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Section 21
Multicultural Mental Health-Care

Question 21 | Test | Table of Contents


Counselors of college students often adopt the view that the counseling situation should be expanded into an event embedded in the wider context of the total life of the student. The need for this humanizing perspective arises spontaneously when one counsels foreign students. The problems foreign students convey to the counselor frequently bring to the surface cultural values and patterns of thinking that undermine common assumptions in counseling. These assumptions usually are considered universal and, though seldom examined for their cultural limits, they deserve scrutiny if the counseling of foreign students is to be effective.

When counselors and counselees share the same culture, counselors intuitively rely on shared assumptions to flesh out intentions of counselees, and on personal knowledge to fill in gaps in the clients' backgrounds. When the cultures of the participants in counseling differ, counselors often lack implicit inferences to create coherent images of counselees. Significant aspects of perceptions, memories, and histories remain silent. The slice of time of counseling sessions should be extended horizontally to include the clients' histories and futures, and vertically, to incorporate cultural meaning.

Counselors should structure the sessions so that counselees can perceive themselves as total persons (Hampshire 1973) beyond temporary rewards and punishments, and sensitive to unexpected cultural assumptions, values, and patterns of thought. The cultural perspective gives a focus to counseling but also introduces a knot of complexity. Counseling becomes another event of intercultural interaction, resembling other events in which persons of different cultural backgrounds participate. Intercultural communication then appears as the key to the problems of counseling, and simplifies the role of the counselor who applies knowledge and experience from the field of intercultural communication.

The counselor sacrifices some of the objectivity usually associated with behaviorism, but the loss is more apparent than real. Current trends from objective psychology in decision making, problem solving, evaluation criteria, and behavior modification propose three ideas. First, actions are probably judged by their consequences; therefore, students should practice adjusting to norms that provide benefits from attending school, thus fulfilling the purposes which brought them to the foreign country. Along with this stress on practicality (utility), there is, second, the assumption that both rewards and punishments can be combined in a calculus that yields choices. Priorities are established according to an unspecified criterion. Finally, the time frame for making choices is brief. Choices refer to relatively immediate objectives, which tend to be practical and concrete, in comparison to more long-range goals, even those which have implications in the present. The implication of these three factors is that the individual is given limited choices that diminish the dignity and sensibilities which so many students, both American and foreign, expect.

In counseling, the counselee should be perceived as going beyond the limits of temporary behavioral contingencies and making choices according to values, patterns of thinking, and other predispositions which shape him as a cultural being. For this purpose objective measures of psychology fall short. Decision theory has failed to explain how the decision maker, combining subjective estimates of his own situation, makes a rational choice from among conflicting options. The experimental evidence, after fifteen years of investigation, is inconclusive (Tversky, 1967). Reviews of decision making in social contexts have fared no better. The theory of utility provides no way to compare the preferences of one actor with those of another (McIntosh, 1969).

In his review of how people combine individual preferences into social choices, Lieberman (1969) ended on an inconclusive note, very similar to the positions of Tversky and McIntosh-they all drew attention to an area that has not been studied. He stated that "one set of processes that undoubtedly have great influence on the social choice problem, but have been virtually unstudied, are the processes involving the effect of past commitments and decisions, and anticipations of the effect of future social choice situations and commitments on the present problem" (1969, p. 110). Although the workings of the past and anticipations of the future are largely unknown, the counselor can gain some insight into these processes by remembering typical errors committed by decision makers in laboratory studies (Slovic et al., 1977), and in real life. We shall consider counseling as a process of decision making and apply the typical errors to counselors. First, vivid and recent experiences exercise a greater influence on the counselor than expected by an objective assessment. Perhaps this result is natural and requires only vigilance to guard against mistaken decisions in counseling. Second, the value placed on securing all available information, a strong tendency in Americans, leads to an emphasis on quantity of information and imperceptibly degrades the standards for assessing the quality of information. The rejection of "theory" or "selectors" to classify information according to quality leads to reliance on practicality and facts and incurs one of the errors identified in decision-making theory. Degraded information, that is, unreliable, unverified information, influences the decision, and its effect on decision making remains even when the counselor is aware the information is degraded. Although the research on decision making has not been applied directly to the counseling situation, the second error seems to apply where knowledge of the client is gleaned from hearsay and incorporates stereotypes. The role of degraded information in counseling is potentially subversive of the objectives of the client. A third decision-making error looms large in counseling and supplies the problem for this chapter. Decision makers typically rely on similarities of superficial features to make predictions and assign cases to appropriate categories (Kahneman & Tversky, 1973). Many errors of this kind, e.g., misuses of stereotypes, lead to conclusions that Latins are emotional and Japanese are polite, which in turn evoke certain actions by the counselor. Perhaps the most important example of the error of similarity in counseling is the assumption that Western approaches are universal, permitting the counselor to disregard cultural differences. The fallacies of this assumption are discussed by Wohl in this volume.

Acquaintance with the typical errors he might commit in making counseling decisions forearms the counselor with certain rules of thumb. Neither decision-making theory nor behaviorism, however, supplies the counselor with explanations of everyday behavior. Reviews of decision-making research concur that when these theories are adequate, the conditions and issues are highly artificial. If we use decision-making as a guide in counseling, we affirm a narrow perception of the foreign student. We perceive a stranger from another culture and see only a small part, with the larger, more important body of unshared experiences buried in his own unique culture. We judge and counsel him on only the small part we see and how it looks to us, rather than on how it looks to him. The reverse view is likewise limited. For our purposes it is necessary to describe actions and choices in a context of the person's total environment and identity, discarding the time-exclusive models of stimulus-response explanations. Since an analysis of theoretical terms is beyond the scope of the present chapter, it suffices to note the need for theoretical concepts-for example, intention-that incorporate freedom of choice, complexity of intention, direction of behavior, and temporal characteristics such as delay and duration (Ryan, 1970, P. 30). In the field of counseling, behaviorism no longer acts as a model or theory. Higginbotham and Tanaka-Matsumi in their chapter in this volume display this view when they discuss the functional analysis of behavior. Although some of the language habits of behaviorism remain, particularly the phrasing of behavior in stimulus-response terms and the use of reinforcement, the center of attention is in social and cognitive variables and not behavior as such. Acceptance of the "person," stress on "skills for regulating their own behavior," and "cognitive-behavioral status" demonstrate the need to interpret behavior and clothe it with meaning. Behaviorism becomes an analytical discipline.
- Stewart, Edward C., Counseling Across Cultures, Paul Pedersen, Juris Draguns, Walter Lonner, and Joseph Trimble (eds.), The East-West Center: Hawaii, 1981

Personal Reflection Exercise #7
The preceding section contained information about cultural sensitivities in counseling. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Self-Assessment of Health Professionals' Cultural Competence:
Knowledge, Skills, and Mental Health Concepts for Optimal Health Care

Argyriadis, A., Patelarou, E., Paoullis, P., Patelarou, A., Dimitrakopoulos, I., Zisi, V., Northway, R., Gourni, M., Asimakopoulou, E., Katsarou, D., & Argyriadi, A. (2022). Self-Assessment of Health Professionals' Cultural Competence: Knowledge, Skills, and Mental Health Concepts for Optimal Health Care. International journal of environmental research and public health, 19(18), 11282. https://doi.org/10.3390/ijerph191811282


Peer-Reviewed Journal Article References:
Bowe, A. (2017). The cultural fairness of the 12-item General Health Questionnaire among diverse adolescents. Psychological Assessment, 29(1), 87–97.

Hart, T. A., Sharvendiran, R., Chikermane, V., Kidwai, A., & Grace, D. (2021). At the intersection of homophobia and racism: Sociocultural context and the sexual health of South Asian Canadian gay and bisexual men. Stigma and Health. 

Nagy, G. A., LeMaire, K. L., Miller, M. L., Bhatt-Mackin, S., & Railey, K. (2020). Training and education to advance multicultural mental health-care delivery (the “TEAM mental health-care delivery model”): A pilot evaluation of outcomes, acceptability, and feasibility. Training and Education in Professional Psychology. Advance online publication.

Powell, H. A., & Cochran, B. N. (2020). Mental health providers’ biases, knowledge, and treatment decision making with gender-minority clients. Psychology of Sexual Orientation and Gender Diversity. Advance online publication.

QUESTION 21
What makes counseling someone from a different culture difficult for a therapist? To select and enter your answer go to Test.

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