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Section 8
Ethics - The Use of Self with Ethnically Diverse Clients

Question 8 | Test | Table of Contents

Eliciting Stance

The initial stories clients tell clinicians contain problems that they have not been able to solve themselves (Laird, 1989; Penn & Sheinberg, 1991). From the eliciting stance the therapist asks clients about their ideas and explanations about the presenting problem and respectfully accepts each one (Real, 1990). Conflicting explanations are not countered, but instead each is explored through open-ended questions. When using the eliciting stance, the clinician does not present himself or herself as an "expert" but rather takes a "onedown" position and thus reinforces the client as the expert on his or her situation; this can be experienced by clients as empowering.

By using the eliciting stance, the clinician, according to Real (1990), "invites greater variety in system members' thinking, not by countering their ideas or by suggesting alternatives, but by simply asking individuals to focus their attention on constructs that may have received only scant attention before" (p. 261). The eliciting stance allows the clinician to bring the issue of ethnicity into the therapeutic discourse in a way that reflects curiosity and acceptance.

Circular Questioning Real (1990) did not include the use of circular questioning (see Fleuridas, Nelson, & Rosenthal, 1986; Penn, 1982) in the eliciting stance. However, we believe that circular questioning should be considered part of the eliciting stance. Circular questioning involves asking different family members their views about the beliefs, behaviors, and patterns of behavior of other family members and their relationships (Penn, 1982). Because problems do not occur in a vacuum, such questioning highlights the interpersonal context (Fleuridas et al., 1986). As a result, clients view and experience their situations systemically rather than focus on individual symptomatology. This shift in perspective results in significant positive change for clients. Straightforward questions can elicit "each person's construction of the situation" (Real, 1990, p.262). Circular questioning enlarges the contextual definition of the problem.

Ethics - Reframing Stance
In Real's (1990) framework the second stance is called the "probing" stance. However, the terms "eliciting" and "probing" are similar in meaning and, thus, could cause the two stances to be confused. Because the clinician's primary activity in the second stance is reframing, we have decided to refer to this stance as the "reframing" stance to avoid confusion.

Reframing the Situation. In the eliciting stance, the clinician draws out distinctions and explanations from the system members; in the reframing stance the opposite is true. The clinician now contributes potentially new, plausible ideas to be considered in the therapeutic dialogue. These ideas consist of ways clients can redefine or reframe important aspects of their situations. One important aspect of a client's reality in which positive reframing may be useful is the area of ethnicity, especially when clients of color seem to have bought into society's devaluation. Client empowerment is reinforced when heretofore negatively defined ethnic attributes are positively reframed.

Contextualizing Stance
Using the contextualizing stance, the clinic a helps clients connect the presenting problem situation to their interpersonal or family-of-origin realities (Real, 1990). The contextualizing stance is typically in use whenever the clinician convenes two or more generations for a family session. Having such sessions implicitly conveys to the family the message that the problem situation has meaning and relevance to all family members. Another implicit contextualizing message in sessions involving multiple generations is that everyone is needed to resolve the problem situation. The use of the contextualizing stance is especially relevant to working with African American families because of the importance of the extended family in African American culture (Hines & Boyd-Franklin, 1982).

Frequently clients see a problem in dichotomous terms in which they hold themselves or other people responsible; either view of the problem can be disempowering. Frequently clients are not aware of the complex interactive and ecological nature of their problem situation. The contextualizing stance allows the client to see the problem with a wide-angle lens. The clinician uses circular questioning in the contextualizing stance to help clients view problems interpersonally, generationally (up or down at least one generation), or societally. Contextualizing is illustrated in the previous dialogue when the social worker asked C who in the family it was easiest for certain family members to open up to. The ease of opening up depends on the interpersonal context, which includes issues of gender and ethnicity.

Ethics - Matching Stance
Using the matching stance, the clinician mirrors (feeds back) to clients key aspects of their reality (Real, 1990). The clinician shares with clients his or her hypotheses about their reality. Real stated that an example of this at the individual level is the clinician's use of empathic responding. In applying this stance to working with ethnically diverse clients, the relevance of their ethnic reality becomes a key point. The use of the matching stance in an empathic manner is illustrated in the previous dialogue when the clinician stated, "So it's been a real struggle for you. You've been a young, single, African American mother of three children trying to make it in a system that doesn't, in many instances, consider what the African American experience is like."

Bicultural Awareness. The matching stance is especially relevant when the client has conflicts or dilemmas that are integral to their problem situation, especially if these conflicts are outside conscious awareness. In everyday life clients of color are presented with conflicts and dilemmas arising from their bicultural lives (Chestang, 1979). Such experiences can be very uncomfortable, and in coping the client of color may be inclined to deny or minimize their existence. Real (1990) referred to this use of the matching stance as "reflecting."

Reflection. After becoming increasingly aware of forgotten strengths and competencies, the client may then have the energy to reflect on the possibility of being in a "bicultural dilemma" and later bring this up in the therapeutic conversation for further exploration. However, if the client does not initiate discussion of this dilemma at a later time, the clinician can revisit and explore its effect on the client by using socratic, circular, and reflexive questioning. These types of questions, according to Tomm (1987), aid clients in selfhealing by getting them to reflect on their current interpretations of reality and generating new patterns of interpreting and behaving. When clients of color are reflective, they become objects of their own observations (Lax, 1992) and, consequently, are able to define the reality of their bicultural dilemma and its resolution themselves.

Amplifying Stance
Taking the amplifying stance, the clinician focuses on a particular idea, affect, theme, or behavior that is a client resource; he or she hopes to evoke more client attention to it as a result of this focus (Real, 1990). According to Real, this stance is based on the constructivist axiom that "Often, all one needs to do to evoke more of any given quality within a system is to attend to it" (p. 267). Real saw the amplifying stance as similar to the emphasis on identifying "exceptions" in solution-focused therapy (Walter & Peller, 1992) or "unique outcomes" in narrative therapy (White & Epston, 1990), in which the clinician and clients identify what has worked previously in problem resolution so that the client will do more of it.

Extended Family. Many clients of color who have been devalued and disempowered by society may deny or downgrade the strengths and resources they have. The amplifying stance is a way to facilitate clients' awareness and use of their strengths and resources. In extended African American families like the Smiths, it is common to have an older male member in the family in the role of "Daddy" or "Big Daddy" and an older female family member in the role of "Big Mama." These roles represent strengths in an extended African American family that need to be maintained in treatment.
- Greene, G. J., Jensen, C., & Jones, D. H. (1996). A Constructivist Perspective on Clinical Social Work Practice with Ethnically Diverse Clients. Social Work, 41(2), 172-180. doi:10.1093/sw/41.2.172

Personal Reflection Exercise #4
The preceding section contained information about the use of self with ethnically diverse clients.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

Papoutsi, C., Hargreaves, D., Hagell, A., Hounsome, N., Skirrow, H., Muralidhara, K., Colligan, G., Ferrey, A., Vijayaraghavan, S., Greenhalgh, T., & Finer, S. (2022). Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings. BMC medicine, 20(1), 459. https://doi.org/10.1186/s12916-022-02654-0

Peer-Reviewed Journal Article References:
Hofhuis, J., Schafraad, P., Trilling, D., Luca, N., & van Manen, B. (2021). Automated content analysis of cultural Diversity Perspectives in Annual Reports (DivPAR): Development, validation, and future research agenda. Cultural Diversity and Ethnic Minority Psychology. Advance online publication

Nightingale, A., Muldoon, O., & Quayle, M. (2021). The transnational patriot: Celebrating cultural diversity between nation-states while promoting hostility toward diversity within nation-states. European Psychologist, 26(1), 45–54.

Stanley, C. A., Watson, K. L., Reyes, J. M., & Varela, K. S. (2019). Organizational change and the chief diversity officer: A case study of institutionalizing a diversity plan. Journal of Diversity in Higher Education, 12(3), 255–265.

Ethics CEs QUESTION 8
What are the five stances? To select and enter your answer go to Test.

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