Category Archives: Cultural Competency
By Xiomara A. Sosa, Clinical Mental Health – Forensic Counselor (Intern)
Founder and Principal, XAS Consulting, LLC
Executive Creator, National Hispanic Mental Health Professionals Network (HMHP)
Hurricane season officially started June 1 and lasts through November. The National Hurricane Center has predicted another busy hurricane season. We have already witnessed devastating tornadoes in Oklahoma. As someone who experienced 9/11up close and personal, I understand intimately how first hand and vicarious trauma from manmade and natural disasters can have an insidious affect on our psychological wellbeing. I was not above it. It was delayed onset for me and I eventually chose to seek help and recovered. I also watched helplessly and lived through the deep personal pain of a loved one battling the damage that came as a result of personal and war zone related trauma. After a long road to recovery for us both, I am now a fierce advocate dedicated to breaking down stigma and advocating for others to seek help when they experience any kind of trauma before it consumes them and their loved ones and causes unnecessary suffering. I now provide disaster mental health services to first and second responders as well as humanitarian workers during emergencies and disasters. And I am beyond proud of my loved one who is now one of the top emergency managers in the field after retiring from an impressive successful Air Force career.
What is a Critical Incident and How Does Culture and Development Affect Survivors?
A critical incident is the actual event that precipitates the trauma. A hurricane is a classic example of a critical incident. I will use my personal experience of living through a hurricane in South Florida. The culture in which this critical incident occurred is the Caribbean, Hispanic and Latin American subcultures living in that part of the country. Many generations of these cultures co-exist, from recent immigrants to those who have been established there as US citizens for decades (James, 2008).
A hurricane is classified as a natural disaster and South Florida is prone to hurricanes. Hurricane season in South Florida begins in June and lasts six months through November. Hurricanes do have a well established and sophisticated warning system in place for the community. However, when a hurricane does hit, many elderly people in the Spanish speaking communities have a tendency to not evacuate when they are asked to by emergency management officials. There are many reasons for this which includes immobility or difficulty with mobility. They also usually do not have transportation, have language barriers and cannot bring themselves to leave their beloved animals, pets or each other behind (James, 2008).
During my experience with one particular hurricane I came across an elderly Cuban American couple. They were in their late stage of life development and had already experienced many hurricane seasons in their homeland of Cuba and in South Florida during their lifetime. This couple escaped the communist regime of Fidel Castro in Cuba and fled to South Florida. They had never returned to Cuba because they were considered political exiles and were not allowed back by their government. Although they experienced hurricane threats in Cuba as young people, they never experienced a tragedy during a hurricane there. However, they have seen destruction, devastation and tragedy in their years living in South Florida, especially when hurricane Andrew devastated the area. That experience profoundly affected them and their response to new trauma. They often refused to evacuate when hurricane warnings were issued because they are afraid that they would have to leave their animals and pets behind and could not bear that thought. They also required transportation, which they did not have, which means they had to rely on public and community services to do so (James, 2008).
As a professional mental health counselor, I adjusted my counseling approach with this couple based on their cultural frame of reference and developmental stage in life. I based my approach on their late life developmental stage. I also considered their cultural needs and I appropriately attended to their language barriers, immobility issues, and their deep rooted attachment to the caring of their animals and pets (James, 2008).
They also required that my approach accommodate the way in which they process stress and information. Perhaps leaving the only home they have known for decades could be too much of a stressful physical change for them. They had the perspective that they would rather stay and protect their humble home and beloved animals and pets rather than leave everything they have behind because of how long it took them to acquire it all. I chose to include in my thinking the possibility of finding shelters where animals and pets are allowed and reassured them that they would be transported back to their home as soon as it is safe to do so. I used very simple language and small steps in trying to reassure them. A lot of patience and seeing the world through their worldview was the most effective approach in this case (James, 2008).
My counseling approach for this critical incident might have been different if the clients were of a different culture. For example, if they were Caucasian, English speaking (monolingual) and living in a more affluent neighborhood. If so, chances are they would have fewer barriers to contend with. They might own a hurricane fortified home that could withstand hurricane winds or have access to transportation to get to a safe place with their animals and pets. They might also have the ability to replace all of their lifelong belongings. This would likely be the case based on a higher socio-economic status. This is not meant as a generalization; however, in South Florida the socioeconomic levels differ quite distinctly between the ethnic communities for the most part, particularly within the Hispanic community. That difference does play a distinct role in how emergency services operate and are delivered. Cultural competency is a necessary part of delivering emergency management services and mental health disaster services (James, 2008).
References:
James, R. K. (2008). Crisis intervention strategies (6th ed.). Belmont, CA: Thomson Brooks/Cole.ISBN: 0495100269
By Xiomara A. Sosa, Clinical Mental Health – Forensic Counselor (Intern)
Founder and Principal, XAS Consulting, LLC
Executive Creator, National Hispanic Mental Health Professionals Network (HMHP)
Impact on Couples and Families
Diversity has a significant impact on the effectiveness of counseling with couples and families and on the quality of services that counselors offer them. The impact that diversity has on couples and families becomes evident in how counselors are able to appropriately perceive those relationships within their specific context. Seeing those relationships within the contexts of their specific diversity allows counselors to recognize the strong influence that it has on them as individuals as well as on their relationships with one another. Couples and families live within societies where their gender identity and expression, sexual orientation, race, ethnicity, religion, among other diverse factors, influence their world view. Ignoring this would amount to ineffective interventions and unethical counseling practices (Thomlison, 2010).
Impact on Counselors
Diversity also has a direct impact on counselors because it necessitates that they increase their attention to contextual issues in their practice directly related to many different diversity factors. For example, counselors must pay attention to power differences between the sexes and cultures as well as in spirituality and religion. They must also remain crystal clear about their ethical duty to remain non-judgmental towards non-traditional couples and families that include sexual and gender minorities. Counselors view these issues as metaframeworks, which unifies gender, culture, and other diversity factors (Thomlison, 2010).
Gender Identity
One issue related to diversity that may have an impact on a couple’s counseling session is gender identity. A couple that has one partner struggling with issues of gender identity can present with issues that are very different from those of traditional couples. It is important that the counselor have the awareness, knowledge, and cultural competency necessary to provide the appropriate counseling required for the couple and to prevent further distress for them (Thomlison, 2010).
Sexual Orientation and Gender Expression
Other diversity issues in counseling include sexual orientation and gender expression. For example, a family seeking counseling as a result of a child coming out as gay, lesbian, bisexual, transgender, intersex, or questioning can present unique challenges. This requires that the counselor be culturally competent in providing appropriate counseling. It also requires that he or she not allow personal biases, including religious and culture based prejudice or beliefs, to interfere with the appropriate, healthy, and ethically founded response that is mandatory when working in the helping professions. Using affirmative therapy in this instance would be an appropriate, ethical and empirically founded technique rather than using reparative therapy, which is not. It would be vital for the counselor to approach the sessions mindfully to avoid further distressing the family (Thomlison, 2010).
Ethical Counseling Practice
Counselors must address diversity in their practice when providing services to couples and families. Contextual issues have an impact in the lives of individuals in negative and positive ways. It is important that counselors address diversity issues in their practice and that they recognize that ignoring these components is unethical as mental health professionals (Thomlison, 2010).
Reference:
Thomlison, B. (2010). Family Assessment Handbook: An Introductory Practice Guide to Family Assessment (3rd ed.). Belmont, CA: Thomson Brooks/Cole.
By Xiomara A. Sosa
Clinical Mental Health – Forensic Counselor (Intern)
XAS Consulting, LLC (www.xasconsulting.com)
Hispanic Americans in general tend to have a distrustful view toward non-Hispanic Americans due to the long history of hostility, prejudice and injustice they have experienced as a group generationally. Catholicism has also had a great influence on the worldview of Hispanics in general. The relationship between a non-Hispanic counselor and Hispanic client could be influenced by that. For example, when a European American counselor who is not culturally competent regarding the influences of those elements attempts to create rapport with a client, there is a possibility that he or she will fail in that attempt (Sue & Sue, 2008).
The traditional therapeutic worldview of a European American could be a barrier in genuinely understanding why the disconnect exists. Lack of training or experience might be part of the problem as well. Demonstrative, tactile interaction among Hispanics is considered normal within the culture and this might need to be acknowledged in the counseling session on some level although that might not be the same norm in the European American culture. Feeling social and intimate creates a sense of familiarity and comfort for most Hispanics and therefore if the counselor is emotionally and socially distant and cold, it can inadvertently put a barrier between the client and the counselor (Sue & Sue, 2008).
Hispanics might seek counseling from someone who they believe they can relate to better, such as another Hispanic. Although this might not necessarily be fair or guaranteed, it starts them off with a greater sense of trust in the process of counseling. Catholicism influences this group greatly and they are more likely to seek guidance from a church leader before they would a professional, clinical authority figure (Sue & Sue, 2008).
It is also very important that a non-Hispanic counselor recognize how intricate family and friends are to the every day life of most people of Hispanic heritage. This is a fact that must be affirmed and recognized as vital rather than dysfunctional within that group. Godmothers, aunts, cousins and other family members carry a lot of weight in the care of the entire family as a unit. They must be valued and considered influential and important to each client as a general rule (Sue & Sue, 2008).
Reference:
Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons, Inc.
By Xiomara A. Sosa, Clinical Mental Health – Forensic Counselor (Intern)
BS Psychology, MS Mental Health – Forensic Counseling (2013)
Founder and Principal of XAS Consulting, LLC
May 13, 2013
As a Latina mental health professional, I will be faced daily with the challenge of making a culturally relevant diagnosis with each individual client that I provide clinical services to. In making a culturally relevant diagnosis, a professional counselor is ethically obligated to begin with an understanding of the influences that describe identities, strengths, and contexts pertaining to the client. The client’s comprehensive make up must be understood without bias.
Cultural competency must incorporate the ability to consider problems associated with age and generation, possible disabilities, religious influences and identity, racial and ethnic identities, sexual orientation and gender identity or expressions, and socioeconomic status. It is very important that as a professional addressing the needs of multicultural communities that I intentionally and mindfully consider the client’s conceptualization of the problem and not impose my own perception of what his or her presenting problem is, and more importantly, not impose my personal views and belief systems about it. Once I, as a counselor, have been able to do so, it then becomes my duty to explain my diagnosis and possible treatment plan in a very clear way to my client.
As a clinical counselor I should be a good match with my clients. I should be able to understand their perspective and be familiar with their frame of reference. I must also be as prejudice-bias free as possible about customs within other cultures. For example, I am ethically bound to use interpreters in my first session with clients when English is not their first language to ensure that I am culturally competent prior to starting the session with the client.
I must also research and learn about the cultures that I have within my diverse clientele and learn the clients’ detailed history, cultural identity and context prior to beginning a counseling session. Not taking any of these steps can lead to a bad experience for the client who may choose not to continue or return to counseling or seek help elsewhere in the future. I can also inadvertently cause the client irreparable damage. This is unacceptable because above all else, I have taken the Hippocratic Oath to “Do No Harm”.
Reference:
Sue, Derald Wing, David Sue. Counseling the Culturally Diverse, 5th Edition. John Wiley & Sons P&T. <vbk:9780470936641#page(107)>.
Written by Xiomara A. Sosa, Clinical Mental Health – Forensic Counselor (Intern)
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. (Adapted from Cross, 1989).
A culturally competent counselor is grounded in his or her practice with a genuine understanding of history and social movements that shape the realities and world views of clients. Counselors must understand the history and cultural realities for each client and how specific groups were historically marginalized or oppressed and the ramifications of that experience on the client as an individual. Counselors who work with individuals from diverse cultural backgrounds have to become familiar with the key historical events and experiences, as well as the social movements that influenced the attitudes of these groups in general. They must understand their behaviors as a group and their values.
Becoming culturally competent as a counselor is vital at this time because the United States has become a country filled with diverse cultures and ethnicities. It is counterproductive for counselors to insist on applying western influenced ideas on populations that are not of that culture. Understanding that what might be effective or respectful in one culture or subculture will not necessarily be so for another.
Counselors must seek out extra training when seeking to become culturally competent. Learning as much as possible through higher education, seminars, conferences and literature is important. However, it is just as important to also become familiar with the day to day reality of different cultures by finding ways to become immersed in them if and when possible.
Volunteering in communities where you wish to provide services is one way. Taking positions in agencies that are located in communities different from your own so that you can learn through experience the inner functioning of that community is another great option.
Reference:
AMCD Multicultural Counseling Competencies. Retrieved from http://www.counseling.org/Resources/Competencies/Multcultural_Competencies.pdf Lee, C.C. (2008). Elements of Culturally Competent Counseling. (ACAPCD-24). Alexandria, VA; American Counseling Association
Latino Mental Health Program: Culturally relevant care for Hispanics
The Dr. Cynthia Lucero Center’s Latino Mental Health Program (LMHP) at the Massachusetts School of Professional Psychology (MSPP) offers medical students the opportunity to train specifically for work in Latino communities.
ALGBTIC Competencies for Counseling LGBQQIA Individuals (pdf document)
http://www.algbtic.org/images/stories/ALGBTIC_Comps_for_Counseling_LGBQQIA_Individuals_Final.pdf
Unintentional and unexamined cultural and racial assumptions can impair functioning of counselors (Arredondo, 1999; Ober et al., 2000; Ridley, 1995; Thompson & Neville, 1999). That statement holds doubly true for crisis workers given the cross-cultural circumstances within which they often operate—particularly in large-scale disaster relief. Pedersen (1987) discusses the following 10 culturally biased assumptions that crisis workers would do well to remember:
1. People all share a common measure of “normal” behavior (p. 17) (the presumption that problems, emotional responses, behaviors, and perceptions of crises are more or less universal across social, cultural, economic, or political backgrounds).
2. Individuals are the basic building blocks of all societies (p. 18) (the presumption that crisis intervention and counseling are directed primarily toward the individual rather than units of individuals or groups such as the family, organizations, political groups, or society).
3. The definition of problems can be limited by academic discipline boundaries (p. 19) (the presumption that the identity of the crisis worker or counselor is separate from the identity of the theologian, medical doctor, sociologist, anthropologist, attorney, or representative from some other discipline).
4. Western culture depends on abstract words (pp. 19–20) (the presumption of crisis workers and counselors in the United States that others will understand these abstractions in the same way as workers intend them).
5. Independence is valuable and dependencies are undesirable (p. 20) (the presumption of Western individualism that people should not be dependent on others or allow others to be dependent on them).
6. Formal counseling is more important than natural support systems surrounding a client (pp. 20–21) (the presumption that clients prefer the support offered by counselors over the support of family, peers, and other support groups).
7. Everyone depends on linear thinking (pp. 21–22) (the presumption by counselors and crisis workers that each cause has an effect, and each effect is tied to a cause—to explain how the world works—and that everything can be measured and described in terms of good or bad, appropriate or inappropriate, and/or other common dichotomies).
8. Counselors need to change individuals to fit the system (p. 22) (the presumption that the system does not need to change to fit the individual).
9. The client’s past (history) has little relevance to contemporary events (pp. 22–23) (the presumption that crises are mostly related to here-and-now situations, and that crisis workers and counselors should pay little attention to the client’s background).
10. Counselors and crisis workers already know all their assumptions (p. 23) (the presumption that if counselors and crisis workers were prone toward reacting in closed, biased, and culturally encapsulated ways that promote domination by an elitist group, they would be aware of it).
All 10 assumptions are, of course, flawed and untenable in a pluralistic world. Cormier and Hackney (1987) warn that human services workers who do not understand their own cultural biases and the cultural differences and values of others may misinterpret the behaviors and attitudes of clients from other cultures. Such workers may incorrectly label some client behavior as resistant and uncooperative. They may expect to see certain client behaviors (such as self-disclosure) that are contrary to the basic values of some cultural groups. The culturally insensitive counselor or crisis worker may also stereotype, label, or use unimodal, inappropriate, or ineffective counseling approaches and concepts in an attempt to help clients from other cultures (pp. 256–258).
Specifically in the field of crisis intervention, there has been criticism of the Western-based trauma model and particularly the elevation of PTSD as a pathological entity that has been coined in self-serving ways by victims’ groups, politicians, and profiteering lawyers and therapists when there is little empirical evidence to support such an assumption (Silove, 2000; Summerfield, 1999). (James 22-23) James, Gilliland. Crisis Intervention Strategies, 6th Edition. Wadsworth Publishing Company, 2007-07-01. . mpair functioning of counselors (Arredondo, 1999; Ober et al., 2000; Ridley, 1995; Thompson & Neville, 1999).
Failure to understand clients’ worldviews may lead human services workers to make erroneous interpretations, judgments, and conclusions that result in doing serious harm to clients, especially those who are culturally different. A vast majority of the world’s population lives by a non-Western perspective. Despite the fact that the world is culturally pluralistic, many of our books, professional teachings, research findings, and implicit theories and assumptions in the field of counseling and crisis intervention are specific to North American and European cultures. Such theories and assumptions are usually so ingrained in our thinking that they are taken for granted and seldom challenged even by our most broad-minded leaders and professionals (Pedersen, 1998; Ponterotto & Pedersen, 1993; Ridley, 1995). (James 22) James, Gilliland. Crisis Intervention Strategies, 6th Edition. Wadsworth Publishing Company, 2007-07-01. .
XAS Advocacy Network Series (ANS)
Xiomara A. Sosa, ANS Executive Consultant
- The National Hispanic Veterans Advocacy Network
- The National Sexual Minority (LGBQQTI) Veterans Advocacy Network
- The National Hispanic Mental Health Professionals Advocacy Network
- The National Sexual Minority (LGBQQTI) Mental Health Professionals Advocacy Network
- The National Latina Mental Health and Wellness Advocacy Network
- The National Modern Family Mental Health and Wellness Advocacy Network
The XAS Advocacy Network Series (ANS) is a bilingual, culturally competent multi-platform advocacy campaign for diverse communities launched by XAS through Get-Right! and You Are Strong! in partnership with prominent social media and coalition partners.
Through these partnerships ANS helps shed light on issues affecting diverse communities through a series of articles about these community members’ needs, resources, events, spotlights, interviews and critical legislative, government, and military initiatives. The campaign includes Legislative Days with representatives and Town Hall Meetings with stakeholders.
The goal is to advocate for mental health and wellness and health and human services needs that are culturally competent and effect positive social change for these communities:
- Hispanic community
- Veteran community
- Sexual minority (LGBQQTI) community
XAS Consulting, LLC Founder Xiomara A. Sosa is committed to creating positive social change through culturally competent advocacy. Her advocacy work is done through the 2 nonprofit organizations she founded: The Get-Right! Organization, Inc. whose mission is to educate families, teach children, and support communities about mental health and physical health; and You Are Strong! Center on Veterans Health and Human Services whose mission is to combat negative stigma and provide health and human services information to veterans and their families.
Xiomara created this advocacy network series to build unity within and awareness about the mental health and wellness and health and human services needs of these communities. These advocacy networks are launched in partnership with like-minded social media and coalitions to unify health and human services professionals that advocate for mental health and wellness and health and human services needs of Hispanics, veterans, and sexual minorities (LGBQQTI). The advocacy campaign is based on empirical, evidence-based research data. This initiative elevates the voices of these communities and spotlights their unique challenges, needs and stories. The partnerships are a natural extension of the social media and coalition partners’ missions to help and support these communities by providing a platform where the greater community can share and receive culturally competent information.
Current ANS partners are:
Latina Lista – Co-media partner through You Are Strong! for The National Hispanic Veterans Advocacy Network (NHVAN) – launched on Memorial Day May 2012.
Stay tuned for the next partnership launch in October 2012 during Hispanic Heritage Month:
New Latina – Co-media partner through Get-Right! for The National Hispanic Mental Health Professionals Advocacy Network (HMHP)
NOTE: YOU DO NOT NEED TO BE HISPANIC, A VETERAN, OR A SEXUAL MINORITY TO SUPPORT, JOIN OR PARTICIPATE IN THIS CAMPAIGN. EVERYONE WHO SUPPORTS THE ANS MISSION IS WELCOME!