Tag Archives: culture

Clinical Interviewing, Suicide Assessment and Intervention, Uncategorized

A Strengths-Based Approach to Suicide Assessment & Treatment with a Particular Focus on Marginalized Client Populations

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Early this morning, I had a chance to Zoom in and present a workshop for Saint Michael’s College in Vermont. This was probably a good thing, because they had more than their share of snow to deal with. I got to be in Vermont virtually from beautiful Missoula Montana, where we’ve had spring most of winter. I wish we could borrow a few feet of that Vermont snow to get us up to something close to normal.

But my point is to share my ppts from this morning, and not talk about the weather. I had a great two hours with the Saint Michael’s professionals . . . as they posed excellent and nuanced questions and made insightful comments. Here’s a link to the ppts:

traditional-and-sb-assessment-for-2024Download
Happiness, Love, Multicultural, Personal Reflections, Writing

Love One Another

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Last week I was dancing and singing in India at my nephew’s wedding. This week I’m jet-lagged in Missoula. But the afterglow continues.

Being at a wedding, it was hard not to think of my mother. She loved weddings and always wished for everyone to find love.

My sisters had similar thoughts. We reminisced and projected my mother into the scene of my nephew marrying an Asian Indian woman in a Hindu ceremony. We wished she could pop back into the world and join in.

Mostly, my mother was shy and insecure. She didn’t learn to drive until age 34. I often wished she had more confidence.

But there was one place where my mom found her voice, early and often. For mysterious and obvious reasons, she became anti-racist in the 1950s, before anti-racism was a thing. She delighted in visits from my father’s Japanese friend, Carl Tanaka. When a Black family moved onto our all-White dead-end suburban street, she was the first to greet them with welcome gifts. She then sat my sisters and I down, and told us with piercing clarity that we would ALWAYS treat every member of that family with nothing but respect and kindness. They quickly became our friends. I have great memories of hanging out with my friend Darrell, who was the closest to me in age and in school.

What I didn’t understand about my mom’s anti-racism—until last week—was that she also had a solution. My sisters told me that my mother’s favorite solution to all that ails the world was inter-racial, inter-cultural, and inter-religion marriage. Of course, I’m not naïve enough to think that any single strategy could solve racism, but last week, during a three-day Hindu marriage ceremony, I returned home transformed and preoccupied with the idea that we can and should love one another.

The internet tells me that love one another has Christian Biblical origins . . . and more. Here’s an excerpt from a site that discusses “love of neighbor” in Hinduism.

Love of the neighbor or the “other soul” is a fundamental requirement for a functioning Hindu who aspires for final liberation from this world. Any injury or insult inflicted upon the other soul is ultimately injury inflicted on oneself—or worse still, the higher being. Neighborly love is integral for one’s social existence in this world. The Anusana Parva (113:8) in Mahabharata encapsulates this wisdom and dictates that one should be unselfish and not behave toward others in a way that is disagreeable to oneself. [From: http://what-when-how.com/love-in-world-religions/love-of-neighbor-in-hinduism/]

The facts were that Stephen Klein married Sahana Kumar last week, in a beautiful coastal setting just south of Chennai, India.

In a marvelous stroke of luck, I happen to be Gayle Klein’s brother and Stephen’s Uncle John. Along with the dancing singing (which I may have overdone), I was completely taken by the intercultural love and acceptance. The Kumar family welcomed Stephen and all of us to be with them not only in the celebration, but in relationship. At the Sangeet, we were invited to dance a Bollywood and a Hollywood dance. We were terrible AND we were completely accepted. To be immersed in another culture, to learn about Hinduism, to experience glimpses of the Southern Indian cultural ways of being . . . was AMAZING.

In love and in relationship, we often fall short. It’s hard to love our politically different family members. It’s hard to love when we feel annoyed. Sometimes, as I heard the famous Julie and John Gottman say, it’s even hard to find the time and timing to love our romantic partners. But love is big and, thanks to my sisters and Stephen, Sahana, and the Kumars, I understand love a little better this week. The intent to love people who are different than us; the invitation to be in relationship across cultures and generations; the desire to be as loving as we can be . . . those are the ways of being my mom might be shouting from the heavens.   

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

Cultural Specificity and Universality: An Indigenous Example

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These days mostly we tend to orient toward the culturally specific, and that’s a good thing. Much of intersectionality, cultural competency, and cultural humility is all about drilling down into unique and valuable cultural and individual perspectives.

But these are also the days of Both-And.

In contrast to cultural specificity, some theorists—I’m thinking of William Glasser right now—were more known for their emphasis on cultural universality. Glasser contended that his five basic human needs were culturally universal; those needs included: Survival, belonging, power (recognition), freedom, and fun.

Although Glasser’s ideas may (or may not) have universal punch, he’s a white guy, and pushing universality from positions of white privilege are, at this particular point in history, worth questioning. That’s why I was happy to find an indigenous voice emphasizing universal ideas.

I came across a quotation from a Lakota elder, James Clairmont; he was discussing the concept of resilience, from his particular linguistic perspective:

The closest translation of “resilience” is a sacred word that means “resistance” . . . resisting bad thoughts, bad behaviors. We accept what life gives us, good and bad, as gifts from the Creator. We try to get through hard times, stressful times, with a good heart. The gift [of adversity] is the lesson we learn from overcoming it.

Clairmont’s description of “the sacred word that means resilience” are strikingly similar to several contemporary ideas in counseling and psychotherapy practice.

  • “Resisting bad thoughts, bad behaviors” is closely linked to CBT
  • “We accept what life gives us, good and bad, as gifts from the Creator” fits well with mindfulness
  • “We try to get through hard times, stressful times, with a good heart” is consistent with optimism concepts in positive psychology
  • “The gift [of adversity] is the lesson we learn from overcoming it” and this is a great paraphrase of Bandura’s feedback and feed-forward ideas

In these days of cultural specificity, it makes sense to work from both perspectives. We need to recognize and value our unique differences, while simultaneously noticing our similarities and areas of convergence. Clairmont’s perspectives on resilience make me want to learn more about Lakota ideas, both how they’re similar and different from my own cultural and educational experiences.

Personal Reflections, Suicide Assessment and Intervention

Why We Need to Empower the Oppressed and Maximize the Marginalized: Contextual Factors and Suicidal Ideation

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In this blog I often focus on factors that contribute to suicidal thinking and suicidal actions. One theme I repeatedly emphasize (and Rita and I hammer away at in our suicide book), is that suicidal thoughts are often natural and normal human responses to difficult or distressing life circumstances. When painful and disturbing things happen outside of the self, it’s not unusual (and not abnormal) for individuals to feel the pain and then notice suicidal thoughts popping into their minds.

Another theme we repeat is the post-modern, constructive method of linguistically moving personal distress outside of the self. Moving personal distress outside of the self is useful because it allows mental health and school professionals to join with clients and students to strategize on how to cope with or reduce the painful distress contributing to suicidal thoughts and impulses.

Ongoing events, including, but not limited to, the death of George Floyd in Minnesota, abduction and murder of indigenous women in Montana, hateful targeting of Asian people around the U.S., and this week’s murders of Asian women in Georgia, are all stark reminders of how events external to the self can reverberate and cause immense feelings of helplessness and hopelessness within people vulnerable to systemic oppression. Even in cases where specific individuals have not been directly or explicitly threatened, if they identify with victims (which is a perfectly normal human phenomenon), they can experience deep emotional and psychological distress. Although many factors can add to the distress people feel around racism, cultural oppression, and an unsafe dominant culture, in particular, feeling helpless to enact change and hopeless that positive change will ever occur, adds substantially to what we’ve intellectually labeled in our book as “Contextual distress.” Addressing contextual distress requires, at minimum, that oppressed people are empowered to contribute to positive change and hopeful that positive changes can and will occur.

In the film, Good Will Hunting, Robin Williams (the therapist) repeatedly tells Matt Damon (the client) that the abuse he experienced is not his fault. Although I’m not a big fan of the therapeutic methods that Robin Williams employs in the film, the message is salient, powerful, and important: “It’s not your fault!”

“It’s not your fault” is also salient for Asian, Black, Indigenous, and other oppressed minority populations. The “fault” is within the dominant U.S. culture. Nevertheless, minority populations may feel internal distress and desperation . . . and sometimes they’ll feel so helpless and hopeless that they also naturally experience thoughts related to suicide. Again, the core messages we need to offer as egalitarian allies include: “How can we empower you?” and “How can we help our whole society feel more hopeful about creating a new dominant culture that includes honoring, equity, and safety for all minority groups?”  

Because it’s relavant to this topic, and how often society and individuals blame people for being oppressed, below, I’m including a short excerpt from our suicide book. This excerpt comes from Chapter 10, where we explore larger contextual factors that can and do contribute to suicidal thoughts and behaviors. I know my approach here is intellectual and clinical, but I also hope to convey the need to address the palpable fear and oppression that’s happening in far too many places within American society.

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    The purpose of depathologizing suicide and externalizing suicide-related problems is not to relieve individuals of personal responsibility. Instead, depathologizing and externalizing are social constructionist tools to alleviate shame; these tools also allow clients to gain enough psychological distance from their problems or symptoms to view them as workable. When depathologizing and externalizing work well, clients feel uplifted and inspired to participate even harder the battle against the internal and external stressors contributing to their suicidal state.

In this chapter, it seems odd that we would need to mention that contextual factors driving suicide can originate outside of the self. However, society tends to blame individuals for their oppressive living conditions or stressful life circumstances. Surely, the narrative goes . . . people living in poverty or drinking lead-laced water in Flint, Michigan, must be lazy, criminal, or somehow defective, otherwise they would lifted themselves up by their bootstraps and profited from the American dream. Of course, this narrative is false. In fact, as we think about the depth and breadth of contextual factors that contribute to suicide, we recall the words of Cassius in Shakespeare’s Julius Caesar: “The fault, dear Brutus, is not in the stars, but in ourselves.” As we look at the 7th dimension, this message is flipped, “The fault, dear Brutus, is not in ourselves, but in our stars” (or systemic socioeconomic disparity, racial inequality, and oppression).  (Sommers-Flanagan & Sommers-Flanagan, 2021, p. 236)

For information on the book, Suicide Assessment and Treatment Planning: A Strengths-Based Approach, go to: https://imis.counseling.org/store/detail.aspx?id=78174

Counseling and Psychotherapy Theory and Practice, Multicultural, Personal Reflections

Integrating Multicultural Sensitivity into CBT

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Woman Statue

A question and brief discussion on Twitter about integrating multicultural competence into CBT inspired me to look back and see what the heck we wrote for that section in our theories text. In the Twitter discussion, we agreed that Pam Hays’s work on CBT and multicultural content is good.

Here’s what I found in our theories text. Obviously it’s a short section and limited, but there are a few interesting points and a citation or two.

Cultural and Diversity Considerations in CBT

CBT focuses on symptoms as manifest within individuals. This position can be (and is) sometimes viewed as disregarding important culture, gender, and sexual diversity issues. For most cognitive-behavioral therapists, culture, gender, and sexuality aren’t primary factors that drive successful outcomes.

This position is a two-edged sword. In the featured case (in Chapter 8), Richard is a white male living a life squarely in the middle of the dominant culture. The therapist was committed to Richard’s well-being. If the client had been an Asian Indian or a bisexual or a woman experiencing domestic abuse the cognitive-behavioral therapist would have been equally committed to the client’s well-being. This is the positive side of CBT being less diversity-oriented.

The negative side is that CBT can be viewed and experienced as blaming clients for their symptoms, when the symptoms may be a function of diversity bias. D. Dobson and K. S. Dobson (2009) articulated the potential for clients to experience blame,

By virtue of looking for distorted thoughts, cognitive-behavioral therapists are more likely than other therapists to find them. Furthermore, some clients do react to the terms distorted, irrational, or dysfunctional thinking. We have heard clients say something to the effect—” Not only do I feel bad, but now I’ve learned that my thoughts are all wrong.” (p. 252)

Awareness of the possibility of client blaming is crucial. For example, what if Richard were a Black American male? And what if his therapist noticed that Richard’s thought record included numerous personalization examples? If so, instead of concluding that Richard is displaying oversensitivity and paranoid cognitions, his therapist should explore the possibility of microaggressions in Richard’s daily life.

The term microaggression was coined by Chester Pierce (1978). Microaggressions were originally defined as “the everyday subtle and often automatic ‘put-downs’ and insults directed toward Black Americans” but now this is expanded so they “can be expressed toward any marginalized group in our society” (Sue, 2010, p. 5).

Microaggressions are typically unconscious. For example, we had a female client come to us in great distress because her vocational instructor had told her “You’re pretty strong for a girl.” Although the vocational instructor defended his “compliment,” the young woman clearly didn’t experience the statement as a compliment. In this circumstance if a therapist is insensitive to culture and gender issues, the young woman might feel blamed for having irrational thoughts and overreactive behaviors. Sue (2010) recommends that mental health professionals exercise vigilance to address microaggression issues inside and outside of counseling. One way in which cognitive behavioral practitioners have addressed the potential for committing microaggressions against sexually diverse clients is by using LGBTQ affirmative CBT (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015).

Returning to racial/cultural microaggressions, let’s briefly pretend that Richard is a 6′7′′ Black American male. In his thought record he notes:

Situation: Walking into the local grocery store. Young female makes eye contact with me and then quickly turns around and goes back and locks her car.

Thoughts: She thinks I’m going to steal her car.

Emotions: Anger.

Behavior: I act rude toward her and toward other white people I see in the store.

If the Black American version of Richard has a therapist who looks at this thought record and then talks with Richard about the distorted thinking style of mind-reading (“Richard, you didn’t really know what she was thinking, did you?”) this therapist is showing cultural insensitivity and will likely be fired by Richard. This is an example of one of the many growing edges CBT should address with respect to women and minority clients.

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As always, your reactions to this content are welcome.

 

Counseling and Psychotherapy Theory and Practice

Breathing New Life into Your Dead, White Counseling and Psychotherapy Theories Course

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IMG-4449

Artwork by Rita Sommers-Flanagan**

On April 18 at 1:00p.m. EST, I’ll be doing a Wiley Webinar. This webinar is free, and especially geared toward academics who want to expand their repertoire for teaching counseling and psychotherapy theories. Because this webinar is sponsored by my publisher, John Wiley & Sons, there will be some minor marketing of my textbook, Counseling and Psychotherapy Theories in Context and Practice (3rd ed.). However, you can attend this webinar regardless of the textbook you use. My goal is to help open all of us up to how we can integrate new ideas into existing “older” theoretical perspectives.

Here’s the link to register: https://www.wileyplus.com/wiley-webinar-series/#john-sommers-flanagan

And here’s the official blurb for the webinar:

Teaching traditional counseling and psychotherapy theories courses can feel dull and boring. In this webinar session, John Sommers-Flanagan will share pedagogical strategies for integrating culture into theory, and engaging students with here-now activities that bring the dusty old theories to life. This webinar will include specific recommendations for how to integrate culture and feminist ideas into traditional theories. Learning activities will be demonstrated, including: (a) early intercultural memories; (b) sex, feminism, and psychoanalytic defense mechanisms; (c) empowered narrative storytelling; and (d) spiritual and behavioral forms of relaxation. Handouts for each activity will be available later on this blogsite.

Beyond this short description, I also want to acknowledge the obvious. As a living White person who writes about, teaches, and practices theory-based counseling and psychotherapy, I know that my ability to claim expertise in making cultural adaptations is limited. I don’t want to be the expert on this (or most things). The purpose of this webinar is NOT to “tell” anyone exactly what diversity modifications “should” be made when teaching counseling and psychotherapy theories. Instead, my purpose is to talk about and illustrate ways in which new diversity-sensitive ideas might be creatively integrated into old theoretical perspectives. From there . . . the application of these and your own ideas about how to breathe new life into old theories is up to you and your unique personal and professional worldview.

Given this big preceding caveat, the webinar’s learner objectives are to help participants:

  • Identify compatibilities of culture, spirituality, and feminist thought with traditional counseling and psychotherapy theories
  • Implement an intercultural memory activity with large or small groups
  • Implement and discuss diverse sexualities along with psychoanalytic defense mechanisms
  • Implement a multicultural empowered storytelling strategy
  • Implement and debrief spiritual and behavioral integrations to achieve relaxation

Soon (right around 4/18/19) I’ll be posting more information related to this webinar. In the meantime, let me know your thoughts on this topic. As always, I value alternative perspectives and enjoy hearing your reactions to the posts on this blog.

Multicultural, Parenting

Working with Parents Across Cultures

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This morning I have the honor and privilege to present an ACA Education session on working with culturally diverse parents. Part of the presentation is business as usual. Sara Polanchek and I will take turns talking about some of the ways in which we work with parents. This content is mostly linked to the “How to Listen so Parents will Talk and Talk so Parents will Listen” book.

But what’s exciting this morning is that two of our U of Montana doc students will intermittently offer cultural commentary on how to work with parents who are culturally diverse. Maegan Rides At The Door and Salena Beaumont Hill are the doc student co-presenters. I have already learned much from them . . . and will be learning more this morning. To share the learning, the powerpoints are here: ACA Parenting 2018 REV #274

Boys and Men, Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Personal Reflections

Cleavage, Revisited

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It’s revision time for the Clinical Interviewing textbook (the 6th edition is coming). Revision time also means revisiting time. About three years ago I posted a new proposed section for the 5th edition cleverly titled, “Straight Talk about Cleavage.”

This time around I’m posting our slightly revised version of that section. What’s new is that I’m explicitly asking and hoping for your comments and feedback. Please note that this makes me nervous, but we (Rita and I) hope your comments and feedback will help us provide more perspective and depth to our discussion. We don’t want to come across as old fogeys or rabid feminists. Instead, we want to be reasonable, thoughtful, and balanced . . . and so we’re turning to YOU.

The section is below. You can post comments directly here at Word Press for all to see or email me privately at john.sf@mso.umt.edu.

Straight Talk about Cleavage

Although we don’t have any solid scientific data upon which to base this statement, our best guess is that most of the time most people on the planet don’t engage in open conversations about cleavage. Our goal in this section is to break that norm and to encourage you to break it along with us. To start, we should confess that the whole idea of us bringing up this topic (in writing or in person) and saying something like, “Okay, we need to have a serious talk about cleavage” makes us feel terribly old. But we also hope this choice might reflect the wisdom and perspective that comes with aging.

In recent years we’ve noticed a greater tendency for female counseling and psychology students (especially younger females) to dress in ways that might be viewed as somewhat provocative. This includes, but is not limited to, low necklines that show considerable cleavage. Among other issues, cleavage and clothing were discussed in a series of postings on the Counselor Education and Supervision (CES) listserv back in 2012. The CES discussion inspired many of the following statements that follow. Please read these bulleted statements and consider discussing them as an educational activity.

  • Female (and male) students have the right to express themselves via how they dress.
  • Commenting on how women dress and making specific recommendations may be viewed as sexist or inappropriately limiting.
  • It’s true that women should be able to dress any way they want.
  • It’s also true that agencies and institutions have some rights to establish dress codes regarding how their paid employees and volunteers dress.
  • Despite egalitarian and feminist efforts to free women from the shackles of a patriarchal society, how women dress is still interpreted as having certain socially constructed messages that often, but not always, pertain to sex and sexuality.
  • Although efforts to change socially constructed ideas about women dressing “sexy” can include activities like campus “slut-walks,” a counseling or psychotherapy session is probably not the appropriate venue for initiating a discourse on social and feminist change.
  • For better or worse, it’s a fact that both middle-school males and middle-aged men (and many “populations” in between) are likely to be distracted—and their ability to profit from a counseling experience may be compromised—if they have a close up view of their therapist’s breasts.
  • At the very least, we think excessive cleavage (please don’t ask us to define this phrase) is less likely to contribute to positive therapy outcomes and more likely to stimulate sexual fantasies—which we believe is probably contrary to the goals of most therapists.
  • It may be useful to have young women (and men) watch themselves on video from the viewpoint of a client (of either sex) that might feel attracted to them and then discuss how to manage sexual attraction that might occur during therapy.

Obviously, we don’t have perfect or absolute answers to the question of cleavage during a clinical interview. Guidelines depend, in part, on interview setting and specific client populations. At the very least, we recommend you take time to think about this dimension of professional attire and hope you’ll openly discuss cleavage and related issues with fellow students, colleagues, and supervisors.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

DSM-5 and the Universal Diagnostic Exclusion Criteria

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Sometimes, even when someone appears to meet all the diagnostic criteria for a mental disorder, assigning a psychiatric diagnosis is still not the right thing to do.

In the following excerpt from the forthcoming 5th edition of Clinical Interviewing, we offer an example of when and why psychiatric diagnosis is inappropriate (see: http://lp.wileypub.com/SommersFlanagan/). We refer to this as the “Three-Dimensional Universal Exclusion Criterion” which is our highly esoteric way of saying, “Whoa on psychiatric diagnosis until you’ve checked to see if there’s an alternative explanation for the observed behaviors!”

Multicultural Highlight 6.2

The Three-Dimensional Universal Exclusion Criterion: Is the Behavior Rationally or Culturally Justifiable or Caused by a Medical Condition?

Let’s say you meet with a client for an initial interview. During the interview the client describes an unusual belief (e.g., she believes she is possessed because someone has given her the “evil eye”). This belief is clearly dysfunctional or maladaptive because it has caused her to stop going out of her house due to fears that an evil spirit will overtake her and she will lose control in public. She also acknowledges substantial distress and her staying-at-home-and-being-anxious behavior is disturbing her family. In this case it appears you’ve got a solid diagnostic trifecta—her belief-behavior is (a) maladaptive, (b) distressing, and (c) disturbing to others. How could you conclude anything other than that she’s suffering from a psychiatric disorder?

This situation illustrates why diagnosis (see Chapter 10) is a fascinating part of mental health work. In fact, if the client has a rational justification for her belief-behavior . . . or if there’s a reasonable cultural explanation . . . or if the belief-behavior is caused by a medical condition—then it would be inappropriate to conclude that she has a mental disorder. One source of support for a universal exclusion criterion is the DSM-5. It includes the statement: “The level of severity and meaning of the distressing experiences should be assessed in relation to the norms of the individual’s cultural reference groups” (American Psychiatric Association, 2013, p. 750).

To explore our three-dimensional “universal” exclusion principle in greater depth, partner up with one or more classmates and discuss the following questions:

Can you think of any rational explanations for the client’s belief-behavior?

Can you think of any reasonable cultural explanations for the client’s belief-behavior?

Can you think of any underlying medical conditions that might explain her belief-behavior?

After you’ve finished discussing the preceding questions, see how many new examples you can think of where a client presents with symptoms that are (a) dysfunctional/maladaptive, (b) distressing, and (c) disturbing to others. Then discuss potential rational explanations, cultural explanations, and medical conditions that could produce the symptoms (e.g., you could even use something as simple as major depressive symptoms and explore how rational, cultural, or medical explanations might account for the symptoms, thereby causing you to defer the diagnosis.

 

Counseling and Psychotherapy Theory and Practice, Parenting

Practicing Cultural Humility with Parents

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Alfred Adler (1958) claimed that every child is born into a new and different family. He believed that with every additional member, family dynamics automatically shift and therefore a new family is born (J. Sommers-Flanagan & Sommers-Flanagan, 2004a). If we extend Adler’s thinking into the cultural domain, it might be appropriate to conclude: “Every family is born into a new and different culture.”

[This is an excerpt from “How to Listen so Parents will Talk and Talk so Parents will Listen.” It’s at: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_5?ie=UTF8&qid=1369460232&sr=1-5%5D

To be sure, culture is not a static condition; it’s a malleable and powerfully influential force in the lives of parents and children. Vargas (2004) stated,

“Culture is not about outcome. Culture is an ever-changing process.  One cannot get a firm grip of it just as one cannot get a good grasp of water.  As an educator, what I try to do is to teach about the process of culture—how we will never obtain enough cultural content, how important it is to understand the cultural context in which we are working, and how crucial it is to understand our role in the interactions with the people with whom we want to work or the communities in which we seek to intervene. . . .  I do not want to enter the intervention arena (whether in family therapy or in implementing a community-based intervention) as an “expert” who has the answers and knows what needs to be done.  I am not a conquistador, intent on supplanting my culture on others.  I have a certain expertise that, when connected with the knowledge and experience of my clients, can be helpful and meaningful to my clients.” (p. 429)

In part, Vargas was making the point that it’s more important for professionals to practice cultural humility than it is to view ourselves as culturally competent.

A Cultural Dialectic

All professionals should strive to be culturally sensitive and humble, seeking to respect and prize human diversity for the richness, variety, and surprises it brings to life.  But while embracing culture, it’s important to acknowledge that there’s no perfect culture, and sometimes cultural practices need to change or evolve for the sake of a given child, parent, or family.  Therefore, although we value divergent cultural perspectives, it’s also reasonable  to question whether specific cultural beliefs and rituals are useful or healthy to individuals, families, and communities. This is a cultural dialectic—similar to the radical acceptance dialectic discussed in Chapter 1.

When working with parents, it’s the professional’s job to do the cultural accepting and the parents’ job to do the cultural questioning. You should accept the parents’ cultural background, heritage, and parenting practices. However, if in the process of examining cultural influences on parenting, parents take the lead in questioning their culturally influenced parenting practices, you can and should remain open to helping parents push against cultural forces to make positive changes. For example, parents may want to discuss any of the following topics with you:

  • Whether or not to have their infant son circumcised
  • Their daughter’s body-image issues as they relate to American cultural values toward thinness
  • Whether it’s acceptable for their Muslim daughter to attend school or pursue higher education
  • Traditional Native American values and their children’s potential tobacco use

Helping parents determine whether their own cultural values clash with individual and/or family well-being is a delicate and potentially explosive process.  The challenge is to remain relatively neutral while helping parents evaluate cultural practices using their own parent-child-family health and well-being standards.

Case: Tobacco, Culture, and Addiction

Parent: I’m worried about my son and whether he’s started smoking. I use tobacco, in traditional Indian ceremonies, but I usually end up smoking more than I want to, and I see it as a bad habit, too. I’m not sure how to approach this with him because I don’t want to be a hypocrite.

Consultant: Tell me some ideas you’ve had, from your cultural perspective, about how to get the message you want to get to your son.

Parent: I want him to know that tobacco use should beceremonial or sacred, even though I use it more often than that. I know regular smoking is very unhealthy and so I don’t want him to have it as a habit, but I don’t know how to tell him that.

Consultant: If you think about someone from your tribe whom you really respect, how do you think that person would handle it?

Parent: In my tribe it’s really important to respect your elders. I’m my son’s mother and he should respect me, but you know how that goes. Maybe if I asked someone else, someone older and with even more respect than me, maybe that would help.

Consultant: Whom would you pick to help you talk with your son about this?

Parent: My older brother, his uncle, is pretty high up in the Tribal Government and maybe I could ask him to tell my son it would be better not to smoke, even though lots of Indian people smoke.

Consultant: Do you think your brother would be willing to give your son that message?

Parent: Yes. He’s traditional in some ways, but he’s very much against all smoking and drinking.

Consultant: You and your brother are both right about the dangers of regular tobacco use. As I imagine this discussion, I can see the two of you having a big impact on your son. But I guess there’s also the issue of your smoking and your son’s knowledge of that. Can you have your brother talk about that with your son, too? Or maybe both of you should do this together. How do you think this might work best?

In this case example, for the most part, the consultant is remaining neutral and respectful of the parent’s cultural traditions and yet, at the same time, helping her explore how to get her son a strong and clear message about not smoking tobacco.

Following the Parents’ Lead in Cultural Identity and Cultural Understanding

For most of us, culture is so deeply woven into our lives that it travels below awareness. From time to time we may glimpse it and wonder how it came to be that we choose to engage in specific cultural behaviors, such as:

  • Sitting on the couch with our children watching The Simpsons
  • Getting eggs from the store rather than directly from backyard chickens
  • Going to church on Palm Sunday where a processional, complete with a donkey, waits quietly in the sanctuary
  • Deferring to one’s husband
  • Expecting our oldest son to take care of us
  • Gathering with friends to overeat and watch the Super Bowl
  • Wearing a yarmulke, burkha, or other garments or pieces of cloth to cover our bodies or heads

Culture carries with it many questions, answers, and mysteries. As you can see from the preceding list, culture is ubiquitous; it’s impossible to escape its influence. It’s also impossible to accurately judge someone else’s cultural identity on the basis of physical appearance or initial impressions (Hays, 2008).

When working with parents, you shouldn’t assume parents’ cultural attitudes and experiences in advance. This is true no matter how similar or dissimilar to you the parents appear.  It’s best to begin with a clearly stated attitude of openness and then follow the parents’ lead.

Consultant: So, you grew up in Malawi?

Parent: Yes. I came to the United States when I was twenty-four.

Consultant: I don’t know how much of your Malawi tradition influences your parenting and so I hope it will be okay with you if, on occasion, I ask you about that.

Parent:  That’s no problem at all.

Consultant: And, as we talk, I hope you’ll feel free to tell me about anything that comes up or seems important about your particular cultural approach to parenting.

Parent: Yes. I’m comfortable with that.

Whether the parent is Laotian, Belizean, Argentine, French Canadian, or from any other cultural tradition, you should remain open to his or her particular and potentially diverse parenting approaches. However, you should also be open to helping parents question whether their own approaches to parenting are bringing them the results they desire. This is your professional duty. Again, the basic principle is to follow the parents’ lead in questioning cultural parenting practices and not become a cultural conquistador who tells all parents the one right way to be a parent.