Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!

Section 5
Counseling Process for Hispanic and Asian Clients

Question 5 | Test | Table of Contents

Read content below or listen to audio.
Left click audio track to Listen; Right click to "Save..." mp3

In the last section, we discussed acculturative stress, as well as compared acculturative stress to "Culture Shock."

In this section, we will discuss three common counseling microskills. We will also discuss the ethical need for modifying these three common counseling microskills in treating culturally different clients. Sound interesting?

Obviously there are a number of common counseling microskills that generally serve to accomplish the first leg of the therapy process, which is getting the client’s story in order to begin the development of a working alliance.

Three Counsleing Microskills for Treating Culturally Different Clients

♦ Microskill #1: Modifying Attending Behaviors
The first counseling microskill we will consider is the basics of modifying Attending Behaviors. Before you sigh and think, "Oh my gosh, is this basic!" Think again. As you are well aware, attending behaviors refer to the way therapists use their bodies to communicate a genuine interest in the client. The operant word here is "genuine." These attending behaviors can, of course, include posture and eye contact, which when used appropriately can transmit positive energy to the client.

However, probably like you, I have found that attending behaviors are culturally based. Obviously, in the dominant culture, an open posture and eye contact are signs of nondefensiveness. These two behaviors can be quite conducive in establishing an effective counseling relationship. However, of course, this does not apply to all cultures. A short case study will illustrate this.

Junji (june’-jee), age 12, had gotten in trouble in school. Junji kept talking to a student in the next desk during a math class. After several requests to stop and threats of punishment, the math teacher sent Junji to the assistant principal for discipline. The school counselor had also been summoned and observed the interaction. As the assistant principal, Charles, tried to communicate with Junji regarding his punishment, he noticed that Junji would not make eye contact and looked down frequently.

Charles was soon becoming frustrated with Junji regarding what he felt was a lack of respect, due to his lack of eye contact.  Charles demanded that Junji look up when he was being spoken to. Do you see the problem with the way Charles tried to communicate with Junji? Obviously, in Asian cultures, direct eye contact is a sign of disrespect. A lowered head is, in fact, the common sign of respect in Asian cultures. How would you have handled communication with Junji? How would you have conveyed this to the assistant principal?

♦ Microskill #2: Clarification
The second counseling microskill we will look at is Clarification. Clarification is an intervention by the therapist to gain a deeper understanding of something communicated by the client. A good therapy principle related to clarification is to assume nothing and ask the client to explain what was meant.

3 Implications of Clarifications
-- First, it highlights the uniqueness of each client.
-- Second, it helps the client tell his or her story.
-- Third, clarification has a cathartic effect.

However, in multicultural counseling, clarification also functions as a tool to better understand the client’s cultural background. I have found that clarification can help differentiate between what is culturally acceptable behavior and what is pathological behavior.  Here’s an example:

Celestina, 32 years old and of Puerto Rican descent, originally sought therapy to help her cope with the death of her sister, Marisol (mar-ee’-soul). Following Marisol’s death, Celestina was sure that evil spirits were trying to control her. How would you deal with a client claiming that he or she was influenced by evil spirits? Instinctively I thought to categorize Celestina as paranoid with poor reality testing.

However, I knew that Puerto Ricans have a common tradition called "espiritismo" (es-peer-eat-ees’-moh). Espiritismo is a worldview that understands one’s fate as determined by good and evil spirits existing outside oneself and warring with each other.

Can you see how treatment for paranoia and poor reality testing would have been inappropriate for Celestina? In Celestina’s case, the counseling microskill of clarification helped me to confirm the world view of espiritismo instead of incorrectly diagnosing the behavior. As you can see, when working cross-culturally, you, as the therapist, have the clinical and ethical obligation to use clarification to gain as much knowledge as possible about your culturally different client’s background.

♦ Microskill #3: Reflection
Following attending behaviors and clarification, the third counseling microskill we will discuss is Reflection. As you are well aware, reflection designates the therapist's attempt to give back to clients the feeling associated with the content of their stories. The reflection microskill has roots in an approach to counseling that is nondirective and emphasizes feelings. However, like the microskills of attending behaviors and clarification, reflection has a different dynamic in the counseling of a culturally different client. Obviously reflecting feelings can be culturally alienating.

For some clients from nondominant cultures, therapists are expected to be experts whose role is to tell the client what to do. Thus, counseling a client of another culture can be an ethical challenge as you negotiate a stance between empowering the client and not alienating the client. In addition reflection has a second dimension, which is the tendency to employ its use for facilitating the expression of affect on the part of the client. In some cultures, such as the Hispanic culture, emotional expression is highly valued. However, I have found that in other cultures, like the Asian culture, emotional expression is seen as a sign of weakness.

Thus using reflection in treating a Hispanic client may be appropriate, while using the same microskill in treating an Asian American may be culturally insensitive. Make sense?

What counseling microskills do you use in treating your culturally different client? The NBCC Code of Ethics states, "Through an awareness of the impact of stereotyping and unwarranted discrimination, that is, biases based on age, disability, ethnicity, gender, race, religion, or sexual orientation, certified counselors guard the individual rights and personal dignity of the client in the counseling relationship." 

Do you use any of the three microskills of attending behaviors, clarification, and reflection that we discussed in this section? Do you take into account the importance of different attending behaviors when dealing with Asian American clients like Junji? Do you use clarification to better understand the cultural background and worldviews of your Hispanic clients like Celestina? What are the ethical implications of using the reflection microskill with your culturally different client?

In this section, we have discussed three common counseling microskills. These three common counseling microskills were attending behaviors, clarification, and reflection. We also discussed the ethical concerns raised by using these microskills in an unmodified manner with clients of a different culture.

On the next section, we will discuss transference and countertransference as they relate to cross-cultural counseling. Regarding transference, we will discuss the traditional analytical framework of the primary caretaker as used in traditional counseling experiences, and compare it to the more appropriate cultural framework that may be necessary in cross-cultural counseling experiences. Regarding countertransference, we will discuss the importance of the therapist’s ability to recognize countertransference as well as the importance of admitting one’s own racist attitudes and ethnic stereotypes.
Reviewed 2023

QUESTION 5
What ethical issue arises when counseling a client of another culture regarding empowerment? To select and enter your answer go to Test.

Test
Section 6
Table of Contents
Top