship to others and within society. Our cultural identities do not exist in a vacuum; rather, they are partially defined by shared rituals and histories. To honor the past and have an active relationship with the traditions that define us can be a vital source of enrichment. There is also value in connecting with others through cultural dialogues. At times these dialogues can affirm our cultural self, and at other times they can push us to think differently. They can also highlight the limits of our knowledge and push us to be more mindful about the lived experiences of other individuals.

Case Example: Mark and Jamie

Consider the following consultation case example between Mark, a 31-year-old White, heterosexual, cisgender male therapist, and Jamie, a 37-year-old biracial (Cuban and White), gay, cisgender male therapist. They discuss Mark’s work with Brian, a 20-year-old, White, gay, cisgender man. The following dialogue is from a consultation meeting following Mark’s eighth session with Brian.

Mark:  I’d like to get your thoughts on something that has been bothering me a little bit with one of my clients, if that’s OK.

Jamie:  Sure, what’s on your mind?

Mark:  Well, overall, I’ve been pretty happy with our work together. I think we have a strong connection, and he has been doing some good work. But he keeps saying he wants to work on his struggles with romantic relationships, but when I try to ask him about that topic, we kind of get off track.

Jamie:  Hmm, so what tends to happen exactly?

Mark:  My sense is that Brian feels like dating will never work for him. He has some very rigid views, in my opinion, about what he has to look like or be like in order to date. It’s almost like he thinks that to date in the gay community here, you have to look like a model or professional athlete. He doesn’t see himself that way, so he kind of gives up on the whole thing.

Jamie:  Do you think there’s any truth to what he is saying?

Mark:  Well, to be honest, I guess I don’t know that much about what it’s like to date in the gay community. But I guess my thought was that it’s probably on a continuum, like most things. I’m sure there are people who are looking for people who look like models, but I’m sure there are people who are OK with normal-looking people.

Jamie:  My guess is that you are probably right that there’s some variability there. But it sounds like Brian’s experience has been one of struggle trying to date. Your hypothesis is that it has something to do with rigid ways of thinking, which is possible. But I wonder if it might be helpful to remain open to Brian’s experience and honor that as you continue to explore this issue with him.

What is your reaction to the dialogue between Jamie and Mark? What did you think of Mark’s perspective on his client? In what ways was Mark culturally humble? In what ways was Mark not culturally humble? How do you think Mark’s cultural identities influenced his perspective? If you were consulting with Mark on this client, how could you encourage him to more fully explore the relationship between his cultural identity and his client’s cultural identity to best serve his client?

Relationship With Power and Privilege

There is another type of relationship we would like you to consider: your relationship with systems of power, privilege, and equity. It may be harder to think about a relationship with systems of power, for example. Yet, being aware of these systems and working to promote justice in the face of bias are at the heart of the multicultural orientation framework. For example, how do you feel about the power (or lack thereof) afforded you based on the gender with which you identify? What other cultural identities do you hold that influence the power you may (or may not) have through your gender identity? How do you use (intentionally or not) your power (or lack thereof) in social interactions? What would do you do to support others who are in a position of less power?

A good example that has received a lot of recent attention in the news relates to bathroom accessibility for transgender individuals (Seelman, 2014). Nontransgender individuals likely do not think about which bathroom to use or how safe they feel in the bathroom. For transgender individuals, this is a much different experience (with state laws prohibiting use). What role do we have in this discussion on a national level? If we do nothing, what does that say about our relationship with power and privilege?

In this next exercise, you will continue your reflection about the relationship or intersection between your cultural identities and power and privilege. For some, the various parts of cultural identity afford a certain amount of power and privilege. For others, this may not be the case. Some aspects of your cultural identity may grant you quite a lot of power and privilege, whereas other aspects of your cultural identity may not grant you much power and privilege at all. For other aspects of our cultural identity, you may even experience prejudice, discrimination, and oppression.

In Figure 2.2, there is one large oval at the top of the page that is labeled “Power.” Near the bottom of the page, there are six rectangles. Pick six aspects of your cultural identity—perhaps use the six identities you wrote down in your sociocultural identity wheel—and write down these identities in the rectangles—one identity in each box. Then spend some time thinking and reflecting about each cultural identity. Does this particular identity afford you a high, medium, or low amount of power and privilege? Then make a mark on the “power line” that connects the box to the large power oval at the top of the page. If the identity affords you a large amount of power and privilege, make a mark near the top of the line, close to the power oval. If the identity affords you a low amount of power and privilege, make a mark near the bottom of the line, far away from the power oval. If the identity affords you a medium amount of power and privilege, make a mark near the middle of the line.

Power lines (Jesse’s example). The boxes at the bottom of the figure represent six aspects of Jesse’s cultural identity. The dots represent Jesse’s relationship with power and privilege for each of the cultural identities. A dot near the top of the line indicates that the cultural identity provides Jesse with a large amount of power and privilege; a dot near the bottom of the line indicates that the cultural identity provides Jesse with a low amount of power and privilege. SES = socioeconomic status.

After you have finished marking your power lines for each aspect of your cultural identity, take some time and think and reflect on the connections between your cultural identity and your experiences of power, privilege, and oppression in our society. Did anything new come up for you while completing this exercise? Did any feelings (e.g., sad, angry, scared, happy, excited) come up for you as you reflected on these connections and your experiences with power, privilege, and oppression? Can you identify an experience in which you were more aware of your power and privilege (or lack thereof)? Have there been times when you have been an ally to someone who has less power and privilege? Overall, how do you feel about your relationship with the power systems in society?

Part of the reason we are encouraging you to think about and consider the deeper meanings and connections associated with your cultural identities is that research has shown that more simplistic considerations of culture and cultural identities may not be helpful in promoting positive outcomes with culturally diverse clients (Cabral & Smith, 2011). For example, early research in this field focused on whether it was helpful to match therapists and clients on their racial or ethnic identity (S. Sue, Fujino, Hu, Takeuchi, & Zane, 1991). The idea was that culture was important, so perhaps having a therapist who shared one’s cultural identity would lead to a stronger working alliance and more effective therapy outcomes. In general, the research findings did not provide strong support for the matching hypothesis to promote therapy outcomes (see Cabral & Smith, 2011).

In contrast, there is a growing set of studies that have found engaging clients with cultural humility can be beneficial to the process and outcome of psychotherapy (e.g., Davis et al., 2016; Hook et al., 2013; Hook, Farrell, et al., 2016; Owen, Jordan, et al., 2014; Owen, Tao, et al., 2016). Specifically, in engaging with clients from different cultural backgrounds, cultural humility (including having an awareness of the limitations of one’s cultural worldview and ability to understand another person’s cultural background and experience) has been linked to being able to develop a stronger working alliance with diverse clients (Davis et al., 2016; Hook et al., 2013), achieving higher rates of improvement (Hook et al., 2013; Owen, Jordan, et al., 2014), and being able to repair relationships with clients following microaggressions in counseling (Davis et al., 2016; Hook, Farrell, et al., 2016). Importantly, these studies approached the study of clients’ cultural identities by allowing clients to self-identify their intersecting and salient cultural identities.

These differences in research findings have shifted the way we tend to think about self-awareness of cultural identities in therapy. Instead of focusing on superficially noticing differences (e.g., I’m Black, you’re Asian—what do you think about that?) or trying to maximize similarities (e.g., We’re both gay, so we should be able to understand each other), we encourage you to develop a deep understanding of how your cultural identities relate to or intersect with your experiences in the world, such as power, privilege, and oppression. We take these relationships into the therapy room, where we then interact with our clients who bring a similar set of relationships or intersections between their cultural identities and experiences of power, privilege, and oppression. Developing an awareness of these cultural considerations is key to cultural humility and effective therapy.

Case Example: Jasmine and Lucy

Consider the following supervision example between Jasmine, a 35-year-old African American, heterosexual, cisgender female therapist, and Lucy, a 44-year-old Asian American, heterosexual, cisgender female supervisor. They discuss Jasmine’s most recent session with Darla, a 28-year-old African American, heterosexual cisgender female client. The following is the dialogue between them as they watched the tape from the most recent session. As you read, think about the intersection of cultural identities between the supervisor, therapist, and client, particularly as it relates to experiences of privilege and oppression.

Lucy:  What jumps out at you the most as you watch this session?

Jasmine:  Well, she definitely seems engaged, which is good. And she’s sharing something that I know is really important to her—her struggles with her dating relationships. But, I don’t know—I mean, sometimes when we talk, I’m just not sure where we’re going—you know what I mean?

Lucy:  Like you don’t necessarily have a clear direction?

Jasmine:  Yeah, maybe. I do feel like we have a good connection, but sometimes it feels like we’re just chatting about things. It seems more informal than with my other clients.

Lucy:  Yeah, I got that sense too. When I was watching, what popped into my mind was that it seemed like you were hanging out with one of your girlfriends. I think it’s definitely more than that, but that thought did pop into my mind. Any thoughts on why you might have this dynamic with this client and not your other clients?

Jasmine:  Well, I think I definitely feel like I understand what she’s going through. We both know what it’s like to be discriminated against and not treated well. When she’s sharing some of her stories, I just want so badly for things to be different for her.

Lucy:  It sounds like when you hear some of her struggles with discrimination and racism, you’re connecting with some of your own experiences around that. And what I’m hearing is that you feel a lot of empathy for her, and you want things to be different for her. Maybe like you want things to be different for yourself?

Jasmine:  Ha ha, now we’re really getting into it! Yeah, I think that’s accurate. It’s not easy being a Black woman, trying to be a professional, trying to navigate a workplace that can be less than ideal. So I think I’m wanting certain things for myself, and to a certain extent, I have made a place for myself. She’s a few years behind me, maybe, so I’m wanting her to have those same things too. And maybe I’m trying to protect her in a way, from experiencing some of the same things I did.

Lucy:  And how do you connect those wants and needs that you have with what we’re watching on the tape?

Jasmine:  Well, I think because we connect on some of the same experiences around being Black, the stuff we have to go through—there’s a really close connection. So I think that’s evident. But I also think that sometimes I hold back from maybe challenging her as much? Like this session, I probably could have called her out more for how she just let Dave [her boyfriend] pretty much take advantage of her, but instead it turned into more like a gab session.

What did you think of this exchange between Jasmine and her supervisor? What cultural identities were most salient for Jasmine in her relationship with her client? What cultural identities might Jasmine and her supervisor have missed? How did Jasmine’s experiences with power, privilege, and oppression come up in the supervision session? How did Jasmine’s experiences with power, privilege, and oppression affect her work with Darla? If you were Jasmine’s supervisor, what additional questions might you have asked to help her in her work with Darla?

Experiences of Privilege and Oppression

As you continue to explore the relationships between your cultural identities and experiences of power, privilege, and oppression, it can be helpful to reflect on some of your personal experiences in a deeper way. In the power lines exercise, you spent some time connecting each of your cultural identities with the degree of power and privilege it affords you in society. In what follows, we invite you to consider some of your personal experiences of power, privilege, and oppression in more depth.

On the basis of the intersection of your various cultural identities, it is likely that you experience some privilege and power in certain areas of your life. In this next exercise, consider and reflect on an experience of privilege. (Again, we define privilege as an identity in which belonging to a group or community affords you certain unearned benefits based on the power of that group to influence social institutions and social norms.) Think about an area of your life in which you believe you have received an advantage or benefit based on one part of your cultural identity or a cultural group you belong to. If you belong to one or more historically marginalized groups, you may find it difficult to identify a part of your cultural identity that is associated with privilege. If this is your experience, we encourage you to push yourself a bit and consider other aspects of your identities that might reflect an aspect of privilege, even if they are not salient to you. For example, perhaps you identify as cisgender or able bodied. Perhaps you have educational or socioeconomic privilege.

What comes to mind? Spend some time reflecting and journaling about the experience. Describe what happened. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. When you became aware of the benefit or advantage you received, how did you feel about it? What did your family or other communities teach you to do with your awareness of privilege? Did your experience of privilege motivate you to do anything? Does it motivate you to do anything now? How do you feel toward others who do not experience the privilege in the same way you do?

In addition to experiencing privilege, you may have had experiences of prejudice, discrimination, or oppression based on one or more of the cultural identities with which you identify. For the next part of this exercise, consider and reflect on an experience of oppression. Think about an area of your life in which you believe you have experienced prejudice or discrimination based on one part of your cultural identity or a cultural group to which you belong. If you cannot think of a time when you personally experienced prejudice, discrimination, or oppression, think about a situation in which you saw someone else experiencing prejudice, discrimination, or oppression.

What comes to mind? Spend some time journaling about the experience. Describe what happened. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. When you became aware of the prejudice or discrimination, how did you feel about it? Did your experience of oppression motivate you to do anything? Does it motivate you to do anything now? Do you wish someone would have stepped in or intervened on your behalf? If so, how would you have liked them to intervene? How do you feel toward others who do not experience oppression in the same way you do?

META- AND EPISTEMIC COGNITIONS

The fourth and final aspect of cultural self-awareness is to engage meta- and epistemic cognitions. Metaprocessing involves the ability to reflect on what is happening in the moment (see King & Kitchener, 1994; Owen & Lindley, 2010). Specifically, Owen and Lindley (2010) noted that

Metacognition reflects four abilities: (a) Self: Self-monitoring personal thoughts in therapy generally reflect a heavy focus on the self. . . . (b) Self-other: Self-other monitoring describes the ability to observe the impact of the self in relation to clients (e.g., “When I made that comment my client started to cry”); (c) Self-other-time: Self-other-time monitoring reflects the ability to have perspective of one’s thoughts in relations to clients over time (e.g., “My relationship with the client has gone through some ups and downs over the course of therapy” or “I felt very close to this client at the beginning of the session but now I feel a barrier between us”); and (d) Self-other-time-settings: Self-other time-settings monitoring simply adds the perspective of monitoring one’s abilities and thoughts from setting to setting (e.g., practicum settings, clients, supervisors). (pp. 131–132)

This framework applies well for building cultural self-awareness because therapists need to be able to see their actions in a variety of interactions, across individuals, time, and settings. Accordingly, therapists can engage in critical inquiry about their ability to culturally connect with others across sessions with the same client, across clients, across settings, as well as within the various structures provided (e.g., supervisors, consult teams). This meta-process also involves several contexts that can be rich sources of learning.

Epistemic cognitions reflect how you think about cultural learning. For example, do you turn to authorities for a better understanding of your cultural identities? Do you turn to psychological theory? Do you believe there are clear-cut answers to questions that may have multiple competing answers (e.g., abortion, health care, immigration)? What is the best source of information to answer value-based questions? How quickly do you feel we should be able to gain cultural self-awareness? All of these questions reflect how we come to think about the nature of cultural knowledge. By reflecting on this level of thinking, we can gain a larger appreciation for the various ways of approaching and understanding cultural differences.

In the next exercise, we hope to help you start to think about your cultural identity across different settings and relationships by gaining insight into how someone else views you and your cultural identities. Sometimes there can be a difference in how we view ourselves culturally and how other people experience us. For example, during his growing up years, Josh did not think too much about his racial identity (White), but once he got to graduate school, he realized that other people viewed his racial identity as having a deeper meaning. Likewise, sometimes it can be helpful to get a sense of how others view us. In this exercise, you will have the opportunity to get a sense of how another person experiences you and your cultural identities.

Pick someone who is willing to work with you on this exercise. If you are working through this book as part of a class or practicum team, pick someone from your group. Or you could ask a friend or colleague to help you. Tell your discussion partner that the purpose of this exercise is to gain more insight about how our cultural identities play out in various relationships or settings by exploring how others experience us culturally, especially in how our cultural identities are related to our experiences of power, privilege, and oppression.

We offer one word of caution when completing this exercise. It is possible that asking someone how they view your cultural identity could lead to painful feelings, especially if the cultural identity is linked to experiences of prejudice or discrimination. Thus, it is important to complete this exercise in a safe context, ideally in a relationship in which some level of openness and trust has been established.

To begin, ask your discussion partner to spend some time describing what they notices about you and your cultural identities. What cultural identities do they notice about you? These identities could be things they pick up from your physical appearance. Or they could be things you have shared with them over the course of your relationship. Or they could even be things that they have assumed to be true about you. Ask your discussion partner to say whatever cultural identities come to mind.

Then, ask your discussion partner to consider which of your cultural identities might be associated with experiences of power and privilege and which of your cultural identities might be associated with experiences of prejudice, discrimination, and oppression. Again, your discussion partner may not know these things about you, and that is OK. People make snap assumptions all the time without having the necessary information to make an informed judgment. Ask your discussion partner just to say what they think, even if it is not correct.

After you have completed this interaction, take some time to think, reflect, and journal about your experience. How did the discussion go? Was it comfortable or awkward? Did anything surprising or unexpected come up as a result of your interaction? Compare the cultural identities that you wrote down in the sociocultural identity wheel exercise with the cultural identities that your discussion partner noticed. Which cultural identities were similar? Which cultural identities were different? If there were differences, what do you make of these differences? Also, compare how you rated your experiences of power, privilege, and oppression associated with your cultural identities and how your discussion partner assumed you might experience power, privilege, and oppression on the basis of the cultural identities they identified. What was similar? What was different? If there were differences, what do you make of the differences? If you have time, complete this exercise with three different people and notice what is similar and different across relationships. If there were differences in how people experienced you, what do you make of these differences?

Conclusion

Taken together, we encourage you to think about your cultural identities and worldview and explore how these identities intersect with systems of power, privilege, and oppression. These relationships between your cultural identities and broader systems will be essential as you begin to think about how your cultural identities, as well as your client’s cultural identities, intersect to affect the processes of therapy. Throughout, we have asked you to maintain an attitude of cultural humility, acknowledging the limitations in your cultural worldview, as well as the limitations we all have to understanding the cultural worldviews of those we come into contact with.

Chapter 3 Working on cultural Biases, Power, and Privilege

It is not our differences that divide us.

It is our inability to recognize, accept, and celebrate those differences.

—Audre Lorde

Josh: When I began to explore my cultural identity in more depth, including the connections or intersections between my identity and experience of power and privilege, the next step for me was to think about how my cultural identities and experiences would affect my work with clients. What personal work could I do to more effectively connect with my cultural identities and those of my clients?

The first step for me was to become more comfortable with cultural differences. When I was growing up, I mostly surrounded myself with friends who were similar to me and believed the same things I did. These relationships and situations felt comfortable, but they did not stretch me and help me to become more effective in engaging with people who were different from me. When I realized this, I tried to be more proactive about developing a wide range of relationships—not just with people who were like me.

I remember developing a close friendship with a woman at my church who was African American. There were some key differences in our beliefs, values, attitudes, and how we saw the world (e.g., religion, family, racial, and economic issues). For example, I remember one night we got into a heated argument about the benefits and drawbacks of corporal punishment. The relationship was not comfortable or easy—the early stages of the friendship were filled with conflict and disagreement. But we both stuck with it. Even though we disagreed, we prioritized the relationship and were committed to trying to understand each other’s perspective. Looking back, I learned that coming into contact with difference—and not running from it when it gets uncomfortable—is an important skill that is only developed through intentionality, practice, and experience.

A second step was to explore some specific areas in which I recognized I held some cultural biases. One example for me was exploring my attitudes toward people who identified as lesbian, gay, or bisexual (LGB). Growing up, I was taught in church that being gay was a sin. I did not have any friends or family members growing up who identified as LGB, so I did not have to question that belief. When I got more involved in my graduate work in counseling psychology, I started to develop stronger values related to social justice, and I struggled to figure out how these new values fit in with the beliefs I had about sexual orientation when I was growing up.

My work in this area involved a combination of reading, research, and personal experience. About halfway through graduate school, one of my best friends from church came out as gay, and I walked with him through a difficult time of trying to integrate his religious and sexual identities. Recognizing I was engaged in this discussion whether I liked it or not, I started reading as much as I could on the intersection of religion and sexual orientation, trying to figure out what I believed. I realized that there was a wide spectrum of how Christians viewed sexual orientation, and many of these viewpoints, although they were different from what I had learned growing up, had both research evidence and scriptural support for their views. This was not a quick or easy process, but eventually, I came to a position that honored my faith commitment as well as the values I was developing that prioritized social justice and equality for sexual minority individuals.

The third step for me was exploring what I thought I should do with the privilege and power I held based on my cultural identities. This was one of the most challenging journeys for me because I did not know what to do. I knew I had experienced a series of unearned advantages based on my cultural identities (e.g., White, male, heterosexual, upper-middle class), but I did not know what to do with that. I focused on trying to understand what it meant to be an ally. What would it look like to support and work for justice in my personal and professional life?

Cultural Humility and Cultural Biases, Power, and Privilege

In the previous chapter, you spent quite a bit of time exploring your cultural background and worldview. You identified the cultural identities, beliefs, and values that are important to you, you explored your motivations for engaging in cultural exploration, and you reflected on how your cultural identities are linked with experiences of power, privilege, and oppression.

In this chapter, we begin to explore how your unique set of cultural identities and particular cultural worldview set the stage for your work with clients. Your cultural identities and worldview can make connecting with certain types of clients easier or more difficult. Also, you might find it easier or more difficult to address certain cultural topics in therapy according to your cultural identities and worldview. In this chapter, we try to come up with a plan for some personal work you can do to set the stage for effective work with clients, focusing on the intersections of your and your clients’ cultural identities and worldviews. Throughout this chapter, the focus is on cultural humility. What do you cherish about your cultural identity and worldview? What are the potential biases, or areas with which you are less familiar because of your cultural heritage? How can you use your strengths while also recognizing your areas for growth, with the goal of engaging in effective work with your clients who hold a variety of cultural identities and worldviews? We organize our discussion into three areas: (a) increasing comfort with cultural differences, (b) working to identify and reduce cultural biases, and (c) using your power and privilege to work toward justice.

Cultural humility is about getting in touch with your strengths and growth edges, as well as being open to cultural differences, with the ultimate goal of becoming a more effective therapist for your clients, especially when cultural differences threaten the work that is being done in therapy. This chapter builds on the previous chapter and walks you through some personal work that you can do to cultivate your cultural humility and set the stage for effective work with your clients. Increasing comfort with cultural differences will help you be open to connecting with clients from different cultural backgrounds. Identifying and reducing your cultural biases will help you work on your growth edges regarding your work with culturally diverse clients. Using your privilege to work toward justice will help you use your strengths to help your clients who hold marginalized cultural identities.

INCREASING COMFORT WITH CULTURAL DIFFERENCES

To begin, we encourage you to think about engaging in a variety of activities that will increase your comfort with your own and other cultures. Often our natural tendency is to surround ourselves with individuals who look like us and have similar beliefs. There are a variety of reasons for this, but in general, being a part of a group provides consensual validation for what we think and believe, which increases our self-esteem and makes us feel better about ourselves (Pyszczynski, Greenberg, Solomon, Arndt, & Schimel, 2004). However, the more we insulate ourselves from others, the more difficult it will be to feel comfortable connecting with individuals who are different from us—including our clients. If we want to be effective in helping and coming alongside clients who hold a wide range of cultural identities and worldviews, we have to become comfortable with a wide range of cultural identities and worldviews. This is directly linked to one of the core pillars of developing a multicultural orientation: cultural comfort (Owen et al., 2017). So the first part of the personal work is to push yourself outside your comfort zone and engage with individuals, groups, and ideas that are different from your own.

Cultural Learning and Exploration

Part of becoming more culturally comfortable with other cultural identities and worldviews involves making it a priority to engage in cultural learning and exploration. In this exercise, we ask you to select a cultural group that you do not know much about and with whom you have had not much experience. To help select what to focus on, consider the following questions: Do you feel you have a tendency to make judgments about a particular cultural group or worldview? Do you feel any cultural group is superior or inferior to you? Do you disagree with any cultural group or worldviews?

Before you do anything, spend some time thinking, reflecting, and journaling about this aspect of culture. What do you know (or think that you know) about this culture? What do you not know about this culture? What are your personal experiences with this culture? What are you curious about? What questions do you have? These questions speak to the heart of cultural humility because we want you to identify when you are feeling less capable of developing a connection with others.

After you have spent some time reflecting on where you are at right now, do some research and find a documentary or book about this cultural group. As you watch, listen, or read, pay attention to any thoughts, feelings, or reactions that come up. To track your reactions, you may want to use the cultural comfort scale presented in Exhibit 1.3. Afterward, spend some time thinking, reflecting, and journaling about your experience. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. What did you learn about the cultural group? How has your understanding or perspective about this cultural group changed? Was anything that you saw or read surprising? Did you find that any of your previous thoughts about this group turned out to be inaccurate or untrue? What feelings came up for you as you watched the documentary or read the book (e.g., sad, angry, scared, happy, excited)? Did this experience motivate you to engage in any further learning and exploration about this cultural group?

Hopefully, this experience sparked your interest in learning about different cultural groups. We encourage you to make this cultural learning and exploration exercise a regular part of your continuing education and learning. For example, you might think about trying to watch one new documentary or read one new book about a different cultural group each month to continue your learning and growth in this area. You can continue to track your reactions with the cultural comfort scale to compare to your level of comfort across different cultural groups.

Case Example: Kate and Grace

As you engage in new cultural learning and exploration, it can be helpful to take risks and explore these issues in supervision. When the goal is to appear as competent as possible, we might be tempted to “fake it until we make it” and conceal areas in which we feel less culturally comfortable. In contrast, cultural humility leads us to accurately view and take responsibility for our limitations. The primary avenue for doing this in our field is supervision or consultation (Hook, Watkins, et al., 2016). We never function independently as therapists, but we always seek to acquire greater wisdom through seeking to balance and temper our perspectives with the perspectives of other professionals. This structure is intended to promote cultural humility systemically, but it only works if therapists are willing to take risks to let others see their work, including potential mistakes or problems.

Consider the following supervision example between Kate, a 34-year-old, White, heterosexual, cisgender, female therapist who is completing her internship at a university counseling center, and Grace, a 50-year-old, White, lesbian, cisgender, female supervisor. They discuss Kate’s initial session with Brad, a 20-year-old, White, heterosexual, transgender man. The following is the dialogue between them. As you read, consider the possibilities that Kate could pursue for cultural learning and exploration about the salient cultural identities for her client.

Grace:  Thanks for bringing up your session with this client. How did you feel like the initial session went?

Kate:  Well, I think OK. If I’m honest, I was a little nervous. I haven’t seen a transgender client before in therapy, so I was kind of scared that I would mess something up. I guess I’m hoping that didn’t come through to my client.

Grace:  So it sounds like this is new territory for you—something you haven’t had a lot of experience with, and you really wanted to help this client.

Kate:  Yeah, exactly. I’m really excited to work with him, and I feel a lot of empathy for individuals who identify as transgender and what they have to go through in our society. But yeah, I feel like a newbie, like I don’t really know what I’m doing.

Grace:  I think it’s pretty normal to feel some anxiety when you’re working with a client who identifies with a cultural identity you haven’t worked with before. So I want to affirm you—what you’re feeling is very normal. Did you notice your anxiety coming through in any way during your session?

Kate:  Well, nothing terrible happened, but I just felt like I wasn’t as comfortable as I normally am. Like, for example, on the intake form, he put down two names—one female and one male. I wasn’t sure what name I should use. I just asked him, which seemed to be OK, but I stumbled a bit on my words, so I wonder if he could tell I was nervous.

Grace:  Well, I think you did the right thing there by asking him. Sometimes the best thing we can do when we aren’t sure about something having to do with our client’s cultural identity is just to ask the question. I think our clients actually appreciate this—it shows that we are humble, curious, and open to explore this aspect of culture that is important to them.

Kate:  Well, thanks, that makes me feel better.

Grace:  I was curious how much you know about transgender issues. One thing that might help with becoming more comfortable is learning more about transgender individuals and the issues they face in society. Have you done much reading or exploring about that?

Kate:  Not a lot. I was thinking about that some after seeing the client. We touched on it a bit in my multicultural counseling course, but to be honest, I haven’t done a lot of exploration in this area.

Grace:  Got it. Well, since you are going to be working with this client, this might be a good opportunity to do some learning and exploration on this issue. Where do you think you can start to find information?

What did you think of this exchange between Kate and her supervisor? How do you think the supervisor handled Kate’s anxiety about her first session with Brad? How did cultural humility play into Kate’s first session with Brad and Grace’s interactions with Kate? If you were Kate’s supervisor, what additional questions might you have asked to help her in her work with Brad?

The Social Contact Hypothesis

The encouragement to increase your comfort with other cultures through learning and personal experience is based on the social contact hypothesis, which states that interpersonal contact with culturally different individuals can reduce prejudice and promote intergroup harmony under certain conditions (Utsey, Ponterotto, & Porter, 2008). In his book The Nature of Prejudice, Gordon Allport (1954) outlined several factors that were necessary for social contact to effectively reduce prejudice: (a) equal status between members of different groups, (b) common group goals, (c) emphasis on cooperation to attain group goals, and (d) support by those in a position of authority. In a review of studies that investigated the contact hypothesis, Pettigrew and Tropp (2006) found that across 525 studies, intergroup contact did work to reduce prejudice. Importantly, the effects were greater when all four of Allport’s conditions were met. The social contact hypothesis has been examined with several different cultural identity groups, including groups that vary by race and ethnicity, gender, age, disability or ability status, and sexual orientation.

In your work with clients who have different cultural identities, it might be helpful to think about how you could implement some of Allport’s (1954) guidelines into your work. For example, one of Allport’s factors is that the members of the different groups have equal status. In therapy, there is already a power differential between the therapist and client. How might you work to decrease that power differential? A second factor is an emphasis on cooperation to attain group goals. How could you work with your client to develop a common goal for therapy or emphasize cooperation toward that goal?

In this next exercise, you will practice having an in-depth cultural conversation with a friend or colleague. Sometimes it can feel awkward to ask questions and discuss a client’s cultural identities because we may not have these kinds of conversations often in our everyday lives. Discussions about cultural identities can feel deep and personal, so sometimes we avoid them unless we already have established a deep sense of intimacy. Cultural differences can also fuel division and conflict in our society (e.g., Haidt, 2012), so we might avoid engaging in cultural conversations because we are afraid of conflict. The best way to become more comfortable talking about cultural identities is to practice. As you talk through some of these questions and issues, the topics will become more natural for you, and you will, hopefully, be more comfortable engaging in these discussions with your clients.

Pick a friend or colleague who is willing to sit down for an hour or two and practice having a cultural conversation with you. If you are working through this book with a class or practicum team, it would be ideal to pair up with someone in your group. Find a place that is comfortable. Leading up to the conversation, spend some time thinking, reflecting, and journaling about your thoughts, feelings, and expectations about the conversation. Also, spend some time thinking about what kinds of questions you might want to ask your discussion partner. Prepare some questions you might want to ask, but be flexible: The conversation may lead you to ask questions that you had not planned. If you feel stuck, the following are some ideas for questions (depending on the cultural identities of you and your discussion partner, some questions may apply and some may not).

Ask questions that address your discussion partner’s cultural identities and worldview (Locke & Bailey, 2013):

What is your cultural heritage? What is the culture of your parents or primary caregivers? With what cultural group(s) do you identify?

Which of your cultural identities are most salient to your identity? Which of your cultural identities are less salient to your identity?

What is the cultural relevance of your name?

What beliefs, values, and attitudes do you hold that are important to you?

What beliefs, values, and attitudes do you hold that are consistent with the dominant culture? Which are inconsistent with the dominant culture?

How does your cultural group view therapy? Are there alternative methods for helping and working with mental health problems that are common in your culture?

How does your view of therapy relate to your cultural heritage?

Ask questions about experiences with various aspects of culture (Locke & Bailey, 2013):

Degree of acculturation: bicultural (comfortable in both the dominant culture and the culture of origin), traditional (more comfortable in the culture of origin), marginal (little connection with the both the dominant culture and the culture of origin), acculturated (more comfortable in the dominant culture).

Poverty: Examine factors such as housing, employment, unemployment, underemployment, educational opportunities, undereducation, and life expectancies.

History of oppression: Explore actual and vicarious oppression.

Language and the arts: bilingualism; cultural understanding of sight, sound, and movement; and nonverbal communication (e.g., tone of voice, rate of speech, pitch, volume, proxemics, smiling, greetings, farewells).

Racism and prejudice: Ask about experiences of individual, institutional, and cultural racism and prejudice.

Sociopolitical factors: Understand the culturally unique social factors that affect a culture.

Child-rearing practices: Examine the kinship network, gender roles, issues of respect, assertiveness of a culture, obligations of children to parents and parents to children, issues of competition.

Religious practices: belief system, belief in God, god, gods, supernatural others, the role of religion in the culture, how religion affects the relationships between individuals, groups, and nature.

Family structure: How does the culture organize itself in kinship patterns, who has authority, what is the impact of marriage outside the cultural group, what is the nature of the relationships among family members, how is lineage determined?

Values and attitudes: worldview and existential questions, time (oriented on the past, the present, or the future), human relations (are individual, collateral relationships, or lineal relationships most valued?), human activity (is the focus on doing, being, or becoming?), human nature (at birth, are people considered basically good, bad, neutral, or mixed?), supernatural (is the relationship with the supernatural one of control, subordination, or harmony?).

After finishing the conversation, spend some time thinking, reflecting, and journaling about what happened during the conversation. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. What thoughts, feelings, and reactions came up for you during the conversation? What parts of the conversation were easy or flowed naturally? What parts of the conversation were difficult or awkward? What was it like to ask questions about your discussion partner’s cultural identities? What was it like for your discussion partner to ask you questions about your cultural identities? What was it like to share about your cultural identities? Were some of your cultural identities easier or more difficult to share about? Following the conversation, how do you feel toward your discussion partner? Do you feel more or less connected to them? Would you like to continue the conversation and talk more about anything that came up? Did the conversation motivate you to talk more about culture and cultural identities in your other relationships?

WORKING TO IDENTIFY AND REDUCE CULTURAL BIASES

In addition to becoming more comfortable with different cultural groups, we believe that an important aspect of personal cultural work involves becoming aware of and reducing cultural biases you might hold. Cultural biases occur when you have an incorrect (e.g., overly positive or overly negative) view of a particular cultural group or issue (Pedersen, 1987). Often cultural biases take the form of stereotypes, which are cultural views that are fixed, oversimplified, and overgeneralized (Ashmore & Del Boca, 1981). Cultural biases can come from a variety of sources. One source involves the cultural and moral beliefs and values you learned in your family and local community (e.g., schools, sports teams, religious or spiritual communities). Often our cultural biases are “caught” more than “taught” within the various institutions of which we are a part. Perhaps your parents or primary caregivers held certain biases or prejudices. Even if they did not explicitly teach you to hold those biases or prejudices, you might have implicitly picked them up from being around your parents or primary caregivers, internalizing their underlying thoughts and attitudes as your own. Also, you may have had negative personal experiences with individuals or groups who hold certain cultural identities, which have influenced your expectations for future interactions.

Identify Cultural Biases

No one is perfect. We all have certain cultural biases that we hold toward various groups. In this next exercise, we ask you to work to identify some of your cultural biases. The purpose of this exercise is twofold. First, it is important to be aware of our biases, so that they do not operate unconsciously in the therapy room. For example, if you hold a negative bias toward a particular cultural group but are not aware of your bias, you may struggle to form a strong working alliance with a client from that cultural group but not understand why. Or you might lead clients in a direction they do not wish to go because you have a negative perception of their cultural worldview, which might affect their goals for therapy.

Also, awareness is often a helpful prerequisite for change. Ultimately, we would like you to develop and implement a plan to reduce your cultural biases, but it is difficult to address or work on issues of which you are not aware. So becoming aware of your cultural biases can be considered an important first step in your journey to reduce your cultural biases so you can be more effective in helping a wider range of clients.

In what follows, we lead you through a series of questions designed to identify cultural biases you might hold. The first set of questions involves powerful negative stories about cultural groups that were taught in your family when you were growing up. Your primary caregivers taught you a large amount of information during your formative years. Some of this teaching was explicit (i.e., it took the form of words and rules). Some was implicit (i.e., it was not spoken but was conveyed through their attitudes and behaviors). Part of this teaching involved how to navigate a diverse multicultural world. These cultural stories can be powerful determinants of your beliefs, values, and attitudes growing up, and they can set the stage for how you engage with people who are different from you.

Take some time and reflect on your childhood. Think about what your primary caregivers and other family members taught you about people from different cultural backgrounds. First, think about what kinds of things were taught explicitly. What did they say regarding people from different cultural backgrounds? What did they teach you about people from different racial or ethnic groups and nationalities? What did they teach you about gender and sexual orientation? What did they communicate about people who were rich versus poor or people who had a disability versus those who were able bodied? Pay particular attention to lessons that encouraged distance from and anxiety toward people who were different. Were any cultural groups framed as dangerous or less than dangerous? Did your primary caregivers share any powerful stories or experiences about people from different cultural backgrounds? What did these stories or experiences communicate?

After reflecting on the lessons that were taught explicitly, spend some time thinking about what your primary caregivers taught you implicitly about people from different cultural backgrounds. Did any members of your family make off-handed comments about people from different cultural backgrounds that framed these individuals in a negative light? How did your primary caregivers react when you became friends with or dated individuals from different cultural backgrounds? Also, think about the types of people with whom your family socialized. Did your parents and grandparents have friends who identified with a range of cultural identities? If so, how do you think this engagement with culturally different groups reflected their attitudes? If not, how do you think this lack of engagement with or avoidance of culturally different groups reflected their attitudes? One approach that may help you identify implicit cultural messages from your family of origin is to spend some time looking through old family photographs or looking through photographs you have posted on social media. As you look through and reflect on these photographs, what memories come up for you about how your family thought about people from different cultural backgrounds? What cultural beliefs or biases did they hold, even if they may not have been explicitly stated?

The second set of questions involves negative past experiences with individuals from various cultural backgrounds. Write down any negative experiences that come to mind about interacting with people from various cultural groups. For example, maybe a person from a particular cultural group made fun of you or beat you up when you were growing up. Maybe you tried to fit in with a certain cultural group but were rejected, and you felt left out. Try to think back on any negative cultural experiences you may have had growing up, and write whatever comes to mind.

After you have finished thinking about the negative cultural experiences, take some time to think, reflect, and journal about this experience. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. Do you notice any themes about the negative cultural experiences you have had? With what cultural groups have you had multiple negative experiences? Were any of the negative cultural experiences especially traumatic? How do you think these negative cultural experiences influence your attitudes toward those cultural groups today? How do you think these negative cultural experiences influence your abilities to make connections with individuals from these cultural groups?

The third set of questions involves identifying whether you might have any personal cultural struggles with your cultural identities or cultural beliefs, values, and attitudes. Countertransference occurs when our reaction toward a client is in some way based on our history or experiences (Racker, 1982). Cultural countertransference occurs when we react to an aspect of a client’s cultural identity because of our personal cultural issues or struggles (Foster, 1998).

Reflect on your cultural identities. Do any of these cultural identities stand out as areas in which you struggled to integrate that aspect of culture into your overall cultural identity? For example, perhaps you experienced racism and discrimination growing up, and these experiences led you to develop negative internalized messages about your cultural identity (i.e., internalized racism; Jones, 2000). Maybe it was difficult for you to feel good about yourself and your racial or ethnic group. Or perhaps you have a disability and have struggled to accept that aspect of your identity. To the extent that you have struggled to integrate various parts of your cultural background into your overall identity, you may struggle to connect with and help clients who share that cultural identity.

Also, consider whether you have experienced changes in any of your cultural identities over time. What do these changes mean? Was the change your decision, or was it forced on you? If it was your decision, why did you decide to change that part of how you identify culturally? Do you have any negative reactions toward the aspect of culture that you used to identify with but is no longer important to you? For example, maybe you were religious as a child or adolescent, but you moved away from religion or changed your religious views as you got older. Perhaps you grew up in a poor neighborhood, but now you identify as upper-middle class. To the extent that you experience negative reactions toward the cultural identity that shifted, you may struggle to connect with and help clients who share that cultural identity.

Spend some time thinking, reflecting, and journaling about what came up for you during this exercise. Summarize the information you gleaned from thinking about the cultural stories that were taught by your family, your negative cultural experiences, and any struggles you have with aspects of your cultural identity. What cultural biases come up for you? What feelings come up for you as you consider your cultural biases? Are you motivated to do anything about the cultural biases that you identified?

Positive Cultural Biases

Although most of the time we think about cultural biases as involving negative views of a particular cultural identity or group, it would be remiss not to consider the possibility of having positive biases toward certain cultural identities or groups. In the course of your work with clients, you may discover that you hold some positive cultural biases that involve fixed, overgeneralized beliefs. Although we might not view positive cultural biases as problematic (at least compared with negative cultural biases), they still can have a detrimental effect on the therapy process. For example, positive cultural biases might result in patronization (i.e., offering inappropriate or unneeded help), overidentification (i.e., denying or minimizing bias because of assumed similarity), idealization (i.e., overestimating desirable qualities and underestimating undesirable qualities), or the failure to challenge and accept less than optimal behaviors because of one’s cultural group (Constantine, 2007).

Work through the same writing prompts that you did when you identified your cultural biases, but think about how your cultural stories, cultural experiences, and personal cultural identities might be related to positive cultural biases. For example, did your parents or caregivers share any powerful positive cultural stories about particular cultural identities or groups? Have you had any positive cultural experiences with particular cultural groups? What aspects of your cultural identity might make it difficult to maintain a neutral stance if you had a client who shared that identity? What positive cultural biases do you have to be aware of in your work with clients?

Case Example: Edward and Bill

Ideally, we assume that the primary avenue for working through cultural biases is in supervision, but it may be that the evaluative role of supervision makes it complicated to gauge whether it is safe to truly disclose your cultural biases. In some cases, it may feel more prudent to conceal one’s areas of cultural bias and instead express thoughts, attitudes, and emotions that align with what one imagines the supervisor wants to see as signs of competence. Of course, this perspective makes it difficult to use supervision effectively to make meaningful progress toward reducing your cultural biases and improving your work addressing clients’ cultural identities in therapy. This is one of the practical reasons why we believe it is important to shift the focus from cultural competence to cultural humility. It is important to provide a safe environment that welcomes therapists to explore and work on the cultural biases that are a normal part of growth and development.

Consider the following supervision example between Edward, a 24-year-old White, heterosexual, cisgender, male therapist, and Bill, a 49-year-old, White, heterosexual, cisgender, male supervisor. They discuss Edward’s most recent session with Mushira, a 33-year-old, Pakistani, heterosexual, cisgender, female client. The following is the dialogue between them as they discussed the most recent session. As you read, think about any possible cultural biases that either the therapist or supervisor may have toward Mushira.

Edward:  I’d like to talk about my session with Mushira if we can.

Bill:  Sure, remind me again what you are working on.

Edward:  Well, her presenting problem was symptoms of depression, and she also has been discussing some problems she is having with her relationship with her husband.

Bill:  OK, yes, I remember now. What came up for you this past session?

Edward:  I felt like we got to a point where we were a bit stuck. We were talking about her depressive symptoms, and I was encouraging her to think about the things in her life that brought her joy, satisfaction, and meaning to see if I could get a sense of what kinds of things she might do that would bring her out of her depression.

Bill:  OK, that makes sense. What did she say?

Edward:  OK, so that’s where I felt like we got stuck. She talked about things like wanting to go back to school, and write, and travel, but she was talking about them in kind of a wistful way, like they were impossible. And then I asked her about that, and she talked about what her husband wanted for her and for their family, which struck me as really controlling.

Bill:  So the husband didn’t want her to go back to school?

Edward:  No, he’s very traditional. And she is too, but I think there is a part of her that wants something different. And her faith is part of it too—it seems like the faith kind of promotes that traditional sort of relationship between her and her husband.

Bill:  So how did you react when she started talking about that traditional worldview that was associated with her faith?

Edward:  Well, I tried to be respectful of her faith, but I also felt like I needed to point out the discrepancy because I think that is related to her symptoms of depression. She has these structures in place, like her husband and her religion, that prescribe one way of life for her. But it seems like her true self is wanting something different.

Bill:  So how did she respond when you made that comment?

Edward:  Well, she kind of nodded, like she agreed with the interpretation. But she also got kind of quiet afterwards, which made me think that maybe it wasn’t the best intervention.

Bill:  I see. It does sound like you have some strong feelings about her situation. What comes up for you when you think of this client, especially related to her cultural and religious background? How do you think your own perspective influences what you want for this client?

Edward:  That’s a good question, and I’ve been trying to think about that. There are definitely some differences there. I was raised in an environment that was very egalitarian. Both my parents worked, and there weren’t a lot of differences in the gender roles in my home. So I grew up thinking of that as kind of normal. I’m also not very religious myself. I don’t think I have anything against religion per se—I think there are some good things about it for some people—but I get really angry when I see religion causing a lot of problems for folks. Like in the case of my client—if I’m honest, I think her Muslim faith is part of what’s making her depressed. I know it’s important to respect her faith, but I don’t really know how to do that and also acknowledge that there might be some parts of her religion that are harmful for her.

Bill:  Got it. It sounds like it will be good for you to continue to check in with yourself about how you are feeling about the intersection between your client’s religious background and your own.

Edward:  Yes, definitely. I will keep thinking about that.

Bill:  Any thoughts on how Mushira’s specific racial/ethnic and religious identities might influence her presenting concerns, beyond the fact that she and her husband ascribe to traditional gender roles? For example, I’m wondering if being a part of two communities, Pakistani and Muslim, that have sometimes been placed under suspicion in this country—especially after 9/11—might influence the priority your client places on community and family.

What did you think of the exchange between Edward and his supervisor? What cultural identities were most salient in this interaction? What cultural identities were most salient for the client? What cultural biases did Edward hold toward his client? What cultural biases was Edward aware of? What cultural biases did it seem Edward had less awareness about? If you were Edward’s supervisor, what additional questions might you have asked to help him in his work with Mushira?

Reducing Cultural Biases

Once you become aware of your cultural biases, the next step is to work toward reducing your biases. We encourage you to develop a plan for identifying and reducing the cultural biases you hold with a combination of intellectual, emotional, and relational interventions. Cultural biases have a variety of possible components. For example, at the intellectual level, we might have the tendency to engage cultural differences with cognitive distortions such as stereotyping, overgeneralization, and confirmation bias (Hilton & Von Hippel, 1996). At the emotional level, we might have the tendency to engage cultural differences with anger and fear (Devine, 1989). At the relational level, we might have the tendency to avoid those who are different from us (Heider, 1958). Because cultural biases have a variety of components, it can be helpful to develop a plan that is multifaceted and activates multiple parts of you. We recommend a plan that involves intellectual learning, emotional experiences, and deep relationships.

In the last exercise, you did some work to identify some of your cultural biases. This is a great first step. In this next exercise, we invite you to do some work to begin to address and hopefully reduce some of the cultural biases you hold. We walk you through a plan that involves engagement from three different angles: intellectual, emotional, and relational.

The first activity for reducing your cultural biases involves intellectual engagement. Often cultural biases, prejudice, and stereotypes are not based on factual information. Instead, the root of cultural biases is usually emotional experiences, and then people gather facts to support their position. In this activity, we invite you to do some research into the actual lived experiences of the cultural group toward which you have a bias. For example, if you have a cultural bias that African American men are dangerous, you might do some research into the criminal justice system and explore how police practices and judicial processes differ according to race. Likewise, if you have a cultural bias that lesbian, gay, bisexual, and transgender (LGBT) individuals should not marry or adopt children, you might read books or articles on LGBT romantic relationships or psychological outcomes for children who have LGBT parents. Knowledge from diverse ideological perspectives has a way of nuancing one’s own perspective.

Pick one of the cultural biases you identified from the previous exercises. Do some research about this cultural group. Read some journal articles and research studies about the bias you hold. After you engage in this research, think, reflect, and journal about what you read. What new information did you obtain about your cultural bias? What about the new information was consistent or inconsistent with your previous cultural views or biases? Do you feel any shift or change in your cultural bias after conducting this research? If so, describe the shift or change you experienced.

The second activity for reducing your cultural biases involves emotional engagement. As discussed earlier, cultural biases are often grounded in emotional reactions and are based on values, rather than being rigorously grounded in facts and figures. In this next exercise, we ask you to do some work to get out your deepest thoughts and feelings about the cultural group toward which you have a bias. This exercise was originally developed by Jamie Pennebaker and colleagues, who have found that expressive writing offers a wide range of benefits (Smyth & Pennebaker, 2008).

Take out a sheet of paper. For the next 20 minutes, write about your deepest thoughts and emotions about the cultural group toward which you have a bias. You might also write about how it feels to hold a cultural bias toward this group. Try not to censor yourself—write whatever comes into your mind. In your writing, let go and explore your cultural bias and how it has affected you. You might relate your cultural bias to your childhood, your relationship with your parents or primary caregivers, your current relationships, or even your career. Try to keep writing for the entire 20 minutes. If you run out of things to write about, it is OK to repeat some of the things you have already written down. Repeat this 20-minute writing process two more times this week.

The third activity for reducing your cultural biases involves relational engagement. Relationships can be one of the most powerful avenues for reducing cultural bias. Often our cultural biases are maintained because we remain distant from the cultural group toward which we hold negative thoughts and feelings. Because of our distance, we do not give ourselves the opportunity for our stereotypes to be disconfirmed, and we also do not begin to accrue positive experiences to counteract our negative biases. Developing positive relationships with individuals who belong to the group that we hold a cultural bias about is a powerful antidote to our bias.

Spend some time thinking, reflecting, and journaling about the cultural group toward which you hold a bias. Do you have any personal relationships or acquaintances who identify with that cultural identity? If so, think about one step you could take to develop or deepen that relationship. Then take that step. If not, think about one step you could take to give yourself the opportunity to meet or develop a relationship with someone from that cultural identity. Then take that step. Before developing these relationships or engaging with others, we encourage you to prepare by doing more work to understand that cultural group. This could involve reading books or articles, watching documentaries, and conducting research online. It is important to put yourself in their shoes as much as possible before interpersonal engagement.

After you have completed the intellectual, emotional, and relational activities, spend some time thinking, reflecting, and journaling about your experiences. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. During the activities, did you notice any change or softening of your cultural bias? If so, what changed? Which activity (e.g., intellectual, emotional, relational) do you think helped soften or change your cultural bias the most? What are some next steps you could take to continue your work on this cultural bias? Did these activities help motivate you to continue to work on this cultural bias? Did these activities help motivate you to continue to work on your other cultural biases?

USE POWER AND PRIVILEGE TO WORK TOWARD JUSTICE

In addition to becoming more comfortable with different cultures and working to identify and reduce your cultural biases, we encourage you to begin to think and reflect on what you might hope to do with your experiences of power and privilege to work toward justice (Constantine, Hage, Kindaichi, & Bryant, 2007; Vera & Speight, 2003). In the last chapter, you spent quite a bit of time exploring how your set of cultural identities was related to your experiences of power, privilege, and oppression. Your clients will likewise bring a set of cultural identities and experiences of power, privilege, and oppression to the therapy room, and there will be an intersection between your cultural identities and those of your clients. How can you use your cultural experiences of power and privilege to connect with and work effectively with your clients?

Exploring What to Do With Power and Privilege

In this exercise, we invite you to consider what you can do with your power and privilege. To begin, pick an aspect of your cultural identity that is associated with a high degree of power and privilege. As we noted in the previous chapter, if you belong to one or more historically marginalized groups, you might have difficulty identifying a part of your cultural identity that is associated with privilege. If this is your experience, we encourage you to push yourself a bit and consider other aspects of your identities that might reflect an aspect of privilege, even if they are not salient to you. For example, perhaps you identify as cisgender or able-bodied. Perhaps you have educational or socioeconomic privilege.

First, spend some time thinking, reflecting, and journaling about what life is like normally with your experience of power and privilege. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. Where do you notice the power and privilege show up in your everyday life? What thoughts or feelings come up for you as you think about your experience of power and privilege? Are you motivated to do anything with your position of power and privilege?

One of the most common questions people ask when they become aware of their power and privilege is what they should do with it. Next, we would like you to brainstorm some possible ideas for what you could do with the power and privilege that you identified. Try not to censor yourself—just write whatever comes to mind. What came up for you during this brainstorming exercise? Was it difficult to think about what you could do with your power and privilege? Did you think of any ideas that might work for you? Do any of your ideas have their roots within one of your other cultural identities? For example, certain religions teach that those with greater resources will be held accountable for helping the poor and marginalized. The field of psychology has stressed the importance of integrating advocacy into one’s professional identity in recent years.

When people begin to become aware of their power and privilege, they usually respond in one of two ways. At one end of the spectrum, some people do nothing. They may frame their response as “not picking sides” or “not wanting to be political,” but when it comes to power and privilege, doing nothing is the same as maintaining the status quo. They might also engage in various defensive processes, such as shifting the focus to their experiences of marginalization in another area or reinforcing ideologies that minimize or deny privilege. What would it look like for you to maintain the status quo in the area of privilege you identified? What feelings come up for you as you think about doing nothing and maintaining the status quo?

At the other end of the spectrum, people might become allies and advocate for social justice for a group or community to increase the power of others who are currently experiencing a low amount of privilege. What would it look like for you to become an ally and advocate for social justice in the area you identified? What feelings come up for you as you think about becoming an ally?

After you have spent some time thinking through your possible responses to power and privilege, reflect on your experience. Which response reflects what you are doing currently? Which response reflects what you would like to do? Which response is consistent with cultural humility? Did this exercise motivate you to do anything different regarding your experience of power and privilege?

Becoming an Ally

As we noted in the previous exercise, often when people begin to recognize their experiences of power and privilege, they want to do something, make a change, and become an ally for justice. However, they may not know what it looks like to become an ally. Or they might look around and begin to recognize injustice everywhere and become overwhelmed, not knowing where to begin or how much is enough. In what follows, we offer some beginning steps to help get you started in the process of becoming an ally for justice. What does becoming an ally or advocate look like in your daily life?

The purpose of this exercise is to develop daily practices of an ally. This involves using your areas of power to influence the power of marginalized individuals and groups. This influence can occur at a local level (e.g., your neighborhood, workplace, or school), or it can occur at a state, national, or global level. The goal is to work toward leveling the playing field to make society more just.

Using your power and influence to be an ally for justice is incredibly important and valuable. Often individuals who have marginalized identities have been fighting for justice for a long time and sometimes see little or no change because of the unwillingness of those in power to change the status quo. This can be a draining and disheartening experience, and those with marginalized identities can benefit from the support of allies in their lives. In what follows, we offer some thoughts and suggestions for how to get involved and effect change, but it is important to note that an important foundation for becoming an ally is to offer one’s presence and support. Sometimes people who claim to be allies are quiet or silent in the face of adversity or tragedy, perhaps because they are unsure of what to say or do. This silence, however, can be deafening and heartbreaking to those who are hurting. Often individuals from marginalized groups are not looking for anything profound, just an honest acknowledgment of their pain and struggle. If you are unsure of what to do, start with offering your presence; listen and acknowledge the pain that others are experiencing. This culturally humble stance provides the foundation for the daily practices of being an ally.

After setting the foundation of presence, the next step to becoming an ally is to clarify your values related to justice in a particular area. For example, you might notice that your workplace or campus building is not accessible for individuals who have a physical disability. Or you might recognize that your waiting area and bathrooms are not welcoming for transgender individuals. Pick one of your cultural identities in which you experience power and privilege. Clarify your sense of how maintaining the status quo falls short of true justice. What would it be like to be a person who identifies with a group of lower power and privilege? See whether you can imagine what it would be like to live a day in the life of this person. What are some things that would give this person more power? What has to be done to make life fairer for this person? If you do not know, you might ask a person from that cultural group what it would look like to have a community that is more fair and just.

Once you have completed that step, our main recommendation for action is to build relationships and connect with others who are already working in this area. When you are starting out, it is easier (and more effective) to join others who have already been thinking and working on these issues. For example, is there a community group or advocacy group in your city that meets to discuss working toward justice on a particular issue? If so, consider connecting with them and see where you can help. How can you apply your energy and influence to join what is already going on? How can you help or be of service? What is the connection between their needs and your gifts and talents?

When you join others who are already thinking and working on these issues, be sure to engage with humility. Do not pretend to be the expert about what has to be done; instead, spend most of your time listening to the individuals who are most affected by the issue at hand. It is OK to be active and offer ideas or suggestions, but avoid speaking over those with marginalized identities. Also, there may be some groups or community settings that are designed only to include individuals who have a particular cultural identity in order to increase safety. When in doubt, it is OK to ask whether it is appropriate for you to attend a particular gathering.

After you have made these initial connections and begun to get a sense of where you can help, the final step is to dive in and get started. Our main recommendation when getting started is to commit to being a regular volunteer for a set period (e.g., 6 months). To grow in your identity as an ally for justice, it is important to take action consistently over time. This may involve setting boundaries on your time at first, so you do not get overwhelmed and burnt out. What would it look like for you to engage in social justice efforts in a way that could be consistently maintained over time?

After you have taken action in this area, take some time to think, reflect, and journal about your experiences. If you like to express yourself through art, draw a picture or create a work of art that reflects your experience. What thoughts, feelings, and reactions came up for you as you engaged in this process? Did it motivate you to live your life differently in relation to your privilege? How does it feel to work as an ally for justice? What would it look like for “ally” to become a core part of your identity?

Case Example: Vicky and David

In addition to becoming an ally or advocate for justice in our everyday lives, it is important to think about how to be an ally and advocate for our clients during the process of therapy. Historically, many therapeutic traditions focused solely on clients’ intrapsychic and interpersonal issues, ignoring how the broader society and cultural context influenced their mental health problems. This is an unfortunate omission. Clients are deeply affected by the sociopolitical context in which they live. At times, effective therapy may involve helping to empower clients to advocate for themselves, as well as assisting clients to fight against the injustice they may face outside the therapy room.

Consider the following consultation example between Vicky, a 29-year-old, White, heterosexual, cisgender, female therapist, and David, a 39-year-old, African American, heterosexual, cisgender, male therapist. They discuss Vicky’s most recent session with Shauna, a 31-year-old, African American, heterosexual, cisgender, female client. In the following dialogue, they discuss the most recent session. As you read, think about how Vicky might use her experiences of power and privilege to be an ally and advocate for her client.

Vicky:  I was hoping I could get your thoughts on a client that I’m working with currently.

David:  Sure, I’m happy to listen and help. What have you been thinking about?

Vicky:  We’ve been working together for about 10 weeks now, and I think we have made some progress, but sometimes it seems like her focus is on other people and situations—almost like she wants to spend the session complaining. I guess I’m struggling with it because I believe that we don’t really have the power to change anyone but ourselves. So sometimes it feels like she wants to complain about things that are outside of her control. When she does that, it doesn’t feel like we’re making too much progress.

David:  Hmm . . . What kinds of things does she complain about?

Vicky:  Well, a lot of it has to do with financial problems. Her job doesn’t pay that much, and she has to take care of her son pretty much by herself. She also gets frustrated with how her boss treats her at work. She needs the job, but it does seem like a pretty bad situation.

David:  So, it sounds like you are experiencing a lot of the pressures she must face on a daily basis in session. It sounds like you try to redirect the conversation. How does she react when you try to do so?

Vicky:  It doesn’t always work. She seems to be really focused on the external stuff.

David:  Do you think there’s any truth in what she says?

Vicky:  What do you mean?

David:  Well, I guess I’m wondering about her experiences at work and in everyday life. Does she ever talk about her experiences as an African American woman? Does she ever feel like the victim of racism or discrimination?

Vicky:  A little bit. I think especially at her job—her boss is a White man, so she wonders if part of their relationship struggles has to do with her racial identity.

David:  How is it for you to engage with her around those discussions, since you identify as White?

Vicky:  It’s a little uncomfortable. I don’t share her experiences around that, obviously. I mean, we connect on the gender thing, but my experience as a White woman is very different than her experience as an African American woman.

David:  Yeah, so there’s definitely a power differential there, both in the room with you being the professional and also with your racial differences. I wonder if there is a way to reduce that power differential or empower her in some way.

Vicky:  What do you mean?

David:  It sounds like a lot of her struggles have to do with how she engages within a sociopolitical system where she is commonly oppressed, discriminated against, and disenfranchised. And there’s a power differential in those situations too, like her relationship with her boss. I wonder if there’s a way that you could help her experience more power in her relationship with you and if that might help her experience more power in her everyday life as well.

What did you think of this exchange between Vicky and David? How did issues related to power and privilege come into play in this discussion? How did issues related to power and privilege come into play in the relationship between Vicky and Shauna? How could Vicki act as an ally for justice in her relationship with Shauna? How could a culturally humble approach from Vicki enable her to better address these concerns with Shauna? If you were consulting with Vicky on this case, what additional questions might you have asked to help her in her work with Shauna?

Conclusion

In this chapter, we focused on becoming more comfortable with different cultures and worldviews, identifying and reducing cultural biases, and using your relationship with power and privilege to become an ally for justice.

As therapists, we are not perfect. We each hold cultural biases that hold us back from doing our best work with our clients. It is important to recognize this and put together a plan to work on it. Also, it can be helpful to think about how we might use our experiences of privilege and power for good, by becoming allies for equality and justice.