When I was in graduate school, I had the privilege of attending a lecture given by psychologist Joseph White, who is sometimes referred to as the “Godfather of Black Psychology.” He took me and my classmates on a tour of the psychological movements of the 20th century – from Freudianism to behaviorism and on to humanism. Lastly, he arrived at multiculturalism, which he described as “the final frontier.” He encouraged us to explore that frontier as we developed our professional identities. Dr. White passed away 2017, but that encouragement endures. So, let’s explore.
The American Psychological Association recently released its updated multicultural guidelines. Caroline Clauss-Ehlers, PhD, who chaired the committee tasked with updating the guidelines, remarked, “When you are working with [a client]… they bring their own identity and cultural background. To be responsive to that person means being aware of their cultural background. It defines their experience and who they are and will help you understand them.”
This emphasis on awareness and understanding should motivate us to acquire knowledge about different cultures and identities. Indeed, it’s helpful for us to know that African-American families may be especially responsive to a multisystems approach. We should also be familiar with how the same-sex couples with whom we work can promote resilience in their children. And it’s helpful to learn about the ways that extended families might be particularly important for Mexican-Americans. Still, in my experience, knowledge does not always equate to competence.
There have been many times, especially earlier in my career, when I thought I understood clients from backgrounds different from my own, simply because I had read up on their culture. But I soon learned that in addition to having cultural knowledge, the mental health provider’s attitude also matters.
My attitude was that as long as I had done my homework, I was competent enough. But that made me vulnerable to working with false assumptions and while doing so, I may have been communicating that my own knowledge was more authoritative than the actual lived experience of the client.
I remember one time meeting with a Latina client and assuming that she was a first generation American. I began asking her well-meaning questions about integrating cultural identities. Turned out that her family had been in California for five generations and she had never been south of the border. Good intentions, bad results.
A more common error in mindset is what is referred to by Christopher G. Wrenn and others as cultural encapsulation – the inability of the counselor to escape his or her own cultural biases, which can lead to culturally insensitive therapy. With this in mind, a truly multiculturally competent mindset calls for us to challenge preconceived notions about our work and our clients. When I was an intern, I met with a Japanese woman who tended to avoid eye contact with me. I assumed that it was because she was ashamed, and I interacted with her under that assumption. I later learned that gaze avoidance is more culturally normative for East Asians than North Americans and Western Europeans.
We all have our blind spots as providers. I believe that by owning this fact, we can be motivated to invite others to help us see new perspectives. We often ask our clients to challenge their own assumptions, and we should probably take our own advice in this respect.
How we speak to our clients can communicate sensitivity and promote understanding. It can be helpful simply to inquire with honest curiosity and appreciation. I remember meeting with a Nigerian-American college student a few years ago. I asked him, “What’s it like for you, right now, to be Black in America?” He responded, “I feel the same discrimination that every other young Black man does, but people think it’s somehow different for me because I’m from Africa and I wasn’t born here.”
In that moment, we opened up a conversation about identity and belonging, both of which turned out to be issues that were central to our work together. I suppose that he could have responded, “You’re not Black so you wouldn’t understand.” But the point was that I wanted to try to understand, and he appreciated that. I didn’t – and couldn’t – learn what it meant to be Black, but I learned about the effects of race and culture from the client himself.
The various strands of cognitive behavioral therapy (CBT) share a unifying principle, which might be summarized as: “how we think about things matters.” Of course, how we make sense of our lives and the world around us is going to be affected by all kinds of factors, including cultural identity and experiences. For instance, if a client has a belief that “It’s not worth trying in life because it never works out anyway,” then it’s worth inquiring if experiences of discrimination have informed that point of view.
Further, we might consider how behavioral coping strategies apply to certain cultures. When working with a religious individual, we should inquire if prayer might be a helpful coping tool. What about encouraging the client to attend services with community members who can sympathize? If we don’t have a base of knowledge about the client’s religion we can at the very least ask what it means to them, and it might yield some new ideas about dealing with stress.
In acceptance and commitment therapy (ACT), the emphasis is on allowing and observing uncomfortable experiences with an eye toward identifying and initiating specific steps toward change. That change is guided by personally chosen values. As mental health professionals striving toward multicultural competence, we should try to understand how factors like race, gender, and heritage inform our clients’ values and how those values might also give us some ideas about taking action from an attitude of cultural empowerment rather than disenfranchisement.
Thinking back, I wonder if Dr. White’s call for us to explore the frontier of multiculturalism was, in a way, a call for modesty. In other words, when you know just how much you don’t know, you might be more comfortable being an explorer and relinquishing the idea that you can conquer that vast frontier alone. With that spirit of modesty and curiosity, I’ll continue to explore and count my clients among my co-journeyers.
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The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE AUTHOR
Ben Herzig, PsyD, is a licensed clinical psychologist in independent practice in Weston, MA, and Cambridge, MA. He is an expert at the Institute for Social Policy and Understanding and a past reviewer for the Journal of Multicultural Counseling and Development and the Journal of Muslim Mental Health.