This document discusses the cultural humility approach to broaching cultural issues in counseling. It defines cultural humility as a lifelong commitment to self-evaluation, openness to new information, and lack of superiority over other cultures. The cultural humility model emphasizes not-knowing over competence and encourages counselors to acknowledge the limitations of their cultural knowledge. The document also presents Day-Vines et al.'s multidimensional model of broaching behavior, which includes broaching intra-counseling dynamics, clients' intra-individual cultural experiences, intra-group issues, and inter-group interactions. Rationales for broaching include improving retention of minority clients and addressing microaggressions and the damage of cultural silence.

1. Difficult Dialogues:
A Cultural Humility
Approach to
Broaching Cultural
Issues
Steve Schoser, LPCC
•steve.schoser@gmail.com
Dr. Sheila Addison, LMFT
•sheila.m.addison@gmail.com
http://tinyurl.com/
Presented at ACA 2016, Montreal, QC, Canada

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. ACA Social Justice Advocacy
Competencies:
 Client empowerment
 Client advocacy
 Community collaboration
 Systems advocacy
 Public information
 Social & political advocacy

4. Cultural humility model
 Developed for physician training
(Tervalon & Murray-Garcia, 1998)
 Social work (Ortega & Coulborn Faller, 2011;
Schuldberg et al., 2012)
 Counseling psychology; Hook et al., 2013)

5. Cultural humility model
 Competetency implies:
 Collecting knowledge
 Mastering skills
 Producing a particular outcome that can be
evaluated

6. Cultural humility model
 Danger: The “cultural zoo” or “tourist” model
of diversity

7. Cultural humility model
 Humility: “Having a sense that one’s own
knowledge is limited as to what truly is
another’s culture.” (Hook et al. 2013)
 Other-oriented rather than self-focused
 Respect for others
 Lack of superiority
 Entertaining hypotheses rather than drawing
conclusions

8. Cultural humility model
Life-long commitment to
self-evaluation & critique
 Staying open to new
information
 Wrestling with the tendency to
view one’s own beliefs, values,
and worldview as superior
 Willingness to hear “you don’t
get it”

9. Cultural humility model
Not-knowing stance
 Consistent with Narrative,
SFBT, Collaborative
Language Systems, feminist
approaches
Accept you will always be
naïve about others’
cultures
 “Embrace the failure”(Wilchins,
2004)

10. 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 talking about identity in
ways that raise our anxiety

11. Not-knowing?
 Not the same as being ignorant or lost

12. Cultural humility model
 Manifests in an ability to express respect and
take a one-down stance, even when
difference threatens the therapeutic alliance

13. Cultural humility model

14. Cultural humility model

15. Broaching cultural issues
Day-Vines et al., 2007
Broaching: Directly
addressing issues of
culture and identity
 that translate into dynamics of
privilege and oppression
 which influence the presenting
issues, the client’s history, and
the counseling relationship

16. Broaching cultural issues
Day-Vines et al., 2007

17. Broaching cultural issues
Day-Vines et al., 2007
Multidimensional Model of Broaching
Behavior
 Or, “How to see the Elephant”
 4 Dimensions
 Intra-Counseling
 Intra-Individual
 Intra-Group
 Inter-Group

18. 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
Intra-counseling Dimensions

19. Every counseling relationship contains
some kind of cross-cultural dimension!
 Race
 Gender
 Age
 SES
Intra-counseling Dimensions

20. We may not see how the difference
impacts the relationship.
But clients do.
Intra-counseling Dimensions

21.  Even if our backgrounds are nearly identical,
that can be a topic that needs to be
broached.
 Silence can be an oppressive force saying to the
client: they don’t have permission to be different
from you.
Intra-counseling Dimensions

22.  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

23. Intra-individual Dimensions
The client’s internal experience of their identities
 Race
 Ethnicity
 Culture
 Gender
 SES
 Sexual Orientation
 Religious Orientation
 Disability
 Geographic Location
 Immigration Status
 Linguistic Diversity
 Body size

24. Intra-individual Dimensions
The client’s internal experience of their identities
 Race
 Ethnicity
 Culture
 Gender
 SES
 Sexual Orientation
 Religious Orientation
 Disability
 Geographic Location
 Immigration Status
 Linguistic Diversity
 Body size
Think, pair, share:
Which of these
dimensions would
be harder for you to
broach?

25. Sample Broaching Statement: "Often I ask my
clients about their [cultural] 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

26. Intra-Group Dimensions
Intra-Racial, -Ethnic, -Religious, etc.
 Sociocultural or within group issues that may
arise between the client and people with
whom he or she shares a common heritage.
 Beliefs, value orientations, and behaviors that
are at odds with values and viewpoints
sanctioned by their cultural group

27. Intra-Group Dimensions
 Examples:
 LGBTQ people of color
 Bi-cultural socialization
 Second, third, etc. generation immigrants –
assimilation vs. cultural fidelity
 Transgressing cultural pride/shame issues
(McGoldrick et al.)

28. Intra-Group Dimensions
 Sample Broaching Statement: Marisol, it
almost sounds like you are feeling rejected by
your friends as “not Latina enough,” since you
don’t speak Spanish. Is that your sense of
what is going on?

29. Inter-Racial, -Cultural, etc.
 Client is managing cultural differences between her-
or himself and people from at least one other cultural
group
 Includes efforts to help the client negotiate the
sociopolitical dynamics of discrimination, oppression,
and powerlessness (social justice advocacy
competencies)
Inter-Group Dimensions

30.  Sample Broaching Statement: What has it
been like for you as a gay Latino man to
work in an organization that is hostile to
sexual minorities?
Inter-Group Dimensions

31.  Danger: We can “gaslight”
clients out of our own
unresolved racial and
cultural anxieties
 “Maybe there’s another
explanation”
 We may try to to help clients
“adjust” to oppressive conditions
 Making themselves less visible, less
outspoken about micro-
aggressions & systemic oppression
 We may try to teach them to
“cope” rather than to explore
advocacy for themselves and
their communities
Inter-Group Dimensions

32.  As clients take the risk of talking about
about intra-individual, intra-group, and
inter-groupl experiences of privilege
and oppression, it’s critical to go back
to the intra-counseling dimension and
check in
Intra-Counseling (again?)

33.  Sample Broaching Statement: Today we’ve
been talking about your sense that many of
your coworkers are prejudiced. How has it
been for you to share experiences of
discrimination with a White therapist who
hasn’t had those kinds of experiences?
Intra-Counseling (again?)

34. 34
 Rationales
 Demographic shifts in population
 Homogeneity of counseling force
 Negative perceptions from minorities
 Ethical responsibility
 Counseling competencies
Why broach?

35.  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?
Why broach?

36. Damage of micro-aggressions
Damage of silence about cultural
factors
Minorities prematurely terminate?

37.  Brief, 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

38. Microaggressions from
counselors - Toward clients
 “I don’t think of
you as a black girl,
I just think of you as
a successful
student.”
 “It must be hard for
you to thrive in that
environment”
 “So who in your
family has ever
been in a gang?”
 “So, do you have a
boyfriend?”
 “LET ME KNOW IF I
TALK TOO FAST FOR
YOU”
 “When did your
family immigrate?”
 “It must take you a
while to get here
on the bus”

39. Microaggressions from counselors -
Toward colleagues
 “Ohhh you work with
parents??”
 “You must see a lot
of low-fee clients”
 “You must have
experience with
body image stuff”
 “I just assumed that
you were into video
games and
computers”
 “I didn’t realize
that you worked
with straight
couples!”
 “Oh, not one of
THOSE cases
again….”
 “Maybe you could
do some training
on diversity for us!”

40. Microaggressions in counseling
 Distrust
 Confusion
 Frustration
 Anger
 Depression
 RAGE
 Then we diagnose
them as “treatment
resistant.”

41. Silence about culture
 When clients of color
perceive that counselors
lacked the capacity to
broach racial, ethnic, and
cultural concerns, clients
opt to meet their needs
outside the counseling
relationship within the safety
and familiarity of friends and
family members (Pope-Davis et al.,
2002).

42. Silence about culture
 “Black Rage: Two Black Psychiatrists Reveal
the Full Dimensions of the Inner Conflicts and
the Desperation of Black Life in the United
States” Cobbs & Grier, 1968
 “Healthy paranoia”
 As a minority, your inability to recognize
threatening situations can be dangerous
 You may be in danger if you don’t think about
how people will potentially react to you

43. Silence about culture
 But silence about these experiences is a
contributor to minority stress
 Silencing the self protects those in the
majority
 Ssilence also leads to RAGE
 “Part of the task of the subjugated is to
give voice to one’s experiences” – Ken
Hardy

44. Result: 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).
Microaggressions & silence

45. Effects of broaching
Establishing rapport
Establishing counselor credibility
Acknowledging that difference
may be an influence on the
relationship

46. Effects of broaching
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.  Enhances
 Counselor credibility
 Client satisfaction
 Depth of client disclosure
 Clients’ willingness to return for follow-up
sessions (D. Sue & Sundberg, 1996)
Effects of broaching

48.  Clients want to feel
understood
 White counselors who
addressed racial and
cultural factors were
deemed more credible
than those who ignored
racial and cultural factors
(Zhang & Burkard, 2008).
Effects of broaching

49.  Due to counseling power dynamics, avoiding the
client’s cultural context may prevent the client
from addressing pertinent counseling concerns
 Loss of counselor credibility
 Client accommodates the counselor’s inability
to broach
 Client censors their own thoughts
Failure to broach

50.  Client educates counselor in ways that
detract from the counseling process
 Client dissatisfaction
 Premature termination
Failure to broach

51. Discomfort with broaching
 Shows up in the language we use:
 “Projecting” your issues onto the client
 “Forcing” your “agenda” into counseling
 “Rushing” to talk about difference before
the client is “ready
“Wait for the client to bring it up”

52. Salience of culture
 Broaching behavior
involves selective
attention to cultural
factors that may impact
the client’s sociopolitical
experience
 Yes, we see what we
look for
 But looking for cultural
“clues” is part of our job!

53. Salience of culture
 We have an obligation to make sure
we don’t screen out clues about the
salience of culture because it is
comfortable for us to do so
 “I do not believe that every issue is
related to culture and identity, but
recognize that when presenting
problems do have cultural
connections, the counselor has an
obligation to acknowledge these
factors in a meaningful and
substantive manner. I also
recognize that clients may not
always immediately give credit to
the way cultural factors are in play,
or speak up about their relevance,
because they are taught not to
from birth.” – Day-Vines

54. Salience of culture
 We’re taught to screen
out information about
difference
 Being “colorblind”
 Looking for explanations
other than race
 Laughing at sexist or racist
“jokes”
 Expecting people to “pass”
as part of the majority culture
(“keep it to themselves,” “not
shove it in our faces,” etc.)
 “We’re all the same under
the skin”

55.  “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.”
 “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.”
Taking the initiative
Dr. Kenneth V. Hardy,
Drexel University,
Ackerman Institute
for the Family

56.  “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 think there’s a greater
likelihood to be a problem
when it doesn’t come up than
when it does come up.”
Taking the initiative
Dr. Kenneth V.
Hardy, Drexel
University,
Ackerman Institute
for the Family

57.  Issues of difference 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.
 The counselor’s broaching
behavior serves as an
assessment tool.
Broaching as assessment

58. Broaching as assessment
 “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.” – Ken Hardy

59. Willingness to broach
 Depends on:
 Our clinical imagination and
empathy!
 Our willingness to directly
address these dynamics,
knowing they will then
become visible in the
therapy room
 Our willingness to consider
how the counseling
relationship might suffer if
these factors are NOT
addressed overtly.

60. Counselor reasons for not
broaching
 “Good counseling is
good counseling.”
 “Blaming everything
on race or gender is
just the client's effort
to avoid taking
responsibility for his or
her actions.”
 “I am not sure that
broaching is an
effective counseling
strategy.”
 “I’m worried that the
client won’t benefit
from it.”
 “If I say the wrong
thing, 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.”

61. Other counselor responses
 “I feel really awkward when I do it.”
 “Sometimes it’s hard for me to know what to
say once the client begins to talk about
cultural factors.”
 “I was taught not to notice race.”
 “I asked if the client was
OK having me as a
therapist and they said it
was fine.”
 “I brought it up!” (One
time. Whew, checked off
that box!)

62. Social justice-informed
counselor responses
 “I generally bring up
identity and oppression
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.”
 “As a counselor, I want
to do whatever it takes,
socially and politically,
to eradicate 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.”

63. Broaching in practice

64. Broaching in practice
 Client: 47-year-old White gay man,
married, no children, history of service in
the Navy for 4 years
 Presenting with anxiety

65. Broaching in practice
 Client: 42-year-old White woman,
unmarried, bisexual, no children
 Problem: Presenting with concerns about
having children late in life

66. Broaching in practice
 Same client as #1
 Anxiety is specifically about sexual
performance

67. 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?”

68. 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”

69. 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.”

70. Guided practice
 Gabe is a 16-year-old African-American male. He was
referred to the School Linked Services Program by his
mother due to what she feels is his inability to open up
and truly express his thoughts and feelings.
 In the past the family has interactions with the D.S.S.
due to a report by a neighbor of suspected abuse.
 During the intake Mother is very upfront with
information and answers all questions asked. Gabe
arrives to the first session with a flat affect and says
very little during the session.
 As sessions continue, the therapist fails to build rapport
with Gabe and eventually finds that he is completely
disengaged from the therapy and that he and his
mother no longer wish for him to receive services.

71. Guided practice
 What are the different dimensions of diversity
in this case?
 How do you believe these different
contextual issues might affect Gabe’s
reluctance to express his feelings, in general,
and specifically in counseling?
 If you could do things over again, how might
you broach cultural issues with Gabe and his
mother?

72. Broaching’s role in treatment
 Validates the client’s concerns
 Empowers client
 Affirms client’s competence
 Accepts the feelings and meanings client attaches
to problem situation
 Identifies client strengths and resources
 Frames discussion of the sociopolitical basis of
the client's concerns
 Generates broaching statements & questions from
observations for effective clinical dialogue
 Engages in multicultural case conceptualization

73. There is no easy way!
Don’t Acknowledge
Difference
 Oblivious;
ignorant
 Angry; resentful
of having to be
“PC”
 Support status
quo
 -> Avoidance,
denial
Acknowledge
Difference
 Defensive
 Guilty
 Shameful
 Hurt
 -> Exhaustion, burn-
out

74. Steve Schoser, LPCC
•steve.schoser@gmail.com
Dr. Sheila Addison, LMFT
•sheila.m.addison@gmail.com
http://tinyurl.com/