Counseling the Culturally Diverse. Laura Smith L.
have proposed a multicultural counseling orientation model (MCO) that extends and complements the awareness, knowledge and skills framework of cultural competence (Davis et al., 2018; Owen et al., 2011). The MCO model posits three different process dimensions of cultural sensitivity: (a) cultural humility, (b) cultural comfort, and (c) cultural opportunity. The most prominent of these three is that of cultural humility.
The concept of cultural humility was first coined in medical education, where it was associated with an open attitudinal stance or a multicultural open orientation to diverse patients (Tervalon & Murray‐Garcia, 1998). The term has found its way into the MCT field, where it also refers to an openness to working with culturally diverse clients (Hook, Davis, Owen, Worthington, & Utsey, 2013; Owen et al., 2014). As more counselors and psychologists have begun to study cultural humility, it has become clear that this concept is a “way of being” rather than a “way of doing,” which also characterizes cultural competence (Owen, Tao, Leach, & Rodolfa, 2011). Cultural humility as an orientation or disposition is thus necessary to facilitate cultural awareness, knowledge, and skills. A counselor must adopt an open, inquisitive orientation in order to engage in self‐reflection and to learn from clients and marginalized communities, which are key ingredients of cultural competence. In a therapeutic context, cultural humility of therapists (a) is considered very important to many socially marginalized clients, (b) correlates with a higher likelihood of continuing in treatment, (c) strongly relates to the strength of the therapeutic alliance, and (d) is related to perceived benefit and improvement in therapy (Hook et al., 2016). Thus, cultural humility as a dispositional orientation may be equally important as three major cultural competence domains (awareness, knowledge, and skills) in MCT.
Increasingly, scholars have also begun to make a strong case that cultural comfort and cultural opportunity are also correlated with effective MCT. In Chapter 1 a strong case was made about how differences create discomfort and evoke powerful negative emotion in many trainees. The concept of cultural comfort refers to a therapist's feeling at ease, calm, relaxed, and open to work with diverse clients. It makes sense that when a counselor is anxious and uncomfortable with topics of race, gender, and sexual orientation it will negatively affect the therapeutic relationship. Likewise, the concept of cultural opportunity refers to “markers” that occur in therapy when clinical openings present themselves where client's cultural beliefs, values and identity can be explored (Davis et al., 2018). Dr. D. missed many opportunities to understand Gabriella's worldview in a deeper manner because he was either uncomfortable with exploring them or was clueless about their implications.
SOCIAL JUSTICE AND CULTURAL COMPETENCE
Building on the multicultural counseling competencies devised by Sue et al. (1992), the American Counseling Association (ACA) developed Multicultural and Social Justice Counseling Competencies (MSJCC) (Ratts, Singh, Nassar‐McMillan, Butler, & McCullough, 2015). At the heart of the MSJCC is the integration of social justice competencies with multicultural competencies. Acknowledging that multiculturalism leads to social justice initiatives and actions, the MSJCC propose a conceptual framework that includes quadrants (privilege and oppressed statuses), domains (counselor self‐awareness, client worldview, counseling relationships, and counseling and advocacy interventions), and competencies (attitudes and beliefs, knowledge, skills, and action).
Perhaps the most important aspect of the proposed MSJCC is seen in the quadrants category, where they identify four major relationships between counselor and client that directly address matters of power and privilege: (a) a privileged counselor working with an oppressed client, (b) a privileged counselor working with a privileged client, (c) an oppressed counselor working with a privileged client, and (d) an oppressed counselor working with an oppressed client. When applied to racial/ethnic counseling/ therapy, various combinations can occur: (a) a White counselor working with a racial or ethnic minority client, (b) a White counselor working with a White client, (c) a racial or ethnicity minority client working with a White client, and (d) a racial or ethnic minority counselor working with a racial or ethnic minority client. Analysis and research regarding these dyadic combinations have seldom been carried out in the multicultural psychology field. Further, little in the way of addressing counseling work with interracial/interethnic combinations is seen in the literature. We address this topic in Chapter 8. We will also cover the issues raised in the MSJCC framework more thoroughly in Chapters 4 and 5.
It is important to note that the definition and practice of multicultural counseling competence is in a continuing state of evolution and change. Recently, in a series of thought provoking articles, Ridley and colleagues (Ridley, Mollen, Console, & Yin, 2021; Ridley, Sahu, Console, Surya, Tran, Xie, & Yin, 2021) have indicated that multicultural counseling competence is a construct in search of an operational definition. Despite nearly all professional organizations advocating for cultural competency, and despite having them incorporated into ethical guidelines and standards of practice, Ridley & colleagues assert that existing models all possess inherent weaknesses, ambiguities, definitional problems, but most importantly a lack of specific guidelines for how clinicians can translate them into therapeutic practice and effectiveness. We believe that their call to the profession to rethink multicultural counseling competence is a worthy and important one. Although they propose a process model of multicultural counseling competence, it is much too early to judge the merit and practical solutions they propose (Vasndiver, Delgado‐Romero, & Liu, 2021).
REFLECTION AND DISCUSSION QUESTIONS
1 If the basic building blocks of acquiring cultural competence in clinical practice are awareness, knowledge, and skills, how do you hope to develop competency? Can you list the various educational and training activities you would need in order to work effectively with a client who differed from you in terms of race, gender, or sexual orientation?
2 What are your thoughts about the basic building blocks of cultural competence? What are your thoughts regarding cultural humility, especially as a conduit to developing cultural awareness, knowledge, and skills? How would you define cultural competence?
3 Look at the six characteristics that define alternative roles for helping culturally diverse clients. Which of these roles are you most comfortable playing? Why? Which of these activities would make you uncomfortable? Why?
IMPLICATIONS FOR CLINICAL PRACTICE
1 Know that the definition of multiculturalism is inclusive and encompasses race, culture, gender, religious affiliation, sexual orientation, age, disability, and so on.
2 When working with diverse populations, attempt to identify culture‐specific and culture‐universal domains of helping.
3 Be aware that Persons of Color, LGBTQ people, women, and other groups may perceive mental illness/health and the healing process differently than do EuroAmerican men.
4 Do not disregard differences and impose the conventional helping role and process on culturally diverse groups, as such actions may constitute cultural oppression.
5 Be aware that EuroAmerican healing standards originate from a cultural context and may be culture‐bound. As long as counselors and therapists continue to view EuroAmerican standards as normative, they may judge others as abnormal.
6 Realize that the concept of cultural competence is more inclusive and superordinate than is the traditional definition of clinical competence. Do not fall into the trap of thinking “good counseling is good counseling.”
7 If