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Calpcc broaching

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Cultural humility and broaching difference

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Calpcc broaching

  1. 1. Difficult Dialogues: Broaching Cultural Issues in Counseling Dr. Sheila Addison Interim Program Director, MACC Alliant International University, SF saddison@alliant.edu
  2. 2. Learning Objectives Attendees will be able to: 1.Describe the difference between cultural competence and cultural humility as approaches to counseling work 2.Articulate professional and clinical rationales for broaching cultural issues during counseling 3.Generate examples of how to broach cultural issues during counseling sessions
  3. 3. MA in Clinical Counseling Alliant International University, SF (est. 2010)  Strengths-based perspective  Multicultural, social justice focus  ACA social justice advocacy competencies  Cultural humility model  Emphasis on critical consciousness & inquiry  Self-reflection & personal growth  Providing training to under- represented students  Providing service to under-served populations
  4. 4. MA in Clinical Counseling Alliant International University, SF (est. 2010)  ACA Social Justice Advocacy Competencies:  Client empowerment  Client advocacy  Community collaboration  Systems advocacy  Public information  Social & political advocacy
  5. 5. Cultural humility model  Developed for physician training (Tervalon & Murray-Garcia, 1998)  Expanded to social work (Ortega & Coulborn Faller, 2011; Schuldberg et al., 2012) and counseling psychology (Hook et al., 2013)  “Comptetency” emphasizes “knowledge”  Humility: “having a sense that one’s own knowledge is limited as to what truly is another’s culture.”  “Embrace the failure” (Wilchins, 2004)
  6. 6. Cultural humility model  The “ability to maintain an interpersonal stance that is other-oriented rather than self- focused, characterized by respect for others and a lack of superiority”(Hook et al. 2013) • Critical for developing “a strong bond in a situation in which relationship partners may have a strong tendency to value their own perspective.”
  7. 7. Cultural humility model  Lifelong commitment to self-evaluation & critique  Make hypotheses rather than jump to conclusions  Overcome the tendency to view one’s own beliefs, values, and worldview as superior  Accept you will always be naïve about others’ cultures
  8. 8. Cultural humility model  An “antidote to or brake on feelings of superiority, frustration, and alienation” that may occur when cultural differences arise in therapy  An ability to stay open and other-oriented when clients are touching on aspects of identity that are most salient to them
  9. 9. Cultural humility model  Manifests in an ability to express respect and take a one-down stance, even when difference threatens the therapeutic alliance
  10. 10. Cultural humility model
  11. 11. Cultural humility model
  12. 12. Broaching cultural issues Day-Vines et al., 2007  Directly addressing issues of culture and identity that translate into dynamics of privilege and oppression that influence the presenting issues, the client’s history, and the counseling relationship. “The counselor’s consideration of racial and cultural factors that may influence the client’s counseling concerns.”
  13. 13. Broaching cultural issues Day-Vines et al., 2007
  14. 14. 15  Rationale  Demographic shifts in population  Homogeneity of counseling force  Negative perceptions from minorities  Ethical responsibility  Counseling competencies Broaching cultural issues Day-Vines et al., 2007
  15. 15.  Current context:  White supremacist  Anti-immigrant  Anti-Muslim  Misogynist  Heterosexist, ableist, sizeist, ageist, classist, etc.  Scott & House (2005) – High levels of discrimination distress associated with avoidant coping styles, whereas feelings of mastery and control correlated with coping strategies such as seeking social support and problem solving in a sample of high school students.  Powell & Jacob Arriola (2003) – examined the relationship between psychosocial functioning and GPA in students of color. Talking about unfair treatment was associated with higher GPAs. Broaching cultural issues Day-Vines et al., 2007
  16. 16.  Previous research indicates that cultural misunderstanding contributes to premature termination among clients from culturally and linguistically diverse backgrounds.  30% of clients prematurely terminate. But 50% of minority clients prematurely terminate.  What could explain this? Broaching cultural issues Day-Vines et al., 2007
  17. 17. Damage of micro-aggressions Damage of silence about cultural factors  Minority clients leave therapy early and fail to get as much benefit.  “A counselor’s refusal to both develop and exercise multicultural counseling competence represents a potential act of malfeasance toward clients.” (D. Sue & Sundberg, 1996). Broaching cultural issues Day-Vines et al., 2007
  18. 18. Damage of micro-aggressions  Brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults toward people of marginalized identities Microaggressions
  19. 19. Microaggressions
  20. 20. Microaggressions
  21. 21.  Recipients: distrust, confusion, frustration, anger, depression, RAGE http://www.microaggressions.com/ Microaggressions
  22. 22. Damage of silence about cultural factors Across the developmental spectrum, people from culturally and linguistically diverse backgrounds experience racialized stressors Van Ausdale & Feagin (2001): ethnographic study to determine whether preschool students confronted issues of race and representation. Spoiler: THEY DO. Broaching cultural issues Day-Vines et al., 2007
  23. 23. Broaching cultural issues Day-Vines et al., 2007
  24. 24. 25  Lewis (2005)  Ethnographic study of children in a suburban elementary school to examine parents’ and teachers’ concept of race, their own racial identities, and the impact of race on opportunity structures.  Even though respondents vehemently denied the role of race within the school and community, race operated as part of the hidden curriculum. Essentially, race was very salient. Broaching cultural issues Day-Vines et al., 2007
  25. 25.  White counselors who addressed racial and cultural factors were deemed more credible than those who ignored racial and cultural factors (Zhang & Burkard, 2008). Broaching cultural issues Day-Vines et al., 2007  When clients of color for whom race, ethnicity, and culture were salient identity dimensions perceived that counselors lacked the capacity to broach racial, ethnic, and cultural concerns, clients opted to meet their needs outside the counseling relationship within the safety and familiarity of friends and family members (Pope-Davis et al., 2002).
  26. 26.  Power dynamics within the counseling dyad can promote or inhibit culture-specific discussions, leaving clients feeling frustrated and unheard (Thompson & Jenal, 1994).  Higher levels of race neutral attitudes were associated with lower levels of multicultural counseling (Burkhard & Knox, 2004; Neville, Spanierman, & Doan, 2006)  Race neutral attitudes among White counselors was associated with endorsement of racial and gender intolerance, racist attitudes, victim blame perspectives, acceptance of social dominance, and apprehension around ethnic minorities (Spanierman, & Heppner, 2004; Neville, Lilly, Duran, Lee, & Brown, 2000) Broaching cultural issues Day-Vines et al., 2007
  27. 27. 28 Failure to broach: Loss of counselor credibility Client dissatisfaction Client censure of own thoughts Client accommodates the counselor’s inability to broach racial and cultural factors Client educates counselor in ways that detract from the counseling process Premature termination Broaching cultural issues Day-Vines et al., 2007
  28. 28.  Given the power dynamics that govern the counseling relationship, avoidance of the client’s cultural context may prevent the client from addressing pertinent counseling concerns.  Acknowledgement of cultural factors during the counseling process enhances counselor credibility, client satisfaction, the depth of client disclosure, and clients’ willingness to return for follow-up sessions (D. Sue & Sundberg, 1996). Broaching cultural issues Day-Vines et al., 2007
  29. 29.  “There’s a wilderness of creative space in the therapeutic dialogue for the recognition of race and class, how they inform who we are, decisions we make or decisions we fail to make. Because there’s no aspect of our lives that aren’t, I believe, shaped by the nuances of all these issues—race, class, gender, all of those things.” Broaching cultural issues Day-Vines et al., 2007 Dr. Kenneth V. Hardy, Drexel University, Ackerman Institute for the Family
  30. 30.  “It’s really important to me to name race very early in the process…. I’ve written about the importance of the therapist being the broker of permission. And I think that that permission to acknowledge and talk about race has to be given before it ever happens because the rules of race in our society is that we don’t talk about it. So I use myself to do that. “Well, as an African- American” or “as a black therapist,” which is my way of saying to you, the white client, “I’m okay acknowledging race. I’m even okay if we talk about it.” Broaching cultural issues Day-Vines et al., 2007
  31. 31.  “I believe that permission granting maneuver requires some subtlety. I don’t agree with the strategy where white therapists ask clients of color, ‘How do you feel about being in therapy with me?’ I also don’t agree with me asking a white client that because of power. In that context of therapy, I’m in a more powerful role. And so I would be asking this person to engage in a level of self-disclosure about a very difficult topic while I’m not revealing anything about myself. It’s my job, the way I see it, to put my views out there about it and not require an answer. It’s up to the client if they want to pick it up and go with it. But my putting it out there is not contingent on them picking it up and going with it. So it’s not like a chess game.” Broaching cultural issues Day-Vines et al., 2007
  32. 32. 33 Broaching behavior involves selective attention to cultural factors that may impact the client’s sociopolitical experience. Broaching cultural issues Day-Vines et al., 2007
  33. 33. Broaching cultural issues Day-Vines et al., 2007 We have an obligation to make sure we don’t screen out clues about the salience of cultural factors because it is most comfortable for us to do so.
  34. 34. Broaching cultural issues Day-Vines et al., 2007 “I think that these fears are impediments to talking and yet I think there’s a greater likelihood to be a problem when it doesn’t come up than when it does come up. And I’m not just talking about bringing up race with clients of color. I’m not just talking about discussing gender with women. I mean, I think it’s important for us to have these conversations with clients across the board and have an openness to look at them. See, I guess that’s the difference. I’m keenly interested in knowing how one’s life and relationships are informed by all of these issues, no matter who’s sitting in front of me. Because I think they do inform our lives though we may not always be conscious of it.”
  35. 35.  Racial, ethnic, and cultural factors may not impact every presenting concern, but the counselor has an obligation to consider the extent to which culture does serve as a context for the client’s concerns. That is, the counselor’s broaching behavior serves as an assessment tool. Broaching cultural issues Day-Vines et al., 2007
  36. 36. Broaching cultural issues Day-Vines et al., 2007
  37. 37. Broaching cultural issues Day-Vines et al., 2007  Only broach when there is visible difference?  No!    Broach similarity rather than pretending that you’re identical - that’s an oppressive force saying to the client that they don’t have permission to be different from you.  
  38. 38. Broaching cultural issues Day-Vines et al., 2007  Depends on  “The counselor’s ability to consider how socio- political factors such as race influence the client’s counseling concerns.” – our clinical imagination and empathy!  The therapist’s willingness to directly address these dynamics, knowing they will then become visible in the therapy room  Willingness to consider how the counseling relationship might suffer if these factors are NOT addressed overtly.  Broaching combats silence.
  39. 39. Possible Feelings of: •Resentment •Embarrassment •Fear •Excitement •Enthusiasm •Curiosity •True Rapport •Incompetence Address Countertransference Issues Normalize Student Feelings Brainstorm adjectives that describe your personal feelings and level of efficacy towards broaching behavior
  40. 40. 41 Continuum of Broaching Behavior Avoidance of Broaching “Way of Being” Lowest Level Highest Level Invitation/Dialogue Isolated Integrated/C ongruent Broaching Behavior/Attitude Moderate to Advanced Continuing/Incongruent
  41. 41. Avoidant Counselor  “The client's race does not matter because good counseling is good counseling.”  “Broaching racial and cultural factors represents the client's effort to avoid taking responsibility for her or his actions.”  “If my client were to bring up racial and cultural factors, I would politely redirect the conversation.”  “I am not sure that broaching is an effective counseling strategy.”
  42. 42. Isolating Counselor  “I’m worried that the client won’t benefit from it.”  “I can try it, but if I don’t do it well, I’m afraid I’ll lose the client and it’s not worth the risk.”  “It just seems like projecting an agenda onto the client before they’re ready.”  “Whew, checked off that box…”  Resulting Behavior: Broaches reluctantly and in a simplistic and superficial manner.
  43. 43. 44 Continuing/Incongruent Counselor  “I feel really awkward when I address racial and cultural factors during the counseling process.”  “Sometimes it’s hard for me to know what to say once the client begins to talk about racial and cultural factors.”  “I asked if the client was OK having me as a therapist and they said it was fine.”
  44. 44. Integrated/Congruent Counselor  “I generally bring up cultural issues every so often throughout my counseling sessions with clients”  “I want to know what my minority clients have experienced in terms of racism and discrimination.”  “I try to make it safe for clients to talk about cultural factors in their lives.”  “I ask about difference, because difference matters.”
  45. 45. Infusing Counselor  “As a counselor, I want to do whatever it takes, socially and politically, to eradicate of all forms of oppression.”  “Disagreeing with discrimination isn’t enough. We have to change the system, even if it’s at our own expense sometimes.”  “I’m willing to go to bat for a client who experienced racism or sexism at my agency.”
  46. 46. Effects of broaching  Establishing rapport  Establishing counselor credibility  Acknowledging that difference may be an influence on the relationship  Giving permission to the client to comment on their experience of difference in the room  Giving permission to the client to discuss the effects of outside cultural forces
  47. 47. Multidimensional Model of Broaching Behavior (Day-Vines, 2007) 4 Dimensions  Intra-Counseling  Intra-Individual  Intra-Racial, -Ethnic, -Cultural, etc.  Inter-Racial, -Ethnic, -Cultural, etc. Spotlighting the Elephant in the Room
  48. 48.  The interpersonal processes that govern the counselor- client relationship.  Cultural differences and misunderstandings between the counselor and client have the potential to create an unhealthy power dynamic within the counseling dyad, which may contribute to counter-transference.  Broaching Example: "I know that this can sometimes be a difficult topic to discuss, but I was wondering how you feel about working with someone who is from a different racial/ethnic background? I ask because although it is certainly my goal to be as helpful to you as I possibly can, I also know that there may be times when I cannot fully appreciate your experiences. I want you to know that I am always open to talking about the topics whenever they are relevant." (Cardemil & Battle, 2003) Intra-counseling Dimensions
  49. 49.  Race  Ethnicity  Culture  Gender  Social Class  Sexual Orientation  Religious Orientation  Disability  Geographic Location  Immigration Status  Linguistic Diversity  Body size Sample Broaching Statement: "Often I ask my clients about their racial and ethnic background because it helps me have a better understanding of who they are. Is that something you'd feel comfortable talking about?" Cardemil & Battle (2003) Intra-individual Dimensions
  50. 50. Intra-Cultural Dimensions  Intra-Racial, -Ethnic, and -Cultural dimensions refer more to sociocultural or within group issues that may arise between the client and people with whom he or she shares a common heritage. That is, the client may have personal beliefs, value orientations, and behaviors that are at odds with values and viewpoints sanctioned by their cultural group (e.g. bicultural socialization). Sample Broaching Statement: Marisol, it sounds like you are feeling rejected by your friends because they say you are not Hispanic enough. Is that your sense of what is going on?
  51. 51.  Inter-Racial, -Ethnic, and -Cultural dimensions refer to efforts to help the client negotiate cultural differences between her- or himself and people from at least one other racial, ethnic, or cultural group. This would also include efforts to help the client negotiate encounters with the sociopolitical dynamics of racism, discrimination, oppression, and powerlessness. Sample Broaching Statement: What has it been like for you as a gay Latino male to work in an organization that is inhospitable to sexual minorities? Inter-Cultural Dimensions
  52. 52.  As clients take risks of talking about intra- individual, intra-cultural, and inter-cultural experiences of privilege and oppression, it’s critical to go back to the intra-counseling dimension and check in. Sample Broaching Statement: Today we have been talking about your sense that many of your coworkers are prejudiced. What has this conversation with me been like for you? What has it been like for you to share experiences of discrimination with a White therapist who hasn’t had those kinds of experiences? Intra-Counseling (again?)
  53. 53. Broaching, or Micro-aggressions?  Counselor trainee conducts a broaching interviewee with her best friend. The trainee is Caucasian female and the interviewee is a person of color. In an effort to address Intra-Counseling Dimensions, the interviewee says:  “I’m a White woman and you’re a Hispanic girl.”  Counselor trainee conducts a broaching interview with her fiancé’s co-worker, who is Korean-American. She makes an effort to open the session and states:  “Your English is really good, I can tell, so – when did your family come here?”
  54. 54. 56  Client's Racial Identity Functioning  Client's Response to Counselor's Broaching Effort  Counselor Considerations  Low Commitment Levels  May reject counselor’s invitation to broach  May have Low Salience attitudes about Race  Accept and explore the client’s reaction to issues of race and representation  May help prepare the client to deal effectively with racist encounters  Strong Commitment Levels  May have strong reactions to counselor's broaching efforts  Do not personalize client reactions  Identify experiences that may have led to strong reactions  Develop interventions that help client function more effectively  Balanced Racial Identity Levels  May appreciate counselor’s willingness to explore how race shapes their presenting problems  Broach using recommended guidelines
  55. 55. Broaching competencies Day-Vines et al., 2007  Ability to broach depends on  The counselor’s ability to consider how sociopolitical factors influence the client's counseling concerns  “The therapist must learn to recognize clients’ cultural meaning attached to phenomena and to subsequently translate that cultural knowledge into meaningful practice that facilitates client empowerment, strengthens the therapeutic alliance, and enhances counseling outcomes.”  Ability to manage their own self-of-counselor reactions effectively to remain open, other- centered, and engaged.
  56. 56. Basic Counseling Skills  Ability to ask open-ended questions  Ability to reflect content and affect  Ability to use foundational counseling skills Ego Strength  Ability to manage client values, viewpoints, and experiences that may differ from one's own  Healthy level of racial identity functioning Multicultural Case Conceptualization Skills  Ability to differentiate between universal and culture-specific issues  Ability to recognize client strengths as opposed to client deficits  Ability to identify/state/discuss the impact of sociopolitical issues on the client (racism, discrimination, power, powerlessness, oppression, privilege)  Ability to gauge own/client's level of racial identity functioning  Ability to identify culturally relevant strategies and interventions Broaching competencies
  57. 57. Broaching’s role in treatment  Validate the client’s concerns  Empower client  Affirm client’s competence  Accept the feelings and meanings client attaches to problem situation  Identify client strengths and resources)  Discuss the sociopolitical basis of the client's concerns  Generate broaching statements & questions in an effort to translate observations into effective clinical dialogue  Engage in multicultural case conceptualization
  58. 58. Broaching’s role in treatment  Explore relevant cultural dimensions with the client  Brainstorm possible coping mechanisms, solution attempts, response strategies in a culturally appropriate context  Evaluate consequences of each strategy  Determine implementation strategy  Implement and review effectiveness of the plan
  59. 59. There is no easy road! Acknowledge Difference Defensive; in denial Guilt; shame; hurt exhaustion, burn-out Don’t Acknowledge Difference  Oblivious; ignorant  Angry; resentful of having to be “PC”  Support status quo avoidance, denial • “A counselor’s refusal to both develop and exercise multicultural counseling competence represents a potential act of malfeasance toward clients.” (D. Sue & Sundberg, 1996).
  60. 60. We can be recipients as well as perpetrators of microaggressions  We must recognize that we all share both  a common humanity AND  particular social identities  which accord power in unbalanced ways  “ Bridging this power divide is at the heart of healing divisions”http ://www.racialequitytools.org/resourcefiles/cushing.pdf  By engaging in the process of ally development, we can enhance our self-care
  61. 61. Practice  How do you identify your  Gender  Race  Ethnicity/geography  Age  SES/Class  Education level  Dis/ability or health status  Religion/spirituality  Body shape/size  Education level  What words would you use with clients?  “As a ____”  “I’ve grown up in/as ______”  “As someone with a background in/from ______”  “My experience as _____”  “Coming from the perspective of ____”  “We both have ____ in common”
  62. 62. Practice  “As a ____”  “I’ve grown up in/as ______”  “As someone with a background in/from ______”  “My experience as _____”  “Coming from the perspective of ____”  “We both have ____ in common”  “… I don’t have the experience of ____”  “…I probably can’t fullly understand what it’s like for you as ____”  “…we probably have a lot of differences in terms of _____”  “…there’s probably a lot of things I don’t get about ____”  “… we probably have a lot of differences in terms of ____ that are important too.”
  63. 63. Guided Practice  In a counseling session with Mrs. Pierce, Pedro, a 16 year old Mexican American male seeks support due to stress and anxiety about the wild fires in California. The fires have resulted in the loss of his family's home. Pedro is finding difficulty focusing in class not only because of the wild fires, but also from anxiety concerning his parents' reported losses to their insurance company. Pedro is afraid that the claim may expose family immigration secrets: Pedro's father is in the U.S. on an expired work visa, his mother arrived illegally in the U.S., while Pedro and his siblings were born on U.S. soil. His extended family members have experienced recent immigration raids that have made him feel increased levels of vulnerability.
  64. 64. Discussion Questions How might the counselor's attitudes about immigration influence her/his ability to broach racial and cultural factors with Pedro? What might you need to learn in order to work more effectively with Pedro? Distinguish between Pedro's universal (etic) and culture- specific (emic) concerns? What culture specific concerns should the counselor address with Pedro? Generate some sentence stems that will help you broach racial and cultural factors with Pedro.

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