Counseling the Culturally Diverse. Laura Smith L.

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СКАЧАТЬ disorders (Ponterotto, Utsey, & Pedersen, 2006). They stress that all theories of human development arise within a cultural context and that using the EuroAmerican values of normality and abnormality may be culture‐bound and biased (Locke & Bailey, 2014). From this case, we offer five tentative cultural/clinical observations that may help Dr. D. in his work with Gabriella.

      CULTURAL CONCEPTS OF DISTRESS

It is obvious that Dr. D. has concluded that Gabriella suffers from a panic disorder and that her attacks fulfill criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) (American Psychiatric Association, 2013). When Gabriella uses the term ataques to describe her emotional outbursts, episodes of crying, feeling faint, somatic symptoms (“heat rising in her chest”), feeling of depersonalization (unreal), and loss of control, a Western‐trained counseling/mental health professional may very likely diagnose a panic attack. Is a panic attack diagnosis the same as ataques? Is ataque simply a Latin American translation of an anxiety disorder? We now recognize that ataque de nervios (“attack of the nerves”) is a cultural syndrome, occurs often in Latin American countries (in individuals of Latinx descent), and is distinguishable from panic attacks (American Psychological Association, 2013). Cultural syndromes that do not share a one‐to‐one correspondence with psychiatric disorders in DSM‐5 have been found in South Asia, Zimbabwe, Haiti, China, Mexico, Japan, and other places. Failure to consider the cultural context and manifestation of disorders often results in inaccurate diagnosis and inappropriate treatment (Sue, Sue, Sue, & Sue, 2022).

      ACKNOWLEDGING GROUP DIFFERENCES

      Dr. D. seems to easily dismiss the importance of Gabriella's Latinx culture as a possible barrier to their therapeutic work together. Gabriella wonders aloud whether he can understand her as a Latina (being a racial, ethnic, cultural being), and the unique problems she faces as a Person of Color. Dr. D. attempts to reassure Gabriella that he can, in several ways. He stresses (a) that people are more similar than different, (b) that we are all “human beings,” (c) that he has much experience in working with Latinx individuals, and (d) that everyone is the “same under the skin.” Although there is much truth to these statements, he has unintentionally negated Gabriella's racialized experiences, and the importance that she places on her racial/ethnic identity. In multicultural counseling, this response often creates an impasse to therapeutic relationships (Arredondo, Gallardo‐Cooper, Delgado‐Romero, & Zapata, 2014). Note, for example, Gabriella's long period of silence following Dr. D.'s response. He apparently misinterprets this as agreement. We will return to this important point shortly.

      BEING AWARE OF COLLECTIVISTIC CULTURES

      It is obvious that Dr. D. operates from an individualistic approach and values individualism, autonomy, and independence. He communicates to Gabriella that it is more important for her to decide what she wants for herself than to be concerned about her parents’ desires. Western European concepts of mental health stress the importance of independence and “being your own person,” because this leads to healthy development and maturity, rather than dependency (in Gabriella's case, “pathological family enmeshment”). The psychosocial unit of identity in many societies is not the individual, but resides in the family, group, or community. Dr. D. fails to consider that in many collectivistic cultures, such as Latinx and Asian American cultures, independence may be considered undesirable and interdependence as valuable (Ivey, Ivey, & Zalaquett, 2014; Kail & Cavanaugh, 2013). When the norms and values of Western European concepts of mental health are imposed universally upon culturally diverse clients, there is the very real danger of cultural oppression, resulting in “blaming the victim.”

      ATTUNING TO CULTURAL AND CLINICAL CLUES

      There are many cultural clues that might have provided Dr. D. with additional insights into Latinx culture and its meaning for culturally competent assessment, diagnosis, and treatment. We have already pointed out his failure to explore more in depth Gabriella's description of her attacks (ataques de nervios), and her concern about her parents’ approval. However, many potential sociocultural and sociopolitical clues were present in their dialogue as well. For example, Dr. D. failed to follow up on why the song “Booty” by Jennifer Lopez precipitated an argument, and what the parents’ use of the term “fetish” shows us about how Russell may potentially view their daughter.

The four‐minute music video “Booty” shows Jennifer Lopez and Iggy Azalea with many anonymous women shaking their derrieres (“booties”) in front of the camera while chanting “Big, big booty, big, big booty” continuously. It has been described as provocative, exploitative, and “soft porn.” Nevertheless, the video became a major hit. While Dr. D. might be correct in saying that the argument couldn't possibly be over a song (implying that there is a more meaningful reason), he doesn't explore the possible cultural or political implications for Gabriella. Is there meaning in her finding the song offensive and Russell's enjoying it? We know, for example, that Latinas and Asian women are victims of widespread societal stereotyping that objectifies them as sex objects. Could this be something that Gabriella is wrestling with? At some level, does she suspect that Russell is only attracted to her because of these stereotypes, as her parents’ use of the word “fetish” implies? In not exploring these issues, or worse yet, not being aware of them, Dr. D. may have lost a valuable opportunity to help Gabriella gain insight into her emotional distress.

      BALANCING THE CULTURE‐SPECIFIC AND CULTURE‐UNIVERSAL ORIENTATIONS

Throughout our analysis of Dr. D., we have made the point that culture and life experiences affect the expression of abnormal behavior and that counselors need to attune to these sociodemographic variables. Some have even proposed the use of culture‐specific strategies in counseling and therapy (American Psychological Association, 2017; Ivey et al., 2014; Parham, Ajamu, & White, 2011). Such professionals point out that current guidelines and standards of clinical practice are culture‐bound and often inappropriate for clients of color and other minoritized individuals. Which view is correct? Should treatment approaches be based on cultural universality or cultural relativism? Few mental health professionals today embrace the extremes of either position.

      Proponents of cultural universality focus on disorders and their consequent treatments and minimize cultural factors, whereas proponents of cultural relativism focus on the culture and on how the disorder is manifested and treated within it. Both views have validity. It would be naive to believe that no disorders cut across different cultures or share universal characteristics. Likewise, it is naive to believe that the relative frequencies and manners of symptom formation for various disorders do not reflect the dominant cultural values and lifestyles of a society. Nor would it be beyond our scope to entertain the notion that various diverse groups may respond better to culture‐specific therapeutic strategies. A more fruitful approach to these opposing views might be to address the following question: Are there ways to both examine the universality of the human condition and acknowledge the role of culture in the manifestation of both the presenting concern and the treatment approach? Recently, researchers have systematically addressed the question. Mounting evidence supports the superiority of culturally adaptive treatment interventions compared to culturally universal ones (Hall, Ibaraki, Huang, Marti, & Stice, 2016; Hall, Berkman, Zane et al., 2021).

THE NATURE OF MULTICULTURAL COUNSELING COMPETENCE

Clinicians have oftentimes asserted that “good counseling is good counseling” and that good clinical practice subsumes cultural competence, which is simply a subset of good clinical skills. In this view, they would make a strong case that if Dr. D. had simply СКАЧАТЬ