CULTURALLY FOCUSED COUNSELING:

INCREASING THE CULTURAL AWARENESS, KNOWLEDGE AND SKILL OF PROVIDERS ESHR Goteborg, Sweden June, 1998

Contents Behaviors are learned and displayed in a cultural context. The "Reproductive Revolution" of medical technology has had an impact. All societies are essentially pronatalistic Long lists of fertility-related cultural issues. Accepting the complexity of culture facilitates care. Accepting the dynamic nature of culture facilitates care The most serious cultural errors a provider can make Cultural encapsulation threatens culture-bound providers A Culture-centered approach increases effectiveness Increasing multicultural awareness is the first stage The broad definition of culture has positive consequences Developing multicultural knowledge is the second stage Basic Behavioral Science Task Force of the National Advisory Mental Health Council (1996) Assumptions guide the majority-culture provider Developing multicultural skill is the third stage Multiculturalism (MCT) has become a Fourth Force Questions the provider needs to ask include

Psychological rules are changing toward a new paradigm Complexity and chaos theory provide a model for the future Figure 1: The Intrapersonal Cultural Grid Figure 2: The Interpersonal Cultural Grid

CULTURALLY FOCUSED COUNSELING:

INCREASING THE CULTURAL AWARENESS, KNOWLEDGE AND SKILL OF PROVIDERS Behaviors are learned and displayed in a cultural context. - Accurate assessment in that context - Meaningful understanding in that context - Appropriate intervention in that context The "Reproductive Revolution" of medical technology has had an impact. - Increased ability to fertilize ova in vitro - Increased opportunities for fertility in couples - Identified genetic characteristics at the four-cell embryo - Allowed post menopausal women to gestate and birth - Developed possibilities to raise genetic children All societies are essentially pronatalistic - Genetic models to preserve family representation. - Economic models to generate a family workforce - Social models for the greater benefits of a society - Psychological models of virility/identity needs Long lists of fertility-related cultural issues. - 500,000 women die annually from pregnancy related causes - Fertility in an inverted "U" shape in developing countries - Family planning and preferences through contraception - Indigenous healers versus Westernized providers - Migration/refugee status affects fertility - Increased adolescent sexuality - About 1 in 4 births in developing countries are unwanted - Urban crowding and density issues - Gender roles in dual career families affect fertility - Imunication to control fertility has become possible. - Demographic trend toward aging affects fertility - Ineffective sexuality education raises problems - Infertile couples/individuals bear a social stigma

Accepting the complexity of culture facilitates care - Manage more variables effectively - Generate more potential answers for each question - Identify contrasting perspectives - Tolerate ambiguity more comfortably - Recognize diversity in each context Accepting the dynamic nature of culture facilitates care - Identify the changing cultural salience - Avoid simplistic solutions - Escape rigid stereotypes - Interpret cultural stories - Understand behaviors in their context The most serious cultural errors a provider can make - Overemphasize diversity - Overemphasize similarity - Assume there are only two choices Cultural encapsulation threatens culture-bound providers - Define reality according to one set of assumptions - Become insensitive to cultural variations - Protect unreasoned assumptions against scrutiny - Prefer quick and easy solutions to complex problems - Ignore other people's cultures A Culture-centered approach increases effectiveness - Increased awareness of culturally learned assumptions - Increases knowledge and understanding of each context - Increases skill for long-lasting clinical intervention Increasing multicultural awareness is the first stage - Become aware of the culture teachers we accumulate - Discover our own multiple cultural identities - Understand how culture controls people - Become comfortable with differences - All situations are multicultural - Identify our own culturally learned assumptions The broad definition of culture has positive consequences - Two people can disagree without either being wrong - Visualize the 1000 people sitting with us - Provide a healthy sociocultural ecosystem - Avoid encapsulation by the self-reference criterion - Rehearse adaptive functioning skills - Surround social justice and moral development - Think linearly and non-linearly - Learn from culture shock

Enhance our spiritual completeness Develop pluralist alternatives to chaos and authority

Developing multicultural knowledge is the second stage - Every action/inaction is political - What is salient in the consumer's cultural context - How does the consumer perceive the provider - What are the symbolic meanings of ideas - What are the important words to use Basic Behavioral Science Task Force of the National Advisory Mental Health Council (1996)

Research demonstrates cultural beliefs shape diagnosis The diagnosis of mental illness differs across cultures Cultures express the same symptoms differently Diagnoses tend to be culturally biased Most providers are majority, clients minorit

Assumptions guide the majority-culture provider - The term normally is assumed to be universal - Individualistic perspectives are assumed best - Specialized boundaries of care are assumed necessary - Abstract low-context language is assumed sophisticated - Dependency is assumed to be undesirable - Support systems are assumed to be marginal - Linear thinking is assumed to have scientific superiority - Health care is assumed to help ill people adjust - Historical background is assumed to be secondary - Cultural biases are assumed to have been eliminated Developing multicultural skill is the third stage - Generate a diversified response repertoire - Verbal and nonverbal messages are processed accurately - Knowing when to change the system or the individual - Recover after having said or done the wrong thing Multiculturalism (MCT) has become a Fourth Force - Each Western/non-Western theory has a worldview - Provider/consumer relationship occurs in a context - Racial/cultural identity influences treatment - Competence requires an expanded treatment repertoire - Alternative/complementary roles need to be included - Personal, family, social consequences need to be considered Questions the provider needs to ask include: - Under what conditions is the treatment valid? - How is the behavior explained in the client's culture? - What are the cultural boundary conditions?

How has your own culture limited your perspective? Which psychological phenomena are culturally robust? Which phenomena occur only under specified conditions?

Psychological rules are changing toward a new paradigm - More emphasis on understanding and social significance - Less emphasis on pure statistical significance - More emphasis on interpretation of statistical data - Holistic perspectives more than atomistic - Particularities more than universals - Cultural context-sensitive more than context-free - Subjectivity more than objectivity Complexity and chaos theory provide a model for the future - Tolerance of ambiguity can be productive - Nonlinear, self-sustaining dynamics - An alternative to linear reductionism - Affirmative post-modernism Figure 1: The Intrapersonal Cultural Grid Role Behavior Demographic race gender age other Ethnographic ethnicity nationality language Status level economic social educational Affiliation formal non-formal informal Expectation ValueMeaning

Figure 2: The Interpersonal Cultural Grid Behavior

Same I. High agreement (ideal) III.Low agreement (personal conflict)

Different II. High agreement (ideal) IV.Low agreement (disengagement)