Counseling the Culturally Diverse. Laura Smith L.
the African American community's experience of racism, discrimination, and oppression as pervasive external factors that have harmful impacts upon individuals and families.
Asian Americans and American Indians tend to emphasize the inherent goodness of people. We have already discussed the Native American belief that people have an innate capacity to advance and grow and that problematic behaviors are the result of environmental influences that thwart the opportunity to develop according to one's nature. Likewise, Asian philosophies (Buddhism and Confucianism) affirm people's innate goodness and prescribe role relationships that manifest the “good way of life.” Central to Asian belief is the idea that the best healing source lies within the family (Daya, 2005; Walsh & Shapiro, 2006) and that seeking help from the outside (e.g., counseling and therapy) is non‐productive.
Latinx American traditions often view human nature as having the capacity for both good and bad. Concepts of dignidad and respeto undergird the belief that people are born imbued with positive qualities. At the same time, traditional elders may appeal to supernatural forces so that children may be blessed with a favorable human nature (Inclan, 1985). Thus, given that a child's nature may be accepted as destiny, parents may be less inclined to seek help from helping professionals or educators. The preferred mode of help may be religious consultations and talking with neighbors and friends who sympathize and understand the dilemma.
LANGUAGE BARRIERS
The use of Standard English in health care delivery can harmfully discriminate against individuals from many cultural groups, including those from a non‐native, bilingual, or lower socioeconomic background (Ratts & Pedersen, 2014; Vedantam, 2005). This inequity occurs in our educational system and in the delivery of mental health services even as the number of bilingual Americans is increasing dramatically; it has approximately doubled since 1980 (Grosjean, 2018), and over 20% of U.S. families speak a language other than English at home (Ziegler & Camarota, 2019). Accordingly, Schwartz, Rodriguez, Santiago‐Rivera, Arredondo, and Field (2010) indicated that psychologists are increasingly finding themselves interacting with clients who have English as a second language (or who do not speak English at all).
When bilingual individuals have no access to multilingual therapy opportunities, many aspects of their emotional experience may not be available for treatment; they may be unable to use the full complexity of language to describe their particular thoughts, feelings, and unique situations. Clients for whom English is a second language often feel like they are constrained to speak in an overly simple or childlike manner to explain complex thoughts and feelings (Arredondo, Gallardo‐Cooper, Delgado‐Romero, & Zapata, 2014). On the other hand, when clinical settings have been able to provide the opportunity for bilingual clients to more fully bring their personal linguistic realities into therapy, it meant that
participants were better able to express and process their thoughts and feelings, convey their true selves, be understood, and find the words to capture what is most meaningful to them. Thus, they had an affirming experience in which they variously felt empowered, liberated, grateful, or even excited using both of their languages. Using both languages also had major effects on how the therapeutic process was experienced. It enabled participants to discuss deeper issues and reach new insights, for instance, and to experience sessions as smooth and efficient. It also enabled a safer, more comfortable therapeutic environment in which to do deeper work. (Pérez‐Rojas et al., 2019, p. 250)
Asking children to translate information is common in many communities with high immigrant populations when psychological, medical, and/or legal professionals speak only one language and do not work in clinics with bilingual services. Even when it is necessary, this practice can have devastating consequences: (a) it can create stress within the parent–child relationship; (b) children usually lack the vocabulary to serve as effective interpreters; (c) children may be placed in a situation where they are privy to confidential medical or psychiatric information about their relatives; and (d) children may be unfairly burdened with emotional responsibilities that only adults should carry (Coleman, 2003). In 2008, California Assembly Bill 775 was introduced to ban the use of children as interpreters. Furthermore, the federal government has acknowledged that not providing adequate interpretation for client populations is a form of discrimination.
The National Council on Interpreting in Health Care (2005) has published national standards for interpreters of health care that address issues of cultural awareness and confidentiality. These standards are based upon a number of important findings derived from focus groups of immigrants (Ngo‐Metzger et al., 2003). First, nearly all immigrants interviewed expressed a preference for professional translators rather than family members. They wanted translators who were knowledgeable and respectful of their cultural customs. Second, using family members to interpret—especially children—was negatively received in light of their inability to translate adult communications effectively. Third, discussing very personal or familial issues was often very uncomfortable (shame, guilt, and other emotional reactions) when a family member acted as the interpreter. Last, there was great concern that interpretation by a family member could be affected by the family dynamics or vice versa. Some general guidelines for mental health professionals in selecting and working with professional interpreters are as follows:
Make sure that the interpreter speaks the same dialect of a particular language as the client.
Monitor carefully whether the interpreter and client appear to have significant cultural or social differences.
Establish a degree of familiarity with your interpreter; they should be understanding and comfortable with your therapeutic style.
Use the same interpreter consistently with the same client.
Be aware that the interpreter is a person within the therapeutic relationship; rather than a two‐person interaction, the relationship is likely to be experienced as a three‐person alliance. Clients may initially develop a stronger relationship with the interpreter than with the counselor.
Provide extra time for the counseling session where possible.
Ensure that the interpreter is in full understanding of the ethic of confidentiality.
If you believe the interpreter is not fully translating the client's words or is interjecting their own beliefs, opinions, and assumptions, it is important to have a frank and open discussion about your observations.
Be aware that interpreters may also experience intense emotions when traumatic events are discussed. Be alert for overidentification or countertransference. You may need to work closely with the interpreter, allowing them periodic debriefing sessions.
CLASS‐BOUND VALUES AND PERSPECTIVES
Diverse cultural perspectives and values can be reflected by diverse social class experiences as well as by racial‐ethnic diversity. Social class and classism have been identified as two of the most overlooked topics in psychology and mental health practice (APA Task Force on Socioeconomic Status, 2007). Statistics suggest that the income inequality gap—the gap between the poorest and the wealthiest Americans—is increasing, and the continuing escalation of wealth inequity in the United States is dramatic. The wealth gap between rich and poor families has grown steadily wider as more and more wealth trickles up to the top (and away from middle‐ and lower‐income families). The top 1% of wealthy Americans owned 200 times the wealth of the average American in 2020; in 1980, they had owned only 60 times as much (Smith & Reeves, 2020). In contrast, the net worth of middle‐income families actually decreased by 20% during that time, while lower‐income families sank even further, experiencing a loss of 45% (Horowitz et al., 2020).
In the United States, 11.8% of citizens overall live in poverty (Tanzi & Saraiva, 2021). Segmented by race, the poverty rate for White Americans in 2019 was 9.0%, while for African Americans, it was over twice that at 21.2%. For Latinx people, the poverty rate