Cultural competence is, without a doubt, required of clinicians who provide therapy to culturally diverse clients. The acquisition of both knowledge and skills, but moreover, the ability to deal with powerful emotional reactivity and unconscious biases associated with race are incumbent (Sue, 2010). When counseling clients who are culturally different, the competent therapist must be aware of the possibility of being uncertain regarding therapeutic discussions of sensitive topics. In order for a clinician to be culturally competent and provide effective therapeutic assistance, one must be knowledgeable of cultural needs, to include language, religion, food, racial identity, and customs (Allain, 2007).
Throughout your professional career a continual effort should be placed on seeking total cultural competence, especially concerning the cultures that will primarily comprise your clientele. As I have not exactly nor assuredly settled into my foreseen client-base, for comparative purposes I will refer to Fairfield County, South Carolina in this composition, as this is the location of many of my relatives. The demographics of this area (as interpreted from the United States Census Bureau) possess a different skew than the United States, as well as the state of South Carolina, in that African Americans at 59% of the population are the majority race, followed by Whites at 39%. American Indian, Alaska Native, Asian and multiracial individuals comprise less than 2% collectively, while an estimated 1.5% of these individuals are of Hispanic origin.
In addition, the percentage of poverty in Fairfield County is 24%, whereas the United States average is near 15%. While Fairfield County is diverse, it is so in its own right. The dynamics of this population create cultural norms that are not necessarily reflected by the perception of American culture at large. A therapist working in this area must understand the intricacies of the cultures, to include cultural beliefs and values based on race, poverty and the availability of resources.
Taking a look at Fairfield County’s majority. When any helping professional provides counseling to an individual of African American culture, there are several factors one must keep in the forefront in order to reach successful therapeutic treatment. The primary factor is that of cultural competence, as it would be when counseling a member of any culture. However, the therapist’s cultural competence is vital to the treatment of African Americans as it is quite common for an individual from this cultural background to be misdiagnosed, and subsequently incorrectly counseled. This is often the result of the impact their culture’s history, racism, and oppression have had on their individual personality, as well as to their entire group as a national minority. Although the clinician, no matter their race, will be unable to dispel any opinions the African American individual may harbor regarding discrimination, it remains their responsibility to aid the individual in attaining cultural acceptance—within their cultural group, as well as all others—and ultimately establishing their autonomy.
Therapists should abide by an obligation to aid the client in constructing the framework leading to development of the client’s autonomy. This is especially the case when counseling individuals in the African American culture, where it is vital for them to become self-aware and fully autonomous as this quality will allow them the capability of personally conquering the effects of discriminatory encounters and the spectrum of microagressions they are guaranteed to continue facing. In order for a clinician to aid in the process of developing racial identity in persons of color, the therapist must guide them in establishing a passive acceptance of the self as inferior, and then facilitate the client to overcome internal racism and develop a self-affirming identity (Constantine, 2005).
When the minority is the majority, such as the case of African Americans in Fairfield County, the therapeutic approach and methodology to counsel these individuals cannot be based solely on their role as a United States minority group, but also their role as a regional majority. The primary adjustment to therapeutic intervention regarding this cultural group involves understanding the effects of, and relationship between, the national and regional cultures through the eyes of the individual.
The national majority. For a clinician to successfully treat members of the Caucasian American culture, they must again utilize their cultural competence when formulating the framework to develop the well-being of these individuals. In regard to the general population of the United States, Caucasians are the majority culture group. And in this light, the therapist’s objective would be to guide them in becoming more culturally aware, as well as to increase their own self-awareness. This would allow them to gain understanding in their typecast role as “oppressor,” acknowledging their unearned assets that constitute White privilege, and adjust their viewpoint with the goal of eliminating any harbored microagressions.
The therapist should assist them in understanding that the source of their conscious or unconscious racism is a result of their culture’s attempt to earn societal prestige through the control and dominance of cultures dissimilar to theirs. And, according to the Psychoanalytic approach, racism surfaces to serve as a defense mechanism of the ego and superego out of one’s fear of loneliness (Utsey, 2002). For Whites, as well as other groups, the attribution of cultural differences to minorities is a hidden expression of racial prejudice (Vala, 2009).
The majority as a minority. Often referred to as the majority, the Caucasian cultural group in many smaller communities represents the minority. In these instances, therapeutic approaches need to adjust due to the fact that many of these individuals have difficulty dealing with the sense that they are seeking racial acceptance from the majority culture, while they are experiencing discrimination. In many instances, one’s racial attitude is an attempt to manage an underlying anxiety associated with one’s intolerance of the dissimilar (Utsey, 2002). A therapist in this situation may find members of the White culture to be anxiety-ridden due to their inability to control the majority culture—which will in fact be a national minority group. Many of the areas where these inverted racial demographics exist are more likely to be impoverished. With a poverty level higher than the United States national average, some of the predominant issues for Whites in these areas are the difficulties stemming from their socioeconomic status. In these situations, it is likely that a great deal of Caucasian individuals are dealing with the denial of their Whiteness because of their shared socioeconomic status with African Americans and other national minority groups.
White privilege in these regions relies predominantly on one’s financial success; and because many Whites have not attained any substantial financial successes, it is more difficult to identify White privilege (Sue, 2010). Also, when Whites are the minority group, they are likely to be self-conscious of appearing racist; for example, it is highly unlikely that one would exhibit overtly racist behaviors if they are one of only seven White children in a class of forty-five students.
The Hispanic population. When functioning at a high level of cultural competence, a therapist treating an individual with a Hispanic cultural background understands the importance of being perceived as a knowledgeable and authoritative therapeutic professional. Likewise, these individuals should be aware that Hispanics are a heterogeneous culture, in that it comprises Cuban, Mexican, Puerto Rican, and several more ethnic groups, each with their own cultural values. Therapists must be knowledgeable of these various cultures, and that their primary similarity is that of sharing the same language; this makes effective intervention and treatment contingent upon understanding the dimensions of the specific client (Altarriba, 1994). The culturally competent clinician is also cognizant of the importance of addressing familial issues with the father of the family system, as Latinos are a highly patriarchal culture. In addition, the clinician should understand the significance of the structure of the entire extended family, as it is common for Hispanic households to include other family members, not solely the nuclear individuals. This family environment also plays a large role in the socialization of the children (Altarriba, 1998).
The role of the therapist also includes being open to alternative approaches to therapy, such as prayer and incorporating priests, as often the role of religion has a significant impact on the Latino family. It is also necessary for the culturally aware clinician to formulate the aspect of immigration into his or her therapeutic approach. Even in cases where the family or individual currently seeking counseling may not have immigrated into the U.S., there is the possibility that they have family members residing in their native country which impacts their current emotions and viewpoints. Furthermore, those who have immigrated have suffered through geographically separating themselves from many social or familial support systems which were previously established (Smart, 2001).
The therapist’s role, when working with Latinos, is also to aid with their assimilation with other cultures of the region, this includes the therapist and client being linguistically compatible. In many instances, Hispanic immigrants deal with their own language barrier within their household, as the parents tend to prefer speaking Spanish in the home, and the children (especially if born in the U.S.) may primarily speak English. The problem this presents to bilingual therapists is that the clinician tends to serve as merely the interpreter for both parties. Another risk associated with the bilingual therapist is in the aspect of dialect—if the therapist’s predominant language is English and they had to learn the Spanish as a second language, they must be fluent in a manner that displays the same authority and competency while speaking in the client’s language (Sciarra, 1991).
Although Hispanics represent the largest minority group in the United States, there are communities where the Hispanic population is less representative such as in Fairfield County, SC where they comprise less than 1.7% of the population. One objective for the therapist, when counseling a member of Hispanic culture, is to foster the client’s cultural awareness of their own cultural group as well increase their awareness of other minority and majority cultures. In essence, the therapeutic approach should include efforts to establish their acculturation. Hispanic individuals may need assistance from helping professionals simply because there is not a large preexisting population of Latinos where they reside, or in the surrounding areas. The primary discriminatory encounters they experience will originate from their skin color, illegal immigration, and reliance on physical labor due to the persistent language barriers (Smart, 2001). In areas where they are the overwhelming minority, the root of their cultural issues often resides in their constant search for acceptance and sense of belonging within the community, and among the other cultural groups.
Multiracial groups. Aside from the African American, Caucasian, and Hispanic cultures, one must also consider multiracial groups, as they hold 1.7% of the United States population. Individuals in this group tend to have their own issues, to include having several identities and not being one-dimensional (Allain, 2007). When requiring therapeutic assistance, they tend to bring a complex set of issues. The concept of culture will remain critical to therapists, as cultural roots are often maintained through parental socialization (Leong, 2010). When working with multicultural groups, therapists can generally model their approach by assessing the client’s racial and cultural identity development and forming a therapeutic alliance by gauging the client’s sensitivity to verbal and nonverbal cues. The therapist also formulates his methodology by assessing how the client identifies themselves collectively, individually, as well as how one’s family values affects the client (Delgado-Romero, 2001).
Often, in order for a therapist to develop a financially successful professional practice, it is essential to provide adequate therapy to both majority and minority cultures as well as cultures which differ from their own. To progress in doing this, it is necessary to conduct research to develop knowledge in a systematic way (Arzubiaga, 2008). In therapists’ attempts to obtain cultural competence, many run the risk of being superficial and counterproductive if they remain underdeveloped in the area of cultural sensitivity. The implementation of cultural competence and sensitivity offer a more rigorous and reflective methodology and therapists must keep that in mind. It is not necessary to become an expert on any particular culture, but rather to concentrate on being aware of one’s own perspective. As therapists, the utilization of critical thinking is vital to understanding how one’s own perspective can affect their ability to acknowledge and understand differing perspectives (Allain, 2007). Finally, be aware that culture is not simply race, and it is my belief that economic status in many instances holds an equal, if not greater, effect on ones manifestations which define their cultural identity.
References
Allain, L. (2007). An investigation of how a group of social workers respond to the cultural needs of black, minority ethnic looked after children. Practice, 19(2), 127-141.
Altarriba, J., Santiago-Rivera, A. L. (1994). Current perspectives on using linguistic and cultural factors in counseling the Hispanic client. Professional Psychology: Research and Practice, 25(4), 388-397.
Altarriba, J., Bauer, L. M. (1998). Counseling the Hispanic client: Cuban Americans, Mexican Americans, and Puerto Ricans. Journal of Counseling & Development, 76(4), 389-396.
Arzubiaga, A. E., Artiles, A. J., King, K. A., Harris-Murri, N. (2008). Beyond research on cultural minorities: Challenges and implications of research as situated cultural practice. Exceptional Children, 74(3), 309-327.
Constantine, M. G., Warren, A. K., Miville, M. L. (2005). White Racial Identity Dyadic Interactions in Supervision: Implications for Supervisees’ Multicultural Counseling Competence. Journal of Counseling Psychology, 52(4), 490-496.
Delgado-Romero, E. A. (2001). Counseling a Hispanic/Latino client—Mr. X. Journal of Mental Health Counseling, 23(3), 207-221.
Leong, F. T. L., Leung, K., Cheung, F. M. (2010). Integrating cross-cultural psychology research methods into ethnic minority psychology. Cultural Diversity and Ethnic Minority Psychology, 16(4), 590-597.
Sciarra, D. T., Ponterotto, J. G. (1991). Counseling the Hispanic bilingual family: Challenges to the therapeutic process. Psychotherapy: Theory, Research, Practice, Training, 28(3), 473-479.
Smart, J. F., Smart, D. W. (1995). Acculturative stress of Hispanics: Loss and challenge. Journal of Counseling & Development, 73(4), 390-396.
Sue, D. W., Rivera, D. P., Capodilupo, C. M., Lin, A. I., Torino, G. C. (2010). Racial dialogues and White trainee fears: Implications for education and training. Cultural Diversity and Ethnic Minority Psychology, 16(2), 206-214.
Utsey, S. O., McCarthy, E., Eubanks, R., Adrian, G. (2002). White racism and suboptimal psychological functioning among White Americans: Implications for counseling and prejudice prevention. Journal of Multicultural Counseling and Development, 30(2), 81-95.
Vala, J., Pereira, C., Costa-Lopes, R. (2007). Is the attribution of cultural differences to minorities an expression of racial prejudice? International Journal of Psychology, 44(1), 20-28.
Jordache Williams is currently based in Rock Hill, SC and is a Licensed Professional Counselor with Atlas Concepts, LLC.
