Preface xix
Section 1 The Multiple Dimensions of Multicultural Counseling and Therapy
Part 1 The Affective Conceptual and Practice Dimensions of Multicultural Counseling and Therapy
1 Understanding Resistance to Multicultural Training: Obstacles to Developing Cultural Competence 5
Expections for the Course 6
Reflection and Discussion Questions 6
Reactions to the Course 7
By The Numbers 8
Emotional Self-Revelations and Fears: Majority Group Members 8
Emotional Invalidation Versus Affirmation: Marginalized Group Members 10
A Word of Caution 12
Reflection and Discussion Questions 13
Recognizing and Understanding Resistance to Multicultural Training 13
Cognitive Resistance-Denial 14
Emotional Resistance 14
Did You Know? 15
Behavioral Resistance 17
Cultural Competence and Emotions 18
Implications for Clinical Practice 19
Summary 20
Glossary Terms 20
References 20
2 Multicultural Counseling and Therapy (MCT) 23
Race and Culture Matter 23
Reflection and Discussion Questions 25
Culture-Universal (ETIC) Versus Culture-Specific (EMIC) Formulations 25
Cultural Concepts of Distress 25
Acknowledging Group Differences 26
Being Aware of Collectivistic Cultures 26
Attuning to Cultural and Clinical Clues 26
Balancing the Culture-Specific and Culture-Universal Orientations 27
The Nature of Multicultural Counseling Competence 27
The Harm of Cultural Insensitivity 27
Good Counseling is Culturally Responsive Counseling 28
By The Numbers 28
Understanding The Three Dimensions of Identity 28
Individual Level: "All Individuals Are in Some Respects Like No Other Individuals" 29
Group Level: "All Individuals Are in Some Respects Like Some Other Individuals" 30
Universal Level: "All Individuals Are in Some Respects Like All Other Individuals" 30
Reflection and Discussion Questions 31
Individual and Universal Biases in Psychology and Mental Health 31
The Impact of Group Identities on Counseling and Psychotherapy 32
What is Multicultural Counseling and Therapy? 32
What is Cultural Competence? 33
Box 2.1: Multicultural Counseling Competencies 34
Did You Know? 35
Social Justice and Cultural Competence 36
Reflection and Discussion Questions 36
Implications for Clinical Practice 37
Summary 37
Glossary Terms 38
References 38
3 Cultural Perspectives and Barriers: The Individual Interplay of Cultural Experiences 41
Reflection and Discussion Questions 42
Characteristics of Conventional Counseling 42
Culture-Bound Values 44
Focus on the Individual 44
Verbal/Emotional/Behavioral Expressiveness 45
Insight 45
Self-Disclosure Openness and Intimacy 46
Styles of Communication 47
Did You Know? 48
Scientific Empiricism 49
Distinctions Between Mental and Physical Functioning 50
Patterns of Cultural Assumptions and Multicultural Family Counseling/Therapy 50
People-Nature Dimension 51
Time Dimension 52
Relational Dimension 53
Activity Dimension 53
Nature of People Dimension 54
Language Barriers 55
Class-Bound Values and Perspectives 56
By The Numbers 56
The Damaging Impact of Poverty 56
Therapeutic Class Bias 57
Overgeneralizing and Stereotyping 58
Implications for Clinical Practice 58
Summary 59
Glossary Terms 60
References 60
Part 2 Sociopolitical and Social Justice Dimensions of Multicultural Counseling and Therapy
4 Microaggressions: Implications for Counseling and Psychotherapy 67
Reflection and Discussion Questions 67
Reflection and Discussion Questions 68
Contemporary Forms of Oppression: Racism Sexism & Heterosexism 70
The Evolution of the "ISMS": Microaggressions 71
Microassault 71
Microinsult 71
Microinvalidation 72
By The Numbers 72
Reflection and Discussion Questions 72
The Dynamics and Dilemmas of Microaggressions 75
Dilemma 1: The Clash of Sociodemographic Realities 75
Dilemma 2: The Invisibility of Unintentional Expressions of Bias 76
Dilemma 3: The Perceived Minimal Harm of Microaggressions 76
Dilemma 4: The Catch-22 of Responding to Microaggressions 77
Did You Know? 77
Therapeutic Implications 77
Microinterventions: The New Therapeutic Frontier 80
Implications for Clinical Practice 82
Summary 82
Glossary Terms 83
References 83
5 Sociohistorical Privilege and Oppression: Implications for Counseling and Psychotherapy 86
An Open Letter to Brothers and Sisters of Color 86
Reflection and Discussion Questions 87
Mental Health Practice and the Reproduction of Oppression 87
Connecting the Dots Between Mental Health Practice and Social Justice: An Overview 89
The Danger of a Single Story: Ethnocentric Monoculturalism 91
Did You Know? 91
Understanding Ethnocentric Monoculturalism 92
Historical Manifestations of Ethnocentric Monoculturalism 94
Ethnocentric Monoculturalism Sociohistorical Oppression and Mental Health 95
Ethnocentric Monoculturalism and Foundational Psychotherapeutic Theory 96
Definitions of Mental Health 96
Connections to the Counseling and Mental Health Literature 98
Pathology and Persons of Color 98
By The Numbers 100
Ethnocentric Monoculturalism and Mental Health Practice: Psychotherapy as a Racial-Cultural Microcosm 100
Reflection and Discussion Questions 101
MCT as a Social Justice Approach to Mental Health Practice 102
Social Justice Advocacy and Cultural Humility 104
Implications for Clinical Practice 105
Summary 106
Glossary Terms 106
References 107
PART 3 Racial Ethnic Cultural (REC) Attitudes in Multicultural Counseling and Therapy
6 Racial Ethnic Cultural (REC) Identity Attitudes in People of Color: Counseling Implications 113
Case Study: Alejandro: Afro-Puerto 113
Racial Awakening 114
Just American to Puerto Rican/Afro-Latino 114
Denial Breakdown 114
The Internal Struggle for Identity 114
Locus of the Problem 115
REC Identity Attitude Models 115
Did You Know? 115
William E. Cross' Nigrescence Model: Foundational Theory 115
A General Model of Rec Identity 117
Conformity Status 118
Dissonance Status 119
Resistance and Immersion Status 120
Introspection Status 121
Integrative Awareness Status 123
Counseling Implications of the R/CID Model 123
Conformity Status 124
Dissonance Status 125
By The Numbers 125
Resistance and Immersion Status 125
Introspection Status 126
Integrative Awareness Status 126
Value of a General Rec Identity Framework 126
Reflection and Discussion Questions 127
Implications for Clinical Practice 127
Summary 128
Glossary Terms 128
References 128
7 White Racial Consciousness: Implications for Counseling and Psychotherapy 130
Whiteness and Multicultural Counseling 130
Reflection and Discussion Questions 131
Steps Toward an Understanding of Whiteness and White Identity 132
Did You Know 133
Models of White Racial Identity Development 135
The Hardiman White Racial Identity Development Model 135
The Helms White Racial Identity Development Model 136
A Descriptive Model of White Identity: Seven Positions 137
By The Numbers 139
An Antiracist White Identity 141
White Antiracist Identifications 142
Principles of Prejudice Reduction 143
Principle 1: Learn About People of Color From Sources Within the Group 143
Principle 2: Learn From the Examples of Healthy and Strong People of the Culture 144
Principle 3: Learn From Experiential Reality 144
Principle 4: Learn From Constant Vigilance of Your Biases and Fears 144
Principle 5: Learn From Being Committed to Personal Action Against Racism 144
Reflection and Discussion Questions 145
Implications for Clinical Practice 145
Summary 146
Glossary Terms 146
References 146
8 Multicultural Counseling Competence and Cultural Humility for People of Color Counselors and Therapists 149
Interracial And Interethnic Biases 150
Impact On Interracial Counseling Relationships 150
Racial Stereotypes Held by People of Color 150
The Who-Is-More-Oppressed Game 151
Interracial and Interethnic Counseling 151
By The Numbers 152
Reflection and Discussion Questions 152
The Politics of Interracial and Interethnic Bias and Discrimination 153
The Political Relationships Between Groups of Color 154
African Americans and Asian Americans 154
Asian Americans and Latinx Americans 155
Latinx Americans and African Americans 155
American Indians and Black Latinx and Asian Americans 156
Reflection and Discussion Questions 156
Within Group Differences Among Racial/Ethnic Groups 157
Cultural Values 157
Communication Styles 157
Issues Regarding Stage of Ethnic Identity 158
Did You Know? 158
Counselors of Color and Dyadic Combinations 158
Challenges Associated with Counselor of Color and White Client Dyads 159
Situation 1: Challenging the Competency of Counselors of Color 159
Situation 2: Needing to Prove Competence 159
Situation 3: Transferring Racial Animosity toward White Clients 160
Situation 4: Viewing the Counselor of Color as a Super Minority Counselor 160
Situation 5: Dealing with Client Expressions of Racism 161
Challenges Associated with Counselor of Color and Client of Color Dyads 162
Situation 1: Overidentifying with the Client 162
Situation 2: Encountering Clashes in Cultural Values 162
Situation 3: Experiencing Clashes in Communication and Counseling Styles 163
Situation 4: Receiving and Expressing Racial Animosity 164
Situation 5: Dealing with the Racial Identity Status of Counselors and Clients 164
Reflection and Discussion Questions 165
Implications for Clinical Practice 165
Summary 166
Glossary Terms 166
References 166
PART 4 Western and Non-Western Perspectives in Counseling and Therapy
9 Multicultural Evidence-Based Practice 171
Reflection and Discussion Questions 172
Empirically-Supported Therapies (ESTs) 172
Reflection and Discussion Questions 175
Empirically Supported Relationships (ESRs) 175
Did You Know? 175
The Therapeutic Alliance 176
Emotional or Interpersonal Bond 178
Empathy 178
Positive Regard Respect Warmth and Genuineness 179
Therapist Self-Disclosure 180
Management of Countertransference 180
Goal Consensus 180
Reflection and Discussion Questions 181
Evidence-Based Practice and Diversity Issues in Counseling 181
By The Numbers 182
Reflection and Discussion Questions 183
Implications for Clinical Practice 184
Summary 184
Glossary Terms 185
References 185
10 Indigenous and Cultural Methods of Healing Among People of Color: Implications for Multicultural Counseling and Therapy (MCT) 188
Worldviews and Cultural Concepts of Distress 189
The Shaman and Traditional Healer as Therapist: Commonalities 190
Case Study: The Nguyen Family 191
A Case of Child Abuse? 191
Did You Know? 193
The Principles of Indigenous Healing 193
Holistic Outlook Interconnectedness and Harmony 194
Belief in Metaphysical Levels of Existence 194
Acceptance of Spirituality in Life and the Cosmos 195
By The Numbers 197
Reflection and Discussion Questions 198
Radical Healing Among People of Color 198
Examples of Healing Practices Among People of Color 199
Implications for Clinical Practice 200
Summary 200
Glossary Terms 201
References 201
PART 5 Assessment Diagnosis and Treatment Issues in Multicultural Counseling and Therapy
11 Culturally Competent Assessment 207
Therapist Variables Affecting Diagnosis 208
Did You Know? 209
Cultural Competence and Preventing Diagnostic Errors 210
Cultural Self-Awareness 210
Cultural Knowledge 211
Culturally Responsive or Multicultural Skills 211
Contextual and Collaborative Assessment 212
Case Study: Erica 213
Principles of Collaborative Conceptualization 213
Infusing Cultural Relevance into Standard Clinical Assessments 214
Cultural Formulation Interview 214
Culturally Sensitive Intake Interview 215
By The Numbers 216
Implications for Clinical Practice 218
Summary 218
Glossary Terms 219
References 219
Section 2 Multicultural Counseling and Specific Populations
PART 6 Counseling and Therapy with Racial/Ethnic Group Populations
12 Multicultural Counseling Contexts: African Americans 225
Sociohistorical Context 226
Strengths and Resiliences 227
Family and Community 227
Religion and Spirituality 227
Resourcefulness and Resilience 228
Positive Racial-Ethnic Identity or Racial Pride 228
Potential Challenges 228
Racism and Discrimination 228
Racial Socialization: When What and How to Discuss Racism 229
Internalized Racism 229
Challenges for Black Women 230
Counseling and Applied Considerations 230
Case Studies: Johnny: When Extra Familial Help Causes Disruption 231
A Clinical Checklist 233
Summary 234
Glossary Terms 235
References 235
13 Multicultural Counseling Contexts: American Indians/Native Americans and Alaskan Natives 239
Sociohistorical Context 240
Strengths and Resliencies 241
Tribal Community Structure and Relationships 242
Family Structure and Relationships 242
Cultural and Spiritual Values 242
Specific Challenges 243
Case Study: Mary 244
Educational Concerns 244
Acculturation Conflicts 245
Alcohol and Substance Abuse 246
Domestic Violence 246
Suicide 247
Implications for Clinical Practice 248
Summary 248
Glossary Terms 249
References 249
14 Multicultural Counseling Contexts: Asian Americans and Pacific Islanders 252
Characteristics and Strengths 253
Asian Americans: A Success Story? 253
Case Study: Katherine 255
Collectivistic Orientation 255
Hierarchical Relationships 256
Parenting Styles 256
Emotionality 257
Holistic View on Mind and Body 257
Academic and Occupational Goal Orientation 258
Cultural Strengths 258
Specific Challenges 259
Racial-Ethnic-Cultural Identity and Conflict 259
Acculturation Conflicts 259
Expectations Regarding Counseling 260
Racism and Discrimination 261
Implications for Clinical Practice 262
Summary 263
Glossary Terms 263
References 263
15 Multicultural Counseling Contexts: Latinx Communities 266
Cultural Strengths 267
Family and Interpersonal Relationships 267
Religion and Spirituality 269
Additional Cultural Strengths 270
Specific Challenges 270
Xenophobia Discrimination and Ethno-Racial Trauma 270
Racism in the Schools 271
Stigma Associated with Mental Illness 272
Acculturation and Acculturative Stress 272
Gender Role Conflicts 274
Implications for Clinical Practice 275
Summary 276
Glossary Terms 277
References 277
16 Multicultural Counseling Contexts: Multiracial Americans 280
Characteristics and Strengths 281
Multiracial Population in the United States 281
The "One Drop of Blood" Rule 282
Strengths 283
Specific Challenges 284
Racial/Ethnic Ambiguity and Multiracial Identity Socialization: "What Are You?" 284
Intermarriage Stereotypes and Myths 285
Discrimination Racism and Microaggressions 285
Racial Identity Invalidation 286
A Multiracial Bill of Rights 288
Implications for Clinical Practice 288
Summary 290
Glossary Terms 290
References 290
17 Multicultural Counseling Contexts: Arab Americans 293
Demographic Characteristics 294
Sociohistorical Context 294
Potential Challenges 295
Strengths and Resiliencies 296
Counseling and Applied Considerations 296
A Clinical Checklist 297
Summary 298
Glossary Terms 298
References 298
PART 7 Counseling and Therapy with Other Multicultural Populations
18 Multicultural Counseling Contexts: Marginalized Religious Communities 303
Counseling Contexts: Jewish Americans 303
Characteristics and Strengths 304
Spiritual and Religious Values. 304
Ethnic Identity 305
Gender-Related Considerations 305
Cultural Strengths 305
Potential Challenges 306
Prejudice and Discrimination 306
Counseling and Applied Considerations 307
Counseling Contexts: Muslim Americans 308
Characteristics and Strengths 308
Spiritual and Religious Values 309
Gender-Related Considerations 309
Cultural Strengths 309
Potential Challenges 310
Counseling and Applied Considerations 311
Marginalized Religious Communities: A Clinical Checklist 311
Summary 312
Glossary Terms 312
References 313
19 Counseling Contexts: Immigrants and Refugees 316
Demographic Characteristics 317
Sociohistorical Context 317
Cultural Dimensions 318
Potential Challenges 318
Gender Issues and Domestic Violence 319
Refugee Issues and Coping with Loss 319
Strengths and Resiliencies 320
Counseling and Applied Considerations 320
Barriers to Seeking Treatment 321
Linguistic and Communication Issues 322
Counseling Refugees 323
Effects of Past Persecution Torture or Trauma 323
A Clinical Checklist 324
Summary 326
Glossary Terms 326
References 326
20 Multicultural Counseling Contexts: LGBTQ Communities 328
Characteristics and Strengths 329
SOGI Awareness 329
LGBTQ Youth 331
LGBTQ Couples and Families 332
Strengths 333
Specific Challenges 333
Coming Out 333
Prejudice Discrimination and Misconceptions 334
Aging 336
Implications for Clinical Practice 337
Summary 339
Glossary Terms 339
References 339
21 Multicultural Counseling Contexts: Older Adults 343
Demographic Characteristics 343
Sociohistorical Context 344
Potential Challenges 345
Mental Deterioration 345
Elder Abuse 345
Strengths and Resiliencies 346
Sexuality 346
Leadership 346
Counseling and Applied Considerations 347
Physical Limitations 347
Cognitive Limitations 347
Elder Abuse 348
Substance Abuse 348
Social Isolation Depression and Suicide 349
The Benefits of Counseling and Therapy for Older Adults 350
A Clinical Checklist 350
Summary 351
Glossary Terms 352
References 352
22 Multicultural Counseling Contexts: Women 355
Demographic Characteristics 356
Sociohistorical Context 356
Potential Challenges 357
Bias and Schooling 358
Organizational and Workplace Bias 358
Harassment and Violence 359
Sexual Objectification and Its Sequellae 359
Social Pressure Toward Unrealistic Body Ideals 360
Caretaker Overload 360
Incidence of Depression 360
Strengths and Resiliencies 360
Counseling and Applied Considerations 361
Gender Bias and Conventional Practices 361
Body Image 362
Addressing Harassment and Violence 362
Educational and Vocational Issues 362
Depression 363
A Clinical Checklist 364
Summary 365
Glossary Terms 365
References 365
23 Multicultural Counseling Contexts: Individuals Living in Poverty 369
Demographic Characteristics 369
Sociohistorical Context 370
Potential Challenges 371
Social Exclusion 371
Educational Inequities 372
Disparities in the Judicial System 372
Classism and the Minimum Wage 373
Health Care Inequities 373
Strengths and Resiliencies 373
Counseling and Applied Considerations 374
A Clinical Checklist 375
Summary 377
Glossary Terms 377
References 377
24 Multicultural Counseling Contexts: Individuals with Disabilities 380
Demographic Characteristics 380
Sociohistorical Context 381
Models of Disability 381
Potential Challenges 382
Prejudice and Discrimination 382
Strengths and Resiliencies 383
Counseling and Applied Considerations 384
Sexuality and Reproduction 385
Spirituality and Religiosity 385
Family Counseling 385
Environmental and Social Justice Issues 386
Counselors' Attitudes When Clients have Disabilities 387
A Clinical Checklist 388
Summary 390
Glossary Terms 390
References 390
Index I-1
