Tag Archives: culture

Working with Parents Across Cultures

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

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Cleavage, Revisited

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.

DSM-5 and the Universal Diagnostic Exclusion Criteria

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.

 

Practicing Cultural Humility with Parents

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.

The White Privilege Piece for the Montana Psychological Association

Michael Smerconish did a feature on White Privilege today on CNN. It was excellent and reminded me of this piece I’d written on White Privilege about 4 years ago. Check it out if you like this sort of thing.

A White, Male Psychologist Reflects on White Privilege

I’m a white male writing about white privilege. This irony makes the task all the more challenging.

Gyda Swaney asked if I would write this piece. This brings me mixed feelings. I am honored. I met Gyda in 1981 and I like and respect her as a person and as a Native American leader in Montana. But the fact that she thinks I might have something useful to say to psychologists about white privilege is humbling. Rarely have I been asked to write about something I know so well and understand so little.

On Invisibility

The challenge begins with the definition. White privilege is defined as an “invisible package of unearned assets” (see McIntosh, 1988 or 2001 for more on this).

As a white, male, psychologist, and university professor, I’m pretty much a white privilege poster boy. Consequently, white privilege, by definition, is generally invisible to me . . . although I do occasionally glimpse it from the corner of my eye or notice its shadow if I sneak up on it when it’s not looking. In fact I think I just saw it – as evidenced by my certainty that I can write a sentence as silly as this last one and get it published in the Montana Psych Association Newsletter.

Like most things invisible (think UFOs, Harry Potter with his invisibility cloak on, ghosts) white privilege is problematic and controversial. This is because white privilege is not always invisible; it’s selectively invisible. It’s obvious to many (e.g., oppressed minorities), but beyond the awareness of those who are busily experiencing the luxury of their unearned assets.

Common Responses to White Privilege

This brings up what may be the most fascinating and disturbing component of white privilege: When the idea of white privilege is brought to the attention of those to whom it’s invisible, it typically evokes a response of defensiveness combined with anger, hostility, outrage, and occasionally guilt. And as we know from our work in psychology, dealing with people who are feeling angry, hostile, outraged, and guilty is very difficult.

There’s something about white privilege that has the potential to make everyone angry.

Personal Reflections

Although White privilege precedes me and I hold no responsibility for its origins, I was born into it and have lived with it every day for nearly 55 years. Even my birth, characterized by greater-than-equal access to healthcare, is an example of my white privilege.

Maybe that’s a phrase that captures much of the white privilege experience—greater-than-equal. My whiteness and the whiteness of most Montana psychologists affords us greater-than-equal treatment, greater-than-equal power, greater-than-equal access, and greater-than-equal perceptions of ourselves. But privilege is complicated . . . and so it’s possible that we also have a greater-than-equal means of denying our privilege.

Privilege grows in complexity when we look at all the different factors that contribute to a more privileged status in one person and a less privileged status in others. My wife consistently reminds me of my male privileged status and although I’m inclined to deny this along with my white privilege, I know better. I was born male and being born male is like being dealt an ace as your first card in a round of Texas Hold-Em. In most cultures it’s clear that to be male is to be superior. That’s the case even though, as most males know, being handed an expectation of superiority isn’t always comfortable or easy. Paradoxically or dialectically, being a white male cuts both ways and isn’t only an unearned asset or gift, it’s also an unearned burden. It’s a burden like having to carry too many gold coins and diamonds to the bank. The weight of gold hurts your back and the diamonds cut your hands, but it’s ridiculous to complain about the fact that you have to carry a treasure to the bank.

Solutions

There are no easy ways to make white privilege quickly materialize and become visible. The resistance and pain associated with being told: “You’ve got unearned assets” is natural, partly because most people hold the perception that they’ve worked very hard to get what they deserve. Here’s a short list of ideas:

  • Teaching and learning about Peggy McIntosh’s Invisible Knapsack is a good place to start. One of the items from her knapsack is:

“I can swear, or dress in secondhand clothes, or not answer letters, without having people attribute these choices to the bad morals, poverty, or illiteracy of my race.”

  • Damn. That’s a nice privilege.
  • Teaching and learning about white privilege can be dangerous and so courage is another important factor in dealing with white privilege. Boatright-Horowitz and Soeung (2009) titled their commentary in the American Psychologist, “Teaching White Privilege to White Students Can Mean Saying Good-bye to Positive Student Evaluations.” When I recently posted about white privilege on my blog, I received one response that was so rabidly irrational it was frightening. Speaking out against the status quo always risks blowback.
  • A big part of the solution is to stop clinging to ideas about white superiority and instead, openly embrace and value the lessons we learn from other cultures. We should actively seek out other cultural perspectives. That isn’t about making the other culture better than ours . . . it just places it on the same, equal cultural footing where it belongs.
  • It’s also important to work on calming our anxiety over displacement from the top of the economic and power pyramid. We all get displaced someday; denying reality is dysfunctional. Actively sharing power along with values of egalitarian personal and community relationships is functional. This is part of the very important personal and communal work we need to do.

In closing, I’m painfully aware that I write this short column from a position of unearned privilege in a cabin on former Crow country on the beautiful Stillwater River; thank you Gyda Swaney, for handing me this challenge and opportunity.

*********************************************************************

John Sommers-Flanagan (Ph.D., 1986, University of Montana) is a clinical psychologist and counselor educator at the University of Montana. His blogsite, featuring material on counseling, psychotherapy, and parenting is at: johnsommersflanagan.com.

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.