I also thank the staff of the American Psychological Association Books Division, especially Susan Reynolds, Genevieve Gill, and Tiffany Klaff, and the external reviewers. Finally, none of the case examples in this book are of real people; they are all composed.
PERSONAL WORK
INTERPERSONAL WORK
For example, in Alaska, a member of the Kenaitze tribe may identify as Alaska Native, Athabascan (one of the Alaska Native groups), Dena'ina (one of the Athabascan cultures), Kenaitze (the Dena'ina people living on the Kenai Islands). Peninsula), American, and at the same time a member of the global movement of indigenous peoples (Hays, 2006a). Although this approach works well for some aspects of multicultural education in the United States, it can be difficult for therapists who want to learn the specifics of clinical work with people with complex identities in a variety of contexts.
RACE
Because language is constantly changing, therapists must remain flexible and open to clients' preferences. What is most important regarding racial identity is an understanding of its meaning for the individual, for the dominant and minority cultures, and for the therapist (Wang & Sue, 2005).
ETHNICITY
However, some people (especially those in California) identify as Chicana or Chicano, while many people in Texas use the term Hispanic to describe themselves. The term minority is traditionally used for groups whose access to power is limited by the dominant culture (Wang & Sue, 2005).
ADDITIONAL TERMS
Privileged members are socialized to be less aware of the boundaries and distinctions associated with privilege. What are the possible meanings of these identities in the dominant culture, in the client's minority cultures, and from the client's personal perspective.
HOW THE ADDRESSING FRAMEWORK CAN HELP
From this brief description and other observed signs (eg, his physical appearance, dress, language abilities, and social skills), the therapist surmised that Jean's identity was closely tied to his family relationships, which he considered to be middle-class and that his national origin central to his identity. She assumed he didn't mention gender, sexual orientation or disability because he assumed they were obvious. She also realized that he may not conceptualize sexual orientation in the same way as the dominant culture (ie, research shows that for Haitians, same-sex sexual behavior "is often unrelated to self-identification as gay or bisexual" ; Bibb & Casimir,
She asked if he had had a "partner" since his divorce, and he said that he had dated a few women but had not developed a serious relationship with anyone.
UNDERSTANDING THE MEANINGS OF IDENTITIES
Likewise, the therapist's experience with the client may involve feelings related to her own mother or grandmother. Compared to Jean, and in the context of Quebec, the therapist is therefore a member of the dominant culture. In this situation, the therapist must distinguish between her general knowledge of African American culture and the client's personal and family-specific experiences.
To avoid being offended in this way, it may be helpful to let the client set the pace of the conversation (D.
PERSONAL HISTORIES IN A HISTORICAL CULTURAL CONTEXT
Second, rapport with the client can be facilitated if the therapist is willing to make contact with important people in the client's environment. Furthermore, the greater a therapist's knowledge of historical events important in the client's culture, the more relevant his or her questions will be. Did he serve in the military, and if so, what was his experience as a visibly Asian American man?
Takaki's (1993) and Zinn's (2005) books on the history of ethnic minority groups in the United States are excellent sources.
MEDICAL AND OTHER HEALTH CARE INFORMATION
It is important to note that most of the questions regarding the client's cultural history (i.e., the top of the timeline) should not be asked directly; it is the therapist's responsibility to learn such information outside of assessment sessions. Even when therapists and clients agree on how they see a situation or problem, their solution preferences may differ depending on what they perceive as the origin of the problem. To increase the likelihood that the therapist and client will work together toward common goals, it is important that therapists ask about clients' understanding and about their health care practices.
This is not to say that therapists and clients must always agree on the cause; but if they don't, it's better to know this from the beginning to avoid misunderstandings later.
THE ASSESSMENT OF TRAUMA
In order to avoid confidentiality problems, it is important that the interpreter does not have a close social relationship with the client. During the initial assessment with the client present, it is important to allow additional time for additional speaking time (Paniagua, 1998). It is important that the therapist avoids talking to the interpreter when the client is present.
Ask about the client's conceptualization of his or her problem, situation and health care (including self-care) practices.
THE MINNESOTA MULTIPHASIC PERSONALITY INVENTORY
The possibility of ethnic bias in the MMPI and MMPI-2 has been extensively researched. See also Butcher, Cabiya, Lucio, and Garrido (2007) for more information on using the MMPI-2 with Spanish-speaking clients. When using the MMPI-2 with people who speak English as a second language, it may be necessary to formally assess the individual's language proficiency before deciding whether to administer the test in English.
If the person's preferred language is clearly not English, there are a number of translated versions of the MMPI-2; however, it is important to remember that there are significant linguistic and cultural differences among people who speak the same language (Rogler, 1999).
PERFORMANCE-BASED PERSONALITY (PROJECTIVE) TESTS
And this brings us to the subject of the next chapter, namely cultural concerns in diagnosis. In one study, a dimensional model of personality disorders was found to have greater clinical utility than the categorical classification of the DSM system (Samuel & Widiger, 2006). Its placement in an appendix at the back of the manual (rather than integrated into the multi-axis system) tends to emphasize this.
'essentialization process'; the DSM-IV-TR reinforces the focus on “decontextualized entities whose characteristics can be studied independently of the particulars of one's life and social circumstances” (p. 342).
FIRST ASSESSMENT SESSION
She had some experience working with people who had immigrated from South America and Europe, and she was familiar with some of the values and behaviors more common in Mediterranean cultures (eg, the emphasis on family, the value placed on motherhood and expectations of marriage and children for both men and women; see Abudabbeh & Hays, 2006; AH, Liu, & Humedian, 2004; Bushra et al., 2007). After listening to Majid, Kate realized that she had some assumptions about Arab and Muslim men's attitudes towards women. She said that she wasn't sure whether to ask about this, so she held back, but at the same time, she didn't want them to think that she was with the U.S.
Counsel also pointed out to Kate the assumption built into Kate's statement that she did not want Mouna and Majid to assume that she agreed with the US.
SECOND ASSESSMENT SESSION
In response to Kate's questions about Mouna's experience in the United States, Mouna said that during her first few months, she continued to wake up early to prepare Majid's breakfast and sit with him while he ate. However, getting up in the morning became more and more difficult for her, and she finally stopped. Majid described his early years in the United States as "tough," but added that "everyone has to go through the same thing when they move here." In response to Kate's questions about his experiences of racism, he said that he had people being rude, staring at him, ignoring him and saying things like "Go home!" at a distance to him.
Majid said showing his brother around the city made Majid realize how much he liked living in the United States.
UNDERSTANDING THE CLIENTS' IDENTITIES
After coming to the United States, he attended a mosque for several years and was happy to meet Muslims from Cambodia, Indonesia, Nigeria, and African Americans. Majid identified himself primarily as Tunisian; however, during his 14-year stay in the United States, he learned that most Americans know little, if anything, about Tunisia. Although he did not specifically refer to himself as belonging to an ethnic minority culture in the United States, his experiences led him to identify with people of color rather than the European American majority.
However, her concern was no greater than would be expected in the face of such a transition.
CONSIDERING THE CLIENTS' VIEWS
In general, with clients who do not completely identify with the AA philosophy, Herman (1997) suggested focusing on the components that work for the individual. For more on ethnic-specific approaches to substance abuse treatment, see Straussner, 2001.). He also advised home visits and creative scheduling—for example, three 1-hour sessions on 3 consecutive days rather than one exhaustive 3-hour session. Age and generational influences - for example, the couple has a large age difference which contributes to a power differential.
Native heritage – for example, a family member has greater authority or status related to a stronger Native heritage (eg both parents are Native vs. one Native parent and one non-Native parent, or someone with a more traditional upbringing).
DEFINING THE PROBLEM
The second step of CR-CBT involves recognizing cultural influences on the cognitive, emotional, behavioral, and physiological components of the client's problem. The daughter got good grades at the community college she attended, but she wanted to do things the mother didn't like (eg going to the movies with friends at night, wearing baggy pants). The therapist's initial inclination was to help the daughter become more independent and eventually move out on her own.
Thus, the therapist worked with the daughter to help her find more effective ways to interact with her mother.
COGNITIVE RESTRUCTURING
These are just a few of the ways in which CBT can be made more culturally responsive (see Appendix 9.1 for an overview). Clarify which part of the problem is primarily environmental (or external) and which part of the problem is primarily cognitive (or internal). Validate the oppressive aspects of the client's environment and look for ways to change these conditions before or in tandem with cognitive restructuring.
Cognitive restructuring focuses on jointly examining the usefulness of a belief (rather than its rationality or validity).
USE OF MEDICATION
Robert received a phone call from a woman who introduced herself as Janet and said she was calling about her mother. Penn that Janet called him because she was worried about her (Mrs. Penn's) health. Out of respect for the family's value that Janet expressed over the phone that Mrs. Penn's place with her family, he did not entertain the idea of an alternative living arrangement for Mrs.
Penn and Janet seemed open to this, so he suggested they schedule a meeting in 2 weeks to discuss the results of Mrs. Penn's medical exam and neuropsychological evaluation and then, afterward, arrange a family meeting.
