Summary
Minor Cross-cultural psychology: Summary Theme 6: Intercultural Clinical Practice
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A broad summary of all the articles of theme 6. It is written in English, because the course exam will also be in English.
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Theme 6Intercultural Clinical Practice
Learning goals:
Vignette 1
▪ What intercultural knowledge, skills and attitudes does a psychologist need?
▪ When do intercultural assumptions become problematic?
Hays (2016). Essential therapist knowledge and qualities.
There are often vastly different perceptions between minority and dominant-culture members
regarding the same event. Because privilege insulates the dominant culture from minority
perspectives that might challenge the dominant view, it’s easy for dominant-culture members to
remain unaware of these alternative views. Because the dominant culture is so dominant, its
members may begin to believe that their view is the right one.
If you belong to a dominant group, your views have more power, and this power can negatively
affect your work because it limits your understanding of clients who do not have the same power.
Truly understanding and connecting with people who have minority perspectives that differ from
yours requires knowledge regarding individual and social biases and power structures.
Essential Knowledge
A psychologist needs to think carefully about how the heritage influences of a clients are relevant to
the assessment. This can facilitate the rapport if the psychologist systematically considers ways in
which personal and professional experiences might be influencing the conceptualization of the
clients situation. If a client feels understood, he or she will be more likely to return.
Understanding Bias
The experiences and training of the psychologists biased her toward a particular view that then
inclined her to take certain action and not others. She did not see those biases on her own, largely
because she thought of bias in dichotomous terms (e.g., that one is either biased or not), the
possibility that she might be biased did not occur to her. A more helpful way to think about bias is
simply as a tendency to think, act, or feel in a particular way. These tendencies may guide individuals
toward more accurate hypotheses and a quicker understanding of someone. In other situations, they
may lead individuals to embarrassingly wrong assumptions.
At the individual level, biases emerge in tandem with two other cognitive processes; categorizing
information and then generalizing this data to new situations are universal processes that help us
organize the vast amounts of information we encounter on a daily basis. Usually, these cognitive
processes facilitate learning and social interaction, but they can also contribute to the formation of
inaccurate assumptions. When these assumptions become rigid, they become stereotypes;
knowledge, beliefs, and expectations associated with a particular group, that in turn feed prejudice
or prejudgement; positive or negative evaluations of social groups and their members.
To avoid making inaccurate assumptions about their client, therapists may decide that the best
approach is to assume nothing about a client’s culture and allow the client to share whatever he or
she believes is important. This contains a problematic assumption; therapists are able to assume
nothing about their clients if they choose. However, such control is extremely difficult, if not
impossible. What is more likely to occur when one attempts to ignore the presence of assumptions is
decreased awareness that one is making them.
1
,It may be helpful to think of a lack of experience with a particular group as creating a hole or
vacuum inside of yourself. There is a tendency for all surrounding material to be sucked in. When it
comes to minority groups, this material often consists of dominant cultural messages that cause
people to assume that differences are deficits, sometimes so subtly that they do not perceive the
assumption. People then use this information to make generalizations and draw conclusions about
individual members of a group despite a lack of direct experience. The challenge as therapist and
human beings is to recognize this and replacing inaccurate information with real experience and
direct learning.
In most initial assessments, therapists do not have the benefit of a sold working relationship with
the client. Upon meeting an individual or family for the first time, therapists must establish rapport
and trust in a short period or risk losing the opportunity to help. Knowledge of a client’s culture can
facilitate, because it enables the therapist to formulate hypotheses and questions that closely connect
to the client’s real experience. The deeper and broader a therapist’s knowledge of and experience
with a client’s culture, the more accurate and relevant these hypotheses and questions will be. Well-
informed hypotheses and questions often increase clients’ trust and confidence in the therapist.
Examining Social Bias and Power
You cannot fully understand bias at the individual level without knowledge of sociocultural
influences. Because high-status groups hold more power, they can exert more control over their own
situations and the situations of lower status groups, through stereotypes:
- Descriptive stereotypes: define how most people in a particular group behave, what they
prefer, and where their competence lies. They exert control because they create a starting point
for people’s expectation. The stereotyped person must choose to either stay within the
boundaries of these expectations or go outside them; the stereotype places a burden on the
person being judged and on his or her interaction with others.
- Prescriptive stereotypes: define how certain groups should think, feel, and behave, e.g.,
cultural expectation of people with disabilities.
Many stereotypes are overt or explicit, meaning that people are aware they hold them. Studies show
that people also hold implicit bias and stereotypes without any conscious awareness, which can
influence people to behave in discriminator ways. These are particularly difficult to change. Because
of stereotypes, prejudice and bias, combined with power, unprivileged people need to pay more
attention to differences and rules. In the US, systems of privilege and oppression are tied to
capitalism. Systems of privilege harm those who hold privilege as well as those who do not.
In therapy, the separation of minority-culture knowledge works against the dominant-culture
therapist’s understanding of and connection with clients of minority groups. Because this therapist is
likely to have the dominant culture’s same limited knowledge and negative bias, he will be limited in
his ability to understand the types of daily situations experienced by such a client.
At the level of personal growth and development, privilege can lead to the internalization of feelings
of superiority. Privilege may also prevent a person from developing coping abilities that less-
privileged individuals develop to survive. Croteau suggested that systems of privilege harm those
who hold privilege as well as those who do not. For instance, traditional healing practices.
Essential Qualities of Culturally Responsive Therapists
Humility, charity, and veracity are equally important in becoming a culturally responsive therapist.
Humility reminds you that your perspective is not always the best and helps avoid judging
differences as inferior. Compassion (=charity) keeps you open and able to appreciate people who
challenge your beliefs and values. Critical thinking (= veracity) requires to question your
assumptions and look for explanations beyond what appears to be self-evident. Courage is the fourth
element, because reaching across cultural divides can be painful.
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, Staying Humble While Thinking Critically
A humbling experience is one that causes us to think more deeply and thus become a better person
(in contrast to a humiliating experience, which is destructive to one’s dignity). When people are
humble, they recognize that other viewpoints, beliefs, behaviours, and traditions may be just as valid
as their own. Thinking critically about our core beliefs and assumptions and the privileges we take
for granted invariably leads to a recognition of the legitimacy of other views and of the unfairness of
systems that privilege some people’s views and not others’. It this way, it facilitates humility,
particularly when we use it on ourselves.
Humility and critical thinking can operate in a reciprocal relationship. Humility opens you to new
forms of learning and diverse sources of knowledge, whereas critical thinking about your knowledge,
sources of information, and ways of learning, along with constant testing of alternative hypotheses,
helps you stay humble and open.
Sound clinical judgments require both humility and critical thinking. Because a willingness to
question oneself is communicated in nonverbal ways, both have the added benefit of facilitating
rapport. Asking questions like “how do I come to this understanding?” will slow down the process of
making clinical judgements by encouraging you to consider the client’s context. This will also
increase the likelihood that your hypotheses are closer to the client’s real experience.
Overcoming Obstacles to Compassion
If you maintain a feeling of compassion, you can communicate much more easily with other people.
There are five obstacles to growth that can also be seen as obstacles to compassion:
1. Fear and ignorance: fear can lead to pulling away from the client’s experience, thus impeding
the ability to engage with and respond compassionately. It is often related to a lack of experience
and knowledge. This hole can be filled by dominant cultural assumptions.
2. Aversion to pain: may lead a therapist to avoid certain topics, shut down, or emotionally
distance himself or herself when a painful topic such as cultural differences arises. You need to
give the client full permission to express his or her deepest pain.
3. Desire and egoism: allowing one’s theoretical orientation to take precedence over a client’s
concerns may result in inaccurate assessment or an invention that is inappropriate or
ineffective.
Minimizing Defensiveness
Fear, ignorance, aversion to pain, and attachment contribute to defensiveness; the cognitive and
emotional rigidity that occurs when one feels threatened or attacked. Feelings of this may lead
therapists to focus on the justification of their own ideas or perspective. This may lead to emotionally
distancing of the client. Therapists’ defensive behaviours may include tense body posture, raised
voice, patronizing voice tone, recitation of one’s credentials, loud sighing, and so on. It is possible and
usually desirable to refrain from engaging in defensive behaviours, particularly if these behaviours
interfere with one’s acceptance of and concern for another person.
Maintaining a Mindful Approach
One way to build humility and sustain openness is to become nonjudgmentally aware of your
experience in the moment, knows as mindfulness. This refers to internal formations, fetters, or
knots. The lack of understanding is the basis for every internal knot. We often experience these as
physical sensations associated with emotions of anger, fear, pain, or jealousy. These can serve as cues
that you are focusing more on yourself than on your client. Increased awareness can help you take
action that helps you stay with the client instead of being pulled into defensive behaviour. Focusing
on your breathing is a way to help with feelings of defensiveness. It may also be constructive to ask
yourself if there are alternative opinions that may be as valid or useful as your own. To summarize,
you can decrease defensive behaviours by following these steps:
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