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Good Ideas about Multicultural Counseling and Psychotherapy – Part II

Three More Ideas About Multicultural Counseling

4.  Developing your Self-Awareness is Central

Both the American Counseling Association and the American Psychological Association place self-awareness of the therapist as a central factor in developing multicultural competency. This is a great, but tricky idea. It’s tricky because of the nature of awareness is such that it’s all too easy for us to remain unaware to very significant multicultural issues. If you’re interested in exploring your multicultural awareness further, you should check out the Implicit Association Test at: https://implicit.harvard.edu/implicit/.

I have a friend who often claimed: “I’m not insensitive, I’m just oblivious!” Of course this was offered in humor, but obliviousness—especially if you’re aware of it—is no good excuse for being insensitive to diversity issues. I’m also reminded of the insensitive and oblivious response of many White Montana students to multicultural discussions. It’s not unusual for some of them to say things like, “I just haven’t had much contact with people from other cultures because we don’t have many minorities in Montana.” When I hear this I try not to gasp aloud as I, or a Native or First Nations Person points out that, in fact, 6.8% of Montana’s population is Native American and that several people IN THE ROOM are Native American.

The initial splash of multicultural awareness is often accompanied by an emotional response . . . and occasionally a bit or a bundle of defensiveness.

5.  As you Work Towards Multicultural Competence, Remember the Concept of Multicultural Humility

Although it’s standard procedure in the counseling and psychotherapy literature to refer to multicultural competence, one major problem with the term multicultural competence is that it implies that there’s an endpoint in the multicultural awareness, knowledge, and skill acquisition process. For this reason, I prefer the terms multicultural humility or multicultural sensitivity.

Similar to awareness, I think humility is central to good multicultural work. Unfortunately, within the dominant cultural media-based messages humility is typically viewed as being weak and confidence, swagger, and even arrogance is seen as more desirable. Thomas Merton (quoted in part I of this blog series) has a quotation that speaks to the tendency for entire countries to engage in self-superiority. He wrote:

“The greatest sin of the European-Russian-American complex which we call the West (and this sin has spread its own way to China) is not only greed and cruelty, not only moral dishonesty and infidelity to the truth, but above all its unmitigated arrogance toward the rest of the human race.”

It’s crucial for multicultural counselor and psychotherapists to move beyond thinking in terms of competence and tolerance (both of which speak to Merton’s ideas of arrogance). Instead, we need to embrace our fallibilities and humility and approach cultural and individual differences with what Marcia Linehan might call radical acceptance and what Carl Rogers would have referred to as unconditional positive regard.

6.  Keep Making Efforts to Understand a Collectivist Cultural Perspective.

In collectivist cultures, values and norms are shared. The self and the personality are defined in terms of group memberships, and the group needs and values are more central than those of the individual. Some people with collectivist perspectives avoid the whole idea of the concept of self or self-esteem or self-image. Instead, Collectivists tend to evaluate themselves based on attaining group goals.

For lots of us folks who have been deeply involved in American individualism, the idea of collectivism can feel odd and repeatedly difficult to grasp. This is where exposure, discussion, and real listening to others becomes so important. Rather than trample on the idea of collectivist being, we need to persistently take extra steps to maintain awareness of this concept that can be so slippery for individualists to grasp.

To close this blog, in 1975 Robert Hogan wrote,

A central theme in Western European history for about 800 years has been the decline of the medieval synthesis or, alternatively, the emergence of individualism. Two hundred years ago individualism was a moral and religious ideal capable of legitimizing revolutions and inspiriting sober and thoughtful minds. Sometimes in the last century, however, social thinkers began to regard individualism in more ambivalent terms, even in some cases as a possible indicator of social decay. (p. 533)

This is interesting stuff, even if it’s sometimes difficult to completely and consistently understand.

Four Good Ideas about Multicultural Counseling and Psychotherapy—In Honor of Martin Luther King, Jr.

1. Don’t think about multiculturalism as being about tolerance. Instead, approach other cultures with an attitude of “what can I learn?”

The Trappist monk Thomas Merton (1974) wrote about his deep regrets for the ways religious missionaries contributed to cultural genocide. He wondered:

“What would the world be like if different cultures had encountered each other with questions instead of answers? What if the questions went something like these?”

What can you tell me about yourselves?

  • What would you like to know about us?
  • What can you teach me about the Creator?

This same idea forms the foundation of affirmative therapy for GLBTQ clients. Because they’re so used to and sensitive to negative judgments, we should approach GLBTQ clients not only with openness, but with a positive and affirming attitude. When I really think about it, it doesn’t make much sense to approach clients who may be different from us with anything other than a positive and affirming attitude?

 2.  Try to Understand the Implications of White Privilege

As a White male I sometimes have difficulty stretching my neck far enough to be able to see all the White privilege I carry around in my invisible knapsack (see Peggy McIntosh’s 1998 article for more on the Invisible Knapsack). White privilege is defined as the unearned assets associated with being an upper or middle class member of a dominant culture. Although White privilege is often hard to see (because unearned assets are invisible), Prochaska and Norcross provide three darn good examples in the 2010 edition of their psychotherapy theories text. They wrote:

  • · “White privilege is when you can get pregnant at age 17 and everyone is quick to insist that your life and that of your family is a personal matter, and that no one has a right to judge you or your parents, even as Black and Latino families with similar challenges are regularly typified as irresponsible and pathological.”
  • · “White privilege is when you are a gun enthusiast and do not make people immediately scared of you.”
  • · “White privilege is when you can develop a painkiller addiction, having obtained your drug of choice illegally, go on to beat that addiction, and everyone praises you for being so strong, while being an ethnic minority who did the same thing is routinely labeled a drug addict who probably winds up in jail.” (p. 408)

3.  When Counseling, Make Cultural Adaptations

Not long ago it was reported that 50% of diverse clients dropped out of therapy after only one session (S. Sue, 1977). This suggests that it only took one therapy session to convince half of all diverse clients not to return for session number two. This is not very impressive.

To address this and other issues, counselors and psychologists now talk about making cultural adaptations so the therapy experience is more appealing to clients from diverse cultural backgrounds. Several cultural adaptations have proven at least somewhat helpful. Two of the most significant are: (a) Language Matching (Surprise! Clients tend to benefit more when they can do therapy in their native languageJ); and (b) explicit incorporation of cultural content/values into the intervention (Griner & Smith, 2006).

 4. Remember that multicultural counseling is like qualitative research; you may not generalize.

This is one of the puzzling paradoxes associated with multicultural counseling. Of course we should learn as much as we can about other cultures—but, because skin color, ethnicity, sexual orientation, disabilities, and other client characteristics all exist within unique individuals, groups, and communities it’s inappropriate to make assumptions about clients based on knowledge about any of these factors. Just as you would never generalize your findings from eight clients in a phenomenological-qualitative study, you shouldn’t use your knowledge of any “categories” to make generalizations about the person or people in your office.

Related to this, S. Sue and Zane (2009) commented on how, when it comes to multicultural knowledge, a little bit does not go a long ways (and often a large amount of knowledge won’t take you very far either). They wrote:

“. . . cultural knowledge and techniques generated by this knowledge are frequently applied in inappropriate ways. The problem is especially apparent when therapists and others act on insufficient knowledge or overgeneralize what they have learned about culturally dissimilar groups.” (p. 5)

Working cross-culturally or interculturally is both a challenge and a privilege. This is part one of a three-part blog about how we can meet this challenge and honor clients who have diverse characteristics. Thanks for being interested enough in this topic to read this and stretch your multicultural competence.

Happy New Year . . .

Non-Drug Options for Dealing with Depression

                               “When it comes to treating depressive symptoms, there’s no better                     medicine than healthy and loving relationships”

 The following options can be very effective for relieving depression symptoms. Although antidepressant medications are also an option, because they’re so widely marketed only non-drug alternatives are listed and described here.

  1. Psychotherapy – Going to a reputable and licensed mental health professional who offers counseling or psychotherapy for depression can be very helpful. This may include family, couple, or group counseling or therapy.
  2. Vigorous Aerobic Exercise – Consider initiating and maintaining a regular cardiovascular or aerobic exercise schedule. This could involve a referral to a personal trainer and/or local fitness center (e.g., YMCA).
  3. Herbal Remedies – Some individuals benefit from taking herbal supplements. For example, there is evidence that Omega-3 Fatty Acids (Fish oil) can reduce depressive symptoms. It’s good to consult with a health care provider if you’re pursuing this option.
  4. Light Therapy – Some people describe great benefits from light therapy. Information on light therapy boxes is available online and possibly through your physician.
  5. Massage Therapy – Research indicates that massage therapy can relieve depressive symptoms. A referral to a licensed massage therapy professional is advised.
  6. Bibliotherapy – Research indicates that some people benefit from reading and working with self-help books or workbooks. The Feeling Good Handbook (Burns, 1999) and Mind over Mood (Greenberger and Padesky, 1995) are two popular self-help books.
  7. Mild Exercise and Physical/Social Activities – Even if you’re not up to vigorous exercise, you should know that nearly any type of movement has antidepressant effects. These activities could include, but not be limited to yoga, walking, swimming, bowling, hiking, or whatever you can do!
  8. Relationship Enhancement – As suggested by the opening quotation, the most potent medicine available for addressing depressive symptoms is a healthy and loving relationship. You can work on improving relationships in many ways, especially by developing effective communication skills, engaging in mutually enjoyable activities, and making a commitment to behaving in ways that support both your own mental health and that of your partner.
  9. Other Meaningful Activities – Never underestimate the healing power of meaningful activities. Activities could include (a) church or spiritual pursuits; (b) charity work; (c) animal caretaking (adopting a pet); and (d) other activities that might be personally meaningful to you.

 For information about this tip sheet, contact John Sommers-Flanagan, Ph.D. at johnsf44@gmail.com

26 Years with Rita

Today, on our 26th anniversary, we started with a run in Greenwich, CT, followed by massages in Eastchester, NY (thanks Chelsea!), and then found a fabulous Indian restaurant with a buffet lunch. It seemed only right to top all that off with a trip to the Goodwill, but somehow we ended up at the Goodwill store in the Bronx, which was a little frightening. . . if only for the traffic. I parked with one tire on the sidewalk while we scored a children’s book, a clear glass mug, and a 5 pound sweet potato from a street vendor. This particular day was a metaphor for the 26 years; no formal gifts purchased, but an entertaining and sometimes unpredictable adventure . . . which turns out to be the best gift of all.

My 2011 Letter to Santa

Dear Santa.

You’re probably keenly aware of the fact that if you do a good job at small things, people just keep asking you for more. That being the case, this year I’ve got four major gift requests.

First, please do what you can to eliminate human greed. I think greed has outlived its evolutionary usefulness. If you could poof away greed (while at the same time overlooking my greedy wishes), that would be simply awesome.

Second, as long as you’re eliminating human greed, it makes perfect sense for you to also get rid of the human revenge impulse. Like greed, there are so many basic problems with the revenge concept that it’s really just starting to look like a creative design flaw. Please take the revenge gene up to the North Pole and bury it somewhere no one will ever find.

Third, I’d like every child, everywhere, to feel loved, every day. I’d also like all these children to never doubt their parents or caregivers love for them, but that’s just part of gift 3 and not a new request. I know that’s a lot to ask . . . but hey, it’s Christmas and you’re Santa.

Fourth, would you please wipe away the effects of trauma? It’s bad enough that so many people on the planet have experienced rape, war, physical and sexual abuse, natural disasters, and countless other horrible things, but to make matters worse, they also have the added burden of carrying around physical, psychological, and emotional trauma burdens into the future.  Life is hard enough without having to deal with flashbacks, nightmares, and other unpleasant symptoms.

At the risk of being too demanding, I’d like to request that you deliver these gifts to everyone and not just Christians. I know you’re mostly a Christian icon and that conflicts among different religious groups might make universal delivery rather complex, but if you could take care of everyone I would really appreciate it. Basically, I think universal delivery of these gifts would go a long ways towards fostering a sense of fairness and inclusivity.

Please tell Sandra and the elves hello. I miss you.

Love,

John S-F

A Few Facts about Children and Teenagers and Antidepressant Medications

Information about Antidepressant Medications: What Parents and Concerned Adults Should Know

By John Sommers-Flanagan, Ph.D.

Why You Shouldn’t Have Your Sad, Cranky, or Depressed Child Take Antidepressant Meds?

Several million American children and teenagers take antidepressant meds. This use of antidepressants is unjustified. Here’s why:

1.   Commonly used antidepressants (like Prozac, Zoloft, Paxil, Celexa, Cymbalta, etc.) don’t have much scientific support. Much of the research shows that antidepressants are no more effective than a sugar pill for reducing depressive symptoms.

2.   Antidepressants have side effects that include hyperactivity, insomnia, stomach pain, agitation, and increased suicide potential.

3    Sexual side effects are of special concern. For example, most antidepressants delay orgasm and can be used to effectively treat premature ejaculation in males; they also may inhibit orgasm in females. No one knows how these side effects influence sexual development

4.   Several years ago the FDA released a Public Health Advisory warning about increased reports of suicidality in youth who had been treated with antidepressants.

5.   Even psychiatric journals acknowledge that non-drug approaches to treating child and adolescent depression should be used before trying medication treatment.

6.   Generally, adding antidepressant medications to non-drug treatments are no more effective than the non-drug treatments by themselves.

7.   As we all know, life is hard and we all have to face challenging situations—situations that can make us feel sad, angry, and guilty. The problem is that antidepressants don’t teach young people anything about handling difficult emotions and coping with life. As our behavior therapy friends like to say, remember, “a pill is not a skill.”

Why You Should Consider Putting Your Child on Antidepressant Medications?

Here are some reasons you might ask a doctor to prescribe antidepressants to your child.

1.   When other, less risky approaches to dealing with depression, such as exercise, a healthier diet, more time listening and caring about the huge stresses of the teen years, and family assistance coping with life’s joys and disappointments have not provided relief.

2.   When counseling or psychotherapy with a credentialed professional who has a positive reputation working with youth has been tried for at least 10 sessions with no improvement. Studies have shown that counseling or psychotherapy is effective in treating depressed youth and the effects may be maintained after the treatment has ended (in contrast to medications, which often must be continued indefinitely).

3.   Your child is actively suicidal and other options haven’t helped. As strange as it may sound, although newer antidepressants appear to increase suicide risk among non-suicidal youth, they can sometimes reduce suicide risk in youth who are already suicidal.

4.   You, or another parent, have a strong history of depression and that depression was dramatically relieved by an antidepressant drug; if so, it may be reasonable, if your child becomes severely depressed, to begin the same medication. Of course, the medication should be closely monitored and you should make sure you’re not confusing your personal struggles with depression with your child’s unique condition.

5.   For personal reasons, it may be your preference and your child’s preference to try medications. If so, you should proceed with caution and work with a physician with a positive reputation.

This information is provided, in part, to balance most of the promotional advertising generated by pharmaceutical companies. It’s very important for consumers to have access to balanced information. Of course, much more information is available on the internet, but I recommend that you do your best to find balanced informational sources. Pharmaceutical companies tend to overstate antidepressant effectiveness and other organizations may demonize antidepressants. The truth is that antidepressant medications help some young people, but they’re not generally very effective, and they produce disturbing side effects. Choosing whether to have your children or teens take antidepressants is a very difficult decision. This handout is designed to provide you a small amount of information that may be helpful to you as you face this challenging decision.

A Few Favorite Parenting Quotations

I like these comments about parenting. They’re a little longish, but capture some challenges and insights about parenting (John S-F, 2011).

If I wouldn’t want to be slapped across the face, why would I slap my son? If I wouldn’t want to be screamed at when I made a mistake, why would I scream at my daughter when she dropped the cake I had decorated for my mother-in-law? If I wouldn’t want to be ridiculed when I attempted to learn to roller-blade at age 43, why would I ridicule my daughter as she jerked the car out of first gear into second after being shown ten times how to do it smoothly. If I wouldn’t want my gardening skills to be compared with my neighbor’s, why would I compare my son’s math performance with his older sisters’? (Coloroso, 1995, p. 14).

It is usually assumed in our society that people have to be trained for difficult roles; most business firms would not consider turning a sales clerk loose on the customers without some formal training; the armed forces would scarcely send a raw recruit into combat without extensive training; most states now require a course in driver’s education before high school students can acquire a driver’s license. Even dog owners go to school to learn how to treat their pets properly. This is not true of American parents. (E. E. LeMasters, 1977, p. 18)

. . . we have inherited a tradition of discounting children’s feelings simply because children are smaller, less rational, less experienced, and less powerful than the adults around them. Taking children’s emotions seriously requires empathy, keen listening skills, and a willingness to see things from their perspective (Gottman & DeClaire, 1997, p. 31)

. . . it’s not easy to ignore your parental agenda in the face of misbehavior—especially when you can feel the sermon on the tip of your tongue. But moralizing about a misdeed without addressing the feelings behind it is usually ineffective. It’s like putting a cold compress on your child’s fevered brow without treating the infection that’s causing the fever in the first place (Gottman & DeClaire, 1997, p. 115)

We must realize the futility of trying to impose our will upon our children. No amount of punishment will bring about lasting submission. Today’s children are willing to take any amount of punishment in order to assert their “rights.” Confused and bewildered parents mistakenly hope that punishment will eventually bring results, without realizing that they are actually getting nowhere with their methods. . . . The use of punishment only helps the child to develop greater power of resistance and defiance (Dreikurs & Soltz, 1964; pp. 69-70)

I secretly believed that sibling rivalry was something that happened to other people’s children

Somewhere in my brain lay the smug thought that I could outsmart the green monster by never doing any of the obvious things that all the other parents did to make their kids jealous of each other. I’d never compare, never take sides, never play favorites. If both boys knew they were loved equally, there might be a little squabble now and then, but what would they really have to fight about?

Whatever it was they found it. (Faber & Mazlish, 2004, p. 1)

To most people, the premise that the first mental structures created by experience are preserved indefinitely, like a scratch on a table, seems reasonable. But, in fact many early ideas and habits either vanish or undergo such serious transformation that they cannot be retrieved in later life, any more than the first strokes of a seascape can be discerned from the larger scene, once a painting is complete (Kagan, 1998,  p. 3).

. . . never lose sight of the homely – and scientifically supported – truth that a good, warm, mutually respectful relationship with your child makes all the difference (Kazdin, 2008, p. 146)

When Mrs. McCormick held Tim in her lap at the playground, she sat alone on a bench across from the other mothers as if she were ashamed of Tim’s clinging. She knew that if she sat by other mothers, they would all give her advice: “Just put him down and let him cry—he’ll get over it.” “MY little girl was just like that before she finally got used to other kids.” “Get him a play date. He can learn about other children that way.” (Brazelton & Sparrow, 2001, p 8).

Even before I had children, I knew that being a parent was going to be challenging as well as rewarding. But I didn’t really know.

I didn’t know how exhausted it was possible to become, or how clueless it was possible to feel, or how, each time I reached the end of my rope, I would somehow have to find more rope.

I didn’t understand that sometimes when your kids scream so loudly that the neighbors are ready to call the Department of Child Services, it’s because you’ve served the wrong shape of pasta for dinner.

I didn’t realize that those deep-breathing exercises mothers are taught in natural-childbirth class don’t really start to pay off until long after the child is out. (Kohn, 2005, p. 1).

No one is more susceptible to an expert’s fear mongering than a parent. Fear is in fact a major component of the act of parenting. A parent, after all, is the steward of another creature’s life, a creature who in the beginning is more helpless than the newborn of nearly any other species. This leads a lot of parents to spend a lot of their parenting energy simply being scared (Levitt & Dubner, 2005, p. 149)

Before my children were born, I was convinced that I would be patient, kind, and nurturing—the quintessential earth mother. But I failed to live up to the ideal mother image that I had pictured for myself. I was daunted by the enormous gulf between the perfect parent that I wanted to be and the flawed parent that I actually was. Since then, I have learned that such feelings are quite common. Scratch any parent, and you’ll find guilt. It’s lurking just beneath the surface, ready to spring out when we lose patience with our children, fail to make them happy, feel resentful of their demands, or believe that when they misbehave its’ all our fault. (Samalin, 2003, p. 265).

A well-educated, cultured man and his wife beat their own child with a birch rod, a girl of seven. I have an account of it. The father was glad that the birch was covered with twigs. ‘It stings more,’ said he, and so he began stinging his daughter. . . . They beat for a minute, for five minutes, for ten minutes, more often and more savagely. The child screams. At last the child cannot scream, it gasps, ‘Daddy! daddy!’ (Dostoyevksy, Fyodor; The Brothers Karamozov, 1881/1957,  p. 234)

“Have Phillip come down after school and I’ll give him a bottle of Show-off Powder. For the next few days sprinkle a little on him before meals, especially when you are having company, and just before he leaves for school in the morning. I’m sure you won’t have any more trouble.”

“But what is this show-off powder? Will it hurt Phillip? Asked Mrs. Carmody fearfully.

“Show-off powder is guaranteed to be harmless,” said Mrs. Piggle-Wiggle. “But it will stop showing off. You see it makes the showing-off invisible>”

“Invisible!” wailed Phillip’s mother. “You mean I won’t be able to see my own little boy?”

“Not when he’s showing off,” said Mrs. Piggle-Wiggle matter-of-factly. “Nobody will be able to see him. But when he stops showing off and is normal he’ll come back into focus.” (MacDonald, 1957, p. 16).