Handbook of Multicultural Counseling [4 ed.] 9781452291512

Table of contents :
HANDBOOK OF MULTICULTURAL COUNSELING- FRONT COVER
HANDBOOK OF MULTICULTURAL COUNSELING
COPYRIGHT
CONTENTS
FOREWORD
PREFACE
ACKNOWLEDGMENTS
PART I- MULTICULTURAL COUNSELING: PAST AND PRESENT
CHAPTER 1- THE HISTORY OF MULTICULTURAL PSYCHOLOGY: FROM THE PERSPECTIVE OF TWO OPPOSING FORCES
CHAPTER 2- FOSTERING THE DEVELOPMENT OF A SOCIAL JUSTICE PERSPECTIVE AND ACTION: FINDING A SOCIAL JUSTICE VOICE
CHAPTER 3- A REVIEW OF THE COUNSELING PROFESSIONS’ ETHICAL GUIDELINES: ARE THEY MEETING THE CHALLENGES OF TODAY’S SOCIETY?
CHAPTER 4- A PERSONAL ASSESSMENT OF THE EBB AND FLOW OF THE MULTICULTURAL COUNSELING MOVEMENT (MCM)
PART II- HONORING OUR ELDERS: LIFE STORIES OF PIONEERS IN MULTICULTURAL COUNSELING AND PSYCHOLOGY
PUSHED BY THE PAST AND PULLED BY THE FUTURE: THOUGHTS AND COMMENTS REGARDING THE INCLUSION OF LIFE STORIES IN THE HANDBOOK
CHAPTER 5- FROM FIVE SIDES OF THE DESK: THE ROLES OF DISABILITY IN MY LIFE
CHAPTER 6- MULTICULTURALISM—THE FINAL FRONTIER: RESISTANCE IS NOT FUTILE
CHAPTER 7- THE ROAD LESS TRAVELED: RESEARCH ON RACE
CHAPTER 8- MY LIFE STORY: MY QUEST FOR CULTURAL RELEVANCE IN PSYCHOLOGY
CHAPTER 9- HEALING: RECLAIMING MY ANCESTRAL LEGACY
CHAPTER 10- IT TOOK A VILLAGE: THE BACKS THAT WERE MY BRIDGES
CHAPTER 11- CHILD OF THE CIVIL RIGHTS ERA: FORMATIVE INFLUENCES ON MY PERSONAL AND PROFESSIONAL LIVES
CHAPTER 12- I UNDERSTAND: MEMORIES OF A CONSTANT CONTRARIAN
CHAPTER 13- MULTICULTURAL PIONEER: CONFESSIONS OF A WARRIOR AND HEALER
CHAPTER 14- LANDSCAPING MY LIFE JOURNEY: UNPEELING A “BANANA”
CHAPTER 15- PIONEER LIFE STORY: LISTENING TO THE STILL, SMALL VOICE
CHAPTER 16- REFLECTIONS OF AN AMERICAN INDIAN PEDIATRIC PSYCHOLOGIST
CHAPTER 17- FACTORS AND EXPERIENCES OF LIFE: REFLECTIONS ON THE ACCOMPLISHMENTS OF THE PIONEERS
PART III- GIVING MEANING AND PURPOSE TO MULTICULTURAL COUNSELING ENDEAVORS
CHAPTER 18- TOWARD A CULTURAL EVIDENCE-BASED PSYCHOTHERAPY
CHAPTER 19- INTO THE FIELD: ANTICOLONIAL AND INDIGENOUS PERSPECTIVES AND STRATEGIES FOR COUNSELING INTERVENTIONS
CHAPTER 20- STORYTELLING AND OTHER INDIGENOUS TEACHINGS: FROM CULTURE TO CLINICAL PRACTICE
CHAPTER 21- MULTICULTURAL TRAINING AND SUPERVISION IN RESEARCH AND SERVICE
CHAPTER 22- COUNSELING PSYCHOLOGY AND DISENFRANCHISEMENT: USING WHAT WE HAVE TO CHANGE THE GAME
PART IV- CURRENT AND FUTURE TRENDS IN MULTICULTURAL COUNSELING RESEARCH
CHAPTER 23- INNOVATIVE APPROACHES: EMPHASIZING EFFECTIVENESS AND SOCIAL JUSTICE FOR ETHNOCULTURAL POPULATIONS
CHAPTER 24- CATEGORY-BASED AND FEATURE-BASED BIAS: MEASUREMENT AND APPLICATION
CHAPTER 25- PSYCHOLOGICAL ASSESSMENT: A BRIEF EXAMINATION OF PROCEDURES, FREQUENTLY USED TESTS, AND CULTURALLY BASED MEASURES
PART V- EMERGING ISSUES AND MOVEMENTS IN MULTICULTURAL COUNSELING PSYCHOLOGY
CHAPTER 26- MULTICULTURAL POSITIVE PSYCHOLOGY: CULTURAL PERSPECTIVES OF THE GOOD LIFE
CHAPTER 27- MULTICULTURAL SPIRITUALITY: A SYNCRETISTIC APPROACH TO HEALING, LIBERATION, AND SOCIAL JUSTICE
CHAPTER 28- INTERNATIONAL ENGAGEMENT IN COUNSELING AND PSYCHOLOGY: HISTORY, FORUMS, ISSUES, AND DIRECTIONS
CHAPTER 29- MULTICULTURAL COMPETENCE IN THE DELIVERY OF TECHNOLOGY-MEDIATED MENTAL HEALTH SERVICES
CHAPTER 30- INTERDISCIPLINARITY IN MULTICULTURAL PSYCHOLOGY: AN INTEGRATED REVIEW AND CASE EXAMPLES
CHAPTER 31- VIOLENCE PREVENTION IN SCHOOLS AND COMMUNITIES: MULTICULTURAL AND CONTEXTUAL CONSIDERATIONS
CHAPTER 32- CONSIDERING DEFINITIONAL ISSUES, CULTURAL COMPONENTS, AND THE IMPACT OF TRAUMA WHEN COUNSELING VULNERABLE YOUTH SUSCEPTIBLE TO GANG INVOLVEMENT
CHAPTER 33- CULTURAL ISSUES IN COUNSELING TODAY’S MILITARY VETERANS
CHAPTER 34- CAUTION: IMMIGRATION MAY BE HARMFUL TO YOUR MENTAL HEALTH
CHAPTER 35- DIFFICULT DIALOGUES IN COUNSELOR TRAINING AND HIGHER EDUCATION
PART VI- AFFIRMING MULTIPLE IDENTITIES
CHAPTER 36- IMMIGRANTS AND REFUGEES: A CONTEXTUAL COUNSELING PERSPECTIVE
CHAPTER 37- ADDRESSING THE NEEDS OF LGBTQ YOUTH: A COUNSELING IMPERATIVE
CHAPTER 38- MULTICULTURAL COUNSELING WITH OLDER ADULTS: CONSIDERATIONS FOR INTERVENTION AND ASSESSMENT
CHAPTER 39- PERSPECTIVES ON DISABILITY WITHIN INTEGRATED HEALTH CARE
CHAPTER 40- DISASTER SURVIVORS: IMPLICATIONS FOR COUNSELING
CHAPTER 41- COUNSELING MIDDLE EASTERN AMERICANS: CHALLENGES AND OPPORTUNITIES
CHAPTER 42- MULTICULTURAL SELF-AWARENESS CHALLENGES FOR TRAINERS: EXAMINING INTERSECTING IDENTITIES OF POWER AND OPPRESSION
PART VII- CULTURE AND INTERVENTION
CHAPTER 43- UNDERSERVED RURAL COMMUNITIES: CHALLENGES AND OPPORTUNITIES FOR IMPROVED PRACTICE
CHAPTER 44- UNDERSERVED URBAN COMMUNITY INTERVENTIONS
CHAPTER 45- CAREER COUNSELING: UPDATES ON THEORY AND PRACTICE
CHAPTER 46- ORGANIZATIONAL CHANGE IN INSTITUTIONS OF HIGHER EDUCATION
EPILOGUE
REFERENCES
INDEX
CONTRIBUTORS LIST
ABOUT THE EDITORS

Citation preview

Handbook of Multicultural Counseling Fourth Edition

As editors, we take great pleasure in dedicating this fourth edition of the Handbook of Multicultural Counseling to our good friend and colleague, Joseph Ponterotto. It would be safe to say that it was his visionary efforts, his hard work, and his strong commitment to social justice and multicultural counseling that brought us together to create, over a period of 20 years, the first and the three subsequent editions of the Handbook. Throughout this time, Joe modeled for us the enthusiasm, commitment, and energy that is required to put together the kind of Handbook of which we could all be proud and which would concomitantly benefit those readers intent on becoming effective multicultural counseling psychologists. At this time, Joe continues to teach at Fordham University and more recently established a private practice. In addition, he has ventured into the area of writing psychobiographies, which enables him to reach a wider audience of readers interested in the psychological development of individuals who are in the public eye. As a result of these endeavors, he has found it necessary to cut back a bit on his multicultural research and writing, including stepping down as a co-editor of this edition of the Handbook. We are quick to note, however, that while he may not be listed as a co-editor, he did not sit on the sidelines while we worked. On the contrary, he continued to patiently help us as needed, including writing the Epilogue for this edition. For all that you’ve done with and for us, and the joy that you have given us throughout the years, we thank you and dedicate this book to you.

Handbook of Multicultural Counseling Fourth Edition

J. Manuel Casas University of California, Santa Barbara Lisa A. Suzuki New York University Charlene M. Alexander Ball State University Margo A. Jackson Fordham University

FOR INFORMATION:

Copyright © 2017 by SAGE Publications, Inc.

SAGE Publications, Inc.

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

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Printed in the United States of America Library of Congress Cataloging-in-Publication Data

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Names: Casas, J. Manuel, editor.

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Title: Handbook of multicultural counseling / editors, J. Manuel Casas, University of California, Santa Barbara, Lisa Suzuki, New York University, Charlene Alexander, Ball State University, and Margo A. Jackson, Fordham University.

India SAGE Publications Asia-Pacific Pte. Ltd. #10-04 Samsung Hub

Description: 4th edition. | Thousand Oaks, California: SAGE, [2017] | Includes bibliographical references and index.

Singapore 049483

Identifiers: LCCN 2015051101 | ISBN 9781452291512 (hardcover : alk. paper)

3 Church Street

Subjects: LCSH: Cross-cultural counseling. | Multiculturalism—United States. | Minorities—Counseling of—United States. Classification: LCC BF636.7.C76 H36 2017 | DDC 158.3—dc23 LC record available at http://lccn.loc.gov/2015051101

Acquisitions Editor:  Kassie Graves

This book is printed on acid-free paper.

Associate Editor:  Abbie Rickard Editorial Assistant:  Carrie Montoya Production Editor:  Olivia Weber-Stenis Copy Editor:  Diane Wainwright Typesetter:  C&M Digitals Ltd. Proofreader:  Theresa Kay Indexer:  Michael Ferreira Cover Designer:  Glenn Vogel Marketing Manager:  Jenna Retana

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Contents

Forewordxi Melba J. T. Vasquez Prefacexv Acknowledgmentsxvii

PART I.  MULTICULTURAL COUNSELING: PAST AND PRESENT

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  1. The History of Multicultural Psychology: From the Perspective of Two Opposing Forces J. Manuel Casas

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  2. Fostering the Development of a Social Justice Perspective and Action: Finding a Social Justice Voice Rebecca L. Toporek William Sapigao Bryan O. Rojas-Arauz   3. A Review of the Counseling Professions’ Ethical Guidelines: Are They Meeting the Challenges of Today’s Society? Charlene Alexander Amy Mitchell   4. A Personal Assessment of the Ebb and Flow of the Multicultural Counseling Movement (MCM) Michael D’Andrea

PART II. HONORING OUR ELDERS: LIFE STORIES OF PIONEERS IN MULTICULTURAL COUNSELING AND PSYCHOLOGY

Pushed by the Past and Pulled by the Future: Thoughts and Comments Regarding the Inclusion of Life Stories in the Handbook J. Manuel Casas

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31

43

51 51

  5. From Five Sides of the Desk: The Roles of Disability in My Life Martha E. Banks

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  6. Multiculturalism—The Final Frontier: Resistance Is Not Futile Guillermo Bernal

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  7. The Road Less Traveled: Research on Race Robert T. Carter

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  8. My Life Story: My Quest for Cultural Relevance in Psychology Fanny M. Cheung

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  9. Healing: Reclaiming My Ancestral Legacy Lillian Comas-Díaz

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10. It Took a Village: The Backs That Were My Bridges Beverly A. Greene

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11. Child of the Civil Rights Era: Formative Influences on My Personal and Professional Lives Bertha Garrett Holliday

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12. I Understand: Memories of a Constant Contrarian Anthony J. Marsella

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13. Multicultural Pioneer: Confessions of a Warrior and Healer Thomas A. Parham

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14. Landscaping My Life Journey: Unpeeling a “Banana” Lisa A. Suzuki

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15. Pioneer Life Story: Listening to the Still, Small Voice Beverly Daniel Tatum

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16. Reflections of an American Indian Pediatric Psychologist Diane J. Willis

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17. Factors and Experiences of Life: Reflections on the Accomplishments of the Pioneers J. Manuel Casas

PART III. GIVING MEANING AND PURPOSE TO MULTICULTURAL COUNSELING ENDEAVORS 18. Toward a Cultural Evidence-Based Psychotherapy Martin La Roche Michael S. Christopher Lindsey M. West 19. Into the Field: Anticolonial and Indigenous Perspectives and Strategies for Counseling Interventions Christine J. Yeh Darrick Smith Noah E. Borrero 20. Storytelling and Other Indigenous Teachings: From Culture to Clinical Practice Dolores Subia BigFoot

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175 177

188

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21. Multicultural Training and Supervision in Research and Service Changming Duan Alexandra Smith 22. Counseling Psychology and Disenfranchisement: Using What We Have to Change the Game Laura Smith

PART IV. CURRENT AND FUTURE TRENDS IN MULTICULTURAL COUNSELING RESEARCH 23. Innovative Approaches: Emphasizing Effectiveness and Social Justice for Ethnocultural Populations Laura Kohn-Wood Donna K. Nagata Jackie H. J. Kim Ahjane D. Macquoid 24. Category-Based and Feature-Based Bias: Measurement and Application Elena V. Stepanova Nao Hagiwara 25. Psychological Assessment: A Brief Examination of Procedures, Frequently Used Tests, and Culturally Based Measures Lisa A. Suzuki Elsa Lee Ellen L. Short

PART V. EMERGING ISSUES AND MOVEMENTS IN MULTICULTURAL COUNSELING PSYCHOLOGY 26. Multicultural Positive Psychology: Cultural Perspectives of the Good Life Lisa Y. Flores Lisa M. Edwards Jennifer Teramoto Pedrotti 27. Multicultural Spirituality: A Syncretistic Approach to Healing, Liberation, and Social Justice Lillian Comas-Díaz 28. International Engagement in Counseling and Psychology: History, Forums, Issues, and Directions Andrés J. Consoli Merry Bullock Melissa L. Morgan Consoli

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225

237 239

249

259

269 271

282

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29. Multicultural Competence in the Delivery of Technology-Mediated Mental Health Services Cynthia de las Fuentes Martha Ramos Duffer 30. Interdisciplinarity in Multicultural Psychology: An Integrated Review and Case Examples Oksana Yakushko Sherry C. Wang Charlotte M. McCloskey 31. Violence Prevention in Schools and Communities: Multicultural and Contextual Considerations Amanda B. Nickerson Matthew J. Mayer Dewey G. Cornell Shane R. Jimerson David Osher Dorothy L. Espelage 32. Considering Definitional Issues, Cultural Components, and the Impact of Trauma When Counseling Vulnerable Youth Susceptible to Gang Involvement Joey Nuñez Estrada Jr. Robert A. Hernandez Steven W. Kim

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315

323

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33. Cultural Issues in Counseling Today’s Military Veterans Molly K. Tschopp Michael P. Frain

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34. Caution: Immigration May Be Harmful to Your Mental Health J. Manuel Casas

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35. Difficult Dialogues in Counselor Training and Higher Education Roger L. Worthington Marvyn R. Arévalo Avalos

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PART VI.  AFFIRMING MULTIPLE IDENTITIES

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36. Immigrants and Refugees: A Contextual Counseling Perspective Pratyusha Tummala-Narra Anita Deshpande

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37. Addressing the Needs of LGBTQ Youth: A Counseling Imperative Amy L. Reynolds

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38. Multicultural Counseling With Older Adults: Considerations for Intervention and Assessment Katy L. Ford Martha R. Crowther

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39. Perspectives on Disability Within Integrated Health Care Colleen Clemency Cordes Rebecca P. Cameron Linda R. Mona Maggie L. Syme Alette Coble-Temple

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40. Disaster Survivors: Implications for Counseling Beth Boyd Hitomi Gunsolley

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41. Counseling Middle Eastern Americans: Challenges and Opportunities Ayşe Çiftçi Lamise Shawahin

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42. Multicultural Self-Awareness Challenges for Trainers: Examining Intersecting Identities of Power and Oppression Margo A. Jackson Jaya T. Mathew

PART VII.  CULTURE AND INTERVENTION 43. Underserved Rural Communities: Challenges and Opportunities for Improved Practice Cindy L. Juntunen Melissa A. Quincer

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445 447

44. Underserved Urban Community Interventions Justin C. Perry Eric W. Wallace Lela L. Pickett

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45. Career Counseling: Updates on Theory and Practice Neeta Kantamneni Nichole Shada

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46. Organizational Change in Institutions of Higher Education Patricia Arredondo Lubnaa Badriyyah Abdullah

485

Epilogue499 Joseph G. Ponterotto References509 Index616 Contributors List

662

About the Editors

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Foreword Melba J. T. Vasquez

T

he ongoing development of competence in multicultural counseling is an ethical responsibility. Culture is significantly involved in the development of individuals within their identity group. Every individual possesses various strands of identity, and those identities are frequently in flux due to acculturation and other influences in society. Many of us who work to develop multicultural counseling competence are working to understand how societal influences and other aspects of diversity intersect with race and ethnicity. People may not only develop “bicultural” identities but are influenced by many strands of identities, including not only race and ethnicity but also sex, gender, social class (including education), sexual orientation, heritage or national origin, immigration experiences, abilities and disabilities, religion and spirituality, age, language, body type, location, or geography (Vasquez & Vasquez, in press). The social construction of identities influences our perceptions of problems and issues as well as what we consider to be healthy and unhealthy, functional and dysfunctional coping strategies. Multicultural competence requires an understanding of how individuals experience and respond to life’s challenges and distress as well as the unique forms of adjustment, resilience, and strengths. We each possess multiple aspects of identity, and the psychotherapist must ask: What aspects of the client’s identities are at the forefront of the presenting problem? Which identities are background in the therapeutic process, and which will the client benefit from bringing to the forefront? How do the strands of the psychotherapist’s identity affect the process? As Trimble (2015a, 2015b) reminded us, the world is changing a great deal thanks to the Internet, tourism, media, and immigration. Many speak two or three languages, practice different traditions, customs, ceremonies, and rituals. What impact does this changing societal climate have on members of society? What impact do these changes have on those of us who seek to have multicultural competence in our counseling, psychotherapy, consulting, teaching, and research? The timing of the fourth edition of the Handbook of Multicultural Counseling is a gift, given the zeitgeist in the United States for racial/ethnic minorities. In a symposium at the 2015 American Psychological Convention in Toronto, Ontario, Canada, James Jones (2015) provided a presentation titled “Post-Racial My *&%$#*: The Impact of Obama’s Presidency on Race in America.” One of Jones’s primary points is that Obama’s elections in 2008 and 2012 did not signal a postracial America but a hyperracial America. Obama and his presidency were greeted with racist images, insults, and disrespect. The implication is that of a backlash in response to the visual of an African American family in the White House, perhaps as well as to the changing world in which we live. Jones cited several polls conducted in 2015 that indicated that both Black and White participants reported a growing racial divide and despair since 2008. A destructive color-blind ideology underlies the postracial myth, according to Jones. Our society has come a long way in improving civil rights and race relations but has a long way yet to go. As I write the Foreword of this essential resource on multicultural counseling, many members of the United States are still reeling from a frightening number of killings and/or maltreatment of African American

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and Latina/o men and women, mostly by police but including by a 21-year-old racist, investigated as having perpetrated a hate crime in Charleston, South Carolina. Yet as a result of the latter tragedy, progress was demonstrated when South Carolina took down the Confederate flag that had flown on top of the South Carolina Statehouse since 1962 as a protest symbol against desegregation and civil rights. While this was an important symbolic act, the issues that affect people’s lives, like access to good education, fair opportunities for employment, equal opportunity for housing, and ability to create wealth, go far beyond what happens with the Confederate flag and are still lagging, despite President Obama’s efforts and those of many others. Another example of progress is the Supreme Court decision in June 2015 that legalized same-sex marriage nationwide. Yet the lesbian, gay, bisexual, and transgender (LGBT) community still face the burdens of housing, employment, and other forms of bias and discrimination. It is not enough to become effective in our work with those different from us. We have to know how to effectively confront bigotry, injustice, and unfairness not only in ourselves but also in our clients, our families and friends, and in society. Part of our responsibility in developing multicultural competence is to understand and prepare people to live in the increasingly diverse world represented in our lives. Jones (2015) suggests that diversity competency requires self-awareness, perspective taking, cultural intelligence and communication, personal and social responsibility, understanding of global systems, and application of knowledge. He urges us to create conditions for all people to thrive in a civil and humane society. This is partly what social justice is about, and one cannot be multiculturally competent without embracing the goals of social justice. Several authors in this volume help us understand how one cannot be a multiculturalcompetent professional without embracing and promoting social justice at both societal structural levels as well as at the individual level. Multicultural competence in counseling has become part of the mainstream fundamental knowledge and skill set required for effective,

ethical practice. More counseling and clinical psychology programs have incorporated multiculturalism in courses and training experiences, and more state licensing boards are requiring diversity continuing-education experiences. Reading the fourth edition of the Handbook of Multicultural Counseling can help us attain the goals described by Jones (2015) by providing a multicultural knowledge base as well as enabling us to develop culturally appropriate and effective skill sets. We know, for example, that insidious biases, even among those who consider themselves to be egalitarian, will only be diminished with ongoing and constant promotion of awareness. Increased knowledge and insights such as those obtained from this invaluable resource can help improve self-awareness as well as knowledge and an understanding of the skills and tools necessary to engage in obtaining those goals. Following on the success of the previous editions, this updated and expanded fourth edition of the Handbook of Multicultural Counseling contains 46 chapters in seven sections. Continued and rapid development and growth of the field of multicultural counseling has led to the ability of almost 100 coauthors who are both emerging and key figures in multicultural psychology to provide up-to-the-minute engaging topics to represent the field’s current breadth and vigor. It is truly the most impressive, comprehensive singular resource on multicultural counseling theory, history, topics, research, and practice. The life stories of eminent visionary pioneers serve as inspiration for many of us. The complex, sophisticated, and diverse content can help us obtain deeper and deeper layers of insights, understanding, knowledge, competence, compassion, sensitivity, and effectiveness. Indeed, often, when struggling with a very difficult client, it is helpful for me to re-read some of the material that helps remind me of the important roles of compassion, sensitivity, and understanding. To practice ethically requires awareness, sensitivity, and empathy for the client as an individual. This partly involves knowledge of and attention to the client’s cultural values, beliefs, norms, and

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behaviors. Multicultural competence is an ethical imperative, and this fourth edition of the Handbook of Multicultural Counseling will help us develop highly effective, ethical counseling practice.

REFERENCES Jones, J. M. (2015, August). Post-racial my *&%$#*%: The impact of Obama’s presidency on race in America. Presented as part of Division 45 Presidential Symposium, Race/Ethnic Relations and the Obama Presidency: Perspectives of Some Leaders in the Field, at the American Psychological Association 95th Annual Convention, Toronto, Ontario, Canada. Trimble, J. E. (2015a, April 11). Culture and Leadership [video]. Retrieved August 16, 2015, from https:// www.youtube.com/watch?v=fuHj3jsBdKE

Trimble, J. E. (2015b, August). Identifying and developing more culturally sensitive and diverse leadership styles. Paper presented as part of a symposium on Race/Ethnic Relations and the Obama Presidency: Perspectives of Leaders in the Field, at the meeting of the American Psychological Association, Toronto, Ontario, Canada. Vasquez, M. J. T., & Vasquez, E. (in press). Psychotherapy with women: Theory and practice. In L. E. Beutler, A. J. Consoli, & B. Bongar (Eds.), Comprehensive textbook of psychotherapy: Theory and practice (2nd ed.). New York, NY: Oxford University Press.

Melba J. T. Vasquez Independent Practice, Austin, Texas Former President, American Psychological Association

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Foreword

Preface

I

t is our pleasure and honor to celebrate the 20th anniversary of the first publication of the Handbook of Multicultural Counseling with the publication of this fourth edition. Over the years, the Handbook of Multicultural Counseling has become a best-selling SAGE book that is cited internationally. The publication of a revised edition of the Handbook reflects the fact that the field of multicultural counseling continues to grow and change rapidly. Wanting to keep up with such changes, we have completely revised and expanded this newest edition to provide an up-to-date and comprehensive topical overview of the field. From the onset, we note that in spite of content revisions, we have maintained the major objectives inherent in the previous editions: (a) to demonstrate the continuing advancement and applicability of multicultural counseling in our diverse society; (b) to give emphasis to current cutting-edge challenges and progress in multicultural counseling practice, theory, research, and training; (c) to increase the competence of researchers, educators, and practitioners to study, assess, understand, and intervene with multicultural persons; (d) to underscore and advance social justice as a core counseling value; (e) to contribute to the development of counselors who are more compassionate, sensitive to and effective in working with multicultural persons and issues; and (f) to support all information contained in the chapters with research and/or clinical-based evidence. In the spirit of the previous editions, we decided to continue using these major driving themes to bring purpose, unity, and direction in pursuit of the above-mentioned goals: social justice, research, and utility. To this end, we asked the contributing authors to use these themes to guide and give life to their work. With regard to social justice, we asked contributing authors to emphasize the importance of counselors’ commitment to and development of a social justice perspective in their writings. In addition, they were asked to focus on social action and advocacy as a means of inciting change. To increase the academic and pragmatic value of the chapters, we requested that the authors provide cutting-edge research to support and validate the information contained in their chapters. Finally, working from the belief that a handbook on or for multicultural populations should have pragmatic and not merely heuristic value, the authors were asked to write on topics of timely relevance to the field and to do so in a manner that could be used by researchers, educators, practitioners, and students. As mentioned above, some major features of the book have changed while others have remained the same:

1. Reflecting the continued rapid development and growth of the field of multicultural counseling, we continue to incorporate a large number of chapters that address up-to-the-minute topics in the Handbook (i.e., 46 chapters). While the categorical topics addressed may be similar (e.g., history, interventions, assessment), the content presented differs significantly from that contained in the third edition. Not including the Epilogue, this edition of the Handbook of Multicultural Counseling is organized into seven parts comprised of a total of 46 chapters. Each part has an introductory section that helps the reader to understand how it selectively addresses the objectives and themes that serve as the core of the Handbook.

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2. As with the previous editions, close to 100 chapter coauthors, representing both seasoned, world-renowned scholars and practitioners as well as new, cutting-edge minds, have contributed their thoughts, ideas, and experiences to the contents of this new edition. It should be noted that out of the large number of authors included in this edition, only 12 contributed to the third edition. Similar to the past editions, the contributing authors represent a broad spectrum of the profession in terms of national origin and geographic locale, race, ethnicity, life and professional experiences, age, sexual orientation, religion, gender, current abilitydisability status, and employment emphasis. Represented among the authors are visionary, trendsetting scholars; master practitioners in a variety of clinical and counseling settings; experienced supervisors, administrators, and social justice advocates; and conservative/liberal change agents. Drawing from such a wealth of knowledge and experiences, what we said about the third edition still holds today: “Without question, this Handbook is the world’s most comprehensive singular resource on multicultural counseling theory, history, research, and practice.” 3. As previously mentioned, the one part of this new Handbook that remains unchanged from the second and third edition is Part II on life stories of eminent, visionary pioneers in the field. In this edition, 12 “new” pioneers or “elders” have honored us with their very personal life stories,

which we hope will inspire young and old alike to strive to attain their personal and professional goals, and most important of all, their dreams.

As with the previous editions, all royalties from the sale of this new edition will be alternately donated to the organizing committees of the Winter Roundtable on Multicultural Psychology and Education held annually at Teachers College, Columbia University, on the East Coast, and the American Psychological Association–sponsored biannual Multicultural Conference and Summit, usually held in the western part of the United States. The intent of the royalty distribution is to support student involvement in the conferences in whatever way deemed most appropriate by the conference organizers. Suffice it to say that in the spirit of the past, this Handbook, like its predecessors, continues to provide a comprehensive and thorough snapshot of the multicultural counseling field as it is today, and also presents a vision as to how the field is evolving and developing. We once more feel honored to present this new edition to you, and we are proud of the work of all of the contributing authors who made this cutting-edge edition possible.

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J. Manuel Casas Lisa A. Suzuki Charlene M. Alexander Margo A. Jackson

Acknowledgments

T

he editors acknowledge and thank the contributing authors who worked diligently to produce 46 state-of-the-art chapters that we believe capture the essence of multicultural counseling scholarship. These authors contributed their efforts and donated their valuable time without financial remuneration; they contributed because of their unwavering commitment to social justice and to the development of a social and mental health care system that works for all people. This commitment is amply demonstrated in the diversity of socially and professionally challenging topics and issues that they address in their respective chapters, including poverty, racism, discrimination, treatment disparities, immigration, and violence. In addition to thanking these authors, we take the opportunity to thank the researchers and writers who laid the foundation for multicultural counseling and whose work is cited throughout the text. Thanks go to the practitioners who keep the academicians pragmatically in touch with the reality and complexity of the problems that their clients face on a daily basis. Thanks also go out to the unsung heroes of mental health, those socially caring and active individuals in our respective communities (families and peers) who freely give of their time and energy to advance equitable social, physical, and mental health for all. Special thanks are also merited by our “clients” and consumers (e.g., students) for serving to remind us of our ethical duties and responsibilities to live up to the human and professional principles that give purpose and direction to our personal and professional lives. From an institutional perspective, our thanks go to the APA Board of Directors’ November 2014 resolution that prompted commissioning the independent investigation of APA ethical guidelines, national security interrogations, and torture, as well as to others whose persistent voices have challenged our profession to account for and redress our complicity in social injustice since 9/11. It should be noted that many individuals who forged ahead to get to the “bottom of things” did so in spite of being repeatedly rebuffed with the intent of curbing dissent. Taking a broader perspective, we think it appropriate to give thanks to individuals or groups who, in one way or another, like the authors in this book, have advanced the principles and concomitant actions that are inherent in multiculturalism, and in particular, those that address attaining social justice nationally and internationally for all. To this end, thanks go out to the significant number of undocumented children who through their suffering, made evident in the summer of 2014, forced us to take a look at the inhumane treatment that young immigrants experience in their efforts to find safety and a better life in the United States. Becoming aware of such treatment, varied socially conscious groups, including psychologists, took action to get policymakers and legislators to make some positive changes in the immigration system. We deem it appropriate to acknowledge those individuals who, in response to the killings of young Black youth by policemen, took it upon themselves to act within the law to stop such killings while concomitantly addressing prevailing social and racial injustices that may be at the core of such incidents. Congratulations are in order to the five Supreme Court justices who created the most significant and ­controversial new constitutional liberty in more than a generation. Relying on the due process and equal xvii

protection clauses of the Fourteenth Amendment and the growing body of social science research, the judges granted gay and lesbian people an equal right to marry nationwide. Pope Francis deserves our acknowledgment for the fervor that he is demonstrating in his efforts to proselytize the gospel of the poor—the rights of the poor. With one voice, he is using it in his position as a spokesman for one of the world’s major religions to hold us accountable to and responsible for the least supported of our brothers and sisters. It is our hope that we in psychology will hear and respond to that voice. Last but not least, we acknowledge and thank each

of you, who, in reading this edition, demonstrate a willingness and commitment to understand and effectively work, within your purview, with the diversity of individuals and issues that are a part of the multicultural world in which we live. Special thanks are saved for the highly efficient SAGE Publications team that has worked so patiently with us throughout the entire publication process, and in particular Kassie Graves, acquisitions editor, Carrie Montoya, editorial assistant, Diane Wainwright, copy editor, Olivia WeberStenis, production editor, and Abbie Rickard, development editor. Thank you.

x v i i i       H a n d b o o k o f M u lt i c u ltur a l Counseli ng

PART

I

Multicultural Counseling Past and Present

P

art I, Multicultural Counseling: Past and Present, comprises four chapters that direct attention to selective movements and needs that gave impetus and direction to the conceptualization, development, and eventual institutionalization of multicultural counseling as a specialization within the field of psychology. To this end, in Chapter 1, Casas provides a succinct overview of the history of multicultural psychology with special attention given to selective academic, social, and professional forces that are recognized to be an integral part of this history. In Chapter 2, Toporek, Sapigao, and Rojas-Arauz direct attention to the humanistic and dynamic aspect of the social justice movement, which they contend has been a primary driving force in multicultural history. They focus on the importance of maintaining counseling’s commitment to the development and advancement of a social justice agenda. To this end, they emphasize the use of social action and advocacy as a means of inciting social change. In the third chapter, Alexander and Mitchell review the history and development of the American Psychological Association’s (APA) and the American Counseling Association’s (ACA) ethical standards. They give special attention to the waxing and waning evidence for multiculturalism in the development of these standards. The history they provide is for the express purpose of highlighting how and in what ways multiculturalism and contextual challenges have shaped and been shaped by these documents. They conclude by examining how the standards are meeting today’s challenges relative to our work with diverse populations. Finally, in the fourth chapter, D’Andrea, drawing from available evidence, addresses the lethargy that he believes has negatively impacted the maintenance and the continued development of the multicultural movement (MCM). Seeking to rectify this situation, D’Andrea puts forth an appeal to (a) explore the historical evolution of this movement; (b) reflect on the revolutionary contributions made by the pioneers of this vital movement (see Chapter 1, this edition); and (c) take time to soberly think about the various factors that have resulted in the devolution, collective inertia, and lack of momentum that he contends currently exists in the MCM. Moving beyond words and admonitions, he calls for and identifies the kinds of actions that he believes are needed to invigorate the movement. It should be noted that his observations and comments are quite appropriate and relevant in this post–Hoffman Report era (see Chapter 1, this edition).

1

CHAPTER

1

The History of Multicultural Psychology From the Perspective of Two Opposing Forces J. Manuel Casas

E

arly in the history of modern psychology, Ebbinghaus (1908) expressed the belief that psychology has a long past but only a short history (Hunt, 2007). In essence, Ebbinghaus conveyed the perspective that the primary subject matter of psychology, seeking to understand ourselves and others (i.e., emotions, thoughts, and behaviors), has been around since the beginning of time (see Marsella, 1993), but psychology as we know it today, with its emphasis on merging academic and applied fields, is a fairly new development. In fact, the term psychology did not exist until 1520 (Hunt, 2007). Before the 18th century, there was no generally recognized conception of psychology as a distinct field. According to Danziger (2008), Ebbinghaus’s statement served as a declaration of independence for the “new” scientific psychology that sought to break any links with the preceding era in which the subject area of “psychology” was based on mere speculation and lacked unity and direction as well as academic-based documentation of change and cumulative development.

HIGHLIGHTS OF THE HISTORY OF MULTICULTURAL PSYCHOLOGY Multicultural psychology is a subspecialty of psychology that directs specific attention to the study of individuals from socioculturally diverse multicultural groups, and in particular, racial/ethnic minority groups living in the United States. It should be noted that because of their physiognomy, persons from such groups are often designated as persons of color. In this chapter, the term multicultural is most frequently used; however, the other terms are used to reflect the preference and intent of the authors and researchers whose work is referenced in the chapter. The applicability of Ebbinghaus’s (1908) statement

3

is based on the fact that like psychology in general, multicultural psychology has a long past and a rather short history. Putting aside the early speculative but important philosophically oriented writings on the nature of human beings, one could arbitrarily say that its past begins during the span of the 18th and 19th centuries when direct interest in the role of sociocultural determinants of human behavior begins to emerge in the writings of such scholars as Rousseau, Locke, and Comte (Marsella, 1993). However, this role is all but ignored after psychology becomes a unique discipline in the late 19th century. More specifically, in the interest of understanding human development and behavior, the preponderance of work focused on understanding individuals in isolation from the sociocultural contexts in which they existed. It would be safe to say that early on, psychology was “acultural” in nature; the focus was on what at that time could be called experimental psychology and encompassed such aspects of psychology that included introspection to identify and objectively measure thoughts and sensations according to their quality, intensity, and/ or duration, and studying the basic elements that constitute the mind. Only a few early psychological scholars got outside of the individual by specifically identifying cultural factors as important to the social psychological developmental process. Most prominent among these scholars was Wundt, whose work “Volkerpsychologie” (loosely defined as social/folk psychology), composed of five volumes, dealt with the psychological origins of language, mythology, customs, and religion (see Wundt, 1916). Though held in high regard by leading psychologists of the time, including G. Stanley Hall, Alexander A. Goldenweiser, and E. B. Titchener, reflecting the “psychology” of the times, their works relative to culture had very little impact on the early direction and focus of the developing discipline of psychology as we know it today. As will be made evident, it would take significant social changes to recognize and accept a culturally rooted psychology. Interestingly enough, much of the early descriptive work on the impact of sociocultural variables 4       M U LT I C U LTU R A L C O U N S E LI NG

on the psychological well-being of individuals was conducted in the early to mid-20th century, not by psychologists but by physicians and/or anthropologists who sought to identify and understand what were then called culture-bound disorders (i.e., ethnic or atypical psychoses) that were found among non-Western people who lived in the still little-explored or understood lands of Southeast Asia and Africa (Marsella, 1985; Simons & Hughes, 1985). For more details relative to this early work, see Marsella (1993). Multicultural psychology, with its focus on sociocultural variables, issues, and concerns relevant to multicultural groups, was beginning to be recognized as a subspecialty of psychology in the second half of the 20th century as multicultural populations increased significantly during this time, becoming a significant segment of the U.S. population. Concomitant with this growing number was the awareness of and sensitivity to the fact that these populations had more than their share of social and economic problems that were being downplayed and/or ignored by society in general, and psychology in particular. Such awareness and sensitivity gave impetus to specific social, cultural, and political movements that addressed, and in turn, sought to remediate prevailing problems (e.g., civil rights movement; the War on Poverty). These movements had significant impact on all aspects of society, including the American Psychological Association (APA). With respect to psychology, the tireless efforts of a small but determined group of psychologists of color forced the APA to take initial steps including, but not limited to, revamping professional and ethical guidelines, revising training curriculum, expanding research horizons, revising accreditation guidelines, and making overall organizational changes in order to better understand and serve the ever-growing number of individuals from multicultural populations. It is safe to say that in spite of continued disagreement among psychologists regarding the purview of psychology, these efforts culminated in the eventual recognition of multicultural psychology as an independent field of study by the profession.

TWO FORCES IMPACTING THE DEVELOPMENT OF MULTICULTURAL PSYCHOLOGY The history of multicultural psychology, like that of any other discipline or specialty, can be studied and explained from a variety of perspectives, including but not limited to individuals (i.e., leaders and major contributors to the discipline) and/ or ­prevailing social, economic, political, scientific, and/or professional conditions and/or movements. This chapter selectively focuses on two major forces that came to the forefront in the 20th century— reactions against scientific racism and social justice (Holliday & Holmes, 2003). Scientific Racism. Much of what comprises the history of multicultural psychology is reflective in psychology’s intimate association with the force of scientific racism. Scientific racism (i.e., the use of “science” to justify racism) had its origins in the European-based 19th-century theories of evolution, genetics, and heredity. These theories, especially those reflective of Darwin’s works (1871), strongly supported and advanced the assumption that racial, ethnic, and cultural differences were due to differences in evolutionary development. While having its origins in the natural sciences, it was quickly accepted and supported by the emerging discipline of modern psychology. Evidence of such early acceptance includes the works of Francis Galton (1869/1962) and G. Stanley Hall (cited in Hothershall, 1990), both of whom are considered founders of psychology in the United States. Support for evolutionary theory increased significantly by the beginning of the 20th century. This increase came about from greater contact with diverse racial, ethnic, and cultural groups that resulted from the worldwide domination, colonization, and enslavement of non-Europeans by White Europeans. Interestingly enough, according to Holliday and Holmes (2003), such domination was justified by the growing number of scientific studies (e.g., the international studies of culturebound disorders) that documented the differences

between cultures, values, social behaviors, and physiology of non-Europeans that were judged to be inferior to the standard established by White Europeans (Holliday & Holmes, 2003). The profession not only accepted and provided support for the assumptions inherent in scientific racism and the practices associated with it, but more specifically, it took some major steps to establish the mind-set from which racial/ethnic minorities would be perceived, understood, studied (e.g., comparative studies), and treated. Such steps included the exclusion of ethnic minorities or persons of color from being involved in major professional and organizational activities, including identifying research concerns or applied topics of interest (i.e., setting the research agenda) and establishing the procedures (e.g., paradigms, methods, or models) from which to address and direct such activities. Other steps included leaving out such persons in the establishment of organizational and administrative structures and professional standards of conduct, academic departments, and scholarly journals (Holliday & Holmes, 2003). These exclusionary steps were supported as psychologists undervalued and/or ignored psychological theories, perspectives, and extant knowledge emanating from non-European peoples and their communities (Holliday & Holmes, 2003). In other words, persons of color were designated to be second-class citizens not able to function as equal colleagues/partners in the discipline of psychology. According to Holliday and Holmes (2003), “psychology continued in a very steadfast, almost blinders on manner to institutionalize the accouterments of an established scientific discipline” (p. 22) well into the 1940s. In line with the tenets of scientific racism, race psychologists continued their work to establish the innateness of inferiority and deficits with respect to people of color. In contrast, other researchers increasingly sought to control the effects of a variety of nongenetic factors and met with mixed success. For example, findings often highlighted the potential effects that environmental and cultural variables could have on human behavior. In addition, the biological integrity of racial categories was increasingly challenged by

TH E HI S TORY OF M ULTI CULTUR A L PS YCHOLOG Y

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other scientific disciplines such as anthropology (cf. Guthrie, 1976, p. 30; Richards, 1997, chaps. 4, 5). According to Holliday and Holmes (2003), reactions involved attention to social contextual factors grounded in indigenous and traditional customs, values, beliefs, historical experiences, and political-economic realities. Social Justice. The goal of social justice is to decrease human suffering and to promote human values of equality and justice (Vasquez, 2012). Until the second half of the 20th century, only lip service was given to social justice principles, especially as they pertained to ethnic racial minority groups. The notion of social justice was often poorly articulated and ignored by the discipline. Many refused to recognize that social issues and problems were not separate from science and were an important part of psychological theory and methodology (Holliday & Holmes, 2003). The Psychologists League (PL) was formed in 1934 as an activist organization committed to both ideological critique of issues pertinent to psychological theory and to direct political action. It was made up of members who were mostly clinicians. The Society for the Psychological Study of Social Issues (SPSSI—Division 9 of the APA) was formed in 1936 and was comprised mainly of academic, nonclinical PhD-level psychologists who were concerned with the application of psychological theory and methods to the study of such social issues as war, industrial conflict, and racial prejudice (cited in Finison, 1986; Morawski, 1986). The establishment of these two entities facilitated the emergence of a distinct group of psychologists that sought to apply psychology to social problems. The focus on the problems of the nation’s communities of color provided the basis for an antiracist perspective that successfully challenged assumptions of scientific racism (Holliday & Holmes, 2003, p. 24). Despite these efforts, APA remained a firmly academic/scientific organization that was not significantly involved in social issues until its reorganization after World War II (Pickren & Tomes, 2002; Smith, 1990, 1992). APA’s reorganization and involvement with contemporary social issues was critical as it addressed 6       M U LT I C U LTU R A L C O U N S E LI NG

the varied social, political, and legal discourse that sought to ensure equitable and just treatment to all persons living in the United States. This movement gave voice to persons from powerless groups who had historically not received such treatment (i.e., racial/ethnic minority persons, LGBT persons, women, the elderly, and persons with disabilities). The following section highlights the demographic changes, issues, and events that eventually led psychology to acknowledge and embrace a social justice framework. The aftermath of World War II (see Holliday & Holmes, 2003), the civil rights movements of the 1950s and 1960s, passage of the Civil Rights Act in 1964 (outlawed major forms of discrimination against racial, ethnic, national and religious minorities, and women), Supreme Court decisions like Brown v. Board of Education, the Voting Rights Act of 1965, and dramatic demographic changes including increased immigration and a high birth rate began a period of significant growth for racial/ ethnic minority groups in the late 1960s and continues to this day with approximately 39.9 million immigrants—the largest number in its history (Passel & Cohn, 2012; U.S. Census Bureau, 2011). As APA acknowledged the changing demographic, political, economic, and social landscape, it was only a matter of a short time before it was forced to recognize and take action to rectify injustices that were initially sanctioned by scientific racism. Due to the efforts of a small, dedicated, and hard-working group of racial/ethnic minority psychologists, along with the support of White socially conscious psychologists, issues such as the underrepresentation of racial/ethnic minority psychologists, inadequately trained psychologists to serve minority populations, and the lack of representation of racial/ethnic persons in the governing structure of the APA were addressed. In order to eradicate these and other prevailing injustices both within APA and society in general, APA found itself needing to reexamine and update “its reason for being” (i.e., its mission, goals, objectives) and subsequently make necessary changes in its guiding principles and policies and organizational structure and practices.

Needless to say, as noted in the following sections, these changes served to greatly facilitate the establishment and development of multicultural psychology as it exists today.

DIVERSITY ISSUES IN THE APA The following section selectively, and more or less chronologically, identifies accomplishments across four time periods on the part of APA and its organizational divisions (e.g., Divisions 17 and 45), boards (e.g., Board of Ethnic Minority Affairs), and committees to (a) improve the status and treatment of marginalized and oppressed individuals from diverse groups (for reasons of space, attention is primarily directed toward racial/ethnic minority groups); (b) address diversity through its organizational structures and ethical principles and

standards; (c) increase the representation of persons from diverse groups within the professional ranks; and (d) identify and develop the process by which the needs of persons from underrepresented and oppressed groups could be more adequately met through the development of multicultural/ diversity curricula and educational, training, and research experiences required of all psychologists, and in particular, those in the counseling and clinical areas. To this end, the section attends not only to policy and organizational changes but to major conferences and events sponsored by the APA and Divisions 17 and 45 that helped to increase the attention given to diversity issues, as well as remind the profession of the continuing needs of persons from oppressed and underrepresented groups. To help guide and orient the reader through the detailed history of multicultural accomplishments that are presented below, the following Table 1.1 selectively highlights these accomplishments.

Table 1.1  Selective Historical Highlights of Multicultural Accomplishments Pre-1980: Early Beginnings and Establishing Foundations 1938

First Ethnic Minority Psychological Association established by the all-Black American Teachers Association Division.

1945

APA Division on Maturity and Old Age is organized.

1963

Ad Hoc Committee on Equality of Opportunity in Psychology (CEOP) is established.

1968

The Association of Black Psychologists is established.

1970

Psychologists Por la Raza founded (gave way to the National Latina/o Psychological Association in 1979).

1971

The APA Board of Social and Ethical Responsibility in Psychology is established.

1972

The Asian American Psychological Association is founded.

1973

The Vail Conference is convened.

1974

The APA Minority Fellowship Program (funded by National Institute of Mental Health [NIMH]) is established.

1975

The Society of Indian Psychologists is founded.

1978

The Dulles Conference is held.

1979

The Office of Ethnic Minority Affairs (OEMA) is established.

1979

The National Latina/o Psychological Association comes into its own.

(Continued) TH E HI S TORY OF M ULTI CULTUR A L PS YCHOLOG Y

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Table 1.1  (Continued) 1980–1991: Growing Awareness and Development 1980

APA Board of Ethnic Minority Affairs (BEMA) is established.

1986

APA Division 45, the Society for the Study of Ethnic Minority Issues, is established.

1987

The National Conference on Graduate Education in Psychology is convened.

1987

BEMA is replaced by the Board for the Advancement of Psychology in the Public Interest.

1992–1999: Increased Awareness and Stronger Commitments 1991

The Association for Multicultural Counseling and Development (AMCD) approves a document outlining the need and rationale for a multicultural perspective in counseling.

1992

APA Code of Ethical Principles (a more diverse and social justice focus) is revised.

1993

APA Committee on Ethnic Minority Affairs (CEMA) is established.

1995

APA revises Guidelines and Principles in Professional Psychology (most notably Domain D: Cultural and Individual Difference and Diversity).

1998

APA passes Resolution on Immigrant Children, Youth, and Families.

2000–2015: A Period of Stabilization and Advancement 2001

APA passes varied resolutions and establishes policies against racism, prejudice, bias, profiling, stereotypes, discrimination, and disparities relative to diverse groups (i.e., racial, ethnic, LGBT, persons with disabilities, the elderly).

2002

APA approves Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change.

2009

APA approves “strategic plan.” The plan is intended to provide a road map to guide and prioritize the work of the organization in the context of factors affecting the discipline of psychology. The core values that are at the heart of the plan include social justice, diversity, and inclusion.

2010

Broadening its sphere of influence, APA publishes report on refugee children and families.

2012

Reflecting changing demographics, APA publishes report on immigrants.

2015

APA approves Resolution to Safeguard Against Acts of Torture and Cruel, Inhuman, or Degrading Treatment or Punishment in all Settings as APA Policy.

Pre-1980: Early Beginnings. While the first ethnic minority psychological association was established as a division as early as 1938 (Guthrie, 1976) by the all-Black American Teachers Association Division for members interested in the teaching and application of psychology, particularly in “Negro” institutions, more concerted efforts relative to diversity focused on the elderly and persons with disabilities. The Division on Maturity and Old Age of the 8       M U LT I C U LTU R A L C O U N S E LI NG

APA was organized in 1945 and the first National Conference on the Psychological Aspects of Aging was convened in 1953. An early effort by the APA to address racial/ ethnic minority concerns was the establishment in 1963 of the Ad Hoc Committee on Equa­ lity of Opportunity in Psychology (CEOP). In 1967, CEOP was made a standing committee and given the task of formulating policy related to

the e­ducation, training, employment, and status of minority groups in psychology. This committee helped to spur the APA into more direct and decisive actions relative to racial/ethnic minorities through the publication in 1969 of its national survey of 398 Black psychologists that underscored the significantly small number of Black doctorates that were being trained by the 10 top-rated departments of psychology (APA, 1997). Over the years, the responsibilities of this committee increased significantly in relation to the four major racial/ethnic groups (i.e., Asian Americans, African Americans, Hispanics, and Native Americans). Wanting to play a more decisive role in addressing the psychological needs of people of color, representatives from the major racial/ethnic minority groups eventually established their own respective independent associations outside the formal APA organizational structure: the Association of Black Psychologists (1968), the Association of Psychologists Por La Raza (1970), the Asian American Psychological Association (1972), and the Society of Indian Psychologists (1975). These associations are currently recognized by the APA and serve as nonvoting members of the APA Council of Representatives. In this capacity, they continue to underscore three major issues: (a) the extremely limited number of racial/ethnic minority psychologists as well as graduate and undergraduate students in psychology, (b) the APA’s failure to address social problems, such as poverty and racism, and (c) the inadequate representation of minorities in the APA governance structure. It bears noting that in 1970, Kenneth B. Clark, an African American, became the first person of color elected to the position of president of APA. The Board of Social and Ethical Responsibility in Psychology (BSERP) was created in 1971 to oversee three committees—the Committee on Academic Freedom and Conditions of Employment, what was later to be called the Committee on Women, and the Committee on Equality of Opportunity in Psychology—as well as a myriad of task forces dealing with social and ethical issues. The Vail Conference, held in 1973, gave strong impetus to the APA’s efforts to address professional t­raining

for racial/ethnic minorities, something that previous training conferences had ignored. In fact, a Task Group on Professional Training and Minority Groups was included in the conference (Korman, 1974). As a result of this conference, the implementation of affirmative action programs and the identification, recruitment, admission, and graduation of minority students was designated as a basic ethical obligation. In addition, the participants underscored their belief that all students should be prepared to function professionally in a pluralistic society. The conference participants also proposed changes that were more structural in nature, including the creation of APA minority boards and committees. A major boost to the representation of racial/ ethnic minority students in psychology was the establishment of the APA Minority Fellowship Program (funded by NIMH) in 1974. This program sought to increase the representation of ethnic minorities in psychology by providing stipends to students and by helping psychology departments improve their capabilities to address cultural diversity. Emphasizing the importance and relevance of the program, Melba Vasquez, the first Latina president of APA, contends that her involvement as a member of the first cohort of the program provided a powerful socializing process into the profession and served as an incentive to contribute to the discipline (personal communication, May 14, 1998). One could surmise that other recipients of a fellowship would support this contention (e.g., Beverly Tatum, Hortensia Amaro, Dolores BigFoot, Gayle Iwamasa, and Richard Lee). For more information on the program and a list of recipients, refer to APA Minority Fellowship Program (2016). To accommodate a growing number of diverse groups that were airing their needs and concerns to the APA, the responsibilities delegated to the Committee on Equality of Opportunity in Psychology and the Board of Social and Ethical Responsibility in Psychology were broadened from specific issues of race (especially involving Blacks) to include all minorities as well as many other issues of social importance but not directly

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c­oncerned with minority affairs. Subsequently, racial/ethnic minority professionals expressed concern that broadening the focus of these bodies could very likely impede the expected progress of racial/ethnic minorities within the APA. This concern eventually served as a major impetus for the Dulles Conference of 1978 that identified and strongly recommended steps that APA could take to increase the participation of minority groups in its governance and administrative activities. Conferees expressed the need for a clearer focus on minority affairs in the APA, including establishment of a Board of Minority Affairs, a Minority Affairs Office, and eventually a racial/ethnic minority division. The APA Board of Directors, and subsequently, the Council of Representatives, took action establishing (1) the Office of Ethnic Minority Affairs in 1979 (OEMA) and (2) an Ad Hoc Committee on Minority Affairs. The main purpose of OEMA continues to be that of increasing the scientific understanding of how psychology pertains to both race/ethnicity and culture through conducting special projects and by publications. 1980–1991: Growing Awareness and Develop­ ments. In 1980, by vote of the APA membership, the Board of Ethnic Minority Affairs (BEMA) was established. This was a very significant accomplishment because it institutionalized within the APA governance structure a mechanism to enhance the pluralism of psychology. To ensure such enhancement, BEMA appointed liaisons and monitors to major boards and committees. BEMA appointed liaisons and monitors to the other major boards and committees and solicited the same from them. It also sought to establish relationships with interested divisions and state associations. BEMA also made sure that when other boards and committees were considering items of import to ethnic minority constituencies, our voices would be heard. (E. Olmedo, first director of OEMA, personal communication, April 27, 1998)

In 1981, BEMA established their first Task Force on Minority Education and Training. The task 10       M U LTI C U LTU R A L C O U N S E L I NG

force concentrated on issues relative to the training of psychologists who work with culturally diverse populations, the underrepresentation of ethnic minority psychologists in the profession, and the funding of education and training opportunities for minorities in psychology. This task force obtained information from surveys it conducted resulting in numerous recommendations for recruitment and retention of minority faculty and students as well as the integration of multicultural curricula in the graduate education and training of psychologists. As will be noted below, BEMA was eventually replaced by the Committee on Ethnic Minority Affairs (CEMA) that is charged to carry out other responsibilities. In addition, a number of conferences were held specifically to address multicultural issues. One of these conferences that merits specific attention is the Teachers College, Columbia University, Winter Roundtable on Cross-Cultural Psychology and Education, which began in 1983 under the leadership of Samuel Johnson Jr., and has been held on an annual basis ever since. This conference has become the longest-running professional education program in the United States devoted solely to cross-cultural issues. The conference centers on themes that relate to training, research, and practice. The second BEMA task force, established in 1984, was the Task Force on Communications with Minority Constituencies, which sought to establish a network of minority psychologists in APA divisions and state associations. The activities of this task force led to the establishment in 1986 of Division 45 within the APA, The Society for the Study of Ethnic Minority Issues. The Division’s purpose is to advance psychology as a science and to promote public welfare through research, to apply research findings toward addressing ethnic minority issues, and to encourage professional relationships among psychologists with these interests. It also represents ethnic minority concerns within the governance of the APA. To these ends, “Division 45 has validated and provided a conduit for ethnic minority psychological issues as well as imparting cultural diversity into mainstream

­ sychology” (L. Comas-Díaz, personal communip cation, May 26, 1998). A National Conference on Graduate Education in Psychology was convened at the University of Utah in Salt Lake City in June 1987 (see Bickman, 1987). This conference, in line with the previous Vail Conference, recognized cultural diversity as an important aspect of graduate education. Recommendations and resolutions on ways to increase the inclusion of cultural diversity within graduate education courses were offered. BEMA also developed a Task Force on the Delivery of Services to Ethnic Minority Populations. The task force subsequently drafted Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (Board of Ethnic Minority Affairs, 1990). In 1987, the APA reorganized itself into three directorates (Science, Practice, and Public Interest). One consequence of this reorganization was that BEMA was eliminated and superseded by a board with a much broader purview: The Board for the Advancement of Psychology in the Public Interest (BAPPI). In Olmedo’s (first director of OEMA) opinion, That event was a significant step backward in our efforts to provide a high profile focus for ethnic minority issues within the APA. However, these efforts continue in the activities of the Committee on Ethnic Minority Affairs, which reports to BAPPI. (Personal communication, April 27, 1988)

Within Division 17, an ardent supporter of multiculturalism in the early 1980s, Allen Ivey (APA president in 1980) reflected, Clearly, the most important thing I did as president was appoint Derald Wing Sue as chair of the Professional Standards Committee. Out of this committee came the multicultural competencies (see Sue et  al., 1982). The Division 17 Executive Committee voted to accept rather than endorse the competencies. I consider that the major defeat and disappointment of my time as president. I and one or two others lobbied hard, but looking seriously at multicultural issues was not for the Executive

Committee at that time. I was greatly surprised and saddened by their resistance and the almost total lack of support and interest. (Personal communication, November 27, 1997)

In 1982, Division 17’s Education and Training Committee offered service and training recommendations regarding ethnic minorities (Myers, 1982). It was recommended that counseling psychology monitor population shifts to determine the focus of needed services and that there be renewed commitment to the recruitment and retention of minority students to help serve the needs of its population. Also at this time, a seminal position paper on cross-cultural counseling competencies (Sue et al., 1982) was published under the auspices of Division 17 in The Counseling Psychologist. This paper recommended that the APA adopt specific cross-cultural counseling and therapy competencies that would be used as accreditation criteria. A stronger commitment by Division 17 to further the development of multicultural counseling was also made evident in a national conference that was held in Atlanta, Georgia, in 1987. The work groups on counseling research (Gelso et al., 1988) specifically discussed the future directions of research addressing racial/ethnic minority issues within counseling. Their recommendations focused on (a) an increased quantity of racial/ ethnic minority research using accurate terminology and focusing on theory development, testing, and application; (b) a need for studies examining actual interventions in the cross-cultural area; and (c) incorporation of nontraditional or alternative research approaches (Ponterotto & Casas, 1991). In 1988, Division 17 took the necessary steps to make its Ad Hoc Committee on Ethnic and Cultural Diversity a standing committee; this committee was charged with providing input to Division 17 on service, training, or research issues that impact racial/ethnic minorities. 1992–1999: Increased Awareness and Stronger Commitments. The 1990s witnessed an increased commitment to multicultural issues, and particularly, multicultural training. For example, a survey

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conducted in 1992 revealed that 89% of counseling psychology programs were offering a multiculturally focused course in their training format (Hills & Strozier, 1992). Other surveys documented the rapid growth of multicultural training in counseling curricula. For example, the “multicultural counseling” course was projected to be the fastest-growing new course offered in the 1991 to 1993 period (Hollis & Wantz, 1994). While there was an increased commitment to multicultural training and competency, other researchers reported that the number of courses and experiences related to culturally different groups was still relatively small (Bernal & Castro, 1994). For more information regarding educational efforts to improve the development of multicultural competencies, the reader is referred to Pope-Davis, Coleman, Liu, and Toporek (2003). The 1992 revisions of the APA Code of Ethical Principles (APA, 1992) were notable from a diversity perspective. Fisher and Younggren (1997) saw the inclusion of the basic moral principle that centers on human diversity and nondiscrimination as one of the major changes in the social justice focus of the current code. Shifting from merely warning to “not cause harm,” the 1992 code takes a more proactive stance, requiring psychologists to be sensitive and respectful of diversity in the broadest sense. Furthermore, while the code directly targets the issue of discrimination in relationship to human diversity, it also addresses the need for professionals to be competent in working with distinct populations in the clinical, academic, and research environment. Although the changes have generally been well received, there have been calls to make the code much more “enforceable” and less prone to “interpretation” (Bidell, 1998). Two major accomplishments were attained in 1992 at the Centennial APA Convention in Washington, DC: (a) APA’s Public Interest Direc­ torate sponsors the first APA miniconvention focused on ethnic minorities, “Ethnic Minorities: Issues and Concerns for Psychology, Now and in the Future,” and (b) the Council of National Psycholo­ gical Associations for the Advancement of Ethnic Minority Interests is established (CNPAAEMI). 12       M U LTI C U LTU R A L C O U N S E L I NG

The Council is comprised of the leaders of the respective national psychology organizations who meet to address issues of importance to ethnic minorities and to the advancement of ethnic minority interests. 1993 saw the establishment of the Committee on Ethnic Minority Affairs (CEMA). In addition to promoting the scientific understanding of the roles of culture and ethnicity in all aspects of psychology, a main purpose of the Committee is to ensure that APA’s membership and leadership reflect the composition of society. The Commission on Ethnic Minority Recruitment, Retention, and Training (CEMRRAT) was established by the APA Board of Directors in 1994 to (a) assess the status of, and barriers to, ethnic-minority participation in psychology, and most importantly, (b) create a 5-year plan to guide APA in its efforts to address such barriers. With some interruptions in its work because of lack of funding, CEMRRAT has continued to address such barriers. Subsequently, in 1995, seeking to act more forcefully relative to training concerns, the APA addressed the need to take into consideration individual differences and diversity as an integral part of the training program accreditation process. Specifically, the APA Council approved revised Guidelines and Principles in Professional Psychology (most notably Domain D: Cultural and individual differences and diversity), which calls for programs to make “systematic, coherent and long-term efforts to attract and retain students and faculty [or interns and staff]” from diverse backgrounds; “ensure a supportive and encouraging learning environment appropriate for the training of diverse individuals”; and provide a “coherent plan to provide students [or interns] with relevant knowledge and experience about the role of cultural and individual diversity in psychological phenomena and professional practice” (APA, Office of Program Consultation and Accreditation, 1996). As a culmination of all the APA organization efforts documented above, in 1998 APA president Richard Suinn (first president of Asian American descent) underscored his and the APA’s ongoing

commitment to diversity: “One of the reasons I am excited about serving as APA president is my belief in the importance of mentors and role models for all students, but especially for students of racial and ethnic minorities” (R. Suinn, personal communication, June 1998). Taking a “hands-on” approach, during his presidential year he visited numerous graduate programs in psychology to mentor and talk to graduate students. Within Division 17, the mid- to late 1990s witnessed greater attention to diversity issues. For example, the position paper on multicultural competencies by Sue et  al. (1982) was updated (Sue, Arredondo, & McDavis, 1992) and led to a number of major books and instruments that focused on guidelines relative to multicultural competencies (see Ponterotto, Fuertes, & Chen, 2000). These multicultural guidelines recognized that the psychological traditions informing practitioners have been associated with a limited cultural frame of reference, while clients come from a wide variety of cultural backgrounds. Given that the evolution of psychological knowledge and practice has been primarily associated with White men of European American backgrounds, these guidelines were needed to assist therapists in working with racial and ethnic minority clients in a culturally appropriate manner. During the presidency of Gerald Stone (1997–1998), the division officially endorsed the multicultural competencies. In a similar vein, in 1991, the Association for Multicultural Counseling and Development (AMCD) approved a document outlining the need and rationale for a multicultural perspective in counseling (Sue et al., 1992). Rosie Bingham, the first Division 17 president of color, was elected in 1997, 51 years since the division began. As her presidential project in 1998–1999, she and several others (e.g., Lisa Porshe-Burke, Derald Wing Sue, Melba Vasquez) from Divisions 17, 45, and 35 organized the 2-day National Multicultural Conference and Summit (NCMS), which was designed to (a) present stateof-the-art issues in ethnic minority psychology; (b) facilitate difficult dialogues on race, gender, and sexual orientation; (c) forge multicultural

alliances for political action and advocacy; and (d) develop strategies for multicultural organizational change. This conference successfully continues to this date. 2000–2015: A Period of Stabilization and Advancement. At the end of the 20th century and the beginning of the 21st century, the APA Council of Representatives reached some groundbreaking accomplishments that would have been impossible to reach at an earlier time. These accomplishments included the passing of a resolution on affirmative action and equal opportunity that promoted psychological and public policy research that would help to identify sources of bias in institutional policies and practices (Holliday & Holmes, 2003); the passing of a resolution on “Racial/Ethnic Profiling and Other Racial/Ethnic Disparities in Law and Security Enforcement Activities” (APA, Office of Ethnic Minority Affairs, 2001a); and the passing of a resolution on “Racism and Racial Discrimination: A Policy Statement in Support of the Goals of the 2001 World Conference Against Racism, Racial Discrimination, Xenophobia, and Related Intolerance” (APA, Office of Ethnic Minority Affairs, 2001b). Two other accomplishments of the early 21st century that merit being singled out are (a) the approval as APA policy by the APA Council of Representatives, August, 2002, of the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists-American Psychological Association and (b) the action taken in 2005, by then-APA President Ronald F. Levant, PhD, to make boosting APA’s diversity one of his presidential initiatives. The Guidelines were developed to provide psychologists with (a) the rationale and needs for addressing multiculturalism and diversity in education, training, research, practice, and organizational change; (b) basic information, relevant terminology, current empirical research from psychology and related disciplines, and other data to support the proposed guidelines and underscore their

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importance; (c) references to enhance ongoing education, training, research, practice, and organizational change methodologies; and (d) paradigms that broaden the purview of psychology as a profession. (APA, 2002, p. 2)

It should be noted that the Guidelines were scheduled to terminate in 2009; however, the Policy and Planning Board requested, and the Council of Representatives approved, an extension of the current guidelines. During the extension, a review of the guidelines was undertaken and revised guidelines were expected to be acted upon in 2014. The essence of Levant’s Presidential Initiative (2005) was to make the APA environment more welcoming of diversity. To accomplish this end, he created the Presidential Task Force on Enhancing Diversity. The work of the task force culminated in a report that was submitted to the APA Council of Representatives in August of 2005. The report put forth a rather long list of prioritized recommendations that included having APA consider the adoption of an association-wide antidiscrimination policy. Other recommendations included the following: conducting a “climate” study within all APA governance entities, identifying the most appropriate strategies for assessing the relationship between a training program’s adherence to Domain D’s requirements and accreditation decisions, and evaluating program promotional materials to see if they state interest in and welcoming of diverse groups (APA, 2005). A brochure titled Psychological Treatment of Ethnic Minority Populations was published in 2003 by the Council of National Psychological Associations for the Advancement of Ethnic Minority Interests (CNPAAEMI) in response to ongoing concerns about the appropriateness and effectiveness of the theories and practices that drive much of the psychological treatment provided to ethnic minority populations in the United States. The brochure had as its goal the empowerment of ethnic minority consumers of psychological services as well as to inform researchers, trainers, funders, and providers of psychological services. 14       M U LTI C U LTU R A L C O U N S E L I NG

Becoming more inclusive in addressing the social and mental health issues and needs of a growing number of individuals from previously ignored populations, APA publishes the following reports: (a) Resilience and Recovery After War: Refugee Children and Families in the United States—Executive Summary of the Report of the APA Task Force on the Psychosocial Effects of War on Children and Families Who Are Refugees From Armed Conflict Residing in the United States (APA, 2010) and (b) Crossroads: The Psychology of Immigration in the New Century—Report of the APA Presidential Task Force on Immigration (APA, 2012). In 2013, the Diversity Initiative of the Committee of State Leaders through the State Leadership Conferences continued to demonstrate significant success in involving ethnic minority psychologists in membership and leadership positions, in facilitating the growth and development of leadership skills for many psychologists from diverse backgrounds, and in enhancing diversity within governance at the state and national levels. The first Diversity Delegates came to the State Leadership Conference in 2000, and to date, approximately 200 individuals have participated (Suzuki & Bolling, 2013). Continuing to broaden its commitment to addressing pressing social issues, in 1985, APA put forth a joint statement with the American Psychiatric Association condemning torture. Subsequent resolutions and positions were put forth by APA in the ensuing years culminating on July 31, 2013, when the Council of Representatives adopted a single, comprehensive, and controversial policy to reconcile prior resolutions focused on detainee welfare and the work of psychologists in national security settings: “Policy Related to Psychologists’ Work in National Security Settings and Reaffirmation of the APA Position Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment.” For details on the varied resolutions, see Hoffman et al. (2015). Unfortunately, as significant evidence of past ongoing collusion between a small group of APA representatives and the Department of Defense

in the use of torture in the interrogation of post9/11 military detainees and the organizational cover-up of such use increased (see Risen, 2014), it became evident that this policy was “too little too late.” It eventually became apparent that more direct action was needed to identify, examine, and, if necessary, change and/or disregard ethical guidelines, organizational and systemic policies, procedures, and reports from special committees and task forces (e.g., the 2005 APA committee called the Task Force on Psychological Ethics and National Security [PENS] that facilitated such collusion). Emphasis was given to the need to hold accountable those individuals who were directly or indirectly involved in the collusion and cover-up. To gather the necessary information to support any action that might be deemed necessary, the APA Board of Directors’ November 2014 resolution prompted commissioning an independent investigation headed by former Chicago Inspector General David Hoffman. The findings of the investigation presented in the Hoffman Report (Hoffman et al., 2015) ignited a furor at APA and contributed to the dismissal of several individuals involved, in one way or another, in what came to be seen as an ethical crisis, and a reassessment of the profession’s ethics, and in particular, the manner in which it developed, implemented, and enforced ethical principles and guidelines. In addition, APA Council at the 2015 APA Convention in Toronto developed and approved a Resolution to Amend the 2006 and 2013 Council Resolution to Clarify the Roles of Psychologists Related to Interrogation and Detainee Welfare in National Security Settings, to Further Implement the 2008 Petition Resolution, and to Safeguard Against Acts of Torture and Cruel, Inhuman, or Degrading Treatment or Punishment in all Settings as APA Policy (APA Council of Representatives, 2015). Seeking to remain a “vibrant and relevant organization,” APA, through its Council of Repre­ sentatives, approved a much-awaited strategic plan in August 2009. The plan, a product of a 2-year effort to collect data from its members, governance leaders, and staff, and the examination of societal trends that could affect psychology, is intended

to provide a road map to guide and prioritize the work of the organization in the context of factors (e.g., demographic and generational trends, globalization, changes in health and mental health care delivery and financing, challenges in the funding of behavioral research and the increase in smaller “niche” organizations) affecting the discipline of psychology, psychologists, membership organizations, and our society. It should be noted that the core values that are at the heart of the plan include social justice, diversity, and inclusion—core values that underlie the positive forces that history has shown to be at the heart of multicultural psychology.

CONCLUSION During the last 60 years, as a result of two major opposing forces, scientific racism and social justice, multicultural psychology established an impressive niche in the history of psychology. As exemplified in this chapter, this is evident in the varied actions taken by APA to bring about positive changes in the attention and responses given to multicultural issues and concerns. It is important to note that changes were not easily attained. On the contrary, there was often much tension surrounding these changes. However, changing demographics and a growing awareness of prevailing social and economic problems that greatly impacted the well-being of racial/ethnic minority groups and that of other powerless groups served to decrease the forceful negative impact associated with scientific racism while greatly playing a pivotal role in increasing the positive actions associated with the force of social justice. Curtailing the one force and advancing the other enabled APA to take actions, as previously noted: 1. Improve the status and treatment of individuals from oppressed groups 2. Increase the representation of persons from diverse groups in the APA organizational structure, especially at leadership levels 3. Ensure that diversity issues and needs are addressed in the APA ethical principles and

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standards and taken into consideration in the accreditation process 4. Develop a process to increase the representation of diversity issues in the curricula as well as in the educational/training experiences required of all psychologists 5. Develop the mechanism to ensure that all work undertaken by APA honestly reflects the ethical and social justice principles that are an inherent part of psychology

Future directions and areas for development include (a) continuing to increase the number of racial/ethnic minority students in graduate training programs, (b) more clearly specifying and enforcing the ethic principles and guidelines and accreditation criteria that focus on diversity

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(e.g., requiring students to pass a cultural competency exam), and (c) increasing the attention given to diverse groups in both the training curricula and practicum experiences. Given the continuing demographic changes in the United States, the increased visibility of persons from diverse groups in leadership positions at all levels of the APA, the growing numbers of individuals committed to diversity, and the existence of the APA strategic plan that gives appropriate attention to multiculturalism, it is quite likely that the professional and social forces for the continued development, inclusion, and integration of multiculturalism will continue to gain momentum well into the future. Given such momentum, multicultural psychology will remain an integral role in the ever-evolving history of psychology.

CHAPTER

2

Fostering the Development of a Social Justice Perspective and Action Finding a Social Justice Voice Rebecca L. Toporek, William Sapigao, and Bryan O. Rojas-Arauz

A

s social justice becomes a more commonly accepted goal in counseling, counseling psychology, and related fields, the concept becomes more refined, informed by disciplines that have articulated a broader sense of the complexities of social justice. Counseling and counseling psychology have, at their core, the interests of clients and communities as a central focus with an emphasis on practice, research, and training. Thus, this chapter focuses on social justice as an applied commitment as well as a developmental perspective. As such, we hope to spark the readers’ reflections of their own voices and actions through a discussion of a triadic model of social justice development as professionals, as well as examples of implementation of social justice–related counseling interventions. The goals of this chapter are to explore pathways toward social justice advocacy and to facilitate new social justice advocates, as well as those who feel the need for reinvigoration. We begin by identifying the framework from which we understand social justice followed by our stories, illustrating how we came to social justice as counseling professionals. We then expand on two examples from practice: (a) a social justice and service learning project working with homeless and long-term unemployed individuals and (b) a group activity focused on critical consciousness raising of youth around power and oppression. Through these examples, we hope to facilitate discussion and move social justice discourse in counseling and counseling psychology in new ways.

FOUNDATIONS AND DEFINITIONS Current work in social justice related to counseling and psychology has its roots in multiple ancestors. Multicultural counseling and psychology, feminist theory, liberation theory, critical psychology, social work, public health, and community counseling and psychology have all contributed perspectives and values that have shaped social justice. For example, multicultural counseling and psychology raised

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questions about the extent to which the disciplines had been mis-serving entire populations (Gardner, 1971; LaFromboise, 1988; Mays, 1985; Snowden, 1982; Sue, 1977). Early psychologists of color contributed research that helped to challenge public policy and social climate. Feminist theory emphasized positionality, power, and oppression in relationships (e.g., Enns, 1988; Gannon, 1982). Liberation psychology has voiced the need for psychology to work toward decolonization as well as facilitating communities opposing the confines of colonization (Martin-Baró as cited in Watkins & Shulman, 2008; Varas-Díaz & Serrano-García, 2003). Critical psychology has focused on critique of psychology as an oppressive force and tool for dominant power structures. For example, authors have been critical of psychology’s role in perpetuating oppression by serving as the “handmaiden to the status quo” (Braginsky, 1985, p. 880) and psychiatry as a tool for social control (Foucault, 1965; Jost, Banaji, & Nosek, 2004; Szasz, 1970). In addition to these major forces, developmental and counseling theories may lend themselves to applications in the interest of social justice when shaped within an informed structure of social justice, or conversely, serve to obscure recognition of systemic oppression with a myopic focus on individual responsibility and control. Although limitations of space prevent elaboration of those important contributions, we will attempt to make explicit the ways we have been informed by these theories and perspectives. Before going further, however, it is important to clarify language by examining definitions and related concepts associated with social justice. With increased attention to social justice in counseling and psychology, a variety of definitions have been proposed (e.g., Aldarondo, 2007; Goodman et al., 2004; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006b; Vera & Speight, 2003). Many of the scholarly definitions put forward in counseling and psychology tend to focus on equitable access to resources, human rights, and fairness in policies and practices. For example, Fouad, Gerstein, and Toporek (2006) defined social justice in counseling psychology as action that 18       M U LTI C U LTU R A L C O U N S E L I NG

focuses on helping to ensure that opportunities and resources are distributed fairly and helping to ensure equity when resources are distributed unfairly or unequally. This includes actively working to change social institutions, political and economic systems, and governmental structures that perpetuate unfair practices, structures, and policies in terms of accessibility, resource distribution, and human rights. (p. 1)

Although this definition is representative in the counseling literature and describes important aspects of social justice and injustice, more complex definitions may enhance the ability of counselors and psychologists to envision and act. Refinement and greater clarity can help toward addressing criticisms of vagueness in social justice discourse (Walsh & Gokani, 2013). As Hamer, Jenkins, and Moore (2013) suggested, a more complex understanding of cultural perspectives of justice may be helpful in more effectively addressing issues of injustice. As a foundation for this chapter, we explore concepts that may be conflated with social justice and identify aspects of justice that may provide a useful framework. Further, it is important to acknowledge that justice, injustice, and social justice describe conditions or outcomes, not action itself. Thus, we use terms such as social action, advocacy, and activism to describe what we actually do rather than what we hope to achieve or hope to dismantle. It is our position that talking about social justice without action has limited potential for change.

Beneficence and Shifting Access and Resources: Philanthropy, Social Service, Social Change, and Social Justice When injustice is considered a problem of access to resources or economic or educational inequity, philanthropy or imparting of resources is one of the ways people with resources respond. Although this type of giving may share some of the economic

resources with those who have less power or privilege in society, it can be argued that this charity or giving does not shift the structural architecture and system that creates or maintains inequity. When Tavis Smiley asked Cornel West to elaborate on a perceived discrepancy of Mayor Bloomberg, New York City, between his giving of scholarships to African American youth while simultaneously supporting “stop and frisk” policies, West replied, Philanthropy is a beautiful thing, that kind of charity is a marvelous thing, but never to be confused with justice. Never to be confused with the unfairness shot through the system and how the system operates, so you can be a Rockefeller, you can be a Bloomberg, you can be a Carnegie or whatever, you can be an Oprah Winfrey, and give money, that’s a beautiful thing, it’s individual and it does become a force of good in the lives of the person it affects. But, that is qualitatively different than justice. (West, 2011)

This perspective highlights the contribution of structural inequalities and the limitations of charity in addressing these structural inequalities. Kivel (2009) posed a similar perspective in relation to social service contrasted to social change and posited that social service may actually perpetuate inequitable systems by functioning as a buffer between the elite “ruling” class and the very large sector of middle-class, working-class, and unemployed individuals. He asserted that “social service work addresses the needs of individuals reeling from the personal and devastating impact of institutional systems of exploitation and violence. Social change work challenges the root causes of exploitation and violence” (p. 129). Kivel argued that social service may have the effect of perpetuating oppression because it distracts and appeases those facing inequity and functions to keep the ruling class from being recognized as the source of inequity. In fact, many social service agencies may be intentionally or inadvertently working to maintain the status quo. After all, the non-profit industrial complex (NPIC) wouldn’t exist without a lot of people

in desperate straits. The NPIC provides jobs; it provides opportunities for professional development. It enables those who do the work to feel good about what we do and about our ability to help individuals survive in the system. It gives the patina of caring and concern to the ruling class which funds the work. While there is always the risk of not securing adequate funding, there is a greater risk that if we did something to really rock the boat and address the roots of the problems, we would lose whatever funding we’ve already managed to secure. (p. 130)

Similar to West (2011), we believe there can be a place for philanthropy and service providing temporary relief for individual inequity. Yet we also concur with Kivel that it is important to maintain a perspective of the extent to which this may, or may not, work toward changing inequitable and unjust systems and structures. Thus, we may combine elements of each of these but with the goal, and appropriate action, to challenge and change the imbalance of inequity. Definitions of justice. West (2011) and Kivel (2009) referred to justice and social change, respectively, as implicating social structures and the role they play in inequity and injustice. It may be helpful to elucidate various aspects of justice and consider how these ideas may be relevant for counselors, psychologists, and related professionals working for social change. The terms distributive justice and procedural justice best describe the types of definitions that have predominated discourse in counseling historically. Kloos and his colleagues (2012) distinguish between these two constructs by defining distributive justice as the allocation of resources and procedural justice as the process of deciding how the resources will be allocated. They further note that in community psychology, procedural justice may also be reflected by the extent to which members of a community are involved in the process or collective decision making. Structural injustice (Young, 2013) can be framed as involving both distributive and procedural injustice. Young used this construct to describe the position of people who are homeless or nearly homeless

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based on their situation and access to resources. She suggested that instances of structural injustice are not merely the fault of the system, or the individual, but a complex interaction of all individuals and systems involved, including the resources and perceived options available to all individuals as well as policies and generally accepted avenues of action. A poignant example describes a woman facing housing instability after the sale of her rented apartment when she is unable to find affordable housing within reasonable commuting distance from her job. Young suggested that she is largely a victim of circumstances beyond her control—the landlord’s decision to sell the apartment building, a sex-segregated labor market that makes low-wage service jobs the primary work opportunity for women without college or technical training, the “spatial mismatch” that locates those jobs far from most affordable housing, and so on. . . . This position, being vulnerable to homelessness, is a social-structural position. Persons in this position differ from persons differently situated in the range of options available to them and in the nature of the constraints on their action. Whether persons occupying the social-structural position of being vulnerable to homelessness actually become homeless will depend partly on their own actions, partly on luck, and partly on the actions of others. Those in a different structural position might act in similar ways, however, and not risk being homeless. The issue of social justice . . . is whether it is right that anyone should be in a position of housing insecurity, especially in an affluent society. (p. 53)

Another form of justice is that of interactional justice, often considered as one aspect of procedural justice (Bies, 2001). Bies coined the term interactional justice and asserted that individuals are not only affected by how the process is perceived but also the quality of interpersonal treatment they receive in the process. Bies further argued that distributive and procedural justice are comparative in nature such that assets are noted in relation to what others receive. However, interactional justice, or the quality of treatment, stands alone rather than in relation to how others are treated. 2 0       M U LTI C U LTU R A L C O U N S E L I NG

Interestingly, Bies also noted that, largely, justicefocused research in organizational psychology has had the effect of supporting management, or those in power, and excluding voices of people in organizations who are relatively powerless. Greenberg (1993) described a related concept, interpersonal justice, defined as the desire to be treated by others with respect and dignity, especially by those in authority positions. Applying these concepts to applications in professional psychology, Lewis (2010) suggested that counselors and psychologists are uniquely trained in understanding interactional justice and asserted that trainees ought to become proficient in assessing clients’ experiences of interactional justice not just within the therapeutic relationship but also outside in their daily lives. He likened this concept to the concept of empowerment described by Toporek and Liu (2001, as cited by Lewis). We would be remiss if we did not consider one perspective of justice commonly understood in U.S. society, that is, justice in response to a wrongdoing. Retributive justice is the term often used for the justice system used in the United States and refers to a “system [that] is based on the philosophy that because the victim has suffered, the offender should suffer as well” (Hamer et al., 2013, p. 359), whereas restorative justice is focused on reparations to the community and the stakeholders affected by the offense with a goal of healing. As Roberts and Stalans (2004) noted, restorative justice focuses on the best interest of the victims of wrongdoing, perhaps toward healing, and is less concerned with establishing and carrying out punishment for the perpetrators of the crime. This shift from punishment to restoration, honoring those who are hurt by injustice and pursuit of righting the wrong, may be a useful perspective when considering social action. The restorative justice movement challenges the structure of the justice system in the United States and may be seen as a move toward social justice inclusive of victim, perpetrator, and community. It is also noteworthy that there has been considerable focus on restorative justice within clinical practice (Umbreit & Armour, 2010).

Justice as a cultural construct. Various forms of justice, as described above, must be considered within a cultural context. Implementing social justice actions without considering cultural context risks imposing a culturally derived definition of what is just and thus desired process and outcome. For example, in a cross-cultural review of research focused on variations in procedural justice perceptions within organizations, Choi (2003) described differences across individualistic or collectivistic lenses and suggested that, to the extent that outcomes are culturally congruent, the procedure is more likely to be viewed as fair. In collectivist groups, cultural values emphasize the good of the group and thus outcomes that benefit the group would be favored as opposed to outcomes that benefit the individual over the group, which would be more congruent with individualistic values. Further, Choi suggested that the preferred process of representation may also vary culturally and influence the degree and form that procedural justice may take. Cultural issues are also relevant in retributive and restorative justice. Elechi, Morris, and Schauer (2010) described an Africentric perspective of justice in which the community takes precedence over the individuals in the center of the conflict. Hamer et al. (2013) posited that justice is a culturally framed concept and described retributive justice as focusing on individualistic objectives and goals contrary to collectivistic cultural perspectives. In their qualitative study elucidating experiences of African American community members, the participants provided rich description of this framework. There has also been discussion of the need to attend to cultural context and perspectives in designing and implementing restorative justice interventions. For example, Umbreit and Coates (1999) explored a case example identifying challenges and proposed a process including multicultural competence components of practitioner cultural self-awareness, understanding of cultural perspectives, values and norms of the victim and perpetrator, and mediation process and skills to help to bridge the cultural perspectives of each

party. Further, Snow and Sanger (2011) emphasized the need to consider the language capacity of the offender and the ability to communicate effectively in a restorative justice intervention, particularly when there may be a language-related disability involved. Elements of the concepts and definitions described above help to deconstruct and question what is meant when social justice is the focus of scholarly discourse. Distinguishing the qualitative difference between service to those who may not otherwise have access to services and giving to those who may not have resources is critical so the focus of social justice work can clearly focus on the sources of injustice, the systems that perpetuate injustice, our role within those systems, and avenues for potential change of that injustice. Further, examination of personal and professional positions within these systems is an essential process.

POSITIONALITY, AWARENESS OF CULTURAL SELF, AND DEVELOPMENT OF A SOCIAL JUSTICE IDENTITY Several authors have discussed the developmental process for persons evolving as social justice change agents (Lewis, 2010; Moane, 2006). The process of developing a “niche of resistance” (Moane, p. 76) can be structured as an intervention or reflect a natural developmental process. One of the contributions of feminist, multicultural, and postmodern frameworks within counseling and psychology is the acknowledgment that context is relevant in discourse. Further, this promotes the notion that the scholar, researcher, or teacher brings not only science and theory but also a personal history and perspective that may influence the content and the method of a story. Thus, we feel it is important to share our positionalities, in particular as they relate to our social justice development. The process of sharing these stories with each other also reaffirmed a sense for us that there are many avenues one may travel to arrive at a commitment to social justice and that three of those avenues (scholar, activist, and

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community member) may be useful in considering ways in which to facilitate a developmental process of entering, or renewing, one’s social justice voice. In the following first-person accounts, we each share our positionality through stories of developmental experiences influencing our commitment to social justice as individuals and professionals to illustrate three unique paths. Will. I grew up in a low-income community in the San Jose–San Francisco Bay Area region, in a Catholic, working-class family. My parents were first-generation immigrants from the Philippines in search of opportunity. Nurturing words from them about staying in school and connecting the significance of their personal narratives to my own were deeply cemented in my journey. They supported me in becoming successful in school and imprinted values of hard work, commitment, and love. I was guided by these meaningful values on the path to understanding my culturally diverse environment and achieving self-awareness. My educational experiences provided me with opportunities and resources to directly work with underprivileged groups. Serving at local homeless shelters and fundraisers as a volunteer in high school played a big part in helping me understand the relationship between my community and me. As I became more involved, I realized that giving back to others, through a commitment to service and action, was meaningful as I fostered many great connections with people who supported such causes and who exemplified the power of community. In college, I was active with the Filipino community. The saliency of my personal identity development and search for a support system coincided with my path of achieving a social justice stance. I found myself involved in groups that strongly supported building community and social awareness. Among them, marching to support Justice for Filipino American Veterans (JFAV) taught me to take a stand and fight oppression. My experience was one of my first exposures to activism and although I didn’t initially identify as an activist, I later recognized I was already sharing many values with activists. 2 2       M U LTI C U LTU R A L C O U N S E L I NG

I attribute much of my awareness and growth as a scholar, community member, and activist to my time as a student. I recognize much of my work giving back to different communities and my professional experiences have stemmed from having the awareness and internal drive to work toward action. From serving the homeless community, rallying to fight oppression, witnessing activism as a bystander, and sharing in a passion and commitment to make a real difference, these life experiences continually constitute not just what I do but who I am. My experiences through scholarship helped me become culturally aware, give back to my community to fight for those oppressed by exploitative systems on many different levels, and moved me to understand the significance of transforming knowledge into purposeful action. Bryan. I’m an immigrant of Costa Rican and Panamanian descent who migrated to the United States when I was 13 years old with the intent to help my family by learning a new language then going back to Costa Rica to become part of a booming tourist industry. This did not happen. I did not go back to Central America until I was a college graduate 14 years later, an accomplishment I had never envisioned. My academic journey has been an unlikely one. In high school, I was an athlete until an accident forced me to change my focus and identity. The energy I had used for sports shifted to organizing and community involvement. I got involved with the League of United Latin American Citizens (LULAC), and through this, I was able to get in touch with people who pushed me to attend college. I found a love of academia, but more importantly, I became a scholar because of the work I was doing in the community. My undocumented status and challenges in high school made it hard for me to believe that college was an option for me. As a first-generation college student, often having the will was not enough; I lacked cultural capital around higher education. However, being an activist connected me with people who supported my success. I felt that I owed that kind of support to the next ­generation,

so I began to do college recruitment with at-risk youth. By being a college student, I was also being an activist; in the end, the scholar and activist were one and the same. The passing of HR4437 (The Border Protection, Anti-terrorism, and Illegal Immigration Control Act of 2005) was the catalyst that moved me to the forefront of my activism. HR4437 made felons of any undocumented immigrant in the United States and their allies. In my attempts to reach out to recruit students to attend the march that would later be known as “The Great American Boycott,” student organizations that I thought would be most invested instead rejected the invitation to get involved. The anger fueled by this rejection became a fire that would help move me forward as an activist. In the spring of 2006, a plethora of people across the United States took over the streets in marches calling for supporters to abstain from buying goods in order to symbolize the financial value of immigrants to the U.S. economy, while also bringing awareness to a broken immigration system. I began to understand the power of activism for change; I began to understand the power of “WE” as a collective. This was the first of many rallies, marches, and demonstrations where being a scholar and activist would intertwine. I became a “Dreamer” or Dream Activist, an undocumented student fighting for equal higher education for all, part of a larger network across the United States that would become the “Chicano movement” of our generation. We vowed to succeed academically in order to continue to fight injustice. My goal of completing a PhD continues to be part of that vow. As an undocumented immigrant for over half of my life, activism is about changing what’s possible. It is about empowerment, changing the views of who we are as scholars. Yet more than anything, it is the hope that one day in academia there will be real diversity, where people can recognize each other’s struggles, life stories, and histories as distinct yet connected. Bringing diversity and justice into higher education is about having a collective voice, about creating role models for future generations, about breaking a cycle of prejudices and misconceptions, about changing what it means

to be a scholar, and reshaping the image of academia as a place for all. I’ve struggled with my place in education as far back as I can remember. Today, I can say that through my activism I’ve found a love for academia I never knew existed. Rebecca. As a 3-year-old child, I, along with my parents and younger sister, moved to the United States from Canada. We settled in a university town in the midwestern United States. Although the population was primarily White and reflected a narrow socioeconomic range, my parents and many of their friends had a strong emphasis on the arts, pacifism, international perspectives, farm worker rights, and antiwar sentiments. In addition, my parents’ beliefs emphasized human rights, justice, and service. I, however, was a shy kid who wanted to fit in but couldn’t tolerate intolerance, a confusing place to be since most of the dominant kids I knew did not seem to share similar philosophies as my family. When I moved to the San Francisco Bay Area upon graduation with my master’s degree, I recognized a significant gap in my life experience and counseling training and began to pursue every professional development opportunity focused on multicultural competence that I could find to develop my skills and abilities. In the process, the concepts of privilege and oppression became amplified and reignited beliefs about justice. As common for many White people, this burgeoning knowledge prompted a complex reaction of excitement, guilt, shame, relief, anger, and confusion. Yet through it all, I made a commitment to persist, accept responsibility for the role that race plays in my everyday life, and engage in a journey with no end. This commitment brought me to a community of activists that I had never known before. In my counseling positions, I worked to gain cultural competence to work with and understand the worldviews of my very ethnically and economically diverse clients, and unavoidably had to wrestle with my responsibility as a White professional to try to confront the systems that supported inequity. It was not long before I began to recognize that the structural challenges in my clients’ lives were significantly interfering in

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my clients’ success and our work together. In my workplace and in my professional organization, I was blessed with friends, mentors, and role models who challenged me and held me accountable, the most powerful form of support. I learned from them about strategy and advocacy toward social change. I became immersed in trying to find my place as a White woman who was committed to cultural competence. This was, and continues to be, essential for my efforts toward being accountable as a person with socioracial, economic, and sexual identity privileges, among many others. I found a community I respected, learned from, and felt allied with, a community of activists. As I reflect on my development as a child and then an adult, I evolved through community and family values, then later gained greater understanding and knowledge through scholarship. It wasn’t until I found allies in multicultural activists and joined them in challenging oppression that I found my community. As a dear friend used to say, “I found my place in a self I’d never been before” (C. Salter, personal communication, September 12, 1986). Themes and emerged model. Through personal and professional experience, counseling professionals arrive at social justice work through a range of different paths. Some may begin as activists, others as community members, and others as scholars. Each foundation is valuable on its own, however, and through development and a confluence of these three foundations, a powerful triad is formed. The social justice advocate who is able to ultimately integrate these foundations is able to support the work with a solid understanding and commitment to community, a firm grasp of the scholarship that informs that work, and the skills and strategies of an activist.

MOVING TO ACTION: FOSTERING SOCIAL JUSTICE SKILLS TOWARD ADVOCACY AND ACTIVISM We chose to present the lengthy discussion of definitions and foundations because we believe 2 4       M U LTI C U LTU R A L C O U N S E L I NG

that the goals and the means by which counseling professionals reflect social justice can be informed by the deconstruction of justice as well as how justice is perceived by communities. Further, our development as counselors and psychologists committed to social justice is shaped by our experiences as activists, community members, and scholars, though the road may be different for each of us. These foundations and trajectories are important forces in understanding, designing, and carrying out informed social action, advocacy, activism, and social change. Although the commitment of counseling and psychology disciplines to social justice has fluctuated over time, there are examples of individual and organizational actions that have furthered social justice goals (for more complete discussion, see Aldarondo, 2007; Fouad et  al., 2006; Kiselica & Robinson, 2001; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006b). Examples of social justice actions reflect a range of objectives and initiatives including challenges to policies and law (e.g., Fine as cited in Award, 2013; Helms as cited in Award, 2008; Lee, Smith, & Henry, 2013; Vasquez & Jones, 2006), promotion of human rights (e.g., Bullock & Lott, 2001; García, Pérez-Sales, & Fernández-Liria, 2010; “M. Brinton Lykes: International Humanitarian Award,” 2013), facilitating community action (e.g., Watkins, 2012), and responding to injustice in communities (e.g., Ahluwalia, 2013; Toporek, 2013). For contemporary examples of social justice and action, the Journal for Social Action in Counseling and Psychology presents a wide array of research, conceptual, and narrative works. Beyond the works that have been published in scholarly venues, there are probably many more in action that are never written because the work is in the doing, not in the writing. The following examples describe two projects combining counseling with the intention of facilitating justice. The core of both examples is the belief that language, voice, and narrative are powerful avenues for agency, especially when accompanied by greater awareness of structural oppression and social capital.

Project Homeless Connect: Service and Justice Income inequity is in the national spotlight as this chapter is being written and the United States prepares for the 2016 election season. Although there has been some attention to poverty as a social justice imperative for some time (American Psychological Association [APA], 2000), this has been limited, and critics charge that psychology and counseling neglect economically poor communities (e.g., Bullock, 2004; Lott, 2002). Attention to the role of counselors and psychologists addressing homelessness by challenging the structural level of inequity has been scarce, although not nonexistent (Ali & Lees, 2013; APA, 2009). The following example is a project designed to integrate service learning with a framework for social justice through employment services and Project Homeless Connect. Created by the San Francisco Department of Public Health, Project Homeless Connect (PHC) began in 2004 as a citywide event to help homeless individuals and families gain access to a wide array of services in one location and in one day. Engaging a strong volunteer base of community members to end homelessness, enhancing a system of care, and developing partnerships to increase service and funds are its main goals. PHC occurs every 3 to 4 months, bringing together nonprofits, government agencies, and corporations to provide services related to food, vision, hygiene, medical care, veterinary, behavioral health, shelter, employment, public assistance benefits, state identification cards, assistive technology repair, and dental care, to name a few. In addition to those who identify as homeless, clients may also identify as living with poverty, substance use, joblessness, veterans, previously incarcerated, transitional-age youth, people with disabilities, people of color, White people, men, women, transgender, older adults, students, and so forth. The meaning of homelessness may vary significantly; for example, people who live in vehicles or “couch surf ” may or may not identify as homeless. Similarly, the faces of people who are homeless reflect a wide range of profiles with many

different stories. The needs of clients attending PHC events vary considerably, reflecting immediate survival needs (e.g., shelter, food, medical care) or longer-term sustainability ingredients such as employment. As a training and service opportunity, the Career Counseling graduate program of San Francisco State University (SFSU) forged a partnership with the County Workforce Development Office to provide “on-the-spot” employment counseling at PHC as a means of providing service using a collaborative strength-based narrative approach to employment counseling; enhancing clients’ agency and power through their stories; fostering trainees’ multicultural awareness, knowledge, and skill; and increasing trainees’ understanding of structural oppression and the role of advocacy. The collaborative strength-based narrative employment counseling approach has several intentions: (a) to help clients make sense of and articulate meaning in their stories and life experiences, (b) to acknowledge barriers and frame those in terms of resilience and strength, and (c) to facilitate clients’ sense of self-authorship, based on self-understanding and visioning of a positive future. This process often begins with a thin narrative using language that reflects tasks completed rather than accomplishments and strengths. The collaborative process of counseling emphasizes the discovery of language to convey the richness of experience and help participants transverse the gap between the language needed to receive services and the language needed to convey a powerful picture as a strong employee. An important goal of this process is to validate participants’ self-construal of their identity and experiences through sharing personal narratives in their own words, as well as clarifying future choices and goals, especially around job seeking. Most important, it is hoped that clients feel a sense of empowerment and shift their self-perception using their narrative, despite present social and economic conditions. Jonsson, Kielhofner, and Borell (as cited by Russell, 2011) suggested that by focusing on narratives, job-seeking individuals are encouraged to be

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active agents in constructing their reality. We shift that frame slightly by acknowledging that larger systems have great impact on the experiences, yet clients can determine how their story is told. This supports the learning objectives for counseling trainees such that, in addition to applying narrative career-counseling skills, they hopefully gain a better understanding of structural oppression, social capital (Garcia & McDowell, 2010), and avenues for advocacy (for more detail see Toporek & Worthington, in press). Given the intersection of social class with a wide range of other cultural identities, the project is also designed to raise trainees’ awareness of their privilege, stereotypes, and biases in relation to their own and the PHC clients’ cultural identities. In addition, trainees are able to see clients in the context of their wide range of needs, help facilitate meeting those needs by being familiar with the range of resources available on the spot, and come to understand all that is required of the participants simply to take care of basic needs—for example, the extensive and persistent work required to obtain nightly shelter. It is also important to note that what may be considered important to professionals may not be seen as a priority to those for whom we advocate. Just like in therapy, the client’s perceived needs must be central in the process of advocacy and is a key aspect of empowerment and helping to create change. The graduate counseling training program has cultural competency as a major emphasis, and the potential for trainee growth in PHC is complex. Thus, multiple levels of preparation and debriefing occur. Putting theory as well as technical employment and counseling skills into action is perhaps the most obvious, yet the development of cultural competence and sensitivity to the wide range of challenges experienced by clients with limited economic and political capital is equally important. Dialogue in class prior to and after the event focuses on developing a personal awareness of one’s many privileged identities and how those influence counseling and the structural positionality of students (see Toporek & Worthington, in press). A number of authors have discussed the usefulness of dialogue in bringing 2 6       M U LTI C U LTU R A L C O U N S E L I NG

awareness of one’s privilege and moving toward an ally or activist position (e.g., Hernandez-Wolfe & McDowell, 2012; Moane, 2006; Sue, 2013). Project Homeless Connect, and the involvement of counseling trainees, could be framed in a range of ways from service to justice. We have chosen to create a structure that emphasizes the potential for justice and challenging structural inequality through raising trainees’ awareness as well as validating and amplifying voices of clients through the strength-based narrative process. Exposure to experiential learning and hands-on community involvement is key to making cultural competence more than just a concept and bringing the many faces of homelessness, as well as the extensive network of systems (both helpful and hindering), to the forefront. Because the counseling relationships within PHC are limited to one day, we use the framework of interactional justice and emphasize developing short-term relationships that express respect and enhance dignity. To help trainees develop an understanding of the role of systems in procedural and distributive justice, we observe, reflect, and deconstruct social capital maps following the event as a foundation for developing advocacy and finding a social justice voice. For a volunteer, experiences listening to, understanding, and validating individual stories can strengthen self-awareness and be a powerful catalyst for trainees. By practicing advocacy and involvement in social justice, we hope to prepare students to be agents for change.

Power and Privilege: Engaging Youth in a Critical Examination Critical consciousness (Freire, 1998) and liberation psychology (Martín-Baró as cited in Chávez, 2012) provide strong frameworks for engaging those who traditionally have less institutional power. Consciousness raising, as an important tenet of liberation counseling (Ivey & Collins, 2003) and feminist intervention (Marecek & Hare-Mustin, 1991), can facilitate those in oppressed groups to come together as a collective and shift the focus

of energy from self-destruction to social change (Watts, Griffith, & Abdul-Adil, 1999). Ivey and Collins (2003) described Freire’s critical pedagogy and consciousness as a framework in which those with limited political power are facilitated through a process of developing language to describe their lives, naming and codifying their experience. Thus, through Freire’s approach, the focus is on engaging people in naming their experience and context in a way that moves from daily tasks to position in a larger sociopolitical context. In contrast to those who have societal power and privilege, students of color, women, and those who are economically poor tend to be much more aware of the differences that these identities bring to them or the disadvantages and barriers they have to cross that others do not (Sue, 2013). From the third author’s experience working with ethnically diverse mandated male juveniles in a drug, alcohol, and trauma program, multiple levels of oppression were overwhelmingly evident. White privilege was something that clients were able to understand with ease. However, they seemed to be unaware of their own privilege in other parts of their lives. The following activity was designed to raise the consciousness of this culturally diverse youth group to better understand their own privilege despite the many facets of oppression they may face, as well as to develop a more complex understanding of power and their relation to it. In this activity, using a narrative framework with principles similar to previous approaches (e.g., Biever, McKenzie, Wales-North, & González, 1995; La Roche & Tawa, 2011; McIntyre, 2000), the facilitator brought out the youths’ narratives of power, their perception of their future story, and opportunities to begin to reconstruct their future stories. The activity aims to first understand and acknowledge the worldview and lived experience of the boys in the group and then facilitate them in exploring a different conception and different possible futures. The facilitator began the group by asking what power or privilege meant in order to invite the youth to bring their experience into the room. The majority of the participants described power as having a “one-up on somebody,” further

defined as having money or strength. Through the process of the activity, two points arose: (a) power dynamics are constantly being reinforced, consciously or unconsciously, and (b) the youth often give or take power away within many contexts of their lives. To illustrate power in a way that could be easily understood by the group, the facilitator next posed the question, “If you had a superpower, what would it be and why?” After each group member shared his response, the activity began. In order to better elucidate their definitions of power and privilege and encourage discourse about how they assign power, the boys were shown 10 pairs of photos containing images that represented two individuals with different characteristics: for example, two congressmen, one of whom was an older man of Latino descent, and the other, a younger man of White European descent. Each slide presented at least two different dimensions of a power wheel, including race, ability, gender, sexual orientation, age, education, socioeconomic status, and religion. Based on the images alone, each group member was asked to mark either A or B on an answer sheet to indicate who within the pair of images had the most power. At the end of the activity, the votes were counted and the results were shared. The facilitator then invited the youth to examine and discuss each of the slides, with the caveat that there was not a right answer but instead that they each define power and privilege. Interestingly, even though the youth had never seen the pictures and were instructed not to talk until all the slides were done, their perceptions of power and privilege matched that of their peers. After discussion of slides and their perceptions of power, group members were asked to share one thing they could change about themselves in the power wheel if they had the opportunity to do so. The intent of this approach was to allow group members to play with their narratives and provide them with an opportunity to change their life story. Education and socioeconomic status were two circumstances the youth identified for change in their current life situations, and this was used to help them set goals for themselves toward creating a more level playing field.

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CHALLENGES FOR THE FUTURE OF SOCIAL JUSTICE IN COUNSELING AND PSYCHOLOGY Despite the commitment of many students, counselors, and psychologists to work toward a more just society, there are some difficult questions that are imperative to consider. Walsh and Gokani (2013) argued that, in its present form, social justice is unattainable by psychologists given their privileged place within the current structure of injustice. We are compromised by our privileged socioeconomic position, which evokes potential conflicts of interest between “our talk” and “our walk.” The net result is that our concepts, research, and social applications have been, are, and will be fundamentally reformist politically. (p. 2)

They suggested that the only way that psychologists (and we would assume counselors by extension) can actually contribute to social justice is by acknowledging the ways in which we benefit from the unjust society and seek to partner with oppressed communities to challenge the system in which injustice is pervasive. Further, in the first issue of The Journal for Social Action in Counseling and Psychology, Toporek and Sloan (2007) challenged that counseling and psychology, with its current focus on individual etiology and change, may contribute to injustice through an emphasis on individual change, and inadvertently, individual blame. As a final challenge, we have observed that social justice is often defined and described in opposition to injustice. Although this may be helpful in identifying targets for social justice work, it is limited in that social justice becomes defined as an absence of injustice rather than as a fully formed vision of what justice looks like. Further, given the critique noted by several authors (Stoudt, Fox, & Fine, 2012; Walsh & Gokani, 2013), it is likely the vision of social justice is colored by positionality

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and privilege. Perhaps we need a clearer vision of justice from a broader spectrum of visionaries.

RECOMMENDATIONS FOR PRACTICE, TRAINING, RESEARCH, AND ADVOCACY Given the scope of social justice work, there are myriad recommendations for counselors, psychologists, and related professionals. We will touch briefly on only a few here using the structure provided by the triadic model of multicultural counseling competencies outlined by Sue, Arredondo, and McDavis (1992) and augmented by Toporek and Reza (2001) to include institutional competence, particularly relevant when considering structural inequalities and systemic social change. Counselor awareness of one’s own beliefs and attitudes is essential for addressing numerous concerns discussed in this chapter. For example, it is critical that social justice–oriented professionals engage in ongoing examination of their beliefs regarding inequity, privilege, power, oppression, justice, homelessness, social class, and other relevant dimensions of cultural identity as well as an understanding of their place in relation to others. Further, developing and challenging their own motivations and aspirations for doing social justice work can help identify issues that may arise by an unexamined practice, such as a savior approach, personal agenda, and inadvertent disempowerment, to name a few (Toporek & Liu, 2001). This is particularly critical when the social justice actor represents significantly different cultural identities from the community with whom the work is being done. In most cases involving economic injustice, the professional will have access to a more economically and politically powerful social capital network and likely more economic resources than members of the community. It is important to note the shift that may occur when one becomes a “part of the system,” transitioning from being one with the community to one who bridges between the community and the system. The model described

by Pitner and Sakamoto (2005) can be used for developing critical consciousness at affective, cognitive, and behavioral levels. In order to be a culturally aware agent of change, it is important to first come to terms with one’s privilege. Finding ways to maintain connections and understanding the community while simultaneously acknowledging that one’s place has changed is critical. When practitioners or researchers share part of their cultural capital with those who have less, communities have greater access to empowerment and are better able to advocate for themselves. Community organizing is an example of taking knowledge of the few and making it accessible to create change. The second dimension, familiar to most readers, is awareness of client worldview. Similar to the issues raised above, this is particularly important when the social justice actor is from a different community than the one represented by the population with whom work is being done. When focusing on homelessness, justice system–involved youth, recent immigrants, or any other community, understanding the experiences of community members is essential as well as understanding cultural norms around communication, values, relational structures, and other fundamental aspects that are important for working collaboratively. In order to better understand partner communities, it is essential to understand their needs and what justice may look like from their worldview as well as the potential impact of consequences that can result from action that challenges injustice. In the process of entering into the space of a different community, or even one’s home community when one’s position has changed, one must come from a position of respect, humility, authenticity, honesty, and compassion, to the extent that one’s willingness to learn benefits the group itself. The third dimension reflects culturally relevant skills. In social justice work and advocacy, the counselor or psychologist should be a facilitator rather than director. Understanding the priorities of community members and clients as well as goals and potential consequences for confronting systems are critical as a part of the process for determining

appropriate social action as well as appropriate ways of facilitating clients in finding the avenue that is most appropriate for them. Dimensions such as ethnic background, level of acculturation, education, family structure, and religious aspects of the community need to be noted, not only as a form of validation but also a form of understanding. Further, complications arising from competing or conflicting goals or perspectives within the community may need to be reconciled. In order to challenge oneself as an advocate for change, one needs to not only know these aspects of the community but to immerse oneself and to be willing to learn from those whom we fight alongside. Humility and the ability to acknowledge one’s own efforts in learning can strengthen the bond created between parties, and validate that change and learning are not unilateral but instead a collaboration. An additional dimension is the institutional level of multicultural competence (Toporek & Reza, 2001). When expanding this to social justice work, it is necessary to develop awareness of one’s relationship to systems, cultural knowledge of the community’s relation to larger systems, and skills at systems-level interventions. This may involve addressing systemic levels of oppression, understanding organizational functioning and culture, procedural practices, policy, and legislative influences. The advocacy competencies described by Lewis, Arnold, House, and Toporek (2002) can be useful in identifying appropriate levels of intervention, resources needed, as well as strategies for developing and implementing action both in collaboration with, and on behalf of, clients and communities. Other examples of social and structural interventions can also stimulate thoughtful reflection (e.g., Codrington, 2013; Estacio & Marks, 2007; Storlie & Jach, 2012; Stoudt et al., 2012).

SUMMARY There are many roads one may travel toward social justice, and there is increased potential for the power of unity with the growing emphasis in

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counseling, psychology, and related fields. The power of this unity is strengthened when motivations, skills, strengths, and collaboration are clear. Whether one begins as an activist, a community member, a scholar, or some other road, the place where we converge is a tapestry not of individuals in charity but of communities committed to justice. As the great Rev. Dr. Martin Luther King Jr. (1963) said, “Injustice anywhere is a threat to

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justice ­everywhere.” Regardless of the journey that brings us to understand the meaning behind those words, the value is in the destination. It is our belief that we, as professionals, need to develop a community where we are able to keep each other accountable through our actions, becoming part of a community where we continue to fight for those who are not yet a part of the conversation, and in the process, contribute to justice.

CHAPTER

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A Review of the Counseling Professions’ Ethical Guidelines Are They Meeting the Challenges of Today’s Society? Charlene Alexander and Amy Mitchell

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he purpose of this chapter is to provide a selective perspective on the history and development of the American Psychological Association’s (APA) and the American Counseling Association’s (ACA) ethical standards. We attend specifically to the waxing and waning evidence for multiculturalism in the development of these standards. This history is provided with the express purpose of highlighting how and in what ways multiculturalism and contextual challenges have shaped and been shaped by these documents. Consideration is also given to how the standards are meeting today’s challenges relative to our work with diverse populations. To this end, our intention is to challenge the profession to examine whether graduating from training programs that methodically direct attention to existing ethical and professional standards does in fact lead to multicultural competency development among counselor trainees. We note that while this chapter focuses specifically on the associations’ efforts to develop the Ethical Standards within a multicultural context, other significant multicultural accomplishments were slowly and successfully attained during this time period (see Casas, Chapter 1, this volume). For the sake of clarity, before addressing the information that is inherent in the chapter, we define the varied segments and constructs that comprise the standards that are discussed throughout the chapter. The APA articulates a set of Ethical Principles and Code of Conduct that is referred to as the “Ethics Code.” The APA Ethics Code is composed of an Introduction, a Preamble, and General Principles (A–E) followed by specific Ethical Standards. The Ethics Code defines the General Principles as aspirational in nature. These are intended to “guide and inspire psychologists toward the highest ethical ideals of the profession.” General Principles, then, in contrast to Ethical Standards, do not represent obligations and should not “form the basis for imposing sanctions” against psychologists (APA, 2010, p. 3). In other words, the General Principles of the Ethics Code, if used to impose sanctions against psychologists, distorts their

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meaning and purpose. Ethical Standards, on the other hand, are designed to cover most situations that psychologists might be faced with and are intended to educate members and students and to protect the welfare of those with whom psychologists work. The Code of Ethics makes a distinction between the purely private conduct of psychologists and their professional behavior; the private conduct of psychologists is outside the purview of the Code of Ethics, but guiding professional functioning and client welfare is the primary purpose of the code. The ACA’s Code of Ethics (2014) first lists the core professional values of the profession, of which there are five, and these values then provide the basis for the six ethical principles found in the Code of Ethics. These principles are described as “The foundation for ethical behavior and decision making” and are not described as aspirational (ACA, 2014, p. 3). The entire ACA Code of Ethics is constructed then of nine sections. Each section begins with an introduction, which describes the ethical behavior and responsibilities to which counselors aspire and “sets the tone for each particular section” (ACA, 2014, p. 3). These sections are arranged in alphabetical order from A–I.

A HISTORICAL PERSPECTIVE Students enrolled in psychology programs today need to understand the historical challenges surrounding the development of the Ethical Standards. Having taught ethics for several years, the challenge of the first author, as instructor, was to help students experience the relevance of these standards to their work as counselors and psychologists. It was unfortunately and astonishingly very easy to find real-life examples of ethical violations for almost every section of the code. The highlight of the course was a day spent observing our state ethics board hearings and watching the ethical guidelines come alive in a way that you cannot capture simply by reading about ethics. Seeing counselors and psychologists having to explain their behavior before a panel of their peers leaves a lasting impression. One student said, “I do not want to go back there.” This is not where we want 3 2       M U LTI C U LTU R A L C O U N S E L I NG

our trainees to land during their career. Beyond avoidance of punishment achieved by outward compliance with ethical requirements, trainees need to develop sensitivity to the potential dilemmas that can face counselors and psychologists. This chapter highlights a commitment to meeting the ethical standards in a multicultural context. The civil rights movement was the backdrop of the profession’s earliest attempts at crafting ethical standards. Interestingly, the authors of our first ethical standards understood the need to respond as a profession to the social inequalities of the time (see Casas, Chapter 1, this volume). From 1948–1953, a diverse team of psychologists created a 171-page document to guide the professions’ ethical decision making (APA, 1953). This team used submissions of current distressing professional challenges submitted by practicing psychologists. The document was published in 1953 as the official APA Ethical Standards. This document contains numerous examples of cases related to diversity. Soon after, the 1953 Ethical Standards were restructured and published in 1959 (APA, 1959). In the latter version, to the dismay of multicultural supportive psychologists, all references related to meeting the needs of diverse populations disappeared from the ethical landscape. The first ACA standards followed this pattern. Specific references to diversity did not reappear for either association until 1977. The 1970s saw a resurgence of conversations about the needs of underrepresented populations. The Vail Conference of 1974 led to the 1982 publication of Sue and colleagues position paper on cross-cultural counseling competencies (Sue et al., 1982). Their “call to the profession” resulted in significantly more practice, theory, research, and a general productivity around multiculturalism. In 1977, the APA ethical guidelines were revised to include gendered language (APA, 1977). Currently, we find the ACA ethical guidelines to be leading the way in effectively articulating the relevance and centrality of multiculturalism in our ethical guidelines. In critique of APA’s current ethics code, Ethnic Minority Psychological Associations believe that the current guidelines reflect Eurocentric

values of individualism and personal autonomy and support discussion about the utility of an APA ethical model developed within a Western colonial framework (Morse & Blume, 2013). Current challenges, including the Hoffman Report (Hoffman et al., 2015), have been related to the ethical guidelines and U.S. national security, interrogation, and torture practices. Perspectives and events such as these serve to beg the question—Do the standards inspire counselors and psychologists to become the multicultural practitioners we expect today?

REVIEW OF THE ETHICAL STANDARDS APA Narrative As noted earlier, the American Psychological Association, working through the Committee on Ethical Standards for Psychology, created the first set of ethical standards in 1953. The committee of psychologists assembled to shape these standards was remarkable and brought two very important attributes to their work. First, these individuals had a keen insight into the importance of the societal context and imperatives of the time. Second, they wanted to ensure that the voices of practitioners, and the daily challenges they faced, were reflected in the document that was finally crafted. The Committee on Ethical Standards for Psychology and subcommittee members included individuals who had various backgrounds and professional expertise. The chairman of this committee, Nicholas Hobbs (1948), presented a review of the reasons for, and the intent in, creating an ethical code specifically for psychologists. Social psychologist Stuart Cook’s research studied the impact of racial and religious prejudice on society (Kennedy, 1993). Dr. Cook and subcommittee member Dr. Isidor Chein were two of the authors on the social scientists brief for the Brown v. Board of Education case. The amicus curiae brief served the purpose of acquainting the judges of the Supreme Court with the impact of segregation on the psychological functioning of African

American children. Dr. Chein, a renowned psychologist who was actively engaged in social justice professional work, served as director of research for the Commission on Interrelations of the American Jewish Congress (Cook, 1982). The court cited two papers written by Dr. Chein in its 7–0 decision to strike down school segregation. Lloyd Yepsen was an advisor to the Chilean Minister of Education and played a key role in the restructuring of Chile’s school system (Keeping Abreast of the Times, 1935). Other notable authors on subcommittees of the 1953 document included Gordon W. Allport, author of the Nature of Prejudice (1954), Frances A. Mullen, an innovator in the international school psychology movement, and Mitchell Dreese, program evaluator for the diversity of APA and author of the Personnel Study of the Division of Counseling and Guidance of the APA (1949). Dreese’s study focused on diversity in APA membership, and specifically the lack of women in APA administrative positions (Dreese, 1949). It is also important to note that the first committee included five female members, compared to the all-male committee involved in the restructuring of the ethical standards in 1959. In addition to convening a committee with significant diversity expertise, this first group of scholars approached the development of the standards as an empirical process that ensured full participation and reflected real-life challenges (APA, 1953). For example, the code specifically states, “Psychologists believe that the ethics of a profession cannot be prescribed by a committee; ethical standards must emerge from the day by day values commitments made by psychologists in the practice of their profession” (APA, 1953, p. v). In 1948 the 7,500 members of the APA were asked by letter to “describe a situation they knew of, firsthand, in which a psychologist made a decision having ethical implications, and to indicate what the correspondents perceived as being the ethical issues involved” (APA, 1953, p. vi). Case studies and specific examples of challenging situations were obtained from more than 1,000 psychologists. These were compiled to create the 106 individual Principles that formed the 1953 ethical guidelines.

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These original principles were brimming with examples in which psychologists were concerned about issues of race, sexuality, gender, and religion. These are mentioned across the many pages of the 1953 document. A few examples are included here to demonstrate the power of the ethical concerns raised by psychologists practicing in the 1950s. For a full review, readers are encouraged to read the original document (APA, 1953). Excerpts from the first APA ethical standards: Under principle 1.11: “The obligation of the psychologist as scientist, teacher, practitioner, and citizen,” Incident 3 described the following situation: A superintendent of a school system was anxious to maintain the “status quo” for the Negro population, and was against de-segregating schools in a community where most of the people were in favor of a single school system. A psychologist employed by the school system was asked to talk to a community group in regard to possibilities of putting through de-segregation legislation, etc. (p. 2)

Principal 1.11-1 states As a scientist, the psychologist is committed to increasing man’s [sic] understanding of man, and in this pursuit he places high value on objectivity, on integrity of procedure, and on full reporting of his work; he investigates where his judgment indicates investigation is needed; and he believes that society will be best served by his efforts when he follows conscientiously the methods of science. (p. 3)

Principle 1.13: Issues involving social values, such as racial or religious prejudice, freedom of speech, freedom of research, etc., Incident 5 details A vocational adviser projected his stereotype of a minority group into the advisement procedure, thereby attempting to persuade a Negro client to accept a lower level objective than the client was capable of reaching even with a realistic social handicap, I believe that if a psychologist agrees to accept a human being as a client he should be

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expected to give as objective and as high quality professional service as possible, regardless of race, color, creed, or fee involved. (p. 9)

The resulting Principle 1.13-1 states The psychologist should express in his professional behavior a firm commitment to those values which lie at the foundation of a democratic society, such as freedom of speech, freedom of research, and respect for the integrity of the individual. He should claim these rights for himself, and uphold them on behalf of others. (p. 10)

And further clarifies (1) The psychologist may not ethically refuse to serve a person because of race, religion, or other considerations of similar nature, nor should he lend support to agencies that use such criteria to discriminate against individuals. If a psychologist feels that he has attitudes that would interfere with his ability to work effectively with a particular individual, he has the obligation to work out a satisfactory referral. (2) It is unethical for a department of psychology or for a psychological agency to exclude students or refuse to hire staff members on grounds of sex, race, religion, political affiliation, socio-economic status, when these concerns are not relevant to the person’s ability to perform duties that will be required of him. This does not abridge the right of a sectarian institution to select staff or students in accordance with criteria essential to its stated purpose. (3) A possible exception to the above may exist in states where the law requires infringement of these basic rights of individuals. Here the psychologist may be expected to conform to the law unless conformity involves a violation of conscience. (See Principle 1.22-3) (p. 10)

Many were critical of the document for being bulky and difficult to handle. Thus, in 1958, a new committee undertook the task of “simplifying” the 1953 ethical standards. This committee reported, “Most dissatisfaction with the present code can be boiled down to two major characteristics: its cumbersome length (171 pages!) and the inclusion

of many principles codifying common courtesies with more strongly worded principles involving issues of clear ethical import” (APA, 1959, p. 266). The 1958 committee believed “a small number of major principles supported by short explanatory paragraphs will have a much greater impact upon a wide audience, both within and outside of psychology, than would continuation of the code in its present cumbersome form” (APA, 1959, p. 266). In describing the rationale used by the committee to reduce the length of the previous standards, the committee indicated that the criteria used would include (d) Only the hard core of ethical issues—those which may conceivably result in a case decision by the Committee on Scientific and Professional Ethics and Conduct—should be retained, (e) The major principles should be general enough to weather considerable growth of psychology, (f) The code should be sufficiently specific to prove an effective instrument for individual action by ethics committees, while allowing latitude for the cumulative wisdom of human interpretation and judgment, (g) The code should be written in straightforward style, emphasizing what a psychologist is (when he is a truly ethical psychologist) rather than what he ought to be. Although there are undoubtedly places where the present draft can be improved, we believe that the general form of the proposed revision is a highly desirable one. (APA, 1959, pp. 266–267)

The APA ethical guidelines were revised in 1963, 1968, and again in 1977. Each iteration of the guidelines achieved the goals of the 1958 committee ensuring that the guidelines were both brief and avoided “issues of common courtesies.” The first ethical standards covered six categories: Public Responsibility, Client Relationships, Teaching, Research, Writing and Publishing, and Professional Relationships with 106 principles. The 1959 ethical standards contained 18 principles with the titles General, Competence, Moral and Legal Standards, Misrepresentation, Public Statements, Confidentiality, Welfare, Client Relationship, Impersonal Services, Advertising, Interprofessional Relationship, Remuneration,

Test Security, Test Interpretation, Test Publication, Harmful Aftereffects, Publication Credit, and Organizational Material. Revisions retained essentially the same organization until 1977, when the material was reformatted into nine principles: Responsibility, Competence, Moral and Legal Standards, Public Statements, Confidentiality, Welfare of the Consumer, Professional Relation­ ships, Utilization of Assessment Tech­niques, and Pursuit of Research Activities. It was also in 1977 that previously gendered language in the Preamble is changed to “individual,” “human,” and “people.” Other notable changes in language include references to social policy, race, age, sex, ethnicity, national origin, socioeconomic, or other social groups. Principle 2 of the 1977 code specifically states a need for competence in these areas. Principle 3 extends this language Psychologists as teachers are aware of the diverse backgrounds of students and, when dealing with topics that may give offense, treat the material objectively and present it in a manner for which the student is prepared. B. As employees, psychologists refuse to participate in practices inconsistent with legal, moral and ethical standards regarding the treatment of employees or of the public. For example, psychologists will not condone practices that are inhumane or that result in illegal or otherwise unjustifiable discrimination on the basis of race, age, sex, religion, or national origin in hiring, promotion, or training. (APA, 1977, p. 22)

The 1981 revision further identifies the need for counselor training, experience, or consultation in the delivery of competent service to or research with protected individuals. These guidelines also note that psychologists need to be mindful of situations where their position could influence personal, social, organizational, financial, and political decisions (APA, 1981). The 1990s brought additional changes to the ethical standards, most notably the addition of six general principles as a separate section from the eight standards (APA, 1990, 1992). The 1992 ethical principles show increased attention to issues of multiculturalism:

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Psychologists are aware of cultural, individual and role differences including those due to age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language and socioeconomic status. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone unfair discriminatory practices. (APA, 1992, pp. 1599–1600)

Revisions in the next 10 years included the additions of “gender identity” and “culture” and a statement on the importance of considering these factors when working with these populations. The 2002 document contributes sexual harassment and unfair discrimination items to the growing list of considerations (APA, 2002). This language remains in place up to the current APA principles and standards (APA, 2010). Fisher (2013) provides a more comprehensive description of where in the 2010 standards issues of individual and cultural diversity can be found. Changes to ethical standard 1.02 made in 2002 and again in 2010 are worth noting, as these changes and the process by which such changes were made had an important role in the review initiated by APA that resulted in the Hoffman Report (see Hoffman et al., 2015) that is briefly addressed herein. The Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture report (the Hoffman Report) was the outcome of an extensive investigation conducted over six months that included interviews with 148 people. The report that was published on July 2, 2015, was 542 pages in length. With respect to the relationship between the standards and the events that led to the need for the report, attention is directed to changes in the standards, specifically ethical standard 1.02, that was made to protect psychologists “who faced difficult choices when their ethical obligations of confidentiality conflicted with legal directives in the form of subpoenas or court orders that required disclosure of confidential patient information” (Hoffman et  al., 2015, p. 56). This change primarily impacted two major groups of ­practitioners—­military and correctional psychologists. The change gave ­ clinicians and 3 6       M U LTI C U LTU R A L C O U N S E L I NG

forensic psychologists protection when breaching confidentiality due to subpoena for treatment records. Military and correctional psychologists were given protection when complying with orders to disclose confidential patient information in lieu of suffering professional consequences for withholding information. From a broader perspective, specific changes to the standards noted in the Hoffman Report (2015) were changes made from the 1992 ethical standards to the 2002 standards, specifically 1992: 1.02—Relationship of Ethics and Law. If psychologists’ ethical responsibilities conflict with law, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict in a responsible manner. 2002: 1.02—Conflicts between Ethics and Law, Regulations, or Other Governing Legal Authority. If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority.

The commission noted the revisions “were proposed in October 2000, nearly one year prior to the attacks of September 11th—and thus could not have been a response to or motivated by the war on terror—or the result of collusion with the government in the wake of September 11th” (Hoffman et  al., 2015, p. 56). As noted above, APA’s ethics committee made the changes to standard 1.02 in 2002 with the express intent of protecting psychologists, when being ordered to disclose confidential patient information, while sacrificing patientcounselor confidentiality. The amendments for the 2010 publication of the APA guidelines changed the standard in this way: 1.02—Conflicts between Ethics and Law, Regulations, or Other Governing Legal Authority. If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists clarify the nature of the

conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights. (p. 15)

The above discussion highlights the impact of ethical standards on the work and lives of psychologists. Minor changes to the language contained in the ethical guidelines can have significant repercussions on the profession. Just the suggestion that changes to the ethical standards were made to allow some psychologists to collude with the government to meet professional and social goals, while clearly false, had a significant impact on targeted individuals and the profession. The 2010 ethical code is the most recent revision of the ethical guidelines. While the ethics code is treated in this chapter as a stand-alone document, it is important to note APA has several policy statements and standards for multicultural competency (see APA, 2008, Report of the Task Force on the Implementation of the Multicultural Guidelines). However, these are not enforceable unless they are included in the ethics code. Examples of how multicultural considerations should be included in the ethical standards can be found from a review of a panel presentation examining and critiquing the APA Code of Ethics (2010) given by members of ethnic minority psychological associations including the Association of Black Psychologists (ABPsi), the Society of Indian Psychologists (SIP), the Asian American Psychological Association (AAPA), and the National Latina/o Psychological Association (NLPA). This panel questioned the relevance of the ethical guidelines for ethic minority people and determined that the 2010 ethical guidelines do not reflect the beliefs and values about minority individuals’ understanding of community, spiritualism, relationships, and the effects of historical trauma or colonialism. Specifically, the panel members presented the belief that the APA Code of Ethics reflects “Eurocentric values, such as self-focused individualism, and personal autonomy” derived without concern for Native values and practices

and calls for a review of the code using a lens that appreciates the wisdom of indigenous cultures. For a more thorough review of the ethical guidelines articulated by each ethnic organization, the reader is directed to the ABPsi (2006), García and Teehee (2014), and Straits et al. (2012). In an open letter to the APA and the Psychological Community members from the American Middle Eastern/North African (MENA) Psychological Network, the MENA group noted that APA had not undertaken an earnest effort to support MENA communities that face rising psychological distress, especially post 9/11. They argue that APA must end the invisibility of MENA psychologists, apologize to Muslim communities for APA’s complicity in abusive interrogations by psychologists, and “conduct a thorough self-examination of long-standing aspects of the organizational culture at APA that fosters the egregious events documented by the Hoffman report” (MENA, 2015, p. 2). Again, the question that needs to be addressed is whether or not the existing ethical standards and their implementation are meeting today’s challenges relative to our work with diverse populations.

ACA Narrative The ACA guidelines follow a different path of development, most likely due to the evolution of the association. The first ethical standards for the American Personnel and Guidance Association (APGA) were published in the October 1961 edition of the Personnel and Guidance Journal. The guidelines addressed seven major areas of professional activity (i.e., General, Counseling, Testing, Research and Publication, Consulting and Private Practice, Personnel Administration, and Preparation for Personnel Work). Each section contains general standards to “serve as guidelines for ethical practice” (p. 206). These standards, like others, note a dedication to society in the preamble as well as “commitment to profound faith in the worth, dignity, and great potentiality of the individual human being” (p. 206). General statements encourage professionals toward ideals about human worth: “The member’s

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primary obligation is to respect the integrity and promote the welfare of the counselee or client with whom he is working” (p. 207), similar to preamble statements found in the APA documents. Also similar to the 1969 APA ethical standards, the 1961 APGA standards were brimming with gendered language and limited attention to diversity. The 1981 revision of the APGA standards contained the beginnings of a social justice focus. For example, Section A.5 states, “In establishing fees for counseling services members must consider the financial status of clients and locality” (p. 1). These revisions attend to social justice and organizational accountability, and how counselors will resolve discrepancies. This revision to the APGA standards addresses the tensions that can occur between a counselor and an institution If despite concerted efforts the member cannot reach agreement with the employer as to acceptable standards of conduct that allow for changes in institutional policy conducive to the positive growth and development of clients, then terminating the affiliation should be seriously considered. (p. 1)

Furthermore, the 1981 revision saw changes in gendered language, including using phrases such as “his-her” and “she-he,” as well as recognition of the significance of socioeconomic, ethnic, and cultural factors and minority group membership in the areas of testing and assessment. The name of the association changed from American Personnel and Guidance Association to the American Association for Counseling and Development (AACD) in 1983, with the next revision to ethical standards occurring in 1988. At this time, attention was given to ethnic, racial, religious, disability, and socioeconomic groups, specifically in accessing technology, testing scores, and hiring practices. Specifically, the standards state, “The member must proceed with caution when attempting to evaluate and interpret the performance of minority group members or other persons who are not represented in the norm group on which the instrument was standardized” (AACD, 1988, p. 6). The most notable addition 3 8       M U LTI C U LTU R A L C O U N S E L I NG

to the AACD’s ethical guidelines can be found in Section A: General guidelines: The member avoids bringing personal issues into the counseling relationship, especially if the potential for harm is present. Through awareness of the negative impact of both racial and sexual stereotyping and discrimination, the counselor guards the individual rights and personal dignity of the client in the counseling relationship. (p. 4)

Already at this time, AACD turned the focus of their ethical standards to first ensuring that the counselor does no harm to the client. The next update to the code of ethics and standards occurred in 1995, which also saw a transition of the American Association of Counseling and Development to the ACA. These standards brought with them an even greater depth and focus on diversity, and attention to the dynamic relationship between the counselor and the client. “Association members recognize diversity in our society and embrace a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of each individual” (ACA, 1995, p. 1). Principle A.2 is titled “Respecting Diversity” with subcategories of “Nondiscrimination” and “Respecting Differences.” The language included here is age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, and socioeconomic status. Specifically, this section details that counselors will actively attempt to understand the diverse cultural backgrounds of the clients with whom they work. This includes but is not limited to, learning how the counselor’s own cultural/ethnic/ racial identity impacts her or his values and beliefs about the counseling process. (p. 2)

The code states counselors are to be “aware of their own values, attitudes, beliefs, and behaviors and how these apply in a diverse society, and avoid imposing their values on clients” (p. 3). In 2005, the ACA had an impressive, laserlike focus on diversity in the next revision to the ethical standards. As an institution responsible for training counselors, it was ahead of its time in

understanding the complexity of the counselorclient relationship and their mission as an institution committed to social justice. Glosoff and Kocet (2006) comment on the changes made to the 2005 ethical guidelines, highlighting updates in the preamble to address issues of “cultural context and values that inform the development and interpretation of the 2005 Code” (p. 6). With a renewed interest in multicultural and diversity issues, many examples of changes to the code can be found. For example, the new code examines the cultural meaning of confidentiality and privacy in standard B.1.a Multicultural/Diversity Considerations. Further, Standard E.5.c states counselors are to “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and the role of mental health professionals in perpetuating these prejudices through diagnosis and treatment” (ACA, 2005, p. 11). Most recently, in 2014, ACA completed and disseminated their latest ethical guidelines. The preamble once again strongly recommits to a focus on diversity. This revision of the guidelines provides an enlightened definition of counseling, which is worth noting: “Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals” (ACA, 2014, p. 3). ACA has redefined for the profession what the purpose of counseling is all about, at a time when such a definition is sorely needed. The document further states, “Professional values are an important way of living out an ethical commitment” (p. 3), and lists the core professional values: 1. Enhancing human development throughout the life span 2. Honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts 3. Promoting social justice 4. Safeguarding the integrity of the counselor-client relationship 5. Practicing in a competent and ethical manner

This is a philosophical shift in the way we understand the purpose and function of ethical standards to the counseling profession. It defines the way in which ethical standards should function for the profession, not simply as a delineation of standards and principles but helping the counselor integrate their multicultural identity as a professional. This change powerfully clarifies the relevance of the counselor in the lives of diverse individuals. ACA is being very clear that the purpose of our work is really to empower the clients that we serve versus a focus on the elite knowledge of the counselor. Having an understanding of who you are in the context of your service to others is transformational in our interpretation of ethical guidelines. So given these new guidelines, imagine the differences in the process of appearing before ethics committees. As the standards are currently written, APA is focused on establishing how psychologists’ behavior has violated an ethical standard. In contrast, ACA has turned toward how counselors understand and use their systemic role in affecting the lives of the clients that they serve.

SUMMARY This historical perspective of our ethical standards is provided for the purpose of highlighting the struggles for embodying diversity and inclusivity in our ethical guidelines. The task force that developed the 1953 APA ethical guidelines understood that “ethical standards must emerge from the day by day values commitments made by psychologists in the practice of their profession” and cannot be “prescribed by a committee” (p. v). Interestingly, this concept is the guiding force in the present ACA (2014) ethical standards, emphasizing the place of professional values in “living out an ethical commitment” (p. 3) and focusing on the needs of clients and the role of the counselor in empowering the clients they serve. Ethical codes are documents that should not be static; thus, revisions are made to ensure that contemporary issues confronting the profession are addressed. The Hoffman Report (2015) serves as a clarion call to the profession of psychology with implications for counseling as well.

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While the report does not indicate a problem with the 2010 version of the ethics code, the application of the guidelines must be questioned. This brings us back to the primary question of the chapter— are the current guidelines meeting the diversity challenges of society today? APA is undergoing extensive efforts to address the issues raised in the Hoffman Report with the establishment of the Blue Ribbon task force. However, the Hoffman Report highlights the many challenges of ethics in the real world. ACA (2014) comes close to articulating a social justice framework for ethics. As a profession, we must identify ways to assess this question of multicultural competency.

Are the Guidelines Meeting Today’s Challenges for Diverse Populations? No, we do not believe the guidelines are meeting the challenges relative to diverse populations today. In all instances, guidelines and standards are only effective to the extent they are implemented. As we have described in our review of the ethical guidelines, societal and other demands can have both positive and/or negative influences on the creation and changes of our ethical standards. The same can be true for our accreditation guidelines. To strongly illustrate this fact, we provide the following example: APA’s independent investigation of the Psychological Ethics and National Security (PENS) task force started with Our investigation determined that key APA officials, principally the APA Ethics Director joined and supported at times by other APA officials, colluded with important DoD officials to have APA issue loose, high-level ethical guidelines that did not constrain DoD in any greater fashion than existing DoD interrogation guidelines. (Hoffman et al., 2015, p. 9)

We should not continue to be so naïve to assume that our standards are free from societal, political, and professional demands, pressure, and/ or manipulation. 4 0       M U LTI C U LTU R A L C O U N S E L I NG

RECOMMENDATIONS First, it is very clear that our ethical guidelines may be too broad to help guide psychologists in their behaviors. Race-based controversies continue to plague our societies. Incidents continue to be reported requiring us to take a stance against discrimination and racism. The Black Lives Matter movement and the racial conflicts at the University of Missouri are just a few of the examples facing our society today. The racial issue is also global in its impact. The United States and countries in Europe are divided around issues of immigration, and terrorism reigns in many parts of the world. Access to higher education, gaps in achievement among low-income and underrepresented students, generational poverty, and neighborhood violence serve to remind us that advocacy around issues of diversity and multiculturalism continue to be essential elements in our ethical responsibilities, and therefore they shape key outcome measures for counselor and psychological preparation programs. Our ethical standards should serve to ensure that counselors and psychologists in training understand the values of our profession and that they can demonstrate awareness and knowledge of critical issues that are relevant today in the lives of those they serve. Thus, if the values of our accreditation standards are not clear, or if we allow societal pressures to influence the construction of those standards, we cannot expect our trainees to aspire toward those principles. Accountability. How do we hold ethics committees and training programs accountable? The authors propose that constant and careful monitoring of the influence of societal and contextual events on the development of ethical standards needs to be continued. Monitoring should ensure that we are, in fact, continuing to preserve the welfare and dignity of the people we serve. We applaud APA’s efforts to create a panel to review APA’s ethics, board, policies, and procedures to ensure that they are aligned with best practices on the development of ethical standards. We would, however, add that APA should be constantly vigilant to the impact of

societal pressures, as those will not go away. Our ethics committees should be guided by two questions: How will this benefit our underrepresented populations? How might this negatively impact our underrepresented populations? Using power and influence to diminish harm versus enhance harm must always guide our work.

and in a reciprocal relationship with the environment. These guidelines could be applied to various processes of development and are consistent with our understanding for the development of multicultural competencies. We therefore encourage our accreditation bodies to clearly articulate these as both process and outcome variables.

Practice. As we think about and prepare accreditation standards, how do we ensure multiculturally competent practice? Our current guidelines suggest psychologists are working in narrowly defined therapeutic spaces. It is clear that we need to broaden our definition of what constitutes therapeutic spaces to meet our clients where they live, work, and play. Our training programs need to evolve to broaden the conceptions of therapeutic spaces, therapeutic interventions, and psychological intervention. This exploration of what constitutes therapeutic spaces may also include identifying additional multicultural and professional competencies that might be expected of students, in a time when the practice and applications of psychology for multicultural considerations are clearly not confined to traditional psychological practices. Additionally, we recommend a review of the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which were adopted by the APA’s (2015) Council of Representatives, the ACA (2010) competencies for counseling with transgender clients, and the APA’s (2012) guidelines for psychotherapy practice with lesbian, gay, and bisexual clients.

Research. Ethical guidelines should encourage faculty to continuously assess students’ dispositions in the area of research, with attention to motivations for conducting ethical research. As considered by Ward Goodenough (1980),

Training. In our opinion, training programs should be designed to meet the professional development goals of the people we are educating. Given the globalization of counseling, we question if, in fact, our training of international students prepares them to be multiculturally competent in their home country or in the United States. Gerstein, Hurley, and Hutchinson (2015) recommend that psychologists’ and trainees’ learning and developing of international competencies must be continuous, recursive, constantly evolving and changing, cumulative, highly dynamic,

If field researchers genuinely feel such respect for others, they are not likely to get into serious trouble. But if they do not feel such respect, then no matter how scrupulously they follow the letter of the written codes of professional ethics, or follow the recommended procedures of field research manuals, they will betray themselves all along the line in the little things. (p. 52)

Although regulating pure motives is not possible, the accreditation guidelines must aspire to clearly articulate what the standards for research might be. APA guidelines make limited mention of diversity concerns in research, while ACA guidelines explicitly state, “Counselors who conduct research are encouraged to contribute to the knowledge base of the profession and promote a clearer understanding of the conditions that lead to a healthy and more just society. Counselors support the efforts of researchers by participating fully and willingly whenever possible. Counselors minimize bias and respect diversity in designing and implementing research” (ACA, 2014, p. 15). Further, in reporting results, counselors are expected to “describe the extent to which results are applicable for diverse populations” (ACA, 2014, p. 16). We recommend that our guidelines clearly outline diversity considerations for research and the applications of research for multicultural considerations. To further ACA’s endeavors, we might extend considerations by explicitly providing behavioral anchors for the multicultural and

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diverse considerations of research. Further, while research guidelines have discussed an emphasis on the benefits of research to the community, relationship with the community, the role participants play in it, and the level of importance of the research to the lives of those studies need to be considered in our ethical guidelines.

CONCLUSIONS We include in this chapter recommendations for practice and research, with an emphasis on training professional counselors and psychologists. A key aspect of these considerations has been the extent to which we can create a structure of accountability for the practice of counseling and psychology. Integrity of bodies and institutions only occurs because of the integrity of individuals who serve within those institutions. In the spirit of the members of the first APA committee that articulated the guidelines for psychologists during an era of civil unrest, counselors and psychologists must give serious consideration to the societal challenges that we face today in order to ensure the respectful and equitable treatment of all. Reflecting on the members of the original APA ethics committee, it is not surprising that in 1953 they paid attention to issues of diversity. Given the current crisis faced by the APA, it behooves all of us to understand the integrity, motivation, and

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dispositions that are required of those who seek to serve effectively within the leadership of the association, and in particular, on ethics committees. The identification and selection of such individuals cannot be left to chance. The guidelines give shape and direction to our practices. They do so for better or worse (see the Hoffman Report; Hoffman et al., 2015). However, their applicability and effectiveness is the ultimate test. A level of critical analysis, with self-reflection and self-monitoring, must exist as an institutional goal and an expectation of individual members. This critical analysis must exist in such a way that it can be sustained over time, dynamically and cyclically. Professional competencies do not occur in isolation; they are achieved through active and deliberate reflection and action. When challenges occur, we cannot allow a few members to direct the course of events to the detriment of the profession. We must all take responsibility for developing and maintaining an ethically realistic and sound profession. This is a complex, multifaceted undertaking that does not lend itself to simple resolutions. Our ethical landscape will be changing in the future, and we hope the reader will keep abreast of these changes and when possible contribute to discussions about the evolution of ethical standards. However, we must be clear from here on out that as psychologists and counselors, our responsibility is first, to do no harm.

CHAPTER

4

A Personal Assessment of the Ebb and Flow of the Multicultural Counseling Movement (MCM) Michael D’Andrea

T

he fourth edition of the Handbook of Multicultural Counseling (HMC) marks the 20th year since the inaugural publication of this monumental scholarly contribution to the mental health professions. It is an honor to not only have had opportunities to contribute to the previous three editions but to have another chance to add to the scholarship that comprises the fourth edition of the HMC. The chapters I coauthored in previous editions of this book consisted of case studies that focused on the strategies counselors and allied professionals used to promote multiculturalism in the mental health professions. These research endeavors included collaboration with several distinguished members of the National Institute for Multicultural Counseling (NIMC). These well-respected multicultural counseling and advocacy brothers and sisters included Dr. Patricia Arredondo, Dr. Judy Daniels, Dr. Mary Bradford Ivey, Dr. Allen Ivey, Dr. Don C. Locke, Dr. Beverley O’Bryant, Dr. Thomas Parham, Dr. Derald Wing Sue, and myself. Collectively, we reported on our efforts to address controversial issues and specifically focused on the ways that institutional racism continues to be perpetuated in various ways in university and organizational settings. These publications also described the negative consequences and blowback that frequently result from the efforts of many multicultural counseling and advocacy allies who work to foster a greater level of justice and democracy in these settings (D’Andrea & Daniels, 2010; D’Andrea et al., 2001). To celebrate the 20th anniversary of the HMC, I have written this chapter as a call to counselors and other allied professionals. More specifically, this call goes out to all persons who self-identify as advocates of the MCM. It includes an appeal to (a) reflect on the revolutionary contributions made by the pioneers of this vital movement, (b) explore the early evolution of this movement, and (c) take time to soberly think about the various factors that have and continue to result in the devolution, collective inertia, and lack of momentum that currently exist in the MCM.

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THE REVOLUTIONARY CHARACTER AND EARLY EVOLUTION OF THE MCM Careful scrutiny of the MCM over the past 50 years reflects a revolutionary movement that has been characterized by both a free flowing and then an ebbing of support for the fundamental assumptions, principles, and actions that marked the genesis of this movement. As used in this context, the freeflowing support for more culturally responsive training and clinical practices were essentially fueled by the courage, determination, dreams, and actions that distinguished the MCM pioneers from other counseling professionals. On the other hand, the process of devolution is associated with times when counselor educators’, practitioners’, students’, and other allied professionals’ potential to exercise their capacity for free-flowing thinking, controversial risk taking, and radical social and professional change efforts was substantially diminished. The diminishment of these important human characteristics was impacted by both environmental factors that repressed such human potentialities and led increasing numbers of counselors to adopt a greater level of conformity in meeting the external expectations and pressures generated by the counseling and psychology professions’ status quo (Prilleltensky, 1989). Many of the foundational principles, assumptions, and actions that anchored the birth and early evolution of the MCM have been validated by a rapidly expanded multicultural research base over the past four and a half decades. A partial listing of the key principles, assumptions, and actions that have been validated by many multicultural counseling researchers are summarized below:  1. The pioneers of the MCM operated from the fundamental assumption that most counselor and allied mental health professionals were trained to operate from an overarching veil of cultural encapsulation (D’Andrea & Daniels, 1996; Sue & Sue, 2015; Wrenn, 1962). 4 4       M U LTI C U LTU R A L C O U N S E L I NG

 2. The evolution of the MCM was assumed to be possible if radical actions were taken to ameliorate the veil of ethnocentricity that has been, and in many instances continues to be, manifested in many counseling and psychology training programs as well as in many culturally biased clinical practices (Ivey, D’Andrea, & Ivey, 2012).  3. The continued use of the counseling and psychotherapy theories that are grounded in a host of cultural biases were recognized as unique forms of professional oppression and injustice, especially when used among vulnerable persons from culturally diverse client populations. This included culturally diverse clients whose constructions of mental health, psychological problems, and appropriate helping interventions differ substantially from traditional Western constructions of these concepts.  4. The revolutionary character of the pioneers and early evolution of the MCM is reflected in the serious critiques that were made about the widely used diagnostic nosology in the fields of counseling and psychology (i.e., the Diagnostic Statistical Manual [DSM]). Many MCM pioneers described how the lack of critical thinking about the culturally biased nature of the DSM often resulted in inaccurate and even harmful diagnoses when used with clients in devalued and marginalized cultural groups (Sue & Sue, 2015).  5. Another central principle that distinguished the MCM pioneers from other counselors and psychologists was the manner in which they challenged the traditional mental health care establishment by demanding that radically different training methods be infused throughout the curricula in professional training programs. The radical nature of this multicultural advocacy endeavor was grounded in the simple assertion that professional training programs needed to nurture the development of future practitioners whose clinical interventions were congruent with and respectful of the worldviews and values of persons in culturally diverse groups. This principle was strongly maintained by the early MCM advocates

despite the resistance and negative blowback that was exhibited by many traditionally trained counselor educators and practitioners during the 1960s and early 1970s (D’Andrea, 2014).  6. The infusion of this key principle in the work that the multicultural pioneers did during the genesis of this movement reflected the sort of courage and assertive actions that were hallmarks of the early evolution of this movement.  7. Leaders in the early MCM rightly assumed that becoming a culturally competent mental health practitioner would be a lifelong process that needed to be mandated by the counseling profession (Sue, Arredondo, & McDavis, 1991).

multicultural counseling competencies in 2003 by ACA (D’Andrea & Daniels, 2010, 2015; Weinrach & Thomas, 2004). 11. Facing increasing hostility by many White counselor educators, practitioners, and students who supported traditional, culturally biased theories and practices, a number of nationally recognized members of the NIMC responded to such resistance by effectively and publicly unpacking the various ways that institutional racism, White privilege, and White superiority contributed to the negative reactions that continued to be directed toward the most outspoken and emboldened multicultural advocates (D’Andrea, 2006, 2014; D’Andrea & Daniels, 2015).

 8. The arduous task of developing a comprehensive set of such competencies spanned more than two decades (from the early 1970s to the early 1990s). The length of time it took to develop these competencies was partly due to the heightened resistance and hostility manifested by many White counselor educators, practitioners, and students who were committed to maintain the sort of cultural encapsulation that Wrenn wrote about in 1962 and an issue that other multicultural advocates revisited almost 50 years later (Daniels, Parham, & D’Andrea, 2011).

12. Despite the heightened levels of resistance and hostility that were directed to the most outspoken advocates of the MCM, these professionals operated in principled ways by remaining disciplined and diligent in implementing a broad range of outreach, consultation, and organizational development efforts by working to garner broad-based support of faculty members in various counseling and psychological organizations and professional training programs during the late 1990s (D’Andrea, 2006).

 9. The culmination of much scholarly reflection and collaborative discussions involving numerous pioneers in the MCM as well as a broad cadre of young counseling professionals of color during the 1970s and 1980s resulted in the crafting of 31 multicultural competencies by leaders in the Association for Multicultural Counseling and Development (AMCD; Sue, Arredondo, & McDavis, 1991). These competencies were later formally endorsed by the American Counseling Association (ACA) in 2003.

13. After directing much time and energy with little success in gaining substantial organizational support from the ACA during the 1990s, a group of highly respected multicultural advocates, who founded the NIMC, informed ACA officials that they planned to hold nonviolent demonstrations at all future ACA conferences until substantial organizational progress was made within ACA in terms of supporting the evolution of the MCM in general and the multicultural counseling competencies in particular (D’Andrea & Arredondo, 1997).

10. The multicultural pioneers who spearheaded, supported, and celebrated these major professional accomplishments continued to be met with hostility and resistance by many White colleagues in the fields of counseling and psychology despite the formal institutionalization of the

14. The above-stated action strategy was directly drawn from the nonviolent principles and protest actions implemented by Dr. Martin Luther King Jr. and many other participants in the civil rights movement. The basic assumption that the members of the NIMC operated from was the belief

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that the implementation of bold, public, and agitational organizational change efforts would result in a greater level of support by large counseling organizations like the ACA. 15. This assumption proved to be true as ACA leaders began to meet the demands presented by the founders of the NIMC. Meeting these demands was partly due to the NIMC leaders who understood the principle that was articulated by Frederick Douglass more than a century earlier. Simply stated, this principle acknowledges that “Power concedes nothing without a demand. It never did and it never will” (Douglass, 1857). 16. There was one particular assumption that is arguably the most distinguishing and controversial of all the assumptions that were key in the founding and early evolution of the MCM. This assumption (which was later validated by multicultural counseling researchers) asserted that the various forms of injustice and oppression that are perpetuated in our society in general and in the mental health professions in particular were known to adversely impact the psychological health and spiritual well-being of many persons in marginalized and devalued groups in our nation (D’Andrea, 2006). It is important to understand how the historic context in which the early MCM advocates and pioneers were situated fueled their courage, shaped their collective vision, and fostered their moral development as they worked to build the revolutionary MCM in the late 1960s and early 1970s (D’Andrea & Daniels, 2005). The results of such courage, visionary leadership, and principled moral actions resulted in building an unprecedented movement in the counseling profession and other allied fields. This unprecedented movement linked practitioners’ commitment to cultural competence and social justice as foundational principles in transforming the mental health professions. As they developed personally and professionally during the social-cultural revolution of the 1960s and early 1970s, the MCM pioneers 4 6       M U LTI C U LTU R A L C O U N S E L I NG

­ emonstrated the courage of their convictions in d passionate and public ways. In doing so, they were able to unveil the specific ways that the enduring and complex problems of White racism, White superiority, and oppressive forms of cultural hegemony resulted in physical, psychological, and spiritual injury of millions of persons in marginalized and devalued groups in the United States (Ponterotto, Casas, Suzuki, & Alexander, 2001). Growing numbers of counselor educators, practitioners, students, and other allied professionals who were becoming increasingly motivated participants in the early development of the MCM were distinguished from others by the developmental changes that occurred in their moral reasoning abilities and ethical consciousness (D’Andrea, 2014). These distinguishing aspects were not only reflected in the words they spoke but more importantly by the risks they took to support the evolution and institutionalization of the MCM. The above section briefly describes some of the ways that the free-flowing radical perspectives, principles, assumptions, and actions resulted in the establishment and early evolution of the MCM. Your attention is now directed to the ways that various forms of devolution resulted in an ebbing of support for many of the radical principles, assumptions, values, and actions that were implemented by the early pioneers and advocates of MCM.

DEVOLUTION: A COMMON DYNAMIC IN MOST ORGANIZATIONS, INCLUDING THE MCM The historic and evolutionary implementation of the above-stated principles and actions fostered transformational changes in the mental health professions in general and the counseling profession in particular. However, far from following a linear process of transformative changes and progress in the mental health professions, my assessment of the changes that have and continue to occur in the MCM included specific factors that contributed

to the evolutionary advancements noted above as well as the devolutionary shifts in the MCM. These latter devolutionary changes occurred, in part, as new MCM leaders and advocates were noted to compromise the radical character and many of the principles, assumptions, and actions that were foundational in the genesis of the MCM (D’Andrea, 2014). Given my direct involvement with many multicultural counseling groups and organizations in the fields of counseling and psychology over the past 35 years, I have been uniquely positioned to observe and informally assess organizational dynamics that are associated with both the evolutionary and the devolutionary processes in the MCM. This assessment reflected a growing awareness that the devolution of this movement began during the mid-1980s and continues in many ways into the present time. Among the key factors that resulted in the devolution of the MCM included (a) the reduced number of faculty members who were known for their radical approaches to education and social-political changes in our society and (b) the tendency for reformist-minded counselor educators and practitioners to steer clear of even the appearance of expressing the revolutionary principles, assumptions, and actions upon which the MCM was founded (D’Andrea, 2014; Giroux, 2014; West, 1993). Based on my observations of the organizational changes that occurred in the MCM over the past quarter century, I noticed that self-identified multicultural leaders and advocates appeared to realize that they could find personal solace and individual career advancement by detaching themselves from the revolutionary tradition that marked the founders and early evolution of the MCM. Paraphrasing Dr. Martin Luther King Jr., it was increasingly apparent that personal convenience and professional comfort took a front seat that replaced the controversies and challenges that the MCM pioneers courageously met head-on. Evidence supporting the above statements is reflected in a growing tendency of self-identified MCM leaders and advocates to propose modest and minor reforms in

the MCM in the 1990s and in the early part of the 21st century. These modest and minor proposals for professional reform are in sharp contrast to the revolutionary proposals, principles, and assumptions promoted by the MCM pioneers. Based on my assessment of these events, it appeared that such minor reforms were particularly popular among many counselors and allied professionals for a couple of reasons. First, advocating for minor reforms avoided the necessity of dealing with uncomfortable controversies that mirrored similar injustices, which the MCM pioneers risked much in addressing. Second, proposing minor professional changes with limited relevance to the radical actions and visions manifested by founders of the MCM did not cause serious inconveniences that would otherwise disrupt the perpetuation of macrolevel structural injustices that adversely impact the overall health and well-being of millions of persons in marginalized and devalued cultural groups (Lewis, Lewis, Daniels, & D’Andrea, 2011). Evidence that supports the above-stated assertions is found in the substantial and growing attention that is currently being directed to understanding the anger, pain, and suffering that results from the expression of microaggressions and the importance in ameliorating these toxic behaviors (Sue & Sue, 2015). Attention to these dynamics in many counseling and psychology training programs often exceeds teaching and learning about the types of macroaggressions that are known to underlie many social, economic, educational, physical, and mental health problems that millions of persons in marginalized and devalued groups experience in their daily lives (D’Andrea, 2014; Giroux, 2014). Self-identified advocates of the MCM who avoid asserting the responsibility, courage, and energy that is necessary to ensure the personal and collective health and empowerment of unprecedented numbers of culturally devalued and marginalized persons in our nation has its own consequences. Among the consequences that reformist-minded members of the contemporary MCM are paradoxically vulnerable to is being viewed as “handmaidens

A P ersonal A ssessment of the Ebb and Flow of the M CM

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of the status quo” and “tools of oppression” (Sue, Ivey, & Pedersen, 1996, p. 24). Such terms were used by early MCM advocates in their denunciation of counselors and other allied professionals who were complicit in perpetuating institutionalized and structural injustices by their uncritical and conforming acquiescence to more conservative organizational expectations and demands (Sue, Ivey, & Pedersen. 1996). This includes but is not limited to the complicity of all the counselors and allied professionals (including those contemporary self-identified MCM advocates) whose reluctance to openly and consistently address the pervasive forms of White cultural hegemony, White superiority, White racism, economic injustice, educational injustice, increasing forms of authoritarianism, and the expanded militarism within our society allow these and other forms of cultural oppression to continue unabated (Davis, 2012; West, 1993). My personal assessment includes the identification of the following factors and dynamics that contribute to the devolutionary process that characterizes much of the MCM movement at the present time. 1. The increasing number of well-publicized, punitive actions taken by universities against radical faculty members has a trickle-down effect that contributes to a chilling shift in the MCM from a source of revolutionary thinking and courageous actions to a more status quo accepting, minor reformist movement in the counseling profession. Several highly outspoken and emboldened advocates of multiculturalism and social justice who have risked their careers by exhibiting the same bold character, commitment to democratic principles, and nonconforming actions that were reflected by the MCM pioneers have been terminated from their educational institutions over the past several years. 2. Accusations have consistently been used to end the employment of outspoken academics. Among those faculty members who have been subjected to repressive and retaliatory actions within 4 8       M U LTI C U LTU R A L C O U N S E L I NG

higher education institutions for boldly speaking out against structural injustices and the increasing militarization of our society include Professor Ward Churchill (University of Colorado), Dr. Norman Finkelstein (DePaul University), and myself (after 20 years of multicultural, social justice, and antiracism advocacy as a tenured full professor at the University of Hawaii), to name a few. The repressive and punitive actions described above have resulted in increasing passive conformity, avoidance in speaking out against the culturalpolitical hegemony that perpetuates institutional and structural injustices, and the general silencing of many self-identified multicultural advocates. The lack of resistance and increasing institutional compliance among counselor educators, practitioners, and students who readily iden­tify themselves as MCM advocates reflect another set of dynamics that feeds the devolutionary process in this movement at the present time. 1. Of particular relevance to this discussion is a clear pattern expressed by many counselor educators, practitioners, and students regarding the “fruitlessness,” “inappropriateness,” and “lack of civility” that is thought to occur when advocates of the MCM use the confrontational, agitational, and disruptive tactics that marked the genesis of the MCM (D’Andrea, 2014). 2. The devolutionary process that continues in the MCM is reflected in the belief that, when counselor educators, practitioners, and students exercise nonviolent, confrontational, resistant, and agitational advocacy skills to promote a greater level of justice in their universities, communities, and society at large, they are often viewed as being “troublemakers” who are “out of control” and “divisive in the counseling profession” (D’Andrea, 2014). 3. There is an important reason why the above-stated feelings and beliefs are paradoxical. The inherent paradox in these reactions is that they conflict with the beliefs, teachings, and principled actions that were consistently reflected by a person who is greatly admired and respected by

many, if not most, counselor educators, practitioners, and students. 4. After all, it was Dr. Martin Luther King Jr. who was committed to using nonviolent, confrontational, resistant, and agitational social justice advocacy tactics in his teachings and actions. Many of these same tactics were also used by many MCM pioneers themselves (Sue, Ivey, & Pedersen, 1996). By implementing a more formal research approach to better understand macrolevel variables that may have contributed to the devolutionary dynamics that allegedly exist in the contemporary MCM, I utilized historical research methods to enhance my personal assessment of the ebb and flow of the MCM. As a result of randomly reviewing an extensive amount of information presented by major news broadcasts and print news outlets, I noticed a substantial rise in uncritical nationalist sentiments within the general citizenry of the United States after 9/11. This uncritical nationalist spirit resulted in many persons in both the lay and professional public passively complying with official government policies related to the War on Terror. More specifically, this included a general tendency to avoid expressing critical comments regarding the injustices that marked many aspects of this nation’s military interventions in Iraq and Afghanistan as well as the criminal torture tactics that were routinely employed at the Guantanamo Bay detention camp (D’Andrea, 2014). The increasing compliance with this growing nationalist spirit in our nation was highlighted by President George W. Bush’s November 2001 statement claiming that “You’re either with us or you are with the terrorists” (Bush, 2001). The general impact of this statement and the massive promotion of pro-war propaganda by the mass media added to an increasing level of uncritical acceptance of a status quo that was being driven by the production and use of unprecedented levels of military resources and interventions that dominated the status quo. The lack of courage to publicly articulate criti­ cal analysis about the perpetuation of questionable

military actions that were directed toward people of color has important implications for the integrity of the MCM (Giroux, 2014). Thus, it is asserted that the pervasive silence and lack of dissent within the MCM as it pertains to the legality and moral principles upon which such deadly interventions continue to be based reflect additional indicators of the devolutionary process in the MCM. 1. The devolution of the MCM is also reflected in the reluctance of counselor educators, practitioners, students, and other allied professionals to work in coalition to address the institutional racism that is manifested in the unprecedented rise of the prison industrial complex in the United States (Davis, 2012). 2. The inability of counselor educators, practitioners, and other allied mental health professionals to work in concert with others to ameliorate the regular use of such well-researched torture policies and procedures, including but not limited to the negative psychological impact of long-term solitary confinement in our nation’s prisons, reflect another dynamic that underlies the devolutionary process in the counseling profession in general and in the MCM in particular. 3. The unprecedented rise in higher education tuition costs has and continues to be greeted with no substantial reaction by counselor educators, practitioners, students, and other allied professionals. This pervasive silence represents another example of the sort of passivity and acquiescing conformity in the face of educational injustices that is increasing in our society and more specifically within the MCM. 4. Such silence and status quo conformity occur despite the recognition that unprecedented tuition increases result in a substantial reduction in the number of middle class, working class, and poor persons of color who will be able to secure a college education much less an advanced degree in counseling, psychology, and/or other allied health professions.

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CONCLUSIONS AND RECOMMENDATIONS The goals of this chapter include providing a personal assessment of the evolution and devolution of the MCM. As stated earlier, this chapter specifically includes an appeal to counselor educators, practitioners, students, and other allied professionals to (a) reflect on the revolutionary contributions made by the pioneers of this vital movement, (b) explore the early evolution of this movement, and (c) take time to soberly think about the various factors that have and continue to result in the devolution, collective inertia, and lack of momentum that currently exist in the MCM. My personal assessment of the evolution and devolution of the MCM suggests that neither of these organizational dynamics are static processes; rather, both are malleable to ongoing changes. Such changes can be accomplished intentionally or unintentionally as well as consciously or unconsciously by persons and dynamics that are both external and internal to the MCM. In the spirit of full disclosure, it is important to acknowledge that my professional and personal biases have led me to conclude that evolutionary changes result in more positive developmental outcomes in organizations and institutions in general, and particularly in the MCM. Conversely, I have concluded that prolonged and heightened levels of devolution—such as those described in this chapter—result in the sort of developmental regression and arrestment that compromise the initial principles, character, and goals upon which many organizations in general and the MCM in particular have been initially anchored.

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The following closing comments offer suggestions for interested readers to consider in moving the MCM from its current state of devolution and inertia to a renewed state of vibrant, risky, controversial, and nonconformity that are consistent with the courage and risk taking exhibited by the pioneers of this movement. 1. It would be helpful for well-recognized and respected leaders in the MCM to convene a special meeting that includes an open invitation to all supporters of this movement to discuss how the evolutionary and devolutionary processes identified above impact the historic mission, purpose, and goals of the MCM. 2. After some consensus has been achieved in discussing the above-stated impact of these organizational processes, the persons convening this meeting would do well to schedule a followup conference. This follow-up meeting would be designed to discuss what can be done to foster changes in the MCM that result in a reestablishment of the evolution of this movement and the elimination of those devolutionary dynamics that impair the realization of the revolutionary potential of this movement. 3. To avoid the continuation of the devolutionary dynamics described above, it is important for contemporary supporters of the MCM to assess how they can make concrete contributions that enable this movement to become a more powerful, culturally responsive, and systemschanging force in the health care system in our nation in general and in the counseling profession in particular.

PART

II

Honoring Our Elders: Life Stories of Pioneers in Multicultural Counseling and Psychology Pushed by the Past and Pulled by the Future: Thoughts and Comments Regarding the Inclusion of Life Stories in the Handbook J. Manuel Casas

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specific reason that is most pertinent for featuring the life stories of highly recognized and respected multicultural psychologists in the separate editions of the Handbook is based on the belief that such stories enable us to better understand and appreciate the history of the field through the personal perspectives and experiences of individuals who were instrumental in the field’s development. The 12 scholars who we feature in this edition have all made, and continue to make, significant and long-lasting contributions to the multicultural emphasis in counseling and psychology. They are clearly pioneers in their groundbreaking efforts to (a) establish culture as a central driving force of all counseling endeavors—teaching, research, and practice, (b) advance the combined scientific and applied aspects of the multicultural field, and (c) work to promote social justice for all peoples. Continuing with the tradition begun in the second edition of the Handbook of Multicultural Counseling, we use the term life stories because we feel it best captures the essence of the contributions presented herein. The term is in line with Atkinson’s (1998) definition of life story as “the story a person chooses to tell about the life he or she has lived, told as completely and honestly as possible, what is remembered of it, and what the teller wants others to know of it” (p. 8). Herein, the pioneers tell their respective stories in their own unedited voices. To this end, we asked the pioneers to present their life stories with a particular focus on events, experiences, and people that were instrumental to their work and commitment to multiculturalism in counseling. We provided few guidelines to the authors, as we wanted each narrative to take the shape and form most comfortable to the individual pioneer.

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The reader will note that the life stories are diverse in terms of format, style, depth of selfdisclosure, and length. Many are organized in a chronological sequence, others are presented as a series of critical incidents or as an examination of important life and career questions. The majority give special and extensive attention to those individuals (e.g., ancestors, family, friends, mentors) and situational contexts that helped them to form and to guide their lives in general and their careers in particular. By and large, the pioneers told us that writing their personal stories was very challenging. Accustomed to scholarly writing, the focus on one’s personal life, family, relationships, struggles, challenges, losses, rewards, and so forth represented a new avenue of public expression, a route understandably accompanied by a sense of uncertainty about one’s depth of sharing. Since incorporating the life stories into the Handbook, we learned that they deeply affected thousands of readers worldwide—it was as if readers were being indirectly mentored by the voices of our wisdom-bearers, our elders. Readers of all ages and professional experience levels, and of all racial and ethnic backgrounds, resonated with parts of the stories. Through some level of identification with the struggles and/or reward of the life work of these pioneers, readers felt empowered, validated,

and motivated to continue their training and work in multicultural counseling. It is our hope that the current set of distinguished life stories will affect readers of this new edition in similar ways. Unfortunately, as in previous editions, space limited the number of very impressive pioneers that we could include in this edition. In addition to their significant contributions to multicultural counseling and psychology, the 12 chosen pioneers were selected based on their willingness to share very personal information at this point in their careers and lives. Furthermore, in inviting these pioneers we attended to group diversity in terms of race, ethnicity, sexual orientation, religion, geographic region, immigration status, and focus of work. We are honored now to present the life stories of Martha Banks, Guillermo Bernal, Robert T. Carter, Fannie M. Cheung, Lillian Comas-Díaz, Beverly A. Greene, Bertha G. Holliday, Anthony J. Marsella, Thomas Parham, Lisa A. Suzuki, Beverly Daniel Tatum, and Diane J. Willis. Regarding the stories, we leave you with the recommendation that you enjoy, learn, and put to good use.

REFERENCE Atkinson, R. (1998). The life story interview. Thousand Oaks, CA: Sage.

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CHAPTER

5

From Five Sides of the Desk The Roles of Disability in My Life Martha E. Banks

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suppose most people think a desk has four sides, but when one’s life is about intersection, the usual limits do not pertain. As I write this, I identify as an African Caribbean American Woman Research Neuropsychologist with a Disability.

EARLY OBSERVATIONS AND EXPERIENCES I grew up in Newport, Rhode Island, the daughter of a mother from St. Vincent in the British West Indies and a father born and raised in Newport, and granddaughter of two rural Virginians and two Vincentians. As a young child, I lived a block and a house up the street from the church that was the site of the fairy-tale wedding of soon-to-be-President John F. Kennedy, and let’s face it, “Princess” Jacqueline Bouvier. Our house was within earshot of the Newport Jazz Festival and half a mile from the summer “cottage” mansions of the ultrarich and famous. Let’s be honest, those things had very little to do with me personally, but they explain the filters that limited my perceptions of disability. When I was little, I noticed that the only people whose bodies did not seem to work right, or who were not perfectly symmetrical, or who were “sick” were Coloured. Sometimes, T’Other Folks used crutches or wore casts, but that was temporary. As I look back, I realize that the public lifestyles of those who could choose were carefully crafted to ensure that only the visibly “beautiful” were revealed and that all hints of imperfection were kept behind closed doors. Of course, in Newport, the “idle rich” summer visitors were White and those who cooked their food and cleaned their toilets were Coloured. In my family, I had a great-uncle who was “blind.” Ironically, he had been an optician who lost his sight to glaucoma. I knew him as a man who did everything but drive. When I was a teenager, he held a family barbecue, which he prepared in front of my temporarily-abled father and me. We watched, helplessly, as my great-uncle got the grill out of the shed, grabbed a bag of charcoal, placed some newspaper in the bottom of the grill, put the right amount of charcoal on the paper, grabbed a match, and lit the 53

newspaper in several places to start the fire. My father and I had never, at that point, used a grill or even attended a backyard barbecue. We were so afraid that my great-uncle would burn himself as he tested the temperature, repeatedly hovering his hands over the gradually diminishing flames. Yes, we watched, helplessly. When the charcoal was ready, he placed the grate on the grill. Then, he grabbed the chicken. It was the first time I ever saw a whole naked chicken; it was missing only its feathers. Yes, the head and neck were intact. My great-uncle held that chicken up in the air by the neck, with one hand, while, with the other hand, he wielded a carving knife barely shorter than a sword. Whoosh, whoosh, whoosh—and the appropriate parts of the chicken were laying on the grill, not even overlapping each other, and the parts we don’t eat were thrown into the garbage. I was starting to learn that, with determination and the right combination of intact skills, People with Disabilities can leave temporarily-abled people in the dust. My father and I did not anticipate what my great-uncle was going to do. If we had, we would have felt compelled to help (do I mean do it for him?) because, after all, he could not see and we could. Alas, we lacked the entire skill set and had to sit, helplessly, while my great-uncle simply went about the business of preparing a meal for the family. In high school, several of my close friends had disabilities. In college, on a barely accessible campus, I dated two visually impaired men. One memorable date was to a silent film, which I quietly dictated to the delight and fury of neighboring viewers. Yes, I started to understand that there was a lot of intolerance for people who had impairments. One of the men sang in the chorus with me. No one bothered to tell him that we were dressed in black and white, so he showed up for his first concert in a brightly colored suit. I could not imagine such an embarrassment happening to my great-uncle; that gave me some insight into the need for advocacy. Perhaps, having filed away the ethnic difference in disability, I was not surprised when I encountered my first lived experience with disability. After my junior year in college, I had severe 5 4       H onoring O ur E lders

upper back pain, for which I still have no diagnosis or explanation. Perhaps it was related to the time I fell off the ropes in high school gym and regained consciousness to see the entire class standing over me, but since that did not involve assessment by any health professionals, including the school nurse, I believe I am supposed to just accept that my back pain was “hysterical.” That pain recurred after I graduated from college, and after a day and a half in the hospital, the hysterical diagnosis was codified and I spent 6 months at home in bed in traction. Yes, the back pain eventually resolved and I came out of traction half an inch taller (never quite accomplishing my desired six feet), but to this day, I have no answers about why I hurt so badly for so long. There was a benefit to the experience of unrelenting pain. I was able to relate to other people who had pain. And yes, that meant I, as an old teenager and young 20-something, was able to talk in real language with much older people. We shared what did and did not work to relieve the pain. I learned about sitting on hard upright chairs instead of soft couches. Pain medications often create more problems than they solve. Certain positions and exercises are helpful; some of them are better learned from people who had the experience because those who merely read and memorized the textbooks do not quite understand the devastating impact of pain or that most people (read that, women, especially Women of Color) do not have the luxury of stopping to get the kind of rest that might lead to relief (Feldman & Tegart, 2003).

PROFESSIONAL LIFE As a psychology graduate student, I had the benefit of training with Rhode Island’s premier neuropsychologist, Dr. Alan Berman. Dr. Berman did not hesitate to give me opportunities to shadow him so that I could learn about the impact of brain function on every aspect of life. Brain dysfunction, whether caused by traumatic brain injury or stroke, can result in bodies that do not work right or are not perfectly symmetrical. So, for the first time, I started to see that some White people had

bodies that did not seem to work right or were not perfectly symmetrical. It should come as no surprise that, as a clinical neuropsychologist, I enjoyed working with older people and with People with Disabilities. The job in which I felt particularly satisfied and effective was geriatric rehabilitation in a Veterans Administration hospital. I worked with the identified patients, but because I understand the criticality of interpersonal relationships, I also worked closely with their families. My identity was practical geriatric neuropsychologist; only later did I consider adding rehabilitation psychologist to that identity. The work was definitely informed by my youthful experience of pain and physical limitation. In addition to my clinical work, I have supervised pre- and postdoctoral psychology interns, and taught undergraduate college psychology and Black studies courses. My courses all included attention to ability issues. During the years I worked at the VA hospital, I had a few students who experienced temporary disability during their clinical rotations under my supervision; without prompting, they each observed aloud that they had increased insight into the difficulties faced by some of the patients. Part of the supervision, for all of my interns, included increasing sensitivity to the impact of pain and the struggles involved in adjustment to acute and chronic impairments. I encouraged my students to help families to develop sensitivity to the difficulties experienced by the identified patients as a way to help the students get in touch with their own prejudices and attempts to distance themselves from patients with disabilities. In my mid-40s, I retired after an extensive illness and life-saving, yet problematic, surgery. Since then, my professional identity has changed from clinician to researcher. I no longer had the stamina required for clinical practice. In order to manage, I had to learn to pace myself with frequent rest. My professional activities occur in spurts. When I teach on a part-time basis, I rest on the days that I am not in the classroom. I have found myself faced with challenges:

Early retirement comes with social consequences. For me, retirement meant being added to another marginalized group. When I understood that I might die during surgery, I was ready, but I did not expect to find myself living with disability. The negative reactions to visible disability are as difficult to manage as the reactions to my apparent age and the invisible aspects of the disability. Psychology colleagues have “diagnostically” informed me of my “improvement” over the years. A potential research collaborator with whom I had met several times with normal peer-to-peer communication, upon seeing me with a cane, refused to establish eye contact with me and prefaced every piece of conversation toward me with, “Can you tell her . . . ?” addressed to another professional in the discussion. When, as division program co-chair, I refused to accept a late proposal, I was informed that “handicapped people have no business” being involved in convention programming. People who have seen me manage without a cane in accessible environments are visibly startled when they see me with a cane, trying to deal with mobility barriers; the most frequent question is, “What’s that for?” The need to educate people about disability was clear when a young boy informed me in a grocery store that I “can’t walk”; I calmed his embarrassed mother and took advantage of the teachable moment. (Banks, 2012b, pp. 256–257)

Despite the challenges presented by disability, I have found ways to turn my experiences and those of others into educational materials that might be of assistance to other people. More precisely, I have found that people attribute to me an expertise at the intersection of gender, ethnicity, and ability status (Banks, 2012a, 2013). I was invited to coedit a special issue of Women & Therapy, which was simultaneously published as a book (Banks & Kaschak, 2003), and later, a multivolume reference set (Marshall, Kendall, Banks, & Gover, 2009). In between and since then, I have been invited to present and contribute chapters and articles. The National Multicultural Conference and Summit invited me to speak on “Disability in the Family: A Life Span Perspective” (Banks, 2003). Perhaps my most meaningful contribution was in bringing attention to women, ethnicity, and disability as F ROM F I VE SI DES OF THE DESK

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one of my Society for the Psychology of Women presidential initiatives (Banks, 2010).

CAREGIVING When I was in high school, my paternal grandmother was diagnosed with cancer. She was my third parent, as she, my parents, and my siblings all lived together. As it became obvious that my grandmother was ill, my mother took care of her. Most of the care took place behind the closed door of my grandmother’s bedroom. In those days, “children” were not welcome to visit relatives in hospitals, so I did not witness my grandmother’s final decline over 2 months. My first experience of caregiving was for my father when he battled cancer nearly 20 years after my grandmother died: In my family, on both sides, despite the differences in national backgrounds, eldest daughters were historically expected to be the family caregivers. As a child, I had observed some of my paternal grandmother’s elderly cousins providing care for other elderly relatives. I assumed they learned from each other as part of a large extended family living in close proximity to each other. I grew up in a nuclear family that included my paternal grandmother; there were no extended family members in the same state. At the time of my father’s illness, I was a single eldest daughter with a career. I was pressured by some distant relatives to give up the career and devote my full efforts to my father’s care. My best contribution to my father’s care was my ability to talk with the healthcare professionals and to facilitate their direct communication with my father. In addition, I was able to assist in his pain management. He tried to follow a schedule for his pain medication in order to avoid addiction. As a result, he had cycles of terrible pain. I explained that he needed to take the medicine more often in order to control the pain; again, I interceded with the oncologist for better explanation that “prn (as needed)” superseded the schedule listed on the prescription. (Ackerman & Banks, 2007, p. 148)

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Twenty years after that, I cared for my mother: Caregiving for my mother was a shared respon­ sibility, with my siblings taking the first turns as primary caregivers. Throughout the process, my siblings and I supported each others’ caregiving efforts. My caregiving contributions for my mother varied across the years and included some personal assistance; emotional support; arrangement for medical assessments, living situations, and healthcare; monitoring progress; and training and retraining treatment staff. Despite following her wishes, I struggled with the amount of monitoring that I should do to ensure that my mother received appropriate physical care. (Ackerman & Banks, 2007, p. 149)

There is no end to learning in caregiving. Care recipients experience changes in health status, sometimes gradually, sometimes suddenly without warning. As a caregiver for my parents, and more recently, for friends, I have found that flexibility is an absolute requirement in order to deal with the repeated disappointments of health setbacks and the triumphs of improvements.

CARE RECEIVING This is really hard. I am a giver, and I receive very poorly. Yet when I was terribly ill following surgery and unable to manage the stairs in my home, a friend with a one-story house offered me a spare room. When I gratefully accepted the offer, I was not aware of how ill I was. My friend had to assist with meals, shopping, laundry, and driving me to appointments. I had expected to be with my friend for about a week, but that week turned into several months, as there were multiple complications from the surgery. Now, I try to take care of myself with a caregiving attitude. That means trying to pace myself and prioritizing activities. I find it very difficult to say “no” to exciting opportunities, but in an effort to not overextend myself, I have to forego some things. In the past, I would ignore well-meaning friends or colleagues who noticed that I looked tired. Now, I take those observations seriously and respond with (usually much-needed) rest.

My disability has both a public face and a private face. Many people perceive me as always active, always thinking, full of history, someone who brings experiences that are different from others in the room. What they don’t see is the woman who works in spurts and needs to rest often. Many would never imagine how much of this chapter is written from bed so that I can type for a while, rest, type some more, and rest again, until I finish. That approach makes much of my work take longer than it would have in the past (Banks, 2012b, pp. 260–261).

SPIRITUALITY, RELIGION, AND ADVOCACY Growing up in Newport presented several challenges for me. Newport is a very predominantly Catholic city, with the Catholics divided among Irish, Portuguese, and Roman Catholics, in addition to Orthodox Greeks, Episcopalians, Anglicans, and members of the oldest Jewish congregation in the Western Hemisphere. The city is also home to one of the first Unitarian churches; the founder of that denomination was born in Newport. As a student in public school, I found myself being the only child, from kindergarten through third grade, who recited the entire Lord’s Prayer. This was just additional marginalization as I was also often the only Coloured child in the class. The religious marginalization was not limited to the Lord’s Prayer in school. Most people had stereotypical views of Baptists as engaging in emotional and demonstrative worship; my church, being affiliated with the American Baptist Convention, held quiet services in which people looked askance at the occasional visitor who said “Amen” aloud (we collectively understood that “Amen” was the last 2 notes of a hymn). Church was important to me. Given the minuscule percentage (estimated 2%–4%) of Coloured people in Newport and the segregation that existed in the 1950s, church represented the only Coloured activity in my life. Due to circumstances about which I received mixed messages across the years, I had minimal access to church after I was about 8 years old, but I watched my grandmother faithfully

attend despite the emotional strain it put on the rest of our family as we spent most Sundays at home. When I got to college, I was able to go to worship services without having to deal with any of the family emotions left over from the problems of my childhood church. I tried to make up for all the years of church I had missed by trying to find a religious home. Each Friday evening, I attended services at Hillel House on campus; that only lasted for a few weeks because, even though I was welcomed and treated well, I missed Jesus. Saturday nights, I attended midnight mass on campus. About half of the services were in Latin, giving me a chance to use the Latin I had learned in 2 years of high school classes and several years of choral singing. It was also a safe place to learn about what my elementary and secondary schoolmates were exposed to. However, I could not get past the focus on Mary and the minimal interaction among the congregants. On Sunday mornings, I attended Protestant services, starting with the Black Baptist churches near the campus. I had been to some of those churches on Sunday afternoons when I was small and my father was playing piano at afternoon programs. Much to my chagrin, I found that I, as a college student, was not welcomed. That was very frustrating. Often no one spoke to me, even though I had introduced myself when they acknowledged visitors during worship service. No one ever invited me to come again or to share a meal. This was so inconsistent with my understanding of Christianity. I was terribly disappointed. In retrospect, given my understanding of the political pressures experienced by Black churches and the media portrayal of college students as dangerous radicals, I am no longer surprised. For my junior and senior college years, I attended a Baptist church with a predominantly White congregation a few miles from campus. I joined the choir, which was directed by one of my mother’s college classmates. They were far more welcoming than the Black churches in Providence had been. After I graduated from college, I became active in the church created by the merger of my childhood church and the other Black Baptist church in Newport. When I had the severe back problems and F ROM F I VE SI DES OF THE DESK

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traction for 6 months, there were no calls from the church. No one came to visit. It was as if I didn’t exist. I prayed a lot. I did not understand how one-way my relationship with church seemed to be. I drove people to activities. I sang in the choir. I visited sick people. But when I was in need, no one was there. My back did get better, and I was able to work and resume church activities. There was no welcome back or acknowledgment that I might have been missed. Nevertheless, I continued to attend that church, sang in the choir, visited sick people, and provided rides. Being active in church was an important part of my support during graduate school. I have been religious all of my life, although I have not always attended religious services. One of the difficulties has been that I was affiliated with denominations that, despite their espoused theologies, were not accepting of educated people— especially “uppity” educated African American women. I frequently faced closed doors when I wanted to contribute in ways that I could because of my professional training and experience. (Banks, 2012b, p. 262)

After I completed my graduate coursework and was preparing to move to Iowa for internship, my pastor invited me to preach. It wasn’t until I was in the pulpit that I realized it was Children’s Sunday. I preached on paying attention to our brothers and sisters and offering help when people are suffering. As I consider that now, I realize that my first sermon was on disability. When I became disabled after surgery, I focused not on the impairments but rather on the idea that God apparently still had work for me to do. Obviously, God had provided me with a firm educational and experiential foundation in psychology. “It allows me to move beyond a narrow definition of who I am as a professional” (Banks, 2012b, p. 257). I have moved among denominations and am currently a member of a United Methodist Church. With the encouragement of a womanist pastor, Rev. Stephanie Lee, I am able to integrate my social justice work from psychology into my religious life, fulfilling more of my spiritual calling. 5 8       H onoring O ur E lders

My writing and presentations on disability serve as foundational to my sermons on disability. In 2010, Rev. Lee invited me to preach on disability. My sermon reflected many of the concerns raised by the World Council of Churches (2003), such as •• the humanity of People with Disabilities, •• changing perspectives on disability (parallel to psychology’s transition from medical/epidemiological, to social, cultural, and integrated models of disability), •• attention to disabled images of God, •• relationships between disability and healing, •• understanding each human being as a gift, •• challenges to theology, ways to ensure that People with Disabilities reach their full potential, and •• making the Church a full community of all people and for all people.

The church hired an ASL signer for the worship service. About a week after I delivered that sermon, the church trustees approved modification of the sanctuary that involved removal of the center pew on each side of the sanctuary to allow room for users of walkers and canes, plus people with longer legs. . . . Two long pews were replaced with two shorter pews to allow spaces for wheelchairs, accessible from the center aisle. (Lee, 2010, p. 15)

After preaching that sermon, I attended a series of public lectures on Disabilities, Theology and the Church offered by the Methodist Theological School in Ohio. Material from those lectures informs my current sermons. Paralleling my involvement with American Psychological Association (APA) and APA division governance, I am very involved in church governance, both within the local church and at the district and conference levels. Similar to my social justice work in psychology, I serve on the East Ohio Conference Commission on Religion and Race and am the Canal District United Methodist Women’s Social Action chair. I also serve on a Vital Signs committee, addressing small church challenges

in the Canal District. Just as I give presentations in psychology which give voice to People with Disabilities and other marginalized people who have been silenced, I preach on issues faced by the same people, placing those issues and the appropriate responses to them in a Christian context, linking social justice Biblical passages to today’s people. In the same way that I have conducted research in psychology, I now use those skills in the Church to address challenges faced by people with the least social power. I am also writing on the intersection among spirituality, religion, gender, ethnicity, and ability status (Banks & Lee, in press). For my work in psychology, I took undergraduate and graduate courses. Now, I have completed training to become a Certified Lay Speaker, a credential recognized by the United Methodist

and Lutheran denominations. No, I have not been called to pastor, but I am called to ministry as a lay person, and still relying on my understanding that God will continue to equip me and provide opportunities to advocate for people less able to advocate for themselves, I am answering that call in as many ways as I can, following the directives of John Wesley (United Methodist Church, 2013): “First: By doing no harm, by avoiding evil of every kind,” “Secondly: By doing good; by being in every kind merciful after [my] power; as [I] have opportunity, doing good of every possible sort, and, as far as possible, to all,” and “Thirdly: By attending upon all the ordinances of God.”

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CHAPTER

6

Multiculturalism—The Final Frontier Resistance Is Not Futile Guillermo Bernal

THE EARLY YEARS We are the Borg. Lower your shields and surrender your ships. We will add your biological and technological distinctiveness to our own. Your culture will adapt to service us. Resistance is futile! You will be assimilated. (Vornholt, 1996, p. 9)

When I first heard the phrase “resistance is futile . . . you will be assimilated,” I was in awe. I was watching the now-classic Star Trek: The Next Generation movie in which a cybernetic species incorporates the uniqueness of other species and races to their own, seemingly erasing all cultural, racial, and individual distinctiveness. With the new conquering cybernetic species, the issues of cultural assimilation, acculturation, and exploitation were brought to the forefront. I have struggled with such issues both personally and professionally for many years, and in particular, resisting assimilation in what at times felt as futile.

My earliest memory of resisting assimilation was refusing to follow persistent instructions from a sixth-grade math teacher at a public school to STOP crossing the number seven. I was 11 years old and my family had just moved from Havana, Cuba, to Miami. My name had been changed to William. “Guillermo,” I was told, was too difficult for Americans to pronounce. Having to sign my name as “William” Author’s note: I am grateful to Ester Shapiro, Blanca Ortiz-Torres, Melanie Domenech Rodriguez, and Irma Serrano-García for their helpful comments and suggestions on this chapter.

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seemed strange; it just wasn’t me. Also, I had to learn a different method of division, English was the new language that I barely spoke, and I was instructed to pledge alliance to a flag that was not mine to honor. For reasons unknown to me then, I drew the line with the number , both literally and figuratively. I was unaware that I had already given up too much. Yet despite the many reprimands, I continued to cross my sevens, a practice I continue to this day. A powerful process of assimilation and acculturation to mainstream U.S. cultural life was being set in motion. My sense of culture, language, nation, my sense of belonging and identity was beginning to shift and be challenged. Years later when I heard, “Resistance is futile. You will be assimilated,” I was reminded of how much I had, in fact, assimilated and that resistance is not necessarily futile. Indeed, assimilation and acculturation is not a one-way street. In October of 1960, I was 11 years of age. I was uprooted from my home in Cuba. Everything in my cultural context changed: the sights, the sounds, the smells (el color, el olor, el sabor, el calor . . .). The places and spaces that signaled “home” were suddenly hundreds of miles away. Yet I had a piece of home with me that was crucial to my well-being; I had my family. In Cuba, I attended a Catholic private school and lived in a highly protected environment. My father was a doctor in pharmacy and a respected member of the national bourgeoisie. My mother completed her high school education in the United States, a definite marker of privilege and wealth in 1940s Cuba. My early privilege set me up to believe I could achieve whatever I set my mind to. As a young child, when the Cuban Revolution triumphed I was proud of the “rebeldes” and “el movimiento revolucionario.” The government was toppled and a new government came into being. It was clear to me that a small group of determined and wellorganized men and women could change society. I learned to value organization, collaboration, and social action. The experience of being uprooted taught me that resources can come and go and that our realities can change at any moment. Later, as a young adult when I read about existentialist ideas

on death and change, deep inside I knew that our world could radically change in the blink of an eye. Also, the notion of impermanence resonated deep within me. I learned to value education, knowledge, skills, culture, family, and relationships; these are likely to have more permanence despite changes in context. Up until 1960, I had not experienced discrimination or “otherness.” Upon our arrival in Miami, I encountered two water fountains at a supermarket. One of them had a label that said “colored.” I immediately ran to that one, expecting water to shoot out as a colorful rainbow. It was just regular water, what a disappointment! I went to my mom to complain that the fountain wasn’t working correctly. Then she said to me, “No, m’ijo (my son), here in the United States there are water fountains and bathrooms for people of color or Negros and other ones for Whites.” Little did I know that despite my light skin, in this new land I would encounter discrimination and racism. Experiences of discrimination and “otherness” were plentiful after that first water fountain shocker. When we were relocated from Florida to New Jersey, I was painfully aware of the implications from messages that read “no dogs or Spics (a derogatory term used in reference to Caribbean and other Spanish-speaking persons in the United States) or Cubans.” For example, once a schoolteacher, after introducing me as a new member to a seventh-grade class, reminded everyone “America is for Americans.” In less than a year, my family was relocated from Miami to Jersey City. My father was soon fired from his job at a pharmacy because he didn’t speak English. My mother worked as a salesperson at another drug store and my older brother found a part-time job after school. I took care of my 9-yearold brother and 5-year-old sister after school and helped with cooking. At about that time, while riding in an old used car with the whole family, I asked my mother, “So we are now poor, right?” She turned around and replied with anger in her voice, “No, we may not have any money but we are not poor. Poverty is in the mind!” My mother was a cognitive therapist even before Beck and Ellis invented the specialty.

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With this “reframe,” I was able to handle realistic material conditions of poverty and oppression differently. Another early incident that strongly influenced my thinking was an unexpected experience with a mentor who cared and challenged me to think about my possibilities and myself in a different way than society suggested I do. These words continue to ring in my ears as I see structures that systematically exclude people based on ridiculous notions of predictors of ability and success such as race/ethnicity, language ability, etc. I know in my own skin that the confidence to succeed requires dedicated mentors that encourage persistence to engage through success and failure. I trust I have been such a mentor to my students. In addition to my family, I also carried within me powerful cultural intangibles and a nationalist imprinting deep inside my bones. As a young boy in Cuba, I would memorize and recite the poems of Luis Carbonel, an Afro-Cuban orator, standup comedian, and celebrity who commented on Cuban culture, highlighting Afro-Cuban culture, music, and life. Benny Moré (an Afro-Cuban big band salsa singer) along with Elvis Presley were my childhood idols whose music I memorized and imitated, which in the case of Elvis I did with almost no knowledge of English. My older brother and I made audio recordings of Fidel Castro and Ché Guevara’s speeches, memorizing and reciting them in parody of their voices, gestures, and postures. The writings of José Martí, the Cuban national poet and hero of the War of Independence from Spain, resonated within my being. His verses and writings were love songs to Cuban culture and national pride. One famous verse is: “Yo vengo de todas partes y hacia todas partes voy; Arte soy entre las artes y en los montes, monte soy.” This translates to: I come from all places and to many places I go; I am art among the arts and mountain among the mountains (or the countryside) (Allen, 2002). I wound up going to many places, experiencing multiple changes in context, and I learned to appreciate the arts, literature, and science but also yearned for the simplicity of the countryside. In 1959, I began a stamp collection. I was fascinated with the new colorful images and shapes 6 2       H onoring O ur E l d ers

of stamps and the historical events that were selected by the Cuban revolutionary government to appear on the stamps. My collection of Cuban stamps was a transitional object that allowed me to hold on to aspects of Cuban culture. I established mail correspondence with philatelics in Cuba for many years, trading U.S. for Cuban stamps. I also expanded my collection to include the United States and later the rest of the world. At home, we gradually seemed to stop talking about Cuba and of those in our family that chose to stay. Through my stamp collection, I kept abreast of what was happening in Cuba while also learning a great deal of history, geography, and culture relative to other parts of the world. In addition, my stamp collecting was a welcomed distraction from the seeming chaos, pain, and adjustment to our life in the United States. In retrospect, my stamp collection was another way of resisting assimilation and maintaining a sort of invisible connection to my roots, culture, language, and country.

CHANGING CONTEXTS I am a person of many contexts. I was born in Cuba, and I have lived in Miami, FL, Jersey City, NJ, Amherst, MA, Philadelphia, PA, San Francisco, CA, and San Juan, Puerto Rico, for extended periods of time. Context has a very particular meaning to me. It has shaped my life, and in some ways I have also struggled to shape aspects of my context. To paraphrase Ortega y Gasset, the Spanish philosopher, I am I and my circumstances. If I do not change my situation, I do not change myself.

Surviving, Belonging, and Assimilation: From Grade School to College While the fabric of my family’s social and economic relations dramatically changed, there were certain situations that we could not change. In such situations, the alternative was to change oneself or adapt to the new context. For example, having attended only private Catholic schools in Cuba and living in

a rather protected environment, I had never been in a fistfight. Upon graduation from sixth grade to junior high in Miami, I got into my first fistfight and was beaten up. Upon moving to New Jersey, I got into another fight and I was again beaten up. As they say, three strikes and you are out! So I began taking Judo lessons. After a third move to another location still in the seventh grade, I knew what was going to happen. I took a preemptive strike approach with the first boy that looked at me with an attitude. I flipped him to the floor and applied a choking technique until he yielded. Then, I became friends with the seemingly antisocial groups in school! I was “accepted” if not respected. During eighth grade, I recall my English teacher telling me I was not high school material and should consider entering the prevocational program. I was humiliated and did not take her insulting advice. I went to a rather rough public high school in which there were fights after every football game (for example, girls would insert double-edge razorblades in their teased hair as a defense from anyone pulling on it). I stayed away from all sporting events to avoid such conflicts. I probably survived high school thanks to a part-time after-school job that kept me busy and out of trouble. My grades during my first two years were not particularly good. But I became interested in reading history, politics, and literature, particularly popular fiction such as Ian Fleming’s James Bond novels. I was also interested in conservative ideas as presented in the magazine National Review. My almost voracious reading improved my grades markedly, and I began to think about college. High school was a relatively lonely experience, but I found a small group within the honor students with whom I could relate. The issue for me was the sense of not being part of any group, and I wasn’t so sure I wanted to be part of some of these groups, either. Yet I did become president of the Spanish Circle. We lived in Jersey City for 8 challenging years. Life was essentially day-to-day survival, particularly during the first 4 years. As my family’s economic situation gradually stabilized, my parents decided that we should return to Miami to be close to extended family. An uncle was moving to Puerto

Rico and he offered his house to my mother. The material conditions were set for the relocation. The year of my graduation from high school we moved to Miami. With help from my older brother, I applied and was accepted to the University of Miami and received student loans and scholarships for tuition. I also worked at a wide range of jobs to make ends meet. The university and the change in scenery was probably the best thing that could have happened to me. I plunged completely into my studies and wanted to absorb all the knowledge that I possibly could. This was the late 1960s. After living in Jersey City, I had a completely different experience of life than most other Cubans in Miami. My initial conservative views began to change. I was against the Vietnam War, I was in favor of the civil rights movement, I had a different sensitivity to the issue of discrimination. I felt I had more in common with Blacks, Puerto Ricans, and other minority groups than most students at the University of Miami. To make things worse (or better), it soon became clear that I could not talk about my progressive views with other Cubans without eliciting major arguments and potential reprisals. But I wanted to feel Cuban so I would go to a cafeteria on SW 8th Street to sip strong black Cuban coffee and smoke a cigar, engaging in the sensual practice of dipping the butt of the cigar in the coffee to savor the merging flavors of tobacco, coffee, and sugar. With the exception of the cultural experiences of my extended family, great music, Cuban food, and exceptional pastries, I was again facing issues of marginalization but now with my own cultural group of reference. Despite the experiences of marginalization, I “assimilated” reasonably well to the mainstream U.S. lifeways and thoughtways. I could slip in and out of Cuban and American contexts with relative ease. At that time, there were few other options as it was an issue of survival. I could speak and write English fluently, my skin is light, but early in college I changed my name back to Guillermo, which was an indication of otherness. Indeed, I am grateful to my undergraduate mentor (Leonard Jacobson) who upon meeting me asked

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how I would like to be called. I said William is okay. He insisted, what do you prefer? I said, well most Americans have a hard time pronouncing “Guillermo.” He said, “Well, I have done things somewhat more difficult than that” (with obvious irony in his voice). “I believe I can learn to pronounce your name correctly.” After that, I changed my name back to Guillermo and felt validated in that encounter; this was another small step in reclaiming my identity and culture, but in truth, at home I was always addressed as Guillermo. In fact, early on my mother had forbidden speaking English at home, to make sure that none of us would lose our Spanish. I worked at Dr. Jacobson’s psychology laboratory for 3 years as an undergraduate student. It was the best possible training that I could have received. The training came not only from him but also graduate students, particularly Stephen Berger. When I realized I wanted to study psychology, I went to every faculty member volunteering my services. Everyone said that they were too busy. The last one on my list was Jacobson. He asked if I knew how to type. I did, and he hired me as a work-study student. I did typing at first, and then worked with the keypunch machines, performed data analyses without having taken a statistics course (but I knew how to cook and follow a recipe!), and administered countless IQ tests to preschool children. By the time I received my BA, I had a strong foundation in social learning theory and in research with two publications in press (Bernal, Jacobson, & López, 1975; Jacobson, Bernal, & López, 1973).

COLLABORATION, ORGANIZATION, AND THE GENOGRAM JOURNEY: GRADUATE SCHOOL YEARS I was the first Latino student to enter the Psychology Program at the University of MassachusettsAmherst. The year was 1972. It was a lonely experience. However, there were a handful of other minority students in clinical as well as other areas 6 4       H onoring O ur E l d ers

of psychology. The only faculty member of color in this relatively large department was Castellano Turner. The minority students began to gravitate toward each other and we began informal meetings to socialize. As inevitably happens, a usual topic of discussion was the Psychology Department. I am not all too clear on how things evolved. I do remember that we never had a designated chair or leader, but soon we were organizing ourselves politically and discussing committees in which to participate so as to increase membership of ethnic minority students. I volunteered for the Clinical Area’s Admission Committee. Other students were able to get into the admissions committees for other areas. The following year, we easily doubled our numbers. The Minority Student Group was formed and continued to meet for a number of years, serving as an important source of support for all of us in that it served to validate our own experience as “minorities.” For example, I recall one student (now a colleague) telling me that every time she asked a question or made a comment in class, she was ignored. Her experience was of feeling invisible as her comments were apparently irrelevant. As the group gained more experience, we began to have some degree of influence on Departmental policy. Recruitment of minority faculty and students became a central issue. Some important gains were made in this area. The group continued to divide up important committees (Graduate Affairs Committee and the Executive Committee) and kept the rest of the group informed on issues of relevance. In my case, my Puerto Rican and African American friends encouraged me to explore my Cuban and Latino roots and challenged some of my ideas on Cuba. I had been moving to the left of the political spectrum, but Cuba was still taboo. I certainly shared the progressive values of social justice in education, health care, and employment that the Cuban model was trying to achieve. Also, I was introduced to the Nueva Canción Latinoamericana that originated in Chile and Argentina with lyrics denouncing injustice, racism, inequality, and colonialism. I learned of a similar movement in Cuba (La Nueva Trova) with songwriters the likes of

Pablo Milanés and Sylvio Rodríguez. Paradoxically, while in Miami, I had lost touch with my Cuban roots; I was cut off from my culture and country of origin. Reggae music was also influential, and Bob Marley was singing of freeing oneself from mental slavery. I drew a great deal of validation from the music and support from the group. This early experience of working collaboratively with other students of color was invaluable. Probably the most important part of my graduate training came from this multicultural peer group that provided an empowering experience—a powerful antidote to racism and a valuable experience in basic organizing to change our context. I should note that a number of those students moved on to make important contributions. For example, Lillian Comas-Díaz was involved with the Office of Ethnic Minority Affairs within the American Psychological Association (APA) and later established the Journal of Cultural Diversity and Mental Health that became the Cultural Diversity and Ethnic Minority Psychology journal of Division 45. Ana I. Alvarez has played an important role in the Interamerican Society of Psychology and in the Department of Psychology at University of Puerto Rico (UPR); Julia Ramos has contributed in the field of mental health in Connecticut; Vickie Mays is well recognized in the area of HIV-AIDS research; Iris Zabala made contributions in the development of innovative mental health services in Puerto Rico; and Ester Shapiro has advanced multicultural psychology at the University of Massachusetts–Boston and has written extensively in the area of grief.

Genogram Journey Two years into my graduate training, I became interested in systems thinking, communications theory, and family therapy. I had read Gabriel Garcia Marquez’s now classic One Hundred Years of Solitude that resonated deep within my sense of what Latin American families are about, and probably more importantly, on the experience of what my family was about. In family systems theory at the time, the “here and now” trumped history. A seemingly innocuous class assignment to draw a genogram

or a family tree of my family was transformative. I discovered that three of my father’s five siblings remained in Cuba, while all five of my mother’s siblings left Cuba. I could generate all sorts of information about the maternal side, but the information on the paternal side was limited. I began to make calls to my parents to get more information. It became clear that those that remained in Cuba could have left but chose to remain. Why? There was another hidden side of the story. At about the same time, I received a letter from an uncle in Cuba. He had read an article I published as an undergraduate (Jacobson et al., 1973) and wondered if I was his nephew. Who read psychological abstracts in Cuba in the 1970s when access to U.S. publications was nearly impossible? This was a time when the Internet or World Wide Web did not yet exist. It was perplexing news to me that my dad’s older brother (whom I knew as a boy in Cuba) was a psychologist and a professor at the University of Havana since the 1940s. I could not believe that after years of studying psychology and well into graduate school, no one in my family bothered to tell me that Alfonso Bernal del Riesgo, my uncle, was a key figure in developing psychology in Cuba (Bernal, 1985; Louro Bernal & Bernal, 2013); this just didn’t make any sense. Thus began a lifelong journey of learning and reconnecting with the side of the family that remained in Cuba as well as those who left. It was clear to me that I needed to visit the forbidden island of Cuba. In fact, the mere idea of visiting Cuba was completely unthinkable as it would be a betrayal of my parents, family, and I could be branded as a communist. Yet I needed to hear the other side of the story, see with my own eyes what had happened, and reconnect with family that stayed behind.

CALIFORNIA DREAMING: FIRST FACULTY POSITION In 1978, I accepted a faculty appointment at the University of California, Department of Psychiatry, San Francisco (UCSF), at San Francisco General Hospital. I was recruited to help develop a community psychiatry program and to develop a clinical

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community psychology component. When I visited San Francisco for the job interview, I felt that San Francisco was the place for me. In a strange way, I felt that I belonged. Since just about everyone was from some other country or place, no one actually belonged, and there was a sense of acceptance in being different that was actually welcoming. As part of my faculty appointment at a major medical school there were clinical, teaching, and research responsibilities. The medical school was in charge of administering a county hospital that provided psychiatric services to 75% of city residents. Within this context, an empowering experience evolved. The hospital was faced with the impossible task of delivering inpatient psychiatric services to language minorities (Latinos/as and Asians), when we did not have the appropriate language resources to treat patients. The department administered four 21-bed inpatient units, a psychiatrist emergency service, and a consult liaison service. My clinical assignment was to one of the acute inpatient units. Soon the small group of minority professionals began to meet informally. There was a Chinese psychiatrist, a Peruvian-born psychologist, a Black psychologist, a Black psychiatric social worker, and myself. The group petitioned the department head to form an Ethnic Minority Issues Committee (EMIC) to advise on department policy, support in recruitment and retention of ethnic minorities, and to provide consultation in the delivery of clinical services. Our petition was well received. To the group, we added a White male gay psychiatrist and we followed a principle of inclusiveness. Ricardo Muñoz, who chaired the committee, probably kept accurate records of this process, but soon we were discussing the reorganization of all clinical services. Our proposal was a very simple one: to place all Asian- (Cantonese, Mandarin, Filipino, Samoan, Korean, Vietnamese, and Japanese) language resources in one inpatient unit and all Spanish-language resources in another unit. The other part of the proposal was to place Latino and Asian language speaking patients in the respective units with the language-appropriate personnel. 6 6       H onoring O ur E l d ers

This proposal, while reasonable, encountered major obstacles. Our committee began to actively lobby the department leadership, staff, and personnel at all levels. The argument of some was that we were proposing to establish a Latino unit and an Asian unit that by de facto meant segregation. The consequence of our proposal might be a Black unit and a “lily” White unit. This argument came from several of the nonminority psychiatrists and led to some discussions on the differences in the historical development of African Americans and other ethnic minorities. Many Blacks have struggled for integration and it seemed to some that we were proposing a new form of segregation, despite the fact that the African American staff supported the proposal. Fortunately, reason (and some behindthe-scenes political maneuvering) prevailed. The department reorganized its bilingual staff and the assignment of patients to units based on language. Other ethnic minority and nonminority patients were assigned using the usual criteria of bed availability. Thus, there was both integration and a focus on providing language minority patients with the minimal aspects of adequate care in a language that was understood by both patient and provider. This seemingly simple administrative reorganization had several consequences. First, a new criterion was included in the recruitment of personnel. Bilingual skills became a major aspect of recruitment. The Latino and Asian teams, initially staffed with minimal Spanish or Asian-language nursing personnel, began to grow. Each team had a critical mass of professionals that focused on the most appropriate treatment for each respective ethnic minority team. Trainees in psychology, psychiatry, and nursing began to request assignment to one of these teams. The teams in these units took it upon themselves to decorate the inpatient units with posters and art from the Latino or Asian cultures. The minority community responded favorably to these changes and the word began to spread. The EMIC gradually grew and expanded its purview. EMIC reorganized itself into task forces to include nursing and psychiatric technicians with the chairs of the task forces comprising the committee. In addition to the Latino and Asian task

forces, we added a Black Task Force, a Gay/Lesbian Task Force, and a Women’s Task Force. Given that our context was San Francisco, this meant that we had effectively organized the majority of the department. Each of these task forces had a treatment-focused team that provided consultation to other teams. The reorganization of psychiatric services was instituted in 1979. The project continued and survived the onslaught of managed care. However, it could not survive the economic crisis of 2008. Yet 29 years of language-appropriate psychiatric services is a wonderful achievement. What began as small teams became full-fledged programs that provided quality cultural and linguistically competent mental health services and training. To summarize, the experiences in San Francisco illustrate a successful effort to change the situation by developing structures to better serve language, ethnic, and racial minorities and constructing a psychology more responsive to minority communities through service, training, and research. Through our day-to-day practice we began to deconstruct ethnocentrism and contribute to a more culturally competent and pluralistic mental health service. Also, at this time, my writing began to center on issues of culture, ethnicity, and race.

JOURNEY BACK TO THE CARIBBEAN In late 1979, I made the first trip to Cuba. I reconnected with family, visited the house where I grew up, and discovered that my first cousin, with whom I was close as a child, had also become a psychologist. We exchanged stories and caught up with each other’s lives after 20 years of being cut off. I was warmly welcomed and appreciated learning of the changes and developments in the land where I was born and that still felt so familiar to me. For a while, I served as a bridge between both sides of the family in the States and the family in Cuba, challenging stereotypes and helping to demystify views on both sides of the divide. I also began professional collaborations in education, training,

and research with Cuban psychologists and on psychology in Cuba (Bernal, 1985; Louro Bernal & Bernal, 2013). I returned for many more visits. Those trips and reconnections went a long way to strengthen my sense of self and my identity as Cuban. Paradoxically, at about the same time, I was able to let go of romanticized notions of a time and a place that no longer existed. I began to acknowledge and accept the loss of country and culture. Returning home probably saved me many years of psychotherapy. Over time, I continued to move politically to the left. After my promotion to Associate Professor at UCSF, it was clear to me that I could play ball in the big leagues. I obtained my first RO1 research grant from NIDA and was involved in several research and training grants. When I learned that a Psychology PhD program was opening up at the University of Puerto Rico, I applied and was offered a position. I was interested in doing psychology from a Spanish-speaking context and preferably in the Caribbean. At the time, I was married to a Puerto Rican psychologist who also wanted to return home. I moved to Puerto Rico in 1986 and I have been here since. In retrospect, the move was an attempt not only to resist but also to reverse the assimilated part of myself to the U.S. dominant culture. Today, I speak Spanish on a daily basis and I write in both languages for the Spanish- and English-speaking academic communities. Yet I prefer to read and write in English. As Pérez-Firmat (1995) wrote on the Cuban experience, I can stop being Cuban no more than I can get out of my own skin. . . . Trying to make sense of my past and present has taught me that, unlike what I once thought, being Cuban doesn’t depend on the pictures on your wall or the women in your bed or the food on your plate or the trees beyond your window. Because Cuba is my past, Cuba is my present and my future. I will never not be Cuban. Whether a burden or a blessing, being Cuban in America is for me inescapable. (p. 269)

Today, I have come to accept the facets of my self that are Cuban, but also Puerto Rican, and yes, American as well.

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IDEOLOGY TO THE TEST Puerto Rico offered the opportunity of doing psychology in Spanish, in an environment rich in human resources, relatively poor, and in a unique context from which to examine dependence and colonialism. Also, there was the opportunity to participate actively in a broader political struggle for the independence of Puerto Rico. This move, in part, was a test of my ideological commitment. It meant a major cut in salary, significantly poorer working conditions, and for a while, a quality of life inferior to the one achieved in San Francisco. My new context was now radically different. I was at a public Puerto Rican university, with a predominately Puerto Rican student body and faculty. The Latino and Latina faces that surrounded me, the tropical ambiance, the warm weather, the use of Spanish on a daily basis, the racial diversity, and variations of skin color was refreshing. In this context, the concept of “ethnic-minority” made less sense. The colonial relationship, that is, the economic, social, and psychological dependence of Puerto Rico and its political and economic subordination to the United States, made more sense. The issue of political status—Statehood (or annexation), Commonwealth (status quo colonial status), and independence—permeates all aspects of life. Puerto Ricans are deeply divided in terms of political status. After over 116 years of colonial rule and another 400 years as a colony of Spain, there are deep-seated beliefs that a small, poor, nonWhite, Spanish-speaking country cannot make it on its own, despite the fact that smaller nations are independent and successful. Oppression takes on psychological dimensions through cognitive violence and internalized dependence. Also, migration to the United States has been massive. There are about 3.5 million Puerto Ricans living on the island and another 4.9 million in the States. Over 45% of those in the island receive welfare benefits. At the university, my academic duties included teaching and supervision. In terms of administrative duties, my task was to direct a Psychological Services Center that did not exist but that was to be part of our PhD psychology training program. 6 8       H onoring O ur E l d ers

One of the unique aspects of working in the development of a center was the absence of a preexisting structure. Thus, the first task was to develop a structure for training, providing psychological services, and research. I approached this challenge with a community-psychology-organizational mind-set and invited all those interested in wanting to develop the center to meetings. In this way, the structure to be developed was based on a participatory process. Rather than a “center,” we began with what we would call a “federation” of relatively autonomous training teams headed by faculty who supervised graduate students; this was important because given our colonial status, we tend to resist anything that seems to be centralized or imposed by decree. Also, our faculty did not have the experience of working together and many had already made commitments with other sites for trainees. Eventually, as in the movie Field of Dreams, “if you build it, they will come.” And come they did. A group committed to training and who shared participatory values began the social construction of the center. Once the training operation was set up with a solid human and physical infrastructure, the context was set for research projects. On the one hand, the center provided a minimal infrastructure, and on the other, small studies were being generated for research. Formal case studies were conducted and new projects emerged. In addition to the psychotherapy training team, we began to have teams on research topics (e.g., domestic violence, adolescent depression, stress in women, needs assessment, etc.). The organizing principle became a set of shared values on training, service, and research oriented toward contributing to psychology in Puerto Rico and with a commitment to a critical examination of the broader social economic context. One of my professional dreams had been to work in a setting where treatment, research, and training are integrated and where it is possible to actively participate in the construction of a more pluralistic psychology. Thus, once the operation of providing training in psychological services was functional, I turned my attention to the development of research programs and projects. While at

UCSF, I learned how to write research grants and I used those skills in the new context. In 1988, a small group of faculty members began to collaborate on a research-oriented undergraduate training program for honor students. The Career Opportunities in Research received funding from National Institute of Mental Health (NIMH) in 1989 and continued with support for 23 years. This program was catalytic. A foundation of research training was set at the undergraduate level and important experiences in faculty collaborating across departments, schools, and campuses was in the works. The initial experience of the faculty in this program also functioned as a support group of colleagues in research. Our faculty group incorporated advanced graduate students and we began an analysis of needs and resources for research. We developed an action plan from the bottom of the hierarchy. A proposal for a research infrastructure support program was drafted; we consulted with colleagues, as with NIMH program staff and UPR-RP administrators. The project was funded, making it possible to initiate major studies on mental health problems and HIV-AIDS and also to develop an infrastructure component in support of faculty and student development in research. The program was funded in 1992 and it was competitively renewed through 2008. Faculty that did not have experiences with NIMH research support conducted a set of treatment development studies. Some of the early projects were on the efficacy of CBT and IPT treatments for depressed adolescents, a study of ADHD types and treatment development, a preventive intervention for young heterosexual women, an effectiveness study of group empowerment for gay men and heterosexual women, and a study of sex roles, sexuality, and HIV-AIDS risk. There was a snowball effect, and a series of other studies were generated with institutional seed money or through other funding mechanisms. We made great advances toward realizing the dream of a setting where treatment, research, and training are integrated. Tied to this notion was the active participation in the construction of a more

pluralistic psychology. However, sometimes the dream felt like a nightmare. These developments in research did not go unnoticed by other sectors of our department and faculty. Change comes at a cost, and we faced major tensions in how academia was constructed. For example, tensions emerged from faculty that favored teaching over research. Those primarily involved in teaching began to see themselves as exploited by those who were involved in research and vice versa. The program continued with a great deal of success. However, tensions and resistance encountered from faculty more committed to teaching grew. Eventually, the differences over how to advance the university were framed in ideological terms suggesting that research with federal funds was a sellout to the imperial power. Faculty involved in research were cast as the “new oppressors” as researchers were freed from teaching duties and were compensated for conducting research. These differences led to a schism within the department of psychology. The research program with its faculty and resources became a separate department of the College of Social Sciences, and the Institute for Psychological Research was created.

LESSONS LEARNED I have shared some of my struggles with identity, assimilation, migration, and adaptation. There are some common threads to these experiences that can serve as empowerment strategies. Early in life I learned that a small group of well-organized men and women could change the social and material reality. That is a powerful empowering notion. Working to change social structures (when this is needed) requires an appreciation for understanding social and historical processes that can guide the course for action. In reflecting upon these experiences, my work has been at two or more levels. On the one hand there is the content, and on the other there are the structures or relationships that shape the content. The quest for constructing pluralistic or multicultural psychology content requires working at different levels to change structures that shape the

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content of our work. At a personal level, the choice is to be or not to be! It is a choice of whether or not to assimilate to existing structures. Indeed, the pressure from the system is to assimilate. The ideological message we constantly receive is not unlike that of the Borg collective cited earlier “resistance is futile . . . you will be assimilated.” Resistance is NOT futile! Participation in organizations, groupings, associations, and conferences are tools not only to resist assimilation but as resources for support, validation, and change. Oppression impacts the personal, the psychological, the professional, and the political. It must be addressed at these different and overlapping levels. The facing of one’s life, learning about the family’s history, examining the apparent heroes and villains in one’s family, and the process of re-owning or recapturing one’s history is personal, professional, and political; this process can be empowering, and in my case meant that the personal, the professional, and the political were inseparable processes. Participation in professional organizations and other groups can be a means toward shaping social processes. There is much work to be done in this area. My work with several professional national and international associations such as American Psychological Association, Society for the Study of Ethnic and Minority Issues (Division 45), the Society of Interamerican Psychology, and more recently with the Caribbean Alliance of National Psychological Associations (CANPA) have taught

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me that we can advance efforts in support of social justice and work toward the construction of a multicultural and pluralistic psychology. The agenda for the future needs to move toward a psychology grounded in its sociohistorical context and sensitive to the issues of class, race, gender, sexual orientation, age, culture, and language. Multiculturalism is our final frontier. To paraphrase the mission of the Star Trek: Next Generation series, ours is to seek out new cultures, races, and ethnicities. A good place to begin that quest is with oneself. For years now, I have been mapping my family tree. I now have rich information on both sides of the family up to the mid-1700s. Here is a history of love, work, oppression, migrations, shame, accumulation of wealth and privilege, and of course, the loss of privilege. In one of my trips to Cuba, I was given a detailed diary written by my great-grandfather. What a wonderful gift! The newfound understanding of my family has both empowered and humbled me. There are probably many roads toward multicultural humility and competence. My advice for appreciating multiculturalism is to begin with oneself. Study your history and context. Draw your family genogram. Start asking difficult questions to your family members. Make contact and interview long-lost family members and learn what was happening at the time. Do a time line of events including world events. Engaging in such a search was essential in appreciating cultural humility and my own sense of humanity and privilege.

CHAPTER

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The Road Less Traveled Research on Race Robert T. Carter

I

am pleased to be asked to contribute to this Handbook, and while I am aware that I am regarded as a pioneer in the field, it is gratifying nonetheless to be asked to share my experiences of being guided and helped, and to discuss the various obstacles and barriers that have stood in my path as I have strived to be a productive student and professional. Before I proceed to talk about my experiences in the field, it is necessary for me to set the record straight about the position I have taken on racial-cultural issues—I am not what some would call a “multicultural” scholar or researcher, and it is important for me to explain what I believe that language represents and why I do not value it. In elucidating my view on this topic, I will also explain how I understand racial-cultural issues. Later, I will discuss my experience as a Black male student, scholar, and researcher working in the area of race and culture, highlighting the costs and benefits of my choice to work in this area, and how they relate to my experiences. Lastly, I will share the story of how my recent research and scholarship on race-based traumatic stress evolved and developed into its current state.

I AM A RACIAL-CULTURAL RESEARCHER AND SCHOLAR Today, there is an abundance of terminology used to refer to issues of racial or cultural difference in psychology and counseling: diversity-sensitive, ethno-cultural counseling, cross-cultural counseling, intercultural or working across cultures, counseling special populations, culture-specific psychotherapy and counseling, the culturally different, the culturally diverse, trans-cultural psychiatry, multicultural, and diversity, to name a few. More often than not, these terms are used to define cultural difference broadly, including a variety of socially defined group memberships (i.e., ethnicity, gender, social class, socioeconomic status, race, sexual orientation, sexual identity, age, or disability). I call these various social-group memberships reference groups. Terms like diversity and multicultural are nonspecific blanket terminologies and can refer to one or more of

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the various reference groups, allowing the speaker or writer to refer to all reference groups at once. The inception of this terminology occurred when cross-cultural counseling competencies were first introduced, defined, and described in the 1980s (Sue et al., 1998), where “cross-cultural” was defined as any counseling interaction that involved any reference group difference between the client and the counselor. Thus, these broad and encompassing terms are still used today to address issues of various types of reference group differences. What I find confusing and difficult to grasp is what is meant by the terms multicultural and diversity. I have written about my confusion elsewhere (cf. Carter & Qureshi, 1995) where I presented a model to clarify what might be meant by such terms. The model I reference is based on highlighting the assumptions about cultural difference that seem to be unstated in various counseling approaches—assumptions that many professionals remain unaware of in their continued use of the various terms today (cf. Carter, 1995; Carter & Qureshi, 1995). It is clear that for much of American history, the basis of difference between groups was assumed to be due to race and culture. How, then, did the effort to address race, racism, and race relations in psychology, counseling, and in American life became a focus on “diversity” and “multiculturalism”? It seems apparent to me that the history surrounding this question has not been discussed very often. Guthrie (2004) writes about the beginning of psychology as a profession and documents how many researchers contributed to racial oppression through research that provided “evidence” of White racial superiority. For example, Duckitt (1992) observed that between 1920 and 1980, psychological research was prejudiced, directed at understanding White domination of “backward people” or racial minorities. During the latter part of this period, social scientists were able to acknowledge that White racism was a part of the structure of American society as a whole, not just in the South (Duckitt, 1992). In essence, it was widely accepted that racial minorities were biologically and genetically inferior to Whites. Black people struggled in various 7 2       H o no r i ng O u r E ld e r s

ways from the 1920s through the 1960s to gain the rights that they were entitled to as American citizens. Blacks’ efforts and struggle for racial justice gained national attention in the 1950s and 1960s—decades where some victories regarding racial equality came along with fierce White resistance and terrorism. The civil rights movement stirred other groups’ racial consciousness (e.g., Native Americans and Hispanics), and they joined Blacks in seeking redress to racial oppression and discrimination. By the 1980s, the cultural difference movement in psychology and counseling and other disciplines was well underway. Initially, the culturally different emphasis did not include a larger range of social groups. Rather, its emphasis was on race as the primary source of the presumed cultural differences, thus conceiving the “race as culture” emphasis that focused on the specific needs of members of racial (sometimes called ethnic minority) groups in most articles and books of the decade. Over time, “cross-cultural” became “multicultural,” and by the 1990s, scholars developed models of psychology and counseling based on the notion of cultural difference, where counseling and helping relationships that were cross-cultural began to be defined in terms of multiple sources of difference such as gender and ethnicity, and where race became one of many aspects of difference. Helms and Cook (1999) contend that terms such as culture, diversity, and multicultural are substitutes for race and that the use of these substitute terms disempowers historically disenfranchised Americans (Blacks, Native American Indians, Hispanics, and Asians). Because the terms refer to the many social demographic groups, “they become virtually useless for explaining the ways in which the therapy process is influenced by racial or cultural factors” (p. 29). More importantly, terms like diversity and multicultural are less threatening to Whites. Furthermore, in the second decade of the 21st century, many of the gains of the 20th century in racial equality have been reversed in economics, education, and health, and legal and civil rights like voting, mortality, and participation in societal

institutions. Therefore, I have chosen to define my research and scholarship as racial-cultural, and I reject the use of the term multicultural or diversity as descriptors of me or of my work. The emphasis is reflected in the title of the two-volume reference handbook that I edited, The Handbook of RacialCultural Psychology and Counseling Volumes One and Two (Carter, 2005a, 2005b). Major contributing factors to the conceptual position that I have adopted come from the experiences that I had as a student and professional.

MY PATH AS A STUDENT AND RESEARCHER From the outset, it is important for me to recognize the people who have taught, influenced, supported, guided, counseled, and cared about me and my work—for without them there would be no story to tell—I think you know who you are. I have also learned lessons from those who worked hard to discredit my work and me. I have chosen work that has personal meaning to me—something that is true for most professionals in psychology. I am pleased to note that my detractors have not been successful, and in spite of them, I have continued to work on issues of race, racism, and culture. A constant in my educational and work life was the idea held by some that I didn’t belong. You see, I was supposed to die young, to go to jail, or to live life on the edge of society. I was not supposed to go to college, or to earn a graduate degree, and I definitely was not supposed to earn a doctoral degree or attain the rank of full professor within 10 years of graduation. There was a time when I accepted the belief that I did not belong, and yet I still struggled to survive. It is clear to me that had I not dropped out of high school I would not have survived. The reality was that my formal education actually ended in the seventh grade—in the eighth and ninth grades, I spent more time out of school than in it. Despite this, I graduated and vowed to do better in high school. To my surprise, my family moved out of Manhattan to an outer borough and I was placed

into a school that I did not select (I was supposed to go to a high school of my choice), so I chose to stay home instead. I tried a vocational school, but I spent more time in the Dean’s office than in class. I was unwilling to listen to the teachers’ stories about topics unrelated to our learning, preferring to talk to my neighbor instead, refusing to sit still and listen. As you might expect, I was the one deemed “out of control” and I did not return after the first half of the school year, and my ambition to be an auto mechanic was dashed. I worked many jobs during the next few years, none of which required much skill or lasted for very long. Most were factory jobs, heavy in laborious and mindless routines, and I did not acclimate well to these situations. After I earned my General Education Diploma (GED) by passing a 2-day exam, I enrolled parttime in a community college in Harlem called Malcolm-King. It was there that I learned that I did have something to offer and that I did belong. Mattie Cook, the president and founder of Malcolm-King, wanted all students to know their value. With the foundation from Malcolm-King Community College, I went on to study full-time at Columbia University with no financial support and with very few believing that I belonged there. Nevertheless, with the help of community activists, I was awarded some academic scholarship aid, which required that I maintain a B average and secure yearly letters of support from faculty. I suspect the belief was that I could not meet the requirements of the scholarship. I was able to maintain my academic scholarship, and I graduated from college after 7 long and difficult years—the first in my family to do so. After being inspired by a friend that was studying counseling and to avoid my student loan bills, I applied for master’s training at Teachers College. I was accepted on probation—there was that message again. I ignored it and set out to complete the program. After a year off to work in the field, I returned to complete my degree and met Dr. Sam Johnson who had just joined the faculty at Teachers College. He became a model and mentor to me, offered encouragement and guidance, and showed me a path I could take that I did not know existed. THE ROA D LESS TR AVELED

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I did not expect, and was at first doubtful, that someone thought I belonged since up until that point in my life the road that I traveled had only a few footprints, and they were from people who were far away. But he had experience walking on a road that he thought I could travel as well. We sometimes say as helping professionals that our work would have meaning if we knew we helped just one person. If he has ever wondered, he should know I am his person—his help and friendship formed the foundation upon which much of my career has been built. He thought I had the potential and ability to take on doctoral study—something that was alien and unknown to me. I knew people had letters after their names from the many books I read as a teenager on philosophy and related topics. I dreamed one day that I might make contributions that others would read and value, as I did with the authors of the books that I read in the solitude of my basement. My reading was a pastime that I seldom spoke about with my peers or family, as I was already unusual enough for them. I recall using terms and words beyond their comprehension and having to monitor this behavior to be accepted by my peers. Sam said he would guide me and that I would not walk the road to the entry gate alone. More importantly, when I asked what pursuing the PhD was all about, he told me something that has stuck with me ever since: He pointed out that the path to a PhD meant something very different than the master’s degree that I was about to earn. With the master’s degree I could practice counseling and help many in the process, yet with the PhD I could contribute to knowledge and shape what was important in the discipline. In this way, it was possible to touch many more people and render aid through the professionals exposed to my work. In that moment I was transported back to the time of the teenager and the books with authors with many letters after their names, and I dared to wonder if I could one day have letters after my name too. So I agreed, and the preparation began: studying for the GRE exam, writing a personal statement, obtaining letters of reference, selecting schools, 74       H o no r i ng O u r E ld e r s

and trying to figure out what the hell I was doing. Others on the faculty thought the effort was in vain, but they smiled and pretended to be supportive. Sam’s guidance and knowledge, coupled with my courage to try, led to success and I was accepted to five of the six programs to which I applied. I accepted the offer of admission to their doctoral program from the University of Maryland’s Department of Psychology. I knew that I wanted to study race and culture, so I took my four children and moved to Maryland. The same year I arrived at Maryland, there was a new member of the faculty, Dr. Janet E. Helms, and as good fortune would have it, she was another person that was willing to guide me in my journey and is now a trusted and valued friend and colleague. At that time, she was my mentor and one of my key supporters. She taught me how to write, to conduct research, and to survive an academic world. She demonstrated and continues to model personal integrity, professional commitment, personal caring, scientific rigor, extremely high standards, and hard work. Above and beyond all, she supported and valued my effort to walk the road less traveled. She made it clear that my role and struggle as a single parent was paramount and that even though others believed that I did not belong—they did not matter. Like others before her, she knew the pitfalls, twists, and turns. She showed me, by her example, that one can take the path less traveled and survive. What I did not know was that I was not prepared for doctoral study—I had gaping holes in my knowledge, and all of what I was taught assumed that I had the foundational knowledge and skills upon which I was expected to build. Janet, unlike other professors, was caring enough to tell me and to help me seek assistance. I failed statistics in the first semester and I also learned I could not write. I also did not know how hard it would be for people, faculty and students alike, to hold on to the fact that I was a single parent with young children and no local support system. My reality and its demands eluded people at every turn. It was amazing to experience this failure of recognition and to have little or no support from the educational

world. A few friends did support me and help when I needed them. In my efforts to manage, I learned the importance of being clear about what matters in life. Janet helped me see that as well. More important, I listened to her—this always was a struggle, but I did not know the path and she did, as my experiences over time revealed. It is important for students at all levels to know that they need to be open to learning and to receiving guidance. This is not a one-way endeavor— openness on my part made it easier for those who helped me to do so. It can be difficult to learn that you are deficient or just do not know, and it takes courage to address your shortcomings or lack of knowledge, but to choose the helping profession sets the expectation and opportunity for one to learn to fix one’s own house as a prerequisite to helping others fix theirs. I went to the writing center, studied math, and worked with a tutor. And after repeating the stats class, I passed, and my writing improved in time. More than anything else, I was willing to learn and to follow guidance even when I did not know where it would lead. This involves trust. I knew I could trust when it was clear that there was concern for me not as a student but as a person. Trusting my friends and supporters has served me well during my career. I learned to believe and trust that those who offered to guide me had my best interests in mind. For most people, career choices and developments are chance events rather than the result of rational planned action. It was chance that in my master’s and doctoral programs Black professors would join the faculty and we would connect and work together. It was chance that my research competence faculty committee would require me to include a comparison group to the Black group I proposed to study (racial identity status attitudes and cultural values). It was chance that as part of my research competence and first study that I would be involved in the development of two instruments (the Intercultural Values Inventory and White Racial Identity Scale). Another chance event was my first book, The Influence of Race and Racial Identity in Psychotherapy: Toward a Racially Inclusive Model (Carter, 1995), since we, Dr. Helms

and I, simply wanted to get the findings from my dissertation published and journal editors and reviewers kept rejecting our manuscript (I was advised to write a book to present the results, and only after the book proposal was distributed and a contract signed did a journal finally accept the manuscript). My book was an opportunity for me to put forward the idea that race is an integral aspect of personality and human development, among other things. What was not chance was my choice to focus my research and scholarship on race and culture, and later on racism. The decision to focus on race has come with benefits and costs. Irrespective of the detractors, wherever they may or have been, I have moved through the academic ranks and I have been able to make some contributions to the field, however small they have been. More than anything else, I have had the opportunity to work with many students, now professionals, who have made me proud to be associated with them—most have and still continue to make meaningful contributions to psychology through their practice, research, scholarship, and dedication. Some of the costs have been a diminished rate of publication: When I submit articles for publication, they are subjected to conflicting and often uninformed critique and bias by journal editors and reviewers that leads to the rejection of manuscripts. Thus, it has been, and continues to be, more difficult for me to publish my work. It was also by chance that while attending the American Psychological Association (APA) convention, I was asked at dinner by a colleague to submit material to be considered for editor of The Counseling Psychologist. I thought there was no way the executive board of the Division of Counseling Psychology would select me (the race researcher and Black male) for such a position. I agreed to submit a statement and my CV on the belief that it would not mean anything more than the committee being able to say they had a minority in the applicant pool. To my shock, I was chosen as editor-elect in 2001. I began to review articles for publication in the volumes of the journal in which I would be listed as editor 2003–2007, and my term THE ROA D LESS TR AVELED

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ended in 2007. I learned later that my term was the shortest of all the editors before me and after, all of whom had over six volumes issued while they served as editor. It is curious that I did not, particularly when one considers what occurred during my term as editor. The journal is a source of revenue for the division, and prior to my term, the journal’s earnings were modest at best. While serving as editor, the contract was renewed twice on the request of the publisher and the division’s revenue more than doubled, moving into the six-figure range. The contract changes were driven by the fact that the impact rating of the journal had risen from low to a high of third in applied psychology journals and later to first—a higher impact rating than the renowned Journal of Counseling Psychology. During my time as editor at The Counseling Psychologist, division leadership, unlike other journals, interfered with decisions that I was empowered to make regarding the journal. These developments were curious and unprecedented, and I concluded that the division’s fear of me bled into their behavior around the journal’s leadership and that rhetoric about difference and diversity was just that—when it came to valuing and trusting the Black guy, that was too much to ask, as was offering him any public recognition for what he accomplished during his term. The division was eager to announce the new editor and they remained silent on my term. This anecdote mirrors how much of what happens in our society is related to race and racial group membership. The less traveled road that I have taken also applies to the teaching and design of training that I promote. I have introduced courses on race, racism, and racial-cultural counseling and competence into the counseling psychology program at Teachers College. I developed and implemented the racially inclusive training model that helps students of all races to cope effectively with issues of race and culture in their own lives, and in turn, in the lives of others. The course Racism and Racial Identity focuses on the historical development of racist ideologies in the United States, offering students models of racial identity and cultural values as mechanisms for understanding 76       H o no r i ng O u r E ld e r s

race and culture. The course is built around the notion that race needs to be understood from both a historical and a cultural perspective. I try to move students away from understanding issues of racism as something that happens to its victims, guiding them in involving themselves in the selfexploration of race and racism. Many courses that teach about racism lean on students’ opinions and subjective experiences. I teach about racism as an intellectual subject, emphasizing the need for students to focus on the self rather than on others’ experiences with racism. The Racial-Cultural Counseling Lab is the second course in the sequence of offerings. The course is experiential and is organized around structured interviews and facilitated discussion about cultural reference groups. It includes lectures and a skill-building component, and students are asked to explore their reference group memberships (i.e., religion, social class, ethnicity, and race). They are asked to consider how these group memberships influence their behavior and their perceptions of themselves as a helper and of others as clients. Like other experiential or practiceoriented training, the evaluation of students and grades issued are based on their use of counseling skills as they interact with others and on their progress in self-exploration activities. In my experience, the emphasis on selfexploration in the racism and racial-cultural lab is a challenge for many students. In our society, the issues of race and racial identity are avoided and are often seen as controversial. It is difficult to explore something with little support or encouragement, especially when that exploration may alter one’s self-concept and/or how one views others. Some students and colleagues struggle to integrate the learning with their professional development, and such people openly talk about the struggle and discomfort with having to learn about themselves in ways they had not thought much about before. For them, the experience is both difficult and valuable. The issue of race in our society is a volatile topic. In my effort to provide leadership in this area, I have triggered strong reactions from some students and colleagues—I

guess it comes with the territory. I think racial and cultural understanding is essential to the work of professional psychologists and educators, and I hold all students and professionals alike to high standards because I expect them to be competent professionals. The idea of standards for racial-cultural competence has been discussed in the counseling literature since 1982. However, application in training programs has been slow. Efforts to hold students to a competence standard has led to significant resistance and conflict in the past. Sometimes when your work makes people uncomfortable—or who you are does—issues and concerns are raised such that one can be subjected to situations that are bewildering and inexplicable (e.g., my experience with the journal). Usually, I have found these situations to be race-based and it has been, and continues to be, these circumstances that led to my needing to understand the impact of race-based experiences and my own reactions to them. These events over the course of my life have contributed to the scholarship and research that I have been involved in more recently: race-based traumatic stress and racial discrimination.

RACE-BASED TRAUMATIC STRESS RESEARCH AND SCHOLARSHIP In addition to the experiences noted previously, the movement in the field away from issues of race and racism has served as further motivation to work in the area around race-based trauma. The early phases of my research focused on racial-cultural issues, which led to my being asked to serve as an expert witness and consult in court, which ultimately resulted in the consideration of how mental health and legal professionals might deal with targets of race-based encounters and also how to help such targets to seek relief. The forensic work involved biracial custody disputes, equity issues in school systems’ racial desegregation plans, and racial discrimination and harassment in schools, in the workplace, and in consumer racial profiling.

For the initial forensic endeavor involving biracial custody court cases, we were asked to apply and testify about racial identity and cultural issues regarding the parents’ ability to raise a biracial child that they had adopted. The work required on those cases resulted in a book chapter on racial issues in family law in Thompson and Carter’s (1997) book on applications of racial identity. That chapter was the first effort at examining the relationship between race and the law. The next opportunity to understand this association was in school desegregation work, which centered on racial inequity in educational systems in the South. This work was followed by a racial discrimination case in California that involved testifying to the emotional and psychological effect of racial harassment in schools on young people and teachers. To assess psychological harm, and in an effort to account for the emotional effects of racial harassment and discrimination, the DSM-IV-TR (APA, 2000) and mental health literature were consulted. It was a surprise to learn that the DSM offered little help, with all that was available being the standard disorders. It was clear that posttraumatic stress disorder (PTSD) was an inappropriate diagnosis since the core criteria (i.e., threat to life) could not be met and race-based harassment and discrimination, for the most part, result primarily in emotional pain. With this revelation, the thinking was how, or if, trauma and racial encounters were related. In collaboration with Janet E. Helms, the literature was reviewed and an answer was yielded: Racial encounters could produce traumatic reactions. With that belief, the explanation of how and under what circumstances racial trauma could occur was presented in a series of talks—the first of several was titled “Racial Harassment: The Identified Trauma” presented in February of 2002. The presentations were followed by the first study that aimed to explore these ideas further, which was later published as the book chapter, “Racial Discrimination and Race-Based Traumatic Stress: An Exploratory Investigation,” in the Handbook of Racial-Cultural Psychology and Counseling: Theory and Research (Vol. 1) (Carter, 2005a). It was our THE ROA D LESS TR AVELED

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contention in the chapter that there are several contributing factors to the problem of understanding race-related experiences and the resulting mental health impact. First, there is a failure to clearly comprehend the impact of racism on its targets due to the vagueness associated with the term racism. Second, the current paradigms of stress reactions have been based on narrow criteria that do not capture race-related experiences. We argued that as a consequence of chronic and persistent racism, targets of racism suffered physical and psychological harm manifesting in the form of stress and other symptoms—a phenomenon not captured by the existing paradigms. Third, there was a failure to clearly document the emotional and psychological effects of chronic racism on its targets, thus hindering our understanding of race-related experiences. Therefore, the chapter deconstructed racism through a differentiation between two types of racism and argued for a distinction that did not exist in the literature. The chapter examined existing evidence that supported the contention that racism was a stressor whose impact stretches beyond that which is captured by the diagnosis of PTSD. We integrated existing psychological models and research on race and severe stress reactions and proposed a test for race-based traumatic stress reactions. The exploratory study was designed to discover the types of racial discrimination People of Color (POC) continue to experience and to understand the types of emotional and psychological reactions produced by experiences of racial discrimination. We wanted to determine whether the reports of the psychological and emotional experiences were better captured by a model of traumatic stress or by the DSM-IV-TR (APA, 2000) criteria for PTSD. Overall, the results of the investigation supported our primary contentions that POC continue to be subjected to experiences of racial discrimination. Of those who encountered racial discri­ mination, approximately three quarters reported lasting emotional and psychological effects, and the incidents were experienced as traumatic. We found that, in general, nearly all of the emotional and psychological effects reported by respondents 7 8       H o no r i ng O u r E ld e r s

conformed to Carlson’s (1997) model of traumatic stress and that a smaller proportion also fit the narrower PTSD criteria. Additionally, the results revealed that there were apparent differences between hostile racial harassment and avoidant racial discrimination experiences, providing support for the deconstruction and redefinition of racism into hostile and avoidant. A few years after the September 11, 2001, tragedy, I was asked by the State of Connecticut’s Department of Mental Health and Addiction Services (DMHAS) to help them think about how to build culturally responsive disaster preparedness. A review of literature in the fields of mental health, disaster, and trauma was conducted resulting in a technical report titled “Disaster Response to Communities of Color” (Carter, 2004), and a training program was designed for and implemented with the DMHAS staff. But again, there was little help from the literature in understanding the role of race and culture in the development of PTSD. What was found from the review and analysis of the disaster and PTSD literature was that POC had higher levels of PTSD that were not well explained by the disaster. A hypothesis was offered that POC’s race and culture were factors in how they were treated and experienced the disaster— one which was not at all related to race or racism. When Hurricane Katrina hit the Gulf Coast, I was working with the National Center on PTSD looking at whether minorities would trust first responders; if first responders’ interactions would lead to helpful psychological interventions for racial minorities; and if so, would those interventions help to reduce trauma, or would the interventions be ineffective due to the absence of racial, ethnic, or cultural considerations present in most intervention approaches. The evidence confirmed that standard and traditional approaches to treating or recognizing trauma did not adequately take into account race or cultural experiences. What, if any, redress was available to people who were treated unfairly or who were potentially harmed by those who were supposed to help them? What recourse was there? I thought the law might offer some answers.

I applied for a fellowship at the national office of the American Civil Liberties Union (ACLU) in 2003 and was accepted. I started my fellowship in 2004 and it ended in 2005. The fellowship was intended to address racial inequities and to offer new avenues for stalled civil rights and social justice efforts by integrating psychology and legal issues associated with racial encounters and emotional distress. The idea was that if racial trauma, as a form of emotional distress, could be established in psychological research, then it could potentially be used in legal efforts to redress harmful racial disparities created by individuals, organizations, and social systems. While not everyone who is exposed to stress develops psychological symptoms, many who are injured need avenues of redress and recognition. Carter and Scheuermann’s (2012) law review article provided a model in which the path for legal redress is presented for employment racial harassment. We note that irrespective of legal progress regarding antidiscrimination, harmful racism and racial harassment continue to exist—especially in the workplace. Further, attempts for aggrieved employees to redress these ills in the employment setting have been ineffective. When employeeplaintiffs seek to pursue their cases through state or federal administrative agencies or the courts, the standards established in federal statutes as well as court rulings can present a daunting “web” of choices for them (Carter & Forsyth, 2009; Carter & Scheuermann, 2012). This confusion can be most acutely felt in the case of employees who have experienced severe injuries such as race-based traumatic stress (RBTS) resulting from workplace harassment. The law review article (Carter & Scheuermann, 2012) proposed a legal and policy framework for more effective prevention of and legal redress for workplace harassment and discrimination. The approach focuses on employees who have suffered severe, demonstrable, emotional and psychological injury due to harassment or discrimination (i.e., RBTS). A brief overview of current federal employment law related to racial harassment and discrimination and its deficits is provided along with a proposal and discussion

of the use of tort concepts to complement and strengthen current avenues to legal redress. Finally, the article proposed a comprehensive approach to workplace harassment and discrimination (Carter & Scheuermann, 2012). The Race-Based Traumatic Stress Symptom Scale (RBTSSS) (Carter & Mazzula, 2011) was presented as a paper at the APA’s annual conference in Washington, DC, and was published in 2013 by the Psychological Trauma Journal (Carter et  al., 2013). A second study involving the scale appeared in Traumatology (Carter & Sant-Barket, 2015) in which elements not addressed in the 2013 paper were reported, such as how to generate scores for the scales. Carter (2007) also proposed that specific types of racial encounters, defined as classes of racism, Hostile, Avoidant, and Aversive-Hostile Racism, were associated with race-based traumatic reactions. In a recent study also to appear in Traumatology, Carter et al. (2016) found empirical evidence for the classes of racism using EFA and Confirmatory Factor Analyses (CFA) within a Structural Equation Modeling (SEM) framework. The analyses resulted in two scales for classes of racism. The two scales were used as predictors of RBTSSS. Overall, the seven RBTS symptoms were related to frequency of racial experiences, with Hostile Racism frequency having the strongest impact. Aversive-Hostile and Avoidant Racism frequency were associated with numerous symptoms. Avoidant Racism stress was associated with six of the seven RBTSSS symptoms. In the analysis for the three classes of racism for stress of racial experiences, the relationships found were more numerous and robust. Avoidant Racism stress was associated with six of the seven RBTSSS symptoms: Depression, Anger, Physical Symptoms, Avoidance, Hypervigilance, and Low Self-Esteem. The stress related to Aversive-Hostile Racism was associated with four of the seven RBTSSS symptoms. Stress from racial experiences was connected to thirteen symptoms. In two other studies, Carter and Muchow (2016) examined the construct validity of the RBTSSS by utilizing CFA and a second-order SEM. THE ROA D LESS TR AVELED

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Findings indicated that the factor structure reported by Carter et  al. (2013) was further supported in a new participant group of 1,100 adults from several racial groups from the community. More important, the theoretical construct of “RaceBased Traumatic Stress” was substantiated by the second order SEM in that a model fit was found. They also reported that the RBTSSS showed measurement equivalence for race and gender as well as showing evidence for predictive validity of the RBTSSS. Carter, Pieterse, and Muchow (2016) also used SEM with only Black participants and found similar results for the RBTSSS and construct, as did Carter and Muchow (2016). The counseling field has historically worked and continues to work toward promoting people’s

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well-being. We use interventions to help people heal from various aspects of life in our society—a society constrained by racial bias. This bias can take the form of discrimination and harassment in an individual’s life as well as in other venues where people interact with those of other racial groups, such as in school and the workplace. With acknowledged measurements like the Helms’s Racial Identity Theory and Measures (Helms, 1990, 2001), the RBTSSS theory and instrument is poised to broaden the scope of techniques available to substantiate experiences that heretofore have not been accepted or recognized. It is my hope that scholars and researchers will continue working on issues of race and racism and that my contribution adds some value to the continued struggle for racial justice.

CHAPTER

8

My Life Story My Quest for Cultural Relevance in Psychology Fanny M. Cheung

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hen I first got acquainted with the study of psychology as a teenager, I thought this interest was primarily rooted in my intellectual curiosity and academic pursuit. I was recently asked to deliver a speech to the graduating class in a high school that was named after my grandfather. I took time to reflect on the impact of the cultural values that my family had fostered in my early childhood, which in turn found their ways in my career development: the emphasis on education, the support for charity, and the maintenance of interpersonal harmony. Growing up in a traditional extended family with uncles, aunts, cousins, and maids living in the same house, respect for social norms and avoidance of social conflict were essential to managing the collective relationship. Watching the multifaceted social interactions in this big family provided me a fertile environment to understand human behaviors. The sociopolitical ecology also presented the wider context in shaping my cultural socialization. As Chinese subjects in a British crown colony until 1997, we have assimilated a bicultural identity to different extents, depending on whether we studied in the English-language schools (considered to be of higher social status) or Chinese-language schools. Our curriculum covered as much English literature and European history as Chinese literature and history. While the colonial government introduced British administrative system and the rule of law, traditional Chinese customs were preserved as a way to govern Hong Kong. In the local community, Confucian values of harmony and human connectedness prevailed. I left Hong Kong at the age of 15 to study in a California high school because I learned that there was a subject called psychology, which was not available in Hong Kong at the time. As a teenager, I was interested in why people think, feel, and behave the way they do. However, my first exposure to psychology was not how psychology is taught nowadays. I remember that the contents of the psychology course I took in the high school then was more like Western philosophy discussing the mind and the soul. I did not encounter any difficulty moving to the United States at this tender age. Academic adjustment was smooth sailing for me. My “culture shock” in America came more from the interaction between culture and gender in an all-girls Catholic boarding school. In the co-educational school that I attended in 81

Hong Kong, academic excellence was the primary pursuit of both boys and girls. I could not understand why the American girls in the dorms would hang around the public phone booth every Friday (before the invention of e-mail, mobile phones, Facebook, and apps), yearning to get a call for a date on the weekend. I’d much rather stay in the dorms to catch up with my studies and enjoy my piano playing. To fend off repeated questions as to how I was going to get married if I did not go out dating, I found cultural differences to be a handy defense. I hid my chuckles as I referred them to the outdated cultural custom of arranged marriages. At the university, I learned about the history of modern experimental psychology starting from Wundt’s Leipzig laboratory and the development of psychoanalysis in Europe. I obtained good grades in most of my courses and did not question that knowledge may be culturally grounded. In some of the term papers and independent studies that I undertook, I tried to apply these psychological theories to Chinese experiences and was able to fit most of them into the Western theoretical frameworks. Other than a couple of professors and graduate teaching assistants who appreciated reading these foreign experiences, most of the others did not show any interest in relating the orthodox scientific models in psychology to vague concepts presented in exotic vocabularies. In the University of California at Berkeley in those days, African, Chicano, Asian, and Native American studies were just budding after the strikers unsuccessfully demanded a Third World College; these cultural perspectives were not yet incorporated in mainstream psychology. Forty years later, cultural perspectives are still not an integral part of mainstream psychology (Cheung, 2012). The Department of Psychology at Berkeley was huge. It was hard to know other fellow students when classes were held in auditoriums with hundreds of students. There were few Chinese students studying psychology or other social science subjects in those days; most of the students from Hong Kong were studying engineering or other science subjects, so I did not get any advice in my academic planning from my peers. When I 8 2       H o no r i ng O u r E ld e r s

suddenly discovered that I had enough units to graduate early at age 19, I quickly scrambled to apply to graduate programs without much systematic planning. I still remember taking the Miller Analogies Test (MAT) for graduate school admission without really knowing what the test was about. Needless to say, I scored poorly on this test. Fortunately, being a foreign student, my test results were not counted as it was recognized to be culturally irrelevant to assess an applicant’s analytic thinking when many of the items were based on American experiences. At least my GPA and GRE scores were decent. I eventually chose University of Minnesota partly because I had learned from my courses that the Minnesota Multiphasic Personality Inventory (MMPI) was a very famous psychological test. I had not foreseen that the MMPI would eventually form the groundwork on my professional career. Moving to Minneapolis from California in 1970 required more cultural adjustment for me than coming to California from Hong Kong. Freezing midwestern winters aside, the Bay Area was much more cosmopolitan and the urban setting was not that different from city life in Hong Kong. I did not need to answer questions like whether Hong Kong was in Japan, or whether we had electricity and running water back home. The host families introduced by the University of Minnesota International Student Advisors’ Office offering to take care of foreign students were genuinely well intentioned, but I obviously offended someone when I once tactlessly expressed my honest opinion that I found Minneapolis to be parochial. The International Student Advisors’ Office at University of Minnesota was forthcoming in engaging international students. The Office organized many activities to promote intercultural communication. Being a graduate student in psychology, I volunteered to assist with counseling Chinese foreign students. There, I worked closely with Dr. Paul Pedersen, director of the office, who was working on his triad model of cross-cultural counselor training (2000). He used the role of an “anticounselor” or “problem” to highlight the cultural dimensions that might interfere with the

counseling process due to the counselor’s ignorance of the client’s cultural perspectives or the client’s mistrust of the counselor. I played the problem role in his training video and was really effective in raising doubt in the Chinese client on the cultural competence of his American counselor. Paul once asked me to try out a Chinese translation of the 16 PF he had received, and we compared my results on the Chinese and the English versions. I had not yet studied language equivalence in cross-cultural testing or language priming at that time. I only noticed that one of the scale scores I got was much lower in the English version than that in the Chinese version. We went through the items of that scale, and then I realized that for the items that referred to my sociability, I responded to the Chinese version with reference to my Chinese friends, whereas I was primed by the English version to think of my social interactions in the American context. Less than a decade later, I would be taking a more in-depth academic look at the differences between Chinese translations of English tests. I returned to Hong Kong immediately after I got my PhD in 1975. At that time, when many foreign students were trying to find a way to stay in the United States, I was determined to return home. I believed that I could only have been a second-class citizen as an immigrant had I stayed, whereas I could make many more contributions as a pioneer in the fledging field of psychology in Hong Kong. I still remember my first clinical practicum in the rehabilitation ward in Minneapolis when I was counseling an elderly midwestern farmer who had suffered a stroke; he was exasperated for having cried in front of a 20-year-old Chinese girl. My age, ethnicity, and gender were all barriers. Back in Hong Kong, age and gender could still be barriers but they were overridden by a PhD degree, as educational achievement was highly esteemed in a Chinese society. My professionalism has helped me to break through these barriers. I have written in other publications my autobiographical notes related to my work on the Chinese MMPI and how it led to the development of the Cross-cultural (Chinese) Personality Assessment

Inventory (Cheung, 2009, 2012). I will not repeat some of the details here. In summary, my cultural awakening in psychology evolved as I began to apply my American training to practice back home. As I was leaving Minnesota, I told my classmates that I would not be using the MMPI anymore back in Hong Kong as it would not be appropriate to test Chinese patients using an English test of 566 items. Soon after I started working in a local hospital, I found out that psychologists were expected to perform assessment, and local psychologists were translating the MMPI on the spot as they were administering the assessment. Needless to say, there was no standard Chinese version, and there could be variations in the translations between psychologists and from one administration to another. There was no verification on whether the translations were accurate. The local psychologists were aware of the challenges in our assessment roles. We formed a working group under the Hong Kong Psychological Society to discuss the needs for local versions of IQ and personality tests. Mindful of what I had learned about translation, adaptation, and standardization expected in psychological testing and what I knew about the MMPI, I decided to undertake a proper Chinese translation of the MMPI, and thus commenced my lifelong research in personality assessment. I participated in many of the international symposia and workshops on the MMPI organized by Professor James Butcher from the 1970s to 1990s. Through these networks, I was able to share experiences and gain knowledge on the advances in cross-cultural research on the MMPI and personality assessment. Around the time I had translated the Chinese MMPI, the Institute of Psychology at the Chinese Academy of Science in Beijing was reopened in the late 1970s after close to two decades of suspension during the Cultural Revolution. One of the first tasks the researchers at the Institute wanted to establish was the scientific status of psychology. They identified the MMPI as the key measure for personality assessment as it could meet that scientific standard and decided to develop a Chinese version. I was later told by my collaborator, Professor M Y LI F E S TORY

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Weizhen Song at the Institute, that in the beginning, they even had difficulty finding the original MMPI items. The only set of items they could find was from an unknown German version of the MMPI. My initial connection with the Institute of Psychology was circuitous. I had met the late Professor Raymond Fowler at an international MMPI symposium. When he led the first delegation of psychologists from the American Psychological Association (APA) to visit the newly reopened Institute of Psychology, he told Professor Song about my Chinese translation. She was more than delighted to find an existing Chinese version so close to home. I began to collaborate with Professor Song to develop a common Chinese version of the MMPI that could be used across Chinese societies. We also launched large-scale standardization studies, first on the MMPI and later on the MMPI-2, using representative samples from different parts of China (Cheung, 2009, 2012). In the initial samples of college students and nurses that I had collected in Hong Kong, I noticed that the group means on some of the MMPI clinical scales were very elevated when the American norms were used. I originally thought that fastpaced life in Hong Kong was probably stressful and conducive to psychopathology. Then, we found the same elevations with the normal samples in China. I undertook to compare the items with highly discrepant endorsement rates between the Chinese samples and the American samples that were included in the MMPI handbook. We doublechecked the translation and consulted with James Butcher, the principal MMPI researcher, on the nuances of the items. I started to realize that the elevations might be contributed by the lack of crosscultural equivalence on the contents and constructs of some of the items and scales. We conducted empirical studies to compare the social desirability ratings between Chinese and American students and found that some of the discrepant items would not be considered to be indicative of psychopathology in the Chinese context. We adjusted the clinical interpretation based on the Chinese norms and derived the Chinese infrequency scale using the endorsement percentages of the Chinese normative 8 4       H o no r i ng O u r E ld e r s

sample (Cheung, Song, & Butcher, 1991). There is now substantial literature on test translation, adaptation, and equivalence that has advanced the standards of cross-cultural assessment (Cheung, 2009; International Test Commission, 2010). We published these findings in journals and book chapters, including Psychological Assessment and the international MMPI handbooks. The Chinese MMPI and later the MMPI-2 was published by the Chinese University Press under the permission of the University of Minnesota Press (Cheung, Zhang, & Song, 2003). In the manual, we compiled an extensive bibliography and highlighted the cross-cultural differences that researchers and practitioners should take into account in their interpretation. Despite the ready availability of these references in the English language, I am disappointed to find from some of the inquiries I have received now and then from North American practitioners about the Chinese MMPI, that it was apparent they have not kept up with the current literature on cross-cultural assessment. For psychologists assessing or researching different ethnic samples, it is imperative that they equip themselves with the understanding of the tools that they use. They need to know whether the test takers are familiar with the language of the test, how good the translation is, whether the translated test is equivalent to the original test, what norms should be applied, and what are some of the cultural differences that affect the interpretation of the scores (Cheung, 2009). As we were making accommodation for these cross-cultural differences in the Chinese MMPI, I started to ponder why we had to continue borrowing from imported tools and not develop an indigenous personality measure for the Chinese people, which constitute one fifth of humanity. We also found that existing English personality tests could not sufficiently cover all the personality constructs which would be useful in person description and clinical assessment. The Chinese MMPI research team embarked on the development of the Chinese Personality Assessment Inventory (CPAI) in 1989. The conceptual background and procedure in developing the CPAI has been reported in many

other publications (Cheung, 2012; Cheung, Fan, & Cheung, 2013; Cheung et al., 1996; Cheung et al., 2008; Cheung, van de Vijver, & Leong, 2011). Readers are referred to these other publications for a full account of the research on the CPAI. Although I learned psychology in North America, I have often reflected on the meaning and applicability of these theories and concepts in my daily work. Theories are only good in helping to capture experiences in a systematic framework and are not supposed to forge the experiences in a way that “cuts one’s toes to fit the shoes,” using the metaphor of a Chinese idiom. When I find my knowledge and my experience to be discrepant, I have to examine how to reconcile these differences. In my early clinical work, I noticed that Chinese patients rarely came forth to seek psychiatric treatment for their depression, as psychiatric illness carries a stigma. Discussing this observation with my colleagues in psychiatry and family medicine, we noted that patients with depression would instead go to their general practitioners for their problems with insomnia, poor appetite, weight loss, palpitations, and other somatic symptoms. The initial discussion in the cultural psychiatry literature on Chinese somatization (Cheung, 1998) explained this tendency as a culture-bound syndrome, attributing it to denial of emotions, an inadequate affective vocabulary, or concrete level of thinking. Based on my own cultural experience, I found these explanations to be oversimplistic. I started a series of empirical studies to demonstrate that Chinese patients would report psychological symptoms when asked by the doctors, but that they would seek help from family and friends rather than professionals for their psychological problems. Integrating these studies with recent research on the holistic way of Chinese thinking (Nisbett, Peng, Choi, & Norenzayan, 2001), we have a much better understanding of the mind-body connections in Chinese conceptualization of psychological problems. I really appreciate the intellectual openness of Professor Arthur Kleinman, who first raised the awareness of this cultural phenomenon, in reframing somatization in the context of the

phenomenology of suffering and communication of the illness experience (Kleinman, 1988). Through empirical research and cultural discourse, we have illustrated that what was once considered to be culture-specific may be reconceptualized in a broader frame to inform the universal. The dialectics between the emic (culturespecific) and the etic (universal) is also a recurrent theme in my work on cross-cultural personality assessment (Cheung et  al., 2011). We began our research on the CPAI with the initial aim of developing a culturally relevant personality measure for use with the Chinese people. To test the convergent and divergent validity of the CPAI with the Five Factor Model, we identified a culturally unique Interpersonal Relatedness factor in the CPAI (Cheung et  al., 2001). To illustrate the incremental validity of the Interpersonal Relatedness factor, we demonstrated that the CPAI Interpersonal Relatedness factor scales predicted additional variance in many dependent variables beyond that contributed by the Big Five. To examine whether the Interpersonal Relatedness factor was unique to Chinese or whether it was also relevant in other cultures, we translated the CPAI into other languages and found the factor structure to be congruent in other ethnic samples, including Korean, Japanese, and Asian Americans as well as Caucasian Americans. We renamed the CPAI as Cross-cultural Personality Assessment Inventory to reflect this cross-cultural relevance (Cheung et al., 2013). The cross-cultural research on the CPAI led us to a deeper understanding of the connection between indigenous and mainstream psychology. Some cultural psychologists regarded all psychologies, including Western psychology, to be “indigenous to the cultures in which they arise and are sustained” (Marsella, 2013, n. p.). Even though Western psychology has been predominant in mainstream psychology, repositioning psychology in the context of culture would enrich our understanding of human behavior beyond the ethnocentric orientation of an imposed universality (Cheung, 2012). Throughout my career, culture has been an underlying theme as my work was contextualized M Y LI F E S TORY

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in my background and experience. Being nonWestern and a woman has placed me in an outsider role, which actually provided me a more objective lens to reflect on mainstream psychology. When I discovered anomalies, I would question why and endeavor to do something about it. This formed the basis not only of my work in cross-cultural psychology but also in my becoming a feminist promoting women’s development in Chinese societies. I did not plan my career trajectory as a pioneer when I began, but as I responded to my experiences and tried to make things right, I have broken new ground and gone down untrodden paths. I used to consider my involvement in promoting gender equality as my sideline apart from my mainstay research in psychology. However, in retrospect, gender is just as important a cultural variable (Cheung & Halpern, 2010) as ethnicity, and both are integral to my quest for cultural relevance. I am now regarded as a gender pioneer and feminist leader in Chinese societies. When I was at Berkeley or Minneapolis, I did not identify with the militant feminism I was exposed to. My understanding of Western feminism at that time was characterized in a confrontational framework that pitched women against men in their critique of male oppression. This framework was discordant with my cultural orientation, which prefers harmony over direct conflict. My feminist awakening began with what I learned from my female psychiatric patients in my first job at the local hospital in 1975. I was appalled to find that many of these young women carried the burden of sexual trauma from an early age when there was no aftercare service for rape victims, the police and medical personnel were insensitive, and the social stigma was overwhelming. I spearheaded the War on Rape campaign in Hong Kong in the late 1970s to raise awareness and acceptance, change legislation, provide crisis intervention services, and conduct training for frontline professionals. At first, we thought of setting up a rape crisis intervention center, but then recognized that with rape as a tabooed term at that time, women would not be ready to approach a stand-alone center associated with so much stigma. I then helped 8 6       H o no r i ng O u r E ld e r s

to set up the first community women’s center in the early 1980s as a first-stop hub for women’s development and support. I adopted a community psychology approach that was inclusive and promoted the concerted efforts of women and men in combatting violence against women (Cheung, 1989). Being an academic, I believe in supporting advocacy with empirical evidence rather than just rhetoric. After joining the Chinese University of Hong Kong, I established the first gender research program and initiated a gender studies curriculum at the Chinese University of Hong Kong, which is still the only academic program in Hong Kong. Without training in gender theories myself, I steered the development of the Gender Research Centre in a framework that may be now accepted as feminist scholarship. In addition to encouraging faculty research, we also built up strong links with women’s groups, service providers, and policy makers in a knowledge exchange network. The frontline experiences focus our attention on issues of concern to women and verify the appropriateness of our academic responses. The Gender Research Centre has served as the key knowledge hub in supporting gender scholarship as well as informing advocacy in Chinese societies. It also provides a platform for Chinese gender scholars to examine a culturally relevant framework to understand gender issues in the local context. My track record in community services and advocacy may have been one of the reasons why I was appointed by the Hong Kong Government to be the founding chairperson of the Equal Opportunities Commission in 1996 to implement the newly enacted Sex Discrimination Ordinance and the Disability Discrimination Ordinance. This ministerial-level position provided me a platform to translate my knowledge and values into impactful actions. The introduction of the new antidiscrimination legislation at that time was controversial. The notions of human rights and equal opportunities were new; misconceptions and oversimplification were rife among the advocates, the public, as well as the media in Hong Kong. Based on my own cultural orientation, I adopted an integrative approach of promoting mutual respect

between women and men, which may be more appreciated in the Chinese cultural context. By promoting a concerted effort by all to advance women’s development and counteract discrimination or violence against women, I found it more effective in gaining public acceptance for my feminist advocacy (Cheung, 1989, 2010). My psychology background also shaped my initiative of grounding the Equal Opportunities Commission not only in a legal framework but one that incorporates research and public education. I realized that it was not enough to establish the mechanism of conciliation to redress discrimination complaints or to assist aggrieved persons to take their cases to court. I set up systems to promote public understanding and acceptance through publicity campaigns, promotional pamphlets, and training modules. We engaged community stakeholders to participate in these campaigns. We also commissioned research to inform our understanding of the local situation and our course of action. This integrative orientation in the foundation of the Equal Opportunities Commission is akin to my adoption of a combined emic-etic approach in cross-cultural psychology. Even though I constructed an indigenously derived personality inventory, I did not subscribe to the ethnocentrism that underlined some nationalistic approaches to indigenous psychology. Emphasizing cultural differences detached from cultural connections would result in isolation. Even though I started

with the initial intention of serving the local needs, I have promoted the combined emic-etic method in cross-cultural personality assessment, which served as the model for developing assessment tools in other multicultural societies such as South Africa (Cheung et  al., 2011). Multiculturalism is also part and parcel of my personal life history. The multicultural self is becoming more prominent given the trend of globalization in different parts of the world. As we live in more multicultural environments across the globe, our models of psychology also need to embrace the global and the local. In closing my address for the 2012 Award for Distinguished Contributions to the International Advancement of Psychology, I concluded, “Time is ripe for psychological science and practice to bridge the global and the local, or the etic and the emic perspectives, and embrace multicultural models in an emerging paradigm of ‘glocalization’” (Cheung, 2012, p. 729). Specifically, this multicultural perspective should be extended to counseling. The multicultural perspective is not confined to simplistic cultural stereotypes of gender and ethnicity. Instead, we should understand the interactions of the multicultural selves and multicultural environments presented in the clients’ voices. Mainstreaming culture in counseling helps us to understand the experience of the clients and their environments, as well as build up our competence as counselors.

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CHAPTER

9

Healing Reclaiming My Ancestral Legacy Lillian Comas-Díaz

Woman is by nature a shaman. Chukchee proverb

THE ISLAND OF THE SPIRITS “Why does Doña Blanca have a white flag in front of her house?” I asked my grandmother Antonia as we walked under the bright Caribbean sun. Born in Chicago, I had just moved to Puerto Rico and everything was new to my 6-year-old eyes. In response, my grandmother stopped walking and folded her umbrella. She pulled out a white handkerchief from her purse and dried the sweat on my forehead. After a pause, she said, “Doña Blanca is an espiritista, a woman shaman who heals with her spirit guides.” When I went to school the next day I asked about the spirits. Everyone had something to say, even my first-grade teacher. To my surprise, no one seemed scared. “The island is full of spirits,” the girl sitting in front of me at school said. Abuela Antonia used to converse with spirits and prayed to the Catholic saints. She was not alone in this practice. Every afternoon, my grandmother’s devout Catholic friends got together in our living room as they exchanged espiritista stories. Qué calladita/so quiet, these women used to say about me, while I sat crossed-legged listening to their tales. Witnessing their stories taught me that there are no boundaries between magic and reality. Certainly, early exposure to a magical realistic worldview led me to develop a syncretistic consciousness, one that allows me to simultaneously hold diverse beliefs, shift from one perspective to another, and integrate multiple orientations (Comas-Díaz, 2011). Growing up with syncretism and magical realism planted the seeds of my development as a multicultural psychologist (Comas-Díaz, 2005).

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Growing Up With Magical Realism My family story is a tale of a circular migration. Like many Puerto Ricans, both of my parents migrated to the continental United States in search of work. Coming from opposite towns in the island, my parents met in New York and fell in love. They married and settled in Chicago—on their way to California. My parents considered themselves lucky when they found factory jobs. A trained nurse, my mother secured a hospital position soon after she learned English. Her employment proved to be providential. Her first child, I was born with a cleft palate. The doctors at the hospital where my mother worked offered to perform a new experimental operation—free of charge. After a serious deliberation, my parents agreed, and I underwent the surgical intervention at age four. The operation was a success, according to an article in a local newspaper. Many years later, an international cleft palate expert examined me and proclaimed my operation a “divine intervention” (Comas-Díaz, 2010). “The surgeons had no idea what they were doing,” the doctor said. “The correct technique was developed decades later,” she concluded, tears in her eyes. Notwithstanding the operation’s success, I struggled with speech difficulties throughout my childhood and adolescence. Growing up on the island of the spirits afforded me mixed experiences. Shortly after my parents’ return to Puerto Rico, they moved back to Chicago for financial reasons. Since I was already attending grade school, I stayed behind with my maternal grandparents. Being separated from my parents and younger brother was excruciating. However, I consoled myself with the company of extended family members. My grandparents and I lived in the same house with my aunt Paulina and her nuclear family. During that period, I enjoyed a magical childhood with my cousins. Storytelling was a special evening treat since we did not have TV until many years later. One evening my aunt Paulina told us a story from her childhood: Her grandmothers were psychics, who as sisters of the heart, communicated

telepathically with each other. When Paulina’s maternal grandmother suddenly died, her father sent her to communicate the news to the family. Twelve-year-old Paulina found her paternal grandmother praying in front of an image of the Virgin Mary: “I know she died—her spirit just visited me to say goodbye,” she told my aunt Paulina. Called despedidas (farewells), stories of the recently deceased saying goodbye abound among many Latina/os (Comas-Díaz, 2006). Upon listening to my aunt’s story, cousin Elba and I decided to practice telepathy. We delved into books about extrasensory perception and metaphysics. Besides our intellectual curiosity, we seemed to have a psychic DNA—we developed intuition about each other’s minds and hearts. Fortunately, our relatives not only accepted our experience, they encouraged it. For instance, our maternal Uncle Chalo, who studied Rosicrucian practices, frequently instructed us on the supernatural, spiritualism, and esoteric traditions. Even more, the community at large reinforced our interest in the metaphysical. Certainly, belief in spirits is part of a magical realistic worldview (Parkinson Zamora, 1995). Magical realism blurs the boundaries between reality and fantasy, and promotes the interaction between the supernatural and natural (Faris, 2004; Flores, 1955). Specifically, Latin American magical realism combines the mystical indigenous worldview with the Western rationality. Moreover, it is a culturally specific coping strategy—a vehicle for resistance and subversion against oppression (D’Haen, 1995). As such, magical realism is a decolonizing agent that promotes empowerment and liberation (Faris, 2004). Since most Latinos maintain close connections with their country of origin (Alegría & Woo, 2009), magical realism flourishes among Latina/os in the United States. For example, research documented that compared to White and African American counterparts, Latina/os use more fantasy, magical thinking, and dissociation (Pole, Best, Metzler, & Marmar, 2005). Interestingly, dissociation is a vehicle for channeling spirits (Castillo, 1994), particularly among Puerto Ricans (Lewis-Fernandez, 1994).

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Without a doubt, magical realism nurtures espiritismo. Puerto Rican espiritismo is a folk healing, religion, and philosophy (Rivera, 2005). Known as a healing for the soul (Nunez Molina, 2001), espiritismo’s main goal is to enhance spiritual development. In essence, espiritistas believe that spirits at the lowest developmental level are ignorant because they are attached to the material world. Therefore, these misguided entities may harm the living, due to their ignorance. In contrast, evolved spirits—those placed at the highest developmental level—protect and guide human beings (Harwood, 1997). Within this framework, Puerto Rican espiritistas aim to channel evolved spirits in order to assist their clients/sufferers. Transmitted through cultural osmosis, the belief in espiritismo is quite prevalent among most Puerto Ricans. Therefore, espiritismo plays a role in defining Puerto Rico’s national identity because just like the Puerto Rican ethnic identity, espiritismo is a syncretistic system (Rivera Ramos, 2001). Daily Puerto Rican life is filled with spirit contacts. For example, numerous people report dreams where deceased significant others communicate important messages. Moreover, many individuals give accounts of experiencing premonitions, visions, and other supernatural phenomena. Indeed, a significant number of Puerto Ricans acknowledge contact with spirits, with or without the aid of an espiritista medium. Furthermore, magical realism designates a sign of ancestral wisdom that includes the existence and communication with spirits (Comas-Díaz, 2006; Parkinson Zamora, 1995).

Bridges to Ancestral Wisdom I spent my childhood with family, friends, and books. Petra, my paternal grandmother, lived in New York and visited us occasionally. Abuela Petra was an attractive, elegant, and charming woman who exuded feminism. A divorced woman, my grandmother was financially independent, something quite uncommon among the women of her generation. As an emancipated woman, Petra made her own path even though she was not formally educated. Her profession? Abuela Petra was a 9 0       H o no r ing O u r E l d e r s

skilled psychic. She “divinized” the future by reading cards, healed through the assistance of spirit guides, and engaged in intuitive counseling. Like Abuela Petra, many Puerto Rican women achieve power and liberation through their healing abilities. As an illustration, Koss-Chioino (1992) conducted a qualitative study with Puerto Rican women healers. Her results showed how these women healers cope, develop, and thrive in the midst of gendered cultural oppression. In discussing her findings, Koss-Chioino argued that Puerto Rican women healers develop power, assertiveness/aggression, spirituality, and earthiness—attributes that the gendered and cultural contexts deny to them but that are essential to the healer role. In other words, Puerto Rican women healers transcend their sociocultural subordination to emerge as emancipators. Indeed, my grandmother Petra was an example of an empowered Puerto Rican woman healer. Needless to say, she had a profound influence on me. Since my father was an only child, Abuela Petra took a special interest in her only granddaughter. In this way, she taught me to become a channel. That is, she instructed me in spiritual practices ranging from intuitive counseling to dream interpretation. In contrast to Abuela Petra, my grandmother Antonia was a humble and modest woman who alchemized adversity into resilience. She sought redemption through prayers to the Virgin Mary, the saints, and the spirits. Abuela Antonia insisted that we have to release hope as the driving force to heal, instead of the last, when we open a Pandora’s box. Proud of her Andalusian gitana (Gypsy) blood, my grandmother Antonia showed me the importance of duende. A mysterious force, duende is associated with spirit, soul, magic, danger, passion, and creativity (García Lorca, 1933). My grandmother’s communion with her duende inspired me to contact my own duende (Comas-Díaz, 2013a). Definitively, both of my grandmothers played a central role in my spiritual development. As Norat (2005) noted, Latina grandmothers are spiritual bridges to ancestral lands. In particular, Latina grandmothers pass along unique spiritual and healing traditions to their granddaughters as a means of empowerment and liberation.

Besides my abuelas, Mami greatly influenced my early development as a healer. Consider the following anecdote. When I was 10 years old, my nuclear family’s circular migration landed them in Puerto Rico a second time. As a result, we moved into a house with my maternal grandparents. However, my mother arrived with an expanded consciousness. Living outside of Puerto Rico exposed her to multiple orientations. In particular, she critically examined her religious affiliation. Raised Catholic, my mother decided to endorse Protestantism. Nonetheless, she oscillated between Catholicism and Protestantism. But she kept loyal to her beliefs in the spirits. In this way, I frequently accompanied my mother when she visited espiritistas. During these consultations, I met some gifted psychics. Nevertheless, I also encountered many charlatans. As I began to question espiritismo, my mother remained loyal to it. A practicing nurse, my mother considered the spiritual roots of illness while she took care of her patients with Western medicine. Surprisingly, my growing skepticism about espiritismo did not interfere with our mother-daughter bond. We were able to respect our dissimilar perspectives. Paradoxically, our difference seemed to strengthen our connection. My mother was a nurse who healed with a thinking heart. Growing up with my mother’s holistic healing perspective influenced my early decision to become a healer. To illustrate, a devastating hurricane destroyed areas of Puerto Rico just before I moved to the island. Many of my school classmates were traumatized by the natural disaster and thus needed help. Community mental health was not available during that time. Interestingly, my speech problem made me a good listener. Children gravitated toward me with traumatic stories of the hurricane. A wounded healer by age 6, I found my calling—I wanted to become a psychologist. As a child, I became fascinated with psychology’s scientific bases. In particular, I fell in love with the scientific method. During adolescence I read books on science and philosophy at the public library. Out of this expedition, I armed myself with psychological tools. As a result, I embarked

on a self-healing journey. After reading about Demosthenes, the ancient Greek orator who conquered his stuttering by practicing speeches with pebbles in his mouth, I too practiced to improve my speech. At age 16, I realized that in order to succeed in college, I needed to conquer the stammer. Unlike Demosthenes, instead of pebbles I placed small fruits—acerolas and guavas—in my mouth during my self-therapy (Comas-Díaz, 2005). Fortunately, this rudimentary cognitive behavioral approach worked, and I stopped the stammer. Success in hand, I immersed myself in the scientific aspect of psychology. Through this process, I forgot the spirits. Instead, politics invaded my consciousness.

A TRANSCULTURAL WOMAN Puerto Rico’s political status—free associated statehood—is a contradiction in terms. The island’s colonial status and geopolitical context places Puerto Rico at the intersection of the Americas and Europe. Politics seemed to be Puerto Rico’s unofficial national sport. As a university student, I became politically active with a group of students who advocated for the island’s independence. Diverse Caribbean, European, North, Central, and South American influences nurtured my perspective (Comas-Díaz, 2010). In this mission, I read Frantz Fanon (1967), Paulo Freire (1970), among others, and committed to fight oppression. Equally important, the life and work of Julia de Burgos profoundly inspired me. A mixed-race Puerto Rican transcultural woman poet, Julia de Burgos is an icon of feminist resistance against multiple intersecting forms of oppression. After completing college I engaged in a circular migration. Like my parents, I moved from Puerto Rico back to the continental United States. My aim was to obtain a doctorate in clinical psychology. Since I needed to learn English, I decided to work before applying to psychology programs. In this way, I found employment at a Connecticut community mental health clinic. Unfortunately, my cultural adaptation was quite challenging. I struggled against racism, x­ enophobia, gendered racism, and elitism. Within this context, I lost HEA LI NG

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my cultural balance. Luckily, I met several Puerto Rican psychologists, including Julia RamosGrenier (nee McKay), a doctoral psychology student who had studied with Paulo Freire. Inspired by Freire’s (1970) pedagogy for the oppressed, we developed a psychology for the oppressed focusing on healing and empowerment (Comas-Díaz, 2012). Along these lines, we engaged in community psychoeducation, organization, and development. Moreover, we provided mental health services to inner-city populations. As a woman of color, the absence of the doctor title detracted from my psycho-sociopolitical efforts. For that reason, I enrolled in a doctoral program in clinical psychology at the University of Massachusetts, Amherst. There, I learned how to conduct clinical research from Bonnie R. Strickland—a mentor, colleague, and friend. What is more, I expanded my psychodynamic orientation with the incorporation of cognitive behavioral psychotherapeutic techniques. Moreover, several Latino doctoral students formed a clinical supervision group under Castellano Turner’s supervision. We engaged in critical thinking and examined the cultural appropriateness of Western psychotherapeutic approaches to Latina/o clients. Around that time, I had a powerful revelation in my community clinical work. During a group therapy session with Puerto Rican migrants, a woman began to converse with my spirit guides. Although familiar with this practice, I initially responded with my psychologist’s voice. To my surprise, many of my clients replied, “You are one of us.” I then realized that several of my clients were espiritistas. This experience helped me to reconnect with myself. Just like I did as a stammering child assisting my traumatized classmates, I remembered how to listen with my whole self. As I attempted to meet my clients at their cultural location, I reconciled with the spirits. In this process, I turned to my psychologist training and researched the field of folk healing. Out of this exploration, I published an article on the healing similarities between Puerto Rican espiritismo and psychotherapy (Comas-Díaz, 1981). This journey helped me to integrate the “spirits” into my healing role. In other words, I ­psychologically 9 2       H o no r ing O u r E l d e r s

interpreted “spirits” as diverse aspects of the self, or in Jungian terms, as archetypes. Notably, Carl Jung believed in spirits— indeed, his mother practiced spiritualism at home (Rowland, 2002). My psychological interpretation of “spirits” facilitated my syncretistic process. Today, I continue to practice and write about multiculturalism, spirituality, feminism, liberation, and syncretism. Embracing syncretism, I began to incorporate mainstream psychology, critical consciousness, Latin American magic realism, and folk healing into my psychotherapeutic approach. My work with people of color, (im)migrants, refugees, and other minority members reinforced my commitment to pluralism and integration. As a result, I attempt to be open, flexible, present, and above all, authentic within my therapeutic role. In witnessing my clients’ stories, I aim to interpret their maladies. Moreover, I realized that I needed to help my clients to awaken their inner healer. Definitely, years before the advent of multicultural psychotherapy, clinical work taught me the importance of cultural humility, cultural empathy, and above all, cultural competence. Needless to say, I received plenty of help throughout diverse stages of my developmental journey. For this reason, I am eternally grateful to my teachers and mentors. Early on, I learned that mentoring is a two-way street. Question: How did I pay a karmic debt? Answer: By giving back. In this way, I am deeply committed to service and to mentoring. Therefore, after obtaining my doctoral degree, I mentored, taught, supervised, delivered clinical services, and conducted research as a faculty member at the Yale University Department of Psychiatry. Later on, I became the director of the Yale University Hispanic Clinic, a program with a mental health component and an alcohol rehabilitation unit. Since my previous training lacked a substance abuse rehabilitation component, this experience filled a professional gap. At a deeper level, however, this experience taught me to understand the addiction illness, a condition prevalent among many of my family members. Such understanding offered me a compassionate lens to view my relatives’ ailment.

Once more, I was blessed with wonderful mentors during this developmental stage. One of my mentors, Stephen Fleck, supervised my clinical work for many years. Stephen was a German Jew who was able to leave his country just before the Holocaust using his intuition. He was a transcultural man who lived at the border of multiple realities. Stephen was a superb example of the mastery of syncretism. In addition to nurturing my clinical skills, Stephen modeled how to be a scholar, healer, and social justice advocate. In essence, this mentor taught me how to live wholeheartedly. Notably, these were transformative years. I worked hard, learned plenty, gave back, lived intensely, and loved deeply. In other words, I followed my duende. In a synchronistic way, my personal life changed dramatically. A 10-year romantic partnership ended. Shortly after, I fell in love again and got married. At the end of my Yale chapter, I moved to Washington, DC, to direct the Office of Ethnic Minority Affairs (OEMA) of the American Psychological Association (APA). During this episode, I learned about administrative and political aspects of psychology. Two significant events marked my APA tenure. First, I contributed to the founding of the APA Society for the Psychological Study of Ethnic Minority Issues (Division 45). Later on, I served as its first secretary-treasurer. The second significant event occurred toward the end of my APA staff chapter. I participated in a joint American Psychological Association and American Psychiatric Association sponsored delegation to Chile to investigate human rights violations under the Pinochet dictatorship. This experience was life transformative. We met with victims of political terrorism and with the mental health professionals who assisted them. In the midst of enhancing my dedication to trauma therapy, the participation in this delegation deepened my commitment to work toward the creation of a safe society. Still, another transition awaited me. After leaving my position at APA, I engaged in private practice. To reaffirm my identity as a scholarpractitioner, I secured a position as a Clinical Professor at the George Washington University

Department of Psychiatry and Behavioral Sciences. In collaboration with my husband, Frederick M. Jacobsen, we founded the Transcultural Mental Health Institute in Washington, DC. Indeed, I was and still am familiar with transculturation. As a transcultural woman, I heal in a strange land (Comas-Díaz, 2011). Without a doubt, I found my niche. Ironically, transculturation enhanced my clinical work because many of my clients are multicultural and/or transcultural individuals. That is, I work with people of color, internationals, immigrants, lesbian, gay, bisexual, and transgender (LGBT) individuals, in addition to White Americans who have lived abroad. Succinctly put, I see clients who self-designate as being culturally diverse. My multicultural clinical practice taught me to endorse a psychological approach that is holistic, empowering, and emancipating. Within this context, my commitment to social justice guided me to explore the establishment of an academic journal that could provide a wide dissemination to multicultural psychological knowledge. In such a search, I partnered with John Wiley & Sons Publishers. As a result, Cultural Diversity and Mental Health was born, and I became the journal’s editor in chief. Afterward, the APA Division 45 acquired this publication as its official journal, and renamed it Cultural Diversity and Ethnic Minority Psychology. The Division’s Executive Committee honored me by asking me to be the journal’s founding editor in chief (Comas-Díaz, 2009). Today, it is rewarding to witness the journal’s development into one of the preeminent journals in the multicultural field.

MAGICAL REALISM IN PSYCHOTHERAPY Like the air I breathe, magical realism is a pervasive element in my life. It has infused meaning, depth, and intensity into my existence. Magical realism has helped me to dissolve the boundary between physical and metaphysical. Moreover, it has helped me to integrate science with spirit. Furthermore, the advent of middle age has deepened my commitment to integrate diverse healing perspectives. HEA LI NG

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As I reclaim my ancestors’ wisdom, I am more comfortable at crossing healing boundaries. Since I often use mind-body approaches in my clinical practice, I see similarities between magical realism and trauma psychotherapy. Furthermore, I realize that trauma work demands a psychospiritual perspective. Therefore, besides guided imagery, creative visualization, Emotional Freedom Techniques (EFT) and Focusing, I incorporate Eastern approaches such as mindfulness, Feeding your Demons (Allione, 2008), and many others into my therapeutic approach. Likewise, another example of my integration of Western and indigenous healing is dream interpretation. In this vein, I provide clients with a mainstream psychological dream interpretation, but when appropriate, I also offer a folk healing interpretation (more Jung than Freud). To enhance my perspective, I obtained training in psycho-spiritual approaches, such as folk healing techniques, intuitive empathy, shamanistic healing (Comas-Díaz, 2012), and contemplative practices. Acknowledging my science-spirit syncretism in public has taken a while. Numerous psychology colleagues continue to endorse a dualistic perspective of reality—one that separates science from spirit. Conversely, I subscribe to a holistic and syncretistic healing that aims to restore balance between clients’ physical, mental, spiritual, and communal aspects. Needless to say, my roots in Latino healing continue to guide me throughout this journey. When appropriate, I use a magical realistic framework in psychotherapy. Working from the perspective that imagination shapes the perception of reality, I am not alone in this endeavor. De Rios (1997), for example, successfully used magical realism in treating traumatized Latina/o children. Moreover, magical realism is conversant with mind-body approaches. To illustrate, I integrate creative visualization and guided imagery into mind-body approaches such as Eye Movement Desensitization and Reprocessing (EMDR). In my experience, this healing syncretism is equally effective with trauma as it is with peak performance enhancement. Along these lines, a scientific-spiritual integration can be

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useful within positive psychology. For instance, after reconnecting with my duende (Comas-Díaz, 2013a), I incorporated this empowering force into my psychotherapeutic approach. When appropriate, I assist clients to connect with their creative passionate force (duende) in order to help them to develop, evolve, and flourish.

CONCLUSION: LESSONS LEARNED Today, I continue to reclaim and honor my ancestors’ wisdom. The shamanic arts of preserving ancestral wisdom, divining the future, and dancing with the spirit are the arts of women (Tedlock, 2005). As a woman psychologist, I invoke the feminine in healing (Comas-Díaz, 2013b). As a seeker, I attend to a thirst for learning. As a crossroads, I inhabit in-between spaces. Finally, as a transcultural woman, I aim to co-create a new reality out of multiple experiences. Following Abuela Antonia’s example, I aspire to alchemize adversity into resilience. Like her, I nurture hope. Even more, as I connect with Abuela Antonia’s energy, I aim to find the gifts of adversity, or in psychological terms, the posttraumatic stress growth. Like Abuela Petra, I envision healing as an empowering and liberation process. Within this framework, I seek to liberate myself by liberating others. To honor my mother, I pledge to live a life of service. Like her, I attempt to heal with a thinking heart. To conclude, I have learned lessons throughout my healing journey. Some of these lessons are contained in what I call

TEN COMMANDMENTS OF MY ANCESTRAL WISDOM Remember who you really are Honor your ancestors’ wisdom See yourself in the other Liberate others and liberate yourself

Exercise your body, challenge your mind, and raise your spirit Engage in self-care as a condition for healing Heal with a thinking heart Embrace healing as a sacred practice Commune with your duende—dare to be passionate and creative Choreograph the dance of your life

The above lessons are contextualized within my localized experience. Hence, consider them according to your context and reality. How­e­ver, these lessons may serve as an impetus for remembering your true essence. Perhaps you can do this by reclaiming your ancestors’ legacy. Finally, I hope that as you reclaim your ancestral wisdom, you become the psychologist that you are meant to be.

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CHAPTER

10

It Took a Village The Backs That Were My Bridges Beverly A. Greene

If you don’t live the only life you have, you won’t live some other life. You won’t live any life at all. James Baldwin, quoted in Goldstein, 1989, p. 185

I

am honored to have been asked by the editors of this volume to provide a brief narrative of how I came to be who I am within the context of “my village.” While I have much that I would like to share, constraints on the length of this chapter force me to selectively direct attention to historical events, individuals, teachings, and memories that I believe were pivotal in giving shape and direction to my life. It is my hope that my words convey something useful to the reader and especially to those who someday might stand on my shoulders.

EARLY SOCIALIZATION: LESSONS LEARNED My parents and their siblings were all born and raised in the Deep South. Our folks were a part of the great migration of African Americans who left the South in the early to middle 1940s for northern cities in huge numbers in search of relief from the oppressive racism of the South, in work, housing, and educational opportunities for their children. While the racism in the North was not as overtly oppressive as it was in the South, it did exist and these migrants still faced racial discrimination in all aspects of their lives. I was the first of four children born in the middle of the last century to Samuel and Thelma Greene. We made home in East Orange, New Jersey, a suburb of Newark. At that time it was a stable, racially and economically diverse city and neighborhood; however, those demographics shifted during the course of my growing up. That area is now predominantly Black (with a heavier emphasis on Caribbean Black Americans) and economically distressed. We lived in a large two and a half family house with a big back yard that was home for a multigenerational group of loving and supportive people. Live-in family included 96

paternal and later maternal grandmothers, paternal aunts and uncles, and often cousins. Dad was a master carpenter, a trade learned from his father. It was work that he always loved, despite the challenges he often encountered in the workplace. Mom spent my early years working in a factory. She left that job when I was 8 and my younger sister was 4 years old to spend more time with us at home. During that time, she ran an informal child care business out of our home. After a 15-year hiatus from working outside our home, she returned to work in the public school system as a paraprofessional with neurologically impaired children. Both of our parents were active in community organizations. They were leaders in those organizations as well as church where our involvement was civic and spiritual rather than doctrine driven. Across generations, education, and literacy in particular, was highly valued by my family. My mother was quite proud of the fact that she and five out of the six of her 11 siblings who managed to survive to adulthood completed high school and excelled academically. We were a family of storytellers and readers. Books always filled our home and there was an explicit love for learning and ideas. We were exhorted to think critically and not simply accept what we were told about ourselves or others, to achieve but to “lift as we climbed,” and to have a sense of humor and playfulness about much of what we would encounter in the world. There were always lively discussions about politics and what was going on in the world around us in our home and we were expected to participate in those discussions and share our thoughts and opinions about things. Our parents were clear about feeling that they needed to do special things to prepare us for the challenges of racism we would face as Black children. It was not unusual for our father to play the devil’s advocate to press us to express an opinion on an issue or event and debate its merits. Later in life, Dad described this as his way of teaching us to stand up for ourselves in a world that would seek to trivialize us. He said that he felt that if we could stand up to him, we could stand up to anyone.

I attended public schools with the same cohort of students from kindergarten through high school. Our school system was amazing in the range of opportunities with which we were presented; however, our classes were grouped based on standardized test scores. This would explain not only why our same cohort was together for so long but I suspect resulted in our class getting opportunities that other students in the same school may not have had available to them. We know that when teachers are told that they are teaching the smart kids that it affects the way they teach and the way they view those students, and when students are told that they are “smart” they perform better. We were frequently told that we were the top students in the school and that we were expected to do well and be successful. This message came with few exceptions from both Black and White teachers and guidance counselors who actively encouraged and facilitated our interactions with college and university recruiters.

THE FIRST BLACK PEOPLE I KNEW WERE MY PARENTS We were known as Negroes or colored people. We would become Black in the late 1960s and early 1970s, and much later, African Americans. I had no idea where those names came from in my youth but I did know that if someone called you Black, or suggested you had African ancestry, it was an insult. All that I knew about what it meant to be “Negro” was defined by my parents and family members long before I knew anything about the formal parameters of race. By the time I was 4, I knew that I was something called Negro and that there were people who did not like us and who would not want their children to play with us because of that fact. How I came to label some of my experiences as having something to do with my being a Black person, and subsequently my subjective sense of being a Black person, was largely dependent on how elders defined this thing called “Negro” or “Black.” This identity came to be shaped by other significant people in the course of my development I T TOOK A VI LL AG E

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as I moved in larger and wider circles of peers and authority figures in our family and in the world. I was aware that I often valued and took on the perspective of those family members to whom I felt close personal bonds or with whom I identified and less so with family members with whom I was conflicted, did not feel close to or regard as highly. When I was older and through my own therapy, I learned that those beliefs that were most difficult to challenge were the ones held by the people I felt closest to or valued most. Our family represented a wide range of tastes, beliefs, values, behaviors, and ways of being in the world that made it possible to feel authentic as an African American/Black and an acceptable person in the full sense of the word. My younger sister, two brothers, and I were raised by our parents and elders to be proud of our people’s history and their struggles, to negotiate racism, and to learn from the struggles and mistakes of the past so as not to repeat them in our own lives. My parents grew up in the midst of the fiercest forms of racism in the last century. Growing up in a multigenerational household, we were given great latitude to disagree with viewpoints of adults, debate the merits of our opinions, and to pursue our own dreams. Our elders shared the knowledge that while many people hated Black folks and felt that we were inferior to them, this belief was completely unfounded. Rather, they communicated that we had a right to a place in the world, and respect as any human being despite what others might think, but we owed others respect in return. We were not to see ourselves as above others; rather, we were their equal. There is nothing in me that is not in everybody else . . . And there is nothing in everybody else that is not in me. (Baldwin, quoted in Goldstein, 1989, p. 182)

My three younger siblings and I were raised by parents and elders who, as mentioned previously, grew up in the midst of the fiercest forms of racism in the last century in rural Mississippi and southern Georgia. We were taught that our struggles to negotiate racism as well as other dilemmas that 9 8       H o no r i ng O u r E l d e r s

are inherent in the human condition were a part of something larger than ourselves to which we were connected by the past and for which we had some responsibility to change in the future. To this end, we were exhorted to assume a sense of social responsibility for the world we live in. For our own good, alongside these teachings, we were reminded that the healthy physical and psychological survival of our elders in the Deep South required that they understand how to negotiate the challenges of racism without losing their personal sense of dignity and humanity. Part of those survival skills involved understanding when to stand your ground and challenge racism or other unfairness and when to acquiesce. Choosing your battles carefully was an explicit part of our socialization. Along this line, one of the tasks that African American parents have faced, mine included, is that of socializing their children to survive in a society that devalues and is often intolerant of them. Many African Americans correctly perceive the existence of a double standard for the misbehavior in African American children versus White children and will punish the former more severely. In fact, depending on the historical period, a minor racial transgression like making direct eye contact with a White person could easily have resulted in your swift demise with no legal recourse. Subsequently, many African American parents felt the need to teach their children to strictly obey them and to behave in socially proscribed ways without question. They correctly feared that if their children did not internalize the need to control themselves and to obey a parent in an absolute fashion, their very lives could be at stake. Our parents were far more permissive by comparison and encouraged us to challenge them if we thought their judgement was unfair. What they decided had to stand, but we were given latitude to ask for explanations for decisions that affected us. Our elders were forthright in explaining that there were people who would challenge our rights to have the same opportunities that they were afforded and would attempt to undermine us both directly and indirectly and that this could be problematic for us. We were also warned that most of

the time we would not be able to challenge these actions directly without imperiling ourselves. As children, we learned it was important to tell our parents if we thought we were facing unfair treatment. In hindsight, what was most significant about their warnings was that racist people could make problems for us if we attempted to achieve; however, we were not the problem. Managing their racist behavior was defined as the problem. Whether or not our elders were consciously aware of it, they were socializing us to recognize a broader systemic social context that we were embedded in and that this context had to be taken into account when attempting to understand our own dilemma as well as that of others. It is another one of those important lessons I grew up with that ultimately found its way into my work as a psychologist and certainly my affinity for the principles of Feminist theory. The importance of context is a core feature of feminist psychotherapy and resonates with the messages I received early in life about the power of social systems in affecting the choices and opportunities that people have and thus shaping the process and outcome of lives. We were admonished by our parents that being part of the majority can make you more powerful but did not mean that you were right or that your actions were just. Similarly, while we were taught to respect authority figures, we were also taught that authority figures are not perfect. We were warned that there was often a double standard for our conduct as Black children. It meant that we might often get into trouble for doing exactly the same thing as a White peer who might escape punishment or criticism. It also meant that we would sometimes need to outperform our White counterpart to be noticed and that we might still not be seen as equal by our counterparts. The overall lesson was that sometimes you have to acquiesce to power and authority, not because it is right but because it is powerful and can harm you. Making the distinction between being powerful and being fair early on in life was an exceedingly important lesson and one that I have always thought protected us from the dangers of internalizing racism. One of the skills developed in the course of this socialization was

that of learning to anticipate the potential for the negative projections of others without internalizing them, and how to manage them psychologically when they occurred. Part of my racial socialization included being suspicious of what has been called White versions of the truth about Black people. That suspiciousness served to provide the basis for my questioning what the majority had to say about other people as well. Our family also instructed that many of “us” might believe the negative characterizations of who we were. This, however, had no credibility either. They asserted that there was good and bad in everyone. These teachings and admonitions prepared me to deal with other aspects of my identity and prepared me in important ways for being a Black female therapist. Up to this point, I have mainly focused on my Black racial identity; however, from very early on I was aware of my sexual identity/orientation. In particular, I was aware that my sexual orientation might be as problematic, and even more so than Black identity for some people. Hence, I tried to make sense of what I had learned about race in relationship to sexual orientation and sex. I somehow reasoned that if they, or some conventional wisdom, could convey so many lies about Black folks, they could also be lying about “other” people as well. I also reasoned that if even some Black people were not immune to believing things that were not true about themselves and about others, they might also harbor information about other people that was untrue as well. This was an important element in my understanding minority sexual orientation despite not having that identity in common with family members that I knew of at that time. I reasoned that group membership alone was not enough to inform you about who could be trusted and who could not, or about who was lying and who was telling the truth, and that being marginalized did not make people immune to marginalizing others. I kept my sexual identity to myself during my childhood thinking that no one else knew, a belief that, as noted later in my story, was not based on fact. Later, I selectively shared that information depending on who I thought could be accepting and supportive. I T TOOK A VI LL AG E

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My family provided a context of love and support that enabled me to develop a sense of empowerment and the belief that I was entitled to think for myself and to define myself.

THE ROOTS OF WHO I AM My rich ancestral roots have played a very significant and impactful role in my becoming the Black woman that I am today; an impact that never ceases to amaze me. I have selected to highlight a few of those that serve to illustrate the source of such impactfulness. My maternal grandfather’s mother, Mary Eliza Melvin Roberson, my great-grandmother, was brought into the United States from the British West Indies, presumably intended for the auction block, just after the beginning of the Civil War. She may have originally been born in Africa. The status of the war and the Carolina port of her entry made her legal status somewhat ambiguous and, while it may have precluded her sale formally as a slave, she was not fully free until the war ended. She married my great-grandfather, Will Roberson, and they had nine children. The last of their children, my grand-aunt Irene, died in 2002 at the age of 102. Longevity was one of the features of that side of the family. Our great-grandfather was a turpentine distiller, which was an unusually good job for a Black man of his time. He made good wages and our great-grandmother, unlike many of her peers, did not have to work outside the home. However, she chose to do so and it seems no coincidence that she chose midwifery as her occupation. In the midst of so much oppression and so many limitations in her own life, she found a place where she could be a healing force. The Black and White babies she brought safely into the world included my mother and her five younger siblings. Mom’s birth certificate bears the “X” that great-grandma, who was unable to write, used to indicate herself as the person responsible for delivering the baby. The last time I saw her she was well over 100 years old and very active for someone of her advanced age. Indeed, when she died in 1966 she was, based on anecdotal stories and census records, 10 0       H o no r i ng O u r E l d e r s

between 109 and 113 years old. She was one of our family’s tangible connections to the middle passage. Having this strong woman as part of my village helped me to learn that there is great power in being a healing force in the midst of unfairness, injustice, and social oppression. Another direct link to slavery that we are able to trace was through my maternal grandmother, Flora Melvin Roberson, who was the grandchild of a slave, Bella, and her master, Mitchell Tison. When Grandma was 7, her mother, Lucy, died in childbirth for lack of medical attention extended to Black people. Lucy was just 38 years old, leaving six young children behind. My grandmother’s experience sensitized her to what she saw as the plight of “motherless” children and their vulnerability to being disparaged by others and by extension, to all people who were ill treated or disregarded. She became a feisty woman who, unusual for her time and place, was known to overtly challenge Whites or anyone she thought treated her, her children, or anyone unfairly, with little regard to their authority. I have been strengthened by their legacy and their bodacious survival during the most difficult circumstances I can imagine. Our maternal grandfather, Dennie Roberson, was referred to derisively as a “smart nigger.” That characterization of Black men usually meant they possessed intelligence that contradicted cherished notions of White supremacy and Black inferiority and who refused to “play dumb” in their encounters with White persons. He was in poor health after his service in World War I due in part to health conditions that developed during his military service. Seeking help for his medical condition, Grandad spent nearly 20 years writing letters to the veterans departments and to President Roosevelt to advance his claim. We were told stories about how he would take his letters to the train station and put them directly in the mail car on the train itself. Mail left in local post offices could be diverted; however, if tampered with once it was on the train, it was a federal crime and less likely to be destroyed before reaching its destination. When his claim was finally adjudicated, it required verification from his doctor attesting to his pre- and postservice health status.

Our mother recalled the night when the town banker, the doctor who attended our grandfather, and a man unknown to her, all White, came to their house. She overheard them as they forthrightly told our grandfather that he would have to agree to sign his retroactive disability compensation over to them, and they would give him a portion of the proceeds as they saw fit. If he refused, his doctor would not complete the required documents and he would have nothing, as in their words, “it was too much money for any nigger man to have.” Grandad refused to comply and his claim was ultimately denied. I have no doubt that it left him a broken man. His health declined further and he died in the Veterans Hospital in Lake City, Florida, in 1939. He was just 47 years old. In our family archive we have responses to many of his letters from the Secretary of the Navy as well as the Honorable Franklin Roosevelt’s office. To help my grandmother raise the seven children still at home in the wake of their father’s death, Mom’s eldest brother, Emmett, and sister, Lucy, went to work in the mornings and then to school at noon recess. Despite the hardship, they graduated at the head of their classes. No matter how challenging, getting an education was highly valued and sought after in Mom’s family. Both of my maternal grandparents and most of their siblings were unusually literate for Black people during that period. My paternal grandparents created quite a bit of unrest in both sides of their families when they married. My grandmother Prencie was the daughter of Emma and Burke Howard. Emma was described as a mixed-race woman of Black, Native American, and White admixture. While Granny identified herself as Black, I felt she could appear racially ambiguous to others. We were told that Granny was the darkest complexioned of her parents’ seven children who, we were also told, were passing for White. In census records, her siblings are designated as Negro or Black, which would challenge the idea that they were light skinned enough to pass. Burke was described as “White,” although we have been unable to discern whether he was actually White or so light skinned that he could easily pass for White, and we are told he did so.

However, census data report him as “mulatto” in the 1920 Census and Black in the 1900 and 1910 Census. This aspect of my family history serves as an excellent example of the social construction of race. Depending on who completed the census papers at any given time and who your neighbors were, a person could be any number of designations in their lifetime. The seven children of Cicero and Emily Greene were dark skinned compared to the Howards, and there was no question, they were unmistakably Black. Marrying my grandfather Thomas meant that neither my grandmother Prencie nor her children could ever pass. We were told that her family objected to the marriage for this reason. Feelings about skin color have often been the dirty laundry of many African American families and it was likely that marrying someone who was very dark skinned would not be viewed favorably. According to family lore, my father and his five siblings could not be openly acknowledged by their maternal grandparents, aunts, and uncles as it would be disruptive for those who were passing. On the other hand, our paternal grandfather Thomas and his family were unusually literate for Black people of that era. His family disapproved of the marriage because they felt that he could find a more suitable wife than a girl 10 years younger than he was who was illiterate. They married despite family objections in December 1907. Thomas Greene was determined that his children be literate. To this end, he kept an old chalk board in their home and regularly drilled his children with “lessons,” to be completed in addition to all of their chores. He was particularly adamant about ensuring that his daughters be educated so that they could avoid having to work as domestics in White homes. It was customary, especially for families of limited means, to make sure their male children had an education. Girls were presumed to have no need of an education. They were expected to marry and have husbands who could take care of them. Grandad was unusual in this respect. He was concerned that if his daughters ever had to work in White homes as domestics they would be subject to unwanted sexual advances from the man I T TOOK A VI LL AG E

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or men in the household. Black women employed in those situations were frequently the target of unwanted sexual advances by male employers who would threaten them with the loss of their jobs, harm to their families, or physical injury to themselves if they refused to comply with the employer’s sexual demands. Although Thomas Greene appears in census records as a “sharecropper,” he actually was a skilled carpenter who taught my father that skill and who built the house in which my father and his five siblings grew up in as well as the general store that our grand-uncle Sam would operate throughout his life. Grandad named our father after his beloved brother Sam. Sam’s store was situated on Dobbs Ferry Road in Vicksburg, Mississippi, until it was changed in recent years to “Sams Drive.” My grandfather drew blueprints for White contractors, who claimed the drawings were their own. He was paid for his work, but he was not identified as the person who created the blueprints because Black men were not permitted to do that kind of work, and Whites would not buy plans drawn up by a Black man. Like our maternal grandfather, Tom Greene was also known as a “smart nigger.” In his case, it was because he had a skill to perform a task that some White men could do or, worse, he had a skill that many White men did not have. In either case, having this skill could easily make him a target for violence. I have often wondered if there is a connection between the degree to which it was not safe historically for Black people to be seen as intelligent and literate and the need for many Black youth to eschew what they consider “book smarts” as skills that defined White people. My paternal grandparents often raised the ire of neighboring Mississippi White farmers because they refused to keep their six children out of school to work in the neighbor’s cotton fields during the times of the year that school was in session. One of my grandfather’s younger sisters, Martha, graduated from Alcorn State College and attended Tuskegee Institute during summers to complete a master’s degree in education. She taught grammar school in Louisiana until her retirement. My father’s eldest three sisters generally completed 10 2       H o no r i ng O u r E l d e r s

2 years of what was then considered college. Rose, despite 2 years of college, performed domestic work in the homes of Jewish professionals for most of her adult life. Whenever they discarded books, she brought them home to us. Hence, we had James Baldwin, Henry Miller, Dorothy Parker, and other writers of the Algonquin Long Table as a matter of routine. It was Aunt Rose who first exposed me to the special pleasure of the New York Sunday Times and its book review. While Black people have often been relegated to menial jobs, it did not define their intelligence, ability, or awareness of a larger world and its offerings.

MY FORMAL EDUCATIONAL AND PROFESSIONAL DEVELOPMENT: “NEW” INHABITANTS TO MY VILLAGE My formal educational development began in the public schools of East Orange. Having briefly touched on my “unusual” and exceptional education that I received in my primary years, I direct attention to my education starting with junior high and beyond. During my high school years between 1964 and 1968, I was aware of the urgency of the movement for civil rights for Black Americans as well as the resistance to that movement as measured by the murders of many civil rights workers. Neighbors attended the famous March on Washington and our television sets were filled with images of civil rights protesters being set upon by dogs, fire hoses, and beaten. It was impossible for that reality to be avoided in the classroom. Hence, there were frequent discussions about what was happening in the world and, more specifically, our place in this world. In my junior year of high school, Charles Herod was our history teacher. He was not simply our history teacher; rather, he taught us “history.” He taught us about the real history that was often overlooked in the history books of the day. Mr. Herod, who was Black, served as an officer in the armed services. That was unusual for a Black man at that time. Perhaps because of his military

background and a role he may have played in World War II, he had an interest for that period and shared information with his classes that, I later learned, was not routine in high school history. He taught us that in addition to the concentration camps in Germany and the murders of Jews in the holocaust, anti-Semitism was a potent force in the United States. He informed us of the role that the United States played in turning Jewish refugees back to Germany during the war even though such action would surely result in their deaths. Even more unusual, he taught us about the United States detaining Japanese Americans in internment camps during the war and confiscating their property via taped interviews with them. Needless to say, such teachings made me more aware and sensitive to the unjust treatment of persons who fall outside of the mainstream in this country and the world at large. On graduating from East Orange High School, I attended New York University in its first group of Martin Luther King Scholars. This was during the late sixties and seventies, a period of significant social unrest, which provided the basis for a great deal of emotionally laden and conflict-provoking discussions among friends, classmates, and teachers. One topic that received a great deal of attention was that of identity: What constituted authentic identity and what did such identity mean during this period of unrest? During those years, I changed my career goals from medicine to clinical psychology. Given my personal background and my experiences in the social movements of the day, I felt that I could use psychology as a tool for social justice. On graduating from NYU, I applied to doctoral clinical psychology programs but was not accepted that year. I spent the year attending Marquette University’s doctoral program in Educational Psychology and applied to clinical programs a second time the following year. After being placed on Adelphi University’s waiting list and almost giving up, I was informed of an opportunity to enter their Clinical Psychology Program with a fellowship in Mental Retardation at New York Medical College.

During the early part of my first year, I was diagnosed with the first of two benign brain tumors, requiring serious surgery and withdrawal from classes. I returned the following year, exhausted but recovered sufficiently to resume my studies. The impact of the surgery was with me for some time. It made navigating the challenges of keeping up with the course work a full-time job. Despite the challenges, I completed my doctorate in the program founded by Gordon Derner, with Derner as my dissertation chair in the spring of 1983. The commencement of June 1983 was Gordon’s last. He died that summer, leaving a legacy of aggressive recruitment of students of color and a program that has probably graduated more students of color with doctorates in clinical psychology than any others of which I am aware. An important juncture of my professional training was my clinical supervision with Dr. William Johnson, the only Black psychoanalyst supervising my training in psychotherapy. It was “Bill” who expanded my nascent vision of how psychodynamic psychotherapy and psychoanalytic principles could be an important tool for helping socially marginalized people understand and not internalize or blindly respond to their marginalization. My work with Bill had a profound influence on my development as a clinician. It also heavily influenced my thinking and writings on the use of psychodynamic approaches to psychotherapy with marginalized group members. My work with Bill is reflected in my own clinical work as both a therapist and supervisor. After working briefly for the NYC Board of Education as a school psychologist, I realized that educational systems did not give high priority to the mental health of students. Hence, I sought positions that were directly focused on clinical work and eventually found a position at Brooklyn’s Kings County Municipal Hospital’s Inpatient Child Psychiatry Division. That appointment was under the direction of Chief Psychologist Dr. Dorothy Gartner and was what I considered my first “real” job as a psychologist. Dr Gartner is the person most responsible for my development into a scholar. Dorothy pursued me incessantly about teaching I T TOOK A VI LL AG E

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diversity courses in the hospital training programs when such courses were rarely offered. She also “encouraged” me to write about cultural issues in psychotherapy. I had no desire to write for publication or pursue a career in academia. I enjoyed the clinical work in public mental health and, despite the obstacles, I believed that I was making a difference in the lives of the children with whom I worked. I also expected academia to be hostile to the kind of ideas I had about psychotherapy and, in particular, the importance of understanding and considering culture and systemic inequities explicitly in the psychotherapy process. Despite my resistance, I begrudgingly complied and began teaching seminars in cultural diversity in the programs. The research for those courses was literally the basis of my earliest publications and professional presentations and awakened an interest in research and teaching. As I began making professional presentations, my work came to the attention of Drs. Laura Brown, Ellen Cole, and the late Adrienne Smith who, like Dr. Gartner, were relentless in their urging me to write about psychotherapy with African Americans, lesbians and gay men of color, social marginalization, multiple identity paradigms, and developing inclusive paradigms in feminist psychology. Had it not been for the sheer synergy of these collective efforts, I doubt that I would ever have embarked on writing and developing the ideas that became the basis of my scholarly works. I joined the Association for Women in Psychology, which provided a welcoming and supportive environment for developing perspectives on working with marginalized people that were not typically welcome in psychology’s mainstream at that time. I also joined the American Psychological Association (APA) and Division 35 where I found a similarly supportive group of colleagues who were actively involved in research, teaching, and clinical work with women as marginalized group members. Despite enjoying my work in public mental health, after leaving Kings County Hospital and working briefly for the University of Medicine & Dentistry of New Jersey’s Newark Community 10 4       H o no r i ng O u r E l d e r s

Mental Health Clinic, my compelling interest in and demands of my research prompted me to reconsider my previously resolved career plan. With my expectations fairly low, I interviewed for a faculty position at St. John’s University and found a friendly community of scholars who welcomed my work. I found challenges but also support around tenure and promotion and was ultimately promoted to full professor and granted tenure in 1995. With the support of St. John’s community, my work continues to flourish.

REFLECTIONS ON PERSONAL AND SELECTIVE LIFE EXPERIENCES AND EVENTS Despite the fact that early on I did not share my sexual orientation outright with family members, their lessons for understanding and managing racism were important to my development in ways that transcended the challenge of ethnoracial marginalization alone. In retrospect, their support for all aspects of me as a person was evident throughout my life. This was strongly brought home in June of 2011 after a late-night vote made marriage equality a reality in the state of New York. As soon as the news broke well after one in the morning, my telephone rang. This was not so unusual as I am a night owl and many of my friends were anxiously following the progress of this bill with great anticipation. I assumed it was one of them wanting to share the good news. What was unexpected was that the call was from my mother. Mom was breathless with excitement. She said, “Did you see it, did you see it? They finally did it, they did it!” I asked her, “Who did what?” She responded in the exasperated tone she has reserved for me since I was a child, on those occasions when she felt I was being completely dense, and she said, “The vote on same-sex marriage in New York! They finally passed the bill, they finally did the right thing!” And she went on and on saying, “Who did they think they were, anyway, telling people who they can love or not love and who can get married and who can’t! It’s time they finally did the right thing!”

At that moment, I mentally flashed back to the night I sat my parents down, over 35 years earlier, to have that conversation, to come out to them. While I always assumed they knew, I was also aware of many instances with friends and clients who also thought their sexual minority status was obvious to close friends and family when it was not. I was following through on a promise I made myself a year prior to that evening, the night before the first of two challenging surgeries for brain tumors, when I thought I might not ever have the opportunity to have that conversation with them. Mom initially looked surprised, shocked, or as if she had eaten something disagreeable. Surprised by her surprise, I asked her if she didn’t already know or suspect what I was revealing to her. Like the good little hysteric mom was, she shrugged and said, “Well, yeah . . . I knew, but I didn’t want to think about it, so I just didn’t. Now, I suppose I have to!” As I was holding the phone that midsummer night in 2011, all I could think was, who is this woman? And what has she done with my mother? But even as I stood there momentarily perplexed at her sheer giddy enthusiasm for marriage equality, I was also reminded of that which I know full well: My mother’s heart was always in the right place. She always ended up, as she had put it, doing the right thing, especially where her children were concerned. The evolution in her perspective on this matter was really no different from any other. Life-threatening events can bring a sense of clarity about whom and what is important in your life and who and what is not; about what you are willing to put up with and what you will not tolerate. That night prior to my first surgery, I thought about my parents, having watched them now for months consumed with worry and anticipatory grief. My mother used her hysteric defenses adaptively to be positive and optimistic although she was clearly frightened. Mom lost her brilliant, 16-year-old, much loved baby sister just 5 months after I was born. Aunt Lola died from head injuries sustained in a car accident that resulted in severe and irreversible brain damage. She lay in a coma for a month after the accident and died after briefly regaining consciousness.

I knew there were elements of my current dilemma that brought painful memories of Aunt Lola’s premature death rushing back to Mom and to my maternal grandmother who commenced praying for me every day. My father, a playful yet usually controlled and stoic man, became emotionally unhinged in ways that I had never seen before. He seemed completely undone by the potential of losing one of his children and having no power to stop what must have to him seemed like watching a slow train wreck. In that long night, I deeply regretted that I never had that conversation with the two people who brought me into this world, who loved me unconditionally, and always made me feel that I was a part of something larger than myself. As noted previously in my story, it was my parents who always encouraged me when I was afraid but reigned me in when I would have gone rushing into places where angels fear to tread. They taught me never to live ruled by fear but to choose my battles carefully and from an informed perspective. They also taught me the importance of strategic perseverance against the adversity I was certain to encounter. Perhaps most important, they modeled the capacity for compassion for those who have little, who struggle and who suffer, even in the midst of your own suffering. They also instilled in me a sense of responsibility to try to leave the world a better place than when I came into it, for the generation that followed me. It was after all what those who preceded me had given me. They were enduring role models for how to face indignity with dignity, humor, and grace. While I may well have arrived at my current destination on my life journey without them, I know that it would have been infinitely more difficult, and I don’t know that I would have become the sort of person people want to honor in the way that I and my work have garnered formal recognition. I reckoned that night that if I survived the next day’s procedure I would have that conversation with them sooner rather than later. A year after spending the night prior to my surgery contemplating my potential demise, I determined that it was time to have that conversation with them. After stating what I thought was the I T TOOK A VI LL AG E

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obvious about my sexual orientation and having the previously described exchange with my mother, I looked over at my father to assess his reaction to what I had just told them. At first he just quietly said, “I knew that.” I asked him if he was ever going to ask me about it or bring it up and he said no, that he figured I would tell him when I wanted him to know. But barely a moment later he grew quite animated and barked at me, “But . . . you’re Black!” I didn’t readily see what that had to do with anything, but before I could inquire he continued, saying, “And you’re a woman!!” You must understand that there was a great deal of tension in the room and I could not help but to attempt to introduce a bit of levity to the discussion. I responded to his latest observation about my sex with, “Well yeah Dad, that’s the point!” My feeble attempts to reduce the tension passed unnoticed; however, I was totally unprepared for what he said next. He looked at me very soberly and quietly said, “And you’re really smart . . . those three things, people hate that! They hate it! And this thing now that you’re going to do, they hate that even more! If you do this, they are going to hate you and try to hurt you in ways that you can’t even imagine.” I told Dad that as long as he and my mother didn’t try to hurt me “more than I could imagine,” other people would have to do whatever they had to do but that I would also have to do what I had to do. The idea of living the only life I was going to have without authenticity in my relationships, for no good reason, opposed all they had taught me about personal integrity and managing racism as a Black person. Not the least of all, the very idea made me angry. It was not an option. Undaunted he raised the issue of “treatment.” He asked, “Have you thought about ‘treatment’?” I asked if by “treatment” he meant psychotherapy to rid myself of this part of my identity. He confirmed that indeed that was exactly what he was asking. I told him that I was in training to be a therapist and although I had been in therapy and probably would again, that it was not focused on ridding myself of my sexual orientation. This was far too much for him. He could not understand why if I were going to do something as drastic, for him, 10 6       H o no r i ng O u r E l d e r s

as being in psychotherapy, why in the world would it not include getting rid of what he saw as “the problem.” I told him that there was nothing broken about this part of myself that needed to be fixed. He responded by accusing me of just being stubborn. This was a predictable feature of discussions between us, particularly disagreements. One of us was always accusing the other of being stubborn. Whenever he accused me of such behavior, I would simply point out that he had taught me to stand my ground when I firmly believed in something and not to be dissuaded by naysayers. His next tactic was to point out forcefully that I just had no idea what I was doing and that I was being naive about how much more difficult this was going to make my life. He finally pleaded, “Wouldn’t it just be easier for you if you changed? Wouldn’t it just make your life easier to do that?” I asked Dad about his life growing up in rural Mississippi, a life that had been surrounded by the inescapable brutality of racism in the past and the everyday racism of his workplace in the present, and asked if he thought his life would have been easier if he were a White man. Without missing a beat, he acknowledged that not only would his life have been much easier but he would have had many more opportunities for himself that would have given us a better life if he had not had to constantly negotiate racial discrimination. I asked if he could take a pill that would make him White, and it was free, if he would do so and if he would want us, his children, to do this. My father was no fool. He gave me that look that parents reserve for those moments when a survival strategy or something they taught you to help you make your way in the world is about to come back and bite them big time. To his credit he quietly said no, that he would never do such a thing and he would hope that we wouldn’t do so either. “We,” he explained, “we are not the problem. Dealing with people who want to harm us is the problem.” He pressed his point and said, “One day people will just have to get over it and realize that we are here to stay. We did not ask to come to this country but we are here and have as much right to be as anyone else, and we are not going anywhere!” I told Dad

that he may not realize it but that he understood perfectly how I felt and why “treatment” for a social sickness, and not my flaw, was no more an option in my life than taking a “White” pill was an option for him. He continued with one last query, no pun intended (well, maybe just a little pun intended). He asked, “But what about your profession? You’re working so hard and spending all of this time and money to develop this career. If you continue on this path what good can come of that? You could lose everything.” We ended the conversation on that note in the summer of 1976. We agreed that no one could know for sure what would come, that my professional future would just have to be whatever it was going to be with the real me. Sometimes you have to start small, climbing the tiniest wall. Maybe you’re going to fall, but it’s better than not starting at all. (Sondheim, 1964)

Dad was 95 when we lost him in May 2014, a little over a year after losing our mother. When going through his belongings last summer I came upon scraps of paper with the notes he made during that conversation, notably among them, “What about your profession? What good can come of this?” I was visiting my parents just prior to being honored as an elder at the National Multicultural Conference and Summit in January 2013. Dad asked me about the forthcoming trip to the summit, knowing that I was being honored for something. He asked sheepishly if I was getting another award for something. When he asked me what the award was for, I tried to explain why I thought I was being honored. He just smiled, clearly pleased

with himself and with me, and said, “Well, I guess that profession worked out all right now, didn’t it?” Yes, Dad, it did.

BRINGING MY VILLAGE TOGETHER Despite the American myth of rugged individualism, none of us gets to be who or what we are by virtue of our talent and hard work alone, none of us, and I am no exception. We all stand on the shoulders and the backs of those villagers who came before us and opened doors that surely would have been closed had it not been for their courage and sacrifice. It really does take a village, and I have been blessed with an incredible village that includes my blood family of origin, my close friends who are my chosen family, and those people who comprised the community I grew up in, many of whom to my amazement still make inquiries about my well-being and in some way continue to hold me as one of their own. They include now very elder neighbors, church members, teachers, etc., who validated my abilities, encouraged my ambitions, and kept me in their prayers long after I left home to make my way in the world, particularly at those times when I encountered serious illness. That village also includes my Association for Women in Psychology and APA family, and other colleagues and friends. Many of those who were important to my development, like my parents, are no longer alive but for them and for the many who remain I am grateful for all of the backs that were my bridges in their extraordinary contributions to my work and my life.

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CHAPTER

11

Child of the Civil Rights Era Formative Influences on My Personal and Professional Lives Bertha Garrett Holliday


A MATTER OF CONTEXT I was an eager newborn who entered this world in a corridor on the way to the delivery room of a Negro hospital, with the assistance of a Negro physician and a Negro nurse. I was brought home to a Negro neighborhood. I began my school career in the city’s Negro public school system—nurtured by Negro teachers who were determined their charges would be prepared for a different world. My values, ethics, and spirit were nurtured not only by my family but also by family friends and members of my Negro church—all of whom I was instructed to “listen to carefully.” I was a child who was well loved, well cared for, and well brought up. But I lived in a de jure racially segregated Kansas City, Missouri. And my behavior, opportunities, and movement through space were restricted by the prevailing rules
of Jim Crow. I am a child of the Civil Rights Era. The Civil Rights Era (1950s–1970s) was a brief but unique historical period when many racially discriminatory institutional structures and practices were successfully challenged. More often than not, these challenges took the form of independent community-based initiatives that were organized and led by local leaders of longstanding Black organizations and institutions. The number, steadfastness, and success of these initiatives captured the nation’s imagination and spurred major changes in national public policy. Collectively, these initiatives and their strategies are often viewed as a template for social justice change. As a child, youth, and young adult, I was profoundly affected as I both witnessed and benefitted from the challenges and victories of the Civil Rights Era.

FAMILY AND CHILDHOOD My father grew up in Leeds—one of the poorest Colored neighborhoods in Kansas City. His family, like so many of his neighbors, had migrated to Leeds from the South. His father was a barber who died t­ ragically 10 8

at a relatively young age. His mother was a laundress in private homes. My mother’s childhood was more privileged. She grew up in a fairly large house in Lawrence, Kansas. Her mother occasionally worked as a cook, while renting out rooms to Colored students at the University of Kansas. Her father worked for more than 40 years as a dining car waiter on the Santa Fe Railroad. My mother became a social worker. Our household of four was busy and noisy— full of opinions, debates, commentaries, discussions, community meetings, and “democracy” (Daddy had two votes; the rest of us had one vote), where “truth” and “fairness” reigned supreme. My father grew into a principled, ambitious, fearless man who was determined to devote a sizable amount of his time and talent to eliminate inequality and the oppression of Negro people. He initially viewed this problem as one dominated by economic considerations and inequities, so he sought to acquire a master’s degree in economics. But at that time (in the early 1940s), the state of Missouri had no such programs for which Negroes were eligible for admission. So it was the state’s policy—consistent with the tenet of separate but equal—that in such cases it would pay a Negro’s tuition to any institution outside the state to which a Negro could gain admission. My father got his master’s from the University of Michigan, but was unable to obtain employment as an economist.
Consequently, he began championing issues of civil liberties and civil rights and became interested in a career in law. But again, there was no law school in Missouri for which Blacks were eligible for admission. And now he had a wife and two children, and believed relocation out of state was impractical. So with the assistance of the local American Civil Liberties Union (ACLU) chapter, he sued the then-private University of Kansas City (now the University of Missouri at Kansas City) for admission to its law school. Two years later he gained admission to that institution. Shortly after my father’s admission to law school, I began kindergarten, but the Negro schools were bursting at the seams so my kindergarten was conducted in a local dance hall, while many

surrounding White schools stood half empty. The Negro community was incensed about this situation and launched a picketing campaign. After my morning kindergarten, my teacher would bundle up some of my classmates and me and send us to the picket line outside where we were joined by parents. In consideration of my father’s lawsuit for law school admission, I viewed picketing my kindergarten as a normal and fun thing to
do. Thus began my commitment to advocacy. The next year, when I entered the first grade, we got our new Negro school—the former (White) prestigious Thomas Benton school, which was immediately renamed after a prominent local Negro minister, Dr. D. A. Holmes. But before we could occupy it, adjustments were made that my friends and I resented: The dance room with mirrors and ballet bars, the swimming pool, the science labs, and other amenities were eliminated, and many classrooms were cut in half. Nevertheless, we thought it was a grand school. After occupying the school for 2 or 3 months, there was a major fire (suspected arson) and half the school was destroyed. For the remainder of that year and part of the next, we went to school in double shifts, sat two to a school desk, and shared one set of books per grade level. Despite these conditions, our Negro teachers never missed a beat: They continued their mission of teaching Negro children—with excellence. When I was about to enter the third grade, the Brown v. Board of Education Supreme Court decision (desegregation of the nation’s public schools) was issued, and the Kansas City, Missouri, school district announced it would immediately desegregate, with notices of school assignment to be sent in the mail. I was so excited! Every day I asked my mother, “Did the notice come today? Where am I going to school?” Finally, one day her answer was, “Yes, it came today and you are going to Greenwood School.” I responded, “Where is Greenwood School?” She looked at me a bit quizzically and said, “It is located up the street at 27th and Cleveland.” I felt like a fool. The school was exactly two blocks from my home and I had passed it several times every day. But because it was a

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White school, I had never felt the need to know its name. This was a very salient lesson for me related to the social ecology of race and marginality and its creation of differing social, psychological, and physical worlds. We Negro kids approached our attendance at Greenwood School with both excitement and apprehension. Would they (the White students) know more than us? Be smarter than
us? My school walking (Black) group would discuss this issue every day as we took our meandering route home from school. We dissected the abilities, skills, knowledge,
interactions, behaviors, and responses of every student in our classes and maintained a continuing racial comparative analysis. After more than a month of these daily discussions,
we unanimously concluded, “No, they ain’t no smarter than us.” And then we began to enjoy this and other benefits of integration. But the following year, the White enrollment decreased from 40% to about 15%, and the year after that, Greenwood was virtually all Black and de facto segregated—as would be the remainder of my elementary and secondary education. The school board’s policy on integration included the right to transfer from one’s assigned school. For me, my brief experience of integrated education was a major lesson on how social/organizational policy, procedure, and practices often serve to reinforce practices of privilege, disadvantage, and inequality, while simultaneously “championing” social justice and change. Another equally important lesson that my classmates and I learned was derived from the analyses conceived by our third-grade minds. We would repeatedly rely on our conclusion of racial equity in intelligence as a source of countervailing evidence and resilience as we grew older and increasingly were assailed with labels (e.g., “culturally deprived,” “linguistically and intellectually deficient,” “low need for achievement,” “victims
of a culture of poverty,” “powerless,” “alienated”) that were intended to devalue our parents, life experiences, and personal competencies and capabilities. During the late 1950s, my mother and father were among leaders of efforts to desegregate Kansas 110       H o nori ng O u r E lders

City’s public accommodations and major employers. Community meetings (based on a coalition model involving nearly every Black organization and institution in the city as well as White allies) were routinely conducted weekly at the local Negro YWCA. My mother and father dragged me and my brother to nearly all of them. As always, we were instructed “to listen carefully.” It was at these meetings that I first learned about major social change skills related to strategy and tactics; community organization, mobilization and dynamics; as well as associated relationship-building, use of media, and mediation/negotiation.

YOUTH My entry into high school in 1961 marked a transition. Not only would I be entering high school, but my brother (my tenderhearted, beloved best friend) would be leaving for college. Because I viewed this transition as a time to “grow up” and “get serious,” I devised a “grown-up” summer project for myself. I would educate myself about my people and the meaning of race in the United States. That summer, I read more than 50 books, starting with Harriet Beecher Stowe’s Uncle Tom’s Cabin and ending with James Baldwin’s Go Tell It on the Mountain. In between these two, I read biographies of Black notables, literature (such as all of Langton Hughes Simple series, Richard Wright’s Native Son, Alan Patton’s Cry the Beloved Country), poetry (by Gwendolyn Brooks and others), social analyses (by E. Franklin Frazier, W. E. B. DuBois, Charles S. Johnson, Gunnar Myrdal, and others), historical analyses (e.g., Lerone Bennett’s Before the Mayflower and John Hope Franklin’s From Slavery to Freedom), and others. I emerged from that summer with not only a strong sense of personal and group pride but also with a clear sense of the many nuanced themes of the Colored/Negro/Black experience of oppression, resistance, resilience, and pursuit of social justice. I also developed an appreciation of the role of scholarship and research. High school was both fun and challenging. One of my (White) teachers had a habit of sharing stories about her son, Craig, who was portrayed

as brilliant, always with a book in his back pocket, doing things and going places that we didn’t or couldn’t. The stories always ended the same way: “Just remember—Craig is your age and in the same grade and you might end up going to college with him.” Although my classmates and I generally viewed Craig as a bit weird, we were nonetheless a bit ruffled by the teacher’s ending story statement. (As fate would have it, one of my classmates and I did become college classmates of Craig.) One day, this teacher mentioned that Craig was involved in getting a foreign exchange student for his school—and we could do the same. Well, a group of about a dozen of us thought that perhaps we could. And during the summer we met weekly, becoming familiar with the foreign exchange student organization’s rules and procedures; devising a fundraising plan targeted to students, community organizations, businesses, and churches; and identifying a highly “respectable” and well-traveled (retired military) family to house the student. We prepared and submitted our application. Subsequently, my mother received a call from the organization’s local chairperson who wanted to meet with my mother and me. At that meeting in our home, we were informed that the organization believed that a foreign student could not get a comprehensive view of America at a predominantly Black school. A couple of days later when, at my mother’s insistence, the local chair of the organization came to my school to inform the students of this decision, some of the toughest guys donned sunglasses while girls openly let their tears flow. But we were exceptionally resilient kids, and the next day we began transforming our fundraising plan into a protest plan involving a letter-writing and media campaign. We secured a front-page story about our dilemma in the city’s major newspaper. In addition, my father (then involved in state politics) wrote a letter to one of Missouri’s U.S. Senators inquiring as to whether the organization received State Department funds (it did) and if so, was it legal for such funds to support racially discriminatory organizations (it was not). Within a month of our rejected application, the national president of the organization flew into town, held a

news conference, and announced we would get our foreign exchange student—and we did! This was my first experience of leadership in community organization and mobilization. A year later, I applied to the same organization to be a foreign exchange student and was selected. To my surprise, this resulted in a family minipageant of the hopes and fears of the Black experience. My Grammy Holliday, a lifelong domestic servant well acquainted with the vulnerability of Black girls, uncharacteristically weighed in and declared, “That girl
is too young to go that far for that long alone.” Daddy, as family patriarch and protector, was of mixed opinion and in need of “more time to think.” Mamma, as the traditional keeper of the Black family’s hopes and futures, simply noted, “This is an opportunity she has earned and deserves and she should go”—and the next day took me shopping for suitcases. I spent my senior year of high school in Denmark. It was an experience that opened my eyes to issues of cultural differences and the alternative possibilities and realities in a multicultural world. I promised myself I would travel the world—and I have.

THE POST-SECONDARY YEARS The University of Chicago (UC) was the site of my undergraduate studies. Despite there being only 24 Black students in my freshman class (a 400% increase from the previous year), I loved its academic climate: its modified “Great Books” approach, its emphasis on the analysis and integration of ideas and not just facts, and its demand for hard study and constant research, as well as clarity in written and spoken communication. Intellectually and academically, I thrived. When it came time to identify a major, I knew I wanted to focus on an area that held some personal relevance. I first thought about anthropology but was concerned that its occupational alternatives (for a Black woman) might be too limited. Then I thought about sociology and took a class on social stratification. During much of the class, the instructor drew line graphs of Xs and Os (high and low statuses) on the blackboard, where the Xs were

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always going uphill and the Os were always going downhill. I couldn’t quite get my head around the notion of parsing the world into Xs and Os. Then I started taking psychology courses, and I was introduced to Kurt Lewin’s ecological field theory, which focuses on the structure of the individual’s/social group’s interactions with social-psychological and physical environments. Colle­ ctively, these interactions are termed a lifespace, which is comprised of “lifespheres.” The latter are differentiated by differing socialization agents, behavior settings, and opportunities for (and barriers to) role-taking and accomplishment. I was especially intrigued by Lewin’s notion of “lifespace barriers” and their positive and negative effects on individuals and social groups. Another psychological theory that sparked my imagination, and struck me as compatible with both salient issues of the Black experience and my personal interests, was Erik Erikson’s theory of life span (ego/identity) development, which views human development as embedded in biosocial, cultural, and historical contexts. In addition, in informal UC study groups involving both Black graduate and undergraduate students, I was introduced to theories of the then-emerging area of Black Psychology, which also emphasizes cultural and historical context. Two persons were especially inspirational and pivotal in solidifying my commitment to psychology. One was Joseph Howard, a UC Black psychology graduate student and brilliant clinician and theoretician who integrated the psychological and political (a la Frantz Fanon), and who repeatedly urged me to become a psychologist. The other inspirational figure was Black UC Professor Allison Davis, a social anthropologist and psychologist who in 1942 became the first Negro to gain a full-time faculty appointment at a major U.S. White university. Later, he conducted landmark studies on both racial bias in IQ tests and the effects of caste (race and class), color, and child-rearing practices on the social experiences and personality development of southern Negro adolescents. I met Dr. Davis when he invited all UC Black students to his large, well–appointed Kenwood townhome. 112       H o nori ng O u r E lders

Most of us were overwhelmed by the setting: dark wood, elegant rugs, walls lined with books and art, wine and hors d’oeuvres passed on silver trays. Then the man himself appeared and descended down the staircase—tall, trim, silver-headed, handsome in a well-tailored perfectly pressed suit. It all was the epitome of the academic life—only brushed in Black! After graciously speaking with each student, Dr. Davis then made a brief speech in which he stated, “You are all unquestionably brilliant or you as Black students would never have been admitted to this University. But in this nation, your brilliance and knowledge and skills will never be fully acknowledged and you will never be able to make all of the contributions of which you are capable. . . . I urge you to move to Africa. . . . I have told my own children the same.” We were all speechless—and I was immediately smitten. The next day I went to the library and began reading everything I could find by Allison Davis. I wanted to understand this man. Two decades later, I discovered an archive of some of Davis’s personal papers. Included were a series of letters written by Davis to foundation officials related to his forthcoming participation at a research project meeting in the South during the late 1930s. I nearly wept as I read Davis’s detailed, carefully crafted, repeated attempts to modify the meeting agenda and arrange train transport from Chicago to the then-Jim Crow southern location in a manner that would preserve some of his professional integrity and dignity. Davis’s words to the UC Black students would come to mind (with varying resonance) throughout my career.

THE POST-BACCALAUREATE YEARS After experiencing 1968 in Chicago—the assassination of Dr. Martin Luther King Jr., the subsequent riots in Chicago, the assassination of Bobby Kennedy, the chaos of the Chicago Democratic Convention with its massive public demonstrations against the Vietnam War, as well as the 1969 murder of Chicago Black Panther Fred Hampton—I

was too emotionally distracted and exhausted to change gears and think about long-term career plans. So I applied to graduate school with a focus on education and the strengths of Black children. I was admitted to the master’s program at Harvard University’s School of Education. Prior to my departure from the University of Chicago, Joe Howard, who was raised in Boston, pulled me aside and with a hint of urgency stated, “Bertha, you need to understand you are leaving the Jewish citadel of higher learning and going to the White Anglo Saxon Protestant citadel of higher learning. They are different animals.” I am still uncertain of Joe’s intended meaning. But at Harvard (compared to UC), I was struck that in informal conversations, students were somewhat more concerned about one’s academic and family/ social pedigrees and connections, and somewhat less concerned about one’s life experiences, knowledge, skills, and intellect. Years later, I would realize that such subtle differences of institutional culture and values (and their implicit assumptions and varying impact) are at the heart of the conundrum of diversity and inclusion challenges. Upon award of the Master’s Degree in Elementary Guidance Counseling from Harvard, I returned to Kansas City—only to discover that the Missouri State Board of Education did not recognize the position of “Elementary Guidance Counselor.” That put a slight damper on my ambition to effect some modicum of change in the treatment and labeling of Black children in
the city’s public school system. (However, over the next 2 or 3 years, I served as campaign director for two successful Black school board candidates.) I did find a job administering developmental screening tests in early childhood education programs and consulting with teachers of children identified as developmentally delayed. After a year on that job, I went on a vacation to West Africa and reveled in my immediate familiarity with, and understanding of, the gestures, postures, and personalities of West African women. I left West Africa secure in the knowledge that I indeed was both an American woman and an African woman.

Upon my return, I was notified that funding for my employing program had been terminated— and I was unemployed. I subsequently secured a job with Kansas City’s Model Cities Program—an L. B. Johnson administration Great Society urban program that emphasized coordinated planning, rebuilding and rehabilitating, social and educational services delivery, and citizen participation. Initially, I was employed as a program evaluator and later as the administrator of the program’s education and manpower development projects. I then (and now) believed Model Cities was a highly innovative program that had great potential for effecting significant improvements in social justice, opportunity, and public policy. Of course, the program also had some shortcomings such as an absence of continuous community leadership development and insufficient systems and resources for continuous data collection linked to program assessment and modification. Such shortcomings were quite fixable. But the political will of this nation tends to be short-lived, and with a change in the presidential administration, federal funding for Model Cities ended 8 years after its initial authorization. After 4 years at Model Cities, I became restless and desired to acquire more skills that might address some of the program shortcomings I observed. I decided to return to graduate school in community psychology. I was admitted to three doctoral programs and chose to attend the University of Texas at Austin for two major reasons: Its program had a great deal of flexibility that enabled multidisciplinary training, and its program director, the iconic Ira Iscoe, strongly desired to diversify his students and was prepared to support students of color financially, academically, and emotionally. I made the correct choice. The curriculum allowed me to develop a love for qualitative research as well as some mastery in the use of data and statistics. The curriculum also allowed me to take courses outside of the Department of Psychology in the Schools of Education, Public Policy, and Social Work, as well as the Department of Sociology. And of course I learned more psychology. Ira was always there to egg me on,

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support me, promote me, protect me. Nevertheless, I experienced the marginality of racial minority status: The Psychology Department had little experience with African American students, and consequently, faculty occasionally were somewhat insulting and more typically rather distant; my fellow program students held group study sessions which I knew nothing about until I was hard at work on my dissertation. Had it not been for Ira’s constant support, such incidents would have been experienced as much more than minor irritations. My dissertation reflected my continuing theoretical interests in the social ecological and developmental theories of Lewin and Erikson. Its title: The Ecological Mapping of the Behavioral Competencies of Latency-aged Black Children in the Lifespheres of Home, Neighborhood and School.

PSYCHOLOGY CAREER Upon receipt of my PhD, I secured a faculty position in a doctoral psychology program at a major southern university. It was not a good experience: It was a poor “person-environment fit.” I recognized this at my first faculty meeting, when the department chair announced that a nearby large Historically Black University did not have “a single decent student”—and none of my colleagues responded. So I closed my eyes, took a deep breath, and raised my hand. Shortly thereafter, I embarked on a “crusade” to encourage the recruitment and retention of diverse students in the program. I am extremely proud of their subsequent professional contributions. I also continued to extend my research on issues of African American family and child socialization, seeking grant money for a study that would examine the effects of social change on child socialization practices. I received a Ford Foundation postdoctoral grant that enabled me to complete several papers for publication and study and conduct research on African American socialization under the tutelage of Urie Bronfenbrenner (social-ecological child development) and Glenn Elder (lifespan
development)—both of Cornell University. 114       H o nori ng O u r E lders

Upon return to my home university, I went up for tenure and was informed that my research area was child development. In response, I noted that my research area was more closely related to family and child socialization, and the theoretical underpinnings of, and questions posed by child development researchers and socialization researchers were different. At the end of the tenure review process, I was asked for suggestions for improving that process. My response was short and simple: “Appoint one senior member of the review committee to serve exclusively as the applicant’s advocate.” I was not granted tenure. Subsequently, I received a Congressional Fellowship sponsored by the Society for Research in Child Development. The Fellowship enabled me to secure a position with the Senate Democratic Policy Committee (the Democratic Senate Leader’s [Robert C. Byrd] staff), where I was afforded a broad and intense view of the nation’s public policy and political processes. The Fellowship also enabled me to reassess my career path. Eventually, I concluded that while I loved the students, teaching, scholarship, and research of academia, I had a distinct distaste for its politics. I decided to remain in Washington, DC, and in consideration of my analytic and statistical skills, reinvented myself as a program evaluator—primarily at St. Elizabeth’s Hospital of the DC Department of Mental Health. There, I had access to an incredible longitudinal database that I used to conduct some then-unprecedented multivariate studies on patient treatment and efficacy, patient outcomes, and related predictors of mental health and demographic statuses. After 18 studies and 7 years of mental health research and evaluation, I decided it
was time for another reinvention that would couple my psychological and administrative knowledge with my public policy and social justice concerns. I assumed the position of
Director of Ethnic Minority Affairs at the American Psychological Association (APA), where I worked under the supervision and mentorship of Henry Tomes for 12 years. I immediately
tasked myself, in consultation with my staff, with developing a strategic map of what an
Office

of Ethnic Minority Affairs in a highly privileged scholarly/professional organization
might do, and how such efforts might result in greater diversity, inclusion, and social justice in psychology. Major components of that map were •• empowerment and greater inclusion and visibility of psychologists of color by seeking and creating opportunities for increasing their voice, visibility, and participation; •• education of the broader membership on both the nation’s changing demographics, and the specific needs and concerns of psychologists and students of color and the communities they serve, as a means for building increased support for diversity; 
 •• diversification of psychology’s educational pipeline relative to students and faculty to ensure that future cohorts are more representative of the nation’s population; 
 •• development of a pluralistic knowledge base in psychology that promotes the infusion and collision of diverse topics, methods, and ideas in the discipline’s professional literature and curricula, and enables psychologists to be comfortably situated in the
midst of such diversity; 
 •• development and promotion of visible communication networks targeted to both psychologists of color and others as a means for increasing the inclusiveness, transparency, and scope of relevancy of the Association’s formal and informal communications, information dissemination, and decision making—especially as these pertain to psychologists of color and the communities they serve; and 
 •• development and promotion of aggressive accountability and evaluation systems on diversity and social justice as a means of ensuring (a) social justice change that is planned and sustainable rather than mere happenstance; (b) continual improvement of related methodology, interventions, strategies, and tactics; (c) promotion of the benefits and success of such efforts and their outcomes; and (d) accountability of 
efforts and their outcomes to supporters, funders, and organization leaders.


The master key of this strategic map is empowerment and associated visibility and voice. For social

justice purposes, it is assumed that the concept of power must be reframed from a zero-sum game (if I win, you lose) to an entity with expansive capabilities that can bring benefit
and advantage to all. 
Specific initiatives derived from this strategic map emerged and changed over time, but the map was never modified. The map was conceived as a personal long-range plan for change that enabled the development of ideas far in advance of the implementation of specific initiatives. Initiatives that I either staffed or organized and take greatest pride in are •• the Commission on Ethnic Minority Recruit­ment, Retention and Training in Psychology (CEMRRAT) and its successive Task Force and Grants Fund;
 •• the 1997 Miniconvention on Racism, which involved more than 300 presentations and 150 hours of programming on the major topics of Psychology of Racism, Racism in Psychology, and Psychology of Anti-Racism; •• the APA Delegation to the 2001 UN World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance (WCAR) in Durban, South Africa, where the delegation proposed policy language related to racism and mental health that was incorporated into the WCAR Declaration and Programme of Action, which was approved by the UN General Assembly; •• serving as a Principal Investigator/Project Director for 13 years (1996–2009) of the APA/ NIGMS Project, which demonstrated that institutional collaborative partnerships involving minority and majority institutions can serve to encourage psychology departments to focus on excellence in minority undergraduate research training, resulting in positive benefits to the entire department; and •• serving as co-editor (with Alberto FigueroaGarcia) of the OEMA Communique News journal.


These accomplishments were not without complications and setbacks. For example, concerns about APA’s participation in the UN Conference on Racism resulted in my being informed by the

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APA Board that I had a limited understanding of racism and was anti-American. After submitting a 200-page proposal for an edited three-book series derived from the 1997 Miniconvention on Racism, I was informed it was declined as the acquisition editor “couldn’t think of 100 people who would buy it.” Fortunately, when setbacks occurred, the guidance provided by the strategic map and its identification of various problems of social justice and diversity in psychology enabled me, without too much difficulty, to “move on” to other issues. During my 16 years at APA, a decision to take action on a specific strategy was primarily based on political opportunity. This involves identifying those unique moments in time and space when there is sufficient leadership interest and will, governance and membership support, external environmental concern, and/or available financing to support the implementation of a specific strategy or initiative. I was informed about such factors and how to leverage them primarily by observing the problem-solving and strategic styles, and by “listening carefully” to the concerns, the stories, the histories—the voices—of a chorus of psychologists of color. The courage, commitment, insight, and passion of these psychologists transformed me: I progressively became more keenly aware of both the differing experience and interpretations of oppression, colonialism, internment, dispossession, and exclusion among racial/ethnic/cultural groups, as well as the commonality of those experiences. These observations and conversations enabled me to make and/or support smart strategic and tactical recommendations that bridged interests of a variety of racial/ethnic/cultural groups. These voices also sparked my more recent interests in the history of ethnic minority psychology and diversity and inclusion. I am particularly indebted to Alvin Alvarez, Carolyn Barcus, Beth Boyd, Toy Caldwell-Colbert, Manny Casas, Joseph Cervantes, Alice Chang, Priscilla Dass-Brailsford, Alberto Figueroa-Garcia, Anderson J. Franklin, Miguel Gallardo, Melinda Garcia, Reginald Jones, Teresa LaFromboise, Harriet McAdoo, Harriet 116       H o nori ng O u r E lders

McCombs, Art McDonald, Edwin Nichols, Corann Okorodudu, Patrick Okura, William Parham, Lisa Porche-Burke, Richard Suinn, and Henry Tomes.

CONCLUSION: LOOKING TOWARD THE FUTURE I am extremely honored and humbled to be regarded as a pioneer and elder. I take this to mean that I will no longer be confronting brick walls with blood and bodies at their foundation. This can now be left to younger, more agile social justice advocates. As an elder, I believe it becomes my responsibility to continue to learn about emergent social justice theories, issues, methodologies, and strategies from younger cohorts, while sharing with these cohorts my past experiences, any resulting wisdom, and lessons learned on how to confront brick walls without incurring significant injury to one’s self, spirit, or soul. Let me take this opportunity to take a stab at elderhood. Based on my experience as a child of the Civil Rights Era, I view institutional and social justice change as very long-term
and incremental processes that require a great deal of reiterative effort, social/political/historical/psychological analyses, implicit and explicit support from an
organization’s top leaders, and forethought. Increasingly, social justice advocates will need skills that extend beyond those required for multicultural competence in interpersonal or group contexts. Indeed, social justice advocates are frequently required to demonstrate multicultural skills and knowledge related to organizational and systemic behavior and functioning, social planning and policy processes in a variety of contexts, negotiation/mediation, and historical analyses of reoccurring predicaments/ challenges and associated responses. Advocates also should be able to envision, relative to a specific issue, what social justice looks like and articulate and share that vision with others. Advocates also benefit from knowledge of research and evaluation procedures, which are critical to lending credence to social justice efforts. Such expanded competence, I would postulate, is what distinguishes

diversity and inclusion/social justice experts from multicultural experts. As a child of the Civil Rights Era, my life has not been without abuse and trauma. Be clear: I am not speaking of the subtle implicit behavior of covert racism and microaggressions but of overt behavior explicitly intended to humiliate and devalue a sense of self, efficacy, and power. Under such conditions, my mother taught me grace; my father taught me resistance. Both of these ways of “being-in-the-world” have served me well as I internalized and made sense of the experiences and lessons of my childhood, youth, and later life. Psychology enabled me to put an intellectual and scientific face on these lessons, which added to my capacity to predict, understand, and manage the effects of abusive/traumatic behaviors. I was exceptionally fortunate to observe and acquire many of the requisite skills and knowledge of social justice advocacy as a result of my lived experiences during the Civil Rights Era. But now, in an era of social conservatism, the acquisition of such skills and knowledge will probably require greater investment in more formal specialized multidisciplinary education and training. I would further suggest that social justice advocates view such training and education as developmental and lifelong. I also encourage those committed to social justice to directly engage the challenge of social

justice advocacy and intervention. As my mentor Ira Iscoe noted, “If you want to know how an organization or system works, try changing it.” Occasional fatigue and failure should be expected and viewed as a source of growth, learning, and possible reinvention. Resistance to change should always be expected. My experiences suggest that the extent and impact of such resistance in part is related to the extent of the goodness of the “fit” between the values, priorities, beliefs, and attitudes of the social justice advocate and those of the organization/system and its leaders. The pursuit of social justice is extremely difficult but highly rewarding work that enables psychologists to integrate concerns of inequality and marginality with psychological knowledge and skills. In addition, social justice work requires passion, patience, and courage. Engagement in this work has provided me a sense of personal fulfillment, joy, and symmetry of my personal and professional lives. My wish for graduate students and early career professionals is that you might, over time, fashion your personal and professional lives in a manner that enables you to use your privilege thoughtfully and responsibly, and to experience passion, fulfillment, symmetry—and the fullness of your humanity.

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CHAPTER

12

I Understand Memories of a Constant Contrarian Anthony J. Marsella

I

am honored to be invited by the editors of the Handbook of Multicultural Counseling to contribute an autobiographical account of those events, forces, and people that have influenced and shaped my particular contributions to the advancement of multicultural counseling and psychology. I have been asked, especially for the sake of students, to comment on some examples of my contributions and the sources inspiring and informing my work. The answers to these questions are complicated. I have chosen to answer the questions by addressing how “multiculturalism,” not as a disciplinary or professional subspecialty, is for me a natural—perhaps reflexive—orientation for life. The recognition and acceptance of diversity in life—differences—stands as the fundamental foundation for my life. Life is diversity! To deny diversity as the manifestation of life’s purposes and presence denies an awareness of life. While so many people, events, and forces deserve citation and mention, I will focus on a few because of limitations in space.

CONTRIBUTIONS From my earliest days as a psychology student, I felt and found the importance of differences among people to be essential to description, understanding, and prediction of behavior. When I read that psychology was the study of “individual differences,” I knew I had found a career topic. Yet it became quite clear that “individual differences” in psychology were limited by the field to the psychological and physical determinants of behavior, while ignoring other sources, especially those confined to anthropology and sociology. Yet I could see from my youthful experiences that differences were also cast in gender, age, social class, race and ethnicity, and cultural roots. I was constantly alert to “individual differences” but saw them within categorical descriptors rather than the uniqueness of the person. The stage was set for stereotypes of gender, racism, and a score of other biases that I would both learn and unlearn. Psychology, in fact, was ignoring one of the essential and most powerful sources of differences and diversity in my construction of reality, and that was the role of ethnocultural and racial determinants 118

of behavior. I lived them! I could see “brain” was critical, but I could not accept that “brain” exists apart from milieu. When I took a graduate class in cross-cultural psychology in 1965 at Penn State University, I was instructed to do a term paper on cultural variations in psychopathology. My future as a “multiculturalist” was assured, indeed, it was fixed. I saw ethnic and racial variations growing up, and I understood why they occurred, why they were important. In 1969, at 28 years of age, following postdoctoral experiences as a Fulbright Fellow in the urban Philippines and as a psychiatric epidemiologist in the jungles of Kuching, Sarawak (British Malaysia), I was privileged to speak at an international conference on culture and mental health in Honolulu, Hawaii, sponsored by the National Institute of Mental Health (NIMH) and attended by 24 of the most distinguished professionals and scientists in the field (e.g., legendary scholars including Gregory Bateson, Alexander Leighton, Jerome Frank, William Caudill, H.B.M. Murphy, Thomas Scheff, Takea Lebra, and William Lebra). I opened my remarks by addressing the ethnocentric biases of Western psychology and psychiatry and the failures to grasp the powerful role of culture as a determinant of human behavior. Especially absent from our knowledge and practices, I argued, were empirical studies of ethnocultural variations in the rates, expression, and descriptive parameters of psychopathology and psychotherapy. The opening lines of my talk, written in 1969 and published in 1972, included the following: 1. Man and his socio-cultural environment are interdependent systems which reflect attributes of one another. 2. Consideration must be given to the interdependencies of the situation and the individual; this is probably best accomplished through multivariate data procedures. 3. All behavior is influenced by the socio-cultural experience of the individual since behavior is influenced and modulated by such learned behaviors as conceptions of time and space, causality, and sensory reliance.

4. Maladaptive behavior is continuous with adaptive behavior and assumes forms and patterns consistent with an individual’s culturally conditioned life style. Thus, disordered behavior in any culture can be considered to be culture-specific.

For the times, these were considered revolutionary assertions, especially by a 28-year-old neophyte amid older and established figures. I recall Gregory Bateson came to me after my talk and said, “Good show, good show,” with that wonderful deep voice and British accent. I was assured. But another participant said to me, “You know, you are a very bright young man, but if you keep talking like that, your career is going to be very short.” Well, my career was not short, and these early years were followed by wonderful opportunities to teach, to study, and to publish articles and books on culture and psychology. This included my selection as the only psychologist to become a leader of a World Health Organization (WHO) Psychiatric Research Center for the Study of Severe Mental Disorders (1978–1998) and the privilege to meet and to work with my lifelong friend and colleague, Paul Pedersen. We received a 3-year grant for Training Multicultural Counselors. Counselors were to be trained to address the variations in personal and group mental health, and to use culturally appropriate and sensitive assessments and interventions (1977–1981). I suggested we use the knowledge-attitude-practice paradigm I had used in WHO studies of fertility regulating methods. It was in this grant that I began to use the term multicultural and to adopt multiculturalism (diversity) as a life philosophy, consistent with lived experiences. My efforts culminated in receiving the American Psychological Association (APA) Award for Contri­ butions to International Psychology, with the attendant offer to deliver a paper on the topic of my choice. I consider this address and paper, published in 1998 in the American Psychologist and titled “Toward a Global-Community Psycho­logy: Psychology in a Global Era,” to be my most impor­tant statement. I have continued to follow its assumptions and conclusions with other publications, including a I UNDERS TA ND

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2014 commentary, “All Psychologies Are Indigenous Psychologies,” an article obviously continuous with statements made 35 years ago. Some have said the 1998 paper on globalcommunity psychology was a new declaration for psychology to move to an international stance, and to move toward an awareness of psychology’s consequences for social justice and activism amid the challenges of our global era—including 20 challenges I listed. By the late 1990s, I was a visible contrarian, speaking out against violence, war, and injustice, and also speaking out against ethnocentric biases. I was living “multiculturalism,” as an ideology and as a lens for reconstructing psychology and psychiatry. Much of the impetus for this behavior—the inspiration—was born and nurtured in my youth.

THE PUSH AND PULL OF LIFE EXPERIENCES My fate as a “pioneer” figure in multicultural psychology was sealed in the earliest days of my youth. I was born into an immigrant SicilianAmerican family in Cleveland, Ohio. Our family lived a traditional Sicilian lifestyle with regard to language, foods, social relations, and waysof-knowing and ways-of-being in the world. I spoke Sicilian because my family, and later my stepfather, spoke Sicilian. My parents divorced when I was 4 years old (1944). There was, as might be expected, rancor and resentment between my parents as the harsh realities of divorce settled upon all of us—issues of money, housing, and face. Issues of honor! I witnessed and experienced the divorce through young eyes, but eyes sensitive and alert to the suffering and pain about me, especially the grief of my mother. The court’s divorce settlement gave my mother custody, and my father was ordered to never have contact with me. No alimony was accepted, and with this act of “revenge,” I was never again to see my father until I was 39 years old, and by then a professor of psychology at the University of Hawaii (Honolulu, Hawaii) specializing in cross-cultural 12 0       H o no ring Our E lders

and international studies of variations in perso­ nality, psychopathology, and psychotherapy. I held this position from 1969 to 2003, when I retired because of cancer. The story of the interim years is a story of being pushed by the past and pulled by a future that seemed to unfold with a guided hand. The combination of experiences and the emergence of opportunities led me from the streets of inner-city Cleveland to extensive national and international roles as an academic scholar challenging the ethnocentric and racial biases of Western psychology and psychiatry. It would also strengthen my behavior as a social activist, driven by experiencing and witnessing the injustices in my youth and in my professional career. There can be no doubt that the injustices and horrors of the Vietnam War (1964–1974) shaped my sense of anti-war activism. I continue to publish and to speak against injustices to minority populations and other populations at risk, including immigrants, refugees, and those burdened by the societal and cultural inequities that impose poverty, illness, and stigma. I experienced these burdens in my own life, often comforted by my mother’s Sicilian-English creation of words to endura (endure) and sopportare (bear the unbearable), much as she did throughout her life. She was compelled to drop out from school in the tenth grade and to work long hours as a cashier in food markets, a produce clerk, and a cafeteria worker. I experienced her suffering and saw the suffering present in so many others. My mother’s suffering was to be an anchor for my insights and concerns for the plight of others— compassion was reflexive. My Sicilian stepfather, Stephen, whom I loved and respected, and who was kind to me, never was able to overcome the burdens of acculturation. America was a strange place for him. It was not what he expected after giving up his roots and identity in the confusion of postwar Italy. He spoke no English; he never learned English during his lifetime; he drove no automobile: he would take two buses to get to work in Cleveland winters; he worked for 20 years enduring long hours as a cabinet maker and furniture repairman for Sears.

My stepfather, Stephen, was as good a human being as one could imagine. He died in my arms at age 66. Days before his death, he told me one of life’s great tragedies was that so many people are never given an opportunity to develop their talents—to be acknowledged for who and what they are—individuals and members of society. I entered his life when I was 12 years old, as he walked down the gangplank of the rusted Italian ocean liner that carried him from Messina to Naples to New York. His talents as an artist and sculptor were never realized. His longing for a return to Sicily was never fulfilled. As I witnessed his struggle against inequity and acculturation pressures, I acquired a new consciousness of the importance of cultural differences.

GROWING UP SICILIAN IN CLEVELAND, OHIO Italian food stores, restaurants, singers (e.g., Sinatra, Bennett, Como, LaRosa, Damone) were symbolic of the Italian community of Cleveland. In addition, many Italian heroes and celebrities were well known and recognized throughout the community in the 1940–1960 era. The community and these individuals, in particular, helped to shape the identities and the futures of many Italian kids during this era. Growing up in Cleveland in the 1940s–1960s in an Italian (Sicilian) family made me well aware of my identity that was reflective of my culture. Neighborhoods included many different ethnic groups; these were kept distant from inner-family circles. As such, the ethnic and racial differences could not be avoided or ignored. Stereotypes, rooted in the realities of daily life, were used by all groups to refer to each other. Everyone was conscious of diversity, even as each group considered itself the best. Inner-city Cleveland was both a melting pot and salad bowl for differences—unity and diversity. Inherent in one’s language or dialect is an entire way-of-being in the world and knowingthe-world. Memories are coded in place, time, and language, and my accumulated memories from

much of my youth are experienced within a Sicilian context. I lived with many family members in a four-story house, in which different families and relatives occupied various floors from basement to attic. All ate together every night at a large family table where seating positions were assigned, and where the “stuff ” of the day was shared amid laughter, teasing, yelling, profanity, and kisses and hugs. Most of the content of the constant talk was about people—descriptions, opinions, evaluations, and judgments. These were exchanged with words, expressions, and gestures, and one had to learn the communication code, and also the hierarchy of who was permitted to say what, and with what authority or justification. Everything occurred in either Sicilian or “Sicilianish,” which was SicilianEnglish. For example, the word for “toilet” was not “il cabinetto” but rather “bacauasa” or “back house.” Amid this context, I was socialized— perhaps a better word is “ordained”—to eventually become a multicultural psychologist. Make no mistake about it! Every aspect of my life, of my Sicilian life—language, food, religion, social relations—carried with it seeds of my identity and being that continue to this day.

ETHNIC AND RACIAL DIFFERENCES Being raised in a multigeneration Sicilian family and household has consequences. I was expected to learn to live with a score of family people according to traditional customs. The family was a “tribal” collection of blood and marital ties. It embraced non-Sicilians who entered la famiglia via marriage (i.e., Poles, Slovenians, Hungarians) but it was considered unfortunate they lacked Sicilian blood. I can recall the descriptive references to them in the rich and expressive Sicilian dialect of our family as La Polaca (the Polack) or Ou Americano (the American). None of this was meant in malice; it was simply part of the experience of Sicilian immigrants coming to terms with life in a new land in which encounters with immigrants from other countries I UNDERS TA ND

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required a negotiation of differences. Differences between, among, and within people was a central part of our lives, and I was sensitized to the differences for as long as I can remember. The awareness (i.e., consciousness) of differences brought with it the inevitable stereotypes for people within the family and those who were not Sicilian. Some of the stereotypes were harsh, cruel, and rooted in ignorance. It took me years to lose some of them through unlearning via daily contact. I want to share some of these biases because they constitute the sources of recognizing differences that are at the heart of my assertion of how “differences” framed my life—differences between genders, races, ethnicity, religions, ages, and the poor and rich. Some stereotypes were validated by the desperate poverty of the conditions in which Blacks lived. I listened to these prejudices as a child, while I simultaneously was enthusiastically cheering the talents of the growing number of Black athletes in Cleveland’s sports teams (e.g., Satchel Paige, Larry Doby, Marion Motley). I had a silent ambivalence. I wanted to question, but did not. We sang Negro Spirituals in an elementary school fourth-grade concert (1949). I was moved by the poignant words, mournful tunes, and by our teacher’s descriptions of Black slavery before the Emancipation Proclamation. (Little did I know the burdens Blacks would bear to our current day.) My new knowledge was overwhelming. I bought a classic comic book, Uncle Tom’s Cabin, by Harriet Beecher Stowe, an illustrated version of accurately keeping the words. I could not believe the evils of slavery—the oppression and abuse. The exposure to slavery brought with it a sense of personal guilt. Why had we treated people—human beings—in this way? I became fascinated with Martin Luther King Jr., Malcolm X, and Eldridge Cleveland who said, “If you are not part of the solution, you are part of the problem!” Did I have a social responsibility? I always wanted to be part of the solution and did so by becoming a strong advocate for recognizing the dangers of ethnocentric and racial bias in psychology and psychiatry. I was living multicultural psychology before it had a name. While many 12 2       H o no ring Our E lders

feared the fiery orations of Malcolm X, I found myself saying, “If I was Black, I would be saying the same thing!” The growing movement of revolutionary Black Panthers in Cleveland was a source of fascination for me, leading me to be considered a revolutionary risk by local and college security. Yes, a revolutionary risk because I joined Black friends and visited and socialized with Black Panthers—a group considered by the FBI to be dangerous—a group betrayed in their assertions and good works by Richard Aoki, as he infiltrated on behalf of the FBI. I know my behavior led to my being placed on the Co-Intel-Pro secret lists of J. Edgar Hoover. Later in my life, when I read the works of James Baldwin, Ralph Ellison, and William Styron’s The Confessions of Nat Turner (circa 1972), I knew I had been a voice for the voiceless! It was part of my nature and experience. I visited Harpers’ Ferry in West Virginia—scene of John Brown’s efforts to end slavery. The place, the events, and the consequences were inscribed in my mind. Jews were also stereotyped in my family. I had difficulty understanding how they were labeled as intelligent, educated, and wealthy, and yet were also the subject of negative stereotypes—greedy, sneaky, and untrustworthy! We were told to get a Jewish lawyer or doctor if we needed help. Yet their intellectual and professional success was never acknowledged to be a function of their unduplicated and disproportionate talents. In my young mind, I envied Jewish people—their talents, confidence, wealth, and success. Later, I was to fall in adolescent love with Jewish girls through junior high school and high school. This corrected many stereotypes. Aside from that, as I grew older and explored my ancestral Sicilian ties, the possibility I had Jewish blood became a reality. Jews who fled the Inquisition in 1494 were only welcomed in Sicily. Even today, one of the largest and most ornate Jewish temples in the world is located in Palermo, Sicily, my ancestral region.

RELIGIOUS DIFFERENCES Differences in religion were also an early source for distinguishing among people using stereotypes. The

big differences were simply between “Catholic” and “non-Catholic.” It was accepted without question that Catholicism was the one and only religious faith, and that all others were doomed to hell for their sins of rejection. Family members would say with somber faces and negative head nods that a “person” wasn’t Catholic—“Non sono Cattolica.” This was often said quietly as if the non-Catholics were cursed. In some ways, the meta-communication of words and facial displays was that non-Catholics were potential sources of evil. Later, in my undergraduate college years, I left Catholicism, but at the time, the struggle for identity was difficult, made all the more so by zealous Protestant ministers, professors, and college administrators who seemed to carry an obvious dislike for me. There was a sense of self-righteousness among them. This, of course, only caused me to assert my presence and to ask more challenging questions in class. I disliked self-righteousness! It was as if only these people knew inherently what was “right” and “wrong.” It was my first serious encounter with American “exceptionalism,” rooted in absolutistic Calvinistic traditions and early justifications of the exploitations and abuses of American history. En loco parentis! I now understood religion, history, and culture in a new way. Knowledge was rooted in the distribution of power and position.

GENDER AND AGE DIFFERENCES Gender was yet another determinant of the social order in my Sicilian youth. Men were considered to be dominant. This gave me a certain status because I was a boy. The socialization process for gender identity was clear: Men act this way, and women act this way. It was accepted that women were critical parts of every decision. Sicilian women can be silent, but their presence must be acknowledged. I remember the men of my early youth—uncles—as working hard from early morning to late evening. Upon their arrival home, all of us ate at a long family table filled with great Italian foods, much laughter, teasing, and expressions of opinion. Men

were dominant in some ways, but women were the glue holding everything and everyone together. They communicated by expressing their opinion emotionally or by showing silence, raised eyebrows, and a restrained—contained—demeanor. A glare from my elderly grandmother was enough to silence anyone! Women were the carriers of tradition and affection—the source of love and caring. The Sicilian men, and thus the boys, were expected to be tough, self-sufficient, and capable of handling anything. The women, and thus the girls, were expected to be strong, caring, uncomplaining, and addicted to perfection in cooking and cleaning house. The whiteness of the sheets and pillowcases was an index of womanhood, as was the cleanliness of the floors and house (“Her floors are so clean you could eat off of them!”), and the ability to cook pasta. Uncle Charlie: “Hey Nina, this sauce is great! Tell Rose what you did so she can cook it.” Aunt Rose: “Listen to him, as if he didn’t like my sauce. What do you think you’ve been eating for the last 20 years.” Grandma Angelina: “Silencio! Tutti! Io vuolo mangiare en pace.” (Quiet— everyone—I want to eat in peace. Laughter from everyone!)

MORE THAN A SPECIALTY: A WAY OF LIFE I will waste no time in sharing with readers my belief that multicultural counseling and psychology are not subspecialty areas of psychology; rather, they embrace an ideology, and affirm a particular view of life. As I reflect on my honored designation as a “pioneer figure in multicultural psychology” from the vantage point of my 73 years, I can see an unfolding of the many forces, events, and people that contributed to my present position. Yet at the time, each of these forces, events, and people seemed unrelated, and escaped any recognition as “seeds” planted along the way toward becoming a voice for multiculturalism in psychology, psychiatry, and civic life. In retrospect, my experiences were building strengths, exposing vulnerabilities, and contesting beliefs and values. A sensitivity to suffering, I UNDERS TA ND

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a capacity for empathy, and a determination to right injustices were unfolding—the seeds of a “multiculturalism” path in life were planted. While the consideration of cultural and racial determinants of human behavior have become acknowledged and accepted in recent years, it is important that the history of multicultural psychology’s struggle for legitimacy, credibility, and moral authority—a quest for power and position amidst the dominance of conventional psychology’s assumptions, methods, and conclusions—be understood. Western psychology was developed and taught by a limited number of White males in positions of academic and political power who framed Western and North American psychology as a “universally” valid scientific and professional field. Any awareness of ethnocentric bias was dismissed by reliance on science and empiricism as the arbiters of “truth.” Of course, it was not science but “scientism.” It was empirical research rooted in white rats, White college students, and implicit Judeo-Christian assumptions of morality and propriety ordering the world. I have now come to see that every topic we choose to study, the methods we use, the choice of data analysis, and the conclusions reached are moral choices, carrying with them power and position as justifications. And so, or in Sicilian “Alora,” I close this autobiographical account written with the specific intent of sharing events, forces, and people that nurtured my career as a professional and academic multicultural counselor and psychologist—a pioneer figure. I was nurtured by a spectrum of academic relationships and experiences, but I was

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also nurtured by the earliest days of my life as a member of an extended traditional Sicilian family in a multigeneration household. These experiences ordained my future. I was conscious of ethnic culture, its potency as a socializing force for behavior. I was surprised, later in my life, to find this powerful determinant of behavior in my own life absent in psychology. What is my lesson to students based on my experiences? Turn to your life experiences— they are valid—do not let them be denied, sullied, or tarnished by those in power. The emergence of multicultural psychology represents an assertion of the validity of diversity in human experience that resides in ethnic and racial heritages and traditions, and that struggles for place and position across social classes, gender, religions, and historical realities. These realities evidence themselves in visible appearances, clothing, foods, and family. But psychologically and behaviorally, these realities were struggles against homogenization via acculturation—struggles in which distinct ethnocultural identities were denied recognition, even as members cry for the dignity of their experience. In so many ways, the emergence of multicultural psychology is a story of the power of the life impulse itself to promote diversity—heterogeneity—and to seek multiple expressions and manifestations of this impulse. The Mexican Nobel Laureate Octavio Paz wrote, “Life is diversity, death is uniformity.” When I read Paz, Freire, and Martin-Baro, and a host of Black writers, I was awakened and inspired. From my own Sicilian roots, I experienced what they were asserting. I understood.

CHAPTER

13

Multicultural Pioneer Confessions of a Warrior and Healer Thomas A. Parham

I

t is interesting, if not totally flattering and humbling, to be invited to write this manuscript as a pioneer of multicultural counseling. The individuals in our profession who have been profiled in previous “pioneer” chapters of this text are a “who’s who” in our field, and to be counted in the same company with professionals I am always inspired and awed by is, as I mentioned, remarkably flattering. When I think about that pioneer label, I think about individuals who devote their life wading into unchartered waters, venturing into unknown territory, or opening up new areas of innovation and research in one’s field of endeavor. I think about great discoveries or the application of new knowledge and information that addresses major issues or solved real problems. I’m not sure that I have done all of that, but for those that see me through the lens of a pioneer, I thank you for your sentiments. However, the pride I feel in writing this manuscript is less about me and more about the validation it provides those who invested many hours in me and my professional and personal growth and development. Hopefully, the label says that their time and energy was worth the investment they made in helping to mold and shape the character I display in the roles I now assume. In retrospect, however, it is difficult for me to claim that title, even in a contemporary context, because my journey through the landscape of multicultural psychology and counseling, while being dotted with aspects of ambiguity, was more like following a roadmap chartered by some folks who came before me rather than navigating the abyss of unchartered territory.

THE DUALITY OF MY IDENTITY In the middle of my office table at the University of California, Irvine (UCI) rests a miniature African stool from Ghana with a plaque on it that reads “warrior healer.” If there is a cultural artifact that describes the posture I have tried to assume in my career, that stool would be it. It exudes culture, legacy, symbolism, excellence, strength, spirit, and determination. But that relic is synonymous of so much more in my life and mirrors a couple of axioms I have embraced in my negotiation with what life presents and confronts me with each and every day. Axioms, like wisdom sayings, are important in life because they provide one 125

with the conceptual anchors needed to ground our responses to daily circumstances in principle rather than mere instinctual reactions. The first axiom is a piece of African wisdom I have stylized over time that says, “Life at its best is a creative synthesis of opposites in fruitful harmony.” The second is more of a formula I borrow from one of my heroes, Dr. Martin Luther King Jr., who argues in his text Strength to Love (1963) for a “tough mind and a tender heart” when navigating my way through the places and spaces I occupy. Indeed, these axioms have served me well in my identity as a warrior healer. Through a warrior’s mind that looks at the world through eyes that now reflect the dark shadows below them that time, long hours, and a commitment to work hard have ushered in over my adult years as a professional, I can see those places where the exercise of a lion’s roar was a necessary posture to assume. That roar emanates from the exposure to situations growing up a Black male in America, from socialization I have received from my mentors, and from teachings and lessons I have been blessed to receive from my professional family in the Association of Black Psychologists (ABPsi) (all too numerous to name), and others in American Psychological Association (APA) and American Counseling Association (ACA) whose teaching, training, nurturing, support, love, and even critique helped me to close the gap between aspiration and actualization. For example, when entering the world of culturally congruent African-centered psychology, the great Dr. Joseph L. White taught me that not only should one not seek validation from your oppressor, but also that using traditional theories developed by traditional psychology and its major theorists to explain the behaviors of African American folks would always result in a profile characterized by weakness and inferiority-oriented conclusions (White & Parham, 1990). Subsequently, I realized and internalized a fundamental lesson imparted to me by the great Dr. Asa G. Hilliard, who taught me and us all that there is something wrong with a psychology that leaves a people strangers to themselves, aliens to their culture, oblivious to 12 6       H o no r i ng O u r E ld e r s

their condition in the world, and inhuman to their oppressors. Consequently, my career, my journey toward leadership, and the body of work I have tried to produce have been a quest to 1. not be a stranger to myself, so I’ve tried to interrogate Fanon’s fundamental question of who am I, understanding that as a psychologist, I am really a healer, trying to be a healing presence in the lives of others; 2. not be an alien to my culture, so I’ve tried to examine and explore culture at the deep structure level, understanding that culture is not simply demographics but rather a complex constellation of mores, customs, values, and traditions that provide a general design for living and a pattern for interpreting reality; 3. be conscious of my condition and the condition of my people, so I have never been a fan of getting my hair relaxed, because I needed my mind crisp and sharp. Nor have I wanted contact lenses that were colored, because I never wanted my vision to be clouded from the realities of life in America for people of color; and 4. never yield to someone else’s definition of my humanity, instead believing what I constantly teach young people, that each of us is a seed of divinely inspired possibility, which when nurtured in its proper context, can and will grow into the fullest expression of all we are supposed to become.

Through a warrior’s mind, I have also come to understand and practice the ideas that the instances of unjustified suffering, unmerited pain, and undeserved harm in America’s “twilight civilization” Cornel West spoke about in his text Race Matters (1994) leads one to conclude that if you don’t understand racism and White supremacy, what it is and how it functions, everything else you think you understand will only confuse you. That revelation from Neely Fuller and Dr. Frances Cress Welsing has caused me to confront those things in life that I thought were racist, whether incidents generally or people’s behavior specifically. Not surprisingly, though, the cultural and social consciousness I developed and now possess

was not an obstacle in my developing friendships and meaningful relationships with people across all demographic lines of race, ethnicity, gender, age, physical ability, and sexual orientation. Thus, I learned early on that being “pro” your own cultural group did not make you “anti” anyone else. What I’m saying here is that a warrior’s posture is how I learned to navigate the world, not in ways that were anti-White but rather were pro-justice. Through a warrior’s mind, I have also learned that predicting success is not always a function of traditional measures and assessment tools, for nothing is stronger than the human potential. This has been an especially challenging belief to practice in a society that treats human beings as disposable capital. But thanks to the cultural icons like Malcom X and Martin Luther King Jr., I came to quickly understand what both speak about and represent. Dr. King argued in 1962, asserting that one of the most important factors responsible for breaking down the walls of segregation in the struggle for civil rights was human determination on the part of Black people. Consequently, I reasoned that if the elders and ancestors could suffer from and yet manage the hardships, indignities, and mad cruelties that they did to get my generation to the place it now occupies, then certainly I could do the same in an environment and context that was less harsh and different, albeit oppressive. Through a warrior’s mind, I have learned that while the exercise of power is played out in the spaces of billionaire fortunes, military might, teachers who hand out grades (deserved or otherwise) to their vulnerable students, or local law enforcement agencies (who protect the public but often abuse their authority), that power may not be real. I have come to embrace the lessons of Wade Nobles, who reminds us that real power is the ability to define reality and make other people respond to that definition as if it were their own. Consequently, one of the roles I have tried to seize is the one that asks different and tough questions, even as I try and define and frame the discourse in ways that are different than what is perceived as traditional. I have also come to believe that people come from circumstance but they are not their

circumstance, and that the fundamental challenge of a Black man or woman in America, as I have characterized it in my own writing and scholarship (Parham, Ajamu, & White, 2011; Parham, White, & Ajamu, 2000), is how does he or she maintain a sense of cultural integrity in a world that does not support or affirm his or her humanity as a person of African descent? The duality of my identity contrasts a warrior’s mind with a healer’s heart. Through a healer’s heart, I have sought to embrace the tender side of my existence, which, although sometimes contrary to the ways Western society teaches men to be, informs the way I approach people and circumstance. I have tried in my life to display a high degree of empathy to people’s circumstance, and kindness to people generally. I have also tried to sustain an always half-full glass approach where love and kindness are related, allowing others the benefit of the doubt in most situations. Interestingly, my mom always worried about that giving and kind heart aspect of my personality, fearing that I might go through life with people taking advantage of me and my kindness, resulting in my chronic disappointment. I assured her on numerous occasions that being disappointed comes from having expectations about how people should respond to your acts of kindness and generosity. And since I had no expectations of anyone other than myself, my satisfaction came in the giving and doing, not in any sort of reciprocal exchange or expectation about what people should or shouldn’t do. But I digress from my description of thinking with my heart and not my head. Interestingly, that healer’s heart has even influenced how I negotiate decision points in my life. For example, throughout my schooling and advanced education, I was always taught to be a rational decision maker, exploring the pluses and minuses of a situation or set of options and then choosing the correct alternative in a rational and systematic way. Admittedly, I learned to do that very well. Yet there was something at odds with my spirit in that reasoning, particularly when I observed people deciding on a course of action that was sometimes good and other times questionable simply because they could rationalize their M ULTICULTUR A L PIONEER

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behavior. As a consequence, I have developed and embraced a style where I first think about decisions, and before determining what course of action I will pursue, I run that decision through my heart. It has always been my heart that tells me what is true and it is my heart that steers me toward what is right and just, irrespective of whether it is popular. Relatedly, in embracing the role of a healer, I knew intuitively that you cannot be a healing presence in the world if you lose the capacity to believe that people can elevate themselves to rightful places of rulership and mastery over their own circumstance. That for me is the essence of heart and spirit in my life, and that is what has helped me to do the work I am committed to doing.

DEVELOPMENTAL YEARS This warrior-healer identity within the field of psychology is where I have arrived on my life’s journey, but it certainly was not where I started. For that, perhaps I should pause and take a step back in my career to see what factors and people influenced me to pursue this course and direction in my life. I grew up in a single-parent household, raised principally by a mother who separated from my father when I was about 3 years old. Watching a single woman raise four children by herself was something to behold, even as I admire in retrospect the tremendous courage, intelligence, discipline, hard work, sacrifice, and faith it took to achieve what she did in raising her children. Raising four children by yourself, all high school graduates, three college educated, two sons with doctorate degrees in psychology, with nobody on drugs, in a gang, in jail, or dead is impressive to say the least. So first and foremost, I am and will be forever grateful for my late mother, Sadie F. Parham. Indeed, I am my mother’s child. I am a product of public and parochial schools, which also provided some interesting life lessons. I was blessed to be bright enough to navigate my way through school without having to give my best effort. But much like that “Parham-ism” I have stylized over time that teaches that “life at its best is a creative synthesis of opposites in fruitful harmony,” I later 12 8       H o no r i ng O u r E ld e r s

came to recognize how that one strength of being bright could simultaneously become my worst nightmare in that it made me a lazy student and learner earlier in my life. I was also a relational child who, like many African American children, performed well in school classes where the teacher was caring, nurturing, and supportive. Conversely, I performed less well in those environments where teachers were less supportive, less engaged, uncaring, or sometimes hostile. Overall, however, I had a positive experience in my schooling and am grateful for the advice my mother gave about education being something no one could ever take away from you, and the advice Brother Malcolm X (1964) gave when he argued that “education is the passport to the future, for tomorrow belongs to those who prepare for it today.” Without question, my “tomorrows” have been exponentially brighter and opportunity more abundant because of my educational background. Growing up in Los Angeles was a multicultural mecca, and my peers from the time I was in grade school were very diverse. My peers were certainly African American but also Caucasian, Japanese and Chinese American, Filipino, and Mexican American. Indeed, I owe much of my appreciation for and embrace of a multicultural worldview to my formative years of growing up in Southern California. Those close connections I was able to establish and maintain with my peers, and oftentimes their families, allowed me to appreciate and affirm their humanity in ways that the broader society didn’t always promote. Undoubtedly, I am a better man today because of that fact, even as I have come to embrace the consubstantial nature of our inner connectedness as brothers and sisters of the human family. Navigating the streets of Los Angeles required a recognition of family expectations about how I should conduct myself when out in public and a sensitivity to street predators that in some cases were common thugs and gang members, but in other cases were those who wore blue uniforms and rode around in police vehicles with slogans that read “To Protect and Serve.” And while this reality for my siblings and I was no different than

many children of African descent, I do not want to leave the impression that life was that hard, even for children who grew up working class and poor. Our mother managed to locate us in housing and neighborhoods that were reasonably safe and commensurate with what her salary as a government worker could afford. We always had enough to eat, had clothes on our backs, shoes on our feet, and a mind-set that never knew we were as economically challenged as we were. And while we lived in South Central Los Angeles, East Los Angeles (in the barrio), mid-city, and in the Miracle Mile/ Wilshire district of Los Angeles, ours was a childhood that, while modest, was happy, full of love, caring, discipline, and anchored in a strong faith in God. The expression “we come this far by faith” you hear in old gospel music tunes was absolutely true in our case. Growing up amid the marvelous militancy of the 1960s and 1970s also helped usher in a cultural consciousness that understood at a basic level the need for Black people to struggle for civil and legal rights and human decency. Being exposed to leaders such as Malcolm X and Martin Luther King Jr., or hearing stories about Rosa Parks, Thurgood Marshall, or watching the social unrest and riots in Watts, Newark, Washington DC, among others, or listening to the R&B music of the time like Motown, The Philly Sound, Marvin Gaye’s What’s Going On album (1971), The Chi-lites’s Give More Power to the People (1971), or the Impressions sing People Get Ready (1965) set the stage for an important internal debate about adopting a nationalist versus an integrationist posture in navigating the pathways to productivity and success. Even watching the high-profile athletes of my day, which included Muhammad Ali, Jim Brown, Arthur Ashe, Tommy Smith and John Carlos, Kareem Abdul-Jabbar, and many others, or hearing and reading about the stories of Jackie Robinson or the Tuskegee Airmen, reminded me that irrespective of the domain one pursued as a life career, you could not be Black and escape the challenges and adversities of a racially charged society, that despite a document called the Constitution of the United States, there was a profound sense of incongruence between what

America preached and how she lived. So even as a child and adolescent, I reasoned that there were choices that had to be made in negotiating the landscape life presented to African American people. One of those decisions was deciding on the best way to achieve social progress—either working outside of the system to create this notion of revolutionary change, or working within the system to create the change that needed to happen. I chose the latter and pointed my career trajectory toward that aim.

COLLEGE YEARS AND THE VALUE OF MENTORING My college years began with vocational aspirations of pursuing a major and subsequent employment in the field of criminal justice. In fact, I spent some time in my high school years thinking about how to change a racist criminal justice system and reasoned that change had to come from within. Thinking that I would pursue a career as a police officer or an attorney, I even joined the LAPD’s Explorer Program while in high school, where I was exposed to the inside look at a life in law enforcement. I then entered college with a major in criminology, determined to join the domains of policing and law as a way to make a difference in my community once I finished college. After graduating from high school, I was accepted to and enrolled in California State University, Long Beach (CSULB). A mere 20 miles from home in Los Angeles, it was far enough away to achieve independence but close enough to be within quick striking distance to home. CSULB also had one of the largest, if not the largest, criminology departments in the western United States and a department chaired by a professor who wrote one of the seminal textbooks on introduction to criminal justice. So academically all was in order, or so it seemed. I also took advantage of the co-curricular learning opportunities that CSULB had to offer. I lived in the residence halls, joined a couple of clubs, made numerous friends, joined several protests about local injustices, and M ULTICULTUR A L PIONEER

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even participated in intercollegiate athletics playing basketball. While in college in my first 2 years, my interests took a different turn when I discovered that working within that criminal justice system was more about manipulation than really helping people. Coupling that perception with experiences in the classroom where some professors were very smart and engaging teachers while others were barely competent, not very engaging, and in a few cases downright racist, turned me off to the field. Fortunately, however, the opportunity to embrace a co-curricular learning opportunity through two internships crystallized my desire to become a psychologist and mental health professional. One semester, I worked at a halfway house for so-called incorrigible and runaway youth. The second semester, I worked in downtown Long Beach at the Community Psychology Clinic. Through those experiences, I became fascinated with the human psyche and received some valuable feedback from supervisors and parents alike who suggested that I had a knack for this work and should consider pursuing it as a career. These experiences forced me to confront a fundamental issue of how to align my consciousness with my destiny. This query is the essence of the Yoruba term Ori-Ire. Literally translated it means “one whose consciousness is aligned with one’s destiny.” Subsequently, I transferred to UCI where I enrolled as a social ecology major. Social ecology was a new and emerging major and discipline with an interdisciplinary focus. Anchored in the study of social sciences, it taught students to take the environmental as opposed to the traditional individual look at the etiology of people’s problems. I really liked that focus and began to broaden my horizons and perspective about how my desire to help others might manifest itself in a new career direction. My specific focus within the major was anchored in the concentrations of human development (psychology) and community mental health. After transferring to UCI, I met my first mentor, Dr. Joseph L. White, one of the contemporary fathers of the Black psychology movement and discipline, who changed my life and pointed me on 13 0       H o no r i ng O u r E ld e r s

a trajectory toward success. First, I took a course from him titled Black Psychology. Watching him provide academic instruction to students was a study in how to be a master teacher. He was scholarly, yet down to earth and engaging. He could lay out a major construct or principle and then walk you through the steps to that theory or concept in a very clear, understandable, and sequential fashion. He had a social consciousness that was simply captivating, and yet for all of the academic pedigree he possessed, he was authentically human. And as much as he tried to be just a regular Brother, he had one of the finest conceptual minds of anyone I have encountered. Fortunately, I did well in his course and received some very valuable feedback on my exams and papers I wrote, and that is how our relationship began. Teacher-student, sure, but his teaching moments extended beyond academic curriculum. His were lessons in life, social justice, institutional politics, civil rights and Black Power struggles, career options, multicultural understanding, and relationships that would penetrate my mind and spirit in ways that no one had ever done. And after a chance encounter on campus a couple months after completing his course, he apparently decided that I was a young man in need of mentoring and guidance. He saw in me talent and potential that I couldn’t see in myself, and in a different narrative, echoed a message my mother had spoken many times before while growing up, which simply said, “Son, you do little work and seem to perform well; if you just worked a little harder, you would be brilliant.” Indeed, there is another piece of African wisdom that says that when the student is ready, the teacher will appear. Well I was ready, and over the course of the next 2 years, through 5 years of graduate study and well into my professional career, I became a willing, obedient student who, like a sponge, absorbed as much as he could give. Joe White’s intervention in my life validated and affirmed my belief in myself, gave me a vision of possibility, provided me with a roadmap for my future, and held me accountable for producing the excellence he was confident that I could achieve.

Along the way, he taught me life lessons that stay with me even to this day: 1. You cannot seek validation from your oppressor. 2. When navigating new environments, always learn to assess what an environment will tolerate. 3. Excellence will bring opportunity. 4. When you go to graduate school, prepare to be good at everything (counseling/clinical work, research, and academic instruction), not just one thing. 5. The key to mental health is always having a broad range of choices and options.

I teach these same lessons to the students and young professionals I have trained and mentored over the years, and they, in turn, pass along the Joe White legacy to those whose lives they touch. My second mentor was Dr. Horace Mitchell at Washington University in St. Louis. A counseling psychologist by training himself, he was a professor of mine during the studies for my master’s degree. Washington University was a wonderful institution to study at. However, it too had some professors who were allies and a couple of them that I would classify as alligators. Ironically, when I graduated from Washington University and left for my doctoral studies, Dr. Mitchell and his family would relocate to the West Coast, taking a position at the institution I had just left, UCI. Through his roles as associate dean for student and curricular affairs in UCI’s School of Medicine and the vice chancellor for student affairs, and later positions as vice chancellor for business and administrative services at UC Berkeley, and later president of California State University, Bakersfield, where he currently resides, he has taught me much and impacted my life in so many ways. He is simply one of the best examples of conscious manhood that I have ever known. He is also an individual who was a profound contributor to many lessons I have learned as an administrator in higher education. Principally among them is his ability to affect a multicultural presence in an institution without antagonizing the powers that be. Also included in those lessons was

a simple revelation that acknowledged that in one’s role as an administrator and/or director, you have no business having things any way other than the way you want them to be when you are in charge. They became the institutional permission slip I needed to manage with confidence and anchor my positions in what I thought to be right, and not necessarily popular. He remains a close personal and family friend to this day. My third mentor was Dr. Janet Helms, who I first met and began to work with at Southern Illinois University Carbondale (SIU-C). SIU-C was a great place to do graduate study and training, and I have fond memories of my time there. What the students in the department built in terms of a Black Caucus that not only significantly increased the representation of Black students but also other students of color was remarkable. The quality of the faculty and the strength of the curriculum was all you could ask for, with the exception of classes on topics related to cultural diversity. Janet was an assistant professor in the Counseling Psychology program then and the only person of color on the faculty. She was a very disciplined and committed academic who capably blended the articulation of exacting standards in the classroom, counseling clinic, supervision sessions, academic instruction, and research with love and nurturance of a Queen Mother who was encouraging and affirming in her feedback and praise. The attention to detail she gave and helped me and others focus on was remarkable, and that refinement helped me to be a better clinician, researcher, and academician. Janet was also very receptive to supporting and mentoring my research ideas, and I was so appreciative of that. In a time when many professors restricted their time to those students who worked in their labs and only on their research projects, Janet was much more giving of her time and energy. What we produced during my time at SIU-C and beyond is one of the ways I was able to reshape the narratives on identity development research. It is also one of the reasons that I am now being considered a pioneer. Consequently, I owe her much in this regard, as does the profession of counseling psychology. M ULTICULTUR A L PIONEER

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She is, without question, one of the brightest and sharpest people that I have ever met, and certainly among the most proficient and productive. I also must give credit to a host of African American psychologists in my ABPsi network; each in their own way helped to impact and shape the professional I became. And beyond my colleagues like Wade Nobles, Na’im Akbar, Robert L. Williams, A. J. and Nancy Boyd Franklin, Halford Fairchild, Linda James Myers, Asa Hilliard, and Bill Cross, there were a host of others that I have been blessed to encounter, study, and train with, work alongside of, and learn from. And then there was Dr. James Jones and the Minority Fellowship Program within the APA. He and the fellowship committee awarded me a minority fellowship while I was at SIU-C, believing somehow that an investment in a young man from California would yield strong dividends on the contributions that I might one day make. I hope that whatever contributions I have been able to make and achieve, my body of work has justified the faith that each of these people were determined to invest in me. Each of my mentors and these celebrated elders in my professional life were determined to provide me with opportunities to excel, and how privileged I have been to have them on my journey toward being a leader. Having been awarded a Lifetime Achievement Award in James Jones’ honor, The Janet E. Helms Award for Mentoring and Scholarship from The Winter Roundtable Conference at Teachers College at Columbia University, Fellow status in APA and ACA, and Distinguished Psychologist status from ABPsi, I have been blessed with validation and affirmation beyond measure, and again, I am humbled and grateful for the accolades. I must also give credit to my multicultural family in ACA, also known as the National Institute for Multicultural Competence (NIMC). How blessed I have been to collaborate with colleagues like Derald Sue, Allen and Mary Ivey, Patricia Arredondo, Michael D’ Andrea and Judy Daniels, Don Locke, Beverly O’Bryant, Courtland Lee, Wanda Dean Lipscomb, and many others.

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DOMAINS OF FOCUS IN MY CAREER While completing my counseling/clinical internship back in California during my last year of graduate school, I was involved in numerous job interviews at institutions around the country. I decided to accept a position at the University of Pennsylvania in their Counseling Psychology program. Becoming an Ivy League professor at the age of 27 was a space I never imagined I’d be in when growing up. And yet the investment my mentors and others had made in me suggested that I was in exactly the right place and space in time. Penn was a university steeped in tradition, having been founded by Benjamin Franklin back in the late 1700s. While I did not know it before accepting the job, I was told after arriving there that I was the first African American academic psychologist that the university had ever hired. Whether that bit of trivia is true or not I never bothered to investigate. But it was an interesting commentary on a university in the early 1980s America that an African American professor could be a first in any academic discipline. In negotiating my contract with the dean and provost at Penn, I asked for and was granted a joint appointment in the counseling center to augment my work in the counseling psychology program. Not only did my interests lie in both domains, but I knew that my teaching would help to keep me conceptually grounded for my clinical work with clients, and my counseling work would keep me practically relevant with my teaching. The responsibilities were an interesting juggling act, but as predicted, each was a nice complement to the other. I also began to do some speaking, training, and consulting work outside of the university in Philadelphia and nationally, which further broadened my scope of interests and impact. In 1985, I was recruited back to UCI for an administrator director’s role in the Career Planning Center. Despite moving from a principally faculty appointment to an administrative one, I managed to sustain my involvements in

academic instruction, counseling center work, research and scholarship, a private practice, and consulting. Thus, if one looks back on my career, the categories of vocational engagement do not change. Rather, the percentage of time I allocate for each category is what has been in flux. Certainly, I have never lost sight of the lesson Joe White taught me and I teach those who I train and mentor: The key to mental health is always having a broad range of choices and options.

Life as an Administrator In thinking back on what is now my 30th year in administration, I find it hard to believe that I have remained in administration for this long. Initially, I thought I might stay 5 years or so and then head back to a full-time, tenure-track faculty position. But such was not to be, and simply loving what I do and loving going to work each day has been a big part of my longevity in this domain of university life. Over the course of my time in administration, my roles and posture as a manager of human, space, and fiscal resources has been guided by a conceptual template as well. As a psychologist and educator, I have tried to be a people-oriented individual who believes in open, honest, and direct communication with others. I have come to recognize that whatever effectiveness I demonstrate as a manager is greatly impacted by the performance of individuals who work with and for me. Consequently, I strive to create an organizational climate and working environment that allows my colleagues to maximize their efforts and potential. I am also a strong believer in and proponent of diversity and multiculturalism. This commitment allows me to endorse and advocate in a manner where respect for diversity is operationalized into specific behaviors and programmatic initiatives for me and my staff. I have also tried to be a very student-oriented individual who believes that student affairs is vital to any academic institution, and in many respects, this division reflects the institution’s character. While some colleagues in the academy may view student

services as a competitor for scarce institutional resources, I have preferred to see it as an important and necessary complement to the academic mission of the university. Clearly, the university is driven by the intellectual pursuit of knowledge and the advancement of scholarly research in a climate of shared governance. I believe student affairs contributes to that educational mission by (a) helping to attract, admit, yield, and fund talented students; (b) providing orientation experiences for freshmen and transfer students; and (c) presenting co-curricular courses and other programs in residential life settings, career and counseling centers, cross-cultural and international student centers, and in student activities. Indeed, the co-curricular learning opportunity is essential to the college experience of any student, and I have sought to be a major contributor to that as well. My psychologist head has also taught me that regardless of which division of a university provides the learning experience students receive, each of these activities is compromised if students who avail themselves of program offerings are themselves consumed by concerns over mental health issues, career dilemmas, physical ailments, residential accommodations, financial problems, and quality of campus life issues. My role within the student affairs domain has focused on facilitating the academic mission of the university by consulting with and assessing student needs, and assisting students in successfully confronting the logistical, social, and developmental tasks that characterize their undergraduate and graduate school years. My life as an administrator has also been characterized by a meshing of my values with those of the institution. And while it is difficult to ascertain whether or not I have been successful in doing what I say I do, I hope that those I have had the pleasure to work with would say that I have brought visions of what is possible to achieve, direction in achieving those goals, a “half full” glass mentality when managing challenging circumstances, a style that leads by example (never expecting staff to engage in initiatives that I am not prepared to assist them

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with), a temperament that is unflappable in the face of difficulty, and a smile I display every day that affirms and validates the efforts of the colleagues I have been blessed to manage and supervise. Much like queries I receive about my research and scholarship, I am sometimes asked in interviews what I am most proud of as an administrator, now that I have spent the majority of my career as a mid-level and senior manager and not a full-time faculty member. In looking back over the past 30 years, I am proud of helping students grow in ways that are important to them, and not just important to me or the institution. I am proud of using my co-curricular programs, one-on-one meetings with students or group meetings to help to dislodge students I touch from their comfortable categories of intellectual, emotional, behavioral, and spiritual apathy that often frames their lives. I am proud of helping to create a workplace atmosphere of fairness, equity, diversity, and excellence where people want to work and enjoy coming to work for a leader they perceive as interested, caring, and involved. I am also proud of being unafraid to wade into the waters of uncomfortable issues on campus where a proactive posture of “constructive engagement” rather than passive reaction framed the intervention strategies of my administration.

Research and Scholarship In looking back over the landscape of my scholarship, I am sometimes asked what my favorite publications are. This is a difficult question to answer because, in an interesting way, I have enjoyed authoring or co-authoring every manuscript I have had a hand in writing. Given the limitation of space, I selectively present the following for illustrative purpose. I also provide a brief rationale for their selection. The book Culturally Adaptive Counseling Skills: Demonstrations of Evidence Based Practices (Gallardo, Yeh, Trimble, & Parham, 2012) is a favorite because it was a collegial effort to see if the model I proposed in Counseling Persons of

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African Descent (2002) was applicable for use with Asian American, American Indian, and Latino populations. There are currently four texts in the Psychology of Blacks series. The first text was authored by Joe White himself, while I had the principal responsibility for the other three, including The Psychology of Blacks: Centering Our Perspectives in the African Consciousness, 4th edition (Parham, Ajamu, & White, 2011). I hope and believe that these texts have contributed substantially to the understanding of an African-centered perspective in developing a psychology of our people. The book Counseling African Descent People: Raising the Bar of Practitioner Competence (Parham, 2002) has always been a favorite of mine because its intent was to build upon a movement to shift from a “Black” perspective in psychology to one that was more African centered. It was also my attempt to blend the theoretical with the pragmatic by raising questions regarding the important elements in conducting clinical/counseling interventions that were African centered and how those elements might be operationalized within the context of a therapeutic encounter. Psychological Storms: The African American Struggle for Identity (Parham, 1993) is a favorite, primarily for the audience for whom it was written—namely, Brothers and Sisters outside of the academy. One of my frustrations with research and scholarship generally, and my own writing in particular, is that it is written for and published in professional journals that cater to a strictly academic market. The persons who are the focus of the work and who might be able to benefit from it have difficulty understanding it and/or have no access to it. I wrote this text for a lay market and tried to address every reason they would have for not reading it. I published it with an African American publisher, restricted it to a little over 100 pages, added pictures and illustrations to break up the monotony of the writing, and priced it at less than $10 so that it was very affordable. To my delight, lay audiences have read the text, including ­average everyday people and even those who live their

life on lockdown courtesy of the prison industrial complex of America. Two manuscripts—Cross, Parham, and Helms (1992a, 1992b)—are favorites because I was able to reunite with Janet Helms and collaborate with Bill Cross, whose original ideas about identity development and psychological nigrescence I was blessed to build upon in my own identity development research (Parham, 1989). Finally, I’m very fond of three articles that I coauthored with Janet Helms (Parham & Helms, 1981, 1985a, 1985b) because they were the basis for my entry into the racial identity research domain. More specifically, they were an outgrowth of ideas and questions that I was asking even prior to graduate school when I was first exposed to the Cross model of psychological nigrescence in Joe White’s African American Psychology course.

Leadership in Professional Organizations My participation in professional organizations began as a student affiliate back in the late 1970s and continues to this day. I remember going through the usual rituals of member participation, attending and presenting at conferences, publishing in journals, and connecting with colleagues. Along the way, however, elders in each association began to somehow take notice of me, and what followed were invitations to participate on committees, serve in different people’s administrations, and ultimately, consider leading particular associations. Admittedly, I have always been a reluctant leader, preferring simply to produce programs and achieve results in the organizations I belonged to and actively participated in. In retrospect, I think my posture here was most influenced by what former civil rights leader, United Nations ambassador, and Atlanta mayor Andrew Young mentioned on one occasion. He commented that he always learned to distrust leaders who were too anxious to seek high office in an organization

or elected position. He believed, as I do, that if people really understood the burdens of elected office and the tremendous responsibility one has to carry while assuming a particular leadership position, then people would hesitate before leaping too fast at a particular opportunity. So while I have often hesitated and been a reluctant leader, I have also tried to be a dutiful colleague when the elders spoke or fellow colleagues urged me to run for office. Having said “yes” on a few occasions, my background now includes stints as national president of ABPsi, the Association for Multicultural Counseling and Development (AMCD), president of the Orange County chapter of the 100 Black Men of America, and national chair of education for the 100 Black Men of America. I hope that whatever contributions I was able to make or advances the organizations were able to achieve under my leadership justified the confidence and trust people placed in me.

ADVICE TO THE NEXT GENERATION Having paused sufficiently to look back on my career, I suspect it is now time to close this manuscript. I am reminded in this moment about a conversation my friends Larry Jackson and Aldrich Patterson (both very accomplished psychologists in their own right) and I had with Dr. Joe White back in the mid- to late-1970s. We were preparing to go off to graduate school and leave the fold of his mentorship and guidance in 1976 when we asked him, “Dr. White, how can we ever repay you and thank you for what you have invested in us?” He replied that while he appreciated our thanks, he expected that we would do for others what he had done for us. In that way, a “freedom train,” as he called it, was born, and our task was to pay it forward and invite and mentor others to board that train, which would help them navigate the pathways to productivity and success. That is a role I have held dear and continue to play in each of my professional endeavors.

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So in that spirit of Dr. Joe White, I want to leave some advice for the younger generations to follow:

will get resolved because our people have been through much worse, and still survived.

1. PRODUCE EXCELLENCE. Excellence will bring opportunity without you having to ask to be noticed. Strive to do your best in every endeavor you engage in. Remember also what the great educator Benjamin Mays argued, that there is no shame in not reaching a particular goal or threshold, only shame in not having a goal to reach for.

4. BUILD FOR ETERNITY. So much of psychology and counseling, including the multicultural aspects, in my opinion, is characterized by what is temporal and fashionable in the moment. The ancient Africans built monuments and structures that continue to stand the test of time thousands of years later. Their formula was simple: solid preparation and construction on one hand and an aspiration to harmonize with Divine intent on the other. Consequently, if we are collectively going to build a strong cultural perspective in the psychology and counseling fields, then each of us must commit to build for eternity and not just for today or the latest edition of a text.

2. FIND A MENTOR. The world is a place that will socialize you to approach life as a rugged individual. I urge you to resist this temptation and identify a mentor who can guide and direct your path. Mentor relationships are sacred bonds and cannot be entered into lightly. However, once found and developed, those relationships are key to helping you create a broader vision of possibility, helping you learn from others, experience the trials and tribulations, and the successes that come with life’s journey. 3. LEARN TO CONTEXTUALIZE STRUGGLE. No matter how difficult the hour or how trying the circumstance, you must believe that you can make it. The evidence that it is possible rests with remembering your past and never forgetting what our ancestors and elders had to overcome in order for us to occupy the places we now inhabit. The social context in which our young people grow up these days is a blending of exciting opportunities on one hand and adversities that challenge their fragile sensibilities on the other. This duality of their life experiences is a mixture of both the exciting and the absurd, with one element being directed toward an oasis of possibility and potential while the other offers a keen recognition that certain social forces have the potential to derail a child’s success trajectory and set it on a course of bad choices, delayed gratification, and even self-destruction. When my students, and even professional colleagues, complain about a particular situation, I try and show as much empathy and compassion as I can while also reminding them, as my ancestors remind me, that “it ain’t a slave ship.” Whatever you are going through can and

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5. BECOME COMFORTABLE WITH WRITING AND PUBLISHING. There is nothing I have seen in my life that will increase your visibility more than writing. I have been blessed to travel and lecture all over the world, and wherever I go, I always ask people how they even know that I exist on this planet. Their constant reply is “we read what you wrote . . .” Writing and publishing, however, is not simply about increasing your visibility. Rather, it is your chance to influence the narrative and help define and frame the discourse on issues that are important to you. 6. DECIDE ON HOW MUCH COURAGE YOU ARE PREPARED TO DISPLAY AND HOW MUCH OF A DEBT YOU OWE. Frequently, I find people remarking that some situations are less than desirable for them to handle, but they are reluctant to speak up and assert their voice. While the dilemmas people face are often framed as not knowing what to do, I have found that intervention is less about not knowing what to do and more about what people are prepared to risk and sacrifice in order to find their voice and promote change. Somewhere I read that “. . . without a vision, the people perish.” But I would also offer that without a voice, the people will suffer. Without a voice, the people lose hope; without a voice, the people squander their power. Each of you must decide how much courage you are willing to exercise and how much of a debt

you owe the ancestors and elders whose sacrifice ushered in the opportunities we now enjoy. 7. ASK YOURSELF IF YOU ARE PREPARED TO FULFILL YOUR LEGACY OR BETRAY IT. The great Algerian psychiatrist Frantz Fanon argued that each generation has an opportunity to fulfill its legacy or betray it. Indeed, we are standing in the shadows of history. The silhouettes of our historic heroes and heroines of our professions and our own cultural traditions provide the backdrop for daring to dream that we could make a difference and fulfill rather than betray the legacy we have been blessed to inherit. That vision helps to create a conceptual template that is anchored in a set of beliefs, values, and customs that guide the intervention we make with the people who benefit from our work. Each of you must come to terms with the legacy you have inherited from previous generations and then explore how your current efforts either converge with or diverge from that inheritance. A retrospective look at your own careers and the paths you have taken will decide if that legacy has been fulfilled or betrayed.

CLOSING In closing this portrait in my journey as a warrior and healer, I want to again reference Dr. Martin Luther King Jr. and one of the most important speeches he delivered. It was titled “The Drum Major Instinct” (1968). Remember the concept of a drum major, that individual strutting down in front of a band during the halftime show at a football game? Dr. King argued for a parallel between that image and the human instinct to be first, perceived as important and in charge. He argued that it was a good instinct if used correctly, and as he quoted from the New Testament scripture that day, he reminds us that whosoever among you wishes to be great shall first be a servant of the people (Matthew 23:11 King James Version). The drum major instinct concept presents us all with a question that must be interrogated. That is, what is the depth of your love and what is the quality of your service to humanity? For in answering that, you come to terms with the fundamental question of what it means to be authentically human.

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CHAPTER

14

Landscaping My Life Journey Unpeeling a “Banana” Lisa A. Suzuki

I

would like to thank my fellow editors for the honor of inviting me to write this story as a “pioneer.” This is not a label that I would use to describe myself. I have benefited greatly from the work of the pioneers featured in this section and in the multiple editions of the Handbook of Multicultural Counseling. I recently began reading David Brooks’s (2015) The Road to Character in which he speaks to the difference between resume virtues and eulogy virtues. I had focused much of my early academic life on building a resume, as evidenced on the amount of time I spent on things that I could list on my curriculum vitae—the academic resume. When I became a fellow of the Society of Counseling Psychology, I spoke about what I wanted my daughter Kaitlyn to see when she “Googled” my name—my contributions to the field of psychology. Now that I am in my 50s, I have had time to reflect more on deeper eulogy virtues, the ones that might be mentioned at my funeral. These would include my relationships with others, life meaning, and acts of service. In this story, these virtues emerge in the unfolding of my life. I highlight aspects of my social location and situate my academic work in multicultural assessment and qualitative methods juxtaposed against my personal landscape as defined by Brooks (2015) in the following quote: “intellectual humility is accurate selfawareness from a distance . . . a landscape view in which you see, from a wider perspective, your strengths and weaknesses, your connections and dependencies, and the role you play in a larger story” (p. 9). I will conclude with what I have learned and what I hope to pass on to future generations. Author’s note: Special thanks to John Kugler, PhD, and Muninder K. Ahluwalia, PhD, for their helpful feedback on an earlier draft of this story.

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IN THE BEGINNING . . . I was born in 1961 to second-generation Japanese American parents who were born in Hawaii (“Nisei”). They experienced life before and after the Japanese attack on Pearl Harbor, “a date which will live in infamy” (Roosevelt, 1941). My father recalled sitting on a hill with his friends wondering why there were “fireworks” going off early one morning at Pearl Harbor. He returned home to find his parents engaged in a flurry of activity, for they knew that Japan had attacked, and as Japanese immigrants, they would experience repercussions from the U.S. military. His father and mother gathered treasured artifacts from Japan, in particular a samurai sword, a symbol of the family’s honor, and buried them in the backyard. The American soldiers entered their home with their “muddy boots” throwing family belongings to the ground searching for proof of their betrayal. Nothing was found, but this experience was burned into my father’s memory—“I knew I had something to prove. I was going to be an American soldier and prove my loyalty and bravery.” He grew up learning about the 442nd Regimental Combat Team comprised of second-generation Americans of Japanese ancestry. Stories of their bravery were often shared, as they were touted as the most highly decorated unit of their size in U.S. military history—awarded 9,486 Purple Hearts, 4,000 Bronze Stars, and 21 Medals of Honor (Maranzani, 2011). The slogan of the 442nd was “Go For Broke.” In college, my father joined the ROTC and later served in the Korean War. He stood at five feet two inches, and the smallest army uniforms had to be altered to fit him. The White soldiers called him an “oriental creep.” Despite the racism of war, my father viewed the U.S. military as the “great equalizer.” He found opportunities to prove his loyalty and bravery on the battlefield. He told stories of serving as the “point man,” searching ahead of his unit for the enemy, with other brave soldiers of color. He was promoted to company commander in the field and was awarded the Bronze Star.

My father attended Georgetown University on the GI Bill and served in the Army Reserves until he retired years later at the rank of colonel. My mother possessed a strong but quieter demeanor in comparison to my father. She grew up on the sugar plantations of Hakalau, Hawaii. She attended business school and supported herself by working for families as a domestic and babysitter. She left Hawaii and traveled to the mainland by herself to marry my father who she had met one summer when they were both working, she as a secretary and he as a summer intern. My mother was and is an adaptive person. She spoke of the importance of maintaining harmony and not “making waves” as she tempered my father’s strong voice. Shikata ga nai, she would say, “it cannot be helped . . . nothing can be done about it,” and gaman, emphasizing endurance, perseverance, and patience. My parents were very frugal since they had little money while my father was a student. She recalls bargaining with the local grocer for two carrots rather than having to buy a bunch. When my sisters and I were born, they bought their first house in McLean, Virginia, while my father was employed by the Department of the Navy after graduating with a degree in transportation management. My father noted that we were the only Asian family in the community—a novelty. My parents believed that there was better quality in the White community—more resources and higher achieving schools. When I was 5 years old, my parents decided to return to Hawaii. I was the middle child between two very accomplished and popular siblings. I was always a bit on the reserved side, shy and bookish. Growing up in Hawaii meant that I lived in the metaphorical “melting pot” of the Pacific in a cultural mosaic emphasizing cultural tolerance and harmony. Hawaii was and is predominantly Asian so I grew up in a community where my teachers, politicians, doctors, dentists, etc., were all Asian, and in particular, Japanese American. I was unaware of the conflicts that were present between

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the native Hawaiians and the United States, and concerns of “locals” that Hawaii was becoming the military center of the Pacific. My parents believed in assimilation as the best way to succeed and passed this on to my two sisters and me. All things could be achieved if one worked hard enough. They emphasized the importance of speaking “good English,” educational achievement, and understanding that we would be judged by our actions, not by our words. I believed, as my parents did, that I could achieve anything through personal effort. I believed in the American dream and was proud to be a part of the “model minority.” A friend once said to me that I was a “banana,” yellow on the outside but White on the inside, and I did not take offense. My beliefs were challenged when I took an ethnic studies class in college, learning about the internment of the Japanese. How could this have been left out of my American history curriculum? I recall asking my dad, “Did you know that the U.S. government interned the Japanese after Pearl Harbor?” My father answered affirmatively but did not elaborate. My mother, however, told me about some of our family friends who had been interned on the mainland and the stories they had shared. She noted that some friends did not talk about their internment experience at all. I was asked to write a reaction paper on internment, and I think I was the only one in the class that wrote an essay supporting the mainstream American perspective about internment because it was logical that Americans would be suspicious of people of Japanese descent. I would write a very different paper today. I attended 3 ½ years of undergraduate schooling at a college on the mainland United States, where I was confronted with the realization that the strategies I had learned at home were not always adaptive. I still remember a professor asking me if I was a new student when I had attended the class for over 3 weeks. I guess he had not noticed me among the eight other students in the class. I learned that I would not be judged only on my actions or performance on exams. I had to learn to “talk” and “challenge” the status quo, for to be 14 0       H onoring O ur E lders

quiet and attentive was to be invisible. Over time, I learned that people attributed my quietness as that “Asian female passive thing.”

BUILDING THE RESUME: RACE, ETHNICITY, AND PSYCHOLOGICAL TESTING I consider myself an “average” person and credit my academic achievement mainly to hard work and perseverance, the values that were passed down from my parents. I also acknowledge that other factors served to launch me on my path to achievement: parental support, positive projections associated with being part of the “model minority,” middle-class privilege, and educational opportunities. During my doctoral training at the University of Nebraska–Lincoln, I returned to Hawaii during summers and worked as a psychological examiner, administering intelligence tests to public-school students living in the Leeward District of Oahu (including Waianae, Nanakuli, Ewa Beach) who had been referred for comprehensive evaluations to determine eligibility for special services (e.g., special education classification). I estimate that over the course of several summers, I administered over 250 intelligence tests to students of color living in the low-income areas of Ewa Beach, Nanakuli, and Waianae. While I administered the tests according to the standardized instructions, I recall feeling discouraged when students obtained low scores indicating limited potential. I became intrigued by the construct of intelligence and how tests comprised of various subtests could yield an estimate of potential. While findings were supported by academic performance (i.e., grades), these students were often doing work in their communities that would indicate higher potential. This was not a novel idea, as reports emerged of the six-hour retarded child—retarded from 9–3 during the school day, 5 days a week, based upon an intelligence test score without regard to adaptive skills (President’s Committee on Mental Retardation, 1969). The focus of my doctoral research addressed questions related to

these experiences: Are there racial/ethnic profiles of intelligence? Does culture reinforce particular forms of ability? My pursuit of these topics brought me into contact with a network of amazing researchers and scholars. My work validated, in part, what was already known supporting the racial/ethnic hierarchy of intelligence (i.e., Whites are greater than Blacks, Native Americans, and Hispanics; Asians/Jews are “somewhat” greater than Whites). After statistically equating full scale IQ, profiles of abilities did emerge that were predictive (better than chance) of racial/ethnic group membership. I thought about my own average intelligence and read works by Flynn (1991) and Lynn (1987) and examined the relationship between Asian group membership, intelligence, and achievement. Unlike other scholars who would interpret racial and ethnic group differences in intelligence mainly to genetics, I hypothesized, along with others, that culture impacted test performance. In addition, I believed that while intelligence was in part innate and heritable, it was also malleable. In perusing the literature, I realized that while many acknowledged that culture impacted measurement of all psychological constructs, an answer to the question of “how” was nowhere to be found. The need to pull together information on multicultural issues in assessment was clearly needed so that the “how” could be understood. Hence, the Handbook of Multicultural Assessment was born and three editions of this text were published by Jossey-Bass, with myself as senior editor and colleagues Drs. Joseph Ponterotto and Paul Meller as co-editors (1996, 2008, 2001). Currently, nearly all volumes on psychological testing include attention to culture, race, and ethnicity. I also had the opportunity to publish with Dr. Richard Valencia an article in American Psychologist titled “Race-Ethnicity and Measured Intelligence: Educational Implications” (1997) and a coauthored book, Intelligence Testing and Minority Students: Foundations, Performance Factors and Assessment Issues (Valencia & Suzuki, 2001), and was lucky to be invited to join the editorial team for the Handbook of Multicultural Counseling

led by Dr. Joseph Ponterotto (Ponterotto, Casas, Suzuki, & Alexander, 2009). These opportunities enabled me to build a resume that in turn led to faculty appointments at Fordham University, the University of Oregon, and now for the last 20 years at New York University.

UNDERSTANDING SOCIAL LOCATION AND CONTEXT: A QUALITATIVE PERSPECTIVE I emerged from this work on multicultural issues and psychological testing feeling like a part of a network of amazing scholars and researchers seeking to understand the impact of culture on psychological practice and research. I also had a firm commitment to promoting culture as one of the major foundations of psychological practice. Over the years, my thinking on this was broadened from an initial focus on only race and ethnic group membership to encompass other identities, with an emphasis on context and social location. I believed that the “best” way to get at this information was through qualitative methods. How else could one understand the diverse perspectives of individuals, families, and communities? This is by no means a novel idea. A famous African proverb highlights this point: “Until the lion has his or her own storyteller, the hunter will always have the best part of the story” (African Proverb, n.d.). Numerous opportunities have arisen during my academic career to pursue qualitative knowledge about diverse racial and ethnic communities. I recall sitting late one night at the 24-hour Perkins Restaurant with a fellow doctoral student, Maria Prendes-Lintel, talking about how concerned we were that whenever the curriculum addressed minority groups it was always through a deficit perspective—low income, low achievement, high risk for mental health problems. On this particular evening, Maria shared with me her experiences in coming to the United States, events that had been left out of American history books. She came to the United States as an unaccompanied Cuban refugee child in the early 1960s under the

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auspices of the Catholic Church. She spoke of how her community in Cuba feared that when Fidel Castro took power he would take over parental rights and send children to indoctrination camps. The community petitioned the Catholic Church in the United States to help them get their children to America. More than 14,000 unaccompanied children arrived in the United States under what became known as Operation Pedro Pan. I was mesmerized by the story, and Maria shared that not much had been written about the group from a psychological perspective. She noted that unlike those we had read about from a deficit perspective, the Cuban community had done well in the United States based upon socioeconomic indicators. It was then that we decided to take a qualitative look at how these unaccompanied children had coped in the United States. We interviewed Pedro Pans and their children. Initially, as an outsider (e.g., not Cuban) I was often asked, “Why are you studying us?” I replied that I was interested in documenting a piece of this important historical event. Maria also introduced me to Monsignor Bryan Walsh, the priest who coordinated the placement of the children in the United States in group homes, orphanages, and foster placements. Maria and I traveled to Miami, Florida, to attend a Pedro Pan reunion. During this trip, Maria and other Pedro Pans went on a tour of the refugee camp where they were placed when they first arrived. I recall observing quietly as an outsider, watching as group members walked among the buildings recalling stories, while others just stated, “I remember . . . ,” with tears streaming down their faces. Our qualitative findings documented the experiences of this unique group of individuals and the ways in which they coped and adapted to life in the United States. As we delved further into the research process, however, I began to question my involvement. Perhaps it was better if the stories were told directly by members of the community like Maria. I shared these thoughts with her and she noted that at times she needed the “outsider perspective,” since at times she felt too close to the data, “I cannot see the forest because I get caught up in the trees.” 14 2       H onoring O ur E lders

Currently, a group of graduate and undergraduate students and I, in collaboration with the Museum of Jewish Heritage: A Living Memorial to the Holocaust, Speakers Bureau, are exploring the process of meaning making, coping, and transgenerational impact from the perspective of survivors. As an outsider, once again, I was asked, “Why are you studying us? Weren’t your people interned in concentration camps too? Why don’t you study them?” To be honest, I have never been able to come up with a good answer to these questions. I often replied that I was committed to understanding and documenting the survivor experiences of the Holocaust. This answer was apparently satisfactory because the conversation often flowed to other related topics after that. In one phone conversation held with the purpose of scheduling an interview, the participant stated, “Suzuki, that is a Japanese name. I bet you do not hear many positive things about your people. Well I’m going to tell you something positive about your people.” At first I was surprised but realized that she was referring to Japan being an ally of Germany and the historical atrocities committed by Japanese soldiers when they occupied parts of Asia. She proceeded to tell me about Chiune Sugihara, vice-consul for Japan in Lithuania during World War II. He issued transit visas that enabled approximately 6,000 Jewish refugees to travel to Japan. In 1985, Israel named him Righteous Among the Nations. In both these qualitative studies, I have had to address and reflect upon my own identity as a Japanese American and outsider to the Cuban and Jewish communities. As I reflect upon this work, I wonder if perhaps studying my own community would feel “too close,” as Maria mentioned. I also am aware that in both these cases I am studying groups that have fared relatively well and succeeded in terms of socioeconomic indicators here in the United States, perhaps unconsciously reinforcing my old belief in the virtue of assimilation. My strong belief in qualitative methods enabled me to connect with others of the same perspective. Early in my career I was fortunate to edit a text titled Using Qualitative Methods in Psychology with

Dr. Mary Kopala (Kopala & Suzuki, 1999). More recently, I worked with Drs. Donna Nagata and Laura Kohn-Wood on the edited volume Qualitative Strategies in Ethnocultural Research (2012).

BEHIND THE SCENES: UNPEELING THE BANANA In the past, I focused on building my resume by understanding the experiences of those outside of the Japanese American community. I recall that when I arrived at my new office at NYU, I was greeted by a small contingent of Asian American students. They were so excited to have an Asian American professor and spoke with me about their interests in studying psychological topics within their communities. I replied, much to my current chagrin, “I don’t do Asian American research, I just happen to be Asian.” I could see that they were disappointed in my response. My statement reflected how I perceived my identity. I thought that to focus on only Asian Americans was too “limiting,” again reflecting my investment in assimilation. It is in some ways painful now to reflect on how my behavior may have negatively dampened the passion that this group of students had in working in their Asian communities. I have also come to understand that I cannot escape my Japanese heritage. I remember when a colleague from China told me that her parents would not be happy that her closest American friend was Japanese. At first I was puzzled and confused by what she could mean by this statement. She clarified by saying that her grandparents and parents had witnessed atrocities committed by Japanese soldiers when they occupied China. The horror of the Japanese legacy is something that I did not have to think about growing up. I am more aware of my pride in being Japanese, but I also struggle with how to incorporate these heinous events in making meaning and accurately remembering the past. In 1998, I married John Kugler, a school psychologist. He is of Irish descent and was born and raised in Bay Ridge, Brooklyn, where we reside

today. It is not surprising that I chose to intermarry outside of the Asian community. My mother used to caution me about getting too much education. “Japanese men do not like to marry women who are more well educated than they are.” John, on the other hand, wanted a partner who had a career and was accomplished in her own right. Being married to an Irish American brought me closer to my Japanese heritage, as I was at times forced to confront how different our perspectives were based upon our experiences and racial appearance. The community where we reside was originally made up of Norwegians, Irish, and Italian families. At times, I have experienced verbal aggressions living in a predominantly White community. An elderly woman walking near me on the street shouted once, “Why don’t you go back to your own country.” I often stayed home on the anniversary of Pearl Harbor Day as the media depicted families who had lost loved ones during the “sneak” attack of the Japanese. Today, there is a growing number of Asian immigrants who have moved into the area, increasing my comfort level to some degree. I still remember my father and how living in a predominantly White community in McLean, Virginia, was good when there were only a few Asians; we were a novelty. He also cautioned that if the numbers grew too large, then we would be seen as more of a threat, leading to more discrimination. In 1999, John and I welcomed our daughter, Kaitlyn Suzuki Kugler, to the world. Having her has changed my life, and I began to understand cultural dynamics on a different level. For example, I became aware of the “color” dynamics in the media. On one beautiful spring day, Kaitlyn was 2 years old and I was pushing her on the swing at our local park. She announced to me “Mommy I do not like Black people.” I was stunned and did not respond right away. Given my hesitation, Kaitlyn spoke even louder, “MOMMY, I SAID I DO NOT LIKE BLACK PEOPLE.” At this point, I picked her up out of her swing and left the park. When we got home I asked, “Kaitlyn, why did you say that?” and proceeded to point out how she had relatives and friends that were Black. She looked at me quizzically and said, “I don’t

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mean them mommy, I mean the Black witches in the Wizard of Oz.” Kaitlyn raised questions as she struggled to understand the concept of “color.” One day when John and I were driving her to school, she said, “So daddy is White, and Mommy is yellow. What does that make me, beige? I do not think that Daddy is really White and Mommy you are definitely not yellow.” We proceeded to try and explain to our 5-year-old the notion of skin color and racial differences during our 10-minute drive. I am not sure we did a very good job, but she seemed satisfied with our answers as she ran to join her friends at school. I wanted my daughter to have a bicultural understanding of who she was as a part-Japanese American. I realized that I had a very limited understanding of Japanese cultural practices and symbols, for I did not understand their meaning. Interestingly, the one symbol that I recall my parents ingrained in us was the symbol of strength in the Japanese culture—the bamboo plant. It is strong because it bends with the forces of nature and never breaks. I needed to know more. I spoke to my mother in Hawaii about this and she sent me a book about what it means to be Japanese. Basically, it was an instructional guide to understanding Japanese customs. Thank goodness for resources like this. I realize that given Kaitlyn’s Asian physical features she will face some of the stereotypes that have impacted my life. One that I have not yet mentioned is that of the perpetual foreigner, that is, the notion that an Asian person will never be truly identified as belonging in America. This point was illustrated when my family attended a festival in the Catskill Mountains. John and Kaitlyn were sitting at a table eating while I stood in line to purchase a funnel cake. A White couple sitting nearby struck up a conversation with John about living in the area. They then asked where Kaitlyn was from and if she was an exchange student. When John told me what had happened, I was saddened as it served as another reminder that my daughter, who looks like me, did not fully fit into this particular American landscape.

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MY EULOGY: WHAT I HAVE LEARNED Writing this story has been a much more difficult process than what I first imagined. The senior editor of this volume, Manuel Casas, PhD, told me one way to approach the task was to think about what I would want Kaitlyn to read about my life. I guess this is moving to thinking about eulogy virtues. I believe it is critical for her to know who she is and where she comes from. She cannot rely solely upon what is written in history books or available on Wikipedia or Google Scholar. I was not always aware of how much oppression my parents were exposed to growing up at a time when having dark hair and slanted eyes represented the “enemy.” The stories that my parents passed on to me were sanitized to represent the values they believed were important for me to know—perseverance and sacrifice. They adapted to their life circumstances in order to succeed. As Brooks (2015) writes, “we don’t create our lives; we are summoned by life” (p. 21). Thus, we must understand our lives in context. As a researcher and scholar, the topics that I study also emerge from the context of my experiences. The populations I choose to study represent aspects of myself, as do the questions that I choose to answer. What is missing from the history I was taught? Whose voices are included in the discourse and whose are missing? I also realize that given my knowledge of assimilation, I have primarily studied groups that have fared well in adapting to life in the United States, just like my parents. I have had to challenge my assumptions and engage in the process of reflexivity—exploring my own conceptual baggage and preconceptions that impact my research findings. In 2007, my colleagues and I published an article that we titled using the following African proverb, “The pond you fish in determines the fish you catch” (Suzuki, Ahluwalia, Arora, & Mattis, 2007). This article addressed the importance of context and how meanings “shift in accordance with our motivations, with our histories, and with an array of situational conditions” (p. 295). In addition,

the proverb illustrates that the contexts in which we conduct our work determine the outcomes that we produce. As a cultural being, my identity is dynamic. Where I started, that is, a person who just “happened to be Asian,” is not where I am today. While I purposefully chose not to study Asian Americans early in my career, the landscape of my life has led me to look at my roots as an Asian American

woman. I have recently been writing with colleagues addressing topics relevant to counseling members of the Asian American community. In 2006, I received the Distinguished Contributions Award from the Asian American Psychological Association. As I accepted this award I thought of how wonderful it was to receive such an honor from my own community. The banana was unpeeling.

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CHAPTER

15

Pioneer Life Story Listening to the Still, Small Voice Beverly Daniel Tatum

O

n Monday, December 9, 2013, a full-page ad appeared in the New York Times announcing the ­winners of the 2013 Academic Leadership Awards. Underneath the photos of four college presidents was this statement:

Carnegie Corporation of New York is proud to honor four exceptional leaders of American colleges and universities with the 2013 Academic Leadership Award. The leadership award, established by the foundation in 2005, recognizes individuals who, in addition to fulfilling their administrative and managerial roles with dedication and creativity, have demonstrated vision and an outstanding commitment to excellence and equity in undergraduate education, the liberal arts, curricular innovation, reform of K–12 education, international engagement, and the promotion of strong links between their institutions and their local communities. Each honoree’s institution receives a grant of $500,000 to be used toward the winner’s academic initiatives.

One of those photos was mine. Being nationally recognized for my leadership as the president of Spelman College, along with the presidents of Duke University, Stanford University, and Arizona State University, was not a career outcome I ever would have predicted for myself growing up in Bridgewater, Massachusetts, or even years into my career as a professor of psychology. But looking at my own smiling face in the New York Times, flanked by the photos of three White men, and reading the published list of the past recipients, I realized that I was the first president of a historically Black college or university (HBCU) to win this award, and the first African American woman to be voted into this club of distinguished honorees. I was indeed a pioneer. How did I get here?

AN INTEGRATION BABY I was born in 1954 in Tallahassee, Florida, just a few months after the momentous Brown v. Board of Education Supreme Court decision outlawing the “separate but equal” doctrine of segregation. I often call

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myself an “integration baby” because the struggle to desegregate American educational institutions has shaped my life from the beginning. My father, Robert Daniel, was an art professor at Florida A&M University. With an undergraduate degree from Howard University and a master’s in fine arts from the University of Iowa already in hand, he sought to earn his doctorate in art education at nearby Florida State University (FSU), but in 1954, the state of Florida still refused to open the doors of FSU to an African American graduate student. Instead, the state of Florida met its legal requirement to provide equal access by paying his travel expenses to Pennsylvania, and in 1957, he completed his doctorate at Penn State. A year later, he became the first African American professor at Bridgewater State College (now Bridgewater State University) in Bridgewater, Massachusetts, the community where I grew up. In that small town, just 30 miles from Boston, I was almost always the only Black student in my classes. Years later, I wrote my doctoral dissertation on the experiences of middle-class Black families raising children in the context of a predominantly White community. Published in 1987 as a book titled Assimilation Blues: Black Families in White Communities, the central question I sought to explore was articulated in the opening paragraph of the book: What does it mean to be a middle-class Black parent living, working and raising children in the midst of a predominantly White community? Does it mean opportunity, success, the “American Dream” realized, or is it rootlessness, isolation, and alienation? Is it some combination of all of these things? (p. 1)

Those questions were clearly inspired by my own experience growing up in Bridgewater. Outside of my own extended family, almost all the people I knew were White. I rarely felt mistreated because of my race. I did not see then what I now understand to be the class privilege from which I benefitted. In my small town, my well-educated parents were highly visible and active in civic life. It seemed everyone knew me as “Dr. and

Mrs. Daniel’s daughter” and they were treated with respect, or so it seemed to me. I later learned about the social slights my mother experienced and the workplace discrimination my father endured, but my parents were determined to protect their children from those frustrations and for the most part, they did.

A CASE STUDY IN RACIAL IDENTITY DEVELOPMENT As the child of college-educated parents and the daughter of a college professor, I grew up knowing that I would go to college. I chose Wesleyan University in Middletown, Connecticut, the most diverse of the small New England colleges I considered. I thrived socially and academically. Though I majored in psychology, for the first time in my life, I had access to African American Studies courses and I took a lot of them—history, literature, religion, even a course on Black child development. It was in that course, taught by my first Black female professor, Fay Boulware, that I was introduced to the work of William Cross on racial identity development (Cross, 1971). I instantly recognized myself in his theory. I could see that I had grown up internalizing many of the cultural messages of the dominant society (PreEncounter), and had come to a limited but growing awareness of the social meaning of my Blackness in high school as the result of my race-related experiences (Encounter), and had arrived at Wesleyan eager for an opportunity to explore my identity in the company of people who had shared at least some aspects of my experience as a young Black woman. I was clearly in the Immersion-Emersion stage Cross (1971) described, characterized by a strong desire to surround oneself with symbols of one’s own racial identity and actively seek out opportunities to learn about one’s own history and culture with the support of same-race peers. In contrast to my high school experience, my friendship group in college was exclusively Black and

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Latino students. We sat together in the cafeteria every day, focused on affirming each other. It was exactly what I needed. I emerged from my Wesleyan experience much more confident in my social self, well grounded in my sense of Blackness. I had developed leadership skills, been mentored by Professor Boulware as a teaching assistant in her classes, had completed a senior thesis on the self-esteem of Black children controlling for social class as a variable, served as a resident adviser in a residence hall, and graduated a semester early with honors. In the fall of 1975, I headed to the University of Michigan to pursue a PhD in clinical psychology. As a graduate student, my friendship network became more racially inclusive. I was moving into the Internalization stage that Cross (1971) described, characterized by a sense of security in one’s own racial/ethnic identity and a willingness to establish meaningful relationships across group boundaries with those who are respectful of that self-definition. One never stops growing and evolving, and while experiences can prompt us to revisit earlier “stages,” that sense of security in my identity as a Black woman has only deepened and grown more nuanced over time.

THE PLANS I am a planner by nature, and as a college senior, I had outlined a 10-year plan for my life that included completing my PhD in clinical psychology, getting married, and having two children, at least 3 years apart, by the time I was 30. It almost went exactly as planned. I met Travis Tatum in Ann Arbor and was 2 months shy of my 25th birthday when we married in the summer of 1979. By that time, I had completed 4 years of graduate study and had completed all my predoctoral clinical internship requirements. Travis had a fellowship opportunity at the University of California, Santa Barbara (UCSB), so 2 weeks after the wedding, we moved there. Santa Barbara was the perfect location for my qualitative study of Black families living in White communities as the Black population was less than 2% at that time. My adviser, Eric Bermann, 14 8       H o no r i ng O u r El d e r s

was very accommodating of my long-distance status, as was the rest of my committee. One of my committee members, the only woman, urged me to finish my dissertation before having children. “If you have a baby first, your child will be 2 years old before you finish,” she said. Despite this sage advice, I planned an “academic year” pregnancy, expecting that I could finish the interviews during my pregnancy, spend the summer taking care of our newborn, and then return to the part-time teaching and counseling I had taken on at UCSB. Work on the dissertation would get done, I imagined, while I was at home with a sleeping baby. It was pretty ridiculous to think it would be that easy, but such is the arrogance of youth! All went according to plan as I became pregnant in September 1980 and was due in May 1981. But then I suffered a miscarriage in December 1980, and I was devastated. I felt completely derailed by this turn of events so beyond my control. Though the year that followed was a very difficult period for me, retrospectively it was a very valuable life lesson: You can’t plan everything. Life happens. Still committed to my vision, however, in September 1981, I became pregnant again, and in May 1982, our first son, Travis Jonathan, was born. I soon discovered for myself the demands of child-rearing and the wisdom in Mary’s warning. As she predicted, I successfully defended my dissertation in June 1984—one month after our baby’s second birthday. In June 1986, we completed our family with the birth of our second son, David. I was 31. My career plan was also evolving. Shortly after arriving in Santa Barbara, I had been hired to work part-time as a therapist at the UCSB Counseling and Career Planning Center and had also agreed to teach a course on Education and the Black Child in the Black Studies Department. That course went well, and a semester later, the department was in need of someone to teach Group Exploration of Racism, a required course for Black Studies majors. I was asked if I would do it, and while I had never taught such a course, I was willing to try. When I started the course in 1980, I was 26 and was certainly a very inexperienced instructor.

But I could see that my students were yearning to talk about this taboo topic. The course, designed “to provide students with an understanding of the psychological causes and emotional reality of racism as it appears in everyday life,” incorporated the use of lectures, readings, simulation exercises, group research projects, and extensive class discussion to help students explore the psychological impact of racism on Whites as well as people of color. Its impact was powerful. At the end of the semester, students wrote on their evaluations statements like “this course changed my life.” And certainly the impact of reading those evaluations changed mine. I was convinced that helping students understand the ways in which racism operates in their own lives, and what they could do about it, was a social responsibility that I should accept. I soon found the joy of teaching a roomful of students about issues of social justice more satisfying than working with one client at a time in a counseling session. Becoming a tenured college professor became my primary career goal.

RETURNING TO MASSACHUSETTS The campus of UCSB sits on a cliff above the Pacific Ocean, a beautiful setting but during our tenure there (1979–1983) it was a difficult place to be for Black faculty. There were just a few Black male professors, and I was the only Black female faculty member among about 500 faculty members. As an adjunct lecturer, I had no permanent status at the university, nor did my husband, and the prospect for either of us gaining a tenure-track appointment at UCSB seemed dim. Buying a house in the expensive Santa Barbara market was beyond our reach. Even affordable apartments were hard to find, and landlords had their choice of tenants. I often suspected housing discrimination when I had the repeated experience of being told an apartment was available on the phone, only to be told it was no longer available by a surprised-looking landlord when I appeared in person to see it. In addition,

many openly refused to rent to people with children, advertising “no pets, no kids.” The year our son was born, we had a short-term lease on a rented house, and the prospect of again looking for housing, this time with a new baby, was daunting. We decided to leave UCSB and move to my home state of Massachusetts. As a dual-career academic couple, we reasoned that the high number of colleges and universities in Massachusetts would increase the likelihood that we could both find jobs, and now that we had a child, I wanted to live closer to my parents. This plan worked, and I was offered a tenuretrack position in the Psychology Department at Westfield State College (now University) in Westfield, Massachusetts. Travis, too, was offered a job at Westfield, working with at-risk students in their Urban Education Program. When we arrived in the fall of 1983, we doubled the Black faculty there from two to four. We began building our career and family life in western Massachusetts, much as my parents had in Bridgewater 25 years before. Like Santa Barbara, the Black population in Northampton was about 2%, and we were the only Black family on our street. Unlike Santa Barbara, though, the Northampton community had a progressive history; indeed, Sojourner Truth had once lived less than a mile from our house, and we enjoyed a quiet but comfortable life in what is called the Pioneer Valley. Though as a young adult my racial identity had always been more salient for me than my gender identity, my status as the only working mother in a male-dominated psychology department heightened my awareness of gender dynamics. Not only was I the only Black woman in the department, I was also the only married woman with a child. At the time, my three female colleagues were unmarried and childless. When my husband and I decided to have a second child, it was the same year that I was being considered for early tenure, and I was concerned enough about potential gender-related bias that I did not reveal my pregnancy to my departmental colleagues until after my tenure decision was rendered in early 1986. My concerns may have been unwarranted, but I had no data to suggest otherwise. Pi oneer Li f e S tory

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None of the tenured women I knew at the college, even beyond my department, had children. When I was offered the job at Westfield State, I was expected to teach Child Development, Theories of Personality, and Psychology of the Family. But I asked the department chair if I might also teach a course on the psychology of racism. His response was, “Sure, if you want to.” It was that simple. For me, the opportunity to teach what was to become my signature course was a condition of employment. I taught the course every semester for more than 20 years. I quickly learned that one key to success in the course was to be sure it answered these three questions: What? So What? Now What? The first question was foundational: What is racism and how does it manifest itself—at the institutional level, at the cultural level, and at the individual level? The second question was relational: So what? What difference does racism in its various manifestations make in terms of how we think about ourselves as members of a racial category—whether categorized as White or as a person of color? What difference does it make in terms of how we perceive and respond to other people? The third question was translational: Now what? Now that we understand what it is and how it affects us, how do we translate that understanding into action? What can we do about it? Moving from “So What?” to “Now What?” was empowering. Social action generated hope—a powerful antidote to despair.

PSYCHOLOGY AND EDUCATION In the fall of 1989, I gave up my tenured position at Westfield State for an untenured job opportunity in the Department of Psychology and Education at Mount Holyoke College. It was a risk well worth taking. I doubt that I would be a college president today if I had not made that choice. I was enjoying my work at Westfield, but with a heavy teaching load, there was little time for research or writing. My first book, Assimilation Blues: Black Families in a White Community, based on my dissertation, had been published in 1987. With a book in hand, I was in a good position to seek another job. When the 15 0       H o no r i ng O u r El d e r s

“Dear Colleague” letter came from Mount Holyoke soliciting nominations for an assistant professor position in clinical psychology with research interests related to ethnic minority mental health, I inquired as to whether the rank was negotiable. After some exploratory conversations, I decided to apply. My interview went well and I was offered an appointment as an associate professor without tenure. I was promised an early sabbatical and tenure review. I was confident I could get tenure again and was excited to have a teaching load of just two courses a semester, and finally some time to write. Joining a department that combined both psychology and education was a perfect fit for me. My Psychology of Racism course quickly became a popular offering, and my initial observations about the pedagogical relevance of racial identity development theory were confirmed in this new setting. When my article “Talking about Race, Learning about Racism: The Application of Racial Identity Theory in the Classroom” was published as the lead article in the Spring 1992 issue of the Harvard Educational Review, my visibility as a scholar increased dramatically, particularly among education researchers. My writing provided a bridge between the disciplinary worlds of psychology and education. At the time, racial identity development theory was not well known beyond the borders of counseling psychology, but my article introduced it to an education audience. I remember sitting at an American Educational Research Association (AERA) meeting in April 1992 listening to Dr. James Banks, a giant in the field of multicultural education, referencing my just-published article, and was surprised to see that the person sitting next to me in the audience was holding a copy of it in his lap. It was my first peer-reviewed article, and I was thrilled!

ZAPPED IN ST. LOUIS—SPIRITUALITY AND SOCIAL JUSTICE Thanks to a postdoctoral fellowship from the Ford Foundation during the 1991–92 school year,

I was able to stretch the semester sabbatical I had been promised at Mount Holyoke into a full-year ­sabbatical leave. It was memorable not only because of the great experience I had as a visiting scholar at the Stone Center at Wellesley College, including hours spent with the late Jean Baker Miller, author of the groundbreaking book Toward a New Psychology of Women (1976), but it also gave me a lot of time to reflect on my life path and explore my spiritual identity. That exploration was given a jump start by a life-changing experience I had that fall. On October 6, 1991, I flew to St. Louis with my friend and associate, Andrea Ayvazian. We were a biracial team on our way to co-lead a 2-day Unlearning Racism workshop for a multiracial group of clergy representing a range of faith traditions. Though we had done many such workshops together, this was the first with an audience made up exclusively of clergy. In the opening session of the workshop, I was “zapped.” Quite literally, I remember standing in front of a room full of clergy talking about racial justice and experiencing a tingling sensation, like a low-level electric shock. At that moment, I thought with particular clarity that the “antiracism” work I was doing was very important work. While this was not a new idea, there was something especially powerful to me about that moment of insight. All I can say for certain was that I was quite agitated when I got home, restless with questions that I felt could only be answered by greater knowledge of the Bible. Something had happened that felt completely beyond my control and that had riveted my attention on my spiritual life. I took my questions to my pastor, Reverend Ed Harding, and with his guidance, I read the Bible from beginning to end. As I read, I became newly aware of the clear Biblical imperatives to work for social justice and to challenge “isms” of all kinds. I discovered Jesus the revolutionary, the quintessential change agent, and I began to reassess what it really means to be a Christian, a follower of Jesus Christ. It was Ed who first described the antiracism work that I was doing as a form of ministry. I was a little taken aback by his use of that word because of my own limited

definition of ministry, reserved for those who were “Ministers” leading a congregation. It was not until I enrolled at Hartford Seminary in 1993 that my definition of ministry began to shift.

A SEARCH FOR INTEGRATION When I returned to teaching in the fall of 1992, I sometimes felt distracted by my persistent spiritual questions, and I again called Ed for advice. “The problem,” he said, “is that your work life and your spiritual life are disconnected. You need to find a way to integrate them,” and he directed me to Hartford Seminary. Drawn to the compelling course descriptions I read in the catalogue, I signed up for my first course and eventually applied to the Master’s Program in Religious Studies, designed for working adults interested in “exploring the meaning of their faith in their roles in education, public service or business.” In the years I spent taking evening classes at the Seminary, I not only learned a tremendous amount about Christian theology and other faith traditions, I came to understand a new definition of ministry, one that facilitated the integration of my work life and spiritual life that I sought. So what, then, is ministry? Simply stated, it is service to others. I learned that the relevant question for faithful Christians (and perhaps all people of faith) is not, “Are you a minister?” but rather, “What is your ministry?” What is your service to others? Thinking about this question deepened my understanding of my work as a calling. As I sought to integrate my sense of God’s purpose for me into all of my daily activities, it became clear that my commitment to social change needed to always be the cornerstone of my professional work. My education at Hartford Seminary led me to ask myself new questions. The most important one was “what am I called to do?” Meanwhile, my research and writing on Black youth in White communities had given me access to K–12 teachers. In 1992, I gave a presentation to a group of Boston-area school superintendents Pi oneer Li f e S tory

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about the experiences of Black youth in mostly White schools, a topic of interest in districts where Black kids from Boston were being bused into majority-White suburban school districts as part of a voluntary desegregation program known as METCO. That presentation eventually led to an invitation from the superintendents to create a professional development course for teachers in those METCO school districts. In 1994, the course Anti-Racist Classroom Practices for All Students was launched with the financial support of seven school superintendents determined to create more inclusive learning environments in their districts. The teachers in my course were excited about what they were learning, and I began writing about the power of antiracist professional development in the lives of educators (Tatum & Knaplund, 1996). My sphere of influence spread from teachers to principals to school superintendents across the nation. By 1995, I was doing 40–50 public presentations a year, in addition to teaching full-time and taking classes at Hartford Seminary in my spare time. My children were 9 and 13, and I was wearing myself out.

THE GIFT OF SILENCE On October 20, 1995, I lost my voice. The laryngitis was the culmination of an exhausting schedule and an 8-hour workshop delivered despite the fact of a very sore throat. By the end of the workshop, I had no voice left, and it took about two weeks to recover. I recognized my illness as a need for rest. In my exhausted and voiceless state, I made a decision to attend an upcoming 3-day silent retreat I had learned about at Hartford Seminary. I had never been on a silent retreat before, and it was a wonderful experience. I spent my time reading spiritual texts, writing in my journal, and meditating. I continued to ask of God in prayer, “What do you want me to do?” On the second day of the retreat, I felt I had an answer. It came in the form of a book title, “Why Are All the Black Kids Sitting Together in the Cafeteria?” and Other

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Conversations about Race and an outline ­consisting of seven chapter headings. Two years later, in the fall of 1997, the book was published. Though I did not begin my journey at Hartford Seminary to write a book, what I learned there certainly helped me write it. It came as the result of the most valuable lesson of Hartford Seminary—learning to listen for that still, small voice.

THE RESTLESS PROFESSOR When I started taking courses at Hartford Seminary in 1993, I was a newly tenured associate professor at Mount Holyoke College. By the time I completed my master’s degree in Religious Studies at the Seminary in the year 2000, I had become dean of the college, and my Seminary adviser, Barbara Brown Zikmund, then president of Hartford Seminary, was asking me if I had considered becoming a college president. The turn toward academic leadership was completely unplanned. By the time “Why Are All the Black Kids Sitting Together in the Cafeteria?” was published in 1997, I was a full professor and chair of my department. The book’s success led to new job offers at research universities. The thought of teaching graduate students was appealing, but I did not want to disrupt my family situation by moving to a new institution. Nevertheless, I recognized my own restlessness. I needed a new challenge. I sought out a senior colleague in my department for some career advice, and she suggested that I consider applying for the position of dean of the college, the chief student affairs position at Mount Holyoke, which included responsibility for undergraduate studies as well as all co-curricular areas of student life. My immediate response was, “Who in her right mind would want that job?” I imagined endless days of boring meetings. She said, “You are not using your imagination. If you were the dean, you could take the ideas that you have been writing about and put them into practice. You could really impact the student experience here. And what you do here will influence practice at other schools, too.” From that vantage point,

campus leadership began to have new appeal. And indeed she was right. In 1998, I assumed the role of dean and immediately found it to be a job full of creative possibility and opportunity for positive impact, both on campus and off. The agenda I set became known as the ABCs—affirming identity, building community, and cultivating leadership for the 21st century (Tatum, 2000). The work was teaching of a different kind, and it was tremendously satisfying. I was able to introduce new programs and policies, all designed to create a more inclusive learning environment for all of our students. I had found a new calling.

CHOOSING SPELMAN Did I want to be a president? I was not sure. But when I was asked to serve as acting president while the sitting president, Joanne Creighton, was away on a 6-month sabbatical in the spring of 2002, I was delighted to test out the role. The day Joanne handed me the keys to her office she said, “I bet you’ll like it.” She was right. I was just a few weeks into the role of acting president when I got a phone call from a search consultant informing me that I had been nominated for the presidency of Spelman College. Though I had many good personal and professional reasons to stay in Massachusetts, I knew I had to give this opportunity some thought. To help me decide, I flew down to Atlanta for the sole purpose of walking around the campus, unannounced, unescorted and unnoticed, just to see what it felt like to be there. On that warm January day, I found the answer I was looking for when I stepped into the admissions office and requested a brochure. On the back of it was a lovely photo of the campus and this paragraph: When you are inducted into the Spelman sisterhood in a candlelight ceremony, you are given the power to change your life and to light the world. When you graduate, you walk into the Oval and through the Arch, the same path past graduates

have taken. For 120 years now, Spelman has sought to develop the total person: to instill in our students a sense of responsibility for bringing about positive change in the world. This is our heritage and our calling.

Then I read this statement of the Spelman mission: An outstanding historically Black college for women, Spelman promotes academic excellence in the liberal arts, and develops the intellectual, ethical, and leadership potential of its students. Spelman seeks to empower the total person, who appreciates the many cultures of the world and commits to positive social change.

Excellence, leadership, empowerment, appreciation and respect for others, social change— these values have been at the core of my personal and professional work for my entire career. I could not imagine a better or more concise statement of what is important to me. When I read these words, I knew what I should do. That still, small voice was speaking. Now, having served 12 years as president, I can say that Spelman College has flourished and so have I, despite the challenge of navigating the hazards posed by the Great Recession. When I assumed the presidency in August 2002, I told the campus community that I wanted Spelman College to be recognized as a place where young women of African descent could say, “This place was built for me and it is nothing less than the best!” In 2014, it is indeed widely recognized as one of the best liberal arts colleges in the nation. Articulating a bold vision and working collaboratively with an entire campus community to bring that vision to fruition has been a tremendous privilege. The presidential burden of responsibility is offset by the joy of shared accomplishment and the knowledge that Spelman College is shining brightly as a strong beacon of opportunity for the next generation of powerful women. My personal narrative is still unfolding. I share it here in hopes that it will inspire others to

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consider the path of leadership. In 2012, almost 60% of all college and university presidents were age 60 or older. The number of anticipated retirements provides a unique opportunity to expand the presidential ranks beyond the traditional White male profile that has been the norm in higher education. It is time for the leadership of

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American higher education to begin to reflect the diverse populations we serve. Where will these new leaders come from? Perhaps from those who have become restless professors, as I once was, men and women who hear the call of leadership, men and women listening to that still, small voice and choosing to respond.

CHAPTER

16

Reflections of an American Indian Pediatric Psychologist Diane J. Willis

I

t is an honor to be asked to contribute to the section of this Handbook on personal life stories of pioneers in multicultural counseling and psychology. I am a proud Native American and a member of the Kiowa Tribe. The following is a brief overview of my personal and professional life experiences.

MY FAMILY HISTORY I am the eldest of seven children born to William Pascal and Zelma Bynum Willis. My father was a member of the Kiowa Tribe, my mother was White. My great-great-grandmother was Eagle Wing, a full-blood Kiowa who was married to Calisay, a full-blood Mexican who was captured at age 5 years and was raised as a Kiowa. Eagle Wing died in childbirth when her daughter Grace was born, and Grace went on to become the grandmother of T. C. Cannon, a famous Indian artist. Grace’s sister, Mary, married a Wyatt, who traces back to the first Colonial Governor of Jamestown, Virginia. Mary was also the mother of my grandmother, Lula Wyatt Willis. My father’s Native American mother encouraged her sons to get an education, recognizing the early discrimination and lack of opportunities in the Indian Territory in which they lived. Thus, my father worked hard to get an education and ultimately obtained his master’s degree in history. He taught school for a brief period, but after marrying my mother, he was offered an opportunity to buy my grandfather’s general mercantile store. He later established another mercantile business and he and my mother worked in it for many years. During the majority of my childhood, we lived in Tulsa and other cities, but at age 12 years we moved permanently to Tahlequah, Oklahoma, which is the capital of the Western Band of the Cherokee Nation. I often worked with my mother in the clothing store while growing up, while my father ran the hardware store located next door. I learned a

Author’s note: A special thank-you to my friend and colleague Jan L. Culbertson, PhD, Department of Pediatrics, OUHSC, for her editorial help with this chapter.

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great deal about business from them, accompanying mother to the Merchandise Mart in Dallas, Texas, to buy the latest clothing lines for our store, keeping books for my father, selling merchandise, and learning to display clothing in the windows of our store. It was anticipated that I would assume ownership and management of the clothing store when I completed college. However, as a biology major at Northeastern State University in Tahlequah, Oklahoma, I had other ideas. I did not want to remain in a small college town my entire life, and I knew I wanted to enter some aspect of the health field. I applied to St. John’s Hospital Medical Technology Program in Tulsa, Oklahoma, was accepted, and with the blessings of my parents entered this 1-year training program. During my last 2 years of college, a number of people in Tahlequah had asked my father to become a candidate for the State House of Representatives. He did so and won the election. That was my first experience with politics, as I campaigned for my father. He went on to serve in the Oklahoma legislature for 30 years, culminating in his election as Speaker of the Oklahoma House of Representatives. He was a champion of education and services for the disadvantaged citizens of the state, and was known as an expert on state financing and budget issues. Campaigning for my father was an eye-opener regarding politics and the rancor that can exist among people. My father was asked by a number of influential business leaders to run for the legislature in order to obtain natural gas for our region of the state. Everyone used propane, and the man who owned the propane company prevented our area from getting access to natural gas as an alternative fuel. This man was my father’s opponent for the same legislative seat. Propane was expensive compared to natural gas. Thus, emotions ran high with the opposition. During the campaign, threats were made to harm my two younger brothers (ages 3 and 5 years), so that the family took great precautions in watching over them. My mother and I were spat upon by the man in charge of local elections, and the opposition ran ads saying that my father had a ghost writer. Because people knew my father 15 6       H o no r i ng O u r E ld e r s

as the “hardware man,” they did not realize that he was an educated man with an almost photographic memory, had a master’s degree in history, had taught school, and was an excellent businessman as well. Upon the suggestion of a very good lawyer friend, a plan was hatched to prevent the election from being “stolen,” given that the person in charge of the election board made it very clear whom he was supporting. My father went to this person’s office and asked if the FBI had been there yet. This clearly startled the person and scared him enough that the election went on without any more “monkey business”! My father won the election by an overwhelming majority, and within his first session in the House of Representatives, our area of Oklahoma received access to natural gas. Within a couple of legislative sessions, he was named Chair of Appropriations and held this position for several years before being elected Speaker of the Oklahoma House of Representatives. As for my six brothers and sisters, two are now retired school teachers, one is a broker who owned her own real estate company, two brothers are attorneys, and one, now deceased, was head of the Lake Region Electric Co-op. While in high school, two of my sisters and I were entering barrel racing at rodeos and riding our horses at a farm owned by our parents. My family members are all close to each other, thanks to my mother who seemed to know where we were and what we were doing at all times, and who kept us all close. Christmas Eve for the past 65 years has been spent at my parents’ home with all the family—spouses, grandchildren, and now great-grandchildren—present. With my parents deceased, the sister next to me in age moved into our parents’ home and the Christmas tradition continues. Of course, after eating, watching the little ones open presents, and taking a group photo, the family heads to their respective homes for their own private Christmas celebration. There certainly was never a dull moment in our home, and it was not unusual for friends to drop in at dinnertime and eat with us. I have always cherished memories of our evening meals when we all sat around our large table to eat and talk (with no TV blaring)— just the family and friends.

EDUCATIONAL AND PROFESSIONAL JOURNEY Now, returning to my educational journey . . . After completing my medical technology training and passing the professional exam, I became approved as a medical technologist (ASCP) and took my first position at a hospital and clinic in Tulsa. The more involved I became in the lab work, the more I realized that I really preferred to work with people rather than with microbes. I had always wanted to attend a school with a religious affiliation but was not permitted to do so because many of them were not accredited. After a year of working as a medical technologist, I applied to Southern Theological Seminary in Louisville, Kentucky, and was accepted. While attending Seminary, I also worked part-time as a medical technologist in the cardiovascular lab at the University of Louisville Medical Center to help pay my expenses. It was a wonderful year at Seminary, studying with Drs. Wayne Oates, Eric Rust, and other notables at the school and making lifelong friends. It was there that I realized that I wanted to go into the field of psychology thanks to the wonderful influence of Wayne Oates, a pastoral psychologist. I made application to George Peabody College in Nashville, Tennessee, and was accepted into their psychology program. I began graduate school in psychology during the 1963–1964 term at George Peabody. During that year and a half, I maintained a part-time position in a lab at Baptist Hospital in Nashville to help pay my expenses. The program at George Peabody College/Vanderbilt University was exhilarating, though there was much hard work. I had the great fortune to study with Drs. Susan Gray, Nicholas Hobbs, Lloyd Dunn, Jules Seeman, Larry Wrightsman, and Charlie Spielberger (who was on the faculty at Vanderbilt at that time). I received my master’s degree in psychology from Peabody College in 1965. By then, I was feeling homesick and decided to apply to a PhD program in psychology at the University of Oklahoma to complete my training. I was accepted and decided to return to my home state. My adviser at Peabody College, Dr. Larry Wrightsman, urged

me to stay at Peabody, but as I stated earlier, I was homesick. I returned to Oklahoma and entered the PhD program in psychology at the University of Oklahoma (OU) in Norman. Needing to maintain a part-time job during my graduate training, I was very fortunate to work in the neuropsychology lab of Dr. Oscar Parsons at the OU Health Sciences Center initially, and later working as a master’slevel clinician at the Child Study Center while completing graduate school. Dr. Oscar Parsons was a great mentor, and I learned much from working in his lab. It was also good to be back in Oklahoma near my family and to be able to drive to Anadarko, Oklahoma, to attend Native American (Kiowa) ceremonies and visit my Indian relatives there. After completing my doctoral training in experimental/ developmental psychology at OU, I completed a 2-year postdoctoral internship and fellowship training in clinical and pediatric psychology at the OU Health Sciences Center. I had the good fortune of completing my early pediatric psychology training under the tutelage of Dr. Logan Wright, who also is Native American. My first professional position as a psychologist was assistant professor (1971–1974) at the University of Oklahoma Health Sciences Center (OUHSC) in the Department of Communication Disorders and the John W. Keys Speech and Hearing Center. This department had never had a psychologist, so I was tasked with ordering equipment, establishing a rotation for interns and postdoctoral fellows, and teaching two courses (i.e., Developmental Psychology and Tests and Measurements) for the master’s and PhD-level speech pathology students. I also consulted to the Oklahoma School for the Deaf, Cleft Lip/Palate Clinic, and the Communication Disorders Clinic. Finally, I provided consultations and evaluations of patients within the clinics. I also served as a consultant to the Baptist Children’s Home and developed an audiology screening service for the children at the home conducted by the department’s audiology students. Over 60% of the children had some sort of hearing problem (e.g., otitis media, severe ear wax, and/or hearing impairment due to other causes).

Ref le c t i o n s o f a n A m e r i c a n Indi a n Pedi atri c Ps ycholog i s t

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Needless to say, I learned a great deal and was very busy as a faculty member at the Keys Speech and Hearing Center. However, in 1974, I was offered the position of Coordinator of Pediatric Psychology Services at the Oklahoma Children’s Hospital, and I decided to make the move to the hospital in order to work more closely with my mentor, Logan Wright, PhD. Logan and I, to the best of my knowledge, were the only two Native American pediatric psychologists in the country at that time. In fact, Logan was one of the three founders of the Society of Pediatric Psychology (SPP) in 1968 (along with Lee Salk and Dorothea Ross). Children’s Hospital became known to psychology graduate students as the place to do an internship in this new field of pediatric psychology. In 1973, I was appointed newsletter editor of the SPP, and in 1976 I became the founding editor of the Journal of Pediatric Psychology. I resigned as journal editor when I was elected President of SPP, believing that one should never hold two positions simultaneously in any organization. Soon thereafter, the Clinical Child Psychology organization, of which I was a member, asked me to assume the editorship of the Journal of Clinical Child Psychology (JCCP), a position I held for 5 years. As editor of JCCP, I guided its transition to a peer-reviewed journal during 1976 to 1981. In 1981, I was elected president-elect of Division 12, Section 1 (Section on Clinical Child Psychology), and I served as president in 1982–1983. Thus, the first 10 years of my professional life were devoted to pediatric psychology and clinical child psychology activities (providing patient care in the hospital setting, supervising psychology interns, writing my first published articles, founding a new journal, serving as editor of two child-related journals, and serving as president of both SPP and the Section on Clinical Child Psychology, Division 12). In 1975 and 1976, I was asked to assume the position of Director of Psychology at the Child Study Center (CSC) in the Department of Pediatrics, OUHSC. I turned down the position in 1975, but when offered the position again in 1976, I accepted. I was working 12-hour days at the hospital trying to see all the inpatient consults, supervising 15 8       H o no r i ng O u r E ld e r s

interns, and following up on patients, and I was exhausted. At CSC life was a little saner, but still very busy. I began this position with one part-time psychologist and an intern. Within 6 years, we had five faculty psychologists, an internship, and a postdoctoral rotation through the CSC. I developed several new clinics, with primary focus on specific learning disabilities, drug-exposed infants, child abuse, behavior disorders, the neonatal intensive care unit follow-up program for infants (along with neurologist Elidee Thomas, MD, and educator Gertrude Ford), and the Pediatric Neuropsychology Program. I was fortunate to hire accomplished psychologists to head these programs, and they flourished. In addition, I worked with pediatricians as the Developmental Pediatrics Program was getting off the ground. I insisted that these pediatric residents accompany faculty to make at least one home visit on their patients. This proved to be a real eye-opener for these medical intern/residents. As soon as Congress passed the child abuse legislation in the late 1970s, the director of the Oklahoma Department of Human Services (DHS) appointed me to a task force to help set up services in the state according to the provisions of the legislation. The Child Protection Office was established within DHS, after which I wrote a proposal to the chair of pediatrics at Children’s Hospital (CHO) to establish a child protection team (CPT) at the hospital to evaluate, treat, and teach others about child abuse. This was approved and CHO became the first hospital in Oklahoma to see patients for abuse and neglect. The CPT became a great learning experience for medical students, psychology interns, social work students, etc. Soon thereafter, a pediatric radiologist, social worker, and I established the Parents Assistance Center to serve as a treatment facility for parents accused of abusing their children. We obtained grants for the program so that parents could be seen free of charge. As I reflect back, I am very proud of our psychology faculty because all were writing grants, publishing articles, seeing patients, teaching psychology students and medical residents, and contributing their expertise to the Department of Pediatrics faculty. I have often

told people that my faculty was smarter than me, but at least I was smart enough to hire them.

MULTICULTURAL WORK ON BEHALF OF AMERICAN INDIANS Advocacy and Program Development One of my first efforts in advocacy occurred in the 1970s, at a time when First Lady Rosalynn Carter embraced the topic of mental health for advocacy. I invited LaDonna Harris, wife of U.S. Senator Fred Harris and a Native American herself, to the Child Study Center for hearings on the topic of mental health services for Indian Country. LaDonna was helping Mrs. Carter on the Mental Health Task Force. The hearing at the Child Study Center focused on mental health issues of Native Americans. A call for papers went out to Native communities and personal invitations were sent to key leaders in Oklahoma tribes to attend the 1-day meeting. The participants were to bring written papers on the issue and be prepared to talk about or present their paper on mental health to Mrs. Harris. It was the 1980s when I more fully turned my attention to Native American issues. After evaluating and consulting with numerous families who brought in either drug-addicted babies or youngsters affected by prenatal substance exposure, I established a drug/alcohol committee at the Child Study Center and asked Dr. Joe Westermeyer, MD, to co-chair the committee with me. Joe was chair of the OUHSC Department of Psychiatry & Behavioral Sciences at that time and had a long history of working with American Indian families and working on alcohol-related disorders. I included on the committee faculty from the departments of pediatrics, communication disorders, pharmacy, psychiatry and behavioral sciences, physical medicine, and social work. Soon thereafter, I hired a young psychologist, Robin Gurwitch, PhD, to run the clinic I had previously established

at Child Study Center for children with prenatal substance exposure and their families. We anticipated serving perhaps 50 patients over the course of the year, but we were shocked to have referrals of over 50 children in the first 3 to 4 months. This clinic served patients from all the Native tribes in Oklahoma as well as non-Native patients. The evaluations and consultations at first were free of charge because of grant funding we had received. The name of the clinic was A Better Chance (ABC) Clinic and it was staffed by a speech/language pathologist, physical therapist, psychologist, social worker, and pediatrician. We had alerted all the Indian Health Service (IHS) clinics in Oklahoma about the ABC Clinic and how to make referrals. During this time, I was also active in consulting, teaching, and providing clinical services to American Indian children and families from the Chickasaw Tribe (at the Carl Albert Indian Health Facility, Human Services Branch) and at Carter Seminary (a boarding school for American Indian children ages 6 years through high school). Later, I was invited to consult and see patients for the IHS, and I established the first child psychology clinics at two rural IHS clinics. I continue to work at these clinics today, even in retirement. Over the years, psychology interns and postdoctoral fellows from OUHSC have signed up to accompany me to these clinics with the purpose of mentoring the next generation of psychologists who will know how to serve American Indian families.

Testifying Before Congress It was in the 1980s that I had the opportunity to testify before a congressional committee on the topic of Mental Health Needs of American Indians. In late 1989, I was asked by Pat DeLeon, PhD, Chief of Staff for Senator Dan Inouye of Hawaii, to testify before the Committee on Interior and Insular Affairs on the subject of American Indian Mental Health. The Honorable Morris K. Udall chaired the committee. This was my first experience testifying before a committee of Congress, so I was sufficiently anxious. In my testimony, I reviewed a National Mental Health Plan for services to

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American Indians, which pointed out that the most common mental health problems included depression, grief reactions, anxiety, suicide and suicide attempts, alcohol and substance abuse, school problems, child abuse and neglect, and other developmental disorders. I recommended to the committee that the words “mental health” be defined to include mental, behavioral, and developmental disorders, as that would encompass the essence of the major mental health problems of American Indians. Second, I recommended the establishment of interdisciplinary child, youth, and family developmental centers, much like our Child Study Center. This need not be a stationary center, as mobile teams could provide services and training throughout various regions and in more remote, rural parts of Indian Country. Third, I was concerned at that time that there were only 17 PhDs or MDs trained to work with children and youth in Indian country, and statistics demonstrated the extreme lack of degreed and highly qualified mental health workers. I recommended on-the-job training by a melding of departments of psychology, psychiatry, and social work and/or degreed mental health professionals who are knowledgeable about American Indians. Finally, I urged the IHS, Bureau of Indian Affairs (BIA), and other tribal programs to form closer ties with academic departments at universities where degreed experts could help train tribal personnel in a variety of mental health areas. Numerous people testified before this committee, and the end result, I later learned, was funding for 100 new mental health personnel for IHS and tribes. In 1992, I was again asked to testify before Congress on behalf of the American Psychological Association (APA) on the issue of child abuse in Indian Country. At that time, there was little research published on child abuse, and nothing pertaining to Indian Country. Therefore, I stressed the need for research funding. I pointed out that the child who has been abused will be the adult and parent of tomorrow, with many of the problems and learned behaviors carried over into his or her future. We needed research on the prevention of child abuse and neglect, research on 16 0       H o no r i ng O u r E ld e r s

the treatment of abused and neglected children and the perpetrators, and research on legal issues related to child abuse and neglect. In my testimony, I highlighted specific questions, as follows: •• What are the long term consequences of abuse and neglect on the child who has reached adulthood? •• What neighborhood, school, family, or centerbased programs are effective in reducing the incidence of child abuse and neglect? •• Are there cultural differences in the area of child abuse and neglect? For instance, we do not know the incidence of child abuse and neglect among American Indians, yet we know that the incidence of mental disorders in Indian children and adolescents is greater than in the non-Indian population (20–25% vs. 12–18%). •• What in-home or clinic-based services are most effective for abusive parents and can assure that the child can safely remain in the home versus being sent to a foster home? •• What risk factors can Child Protective Service workers follow that can guide their decision making regarding removal of a child from his or her home versus establishing in-home services? •• What are the long-term consequences of neglect? Is it more insidious and destructive on the development of children than any other form of abuse? We know very little about neglect.

I concluded my presentation with the following: “Someone once said, ‘As psychologists, we can try to mend tragedy. As citizens, we must try to prevent it. The children’s lives are in our hands, but our future is in their lives.’”

The Birth of the Section on Clinical Psychology of Ethnic Minorities Over the years, in the various offices I held, I tried to acquaint psychologists with the needs of American Indians. In 1975, the president of Division 12, Bonnie Strickland, appointed me to the Ad Hoc Committee on Equal Opportunity and Affirmative Action (EOAA), which was chaired by

Asuncion Austria. I served with several outstanding psychologists, and from this committee we recommended the formation of Division 12, Section 6. We gathered information from 100 departments of psychology with accredited clinical programs in 1974–1975 and learned that of the students enrolled, 666 were African American, 10,814 were Caucasian, 110 were Spanish-speaking or had Spanish surnames, 18 were American Indians, 149 were Asian Americans, and 296 were foreign nationals. We also learned that women comprised only 14% of the overall faculties of the graduate programs, and minorities were also a small proportion of the faculties. Thus, women and minorities were underrepresented both in academic and practicum training settings. Bonnie Strickland presented the full report of the EOAA Task Force to the Division 12 executive committee. In 1976, I wrote a report for the committee titled “Old Ways vs. New! Equal Opportunity and Affirmative Action Report,” and I began the article as follows: “Why should I join a division whose structure and governance is that of the white male? That is the question the newly formed EOAA Committee has been asked by numerous minority groups.” Aside from the recommendations our committee made to Division 12, we were successful in creating the Section on Clinical Psychology of Ethnic Minorities, and that Section remains strong today. From the 1980s to the present time, I have been active in Division 37 (Child, Youth, and Family Services and Advocacy)—a division devoted to advocacy. I was asked to write a guest editorial for the division newsletter titled “The Critical Needs of Ethnic Minorities” (Spring 1988, Division 37 Newsletter, Vol. 11, No. 2). In the article, I hoped to help readers become more sensitive and knowledgeable about the multiple problems confronting minorities, and particularly American Indians. This article reviewed the social and economic issues, leading causes of mortality, the number of deaths as a function of age and race, the number of accidental deaths, and deaths related to alcoholism. The article concluded with recommendations to improve the status of American Indians and other minorities.

Teaching and Mentoring In the early 1990s, I obtained monies for a postdoctoral position at the Child Study Center and I asked Delores “Dee” Bigfoot to fill that position. Dr. Bigfoot made a very favorable impression on the entire faculty who worked with her. At the completion of her postdoctoral fellowship, she was hired to work in the Center on Child Abuse and Neglect (CCAN) at the Child Study Center, OUHSC. Dee worked on a project to train behavioral health workers in Indian Country on child abuse and neglect issues, and then she began Project Making Medicine. I had the good fortune of working on this project for several years with Dee and Dr. Barbara Bonner, director of CCAN, as we brought in tribal behavioral health workers from across the United States for a week of intensive training. The grant provided for weekly telephone consultation to each participant, and at the end of the year, a 2- to 3-day community training was provided by two of the three project leaders to provide information and raise community awareness about child abuse and neglect. Dr. Bigfoot has continued this project through 2014 and has trained hundreds of tribal people across the United States. Dr. Bigfoot’s Project Making Medicine has been well received in Indian Country. Dr. Alisha Lee, Department of Public Health at OUHSC, obtained grant monies that enabled development of a course on American Indian health in the Native American Studies Program at University of Oklahoma. As the course became instituted at OU, I was asked to teach the course by the head of the Native American Studies Program, Dr. Clara Sue Kidwell. For several years, I was honored to teach students about the types of health-related problems confronting Native Americans, about the IHS, and about prevention of health-related disorders from cancer, cardiac disease, and diabetes to substance abuse, child abuse and neglect, and other mental health and emotional disorders. I still serve as an adjunct professor in the Native American Studies Program at OU. In the early 1990s, Dr. Bigfoot, Toni Dobrec, and I wrote a chapter on treating American Indian

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victims of abuse and neglect, and later, Luis Vargas and I served as guest editors of a special issue of The Journal of Clinical Child Psychology, focusing on “New Directions on the Treatment and Assessment of Ethnic Minority Children and Adolescents.” From 1989 through 1993, I was most fortunate to be appointed to the U.S. Advisory Board on Child Abuse and Neglect. Because American Indians are often the forgotten race, we are not included in many of the publications coming out of the Department of Health and Human Services (DHHS) and other organizations. As a member of the U.S. Advisory Board, it was my good fortune to be able to insert information about the needs of American Indian and Alaska Native peoples into the two major publications submitted to DHHS from the Advisory Board. I inserted information about the services that could be provided by the IHS, the role of the Indian child welfare (ICW) workers, and the strengths and challenges of Indian people residing on reservations.

Work With Head Start and Early Head Start Soon after President Clinton and his administration passed the legislation establishing Early Head Start (EHS), I was invited to consult with Three Feathers Associates in Norman, Oklahoma, an agency run by three Native American professionals who administered the American Indian Head Start/Early Head Start quality improvement grants to help tribes initiate their own EHS programs around Indian Country. As a consultant hired by Three Feathers Associates, I worked with several tribes, helping them develop their program services and meet the national standards for EHS programs. Although I was still a faculty member in the OUHSC Department of Pediatrics and Child Study Center, I had worked out an agreement with the chair of pediatrics whereby Three Feathers Associates contracted with the department for part of my time and salary. Working with the EHS Wave 1 grantees was both extremely rewarding and extremely frustrating. Tribes, of 16 2       H o no r i ng O u r E ld e r s

course, hire from within their communities, and many of them hire their relatives or close friends regardless of qualifications for the positions. Many of the programs with which I worked had EHS directors who knew little about the goals and aspirations of EHS, had little knowledge about early development of infants and toddlers, and served as poor role models for parents who, in some cases, did not want their infants/toddlers in a program in which they had little respect for either the director or the teachers. Therefore, in the first 12 to 18 months, many program changes were made to improve the stability of staff and programs. This process took time, and we spent many hours doing training on-site with EHS staff and assuring that staff could attend specialized training events to learn about infant and toddler development. With these efforts, programs soon began to flourish. The EHS staff recognized that if we can get pregnant mothers to come in for services (i.e., health care, nutrition, emotional support, helping them stop smoking or drinking, and showing them how promising this can be for them and their baby), the tribe would eventually have healthier children and families. During these early years of EHS, I realized that I had found a program that could have profoundly positive consequences for our Indian children and families. I believe that Early Head Start was, and is, a program all of our tribes must have, though the professional training and supervision must be built in to enhance the skills of the staff. Otherwise, EHS would end up being just another child care or babysitting service. At our meetings of the American Indian Programs Branch (AIPB) of the Department of Health and Human Services in Washington, DC, many of us began advocating for mental health to be a component in the EHS regulations, along with funding tied to this component. After Three Feathers Associates lost their HS and EHS contracts, the American Indian Institute (AII) at the University of Oklahoma became the lead consultant for EHS/HS in Indian Country. Anita Chisholm, the very able director of the American Indian Institute, asked me to join them to provide consultation and training on the EHS portion of

their consulting grant. I loved this work so much and felt that it was of such enormous benefit to tribes, children, and families that I decided to take early retirement from the Department of Pediatrics at OUHSC to join AII full time. When extensive training and travel became too much for me, I moved into a position of consultant to tribes and speaker at EHS conferences. Soon thereafter, when the AII contract expired, I was invited to be on a committee developed by Berry Brazelton, MD, Harvard University, to consult with tribes regarding early intervention with infants and toddlers. I remained on this committee for 1½ years. Even now, when asked, I provide pro bono services and consultation to American Indian Head Start programs in Oklahoma. Another noteworthy issue was that of reimbursement for psychological services under Medicare. Obviously, if psychologists could be reimbursed, psychological services would be available for all racial groups over a specific age range. It would also help determine our profession’s “ultimate fate,” as Senator Inouye stated in his March 23, 1977, letter to Marvin Metsky, PhD, and forwarded to Division 12’s leadership by Max Siegel (president). The Division leadership and members began a grassroots effort to contact our various congressional leaders at the state level, and as any mental health professional knows, reimbursement for mental health services now exists. Logan Wright and I had already worked at the state level to obtain services for abused children and their families where psychologists could be reimbursed under Medicaid. Oklahoma was the first state to receive such reimbursement, which now is commonplace. I have shared with students that it is important to be proactive in their lives and in their profession and that they can make a difference in the world around them. Many have said, “But it’s just me— what can I do?” I remind them that every great movement was started by a single individual and that they have the intellect to see what is needed and the power, perhaps commitment, to start new programs, advocate for change in existing programs, write up sound, well-researched papers

to share with legislators, program administrators, APA advocacy office, and other organizations who might share your views. For example, Early Head Start can make a tremendous difference in the lives of low-income and minority children and families, yet the current Congress has cut funding for this important program. We know more about developmental issues, brain, and psychosocial development than any member of Congress. Can we educate our own legislative group within our state and provide them, and their aides, with written information that they can use as talking points with their colleagues? Yes, I tell students, any one of us can be an important advocate for those issues about which we care.

APA Activities It was not until 2001–2002 that I again became active in Division 12. Over the years, the division had not changed much (with the exception of David Barlow’s presidency), when in 2002, I was elected president-elect and then assumed the presidency in 2003. The first order of business for me was to put ethnic minorities on the board. As president-elect, I recommended that the division create a new award honoring ethnic minorities and suggested that the award be named the Stanley Sue Award. This was approved unanimously. As president, I asked Stanley to chair the society’s Committee on Science and Practice, and by the way, we gave the first Stanley Sue Award to Stanley! I appointed three more ethnic minority professionals to committees. John Robinson chaired the Membership Committee, Asuncion “Siony” Austria chaired the Governance Committee, and Lahoma Schultz (an American Indian psychology student) was appointed as a special student representative. My first presidential article for The Clinical Psychologist was titled “Best Practices With Special Populations.” Over the years, I have been blessed with receiving various awards. Because of my advocacy and mentoring work, APA Division 37 (Children, Youth, and Family Services and Advocacy), in conjunction with the American Psychological

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Foundation (APF) named an award after me— “The Diane J. Willis Early Career Award.” The division raised $50,000 so that the annual awardee receives $2,000. In 2010, APA Division 45 (Society for the Psychological Study of Ethnic Minority Issues) presented me with the Distinguished Career Contributions to Service Award. In 2013, I was much honored to be nominated and to receive the Distinguished Elder’s Award, given on behalf of the National Multicultural Conference & Summit. Other awards that have meant a great deal to me include the Indian Woman of the Year Award given by the Oklahoma Federation of Indian Women, the Nicholas Hobbs Award for Distinguished Child Advocacy given by Division 37, the Distinguished Alumni Award, and the Distinguished Professional Contributions Award given by Division 12 (Society of Clinical Psychology) in 1996.

BALANCING WORK AND PLAY Balancing one’s professional life early in one’s career might be challenging, but it can be done. Indeed, it gives us new energy and ideas when we take that break. I must admit, though, that my first few years as a faculty member at OUHSC were extremely busy, and even more so when I assumed editorship of a newsletter and two journals. But I began to work a more normal schedule after several years. In today’s market, new professionals are busy in their new jobs developing courses, writing grant proposals to help pay their salary, starting research projects so that tenure and promotion can be attained, seeing patients and setting up guidelines for referrals, ordering diagnostic tests, and developing a professional “presence.” In my career, I found outlets for relaxation in several ways. Being at the OUHSC and living in Norman, Oklahoma, where OU football is “king,” I bought season tickets to the football games, and every year on football weekends, my home was filled with friends and family. It was great fun and a welcome change of pace from the work week. Later in my career, I was privileged to teach courses on U.S. military bases 16 4       H o no r i ng O u r E ld e r s

in Europe and around the world. In conjunction with the teaching assignments, I would add an extra week of vacation so I could travel in the region where I was teaching. There were memorable travels in Germany, Italy, England, Spain, and Iceland. At least once or twice per year, I traveled in the United States to the Navajo and Hopi Indian reservations in Arizona, where I visited friends and attended ceremonies. Perhaps the best and most memorable times I spent away from the office were the times in which I was involved with APA activities and various Divisions (12, 37, 45, 53, and 54). As a young psychologist, it was exciting to be a part of “growing new divisions” within APA (especially, 37, 45, 53, and 54), attending business meetings, social hours, and many of the programs sponsored by these groups. Within these divisions and the boards and committees on which I served, there is great satisfaction in initiating new projects that can improve the welfare of people, or testifying before Congress, or being a part of something that is bigger than ourselves. I would encourage young psychologists to get involved and volunteer time to APA in order to cross paths with other professionals from across the United States. Many of my best friends are persons whom I met at APA in various capacities (i.e., committee of board members, colleagues in various divisions, etc.). Not only do we enjoy coming together once a year at the annual convention, but we also travel together and visit each other at other times during the year. Now that I am retired, I have more time to garden, read, travel, attend Kiowa ceremonies, work on genealogy, play with my large family of cats, and see my family (some of whom still come to my home on football weekends).

REFLECTIONS FOR YOUNG PROFESSIONALS, OR LESSONS LEARNED First, let me say that I have had a wonderful life. My friends and family mean the world to me, and they all give me sustenance. As I reflect back over the

years, it is very important that young professionals make time for friends and family, as one’s social network can be inspiring, challenging, relaxing, and enjoyable. It is important to build meaningful time for friends and family. Second, in one’s life it is also important to embrace the idea of lifelong learning and to explore areas you might not have had time to explore. And be sure to develop a hobby! In my senior years I have cherished the opportunity to travel abroad, to read biographical books I never had time to read before, and to read about the countries I visited or places in which I have taught courses. I have learned a great deal about history, politics and government, and about universal health care in most of Europe and other parts of the world. As a “closer-to-home” hobby, I am devoted to my animal friends, to my home, to genealogy, and to gardening. And for those young professionals, now is the time to start investing your money so that in your twilight years you’ll be able to enjoy outside activities. Take care of

your health, mentor your students, be honest in your work, make a difference in the lives of those you touch, and advocate for people and programs about which you are passionate. Finally, join your professional organization and be active in it. The contacts you will have around the United States and the world will be a source of great pleasure. If you have students who need jobs and letters of reference, these contacts will be very helpful to them. Mostly, though, the professional contacts are rewarding friendships that you will treasure over the years. In conclusion, I cherish my past mentors— Susan Gray and Nicholas Hobbs at Peabody College; Logan Wright and Oscar Parsons at OUHSC; my father, W. P. “Bill” Willis, for his honesty and advocacy work in the legislature; my mother, Zelma Bynum Willis, for her loving and generous spirit; and my loving grandparents, Herb and Orpha Bynum, who overlooked every mistake I ever made and still loved me.

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CHAPTER

17

Factors and Experiences of Life Reflections on the Accomplishments of the Pioneers J. Manuel Casas

I

n this chapter that concludes the pioneer section of the book, I have the honor of reflectively summarizing and discussing varied aspects of the pioneer stories as a whole and each story in particular. I do this by first acknowledging the fortitude and willingness demonstrated by the pioneers in courageously sharing their personal lives with us. To this point, as you will have noted, the life stories are highly revealing and quite poignant, with both deeply painful and empowering life events described. Through their sharing, we can now see and better understand the “person” behind the pioneering work. Seeking to avoid solely providing straightforward summaries of the stories, the goal of this chapter is to provide summaries that highlight selective attributes, factors, challenges, and experiences in the pioneers’ lives that, in one way or another (i.e., positively or negatively), gave shape and direction to their personal lives and their professional efforts and accomplishments. Such factors and experiences include but are not limited to 1. national and international world-shaking historical events that were experienced directly or indirectly and as evident in their stories impacted differentially on various aspects of their lives: the Cuban revolution, the civil rights movement, the Brown v. Board of Education decision (desegregation, end to separate but equal), the Vietnam War, assassinations (i.e., John Kennedy, Dr. Martin Luther King Jr., Robert Kennedy), the farm workers movement, the women’s movement, the LGBT movement, the AIDS epidemic, the Iraq War, and the War on Poverty; 2. sociocultural and family contextual factors, which include having the opportunity to learn from family and community about one’s past historical/ancestral and family background (e.g., it takes a village . . .); being taught to make use of one’s past to build a better tomorrow; growing up in a close-knit family, including extended family members; learning to respect one’s elders; being raised in a family that promotes resiliency, enabling one to deal effectively with stressful life situations; growing up in a family or community that sees

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education as the key to a better future; having family, friends, or mentors who could help you understand and effectively cope with such negative factors like racism, sexism, homophobia, discrimination, segregation, and microaggressions; and 3. from a social justice perspective, learning at a young age the importance of taking care of the “least of your brothers,” that you are your brother’s keeper; being taught to believe and trust in one’s self; being in touch with individuals who believe in you and your ability to “become”; and belonging to a family and/or community that values religion and/or spirituality and has strong adherence to traditions and customs.

Having identified selective factors that have impacted the personal and professional development of our pioneers, I now present the summaries that highlight these factors.

SUMMARY OF STORIES HIGHLIGHTING IMPACTFUL FACTORS AND EXPERIENCES IN THE LIVES OF THE PIONEERS In her story, Dr. Martha Banks shares with great sensitivity her physical and psychological pain and associated experiences associated with a disability that she has endured throughout her life—a pain that in one way or another has impacted all of her life experiences and concomitantly instilled in her a worldview of life that she has put to good use in attaining very admirable personal and professional goals. Some of the experiences, factors, and beliefs that have impacted her life and that she shares in her story include the importance of religion, and more specifically, the church relative to her developing and flourishing as a woman of color (to this end, when referring to her early life, she writes, church was “the only Coulored activity in my life”); the importance of listening and paying attention to all individuals and especially those

with disabilities; the belief that there’s work to do and those who can should do it—payback for all that has been given to you; extensive experiences as both a caregiver and care receiver; and a determination to not let any barriers—racial and others—impede her work. Her work, rooted in such beliefs, is widely recognized as having developed an expertise that encompasses the intersection of gender, ethnicity, and ability status (Banks, 2012). Underscoring this perspective in her own words (Banks, this volume, Chapter 5): I was invited to co-edit a special issue of Women & Therapy, which was simultaneously published as a book (Banks & Kaschak, 2003) and, later, a multivolume reference set (Marshall, Kendall, Banks, & Gover, 2009). In between and since then, I have been invited to present and contribute chapters and articles. The National Multicultural Conference and Summit invited me to speak on “Disability in the Family: A Life Span Perspective” (Banks, 2003). Perhaps my most meaningful contribution was in bringing attention to women, ethnicity, and disability as one of my Society for the Psychology of Women presidential initiatives (Banks, 2010).

Dr. Guillermo Bernal, an immigrant to the United States from Cuba during the early tumultuous days of the Castro revolution, experienced many of the contextual, social, and psychological barriers and challenges that are associated with being an immigrant and a person of color simultaneously. (For details regarding life experiences that are associated with being designated as such, refer to the two chapters in this edition that focus on immigration.) As evident in his story, these experiences (i.e., barriers) that have had a significant impact on his becoming the person and the professional that he is today include linguistic challenges, economic misfortunes, and discrimination in schools and other settings based on race and/or ethnicity. One group of experiences to which he gives specific attention because of the stressful yet motivating impact that they have

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had on him throughout his lifetime are those associated with acculturation/assimilation. More specifically, Dr. Bernal writes quite poignantly and provokingly about the “pull and push” associated with acculturation (i.e., its acceptance as a given or an active resistance toward it), and in particular, how this dynamic and his dealing with it has influenced his work in the area of multiculturalism. Not to dwell on the negative, Dr. Bernal directs attention to the important role that his family has played in his life. Accordingly, his parents and extended family members taught him to value his culture, history, ancestors, traditions, family relationships, and education. These teachings reflected the belief, held by many immigrants, that realities can change at any moment; however, values such as these have more permanence despite changes in time and context. A selection of his accomplishments include being the first Latino student to enter the prestigious Psychology Program at the University of Massachusetts–Amherst. To this day, he talks about the “lonely experience” of being the only one (an experience relayed by several pioneers). Much of his pioneering work has consisted of breaking “new ground”—developing and implementing programs in settings where none had previously existed. At the University of California, San Francisco, he was at the forefront in developing a model community psychiatry/psychology program to serve a very large and diverse population experiencing very complicated psychosocial problems. He has a very impressive list of publications, one of which he is the first editor and that has been of great use to the field is the Handbook of Racial Ethnic Minority Psychology (Bernal, Trimble, Burlew, & Leong, 2003). Dr. Robert Carter’s impressive story strongly illustrates the fact that in spite of experiencing educational, social, and eventually professional obstacles and challenges (e.g., confronting the belief held by others that he didn’t belong), it is possible to confront and overcome them, allowing a person to follow “the road less traveled,” a road that can lead to personal and professional accomplishments and satisfaction. According to Dr. Carter, successful 16 8       H onoring O u r E lders

navigation along this road is made possible by the existence of specific social and personal factors that include the following: persistence, patience, determination, high personal value, belief in self, motivation and drive, an “I’ll show you attitude,” and encouragement, guidance, and support from friends/mentors (e.g., Dr. Sam Johnson, Dr. Janet Helms). In referring to the help and encouragement offered by Dr. Johnson, friend and mentor, Dr. Carter states, “He became a model and mentor to me, offered encouragement and guidance, and showed me a path I could take that I did not know existed. . . . He had experience walking on a road that he thought I could travel as well.” (Carter, this volume, Chapter 7). As a result of the challenges he has faced in life, having empathy, and having learned to have compassion for others who may have faced similar challenges, he has directed his research and publication efforts to work that has personal meaning. To this end, he has done groundbreaking work on the issues of race, identity, and culture. More specifically, he has applied analysis of race, racial identity, and culture to psychotherapy processes and outcome, legal issues, organizational development, and health and educational disparities. His most recent area of inquiry is race-based traumatic stress outcomes on mental health. Acknowledgment of Dr. Carter’s accomplishments include being appointed and serving as editor of The Counseling Psychologist (TCP) from 2001–2007. It bears noting that he was the first and only Black psychologist to serve in this capacity. According to Dr. Carter, while Division 17 failed to acknowledge his accomplishments as editor, it is a fact that during his tenure TCP was listed as having the highest impact factor among journals in applied psychology. In addition, Dr. Carter received the American Civil Liberties Union (ACLU) Ira Glasser Racial Justice Fellow (2004–2005). He was awarded the Janet E. Helms Award for Mentoring and Scholarship in Psychology and Education, Teachers College, Columbia University, and most recently, he was designated as an Elder by the National Multi­ cultural Conference and Summit.

Dr. Fannie Cheung’s (native of Hong Kong) accomplishments are so vast and impressive that it is impossible to contain them in a short paragraph. Thus, I will only single out a few to give you a sense of all that she has done as a researcher and social justice advocate. Quite impressively, Dr. Cheung, who received her secondary and advanced education in the United States, was a leading figure in establishing the scientific status of psychology in China. The preponderance of her research focused on all aspects of personality assessment. She developed a Chinese version of the MMPI and then went on to develop the Chinese Personality Inventory and the Cross-Cultural Personality Assessment Inventory to reflect cross-cultural relevance. From a social justice perspective, she is considered a gender pioneer and feminist leader in China. To this end, she spearheaded a war on rape campaign in Hong Kong in the late 1970s that included her working to raise awareness, change legislation, develop crisis intervention services, and train “front line” professionals. She established the first gender research program and initiated a Gender Studies Curriculum at the Chinese University of Hong Kong. Finally, she was the founding chairperson of the Equal Opportunities Commission in Hong Kong in 1996. Dr. Lillian Comas Díaz’s story interestingly illustrates how her growing up with syncretism and magical realism planted the seeds for developing into an acclaimed multicultural researcher, academician, writer, and practitioner who dares to explore, understand, and make use of the very fascinating, provocative, and challenging relationship that exists between the spiritual and the psychological. To this point, one area in which she is truly an expert is that of magical realism, which she contends blurs the boundaries between reality and fantasy and promotes the interaction between the supernatural and the natural. She credits her interest and work in this area to the teaching and life examples provided by her grandparents, parents, and extended family with whom she lived on both the mainland and the island “del encanto,” Puerto Rico. It is safe to say that all of her work is infused with a commitment to social justice, and

in particular as it relates to people of color and women. Specific accomplishments that give her a special standing in the history of the American Psychological Association (APA) include being the first director of the Office of Ethnic Minority Affairs (OEMA), a founding person of APA Division 45 (Society for the Scientific Study of Ethnic Minority Issues), and founding editor of the official journal of APA Division 45, Cultural Diversity and Ethnic Minority Psychology. Dr. Beverly Greene’s ancestral family history (i.e., slavery), her family, strong educational and religious orientation, and life experiences (e.g., racism) greatly imbued her thinking, theorizing, writing, and clinical practice. Very early on she learned, among other things, the importance of taking responsibility for the world we live in, how to navigate and survive within a racist society, and the need for taking content and context into consideration when seeking to understand others. These elements of her life served to attract Dr. Greene to psychology, and in particular to the study of marginalization and feminism. Her work with marginalized individuals served as the entry point for her widely acknowledged work in the area of feminist psychology. A major accomplishment relative to this work was that of expanding the feminist movement to become more aware and responsive to women of color. In addition, she brought much-needed attention to the fact that women do not have only one identity. On the contrary, they have multiple identities, and as such, the notion that the primary locus of oppression of all women was gender was greatly overstated. Since Dr. Greene began her career in psychology, there have been many important advances in psychology’s understanding of and approach to those who are multiply marginalized for varied reasons. This does not mean, according to Greene, that systemic inequality no longer exists. She believes that as much as psychology has advanced in recognizing its own limitations, inequalities are still prevalent. She believes that psychology has to work continuously toward recognizing that racism and discrimination against certain people are still very much a reality. Dr Greene strongly contends

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that science should be used to facilitate equality, social justice, and change. From her perspective, she expresses the belief that challenges arise when those of the majority fail to recognize the need for change, or create the illusion that these issues have been resolved. Dr. Bertha Holliday has admirably demonstrated a lifelong commitment toward working for social justice for all, but in particular, persons of color. This commitment is a reflection of her total life experiences. According to Dr. Holliday, she was born into a busy and noisy household where opinions were openly expressed and discussions and debates flowed freely. As a result of a stimulating environment, she developed a very keen and sharp mind that she eventually put to good use in advocating for and actually bringing about social justice change in a variety of settings, including the APA. Her propensity to advocate on behalf of the less fortunate can be attributed to her parents, who appear to have been excellent social justice advocacy models. Her mother held helping positions and her father sought to eliminate inequality by working to increase civil liberties and rights where they might be lacking. Her intellectual abilities as well as her abilities to navigate through segregated schools are underscored by the fact that she broke new ground by successfully attending major universities and colleges where persons of color were highly underrepresented. To carry out her work, she has relied greatly on her outstanding intellectual abilities, excellent education and training, and extensive experiences in the area of social and organizational development. She contends that passion, patience, and courage have enabled her to attain the personal and professional goals that she set for herself. Her accomplishments within professional psychology, especially from an organizational perspective, are too numerous to mention. Suffice it to say that she has been at the vanguard for most, if not all, of the advances that APA has made in the realm of multicultural psychology. More specifically, she and her very competent staff have been at the forefront of developing and/or implementing the majority of multicultural-focused policies, offices, programs, 17 0       H onoring O u r E lders

committees, and task forces at APA (see Casas’s history, Chapter 1, this volume). It would be safe to say that Dr. Holliday’s greatest accomplishment is that at one time or another, or in one form or another, she has helped almost all psychologists of color, including myself. Dr. Anthony Marsella is a monumental multicultural psychology pioneer among the pioneers included in this edition of the Handbook. From his story, it is safe to say that he was working in the field of multiculturalism before it became the “right and timely” thing to do. Based on his explanation regarding his very personal relationship and commitment to multiculturalism, his doing so is not surprising. In his own words, “Multiculturalism, not as a disciplinary or professional subspecialty, is for me, a natural—perhaps reflexive—orientation for life. The recognition and acceptance of diversity in life—differences—stands as the fundamental foundation of my life. Life is diversity!” (Marsella, this volume, Chapter 12). His life experiences and research endeavors both in and outside of the United States led him to become quite sensitive and critical of the ethnocentric biases that are rooted in psychology. As evident in his work, he was an early protagonist of the now widely accepted fact that behavior is the product of varied and interacting factors including race, ethnicity, culture, and social and situational conditions and experiences. In his story, he best expresses his ongoing commitment toward making psychology more responsive to social justice, stating that it behooves psychology to move toward an awareness of psychology’s consequences for social justice and actions amid the challenges of our global era. In recent years, he has become quite active in speaking out against violence, war, and injustices wherever they occur. Acknowledgment of his accomplishments as an academician, researcher, and social activist are many. However, since he downplays these in his story, as only a person of his stature with great humility can do, I mention but one: The APA award for Contributions to International Psychology. Dr. Thomas Parham’s story could aptly be titled Lessons and Thoughts to Help One Lead a Socially

Just Life. Drawing from a strong and respectful relationship with his mother, who directed and supported his religious and educational development, his challenging life experiences, and the friends and mentors (e.g., Joe White, Janet Helms) who he met and worked with along the way, he developed some very thought-provoking ideas from which to understand and navigate the world. I think that his ideas, of and by themselves, are a great contribution to multicultural counseling and life itself, and as such, I choose to selectively share the following that are contained in his story: •• “. . . my journey . . . was more like following a roadmap chartered by some folks who came before, rather than navigating the abyss of unchartered territory.” •• In referring to persons of color who have experienced discrimination, “You cannot seek validation from your oppressor.” •• Lesson learned from A.G. Hilliard: “There is something wrong with a psychology that leaves people strangers to themselves, aliens to their culture, oblivious to their condition in the world, perceived as inhuman by their oppressors.” •• “. . . each of us is a seed of divinely inspired possibility, which when nurtured in its proper context, can and will grow into the fullest expression of all we are supposed to become.” •• Demonstrating respect for and knowledge of the past: “. . . if the Elders and Ancestors could suffer from and yet manage the hardships, indignities, and mad cruelties that they did to get my generation to the place it now occupies, then certainly I could do the same in an environment and context that was less harsh and different, albeit oppressive.” •• “Life at its best is a creative synthesis of opposites in fruitful harmony.” •• Focusing on the importance of education Dr. Parham quotes Brother Malcolm X (1964): “Education is the passport to the future, for tomorrow belongs to those who prepare for it today.” •• Quoting African wisdom, “When the student is ready, the teacher will appear.” •• Our debt to others yet to come: Borrowing from Joe White and in reference to the freedom train, “. . . our task was to pay it forward and invite and

mentor others to board that train, which would help them navigate the pathways to productivity and success.” •• “. . . it ain’t a slave ship.”

Relative to other accomplishments, he is quite possibly the first African American academic ­psychologist hired by the University of Pennsyl­ vania in the early 1980s (not too long ago). Starting from that position, he then went on to do some very impressive academic and administrative work across varied institutions. His sphere of work has been so impressive that it has brought him numerous well-deserved accolades, which include a Lifetime Achievement Award in James Jones’s honor, the Janet Helms Award for Mentoring and Scholarship from the Winter Roundtable Conference of Teachers College of Columbia University, Fellow status in APA and the American Counseling Association (ACA), and Distinguished Psychologist Status from the Association of Black Psychologists (ABPsi). In her story, Dr. Lisa Suzuki provides some very interesting and poignant insights into two major social psychological processes that strongly impacted her parents’ life, her life, as well as that of many of the pioneers included in this and previous editions of the Handbook: discrimination and assimilation. She does not address these processes clinically but does so from a very humanistic and personal perspective. To this end, she shares the impact that being born in 1961 to second-­ generation Japanese American parents, who were born in Hawaii (“Nisei”) and who experienced life before and after the Japanese attack on Pearl Harbor, had on her development as a person, a professional, and more recently, as a mother. She very thoughtfully explains how her parents’ life experiences, and subsequently her own experiences, gave shape to her self-image and self-concept in relationship to both her ethnic/ racial culture of origin and to the dominant White culture as a whole. In addition, she also addresses how these experiences, concepts, and images in turn impacted her behaviors across diverse events, settings, and situations. She particularly

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directs attention to discrimination as differentially experienced by her parents and herself. It appears that her parents, and later on Dr. Suzuki herself, focused on becoming assimilated into the dominant culture as the way to reduce, and over time hopefully overcome, discrimination. In order to assimilate effectively, her parents instilled in her the importance of working hard, getting as much education as possible, speaking “good” English, being a proud part of the “model majority,” and making yourself understood and accepted by actions and not merely through words. The push for assimilation was such that her father, seeing the military as the “great equalizer,” served honorably in the Korean War. Dr. Suzuki believes that this push strongly impacted her decision to not become identified as the “expert” in the area of Asian American/Japanese psychology but instead to direct her choice of work in the field of assessment with attention given to those variables that differentially impact all cultures. While she has continually grappled successfully with identity facets of her life, as well described in her story, she more recently has given more attention to such facets as they are impacting her daughter, who is fortunate enough to be biracial. Her description of her working with her daughter, Kaitlyn, on issues relative to race and ethnicity is quite moving and educational. While she extended efforts to assimilate throughout her lifetime, her life experiences, and most recently those that involve her daughter, have led her to openly and gratefully accept the reality that she cannot escape her Japanese heritage. In spite of Dr. Suzuki’s efforts to avoid the limelight, her impressive accomplishments rightly place her in the spotlight as being one of our most productive multicultural researchers whose work in the area of assessment and qualitative research is of value to researchers, practitioners, educators, and students alike. She has recently been writing with colleagues addressing topics relevant to counseling members of the Asian American community. In 2006, she received the Distinguished Contributions Award from the Asian American Psychological Association. According to Dr. Suzuki, as she accepted this award 17 2       H onoring O u r E lders

she thought of how wonderful it was to receive such an honor “from my own community.” Dr. Beverly Tatum begins her very impressive story in the following manner: On Monday, December 9, 2013, a full-page ad appeared in the New York Times announcing the winners of the 2013 Academic Leadership Awards. Underneath the photos of four college presidents was this statement: Carnegie Corporation of New York is proud to honor four exceptional leaders of American colleges and universities with the 2013 Academic Leadership Award. The leadership award . . . recognizes individuals who, in addition to fulfilling their administrative and managerial roles with dedication and creativity, have demonstrated vision and an outstanding commitment to excellence and equity in undergraduate education, the liberal arts, curricular innovation, reform of K-12 education, international engagement, and the promotion of strong links between their institutions and their local communities . . . One of those photos was mine. Being nationally recognized for my leadership as the president of Spelman College, along with the presidents of Duke University, Stanford University, and Arizona State University, was not a career outcome I ever would have predicted for myself growing up in Bridgewater, Massachusetts, or even years into my career as a professor of psychology. But looking at my own smiling face in the New York Times, flanked by the photos of three White men, and reading the published list of the past recipients, I realized that I was the first president of a historically Black college or university (HBCU) to win this award, and the first African American woman to be voted into this club of distinguished honorees. (Tatum, this volume, Chapter 15)

Accomplishing this impressive feat is enough to place Dr. Tatum into a unique class of groundbreaking pioneers that we have honored in previous editions of the Handbook. However, wishing to entice you to read her captivating story in its entirety, I provide you with a few aspects of her life, her character, and other accomplishments she has attained. From very early on, Dr. Tatum

received a great deal of educational encouragement, support, and direction from her parents. This is not surprising given the fact that they were highly educated: Her father was a college professor. She also was provided with a strong religious orientation that over the years, due to varied life experiences, has grown in strength and broadened in focus. To this end, she now approaches her ­dedication to antiracism work as a form of ministry. Like several of the pioneers whose stories appear herein, she was raised in a small, predominantly White community in which she early on experienced discrimination. Throughout her life, she continued to experience and fight discrimination as well as segregation in one form or another. Acknowledging this fact, she states, “the struggle to desegregate American educational institutions has shaped my life from the beginning” (Tatum, this volume, Chapter 15). Drawing from her life experiences, she wrote two books that had a significant impact on both the educational and psychological aspects of being Black in America: Assimilation Blues: Black Families in a White Community (1987) and “Why Are All the Black Kids Sitting Together in the Cafeteria?” and Other Conversations about Race (1997). If there was an equivalence of a decathlon event in psychology, Dr. Diane Willis would be a major contender and quite likely come out the winner. She has been a participant and a leader in so many groundbreaking events in psychology during her lifetime that I would have to reproduce her story to give justice to all that she has successfully accomplished. Not being able to do this, I very selectively present what I consider to be some of her more meritorious accomplishments. Before doing so, I would like to note that in all aspects of her personal and professional life, she presents herself with a great deal of pride and knowledge regarding background and identity as a Native American woman. Her family provided her with strong commitment to education, religion, community involvement, and social justice in general—­qualities that provided her with a strong foundation for her chosen field of work.

With respect to her professional accomplishments, from the beginning (1974), Dr. Willis stood out among her peers by becoming one of the first Native American pediatric psychologists in this country. Her early work involved developing new clinics at the University of Oklahoma Health Sciences Center. From that point on, her work reads like the history of pediatric/child psychology at Oklahoma. She was the founding editor of the Journal of Pediatric Psychology. Her advocacy relative to Native American issues picked up steam in the 1980s. She managed to get funding for mental health personnel for the Indian Health Services and tribes. Moving outside of the university setting, she established the first child psychology clinics at two rural Indian health service clinics. She fought for research on the prevalence and impact of child abuse in Indian country. Her strong commitment to her work with children is aptly expressed by the following quote that is found in her chapter: “Someone once said, ‘As psychologists, we can try to mend tragedy. As citizens, we must try to prevent it. The children’s lives are in our hands, but our future is in their lives’” (Willis, this volume, Chapter 16). It should be noted that the work noted above was done while she also wrote grants, published articles, saw patients, and taught psychology students and medical residents. With regard to awards and other forms of recognition, let me mention a few: APA Division 37 (Children, Youth, and Family Services and Advocacy), in conjunction with the American Psychological Foundation, named an award after her—The Diane Willis Early Career Award. In 2010, Division 45 gave her the Distinguished Career Contributions to Service Award, and in 2013 she received the Distinguished Elders Award.

CONCLUDING REMARKS AND RECOMMENDATIONS In conclusion, having provided you with some highlights of the stories and life factors that strongly contributed to the accomplishments attained by these multicultural psychology ­pioneers, I leave

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you with the following thoughts and recommendations: (a) Drawing from the stories, keep working toward your desired personal and professional goals in spite of any life experiences that may challenge your efforts; (b) Don’t try to travel the “treacherous” landscape alone. Seek out maps, mentors, and friends who can help guide and show you the way; (c) Remember that it is within you to be a pioneer and eventually share your p ­ otentially

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inspirational story in a future edition of this book or in any other media outlet; (d) If you are reading this book, there is a high probability that you are succeeding in your life and in your chosen field of work. Working from this perspective, remember that you have a responsibility to reach out and mentor those who are following in your footsteps. From a social justice perspective, show them the way.

PART

III

Giving Meaning and Purpose to Multicultural Counseling Endeavors

R

eflecting two of the major themes inherent in the Handbook, utility and social justice, the third part of the Handbook directs attention to the selective sociocultural elements of meaning and purpose that we believe need to be understood and considered in any multicultural counseling endeavors, and especially in reference to marginalized and oppressed groups. Such endeavors may take many forms. To illustrate such forms, the chapters that comprise Part III highlight various perspectives including cultural evidence-based psychotherapies (EBPs), indigenous and anticolonial perspectives and intervention strategies, multicultural training and supervision, and empowerment and collaboration strategies to create social equity by reducing social exclusion. In the chapter titled “Toward a Cultural Evidence-Based Psychotherapy,” LaRoche, Christopher, and West highlight the different ways in which culture has been conceptualized in the EBP literature. Based on this literature, they propose three conceptual categories emphasizing race, ethnicity, and culture: Universal Evidence-Based Psychotherapies (UEBPs), Race and Ethnic Evidence-Based Psychotherapies (REEBPs), and Cultural Evidence-Based Psychotherapies (CEBPs). Each conceptual category is discussed along with recommendations to promote the advancement of cultural EBPs. “Into the Field: Anticolonial and Indigenous Perspectives and Strategies for Counseling Interventions” by Yeh, Smith, and Borrero examines the potential contributions to multicultural counseling endeavors of developing and using indigenous anticolonial interventions. Unfortunately, content analysis of the curriculum in counseling psychology programs points to the lack of such courses, and in particular, those that have both an indigenous and social justice focus. Addressing this situation, the authors emphasize the need for culturally meaningful, anticolonial, and indigenous interventions courses and practicum that are formulated in collaboration with multicultural communities. Implications for research to validate the use of such interventions are also highlighted. The chapter by BigFoot titled “Upon the Back of a Turtle: From Traditional Indigenous Stories and Practices to Psychological Interventions” focuses on culturally based and interrelated traditions (e.g., storytelling, culturally based teachings, and select indigenous practices) that can be used to culturally enhance, and in turn, give meaning and purpose to contemporary therapeutic interventions, including evidence-based treatments. Bigfoot makes use of the Honoring Children’s Series to illustrate how such enhancement can be successfully implemented. 175

In the chapter titled “Multicultural Training and Supervision in Research and Service,” Duan and Smith describe the current state of multicultural training in counseling and counseling psychology. Their critical analysis of the literature leads to the formulation of significant areas and future directions for multicultural counseling training and supervision to meet the challenges that exist in contemporary society, including racial biases. Specific strategies are provided in the context of the authors’ own personal and professional experiences and biases. Finally, “Counseling Psychology and Social Disenfranchisement: Using What We Have to Change the Game” by Smith emphasizes the commitment of counseling psychology to create social equity through empowerment and collaboration with disenfranchised groups. Her work takes into consideration complex sociopolitical histories and contexts that lead to social location and relative societal positions (e.g., marginalization). Smith cites literature on classism linking social exclusion to symbolic violence. Discussion of psychopolitical validity in relation to intervention and collaboration with community groups through Participatory Action Research (PAR) is highlighted.

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CHAPTER

18

Toward a Cultural Evidence-Based Psychotherapy Martin La Roche, Michael S. Christopher, and Lindsey M. West

T

he objective of this chapter is to examine the intersection between evidence-based practices (EBPs) and culture. Although the EBP literature is very diverse and complex, we categorize it using a classification system that underscores culture. In this classification system, the influence of culture on EBPs is examined using three categories: (a) Universal Evidence-Based Psychotherapies (UEBPs), (b) Race and Ethnic Minority Evidence-Based Psychotherapies (REMEBPs), and (c) Cultural EvidenceBased Psychotherapies (CEBPs). Each of these three types of EBP is described with an emphasis on the ways in which race, ethnicity, and/or culture is understood and operationalized within each model. We start with a brief history of the EBP movement, followed by a description of the three types of cultural EBPs, and conclude with suggestions to promote the advancement of a cultural EBP.

HISTORY OF EVIDENCE-BASED PSYCHOTHERAPY The inclusion of evidence to support the efficacy of psychotherapy began largely as a response to Eysenck’s (1952) review of the treatment outcome literature, from which he concluded that psychotherapy’s rate of success was not greater than spontaneous remission. Beginning in the early 1970s, Luborsky and colleagues’ (e.g., Luborsky, Singer, & Luborsky, 1976) research suggested that irrespective of theoretical orientation, therapy was generally effective. The advent of meta-analysis (Smith & Glass, 1977) allowed for the computation of effect sizes and ultimately for the definitive determination that psychotherapy’s rate of success was in fact greater than spontaneous remission. Relatedly, meta-analysis in general stimulated movement away from demonstrating the generic efficacy of clinical interventions to a more specific approach wherein a particular therapy or component of treatment could be assessed across several studies. The move toward empirically supported treatment was also fueled by the erroneous perception in the health care field that psychotherapy is either ineffective or inferior to pharmacological treatments. This misperception persists despite the wealth of research that demonstrates that effect sizes of psychological interventions for a variety of pediatric and adult psychological disorders rival or exceed those of widely 177

accepted pharmacological treatments (Driessen & Hollon, 2010; Spielmans, Berman, & Usitalo, 2011; Walkup et al., 2008). One of the first and most significant efforts to systematize EBPs was the Empirically Validated Treatment guidelines—subsequently called Empirically Supported Treatments (ESTs). ESTs galvanized support in 1995 via the American Psycho­ logical Association’s (APA) Division 12 (Society of Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures. Although ESTs are comprised of a heterogeneous set of interventions, the requirements for achieving EST status were clearly defined by APA’s Division 12 Task Force (1995). In brief, the criteria put forth for a “well-established” EST is that a treatment be manualized and be (a) superior to a placebo or other treatment or (b) equivalent to an already established treatment in at least two “good” group design studies or in a series of singlecase design experiments conducted by different investigators. A more recent effort to systematize evidence stemmed from the APA Presidential Task Force on Evidence-Based Practice (APA, 2006). In a policy statement, the task force defined evidence-based practice in psychology (EBPP) as “the integration of the best available research with clinical expertise in the context of client characteristics, culture, and preferences” (p. 273). The task force noted that their objective was to promote effective psychological practice and to enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention by taking into account the full range of evidence that psychologists and policy makers consider in choosing effective treatment for each client. In addition, other APA divisions offered frameworks for integrating the available research evidence. In 1999, APA Division 29 (Psychotherapy) established a task force to identify, operationalize, and disseminate information on empirically supported therapy relationships given the powerful association between treatment outcome and aspects of the therapeutic relationship (Norcross,

2001). Similarly, several additional frameworks from other APA (e.g., Division 17) and non-APA (e.g., Society of Behavioral Medicine; Davidson, Trudeau, Ockene, Orleans, & Kaplan, 2004) divisions have been proposed. Clearly, there are many types of EBPs (e.g., ESTs, EBPPs). In this chapter, we refer to EBPs broadly as psychotherapeutic approaches that share the assumption that it is necessary to utilize empirical evidence gleaned from research findings to inform what works in psychotherapy and then to directly apply these findings to treatment selection. The assumption that evidence should inform psychotherapeutic guidelines has become a central principle for the development of psychotherapy, and within this framework, many psychotherapies can now be classified as an EBP. From the onset, we must state that we fully endorse EBP’s basic assumptions, and our efforts are directed toward a widening and refining of the evidence to make it more applicable to different cultural groups. It is herein important to state that culture is defined in many ways and we will start by clarifying these terms.

DEFINITION OF RACE, ETHNICITY, AND CULTURE Many definitions of race, ethnicity, and culture exist, and these concepts are often confused (Betancourt & Lopez, 1993). Thus, before we describe our classification system to categorize EBPs according to cultural assumptions, we define and differentiate these constructs. We believe that the two most revealing characteristics of a definition are how it is measured (i.e., how it is operationally defined) and how individuals are classified as belonging to one group and not another. For these reasons, we highlight measurement differences among race, ethnicity, and differences that are used to classify groups. Race is often defined in terms of selected physical characteristics, criteria, or permanent attributes such as skin color, hair, or facial attributes (Betancourt & Lopez, 1993). Accordingly,

17 8       G i v ing M eaning and P urpose to M ulticultural Counseling Endeavors

researchers may define and document race by observing participants’ physical characteristics (e.g., skin color, hair texture) or by more frequently having them select from a set of permanent categories (e.g., Black, White). Race is often easily and objectively measured. Racial classifications (e.g., Black, White) are a result of these categories. Ethnicity refers to the shared nationality, language, common values, beliefs, and customs of an identifiable group of people (Betancourt & Lopez, 1993; U.S. Department of Health and Human Services [USDHHS], 2001). Ethnicity is often operationalized by asking clients about their country of origin, which generates ethnic categories (e.g., Cambodian, German). Culture refers to common ways in which individuals construe or make meaning of themselves and their worlds. Meanings are often assessed through open-ended questions or values/beliefs questionnaires. Cultural groups can be defined from among many possibilities, for example, by people of the same sexual orientation, disability, or religion. Cultural groups are ever changing (meanings evolve) and complex (people can belong to many cultural groups), while ethnic or racial groups, in general, tend to have less flexible boundaries and are often more clearly defined by predetermined categories.

PSYCHOTHERAPY, CULTURE, AND EBP As the practice of psychotherapy has evolved over the years, the field promoted itself as holding much promise for the well-being of all people. However, during the 1970s, several studies challenged this ideal noting that ethnic minorities were not faring well in the mental health system. In his landmark study, Stanley Sue (1977) reported that 50% of ethnic minorities who sought psychotherapy with a White clinician did not return for a second appointment. In contrast, 30% of Whites returned for a second appointment. Almost immediately after Sue’s article, the President’s Commission on Mental Health (1978) documented ethnic minority mental

health disparities. Awareness of ethnic and racial discrepancies in mental health utilization became widespread in 1999 when the Surgeon General of the United States released the first report specific to mental health, which highlighted racial and ethnic minority health disparities. The topic received even more attention through a follow-up government report in 2001, Mental Health: Culture, Race, and Ethnicity (USDHHS, 2001). The President’s New Freedom Commission (Druss, 2003), in addition to other well-documented and publicized reports, documented these disparities even further. In short, these reports consistently concluded that mental health services are not accessible, available, or effectively delivered to racial and ethnic minorities. Compared to White Americans, racial and ethnic minority groups underutilize services or prematurely terminate treatment (Pole, Gone, & Kulkarni, 2008; Sue, 1988). Potential reasons for this discrepancy are that racial and ethnic minorities receive a lower quality of health care than do nonminorities, have less access to care, and are not as likely to be given effective, state-of-the-art treatments (USDHHS, 2001). These disparities exist because of inadequate access to services, such as insurance (e.g., Smedley, Stith, & Nelson, 2003; Sue, 1988). Despite strong egalitarian and social justice ideals within the field of mental health, ongoing efforts to understand and respond to these inequities remain crucial as psychological research continues to document racial and ethnic discrepancies in the utilization of mental health services. A large number of racial ethnic minorities—relative to their White counterparts—are not accessing mental health services or are not benefiting sufficiently from these interventions (Alegria et  al., 2008; Cook, McGuire, & Miranda, 2007; USDHHS, 2001). Many racial and ethnic minorities in the United States not only present with more severe and enduring mental health problems but they also receive less effective services to ameliorate these problems (e.g., Pole et al., 2008). These continued discrepancies point to failures within traditional mental health interventions and suggest the need for additional effort to achieve equity.

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Culturally competent treatments were developed in response to this need. Although many types of psychotherapeutic practices have been used to describe these efforts (e.g., multicultural counseling, cross-cultural psychotherapy, ethnic family therapy, ethnic psychiatry), in general, culturally competent practices share an emphasis on developing therapeutic interventions that are responsive to the specific characteristics and needs of minorities. A key principle of cultural competence is to “match” mental health services with clients’ characteristics. Two types of matches have been underscored in the cultural competence literature: ethnic match and cultural match. Ethnic match refers to services in which clients receive services from clinicians of their same ethnic, racial, or linguistic background. Cultural match emphasizes the need for mental health treatment to be consistent with clients’ worldviews. When clients perceive services to be congruent with themselves, they are more likely to utilize and benefit from them and then recommend services to others. Our threefold classification system builds upon the different ways in which evidence-based models define or neglect the “match.”

THREE APPROACHES TO INTEGRATE EVIDENCE AND CULTURE Given the many ways in which race, ethnicity, and culture are conceptualized in EBPs, we have developed three categories to understand these differences (La Roche, Davis, & D’Angelo, 2015). The three categories highlighted here, however, are not exhaustive of all research strategies. Clearly, multiple alternative classification systems are possible. Only EBPs as defined by EBPP’s broader and more inclusive guidelines (APA, 2006) are herein included. The three models highlighted in our classification system are (a) Universal EvidenceBased Psychotherapies (UEBPs), (b) Race and Ethnic Minority Evidence-Based Psychotherapies (REMEBPs), and (c) Cultural Evidence-Based Psychotherapies (CEBPs). Each of these three types

of psychotherapies has specific methodological requirements that define acceptable types of “scientific evidence,” “truth,” or “data.” Similarly, race, ethnicity, and/or culture are construed in accordance with these understandings of evidence. Cultural, ethnic, or racial differences are defined according to the way evidence is evaluated. Furthermore, the accepted types of scientific evidence are the building blocks that define psychotherapeutic interventions that in turn influence what unfolds during the psychotherapeutic session. Our research standards play a pivotal role in defining what is therapeutic or not. These research standards are highly influenced by our cultural landscape (Cushman, 1995; La Roche, Fuentes, & Hinton, 2015).

UNIVERSAL EVIDENCE-BASED PSYCHOTHERAPIES (UEBP) Characteristics. UEBPs are evidence-based psychotherapies in which clients are viewed as sharing similar core psychological characteristics irrespective of race, ethnicity, and culture. In UEBPs, it is assumed that underneath individual differences we are basically the same. We may differ on language, symbols used, or hair color, similar to the ways in which we differ in our approaches to psychological concepts, such as self-esteem, oedipal complexes, schemas, or self-actualization. Cultural differences are superficial expressions of deeper and more universal attributes. Moreover, cultural differences are often seen as categorical, analogous to, as an example, the “Big Five” trait perspective that is based on the separate categories of openness, conscientiousness, extraversion, agreeableness, and neuroticism (Heine & Buchtel, 2009). From Freud’s oedipal complex to Maslow’s self-actualization, most psychological concepts were developed by majority culture theorists among majority culture clients and research participants who were assumed to operate equivalently across various groups. Many researchers who take a Universalist stance assume that psychotherapeutic interventions are more credible because they are tested through rigorous and objective methodological

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procedures (e.g., randomized controlled trials or laboratory experiments). This emphasis on scientific rigor led APA’s Division 12 Task Force (1995) to develop lists of “well-established” treatments (Chambless et  al., 1996, 1998) for their Empirically Supported Treatment (EST) criteria. ESTs, for example, underscore the need to obtain appropriate estimates of internal validity as a means to empirically validate specific treatment interventions that are beneficial to groups of clients with specific disorders (Chambless et  al., 1996, 1998). Emphasizing internal validity permits researchers to systematically test hypotheses, isolate variables of causation, and demonstrate that therapeutic change is a result of a specific intervention. In the research process objective, data that are both reliable and valid are prioritized (e.g., standardized diagnostic interviews) while practitioners’ personal and contextual influence is minimized to avoid tainting the objectivity of the data. Unfortunately, the establishment of more rigorous and objective methodological procedures immediately excluded most types of cultural studies. Since producing hard evidence depends on costly randomized control studies, it is not possible for many research teams, even from different countries, to contribute to this knowledge. An effective strategy to identify a UEBP is to determine if the treatment omits racial, ethnic, and cultural variables. For example, if studies to assess difference in therapeutic outcomes by ethnicity or race have not been conducted—or suggested—or if cultural variables (e.g., ethnic identity, self-orientation, gender roles) have not been considered or examined, it is very likely that the psychotherapeutic model is consistent with Universalist assumptions. In UEBP research, the ethnic or cultural match is not perceived as significant, and in fact may be perceived as a barrier to demonstrating efficacy of the intervention. Treatments devoid of these considerations suggest that culture is secondary or not relevant within their theories. To that end, cultural variables are perceived as nonessential to the theories driving the treatment, and as a result, the treatment itself. For example, when UEBPs do measure cultural variables—often

race is the only cultural variable examined because it is easily and objectively measured—it is treated as noise or error (La Roche & Christopher, 2008). Although this trend is changing rapidly, some psychotherapy models (e.g., traditional psychoanalysis) and ESTs have yet to systematically examine race, ethnicity, or culture. Evidence. UEBPs aim to demonstrate efficacy in the treatment of specific dysfunctions, deficits, or disorders within certain invariable characteristics (e.g., unconscious issues, serotonin deficiencies, behavioral inactivation, lack of self-efficacy, etc.). There is a large and growing body of evidence suggesting that interventions designed to treat specific psychological disorders (particularly anxiety disorders and depression) are quite effective in the laboratory (e.g., Barlow, Gorman, Shear, & Woods, 2000) and in actual practice (e.g., Stuart, Treat, & Wade, 2000). The UEBP framework is based on the premise that if we all share similar characteristics then we all benefit from these rigorously tested psychotherapeutic strategies. Consequently, psychotherapeutic interventions developed for one cultural group (e.g., European Americans) are easily transferred to other groups. The implication of this assumption is that diverse cultural groups can benefit from EBPs without having these interventions undergo significant cultural modifications. Miranda and colleagues (2005) reported evidence to support this view after reviewing the available EBP literature. They concluded that “evidencebased care is likely appropriate for most ethnic minority individuals . . . and we encourage clinicians to provide state-of-the-art, evidence-based care to our ethnic minority populations” (p. 134). However, the authors also repeatedly underscored the need to tailor EBPs to the cultural characteristics of different racial and ethnic minorities. Advantages and Disadvantages. It is important to understand UEBPs within their historical context. UEBPs were the first wave of EBP research that successfully proved the efficacy and cost-effectiveness of psychotherapy. Thanks to their pioneering efforts, a growing number of mental health patients

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have experienced reductions in suffering. This has been particularly true for ESTs, such as cognitivebehavior therapy (CBT), which have demonstrated robust efficacy and effectiveness in treating a variety of psychopathologies and enduring effects relative to psychotropic medications (e.g., Driessen & Hollon, 2010). UEBP’s goal is to develop psychotherapeutic strategies for all that ameliorate mental health disorders as quickly and effectively as possible. Ultimately, providing more effective treatments increases access, which in turn gradually diminishes ethnic minority health disparities. Clearly, UEBPs have significantly advanced the efficacy of psychotherapy, and the following criticisms need to be considered within this context. Even during the early stages of EBT, many researchers acknowledged the need to examine their interventions with culturally diverse samples because not doing so would mean that both EST and EBT findings would continue to not be generalizable to different ethnic groups (e.g., Chambless et al., 1996). Unfortunately, this cultural research has been slow to come about. Before 1995, most psychotherapy outcome studies did not inquire about race or ethnicity, and when they did, the majority (92%) of participants were White (e.g., Doyle, 1998; USDHHS, 2001). Starting in 1993, the National Institutes of Health (NIH) mandated that the race and ethnicity of participants in any research project be documented. Unfortunately, recent studies still note the need to increase the number of ethnic minorities in research projects. For example, Stewart and Chambless’s (2009) metaanalysis revealed that out of 57 effectiveness studies for CBT for adult anxiety, only six studies contained samples of at least 20% African Americans and only two studies included samples of at least 20% Latinos. Similarly, Gonzalez and colleagues (2010) found that ethnic minority participation in research studies and documentation of this participation remains low. Outcome research on Acceptance Based Behavioral Therapies (ABBT) may, however, be a notable exception. A recent meta-analysis of 32 studies among 2,198 nonWhite clients found small to large effect sizes, which substantiates the promise for the utility and

acceptability of ABBTs in this population (Fuchs, Lee, Roemer, & Orsillo, 2013). Even though many EBPs have yet to be tested with different cultural groups, reviews have found that overall ethnic minorities benefit from EBPs even if not culturally adapted (Miranda et  al., 2005). If EBPs are effective with ethnic minorities, why not just employ them with ethnic minorities and save ourselves the costly effort of culturally adapting them? The response to this question is that Miranda and colleagues (2005) were unable to determine whether culturally adapted interventions are more effective than nonculturally adapted interventions because studies available at that time did not specify the type of cultural modification conducted. This lack of specification leads us to our central criticism of UEBPs, which is that they generally fail to operationalize cultural variables. For UEBPs, race, ethnicity, and culture are not central and are rarely examined. Culture is often not defined and is often confused with ethnicity or race (La Roche & Christopher, 2008, 2009), which leads researchers to miss cultural influences within the psychotherapeutic process. How can we understand what we do not measure? This omission is evidenced in the research strategies used, which seek to minimize cultural influences (e.g., sterilize the laboratory or factor out ethnicity) to the psychotherapeutic session itself where dialogues of culture are not included. For example, many EST manuals exclude specific considerations for how to address cultural dialogues (La Roche, 2013). Relatedly, it is also important to mention that psychotherapeutic treatments are influenced by dominant cultural assumptions (Cushman, 1995; La Roche & Lustig, 2010). Unfortunately, UEBP’s emphasis on objectivity may cloud an awareness of how these cultural assumptions shape research projects and psychotherapeutic interventions. Additionally, many UEBPs such as ESTs have also been met with skepticism because of a variety of methodological concerns, such as an overemphasis on brief manualized treatments and specific therapeutic ingredients as opposed to flexible treatment and common therapy effects (Sue et al., 2006; Wampold, 2007;

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Westen, Novotny, & Thompson-Brenner, 2004). (For a thorough review of EST cultural criticisms, see La Roche & Christopher, 2008, 2009.)

RACIAL AND ETHNIC MINORITY EVIDENCE-BASED PSYCHOTHERAPIES Characteristics. In contrast to UEBPs, REMEBPs assert that race and ethnicity are essential in the psychotherapeutic process. New research and treatment approaches are emerging that explicitly include the effects of race and ethnicity in their formulations. REMEBPs encourage the development of intervention strategies that are effective with members of different racial and ethnic groups. The main aim of REMEBPs is to address the needs of racial and ethnic minorities and reduce ethnic health disparities. As a result of an explicit inclusion of race and ethnicity in REMEBPs, the Universalist assumption that the same psychotherapeutic interventions are effective across groups is being challenged. This challenge has fostered the emergence of the cultural competence movement, which promotes the development and use of specific cultural competencies with different ethnic or racial groups. Similarly, an understanding of race and ethnicity influences the manner in which research findings are conceptualized. Although REMEBPs have taken on many forms, for the purposes of this chapter we focus on the aspect of match between therapist and client in terms of ethnic, racial, or linguistic background. The general presumption underlying racial and ethnic match is that fitting clients with therapists of the same background results in stronger therapeutic alliances (Sue, 1977; Sue & Zane, 1987). This assumption is based on a vast set of basic tenets of social psychology that date back to Newcomb (1961), who stated that people typically associate, prefer, and communicate more effectively with those they perceive to be similar to themselves. Evidence. The basic treatment assumption underlying REMEBPs is that the racial and ethnic

match between client and therapist increases the likelihood of a positive treatment outcome. We reviewed evidence that examines the ethnic match through four outcomes: (1) as an increase in preference for therapists of the same race and/ or ethnicity, (2) as an increase in perceptions of ethnically and/or racially similar therapists’ competencies or credibility, (3) as a decrease in the dropout rate, and (4) as an improvement in the therapeutic outcome. Most studies have found that ethnic minorities do in fact prefer therapists of their same racial or ethnic background. For example, Coleman, Wampold, and Casali (1995) reviewed 21 studies and found a strong preference (d = .73) for a therapist of one’s race and/or ethnicity. In a more recent meta-analysis of 52 studies, Cabral and Smith (2011) found a similar effect size (d = .63) indicating a preference for a therapist of one’s own racial and/or ethnic background. This tendency is particularly strong for African Americans who significantly more often than other ethnic groups prefer to be treated by African American clinicians (Cabral & Smith, 2011). It is, however, important to note that smaller size reviews have found no or significantly smaller differences on preferences for ethnic match (Maramba & Hall, 2002; Shin et al., 2005). Some evidence to support the hypothesis that patients perceive more favorably therapists of their own race and/or ethnicity than those of a different race and/or ethnicity was also found on Cabral and Smith’s (2011) meta-analysis. The authors examined 81 studies and found a small effect size (d = .32) indicating that racial and ethnic minority patients perceived therapists from their own race and/or ethnicity more positively than therapists from a different race and/or ethnicity. Again, African American clients tended to evaluate African American therapists more positively than other therapists (2011). Although Sue (1977) found significant evidence indicating that ethnic minorities drop out of treatment more frequently than Whites, more recent studies have found no statistically significant differences (Maramba & Hall, 2002) or smaller

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effects that are not statistically significant (Cabral & Smith, 2011). Differing findings seem dependent upon the way in which drop out or therapy attendance is defined (Smith, Domenech-Rodriguez, & Bernal, 2011). Clearly, more studies are needed to further explore drop-out rates in ethnic minorities. The main assumption of the ethnic match literature is that ethnic and racial minority clients have better treatment outcomes with a therapist of the same ethnic, racial, or linguistic background. In a meta-analysis, Griner and Smith (2006) found positive outcomes were twice as high when clients were matched with a therapist of their own language. In a follow-up meta-analysis, however, Cabral and Smith (2011) found that ethnic match had a small, nonsignificant treatment effect size (d = .09). Although African Americans tended to benefit more from therapists of their same ethnic background than other groups, Cabral and Smith (2011) conclude that improvement in treatment is largely independent of therapists’ race and/or ethnicity. Advantages and Disadvantages. Clearly, the inclusion of race and ethnicity into the psychotherapy outcome research is a significant step forward in refining our understanding of the psychotherapeutic process. Relative to UEBPs, the theoretical underpinnings of REMEBPs hold that salient differences may exist between racial and ethnic groups regarding the effectiveness of various psychotherapies. This inclusion has brought accountability in terms of being able to determine scientifically that members of racial and ethnic minority groups are not benefiting from psychotherapy as much as their White counterparts. Furthermore, it has allowed for an examination of which types of interventions are most effective for different racial and ethnic groups. This enhanced knowledge has fostered the growth of the culturally competent movement. Nevertheless, much remains to be done. One of the most difficult challenges we still face is how to foster and disseminate the development of more effective EBPs for the benefit of culturally diverse and international groups (Farchione & Bullis, 2014; Hinton & Jalal, 2014).

Research indicates that ethnic match affects some areas of the psychotherapeutic process (e.g., preference, credibility), whereas there is less known, and even inconsistent, information regarding drop-out rate and outcome (Cabral & Smith, 2011). Ethnicity and race are relevant in the psychotherapeutic process, particularly in the beginning of treatment, but they do not appear to determine the outcome of treatment (Cabral & Smith, 2011). Ethnic match seems more important for some individuals, perhaps even for some ethnic groups (e.g., African Americans), but not all (Sue & Zane, 1987). Although ethnicity and race are central, we believe that they are insufficient to capture the complex and powerful cultural influences emerging within the psychotherapeutic process. These broadly defined variables may inadequately ascertain the specific therapeutic mechanisms through which they impact the psychotherapeutic process. Sue and Zane (1987) assert that race and ethnicity are distal variables that do not explain how they influence the psychotherapeutic process. Furthermore, by solely emphasizing race and ethnicity, it seems that distinct and separate psychotherapies are being created for each race and ethnicity. In doing so, it seems that psychological characteristics are attributed to all members of one race or ethnicity by overlooking individual differences and promoting ethnic or racial stereotypes. These challenges in the intervention literature have led to the gradual development of Cultural Psychotherapies (La Roche, 2013).

CULTURAL EVIDENCE-BASED PSYCHOTHERAPIES Characteristics. CEBPs refer to those evidencebased psychotherapeutic strategies that not only emphasize race and ethnicity but also emphasize more proximal cultural variables such as self-­ orientation, socioeconomic status (SES), neighborhood violence, and religion. As previously mentioned, culture is defined as meanings that are more common in specific groups. These meanings

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are ­inseparable from the cultural context in which they are understood (La Roche, 2013). A core assumption underlying CEBPs is that if the cultural context is not examined it is impossible to accurately understand the psychotherapeutic process; thus, it is important to assess contextual variables (e.g., levels of community violence, health access, SES, etc.) in relationship with cultural variables. In CEBPs, the therapeutic value of the cultural match—although Sue and Zane talk about cognitive match instead of cultural—is emphasized, which highlights the need for treatment to fit the cultural lifestyle or experiences of clients. This enhanced view of the cultural match is consistent with current and more sophisticated formulations of “psychological treatments” (Barlow, 2004). Sue and Zane (1987) argued that ethnic match is insufficient to explain ethnic minority differential treatment outcomes and underscore the need to include more proximal variables. CEBPs are a response to Sue and Zane’s (1987) call to shift focus from distal to more proximal and cultural variables. Bernal and Domenech-Rodriguez’s (2012) push for cultural adaptations is consistent with this shift. They define a cultural adaptation as the systematic modification of an EBT or intervention protocol to consider language, culture, and context in such a way that is compatible with the client’s cultural patterns, meanings, and values. This definition further specifies the need for changes to be conducted in a systematic manner that is itself meticulously documented so that it is observable and replicable. (p. 11)

Cultural adaptations are not only beneficial to ethnic minorities but they can be beneficial for all. We live in cultural contexts and we need to make culture the domain for all and not just a select few (Gallardo, 2014). An added advantage of using more proximal characteristics (e.g., ethnic identity, acculturation) rather than ethnicity or race is that these characteristics diminish inappropriate generalizations to entire groups. It is not our skin color or place of birth that is solely affecting the outcome of treatments, but it is also our cultural characteristics (e.g., allocentrism, ethnic identity)

that are m ­ easured. Finally, CEBPs expand our lenses to examine the influence of cultural values (e.g., individualism, competition, gender roles) on the development of cultural interventions (e.g., emphasis on self-development, success). It is important to examine the cultural values of our society and interventions to ensure that they match those of our clients. Evidence. Some support for the effectiveness of culturally adapted interventions comes from Smith, Rodriguez, and Bernal’s (2011) meta-analysis. They found an effect size (d = .46) for culturally adapted interventions in comparison to traditional interventions. Although some of the cultural modifications they identified were in reality ethnic matches (e.g., language match), they found that as these interventions had a greater number of cultural components (e.g., cultural variables, context) they were more effective (Smith et al., 2011). These findings are consistent with more complex conceptualizations of culture in CEBPs, indicating that as treatments are tailored in accordance with the different cultural characteristics of clients, not just based on racial and/or ethnic match, interventions are more effective. More recently, several authors have suggested that mindfulness and acceptance-based behavioral therapies (MABBTs) may serve as a seamless fit as a CEBP (e.g., Christopher, Woodrich, & Tiernan, 2014; La Roche & Lustig, 2013). Moreover, Hall, Hong, Zane, and Meyer (2011) suggest that because of their theoretical grounding in East Asian philosophies, MABBTs appear to constitute promising ways to provide culturally responsive mental health care to Asian Americans. MABBT is a highly contextualized treatment where the exploration of “cultural variables” is the essence of the treatment (Rucker-Sobczak & West, 2013). Studies are also starting to examine how cultural processes influence the development of interventions. For example, American society’s emphasis on individualism (Cushman, 1995) is reflected in many treatment goals such as self-esteem, self-­ actualization, individuation, ego strength, and selfdevelopment, which are often unquestionably sought

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in psychotherapy (La Roche, 2013). Furthermore, cultural differences (e.g., collectivism) can be construed as deficits or psychopathology (e.g., enme­ shment, immaturity, etc.). La Roche, Batista, and D’Angelo (2010) illustrated this idea in their study in which they found that relaxation intervention strategies—as perhaps many other psychotherapeutic interventions—are highly influenced by individualistic assumptions. Inadvertently, the effectiveness of these cultural-bound interventions may be limited with clients who endorse alternative views (La Roche, 2013). The best way to measure the cultural match is to directly examine the discrepancy between clients and clinicians in a clearly defined set of comparable variables. Unfortunately, to the best of our knowledge, not many studies have directly measured the cultural match. Perhaps the largest and most rigorous study was conducted by Zane and colleagues (2005), who found promising data to suggest that cultural matches are consistently related with positive outcomes. Similarly, La Roche (2013) found that as Latino clients tend to be more relational, they had larger decreases in anxiety symptoms and emergency visits when using relational treatment strategies. Advantages and Disadvantages. Findings are clearly indicating that the inclusion of cultural variables refines our understanding of the psychotherapeutic process. An examination of cultural variables (e.g., acculturative stress, perceptions of discrimination) and the cultural context is allowing us to determine which characteristics in certain cultural groups permits them to benefit from certain therapeutic ingredients and in which contexts. Essentially, this enhanced understanding allows us to have a better understanding of the mechanisms through which psychotherapy works. An important therapeutic implication of these findings is that clinicians can effectively treat clients from different ethnic and/or racial backgrounds provided they have learned culturally competent skills. This is encouraging as ethnic matches are often not feasible. However, more

information is required on the effectiveness of these culturally competent skills. For example, which matches are more therapeutic for whom? Additionally, cultural adaptations are not risk free; they can compromise the fidelity of the interventions and their effectiveness (Castro, Barrera, & Martinez, 2004). Furthermore, the cultural adaptation process could lead to an endless, costly, and inefficient proliferation of culturally adapted interventions; hence, there is a need to continue developing more sophisticated research guidelines to determine when cultural adaptations are in fact warranted. These guidelines are still a work in progress (La Roche & Lustig, 2010; Lau, 2006). Our hope is that a greater knowledge of which factors— including race, ethnicity and culture—are affecting our clients will guide us in the process of refining our therapeutic interventions.

CONCLUSION EBPs continue to become more efficacious as they are informed by scientific evidence. However, within the EBP movement, different models to understand cultural processes have been developed. We have highlighted UEBPs, REMEBPs, and CEBPs, which at times clash. UEBPs emphasize internal validity and efficacy, whereas REMEBPs and CEBPs also underscore external validity and effectiveness. While UEBPs underscore individual (and only more recently relational) therapeutic factors, they have overlooked contextual and cultural variables highlighted by REMEBPs and CEBPs. Similarly, UEBPs underscore individual change while neglecting the attention to contexts, which is central to CEBPs. REMEBPs underscore race and ethnicity, and in CEBPs cultural variables are also included. However, these differences are not insurmountable. In fact, we believe that all three approaches have been fruitful. Nevertheless, psychotherapy outcome research should evolve toward a CEBP in which psychotherapy is both culturally competent and empirically assessed. The following 10 considerations are specific recommendations to pursue this goal.

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TEN CONSIDERATIONS TO ADVANCE A CULTURAL EVIDENCE-BASED PSYCHOTHERAPY 1. The need to emphasize culture, ethnicity, and race in all aspects of research and the psychotherapeutic process cannot be underscored sufficiently. Furthermore, the proximal and complex nature of cultural variables should not negate or water down the socioeconomic impact of race and/or ethnicity that has historically been neglected by EBPs. 2. It is important to differentiate and operationally define race, ethnicity, and culture, as each impacts the psychotherapeutic process in a particular manner. Similarly, it is necessary to examine the effect of different cultural variables on the psychotherapeutic process. An enhanced understanding of the differential contribution of these variables will ultimately end up refining the efficacy and effectiveness of cultural competency recommendations. 3. Race, ethnicity, and culture can have multiple and interacting effects on the psychotherapeutic process. Psychotherapy research can no longer treat these solely as independent variables (e.g., as REMEBPs do) or as sources of extraneous “noise” (e.g., as UEBPs do) that must be controlled for. Researchers need to explore and conceptualize different types of cultural interactive processes. 4. Outcome studies need to be examined through mixed-methods studies (e.g., including RCTs and qualitative strategies). 5. We not only encourage clinicians and researchers to explore their own cultural assumptions and biases but also the cultural assumptions of their psychotherapeutic interventions and contexts. Psychotherapeutic interventions are reflective of dominant cultural assumptions that if not checked can lead us to perceive cultural differences as deficits. 6. Studies have found that clients can benefit from the psychotherapeutic treatment p ­ rovided by

therapists of different ethnic and racial backgrounds than their own. These findings underscore the need to develop more elaborate and empirically based cultural competencies that allow clinicians to more effectively align their interventions with their clients’ worldviews. 7. The advancement of cultural competencies is not only beneficial for ethnic minorities but for all individuals, since we all live in cultures and we can all benefit from enhanced cultural competencies. 8. By exploring the treatments of certain disorders with cultural variables, we can start clarifying what in the psychotherapeutic process is universal or specific to a cultural group. 9. It is important for the development of EBPs to make assumptions explicit about why a theory is particularly well suited for a particular cultural group. 10. An enhanced understanding of what is universal or specific within the cultural psychotherapeutic process can allow clinicians and researchers to have a better understanding of the mechanisms through which psychotherapy works, not just for racial and ethnic minorities but for all.

FINAL THOUGHT We hope that as the conceptualization and operationalization of race, ethnicity, and culture are broadened with EBPs, they will evolve into CEBPs in which interventions are embedded in cultural contexts and no need for cultural or multicultural qualifiers are needed (Quintana, Troyano, & Taylor, 2002). As culture is more clearly measured, it can become both a more effective and inclusive type of psychotherapy. The result of such efforts would then put an appropriate end to our current cumbersome distinctions (e.g., UEBP, REMEBP, or CEBP). To that end, we are arguing for an expanded and operationally refined understanding of outcome research that defines culture beyond racial and ethnic minorities or culturally diverse groups.

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CHAPTER

19

Into the Field Anticolonial and Indigenous Perspectives and Strategies for Counseling Interventions Christine J. Yeh, Darrick Smith, and Noah E. Borrero

T

he multiple possibilities for indigenous and anticolonial group interventions in counseling ­psychology have not yet been realized. Although graduate students in counseling psychology are required to take a course in group counseling for their practicum training, the majority of these students do not have the opportunity to actually develop and implement an anticolonial counseling intervention. Specifically, we performed a content analysis of the curriculum in Counseling Psychology programs and found that intervention courses tend to be electives and do not necessarily embed a strong social justice or indigenous focus. These educational structures and practices reveal specific philosophical priorities in counseling psychology models highlighting individually based talk therapy and limit the discourse on culturally meaningful, anticolonial, and indigenous interventions for, and in strong collaboration with, multicultural communities. Anticolonial and indigenous counseling interventions, in fact, have significant potential with marginalized communities of color, yet are greatly underrepresented in counseling theory, research, and practice. We define anticolonial counseling as (a) an ideology that intentionally interrogates and disrupts hegemonic structures, assumptions, values, and practices; (b) indigenous interventions grounded in heritage knowledge that prioritize the reclamation of cultural and historical traditions and healing practices; and (c) the creation of a liberatory space that sustains and harnesses community members and their relationships in the face of subtle as well as coercive forces of oppression (see Choudry, 2007; G. H. Smith, 2002; L. T. Smith, 2004). Moreover, the multicultural counseling literature often centers on dyadic relationships for exploring particular dimensions in counseling such as cultural competence (Carter, 2003), relational dynamics (Yeh, 2012), counselor credibility (Kim, 2011), racial identity dyads (Jernigan, Green, Helms, Peréz-Gualdrón, & Henze, 2010), and process and outcome (Muran et al., 2009), as examples. While these areas of counseling are absolutely essential in developing and implementing specific counselor strategies, it is also important to consider group-level intervention programs (Thompson & Carter, 2013) that prioritize 188

equity. This lack of focus on group interventions is especially surprising since collaborative and community-based interventions have the potential to offer cultural validation and a humanizing experience (Chang & Yeh, 2003; Shea, Ma, & Yeh, 2007). Group- (versus one-on-one) oriented intervention programs are especially relevant for communities of color because research has consistently found that for many ethnic minority groups there is a strong preference for indigenous healing practices and collectivistic, versus individualistic, methods of coping (Gallardo, 2011). Specifically, collectivistic coping refers to culturally meaningful ways of dealing with stress that emphasize connections to others or a greater being. Group-oriented practices for counseling are culturally meaningful because they are congruent with collectivistic priorities in many ethnic minority groups. This work emphasizes the ways that participants feel validated and supported when their experiences are shared with others. The emphasis of collectivistic cultures on group cohesion, interconnectedness, social harmony, conformity, and solidarity greatly influence the help-seeking patterns of individuals with interdependent selves (Yeh & Kwong, 2008). In recent years, counseling psychology research has begun to take a closer look at the impact of culturally responsive interventions. However, this work has tended to center on evaluation studies that examine the content and outcomes of groups with specific samples and problems (i.e., Cornish, Wade, & Post, 2012; Harper & Montgomery, 2003; Shea, Ma, Yeh, Lee, & Pituc, 2009; Yeh & Borrero, 2012), whereas in this chapter, we focus on indigenous, participatory, and strength-based interventions. Further, we provide cases from our own work to provide examples for establishing an anticolonial framework in counseling interventions. We explore central themes in anticolonial and indigenous counseling interventions that cut across various types of programs with specific communities. These themes focus on indigenous wisdom and symbols, geopolitical context, counselor positionality, participatory counseling, ecological cultural assets, and cultural pride.

SETTING UP THE ANTICOLONIAL FRAMEWORK IN COUNSELING In establishing a strong decolonizing approach to counseling interventions, we must begin by understanding the interruptive nature of the colonial process. Numerous books, chapters, and articles in counseling psychology (e.g., David & Nadal, 2013; Ponterotto, Casas, Suzuki, & Alexander, 2009; L. C. Smith & Geroski, 2015) have recognized and discussed the destructive role of colonialism in educational, community, occupational, and mental health locations. Further, the educational, historical, anthropological, political, and sociological literature include various discussions of the damaging nature of colonization and enslavement throughout the Americas, Africa, South Asia, and the various island nations in both the Caribbean and spread throughout the Pacific (e.g., Ball, 2004; Brah & Phoenix, 2013; Buttaro, 2010; Dei, 2012; Nkomo, 2011; Paris & Winn, 2013, L. T. Smith, 2004; Tejeda, Espinoza, & Gutierrez, 2003). The colonial movement used the guise of “good intentions” to justify assimilationist practices and the eradication of cultural traditions of the dominated group. It has been noted from the early “discoveries” by the Spanish into the present day that resistance activities were feared to develop out of the cultural rituals of the invaded society. These rituals, gatherings, and even basic forms of communication were often viewed as a threat to the colonial agenda. Assimilationist practices enforce the restriction of the speaking of one’s indigenous language (as in English-only policies in public schools), the practicing of one’s religion (lack of school recognition of non-­ Christian ­holidays), or the participation in traditional communal activities and celebrations such as Samoan funeral practices that last several days (as described in Borrero, Yeh, Tito, & Luavasa, 2010). The social enactment of “being” indigenous or non-European in social and cultural spaces is in itself a potentially dangerous act throughout colonization (Kempf, 2006). I NTO THE F I ELD

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Understanding the history and present-day reenactments of colonialism is absolutely essential when developing counseling interventions with marginalized communities. For example, in her work with the Atayal aboriginal community, Yeh (2014) met with Atayal community representatives, politicians, educators, students, activists, and families to learn about their history of colonization and hear their perspectives on present-day pressures to assimilate. In addition, she spent several months researching documents and books to learn about the longstanding history of displacement of aboriginal individuals in Taiwanese social, cultural, community, and educational contexts. This research not only gave Yeh some historical knowledge but it also helped her to build relationships and trust in the Atayal community through sharing and discussion. This relational and reciprocal process also reinforced the important assumption that the community members, not the facilitator or counselor, hold an important wisdom that is absolutely necessary for community empowerment.

INDIGENOUS WISDOM AND SYMBOLS With the history of colonialism in mind, we assert that counseling interventions with marginalized communities must incorporate an anticolonial conceptualization of group engagement and counseling. Such an approach insists that a critical element to developing community partnership and trust involves the reclamation of cultural and historical practices that serve to sustain community bonds and strengthen community members in the face of subtle as well as coercive forces of control and oppression (G. H. Smith, 2002; L. T. Smith, 2004). Cultural elements and practices may include indigenous symbols, traditions, beliefs, words, and stories. For example, in their collaborative work with low-income Samoan youth, Yeh and colleagues (2014) describe using traditional Samoan tattoo art, symbols, and legends to foster positive cultural identities, intergenerational connections, community engagement,

and leadership competence in a community-based summer counseling intervention program. Specifically, Yeh and colleagues (2014) worked closely with Samoan community leaders, youth collaborators, and elders in a low-income community to develop a meaningful 8-week culturally responsive counseling curriculum, “Wear Your Pride,” that enlisted Samoan elders to use traditional legends and stories to help Samoan youth grapple with contemporary issues impacting their lives in urban poverty. Samoan youth learned about different Samoan tattoos and their historical meaning, such as the symbols for courage, strength, and family bonds. Then they designed unique T-shirts combining tattoo symbols, graffiti art, and traditional Samoan words with traditional meanings. The group participants also related these cultural symbols to their current lives. For example, youth in the group discussed the importance of the Samoan asset of “warrior strength” in addressing everyday challenges, violence, and discrimination as youth living in low-income neighborhoods. Reclaiming such historical and cultural elements of the community serves two main purposes. First, indigenous elements are an important reminder of the critical role of the elders who transmit these practices (G. H. Smith, 2002). In this regard, elders are giving back to the next generation and symbolically demonstrating their concern for the development of future leaders in the community (Yeh, Borrero, Tito, & Petaia, 2013). This approach also gives credence and status to those who hold this wisdom and the lens that must be transmitted to younger members in the community—the affirmation of elders as community foundations. In fact, in many collectivistic cultures, there is great respect and admiration of elders (Yeh, Arora, & Wu, 2006), which contrasts significantly with the marginal status of older adults in the United States. Second, integrating indigenous wisdom and elements into counseling intervention approaches reminds participants and facilitators of the longstanding strengths and rituals in the community that predate existing structures of global and

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c­ommunity repression. This important passingon of traditional ideas symbolizes cultural ways of being that provides an enduring and timeless sense of power in the community untainted by assimilationist definitions of community strengths, mental health, and success (Parham, 2011). Specifically, in a participatory study with Native Hawaiian youth and counselors (Borrero, Yeh, Cruz, & Suda, 2012), Native Hawaiian youth described historical knowledge about discrimination, colonization, and displacement to be a foundational representation of cultural resilience and solidarity. This inextricable link between struggle and strength uses indigenous wisdom to counteract youths’ feelings of alienation and powerlessness in the face of oppression (Young, 2009) as they become meaningfully connected to a larger cause and fight for equity. Further, counseling interventions must explore how and why indigenous knowledge has become threatened and dismantle the colonial infrastructure that continues to “harm the agenda of decolonization and self-determination” (Simpson, 2004, p. 375).

GEOPOLITICAL CONTEXT Anticolonial and indigenous counseling interventions must also acknowledge the social, political, and historical location of the community and how the intervention program in particular stands in alliance with the preexisting struggles to resist these historical and current forms of oppression. Understanding geopolitical context is critical because it also serves to support our focus on indigenous wisdom and symbols. Such a framing locates the community as one of resistance that has both viable ideologies and practices necessary for the improvement and sustainability of their future (Kovach, 2005, 2009). This approach contrasts significantly with paternalistic notions of the counselor as the all-knowing expert who “fixes” or “saves” a community. Understanding the geopolitical context of a community entails an acknowledgment of the micro- and macrodynamics of the location. This may include microaggressions and reenactments

of colonization through everyday commonplace ­practices to larger scale institutional structures that systemically “other” marginalized communities (see Borrero et  al., 2012). For example, the institution of school is a space where notions of academic success are embedded within the norms of an assimilationist agenda (Kliewer, Biklen, & Kasa-Hendrickson, 2006; D. Smith, 2015). Pedagogical strategies, high-stakes testing, and curricular activities impose a hegemonic ideology of colonization and dictate how students understand their academic identities (Ghosh, Mickelson, & Anyon, 2007). Hence, counselors must situate themselves in a geopolitical context with decolonizing practices and the recognition that colonization and assimilation establishes the retaining of culture as oppositional. This further incorporates the history of communal capacity for self-help and peer support. The relationships and knowledge that emerge from this approach to counseling have to first be located within a larger geopolitical context. This implies that it is not prudent to wait for projects to conclude to locate meaningful outcomes within a global and local context. Rather, it is critical for the counselor to enter the intervention with a fundamental understanding of the community dynamic and how challenges that they face fit within a global and local social and political frame. Such awareness helps to shape and inform the language, the introductory processes, and the overall program design, which makes such reflection absolutely critical to the interventions’ success and functionality. In establishing a long-term partnership with the Samoan community in the San Francisco Bay Area, Borrero and colleagues (2010) examine the political context and marginalization of the Samoan community, which involves many complex issues such as immigration trends, U.S. Census policies, and global relationships with the United States, American Samoa, and Western Samoa. For example, census policy has historically mandated a specific format for inquiring about racial and ethnic information that has oppressed and ignored Samoan identities. This “othering” of Samoan Americans represents I NTO THE F I ELD

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political practices in controlling ethnic identification and impedes accurately understanding their social, economic, cultural status, public health, education, and immigration needs (Srinivasan & Guillermo, 2000). Specifically, in 1990 the Office of Management and Budget (OMB) developed the Statistical Policy Directive 15 that put forth five racial/ethnic category options including “white, black, Asian/Pacific Islander, American Indian/ Alaskan Native, and Hispanic” (Fernandez, 1996). In 1997, The Revisions of the Statistical Policy Directive No. 15, Race and Ethnic Standards for Federal Statistics and Administrative Reporting, revised that category into “Asian” and “Native Hawaiian and Other Pacific Islander.” The U.S. Census practice for ignoring specific Pacific Islander and Native Hawaiian identities represents a significant geopolitical context for the attempted homogenization of marginalized communities. Geopolitical contexts also include local practices in oppression and displacement. For example, in their collaboration with the Samoan community, Borrero and colleagues (2010) learned about the unsafe and inconsistent public transportation for community members living in low-income housing projects in San Francisco. The lack of regular transportation made it nearly impossible for youth to commute to public schools for an education, directly impacting their inaccurate educational reputation as “truant,” “tardy,” and “troublemakers.” Political understanding of location not only involves a deep appreciation of community historical context but also of facilitator and counselor selfawareness and positionality as a necessary aspect of meaningful collaboration.

POSITIONALITY Counselors, by nature of their educational training and life experiences, are contaminated, biased, and subjective individuals. Their positionality is influenced by cultural, ethnic, and racial backgrounds, privileges, political ideologies, educational experiences, and social justice intentions. An anticolonial perspective to counseling necessitates deep exploration and understanding of one’s own cultural values

and worldviews when facilitating interventions with marginalized communities. Specifically, counselors often fail to realize their own unconscious contribution to everyday interactions and how their values and worldviews may influence and even pathologize their interpretations of community members’ experiences. Counselors and educators not only need to be cognizant of the unique concerns of historically targeted groups, but they also need to recognize how their own background, biases, assumptions, and previous counselor-client interactions influence the intervention’s climate and client psychologies. Hence, collaborating with communities must be viewed as a reciprocal process of growth and learning between counselor and clients (Yeh & Pituc, 2008). Much of the research and literature in multicultural counseling tends to center on specific counseling and intervention applications, skills, conceptual frameworks, and strategies as well as particular issues and concerns (e.g., stress and coping, racism and health, etc.), and with good justification. Counselors must be knowledgeable about the history of oppression, indigenous wisdom, and geopolitical context of partnering communities. However, one of the most critical aspects in the process of counseling involves recognizing how our own positionality, or our cultural, personal, and educational background and experiences, influences our interpretations and subsequent understanding and interactions with marginalized groups. A counselor’s understanding of positionality or political, cultural, and personal location involves exploration, self-awareness, and understanding of worldview (Sue, 2001). A counselor’s positionality is integrally bound with his or her counseling, clinical, and educational intentions and actions (Yeh & Pituc, 2008). However, assimilationist and colonial ideologies are often deeply embedded in psychological theories and approaches so that many counselors may not be aware of their biases and assumptions and how their actions may further contribute to an oppressive environment for marginalized groups. Hence, locating one’s position and critically examining one’s cultural values

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and worldview will allow counselors to better understand their role and participation in terms of individual, cultural, and institutional racism (see Alvarez, Juan, & Liang, 2006). Positionality extends beyond self-awareness about location and also involves the positioning of the counselor or facilitator within the context of an anticolonial framework. Thus, an educational relationship frames the client and counselor (or student and teacher) as participants in an exchange of knowledge (Freire, 1970). Known in the field of education as a popular or liberatory education, this approach was historically intended to address the needs of marginalized peoples and maximize the effectiveness of those who chose to serve them as educators. Rooted in a concern for justice and intended to fortify individuals and their communities against systemic and relational forms of oppression, when adapted for counseling, this philosophy also aims to guide clients and their counselors toward a more humanized self (Gallardo, 2010). Anticolonial counseling locates the knowledge and ability to thrive as already existing in the community. Counselors must hold this belief with a strong resolve to confront the paradigm that assumes counselors or facilitators are the ones with knowledge and expertise. While it is often much easier to exclusively discuss the expected outcomes and process of the intervention itself rather than provide any analysis of the counselor, as is common, this counselor analysis must occur prior to, and during, the intervention process. However, the significance of counselor perspective must be appreciated given the participatory model of the intervention and the importance of “culture” as both a space for deep analysis and a mediating force between group members.

PARTICIPATORY We refer to participatory counseling as a form of advocacy-oriented collaborative counseling, similar to participatory research, in which a counselor enters a community space in a way that maintains the integrity and humanity of the group members

(see Suzuki, Ahluwalia, Mattis, & Quizon, 2005; Yeh & Inman, 2007). Based on work in Community Based Participatory Research (CBPR) (Hacker, 2013), participatory counseling prioritizes the active and equal involvement of community members across all levels of the intervention process, from conceptualization to termination. CBPR also emphasizes mutual goals, flexible relationships, open communication, and a history of trust, which align with community strengths and priorities for partnership. Participatory counseling entails close selfexamination and awareness of biases, positionality, worldview, racial identity, and motives for partnership (Yeh & Pituc, 2008). It is also important to explore the community’s history with previous partnerships. In their work with the Samoan community, Borrero and colleagues (2010) learned early on in the partnership that the Samoan community had previous negative experiences with university-based researchers who had collected data and disappeared from the community despite promises for change and hope. As in participatory research, an intimate connection develops with clients, which may also parallel the working alliance with a client and counselor in a counseling relationship (Ladany, Brittan-Powell, & Pannu, 1997). CBPR in particular involves group decision making, ecologically valid, and culturally responsive interventions based on local cultural realities and the identification of needs for systematic social change (e.g., Fine et al., 2003). A participatory approach was used when developing a cultural adjustment intervention program for low-income recent immigrants in a New York City public school (Yeh, Ching, Okubo, & Luthar, 2007). Yeh and colleagues (2007) partnered closely with a group of youth collaborators who represented immigrant youth who were the focus of the intervention. Youth collaborators met twice a week with Yeh and colleagues to establish trust, equal roles, mutual decision making, flexibility, and a deep understanding of the historical and geopolitical underpinnings of the immigration and cultural adjustment process of Asian immigrant youth in this particular New York City I NTO THE F I ELD

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school. From start to finish, the youth collaborators were involved in every aspect of the intervention ­including curriculum development, recruitment of participants, evaluation questions, and involvement of school staff, teachers, and peers (Yeh et al., 2013). The strong and active involvement of youth collaborators allowed for a sustainable and culturally meaningful intervention program (Yeh, et al., 2014; Yeh, Kim, Pituc, & Atkins, 2008). The resulting interventions allowed for a focus on youth cultural assets from multiple ecological levels.

ECOLOGICAL CULTURAL ASSETS Our framework for implementing indigenous anticolonial interventions builds upon this vision of participatory counseling by striving to place community members’ (and especially youths’) lived experiences at the center of our work as counselors. More specifically, we believe that effective interventions begin with an authentic belief in community agency— communities possess the knowledge to achieve any and all desired outcomes in a given context. At its core, this knowledge comes from the cultural assets (e.g., Borrero et al., 2012) that marginalized community members develop through their relationships with family and friends and their navigation of the cultural contexts they encounter daily. For many communities of color, these assets are rooted in cultural understandings of a group’s own historical traditions and struggles (e.g., Borrero et al., 2012) and their interactions across institutional (e.g., school and home) and generational contexts (Moll, Amanti, Neff, & González, 1992; Paris, 2010; Yeh et al., 2013). Central to our framing of cultural assets as a core theme in anticolonial interventions is our ecological perspective—we view these assets as collective, reciprocal, generative, and fluid realities that youth share with one another. Thus, effective interventions foster and harness these assets. In so doing, they disrupt the pathologizing of youth of color in schools and communities and they counter the individualistic and monolithic narratives of

belonging, achievement, and success that schools (and other institutions) proliferate (e.g., Ayers & Ayers, 2011). These assets are reflected in other approaches to strength-based counseling (Ching, Yeh, Siu, Wu, & Okubo, 2009; Peréz-Gualdrón & Yeh, in press), and we argue that they deserve greater attention in both research and practice. Meaningful interventions that center youth as the most important holders of knowledge in a given context are prime opportunities for cultural assets to be highlighted and studied (e.g., Camangian, 2013; Yeh et  al., 2014). It is in these spaces that community members share, learn, grapple with, and create new possibilities for participation and collective action (at school, in the community, with extended family, etc.). Borrero’s (2011) work with immigrant Latino/a middle schoolers in California reflects our approach to ecological cultural assets. The Young Interpreters Program was created to highlight the bilingual and bicultural capabilities of students who were labeled English Language Learners at their K–8 site. Instead of focusing on students’ English deficiencies, the intervention specifically built upon students’ burgeoning bilingualism—creating opportunities for them to exhibit their bilingual and bicultural identities and teaching them specific literacy skills in the context of their translating and interpreting (at school and in the community). The intervention sought to disrupt the English-only ideology of the school through showcasing the bicultural capabilities of students. Through this focus on youths’ assets, all ecological connections involved (counselors, teachers, students, parents, community members) had opportunities for transformation. For example, while the initial intervention focused on students’ linguistic assets, it quickly became clear to all that language was only a marker to far deeper, more community-embedded assets that youth possessed. Students succeeded at schoolbased opportunities like interpreting for a parentteacher conference, and in so doing, they gained insight into the value of bilingualism—as a tool for communication and navigation between the cultural worlds they exist in and create.

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CULTURAL PRIDE Our approach to ecological cultural assets is not simply a positivistic outlook on individuals’ backgrounds and identities (e.g., Borrero & Bird, 2009). Rather, we posit that effective indigenous, anticolonial interventions position individuals’ assets in ways that provide opportunities for participants to remember and embrace their own connections to family, elders, traditions, and history. With this comes a need for interrogation of self—for both counselor and student. As discussed above, issues of positionality (e.g., class, gender, race, sexual orientation, etc.) and power must be explored (e.g., Yeh & Inman, 2007). This may require space for individuals (especially youth of color) to unlearn the erroneous, silencing narratives that they have been taught as a part of their formal schooling (e.g., Camangian, 2013; Delpit, 2012) and counselors to address the individualistic and oppressive forces working against individuals in many institutionalized developmental contexts. In striving to create such spaces collaboratively, marginalized community members’ identities are affirmed as they become a part of the intervention itself. This intentional process builds cultural pride—not just through individuals connecting with their own cultural assets but through the group (counselor included), building a shared understanding of similarities, differences, and collective strengths. For example, in the intervention with Samoan youth, “Wear Your Pride,” Yeh and colleagues (2014) did not give or create pride in the participants. Rather, through indigenous symbols (Samoan tattoo art and traditions), connection to Samoan stories and words, and lessons from Samoan elders, participants recovered their strong bond with the solidarity, pride, and historical struggle of the Samoan experience in the United States. It was through this reclamation and deepened understanding of geopolitical context that great cultural pride emerged, which was shared across individuals, families, and the community as a whole. This ecological perspective of cultural pride is essential to community-based interventions

because it acknowledges the fluidity and multidimensionality of individuals’ social interactions (Yeh et al., 2014). Thus, cultural relevance is a process—individuals’ identities are honored through histories, traditions, and filial relationships while also valuing their daily, lived experiences. Cultural pride is not a fixed sentiment that members have about their past but a shared connection to something they help shape. The intervention, then, becomes one of fostering this process and sense of belonging (e.g., Yeh et al., 2014).

CONCLUSION At its core, anticolonial counseling assumes the existence and presence of a viable community with capable members in the face of marginalization. This relational, contextualized approach to counseling communities is congruent with Participatory Action Research (Altrichter, Kemmis, McTaggart, & Zuber-Skerritt, 2002) and critical reflective framing practices or reflexivity (Lahman, Geist, Rodriguez, Graglia, & DeRoche, 2011). This idea of cultural relevance extends beyond race and ethnicity to questions of nationality, class, gender, and religion. The self-reflective practices of counselors are rooted in a clear set of ethics that mandate introspection and respect the complexity and capacity of the collaborating community. As such, counselors must then intentionally allow themselves to be impacted through engaging with the intervention participants. This openness to be altered by the collaborative process is also part of an action-research model (Kemmis, 2009). It is a critical and self-critical process focused on illuminating these transformations through individual and collective self-transformation. Without these ethics or values at the core of the framework, counselors run the risk of implementing interventions that resemble a form of control or exploitation. Such an oversight can lead to a relationship that mimics one of colonialism. Anticolonial and indigenous approaches to counseling create and enhance a process that is deeply restorative. Our focus on restoration suggests that something special and much needed I NTO THE F I ELD

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already exists within the community and that this knowledge, situated in the community, humanizes that community. This premise takes the condescending novelty out of cultural artifacts and symbols and turns them into global sources for wisdom and innovation that are first and foremost acknowledged as originating in marginalized communities in serving first and foremost the very people in those communities. Further, we do not situate marginalized communities as merely extraction points for precious nuggets of information to be used by the general public, academics, or mental health professionals. Rather, we assert that the indigenous wisdom located within these communities has been

i­nterrupted by larger geopolitical phenomena, which has marginalized the community. The socializing power of this geopolitical force has led counselors to unwittingly perpetuate the oppression of these communities. These forces have also led to the internalization of destructive messages and the desperation that impacts the community’s collective ability to challenge systematic repression. Hence, the importance of restoring communal tools, strategies, foundations, and connections becomes a central focus of counseling. Through collaboration and the reclamation of indigenous wisdom, anticolonial counseling has the potential to be a critical element in the cultural empowerment of marginalized communities.

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CHAPTER

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Storytelling and Other Indigenous Teachings: From Culture to Clinical Practice Upon the Back of a Turtle: From Traditional Indigenous Stories and Practices to Psychological Interventions Dolores Subia BigFoot

INTRODUCTION In 1994, I was asked to develop a clinical training program for mental health clinicians working in Indian Country—that is, those who serve American Indians and Alaska Natives both on and off reservations or on Indian trust/allotment land. At the time, the Indian Health Service (IHS) and the Children’s Bureau (HHS-CB) were following the unfunded mandate of the 1990 Indian Child and Family Protection Act to provide culturally appropriate clinical treatment to American Indian and Native Alaska children and families who were the victims of physical and sexual abuse. Drawing from effective clinical approaches, the Project Making Medicine clinical training program was established (BigFoot & Bonner, 1995). With the help of colleagues, Project Making Medicine became the gold standard for clinical training in the treatment of child physical and sexual abuse in Indian Country. From this initial effort, an array of programs were developed to be generative in breadth and focus. This was accomplished by taking research/evidence-based treatments and making them more relevant for American Indian and Alaska Native people by adapting or enhancing them into culturally sensitive and responsive training and practice vehicles (Chaffin, Bard, BigFoot, & Maher, 2012). In this chapter, three such programs that are a part of the Honoring Children Series (BigFoot & Schmidt, 2010) that encompass a cultural enhancement of Trauma-Focused Cognitive Behavior Therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006), Parent-Child Interaction Therapy (PCIT; Hood & Eyberg, 2003), and the treatment of children with sexual behavior problems (CSBP; Silovsky & Bonner, 2003) are identified and discussed: Honoring Children, Mending the Circle (BigFoot & Schmidt, 2010); Honoring Children, Making Relatives 197

(Funderburk, Gurwitch, & BigFoot, 2005); and Honoring Children, Respectful Ways (Silovsky, Burris, McElroy, BigFoot, & Bonner, 2005). Relative to the objective of this chapter, and more specifically, its organization, I first selectively identify and discuss culturally based and interrelated traditions, especially storytelling, culturally based teachings, and select indigenous practices that are therapeutic in application. I then provide a rationale for selecting evidence-based treatments (EBTs) as the preferred therapeutic medium for such enhancement and use. Special attention is given to the framework that underlies those EBT programs that are the focus of this chapter. Finally, the culturally enhanced EBTs that comprise the Honoring Children Series are described and discussed. Before moving on to the objectives of this chapter, it is important that I put forth the following caveats: It should not be assumed that EBTs have equal and unquestionable application with all cultural groups and for all presenting problems. Not all indigenous teaching, beliefs, or practices can be explained and/or used within the context of these treatments. From my experiences, I have found that EBT approaches are applicable to the clinical treatment of childhood traumas, including child physical and sexual abuse, managing problematic sexual behaviors in children, and specific parenting techniques that address parent-child interactions. Furthermore, the argument still holds that the use of Western evidence-based practices has the potential to continue the colonizing tendency toward oppression and discrimination that has for centuries resulted in challenging, discounting, and/or displacing practice-based evidence (PBE) that are more familiar and oftentimes are seen to be more appropriate and effective for use with indigenous populations (Cross, 1998; Gone, 2003, 2009).

Teller of Tales: The Basis for Teaching and Helping I am a storyteller. I am a carrier of stories and a teller of tales. A storyteller not only carries the words to the listeners but creates a presence of the story that

evolves in the imagination of the listener. It could come in the form of words or actual images that hopefully would be repeated and enriched when the listeners add their own details, reflecting their own understandings of the story, and most important, what they choose to take from the story that can help them to better understand themselves and their lives. I did not choose to be a storyteller, and I am not certain if storytellers have a choice. Rather, there is a story to be told and I happen to have been gifted with the voice that forms the story and many other stories that follow. This perspective is the essence of this chapter. More specifically, in this chapter I tell the story of transforming the use of tales inherent in culturally based understandings, teachings, and practices into tales that have therapeutic application within a framework of EBT. More specifically, I present the use of stories and familiar objects (e.g., the Circle), and the “connectedness” each brings as vehicles for understanding human behavior and transmitting cultural knowledge. I should note that specific attention is given to those ancient stories that provide explanations about life and nature that are quite reflective, complementary, and supportive of recent explanations that have been derived through the “scientific method.” Upon the Back of a Turtle. As with any good story, we should start at the beginning. Stories can be introduced in many ways. Many of our indigenous stories begin with an understanding of the following starting phrase: “Upon the back of a turtle.” The main point of this saying is that stories are carried to us many times upon the back of a turtle (King, 2003). It is a way of catching the listeners’ ears, alerting them that now the story will begin. Why the turtle? I didn’t know the answer to that question when it was first asked of me. I assumed we used the phrase because turtles have long lives and because turtles could be used for food, rattlers, jewelry, or any number of things that we as two-legged/fivefingered creatures could use for our own good. I know differently now. The introductions to our stories come from the Ancient Ones (Sipes, 2005), those who explained

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life, creation, and the universe as best they could using familiar objects that were part of their lives and upon which they relied for subsistence in some way. They gave us the world in the image of the turtle moving slowly with a hardened shell scored by scutes (Anatomy of the Turtle’s Shell, http://www.turtlepuddle.org/health/anatomy. html) that we now know as similar to our own vertebrae but evolving differently. In essence, our Ancient Ones used the turtle to share stories of what they understood and to convey to us, living centuries later, what life was like for them and what life would be like for generations yet to come. I continue to use stories in this manner. I use them to help individuals understand how they got to where they are and what choices they can make and actions they can take to improve their lives. That is where they came from, why they are here, and where they may be going. Reflecting the ancient perspective of the turtle, we have more recently learned that our earth’s crust has plates (Kious & Tilling, 1996) that move slowly and bump into each other. Scientists call this process plate tectonics. If we consider that while our Ancient Ones had no current scientific knowledge of plate tectonics, they understood the earth as a living creature called the Great Turtle Island. Subsequently, with this understanding they ably used the turtle with its scutes to describe the earth and how we came to be upon it. This understanding, in turn, provided an indigenous answer as to why our stories are carried on the back of the turtle, and especially an understanding of why the earth is considered the Great Turtle Island upon which the two-legged/five-fingered creatures that we call human beings lived and developed the stories that we presently share with each other. Such stories are rich and are based on happenings that are below, on, and above the Great Turtle Island. Finally, these stories provide the basis for the teachings and practices that we call Old Wisdom. Stories of happenings above the Great Turtle Island tend to focus on stars, night sky, sky walkers, and other celestial beings. Many times, creation stories, which tell of the origin of a Tribe, begin with happenings above and the connection to

how Turtle Island came about. For some stories, the connection between the Great Turtle Island and the stars may be told. For instance, many Tribes tell their own version of the story of the seven brothers or seven sisters that became stars. I am more familiar with the Cheyenne legend of Quillwoman (much condensed in this writing) who took bundles full of beautiful beaded quill hides (clothing decorated with porcupine quills) to offer as gifts (visitors/families exchange gifts) to her seven brothers who she had finally found living in a far distant land. Once found, there was much song (welcoming, honoring, social) and gift giving; however, the buffalo nation was furious. It may be that they saw themselves as less beautiful than the beaded quill hides given as gifts. They attacked Quillwoman and her brothers because they wanted to be the most beautiful; as such, they plotted to take Quillwoman’s beautiful quill hides for their own. To protect themselves, the siblings climbed a tree. This infuriated the buffalo nation and thus it charged the tree again and again causing the tree to sink into the Great Turtle Island. However, Quillwoman and her brothers climbed higher. Their climbing up was facilitated by one brother who kept shooting arrows upward over and over causing the tree to grow taller each time (counteracting the sinking) until he finally shot one arrow that pierced the sky; this allowed them to climb into the sky to become the star people. This type of story is helpful to explain that indigenous knowledge is still available, that challenges come in many ways, that working together in groups (families) can help overcome obstacles, and that sometimes we don’t always know what the answers will be until we engage in the process (based on an oral story of Cheyenne Chief John L. Sipes, 2005). From the indigenous perspective, we are all related to the stars. Of relevance to this story is an article titled “The Cosmic Recipe for Earthlings” that was published in Discover (Setton, 2013). It states that “Stars cook up nearly all of the approximately 60 atomic elements in people’s bodies” (p. 12). This story exemplifies the belief that the Old Wisdom of our Ancient Ones is based on what understandings they had of who we are and

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where we come from. Is it a leap to think that the star people stories of the Ancient Ones, shared from generation to generation, were based on intuitively knowing that we were made up of star material? Were the stories remembered because they were important information to be handed from one generation to the next or because they were just good stories? Are there messages to be learned from these stories as relevant today or beyond their ability to merely entertain? Regardless of the answers one gives to these questions, the fact of the matter is that they provide guidance in who we are, where we come from, and why we are here—all relevant for American Indian and Alaska Native youth who struggle with issues of identity, connectedness, and belonging (suicide research). The Ancient Ones said there are great mysteries that we are not able to explain. However, of the knowledge we have access to through the stories, practices, and other ways of indigenous perspectives, we can utilize these particular concepts to provide guidance, examples, understandings, or activities that can shape and support a therapeutic framework. That framework within an indigenous perspective is the form, use, and image of a circle. An integral and important part of such knowledge is the Circle concept, which many indigenous persons believe can provide guidance regarding what can be drawn in and embraced relative to all aspects of life. The oral teachings of Black Elk, a Lakota Holy Man (Niehardt, 1932), eloquently illustrate the Circle concept. Our tepees were round like the nests of birds, and these were always set in a circle, the nation’s hoop. If the vision was true and mighty, as I know, it is true and mighty yet; for such things are of the spirit, and it is in the darkness of their eyes that men get lost. The sacred hoop of my people was one of many hoops that made one circle, wide as daylight and as starlight, and in the center grew one mighty flowering tree to shelter all the children of one mother and one father. And I saw that it was holy. I did not know then how much was ended. A people’s dream died there. It was a beautiful dream. Everything an Indian does is in a circle, and that

is because the power of the world always works in circles, and everything tries to be round. In the old days when we were a strong and happy people, all our power came to us from the sacred hoop of the nation, and so long as the hoop was unbroken the people flourished. Everything the Power of the World does is done in a circle. The sky is round, and I have heard that the earth is round like a ball, and so are all the stars. The wind, in its greatest power whirls. Birds make their nest in circles, for theirs is the same religion as ours. The sun comes forth and goes down again in a circle. The moon does the same and both are round. Even the seasons form a great circle in their changing, and always come back again to where they were. The life of a man is a circle from childhood to childhood, and so it is in everything where power moves. Our tepees were round like the nests of birds, and these were always set in a circle, the nation’s hoop. (pp. 150–151)

It would be impossible to characterize all American Indian and Alaska Natives as the same when there are over 650 Federally Recognized American Indian and Alaska Village Tribes plus various state and treaty Tribes, in addition to selfidentified indigenous people within the continental United States who identify as American Indian or Native Alaskan. They hold various cultural beliefs and practices, oral-based creation stories, lineages, languages, separate histories, customs, and teachings. Their citizens can be identified by their enrollment with the Tribe or village, their association with extended family or clan/bands, through intermarriage, adoption, or other types of affiliation, or culturally based from attachment to the land and sacred sites. However, one feature that unites almost all indigenous people is the Circle. The Circle is a sacred symbol that has long been acknowledged to be a teacher, a helper, and a healer that provides an orientation or worldview of the individual, families, Tribes, and of life in general. The Circle or hoop typically includes such elements as colors, directions, animals, symbols, quadrants, dimensions, locations, seasons, levels, dynamic movement, and connections or relational links between and among these elements. Each respective element by itself or in combination

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with others provides indigenous wisdom about life (BigFoot & Schmidt, 2012; Sipes, 2005). The symbolism of the Circle is Old Wisdom transmitted in oral stories, carved into rock formations, sculpted in wood or clay, woven into reed baskets, or painted in colored sand. Interestingly, as will become evident later in this chapter, the Circle can be perceived as providing the philosophy, teachings, and practices that can be complementary to EBT, making these approaches more historically grounded because of the familiarity of concepts that are indigenous based. The concept of the Circle is incorporated into American Indian and Alaska Native lifestyles and belief systems through images, practices, explanations, teachings, and ceremonies. Examples include the simple circular image of a mother holding a child, the beginning of the grand entry for powwows (tribal social and/or ceremonial gatherings), the physical placement of participants during sweat lodge or other ceremonies, the shape of the drum and dance arenas, ceremonial structures, such as medicine lodges, and many kivas and family dwellings such as grass or reed shelters built with wattle and daubs. The basic teachings inherent in the respective Circle emphasize respect, love, understanding, communication, sharing, acceptance, and strength. In essence, these constructs serve as the basis for mutual respect and provide the rules to govern behavior. When used properly, this teaching, the Circle, can be a very powerful means of touching or bringing some degree of healing to the mind, the heart, the body, or the spirit (Archambault-Stephens, 1996). It was with this intent that I constructed the framework for enhancing and adapting EBT that have foundational principles that reflect similar or same values that are effective with indigenous people. The most widely recognized American Indian symbolic circle is the Medicine Wheel. The constructions of the Medicine Wheel and its teachings have been documented since 7,000 BCE (http:// solar-center.stanford.edu/AO/). Other symbolic circles include the Sacred Hoop, the Sacred Circle, Children as the Center, and the Circle of Life. Given the limitations of length in explanation of

the Circle, attention is mainly directed to what are short descriptions from teachings of the Medicine Wheel. Graphically, it is divided into four parts representing the four parts of man: the physical, mental, emotional, and spiritual. The Medicine Wheel gives mankind an understanding of good medicine and bad medicine. In application, the Medicine Wheel incorporates knowledge and skills to help us make sense of all available information. To this end, it provides the basis for a more comprehensive and systematic use of overlapping and/ or distinct areas of information that help to bring clarity. To a certain extent, as will be addressed later in this chapter, this is quite comparable to what is done through the use of cognitive-behavioral approaches. From a circular perspective, one starts off with an event then  thought  feeling  behavior  event (changes and evolves). The Medicine Wheels offers many teachings, and one is the teaching of the Seven Sacred Directions. More specifically, wisdom, knowledge, and learning come from using the Sacred Directions as messengers to help in the search for guidance and understanding (White Crow, 1986). As might be expected, the Sacred Directions include the four cardinal directions: east, south, west, and north. According to tradition, it is believed that these directions were established by the intuitive sense of being on this Great Turtle Island. In addition to these four directions, there is the upward direction that is believed to be Father Sky and the downward direction that is believed to be Mother Earth, the Great Turtle Island. Father Sky has the rights to the sunlight, the wind, and the rain. The changes in the seasons, the change in temperature, and the change as the earth moves across from east to west come from the direction of the sky. Ahead of so-called Western civilization, the indigenous people knew intuitively that the Great Turtle Island revolved around the Father Sun—Father Sun did not revolve around the Great Turtle Island. As important as the upward direction, there is also the recognition of the downward direction to Mother Earth, the Great Turtle Island. This direction is the provider and connector of all earthbound necessities needed for life to thrive and continue.

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Special attention was given toward embracing the Great Turtle Island as a teacher that provided basic instructions for living among the two-legged/fivefingered ones. Such instructions included being respectful toward oneself, others, and both immediate and far surroundings. In addition, because of the generosity of the land, being generous toward others was also valued. Together, the two latter directions bring fertility and reproduction to the environment. It should be noted that most indigenous people were respectful and acknowledged the holistic nature of life and subsistence lifestyles with the interdependency of giving back with prayers, offerings, and taking only what was needed (Chief Seattle as recorded by Clark, 1985). Today, we can see there is a toll on the environmental impact by humankind and that the indigenous perception of the cycle or circle of returning good back to the Great Turtle Island should not be understated. We can affirm that indigenous teachings once again lend much weight to balance in health and spirit and even with our physical environment. The last direction, called the Seventh Direction, is the medicine of self. When the medicine is good, then everything is in harmony with self. This is what is strived for. When people know who they are and the direction they are to follow, they are self-assured, they are self-regulated, and they are self-disciplined. As a whole, the Sacred Directions help to establish identity and self-confidence. Striving for these self-truths is quite similar to the goals that individuals seek to attain through modern therapies, including EBT. For more clarification on one of the Seven Directions of the Medicine Wheel, I wish to discuss the teachings of the Southwest Direction as taught to me by my tribal teachers. Other Tribes have the same, similar, or different additional teachings that are inherent in the Medicine Wheel. Given its association with youth, the Southwest Direction gives emphasis to learning, sharing information, and growing in knowledge. Interestingly, the rodent (i.e., mice or rat) is the animal that represents this direction. The story goes that thousands of years ago, the Ancient Ones wanted to relay information or prophecy about future generations, even

our generation and especially the youth, about what would be ways of understanding our place on this Great Turtle Island. To this end, they used the teachings of the circle—the Medicine Wheel. Indigenous people still believe that the Medicine Wheel continues to serve as the basis for providing the information that is needed for our learning today. I make the point that today most information is virtual, spread across the World Wide Web in the form of binary numbers in which all information is stored as a sequence as 0 or 1. Interestingly, the mouse label has been given to the handheld device that enables unlimited amounts of information to be sent across the World Wide Web. Also, when we examine mouse droppings, we see that they are round as in 0 and shaped like the number 1. The Ancient Ones used what was familiar to them, that is, a mouse, to describe what our world would be like today, including how information is shared. The Southwest Direction is about youth, about sharing information, engaging one with another, about prophecy, and about knowing a person’s place within their generation. Unstated but assumed is the appreciation for sharing (communication), which is a critical part of the construct of this teaching. Today, we know that communication and how we share information has an impact upon those whom we seek to help. Some may argue that this “interpretation” is coincidental, that prophecy is not valid, and that this idea stretches the imagination, but imagination is what inspires creativity and the ability to be visionary and see all that is possible, as with the Ancient Ones. These traits were there for the Ancient Ones and are still available for indigenous people today. Needless to say, indigenous youth especially need to know how they are connected to history, how communication is important, embrace and understand their future and its promises, appreciating creativity and prophecies, embrace technology that was recognized early, and have the ability to bring more balance and healing into their circle. Counselors and therapists who can appreciate the Ancient Ones’ teachings can use these concepts to encourage and stimulate American Indian and Alaska Native youth to know they were envisioned

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and understood many generations before their entrance onto this Great Turtle Island. Accepting a possible relationship between ancient stories and present-day communication technology and other aspects of our lives enables us to teach our students and counsel our clients that knowledge from the Old Wisdom is still applicable and useful in explaining how the world works, how we maintain our well-being, how we heal (i.e., the use of specific therapies and treatments), and most important of all, how we can best interact with and relate to the two-legged/five-fingered creatures and the other elements and creatures of this Great Turtle Island.

From Culturally Based Old Wisdom and Practices to Present-Day Evidence-Based Theories and Practice My story continues by bringing us to the present. As noted above, the Circle, the Great Turtle Island, and creation stories all provide the foundation for theoretical models for explaining human behavior from an indigenous perspective. Introductory classes in psychology also typically present theoretical models to explain human behavior. Such models are contained in the works of psychologists including, but not limited to, Freud, Bandura, Rogers, Skinner, and Erikson. The contributions of stories, practices, and way of life to present-day psychological theories and practices are well exemplified in the Blackfoot/Blood teachings toward children, parenting, self-regulation, and selfrespect. More specifically, Blood and Heavy Head (2007) tell the story of how psychologist Abraham Maslow’s strongest contributions to motivational theory, normative human psychology, and organizational psychology were all crucially influenced by the Blackfoot/Blood (tribal) way of life. Starting in 1938, Maslow and two colleagues spent time among the Blackfoot/Blood Indians on the Blood Reserve (tribal land) in Siksika, British Columbia, Canada. He spent several summers with Blood band (there are three bands [divisions] of one Tribe), exploiting from them the self-actualization

theory for which he became known (http://www .terrapsych.com/maslow.html). According to the oral histories still being told, he was rude, disrespectful, and disregarded protocol; however, he marveled to see their nonauthoritarian, intertribal leadership styles, their affection for their children, their openness, and their lack of crime, dishonesty, and aggression toward one another. Additionally, Jung’s interpretation of dreams has a basis in indigenous dream talking. It is said that he visited the southwest tribes to better understand the interpretation of dreams. Suffice it to say that disparate parts of psychological theory are not new to Indian Country, that positive interactions were promoted, and that theorists and practitioners are not limited to formally trained scholars and clinicians. More recently, models of evidence-based cognitive-behavior intervention has shown itself to be an effective treatment for depression (Beck, 1967; Hollon, Stewart, & Strunk, 2006). While in the Alaska Yupik area, the generations-old practice of daily getting dressed, walking around outside, doing good for others, and watching out for the well-being of elders has been recognized as an antidote for sadness. Consider that Cohen, Deblinger, and Mannerino (2004) have advanced the treatment of trauma using trauma-focused cognitive behavioral therapy. While these cognitive-based treatments appear to be “new,” the fact of the matter is that the connection between the thinking-feeling-doing, which is at the core of cognitive-behavior theory and treatment, had been addressed by indigenous circle theory and practice for centuries before the emergence of psychology as a science (BigFoot & Schmidt, 2010; Hays, 2006; McDonald & Gonzalez, 2006). Many concepts and interventions that are inherent in evidence-based treatments are not “new science.” On the contrary, from very early on, indigenous peoples made great strides to improve their lives through what we now might consider to be scientific endeavors. Such endeavors included the training of birds of prey, the domestication of dogs (the Cheyenne and other Plains Tribes), and throughout the plains, the transition from farming and gathering to activities that required outstanding horsemanship. In retrospect, it is

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safe to say that these accomplishments indicate that American Indians, prior to the 1400s, had a working knowledge of genetics, chemistry, behavioral principles and practices (e.g., reinforcement, shaping, relaxation, time out), and the importance of selective attention, relationship building, and mind-body-spirit association. Selective attention and ignoring for controlling and/or shaping behavior was also prevalent among many Tribes relative to interpersonal interactions. The application of principles and practices noted above are well exemplified in their use in Council (tribal governing body). For illustrative purposes, a brief overview of the protocol structure in Council follows. To begin with, the use of ceremonial tobacco has a long history with American Indian Tribes (Native American Rehabilitation Association, 2010). Commercial tobacco is processed for daily consumption. Unfortunately, such commercial consumption typically results in addiction. In contrast, ceremonial tobacco has been used for centuries as gifts, as offerings for requests and thanksgivings, as blessings, and as acknowledgment for personal accomplishments and life events. During Council, a protocol was followed that involved the sharing of the tobacco in a hand-carved pipe, along with some form of drumming on a brain-tanned hide drum. Within the circle of Council, there was the pipe-offering ceremony using ceremonial tobacco. The protocol followed in this ceremony included the expectation of patience, listening and waiting on the participants’ part in order for each to have a voice, and by so doing share their thoughts, feelings, concerns, observations, predictions, alliances, and agreements. The outcome, much like feminist process theory, resulted in complete support and total consensus among the participants. In other words, the protocol, the activities inherent therein, promoted group relaxation, created a respectful ambience, facilitated calm dialogue, encouraged thoughtful considerations, enabled equal input, and provided an arena in which to solicit input from all, including experienced elders, and a respectful presence toward one another (Sipe, 2004). Between the use of ceremonial tobacco, singing/drumming, and the application of protocol-based activities,

the atmosphere became one of solidarity, unity, a sharing of a common heartbeat, and synchronicity (Dickerson et al., 2014). From a practical perspective, the intentional purpose of the ceremony was to create a calming environment to counter potentially heated discussions about territories, horse stealing, betrayals, broken alliances, warfare, or any number of life-challenging stressors. This purpose and the activities inherent therein are not too far removed from the circles and activities used today in counseling groups to resolve prevailing issues occurring outside and inside counseling sessions. Likewise, in place of tobacco, breathing exercises, prosocial, and other relaxation activities are used to help individuals deal more effectively with their emotions while thinking and expressing themselves more clearly and respectfully. There is a Great Mystery that not all can be explained. Lame Deer, Seeker of Vision (Lame Deer & Erdoes, 1972), and others like Vine Deloria Jr., recognize this Great Mystery (Cater & Bernstein, 2012; Moore & Demeyer, 2013). However, they also contend that there is much that can be taught and explained by Old Wisdom, by the Circle, and in particular, by the stories associated with the Circle. Such stories include existence and creation stories, behavior stories (how, why, and how-come stories), and stories that emphasize the relationship between thinking-feeling-doing stories. To repeat, such stories are an inherent part of the Honoring Children Series that is addressed in the following section.

Honoring Children Series—Concept of Wellness and Healing Before addressing the specific components that comprise the Honoring Children Series, it is important to underscore three particulars that give it shape and direction. The first is the fact that the Series focuses on children. The reason for this comes from the indigenous life-guiding belief that children are the center of the circle, that they are gifts from the Creator, and that their spirits, souls, hearts, minds, and bodies should be honored and respected.

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With respect to the second, special attention is directed to the spirit, given the belief that this spirituality plays an important role in the lives of indigenous people, that it is essential to the Circle, and that it gives more meaning to the holistic view of well-being and healing. There is an acceptance that there is no separation of the physical from the spiritual; it is interwoven and intertwined, which is complementary and reciprocal. The third fact, as mentioned previously, is that many of the indigenous teaching and healing approaches that have been successfully used are aligned with the principles and procedures inherent in cognitive-behavior theory. Thinking, feeling, and doing are not new but basic aspects of being two-legged/five-fingered creatures. While the terminology used may be recent, the concepts of teaching, instruction, understanding, explanation, and modeling are not new. One could say that before the written word became a common form of communication there were campfire theorists that transmitted these concepts through stories, songs, and example. When American Indian and Alaska Native people typically acquired a new skill, such as beadwork, it was done so by utilizing concepts and teaching approaches that included watching, listening, modeling, and practice. Additionally, when shaping the behavior of animals, they did this based on the intuitive understanding that rewarding behavior increases the frequency of such behavior (i.e., behavior modification). For example, the Nez Perce Tribe had a well-established breeding and training program for Appaloosa horses that used such approaches prior to the 1800s.

Adapting and Using EBT Treatments with Indigenous Peoples: The Challenges Numerous cultural and professional problems and challenges had to be addressed in the process of adopting and/or culturally enhancing EBT for use with indigenous people. Such problems and challenges are selectively addressed here.

According to Manson (2006) there are significant epistemologically related problems in the area of mental health research with American Indian and Alaska Native people that may negatively impact the use of nonindigenous therapies. One problematic area that may impact such use involves differences in the preferred use of terminology, constructs, and concepts relative to mental health. For instance there is disagreement on the use of the term mental illness instead of the indigenous-preferred terms such as mental health, mental wellness, or well-being. American Indian and Alaska Native people embrace wellness as a self-determined positive construct that has little or none of the stigma that is typically associated with the disorders that have been assumed under the heading of mental illness. Another problematic area involves the mainstream tendency to direct a great deal of attention to etiology and treatment. Relative to this tendency, American Indian and Alaska Native populations would strongly argue that there is the need for more focus on prevention and promotion of wellness rather than focusing on stigmatizing conditions and problems. Problematically, there are no large-scale, population-based surveys or randomized clinical trials conducted with American Indian and Alaska Native populations relative to the status of mental wellness or mental health disorders. With respect to majority population, these types of research are the gold standard for scientific evidence. However, at this time, given the lack of such research with American Indian and Alaska Native populations, conclusions identifying effective treatments cannot be reached. Reaching such conclusions is impeded by the lack of studies that take into consideration gender or social class within the respective indigenous cultures. Relevant research that takes into consideration the historical forces that shaped the contemporary context in which indigenous peoples find themselves, including historical and sociopolitical trauma, intergenerational trauma, and ­historical grief and loss, is also lacking. Without such research it is almost impossible to comprehensively understand many of the problems faced by indigenous

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people. Needless to say, failure to take such forces into consideration not only may impede the effectiveness of treatments but more important, negatively impact the willingness to seek help from mainstream providers who solely use mainstream theories and practices. Many times, current Western approaches focus on deficits of the individual rather than the negative environment, disruption of cultural norms and lifestyles, or harsh social conditions that contribute to an unbalanced lifestyle. The use of EBTs, in particular those that are cognitive-behavioral in nature, is being promoted nationally by the Substance Abuse Mental Health Services Administration (SAMHSA) and other federal agencies as well as individual states because of the body of research that supports their efficacy; however, in spite of such validating research, American Indians and Alaska Natives have been hesitant to adopt these Euro-Western psychological treatments into their service and treatment programs for reasons noted above, and in particular, for those that follow (Cruz & Spence, 2005): While there is research to validate EBTs, indigenous populations have not been included in clinical trials and thus the generalizability of the findings are limited relative to these populations. Furthermore, they believe that by not being included, deliberately eliminated, or being ignored in the developmental stages of such treatments they may be of little relevance to them. More specifically, they feel that the development and evaluation of such treatments may have ignored their unique cultural history and their strong desire to retain their own healing ways within the context of innovative therapies. Worse yet, given the past history of psychology’s oppressive and prejudicial treatment of indigenous people, there is the prevailing concern that EBT may not only be irrelevant but may actually be psychologically and collectively harmful (Gone, 2013). Reluctance to adopt and/or hesitancy to use EB therapeutic practices and interventions is most often based on the fact that indigenous persons are apt to prefer and seemingly benefit more from those interventions that are more culturally congruent with their respective cultures and practices. As previously exemplified in

this chapter, American Indian and Alaska Native cultures have healing practices, activities, and ceremonies that are well established and have been used successfully for eons. These practices and activities as well as the method in which they are taught and passed from one generation to another cannot be ignored. In spite of the varied reasons that could negatively impact the acceptance of cognitive behavioral EBTs, there are many aspects that make them attractive for enhancement for use with indigenous populations. These aspects include the following: The principles that underlie evidencebased cognitive behavioral treatments are in line with the concepts inherent in the Circle and are complementary to the concept of the Circle. Furthermore, the teaching process that underlies these treatments is also complementary to the teaching/intervention methods inherent in indigenous cultures—instruction, watching, listening, and modeling (BigFoot, 1989). Cognitive-behavioral approaches have been described as more culturally appropriate for American Indian and Alaska Native populations than most other mainstream mental health treatment models because of their sensitivity to how people see and experience the world (Hays, 2006; LaFromboise, Trimble, & Mohatt, 1990; McDonald & Gonzalez, 2006; Trimble & LaFromboise, 1985). Similar to CBT, indigenous teachings, as conveyed through stories and ceremonies, emphasize the circular interrelationship that exists between and among thoughts (i.e., beliefs), emotions/feelings, and behaviors. Indigenous teachings/stories often focus on the consequences of one’s behavior (e.g., rewards, punishment), and the importance of identifying and expressing emotions, and especially outcomes (how, why, what, and creation stories).

The Development/ Enhancement of EBT Continuing my story . . . Working from the perspective that the positive outweighs the negative, Dr. Barbara L. Bonner and I, as codirectors, applied

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for and were awarded a 2003 development grant from SAMHSA as part of the National Child Traumatic Stress Network (NCTSN). This funding allowed us the opportunity to build on the previously mentioned Project Making Medicine curriculum to culturally enhance three evidence-based cognitive-behavioral-based therapeutic approaches for use with American Indian and Alaska Native children and families, and especially those impacted by trauma, experiencing problematic behavior problems, including sexual, and/or needing to improve parenting, parent-child communication, and parent-child interactions. The end result was the Honoring Children Series, which was eventually developed by the Indian Country Child Trauma Center (ICCTC) and consisted of Honoring Children, Mending the Circle (BigFoot & Schmidt, 2010), Honoring Children, Making Rela­tives (Funderburk et  al., 2005), and Honoring Children, Respectful Ways (Silovsky et al., 2005). The process for developing these treatments was complex and extensive, requiring a good deal of time, perseverance, and patience. Herein, the developmental process generally used across the Honoring Children Series included initial identification and enhancement efforts, development of materials, pilot training of clinicians, and the implementation of the models. The Enhancement Process The process of cultural adaptation paralleled and expanded upon the recommendations of de Arrellano (2005) and Whitbeck (2006). However, our process also included many additional aspects learned during implementation of our Project Making Medicine (2005), which began in 1994. The actual steps taken to adapt, enhance, and implement the treatments included 1. review of the core and common components of EBPs, including TF-CBT, treatment of children with sexual behavioral problems, and PCIT; 2. identification of PBE concepts that the core principles of EBT could be complementarily with;

3. review of the current counseling research literature with American Indian and Alaska Natives; 4. consulting and working with the original developers of the EBT; 5. inviting indigenous cultural experts and clinicians to review, revise, and correct the enhancements (i.e., simplifying and clarifying terminology, using examples, situations, language, illustrations); 6. pilot testing the treatments and materials and making changes where needed; 7. implementing the treatments in selected sites; and 8. assisting in developing implementation plans for institutionalizing the EBT programs (e.g., ongoing training, evaluation, and making adjustments).

An essential aspect of the Honoring Children Series that bears repeating is that it very methodically incorporates indigenous beliefs, stories, traditions, and practices into the healing process. Since the three programs addressed in this chapter share much in common (e.g., theories underlying the treatments, use of indigenous stories and practices, and skills taught), the Honoring Children, Mending the Circle (HC-MC; BigFoot & Schmidt, 2010) treatment is used as a prototype for describing the basic cognitive-behavior method use that would be common for the other two treatments. However, certain features of each of the EBT are not interchangeable (i.e., live coaching in PCIT, sexual behavior rules in CSBP, and trauma narrative in TF-CBT, to name a few). Honoring Children, Mending the Circle. The HC-MC treatment is based on TF-CBT (Cohen, Mannarino, & Deblinger, 2006), which combines trauma-sensitive interventions with elements of cognitive-behavioral therapy into a treatment designed to address the unique needs of children with post-traumatic stress disorder (PTSD) and other problems resulting from traumatic life experiences. This model has been extensively promoted and implemented in Indian Country with the support of the Children’s Bureau and the NCTSN.

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HC-MC treatment offers a clinical application of TF-CBT in a traditional framework that supports the American Indian and Alaska Native cultural models of well-being. The theoretical basis of HC-MC is an elaboration of the theory that supports the core concept of the TF-CBT Cognitive Triangle model. This model contends that there is a direct relationship between one’s thoughts, emotions, and behaviors. How one thinks determines how one feels and how one behaves. When thoughts are positive, feelings are positive and behaviors will, more than likely, also be positive. The reverse is true when thoughts are negative. When there is a healthy positive balance between thoughts, feelings, and behaviors, a person can function well. From a complementary perspective, and as noted previously, well-being in American Indian and Alaska Native culture is viewed as a healthy balance within and between the spiritual, physical, relational, mental, and emotional aspects of life, both individually and collectively. They work together and they reflect each other. As trauma creates imbalance between these aspects of life, addressing the unbalance is important while allowing that healing must work to restore the balance. This treatment makes extensive use of proven indigenous teaching approaches and activities (e.g., watching, instruction, modeling, practices) that complement those used in the TF-CBT

model. It essentially seeks to help individuals develop a better understanding of trauma and trauma responses while concomitantly teaching them to acquire the cognitive and behavioral skills to effectively deal with the trauma-related problems or symptoms that they are facing. The skills that are taught and the approaches that are used include those previously mentioned: identifying feelings, coping, relaxation, impulse control, problem solving, abuse prevention, and prosocial relationship building. In addition, specific attention is given to the following. Reflecting the indigenous belief in the interrelationship that exists between thoughts, feelings, and behaviors, the program seeks to teach cognitive coping and processing skills that embody such a relationship. Such teaching seeks to explore and correct inaccurate attributions associated with everyday events that might negatively impact performing routine activities (e.g., going to school, sleeping, socializing, etc.). As a direct therapeutic intervention, this treatment illustrates the use of storytelling. Storytelling can be introduced by the simple illustration of the Well-being Circle (see Figure 20.2) with the five elements of cognitive, emotional, spiritual, physical, and relational. With each component of TF-CBT, a story like the Buffalo and the Storm (see Figure 20.1) can be expanded and psychoeducationally and therapeutically used.

Figure 20.1  Buffalo and the Storm As is known, millions of buffalo roamed the Great Plains areas in years past. As was common then, and still today, is the tumultuous lightning and thunderstorms that cover the landscape from early spring into the summer months. We are familiar today with those raging, darkening storms that typically form in the west and move toward the east, especially those that grow quite menacing with tornados, strong forceful winds, pounding hail, and/or icy rain. Out in open prairie, the buffalo were intensely aware of approaching storms. The question the elders would ask when someone was hesitant about the next move or questions undertaking a difficult task, was did the millions of buffalo gather into a single mass for protection, did they run into the menacing storm force or did they run away from the approaching storm? When watching buffalo out on the plains, the people saw that the buffalo ran into the storm because the buffalo instinctively know that there was calm, brightness, sunshine, and peaceful grazing behind the retreating storm. Source: Retold by Dolores Subia BigFoot, 2011.

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Treatment Components The TF-CBT model incorporates a componentsbased structure to guide clinicians through the treatment process (Cohen, Mannarino, & Deblinger, 2006). Treatment components are organized to facilitate the learning and skill building process for children and parents/caregivers. Knowledge and skill components gained during earlier sessions assist clients in their progress through later components. The HC-MC model maintains this

components-based structure within the context of the circle model as depicted in Figure 20.2. For each component, the therapist assists the child and family in working toward balance both within and between each circle domain (spiritual, physical, relational, mental, and emotional) using stories whenever possible. For example, reflecting the elders’ ceremonial use of tobacco to relax, one of the first TF-CBT components focuses on assisting youth in learning relaxation skills in order to

Figure 20.2  Honoring the Children—Mending the Circle Model Goals:

RELATIONAL Activities:

Model of Well-Being

Goals:

Goals: EMOTIONAL Activities:

SPIRITUAL Activities:

MENTAL Activities:

PHYSICAL Activities:

Goals: Spiritual Goals:

Source: Indian Country Child Trauma Center.

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reduce the physiological manifestations of stress and PTSD. This often incorporates the teaching of deep breathing and progressive muscle relaxation as methods for stress reduction. In the HC-MC model, the therapist can use stories to reinforce the cultural application of relaxation by assisting the youth in incorporating familiar soothing traditional images. When learning deep breathing, the youth is taught to pair inhalations and exhalations with relaxing images such as the sway of windswept grasses or of the movement of a woman’s shawl during a ceremonial dance. For some American Indian and Alaska Native youth, images such as the tensing and relaxing of a bow string may be useful in teaching the difference between relaxed and tense muscles during progressive muscle relaxation. The incorporation of familiar traditional images such as these not only enhances the meaningfulness of the activity for the youth and family but also reinforces the youth’s spiritual, historical, and relational connectedness. The therapist may also assist the child and family in identifying spiritual practices that the family engages in, such as the Sweat Lodge, and that facilitate relaxation. This not only supports the family’s own sense of spirituality but also reinforces the family’s connectedness with one another, with the past, and with other helpers and healers in their community. When considering the emotional and mental components of relaxation, the therapist may assist the child in understanding how one’s thoughts and feelings can support physical relaxation. For example, with trauma-exposed children, a common symptom is intrusive thoughts that create anxiety and inability to relax. Common reactions to trauma include physical sensations of rapid heartbeat and breathing that result in distress or discomfort. To combat such discomfort, TF-CBT essentially instructs the child to talk himself or herself into a more relaxed state. Complementing such instructions from a culturally sensitive perspective, the counselor might use traditional instructions that are used in ceremonial or related activities: “Know that this is a safe place, a place for you. If you have bad or frightening thoughts, you can leave them outside this place. Think about who you are, close

your eyes, breathe in, feel how you are sitting, think about who is sitting next to you.” As therapy progresses, there is the eventual introduction of a different story called the trauma narrative. In some cases, a Journey Stick (an 18-inch dowel wrapped with a variety of yarn or other material to symbolically represent life events which is created by the client) may be completed before the trauma narrative. The trauma narrative consists of the trauma told from the perspective of the traumatized individual and not from that of the therapist. The therapeutic aspect of such storytelling is based on the fact that it enables individuals to gradually expose themselves to those aspects of their perceived experiences that have created difficulty in managing their reactions, emotions, or thoughts regarding their trauma. They are gently challenged by the therapist to increase their discomfort level until they gain mastery over their thoughts, feelings, and reactions toward the past trauma or traumas. The story can be told verbally, in writing, and/or symbolically by the client; however, the therapist must track the story concretely to use it in the most effective way possible. The trauma narrative is used to desensitize the individual, helping him or her deal more effectively with the negative and often life-limiting and terrifying emotions that are associated with specific life-changing traumatic events. It bears noting that traditional American Indian and Alaska Native ceremonies and healing practices have long included aspects of gradual exposure. For example, the American Indian and Alaska Native oral tradition of storytelling is a natural method of gradual exposure that also includes elements of cognitive processing and restructuring. From the perspective of the counselor or therapist, the trauma narrative can help identify inaccurate and/ or catastrophic thinking patterns that impede attaining desired therapeutic goals. Conjoint parent/child sessions are a part of all of the Honoring Children Series. However, within HC-MC, these sessions are intended to enhance communication and discussion regarding a specific trauma that the child has experienced. As can be assumed, the sharing of the trauma narrative

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within a supportive environment with the parent(s) or caregiver(s) is expected. For the child, the sessions provide the opportunity to share his or her trauma narrative (re-created trauma experiences of thoughts, feelings, reactions) and allowing the parent to support the healing process for the child and the family. Finally, both individual and conjoint sessions seek to provide education including, but not limited to, personal safety skills, interpersonal relationships, and may include healthy sexuality (https://www.childwelfare.gov/pubs/trauma/ trauma.pdf#page=4&view=Key). When referring to conjoint sessions it bears noting that in the HC-MC cultural enhancement of TF-CBT, the term family or caregiver is expanded to include the natural helpers and healers that are critical to the child’s recovery process. For American Indian and Alaska Native children, this may include extended family and traditional helpers and healers. This may also include the child’s relationship with elements within the natural and spiritual world. While the HC-MC well-being model is based on tribal teachings of a circle with interrelated parts, it remains flexible in order to accommodate individuals of diverse cultures and spiritual and religious beliefs. The HC-MC model can be customized to incorporate factors that are culturally relevant for participating families (e.g., tribal specific beliefs, stories, practices, or customs). Families may wish to incorporate tribal-specific songs, names, words, or healing ceremonies into the treatment process. Tribal stories that incorporate familiar animals, birds, or locations may carry increased meaning for children. At the beginning and throughout the therapeutic process, it is important for the counselor to communicate with the family about the family’s desire for incorporation of tribal-specific beliefs and practices. For example, for a family that views specific tribal religious practices as important in the healing process, the therapist may work with the family and tribal healers to arrange the family’s participation in these practices. Honoring Children, Making Relatives. Honoring Children-Making Relatives (HC-MR; Funderburk

et  al., 2005) is the culturally enhanced version of PCIT. Like HC-MC, special emphasis is given to the development of a parenting orientation and the teaching of concomitant skills to enable parents to interact positively with their child. While maintaining the guiding principles of PCIT, the enhancement version incorporates traditional indigenous beliefs, perspectives, and practices of relevance to the family. These include but are not limited to honor, respect, and the importance of the extended family. This version also makes extensive use of indigenous-based stories, teaching, and instructional methods. More specifically, the teaching includes explaining, demonstrating, modeling, and practicing targeted behaviors. It provides time and opportunity for the parent to work directly with the child by having the therapist coach the parent in specific positive interactions with the child. Most important, it teaches parents to focus on and provide praise for appropriate behaviors (i.e., reinforcement). For example, when children demonstrate disruptive behaviors or are difficult to control, parents may automatically punish a child or respond negatively with words or facial expressions. However, the traditional American Indian and Alaska Native concept of respect, honor, and generosity would dictate that the adult would be patient, instructive, would not embarrass the child, and would use the opportunity to teach more appropriate ways of behaving. The therapist in HC-MR would provide guidance with immediate support and encouragement to either ignore inappropriate but nonharmful behaviors or to enthusiastically seek to engage the child in a very deliberate positive exchange. In a similar vein to the indigenous way, the parent is taught to engage the child in positive interactions, attend to the child, let the child know what the child is doing that is right, and eventually instruct the child in good behavior. Again, bringing the individual’s culture into the picture, stories can be used to teach and/ or demonstrate good parenting skills. Honoring Children, Respectful Ways. This age-appropriate prevention/intervention focuses on helping young individuals develop healthy,

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s­elf-respecting, and age-appropriate sexual attitudes and behaviors. As with the other treatments of the series, it is specifically designed to connect indigenous persons with their traditional ways and practices previously identified. Such connections are subsequently used to promote self-respect; respect for others, including their elders; respect for all living things; and inclusively, all their surroundings. The core components of Honoring Children, Respectful Ways include identifying indigenousrooted attitudes (e.g., self-respect), rules (e.g., setting physical boundaries), and guidelines and practices (e.g., developing and maintaining selfdiscipline) to maintain healthy interpersonal relationships. This treatment places a strong emphasis on addressing attitudes and teaching and does so by using indigenous content, stories, teaching approaches, and practices.

CONCLUSION Getting to where I am today as a clinician and teacher has been a long professional journey that has involved the development of an appreciation for and an understanding of the teaching and instructional approaches embedded in my indigenous culture. Concomitantly, this journey has also enabled me to develop my own culturally rooted form of storytelling. Through this journey that has resulted in a greater appreciation of my form of storytelling, I have found that the use of stories, the teachings inherent in Old Wisdom, and the sacred symbols based on similar teachings, such as the Medicine Wheel or Circle, have great application for the people with whom I work. When I seek to convey a construct, I think in images, or models, or forms. It is common for me to utilize personal and professional models such as the Medicine Wheel or other images (beadwork), forms (water/fire), or creative illustrations (Buffalo and the Storm) that depict entities like the star people. Finally, through the use of stories over time, I have searched back toward Ancient Ones to capture my own culturally rooted form of storytelling as evident in this chapter. Working from this perspective, I would say that I have come full circle in telling my story

regarding the enhancement of traditional indigenous stories and practices so that this can be reflected in current psychological interventions. Now, I start the circle again by briefly retelling the story contained herein. According to American Indian and Alaska Native cultural teachings, many stories that explain and depict practices and teaching techniques relative to life and the world around us are maintained and carried forward from one generation to another upon the back of a turtle. In essence, these stories convey the teachings of Old Wisdom. In addition to stories, such teachings are also represented through basket weaving, carvings, legends, pottery shapes and designs, beaded clothing and dance regalia, hand-woven rugs, and medicines. While the use of indigenous stories may be a culturally relevant and effective practice to adapt, enhance, and use in treatments like EBT, there are other practices noted above that are equally effective. However, regardless of what techniques and/ or practices are used, there are certain caveats that merit serious consideration. First, the use of any specific therapeutic technique should be driven by a solid and sound understanding and knowledge of what the specific outcomes or results will be when that particular technique is used. The clinician should be able to demonstrate cultural humility and competency in the application of indigenous belief systems and practices. A clinical professional should be an expert or receive appropriate training in the clinical services they seek to provide. It is challenging to work with individuals from a different cultural perspective or with individuals who are experiencing distress due to the displacement of cultural anchors. Developing sound clinical approaches in another’s cultural teachings is critical for needed recovery and healing among indigenous people around the world. Use of such belief systems and practices by untrained and/or nonindigenous people is ethically questionable and can have negative consequences for both the clinician and the client. With respect to culturally adapting or enhancing an EBT, the clinician must have a solid foundation in evidence-based treatments as well as a

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comprehensive and humble understanding of the culture toward whom the adaptations are directed. To this end, the safe thing to do is confer or consult with both treatment and cultural experts, including designated indigenous tribal leaders, healers, and teachers. The counsel of the Ancient Ones still resonates today with Watch (see beyond what the person brings with their distress and despair), Listen (stories are told in many different ways and with

many different methods), Instruction (what is being told must be helpful and have immediate application—breathe), Ask (be curious and be cautious that what is being extended from you can be effective and be beneficial immediately and long term), Practice (are you willing also to do what you ask others to do—be balanced), and Teach (i.e., explain, explain, explain, practice patience with self and others, and especially those two-legged/ five-fingered creatures). Also, be humble.

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CHAPTER

21

Multicultural Training and Supervision in Research and Service Changming Duan and Alexandra Smith

I

n today’s social and cultural landscape, few would question the necessity of training the next g­ eneration of counselors and counseling psychologists to be multiculturally competent service providers and researchers. This is truly worth celebrating. However, providing efficacious training and supervision toward multicultural competence remains a challenging task. Moreover, the progressive nature of multicultural understanding and practice presents us with new challenges and demands, renewed energy, and passion toward continued progress from all of us. It is in this unique time and place that we present this chapter and invite the reader to join us in considering the path ahead, as our field works to better meet the needs of the people we serve in our ever-changing world. In this chapter, we first briefly describe the current state of multicultural training in counseling and counseling psychology based on a review of the literature. We then offer a critical analysis of some significant areas and discuss future directions for advancing and renewing multicultural counseling training and supervision to meet the challenges we face in today’s world. Since we drew upon our own perceptions and understandings in outlining possible strategies to move forward, our personal biases will undoubtedly influence the perspective presented in this chapter. For this reason, we briefly discuss our personal and professional biases and how we tried to stay aware of them throughout the review and writing process. Changming Duan is a first-generation immigrant cisgender woman in her 50s from China. I received all my graduate education in North America and have worked as a counseling psychology faculty member in different U.S. universities over the past 20 years. I have consistently taught the required multicultural counseling course. My professional development is enriched and biased by my Chinese cultural background, my personal and professional experience in North America, and the experience of teaching the multicultural counseling course. I enjoy the privilege of being the designated instructor for this course but have struggled in teaching it effectively. I have experienced difficulty in translating my passion for promoting multiculturalism and social justice in counseling practice into effective student learning, perhaps due to

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(a) my strong emphasis on student development as socially responsible people (engaging oneself in the fight against isms); (b) my failure in meeting students “where they are” in terms of their developmental level in understanding culture, diversity, and their social responsibilities; and (c) my bias in viewing Western culture and theories due to my Chinese cultural heritage. Alexandra Smith is a straight White nondisabled cisgender woman who grew up in two middle-class families in a midwestern college town in the United States. After college and before getting her MS in Counseling Psychology, she lived in Beijing, China, for 3 years with her Chinese ex-husband, where she worked as an editor and translator. I see now that I was trying to shrug off my own culture and be as Chinese as it was possible for a lost White girl to be. After returning to the United States, I gradually developed a new understanding of my own racial identity, and a burgeoning acceptance of what it entails. I learned that I can continue to choose behaviors that seem culturally appropriate for different types of interactions, without deceiving myself that behaviors are the costume pieces that make up cultural identity. I am grateful for this new sense of self, without which I can’t imagine making much progress toward cultural competence as a White counselor working in a diverse world. I have been a student and classmate in three multicultural courses and have taught four classes of mostly White college freshman 3-week units on diversity. I notice that my whiteness allows me greater privilege to express my dissatisfaction with the status quo and my impatience with our slow progress both as a society and within our profession. I watch as colleagues of color are required to express their own discontent much more carefully. In writing this chapter, we met often to discuss our personal and cultural biases. Our shared biases include seeing significant limitations in the current practice of multicultural training and supervision. We also share the unpopular view that there still is a lack of competence in and commitment to multicultural training on the part of trainers and supervisors.

THE CURRENT STATE OF MULTICULTURAL COUNSELING TRAINING AND SUPERVISION We have come a long way from theories and models of counseling in which cultural differences were explicitly pathologized. However, cultural differences continue to be overlooked, misinterpreted, or implicitly pathologized as a result of differing value systems. To prevent future practitioners and researchers from doing harm or failing to serve our diverse populations, careful and focused efforts must be made to promote multicultural competency through training and supervision.

Multicultural Training Level of Inclusiveness. Historically, the multicultural movement in counseling and psychology started with an awareness of cultural encapsulation in counseling practice (Wrenn, 1962) and the human rights movement. Multicultural or crosscultural training initially focused on training counselors to provide service to racially and ethnically diverse clients (Carter, 2000). Although the shift was not without controversy (see Lentin, 2005), this scope of coverage was then expanded to include other groups that are socially or culturally marginalized as the field progressed in its understanding of culture and diversity. In 2003, the American Psychological Association (APA) described multiculturalism and diversity as including “aspects of identity stemming from gender, sexual orientation, disability, socioeconomic status, or age” (p. 9). To address the plurality and complexity of individuals’ cultural identities, Hays (2001) presented the ADDRESSING model, delineating diversity as including Age, Developmental and acquired Disabilities, Religion, Ethnicity, Socioeconomic status, Sexual orientation, Indigenous heritage, National origin, and Gender. Social Justice Inclusion. In recent years, there has been increasing emphasis on social justice

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in training (Toporek & Vaughn, 2010). This is a positive development, as respecting and serving all people has always been at the center of the multicultural movement (Arredondo & TovarBlank, 2014). Vera and Speight (2003) pointed out that promoting social justice requires addressing systemic inequalities and expanding the scope of service beyond counseling. Social and cultural contexts play significant roles in individuals’ psychological health, and focusing only on remedial interventions may inadvertently perpetuate an unjust status quo. Thus, recently the competence movement has also given emphasis to awareness, sensitivity, and skills in advocacy for social justice. In 2003, APA asserted psychologists’ responsibility to act as agents of change for social justice, and the American Counseling Association (ACA) formally endorsed a social justice framework in the same year, specifying advocacy at three levels: client/ student advocacy, school/community advocacy, and public arena level of advocacy. Theoretical Framework. The majority of scholarship in the area of multicultural counseling employs a tripartite competence model consisting of awareness (of one’s own cultural and racial heritage, social experience, values and biases, attitudes and behaviors), knowledge (of cultures, alternate worldviews, and of social and systemic factors that impact others), and skills for conducting multiculturally competent counseling with diverse populations (Carney & Kahn, 1984; Sue, Arredondo, & McDavis, 1992). These three components are included in Sue’s (2001) three dimensional illustration of multicultural counseling, in which counselors (a) attend to group-specific worldviews (race, ethnicity, gender, sexual orientation, physical abilities, age, and so on), (b) exercise three competences (awareness of attitudes/beliefs, knowledge, and skills), and (c) conduct therapeutic interventions at individual, professional, organizational, and societal levels. This framework seems to underline most multicultural training efforts and the development of multicultural counseling competencies. However, there has not been and will likely never be uniformity in how the model is understood or

how training is provided given the complexity of the ideas involved. Delivery of Multicultural Counseling Training. After several decades of promotion, multicultural training seems to have become a staple ingredient of training in most counseling and counseling psychology programs (Pieterse, Evans, RisnerButner, Collins, & Mason, 2009). To facilitate programs’ pedagogical choices in delivering training, Ridley, Mendoza, and Kanitz (1994) described a Multicultural Program Development Pyramid that encourages deliberate, stepwise decision making by delineating six different models of training. These six models range from least to most adherent to established multicultural training mandates, with the least adherent model positing that theories and interventions developed for European American clients should work for everyone. The second and third models supply trainees with a workshop or a course, respectively, that addresses multiculturalism. The fourth model involves partnership with other departments to allow interested students to seek multicultural training outside of the counseling program. The fifth model features an optional multicultural subspecialty within the program itself. The sixth and most advanced model of multicultural counseling program development involves a unified department in which faculty members infuse multicultural realities into all areas of the curriculum. At the system level, all Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredited programs are required to offer at least one multicultural class. Although APA accreditation does not require a targeted course, many accredited programs do (see Shallcross, 2013). This targeted course trend is supported by the argument that conducting self-exploration of “racist, sexist, heterosexist, or other detrimental attitudes, beliefs, and feelings” (Sue & Sue, 2003, p. 19) in order to understand one’s own racial, cultural, and social privileges (McCreary & Walker, 2001) is emotionally involved and demands “intensive, in-depth training” (Ridley et al., 1994, p. 274).

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This single course approach warrants further scholarship as to how it can be most effective. Course Content. In most multicultural courses today, racial and ethnic diversity retains the primary focus, but other social and cultural groups are studied as well. After analyzing 64 course syllabi collected from counseling programs, Priester and colleagues (2008) noted widespread inclusion of sexual orientation (72%) but much less inclusion of other diversity dimensions such as gender (41%), religion (35%), disability (25%), social class (17%), and older adults (13%). In another study, Pieterse and colleagues (2009) examined 54 multicultural course syllabi from a sample of U.S. counseling programs and found that the majority of courses are structured around examining different specific ethnic and cultural groups, using textbooks that devote chapters to the different groups. While African Americans, Asian Americans, Latinos, Native Americans, and LGBTQ individuals are the most commonly studied, Arab American/Middle Eastern, White/ Caucasian, Appalachian, disability, gender, age, homelessness, immigration, socioeconomic status, and sizism are groups or topics that are commonly less explored or left unexplored (Pieterse et al., 2009; Priester et al., 2008). Although social justice, which “looks at the negative societal factors that work to complicate the psychological wellness of individuals” (A. Coker, quoted in Shallcross, 2013, para. 25), has become more recognized as an important part of training, only 37% of the syllabi reviewed by Pieterse and colleagues (2009) designated at least one class period to cover social justice. Furthermore, less than half of the courses reviewed devoted even one class period to the topics of racism, prejudice, discrimination, or privilege, and only 13% focused on the role of counselors as agents of social change. Targeted Competencies. Guided by the tripartite training model of multicultural competence, 96% of syllabi that Pieterse and colleagues (2009) reviewed described a goal of the course as raising awareness, knowledge, and skills for multicultural

counseling. However, a review of daily course content and grading methodology as described in the syllabus suggested that the primary focus is on awareness and knowledge, not skills. Only 40% of classes spent at least one course period discussing counseling interventions or multicultural counseling skills, and very few included any skills-related assessments in the final grade. In their 2008 study, Priester and colleagues also found that despite claiming a tripartite model, courses seemed to be based primarily around specific knowledge of cultural groups (with a high emphasis in 84% of courses), lesser prioritizing of self-awareness (41% of courses having a high emphasis, 31% a low emphasis, and 16% no mention at all), and even less focus given to skill development (only 12% of courses displaying high emphasis, 48% low emphasis, and 28% not mentioning it at all). This imbalance is not new, as shown by a 1988 survey by Heath, Neimeyer, and Pedersen. Instructors and Instructional Methods. Instru­ ctors often face unique challenges in teaching multicultural courses and may find their own identity becoming a teaching instrument for the course. A survey of 169 faculty members (60 White, 31 African American, 32 Latino/a, 17 Asian, 4 Native American, 14 multiethnic, and 11 “other”) who teach multicultural courses revealed that 85% believe that their own cultural background impacts their course and how they interact with students (Reynolds, 2011). The demographics of the sample show a disproportionately high number of faculty of color relative to the racial composition of counseling psychology faculty in general (see Moradi & Neimeyer, 2005). It seems that faculty of color are more likely to be the designated instructors for multicultural courses. In the first edition of this Handbook, Reynolds (1995) offered a detailed account of challenges at institutional, programmatic, and individual levels. She discussed the lack of consensus among theorists and practitioners in terms of how to balance the need to (a) concentrate on increasing multicultural awareness and sensitivity, (b) unlearn

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oppression and sensitize trainees to the realities of racism, sexism, heterosexism, and other forms of oppression; and (c) enhance multicultural attitudes, knowledge, and skills for working with diverse clients. She specifically pointed out one major pedagogical obstacle, that “too much challenge causes trainees to withdraw because they feel overwhelmed. Too much support leads to complacency and detachment because there is nothing testing or challenging the trainees” (p. 318). To address this obstacle, she promoted a developmental approach in which trainees’ level of development is fully considered in making instructional decisions. It is interesting that 20 years later, this challenge still exists. To be sure, as observed by Sue (1991), “cultural diversity training . . . is a complex and long-term problem” (p. 104). To promote multicultural competence, specific training strategies have been developed to operationalize the tripartite competence model (e.g., Arredondo & Arciniega, 2001). One aim of such effort is to make the training emotionally powerful as well as cognitively helpful, which entails moving the instruction and learning “from content to process, from knowledge to experience, and from quantification to personal narratives” (Ponterotto, 1998, p. 43). Empirical literature that examines common practices supports this observation and has identified various effective teaching strategies, such as didactic instruction (e.g., Ridley et  al., 1994), experiential learning activities (e.g., Kim & Lyons, 2005), interactive activities (e.g., Sammons & Speight, 2008), reflective or narrative approaches (Kerl, 2002), and modeling and participatory learning (e.g., Ridley et  al., 1994). Assignments that might reflect these methods include journal writing, cultural self-examination papers, reaction papers, attending cultural events, class presentations on cultural groups or issues, interviewing a member of a cultural group, research papers, research critiques, and research proposals (Priester et al., 2008). Effectiveness of Multicultural Training. Evidence has shown that training has some positive impact on

counselors’ multicultural competence. Constantine (2001) found that higher levels of multicultural training were related to higher self-perceived multicultural competence, regardless of ethnicity. A meta-analysis by Smith, Constantine, Dunn, Dinehart, and Montoya (2006) showed that multicultural training is associated with increased racial awareness and cultural sensitivity. Similarly, Griner and Smith (2006) documented a .48 effect size for culturally sensitive interventions in psychotherapy outcome. Meanwhile, qualitative investigations have also demonstrated that receiving multicultural training through didactic, interactive, and reflective learning led to students’ increased selfunderstanding, attitudes, and behavior in regard to diversity and multiculturalism (Sammons & Speight, 2008). However, the efficacy of multicultural training has been debated (e.g., Vontress & Jackson, 2004), and research is lacking in determining training efficacy in terms of client outcomes. More experimental or quasiexperimental studies are needed that control for pretest scores and standardized training methodology so the study can be replicated (Smith et al., 2006).

Multicultural Supervision Multicultural competency must also be fostered and cultivated within the supervisory relationship. However, both the definition and the effectiveness of multicultural supervision are difficult to pin down (Falender, Burnes, & Ellis, 2012), and the literature on multicultural supervision has had a delayed development (Inman & Ladany, 2014). Following some sporadic discussions on racial and ethnic issues in supervisory dyads in the previous decades, the early 2000s witnessed the development of various multicultural supervision models and assessments that advocate for including the cultural identities and experiences of supervisors, supervisees, and clients into the building of the supervisory relationship (e.g., Ancis & Marshall, 2010; Burkard et  al., 2006). The literature tends to focus on addressing the role of multicultural ­competence within the areas

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of supervisee d ­ evelopment (e.g., Aten, Strain, & Gillespie, 2008), supervisor-supervisee relationship (e.g., Field, Chavez-Korell, & Rodríguez, 2010), and the client-counselor-supervisor triad (e.g., Inman & Ladany, 2014), and on how supervisors fulfill their multiple roles such as monitoring client welfare and facilitating counselor professional development through an interactional approach (Chen, 2001). More recent work in this area seems to extend the focus from the specific parties involved (supervisor, counselor, and client) to including “the multiple systemic and cultural contexts (e.g., global, national, and local communities and institutions, such as school, family, training setting/program) within which the three parties live and develop” (Inman & Ladany, 2014, p. 647). This expanded framework conceptualizes multicultural as containing both “the multiple cultures within which our identity is linked . . . and its intersection with social conditions or contexts” (p. 648). Research has pointed to specific facilitative or hindering factors for multicultural supervisory relationships and outcomes (Inman, 2006). Both theory and empirical evidence seem to support supervisors’ awareness of and openness to explicit discussion about cultural-specific issues as well as their own racial and cultural consciousness and knowledge as positive factors in facilitating trainees’ development of multicultural competence (Inman & Ladany, 2014). Correspondingly, supervisors’ gender bias, racial microaggression and unintentional racism, and insensitivity to trainees’ cultural experiences are harmful to supervision process and outcome (e.g., Constantine & Sue, 2007; Dressel, Consoli, Kim, & Atkinson, 2007). Additionally, the specific experiences of supervisors and supervisees when paired with racially/culturally similar or different partners demonstrated both the need for and the complexity of providing multiculturally competent supervision (Duan & Roehlke, 2001). One thing is certain, however: engagement in multiculturally competent practice is every supervisor’s responsibility.

A CRITICAL ANALYSIS OF THE CURRENT STATE OF MULTICULTURAL TRAINING AND SUPERVISION Lack of Understanding of Deep Structures of Multiculturalism Despite multiculturalism’s new prominence in counselor training, sobering realities abound: People with nonmainstream cultural identities still tend to underutilize mental health services (Ponterotto, Casas, Suzuki, & Alexander, 2001); racial minorities tend to be overrepresented in the “largest mental institution,” that is, prison (Phillips & Bowling, 2003), or overdiagnosed with severe mental disorders (Schwartz & Feisthamel, 2009); culturally biased standardized test scores are still heavily relied on in graduate program admissions (D’Andrea & Daniels, 2006); LGBT individuals, especially children and young people, often experience isolation and discrimination in our communities (Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012); and so on. These observations may be suggestive of inadequacies in our training. Some theorists and educators have pointed out that our existent multicultural training has remained superficial (e.g., Bemak, as quoted in Shallcross, 2013). There are professionals who view themselves as multiculturally competent practitioners and advocates who “have lost sight of or perhaps never really understood the deep structure of the multicultural counseling movement” (D’Andrea & Daniels, 2006, para. 2). Learning about diversity on a superficial level means leaving the hegemonic structures of multiculturalism out of our consciousness and instead choosing a comfortable way of achieving something resembling competence. However, by not addressing the deep-seated structural, paradigmatic, and pervasive system of privilege and oppression, or in the words of Asa Hilliard, the “pillars of dominance” (cited in D’Andrea & Daniels, 2006), we continue to allow counseling practice to

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fail diverse populations and sustain a system in which “White, European, heterosexual, physically abled, middle class, and Christian cultural/racial values, beliefs, preferences, and worldviews underlie the hegemonic thinking that characterizes our contemporary society” (Exploring Hegemony section, para. 1). The danger of this system manifests in the continued use of culturally biased counseling interventions in clinical practice and in the overgeneralization of unrepresentative research findings to persons from culturally and racially diverse groups (e.g., use of biased data in clinical diagnosis, or using culturally biased entrance exams for admission). Comfortable superficiality in multicultural training may prevent the profession from addressing the most fundamental contextual factor: social inequality.

Insufficiency of Competence Among Trainers and Supervisors Multicultural theorists and researchers have long been aware that the preparation of trainers, mentors, and supervisors is a necessary condition for effective training. Joseph Ponterotto (1998) described in detail 16 necessary characteristics of trainers and mentors, which include active engagement in ongoing examination of their own racial identity, developing a multicultural identity, understanding the dynamics of oppression, and recognizing their own participation in oppression and privilege. Over a decade later, research efforts in addressing multicultural training issues still focus mostly on trainees. There is little evidence as to whether or not and in what ways most trainers and supervisors are engaged in continuous learning and self-examination to gain multicultural competence. It is still common for a program to designate one faculty member (often junior, untenured, or a minority person) to teach the multicultural course, and often these instructors must choose between risking lowered student evaluation scores or sacrificing the goals of the course by limiting instruction to the kind of comfortable cognitive and intellectual analysis that is known to be less effective (Reynolds, 1995; Steward, 1991).

Lack of Theoretical Clarity: Why, What, and How to Provide Training? Why do we train for multicultural competence? One of the most often cited rationales for promoting multicultural training is demographic changes in the United States, which require our learning to serve diverse groups. While this is a reasonable motivator, it alone is actually implying a “we serve them” mindset where “we” are the ones who are empowered and offer help to “them” who receive our help. This hierarchical attitude may lead to misconceptions about the essence of multicultural training and practice. This may also partially account for the heavy emphasis placed on understanding and working with different cultural groups while neglecting the deeper structures of multiculturalism (Shallcross, 2013). A more helpful and truthful conceptualization would acknowledge that in fundamental ways, the science and practice of counseling has been culturally biased, which contributes to the social oppression that minorities suffer (Ratts, 2011). Thus, training for multicultural competence must prepare professionals to not only meet the individual needs of cultural minorities but also to counteract the injustices and disparities our field has contributed to, and to renew counseling theories and practices in fundamental ways that will promote social justice and multiculturalism in mental health. What are necessary process goals of multicultural training? The undisputed goal of multicultural training is to prepare trainees for offering culturally effective service and conducting culturally relevant research. However, due to the nature of multicultural competence development, which requires both affective and cognitive investment (Jun, 2010) as well as a shift in worldview (Reynolds, 1995), this goal may seem elusive. In a progressive manner, the competence movement in the field directs attention to “behavior anchors” identified to guide the training and measure training outcomes (APA, 2012). Although this approach is helpful, we see two limitations in conceptualizing multicultural competence in specific and exclusive behavioral

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terms. One is that there are currently no broadly accepted theories about what specific multiculturally competent behaviors should look like. Secondly, the focus on specific behaviors may consume attention and leave the “deep structures” of multiculturalism unattended in the process of training. Process goals (as opposed to behavioral goals) are needed to guide training efforts. Research has shown that instructors of multicultural courses often struggle with how to help students move past resistance to achieve awareness and knowledge and to develop skills. Unfortunately, cognitive teaching methods that are designed to address student resistance may not be as effective at encouraging the deep emotional work and perspective shifting necessary for multicultural competence. For example, overreliance on studying specific cultural groups risks allowing students to compartmentalize these groups and to distance themselves from their perceived objects of study (Pedersen, 1994). Perhaps well-articulated process goals, such as becoming willing to self-examine, developing passion for social justice, or risking openness to engage in difficult dialogues, can help prevent false feelings of achieved competence and encourage continuous engagement on the journey toward multicultural competence. How do we conduct multicultural training and supervision and measure its effect? Multicultural training differs from training in other areas that are more content-centered. Trainers and trainees bring diverse cultural views, receptivity levels, and competencies into the training and supervision process. Therefore, effective training should be designed with flexibility. The literature has shown that the racial and cultural identities of instructors and students contribute to their training experiences (Reynolds, 2011). Additionally, if we agree that there are large variances in individuals’ opinions, realities, and ideological positions concerning race, culture, sexual orientation, social class, religion, and other group identities, we may begin to question the approach that seeks to meet a set of criteria or competencies as exclusive goals of training. Perhaps the yardstick that is used to measure training effectiveness should consider the

growth or development that trainees achieve in the context of where they began.

Narrow Understanding of Multicultural Supervision Multicultural supervision seems to have been underemphasized and underresearched in our literature and practice. One of the reasons may be the idiosyncratic nature of supervisory practice that causes challenges for large-scale studies. Moreover, there is a likelihood that racial and cultural majority supervisors and supervisees view their supervisory relationships as being multicultural only when their counterpart belongs to a minority group. This narrow view of multicultural supervision limits its efficacy and fails to reinforce multicultural training where it may be needed most. Supervisory conversations and case formulations that are biased by the denial or ignoring of cultural contexts, or by cultural otherizing, are unlikely to live up to our ethical principles of beneficence, nonmaleficence, and justice. This risk is especially high when both the supervisor and supervisee represent dominant groups while the client is a member of a subordinate group(s). As a White supervisee whose supervisors have all been White, Alexandra Smith reflects: I worry about whether a White counselor and a White supervisor sitting in a room together voicing their opinions about a client of color (who isn’t even present to speak for themselves) could ever be multiculturally appropriate—unless all they do is keep each other from making assumptions and call each other out when they get too enamored of their own “expert” status. There are clear challenges both in terms of counselor development and client outcome when conducting multicultural supervision where there is a lack of diversity among supervisors and supervisees.

MOVING FORWARD: MEETING THE CHALLENGES Toward the goal of bringing multicultural training to a new level, we identified some possible d ­ irections

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for consideration. We hope to stimulate continuous discussion on this important topic.

Focusing on Multicultural Identity Development It is our conviction that the focus of multicultural training should be on training multiculturally competent persons, which is more than training for specific competencies. Consistent with the counselor development theory by Duan and Brown (in press), a multiculturally competent person would have a multicultural identity, multicultural consciousness, a passion for social justice, and interest in serving the culturally diverse. Training may facilitate trainees’ development of the multicultural identity through various experiential learning and emotional work. With a multicultural identity, individuals are able to understand any unearned disadvantages they may have in a social context, acknowledge their unearned privileges, and take responsibility for the role they play in the disadvantages that others suffer due to social inequality. Although it may sound less task/competency focused, developing appreciation of and respect for the culturally diverse and a passion for social justice may aid in the acquisition of a multicultural consciousness, thus allowing the individual to identify with the oppressed and feel responsible for and capable of providing fair, just, and effective service for all people (Jun, 2010).

Defining Multiculturalism as Context While including more group memberships in the definition of multiculturalism marks progress in our cultural awareness, we need to be aware that training based primarily on studying discrete cultural groups, unit by unit, may contain the risks of 1. further otherizing minority and disadvantaged groups in the eyes of trainees. When we conceptualize multiculturalism as being about cultural groups, “special populations,” we are confirming

and augmenting their misconceptions, cementing the idea that multicultural practice is something about “others,” something we do for them, bothering to learn about them and modify our treatments for them so in case we run into one of them professionally, we’ll be able to help them; 2. being imbued with leftover ideas from “colorblind” thinking. If all we seem to advocate is acknowledging that every cultural group is special, avoiding judging them, and appreciating them for what they are, then we are unintentionally ignoring existing prejudice and disadvantage and their impacts, and we are ignoring privilege, and we are avoiding the responsibility to work actively to address and correct inequalities; 3. ignoring intersectionality of identities. By thinking of cultural group affiliation as discrete, we risk ignoring or misrepresenting those individuals whose identities span more than one of those neat group memberships. Their experience at the intersection of multiple identities is different than the sum of their individual identities. A counselor who is not intersectionally competent may not be able to provide meaningful service to clients who do not fit neatly into one of the boxes they have been taught to expect “multicultural” clients to inhabit; and 4. reinforcing stereotypical and linear thinking. Although we acknowledge that effective helping methods may differ with client cultural identities, an exclusive focus on how to work with each discrete group may inadvertently reinforce stereotypical and linear thinking. These types of thinking may foster “isms” (Jun, 2010, p. 29).

In an effort to circumvent these risks, and using “multicultural” as a term that takes into consideration the full range of human diversity, we propose that multicultural counseling is counseling practice that recognizes the significant influence of the social and cultural context in individual experiences (including suffering) and conceptualizes, interprets, and intervenes in client issues accordingly. With a definition that emphasizes context over “groups,” and provided that we modify our training theory and methodology in accordance with this new definition, we believe that many

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of the aforementioned problems can, with effort, subside. Making this conceptualization clear to trainees could go far in advancing these goals.

Infusing Social Justice Both In and Out of the Counseling Room By and large, our multicultural training effort recognizes the negative impact of social oppression, but has done “little specifically about ways to advocate for social justice” (Vera & Speight, 2003, p. 257). As noted, “counseling primarily seeks to change individuals rather than to change the social context” (p. 258) and such practice implicitly “joins the forces that perpetuate social injustice” (Albee, 2000, p. 248). The time is here that more emphasis be given to training competencies for social advocacy to reflect our professional values and aspirational ethics. Eliminating systems of oppression is a goal that should be infused in everything we do as a helping profession, including research, training, and supervision. Only by doing so can the next generation of counselors and counseling psychologists be prepared to serve our multicultural population.

Increasing Scholarship on How to Teach the Multicultural Counseling Course Managing student expectations. With good intentions, many students sign up for multicultural courses expecting straightforward answers— memorizable information about how to “do” counseling with clients from different cultural groups (Carney & Kahn, 1984). They enjoy hearing things like when not to make eye contact, how important religion might be, or which member to address when working with families. They are less prepared to explore their own values and biases or engage in difficult conversations that may confront their isms, so they often resist meaningful engagement in these kinds of learning activities, viewing them as irrelevant, pointless, or invasive, and may quickly decide they are not learning anything from

the class and stop trying. It is critical that we design the course with students’ developmental level in mind. It may help if the course starts by heading off this misunderstanding at the pass—explaining multiculturalism as an awareness of the social and cultural context that influences all individuals and everyone’s unearned advantages and disadvantages rather than a collection of information about specific minority groups. By validating their desire to have concrete helping tools but explaining that self-reflection and a deeper understanding of social justice must come first, instructors may be more successful in helping their students to see and experience the contexts in which culturally diverse groups live. Adopting a student-centered and growth-focused approach. It is unrealistic to require everyone to reach a pre-identified, measurable threshold of achievement after one course because students begin in different places. There may be advantages to using flexible goals, focusing on positive growth. This will allow instruction to be learning focused (versus evaluation focused). It may help reduce some often-observed hindering emotions such as resistance, resentment, or reactiveness. Our personal experiences in teaching have convinced us that motivating students to confront their isms, engage in lifelong pursuit of a multicultural identity, and show both empathy for and interest in diverse cultures is the most important outcome of this course. Emphasizing basic skill (not strategy) training with a context and strength-based orientation. If we define multiculturalism as context, then the counselor’s multicultural understanding, appreciation, and respect should be the foundation of skill development. We deliberately differentiate skill training from strategy training. In recent years, with the push from the evidence-based practice movement, treatment strategies or specific methods gain much attention. However, we argue that in working with people from diverse cultures, there are culturally sensitive and appropriate basic skills that effective counseling cannot go without. Based

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on our current understanding of diversity, these skills overlap significantly with a focus on social justice (Arredondo & Rosen, 2007). A narrow focus on specific strategies may reflect a fragmented view of diversity, reinforce stereotypes of cultural groups, and inadvertently perpetuate culturally biased theories in practice. Instead, we recommend training in basic skills emphasizing various ways to validate, respect, and advocate for clients, especially those with socially marginalized identities. Applying evidence-supported best instructional practices. There has been limited research on the pedagogical aspects of teaching the multicultural course. It appears that effective methods include interactive and experiential learning and reflective activities (e.g., Neville et al., 1996; Sammons & Speight, 2008). Factors such as the insensitivity of classmates and students’ own personal concerns were identified as weakening student multicultural learning (Heppner & O’Brien, 1994). It is expected that each instructor must gauge classroom climate and interpersonal dynamics in choosing instructional methods. However, we encourage application of evidence-supported methods, with whatever modification deemed necessary, because those methods tend to contain flexibility, are process oriented, and show respect to learners and their developmental levels. As we move forward, more efficacy research is needed to inform the teaching effort toward increasing counselor competence (Priester et al., 2008). Training future supervisors as one of the goals. One out of five practicing psychologists engages in providing supervision (Norcross, Hedges, & Castle, 2002). It may help if training future supervisors starts early. Discussions about how supervision is an important vehicle to ensure effective multicultural practices as well as enhance counselors’ multicultural skills may help trainees learn how to maximize their learning through supervision as supervisees and how to prepare themselves for being multiculturally competent supervisors in the future.

Centrality of Multicultural Training and Supervision: Toward Integration Multicultural training and supervision must be at the center of training. This requires significant commitment from programs, from every faculty member, from every supervisor, and from the administration. This integration requires that multicultural material is built into everything we teach, including theories, methods, and skills. It should be noted that adding a “special populations” section in each content area does not equal integration. In fact, this practice may risk further cultural encapsulation. Secondly, integration requires that all trainers and supervisors be role models in doing their own work toward multicultural competence (including self-exploration and unlearning and relearning). Thirdly, faculty resource integration is needed in making the capstone multicultural course effective. While in many ways having one passionate and devoted faculty member of color teach the course is advantageous, the message this may inadvertently convey is that multiculturalism is something minorities care about, something for “other” people to bother with. To avoid giving this impression, multiple faculty members with varying social and cultural identities must be involved in teaching multicultural courses and in promoting multicultural realities in every course.

CONCLUSIONS The multicultural nature of humans and communities in the United States and in the world demands that counseling and counseling psychology training programs train the next generation of professionals to be culturally aware, knowledgeable, and skillful. If we fail to do so, counseling cannot remain a viable profession in the 21st century. Every counselor educator or counseling psychologist should feel the urgency and responsibility to help address the challenges we face in multicultural training. It takes the profession as a whole to move the training forward.

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Counseling Psychology and Disenfranchisement Using What We Have to Change the Game Laura Smith

“If we are not using what we have for changing the rules of the game, then we are just playing the game.”

T

he quote above is from an interviewee in a study of White antiracist identity (L. Smith & Redington, 2010, p. 544), and it represents just one of the many times that I have learned something profound and unforgettable from a qualitative research participant. It surfaced again for me in association with the topic for this chapter: How can counseling psychology serve disenfranchised people? As individuals with accepted formal credentials and members of a respected professional field, counseling psychologists enjoy a relatively advantageous position amid our nation’s social class arrangements. We certainly are not the most powerful or most affluent players in the game (to use my interviewee’s metaphor), and we work very hard to acquire and refine the skills and knowledge that are the basis for our chosen profession. Moreover, to the extent that we ourselves embody marginalized identities, our social privilege is mitigated by the biases associated with them. Nevertheless, our careers have the potential to provide us with reasonably comfortable lives. Our workplaces allow us a fair amount of creativity and autonomy; typically, we do not need to punch time clocks or ask for bathroom breaks, and when policies or procedures are reviewed, we frequently have input. Most often, we are not constrained to risk life or limb in the course of a workday, or to tolerate working conditions that are consistently monotonous or significantly socially devalued. By virtue of our advanced educational degrees, others are often inclined to listen to what we have to say. We live lives that allow us to feel and see every day that we are part of the valued, accepted social mainstream, in that the people who are represented as normal and respectable in the media and elsewhere live and work much as we do, as do the people who run things in our system of participatory government. 225

As a specialty, counseling psychologists also constitute a group of professionals who do not wish merely to navigate the game; they have affirmed their intentions to change the game, to align their professional efforts with movement toward social equity. These intentions can be traced through the contributions of counseling psychologists, to the creation of the American Psychological Association (APA) Multicultural Guidelines through the declarations that emerged from the 2000 Counseling Psychology Conference in Houston (Fouad et al., 2004), to current explicit social justice approaches to counseling and advocacy (e.g., Toporek, Lewis, & Crethar, 2009). The incorporation of this emphasis at the heart of the specialty reflects, perhaps, not so much a new direction as it does the evolution of a professional identity that has always coalesced around the challenges that face human beings by virtue of their humanity and their membership in society, and not as part of a disease process. How might we see this development continue? We have so much to work with: counseling and other “people skills” par excellence, a strong scientific foundation, an analysis of oppression in its overt and its nuanced forms, research and writing abilities, membership in elite institutions and respected agencies, and a public platform that derives from our scholarly identity. How can we use what we have to amplify the efficacy of our work in service of a more equitable society—to change the game? The suggestions that follow emerge from expanded conceptions of what we do and how we do it within three broad, overlapping professional areas.

GAME-CHANGING CONCEPTIONS OF HELP: TO HELP PEOPLE, INCLUDE THEM We know that members of our field are genuine and committed in their wish to help and empower members of disenfranchised groups. Altruistic motives are deeply bound up with social justice intentionality, yet we also understand that the assistance offered by relatively privileged people to those

who are socially excluded comprises a complex and sometimes contradictory transaction. Paulo Freire (1970) offered a term for transactions characterized by the proffering of help to oppressed people in the absence of social justice analysis or action: He called it “the false generosity of the oppressor” (p. 29). Freire described such expressions of concern and sensitivity as derived from a wish to experience oneself as beneficent and nonoppressive while leaving the systemic sources of suffering unacknowledged and unaddressed. The ultimate outcomes of this help-in-a-social-vacuum are that one’s own privileged position is maintained and the status quo is preserved even as one perceives himself or herself as dissociated from systems of oppression (by being a charitable giver). Freire explained that “an unjust social order is the permanent fount of this ‘generosity,’” whereas “true generosity lies in striving so that these hands—whether of individuals or entire peoples—need be extended less and less in supplication, so that more and more they become hands which work, and working, transform the world” (p. 29). Charitable helping efforts on behalf of people living in the context of oppression may occur within a professional context (as in our delivery of therapeutic or programmatic offerings) or in a personal context (as when we volunteer in a soup kitchen or donate goods or money to a charitable cause), and they all have value—in fact, charitable efforts are often vital to the survival of people in crisis. The Freirean perspective, however, points us toward an expanded conception of helpfulness as we examine our actions critically. When I express my altruistic intentions by offering helpees some benefit of my social location, professional knowledge, or purchasing power, there are always more than the two of us present for the transaction. Each of us is accompanied by the sociopolitical history and context that swept us into these positions relative to each other—and whose currents will carry us forward in different directions following the transaction. When this presence goes unacknowledged, the transaction seems only to be about the two of us as individuals, one who comes in relative abundance and beneficence and health, and

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another who is relatively needy and comes with hand extended. It is undoubtedly kind and appropriate for the one who has more to share. But why am I here and you there? Yes, I worked hard—but my critical analysis does not stop there if I remember that there is more in the room than just two people. Why do I have so much, and why are you constrained to seek help? What is the meaning of my continuing location within a social system— the game of which my interviewee spoke—that contributes to these disparate outcomes for myself and other people? When my help is delivered as though we exist in a sociocultural vacuum, those questions go unasked and my transaction serves as an embodiment of our social context (even as it allows me to experience myself as dissociated from systems of oppression). Freire counsels privileged helpers like us to check ourselves before we act on our good intentions to help—to ask ourselves what is help, anyway? When the context is one of oppression, charity is not the final answer. As Freire explained, true generosity consists of transforming the world so that all people have an equal opportunity to transform the world, and when we place that restructuring at the heart of our notions of help, we have helped to reveal what authentic help isn’t. The other side of that coin involves envisioning what it is. A concept that can frame that answer for us is social exclusion/inclusion. Because the focus of my own work is classism and classist exclusion, I will refer to classism as I explain this concept, but it will be readily apparent that the same framework applies to members of all socially marginalized groups. The way that oppression affects the lives of people in marginalized groups obviously includes the ways that they experience direct, harmful impacts in the form of discrimination, unjust treatment, biased attitudes, harassment, and violence. It also includes the exclusion of marginalized groups from opportunities and experiences that members of more privileged, enfranchised groups often take for granted—the opportunity to move in public spaces without arousing suspicion or scrutiny, the opportunity to anticipate career availability and

advancement commensurate with one’s ability, and the opportunity to participate in our nation’s system of participatory democracy, to name a few. People living in poverty, for example, are largely excluded from full participation in many of these mainstream social experiences (L. Smith, 2013). Their exclusion can be seen as one of the consequences of living as a member of this marginalized group—or it can be brought to the forefront as one of its essential defining features. This perspective corresponds to a way of conceptualizing oppression called social exclusion theory. Silver (1994) listed some of the opportunities whose relative unavailability can constitute social exclusion. Consider just a few of the things that the literature says people may be excluded from: a livelihood; secure, permanent employment; earnings; property, credit, or land; housing; the minimal or prevailing consumption level; education, skills, and cultural capital; the benefits provided by the welfare state; citizenship and quality before the law; participation in the democratic process; public goods; the nation or the dominant race; the family and sociability; humane treatment, respect, personal fulfillment, and understanding. (p. 541)

It is easy to imagine the ways that each variety of exclusion may undermine the lives of poor people, people of color, LGBTQ people, women, and people with disabilities. Yet there is also reason to believe that, more generally, exclusion itself— the very experience of exclusion—constitutes a unique source of harm to these individuals. Using experimental paradigms in which, for example, participants are excluded or rejected by peers, psychologists Jean Twenge, Roy Baumeister, and their colleagues have studied the experience of social exclusion throughout a decade of research. They have found that this experience is consistently associated with strikingly unfavorable results: excluded participants behaved more aggressively (Twenge, Baumeister, Tice, & Stucke, 2001), made more high-risk, self-defeating decisions, and procrastinated more (Twenge, Catanese, & Baumeister, 2002). They gave up sooner on frustrating tasks (Baumeister, DeWall, Ciarocco, & Twenge, 2005)

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and showed decrements on logic and reasoning tasks (Baumeister, Twenge, & Nuss, 2002). Socially excluded participants were more likely to agree that “Life is meaningless,” to have a distorted sense of time, to avoid emotional language, and to face away from mirrors, which led Twenge, Catanese, and Baumeister (2003, p. 409) to hypothesize that social exclusion may even produce a kind of “inner numbness” that relates to suicidality. We know better than to overgeneralize such laboratory-induced effects by translating them literally into real-life situations and consequences, yet it also seems extreme to reject completely that this research evidence is applicable to actual experiences of social exclusion. It seems reasonable to assume that a lifetime spent on the social margins, a lifetime of seeing few like yourself represented among national civic or business or professional leaders, a lifetime of seeing other people portrayed as the ones who are important or beautiful or healthy or normal could contribute to a self-defeated alienation that might be termed inner numbness. What the social exclusion research teaches us, therefore, is that the fact that we allow people to be excluded is a form of violence all its own. Every day that we stand by and leave people on the outside looking in, we participate in an assault. Sociologists Pierre Bourdieu and Loïc J. D. Wacquant had a name for this assault: symbolic violence, which they considered to be as real and damaging to excluded groups as physical violence (Bourdieu & Wacquant, 2004, p. 272). Being part of changing the game and insisting upon inclusion requires us to interrogate the ordinary, to ask questions like, why are poor people never included in any way in the policy-making that affects them? How does our nation allow families and whole communities to exist outside the services, protections, and resources that are the foundations for our lives? Notice that I am not asking why poor families need basic resources like access to mental health care, how its lack is damaging them, or how they would benefit from having it, nor am I suggesting that anyone needs to study or enumerate these things. We know the answers to those questions, and the mountains of evidence

attesting to it have existed for decades (L. Smith, 2010). What I am asking is, what’s going on with the rest of us that we are unable to see our own exclusionary practices (regardless of how sympathetic we may be)? What are the attitudes and assumptions that support this inequitable state of affairs, and how can counseling psychology use its research and practice to reveal them and address them? It is akin to studying the dynamics of White privilege rather than confining our study to the harmful impact of racism. Once we begin to define help as change and inclusion, everyday opportunities to spread the word will become apparent. Traditional charitable efforts will always have a place among our profession’s altruistic undertakings, yet it is noticeable that these activities alone are often the ones that come to mind when an individual or a group is, for example, brainstorming a service learning or social justice event. We’ve likely all been part of groups choosing a public service undertaking, perhaps as a holiday event. In a recent instance, I heard suggestions such as cleaning up a playground in a low-income neighborhood or organizing a canned food drive. I feel certain that either of these projects would have been appreciated by their beneficiaries, but what about spending a day volunteering or raising money for a local legal advocacy organization? Or the People’s Institute for Survival and Beyond, which organizes antiracism trainings around the country? How about an organization dedicated to leadership development among young LGBTQ people of color (like FIERCE, http://www.fiercenyc.org/) so that these young people can teach and lead and help us? We could volunteer on behalf of coalitions of fast-food workers (like Fast Food Forward, http://fastfoodforward.org/) or domestic workers (Domestic Workers United at http:// www.domesticworkersunited.org/), campaigning for dignity and a living wage; maybe there are ways we can contribute to the inclusiveness of their voices within mainstream discourse. When we start to think about it, there are so many ways to enact our altruistic intentions that go beyond charity. When help for the poor (or for members of any marginalized group) is referenced, let’s be the ones

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who bring up the notion that fighting the causes of inequity and exclusion is help. When mental health professionals suggest that efforts like these lie outside the scope of their practice, let’s be the ones who explain that advocating for social equity is advocacy for emotional well-being—that oppression is a pathogen (L. Smith, Chambers, & Bratini, 2009) and exclusion is violence.

Game-Changing Innovations in Practice: New Tools for the Toolbox Counseling psychologists have literally led the field in illuminating the relationship between oppression, mental health, and psychotherapeutic technique, bringing to life Belle and Doucet’s (2003) contention that the diagnosis and treatment of mental disorders “should build on our knowledge of the depressogenic nature of poverty, inequality, and discrimination” (p. 109). In other words, when clients live in the context of oppression, our conceptualizations of their presenting issues must exceed the parameters of traditional psychopathological typologies. Rather, oppression itself is considered to be a pathogen (L. Smith, Chambers, & Bratini, 2009), in that the experience of living in a condition of ongoing social exclusion, discrimination, and identity-related microaggressions exacts harm upon the emotional well-being of marginalized group members. If we accept this contention, then it is reasonable to suppose that our best efforts to address this damage will not be limited to traditional psychotherapeutic interventions, even those that are delivered in a multiculturally competent way. Along these lines, Guideline 5 of the APA’s Multicultural Guidelines (2002) states that “psychologists strive to apply culturally-appropriate skills in clinical and other applied psychological practices” (p. 47). The explanation of this guideline goes on to reassure psychologists that “it is not necessary to develop an entirely new repertoire of psychological skills to practice in a culture-centered manner. Rather, it is helpful for psychologists to realize that there will likely be

situations where culture-centered adaptations in interventions and practices will be more effective” (p. 47). While this is true, psychologists have thus far been fairly lenient with themselves with regard to adding new skills to their repertoire. Although many psychologists would agree in concept that conventional psychotherapeutic roles and interventions can be oppressive to clients from marginalized groups, my observation is that most agencies and graduate programs employ and train students to use primarily those techniques. Moreover, positioning this guideline within a social justice context, the aim becomes not just to use interventions that are “culture-centered” but to use ones that address positionality and hierarchy with regard to systems of power and oppression. Ideally, then, our interventions would address the effects of oppression and exclusion themselves. How can we continue to expand and develop our conceptualizations of socially just therapeutic practice in this direction? Prilleltensky (2003) introduced a concept that can guide psychologists in understanding what might constitute such an intervention. Prilleltensky pointed out that psychologists have advanced their theoretical knowledge regarding oppression and liberation; the challenge is to more fully incorporate this knowledge into research and action. Toward this end, he suggested that we create and evaluate our actions according to a new type of validity: psychopolitical validity. To be psychopolitically valid, interventions and research must (a) be informed by knowledge of oppression and power dynamics at every level (epistemic validity) and (b) produce transformative action toward liberation in personal, interpersonal, and/or structural domains (transformative validity). How can the transformative psychopolitical validity of an intervention be gauged? Prilleltensky suggested the following questions as avenues for determining psychopolitical validity: 1. Do interventions promote psychopolitical literacy? 2. Do interventions educate participants on the timing, components, targets, and dynamics of best strategic actions to overcome oppression?

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3. Do interventions empower participants to take action to address political inequities and social injustice within their relationships, settings, communities, states, and at the international level? 4. Do interventions promote solidarity and strategic alliances and coalitions with groups facing similar issues? 5. Do interventions account for the subjectivity and psychological limitations of the agents of change? (p. 200)

Prilleltensky (2003) addressed his comments to community psychologists, but they can be applied equally powerfully to practitioners. They invite applied psychologists to create interventions that create inclusion, promote critical consciousness, facilitate coalitions, and initiate action steps. They also direct practitioners to incorporate checks on their own limitations as would-be change agents who bring biases and connections to privilege that can undermine their work with marginalized clients. A number of possibilities emerge from these suggestions, and I think of them as falling along a continuum that locates a particular practice with regard to its distance from conventional psychotherapeutic practice (L. Smith, 2010). In other words, some modifications—transformed practices—correspond to the familiar psychotherapeutic dyad and could plausibly be employed by a psychologist working in a setting where such dyads were requisite practice. Others look different, such as group work or other counseling options created by psychologists working in community or other settings where the prioritization of local culture and local needs result in new interventions that I call co-created practices. Finally, community praxis activities are most dissimilar from psychotherapy and represent full-on collaborations between psychologists and community members to incorporate social action into the work itself. The familiar end of the continuum has been extensively explored within multicultural and feminist models of psychotherapeutic practice, and I will not elaborate upon it here beyond noting that these practices, such as RelationalCultural Therapy (Miller & Stiver, 1998), stand as

exemplars that correspond much more closely to Freire’s conceptualization of authentic generosity than do conventional expert dispensings of “help.” In conventional dyads, existing structural dynamics remain unchallenged, resulting in “helpful” interactions that reenact power-over dynamics between a relatively privileged therapist and a socially marginalized client. In these transformed practices, the therapist’s role and technique within the dyad are seen as collaborative and mutually growth enhancing. More dissimilar to conventional modalities are co-created therapeutic practices. These are practices designed to promote the emotional well-being of specific constituencies or communities that are developed collaboratively between mental health professionals and members of those communities, and they represent more radical departures from conventional psychotherapeutic techniques. Although they are therapeutic interventions in which mental health professionals are making use of their skills, they are not forms of psychotherapy. In my experience, these have included psychoeducational discussion groups held in community-based organizations or homeless shelters (L. Smith, 2005) and process-oriented group modalities based on poetry reading and writing (L. Smith, Chambers, & Bratini, 2009). In each case, the point of departure in the creation of these interventions was what community members had to say about their needs and about the intervention formats that felt most healing and comfortable for them. The activities that resulted are certainly recognizable as group practices, yet they are not psychotherapy groups and not workshops and not lectures—they are healing interventions tailor-made for and with a particular community constituency. At the far end of the continuum are practice/ actions through which practitioners create partnerships with groups of community members in a process of reflection and learning in which all are included, all grow, and all participate in the creation of socially just action. I refer to these forms of practice/action as community praxis, again borrowing language from Paulo Freire (1970). As mentioned, Freire described praxis as a merging

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of reflection and action, as an action that emerges from and is inseparable from reflection, learning, and personal growth. These interventions invite mental health practitioners to engage in experiences that are not psychotherapy, yet are understood to be therapeutic nonetheless. Together with my colleagues, I have proposed that we consider Participatory Action Research (PAR) projects to be among the community praxis interventions in which counseling psychologists participate, and we have explored this use of PAR with both adult (L. Smith & Romero, 2010) and youth (L. Smith, Bratini, & Appio, 2012; L. Smith, Davis, & Bhowmik, 2010) co-researchers. PAR is a process of education, research, and action in which professional or academic researchers and community members come together to share experiences, identify concerns, and study issues relevant to community needs (L. Smith, Rosenzweig, & Schmidt, 2010). Together, this research team collects data and/or shares community experience and expertise, and together they use the co-owned results to create action plans based on the knowledge that was generated. In its essence, therefore, PAR contradicts traditional research paradigms, in which outside ‘‘experts’’ enter communities or schools to determine the questions being asked and how the results will be interpreted and used. Why should such a process be thought to have anything to do with emotional well-being? Briefly, the reason is one referenced earlier: If we understand oppression to be a pathogen, then actions that address directly the effects of oppression should be healing. The silencing of marginalized people—their exclusion from participation in mainstream dialogue and shared governance—is one of the operations by which oppression damages excluded groups. By opening the process of knowledge-creation to all people, by positioning all people as citizens with expertise to share, by amplifying the voices of communities who are seldom heard, PAR is such an action. Our co-researchers have confirmed the healing, growthful impact of being part of a PAR team, a benefit that generalizes to many areas of their lives:

When I do research into the community, when I do research and I find out what people need, what people don’t have, what people have, and then I put myself in a position to be able to offer something, it makes me feel so good, it makes me feel lighter. . . . Lighter means less baggage. When I feel good and I’m part of something, I want to take care of myself a little more, you know? So my wellness, it’s made me more conscious of my feelings, on my health, on what I eat. Just everything, it’s had that big impact on every—you know, my whole wellbeing, everything. (L. Smith & Romero, 2010, p. 19)

Transformed psychotherapeutic practice, cocreated interventions, and community praxis, to varying degrees, subvert power-over dynamics by explicitly locating counseling work within a social, cultural, historical, and political context. In this way, in addition to supporting people in making creative, responsible use of the life chances and options that are available to them, these approaches help people interpret and analyze broad sociocultural conditions rather than internalizing them as personal failings. All three of them may also, and community praxis certainly does, comprise the creation and implementation of actions that can ally practitioners with people and communities as they work together for social justice.

Game-Changing Transformations of Scholarship and Education Changing our conception of help so that it incorporates inclusion at its heart, changing our practices in keeping with our values of participation and mutuality, and taking our service to disenfranchised people beyond the consulting room are all important ways of transforming ourselves and our institutions. There are other aspects of our professional and institutional function that are equally central to counseling psychology, however. One of these involves our work as scholars, researchers, and educators—a dimension of professional identity that is foundational to our applied practice and that

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is central for those of us who are professors in academic settings. Research productivity establishes our credibility as scholars in the eyes of our faculty colleagues—they who will or will not vote to support our tenure appointments—and our legitimacy as service providers to third-party payers. It gives us a basis for alignment with hard scientists and with medical professionals, associations that facilitate our earning potential and that many of us prize. It is no wonder, then, that our professional identity as researchers and scholars can be a highly charged source of pride, angst, gravitas, and debate. At times, debate of these issues has concerned what is and what is not “real” or valuable research, with points of the debate touching upon such matters as the rigor of quantitative versus qualitative methodologies, or statistical analyses of varying obscurity and complexity, or the comparative merits of the many scales, tests, measures, and inventories devised by psychologists. As Schorr and Yankelovich (2000) observed, these discussions of paradigmatic differences can sometimes feel like religious quarrels: “Quarrels over which method represents ‘the gold standard’ make no more sense than arguing about whether hammers are superior to saws. The choice depends on whether you want to drive in a nail or cut a board” (p. 2). Changing the way that we understand our practice invites (if not requires) reconsideration of the ways that we evaluate and study and teach that practice. Along the same lines, it invites reconsideration of the positions that we have taken up and/or inherited regarding suitable research frameworks in which to carry out our scholarship. Counseling psychologists have affirmed their commitment to the diversification of their practice in keeping with social justice tenets; as we think ahead to the examination and analysis of these efforts, does it make sense to assume that the yardsticks and formulae of conventional procedures will always apply? As for new interventions that may be on the horizon, community praxis interventions seem clearly to defy such assumptions: How can we evaluate a process that encompasses both individual and community goals, that prioritizes participants’ own experiences and evaluations of

outcomes, and that is essentially time-unlimited? As such a process cannot be forced into a conventional paradigm, we are left with the decision of either (a) creating new yardsticks or (b) confining our work to only the things that our old yardstick can measure. Smyth and Schorr (2009) explored this dilemma in a working paper published by the John F. Kennedy School of Government at Harvard University. The authors wrote of innovative human services programs that offer contextualized, multifaceted services and advocacy on behalf of marginalized families and communities, calling them the “What It Takes” programs. Discovering that effective, pioneering programs such as these exist is the good news, according to Smyth and Schorr; the bad news is that these programs are struggling to survive due to the conventional quantitative definitions of “success” and “evidence” and “proof ” imposed upon them by funders and policymakers. They offered one program director’s description of the Procrustean situation that resulted: [The] kind of rigid, narrow accountability that funders are demanding is of questionable validity . . . [and will force] programs [to] keep doing only what worked yesterday, instead of what works today. Scientific evaluations generally require staff to standardize interventions and deliver them consistently over long periods of time, regardless of individual needs, cultural considerations, or changes in circumstances. In contrast, [our program] aims to be flexible, innovative, and culturally competent. And so the very qualities that staff and families believe make the program effective are the qualities that make measurement difficult. (Silverstein & Maher, 2008, p. 23; quoted in Smyth & Schorr, 2009, p. 6)

According to Smyth and Schorr (2009), effective contextualized programs are often forced to distort, de-emphasize, or simply eliminate the very components that made them successful in the first place as they attempt to comply with funders who require experimental manipulations and quantitative data in exchange for continued support. As guidelines for new research and evaluation paradigms, the

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authors proposed a new model that would, among other things, incorporate methods like case studies and other qualitative approaches, allow for systemic complexity, and allow programs to establish outcomes that are meaningful to their work. These ideas regarding new, expanded understandings of evaluation/research/scholarship largely defy conventional psychological models and will inspire many of us to retreat. Our professional socialization leads us to look askance at such methods as quaint and user-friendly and certainly not rigorous and binding. This reaction, of course, exists side by side with a willingness to make a leap of faith that we seldom discuss: that our self-report questionnaires and scales are suitable vehicles for scientific rigor, especially when less-familiar statistical analyses are performed on people’s responses to them. This is a supposition that our colleagues in the hard sciences find quaint. Psychological questionnaires and scales are undoubtedly useful in many scholarly undertakings and clinical applications. My point is that I am not persuaded that they are inherently more valuable or valid than qualitative methodologies—that they are open to question, too—and that our inherited preference for them may need to be interrogated if we are to advance our scholarship in keeping with our social justice intentions. In encouraging an expansion of our conceptions of scholarship and research, I am merely echoing earlier calls for methodological creativity and paradigmatic transformation that have previously been heard in concert with social justice theorizing. This dialogue has roots in the epistemological foundations of PAR in that they lead mental health professionals to question and expand dominant-culture paradigms of knowledge production. It contains echoes of what David Bakan (1967) called psychology’s inclination toward “methodolatry,” or the narrow privileging of methodology to the extent that our selection of methods ends up dictating the phenomena that we investigate. It also calls to mind Linda Tuhiwai Smith’s (1999) exposition of decolonized methodology, which offers researchers and community members the opportunity to “research

back” in the tradition of “writing back” or “talking back.” (L. Smith, 2010, p. 7)

As Goodman, Smyth, and Banyard (2010) summarized: To the extent that some of the most innovative and context-sensitive approaches to mental health may be the poorest fit for evaluation using controlled clinical trials, we risk continuing to privilege interventions that are more easily studied by traditional methods over interventions that may be more effective and meaningful, but less responsive to these traditional tools—to the detriment of impoverished individuals and families. (Smyth & Schorr, 2009, p. 21)

Finally, we must also try to incorporate these intentions within the way that we educate and train the students who will follow us into the profession. Many psychologists who are interested in social justice approaches have been influenced by the pedagogy of Paulo Freire (1970), who is quoted frequently throughout the literature (and in this chapter). Yet there is very little about the academic context in which many psychologists work together and train future psychologists that resembles the collaborative, liberatory, problem-posing endeavor that Freire described, and the “teacher-student among student-teachers” (p. 67) does not appear to be a social location that many of us are eager to occupy. On the contrary, students often receive instruction even in multicultural coursework according to the same patriarchal, power-over model that characterizes Western education more generally, with many of their professors passing this model along unquestioningly—because that is the way that they were trained. Of course, certain constraints apply to instructors on the basis of their employment within institutions of education, and I am not proposing that professors attempt to completely subvert existing protocols (right away). Yet alternative models do exist that would allow us to live out more authentically our pronouncements regarding oppression and liberation. Education as the Practice of Freedom is the subtitle of the 1994 book Teaching to Transgress and

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expresses in a nutshell the intention of such a model offered by bell hooks. hooks recalled reaching graduate school as a young woman who believed in education’s potential to promote liberation and self-actualization, only to encounter professors who often used the classroom “to enact rituals of control that were about domination and the unjust exercise of power” (hooks, 1994, p. 5). hooks went on to describe her discovery of Freire’s (1970) pedagogy and the relative acceptance of critical thinking that she found in feminist classrooms. Later, as a professor herself, hooks merged these paradigms with her own conviction that serious intellectual and academic engagement could and should be joyful experiences; her book documents the philosophy and practices by which she and her students create a classroom that is a “radical space of possibility” (hook, 1994, p. 12). If such sentiments sound too good to be true, it is only because our own internalized patriarchal values tell us so. Freeing ourselves to live out the intention of our social justice ideals—to walk the talk—means questioning the taken-for-granted rules and codes that lead us to believe that there is only one way to live and work together. A few graduate programs have attempted to enact social justice commitments throughout program structures, procedures, curricula, and training experiences; a model developed by the Counseling and Development Program at George Mason University in Virginia is one such example. At George Mason, multicultural and social justice concepts are not only reflected in the mission statement and coursework of the program but also in the ways that program members relate to each other: at periodic retreats, faculty spend time exchanging ideas on social justice and how to operationalize it, as well as to support and mentor each other with regard to that process; open communication between faculty and students is provided via such opportunities as town hall meetings (Talleyrand, Chung, & Bemak, 2006). As we go forward to advance multicultural competence in service of social justice initiatives, we know that we must take care not to lessen our attention to the images and attitudes bred into us

by a patriarchal, racist, classist, heterosexist culture, nor to stop supporting each other in continuing that work. Even the most genuine, outspoken commitment to multiculturalism and social justice does not provide immunity against the internalization of oppressive attitudes or the commission of microaggressions against our students, colleagues, and clients—and this is not to suggest that there are outstanding claims to the contrary. Rather, we would not wish our commitment, hard work, and accomplishments on behalf of multicultural competency and social justice to leave us with an Achilles’ heel: a degree of complacency.

Concluding Comments I began this chapter with some general observations about psychologists’ class privileges, and then presented some ideas about how our assets and skills could be leveraged as social justice game-changers. Before concluding my discussion, I wish to underscore that social class privilege and oppression represents one of the most pervasive, yet least-explored, aspects of disenfranchisement within the multicultural/social justice literature. Elsewhere (L. Smith, 2010), I have reviewed the ebbs and flows of psychology’s scant attention to issues of poverty and classism, a thread that runs through the community mental health movement of the 1960s and 1970s to the feminist analysis of classism in psychology in the 1980s to the observation that “the most important topics in poverty research have been almost totally neglected by psychologists” (Furnham, 2003, p. 164). Opening our eyes and our practices and our research endeavors to the reality of classism will better position us to change a system in which “the rich get richer and the poor get poorer,” as the familiar cliché puts it. Classism is revealed through the analysis of such examples as environmental injustice, through which the communities of poor people and people of color become waste dumping grounds (Bullard, 2005); educational inequities, which result in the provision of fewer books, computers, and teachers for public school students in poor communities (Kozol, 2005); and

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the negative images of the poor that permeate the media (Bullock, Wyche, & Williams, 2001) and our own attitudes (L. Smith, Mao, Perkins, & Ampuero, 2010). Importantly, these negative conceptions appear to go beyond the merely cognitive: Responses to the poor seem to comprise a degree of disgust that may exacerbate punitive reactions as it widens the sense of distance that members of other classes feel from them (L. Smith, Baranowski, Allen, & Bowen, 2013). These considerations open new realms of social justice inquiry for psychologists in that many economically related cultural phenomena that they may have considered to be outside their purview, such as labor relations, attitudes toward labor unions, and the living wage movement, will be discovered to have psychological relevance within the social justice study of classism (L. Smith, 2013). Enacting our game-changing, help-as-inclusion perspective on behalf of the poor and other marginalized groups can have a daunting sound to professionals who can barely keep up with the routine demands of their jobs, much less find time to organize policy initiatives or participate in rallies and speak-outs. Yet there are many ways to throw our weight behind movement toward equity, some of which require almost no extra time. Our professional organizations offer a number of vehicles for this participation. For example, as a member of the APA Office on Socioeconomic Status Listserv, I receive poverty-related policy updates and notification of events and opportunities for advocacy. This is a convenient way for professionals to keep up with national developments related to poverty and social class, and to participate in collective petitioning or letter-writing campaigns targeting specific initiatives. In addition, there are less formal opportunities for contribution to national dialogue and policy where oppression and exclusion are concerned. Certainly, writing and speaking for scholarly audiences will always be a priority, but oppressive messages abound in everyday life and infuse the consciousness of many Americans, and it is vital

that we not talk only to each other about them. Finding ways for psychology’s social justice voice to become a clearer part of national dialogues will be a social justice undertaking in itself. For example, the microaggressive comments of political or entertainment figures are periodically the subject of national headlines and television newscasts, and the discussions of these events by media commentators are often just as cringingly racist, sexist, or otherwise oppressive as the original comments. Whenever I listen to commentary such as this, my recurring fantasy is that a social justice psychologist like the ones cited in this chapter would materialize as part of the television panel, making use of those handy counseling skills as he or she clarifies the oppressive elements of the conversation. Although the remarks of television personalities may seem lacking in gravity when compared to our scholarly pursuits, these kinds of events and dialogues are at the heart of our nation’s cultural life (for better or worse), and I believe that we need to help shape them. My point is that whether by participating in public speaking opportunities, writing for popular publications and newspapers, or working as activists, social justice psychologists need to venture forth from their offices, classrooms, and conferences to share their ideas with a broader, nonacademic audience. Great leaps in understanding and humanity are happening within the cloistered settings in which we spend our working lives—and yes, that scholarly foundation of knowledge can be hoped eventually to trickle out to mainstream culture. Nevertheless, it has been decades since multicultural pathbreakers like Derald Wing Sue (1978) energized the social justice dialogue among counseling psychologists. Perhaps by expanding our conceptions of our scholarship, our practice, and of help itself, we can become more creative in finding ways to involve a nation still not part of that conversation. As counseling psychologists, our skills, our knowledge, our practice, and our voices can all contribute to the creation of a more participatory, more inclusive world.

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PART

IV

Current and Future Trends in Multicultural Counseling Research

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he three chapters included in Part IV reflect two of the major objectives inherent in the Handbook: (a) to give emphasis to current cutting-edge challenges and progress in multicultural counseling research and (b) to increase the competence of researchers, educators, and practitioners to study, assess, understand, and intervene with multicultural persons. The chapters specifically address the advances that have been made in the field of multicultural counseling that are based on the development of innovative research methods and measurement tools. More specifically, they focus on advances made in three areas— qualitative methods, measures of category-based bias and feature-based bias, and assessment instruments used in mainstream psychological evaluations and the development of culture-specific measures noted in the literature. In the chapter titled “Innovative Approaches: Emphasizing Effectiveness and Social Justice for Ethnocultural Populations,” Kohn-Wood, Nagata, Kim, and Macquoid review innovative qualitative interventions and procedures that comprise a framework for promoting empowerment and accessibility. Discussion of methods and procedures designed to access knowledge regarding populations whose mental health needs have not been met through standard research practices are noted. Innovative approaches are framed as an issue of social justice. Stepanova and Hagiwara begin their discussion of “Category-Based and Feature-Based Bias: Measurement and Application” discussing the tragic killing of Trayvon Martin, an African American, by George Zimmerman, which brought racial bias once again into the national spotlight. The authors draw upon theories and empirical findings from the social psychological literature on racial bias, specifically, category-based and feature-based bias. An overview of measures developed by social psychologists to assess both types of bias are reviewed with a focus on implicit measures. Application of such measures to multicultural counseling practice is noted in cases of bias toward women, sexual minorities, and those with mental or physical disabilities. The chapter by Suzuki, Lee, and Short, “Psychological Assessment: A Brief Examination of Procedures, Frequently Used Tests, and Culturally Based Measures,” critiques the current usage of psychological measures with members of diverse racial, ethnic, and cultural groups. Historical challenges regarding

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the usage of traditional mainstream measures are highlighted. The process of assessment including interviewing and observation are discussed. Culture-specific measures that focus on such

­ rocesses, constructs, or phenomena including, but p not limited to, acculturation, racial identity, ethnic identity, personality, and traumatic stress that have emerged in the literature are also addressed.

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Innovative Approaches Emphasizing Effectiveness and Social Justice for Ethnocultural Populations Laura Kohn-Wood, Donna K. Nagata, Jackie H. J. Kim, and Ahjane D. Macquoid

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n this chapter, we review innovative qualitative approaches and procedures that comprise a framework for promoting empowerment, accessibility, and/or knowledge for populations whose mental health needs have gone largely unmet by standard research and practice in the field. We attempt to frame our discussion of innovative approaches as an issue of social justice—defined by Rawls (1971) as “collectively determined equal distribution of goods that privileges liberty and fairness over efficiency and welfare” (as cited by Kohn-Wood & Diem, 2012, p. 86) and extended to include the value expressed by Coates (2007) such that “individuals have inalienable rights, respect for which is universally and globally expected” (as cited by Mertens, 2012, p. 62). Further, Gergen, Josselson, and Freeman’s (2015) review of the qualitative “movement” presents qualitative inquiry as an opportunity for the field of psychology to be enriched by (a) including pluralistic forms of knowledge production, (b) offering opportunities for interdisciplinary inquiry, and (c) creating greater inclusion in the research literature for understanding experiences of discrimination and oppression among marginalized groups. In this sense, our review is defined and therefore limited to those approaches we feel meet the criteria outlined above. Two additional frameworks provide help to direct this chapter. The first resonates with Denzin and Giardina’s (2009) discussion of the ethical obligation of researchers to challenge systemic oppression and the particular role qualitative scientists play in furthering social justice and human rights. We believe a similar imperative holds true for practitioners who work with underserved and ethnocultural populations. The second reflects Mertens’s “transformative paradigm” (2009, as cited in 2012), which articulates ethical principles of respect, justice, and benefits to individuals and communities when working with ethnocultural populations. Working from these frameworks in this chapter, we sought to review methods and procedures that (a) are immersive in cultural issues, (b) are aware of differences in access to power,

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(c) are deployed in service of challenging oppression, either directly or indirectly, and (d) involve communities in meaningful and transformative ways. We seek to model these two value-driven frameworks by including approaches that reflect social justice and transformative possibilities. Below, we define the terms we utilized for our review, including ethnocultural populations and innovative approaches. We use ethnocultural as a term that is inclusive of both ancestral heritage as well as cultural self-identification (e.g., race, ethnicity; see Nagata, Kohn-Wood, & Suzuki, 2012), although we recognize that researchers utilize varying terminology to reference similarly delineated groups. What constitutes “innovation” in the area of qualitative methodology has been a contested topic, with the claim of novelty highly influenced by pressures to publish, secure grant funding, or individual or institutional academic prestige (see Travers, 2009; Wiles, Crow, & Pain, 2011). Previously, innovation has been defined as the creation of new methods or advancement or adaptation of existing methods (Wiles et al., 2011). In addition, innovation may be dependent on whether or not a particular method has been accepted and utilized by other researchers (Taylor & Coffey, 2008), or rather, is so new as to be outside the mainstream in terms of research practices (Xenitidou & Gilbert, 2009). For the purpose of this chapter, our definition of innovative is informed both by temporal considerations as well as the degree to which methodologies and procedures represent approaches that question, challenge, complicate, extend, or reject traditional theoretical orientations (positivist ontology and determinist epistemologically driven tools). Temporally, we sought to cover approaches that have appeared no earlier than the previous decade. Further, our criteria for inclusion involved an evaluation of how these novel approaches represent tools for the dismantling of unjust practices or inequities. We hope that being explicit about how we thought about and chose material for this chapter will allow the reader to judge the appropriateness of what we have included and recognize that many additional projects, procedures,

research, and interventions could be added and others removed based on the relative assessment of the terms we utilized. We acknowledge that claims of innovation, when subjected to scrutiny, typically consist of new research designs, methods, new adaptations of existing approaches, or the transfer of methods across disciplines (e.g., to social science from arts/humanities) rather than entirely new methodologies (Wiles et al., 2011). To summarize, in this chapter we discuss innovative approaches including innovative ethnographic, technologic, and arts-based approaches, and approaches that utilize decolonization and cultural equity as frameworks for facilitating inquiry and change.

INNOVATIVE ETHNOGRAPHIC APPROACHES: AUTOETHNOGRAPHY Previously, both performance and autoethnography, while not new, have been described as promising novel qualitative approaches to understanding the psychology of ethnocultural populations (see KohnWood & Diem, 2012; Jones, Adams, & Ellis, 2013; Spry, 2011). Performance encompasses a broad net of human actions and events that are presented in varied settings, which simultaneously highlight commonalities and distinctiveness between cultures (Schechner, 2002). It can be a form of communication, which is often presented in a manner understood by its target audience, conveying a range of direct or indirect messages in a planned manner with clear beginning and end, or in an unplanned manner in our day-to-day interactions (Bauman, 1975). Performances become the point of remembrance of traditions, representation of existing practices, and inspiration of future ideals (Bauman, 1975). Autoethnography is one way of documenting these performances (Jones et al., 2013). A review of the social science literature indicates that there have been few published attempts to utilize performance ethnography over the past several years, and those studies that appear tend to be limited to health-related fields such as nursing (Smith & Gallo, 2007), health education (Carless &

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Douglas, 2010), or music therapy (Snow, Snow, & D’Amico, 2008). A more focused review of performance-based tools used as innovative methods for inquiry and intervention is covered in the section on arts-based approaches. The use of autoethnography, on the other hand, has been robust over the past several years (Jones et  al., 2013), characterized in part by a debate published in the Journal of Contemporary Ethnography (see 2006, 35[4]) in reaction to an article by Anderson (2006) who attempted to delineate “analytic autoethnography” as distinct from “evocative autoethnography.” While we cannot recreate the cogent arguments in the journal, below we define and discuss various aspects of autoethnography, including recent examples of the innovative ways it has been used to understand cultural phenomena.

Autoethnography as an Innovative Method: Definition and Debate While ethnography refers to “the practice of systematically identifying, describing and making meaning of observations from fieldwork” (Kohn & Diem, 2012, p. 87), autoethnography is an approach that analyzes personal experiences in a systematic way in order to merge cultural experiences with social justice and social consciousness into a framework for doing research (see Ellis, Adams, & Bochner, 2011). As a method that is both “process and product,” autoethnography developed as a response to the positivist scientific paradigm that simplified, reduced, and essentialized social phenomena to units of analysis that do not reflect the complexity, identity, meaning, and relational aspects of deeply personal human experiences (Ellis et al., 2011). Autoethnography has been further characterized as an active form of resistance to the process and products of empirical research that reflect a hegemonic perspective that is White, upper class, heterosexual, Christian, and able bodied (Ellis et al., 2011). The method is a combination of autobiography, whereby researchers

choose particularly meaningful experiences from their pasts to write about, and an ethnography, whereby a researcher inductively studies the cultural values, beliefs, norms, patterns, and relations of a group to create the “thick description” that Geertz (1994) describes as a hallmark of the method. The autoethnographer, therefore, utilizes the tools of both approaches: writing about experience and analyzing that experience using ethnographic tools such as observations, interviews, and examinations of discourse, artifacts, and texts (for overview and descriptions, see Delamont, 2009; Ellis, 2004; Ellis & Bochner, 2000; Holman Jones, 2005; Jones et al., 2013). As researchers have increasingly utilized autoethnography as a way to encode the ways in which their personal experiences intersect and illuminate specific social phenomena, categorization and controversies about the methodology have increasingly emerged, which arguably catalyzed innovation. According to Ellis et al. (2011), categories of autoethnography include indigenous/native ethnographies (see decolonization section below), narrative ethnographies, reflexive ethnographies, dyadic interviewing and ethnographies, layered accounts, interactive interviews, community ethnographies, co-constructed narratives, and personal narratives (e.g., Berry, 2007; Goodall, 2006; Poulos, 2008; Tillmann, 2009). The growth in the use of autoethnography has engendered new commentary and critiques. Recently, a distinction between “evocative autoethnography” and a new designation of the “analytic autoethnographic paradigm” was articulated as a way to delineate a form of research that is more compatible with traditional ethnography. More analytic applications of the method seemed to diverge from the oft-critiqued “narcissistic, misrepresentative” forms of autoethnography (Kohn-Wood & Diem, 2012). Anderson (2006) proposed five key features of analytic autoethnography including (a) the researcher being a “complete member” in the social world of inquiry (e.g., having “complete member researcher” status), (b) engaging in “analytic reflexivity” that involves both social and self-analysis, (c) narrative visibility I NNOVATI VE A PPROACHES

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of the researcher’s self, particularly as it relates to other members of the social world, (d) engaging and analyzing dialogue with informants beyond the self to avoid self-absorption, and (e) committing to an analytic agenda such that the purpose of the project is to “use empirical data to gain insight into some broader set of social phenomena” (Anderson, 2006, p. 378). He further proposed that analytic autoethnography represents a form of “realism” whereby the primary goal of the inquiry situates the self-study as a source for broader generalization in service of theory generation. This distinction, however, was soundly rejected by several prominent ethnographic researchers (see Denzin, 2006; Ellis & Bochner, 2006) and critiqued by others. For example, Vryran (2006) suggests that distinguishing between different forms of autoethnography ignores the utility of data in which the author is the sole source. Burnier (2006) criticizes the characterization of evocative versus analytic autoethnography as being deceptively dichotomous, and Charmaz (2006) indicates that regardless of the characterization of these two forms of autoethnography, they are difficult to discern in practice. Therefore, the nomenclature separating evocative autoethnography from analytic autoethnography has not gained traction. What has been innovative, however, is the increasing representation of autoethnography in the research literature, albeit still mostly in niche journals, and the ways in which autoethnography has been used to understand the experiences of ethnocultural groups.

Autoethnography as an Innovative Method: Examples Some examples of this innovative methodology may illuminate how complicated issues such as social class, race, identity, and marginalization can be examined in depth. Autoethnography can help explore, contrast, compare, and make meaning of alternative theories of social class, identity, social deviance, and socioeconomic status. For example, Schingaro (2014) utilizes four “scenes” from his life as someone who grew up in a poor, crime-ridden

Italian ghetto. His autoethnographic research leads to recommendations for urban and political policies that could generate a “cultural and social re-birth” of similar communities (Schingaro, 2014). Somewhat similarly, Jones (2013) incorporates social identity theory and philosophical perspectives to examine competing cultural identities, subsequent cultural adaptation, and intersectional identity formation via three reflexive autoethnographic frames. Jones provides an account of “who I am” as a Bavarian through understanding “where I am” after living in England but also includes physical space, interactions, discourse, and experiences along with a third “inner space” described as “No Man’s Land” (Jones, 2013, p. 746). Another researcher utilizes her multiracial family as a vehicle for analyzing family processes associated with multiculturalism, bilingual language acquisition, and heritage maintenance. She provides perspective as the offspring of a working-class Afro-Columbian father who grew up poor and a White American middle-class social scientist mother (Kennedy & Romo, 2013). In each of these examples, autoethnography is highlighted as a methodology for illuminating cultural, class, linguistic, and social dynamics. As things stand now, these dynamics are not well represented in the psychological literature, and as such, their impact on an individual is not well understood. Such understanding could be attained through the “thick descriptions” (Geertz, 1994) that are inherent in autoethnographic explorations. We have described ethnography, and specifically autoethnography, as an innovative approach that has been used to examine the experiences of marginalized individuals and groups. This approach holds promise for uncovering psychological dynamics that exist within ethnocultural populations that have not previously been well represented in the psychological literature.

INNOVATIVE INDIGENOUS APPROACHES: DECOLONIZATION In discussing innovative methods that allow for the rich study of underrepresented ethnocultural

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groups, we acknowledge that the experiences of Native or indigenous populations have historically been less voiced. Nevertheless, new approaches have been developed to increase our knowledge base, particularly “decolonization” theory—a framework for highlighting the unique psychological dynamics among indigenous groups. We review the development of this theory and provide examples of how this work has been utilized.

Decolonization Theory and Definitions Denzin, Lincoln, and Smith (2008) discussed the progression of critical social science theory that led to the development of indigenous theory and methodologies as a response to the hegemonic marginalization of Native peoples. Wendt and Gone (2012) also offered a robust argument for the power of qualitative research as a decolonizing methodology for understanding indigenous groups. Specifically, decolonization work seeks to undo the insidious and hegemonic harm of colonization as an integral component of psychological research and practice. Among accepted definitions of colonization and colonialism in the critical literature, a common definition is that colonization is the process of an empire occupying foreign lands for the purpose of incorporating, dominating, and subjugating them and their peoples (Kanuha, 2002, as cited in Morrow & Hawxhurst, 2012; Smith, 1999). Decolonization can be broadly understood as forms of resistance and consciousness raising, which have been employed to stop the continuous oppressive pursuit (even into the self) of empire (Morrow & Hawxhurst, 2012). Contemporary decolonization builds on resistance movements, which have challenged empires since its inception (Robinson-Zañartu, 2008). Within an individual colonial history, decolonization first emerged in peoples’ revolts against colonial power and continues in resistance movements and ultimately in the work to dismantle internalized and institutionalized colonialism even after the formal colonial arrangements have been terminated.

Contemporary Decolonization Work: Philosophy and Tools Decolonization work (Huygens, 2009) seeks to deconstruct the control and harm of colonialism within individuals, whether formal or institutionalized control exists or not. This work challenges the psychological imperialist and hegemonic tendency to generalize and even export psychological findings and practices from White, middle-class, U.S. populations out to the world (Gergen, Guleree, Lock, & Misra, 1996; Huygens, 2009). In the same way, decolonization work also denies longstanding “colonial commonsense,” which understands indigenous people as enemies and assertions of their collective rights as primitive impediments to a worldwide capitalism (Huygens, 2009, p. 268). It is perhaps most salient and well known in indigenous contexts where the pursuit of indigenous rights, restored identities, and ownership of community members’ narratives have been deprived under colonialism. There is a consensus in the literature that generalizing across indigenous communities is highly problematic, though basic essential elements of the approach can be isolated (Stewart, 2009b). Indigenous decolonization requires allowing indigenous peoples to set their own agendas for change themselves (Smith, 2000, as cited in Zavala, 2013), including supporting indigenous practitioners and scholars (Sherwood, 2009; Stewart, 2009b). It means embracing traditional knowledge and indigenous worldviews, linking liberation and wellness to the recovery and reaffirmation of indigenous ancestral knowledge (Walters & Simoni, 2009), and the development of indigenous psychologies (Huygens, 2009; Smith, 1999). Moreover, no matter the population, decolonization is a self-emancipatory process “requiring auto-criticism, self-reflection, and a rejection of victimage” (Walters & Simoni, 2009, p. S75). Decolonization work embodies a social constructivist, postmodern understanding of truth that is well suited to working crossculturally (Stewart, 2009a).

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Efforts to deconstruct colonialism must be tackled by both indigenous and nonindigenous communities alike. Such work creates the space to validate indigenous paradigms or research—­ guiding beliefs about the world and knowledge (Hart, 2010). Participatory Action Research (PAR) is one type of decolonizing strategy adapted and used by nonindigenous professionals involving projects originated and guided by indigenous people and their own struggles (Zavala, 2013). By allowing research participants to guide all levels of research, from subject to methods, PAR “brought about a search for new ways of thinking about social research that ruptured the intellectual colonialism and ‘imitation’ of Western traditions and methods” (Fals-Borda & Mora-Osejo, 2003, as cited in Zavala, 2013, p. 58). In implementing PAR, professionals from majority groups, whether labeled settlers, colonists, or otherwise, must be decolonized in their own way (Lang, 2006). For counselors, this means not only the self but also the systems that created and support psychology (Lang, 2006). As Tuck and Yang (2012) caution, true decolonization work in multicultural counseling must be transformative, adopting an indigenous gaze and using tools and techniques based on indigenous knowledge. Among the growing examples of decolonization research relevant to counseling psychology is Hill, Pace, and Robbins’s (2010) critical, participatory mixed-methods investigation of the validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 with American Indians. In this study, the authors described evidence for differential endorsement of 30 items, which cumulatively led to significantly different clinical cut-off scores between groups (Hill et al., 2010). Further, qualitative interviews yielded nine themes related to unique indigenous beliefs, norms, and practices that underlay observed differences on the MMPI-2 rating scale. These themes included core beliefs, experiences of racism and discrimination, conflicting epistemologies, living in two worlds, community connectedness, responsibility and accountability to one’s community, traditional knowledge, stories as traditional knowledge and

language, and historic loss (Hill et al.). Similarly, Gone’s (2013) investigation of therapeutic outcomes from a healing lodge approach to treat distress among Native Americans also involved participants as “co-analysts” in the research process. Through thematic analysis, he uncovered themes related to the necessity of indigenous heritage, Native identity, and spiritually based healing methods that draw upon local expertise and legacies of healing. The discourse with staff and clients is described as a useful tool for bridging evidence-based treatment approaches with culturally determined interventions to address the needs of Native communities (Gone, 2013). Both studies reflect decolonization and indigenous methodology by amassing evidence to dismantle the validity of traditional therapy and assessment approaches that potentially overpathologize indigenous populations. Further, both projects allow the research to “designate(s) space for an Indigenous perspective and voice throughout the entire research process” (Hill et  al., 2010, p. 25). Therefore these studies are “heavily informed and directed by indigenous methodologies” such as narrative inquiry. This relational approach aligns with exploring traditional knowledge through oral-based storytelling and privileges indigenous epistemologies (Smith, 1999, as cited in Hill et al.; Stewart, 2009b). Not only should decolonization research address what are arguably colonizing artifacts in contemporary psychology, but members of an American Indian nation must be involved in the research from the idea stage right to publication “to ensure that the research process was culturally credible, competent, responsive, and accountable” (Trimble, Scharrón-del Río, & Bernal, 2010, as cited in Hill et al., p. 18). Working in accordance with these principles involves “negotiating the expectations, responsibilities, and obligations inherent within both Western and Indigenous methodologies” and “required tremendous amounts of time, energy, and patience” (Hill et  al., p. 24). Decolonization work in counseling practice and research is as challenging as it is necessary. While autoethnography and indigenous approaches to research and interventions provide

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new ways of “knowing,” understanding, and amplifying diverse lived experiences, other forms of innovation in the field involve specific tools based on technological advances.

INNOVATIVE TECHNOLOGYBASED APPROACHES: INTERNET AND MOBILE APPS Innovative technology-based approaches have been developed and used in the field for nearly two decades, both as psychoeducational programs (see Griffiths, Christensen, Jorm, Evans, & Groves, 2004) and psychotherapy treatment (for examples and reviews see Andersson & Cuijpers, 2009; Barak, Hen, Boniel-Nissim, & Shapira, 2008; Cuijpers et al., 2011; Hedman, Ljótsson, & Lindefors, 2012; Wagner, Knaevelsrud, & Maercker, 2006). A critique of these approaches, however, is that in their development, innovators have ignored culture or context as important constructs, and ethnocultural populations have not been represented in the burgeoning research and literature. As such, these innovators are in danger of repeating the mistakes of the evidence-based treatment (EBT) movement, whereby, save for a few exceptions (Bernal & Domenech Rodríguez, 2012; Griner & Smith, 2006; Huey & Polo, 2008; Santisteban et al., 2003), race, ethnicity, culture, context, and human complexity have largely been left out of the development and establishment of “empirically validated treatments.” The problem that the EBTs do not often translate well “on the ground” or with diverse communitybased clients (Lau, 2006; Whaley & Davis, 2007) has led to problems with real-world translation of treatment approaches and brought to the fore the need to focus on clinical translational science (Tashiro & Mortensen, 2006; Woolf, 2008; Zerhouni, 2005).

Technology-Based Approaches and Ethnocultural Groups Ethnocultural groups have not been well represented in studies that utilize technology for data collection, evaluation, or behavior change, despite

the increased use of mobile technology and other media-related tools in research designs. Daily diary approaches to data collection represent ecologically valid ways to sample behavior by reducing recall bias, capturing behaviors pre- and postinterventions, and providing easier sampling of multiple behavioral events over many temporal periods (for review of mobile technology in research on behavior change, see Cohn, HunterReel, Hagman, & Mitchell, 2011). Given that ethnic and/or racial minority groups (e.g., African American men) may avoid traditional research or mental health services (Watkins & Jefferson, 2013), the Internet, online communities, and social media sites are other sources for developing innovative research or intervention projects, yet remain largely untapped. Therefore, our review of technological innovations is limited yet represents an area of great future promise. Many members of ethnocultural groups who are generally not well represented in psychological research or counseling psychology intervention studies are frequent users of social media and mobile gaming applications. For example, young adults are more likely than older adults to play online games (Yee, 2006), and adults aged 18 to 29, urban residents, African Americans, and Latinos use social media sites such as Twitter and Instagram comparatively more often than other Internet users (Duggan & Brenner, 2013). While the Internet, online and social media sites, and mobile gaming all reflect the diversity of the population, research and intervention using technology-based applications has not capitalized on this diversity, missing an opportunity for innovation. This is reflected by a recent focusing on ethnic minority men finding that no peer-reviewed articles describing the use of Internet or online, web-based, or telehealth programs exist, other than one study that examined the use of online social support groups for Asian American men (see Chang & Yeh, 2003, cited in Watkins & Jefferson, 2013). The lack of ethnocultural representation in studies utilizing newer mobile-based technology is particularly disturbing given the persistent under­ utilization of traditional mental health services I NNOVATI VE A PPROACHES

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among minority groups and consistent lack of representation in social science research despite the promise offered by newer technological tools. For example, mobile apps as sites for research and intervention are more cost-effective, more accessible and widespread, private, more convenient (Watts et al., 2013), more acceptable (Proudfoot, 2013), and have more functionality and reliability than computer or Internet-based applications (Bang, Timpka, Eriksson, Holm, & Nordin, 2007). There is some evidence that multimedia and/or computer games can potentially reduce risky behaviors, including sexual initiation and sexual activity among youth (Mustanski, Garafolo, Monahan, Gratzer, & Andrews, 2013; Roberto, Zimmerman, Carlyle, & Abner, 2007; Tortolero et  al., 2010), and increase knowledge and self-efficacy beliefs (Markham, Shegog, Leonard, Buia, & Paul, 2009; Roberto et  al., 2007; Verduin, LaRowe, Myrick, CannonBowers, & Bowers, 2013). An emerging study of a mobile app-based intervention called “Wellness in Your Hand” is designed to enhance game players’ self-efficacy and well-being in six domains: interpersonal, community, occupational, physical, psychological, and economic (I COPPE framework; Prilleltensky, 2012), with preliminary data indicating that the majority of players found the games feasible, acceptable, and useful (Prilleltensky et al., 2013). Our contention here is that most innovative work with newer technologies such as mobile applications is not being done with ethnocultural populations in mind, regardless of the fact that it has great promise, nationally and internationally, for addressing some of the previously identified barriers to treatment seeking and the utilization and continuation of mental health services as well as monitoring and self-management. These empowering mechanisms for health promotion may be helpful in reducing inequities in treatment access for ethnocultural groups. We have reviewed innovation in the areas of ethnography, decolonization, and technology. Finally, we discuss innovative approaches that utilize the arts, broadly defined, to understand and impact diverse life experiences using photography, artwork, and performance.

INNOVATIVE ARTS-BASED APPROACHES Participant-Employed Photography Arts-based approaches that utilize methods from the arts and humanities have been particularly conspicuous among qualitative intervention and research approaches that are characterized as innovative (Wiles et al., 2011). Castleden, Garvin, and Huu-ay-aht First Nation (2008) noted that the use of photography in academic research has been a tool in fieldwork since the 1920s. While the use of photos does not represent a new or novel research approach, the use of photos taken by participants as a means of community-based research is a more recent development. In such participant-employed photography (PEP), the photos form a basis from which participants can draw upon to share a narrative and perspectives on their experiences and community. Castleden et al. (2008) pointed out that PEP has several advantages, including allowing the participant to take an active role in determining the subject and meaning of what is photographed, which allows for a more equal power role in the research, facilitating a richer description of the issue of concern and allowing for the communication of significant sociocultural perspectives. Photovoice, developed by Carolyn Wang (Wang, 1999; Wang & Burris, 1997), describes a particular form of PEP that has relevance to the social justice concerns of ethnic minority and marginalized individuals and communities. This methodology, which provides community members with cameras, not only allows individuals to photograph and reflect upon issues within their community but also encourages those members to discuss their photos with each other in a group as a means of generating grassroots social action that can then influence policy change (Castleden et  al., 2008; Spencer, Kohn-Wood, Dombrowski, Keeles, & Birichi, 2012; Wang, 1999). As summarized by Spencer et  al. (2012), Photovoice allows participants’ photos to raise questions, including “Why does this situation exist?” and “Do we

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want to change it, and if so, how?” (p. 144). The methodology is designed to empower vulnerable/ marginalized populations and to value knowledge that is grounded in the lived experiences of those with local expertise and insight. A range of studies conducted within the last 10 years has utilized photography and Photovoice to address concerns within ethnic minority and underserved communities. These have included interventions addressing experiences of rural African American breast cancer survivors (Lopez, Eng, Randall-David, & Robinson, 2005), Latino American adolescent immigrants (Streng et  al., 2004), African American parents’ awareness of the impact of environmental hazards in Detroit (Spencer et al., 2012), and First Nation Canadian perspectives on health and environment issues (Castleden et al., 2008). These Photovoice efforts have helped to refine the implementation of PEP within ethnocultural communities. For example, an important modification in the Castleden et al. (2008) study was the extended use of Photovoice across 6 months within the Huu-ay-aht First Nation. This prolonged implementation was considered to be an important part of building trust, a particularly key concern given the colonial legacy of indigenous communities. Rather than following the academic trend of one-shot research that typifies many Photovoice efforts, the lengthier research framework allowed for greater immersion into the community. The researchers also modified their recruitment and interview process based on input from the First Nation members of their Advisory Committee, balancing the importance of gathering indigenous knowledge from the elders with a recognition that many such elders had limited mobility that prevented them from participating in Photovoice directly. As a result, elder views were sought informally through home visits and via community potluck dinners. More recently, photography has been used in conjunction with other interventions. Shea, Poudrier, Thomas, Jeffery, and Kiskotagan’s (2013) Community Based Participatory Research, or CBPR, project explored the health, body image, and community perceptions of First Nation girls

via their photographic collages in conjunction with the use of sharing circles (a format consistent with the participants’ cultural values) to facilitate discussion about health-body topics, provide the opportunity for individual interviews, and gather surveys to obtain feedback about the research process itself. Gibson et  al. (2013) used photos in conjunction with audio diaries and interviews to elucidate how disabled young men “establish, maintain, and reform their identities in everyday practices” (p. 383). Photo elicitation was seen as a means of facilitating discussions on sensitive topics among the men (Orliffe & Bottorff, 2007), while audio-recorded diaries allowed participants to share aspects of their selves using a method that could be easily utilized by individuals with physical limitations (Worth, 2009, as cited in Gibson et  al., 2013). Together, the methods allowed the young men to “actively negotiate the details of the photos and diaries” (Gibson et al., 2013, p. 387) and illuminated perspectives and practices that might have been difficult to discuss in a face-to-face interview.

Artwork Other forms of art aside from photography have also been incorporated into novel applications within ethnocultural communities. Fine et al. (2012) incorporated the use of drawings in the form of identity maps and surveys with focus groups to explore how Muslim youth “represent and negotiate their hyphenated identities” (p. 121) in the United States and in Israel. In this action research effort, members of a participatory advisory board of Muslim youth used paper and crayons to draw identity maps of their “many selves.” These drawings were seen to be especially helpful in illuminating ways in which the youth integrated their Muslim and American identities, separated these as parallel identities, or represented conflict, fear, and tension between them. Other recent efforts incorporate more unique art forms. Washington, Moxley, and Garriott (2009) employed a quilting workshop with older African American women to help them transition out of homelessness and manage the effects of I NNOVATI VE A PPROACHES

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marginalization. The women participated in more traditional group interventions to learn cognitive and behavioral techniques targeting their sense of control, personal agency, social relationships, and traumas related to homelessness. However, they also participated in extensive narrative interviews about their homelessness and recovery and constructed a quilt patch to reflect their experiences. The patches were then combined into a larger quilt in a group “quilting bee” during which the women were able to build a sense of community, affirm a group identity, and offer mutual support. In addition, the group effort resulted in a concrete outcome that visually reflected their challenges and resilience.

Performance Performance offers yet another innovative approach to addressing issues of identity and empowerment. Rodriguez and Lahman (2011) collected data from Latina college students through individual interviews, a culturally responsive focus group, and photos. Using quotes from their participants, along with fictitious conversations created by the authors, a performance dialogue called “Las Comadres” was created that illuminated “how five Latina students view their ethnic identities and educational values based on messages from family and peers” (p. 602). In turn, the performance dialogue could be used to make the participants’ stories accessible to those outside of academia to portray hope, strengths, and educational achievement of Latina college students. Performance theory also informed Powell’s (2008) analysis of the contemporary practice of taiko drumming as a means of challenging “fixed notions of identity and hegemonic descriptions of race as a discrete category” (p. 901). Taiko are Japanese percussion instruments that have historical roots in Japan. Taiko drumming in ensembles, a more recent trend that has emerged in the past 50 years, typically includes powerful, rhythmic drumming on barrel-shaped and smaller drums in a performance group (Powell, 2008). Referencing ethnography and

autoethnography, Powell describes how taiko performance can be seen as reflecting Asian American identity politics by helping performers to not only take pride in their Japanese heritage but also to challenge the cultural myth of quiet and docile Asians.

CONCLUSION In this chapter, we select and describe innovative approaches and procedures that may hold promise for understanding the lived experiences of ethnocultural groups. To this end, attention is given to methodologies and interventions that can be more effective than traditional approaches in engaging such groups, addressing unique needs, amplifying their unheard voices, and redressing persistent inequities to which they are subjected in social science and psychology intervention settings. Our definition and criteria for our selection relies on both a subjective evaluation of the social justice and transformative potential of specific approaches that have appeared in the literature relatively recently. As such, we selectively discuss autoethnographic, arts-based, technology-based, and decolonization approaches because they exemplify innovation in both research and practice, and they also demonstrate how they can be used to provide opportunities for reducing disparities in the understanding of psychological phenomena across groups. Clearly, this chapter does not provide a complete compendium of all forms of innovation in the field given the vast degree of methods and procedures that exist. We have specifically chosen particular approaches to highlight given our intended framework and definition—strongly influenced by social justice concerns and goals of transformation. That said, numerous other innovative approaches are present in the extant literature and many more are being developed as this is written. We challenge researchers and practitioners to reflexively evaluate their own practices of inquiry and intervention to determine the degree to which they can adapt or innovate to serve the goals of social justice and the dismantling of social inequity.

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CHAPTER

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Category-Based and Feature-Based Bias Measurement and Application Elena V. Stepanova and Nao Hagiwara

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n the dark, rainy night of February 26, 2012, Trayvon Martin, a 17-year-old teenager in a hooded sweatshirt, went to a nearby convenience store to purchase a pack of Skittles candy and Arizona iced tea and was walking back to the townhome where he was staying. George Zimmerman, a 28-year-old neighborhood watch volunteer in Sanford, Florida, spotted the teenager and called 911 to report “a suspicious person” walking in the neighborhood. Zimmerman received instructions to remain in his vehicle and not to follow Martin; he disregarded the instructions. Minutes later, neighbors reported sounds of gunfire, and unarmed Martin was found dead. This case brought issues of race, and more specifically, racial bias, into the national spotlight as Trayvon Martin was an African American, while George Zimmerman was the son of a European American father and a Peruvian mother. Some speculated that Martin’s murder was driven by racial hatred and that Zimmerman was a violent racist who shot Martin simply because of his disdain for African Americans. Some argued Zimmerman labeled and treated Martin as a criminal simply because he was a young African American male in a hooded sweatshirt. Yet others argued that Zimmerman could not be racist as he was also a member of a minority group himself (i.e., half Hispanic). In this chapter, we aim to shed some light on this tragic event by drawing upon theories and empirical findings from social psychology research on racial bias. More specifically, we first review two major distinct, yet clearly related, processes involved in racial bias (i.e., category-based bias and feature-based bias) and explicate how these processes can be used to explain the tragic outcomes of the Martin–Zimmerman case. We then provide an overview of measures developed and used by social psychologists to assess both types of bias, with more focus on what is called implicit measures. Finally, we conclude this chapter by discussing applications of social psychology research on racial bias to multicultural counseling. We note the current review primarily focuses on racial and ethnic biases, particularly bias toward African Americans, mainly because there are more empirical studies examining this particular form of bias in social psychology 249

research. However, some of the processes involved in category-based and feature-based bias reviewed in this chapter should be applicable to other forms of bias, such as bias toward women, sexual minorities, individuals with mental or physical disability, or individuals with obesity.

THE ROLE OF SOCIAL CATEGORIZATION IN STEREOTYPING, PREJUDICE, AND DISCRIMINATION: CATEGORY-BASED BIAS In social psychology, we consider bias as consisting of processes operating at multiple levels: cognitive, affective, and behavioral levels. Stereotyping is a cognitive level process in which people make inferences about an individual based on his or her group membership to a certain social group. Prejudice is a negative affective reaction to an individual based on their group membership, and discrimination is a behavioral reaction to an individual, again based on their belonging to a certain social group. As can be seen in these definitions of bias, research has postulated for a long time that categorizing others into social groups is a precursor to many forms of bias (Allport, 1954). Because human beings live in a complex world where they are constantly required to process large amounts of information, we have developed strategies to preserve cognitive resources (Macrae, Milne, & Bodenhausen, 1994). One such strategy is to categorize information (people, animals, objects, etc.) into meaningful groups based on certain characteristics. According to the major models of impression formation, such as the dual process model (Brewer, 1988) and the continuum model (Fiske & Neuberg, 1990), when people encounter and make judgments of a new individual, they often automatically categorize that person into a particular social group based primarily (and oftentimes solely) on visible physical features, as they have mental representations of a variety of social groups. For instance, people have concepts of how

typical men and women should look in terms of eyebrow shape, cheekbones, stubble, and hairstyle, and use them when identifying an individual’s sex (Brown & Perrett, 1993). Once people categorize the target person into a specific social group, they then form their impressions of that person based on the stereotypes associated with the social group to which the target person was categorized, as well as their attitudes toward the group. If their beliefs about and attitudes toward the social group are negative, their beliefs about and attitudes toward the target person would be also negative, resulting in category-based racial bias (Brewer, 1988; Fiske & Neuberg, 1990). Thus, although automatic categorization of people into social groups is part of normal perceptual processes that help human beings function effectively in everyday life, it can have negative consequences when impression formation is overgeneralized (Otten & Moskowitz, 2000). Bias toward African Americans can be explained using these models of impression formation. Some physical features are shared by many African Americans and more informative than other features when it comes to categorizing individuals into a social group “African American.” That is, people have mental representations of what African Americans look like in general based on commonly shared physical features. These features include darker skin and eye color, wider nose, thicker lips, and coarse hair, and they are collectively referred to as Afrocentric features (Blair, Judd, Sadler, & Jenkins, 2002). When people encounter African American individuals whom they do not know, they are likely to use Afrocentric features to automatically categorize the target person as African American. Once the target person is categorized as African American, he or she is subjected to stereotypes associated with the social group “African American” as well as negative evaluations of the group (Blair et  al., 2002; Corneille, Huart, Becquart, & Brédart, 2004; Eberhardt, Goff, Purdie, & Davies, 2004; Maddox, 2004; Maddox & Gray, 2002; see also Bodenhausen & Macrae, 1998; Fiske & Taylor, 1991). How may processes involved in category-based bias explain Martin’s case? When Zimmerman

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encountered Martin on the dark, rainy night, he saw a dark-skinned individual in a hooded sweatshirt. Zimmerman might have been likely to automatically categorize Martin as African American. Once categorized as such, Martin was likely to be subjected to stereotypes associated with a social group “African American,” which include negative attributes such as aggressive, dangerous, and criminal. Zimmerman’s attitudes toward Martin were also likely to be based on his attitudes toward African Americans. These activated stereotypes and prejudicial attitudes then affected Zimmerman’s behavior, especially as it was carried out in ambiguous (dark, rainy night) and stereotype-consistent context (the neighborhood was recently burglarized; Barden, Maddux, Petty, & Brewer, 2004).

THE ROLE OF INDIVIDUATING FEATURES IN STEREOTYPING, PREJUDICE, AND DISCRIMINATION: FEATURE-BASED BIAS Although many African Americans experience bias, even within their same racial group there is still variation in the amount of bias they experience. That is, some African Americans experience more bias than other African Americans. Such within-group variation is difficult to explain by category-based bias. Over the past decade, an increasing number of studies have started to provide strong evidence that Afrocentric features are used to not only categorize others into “African American” or “European American” groups but also to determine the degree to which individuals appear “African American” or “European American” (Stepanova & Strube, 2009, 2012a; Stepanova, Strube, & Yablonsky, 2013). This work shows that certain phenotypic features contribute to people’s perceptions how much “African American” or “European American” an individual appears. Our most recent work (Stepanova & Strube, 2012a; Stepanova et  al., 2013) indicates

that skin tone and facial features interact to impact racial categorization. Specifically, when skin tone is dark, people tend to pay attention to skin tone only, and perceive such faces as unambiguously African American. However, when the skin tone is light, people attend to facial features as well, and their racial categorization judgments are more variable. The within-group variation in Afrocentric features also affects attitudes and behaviors. For instance, African Americans with stronger Afrocentric features (dark skin and eye color, wide nose, thick lips, coarse hair) were more likely to be perceived as possessing attributes consistent with stereotypes (both negative and positive) associated with African American than African Americans with weaker Afrocentric features (light skin and eye color, narrow nose, thin lips, and soft hair; Blair, 2006; Blair, Judd, & Fallman, 2004; Blair et al., 2002; Maddox & Gray, 2002). Additionally, research has shown participants, on average, feel more negatively toward African Americans with stronger Afrocentric features than African Americans with weaker Afrocentric features (Hagiwara, Kashy, & Cesario, 2012; Livingston & Brewer, 2002; Stepanova & Strube, 2012b). Importantly, these negative perceptions of and attitudes toward African Americans with stronger Afrocentric features more frequently and intensely result in negative treatment of them. For instance, Blair, Chapleau, and Judd (2005) have demonstrated that inmates with stronger Afrocentric features (whether they were African American or European American) were more likely to receive harsher sentences than inmates with weaker Afrocentric features. Similarly, Eberhardt, Davies, Purdie-Vaughns, and Johnson (2006) found that Black male defendants with stronger Afrocentric features were more likely to be sentenced to death than their counterparts with weaker Afrocentric features when the victim was White. In fact, differential treatments of African American individuals based on physical features are further reflected in their reports of experiences with racial discrimination. Klonoff and Landrine (2000) have found that African Americans with darker skin tone reported

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experiencing racial discrimination 11 times more often and appraising their experiences with racial discrimination as more stressful as compared to those with lighter skin tone. Furthermore, several studies have shown such increased perceived discrimination often results in poorer self-reported and objectively diagnosed health (Boyle, 1970; Dressler, 1991; Hagiwara, Penner, Gonzalez, & Albrecht, 2013; Sweet, McDade, Kiefe, & Liu, 2007). Why are African Americans whose physical features are strongly associated with their racial group more likely to be subjected to negative perceptions, evaluations, and treatment? According to the attribute-based linear models of judgment (Anderson, 1981; Carroll & Johnson, 1990), people identify attributes of the target person that are relevant to the specific dimension of judgments. Then, they weigh and combine the implication of each attribute algebraically to come up with an overall judgment. Finally, people determine the degree of similarity/dissimilarity of the target person to the existing mental representation of social group “African American.” In the context of the judgment of Afrocentricity, this model suggests some African American individuals possess physical features similar to the existing mental representation of “African American” as stored in the minds of the general public more than others. They are likely to be subjected to stereotyping, prejudice, and discrimination that are associated with the social group “African American,” resulting in feature-based bias. Let’s go back to the Martin case and explore how it may be explained by processes involved in feature-based bias. Many of Martin’s pictures available online show that his appearance does present rather unambiguously strong Afrocentric features; he has dark skin, a wide nose, and coarse hair. Feature-based bias suggests Zimmerman might have automatically inferred negative stereotypes associated with African Americans (e.g., aggressive, dangerous, or threatening) as more applicable and meaningful because Martin’s physical appearance was similar to the existing mental representation of “African American” stored in Zimmerman’s mind. Once Zimmerman perceived Martin to be

aggressive and dangerous, those perceptions likely influenced his decision to shoot Martin.

MEASURING CATEGORY- AND FEATURE-BASED RACIAL BIAS Whether category-based or feature-based biases contributed to Martin’s demise, perhaps the reasons behind his murder are not rooted as much in open hatred and blatant racial bigotry but rather in more subtle (but nonetheless quite dangerous) racial biases. In social psychology, the first form of bias is commonly referred to as explicit racial bias, whereas the latter form is referred to as implicit racial bias. Due to social norms valuing egalitarianism, most people are highly motivated to be (or appear to be) egalitarian (Shelton, Richeson, Salvatore, & Trawalter, 2005; for review, see Crandall & Eshleman, 2003). Thus, when participants are asked to report their beliefs about or attitudes toward African Americans, most do report favorable attitudes toward African Americans (Dovidio & Gaertner, 1996). However, people are still aware of negative attributes that are socially attached to African Americans. Such knowledge can still influence their attitudes and behaviors toward African Americans even without their conscious awareness (e.g., Dovidio, Kawakami, Johnson, Johnson, & Howard, 1997; Fazio, Jackson, Dunton, & Williams, 1995; Greenwald, McGee, & Schwartz, 1998; Payne, 2001; Wittenbrink, Judd, & Park, 2001). Experimental evidence indicates that even African Americans have negative implicit attitudes toward fellow in-group members (Ashburn-Nardo & Johnson, 2008; Dasgupta, 2004; Goff, Eberhardt, Williams, & Jackson, 2008; Livingston, 2002). Social psychology research has consistently demonstrated that distinguishing implicit and explicit bias is critical, as they predict different types of behavior. More specifically, research has robustly documented how explicit bias (within conscious awareness) often predicts planned behaviors (e.g., verbal behaviors), whereas implicit bias (outside conscious awareness) often

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predicts spontaneous behaviors (e.g., nonverbal and paraverbal behaviors; see Hodson, Dovidio, & Gaertner, 2004, for review). Explicit bias is usually assessed with self-report measures because people are aware of such bias. There are many self-report measures aiming to assess explicit attitudes toward African Americans, such as the Modern Racism Scale (McConahay, Hardee, & Batts, 1981), Symbolic Racism Scale (Henry & Sears, 2002), and Feeling Thermometers, where participants are asked to rate their feelings for various social groups from “warm” to “cold” (Nelson, 2008). In contrast, implicit bias cannot be assessed with self-report measures as people are often unaware of such bias. To address this problem, social psychologists have developed several measures that aim to assess association between a social group “African American” and negative objects or concepts by utilizing the priming methods and reaction time assessments (for review, see Blair, 2001; Fazio, 2001; Fazio & Olson, 2003; Gawronski & De Houwer, 2014). Below, we will provide a quick review of the most popular measures tapping into implicit bias. Although the actual procedures vary by measures, generally, in these tasks, people are presented with primes representing certain social groups (commonly pictures of individual faces or lexical labels of social groups such as “African American” and “European American”) followed by, or simultaneously presented with, target stimuli such as positively or negatively valenced words/ images or stereotypic and nonstereotypic words/ images. While the target stimuli vary depending on whether the measures are designed to assess affective, cognitive, or behavioral reactions, the premise here is that the nature of the prime influences the accuracy and speed of participants’ responses to the target stimuli. One of the most commonly used measures of affective reactions and stereotypic associations is the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998; Greenwald, Nosek, & Banaji, 2003). In the Race-IAT assessing affective reactions, participants respond to items that are to be classified into four categories: two

representing social groups (e.g., African American vs. European American) and two representing valence (positive vs. negative), which are presented in pairs. The premise is that participants respond more quickly when the social group and valence mapped onto the same response are strongly associated (e.g., African American and negative) than when they are weakly associated (e.g., African American and positive). In addition to the original IAT test, there are several other variations of the test, such as the Brief IAT (BIAT; Sriram & Greenwald, 2009) and single-category IAT (SC-IAT; Karpinski & Steinman, 2006). Although they vary in length and structure, they have been demonstrated to reliably assess implicit bias (Greenwald & Sriram, 2010; Karpinski & Steinman, 2006; see for review Gawronski & De Houwer, 2014). Another popular set of measures tapping into implicit bias are affective priming or evaluative judgment tasks. One such measure is the Sequential Priming Task (SPT; Fazio et  al., 1995). The task assesses how accurately and quickly people can categorize the target words as positive versus negative when preceded by primes (e.g., African American vs. European American). Faster reaction times to negative words following a particular prime indicate more negative affective reactions to that prime type, and faster reaction times to positive words following a particular prime indicate more positive affective reactions to that prime. The target stimuli used in measures designed to assess cognitive reactions (i.e., the degree of activation of stereotypes) to African Americans are usually words either stereotype-consistent or -inconsistent (e.g., violent, athletic vs. greedy, intelligent). For instance, the Stereotype-IAT assesses how fast people respond when the social group and stereotypes mapped onto the same response are strongly associated (e.g., African American and violent or athletic), as opposed to weakly associated (e.g., African American and greedy or intelligent; Amodio & Devine, 2006). For another instance, the Lexical Decision Task assesses how quickly people can categorize a string of letters appearing on a computer screen as either actual words (e.g., VIOLENT, GREEDY)

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or nonwords (e.g., ROOR, GEEDLY) following primes (Wittenbrink, Judd, & Park, 1997). The premise here is that an individual would be faster to categorize a string of letters consistent with stereotypes of African Americans as words, as compared to a string of letters consistent with stereotypes of European Americans. Note several tasks assessing implicit bias very clearly resemble a real-life situation in which George Zimmerman found himself on the night of the shooting. While Trayvon Martin’s case is one of the most recent to grab national attention, several other highly publicized cases involved unarmed African American men mistakenly shot by police officers (e.g., Timothy Thomas, Amadou Diallo, Sean Bell, and Officer Omar Edwards). Payne (2001) has designed his Weapons Identification Task (WIT) after the case of Amadou Diallo, an African immigrant. Diallo was shot by New York City police officers who had mistaken his wallet for a gun; that research assesses associations between target groups (e.g., “African Americans”) and guns, violence, aggression, and criminal behavior or simply threat. In this task, participants are required to classify a target object (a gun or a tool) as either a weapon or a nonweapon that appears on a computer screen following a prime of either an African American or a European American face. Racial bias is indicated by (a) faster reaction times for correctly classifying a handgun as a weapon, (b) slower reaction times for correctly classifying a nonweapon (e.g., wallet) as a nonweapon, and (c) greater misclassification of a nonweapon as a handgun. In a similar task, First Person Shooter Task (FPST; Correll, Park, Judd, & Wittenbrink, 2002; Correll, Urland, & Ito, 2006; see also other tasks by Greenwald, Oakes, & Hoffman, 2003; Plant, Peruche, & Butz, 2005), participants are asked to shoot a person with a handgun and not to shoot a person with a nonweapon (e.g., a cell phone). The critical component of this task is that researchers manipulate race of the target person holding the object. Again, racial bias would be indicated by (a) faster reaction times for shooting an African American target with a handgun,

(b) slower ­reaction times for not shooting an African American target with a cell phone (participants are still required to press a key for not shooting), and (c) greater errors of shooting an African American target with a cell phone. These patterns of results suggest decisions to shoot an unarmed African American individual are driven by associations between guns and African Americans. In the context of this theory, it is plausible that in the Trayvon Martin case, Zimmerman’s decision to shoot was driven by activation of certain racial associations in mere presence of certain physiognomic cues (i.e., skin color and facial features) identifying Martin as African American. All these measures reviewed above were originally developed to assess category-based bias. However, recent studies have demonstrated that they can be modified to assess feature-based bias (Hagiwara et  al., 2012; Kahn & Davies, 2011; Livingston & Brewer, 2002; Ma & Correll, 2011; Stepanova & Strube, 2012b). For instance, Hagiwara et al. (2012) and Stepanova and Strube (2012b) assessed people’s affective reactions to African Americans with different degrees of Afrocentric features by using variations of an affective priming task. In these studies, we manipulated skin color (from dark to light) and Afrocentricity of facial features (from more to less Afrocentric) of African American faces, resulting in four subgroups of African Americans: (a) dark-skinned African Americans with more prototypical facial features, (b) light-skinned African Americans with more prototypical facial features, (c) dark-skinned African Americans with less prototypical facial features, and (d) light-skinned African Americans with less prototypical facial features. The authors have shown that European Americans do respond differently toward each subgroup. Specifically, people’s implicit affective reactions toward African American male targets were both independently affected by skin tone and facial features, indicating that certain facial cues can directly lead to featurebased bias, potentially skipping category-based bias altogether. In another study, Kahn and Davies (2011) assessed people’s behavioral reactions to African

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Americans with varying degrees of Afrocentric features by using a modified version of FPST. In this study, they had target categories representing African Americans with strong Afrocentric features and those with weak Afrocentric features. They found respondents (including African Americans) adopted a lower shooting criterion for the target with strong Afrocentric features, demonstrating that they were more willing to shoot them, either correctly or incorrectly. It is beyond our scope to provide step-by-step explanations of the procedures involved in these measures. Readers who are interested in learning how to administer these measures in their research are strongly encouraged to look at the original papers cited in this chapter for more detailed descriptions of the procedures. It should be also noted that there are a number of measures designed to assess implicit racial bias that we could not review in this chapter due to the limited space (e.g., Bargh, Chen, & Burrows, 1996; Brown, Croizet, Bohner, Fournet, & Payne, 2003; Chen & Bargh, 1997; Payne, Cheng, Govorun, & Stewart, 2005; Phelps et al., 2002; Spencer, Fein, Wolfe, Fong, & Dunn, 1998; see also for review Gawronski & De Houwer, 2014).

THEORETICAL AND PRACTICAL IMPLICATIONS OF CATEGORY- AND FEATURE-BASED BIAS FOR MULTICULTURAL COUNSELING It is well-documented that racially/ethnically concordant client-therapist interactions have more positive consequences than racially/ethnically discordant interactions (for review, see Cabral & Smith, 2011; cf. Shin et  al., 2005). The most recent meta-analysis by Cabral and Smith (2011) revealed clients prefer a therapist of their own race/ethnicity and perceive therapists of one’s own race/ethnicity more positively than therapists of other races/ethnicities; additionally, African American clients specifically receive the highest

benefits in terms of treatment outcomes in racially concordant pairs. According to the U.S. Census Bureau (2012) projections, by 2060, non-Hispanic European Americans will comprise 43% of the U.S. population (compared to 63% in 2012), while proportions of Hispanic of any race, African American, or multi-racial individuals will increase to 31% (compared to 17% in 2012), 15% (compared to 13% in 2012), and 6.4% (compared to 2.4% in 2012) correspondingly. As racial and ethnic diversity of the population increases, racially/ethnically discordant client-therapist interactions are inevitable in the future. Thus, understanding the mechanisms underlying racially/ethnically discordant clienttherapist interactions is important because they are often characterized as negative. We believe that research on category- and feature-based bias in social psychology is useful for understanding such mechanisms.

Potential Negative Consequences of CategoryBased Bias in Counseling and Its Implications Category-based bias may affect the quality of racially/ethnically discordant client-therapist relationships in at least three ways. First, category-based bias can affect European American therapists’ perceptions of and attitudes toward African American clients. Some evidence is provided by current work on racial health care disparities (for review, see Penner, Gaertner et  al., 2013; Penner, Hagiwara et al., 2013). For instance, non-African American health care providers view African American patients as less trustworthy and compliant than European American patients (Cooper et al., 2012; Moskowitz et al., 2011). Analogously, upon encountering an African American client, a non-African American therapist might perceive the patient as less trustworthy and/or compliant, even without explicit awareness. Secondly, category-based bias may also have effects on African American clients’ perceptions

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of and attitudes toward their European American therapists. For instance, research has shown that African American patients are less likely to trust their non-African American health care providers (e.g., Blair et  al., 2013; Doescher, Saver, Franks, & Fiscella, 2000; Halbert, Armstrong, Gandy, & Shaker, 2006) and show declines in trust immediately following an interaction with a non-African American physician (e.g., Gordon, Street, Sharf, Kelly, & Souchek, 2006). Similar effects may occur in racially discordant client-therapist interactions involving African American clients. Thirdly, there is a potential for bias in an African American therapist–European American client dyad. While African American counselors show more multicultural awareness than European American counselors (e.g., Granello & Wheaton, 1998) and are less likely to perceive and treat clients of various racial/ethnic backgrounds differently (e.g., Kelly & Greene, 2010; Rosenthal, Wong, Blalock, & Delambo, 2004), cultural stereotypes of and attitudes toward African Americans also affect the clienttherapist interactions and therapy outcomes when the counselor is an African American. Clients commonly apply these beliefs and attitudes to African American therapists (see Kelly & Greene, 2010). The current emphasis on training in culturally sensitive counseling (for review, see Herman et  al., 2007; Manese, Wu, & Nepomuceno, 2001) can make the general public aware of these biases and serve as the first step toward reducing negative consequences of racially discordant client-therapist interactions. However, increasing awareness might not be sufficient to eliminate the negative consequences. As we have previously reviewed, social categorization is part of normal mental processes we engage in everyday life. Because clients and therapists in racially discordant interactions are likely to differ in multiple social dimensions (e.g., race, status, power), therapists/clients are likely to automatically categorize their racial/ethnic minority clients/therapists into a different social group than theirs, even if they successfully avoided using race/ethnicity as a basis for social categorization. Therefore, it may be important to utilize training programs focusing on becoming aware

of social categorization in addition to training that educates about potential negative consequences of category-based bias. There are several approaches that can be emphasized in training programs to ameliorate the effects of category-based bias. One of the approaches employed by counselors in discordant race dyads is broaching behavior—the counselor openly invites the client to explore the topic of race and ethnicity, including how different racial backgrounds might influence the client’s counseling concerns (see Day-Vines et  al., 2007). Perhaps openly addressing consequences and mechanisms of social categorization in racially discordant therapist-client pairs is a first step in addressing the problem. This is especially important in situations when clients have also previously experienced racial biases. Besides acknowledging and validating clients’ concerns about racial profiling, counselors might need to employ certain strategies explaining the mechanisms of category-based race bias. In fact, the currently used Triad Model (see Pedersen, 1988, 2003) can be utilized for this purpose. In a team of counselors, a coached anticounselor (who makes an explicit negative message) can be trained to present how automatic and unavoidable social categorization is, while a coached procounselor (who makes an explicit positive message) can elaborate how social categorization can potentially lead to racial biases contributing to a client’s problems. Additionally, prior work on health disparities (e.g., Penner, Gaertner et  al., 2013) has shown changing mental representation of “us versus them” to “us” in racially discordant medical interaction between African American patients and European American primary care physicians by introducing a common in-group identity (a new group identity that encompasses both “us” and “them” and forms a new category, “us,” commonly through cooperation) has successfully increased African American patients’ subsequent trust in and adherence to non-African American primary care physicians. Extending these prior studies in health disparities research, we may be able to design more cost

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efficient, yet effective, interventions that are useful in counseling psychology.

Potential Negative Consequences of Feature-Based Bias in Counseling and Its Implications The quality of racially discordant client-therapist relationships is not only affected by categorybased bias but also by feature-based bias. Just like category-based bias, feature-based bias may affect both European American therapists’ and African American clients’ perceptions of and attitudes toward one another and influence the quality of client-therapist relationships. From the European American therapist perspective, feature-based bias can affect attitudes and behaviors toward their African American clients (i.e., non-African American therapists reacting more positively to African Americans with weak Afrocentric features than to African Americans with strong Afrocentric features), which is also predominant in the African American community at large (Russell, Wilson, & Hall, 1992; Spickard, 1989). While the effects of skin color have been addressed in the context of therapist-client dyadic relationships (e.g., Hall, 2010; Tummala-Narra, 2007), effects of other features on racial bias have been rarely discussed. Turning to African American clients’ perspectives, feature-based bias may affect African American clients’ expectations about their European American therapists. As research has shown, African Americans with stronger Afrocentric features do perceive greater discrimination than their counterparts with weaker Afrocentric features (Hagiwara et al., 2013; Klonoff & Landrine, 2000). African American clients with stronger Afrocentric features may be less open to European American therapists than African American clients with weaker Afrocentric features. The negative consequences of feature-based bias have been also observed in racially concordant client-therapist relationships between African American clients and African American therapists.

More specifically, Kelly and Greene (2010) have shown dark-skinned African American clients do not trust light-skinned African American therapists. This might be due to sentiment of anger and jealousy toward African Americans with lighter skin tone in African American communities, possibly due to the more favorable treatments such individuals historically received from European Americans (Kelly & Greene, 2010; Russell et  al., 1992; Spickard, 1989). Analogously, in racially discordant African American therapist-European American client dyads, feature-based bias can also have an impact on the quality of client-therapist relationships (e.g., European American clients reacting more positively to African American therapists with weak Afrocentric features than to African American therapists with strong Afrocentric features). While the effects of Afrocentric features on client-therapist relationships have not been addressed empirically, the effects of skin tone, hair structure, and hairstyle in clients’ perception of African American therapists are documented (Kelly & Greene, 2010). How do we reduce the negative consequences of feature-based bias? At this point, our suggestions for intervention are fairly limited. Research on feature-based bias is in its infancy, and the majority of the existing studies are primarily focused on describing the effects of such bias. Very few studies systematically examine the mechanisms involved in feature-based bias. In one study examining the effects of explicit education about the negative consequences of feature-based bias on people’s reactions to African Americans (Blair, Judd, & Fallman, 2004), researchers informed European American participants that psychological research has found that people use facial features to make judgments of other people resulting in stereotyping and prejudicial attitudes. Then, they gave explicit instructions to avoid using stereotypes associated with Afrocentric features when making inferences about African American individuals with a varying degree of Afrocentric features. They found participants, even with the explicit instructions, judged African American men with stronger Afrocentric

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features as significantly more stereotypic of African Americans than those with weaker Afrocentric features. This study clearly demonstrates how education alone cannot reduce the negative consequences of feature-based bias. As we discussed before, more research examining the mechanisms of feature-based bias is needed to design effective interventions.

CONCLUDING REMARKS In this chapter, we provided brief reviews of two major forms of social bias—category-based bias and feature-based bias—and demonstrated how these distinct yet interrelated processes can explain issues involved in interactions between African Americans and non-African Americans (mainly European Americans). While we are concluding writing this chapter, the whole country is watching Ferguson, Missouri. Michael Brown, an unarmed African American teenager, was shot by a White police officer, Darren Wilson, which led to protests and civil unrest. Some eyewitness accounts indicate that Officer Wilson fired several shots at the teenager who appeared to surrender after attempting to flee (Kohler & Patrick, 2014). Many question why Darren Wilson did not simply Taser Michael instead of using lethal force. While many individuals in the United States are saddened by this tragic incident, the Brown–Wilson case is only one of several recent incidents involving an unarmed Black individual mistakenly shot and killed by a White police officer. Although the Brown–Wilson case is still undergoing extensive investigation and the full picture of what really

happened is not understood, one of the reasons behind the shooting of Michael Brown may be psychological processes involved in the Martin– Zimmerman unfortunate case as we discussed earlier. These events of unarmed Black victims of police shootings that have been happening repeatedly throughout our American history underscore the importance of educating the public and counseling professionals how two forms of social bias described in this chapter can be strongly associated with such disastrous outcomes. In this chapter, we also aimed to inform counseling psychologists how these forms of bias are assessed in social psychology research and how the findings from such research can inform their work. Social psychology research on racial bias has very important theoretical and applied implications in counseling psychology. Besides describing the potential negative consequences of category- and feature-based bias on racially/ethnically discordant client–therapist relationships, it identifies roots and mechanisms of such bias and provides insights into developing effective interventions to improve the quality of racially/ethnically discordant clienttherapist relationships. In fact, an increasing number of studies in health disparities research started to systematically investigate the effects of both category- and feature-based bias on the quality of racially discordant medical interactions (see Penner, Hagiwara et al., 2013). As there are some similarities between patient–physician relationships and client–therapist relationships, we believe bridging social psychology research of racial bias and counseling psychology is a promising area of research for multicultural psychology.

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CHAPTER

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Psychological Assessment A Brief Examination of Procedures, Frequently Used Tests, and Culturally Based Measures Lisa A. Suzuki, Elsa Lee, and Ellen L. Short

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ssessment is one of the major cornerstones of psychological practice. Interviews, observations, projectives, norm-referenced, and criterion-referenced tests are critical tools used to inform diagnosis, educational intervention, treatment planning, and the operationalization of psychological constructs in empirical research studies. The appropriateness of commonly employed assessment practices with members of diverse racial, ethnic, and cultural groups has been repeatedly challenged in the literature (e.g., Suzuki & Ponterotto, 2007). This chapter highlights some of the cultural implications in the use of mainstream assessment instruments (i.e., personality, intelligence, and vocational interest) and some measures designed to address culturally based constructs (i.e., acculturation, ethnic identity, racial identity, spirituality, and racism).

CULTURE AND TRADITIONAL ASSESSMENT PRACTICE Psychological assessment includes the synthesis and analysis of information from multiple informants (e.g., parents, teachers) and often incorporates multiple domains of functioning (e.g., intelligence, personality). We highlight cultural implications throughout the assessment process that can inform case conceptualization and treatment planning including the clinical interview, behavioral observations, formulation of a diagnosis, and use of psychological measures.

Clinical Interview Information obtained from the clinical interview forms the contextual backbone of the assessment. The clinical or intake interview is often conducted during the initial meetings with clients and/or families

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and informs subsequent diagnostic and treatment decisions (Wiger & Huntley, 2002). The interview is more than mere “information gathering,” as it offers valuable clinical information beyond what can be extracted via self-report measures and/or formal psychological testing procedures; the clinical interview is the backbone of the evaluation and may inform next steps in the assessment process, including the selection of appropriate assessment measures and procedures. Clinical interviewing requires psychologists to demonstrate cultural competence in initially developing rapport and as they form a trusting relationship with the client. If not done effectively, clients who have doubts about treatment may not return. This is especially applicable to members of marginalized and oppressed minority groups that have a historically higher attrition rate from mental health services than their White counterparts (Reis & Brown, 1999; S. Sue, 1977; S. Sue & Morishima, 1982). Clinical inquiry with members of marginalized and oppressed racial and ethnic groups is an essential medium for gathering data on the client’s psychological, medical, social, and cultural background (McKitrick, Edwards, & Sola, 2007; Ridley, Li, & Hill, 1998). The challenge of conducting an effective multicultural clinical interview includes the awareness of potential cultural barriers, which include socioeconomic status, communication, language, stigma, mistrust, racism, and clinician bias in judgment (Aklin & Turner, 2006; Alcántara & Gone, 2014). The concept of dynamic sizing applies here as the clinician makes judgments to consider knowledge regarding group membership while taking into consideration the unique context of the individual (S. Sue, 1998). Failure to account for cultural variability often leads to inaccurate diagnostic inferences and case conceptualization (D. Sue & Sue, 1987). Semistructured interviews are considered more preferable than free-flowing or structured interviews (Aklin & Turner, 2006). The purpose of using semistructured interview protocols is to reduce variance and improve clinical validity and reliability

(Lesser, 1997), as they provide the flexibility that allows clinicians to clarify with follow-up questions when cultural concerns arise.

Diagnosis Although there are shared clinical expressions and universality in many psychiatric disorders, there is also robust evidence suggesting significant variance in the sources and manifestation of psychopathology among different ethnic and racial groups (Draguns & Tanaka-Matsumi, 2003; Okazaki, 1997). For example, differences in somatization were found (Kirmayer, 1984; Kirmayer & Young, 1998) as individuals from Asian and Hispanic backgrounds were more likely to attribute emotional symptoms to organic factors (Angel & Guarnaccia, 1989; S. Sue, Wagner, Davis, Margullis, & Lew, 1976). Incorporation of the cultural framework of psychopathology during the interview process is crucial in identifying possible culturebound syndromes that are common to indigenous healers but may be otherwise misinterpreted or overlooked in the contexts of western mental health services (see American Psychiatric Association, 2013, DSM-5 Appendix X). Systemic efforts to enhance the cultural validity of diagnostic and psychological testing practices have been identified over the past decade. The American Psychological Association (APA) developed a set of multicultural guidelines focusing on training, research, education, practice, and organizational change (APA, 2003). Guideline 5 specifically addresses assessment in clinical practice. The DSM-5 (American Psychiatric Association, 2013) includes the consideration of cultural knowledge throughout the text (i.e., cultural formulation guidelines and a glossary of culture-bound syndromes). In addition, DSM-5 contains the Cultural Formulation Interview (CFI). The CFI consists of 16 standardized questions organized in four s­ections addressing the cultural definition and perception of the cause of the problem, as well as cultural factors that affect the support, coping system, and help-seeking

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behaviors. Explicit questions are included to guide the clinician’s investigation with clear probes and directions that allow for additional data collection when necessary. Other efforts to emphasize multicultural considerations in the assessment process include the Multicultural Assessment Procedure (MAP; Ridley, Li, & Hill, 1998); the Person-in-CultureInterview (PICI; Berg-Cross & Chinen, 1995); and the Cultural Assessment Interview Protocol (CAIP; Grieger, 2008). The MAP constitutes a comprehensive framework to inform the role of culture in assessment. In the context of clinical interviewing, Ridley, Li, and Hill (1998) proposed that clinicians utilize the clients’ expertise to collect and clarify any data pertinent to their specific cultural background when clinicians are unfamiliar with the clients’ culture. The PICI and CAIP are open-ended interview protocols that guide the acquisition of cultural information. These tools can be used with clients and/or collaborative sources (e.g., guardians) when clients are unable to present a full picture of their symptoms and may desire to include other members of their support system in the treatment process.

Behavioral Observation Behavioral observation has a long history in clinical practice (Wasik, 1984) and offers valuable qualitative information that is expressed during clinical interviewing, assessment, and treatment. Observations include both verbal and nonverbal behaviors, and clinical information can be derived based upon the presence or absence of certain manifestations—eye contact, bodily and facial expressions, physical appearance, behavior during session, as well as the level of cooperation. Other observations include congruence between reported mood and affect, expressions of thoughts and feelings, and speech and verbal expressions. Clinical judgments are frequently made based on an individual’s presentation. Any discrepancy in verbal or nonverbal behavior and findings on formal assessment becomes the basis for the clinicians’ further

inquiry and may lead to modifications in client conceptualization. It is essential to consider the role of culture when making clinical decisions based on behavioral observations. While interpretations of verbal and nonverbal behaviors are based heavily upon the experience and theoretical orientation of the clinicians (D. Sue & Sue, 1987), the understanding and implications of these behaviors are mediated by the cultural expectations of the assessment relationship. A Black client who sporadically stares away and avoids eye contact may be interpreted as avoidant and uncooperative if the cultural context is not considered. A client of Asian descent who demonstrates minimal facial expression and fails to volunteer personal information readily during an interview may be perceived as flat, withdrawn, and resistant. The “irrepressible impact” (DePaulo, 1992, p. 205) of a client’s nonverbal behaviors highlights the importance of taking extra precaution when interpreting any nonverbal forms of communication within the appropriate cultural context. Eye Contact. The meaning attached to eye contact has been examined in relation to different racial and ethnic groups. A number of researchers have found that Blacks showed less visual interaction and maintained briefer glances or more gaze aversions in conversations and interview settings compared to Whites (Lafrance & Mayo, 1976). One argument for this finding is that Blacks are more likely to utilize other forms of impression management through kinetic, paralinguistic channels (Fugita, Wexley, & Hillery, 1974). Gaze avoidance is observed in certain East Asian cultures because direct and excessive eye contact may suggest rudeness (Argyle & Cook, 1976), a challenge, and an invasion of privacy. The social expectation that eye contact should last anywhere from 3–10 seconds (Argyle & Dean, 1965) may therefore not be applicable and relevant to certain minority groups. One can easily miss or distort the implications of eye contact (or the lack of it) in a clinical context when cultural meanings are not considered.

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Facial and Bodily Expressions. Because our nonverbal and bodily postures tend to reflect our affective states (Mehrabian & Friar, 1969), clinicians are trained to pay close attention to the way one presents himself or herself in a clinical context. While there is evidence supporting the argument that basic facial expressions of emotions are universal (Ekman, 1993; Frijda, 1988), Russell (1994) explained the role of cultural variability and how certain expressions may not be permitted in particular cultural groups, rendering specific emotions culture-dependent. For instance, certain collectivistic cultures (e.g., Japanese) tend to exert more control over their emotional display with friends and family than Americans (Matsumoto, Takeuchi, Andayani, Kouznetsova, & Krupp, 1998). Other studies have questioned the universality of emotional recognition across cultures, as it was found that persons from individualistic cultures are more likely to rate and recognize negative emotions accurately (e.g., anger and fear) than their counterparts from collectivistic cultures (Matsumoto, 1989, 1992). Ekman and Friesen (1974) argued that it is the quantity (or intensity) not the quality of emotions that can be observed, implying that no specific facial/bodily gestures can accurately inform how a person is feeling but only how much of the emotion he or she is feeling (Wallbott, 1998). These findings challenge to some extent the clinical utility of making diagnostic impressions based on emotional display and its congruence with the clients’ reported mood, as they could be subject to error when cultural variables are not considered. It is therefore essential for clinicians to develop the skills in furthering their inquiry when significant incongruence between subjective mood and observable affect are noted. Language/Speech. Speech/language is another important domain that is observed when clinicians conduct assessments. As with other forms of behavioral observations, verbal expression is a domain that can be subject to cultural misinterpretation. D. W. Sue and Sue (1977) commented that because the acquisition and adept use of language are highly prized assets in Western society

and other individualistic cultures, the emphasis on language alone constitutes grounds for inaccurate clinical impressions. They further argued that brief, unelaborated verbal responses of minority clients may be perceived as repressed and uncooperative, even though verbal self-expressions and speech are not commonly encouraged in some collectivistic cultures (Kim & Sherman, 2007) and often represent the cultural norm. Other studies have shown that Blacks tend to be less responsive to feedback from Whites in social interactions, a phenomenon known as disengagement, which is a strategy to prevent one’s self-worth from being dependent on feedback received during an interaction (Dovidio, Hebl, Richeson, & Shelton, 2006; Major, Quinton, & McCoy, 2002). Such a communication pattern may simply reflect a coping response from systemic oppression and anticipated bias rather than a psychopathology. These findings suggest that reliance on an etic approach in the interpretation of speech/verbal expression may result in flawed judgment and treatment of minority groups.

PSYCHOLOGICAL MEASURES The most frequently used psychological measures have remained the same for 50 years (Camara, Nathan, & Puente, 2000). Based on Camara et al.’s survey of test usage, the top 10 instruments identified included the Wechsler adult and child intelligence tests (e.g., Wechsler, 2008, 2014), Minnesota Multiphasic Personality Inventory (MMPI; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), Rorschach Inkblot Test (Rorschach, 1921), Thematic Apperception Test (TAT; Murray, 1943), and the House-Tree-Person (Buck, 1948). Our goal is not to comprehensively review these measures from a cultural perspective since this has been done extensively in other publications (e.g., Cheung, 2009; Dana, 2000; Suzuki & Ponterotto, 2007). Rather, our goal in the following sections is to provide brief highlights and a discussion of cultural implications regarding test usage with respect to these measures of personality, intelligence, and vocational interest.

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Personality Tests Understanding the cultural application of personality measures continues to be an important part of a comprehensive psychological evaluation including both projective and objective measures. In this section, we will review the MMPI-2, the TAT, and the Rorschach. MMPI-2. The MMPI-2 is the most widely used psychodiagnostic instrument in the United States (cited in Kwan & Maestas, 2008). It is estimated that there exist approximately 150 language versions of the original MMPI and 33 translations of the MMPI-2 revision (Butcher, Cabiya, Lucio, & Garrido, 2007). The MMPI was originally developed as an etic measure, developed in a European American context, and was not originally designed to be sensitive to ethnic and cultural differences (Hall & Phung, 2001; Kwan & Maestas, 2008). Scholars anticipated that the MMPI items would be difficult to translate and adapt culturally given the culture-bound content (e.g., religion). However, over time, this instrument gained favor among psychologists and is commonly used to assess diverse racial and ethnic minority populations. GrothMarnat (2009) has emphasized the need for further study, including attention to ethnic group differences, language, acculturation, perceived minority status, and individual perceptions of discrimination to avoid the potential overpathologizing of members of marginalized and oppressed racial and ethnic minority groups (Ghafoori & Hierholzer, 2010; Ketterer, Han, Hur, & Moon, 2010). One of the few culturally and empirically based objective measures of personality is the Chinese Personality Assessment Inventory (CPAI; Cheung et al., 1996). This measure was developed to address gaps in culturally relevant constructs in translated measures (e.g., from American instruments) and uses a combined emic-etic approach to address the need for the application of indigenously derived measures. TAT. The TAT was developed based on Murray’s (1943) concepts of personality. The TAT has been

used as a technique to facilitate the process of self-revelation during the early stages of therapy. The process of the client’s storytelling revealed their drives, emotions, sentiments, complexes, and conflicts (Costantino, Flanagan, & Malgady, 2001; Murray, 1938). Concerns regarding the TAT’s reliability and validity (e.g., as a result of the lack of clarity regarding scoring and interpretation of results) have been raised given that it is interpreted based upon clinical judgment, as with most projective tests. However, the TAT has been used more recently to assess immigrant children (SuárezOrozco, Suárez-Orozco, & Todorova, 2008). Tell-Me-A-Story (TEMAS; Costantino, Malgady, & Rogler, 1988). The TEMAS is sometimes referred to as a cross-cultural TAT. This projective test requires children and adolescents ages 5 to 13 to respond to a series of pictures depicting multicultural stimuli—minorities and nonminorities. The cards specifically pull for problem solving, and normative data is available for Black, Puerto Rican, other Hispanic, and White children. Rorschach. The Rorschach (1921), although originally designed as a projective method, is a performance-based test of personality functioning that is based on interpreting an individual’s responses to 10 bilaterally symmetrical inkblots. The central thesis of Rorschach interpretation is the process by which individuals organize their responses to the assessment. Supposedly, such responses are representative of the ways in which they confront other ambiguous situations that require organization and judgment (Exner, 1993; Groth-Marnat, 2009). The Rorschach Comprehensive System (Exner & Erdberg, 2005) has been proposed as a culturefree assessment because of its use of inkblots as test stimuli, which are ambiguous enough to eliminate most cultural bias (Ritzler, 2001). Data suggested that normative differences were not great across cultures; thus, norms developed in the United States “probably can be used to assess results from other cultures” (Ritzler, 2001, p. 238). Scholars cite the need for more appropriate culture-specific PS YCHOLOGI C AL ASSESSM ENT

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norms (Costantino, Flanagan, & Malgady, 1995; Ritzler, 2001) noting the potentially important role of acculturation and language as they impact response patterns (Esquivel, Oades-Sese, & Olitzky, 2008). Costantino et al. (1995) further cited the lack of research available to determine if the Rorschach Comprehensive System is biased in terms of mean differences, factor invariance, differential validity/ regression, and measurement equivalence, thus making generalization of norms problematic. The authors indicated that the development of culturespecific norms would provide a potential solution to these problems. House-Tree-Person (HTP). The HTP (Buck, 1948) has been identified as a useful projective device that uses the respective drawings of the individual child as representations of conscious and subconscious processes and symbolic representations of feelings, conflicts, and needs (Esquivel et  al., 2008). Differences in children’s drawings have been attributed to age, cultural background, gender, and personal history. The popularity of drawing tests has been maintained despite concerns regarding the lack of norms and concerns regarding reliability and validity. Esquivel et al. noted that the “application of the H-T-P as a culturally sensitive technique remains controversial” (p. 354).

Intelligence Tests One of the most consistent findings in social science research has been racial and ethnic group differences in scores obtained on cognitive ability tests. Group differences in intelligence test scores have placed East Asian and some Jewish groups (e.g., Ashkenazi) higher than Caucasians, and African Americans at approximately one standard deviation below Caucasians (15 points), with Latino/as scoring in between (Mainstream Science on Intelligence, 1994). The Wechsler Scales. Despite challenges of cultural bias and cultural loading, the Wechsler scales have continued to be the gold standard of intellectual

assessment. In order to address potential sources of bias, the Wechsler scales have used expert review panels, racial and ethnic oversampling, and inclusion of statistical practices to address forms of cultural equivalence. The Wechsler scales have also been exported to other countries and been translated, renormed, and restandardized (e.g., Georgas, Weiss, van de Vijver, & Saklofske, 2003). Reliability and validity of the measures have been studied in the new cultural contexts. The complexities of application of these measures, however, are not easy to solve. For example, the Spanish version of the test developed in a Spanish-speaking country may not be suitable for a Spanish speaker in the United States.

Vocational Interest: Strong Interest Inventory Assessment of vocational interests is critical to the exploration of educational and vocational options (Jackson, Holder, & Ramage, 2008). Most measures in this area are based upon Holland’s (1973) conceptual model comprised of six occupational themes—Realistic, Investigative, Artistic, Social, Enterprising, and Conventional (RIASEC). Strong Interest Inventory (SII; Harmon, Hansen, Borgen, & Hammer, 1994). One of the most frequently used and psychometrically established vocational measures is the Strong Interest Inventory that assesses career-related interests for individuals 14 years and above. The SII is an empirically derived RIASEC assessment (Consulting Psychologists Press, n.d.). Historically, much of the research on the SII employed Caucasian samples; however, more recent studies have indicated “good support” for its usage with members of diverse U.S. ethnic groups (Subich, 2005, p. 401). There are indications that the location of interests (e.g., RIASEC) may differ between particular racial and ethnic groups. For example, interests for Asian Americans as a group seem to closely align with those of Caucasian Americans, whereas those of African Americans were found to be more similar to Hispanic Americans.

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CULTURALLY BASED ASSESSMENT TOOLS A number of assessment measures have emerged in the literature in the past 20 years addressing culturally based constructs. These include acculturation, racial identity, and ethnic identity. A comprehensive literature search of PsycINFO was conducted utilizing the key terms racial identity, ethnic identity, and acculturation alone and in combination with various racial and ethnic group identifiers (i.e., Hispanic, Latino/a, Asian, Asian American, Black, African American, American Indian/Native American, and White/Caucasian). This search identified the existence of 11 acculturation scales, 13 ethnic identity scales, and 8 racial identity scales (Suzuki, Rodriguez, Onoue, & Ahluwalia, 2011). In addition, other areas of assessment in the areas of religion/spirituality, racism, and minority stress have also emerged in the research literature. In this section, due to space constraints, we highlight only a few measures, taking into consideration representation of various racial and ethnic groups in each of these categories to illustrate some of the features of these measures.

Ethnic Identity Numerous definitions of ethnic identity exist in the literature. In general, however, ethnic identity refers to an aspect of an individual’s social identity in relation to the value and emotional significance of membership in a particular ethnic group (Phinney, 1992). Thus, an individual may make decisions about the role of ethnicity in their lives regardless of their involvement in their ethnic community. The measures in this area often address the group members’ retention of cultural characteristics related to behavior and ideology as well as their internal experience of their ethnic identity (Suzuki et al., 2011). Multigroup Ethnic Identity Measure (MEIM; Phinney, 1992). The MEIM is a 15-item measure designed to address linear stages of development

and achievement based upon the components of self-identification and ethnicity (committed ethnic identity via identity achievement), ethnic behaviors and practices (related to one’s own ethnicity), and belonging (affirmation from one’s own ethnic group). The commonalities between cultures are believed to serve as the foundation of the scale. Thus, the MEIM examines the role of ethnic identity across groups, and therefore is limited in its application to culture-specific factors (Fischer & Moradi, 2001). East Asian Ethnic Identity Scale (EAEIS; Barry, 2002). The EAEIS is a 41-item scale designed to address the complexities of East Asian ethnic identity, including common ethnic group factors such as affirmation and belonging, as well as specific ethnic group identity factors (e.g., indigenous family values). Three subscales were derived based upon factor analysis: family values (Confucian-based and emphasize obligation to others), ethnic pride (language, sense of belonging to a larger East Asian group and recognition of the uniqueness of native language), and interpersonal distance (“transcended importance of friendship and included reluctance to stand out in a group and interact with strangers” [Barry, 2002, p. 92]). Bicultural Ethnic Identity: American Indian Adolescents (Moran, Fleming, Somervell, & Manson, 1999). This measure was designed to address two worlds—the Indian culture and the mainstream or White culture. The items for this scale were based upon the Bicultural Ethnic Identity Scale (Oetting & Beauvais, 1991) and expanded to include items addressing current family cultural activities, future personal involvement in cultural traditions, language use in childhood home, and importance of religious or spiritual beliefs. Internal-External Ethnic Identity Measure (IntExt Id; Kwan & Sodowsky, 1997). The 47-item IntExt Id measure combined numerous frameworks addressing internal and external aspects of ethnic identity. These included specific ethnic behaviors and practices (external), and pride and attachment

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to one’s racial/ethnic group (internal). Factor analysis of the scale yielded the ­following: Ethnic Friendship and Affiliation, Ethno-Communal Expression, Ethnic Food Orientation, and Family-Collectivism based upon a Chinese American immigrant sample (Kwan, 2000). The author noted that these factors are also found in measures of acculturation.

and intolerance for other groups”), pseudoindependence (“intellectualized commitment to one’s own socioracial group and deceptive tolerance of other groups”), and autonomy (“informed positive socioracial-group commitment, use of internal standards for self-definition, capacity to relinquish the privileges of racism”; Helms, 1995, p. 185).

Racial Identity

Acculturation

Racial identity refers to an individual’s perception of a collective or group identity based upon a common heritage with a particular racial group (Helms, 1995). A number of racial identity measures have been developed, and we provide brief descriptions of a few of these measures.

Acculturation is a multifaceted and bidimensional construct, and measures of this dynamic process assess the process of change and adaptation that individuals experience as a result of contact with different cultural groups (Rivera, 2008).

Revised-Multidimensional Inventory of Black Identity (R-MIBI; Sellers, Rowley, Chavous, Shelton, & Smith, 1997). Based upon the Multidimensional Model of Racial Identity, the R-MIBI is a 51-item scale assessing three stable dimensions of African American racial identity: Centrality (“a person’s proclivity to define her or himself in terms of race”), Ideology (“individual’s beliefs, opinions, and attitudes with regard to the way she or he feels that the members of the race should act”), and Regard (“a person’s affective and evaluative judgment of her or his race”; p. 806). Seven subscales are reported with respect to the original MIBI: Centrality, Regard (subscales Private and Public), and Ideology (subscales Assimilationist, Humanist, Nationalist, Oppressed Minority). White Racial Identity Attitude Scale (WRIAS; Helms & Carter, 1990). The WRIAS is a 50-item scale designed to assess attitudes related to the statuses of White racial identity development. The five statuses are contact (“satisfactions with racial status quo, obliviousness to racism and one’s participation in it”), disintegration (“disorientation and anxiety provoked by unresolvable racial moral dilemmas that force one to choose between owngroup loyalty and humanism”), reintegration (“idealization of one’s socioracial group, denigration

Bicultural Acculturation Scale for Hispanics (BAS; Marín & Gamba, 1996). The BAS is a 24-item measure designed to address three language-related areas as well as language use (frequency of English or Spanish use), linguistic proficiency (how well the person responding spoke, read, understood, and wrote English and Spanish), and electronic media (frequency of use of electronic media—radio, television, music—in English and Spanish). A Short Acculturation Scale for Hispanics (ASASH; Marín, Sabogal, Marín, Otero-Sabogal, & Perez-Stable, 1987). The ASASH is a 12-item questionnaire designed to measure three areas of acculturation: language use and preference at work, at home, and with friends; language use and preference in media (i.e., TV and radio); and preferred ethnicity of individuals in which the person forms social relationships. The ASASH has been adapted using back translation methods for use with Filipino Americans (A Short Acculturation Scale for Filipino Americans; dela Cruz, Padilla, & Agustine, 2000). African American Acculturation Scale (AAMA; Landrine & Klonoff, 1994). The AAMA is a 74-item scale designed to address dimensions of African American culture represented by 8 subscales—Preference for African American Things (e.g., games, music, reading materials); Traditional

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Family Practices and Values (e.g., lending money, living arrangements); Traditional Health Beliefs, Practices, and Folk Disorders (e.g., healing from illness); Traditional Socialization (e.g., membership and activities in a Black church); Traditional Foods and Food Practices (e.g., cooking ham hocks, collard greens); Religious Beliefs and Practices (e.g., belief in Holy Ghost, speaking in tongues); Interracial Attitudes (e.g., discrimination); and Superstitions (e.g., belief in superstitious behaviors and beliefs).

The relationship between spirituality and psychological well-being has been broadly studied, with solid evidence demonstrating an inverse association with depressive symptoms (Koenig, George, & Titus, 2004; Nelson, Rosenfeld, Breitbart, & Galietta, 2002) and anxiety (McCoubrie & Davies, 2006), and a positive correlation with self-esteem (Krause & Van Tran, 1989), subjective well-being (Green & Elliott, 2010), and overall mental health status (Williams, Larson, Buckler, Heckmann, & Pyle, 1991).

Asian American Multidimensional Accul­turation Scale (AAMAS; Chung, Kim, & Abreu, 2004). The items of the AAMAS were adapted from the Suinn-Lew Asian Self Identity Acculturation Scale (SL-ASIA; Suinn, Rikard-Figueroa, Lew, & Vigil, 1987) and converted to a multilinear format requiring respondents to rate each item with respect to their culture of origin, other Asian Americans, and European Americans. Thus, the AAMAS is comprised of three 15-item scales—AAMAS Culture of Origin, AAMAS-Asian American, and AAMASEuropean American. The scales are designed to measure four acculturation domains of cultural identity, language, cultural knowledge, and food consumption.

Spiritual Well-Being Scale (SWBS). The spiritual well-being scale is a 20-item measure with two subscales that taps into the religious, existential, and overall spiritual well-being of an individual (Ellison, 1991; Paloutzian & Ellison, 1982). This measure was developed to assess the vertical and horizontal nature of spiritual well-being, with the vertical dimension referring to one’s spiritual well-being in relation to God and the horizontal component capturing one’s satisfaction and sense of purpose in life. Although this scale has been widely used in clinical and research settings with heterogeneous samples, studies showed that the factorial construct validity of this scale is not well-supported (Ledbetter, Smith, Fischer, & Vosler-Hunter, 1991a). Other critiques include the presence of a ceiling effect, limiting its clinical utility to low scores (Ledbetter, Smith, VoslerHunter, & Fischer, 1991b), although such findings were not supported in another study that investigated the clinical usefulness with a psychiatric inpatient population (Scott, Agresti, & Fitchett, 1998). Racial differences were also demonstrated in the underlying factor structure of the scale, such that a five-factor SWBS model best fit the African American sample while a three-factor SWBS model best fit the White sample (Miller, Fleming, & Brown-Anderson, 1998).

Spirituality Spirituality is an intricate construct that can be defined in various ways and explained in multiple dimensions. According to Prest and Keller (1993), spirituality represents the individual’s drive to search for meaning within the self and in relationships with other people, as well as connections with a transcendent object. Walsh-Bowers (2000) and Emmons (1999) posited that spirituality is associated with having a transcendent relationship with something that is sacred in life or something divine beyond the self, which influences the way he or she interprets faith, love, trust, suffering, and a higher power. It also serves as a guide to a person’s view of the self and the world (Beuscher & Beck, 2008).

Spirituality Assessment Inventory (SAI; Hall and Edwards, 1996). The SAI is a 49-item measure of spirituality that consists of five factors: awareness of God, disappointment in relationship with God,

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realistic acceptance of God, grandiosity in relationship with God, and instability in relationship with God. Correlations of the five factors with the Bell Object Relations Inventory were performed, and findings supported the validity of SAI as well as its clinical usefulness for assessment and research purposes. No racial/ethnic studies have been conducted to examine its validity with minority communities.

Racism and Minority Stress Experiences of racism have been identified as traumatic and a rationale for the development of post-traumatic stress disorder among African Americans, Latino/as, Asian Americans, and Native Americans (Helms, Nicolas, & Green, 2012). A number of scales have been developed to assess experiences and reactions to racist events. Index of Race-Related Stress-Brief Version (IRRS-B; Utsey, 1999). The IRRS-B is a 22-item multidimensional measure of race-related stress focusing on the experiences of African Americans. Three factors are addressed: cultural, institutional, and individual encounters with racism. Race-Related Events Scale (RES; Waelde et  al., 2010). The RES is a 22-item checklist that addresses lifetime exposure to race-related stressors. The items focus on exposure to events including exposure to threat of injury or death to self or others and fear, helplessness, or horror during a race-related stressor. Race-Based Traumatic Stress Symptom Scale (RBTSSS; Carter et al., 2013). The purpose of the RBTSSS is to address psychological and emotional stress reactions to racism and racial discrimination. The 52-item measure has seven subscales—Depression, Anger, Physical Reactions, Avoidance, Intrusion, Hypervigilance/Arousal, and Low Self-Esteem. Schedule of Racist Events (SRE; Landrine & Klonoff, 1996). The SRE was developed to examine

racist discrimination among African Americans. The 18-item scale assesses racist discrimination in the past year as well as over the respondent’s lifetime and examines the extent to which these racist events were perceived (appraised) as stressful.

CONCLUSION Psychological assessment constitutes one of the mainstays of our profession. Use of the various measures covered in this chapter can enable the clinician to obtain vital information to enhance understanding of an individual’s background, personality, ability, spiritual life, and experiences of racial discrimination. The clinical interview continues to form the backbone of the assessment, as critical information regarding the context of the individual’s life are obtained through this questioning process. The interview should include attention to critical issues embedded in cultural interview protocols cited. In addition, observed behaviors must be understood within the respondent’s cultural context. The most popular tests continue to be used frequently in our profession. This chapter highlights cultural issues that must be considered in selecting and interpreting test findings. A growing number of ethnic identity, racial identity, acculturation, spirituality, and racism scales have emerged in the literature to enhance understanding of the individual’s life in context. Cultural competence in assessment requires clinicians to be ever vigilant in the selection, administration of psychological measures, and interpretation of test results in order to ensure the fair and just treatment of persons from diverse cultures. Future directions in this area include the continued proliferation of measures addressing a multitude of psychological variables, expansion of norming samples to include members of diverse communities, inclusion of statistical procedures to address potential bias, attention to the impact of cultural factors in graduate training, and consideration of culture throughout the assessment process (e.g., selection of instruments, use of translators and interpreters, and interpretation of test results).

2 6 8       C u r r e n t a n d F u t u r e Trends i n M ulti cultur a l Counseli ng Resea rch

PART

V

Emerging Issues and Movements in Multicultural Counseling Psychology

T

he 10 chapters included in Part V reflect two of the major objectives inherent in the Handbook: (1) to give emphasis to current cutting-edge challenges and progress in multicultural counseling research and (2) to increase the competence of researchers, educators, and practitioners to study, assess, understand, and intervene with multicultural persons. The chapters address critical areas that have emerged in the literature on multicultural counseling, including positive psychology, spirituality, international engagement, technology, interdisciplinarity, violence, and trauma. In the chapter titled “Multicultural Positive Psychology: Cultural Perspectives of the Good Life,” Flores, Edwards, and Pedrotti highlight the importance of understanding the impact of culture in the advancement of multicultural positive psychology in training, practice, and future directions for the field. Their chapter also addresses the origins and roots of the positive psychology movement and its impact on diverse communities. Comas-Diáz begins her discussion of “Multicultural Spirituality: A Syncretistic Approach to Healing, Liberation, and Social Justice” by providing a brief overview of religions prevalent among diverse communities. Many people of color endorse a multicultural syncretistic spirituality to cope with life and to struggle against oppression. The promotion of empowerment, liberation, and social justice are noted as this chapter explores the potential impact of multicultural spirituality on clinical practice. The chapter by Consoli, Bullock, and Consoli, “International Engagement in Counseling and Psychology: History, Forums, Issues, and Directions,” traces the advancement and transformation of our profession through international exchanges. The authors provide an overview of the history of this movement as well as the forums where international engagement are occurring in our profession. Globalization and context are discussed in light of future recommendations. In the chapter titled “Multicultural Competence in the Delivery of Technology-Mediated Mental Health Services,” de las Fuentes and Ramos Duffer contend that the increased use of technology represents the most recent wave of innovation in mental health. Directing attention to multicultural groups, they identify and critically examine the array of technological advances that are opening up new possibilities for providing effective and efficient multiculturally competent therapeutic interventions to such groups who, for a variety of reasons, have been disparately treated relative to mental health services. The authors

269

address and discuss the fact that the appropriate and effective use of technology will demand that practitioners embrace the discomfort of change as they seek to incorporate technology into their practice. The authors conclude that such incorporation can result in decreasing or even eradicating longstanding disparities in the provision of mental health services. Yakushko, Wang, and McClosky address multicultural psychology in light of a growing emphasis on “Interdisciplinarity in Multicultural Psychology: An Integrated Review and Case Examples.” The authors cite challenges and benefits of interdisciplinarity in the context of multicultural psychology. Examples of interdisciplinary work in community mental health settings and training approaches are also provided. The chapter titled “Violence Prevention in Schools and Communities: Multicultural and Contextual Considerations” by Nickerson, Mayer, Cornell, Jimerson, Osher, and Espelage addresses growing concerns regarding safety and security in our schools and communities. They cite numerous examples of school violence and integrate an understanding of the theoretical and empirical literature relevant to multicultural populations. Attention to violence prevention efforts that promote the mental and emotional health of students is provided along with a discussion of threat assessment. “Considering Definitional Issues, Cultural Components, and the Impact of Trauma When Counseling Vulnerable Youth Susceptible to Gang Involvement” by Estrada, Hernandez, and Kim highlights systemic root causes that lead to cultural identity frustration, leaving vulnerable youth susceptible to gang involvement. The authors emphasize the need for cultural competence and an understanding of the impact of trauma on these vulnerable youth.

Tschopp and Frain write about the growing population of military veterans in “Cultural Issues in Counseling Today’s Military Veterans” from a multicultural strength-based approach to counseling. Given the fact that diversity among the veteran population has grown over time, the authors emphasize the importance of clinicians adopting culturally sensitive mental health practices in order to effectively treat the growing diversity of physical and psychological issues confronting military veterans as they reintegrate and adjust to life in their respective communities. Casas addresses the potentially traumatic impact of the immigration process in his chapter titled “Caution: Immigration May Be Harmful to Your Mental Health.” Current statistics regarding immigration provide the backdrop for this chapter as selective challenges, problems, and events that impact the mental health of these diverse populations are addressed. Existing policies, barriers, and challenges to providing mental health services are identified and recommendations to advance training, research, practice, and policy relevant to the immigrant population are discussed. Worthington and Avalos provide a critical tool in their chapter on “Difficult Dialogues in Counselor Training and Higher Education.” The authors note the critical role of higher education institutions to prepare students and future leaders for the new global realities they will face in the near future. As noted in the earlier chapters that form this section, more so than ever, people around the world are engaged in discourses across differences. Ideological rhetoric and conflicts of identity result in polarization in local, regional, national, and international contexts. This chapter demonstrates the use of “difficult dialogues” to advance multicultural understanding and social justice in educational and organizational settings.

2 7 0       H A N D B O O K O F M U LTI C U LTUR A L COUNSELI NG

CHAPTER

26

Multicultural Positive Psychology Cultural Perspectives of the Good Life Lisa Y. Flores, Lisa M. Edwards, and Jennifer Teramoto Pedrotti

HISTORY OF POSITIVE PSYCHOLOGY Since the beginning of modern psychology (see Casas, this volume, Chapter 1), theorists, researchers, and practitioners across psychological areas have worked to understand and promote positive healthy mental functioning. From William James in the early 1900s to Donald Super, within counseling and vocational psychology in the 1950s through the 1990s to humanistic psychologists such as Abraham Maslow and Carl Rogers in the 1960s, these psychologists have discussed mental health and well-being from diverse perspectives (Day & Rottinghaus, 2003; Gray, 2011; King, 2011). The actual term positive psychology first appeared in Maslow’s (1954) final chapter of Motivation and Personality where he used the term to describe a fully functioning person. In addition, he strongly took the position that, within psychology, the field of humanistic psychology was very well poised to take the lead in fostering optimal human development (Lopez & Edwards, 2008). After being somewhat ignored for some time, the term positive psychology resurfaced in 1998 when Martin Seligman, then president-elect of the American Psychological Association (APA), described as his presidential theme a new initiative: prevention and the scientific pursuit of optimal human functioning (Seligman & Csikszentmihalyi, 2000). Soon after, the American Psychologist published a special issue devoted to positive psychology, which highlighted research about strengths and mental health and provided a framework for the scientific study of strengths (Seligman & Csikszentmihalyi). The overarching message in this issue was that societal changes and professional attitudes, beliefs, policies, and practices had caused professionals to work from a disease-based model that focused primarily on pathology, illness, and weakness. This focus on the negative needed to be augmented by a positive focus, which could then result in increased prevention research that would direct attention to positive and strength-based variables that contribute to the well-being of individuals. At the present, the field of positive psychology has expanded and is quite prominent in public and scholarly realms (King, 2011). Issues surrounding the “newness” of positive psychology arose 271

almost immediately following the publication of Seligman and Csikszentmihalyi’s (2000) special issue. Scholars critical of positive psychology have argued that positive psychology has not added original knowledge to the field of psychology but instead has replicated other approaches to human functioning such as humanistic psychology and counseling psychology (Fernandez-Rios & Cornes, 2009; Lazarus, 2003). Since humanism as a collection of theories has focused on health, well-being, and resilience for many decades (McDonald & O’Callaghan, 2008), it is important that these philosophical and theoretical roots be acknowledged. In addition, strengths-based perspectives also have been used by social workers for many years (Gray, 2011; Saleeby, 1992). Specific approaches such as solution-focused therapy and narrative techniques have been developed that locate the process of change in the collaboration of client and therapist toward identifying strengths, solutions, and exceptions to distress (De Jong & Miller, 1995; De Shazer, 1985). Interestingly, social work’s strengths-based perspective has also been critiqued as ignoring its roots in humanism (Gray, 2011). As such, paying homage to both social work and humanistic roots while finding ways to build on earlier research is an important goal as the positive psychology movement advances. In addition, the phenomenological aspects of humanism can lend to a more complete discussion of strengths and weaknesses, as the very nature of this approach encourages a higher level of cultural competence in conducting and analyzing research in the area of positive psychology. Having identified positive psychology and provided information on its origins and roots, the remaining sections of this chapter address (a) the necessity of incorporating culture in the development of positive psychology; (b) intersections of positive psychology and multicultural psychology; (c) noteworthy advancements in multicultural positive psychology theory, research, and assessment; (d) applications of multicultural positive psychology to clinical practice and training; and (e) future directions of multicultural positive psychology.

A Culturally Embedded Positive Psychology There has been a push for cultural competence in positive psychology from very early on in its reemergence (Constantine & Sue, 2006). Many psychologists have recognized that positive psychology cannot be a viable or cohesive area of research without considering the cultural context of the work that we do (Lopez, Pedrotti, & Snyder, 2014; Pedrotti, 2014; Pedrotti & Edwards, 2014). Though in the past some have argued that attending to culture is not necessary when one is adhering to scientific and objective rules, many today recognize that our personal values, ideologies, and backgrounds greatly influence the type of research we conduct, the hypotheses we make, and the methods we use (Cabrera & Padilla, 2004; Clauss-Ehlers, 2008). In summary, current research strongly suggests that culture must be included in all discussions and works relative to positive psychology in order to have a richer and more accurate understanding of the phenomenon (e.g., constructs, behaviors) that is the focus of interest. Research shows that cultural groups may define, manifest, and utilize constructs in different ways though at times using the same term. For instance, from a definitional perspective, Benedikovičová and Ardelt (2008) found that while college students in the United States commonly emphasized cognitive aspects in defining the construct of wisdom, students in Slovakia emphasized affective aspects. Additionally, Yang (2008) found that Taiwanese participants emphasized both cognitive and affective components when defining wisdom. Thus, cultural equivalence does not exist for this construct, though it has sometimes been touted as universal (e.g., Peterson & Seligman, 2004). With respect to psychological processes, these may also be manifested differently across various cultural groups. Consider, for example, studies that have shown differences in intensity of expressed happiness between Eastern and Western cultural groups (Uchida, Norasakkunkit, & Kitayama, 2004), as well as different understandings of

272       Emerging Issues and Movements in Multicultural Counseling Ps ycholog y

f­unctional forgiveness in varying populations (Sandage, Hill, & Vang, 2003). In these situations, when cultural context is not attended to, one might mistakenly conclude that a population shows a deficit to another with regard to a particular quality (e.g., thinking that Eastern populations are not as happy as Western because of a lack of intense expression) or may miss the presence of a construct altogether. With regard to forgiveness, the Hmong culture treats forgiveness only as an interpersonal construct, thus a researcher might not find evidence of this trait if it is only explored intrapersonally (Pedrotti, 2014). Finally, some constructs may be viewed as “positive” in some cultural groups but not be viewed as such in other cultural groups. A gratitude task, for example journaling, is related to increased well-being in Western groups but not so in Eastern groups. This difference may be due to a stronger relationship between gratitude and indebtedness found in Eastern populations that does not exist in Western groups (Layous, Lee, Choi, & Lyubomirsky, 2013). Similarly, research suggests that pessimism, often depicted negatively and related to depression in Western groups, is not associated to depression in Asian Americans, and in fact is positively linked to problem solving (E. C. Chang, 2001). The conclusion to which this leads us today is that we cannot discuss what is healthy or unhealthy, good or bad, without first taking a step back to survey the cultural context of the populations we study (Pedrotti & Edwards, 2014). It is from this position that we discuss positive psychology in working with diverse cultural groups, both domestically and internationally, in counseling.

Connection Between Positive Psychology and Multicultural Psychology The importance of a strengths perspective within multicultural psychology is abundantly clear when examining how culture has historically been approached by psychology (see Casas, this volume, Chapter 1). In the early 1900s when Western

­psychology emerged, deficit models of people of color dominated in psychology, promoting the idea that non-White, non-Westerners possessed inherent biological deficiencies that explained differences in personality and IQ (see Casas, this volume, Chapter 1; Downey & Chang, 2014b; Sue & Sue, 2013). These deficit models were used as “evidence” to suggest that working to improve circumstances for racial and ethnic minorities was pointless since these groups were genetically inferior. As scholars began to critique deficit models in the 1920s and 1930s, deprivation models emerged that suggested that lack of opportunity and unequal, hostile environments were instead to blame for racial differences (Allport, 1954). Though proponents of deprivation models were likely attempting to shed light on oppression and discrimination as causes for racial differences, research from this perspective served to perpetuate pathological assumptions about racial and ethnic minorities. As can be seen, people of color have been historically described in the field of psychology in relation to their weaknesses much more often than their strengths, similar to the lack of attention to strengths for all people noted by Seligman and others (Seligman & Csikszentmihalyi, 2000). This double jeopardy faced by people of color has led to overattention on weaknesses, with few opportunities for balanced descriptions of behavior that include individual and cultural strengths (Lopez et al., 2006; Pedrotti, Edwards, & Lopez, 2009). Fortunately, the field of psychology has evolved greatly over the past years, resulting in an increased appreciation for the influence of varied social and cultural contexts on individual functioning and behavior. Indeed, one could say that multicultural psychology has gained a certain degree of prominence in psychology (see Casas, this volume, Chapter 1; Fowers & Davidov, 2006; Pedersen, 1991) as evident in the increased attention given to research efforts to understand broad issues and topics relative to mental health, including but not limited to cultural variables, resiliency, differential access to power, poverty, detrimental effects of discrimination, and disparities in treatment and services.

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One area of interest that has received a good share of attention is that which focuses on cultural values and positive characteristics of ethnic minority individuals and groups that contribute to the well-being and resiliency of such groups. Interestingly enough, this interest and concomitant studies came about well before the emergence of the positive psychology movement (Downey & Chang, 2014a, 2014b). Yet even with the early and increased attention, scholars have noted that more attention to strengths and assets are still needed within multicultural psychology (Pedrotti et  al., 2009; Roysircar, 2012; Sandage et al., 2003), just as more attention to culture is needed within positive psychology (Christopher & Howe, 2014). As an example, a recent publication from the Society for Research in Child Development highlighted the importance of obtaining information relative to positive development among racial and ethnic minority children (Cabrera, 2013), acknowledging that the broad base of literature about development among diverse youth has generally focused on problems and stress. Publications such as this serve to remind us that much work relative to strengths among multicultural, marginalized, and/or underserved populations is still needed. One of the hallmarks of multicultural psychology is its attention to both individual-level variables as well as those that exist on broader, systemic levels. Recent writings in the area of colorblind racial ideology (i.e., perspectives that de-emphasize the influence of culture; Neville, Awad, Brooks, Flores, & Bluemel, 2013), for example, have emphasized both the influence of race and power on an individual’s experiences and perceptions. Issues of power are those that relate to inequities in environments that have profound influences on individuals, groups, and communities. From a strengths-based perspective, it is critical to understand the resources that groups and communities might possess even in oppressive social environments. In her discussion of intersecting identities, Hays (2008) notes that cultural strengths can be personal/individual (e.g., bilingualism, ethnic identity, religious faith), interpersonal (e.g., extended families, traditional

celebrations and rituals), and/or environmental (e.g., cultural foods, animals, or a space for prayer or meditation). These strengths might be the critical protective factors that promote resilience in times of stress for racial/ethnic minority individuals (Bowman, 2006; Walters & Simoni, 2002). Multicultural psychology is clearly poised to continue to work to understand the nature and roles of these unique cultural resources and strengths.

Advancements in Multicultural Positive Psychology Over the years, the APA has developed and implemented a good number of policies, standards, and guidelines for education, training, research, practice, and organizational change of significant relevance to culturally diverse populations (see Casas, this volume, Chapter 1). With respect to the standards, in their most recent version (APA, 2003), they provide a framework that can be used to ensure that advancements in positive psychology theory, research, and practice give accurate, relevant, and effective attention and consideration to the role of culture in the wellbeing of all clients. In the following sections, we selectively highlight variables that multicultural positive psychology should consider and address relative to theory, research, and assessment. Theory. The dominant focus in positive psychology has been on positive emotions and experiences and how they are related to positive outcomes. Two recent theoretical contributions in positive psychology hold promise for advancing positive psychology research and practice with culturally diverse populations. First, Constantine and Sue (2006) proposed a theoretical model of optimal human functioning for people of color in the United States (see Figure 26.1). The two cornerstones of this model include cultural factors (values, beliefs, and practices) and strengths gained through adverse life experiences, both of which can be incorporated into strengths-based conceptualizations of people of color. These

274       Emerging Issues and Movements in Multicultural Counseling Ps ycholog y

authors identify five culturally relevant strengthsbased concepts that can be used to understand the positive functioning and health of people of color: (a) collectivism; (b) cultural identities; (c) spirituality and religion; (d) interconnectedness of mind, body, and spirit; and (e) interdependent relations among family and community. Moreover, Constantine and Sue address the skills and strengths that people of color develop as a result of dealing with negative life conditions related to oppression, such as heightened perceptual wisdom, the ability to tap into nonverbal and contextualized communication, and bicultural flexibility. Future multicultural positive psychology research that applies one or both of these factors in research with people of color can make important contributions to knowledge of how positive and negative events linked to culture can promote positive human functioning. Second, Wong (2011) introduced a framework (see Table 26.1) that aims to provide a balanced perspective in examining both positive and negative

Table 26.1  W  ong’s (2011) Balanced Approach to Character Traits and Outcomes Outcomes

Positive Traits

Negative Traits

Positive

Quadrant I: Positive Traits/Positive Outcomes

Quadrant II: Negative Traits/Positive Outcomes

Negative

Quadrant III: Positive Traits/Negative Outcomes

Quadrant IV: Negative Traits/Negative Outcomes

traits and outcomes. He argued that rich knowledge about the good life can be gained by shifting the current perspective of examining positive traits that lead to positive outcomes, to also examining conditions under which positive traits can lead to negative outcomes, or negative traits can lead to positive outcomes. Increased research in the latter two areas paints a more accurate picture of the

Figure 26.1  Constantine and Sue’s (2006) Model of Optimal Human Functioning for People of Color

Optimal Human Functioning for People of Color

Cultural Values, Beliefs, and Practices

Strengths Gained Through Adversity

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role of both positives and negatives in the lives of individuals and communities, and accounts for the varied outcomes of both positive and negative traits and behaviors. As multicultural positive psychology research aims to generate more empirical data from Quadrant I with culturally diverse samples, more work is also needed in understanding how adverse life events such as oppression, poverty, and harassment can lead to positive outcomes among culturally diverse individuals (Constantine & Sue, 2006). Findings from such studies can inform positive psychological interventions with people of color and other oppressed groups (gay men and lesbian women, low socioeconomic status [SES] groups, women, etc.) experiencing similar stressful life events. To advance multicultural positive psychology research in the area of coping, Heppner, Wei, Neville, and Kanagui-Munoz (2013) proposed the cultural and contextual model of coping for racial and ethnic minorities in the United States that highlights the role of culture in how people deal with life events. One of the main premises of this model is that coping occurs within a larger social context that takes into account cultural norms and expectations. Specifically, this cultural coping model describes coping as the interactions between an individual and three nested environmental systems consisting of immediate relationships, working and living environments, and the larger sociocultural environment. This complex, conceptual model includes five key domains: individual factors, environmental factors, stressors, coping, and health outcomes, each of which is hypothesized to influence one another. Future research is needed to test how well this model explains positive mental health outcomes with U.S. racial and ethnic minorities. Research. Downey and Chang (2014a) characterized the current stage of multicultural psychology research within positive psychology as being in its adolescence stage. This stage reflects the strides that positive psychology research has made and at the same time highlights areas of continued work to enhance the cultural relevancy of positive

psychology knowledge and research. Positive psychology research is capitalizing on advancements in multicultural research methodology to improve the generalizability of positive psychology research. This work benefits culturally diverse communities by increasing knowledge on the development of positive psychological constructs within these communities. Recently, Downey and Chang (2014a) provided a thorough review of multicultural positive psychology research that covers the domains of positive affect, creativity, emotional intelligence, flow, hope, mindfulness, optimism, and wellbeing. In addition to reviewing their chapter, readers wanting more information relative to multicultural positive psychology are also directed toward the body of work conducted by Edward C. Chang (optimism and pessimism) and Ed Diener (­subjective well-being) as exemplars of programmatic lines of research within positive psychology that address the role of culture and strengths. Chang’s contributions to the area of multicultural positive psychology include exploring cultural group differences in levels of optimism and pessimism and their respective effects on health outcomes, as well as cultural equivalence in how these constructs are manifested across diverse groups. Finally, Diener’s investigations on subjective well-being have explored the significance of this construct in cross-national samples as well as identifying the predictors of subjective well-being in individualistic and collectivistic cultures. Assessment. A number of measures have been developed to assess strengths and positive constructs, reflecting the vitality and growth of positive psychology over the past several years (Diener, 2009). As our communities become increasingly diverse and our lives are situated within a global context, assessments must be sensitive enough to accurately reflect the manifestation of individual and community strengths as well as positive, healthy behaviors and attitudes across diverse groups. Advancements in multicultural positive psychology assessment have occurred as (a) existing measures are adapted and reliability and

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validity evidence for scores on that measure are provided for culturally diverse groups, and (b) new measures are developed to assess a particular positive psychological construct within a specific cultural context and items are generated to reflect the meaning of the construct from that culture. The coping literature provides several examples of research that has validated existing measures with culturally diverse samples. For example, a series of studies indicated that the Problem Solving Inventory (PSI; Heppner & Petersen,

1982; Heppner, Witty, & Dixon, 2004) scores were reliable and replicated the PSIs 3-factor structure with samples of Black South African college students (Heppner, Pretorius, Wei, Lee, & Wang, 2002), Italian adolescents (Nota et al., 2013), and Mexican American adolescents (Huang & Flores, 2011). Others have used a bottom-up approach and developed new measures to assess problemsolving and coping that are tailored to a specific culture (see Table 26.2 for examples of such measures). In a series of three studies using a sample

Table 26.2  Sampling of Cultural-Specific Positive Psychology Measures Positive Psychology Instrument

Sample

Reliability

Validity

Citation

Collectivistic Coping Styles Measure

204 African, Asian, and Latin American international students

Cronbach’s alpha of .84 and .95 for the seeking social support and forbearance subscales, respectively. Test-retest reliability of .80.

Confirmatory factor analysis supported 2-factor structure (seeking social support and forbearance). Seeking social support subscale scores were positively related to perceived support from family and friends and seeking mental health services. Forbearance subscale scale scores negatively associated with seeking mental health services and positively related with avoidance coping strategies.

Moore & Constantine (2006)

Collectivistic Coping Styles Inventory

Over 3,000 Taiwanese college students

Cronbach’s alpha range from .60 to .90 for the full scale and subscale scores. Test-retest reliability ranged from .56 to .77 for the full scale and subscales.

Five-factor structure: acceptance, reframing, and striving; family support; religionspirituality; avoidance and detachment; and private emotional outlets. Scale scores were associated to problem-solving appraisal, problem resolution, and psychological distress in the expected directions.

Heppner et al. (2006)

Living Up to Parental Expectation Inventory

392 Taiwanese college students and 99 Taiwanese college students

Cronbach’s alpha ranged from .74 to .91. Test-retest reliability ranged from .61 to .85.

Three-factor structure: personal maturity; academic achievement; dating concerns. High levels of living up to parental expectations were related to low levels of psychological distress and unrelated to social desirability.

Wang & Heppner (2002)

Psychological Empowerment

439 ethnically diverse high school students in the United States

Internal consistency alphas ranged from .80 to .83.

Four-factor structure: motivation to influence school and community; participatory behavior; sociopolitical skills; and perceived control. Subscales correlated positively to measures of self-esteem, social support, and self-efficacy.

Ozer & Schotland (2011)

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of over 3,000 Taiwanese college students, researchers presented reliability and validity data for the Collectivistic Coping Styles Inventory (CCS), a bottom-up measure of situation- and culturespecific coping in Asian cultures (Heppner et al., 2006). Findings suggested a 5-factor structure of the CCS that included acceptance, reframing, and striving; family support; religion-spirituality; avoidance and detachment; and private emotional outlets. Asian participants indicated that coping strategies related to acceptance, reframing, and striving were the most likely and most helpful coping strategy that they used (Heppner et  al., 2006). Finally, Moore and Constantine (2005) developed the 9-item Collectivistic Coping Styles Measure with international students and provided evidence to support the reliability of scale scores and a 2-factor structure (seeking social support and forbearance). To summarize, we have highlighted some key contributions in recent years that have addressed the role of culture in positive psychology theory, research, and assessments. We also direct readers to two recent edited volumes (see E. C. Chang & Downey, 2012; Pedrotti & Edwards, 2014) for relevant reviews. We hope that more psychology scholars are engaged in understanding how cultural factors relate to positive functioning and utilize recommended practices for conducting multicultural and cross-cultural research (Bernal, Cumba-Aviles, & Rodriguez-Quintana, 2014; J. Chang & Sue, 2005).

Broadening Our Approaches to Practice and Training: Toward a Social Justice-Oriented Positive Psychology As discussed in this chapter, a growing body of research has emerged that lies at the intersection of multiculturalism and positive psychology, and which has the potential to inform mental health professionals about how to promote wellbeing among diverse individuals and communities. As noted above, while research relative to the

integration of multiculturalism and strengths has been summarized and discussed in at least two edited volumes (see E. C. Chang & Downey, 2012; Pedrotti & Edwards, 2014), specific suggestions for merging these two areas in clinical practice have been slower to develop. More important, there are few theoretical models to guide clinical practitioners and trainees in their efforts to integrate these two areas. In the following section, therefore, we first review what we have found to be a promising framework for counseling from a strengthsbased, multicultural perspective. This model, the Strength-Based Counseling Model (Smith, 2006), provides a blueprint for working with diverse youth and adults. Then, we discuss how we might broaden this model to give more attention to advocacy, one of the hallmarks of the field of counseling psychology, and a critical piece of a social justice approach. Finally, we address how multicultural positive psychology can be infused in graduate training programs to promote research and practice in this area. The Strength-Based Counseling Model. The Strength-Based Counseling Model (SBCM; Smith, 2006a) was proposed as a model for counseling atrisk youth, though the basic concepts and stages could be readily applied to other populations. Drawing from counseling psychology, positive youth development, prevention social work, narrative therapy, solution-focused therapy, and positive psychology, SBCM emphasizes the search for protective and risk factors that are both internal and external to increase client resiliency. The model describes 10 stages of counseling through which the counselor helps clients identify strengths that can be used as resources for positive change. Basic principles about strength-based counseling that are reflected in this model include assumptions about the influence of clients’ environments, their race, class, and gender on counseling interactions, the role of development, and the idea that all clients have strengths and the capacity for growth and change (Smith, 2006a). The stages of SBCM (Smith, 2006a) and a brief description of therapist’s role at each stage are as follows:

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c­omprehensive, strengths-based model for practice that integrates the influence of culture. Though Smith (2006b) acknowledged that there are many areas for refinement in her model, she also proStage 2: Identifying Strengths—utilizing narrative vided specific suggestions for different levels of techniques to help clients clarify their strengths. client intervention. The primary level of intervenStage 3: Assessing Presenting Problems—gaining tion would involve the prevention of problems by information about client’s perceptions of problems. utilizing a resiliency framework. The second level Stage 4: Encouraging and Instilling Hope—­ of intervention would involve working with indirekindling hope by identifying client’s hopeful life viduals or groups on specific issues. Finally, the experiences and circumstances. third level of intervention is ecological or systemic (i.e., environmental), involving advocacy work to Stage 5: Framing Solutions—utilizing solution effect change. We agree with Smith’s assertion that focused strategies such as exception questions to advocacy is both important and difficult to achieve formulate solutions to problems. given the individual training focus that most counStage 6: Building Strength and Competence—­ selors receive (Smith, 2006b). We believe, however, helping clients recognize their sense of autonomy that more attention should be given to advocacy by utilizing internal and external strengths. within any approach to counseling, particularly Stage 7: Empowering—collaborating with client to one that integrates strengths and the influence of a explore context and activate internal and external client or community’s environment. resources. Several groups have worked to articulate the goals of a social justice approach to counseling Stage 8: Changing—helping client become aware of goals and modifications that need to be made to and the competencies necessary for conducting improve circumstances, providing encouragement effective advocacy. A social justice–oriented counby noting client’s efforts and successes, and reframseling paradigm can be considered a multifaceted ing the meaning of life events. approach to addressing “inequitable social, political, and economic conditions that impede the acaStage 9: Building Resilience—developing coping demic, career, and personal/social development skills to deal with problems should they reoccur. of individuals, families, and communities” (Ratts, Stage 10: Evaluating and Terminating—working 2011, p. 160; see Casas, this volume, Chapter 1). In a with the client to identify resources that were most further elaboration of this approach to counseling, valuable to the change process and to honor progthe American Counseling Association’s Advocacy ress that has been made. (pp. 39–48) Competencies (Lewis, Arnold, House, & Toporek, 2002) provide a specific model for both trainees It is not difficult to imagine how a practitioner and professionals to consider how advocacy can might work through these stages with a client and be integrated into work with clients at different how different this approach might look as comlevels: client/student, school/community, or public pared to a counseling model which focuses on arena levels. In this model, professionals can work identification of symptoms and pathology related with clients or on behalf of clients at the various to distress. Most important, Smith highlights that levels. Working with clients on a microlevel (client/ working on strengths does not preclude a discusstudent) might include helping a student identify sion of concerns or problems; rather, it provides an external barriers affecting her academic perforopportunity to marshal assets and resources to deal mance, as well as strengths and supports. On a with current problems. school/community level, a counselor might advocate to include additional classes or workshops for The Role of Advocacy. Smith’s SBCM model students who need additional support or integrate represents an ambitious effort to provide a Stage 1: Creating the Therapeutic Alliance—­ discussing client’s strengths and conveying a respect for client’s personal struggles.

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Positive Youth Development models on campus (Holtz & Martinez, 2014). Finally, on a macrolevel, a professional might engage in social/political advocacy or disseminate information publicly to lobby for legislation and policy change to address the lack of resources around support services. Each of these levels provide unique opportunities for counselors to advocate for clients and bring about increased positive change, particularly within a strengths-based framework. We propose, then, that the role of the counselor as a social justice advocate be considered in any approach to strengths-based counseling. Clinical and Research Training. A strengthsbased approach to clinical and research training complements multicultural training in many ways. First, it is important to teach students to identify and recognize an individual’s strengths as well as the strengths that they draw on from their culture or that the community provides—a holistic perspective on culturally diverse clients. Focusing on strengths or balancing positives with negatives provides alternative routes for assisting clients in dealing with their presenting concerns and it changes how research questions are framed. A strengthsbased approach counteracts negative stereotyping and negative images of culturally diverse individuals that are prevalent in our society and balances prior research that focused on cultural deficits in a generation of new psychological knowledge. Pedrotti (2011) proposed steps for blending multiculturalism within positive psychology training classes. These recommendations can be flipped to apply to the integration of positive psychology in multicultural psychology training and coursework. Specifically, instructors can:

1. Emphasize strengths from the outset. Whether it is a clinical practicum course or a research methods course, and assuming that multiculturalism is already integrated within these courses, instructors should highlight the need to focus on individual and community strengths in practice and research in the first class and continue to emphasize this throughout the duration of the

course. Multicultural clinical training should include an assessment of positive psychology constructs during clinical intakes and in developing conceptualizations of the client. Using case examples and vignettes that contextualize positive psychology constructs from the view of a particular culture (e.g., Heppner, Wang, & Heppner, 2012; Sandage et al., 2003) can assist students and trainees in developing clinical skills that integrate a strengths-based perspective.

2. Challenge students to identify clinical approaches or conceptual models that can be pathologizing or focus solely on the negative. Help students to develop the skills to critique existing clinical models that focus primarily on negative aspects and encourage them to find ways to blend positive psychology frameworks and constructs in their clinical work and in conceptualizing the client’s concerns.



3. Present psychological research that provides a balanced perspective (focuses on positives and negatives) of the individual. Add supplemental readings to weekly lessons that report positive psychology research with culturally diverse samples. For example, in a multicultural course, a lecture on multicultural and cross-cultural research can introduce some of Chang’s programmatic work on hope, optimism, and happiness with analysis of multicultural applications (E. C. Chang & Banks, 2007; E. C. Chang, Sanna, Kim, & Srivastava, 2010; E. C. Chang, Yu, Kahle, Jeglic, & Hirsch, 2013; Hirsch, Visser, Chang, & Jeglic, 2012; Tsai, Chang, Sanna, & Herringshaw, 2011).

Current Status and Future Directions of Multicultural Positive Psychology A central challenge to the positive psychology movement pertains to its efforts to fully infuse and integrate multicultural perspectives in positive psychology research, teaching, and practice (e.g., Christopher & Howe, 2014; Kubokawa & Ottaway, 2009). Progress has been made in the multicultural positive psychology research (Downey & Chang,

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2014b). Nevertheless, generalizability to and utility for diverse populations is limited given the fact that the vast majority of the research has paralleled the biased trends that we have seen in psychology at large: It has primarily focused on domestic samples that are predominantly White college students (Snyder & Lopez, 2005) and adheres to conceptions of the self that stem from Western ideology (Christopher & Hickinbottom, 2008). Needless to say, there is a need for research that includes diverse populations and that incorporates non-Western ideologies of the self. In addition to addressing this need, there are other challenges that present research opportunities for the next phase of the positive psychology movement. First, positive psychology research can provide more balanced perspectives of an individual by examining both positive and negative experiences that contribute to the good life and understanding how the good life is manifested in culturally diverse samples (Christopher & Howe, 2014; Pedrotti, 2014; Wong, 2011). Additionally, positive psychology can expand the focus on the individual to broadening understanding of what constitutes a good environment (Diener, 2009; Wong, 2011) and how good environments contribute to optimal health in culturally diverse individuals. Second, as more research is generated with diverse racial and ethnic individuals and communities, the discipline would benefit from (a) employing qualitative methodology to exploring what is good and meaningful in the lives of culturally diverse samples (Fernandez-Rios & Cornes, 2009) and (b) refinement of the positive psychological assessments that are available for research and practice with such populations. Third, to enhance positive psychology research and practice at the group level, scholars need to develop reliable and culturally valid assessments of positive constructs at the group, institution, and community levels. These efforts need to consider the culture of groups, organizations, and communities in the development and application

of group-level positive psychological constructs. Fourth, ensuring that the next generation of positive psychology scholars and practitioners are representative of the cultural diversity found in the United States and around the world (Bacigalupe, 2001) may help in the advancement of understanding the ways in which culture plays a role in optimal functioning. Fifth, increasing attention toward constructs that are not typically central in Western culture, such as compassion, harmony, and altruism, may broaden the utility and relevance of positive psychology (Lopez et al., 2014). Finally, given the central role of work in our lives and the link between occupational satisfaction and life satisfaction (Blustein, 2008; Lent, 2004), positive psychology can place more emphasis on positives associated in one’s career development (Robitschek & Woodson, 2006; Youssef-Morgan & Hardy, 2014). For example, future positive psychology research can examine the effects of individual and organizational strength-based variables such as cultural values, interpersonal relations (Blustein, 2011), and work climate on the job satisfaction of culturally diverse workers. Research on how culture contributes to the construction of meaning from work experiences (e.g., Chaves et al., 2004) can also make important contributions to improving the work life of culturally diverse groups. To conclude, more than 15 years since its resurgence, positive psychology has made significant strides toward incorporating multicultural psychology in its research and theory. We call upon the multicultural positive psychology leaders to continue this push toward inclusion and to the next generation of multicultural positive psychologists to build on this important work. As evident in this chapter, the selective merging of the respective theories, research, and practice inherent in and often shared by both positive and multicultural psychology can result in beneficial outcomes for individuals from diverse cultural groups that are dealing with a variety of challenges across diverse settings.

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CHAPTER

27

Multicultural Spirituality A Syncretistic Approach to Healing, Liberation, and Social Justice Lillian Comas-Díaz

Give thanks for unknown blessings already on their way. Native American saying

S

ince the beginning of time, people across cultures have wondered about the mystery of life and death. Spirituality and religion evolved to frame the human quest for meaning. Like most individuals, people of color embrace diverse religious and spiritual orientations. In particular, many people of color practice spirituality to anchor and sustain themselves within their communities. However, regardless of religious and/or spiritual affiliation, most people of color share a common denominator—a history of slavery, colonization, genocide, and oppression. Such legacy created a collective unconsciousness, distinguishing people of color who have endured cultural oppression from those who have not. Moreover, this legacy fosters identification, affiliation, and group membership related to racial and cultural oppression (Comas-Díaz, 2007). To cope with oppression, many people of color find redemption in spirituality and religion. Although commonly used interchangeably, religion and spirituality are different concepts. While religion entails an organized belief system, spirituality refers to a personal experience with the sacred (Abernethy, Houston, Mimms, & Boyd-Franklin, 2006). For most people of color, spirituality is more culturally relevant than dominant religions because spirituality affirms their ethnocultural identity and offers cultural continuity and autonomy (Comas-Díaz, 2012a). In this chapter, I discuss what I call a multicultural spirituality. To this end, first, I present a brief overview of religions that are prevalent among people of color. Then, I examine the pervasiveness of Spirit among most people of color. I contend that many people of color endorse a multicultural syncretistic spirituality to cope with life and to struggle against oppression. Within this context, I examine m ­ ulticultural spirituality’s

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healing functions, including examples of multicultural psychospiritual psychotherapies. Afterward, I discuss multicultural spirituality’s promotion of empowerment, liberation, and social justice. I conclude the chapter with an exploration of what multicultural spirituality can offer to psychologists, including recommendations for the inclusion of spirituality in working with people of color.

RELIGIOUS DIVERSITY AND SPIRITUAL CONNECTEDNESS AMONG PEOPLE OF COLOR To varying degrees, religion and spirituality are central forces in the lives of many people of color. Ethnic minorities are diverse in their religious affiliation, yet as previously mentioned, they are spiritually connected due to a shared history of oppression. To further discuss this assertion, I first address the religious diversity among various ethnic minority groups, and afterward, I discuss people of color’s spiritual connectedness. For the purpose of this chapter, I concentrate on four major groups of people of color, namely, African Americans, American Indians/Alaska Natives, Asian Americans/Pacific islanders, and Latina/os/Hispanics. African Americans are significantly more religious than the general population (Pew Research Center, 2009). As a concrete example, 88% of African Americans reported being absolutely certain that God exists (Pew Research Religion & Public Life Project, 2009a), and research found that they engage in spiritual practices as a coping mechanism (Chatters, Taylor, Jackson, & Lincoln, 2008). Certainly, Black churches are a central institution among many African American communities and draw inspiration from African spiritual traditions (Hodge & Williams, 2002). For example, most African American clergy have reinterpreted Jesus as a man of color who fought against oppression and sided with the marginalized (Comas-Díaz, 2012a). Even more saliently, Black churches focus more on civil rights and social justice issues than mainstream churches. Although most African Americans identify themselves as Christians, there

is a growing number of Muslims. Many converted to Islam as a rejection of the oppressive White Christianity, comprising 35% of all Muslims in the United States (Younis, 2009). In addition, the religious diversity among African Americans includes Jewish, Ba’hai, Buddhist, Yoruba-based religions, and metaphysical-based traditions (Harrell, Coleman, & Adams, 2014). Spirituality is a way of life among most American Indians. Although there is diversity among Native Americans, most derive spiritual, psychological, and cultural satisfaction from their traditional beliefs. For example, numerous Native Americans believe in the Great Spirit, a combination of Father Sky and Mother Earth. Moreover, a significant number of American Indians revere the universal nature and subscribe to animism, or the belief that everything is infused by spirits. Such spirituality promotes a sacred interconnection of spirit, mind, and body, and of everything in the cosmos (Garrett & Garrett, 1997). In this way, a shared Native spirituality embraces a belief in the sacredness of everyday life, the responsibility to teach, and the recognition that it is human to err (Comas-Díaz, 2012a). Moreover, this spirituality fosters the value of cooperation, resource sharing, honoring ancestors, and noninterference (Sue & Sue, 2008). Eastern philosophies and traditions influence the spirituality of many Asian Americans/Pacific Islanders; however, these populations comprise a mosaic of religions (Ai, Bjorck, Appeal, & Bu, 2013). According to the Pew Research Center (2012), 42% of Asian Americans are Christians, 24% are Buddhist, 10% are Hindu, and 26% are unaffiliated. Each of the major immigrant Asian American groups has a different religious complexion. For example, Filipino Americans tend to be Catholic, most Korean Americans are Protestant, half of Indian Americans are Hindu, many Vietnamese Americans are Buddhist, and Japanese Americans are a blend of Christians, Buddhist, and unaffiliated (Pew Research Center, 2012). Even though the Asian American population ranges from being highly religious to highly secular, most Buddhist and Hindus

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maintain religious traditions and practices such as belief in spirits, ancestor worshiping, and keeping a shrine at home (Pew Research Center, 2012). Along these lines, a significant number of Asian Americans consult the I Ching, a Chinese spiritual guidebook for divination purposes (Le, 2014). Moreover, Asian American traditional spirituality is holistic and focuses on liberation. Within this context, liberation is defined as the freedom from negative elements that cause imbalance, and thus, attaining liberation leads to being in harmony with the cosmos. Of interest, many Asian Americans behave in a bicultural spiritual manner, where they exhibit a Western behavior in the workplace and engage in traditional Eastern approaches at home (Tan & Dong, 2000). Although the majority of Latina/os in the United States are nominally Catholic, they are becoming religiously diverse. To illustrate, there is a significant number of Protestants (evangélicos; Pew Hispanic Center, 2007). Moreover, due to a desire to connect with their Moorish roots, a growing number of Latinos are converting to Islam (Wakin, 2002). A small segment of the Latino population is Jewish, and there are Latina/ os who are agnostic. Regardless of religion, most Latina/os endorse a personal relationship with God and practice in an ethnocultural-oriented spirituality (Pew Hispanic Center, 2007) whereby they prepare home altars, light candles to divinities including saints, engage in pilgrimages, and present ofrendas (offerings; Cervantes & Parham, 2005). Furthermore, research found that many Latina/os use spiritual coping such as praying, asking others to pray for them, and consulting a curandera/o (shaman) for healing purposes (Reyes-Ortiz, Rodriguez, & Markides, 2009). Without a doubt, faith plays a major role in the lives of many people of color. Their religious and spiritual communities provide cultural, emotional, spiritual, and practical support. These resources are central to many immigrants of color as numerous ethnic churches empower them with information on employment, education, health care, housing, marital/family counseling, legal advice, and other

forms of assistance. To illustrate, Korean immigrants with professional degrees acquire status positions in ethnic-oriented churches and thus feel empowered in their roles as assistant ministers, education directors, elders, deacons, and other unordained positions (Le, 2014). In this chapter, I use the concept of multicultural spirituality to designate the spiritual practices of many groups of people of color in the United States. More specifically, multicultural spirituality refers to people of color’s syncretism of indigenous traditions with Christian and Eastern spiritual orientations in order to find solace, seek ethnic specific healing, manage oppression, and commit to personal and social actions. A multicultural spirituality foments cultural survival and validates people of color’s experience as a source of healing, empowerment, and liberation. Moreover, it cements the preeminence of Spirit in their life.

MULTICULTURAL SPIRITUALITY: THE PREEMINENCE OF SPIRIT The word spiritual in English is always connected with religious. For me the spiritual is right there. There is nothing mystical about spirituality. Its everyday life you can see it, you can hear it, you can feel it. That’s spirituality. Basil Johnston, American Indian writer

A legacy of cultural oppression has resulted in soul wounds among many visible people of color. Soul wounds refer to people of color’s ungrieved losses, internalized oppression, internalized racism, and learned helplessness as reaction to their history of cultural trauma (Duran, 2006). For instance, numerous Native Americans consider addiction a crisis of the spirit and a manifestation of a soul wound (Brave Heart, 2003). When the oppressors suppressed indigenous spirituality by imposing colonizing religions, numerous people of color invoked Spirit as they camouflaged their original belief systems into the imposed religions. Multicultural spirituality emerged out of this invocation in an attempt to address people of color’s

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soul wounds. A syncretism of indigenous beliefs with colonizing religions, multicultural spirituality infuses people of color with cultural resistance, affirmation, and subversion against oppression. Even though multicultural spirituality is encased in specific cultural and sociopolitical contexts, it is constantly adapting to accommodate people of color’s lives and changing needs. Multicultural spirituality fosters a belief in co-agency with the divine and/or universal intelligence. In this regard, numerous people of color enact a contextual locus of control to exercise their co-agency. Rooted in spirituality, a contextual locus of control affords individuals the choice of locus of control (internal or external) according to what they believe is required in a particular situation (Comas-Díaz, 2012a). Many people of color invite the Spirit into their daily activities. Such a spirit-filled orientation fosters a connection with their higher power, helping them to reclaim inner resources in order to cope with life. To illustrate, a significant number of Latina/os experience a lived spirituality that recognizes the sacredness in their daily stream of life (Koerner, Shirai, & Pedroza, 2013). The preeminence of Spirit in daily life provides people of color with meaning during adversity and cements ethnic-oriented practices with worship (Pew Research Center, 2007). For instance, most African Americans prefer an action-oriented spirituality where the supernatural, music, movement, and faith constitute major elements (Comas-Díaz, 2012a). In other words, multicultural spirituality provides the basis for a participatory practice that assists people of color in affirming their connection to their ethnic community. Anchored in an amalgamation of indigenous and dominant belief systems, multicultural spirituality embraces the metaphysical through the interrelationship of the natural and supernatural. In this vein, numerous African Americans endorse spiritual activities that originate in African mysticism such as speaking in tongues, dancing in the spirit, prophesying, and spirit possession (Baker, 2007). Compared to White Americans and Latinos, African Americans believe more in reincarnation, contact with the

dead, and the evil eye (Pew Research Religion & Public Life Project, 2009b). Similarly, many Latina/os endorse a magical realism—the blending of magical elements with reality—where they experience prophetic dreams, visions, intuitions, and other supernatural events (Pew Hispanic Center & Pew Forum on Religion & Public Life, 2007). The belief in supernatural experiences provides a sense of belonging and empowerment to many persons of color. Empowerment and liberation are central aspects of multicultural spirituality. These forces translate into a strong commitment to social justice and racial equality. Indeed, a goal within multicultural spirituality is the development of global solidarity among oppressed individuals, particularly among people of color. Summing up, the characteristics inherent in multicultural spirituality are (a) survivalist (emphasis on collective survival), (b) sensual (transmitted orally, visually, and somatically), (c) communal, (d) relational, (e) holistic, (f) liberating, and (g) social justice oriented (Comas-Díaz, 2012a). Many people of color are familiar with a set of multicultural spiritual assumptions that are selectively addressed above. Table 27.1 presents multicultural spirituality core assumptions.

SYNCRETISM: MULTICULTURAL SPIRITUALITY IN TRANSFORMATION The number of Americans who do not identify with any religion but endorse a fusion of spiritual beliefs is increasing at a rapid pace (Pew Research Religion & Public Life Project, 2012). People of color have historically engaged in this trend, but unlike their European American counterparts, people of color’s syncretistic spirituality functions as a coping mechanism against oppression. Indeed, syncretistic practices such as curanderismo, espiritismo, and Santería emerged to help people of color preserve and adapt their spirituality in the midst of oppression (Comas-Díaz, 2012b). I discuss these spiritual orientations, among others, in a later M ULTI CULTUR A L SPI RI TUA LI T Y

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Table 27.1  Multicultural Spirituality Core Assumptions Personal relationship with Spirit Close connection to the divinity, higher power, and/or spiritual system Meditation, mindfulness, and contemplation Spirit-infused daily life Syncretism Blend of indigenous, Eastern practices, and dominant religions Openness to new and diverse spiritual paths Ongoing adaptation to address people of color’s evolving needs Holistic healing Health as balance of mind, body, spirit, community, and environment Illness caused by imbalance, disharmony, and disconnection Promotion of self- and communal healing Cultural relevance Incorporation of traditional beliefs into evolving ones Culture-specific practices and ethnic-oriented worship Meaning-making within a cultural context Interrelationship between the natural and the supernatural Belief in the metaphysical Trance, visions, prophecy, spirit contact, and other metaphysical occurrences Magical realism Co-agency with the divinity/universe Contextual locus of control Cultural resilience as a spiritual value Empowerment and liberation Recovery from soul wounds and from historical/contemporary oppression Promotion of individual and collective empowerment and liberation Commitment to social justice Promotion of racial and gender equality Social justice action Global solidarity with oppressed individuals

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section of this chapter. As dynamic traditions, these spiritual practices constantly evolve through cross-fertilization. Without a doubt, syncretism keeps multicultural spirituality alive and nurtures its ongoing development. For example, Latinos in the United States continue to blend diverse traditions into their spirituality. According to the Pew Research Religion & Public Life Project (2009) Latina/os are more likely than their White counterparts to believe in yoga, the presence of spiritual energy in physical objects, astrology, and the evil eye. Moreover, as previously mentioned, many Latina/os subscribe to magical realism to obtain a deeper understanding of life. This orientation is so pervasive that most Latina/os acquire their belief in magical realism through cultural osmosis. Moreover, a growing number of Latina/os are abandoning the religion they grew up in and choosing a syncretistic form of spirituality based on meditation and enlightenment (Pinzon, 2011). For instance, numerous Latina/os practice syncretistic rituals that fuse indigenous traditions with Christianity, Eastern traditions, and magicospiritual practices. Furthermore, an increasing number of Latina/os engage in Eastern practices like divination with Tarot card reading and other divination tools as well as mediumship, herbal remedies, and others, and with alternative and complementary medicine such as acupuncture, Reiki, and yoga, among others. Of interest, many people of color simultaneously use multicultural spiritual approaches with mainstream medicine for healing (Comas-Díaz, 2012b).

HEALING: MULTICULTURAL SPIRITUALITY AND WELLNESS The relationship between spirituality and health has been documented in the general population across varied studies (Larson & Larson, 2003). Likewise, a study with individuals from five different religions found that spirituality, as compared to religion, correlated positively with mental health in the forms of positive personality traits (extraversion) and negatively with negative

personality traits (neuroticism; Johnstone et  al., 2012). Moreover, Miller and her associates (2014) studied individuals with a high risk of developing familial depressive illness. Their findings showed that the importance ascribed to by research participants to religion and spirituality, but not their frequency of their attending religious services and practices, was associated with thicker cortices in the left and right parietal and occipital regions, the mesial frontal lobe of the right hemisphere, and the cuneus and precuneus in the left hemisphere, independent of familial risk. Based on these dramatic findings, the researchers concluded that a thicker cerebral cortex associated with a high importance of religion or spirituality may confer resilience to the development of depressive illness in individuals at high familial risk for major depression, possibly by expanding a cortical reserve that counters to some extent the vulnerability that cortical thinning poses for developing familial clinical depression. Spirituality has been associated with health and wellness among African Americans (Holt, Schulz, Williams, Clark, & Wang, 2012). Moreover, spiritual approaches have been used successfully to encourage African American women to pursue cancer testing (Mayfield-Johnson, Rachal, & Butler, 2014). Similarly, research studying African American women exposed to domestic violence found that women who expressed higher levels of spirituality and religious involvement reported fewer symptoms of depression and posttraumatic stress (Watlington & Murphy, 2006). Analogously, an empirical study showed that spirituality helped Latinas to effectively manage their depression (Soto, 2013). Additionally, Puerto Rican women with HIV used their spirituality to enhance their coping with the illness (Simoni & Ortiz, 2003). What is more, research documented that Latina/os who reported a high use of religious and spiritual strategies managed pain better (Abraido-Lanza, Vasquez, & Echevarria, 2004). In a similar fashion, Constantine, Alleyne, Caldwell, McRae, and Suzuki (2005) found that spirituality helped people of color who witnessed the September 11, 2001, attacks to cope effectively with posttraumatic stress M ULTI CULTUR A L SPI RI TUA LI T Y

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disorder (PTSD). Even more importantly, research documented that spirituality helped the development of posttraumatic growth among Latinos (Cordero, 2011). These empirical findings are not surprising given that spirituality facilitates the recovery from significant psychological trauma and PTSD (Wilson & Moran, 1998). The above research findings raise the issue of spirituality’s role in the promotion of health and wellness. As an illustration, spirituality played a protective role among African American women exposed to family violence (Paranjape & Kaslow, 2010). Likewise, Native American families treated with a combination of mainstream treatment with traditional Native healing exhibited reduction in domestic violence as compared to those families who did not received the integrated treatment (Puchala, Kennedy, & Mehl-Medrona, 2010). Similarly, Woods-Giscombé and Black (2010) designed a mind-body psychospiritual intervention to reduce African American women’s health-compromising behaviors such as emotional suppression, extraordinary caregiving, and selfcare postponement. A part of holistic practices, multicultural spirituality fosters wellness. To illustrate, research found that people of color, specifically African Americans, American Indians, and Latina/os, who used spirituality to cope with life challenges had more positive relationships, coping mechanisms, quality of life, and sense of well-being than their White counterparts (Kirk, 2011). Similarly, many Latina/o immigrants overcome acculturation pressures through their spirituality (Sanchez, Dillon, Ruffin, & de la Rosa, 2012). Moreover, research has documented that a strong ethnic identity protects Latina/os against acculturation stress (Iturbide, Raffaeli, & Carlo, 2009). Likewise, Watt (2003) found that African American college women used spiritual understanding to cope with stress and to develop healthy ethnic identity. Without a doubt, spirituality has salubrious effects on people of color. In the next section, I offer examples of multicultural spiritual psychotherapies as illustrations of holistic and syncretistic practices.

MULTICULTURAL SPIRITUALITY PSYCHOTHERAPIES To cure sometimes, to relieve often, to comfort always. Anonymous

Developmental milestones, crises, and adversity provide people of color with opportunities to revisit their cultural and spiritual beliefs. Following this reasoning, most people of color require culturally and spiritually informed therapeutic approaches. Spirituality informs individuals’ beliefs and healthrelated behaviors as well as explanatory models of distress, including treatment expectations. As a healing practice, multicultural spirituality offers several psychotherapeutic approaches. These approaches are culturally and spiritually relevant. For instance, mainstream mind-body approaches tend to reflect an individualistic orientation. As an illustration, La Roche, Batista, and D’Angelo (2011) conducted a content analysis of guided imagery scripts in psychotherapy journals. The researchers found that most of the relaxation scripts used idiocentric (individualistic) imagery exercises (e.g., “imagine yourself on a beautiful beach”) as opposed to allocentric or sociocentric imagery (e.g., “imagine yourself surrounded by loved ones”). Along these lines, Hall, Hong, Zane, and Meyer (2011) observed that the mainstream practice of mindfulness and acceptance-based psychotherapies appeared to be more consistent with Western worldviews than with Eastern philosophies. These authors recommended using Eastern approaches that highlight the self-in-relation, such as loving-kindness meditation, a Buddhist orientation toward others, in the treatment of Asian American clients. A main purpose of the multicultural spiritual therapies is to assist clients in their self-healing (Fu-Kiau, 1991), empowerment, and psychospiritual development. A major focus of multicultural spirituality is the attainment of wisdom throughout the psychospiritual journey. For example, healers assist clients in transforming psychological and physical distress into lessons in understanding the

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distress that they are experiencing (Cervantes & Parham, 2005). Therefore, multicultural healers use meditation, altered states of consciousness, contact with spirits, prayers, and the channelling of cosmic energies into the healing process. To expand this discussion, I present several multicultural psychospiritual approaches, namely, shamanism, curanderismo, Ayeli, espiritismo, Feeding Your Demons, Ntu psychotherapy, Morita therapy, Naikan therapy, and Santería. Shamanism is the oldest healing practice. Within this perspective, spirits—in the form of dislocations—are the underlying cause of illness because they prevent the unity of mind, body, environment, and soul. Therefore, shamanistic healing involves a dialogue with the spirit (distress, problem) whereby the shaman aims to identify, understand, and transcend the cause of the client’s imbalance. Both shaman and client meditate and enter a trance where the interrogation occurs and the “spirit” (clients’ higher self) suggests ways to solve the problem. For example, healers may ask the spirit to help them understand what is afflicting the sufferer by asking the following questions: Who are you? Where did you come from? Why are you here? Where are you going? What would you look like if the distress (sorrow, problem, illness) were not here? What is it that you really meant to ask for? (Mehl-Medrona, quoted in Comas-Díaz, 2012b). Answering these questions entails a process of surfacing and clearing, one that helps clients to release deep-seated traumas in a cathartic manner. This method provides potential solutions to the problem, strengthens the client’s intuition, and promotes psychospiritual development. Rooted in shamanism, curanderismo is a Latin American folk healing. It involves a combination of indigenous beliefs with Catholic elements such as prayers, invocations to Jesus, Virgin Mary, and the Saints, including Santa Muerte. From the Spanish word curar (to cure), curandera/os (healers) consider their ability to heal to be a gift from God. Therefore, they use a holistic perspective to balance their clients with the living elements and divine entities. Within this context, intuition, dreams, and other transrational modes serve as communication

pathways with universal intelligence. Magical rituals play a central role in curanderismo, such as limpias (spiritual cleansings), barrida (sweeping/ritual cleansing), sahumerios (incensing for purification), and sortilegios (spells; Trotter & Chavira, 1981). Ayeli is a Cherokee psychospiritual assessment and healing approach. According to Garrett and Garrett (2002), Ayeli entails a process of looking into the four winds. Within this psychospiritual framework, the East represents belonging, South is associated with mastery, West refers to independence, and North is associated with generosity. Ayeli healings are based on seeking answers to questions such as: Where do you belong? Who is your family, tribe, ethnic group, community? (East); What do you do well? What do you enjoy doing? (South); What are your sources of strengths? What limits you? (West); and What do you have to offer? What do you receive? (North). The Ayeli dialogue that ensues from such questions aims to increase clients’ awareness of their healing needs, as well as their gifts, challenges, and life lessons. A religion and a healing practice, Puerto Rican espiritismo emerged as a cultural adaptation of Allan Kardec’s spiritualist philosophy (Comas-Díaz, 2012b). The espiritista acts as a medium, healer, and psychotherapist (ComasDíaz, 2012b). Like other multicultural spiritual healers, espiritistas treat clients with rituals, spirit possession, prayers, and herbal remedies (ComasDíaz, 2012b). During diagnosis and treatment, the mediums frequently dissociate (as an altered state of consciousness) as they become possessed by the spirits. A syncretistic practice, espiritismo affirms clients’ ethnocultural roots as a sociopolitical resistance and subversion. In this vein, espiritismo helps individuals to cope with powerlessness and oppression through identification with the powerful spirits (Comas-Díaz, 2012b). Santería is a classic example of the infusion of an original spirituality into an imposed religion. A faith that blends Yoruba (West Africa) mysticism with Caribbean traditions and Roman Catholicism, Santería is a religion, healing, and philosophy (Comas-Díaz, 2012b). Since the slave owners prohibited their slaves to worship their own M ULTI CULTUR A L SPI RI TUA LI T Y

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­ eities, Africans disguised their Orishas as Catholic d saints in order to practice their original religions. In other words, when devotees of Santería honor Catholic saints, they are practicing their original African religions through the worship of Yoruba deities. As such, Santería strengthens people of color’s ethnoracial identity and connection to their African roots. In addition to its healing properties, Santería is a way of life that includes magic and a divination practice. Feeding Your Demons is based on the Tibetan Bon, a shamanic practice that was syncretized into Tibetan Buddhism. This psychospiritual approach involves a recognition of clients’ demons and transforms them into allies through a meditative dialogue (Allione, 2008). In essence, the therapeutic process of feeding demons involves five stages. In the first stage, finding the demon, the client identifies the issue he or she wants to work on. In the second step, personalizing the demon and finding out what it needs, the client asks the following questions: What do you want? What do you need? How will you feel if you get what you need? In the third stage, the client becomes the demon and answers the questions. In the fourth phase, the client feeds the demon (based on the answers to the previous questions) and meets the ally. In the last stage, the client rests, allowing the ally to resolve within himself or herself. Ho’oponopono is a Hawaiian ancient tradition where a healing priest (Kahuna) or elder performs a forgiveness practice. Within this spiritual orientation, illness is caused by the sufferer’s errors or transgressions. The healer performs a ceremony aimed at resolving and atoning the error. Healing begins when the client or a family member confesses and apologizes. A family and communityoriented healing, Ho’oponopono treatment aims to restore and preserve functional relationships between client and significant others and between client and universal energies (Sue & Sue, 2008). Modern Ho’oponopono is a syncretistic practice embracing Eastern spiritual beliefs such as karma and reincarnation (Ramniceanu, 2012). Ntu psychotherapy is a psychospiritual Afrocentric approach to healing. The concept

of Ntu refers to the African notion of a unifying spiritual energy that connects all living beings with all forms of existence. According to this orientation, Ntu therapists assist clients in attaining a harmonious living through a reconnection with the spiritual energy through the centering of the spirit and energy (Phillips, 1990). Ntu is a family- and community-oriented therapy that helps clients to balance their internal systems as well as their external relationships in an authentic manner. Based on the Kwanza principles, Phillips (1990) identified the elements of Ntu psychotherapy as (a) harmony (development of therapeutic relationship with authenticity and empathy), (b) awareness (clarifying and deconstructing client’s problem), (c) alignment (achieve congruence between client’s internal and external systems), (d) actualization (asking clients to make necessary life changes to achieve balance), and (e) synthesis (client’s reflection on his or her therapeutic process). Drawing on Phillips’s conceptualization, Gregory and Harper (2001) described the Ntu therapy as a syncretistic approach where therapists blend mainstream therapies with Eastern approaches such as imagery, meditation, herbal therapy, and others in order to foster clients’ actualization of their human potential. As a holistic approach, Ntu therapy promotes the cultivation of inner strength anchored in wellness, harmony, and self-defined authenticity (Woods-Giscombé & Black, 2010). Finally, there are two Japanese psychotherapies anchored in spirituality: Morita and Naikan therapy. Shoma Morita (1874–1938), a psychiatrist, developed Morita therapy (based on Zen Buddhism), an approach that includes prescribed rest, life renormalization, rehabilitation, meditation, involving his patients in journal writing, and related experiential activities (Reynolds, 1980). On the other hand, Naikan therapy, based on Japanese Shinshu Buddhism, emphasizes self-reflection as a healing method. This therapy helps clients to change their perspective toward life by developing insight and appreciation and engage in expressing gratitude toward others. For example, Naikan clients examine their significant relationships, especially their parental figures. Similar to Morita

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therapy, Naikan therapists prescribe meditation to their clients. In the following sections, I discuss multicultural spirituality’s promotion of empowerment, liberation, and social justice.

MULTICULTURAL SPIRITUALITY: LIBERATION AND SOCIAL JUSTICE Without a revolution of the spirit, the forces which produced the iniquities of the old order would continue to be operative, posing a constant threat to the process of reform and regeneration. Aung San Suu Kyi, Burmese leader and Nobel Peace Prize awardee

To confront an oppressive situation, many people of color find support and empowerment in their ethnic churches. As previously mentioned, Black and Afrocentric churches historically functioned as a liberation force, acting as social witnesses in the journey to sociopolitical reform (Comas-Díaz, 2012a). Within this context, African American clergy preached liberating messages to their parishioners, established Afrocentric Christian schools, and nurtured the emergence of an African American cultural and psychospiritual consciousness. To identify with the divine, numerous African Americans revised Christianity religious dogma, subverted the established canon, and transformed sacred figures into deities of color (Comas-Díaz, 2003). Many Black churches embraced Prophetic Christianity, a justice-oriented Christianity, as opposed to the imperial Constantinian Christianity (Greene, 2008). Prophetic Christianity follows the Old Testament definition of a prophet—to tell the truth—by speaking on behalf of the poor and the oppressed. Moreover, the African American cultural-spiritual consciousness emerged to promote empowerment and liberation. To illustrate, the Black liberation theology stands on the side of the oppressed, provides a platform for resistance and resilience, and works toward achieving social justice and freedom. For instance, Black liberation theologians added their voices to the cries for

freedom that mobilized the civil rights movement. In a slightly different liberation context, Elijah Muhammad’s Nation of Islam called for African Americans’ self-sufficiency, empowerment, and autonomy. Like African Americans, most Latina/os have a spiritual legacy of liberation. Indeed, liberation theology emerged in Latin America as a reinterpretation of Christianity from the perspective of the victimized, poor, and marginalized. In other words, liberation theologians side with the oppressed to combat poverty, inequality, and to foment social justice. Liberation theology gave birth to psychology of liberation. Developed by Ignacio Martín-Baró, a priest and psychologist, liberation psychologists aim to understand the psychology of oppressed individuals and communities; work to fortify individuals’ strengths and resilience; affirm ethnic, cultural, and psychospiritual identities; and work toward mitigating the oppressive sociopolitical circumstances (Comas-Díaz, Lykes, & Alarcon, 1998). Liberation approaches have been applied in several contexts. For example, many Latina/o evangélica/os embrace liberation spirituality for individual and collective empowerment (CondeFrazier, Maldonado-Perez, & Martell-Otero, 2013). Moreover, liberation approaches have been successfully applied to psychotherapy with lesbian, gay, bisexual and transgender (LGBT) individuals (Russell & Bohan, 2007). Unfortunately, some ethnic churches have used religious beliefs to support internalized racism, sexism, and heterosexism (Greene, 2008). Indeed, most religiously observant people of color tend to be less flexible than those who solely endorse spirituality. According to the Pew Research Religion & Life Project (2009a), 58% of religiously observant African Americans were more likely to oppose abortion and homosexuality. Along these lines, religious African Americans who are LGBT face the Black church’s conservatism. For example, African American LGBT individuals confront serious difficulties in coming out to their religious communities (Greene, 2008). Certainly, many LGBT African Americans who subscribe to religion experience existential and spiritual crises. M ULTI CULTUR A L SPI RI TUA LI T Y

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However, to avoid alienating African American LGBT individuals, many Black churches enacted a “don’t ask, don’t tell” policy. Fortunately, positive changes toward inclusion have begun. For example, the Unity Fellowship Church Movement was established to affirm LGBT people of color’s spirituality (http://www.unityfellowshipchurch .org/mainsite/). Without a doubt, therapists can benefit from incorporating elements of multicultural spirituality into their practices.

WHAT MULTICULTURAL SPIRITUALITY OFFERS PSYCHOLOGISTS The desire to reach for the stars is ambitious. The desire to reach hearts is wise. Maya Angelou

From a syncretistic perspective, there is a need to incorporate spiritual and religious diversity into psychological practice (Hage, Hopson, Siegel, Payton, & DeFanti, 2006). For instance, clinical studies with mental health clients found that Christian participants preferred to incorporate faith into their therapy (Cragun & Friedlander, 2012). Similarly, the need to integrate spirituality in the psychological treatment of most people of color is culturally relevant (Worthington, 2011). Indeed, the American Psychological Association’s (APA, 2003) Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change state that culturally relevant psychological services for people of color may need indigenous and/or non-Western traditional spiritual interventions. Notably, practitioners’ application of these interventions may require the development of additional psychological skills and/or consultation with culturally recognized helpers. Since research demonstrated that clergy and spiritual advisers have a key role in the mental health treatment of Asian Americans (John & Williams, 2013) as well as other ethnic minority groups, practitioners working with clients of color can consider consulting spiritual helpers.

It is paramount to address clients of color’s spirituality during the clinical assessment. For instance, Carter (2002) suggested discussing religious and spiritual matters during clinical assessment in order to examine whether these factors will influence clients’ treatment decisions and compliance. Likewise, clinical studies showed that therapists’ assessment of clients’ spirituality during initial contact facilitated the discussion of spiritual matters throughout treatment (Cragun & Friedlander, 2012). Examples of spiritual assessment include questions such as the following: How important is spirituality or religion in your life? Do you believe in a higher power? If yes, what is your relationship with this higher power? Has your current problem affected your relationship with your higher power? Have you involved your religion/spirituality in resolving your problem? Who are you in connection to your ancestors? What life lessons did your parents provide you? Interested readers can consult Comas-Díaz (2012b) and Saunders, Miller, and Bright (2010) for more examples of spiritual assessment questions. Therapist sensitivity in the assessment of client spirituality is recommended. For example, clinicians can ask clients about their complementary religious and spiritual beliefs as opposed to their alternative beliefs (Baez & Hernandez, 2001). This type of sensitivity can help clients to differentiate positive forms of spiritual coping from negative ones. For instance, a study of adult survivors of childhood sexual abuse found that those survivors who engaged in positive spiritual coping (spiritual support) exhibited less distress than those survivors who engaged in negative spiritual coping (spiritual discontent; Gall, 2006). The use of a spiritual genogram enhances the significance of the spiritual assessment. Similar to a regular genogram, a spiritual genogram focuses on clients’ and families’ dynamics in addition to religious and spiritual areas (Hodge, 2005). Moreover, clinicians may want to complement the spiritual genogram with a cultural genogram. As conceived by Hardy and Laszloffy (1995), a cultural genogram unfolds the centrality of culture and contexts in

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people’s lives. Additional psychospiritual assessment tools include spiritual life maps, spiritual ecomaps, and spiritual ecograms (Hodge, 2005). Also, spiritual journaling can help clients deal with their beliefs, meditate, examine transcendent experiences, contact their higher power, reflect on sacred writings, and deal with psychological reactions to life experiences—ultimately creating a journal of spiritual development (Cashwell & Young, 2011). Furthermore, I suggest that clinicians encourage clients to use creativity in designing ways of exploring and expressing their spirituality. Therapists working within this orientation are not a blank screen. For instance, Cervantes and Parham (2005) suggested that therapists examine their own spirituality/religiosity (or lack thereof) to better understand this dimension in therapy. To facilitate this process, practitioners can complete their own spiritual genogram and explore (a) personal spirituality and religiosity, (b) current understanding of spirituality and religiosity, and (c) relationship between personal spirituality/ religiosity and professional functioning (Haug, 1998). Along these lines, I recommend that therapists compare their own cultural and spiritual genograms with those of their clients of color—a kind of an exploration of spiritual transference and countertransference. For example, a White lapsed Catholic therapist man may want to examine his countertransference toward his devout Catholic Latina client. Moreover, therapists can analyze the societal power differential within diverse religions and spiritualities. To illustrate, while Christian therapists may examine if they harbor internalized anti-Semitism, Jewish therapists can examine if they have aversive Islamophobia. Unearthing therapists’ unconscious reaction to religious and spiritual material can be a challenging endeavor. However, Cervantes and Parham (2005) reminded us that therapists, just like other healers, are vessels of healing energy acting as a conduit to activate clients’ self-healing. To cultivate

this ability, therapists need to attend to their own healing, exercise self-care, and engage in psychospiritual development. Therefore, healing within a spiritual context requires accessing the client’s mind, body, and heart. As an illustration, in her qualitative study, Koss-Chioino (2006) observed that Puerto Rican healers developed what she called a radical empathy—a capacity for relatedness and connectedness that results out of the healer’s spiritual evolution into an altruistic stance toward the client. Thus, a radical empathy blends the differences between healer and client into one field of experience. Incidentally, in my clinical practice, I have observed that the therapist’s intuition sustains such a unified field of experience, creating a radical empathy. Of interest, Frank (1985) noted that most gifted therapists have a healing power stemming from their ability to connect with their clients with telepathy, precognition, and other parapsychological ways. Consequently, therapists and counselors may want to nurture their development of radical empathy. Perhaps the most important aspect in working on spiritual matters with clients of all colors is the therapist’s desire to heal heart to heart. Similar to folk healers, therapists and counselors can aspire to reach their clients’ hearts by using their hearts to activate altruism as a healing power. To paraphrase Maya Angelou, when therapists desire to reach clients’ hearts, they can become wise. In conclusion, multicultural spirituality is a syncretistic, healing, and transformative practice anchored in a liberation foundation. This psychospiritual orientation involves a commitment to empowerment, healing, and social justice. Therapists working with clients of color can enhance their cultural competence when they endorse a multicultural spiritual approach. Certainly, psychologists can become better therapists if they develop radical empathy. Therapists can achieve this goal when they engage in a psychospiritual journey.

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CHAPTER

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International Engagement in Counseling and Psychology History, Forums, Issues, and Directions Andrés J. Consoli, Merry Bullock, and Melissa L. Morgan Consoli

T

he fields of counseling and psychology in general have been advanced and transformed through international exchanges, engagement, and scholarship. In order to appreciate this transformation, we provide a brief overview of the history of both fields and of possible framings of the word international within their context. Next, we highlight some of the forums where international engagement is taking place currently and identify some of the salient issues at the international level. Furthermore, we discuss current directions in counseling and psychology born out of international engagement and provide some recommendations for the future.

BRIEF HISTORY AND CONCEPTS In this section, we articulate a brief history of international counseling and psychology and then put forward three possible conceptualizations of the term international: internationalism, internationalization, and international pluralism. From its very beginnings, counseling and psychology have been shaped and influenced by international exchanges. Starting with the origins of psychological discourse in Asia (e.g., Confucius, Mencius), in Europe (e.g., Plato and Aristotle at the Academy of Athens in Greece), in India or the Middle East, to the beginnings of “modern” counseling and psychology at the turn of the 19th–20th centuries, psychological knowledge has been carried across borders and cultures. This international dimension also characterized the first International Congress of Physiological Psychology in 1889 where 200 scholars from 20 countries gathered (Bullock, 2013).

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The initial developments of modern psychology can be found in laboratories and clinics established on most continents by the early 1900s. Initially, there was a predominance of ideas from Europe, mainly Germany, France, and Britain, and a considerable flow of aspiring academics traveling to Europe to be trained in psychology. For example, 16 of the pioneering psychologists in the United States earned their doctoral degrees in Leipzig, including G. Stanley Hall and James McKeen Cattell (Pickren & Rutherford, 2010). This center shifted during the first half of the 20th century due to political strife and war in Europe so that many European psychologists emigrated from Europe, mostly to the United States although also to countries in Latin America, particularly Argentina, Brazil, and Mexico. As Danzinger (2006) noted, the second half of the 20th century was characterized by a flow of students from many countries coming to the United States for training in psychology. It is perhaps in these transnational exchanges, in the growing diversity of populations through migratory processes, and in the keen interest in human and civil rights through affirmative action and antidiscrimination laws, that increased attention was given to recognizing the importance of culture in behavior and in psychology (see Casas, this volume, Chapter 1). Moreover, an increasing awareness that knowledge, theories, and models developed in a Western or European/ North American tradition did not fit well with phenomena observed in other cultures raised questions about the assumptions of psychology as a culture-free science and challenged the assumption of universally applicable knowledge, especially in psychosocial areas. As Bullock (2013) noted, international engagement has “helped to highlight the cultural embeddedness of much of psychological knowledge” (p. 566). While much of the history of counseling is closely associated with its development in the United States beginning in the late 1800s and early 1900s, its current manifestation is international.

There are over 40 countries in seven different regions of the world that currently recognize counseling to varying degrees (Hohenshil, Amundson, & Niles, 2013). Over the last two decades, leading U.S.based organizations in counseling and psychology have formally recognized the importance of culture in their respective disciplines through the development of cultural guidelines (American Psychological Association [APA], 2003; Sue, Arredondo, & McDavis, 1992). The initial multicultural framework based on awareness, knowledge, and skills has been adapted to international competencies by drawing upon Urie Bronfenbrenner’s ecological model and emphasizing the influence exerted by diverse contexts on people’s values, beliefs, personality, and ultimately, behavior (Heppner, Leong, & Gerstein, 2008). Contemporarily, some see international engagement as the logical evolution of the advancement of multiculturalism, others place international engagement and multiculturalism as two perspectives with some overlap but different concerns, and others see a disconnect between U.S. diversitymulticultural issues and international issues (Casas, Park, & Cho, 2010; Lowman, 2013). We now turn to a discussion on possible conceptualizations of the term international.

CONCEPTUALIZING INTERNATIONAL What is to be understood when using the expression international counseling or international psychology? For some, international has meant going abroad to export counseling and psychology to a given country. Most of the time, this has been done with good intentions, though typically from a dominant country to one that is perceived or (mis)construed as “in need.” We refer to that process as internationalism. In its more benevolent form, exporting psychology from one country to another can serve to help the receiving country

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develop its science and practice by providing a framework upon which to build. However, in its more malevolent form, exporting psychology can be akin to colonialism, in which there is no recognition that the needs, values, and perspectives of the host culture must provide a framework into which the exported psychology may be adapted. Not to recognize this disrespects the host culture by ignoring its own processes and imposes a psychological discourse conceived elsewhere. Internationalism, when it follows a “one size fits all” model, ignores the fact that all psychologies are embedded within a cultural framework and are thus, to some extent, indigenous to their culture. For others, international has meant describing and documenting the presence of counseling and psychology in multiple countries and attempting to recognize differences in the discipline as practiced in those countries. We refer to this process as internationalization. This process is the first step in advancing a more pluralistic form of an international, diverse discipline as it acknowledges that science and practice can take different forms across nations and cultures. In its more sophisticated forms, internationalization attempts to understand the differences by exploring the role of culture, history, and context in counseling and psychology. In its simpler forms, internationalization remains a cataloging of national differences, or worse, a ranking of “better” or “lesser” approaches. Yet for others, international refers to international engagement that crosses national boundaries and that is characterized by mutuality and reciprocity among partners. We refer to this process as international pluralism. This occurs when practitioners or scientists in an international exchange strive to understand each other’s perspectives through mutual engagement, interrogation, and relatedness (Dallmayr, 2010), when involved parties recognize each as valuable while seeking to appreciate each other as “learning partners” (APA Task Force on APA’s Role in International Quality Assurance, 2008). Examples of international pluralism can be found in attempts to reach international consensus on guidelines for the training of psychologists in different regions of

the world (e.g., Latin America, Europe), for psychological practice, or for psychological principles such as expressed in the Universal Declaration of Ethical Principles for Psychologists. International pluralism transcends internationalization to the extent that it both recognizes differences (as does internationalization) but goes further to find areas of consensus in goals and products that simultaneously respect the locality of knowledge, science, and practice. Moreover, international pluralism recognizes that all psychologies are indigenous to their histories and contexts of development and considers international engagement as a platform for exploring and affirming the role of culture in the disciplines (Lowman, 2013).

FORUMS International Associations There are many international associations in psychology and counseling that have played a significant role in advancing international engagement. In psychology, a partial list includes the International Union of Psychological Science (IUPsyS, www .iupsys.net), the International Association of Applied Psychology (IAAP, www.iaapsy.org), the International Council of Psychologists (ICP, www.icpweb.org), the International Association of Cross-Cultural Psychology (IACCP, www.iaccp .org), the International Society for Traumatic Stress Studies (ISTSS, www.istss.org), and more recently, the World Council for Psychotherapy (WCP, www .worldpsyche.org), among many others. In counseling, there are two prominent associations with international foci: the International Association for Counselling (IAC, www.iac-irtac.org) and the International Association for Educational and Vocational Guidance (IAEVG, www.iaevg.org).

Regional Organizations Although there is considerable overlap between regional and international organizations as regional organizations are, by definition, international as well, there is a special role occupied

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by those organizations that focus on distinct geographical regions. The longest standing, the Interamerican Society of Psychology (known as SIP, the Americas, www.sipsych.org), the Union of Latin American Entities in Psychology (ULAPSI, Latin America, www.ulapsi.org), and the European Federation of Psychologists’ Associations (EFPA, Europe, www.efpa.eu), have served to unite psychological organizations and individuals across geopolitical and language groups through regular conferences, workgroups, policy activities, and publications. The last decade has seen the rise of general regional organizations on almost every continent in the world. Since 2005, regional organizations have begun in Asia (ASEAN Regional Union of Psychological Societies, ARUPS), the Caribbean (Caribbean Alliance of National Psychological Associations, CANPA, www.can panet.org), and Africa (Pan African Psycholo­ gical Union, PAPU). In addition, there are many content-specific regional organizations, especially in Europe and Asia (see www.psychologyresources.org for a list). The important role played by regional organizations is to address issues that rest on shared or similar historical circumstances, educational systems, political systems, language, or common social issues, and to develop consensus regionally despite individual country differences. In a sense, the role of culture is more poignant among regional organizations than international organizations because of the tasks that regional organizations assign themselves of fostering common systems, education, or policies at the regional level. For example, EFPA spearheaded the development of a common standard for professional psychology across 35 countries in the European area that represented a range of different educational systems, psychology traditions, languages, and cultures. This standard, EuroPsy, which offers a European certificate in psychology, is one of the newest and most exciting developments in the international arena because it has managed to build consensus on standards while attending to cultural, structural, and historical similarities and differences (www.europsy-efpa.eu).

USA Associations With International Foci There are also U.S.-based national associations that directly focus on international engagement. The APA’s Office of International Affairs (www.apa .org/international) coordinates APA’s participation and representation in international venues and promotes international exchanges. APA has a standing committee, the Committee on International Relations in Psychology (CIRP), founded in 1944, which fosters the development of international psychology as a science and profession and advises APA governance about international matters. APA’s Division 52: International Psychology (www.div52 .org) publishes the International Perspectives in Psychology: Research, Practice, Consultation. In addition, Division 17: The Society of Counseling Psychology (www.div17.org) publishes The Counseling Psychologist (TCP), which contains a special section titled “International Forum” (Pedersen & Leong, 1997). In counseling, the National Board for Certified Counselors (NBCC) created NBCC International in 2003 (www.nbccinternational.org) for the purpose of advancing the counseling profession worldwide.

Databases and Publications There are several databases with relevant international materials including PsycINFO, PsycExtra, Redalyc (for Spanish), and Psyndex (for German), among others. Moreover, information about the status of psychology in a specific country or region often offers invaluable insight into the issues, perspectives, and unique cultural frameworks in which psychology education and training occur in those countries. The Psychology-Resources website (http://resources.iupsys.net/iupsys/index .php/patw-resources) hosted by IUPsyS has links (and some full text articles) to a large range of descriptive material organized at the country level (under “country overview”) as well as regionally. In addition, this web resource lists departments of psychology in every country in

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the world, ­offering a glimpse of the many ways that psychology is named and placed within the larger educational institution (e.g., as science, humanities, philosophy, education, and the like). Furthermore, there are by now many handbooks on counseling and psychology around the world (e.g., Gerstein, Heppner, Ægisdóttir, Leung, & Norsworthy, 2009; Hohenshil et al., 2013; Stevens & Gielen, 2007; Stevens & Wedding, 2004), and several special issues in journals and newsletters such as the Journal of Mental Health Counseling (April & July, 2005), Career Development Quarterly (September, 2005), Psychology International (www.apa.org/ international/pi/), and International Psychology Bulletin (http://div52.org/publications/newslet ter). For a longer list, please see http://resources .iupsys.net/iupsys/index.php/iupsysresources/300bibliographies/45098-handbooks-in-psychology.

ISSUES RELATED TO INTERNATIONAL ENGAGEMENT In this section, we address some specific issues related to international engagement, particularly as it concerns the exchange of scholars and students, service provision, cross-cultural research, and counselor training. Furthermore, we identify a range of matters pertinent to counseling and psychology that can benefit from an international and transnational perspective and approach.

Exchange of Students and Scholars There is no doubt that personal exchange across cultures and languages is invaluable in promoting an international perspective. Student and faculty exchange allow immersion in a culture, country, language, and educational system. Such exchange is also consonant with current trends in higher education institutions to promote international perspectives by fostering local students and faculty to spend time abroad and by encouraging the recruitment of international faculty and students at all levels. In general, psychology is less well represented in

i­ nternational student-faculty exchanges at the graduate level than other disciplines. Nonetheless, comments from those who have participated in short- or long-term exchanges underscore the importance of this avenue—the experiences are generally seen as transformational and life changing. Although there are numerous opportunities for international exchange at the undergraduate level for U.S. students (e.g., study abroad programs, university to university exchange programs), there are fewer structured opportunities for graduate student exchange in psychology. Most international graduate school experiences tied to U.S. educational programs are shorter term—for a few weeks to months—often as part of a community engagement component or faculty research program. This is an area that could benefit from more structured predoctoral and postdoctoral professional internships abroad. Students interested in international experiences can volunteer for summer internships with nongovernmental organizations (NGOs) or other service organizations, or search for facultyled research projects that include international collaborations. There are also international summer schools made available through international or regional psychology associations that can provide networking and collaboration opportunities. There are relevant models from other countries that do provide regular institutional support for studying abroad. For example, in Brazil, many psychology graduate students are expected to participate in the “sandwich” year in which they receive federal support to study abroad for up to 1 year in the middle of their graduate programs. Others, such as Germany or Japan, offer generous stipends to students who are willing to spend 1 to 2 years abroad. There is no specific formal program for U.S. students to study abroad. Some do so informally, choosing to matriculate at an international university for 1 or several years, but this is generally on an individual, ad hoc basis. Within science-oriented programs, such experiences generally fit into the sequence of graduate studies. However, for students who are in programs leading to licensure, international exchange is more complicated to plan because of

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requirements concerning supervision and supervised hours. Nonetheless, programs are beginning to embrace both the value of such international experience and the pressing need and desire on the part of students, many of whom are committed to a professional life that incudes international collaboration, work, and residence. In the United States, postgraduate and faculty exchanges are available through the Fulbright programs as well as from some federal funding programs (see http://www.apa.org/international/ resources/networks/funding.aspx). For an overview of opportunities and best practices for faculty exchange, please see http://www.apa.org/interna tional/resources/academics-abroad.aspx.

Foreign Students in the United States The United States has long been host to students from abroad. Although estimates of the numbers of exchange students are difficult to locate, the proportion of foreign graduate students in psychology is much lower than in some other disciplines. For example, the 2009 National Science Foundation’s statistics for foreign students enrolled in U.S. institutions show 8,500 in psychology versus 31,530 in biology, 13,230 in mathematics, and 16,250 in economics (Burrelli, 2010). More recent studies report similar low patterns of foreign student representation in the social sciences in general and psychology in particular (see www.webcaspar.nsf .gov). International students in the United States offer a rich educational resource as they can bring diverse, multicultural perspectives into graduate training. We highlight some of their contributions and the challenges they experience in the next sections.

Cross-Cultural Counseling Challenges Prominent among the issues faced by counselors and psychologists who work internationally is how to practice cross-culturally or cross-nationally in a

competent and humble manner, how to consider acculturative processes, how to overcome communication barriers, and how to adapt existing treatment modalities. Cross-cultural counseling has some overlap with the multicultural movement that has received much attention in recent years in counseling and psychology. Specifically, the Guidelines for Multicultural Competence (Sue et al., 1992) encouraged psychologists to increase their own knowledge, skills, and awareness for working with individuals of different races or ethnicities. In addition, many psychology programs have developed multiculturally focused courses, which specifically train students to conduct therapy with individuals who are culturally different from them (see Casas, this volume, Chapter 1). Both of these initiatives have served to increase counselors’ and psychologists’ capabilities to work cross-culturally, which, in theory, encompass working with international individuals. However, the multicultural movement has focused less on cross-culturalism at the international level and until recently also included working with immigrants (see APA, 2012), working with international students in the United States, and working with individuals in other countries. Differentiated from multicultural counseling by Gerstein et al. (2009), cross-cultural counseling is defined as the pursuit and application of universal and indigenous theories, strategies (e.g., direct service, consultation, training, education, prevention) and research paradigms of counseling and mental health helpseeking grounded in in-depth examination, understanding, and appreciation of the cultural and epistemological underpinnings of countries located worldwide. (p. 4)

This covers both psychologists in the United States working with individuals from outside of the country or another culture as well as psychologists who go outside of the United States to provide services in another country or culture. Relatedly, cross-national counseling has been defined as “collaborative professional activities (e.g., program

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development and implementation, training, teaching, consultation) jointly pursued by mental health professionals residing in at least two countries” (Gerstein et al., 2009). There are several challenging issues to be reflected upon when considering these realms of cross-cultural work. Common to all of these contexts is the concept of acculturation. In its original and common conception, acculturation pertains to how a person coming to a new culture interacts with and adapts to that new culture (Berry, 2003; Padilla & Perez, 2003). More recent conceptualizations of acculturation utilize a multidimensional perspective, incorporating social networks and cultural knowledge (Padilla & Perez, 2003). Another important area of cross-cultural counseling, which can also be a part of the difficulties of acculturation, is communication barriers. Those entering the new culture may present with anxiety or even depression, which can be largely based on the lack of skills necessary to achieve daily living. Avoiding the uncomfortable feelings associated with communication in the new culture may leave the newcomer isolated and without support, and without the feelings of competence that are necessary for achievement (Berry, Phinney, Sam, & Vedder, 2006). Finally, also related to acculturation issues are issues of identity. When individuals must live in “two worlds,” conflicts between the culture of origin and the host culture can arise. This situation may force the individual to feel like he or she must choose a behavior or value that is inconsistent with his or her own belief systems or values, causing distress surrounding one’s perception of self. All of the above issues have potential negative effects on students entering a new culture. Some of the most common presenting problems for international students are feeling “down” or depressed, difficulty standing up for oneself, and nervousness (Nilsson, Berkel, Flores, & Lucas, 2004). In general, international students have been found to experience more mental health problems than their noninternational peers. Ironically, international students are one of the most underserved groups on college campuses. Differences in worldviews

between student and counselor may contribute to this underutilization, particularly when the student’s cultural values endorse interrelatedness between people or maintaining the “face” of the family (Volet & Karabenick, 2006). Similarly, the above issues affect immigrants, whether the client coming to the new culture or an immigrant therapist going to another culture. Immigrants are also often underserved given issues such as the significant challenge presented by language barriers and differences in worldviews (Sue & Sue, 1999). For more information on the impact that these issues have on immigrants, see Tummala-Narra (this volume, Chapter 36) and the APA report titled Crossroads: The Psychology of Immigration in the New Century (2012). Despite experiencing these adversities, and perhaps sometimes due to experiencing them, international students and immigrants are often resilient people, encompassing traits, characteristics, and experiences that help them to overcome adversities (see APA, 2012). Such individuals have been found to have more positive emotions than locals, for example. Of particular benefit to facilitating resilience in this population are social connectedness, greater sense of meaning in life, and focus and flexibility. Similarly, a welcoming environment can be a valuable support system that can aid in their success (Hayes & Lin, 1994). The cultural values and sense of identity that immigrants possess when they arrive in the United States has been shown to be a benefit in dealing with adversity (Portes & Rumbaut, 2006). Relatively recent, attention has been given to cultural applicability of common therapeutic practices. Many traditional therapies grew out of theories originated by and for White Western populations and may not be directly suitable for individuals of other cultures. Cultural adaptation (Bernal & Domenech-Rodriguez, 2012) and cultural responsiveness (Gallardo, Parham, Trimble, & Yeh, 2012) are among the emerging models that consider culture, and many evidence-based treatments have been culturally adapted for several distinct populations (for a review, see DomenechRodriguez & Bernal, 2012).

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CROSS-CULTURAL RESEARCH Cross-cultural research has also been an area for exploration in international psychology. Encompassing everything from studying immigrants or international students in the United States, to studies conducted in two countries, to studies of U.S. individuals in other countries, this last area has not been widely researched. Perhaps the most researched are international students in the United States. Studies have tended to focus on challenges faced by these groups and less on strengths they possess. Most research summarizes their needs and the underutilization of services; however, recent attention has been given to how interventions might be culturally adapted to help with this problem (see above). Despite more attention being paid to such areas, this literature still has room for growth. For example, many studies look at “international students” as a whole, ignoring the plethora of differences between students coming from different (or even the same) countries. While research has been done specifically on immigrant populations, the focus has often been noninclusive or categorical. For example, it has been noted that prior scholarship was influenced by the political debates of the 1920s regarding criteria for acceptance or rejection of immigrant groups (e.g., Chinese Exclusion Act), historically overemphasizing such concepts as required adaptation to the host community and immigrants having the single option of assimilation (Gabaccia, 2006). Similarly, research has often split immigrants into “good” (e.g., bicultural) and “bad” (e.g., monocultural) types (Wills, 2010) and highlights negative views of immigrants without taking into account the receiving society’s influence on their functioning (Yakushko, 2009). Most researchers have not attended to the individual and cultural complexities faced by immigrants. For example, most scholarship focuses on individuals without considering the context of their families and communities (Suarez-Orozco & Carhill, 2008). Additionally, limited attention has been given in the literature to binationalism, which characterizes many within the immigrant

populations, particularly those who are more educated. Binational immigrants engage in business and social transactions across borders, building necessary means of financial and social support (Portes, Guarnizo, & Landolt, 1999), and thus effectively being immigrants in both places. Moreover, and unfortunately, much of the international student or immigrant literature has a deficit focus (Pedersen, 1991), detailing the problems encountered and avoiding the strengths and resilience displayed by individuals who pick up and move from another country for academic opportunities. This resilience has been the focus of a few studies as noted above, but there is much more that remains to be investigated in this area. Such information could help us to better serve and help international students and immigrants to succeed in their new countries. Finally, research on international students and immigrants could benefit from including more of the voices of the newcomers themselves. Qualitative and mixed methods research lends itself particularly well to giving voice to disenfranchised populations (Morrow, 2007). Understanding the experiences and needs of these individuals from “the inside out” is helpful in information systems and programs designed for serving these populations. Studying Psychology in the United States (Hasan, Fouad, & Williams-Nickelson, 2008) stands out as a particularly useful model from which to address such research.

Counselor Training Leong and Ponterotto (2003) were among the first in counseling psychology to articulate a comprehensive list of priorities that counseling training programs should embrace in order to facilitate the graduation of internationally competent psychologists. The list included criteria at the time of admission (e.g., study abroad and international travel as strengths among applicants), during training (e.g., opportunities for international exchange, attending conferences abroad, internship opportunities in other nations, requiring a foreign language proficiency and readings from non-U.S. authors), and as

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part of the program’s philosophy and practice (e.g., integrating multiculturalism with international engagement, welcoming faculty members from other countries). Turner-Essel and Waehler (2009) used Leong and Ponterotto’s list as a proxy to assess the extent to which U.S. counseling psychology training programs embrace an international perspective. The vast majority of respondents indicated that their programs integrated international perspectives into multiculturalism. Nonetheless, only two out of 47 respondents acknowledged a formal international exchange program and none required studying a foreign language in their training, despite prior recommendations to this effect (see Belar, Nelson, & Wasik, 2003). Turner-Essel and Waehler (2009) highlighted the marked influence that a single faculty member with an international interest can have in a department, the strong role that student initiative can play in internationalizing a program, and the important function that international students can serve in connecting their institution with their countries of origin. Hurley, Gerstein, and Ægisdóttir (2013) conducted a similar study and found that 3 years later there was no noticeable increase in international training opportunities, while there was an increase in the incorporation of international engagement as part of multiculturalism.

Further International Issues The list of matters related to counseling and psychology that require or can benefit from transnational approaches is an extensive one. We have addressed some of these issues and will address several more in the next section. Here, we would like to underscore some poignant items in such a list, again, items that require or can benefit from collaborative, ultimately emancipatory international engagements. Paramount among these issues is the matter of socioeconomic status, specifically poverty, in its threat to health and mental health, and the realization that the causes of poverty can be found in the disadvantageous exchanges within the global market, which, in turn, deepen

inequalities in the distribution of wealth (APA Task Force on Socioeconomic Status, 2007). Similarly, matters related to human rights are best appreciated in an international arena where the interplay between dominant forces carrying out abuses and nations supporting or profiting from those abuses can be exposed. Migration and immigration, and closely related to them intercultural conflicts and refugee asylum, are matters that must be understood and dealt with on international terms, above and beyond the individual level. Likewise, oppressive, prejudicial, and unfair discriminatory beliefs and practices of all kinds (e.g., race, ethnicity, sex, gender identity, sexual orientation, religious/spiritual beliefs, age, size), but particularly xenophobic ones (i.e., national origin), create much human suffering; counseling and psychology can offer much to redress the perpetrator’s actions and empower the recipient of such practices, all the while concerning ourselves with the policies that condone or sanction those practices. Overpopulation, global warming, human trafficking, communicable diseases, subversive and state terrorism, war, and ultimately, peace, among nations and in the world, are matters that necessitate an international perspective (Christie & Montiel, 2013; Leidner, Tropp, & Lickel, 2013; Stevens & Gielen, 2007).

DIRECTIONS: INTERNATIONAL ENGAGEMENT IN ACTION In this next section, we discuss some of the current directions in international engagement. We do so through highlighting some of the achievements and opportunities that have come out of a commitment to engaging in emancipatory, affirmative, transnational practices.

The Universal Declaration of Ethical Principles for Psychologists (UD) The UD is an example of international engagement that brought together psychologists from diverse

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nations to develop consensus and common ground while affirming cultural, national, and regional differences (Gauthier, 2008). The UD articulates a moral framework and a set of fundamental ethical principles intended to guide psychologists in their scientific, academic, and professional endeavors and to advise psychological organizations in the development and evaluation of their code of ethics. The UD affirms four principles, including respect for the dignity of persons and peoples, competent caring for the well-being of persons and peoples, integrity, and professional and scientific responsibilities to society. These principles are then further specified through related values. For example, the values specifying respect for the dignity of persons and peoples encompass the respect for dignity and worthiness of all human beings, nondiscrimination, informed consent, freedom of consent, privacy, protection of confidentiality, and fair treatment/ due process. Altogether, principles and values form a high-order agenda that is to guide the scientific, academic, and professional endeavors of all psychologists and their organizations. Yet as the UD notes, the principles and related values are general and aspirational rather than specific and prescriptive. Their application to the development of specific standards of conduct will vary across cultures and must occur locally or regionally in order to ensure their relevance to local or regional cultures, customs, beliefs, and laws.

Search for International Consensus in Psychology Education and Training and in Competencies for Professional Psychology As psychology has developed internationally, it has become clear that there is enormous variability in the education and training systems for the discipline, as well as in the understanding and regulation of the title, entry level, and activities performed under professional practice. This variability makes it difficult to define what core psychology training

entails and makes it even more difficult to foster international mobility in psychology education or in professional activities. Psychological organizations have begun to address these issues. In 2012, the IUPsyS organized a workshop on “Psychology Education and Training: A Global Perspective” in which participants addressed current variability in psychology education and worked to develop a framework to think about global consensus on principles and competencies for psychology education. The discussion at this workshop and thoughtful commentary are summarized in a conference proceedings volume (Silbereisen, Ritchie, & Panday, 2014). In 2013, the fifth of a series of conferences under the title “International Conference on Licensure, Certification and Credentialing in Psychology” addressed mobility and regulation systems. Much like the process underlying development of the UD, the idea is to create a forum for international discussion and dialogue that will allow psychology, internationally, to reach consensus on international definitions, training, and practices for professional psychology. For more information on this process, see http:// www.apa.org/international/pi/2013/10/coverstockholm.aspx or http://www.bps.org.uk/news/ global-agreement-psychology-competencies.

Further Examples of International Engagement The International Union of Psychological Science, the International Association of Applied Psychology, and the International Association of Cross-Cultural Psychology have collaborated since 1992 in organizing capacity-building workshops titled “Advanced Research and Training Seminars” and known by the acronym ARTS (Poortinga, 1993; http://www.iupsys.net/events/capacity-buildingworkshops/advanced-research-and-training-sem inars-arts.html). The workshops consist of several simultaneous, 2- and 3-day intensive trainings that take place at one of the major international congresses (see the International Journal of Psychology,

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e.g., Bullock & Soygüt, 2011, for a summary). The focus of the workshops is on facilitating the acquisition of research and scholarship skills among a selected group of psychologists who come from low-income countries, countries in transition, or countries where psychology is not well developed. In the clinical domain, there are a number of instances of attempts to reach international consensus, collaboration, and engagement. For example, the International Classification of Functioning, Disability and Health (known as ICF, www.who.int/classifications/icf/en/), which complements the more well-known International Statistical Classification of Diseases and Related Health Problems (or ICD), both generated by the World Health Organization, is an effort to generate a common, shared language and framework for describing and conceptualizing health and health-related states that focuses on functioning rather than deficit. The ICF is particularly relevant to internationally engaged counseling and psychology researchers, academics, and practitioners as it distinguishes a person’s capacity from his or her performance and emphasizes a psychosocial perspective that understands a person’s activity and participation as mediated by environmental factors. Another example is the Latin American Guide for Psychiatric Diagnosis (known as GLADP for its acronym in Spanish, and since 2012 known as GLADP-VR for its revised version; Berganza, Mezzich, & Jorge, 2002), which is a concerted effort by national psychiatric associations in Latin America to honor cultural and contextual dimensions in the diagnostic processes, case formulations, and psychiatric nosology in use in Latin American countries. The GLADP was revised in 2012 to make it congruent with the revisions to the ICD, which itself was revised to reflect a more functional approach to classification and diagnosis, also adopting a consensusbuilding model to support a culturally congruent approach to mental health assessment and evaluation (Reed, 2010; Saavedra, Mezzich, Otero, & Salloum, 2012). A last example is the international guidelines for disaster response, which

have adopted an explicit biopsychosocial model that puts local needs and realities in the forefront of disaster relief and long-term recovery (see Reyes & Jacobs, 2006).

RECOMMENDATIONS We close this chapter by offering some recommendations for counseling and psychology that affirm our understanding of international pluralism. We believe that for both fields to remain robust, they must embrace a transnational agenda that is characterized by mutuality, partnership, and relatedness, one that seeks to redress differences based on privilege, history, or level of psychology development among countries. To pursue such an agenda, it is important to recognize the contextually embedded nature of counseling and psychological theory, models, and practice, both within societies and within the spectrum of the social sciences. As counselors and psychologists, we must embrace paradigms that contextualize psychological discourse through the use of historical, economical, sociological, and political knowledge. We also believe we have a specific responsibility to contribute to a psychologically sound understanding of the public good, the good society, and the good life. For many, this means promoting engagement in transnational and multicultural advocacy and social justice action that affirms and promotes a rich and contextualized understanding of human behavior. What skills and competencies are crucial for an internationally engaged counselor and psychologist? We believe that cultural competency, a lifelong endeavor, needs to be matched by cultural humility (Tervalon & Murray-García, 1998). We also believe that true international engagement requires interaction in local languages— this would entail the acquisition of a second or third language that is utilized professionally (e.g., see Belar et  al., 2003). Meaningful international engagement also requires an understanding of our own cultural contexts. As cultural beings, it is difficult for people to appreciate their own cultural milieu while immersed in it. This understanding, including understanding of how one’s own

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perspective is indigenous to a specific cultural and historical background, is facilitated through purposeful travel and reflection on international collaborations and exchanges. We believe that our educational programs need to encourage professionally meaningful international engagement, including scholarship (e.g., research projects and dissertations), service (e.g., externships,

internships, postdoctoral positions), and faculty exchange. Engaging in such activities paired with guided reflection are important ways of advancing counseling and psychology’s appreciation of the diversity in cultural contexts, of noting the cultural embeddedness of psychological knowledge, of building an international curiosity, and ultimately, of building an internationally engaged discipline.

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Multicultural Competence in the Delivery of Technology-Mediated Mental Health Services Cynthia de las Fuentes and Martha Ramos Duffer

Reports that online cognitive behavioral treatment can be as effective as in-person psychotherapy suggest that technology will expand access, extend the impact of a therapist, and expedite treatment for people who might not find “seeing” a therapist acceptable. (Insel, 2014)

I

n his “Director’s Blog: May Is for Meetings and Mental Health,” Dr. Thomas Insel, the director of the National Institute of Mental Health, described the technology he saw at the 2014 National Council for Behavioral Health Conference: “From wearable sensors to video game treatments, everyone seems to be looking to technology as the next wave of innovation for mental health care” (Insel, 2014, para. 4). Indeed, due to the near ubiquitous availability of electronic and wireless communication technologies, mental health professionals and their clients, trainees, and research participants are already no longer limited to face-to-face (F2F) encounters. Because the evaluation, diagnosis, and treatment of mental health conditions have traditionally been delivered in an audio and visually rich environment (i.e., F2F), with interventions often including in-between sessions homework, the nature of this health service can lend itself fairly well via communication technologies such as telephone, videoconferencing, e-mail, and smartphone applications (apps). These technologies can create and maintain therapeutic relationships, provide evidence-based interventions, and be the vehicle to propel change processes, whether in a therapy office, a classroom, a home, or a community. Citing data that makes it clear that one-to-one psychotherapy models will never be sufficient to address the prevalence of mental disorders in the United States, much less the world, Kazdin and Blasé (2011) suggested that it is incumbent upon mental health professionals to consider multiple new possibilities in the delivery of mental health services in order to reduce the challenges of mental illness on

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society. This imperative becomes clearer in light of the lived realities of members of historically marginalized groups, including multicultural groups, who often experience negative stereotypes, the effects of which have been shown to create stress responses that adversely impact health and psychological well-being, as well as create barriers to equal access to effective treatment (Chiao & Blizinsky, 2013; Sue & Sue, 2012). The numbers of people fitting this category are increasing because in addition to the growing numbers of people of Latina/o, African, Asian, Pacific Islander, and Native American heritage currently in the United States, demographers project that by 2050 nearly one in five people living in the United States will be an immigrant (Passel & Cohn, 2008). Other researchers have found that people in rural areas have less access to mental health services than those in urban areas, and individuals within the lowest socioeconomic status are estimated to be 2 to 3 times more likely to have a mental disorder than those within the highest socioeconomic status (Safran, 2009). The fact that mental health disorders are among the highest causes of morbidity and mortality worldwide has caused some researchers to state, “There can be no health without mental health” (Prince et  al., 2007, p. 859). Therefore, the opportunities for increased access to mental health services created by communication technologies are particularly compelling when considering well-documented disparities in health and mental health access and services (e.g., Safran et al., 2009).

(closed-circuit) television in group therapy. Presciently, perhaps, they summarized their article with the following statement:

Telehealth Origins and Common Terminology

Access Issues

From the Greek word tele, meaning “at a distance,” telecommunication has been around since the use of smoke signals. In modern times, however, the use of communication technology to facilitate mental health treatment appears in the literature as early as 1961 when Wittson, Affleck, and Johnson coauthored a paper on the use of two-way

It appears that the procedure is technically possible, and would be limited only by the problem of achieving clear video transmission over longer distances. New developments . . . may be the means for skilled mental health personnel to extend their services to persons in distant areas which have an insufficient number of therapists. (p. 23)

Over a decade later, the term telepsychiatry appeared in the literature when it was used to describe “psychiatric consultation by interactive television” (Dwyer, 1973, p. 865). Currently, the terminology to describe the delivery of mental health services from a distance and/or via electronic means also includes telehealth, telemedicine, telemental health, telepsychology, telepsychiatry, behavioral telehealth, telepractice, teletherapy, online counseling, online therapy, computermediated therapy, cybertherapy, e- (for electronic) health, e-mental health, m- (for mobile) health, m-behavioral health, and m-health technology, among others. These terms describe the technology that facilitates mental health treatment and include interactions and/or interventions that are either synchronous (e.g., “live,” as in videoconferencing) or asynchronous (e.g., different times, not live, “store-and-forward,” as in e-mail exchanges), as well as computer websites and smartphone apps that purport to treat or are adjunctive to the treatment of psychological conditions.

Unfortunately, the very bridge e-mental health care is capable of building is hindered because income, education, and age matter most in technology disparities in the United States as older, Black, and/or Latina/o, less educated, and less affluent individuals have significantly lower odds of reporting any Internet connectivity (defined as having access to a computer and/or Internet at home or elsewhere),

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while younger, non-Latina/o White, more educated, and more affluent individuals are significantly more likely to be connected across multiple settings and devices (File, 2013). The above notwithstanding, the increasing proliferation of smartphones, even for people with low disposable income, is playing a significant role in diminishing the often cited economically driven historical digital divide (e.g., File, 2013). As a Pew Report (2009) on wireless Internet use revealed, Black and Latina/o people in the United States are increasingly accessing the Internet through mobile phones, and Guadagno, Muscanell, and Pollio (2013) found that homeless young adults and college students had similar levels of social media use. Moreover, a recent news article (“Deputy UN Chief,” 2013) urging progress in sanitation made the startling comparison that worldwide access to mobile phones exceeds access to toilets or latrines, stating that 6 billion people of the world’s 7 billion population have access to mobile phones while only 4.5 billion have access to toilets. When we consider the historical and traditional challenges of access to psychological services, particularly for multicultural people of color, people who are poor, homeless, differently “abled,” lesbian, gay, bisexual, transgender, and/or who use nondominant languages in their communities, the findings noted above offer very compelling implications for the possibilities of overcoming barriers to access that mobile phones may create. At a time when the Internet is increasingly available, accessed, and convenient, the benefits of communication technologies in e-mental health include increased access to clients, providers, treatments, and interventions; decreased lost time (e.g., due to travel, sitting in a waiting room), travel and dependent-care costs; lower overhead costs to providers who work from home and insurers and employers who do not have to pay for providers’ travel to remote locations; and uninterrupted continuity of care (e.g., for those times when a client or provider’s child is ill, when one or the other travels out of town). In their Delphi poll forecasting psychotherapy in 2022, Norcross, Pfund, and Prochaska (2013) found that the top five predicted

changes in therapy interventions are online therapies, smartphone applications, self-help resources beyond books, virtual realities, and social networking interventions, all of which have the potential to be accessed via smartphones. While lamenting the loss of “the very presence of another human being” that teletherapy ushers in, Hyler and Gangure (2002, p. 27) noted that the challenge lies with connecting those in need with the technology that can deliver those services. Indeed it does, but perhaps a greater challenge is in connecting health service providers to those in need via the technology they already have at hand.

Efficacy: Does It Work? For decades, practitioners and scholars have consistently identified the quality of therapeutic relationships between therapists and clients, characterized by empathy, warmth, and trust generated by responsiveness and shared goals, as one of the most powerful curative factors of any therapeutic intervention (Cavanagh & Millings, 2013; Lambert & Barley, 2001). More recently, advances in the fields of neuroscience and interpersonal neurobiology have further elucidated the complex and layered healing that occurs as neural integration in the patient is facilitated by the attuned presence of the therapist who is able to facilitate a state of “resonance” within the relationship in which the patient “feels felt,” and thus is able to develop transformative internal coherence and brain integration (Schore, 2012; Siegel, 2010; Siegel & Solomon, 2013). In addition, therapist-client match of identity characteristics such as race, ethnicity, gender, sexual orientation, and ability play a role in the formation of a therapeutic working alliance, reducing premature termination and enhancing therapeutic outcomes (Farsimadan, Draghi-Lorenz, & Ellis, 2007; Meyer, Zane, & Cho, 2011, Walling, Suvak, Howard, Taft, & Murphy, 2012). Therefore, therapeutic healing can be facilitated by technology-mediated mental health services by increasing the likelihood of creating desired identity-based matches in therapeutic dyads. At a minimum, researchers and practitioners alike have discovered that, regardless of identity

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characteristics, to be effective, therapists must be multiculturally competent (Fuertes et  al., 2006; Sue & Sue, 2012). A foundational component of multicultural competence is the willingness to be changed by the relationship or encounter as one experiences other ways of perceiving and being in the world and learns to value these as much as what was previously known. The case can easily be made that the additional distance created by mediating a relationship or encounter through technology, which often severely restricts interpersonal cues, can interfere with this process, making it more difficult and less likely. Yet some social justice–focused researchers, clinicians, and scholars have argued that the continued focus on intrapsychic factors as sources of psychopathology and treatment in F2F encounters can serve to perpetuate oppression by ignoring sociocultural forces and environmental realities that lead to the development of mental illness (Greenleaf & Bryant, 2012; Jacobs, 1994). As illustrated below, effective multicultural counseling must therefore consider moving beyond the therapeutic alliance to incorporate interventions specifically designed to address oppression and increase psychological freedom (Hanna & Cardona, 2013). Technologically based interventions can easily be adapted or developed to educationally and therapeutically address such issues.

Teletherapy The evidence is mounting that technology-mediated therapeutic interventions are effective in the treatment of mental disorders (Backhaus et  al., 2012; Botella, Garcia-Palacios, Baños, & Quero, 2009; Slone, Rees, & McClellan, 2012; Stubbings, Rees, Roberts, & Kane, 2013) and that clinicians and patients find it to yield comparable therapeutic relationships with strong working alliances as those developed within F2F frameworks (Cavanagh & Millings, 2013; Morgan, Patrick, & Magaletta, 2008). In a review of existing studies on managing depression among Asian, African American, and Latino adults through telecounseling, Dorstyn,

Saniotis, and Sobhanian (2013) found short-term moderate to large improvement across several outcome measures as well as positive longer-term treatment effects. Furthermore, in their 2008 meta-analysis of 92 studies, Barak, Hen, BonielNissim, and Shapira found no statistical difference between outcomes of Internet-based therapy and F2F psychotherapy. Concluding that the therapeutic relationship “may be relatively robust to distance, asynchrony, and limited contact,” Cavanagh and Millings (2013) posed the critical question, “How can the therapeutic relationship be critical to the clinical benefits associated with psychological interventions, and yet, remote, limited and self-guided psychological interventions be of significant benefit, in some cases of a magnitude comparable to traditional relationship encompassing interventions?” (p. 198).

Interventions Via Texting and E-Mail Perhaps an explanation to Cavanagh and Millings’s (2013) question lies in the fact that, despite the strong clinical evidence that as healing as therapeutic alliances have been found to be healing in and of themselves (American Psychological Association [APA], 2012), there are many other sources of therapeutic benefit, from self-guided mindfulness practices to bibliotherapy, that are not dependent on a therapeutic relationship. For example, while e-mail and texting have become a quick and convenient way to communicate, the research on using these communication technologies as behavioral health interventions is also growing. Aguilera and Muñoz (2011) found that text messaging for the purposes of homework adherence, improving selfawareness, and tracking progress was very effective with their low-income population, and personalized text messages to support smoking cessation was also found to be significantly effective even 6 months after the intervention in a study conducted by Rodgers et al. (2005). Additionally, ColeLewis and Kershaw (2010) found that across age, minority status, and nationality, text messaging,

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as a tool for behavior change, was validated in their review of the scientific literature. On the other hand, e-mail was also used successfully for behavioral health interventions, as Trockel, Manber, Chang, Thurston, and Tailor (2011) found when they were able to positively affect sleep quality and depressive symptoms via e-mail-delivered cognitive behavioral interventions. In their smoking cessation e-mail interventions, Lenert, Muñoz, Perez, and Bansod (2004) were able to achieve similarly effective results. Furthermore, computer-assisted therapeutic interventions that do not include a synchronous therapeutic alliance have been found to be efficacious in the treatment of multiple disorders (e.g. Slone et al., 2012).

motivation and risk of harm to the consumer, with impunity to developers, especially if they are not accountable to regulatory boards or professional association ethics codes. Although initial studies are evidencing promising results (Morris et  al., 2010; Warren, 2012; Watts et al., 2013), given their recency, well-designed outcome studies are limited and many questions remain about their reach and effectiveness, especially with multicultural and diverse populations (Clarke & Yarborough, 2013; Luxton, McCann, Bush, Mishkind, & Reger, 2011; Morris & Aguilera, 2012).

Interventions via mHealth Apps

Regardless of the social justice imperative, convenience, efficiency, and cost effectiveness, the complications in using communication technologies in the delivery of health-care services are many and must be addressed if one is considering offering behavioral health services via telecommunication technologies. These complications include the fact that confidentiality is limited by context and technology, as neither party can be absolutely certain that the conversation is private; because identifying information can be intercepted, technology and procedures need to comply with federal privacy and security laws (e.g., U.S.—Health Insurance Portability and Accountability Act [HIPAA], U.S.— Health Information Technology for Economic and Clinical Health [HITECH], Canada—Personal Information Protection and Electronic Documents Act [PIPEDA], 2011); the identity and location of the participants need to be verified (because of jurisdictional issues); the capacity for crisis intervention may be diminished (e.g., a client in crisis can turn off the connection) and extra steps need to be taken to learn about crisis response venues, mandatory reporting, and involuntary hospitalization laws in the client’s locality; and unscrupulous participants may record, edit, distort, and distribute sessions. Furthermore, text-based communication (e.g., e-mail, chats, texting) and virtual applications (e.g., therapy done in virtual counseling offices

Over 17,000 mHealth apps, many of which are designed by software developers without clinical or scientific training, are currently available in app stores, and predictions are that by 2015 500 million people will be using mHealth apps (Jahns, 2010). Some of these apps help the user track symptoms, others guide users through progressive relaxation exercises, others offer hypnosis to stop smoking, while yet others send reminders to the user to practice therapeutic exercises to manage specific disorders and symptoms such as depression, alcohol abuse, anxiety, insomnia, stress, and psychosis. Unfortunately, we found no culturally informed behavioral intervention technologies, a fact that is made worse because the U.S. Food and Drug Administration (2013) has only just begun issuing guidelines on investigating the treatment claims and health benefits of certain health apps. The danger to the mHealth consumer is that many apps often come with a fee, and the intervention claims are rarely empirically validated (notable exceptions include those apps designed through a collaboration of the National Center for PTSD of the Veterans Administration and the U.S. Department of Defense’s National Center for Telehealth and Technology; Kuhn et  al., 2014), increasing profit

Ethical and Legal Complexities

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using avatars) are unlikely to be as effective as visual and auditory appraisals (e.g., F2F or video conferencing) in assessing symptoms such as flat affect, poor hygiene, slurred or pressured speech, and vocal and/or motor tics. Except in teletherapy where the scientific literature is becoming robust and demonstrating a positive trend (e.g., De Las Cuevas, Arredondo, Cabrera, Sulzenbacher, & Meise, 2006), the scientific evidence, in general, regarding the impact of technology upon the therapeutic relationship is in its infancy and rigorous investigations are very few (Rochlen, Zack, & Speyer, 2004). Unfortunately, so much less is known about culturally competent e-mental health care or how it compares with culturally competent F2F services that Yellowlees, Marks, Hilty, and Shore (2008) rightly asked, “What kind of assessment tools, methods, and measures are needed to assess the patients, providers, systems, technology, and other important issues that bear on the provision of culturally appropriate or competent mental healthcare to diverse populations by technology?” (p. 490). Despite the above-noted drawbacks, use of telecommunications technology in psychotherapeutic relationships is nonetheless becoming widespread. For example, in 2013, the APA adopted Guidelines for the Practice of Telepsychology to educate and inform its members of current accepted standards of professional practice when using telecommunication technologies in their delivery of psychological services. Yet 5 years earlier, a 2008 survey of psychologists conducted by the association (APA, 2009) found that 87% used telepsychology (e.g., telephone, e-mail, Listserv, videoconferencing, podcasts, and chat rooms) to deliver health services. Clearly, the psychologists practicing telepsychology in this survey are responding to the needs of their practices by using communication technologies for a variety of purposes. The survey did not, however, report if data were collected regarding training and evidence of competence, guidelines the respondents relied upon to inform their practice, practice jurisdictions, or types of technology used, so inferences about those important areas cannot be made.

Unfortunately, the slow pace that regulators, health service disciplines, and science have taken in evaluating and guiding the incorporation of communication technology in health service provision has created generational, jurisdictional, and consumer-provider divides in technology adoption, access, and application. Because of the historical lack of regulatory and professional guidance specific to this area, the risk to licensed providers is that they may succumb to pulls of convenience and/or client entreaties to use technologies to deliver services via insecure platforms, outside of their jurisdiction, and beyond their areas of competence, leaving them vulnerable to legal, regulatory, and ethical sanctions and providing ineffective or even harmful services.

Guidelines, Standards, Codes, and Law Well behind the proliferation and use of telecommunication technologies, most major national mental health associations in the United States and Canada finally now have guidelines, statements, and codes of conduct that address the use of videoconferencing technologies in the delivery of behavioral health services (e.g., American Counseling Association [ACA], 2005; American Mental Health Counselors Association, 2010; American Psychiatric Association [APAMD], 2009; APA, 2013; Association of Canadian Psychology Regulatory Organizations, 2011; National Association of Social Workers & Association of Social Work Boards [NASW & ASWB], 2005). Although they vary in breadth and depth, in general they all assert that existing ethics codes and practice guidelines and standards that were created under F2F assumptions also apply to their memberships when delivering services via telecommunication. These include those that direct attention to multiculturalism and diversity as a whole. Competence. For providers desiring to deliver therapeutic services via videoconferencing, their boundaries of competence must now also

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e­ncompass knowledge of the technologies (e.g., hardware and software) used in their practices and awareness of the potential impact of the technologies upon clients and the therapeutic relationship (e.g., APA, 2013), as well as assuring that the benefits, limitations, potential risks, and provisions to minimize those risks of such technology is discussed in an informed consent process prior to engaging in telehealth services (e.g., NASW & ASWB, 2005). The multiculturally competent provider of telemental health services must additionally become aware of how a client’s cultural background influences her or his comfort with technology as well as how culture-specific communication styles may play a role in determining the effectiveness and appropriateness of teletherapy as a treatment modality (Shore, 2008; Yellowlees et  al., 2008). Multicultural competence should also be inclusive of military culture (as the U.S. Department of Defense and the Veteran’s Administration are two of the largest providers of teletherapy; Girard, 2007), geographic differences (Shore [2008] stressed the importance of addressing cultural differences between providers who are more likely to be in urban areas and clients who are more likely to be in rural areas), poverty (most states’ Medicaid programs, including that of the District of Columbia, allow teletherapy; National Conference of State Legislators [NCSL], 2013), in addition to the intersectionalities of poverty, age, and ability (Medicare has reimbursed for telehealth since 1997; “Evolution of Medicare,” 2013). Confidentiality. A significant concern that major national mental health associations address in their guidelines and codes (e.g., NASW & ASWB, 2005) is confidentiality and the difficulty of assuring and maintaining the confidentiality of electronically transmitted communications due to computer viruses, hackers, theft, and authorized and unauthorized individuals who have access to the technology (e.g., employers, IT specialists, office workers, and family members). Although the use of “end-to-end encryption” (E2EE) provides a measure of assurance of confidentiality,

practitioners and their clients need to know that not all companies and systems offering this technology are truly E2EE in that many have a “back door” for their system administrators. Some E2EE companies will not offer business associates agreements subject to HIPAA (and therefore are not HIPAA compliant), nor are they set up to provide audit trails and/or breach notifications (and therefore are not HITECH compliant). Furthermore, to avoid security breaches due to lost or stolen equipment, all electronic communication devices and software (e.g., computers, laptops, tablets, e-mail accounts, and cell phones) that have client information on them (including just phone numbers) must also be encrypted in order to be in compliance with HITECH requirements (U.S. Department of Health and Human Services’ Health Resources and Services Administration [HRSA], 2003) to minimize the risk that private client information will be compromised. Jurisdiction Issues. Very importantly, the major national mental health associations all agree that existing federal, state, territory, and provincial laws and regulations apply in the delivery of behavioral health services via electronic methods (e.g., APA, 2013; APAMD, 2009). For those practicing teletherapy, this is not an easy task because in addition to U.S. and Canadian federal laws (such as HIPAA, HITECH, and PIPEDA), there are 64 states, territories, and provinces of the United States and Canada, each with their own health services provider regulatory boards that license or certify the professionals who may practice within their jurisdictions. The vast majority of these jurisdictions have not enacted statutes or regulations governing e-mental health or telepsychology specifically (e.g., Baker & Bufka, 2011), and the few that have tend to use the label of “health care providers” in general and authorize “telemedicine” or “telehealth” within a scope of practice. One problem for many health service providers is the jurisdictional boundary that limits their practice within the borders of the state, territory, or province in which they are licensed or certified. For example, most regulating agencies require that

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the mental health provider be licensed by the state, province, or territory where the client who is receiving services is located (“Changing Landscape,” 2014). Predictably, problems have arisen due to the competing values and laws that implicate both state and national concerns (e.g., natural disasters and/or acts of terrorism that displace residents, and clients, of one state in another), and interjurisdictional needs uncomfortably press upon the borders, pitting solutions (e.g., allowing telehealth to be delivered to underserved populations) and checks and balances (e.g., a state cannot have jurisdictional authority in another state; therefore, only licensees of a state can provide services to its citizens) against one another. Although it is beyond the scope of this chapter to delve further into the area of interjurisdictional practice and its barriers, the Federal Communications Commission (2010) and the U.S. Department of Health and Human Services’ Health Resources and Services Administration (2010) have both advocated for licensure portability and/or national licensure to enable e-healthcare to address workforce needs in Health Professional Shortage Areas (HPSA) and provide access to care to the millions currently underserved. The U.S. federal government has been a leader in addressing the needs of those U.S. populations under its purview (e.g., Indian Health Service, Department of Defense, Veterans Administration, Medicare [rural areas only], and federal prisons) through telehealth services (including psychotherapy). These services are authorized and reimbursable, saving millions of taxpayer dollars (American Telemedicine Association, 2013) while improving access to mental health care to people living in underserved areas (Deslich, Stec, Tomblin, & Coustasse, 2013) who require the services of specialists (e.g., Lopez et al., 2004) and/or require services to be delivered to them in hospitals, clinics, or nursing homes, whether stateside or abroad. Furthermore, Medicaid (in most states in the United States), various state and federal grants to facilities in HPSAs, and some private insurers are also now reimbursing for telehealth services under certain circumstances (“Changing

Landscape,” 2014; National Conference of State Legislators, 2013).

Managing Boundaries in the Age of e-Mental Health Throughout the history of psychotherapy, practitioners have had to consider relational exchanges outside of the therapy hour as part of the therapeutic treatment (Gutheil & Gabbard, 1993). This includes consideration of the impact of accidental encounters outside of the place of treatment (e.g., at retail establishments, community organizations, church), contacts for scheduling additional sessions or changing scheduled session times, and responding to patient distress or concerns that arise between sessions. Ethical codes and practice guidelines (e.g., APA, 2002, Amended, 2010; ACA, 2005) have been developed to assist practitioners in considering how to conduct themselves during encounters that could reasonably be considered social and could enhance the risks that accompany potential multiple relationships. These ethics codes also urge consideration of the multicultural implications of relationship negotiation and boundaries, understanding that formality and informality, professionalism, relational warmth, and appropriate physical, social, and emotional boundaries are all culturally mediated constructs. For example, therapist and patient might also be active members of the same religious congregation or have children in the same third-grade class, both of which may increase opportunities for overlapping relationships. Ethics codes for therapists do not prohibit dual or multiple relationships but rather require that the provider carefully evaluate the possibility of the additional relationship leading to exploitation or relational power dynamics that have the potential to harm the client (e.g., APA, 2002, Amended, 2010; ACA, 2005). Social Media. We mention the above because the expanding world of technology extends the possibilities for therapist and patient to encounter each other in cyberspace in addition to the post office or

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grocery store. For example, a therapist and patient may have overlapping friends and colleagues in their extended circles, leading social and professional networking vehicles to suggest “friending,” “linking,” or “following” the other. Other examples include communication apps that search phonebook lists and connect users who have each other’s numbers. Whether the psychologist or patient chooses to act on the suggested contact, the acceptance, refusal, or ignoring of it creates an encounter and consequences that can impact the therapeutic relationship (Yonan, Bardick, & Willment, 2011) and must be considered within the context of culturally informed determinants of meaning. In the same way that practitioners are encouraged to discuss with their patients their policies and practices related to contact outside of the therapy session for physical encounters and phone calls, practitioners are also encouraged to develop social media policies and discuss their policies and practices related to technology (Kolmes, 2010). The consensus among most practitioners and the literature in this area is that it is unadvisable to be “friends” or “followers” with clients on social networking sites because to do so would increase the chances that clients and therapists could gain access to otherwise unavailable information about each other’s social lives that could impact the therapeutic work and increase the possibility of breaching client confidentiality (Kaslow, Patterson, & Gottlieb, 2011). It is also ethically problematic to have patients as “fans” or “recommenders” given the ethical proscription against seeking testimonials from patients who may not feel empowered to decline such a request and the likely violation of confidentiality this creates (Kolmes, Merz Nagel, & Anthony, 2010). E-Mailing and Texting. One of the most complex issues in contemporary psychotherapy involves the often fine boundary between therapy and other types of communications. In the case of e-mail and texting, at what point does that kind of communication become therapy (APAMD, 2009)? E-mails and text messages that extend therapeutic

discussions, and messages where advice is sought and given, are clearly e-therapy. However, while it may be easy to assume that “housekeeping” communications such as cancelling, rescheduling, and making appointments are not therapy, one can hardly disagree that a client-initiated message requesting an appointment reschedule that cannot be accommodated can quickly become grist for the transference relationship mill. Because miscommunications may occur in the therapeutic dyad that can make one act on assumptions based on the perceived failure of a prompt or hastily written reply, the provider who uses these mediums for interactions with their clients between sessions would be wise to consider developing a policy to share with their clients, even if it simply states, “If I don’t reply by the end of the next business day, please call the office.”

CONCLUSION Technological advances have brought a promising array of new possibilities for effective and efficient multiculturally competent therapeutic interventions with the potential to break through multiple access barriers for historically marginalized groups. New approaches in mental health are often viewed with skepticism, due as much to their unfamiliarity as their lack of scientifically proven success over time. As the research on the effectiveness of technology-mediated mental health services continues to proliferate, it demands that practitioners embrace the discomfort of change and be willing to reimagine their roles, healing relationships, and the myriad of forms that mental health service delivery can take. Each step in this direction requires careful consideration of the complex ethical and legal terrain, skill building and training in technology usage, and related multicultural and social justice implications. Despite the complexities, risks, and required learning curve, the potential of technologymediated mental health services becoming a primary tool in decreasing or even eradicating longstanding disparities in mental health is too great to not act.

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Interdisciplinarity in Multicultural Psychology An Integrated Review and Case Examples Oksana Yakushko, Sherry C. Wang, and Charlotte M. McCloskey

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ulticultural psychology, including research, practice, and training, has consistently emphasized the vital importance of considering multiple cultural, disciplinary, and theoretical perspectives in understanding the experiences of diverse communities and individuals (Carter, 2004; Ponterotto, Casas, Suzuki, & Alexander, 2009; D. W. Sue, Bingham, Porché-Burke, & Vasquez, 1999). Scholars and clinicians have highlighted that although Western traditions tend to separate aspects of human and communal living into distinct categories, such as physical functioning, mental health functioning, social functioning, or career functioning, such distinctions are not consistent with the worldviews of individuals and groups outside of Western cultural frameworks (e.g., D. W. Sue, 2001; Suzuki, McRae, & Short, 2001; Yakushko, 2009). However, despite the recognition of the importance of an interdisciplinarity in multicultural psychology, limited focus in the literature has been given to discussing history, definitions, challenges, and approaches to practice, research, and training that actively involve interdisciplinary strategies related to work with diverse populations. Thus, this chapter’s focus is to provide background understanding of interdisciplinarity in scholarship and practice in addition to discussing examples from work within interdisciplinary community mental health settings that serve diverse populations.

DEFINITIONS AND APPROACHES TO INTERDISCIPLINARITY Scholars and practitioners tend to use words such as interdisciplinary, multidisciplinary, cross-disciplinary, and transdisciplinary interchangeably, implying collaborations by individuals and groups across several established disciplines (Garvin, 2012). However, methodological researchers began to highlight that these terms are not interchangeable and imply differing strategies related to collaborative work (Barry, Born, & Weszkalnys, 2008; Klein, 2008). Specifically, interdisciplinary work includes interactions between individuals trained in different disciplinary domains and approaching phenomena from distinct 315

epistemological standpoints (Rhoten, 2004) so that they “learn, understand, and value” others’ disciplinary perspectives without adopting them (Garvin, 2012, p. 323). Examples of interdisciplinarity include community psychologists who engage in policy work (Chu, Emmons, Wong, Goldblum, Barrera, & Byrd-Olmstead, 2012). Similarly, practices that are cross-disciplinary or multidisciplinary typically imply parallel work by individuals from varied disciplines without interaction that leads to active juxtaposition or change in perspectives (Klein, 2008). Professionals from both professions may reach out to the same community and individuals solely in their professional roles and responsibilities with focus on their domains of service. For example, psychologists may work with law enforcement personnel in addressing a challenging community event. In contrast to interdisciplinary as well as crossdisciplinary or multidisciplinary practices, transdisciplinarity requires that collaborators transcend their disciplinary boundaries in order to create and adopt a novel and original epistemology that can be applied to addressing phenomena (Garvin, 2012). For example, Neuhauser, Richardson, Mackenzie, and Minkler (2007) discussed that many concerns that affect the global communities can only be addressed through transdisciplinary efforts. The authors discuss such issues as violence and emphasize that understanding and ameliorating violence can occur when related phenomena such as economic challenges, government policies, prejudice and discrimination, environmental factors, historical realities, and psychosocial dynamics are addressed. For the purpose of this chapter, we refer to the term interdisciplinarity because it appears to best address the practices in psychology involving collaborations between professionals from varied disciplines.

CHALLENGES TO ENGAGING IN INTERDISCIPLINARITY Although definitions and examples highlight distinct approaches to integrating varied disciplines

in research and practice, many scholars highlight that such distinctions are challenging to maintain (Newell, 2001). Specifically, disciplines as distinct phenomena in and of themselves have been questioned as creations of territorialism in academia (Reich & Reich, 2006). Stepping out of one’s disciplinary domain threatens individuals and groups with losing their disciplinary home (e.g., psychologists functioning primarily as community advocates), and groups or individuals who consider collaborations may face challenges such as threats to their professional identity, differential treatment of professional and academic groups within systems, different professional values and professional acculturation, as well as pressures to and against maintaining one’s disciplinary superiority (McNeil, Mitchell, & Parker, 2013).

DISTINCT FOCI ON INTERDISCIPLINARITY IN MULTICULTURAL PSYCHOLOGY Despite these challenges, interdisciplinary practice and research have a longstanding history and are receiving a renewed emphasis in many disciplines, including psychology (Chu, Emmons, Wong, Goldblum, Barrera, & Byrd-Olmstead, 2012; Garvin, 2012; Reich & Reich, 2006). A call to interdisciplinary perspectives in multicultural psychology stems primarily from the recognition that individuals and communities outside of dominant Western perspectives do not recognize the same divisions between aspects of their experience as those emphasized within Western academic, political, and social spheres (Hall, 2001). Specifically, in most cultures, the division between mind and body does not exist (Gergen, Gulerce, Lock, & Misra, 1996; Kim & Berry, 1993). In addition, in many communities, individual functioning is not separate from community functioning and well-being (Gee, 2002; Karlsen & Nazroo, 2002; Ratts, 2011). Although the vital importance of culture in psychology has been espoused by the discipline,

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as evident in its policies, practices, and publications, multiple challenges continue to mark psychology’s efforts to embrace interdisciplinary multicultural frameworks. For example, La Roche and Christopher (2008) highlight that the current emphasis on empirically validated treatments often conflicts with the need to create culturally sensitive treatments that are adaptive and tailored to diverse individuals and communities. In addition, Reich and Reich (2006), in their discussion of cultural competence in interdisciplinary collaborations, highlight the ways in which power dynamics often remain unaddressed due to the emphasis on ladders of academic achievement and disciplinary superiority. Reich and Reich further suggest that in many interdisciplinary efforts diversity merely reflects tokenism: an inclusion of diverse groups in an effort to appear multicultural. Lastly, historical trauma related to oppression can significantly influence any interdisciplinary efforts, often in an implicit or unconscious manner (Okazaki, David, & Abelmann, 2008; Ridgeway, Johnson, & Diekema, 1994). For example, scholars have suggested that multicultural psychology must attend to the colonizing influences within its own theorizing, such as in its continued emphasis on Western approaches to research and treatment (Christopher & Hickinbottom, 2008; Cruz & Sonn, 2011; Prilleltensky, 2008; Watkins & Shulman, 2008). Psychology’s emphasis on the discipline as a “science” may undermine its efforts to create interdisciplinary collaborations by attending to social, behavioral, and historical aspects of oppression (Gone, 2011). These challenges point to the continued need for psychology in general and multicultural psychology in particular to engage in a self-reflective process of development in pursuit of interdisciplinarity. However, it is our view that interdisciplinary practice is both the foundation and the future of multicultural psychology. Thus, the following examples of interdisciplinary practice highlight the current practices, challenges, as well as aspirations that can guide multicultural psychology in creating a dynamic multicultural agenda for psychology.

INTERDISCIPLINARY MULTICULTURAL APPROACHES IN HEALTH Interdisciplinarity in multicultural psychology provides a pathway for social change that addresses significant disparities that continue to influence communities marginalized by poverty and discrimination. Health, as defined by the World Health Organization (WHO; 2001) includes physical, mental, and social considerations, and moves beyond the previously held definition of being either with or without disease or infirmity. Moreover, research strongly supports such definition. For example, in a meta-analysis of available literature on stress and the immune system of over 300 articles, Segerstrom and Miller (2004) found that psychological distress can have an adverse impact on immunity function and declines in overall health status. Therefore, integrated psychotherapy occurs when varied aspects of a person are considered, including the psychological, cognitive, behavioral, and physiological, toward an overall well-being. Thus, integrative and interdisciplinary approaches to health care must bring together health professionals from different fields into a team to work to treat the whole person. For example, smoking cessation research is an area that has actively emphasized collaborations among mental health, medical, and educational community work (Baker et  al., 2003; Hoffman & Little, 2011; McFall et  al., 2005). Richards, Cohen, Morrell, Watson, and Low (2013) warned that attempting smoking cessation only through mental health interventions may be ineffective because smoking is related to physical health risks such as obesity and cardiovascular disease, and that, conversely, exclusively medical approaches to smoking cessation can also fail through lack in addressing individual psychological and cultural or community experiences related to smoking. Beyond integrating physical and mental health in treatments such as for smoking cessation, it is also important to recognize that treatment must also

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be culturally sensitive. Specific calls attending to the cultural norms, beliefs, and practices related to both physical and mental health have been made among both psychological and medical communities (Abe-Kim & Takeuchi, 1996; Danish, Forneris, & Schaff, 2007; Fung, Andermann, Zaretsky, & Lo, 2008; Sheely-Moore & Kooyman, 2011). Studies have shown that consideration of culture influences not only treatment compliance but also rates of dropout and positive relationship with the provider of care (Danish et  al., 2007; Whealin & Ruzek, 2008). For example, a study by Daley et  al. (2010) with American Indian communities showed that a culturally tailored model of abstinence is the most effective in smoking cessation efforts. Notably, the study team was multidisciplinary, utilizing not only health care providers (i.e., physicians, psychologists, nurses, social workers) but also community members and leaders throughout development and implementation of the program. This example echoes the calls for both interdisciplinary and community-based research approaches to health and well-being of individuals from diverse cultural backgrounds (Daley et  al., 2010). Community members must be stakeholders not only in the development of new interventions but also in how information is used or distributed (Daley et al., 2010; Littlefield, Robinson, Engelbrecht, Gonzalez, & Hutcheson, 2002; Perez & Martinez, 2008). Although an emphasis on community involvement has been central to community health services (Flewelling et  al., 2005; Kruger, Lewis, & Schlemmer, 2010), development of treatments within hospital settings, institutional settings, and universities often occurs without direct inclusion of the members of the studied cultural communities or without attention to power differential and cultural dynamics in such interactions (Whealin & Ruzek, 2008). Therefore, Daley et  al. (2010) suggested that one of the key attitudes in interdisciplinary research and treatment may be humility. In working on interdisciplinary health teams that serve culturally diverse populations, providers may be both an expert and a novice (Sheely-Moore & Kooyman, 2011; S. Sue, 2006).

Training Issues in Interdisciplinary Health Work Multicultural psychologists have long recognized the importance of cultural awareness and cultural competence in psychology training programs (Sheely-Moore & Kooyman, 2011). Although multiculturalism has been emphasized within psychology training, an inclusion of training on physical health, mind-body approaches, or community engagement in psychology is nascent. Hendrick and Hendrick (2011) provided an example of including psychology interns in providing services in a cancer and stem cell transplant center alongside medical residents, whereas Ratts, Toporek, and Lewis (2010) highlighted examples of psychologists’ active community engagement. Scholars and practitioners emphasize that psychology training must begin to effectively address the growing role of psychologists in health care as well as community settings (Cubic, Mance, Turgesen, & Lamanna, 2012; Prilleltensky, 1997; Ratts et al., 2010).

Current Examples of Interdisciplinary Health Collaborations Examples of successful interdisciplinary health collaborations serve as good models of such partnerships. Townsend, Bruce, Hooten, and Rome (2006) provided a well-formulated case example of how a multidisciplinary team worked to help reduce impairment and aid patients in regaining quality of life in living with chronic conditions. The published case example showed that the interdisciplinary team of health care professionals included a medical director, psychologist, a cognitive-behavioral therapist, clinical nurses, physical and occupational therapists, biofeedback therapists, and a pharmacist. In addition, the interdisciplinary team utilized services of dieticians, chemical dependence professionals, a chaplain, and a vocational counselor. The authors of the study, published in a medical journal, emphasized that chronic conditions, especially those that result in

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chronic pain, require active focus on all aspects of personal functioning, including mental health. Another form of current interdisciplinary practice emphasizes an inclusion of indigenous and non-Western approaches to healing and health. Libby, Pilver, and Desai (2012) reviewed information regarding the utilization of complementary and alternative modalities and interventions when treating both psychological and physical concerns related to traumatic brain injury among American veterans. Their report highlighted that many centers offering services to veterans include services such as traditional Chinese medicine, acupuncture, naturopathic medicine, Ayurveda, Native American herbalism, and meditation. In addition, the report highlighted that increasing emphasis is placed on “mind-body medicine,” which utilizes spirituality-based approaches, biofeedback, creative movement, and mindfulness meditation. These non-Western practices are integrated together with biologically based interventions including medication and clinical nutrition therapy.

Challenges to Interdisciplinary Work Despite the call and the need for interdisciplinary health care approaches to training, treatment, and practice, especially with diverse populations, such collaborations continue to be somewhat rare, especially outside of established institutions, and they face many challenges. Miller and Swartz (1990) discussed power differentials that can play a negative role in health care delivery. Specifically, they highlighted that psychologists may be devalued in medical health care settings because of the perceived superior position of biomedical training, research, and practice. The authors suggested that psychologists may seek to directly address these interprofessional power differentials and educate other professionals on the significance of their contribution to patient care. On the other hand, psychology and multicultural psychology may lack self-reflection of its own worldviews

and perspectives that overemphasize certain types of cultural perspectives (i.e., Western medical model) and underemphasize others (e.g., indigenous models of wholeness; Hook & Davis, 2012).

Social Justice Aspects of Interdisciplinary Health Work When working in the public sector, mental health providers are tasked with the challenge of attending to multiple levels of marginalization (Miller, DeLeon, Morgan, Penk, & Magaletta, 2006). Typically, such efforts address the needs of individuals who are not only culturally diverse based on their race, ethnicity, age, gender, sexuality, or ability but also economically disadvantaged and who present with multiple basic needs and co-occurring disorders (President’s New Freedom Commission on Mental Health, 2003). The ability to meet the needs in these areas at the individual level is further complicated by challenges at the systemic level (Aaron, Wells, Zagursky, Fettes, & Palinkas, 2009; Lating, Barnett, & Horowitz, 2010). Thus, the community health system has been criticized as providing “disorganized and inefficient services to those in need, often resulting in effective services” (Contractor et al., 2012, p. 25). Among the ways to improve community mental health are the inter- and intradisciplinary collaborations to serve the needs of multicultural populations, integration of evidence-based treatments, which are culturally congruent for diverse and historically marginalized populations, and the training of scientists and practitioners in advocacy roles. Recently, greater recognition has been given to the problems within the public mental health sector, including mental health care disparities for underrepresented groups as well as insufficient policies and procedures (Chu, Emmons, Wong, Goldblum, Reiser, & Barrera, 2012). These issues especially affect provision of care to culturally and linguistically diverse groups who are unable to receive culturally congruent care (Agency for Health Care Research and Quality, 2010). Furthermore, the public health care system

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is marked by the lack of fluid interdisciplinary services, such as with frequently presented dual diagnoses and co-occurring disorders that require psychological, medical, pharmacological, social, and culturally relevant interventions (President’s New Freedom Commission on Mental Health, 2003). Although it is useful for clinicians to have awareness of the sociopolitical influences on all their clients, a contextual and cultural understanding of client experiences is imperative for those working with marginalized communities. Specifically, such awareness is vital because community mental health setting services are continually impacted by changes in state and federal legislation related to reimbursement, billing, and insurance policies as well as continued cultural oppression (Rosenberg & DeMaso, 2008). Although changes in policies and laws directly affect psychologists and their diverse clients, psychologists’ involvement as policymakers and advocates continues to be rare (Heinowitz et al., 2012). The need for psychologists to move beyond the exclusive role of a counselor has been underscored in the past decade (Ratts et al., 2010; Vera & Speight, 2003). Such engagement can only occur when psychologists view themselves as interdisciplinary agents of change rather than narrowly focused technicians. Examples of such multiple roles by psychologists have included not only actions in the political sphere (e.g., Moane, 2010) but also acting as cultural brokers with refugee populations, offering assistance to diverse communities through mentorship and friendship (Pipher, 2002), or creating global humanitarian organizations (Norsworthy & Khuankaew, 2012). Lack of engagement outside of counseling work has been named as one of the chief contributors to the cycle of individually focused disease remediation services rather than addressing causative factors through a proactive preventative stance (Prilleltensky, 1997). Addressing health disparities requires active engagement with issues of social justice. Buki (2007) reflected on the important role psychologists play in reducing health disparities and encouraged psychologists to become far more

engaged in health care reform that is culturally sensitive and accessible to all individuals. Since health disparities are a form of oppression, the work to reduce and eradicate these disparities is indeed related to social justice work (Rogers & Kelly, 2011). The prevalence of disease, both physical and psychological, is worsened by the lack of effective and affordable care that addresses physical and mental concerns (Carpenter-Song, Whitley, Lawson, Quimby, & Drake, 2011). Providing mental and behavioral health services as part of a primary care model may increase access for and effectiveness in treatment of underserved populations, although, in our opinion, only when psychologists actively address community and individual-based forms of oppression and marginalization as well as include indigenous or culturally based forms of healing embraced by culturally diverse communities (Prilleltensky, 1997; Ratts et  al., 2010; Watkins & Shulman, 2008). By providing integrative health approaches rooted in respect, humility, and multicultural awareness, a psychologist can be part of a solution to a large systemic problem.

Addressing the Challenges of Interdisciplinary Health Work As we noted throughout, the needs of diverse populations in community health settings cannot be understood and addressed without a focus on continued oppression, which occurs on individual, institutional, and cultural levels (e.g., Moane, 2010). Interdisciplinary community mental health practices must account for intergenerational, historical, and cultural trauma related to oppression in the lives of underserved and underrepresented groups (e.g., Duran & Duran, 1995; Gone, 2013a, 2013b; Wilkins, Whiting, Watson, Russon, & Moncrief, 2013). Thus, although psychologists working within community mental health have been pressed to implement what are touted as empirically based treatments, limited attention has been given to the fact that such scientifically derived approaches are typically based exclusively on the “West-is-best”

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worldviews (Gone, 2013a, p. 147). One form of such oppression is continued emphasis on exclusively Western notions of mental health, which focus on valuing the autonomous individual self, separating mind and body, and devaluing the role of cultural values (Hwang, 2009). As we noted earlier, such beliefs are inconsistent with worldviews found in many non-Western cultures (Lewis-Fernandez & Kleinman, 1994), which emphasize the communal nature of the self, the unity of mind and body, as well as primacy of cultural norms and beliefs. Integration of non-Western values in psychological treatment thus necessitates an interdisciplinary standpoint, which actively includes cultural, psychosomatic, and communal forms of healing. Efforts have been made to develop culturally sensitive treatments (CSTs), which focus exclusively on research-based approaches to care with ethnoracial and cultural minorities in community settings (Hall, 2001). Another interdisciplinary function of psychologists in community mental health involves actively exploring the balance between “empirically supported” treatments, typically developed with monocultural clients in “controlled clinical settings” (Kazdin, 2008, p. 147), and the needs of diverse clients seeking mental health services (Hall, 2001). Collaborating actively with community settings to form partnerships is the hallmark of methodologies such as Community Based Participatory Action Research (CBPR), which emphasizes an interdisciplinary connection between researchers from multiple disciplines and members of diverse communities toward mutually supportive, collaborative, and empowering partnerships (Taylor et al., 2004). In addition to including perspectives of both the community members and scholars from varied disciplinary backgrounds, CBPR emphasizes the need for methodological diversity in the form of quantitative, qualitative, and mixed methods approaches (Badiee, Wang, & Creswell, 2012). The goals of the CBPR collaborations include not only directly meeting community needs but also facilitating long-term structural changes through advocacy (Israel, Schulz, Parker, & Becker, 1998).

Interdisciplinary Social Justice and Advocacy Training for Psychologists It is important to note that several subfields of psychology already emphasize such interdisciplinary practice by psychologists in community settings. Community psychology is one such example (e.g., Yoshikawa, 2006), and Chu, Emmons, Wong, Goldblum, Barrera, and Byrd-Olmstead (2012) have highlighted that public sector community psychologists must engage as administrators, direct service clinicians, consultants, trainers, policy advocates, researchers (e.g., program evaluators and grant writers), and supervisors. Such interdisciplinary practice requires training in not only the assessment and treatment in mental health, substance abuse, and comorbid disorders but also knowledge of developing practices, engaging in community-based research, grant writing, conducting needs assessment and program evaluation, participating in organizational consultation and management, and acting in public policy and advocacy arenas. Such interdisciplinary competencies are seen as essential in serving diverse clients within community mental health settings (Chu Emmons, Wong, Goldblum, Barrera, & ByrdOlmstead, 2012). The interdisciplinary emphasis in community mental health is not unique for psychology: It is also emphasized in fields such as psychiatry, social work, nursing, and primary care (e.g., Bronstein, 2003; Fouche, Butler, & Shaw, 2013; Meyers, Hales, Yong, Nesbitt, & Pomeroy, 2013). An example of the emphasis on contextual and cultural sensitivity in treatment services is found in the social-ecological model prominent in public health fields (McLeroy, Bibeau, Steckler, & Glanz, 1988). Thus, familiarity with models utilized by providers from other disciplines may facilitate stronger ties, which is foundational to positive interdisciplinary practices. Incorporating public policy work as one of the functions of mental health care providers often requires awareness and knowledge stemming from other disciplines. For example, basic

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understanding of historical, political, and structural underpinnings of the U.S. economy may be needed in order to actively address needs of the uninsured as well as confront the funding issues for community mental health services (Aaron et al., 2009; Lating et al., 2010). Although multicultural competencies in individual treatment must continue to be a hallmark of training in psychology (D. W. Sue, Arredondo, & McDavis, 1992), cultural competence training related to functioning of psychologists in multiple settings and working alongside of practitioners of multiple disciplines is also needed (Chu, Emmons, Wong, Goldblum, Reiser, & Barrera, 2012; Delphin & Rowe, 2008; Park-Taylor et al., 2009). Training in social justice and advocacy work for psychologists is essentially an interdisciplinary endeavor, inviting the field to continually expand its boundaries of knowledge and its scope of practice toward a greater embrace of multiple perspectives and practices (Delphin & Rowe, 2008).

CONCLUSION Challenges that face not only diverse communities within the United States but also communities globally require interdisciplinary approaches.

Whether it is treatment of returning war veterans in Veterans Administration medical centers or political refugees in community mental health settings, addressing the needs of ethnically marginalized communities facing the aftermath of sociopolitical oppression, or efforts to address human trafficking or global warming, inclusion of perspectives and resources of stakeholders from all professional disciplines together with community members themselves are vital to providing effective ethical care. Many psychologists are functioning in such interdisciplinary settings or engaged in interdisciplinary work, specifically when it addresses the needs of culturally diverse and historically marginalized communities. Undoubtedly, working across disciplines has many challenges, such as those related to interprofessional hierarchies, overemphasis of Western values and practices, and limited funding. However, multicultural changes in the demographic composition of societies and among the members of professional disciplines, as well as the presence of global problems such as wars or economic injustice, necessitate that psychology as a field in general, and multicultural psychology in particular, embrace the call to interdisciplinarity through its inclusion in training, research, and practice.

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Violence Prevention in Schools and Communities Multicultural and Contextual Considerations Amanda B. Nickerson, Matthew J. Mayer, Dewey G. Cornell, Shane R. Jimerson, David Osher, and Dorothy L. Espelage

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outh violence is of great concern to educators, parents, and society as a whole. Fueled by the ­understandable outrage that follows highly publicized, yet extremely rare, events such as school shootings, there is a demand for immediate solutions. However, a reactive, quick-fix approach can lead to unwise decisions and approaches that have unintended negative consequences. In an effort to provide factual, research-based information about how to make meaningful change to promote safety and security in our schools and communities, the Interdisciplinary Group on Preventing School and Community Violence (2013) wrote and widely disseminated a position statement following the December 2012 shooting at Sandy Hook Elementary School that resulted in 27 deaths. Authored by nine coauthors representing eight separate universities and major research organizations, the position statement has been endorsed by 107 organizations (representing over 4 million professionals in education and allied disciplines) and 212 individuals in several countries. The position statement has been integrated into briefings and testimonies with policymakers. This chapter elaborates upon the position statement by grounding the key concepts in the theoretical and empirical literature with an integration of its application to multicultural populations. First, an overview of youth violence across diverse cultures within the family and community contexts is presented, followed by a more specific focus on violence in schools. Next, a balanced, thoughtful approach to violence prevention that includes well-integrated efforts to promote students’ mental and emotional wellness, behavior, and achievement is discussed, with an emphasis on communication, connection, and support.

Authors’ note: We would like to thank Ron Astor, Michael Furlong, and George Sugai, our coauthors and contributors to the December 2012 position statement.

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Finally, larger community and societal issues such as mental health needs, structured threat assessment approaches, exposure to violent media, and access to guns are examined. We articulate that a broad-based, multitiered approach to prevention derived from scientific studies is the most effective way to reduce youth violence.

OVERVIEW OF YOUTH VIOLENCE Youth violence in the community, home, and school settings has been documented as a global public health problem across diverse cultures and contexts (Bondü, Cornell, & Scheithauer, 2011; World Health Organization [WHO], 2002). The World Report on Violence and Health (WHO, 2002) provided a comprehensive review of violence worldwide, including conceptual definitions and data on populations affected by violence across gender, cultural background, and age. The WHO (2002) defined violence as the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation. In the United States, the Centers for Disease Control (CDC; 2012) have documented violence among and toward youth for decades. Such violence can lead to negative outcomes such as illness and death, increased cost of health and welfare services, and decreased overall quality of life (CDC, 2012; WHO, 2002). Youth violence in community, home, and school settings is briefly discussed in the following sections.

Youth Violence in the Community and Family Worldwide, over 550 children, adolescents, and young adults between the ages of 10 and 29 have died daily as a result of interpersonal violence (Pinheiro, 2006; WHO, 2002). Rates of youth homicide vary by region, with high rates reported in Latin America, the Russian Federation, and

some southeastern European countries. The report highlights that youth homicide rates that are above 10 per 100,000 are typically seen in developing countries, as well as in countries undergoing rapid economic and social transformations. In the United States during 2010, 4,828 young people aged 10 to 24 were victims of homicide, an average of 13 youth each day, which is the second leading cause of death for young people between the ages of 15 and 24 (CDC, 2012). Internationally, nonfatal injuries account for a large proportion of youth receiving hospital care due to violence (Pinheiro, 2006; WHO, 2002). For each homicide death, approximately 20 to 40 youth are admitted to the hospital due to an injury. In the United States during 2011, over 707,000 youth aged 10 to 24 years had physical assault injuries treated in emergency departments, an average of 1,938 each day (CDC, 2010). Exposure to violence and child maltreatment is another form of violence that takes place in the family and community setting. About 72% of children and youth in the United States will have experienced at least one stressful event (e.g., witnessing or being a victim of violence; experiencing sexual, physical, or emotional abuse; suffering a serious injury or medical condition; death of a parent or sibling) before the age of 18 (Deryck, Silver, & Prause, 2014). Child maltreatment includes physical and emotional ill-treatment, as well as negligent treatment that may result in actual or potential harm to the child’s health, development, or survival (WHO, 2006). Perpetrators of child maltreatment may include parents and family members, caregivers, friends, other children, and employers (WHO, 2006). Long-term health consequences of child maltreatment include brain injuries, fractures, alcohol and drug abuse, depression and anxiety, poor relationships, and poor school performance (WHO, 2002).

Youth Violence in the School Context Whereas the media often popularize high-profile incidents of school violence, evidence indicates

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that schools are among the safest places for youth. Over the past two decades, the safety of U.S. schools has been corroborated by the compilation of data—the Indicators of School Crime and Safety (e.g., Robers, Kemp, & Truman, 2013) and the Youth Risk Behavior Surveillance System (e.g., CDC, 2010)—which reveal favorable trends regarding crime, safety, and harm indicators for youth. These studies indicate that severe forms of youth victimization (e.g., assault with a deadly weapon) have declined at school. However, less overt, nevertheless serious, forms of youth victimization (e.g., bullying, racial and ethnic microaggressions) are prevalent (Huynh, 2012). For example, during the 2010–2011 school year alone, 1.25 million nonfatal, schoolbased crimes of violence or theft were reported among 12- to 18-year-old students, while 27% of secondary students and 37% of sixth-grade students reported experiencing bullying at school (Robers et al., 2013). Internationally, bullying is also pervasive, with the highest percentages of 13-year-olds having “sometimes” engaged in bullying at school in Austria (64%), Germany (61%), Denmark (58%), Lithuania (57%), and Greenland (57%) (Currie, 1998). The lowest percentages of bullying reports were found in Sweden (12%), England (13%), and Greece (19%; Currie, 1998). In the United States, 35% of 13-year-olds reported “sometimes” having engaged in bullying during the school term. Craig and colleagues (2009) have speculated that cultural differences (e.g., variations in the conceptualization and understanding of bullying and social victimization discussed by Smith, Cowie, Olafsson, & Liefooghe, 2002), national policies, and various programs implemented to address bullying issues (e.g., discussed by Jimerson & Huai, 2010) may be potential reasons for differences in bullying rates across countries. International information pertaining to bullying in the school context is featured in The Handbook of Bullying in Schools: An International Perspective (Jimerson, Swearer, & Espelage, 2010). Further, The Handbook of School Violence and School Safety: International Research and Practice (Jimerson, Nickerson, Mayer, & Furlong, 2012) provides a contemporary and comprehensive analysis of violence and safety within the school context.

KEYS TO PREVENTION: A THOUGHTFUL APPROACH TO SAFER SCHOOLS School safety includes not just the absence of physical threat or harm but also emotional safety. Emotional safety includes freedom from sarcasm, teasing, harassment, microaggressions, and relational bullying, as well as intellectual freedom to express your thoughts and feelings, including to adults (D. Osher, Kendziora, Spier, & Garibaldi, 2014). Safety is linked to academic performance through improved attendance and capacity to concentrate and engage in schoolwork (D. Osher, Poirier, Jarjoura, Kendziora, & Brown, 2015; Gregory & Weinstein, 2004). Reactive, exclusionary, and punitive approaches to discipline, which disproportionately affect students of color, can undermine emotional safety, trust of teachers, and reduce opportunities to learn (Gregory & Ripiski, 2008; Gregory, Skiba, & Noguera, 2010). A lack of cultural and linguistic competence can lead to or exacerbate this problem due to a variety of staff and school factors. Staff factors may include an inability to understand or respond to culturally grounded behavior or responses to historical trauma, discomfort in bicultural or multicultural interactions, stereotype priming (i.e., when individuals experience a stereotyping stimulus that influences how they will respond to a different stimulus that aligns with the racial stereotype; Eberhardt, Goff, Purdie, & Davies, 2004; Goff, Eberhardt, Williams, & Jackson, 2008; Mendelberg, 2008), and implicit bias (Gregory & Thompson, 2010; D. Osher, Cartledge, Oswald, Artiles, & Coutinho, 2004). School factors may include leader indifference, inability to recruit or retain culturally and linguistically diverse staff, disconnection with the community, and oppositional student behavior generated by perceived or actual discrimination (Gregory & Weinstein 2008; Skiba & Rausch, 2006). Creating a safe school environment requires a balanced approach to address the important links between students’ mental and emotional wellness,

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behavior, and achievement. When unaddressed, mental, emotional, and behavioral problems can lead to risky behaviors that can compromise safety, including interpersonal violence (Dwyer, Osher, & Warger, 1998). These matters are particularly challenging in schools where many students have such needs and where staff frequently employ punitive and reactive discipline (D. Osher et al., 2004). It is both necessary and cost beneficial to align efforts that address safety and academics because schools have limited resources. Safety, which broadly includes an environment of connectedness, positive peer relations, and support, is a key condition to facilitate learning and to prevent behavioral and safety problems (D. Osher et  al., 2015). Simultaneously, academic engagement and success can, in at least some cases, contribute to reduced emotional distress and improved behavior (Kellam, Rebok, Mayer, Ialongo, & Kalodner, 1994). It is also important to align interventions to enhance outcomes while reducing fragmentation and staff overload (Jones & Bouffard, 2012; D. Osher, Bear, Sprague, & Doyle, 2010). Creating environments characterized by open communication and connections are key to a comprehensive approach to violence prevention.

Communication Violent attacks are not spontaneous events that occur without warning. On the contrary, comprehensive analyses of shootings on school campuses, as well as targeted attacks in other public settings, have found that these events are often preceded by weeks, if not months, of contemplation, planning, and preparation (Drysdale, Modzeleski, & Simons, 2010). During this period, the attacker’s behavior often arouses concern among family members or friends, who may observe the attacker’s distress and withdrawal, anger and resentment, symptoms of mental illness, or preoccupation with violence. In many instances, an attacker has made threats of violence, asked for assistance in obtaining weapons, or warned others of the impending attack. Furthermore, numerous school shootings have been prevented because a concerned family m ­ ember or

friend sought help for a troubled youth who was actively planning a violent attack (Daniels et  al., 2007). These observations have led many authorities to conclude that the most effective way to prevent acts of violence targeted at schools, as well as other public settings, is by maintaining close communication and trust with students and others in the community so that concerns about violence will be reported and can be investigated by responsible authorities (Cornell, 2006; Drysdale et al., 2010). Authorities must be wary of using psychological profiles or lists of warning signs as a means of identifying imminently violent individuals. These methods typically identify psychological traits (such as impulsivity or anger) and risk behaviors (such as substance abuse) that can be statistically associated with violence but that are also commonly found among many youth who are not violent. There is widespread agreement that psychological profiles or checklists are not useful and are most likely to result in false identification of innocent individuals as being dangerous (O’Toole, 2000; Vossekuil, Fein, Reddy, Borum, & Modzeleski, 2002). Racial profiling is an especially controversial form of profiling in which the police explicitly or implicitly target individuals of minority background for increased surveillance, traffic stops, and other forms of interdiction (Engel & Cohen, 2014). There is little evidence that racial profiling is effective as a law enforcement strategy, although its negative impact as a discriminatory practice is well recognized. Another ill-advised approach is the use of zerotolerance discipline, in which schools rely on harsh punishment, usually long-term suspension from school, without consideration of the context or circumstances of a student’s misbehavior. Despite its widespread use, there is no evidence that zero tolerance makes schools safer, and there is considerable evidence that school suspension is associated with negative consequences, including school failure, dropout, and juvenile court involvement (American Psychological Association [APA] Zero Tolerance Task Force, 2008; Fabelo et al., 2011). Instead of profiling or zero-tolerance approaches, school authorities should concentrate

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their efforts both on prevention and on training a team of staff members both in racial and cultural self-awareness (D. Osher et  al., 2012) and to use principles of threat assessment. Threat assessments are initiated when a threat or threatening behavior is reported and involve a careful investigation of the context and meaning of the student’s behavior. Threat assessment teams take a problem-solving approach to violence prevention that concentrates on resolving problems and conflicts before they escalate into violence rather than making predictions of violence or designating someone as dangerous. A series of studies has found that student threats of violence can be resolved with a threat assessment approach with almost all students able to continue in school without long-term suspension (see review in Cornell, Allen, & Fan, 2012). Concerned students, parents, educators, and stakeholders in the community should attend to troubling behaviors that signal something is amiss. For example, if a person utters threats to engage in a violent act or displays a pronounced change of mood and related social behavior, or is engaged in a severe conflict with family members or coworkers, it makes sense to communicate concerns to others who might provide assistance. Early identification helps ensure that troubled individuals receive the support, treatment, and other assistance they may need. From a threat assessment and prevention perspective, services are provided because of the individual’s needs and concerns, not because of a prediction of violence. A critical problem is that youth are often unwilling to seek help from adults when they have concerns about potential violence. One barrier is the code of silence among students (as well as adults) that prohibits reporting about a peer’s behavior (Syvertsen, Flanagan, & Stout, 2009). It is especially important to teach students to distinguish snitching from help seeking. A second barrier is that students may not perceive school staff as supportive and willing to provide assistance (Eliot, Cornell, Gregory, & Fan, 2010). School authorities should strive to build a sense of community in schools so that students, parents, and staff members feel comfortable bringing concerns

regarding safety to their attention (Dwyer et  al., 1998) and to be sure that school staff members are not perceived as acting in an arbitrary, capricious, or biased manner.

Connection and Support Research on a life course theory of delinquency has supported the notion that making positive connections and attachments at school enables youth to refrain from delinquent and antisocial behaviors (Sampson & Laub, 1993). Youth who feel disconnected from schools are likely to engage in more violence and other conduct problems at school. Indeed, studies of the relation between school environment and behavior problems (Resnick et al., 1997) reported that a safe and nurturing school environment reduces the risk of negative developmental outcomes, such as behavior problems in school. In contrast, a high-risk school environment (e.g., students carrying a lethal weapon) has been linked to externalizing behavior (Brockenbrough, Cornell, & Loper, 2002; Reinke & Herman, 2002). Further study findings indicate that the quality of teacher-student relationships is associated with children’s school adjustment (e.g., Baker, Grant, & Morlock, 2008; Gregory & Ripski, 2008). Negative teacher-student relationships are strongly associated with school externalizing behavior (Murray & Murray, 2004), such as disruption, defiance (Gregory & Ripski, 2008; Lapointe, 2003), and aggression (Lewis, Romi, Qui, & Katz, 2005). The importance of connectedness and feeling that one belongs at school is likely to be particularly important for students of color and their families who may experience schools and school staff as biased, insensitive, and unwelcoming (e.g., Brewster & Bowen, 2004; Matusov, DePalma, & Smith, 2010; Sue, Lin, Torino, Capodilupo, & Rivera, 2009). Taken together, prevalence rates suggest that American youth and their parents regularly experience a wide range of academic and psychosocial challenges that tend to co-occur and are longitudinally linked, including family violence, hate crimes, gangs, school victimization, and alcohol and drug use (Espelage, Low, Rao, Hong, & Little,

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2014; Hamby & Grych, 2013). Because these problems tend to be layered, often understood and experienced through cultural lenses, and require a range of interventions, it is necessary and cost efficient to use culturally competent multitiered efforts. In other words, prevention and intervention should be universal for the general population, selective for individuals who are at risk for academic, behavioral, or mental health problems, and indicated to target individuals who are already displaying signs of problems in these domains (Institute of Medicine, 2009; U.S. Public Health Service, 2000, 2001). Universal interventions include both promotive practices that build individual and environmental assets and preventive ones that reduce the likelihood of problem behaviors. Individual promotive practices include social and emotional learning (SEL) and effective pedagogy. SEL has been demonstrated to build social competence, reduce problem behavior, and improve academic outcomes (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Espelage, Low, Polanin, & Brown, 2013). Effective pedagogy builds upon children’s strengths, is culturally responsive, demands critical thinking, and ensures that students gain access to basic skills (Delpit, 2012). Promotive processes include strong conditions for teaching and learning, and building connections and trust among all members of the school community (Bryk & Schneider, 2002; D. Osher & Kendziora, 2010). These processes require training in culturally responsive teaching, cultural competence, child and adolescent development, and family and community engagement. Universal prevention also mitigates factors that place students at risk such as chaotic classrooms and transitions, punitive responses to troubling behavior, unclear or unfair expectations, and skill deficits. Universal prevention approaches include proactive classroom and schoolwide positive behavioral approaches, and the use of formative data and progress monitoring to identify and address behavioral and academic problems (Johnson, Kendziora, & Osher, 2012). Although universal promotion and prevention strategies can reduce the likelihood of academic,

behavioral, and safety problems, some students will remain at elevated levels of risk. A balanced approach includes building school capacity to address these needs quickly, efficiently, and differentially using culturally responsive practices. Because selective and indicated interventions may be more demanding and intrusive, it is important to engage students and families with interventions that are evidence-based, culturally competent, and appropriate for the school context. Because engagement is a key to success, these interventions should be student and family driven and linguistically and culturally competent (T. W. Osher et  al., 2011). Schools also cannot meet all needs on their own. Therefore, coordinated partnerships with community agencies that work with students, teachers, and families are critical. Next, societal issues of mental health needs, violence in the media, and access to guns are reviewed.

LARGER COMMUNITY AND SOCIETAL ISSUES Mental Health Needs Nationally, the mental health needs of youth are often shortchanged or neglected, especially among ethnic minority youth. Approximately one in four adolescents has experienced mental disorders resulting in serious impairment (Merikangas et al., 2010), and nearly two thirds did not receive mental health treatment (Merikangas et al., 2011). There are substantial barriers to receiving mental health treatment, often because services are either not available or not affordable, or because the social stigma of a mental disorder discourages youth and their parents from seeking help. There are also important cultural differences in the manifestations of mental disorders and in willingness to obtain professional mental health treatment. Even seemingly universal symptoms such as anxiety, depression, and anger must be considered from a cultural and familial context in order to understand their meaning, intensity, and impact on an individual. The Western notion of seeking help from a professional may be unfamiliar and uncomfortable

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to individuals from non-Western societies. At the same time, families of color as well as economically disadvantaged White families may experience interventions as invasive, insensitive, and unhelpful (e.g., T. W. Osher et  al., 2011; U.S. Public Health Service, 2001). Mental health professionals must strive to be child and family driven as well as to achieve cultural competence in their work with children and families from culturally diverse backgrounds (Cross, Bazron, Dennis, & Isaacs, 1989; T. W. Osher et al., 2011; Sue & Sue, 2012). Mental disorders include a wide range of conditions, and the relation between these disorders and violence is complex, so that there is potential for inaccurate generalizations. Some conditions such as attention deficit/hyperactivity disorder and conduct disorder are risk factors for violent behavior, and it is important to provide preventive services as well as treatment for these conditions (Weisz & Kazdin, 2010). Substance abuse is a potent risk factor for violence that appears to exacerbate the influence of other mental disorders (Van Dorn, Volavka, & Johnson, 2012). The most severe forms of mental disorder are often described as serious mental illnesses and include conditions such as schizophrenia and bipolar disorder. Although most violent acts are not committed by individuals experiencing a serious mental illness, there have been several high-profile cases of mass shootings linked to persons with serious mental illnesses that have raised public concern (APA, 2013). These cases have brought attention to the inadequate treatment provided for severe mental illness in the United States and the need for public policy changes that would improve both the availability and continuity of treatment. In particular, there is a need for improved civil commitment policies that provide more extended treatment and support for individuals with a substantial risk of violence (Kinscherff, Evans, Randazzo, & Cornell, 2013). Although the urgent need to improve community- and school-based mental health services is widely recognized in the United States and worldwide (Kieling et al., 2011), it is just as widely neglected, despite strong evidence that there are

cost-effective treatments available (Garland et al., 2013). As previously stated, mental health services should also include prevention efforts at universal, selective, and indicated levels (APA, 2013; O’Connell, Boat, & Warner, 2009). When individuals with mental disorders threaten violence, there are limited resources available to family members and friends who might seek help. With much-needed federal and state funding, community-based mental health organizations should work in cooperation with local law enforcement, schools, and other key community stakeholders to create a system of community-based mental health care, including crisis and threat assessment services (APA, 2013). These efforts should promote wellness as well as address mental health needs of all community members while simultaneously responding to potential threats to community safety. This initiative should include a large-scale public education and awareness campaign, along with newly created channels of communication to help get services to those in need.

Exposure to Violence in the Media Four decades of reports from a broad array of peerreviewed research and governmental, professional membership groups, and advocacy/public interest groups have identified increased risk of harm from children’s exposure to violence from TV, movies, and video games (American Academy of Pediatrics, 2009; Anderson et  al., 2010; Huesmann, MoiseTitus, Podolski, & Eron, 2003; U.S. Department of Health and Human Services, 2001; U.S. Surgeon General, 1972; Willoughby, Adachi, & Good, 2012). Huesmann et  al. (2003) reported the results of a 15-year longitudinal study that found that people across social strata are at increased risk for adult aggression and violence after having a steady highlevel diet of violent television in childhood. A metaanalysis by Anderson and colleagues (2010) found that with increased exposure to violent media over time, there is increased risk of aggressive affect,

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cognition, and behaviors. Derksen and Strasburger (1996) reviewed research on media violence exposure, identifying six primary effects: (a) displacement of healthy activities, (b) modeling inappropriate behaviors, (c) disinhibition of socially proscribed behaviors, (d) desensitization to the harmful effects of violence, (e) aggressive arousal, and (f) association with a constellation of risk-taking behaviors. Drawing on prior research, the American Academy of Pediatrics (2009) reported that children in the United States ages 8 to 18 spend on average more than 6 hours per day engaged with various forms of media, and children ages 0 to 8 spend close to 2 hours per day watching screen media. The National Television Study (Center for Communication and Social Policy, 1998) reported that over 60% of programming displayed interpersonal violence, based on an evaluation of approximately 10,000 hours of television programming from 1995 and 1997. Analyzing 248 prime-time television episodes from 1998–1999, researchers found that images depicting serious violence were displayed 14 times per hour on average, and for high-violence shows, 54 times per hour (Lichter, Lichter, & Amundson, 1999). By age 18, it is estimated that the average American child will have viewed on television more than 8,000 murders and 100,000 acts of violence (Bushman & Phillips, 2001). Other published peer-reviewed research has called into question the widespread findings concerning harm caused by violent media exposure. More recently, some scholars have called for a reevaluation of the research, as some prior studies may have been methodologically flawed or limited (Adachi & Willoughby, 2011; Ferguson, 2013). Many of these concerns coalesced around the Supreme Court case of Brown v. Entertainment Merchants Association (2011), where the court ruled in favor of the video game industry’s free speech argument, finding that video game content could not be regulated by the government. The case stemmed from lower court cases in California that began with a challenge to a 2005 state law restricting the sale of violent video games to minors. Central to the Supreme Court case was the

judicial standard of strict scrutiny, where the court weighs the government’s responsibility to protect the public from harm (i.e., determining if video games cause violence) against limiting the public’s rights with respect to constitutional protections (i.e., freedom of speech). With the exception of a minority opinion from Justice Breyer finding sufficient scientific evidence of harm from exposure to media violence based on longitudinal and experimental studies, the remaining justices and court as a whole found insufficient scientific evidence to warrant a decision regulating violent video game content. This case and related scholarly publications have identified several areas of concern in prior research: (a) limited rigorous causal research findings, with heavy reliance on correlational findings; (b) questionable validity of measures to assess aggressive outcomes; (c) lack of controls on comparison nonviolent video content in analyses for aspects of competitiveness, challenge, and pace of action, which might confound measures of aggression; (d) small effect sizes; (e) publication bias; and (f) lack of explanation for declines in youth violence co-occurring with increases in video game sales (Adachi & Willoughby, 2011; Ferguson, 2013). Clearly, there is more work needed regarding the issue of media violence. Scientifically drawn conclusions appear to be influenced by public advocacy positions on both sides of the argument. Future research needs to better delineate questions being addressed, whether risk or causally linked demonstration of harm is at issue, and the populations and situations to which findings can be generalized.

Access to Guns Youth are disproportionally represented as victims and perpetrators of firearm homicide in the United States, and victimization is particularly high among African American and Hispanic youth (Child Trends Data Bank, 2012; Hepburn & Hemenway, 2004). Homicide is the primary cause of death for African Americans (51.5 per 100,000) and the second leading cause of death for

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Hispanics (13.5 per 100,000) for males age 10 to 24 as c­ ompared to a rate of 2.9 per 100,000 for nonHispanic, White males age 10 to 24 (CDC, 2012). In 2010, firearms were responsible for 83% of the homicides of persons age 10 to 24 (CDC, 2012). The odds in favor of youth access to guns increase relative to community location (Blumstein & Cork, 1996; Cook & Ludwig, 2004), with several researchers finding that the illegal gun market is a significant predictor of local violent crime (Braga & Kennedy, 2001; Stolzenberg & D’Alessio, 2000). Furthermore, survey research reveals that about one third of U.S. homes reported gun ownership (Cook & Ludwig, 1997; Okoro et al., 2005). Approximately 40% of adults who have minor children living in their homes report that their firearms are unlocked (Johnson, Miller, Vriniotis, Azrael, & Hemenway, 2006). Data from the National Longitudinal Study of Adolescent Health show that about 24% of adolescents report having easy access to guns at home (Swahn, Hamming, & Ikeda, 2002). Although less than 1% of student homicides occur at school (school-related events and including travel to or from school; Robers, Zhang, & Truman, 2012), the majority involve a firearm (Modzeleski et al., 2008). In fact, 80% of schoolrelated homicides and suicides from 1992–1999 involved firearms obtained from the home or a friend or relative (Reza et al., 2003). Research showing the linkage between gun access and gun violence suggests that efforts to restrict easy access to firearms by youth will help reduce gun violence (Sharkey, Welsh, & Furlong, in press). For example, keeping firearms locked and

storing ammunition in a separate locked location are feasible and protective strategies to reduce injuries (Grossman et al., 2005; Reza et al., 2003). On a broader level, community-based policing using a systematic approach of problem identification, analysis, response, and intervention, as well as gun purchase restrictions for individuals with prior felony records, has been correlated with reductions in gun homicide, gun-related assault, and youth homicide (Braga & Weisburd, 2012). It is clear that gun violence poses a threat to children and youth in terms of homicide, suicide, and accidental deaths, which calls for a focus on efforts to promote prevention and reduce accessibility (Brock, Nickerson, & Serwacki, 2013).

SUMMARY The complex problem of youth violence requires careful and balanced attention to multiple issues. Drawing on the scientific findings, it is clear that comprehensive prevention efforts that emphasize connections, communication of concerns, and support for academic, behavioral, and mental health challenges are needed. The provision of coordinated and evidence-based interventions to address mental health needs, and the critical examination of the effect of societal influences such as violent media exposure and the accessibility of guns, remain major policy challenges. Addressing this public health issue requires the commitment of researchers, practitioners, and policymakers to support and implement well-reasoned approaches that hold the most promise for creating safe schools and communities.

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CHAPTER

32

Considering Definitional Issues, Cultural Components, and the Impact of Trauma When Counseling Vulnerable Youth Susceptible to Gang Involvement Joey Nuñez Estrada Jr., Robert A. Hernandez, and Steven W. Kim

Y

outh street gangs have a long history in the United States, with documented reports dating back to colonial times (Chaskin, 2010; Pearson, 1983; see Howell, 2012, for a historic overview of gangs in the United States). In the early part of the 19th century and throughout the latter part of the 20th century, youth street gangs proliferated in conjunction with the escalation of inner-city poverty, which grew to some extent as a result of migratory patterns, changes in the arrangement of financial opportunity, and legislation and procedures that cultivated racial and economic ghettoization (Chaskin, 2010). Nowadays, youth street gangs have galvanized the attention of American society by influencing components of popular culture (i.e., music, movies, video games) or appearing as a frequent topic in the news media. Additionally, youth street gangs have become an important focus of research, policy, and prevention and intervention efforts (Chaskin, 2010). Given this increased focus on gangs, this chapter seeks to highlight systemic-induced root causes that lead to the traumatic experiences and cultural identity frustration of vulnerable youth susceptible to gang involvement. Due to the enormous challenge to identify all of the risk factors for why youth find refuge in gangs, this chapter focuses on the necessity for cultural proficiency in understanding the impacts of trauma when providing services to high-need vulnerable youth. To this end, we begin the chapter by addressing definitional issues, criminal street-gang labels, and the tendency to criminalize (i.e., designate as gang members) youth of color. We then highlight the importance of system-induced trauma and culture as influential components of gang involvement. We conclude the chapter with a brief overview of a culturally based, trauma-informed intervention approach. The overall intent of the information contained herein is to challenge counselors to shift the lens through which they view vulnerable youth who are susceptible to gang involvement. 332

WHAT IS A STREET GANG? Recent research conducted by the National Gang Center reveals that in 2011 there were an estimated 29,900 gangs and 782,500 gang members throughout 3,300 law enforcement jurisdictions across the United States (Egley & Howell, 2013). However, it is important to note that these numbers may be an over- or underestimation since there “is no single, universally accepted definition of a gang or a gang member” (Howell, 2012, p. 53). In the 1980s, the U.S. Department of Justice held a series of meetings between researchers, policymakers, community activists, police, and others attempting to develop a straightforward common definition but to no avail (Curry & Decker, 1998; Spergel & Bobrowski, 1989). To date, practitioners, law enforcement agencies, criminologists, sociologists, and other gang researchers have failed to reach a consensus on a definition (Curry & Decker, 1998; Howell, 2012). Klein and Maxson (2006) review the five most influential attempts to define gangs. Due to space limitations of this chapter, we will only describe the fifth definition, which was judiciously developed in the late 1980s through California legislation known as the Street Terrorism Enforcement and Prevention (S.T.E.P.) Act. It refers to the “criminal street gang” as any ongoing organization, association, or group of three or more persons, whether formal or informal, having as one of its primary activities the commission of one or more of the criminal acts enumerated in paragraphs (1) to (25), inclusive, or (31) to (33), inclusive, of subdivision (e), having a common name or common identifying sign or symbol, and whose members individually or collectively engage in or have engaged in a pattern of criminal gang activity [California Street Terrorism Enforcement and Prevention Act, 1988]. (p. 8)

This definition, which has been widely endorsed by public officials and replicated in many states, instituted a legal category of criminal street gangs to expand the capacity of law enforcement to suppress gangs (Klein & Maxson, 2006). However, this definition is quite vague and the inability to appropriately define a street gang beyond this legal categorization

has resulted in the exploitation and criminalization of vulnerable populations. The S.T.E.P. Act, which served a specific purpose for police and prosecutors, demonized youth groups of color by labeling them as criminal street gangs and incarcerating them for as long as possible (Klein & Maxson, 2006).

Criminal Street Gang Label and Criminalization of Youth of Color It would be safe to say that youth groups have existed in this country from very early on in time. Dating back to the 1800s, many of these groups were made up of Irish, Italian, Polish, and German youth (Howell, 2012). Several of these youth groups engaged in what can be considered harmful acts of violence such as rape, robbery, and murder. The response in dealing with the delinquent behaviors of these maladjusted, troublesome White youth groups was to encourage more parental supervision (Sheldon, Tracy, & Brown, 2004). However, when large-scale migratory patterns resulted in the formation of youth groups of color (primarily Blacks and Latinos) as a means of protection from the oftentimes violent discriminatory acts committed against them by White youth groups, there was a shift in the response to troublesome youth behavior in American society. As youth groups of color began to assert themselves through an identified subversive cultural identity by way of dress, language, and demeanor, they were in turn identified as criminal rather than just troublesome. According to Sheldon and colleagues (2004), this criminalized response to troublesome youth behavior in American society largely stemmed from a “moral panic” that was driven by racial and ethnic stereotypes. This panic led to negative perceptions, discriminatory policies, gang suppression tactics, and mass incarceration of youth of color (Alexander, 2012). According to a recent report by the Sentencing Project (2013), if current incarceration trends continue, one in every three Black males and one in every six Latino males born today can expect to go to prison in their lifetime.

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This epidemic of incarcerated individuals has led to the prison industry being one of the largest budget items behind health, education, and transportation (Henrichson & Delaney, 2012). As a result, social programming and services such as employment, education, health care, housing, and prevention/intervention programs are compromised and oftentimes eliminated.

System-Induced Traumatization and Retraumatization Leading to Gang Involvement Cultural- and racial-motivated forces, such as the violent historical events, discrimination, and oppression experienced by prior generations, can

potentially affect the lives of current and future generations in the form of unresolved grief and ongoing system-induced trauma (Overstreet, 2000). This system-induced trauma is the unintended retriggering of complex traumas by institutional failures that further deepen one’s psychological wounding. Building off Vigil’s Multiple Marginality Framework (1983, 1988, 2002, 2010), Figure 32.1 illustrates the progression toward system-induced traumatization and retraumatization that may result from historical and structural failures. Historically, legislative policies and racial segregation procedures cultivated racial and economic ghettoization, which resulted in non-Whites being placed in impoverished, clustered enclaves. These clustered enclaves, often in areas cut off from resources, include fragmented social institutions that lack

Figure 32.1  Progression Toward System-Induced Traumatization and Retraumatization Historical and Structural Failures

Clustered Enclaves

Fragmented Social Institutions

Lack of Opportunity

Poverty and Economic Insecurity Psychological and Emotional Strain

Traumatic Experiences (Retraumatization)

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the ability to appropriately respond to the needs of groups residing within underserved communities. Additionally, continual cutbacks in social services have a direct impact on the availability of critical programs for high-need vulnerable youth, thus further widening the economic and social capital gap among disenfranchised populations. The challenges produced by the lack of opportunities and financial insecurity influences the family structure, stability, educational readiness in the context of language, cultural differences, and points of contact with police and the criminal justice system (Vigil, 2010). This dynamic creates psychological and emotional strain on systems (i.e., families, schools, churches, parks and recreation centers, etc.), causing traumatic experiences for families and youth exposed to such living conditions (Vigil, 1983, 1988, 2002, 2010). The multidimensional psychological and emotional strain experienced presents traumatic experiences and sometimes retraumatization for vulnerable youth navigating impoverished neighborhoods. The subordination of being lower class in an economic and social system that ignores and fails to meet the needs of vulnerable youth results in feelings of frustration and leads to the desire to fulfill their unmet needs outside of traditional institutions (Thompkins, 2000). Additionally, racial profiling against communities of color and discriminatory policies (e.g., gang enhancements, gang injunctions, zero tolerance, etc.) are examples of systeminduced institutional violence that further subjects vulnerable youth and communities to trauma. The intergenerational accumulation of trauma, the persistence of oppression, and a disadvantaged social status have promoted multigenerational trauma, lending itself to violence and street socialization, also known as the cultural identity of street gangs (Song, 2003; Vigil, 2010).

Street Gangs as a Reactive Contraculture Several scholars have proclaimed that street gangs emerged as a result of the status composition of

American society (Campbell, 1982; Cohen, 1955; Vigil, 1997). Arfaniarromo (2001) reiterates the fact that high-need youth are often placed within a contextual “no-man’s land” of society, and their decision to join or be involved with street gangs is “an alternative response to disturbing societal conditions that are rooted in social, cultural, ecological, economic, historical, and political dilemmas” (Arfaniarromo, 2001, p. 134). Street gangs present an opportunity to depart from a perceived underclass status to one that offers prestige, power, material goods, and a chance to belong to a group that receives youth unconditionally (Calabrese & Noboa, 1995). Thus, street gangs emerge under situations in which the social relatedness needs of its adolescent members have not been sufficiently met by the dominant culture’s institutional capacities or family arrangements (Spergel, 1995). When adolescents feel alienated, they lack a sense of belonging and feel removed from family, friends, and/or school (Bronfenbrenner, 1986). These vulnerable youth begin to recognize that there is no strong support structure in place within their conflicting cultural systems, often seeking and finding refuge in environments that will provide the love, approval, acceptance, and support that they are so desperately seeking—gangs (Clark, 1992). The decision for youth to join a street gang is often a reaction to traumatic experiences they have encountered in their environment rather than a well-thought-out intention and represents an expression of anger, pessimism, and unceasing hopelessness (Calabrese & Noboa, 1995). From work done in juvenile hall institutions and the community at large, researchers have obtained practicebased evidence that strongly suggests that there are far too many youth who have found acceptance and identity through street gangs in hopes of equalizing marginality in multiple arenas of their lives. Adolescent awareness of the negative impact of poverty, discrimination, poor education, lack of job opportunity, and other marginalizing factors creates psychological strain and status frustration that results in a reactive contraculture, which rejects all middle-class values and norms (Campbell, 1982; Cohen, 1955; Vigil, 1997). As youth realize their

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incapacity for meeting middle-class standards, they create a delinquent subculture or street gang as a means of securing prestige, financial success, and status (Belitz & Valdez, 1997). Since these youth struggle to identify with the dominant culture due to traumatic familial struggles (i.e., underemployment, domestic violence, etc.), school-related problems, and other cultural and ethnic value conflicts (i.e., language barriers, religious differences), they satisfy their needs by adopting opposing worldviews that disown and scorn that of the governing culture (Campbell, 1982; Cohen, 1955; Vigil, 1997). This rejection of the dominant culture’s values is evident in their adopting different and often alienating behaviors, styles of dress, language, drug use, and other gang customs.

Acculturation Adjustment Difficulties Another explanation for the emergence of street gangs as a contraculture stems from issues associated with the acculturation process. For instance, since youth often acculturate faster than their parents because of their involvement in the educational systems and interactions with peers, disagreement between the parents’ and the youths’ (i.e., the first and second generations’) values and beliefs tend to arise, creating parent-child conflict, loyalty friction, and identity confusion for the youth (Belitz & Valdez, 1997; Vigil, 1988). This value conflict and the frustrations that arise between first- and secondgeneration immigrants (which at times results in traumatic domestic abuse) places youth at high risk for identifying and associating with peers who adhere to negative cultural standards and values that are an inherent part of the street gang’s contraculture (Belitz & Valdez, 1997). In other words, instead of resolving the parent-child value conflict and healing some of this trauma, or vigorously investigating the meaning of their culture, ethnicity, and/or identity, these youth reject the dominant and governing cultural norms (Belitz & Valdez, 1994; Vigil, 1988), the norms to which their parents might adhere, and in turn, embrace the gang’s—their

peers’—limited construct of culture. During this process, youth form self-identities to individualize their place within the peer group and also engage in risky behaviors attempting to suppress the psychological strain and traumatic experiences they have suffered. Stronger bonds of loyalty continue to form as gang-involved youth experience various events of partying, ritualistic drug and alcohol use, street altercations, and other delinquency acts over time (Vigil, 2010). This loyalty is often the driving force of being there for one’s homeboy/homegirl no matter the consequences, which includes the threat of incarceration or death. Since many people lack understanding of ganginvolved youth, a fundamental intolerance develops, limiting their complete integration into the more conventional social culture (Horowitz, 1987). Hence, street gangs fulfill the sense of belonging that is missing from the community and family, and they provide a feeling of security and a source of support and group identification (Holleran & Waller, 2003; Vigil, 1988). Gang membership allows youth to form a personal, social, and cultural identity (Belitz & Valdez, 1997). Identification with this contraculture provides the youth a sense of belonging to a family type system, a sense of being fully accepted and validated, a sense of competency and mastery, an accepted means of managing psychological distress, and a sense of personal cultural identity. (Belitz & Valdez, 1997, p. 64)

The Cultural Values of Gangs Match That of the Dominant Culture Some of the values to which a street gang adhere are power, respect, loyalty, attachment, commitment, protection, security, unity, and acceptance. While these are all values that can be found in the dominant culture as well, a street gang tends to interpret them in a twisted and oftentimes destructive manner. For instance, power is gained by the amount and type of trouble a member experiences,

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respect is earned by displaying toughness through physical strength and fighting ability, and loyalty may be determined by the willingness of a member to commit a drive-by shooting (Hasan, 1998). As evident above, street gangs represent a culture that is as unique as any other culture (Hasan, 1998). With their distinct set of values, code of conduct, and behavioral and communication patterns, street gangs provide youth an alternate cultural identity. This alternate identity is passed from generation to generation of traumatized, confused, alienated youth who are frustrated by their inability to meet the standards imposed on them by the mainstream culture. Given the importance of culture and trauma as described above, counselors must give serious consideration to these dynamics when attempting to understand and intervene with gang-involved youth.

Understanding and Addressing Trauma When Counseling Gang-Involved Youth According to the National Child Traumatic Stress Network (NCTSN; 2009), gang-involved youth suffer higher levels of trauma exposure than nongang peers. For instance, gang-involved youth have been exposed to high incidents of physical and sexual abuse, neglect, and maltreatment, and have witnessed high levels of community violence and another person being killed or seriously injured (NCTSN, 2009). When compared to other youth, the rate of posttraumatic stress disorder (PTSD) is doubled for gang-involved youth (NCTSN, 2009). This type of trauma, as a result of community and interpersonal violence exposure, is a common thread often expressed by incarcerated ganginvolved youth (NCTSN, 2009). These traumatized youth commonly experience issues with depression, which is exhibited as acting-out behavior, attention deficit-hyperactivity disorder, anxiety, mood disorders, and signs of PTSD (Corcoran, Washington, & Meyers, 2005). However, behaviors of traumatized youth have all too often been mislabeled, thus impacting a counselor’s approach

to providing efficient intervention practices. For example, a youth exhibiting symptoms for antisocial behavior may be diagnosed for a personality disorder if a primary diagnosis for trauma is overlooked. Service providers, educators, and law enforcement may encounter a youth exhibiting a lack of empathy or remorse (a symptom of antisocial personality disorder) when instead he is exhibiting a psychic numbing (a component of PTSD). Recognizing this distinction will impact the way traumatized youth receive services. Understanding the trauma experienced by many gang-involved youth provides an opportunity to explore beyond the external descriptors and physical realm of a gang member. Although some gang-involved youth may generate attention to themselves through aggressive or delinquent behavior, most successfully disguise the magnitude of their psychological complexities (Herman, 1997). These youth often are able to reach adulthood with their secrets intact and “slip through the cracks” without receiving the necessary mental health services. Additionally, gang-involved youth tend to exhibit poor coping skills and experience issues of loneliness, isolation, and low frustration tolerance. Therefore, it becomes difficult for gang-involved youth to achieve a healthy sense of identity and selfidentification, especially if exterior stressors such as poverty, drugs, family dysfunction, and other fragmented institutions (i.e., schools, law enforcement, and community) have negatively affected their lives, making for a problematic psychosocial moratorium (Vigil, 1983). These vulnerable youth become prisoners to their traumas, and as time passes, shame concretes within their self-beliefs, thus impacting social and psychological health. Yet the vulnerable youth believe it is easier to hide their distress through the confines of gang membership than to process the inner trauma with a counselor they do not trust or believe can help them. Still, some gang-involved youth exposed to and trapped in highly violent environments search “for a space to preserve a sense of trust in people who are untrustworthy, safety in a situation that is unsafe, control in a situation that is terrifyingly

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unpredictable, power in a situation of helplessness” (Herman, 1997, p. 96). However, if counselors are unable to provide this safe, supportive, trusting space, the youth will quickly retreat back to the street gang that offers a sense of protection, control, structure, and an outlet for frustration and anger (NCTSN, 2009).

Considering a Culturally Based Trauma-Informed Approach Though many attempts to assist gang-involved youth have been made, most counseling intervention programs ignore the role culture and trauma plays on gang involvement. Consequently, it is not surprising that over time most counseling intervention programs fail in reducing levels of gang involvement because they tend not to focus on the status frustration, value conflict, identity confusion, or traumatic experiences of youth as the nucleus of the treatment plan. Rather, the focus is on attempts to control delinquent behavior that the gang-involved youth does not view as problematic. Thus, until transformations take place that position cultural conflict and trauma as key contributing factors, it is unlikely that existing counseling interventions will demonstrate appreciable results on gang-involved youth. Since many counselors will often focus on controlling or modifying behaviors rather than learning about the person, most will encounter resistance from gang-involved youth during the beginning stages of counseling. Basic counseling faculties consisting of compassion, trust, autonomy, initiative, competence, identity, and intimacy become key elements in the relationship-building process to clear avenues for service provision (Herman, 1997). Additionally, due to the complexities and magnitude of the various traumas encountered, a trauma-informed approach is necessary to implement when working with gang-involved youth. Trauma-informed care allows for an entry point into the beginnings of intervention work with gang-involved youth. In a trauma-informed approach, all service components are built on a thorough understanding

of the susceptibilities to and effects of trauma, and the multifaceted and diverse pathways in which survivors recover and heal from trauma (Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). This approach aims to avoid retraumatization by concentrating on safety first with a commitment to do no harm (SAMHSA, 2013). Additionally, this approach works in collaboration with trauma survivors, their family and friends, and other institutions to facilitate empowerment, healing, and recovery (SAMHSA, 2013). In order to effectively work with vulnerable youth susceptible to gang involvement, it is important to consider both traditional and nontraditional modalities that go beyond Band-Aid attempts to merely address symptomology and instead take a more comprehensive approach that focuses on healing the traumatic experiences that emerge from the historical and institutionalized root causes of gangs. To this end, it would be necessary to start with an ecological perspective to get an understanding of the person-in-environment and the historical, social, and ethnic identity dilemmas experienced by marginalized youth (Bronfenbrenner, 1979; Vigil, 2010). The environmental context of each individual differs, so it is important to consider the multisystems that may or may not have an impact on gang-involved youth. Beginning from this point would allow for the identification of the risk and protective factors as well as the traumatic experiences within and beyond various microsystems that play a role in the youth’s decision to join or get involved with a gang. For instance, one could recognize potential salient traumatic experiences of the individual such as individual factors (e.g., helplessness, loneliness, and powerlessness), family circumstances (e.g., domestic violence), negative peer influences (e.g., delinquent friends), school difficulties (e.g., language barriers and lack of resources), and community characteristics (e.g., community violence, inadequate housing, lack of job opportunities) related to gang involvement and membership (Calabrese & Noboa, 1995; Sule, 2005; Vigil, 1983, 2010). Once risk and protective factors are identified, a focus on reducing the risk factors

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and an emphasis on protective factors is critical in healing the trauma and frustration that leads many youth to join gangs to fulfill their unmet needs (Thompkins, 2000). To this end, interventions that focus on developing cognitive and behavioral processes that enable the individual to identify and make use of existing strengths and resources to effectively manage internal and external tensions and challenges need to be employed. Treating gang-involved youth that have experienced trauma requires a multidimensional method. The most vital component of a comprehensive treatment approach is developing strong rapport and creating a safe environment of compassion, kinship, and trust. At each stage of recovery, intervention and treatment must address biological, psychological, and social components of the issue at hand. Positive progress will reveal itself through evidence of authentic moments of kinship and compassion between the provider and client. The previously demonized gang member becomes humanized, victims transform into survivors, and hopelessness finds avenues of hope in a life that was once drowned by marginalized inequalities and traumas that became self-fulfilling prophecies. Given the cultural dynamics and traumatic stressors that influence gang involvement, it would be expected that counselors consider multiple factors to determine what effective intervention responses could be used to address the traumas and youth status frustration, resolve the value conflict, and promote a strong cultural identity that is more consistent with societal norms and standards. Counseling intervention models must work to remedy the trauma of multiple marginalities such as the negative impact of poverty, discrimination, poor education, lack of job opportunity, and other factors that create the status frustration and street socialization among gang-involved youth. Furthermore, the parent-child conflict, loyalty friction, and identity confusion that arise when youth experience acculturation adjustment must also be addressed for a counseling intervention to be comprehensive and successful. Thus, a range of services should be available and include individual

counseling, social competence training, academic skills, parent-child conflict management training, narrative therapy, functional family therapy, and value conflict resolution (Benda & Turney, 2002; Brewer, Hawkins, Catalano, & Neckerman, 1995; Greenberg, Kusche, Cook, & Quamma, 1995; Klein, Alexander, & Parsons, 1977; Loeber & Farrington, 1998). Behavioral, cognitive, and pragmatic family therapies are all possible modalities that may be used with gang-involved youth as identified needs arise (Henggeler, 1998). Additionally, there is a substantial need for the diverse general public to come together and align perspectives, norms, values, goals, and interventions to change social systems that are failing marginalized gang-involved youth (Benda & Turney, 2002). In general, there needs to be a fostering of social competence through increasing bonds of connectedness between families, schools, community agencies, and other prosocial groups and activities. Also, building a sense of purpose and future in youth by providing counseling programs such as support groups and communities of kinship that offer unconditional caring, listening, encouragement, and support will likely lead to the development of positive cultural identities that help heal trauma and may buffer youth from joining gangs (Leap, 2013). Furthermore, by allowing youth to participate and contribute to meaningful activities and by sending a conscious message that there are high expectations of success for all children, counselors increase the likelihood that youth will adapt to mainstream societal standards, which will result in more positive lifestyle choices.

CONCLUSION: SHIFTING THE LENS OF COUNSELORS TO BETTER SERVE GANGINVOLVED YOUTH The complexities of understanding gangs and gang-involved youth have spurred many discussions around what are the best approaches to deal with this multidimensional issue. Though found to be ineffective, suppression methods continue

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to be a popular unsuccessful practice in addressing the challenges of gang-involved youth (Chaskin, 2010; Klein & Maxson, 2006). Although at times there is a need for suppression, there is a far greater need for comprehensive counseling intervention services that work toward addressing the root causes of the multiple marginalities experienced by gang-involved youth (Vigil, 2010). Exploring the historical background and cultural framework of individuals who join gangs only sets the agenda to force us as counselors to challenge our own personal biases and resistance so we can look

beyond the external masks that highly traumatized youth put on to navigate their fragmented world. The effectiveness of counseling interventions with gang members will increase when counselors develop the ability to view gang-involved youth through a lens of compassion. Then and only then can we as counselors begin the process of building an authentic, trusting relationship as we work toward a better understanding of the foundational biopsychosocial and historical traumas that contribute to vulnerable youth being susceptible to gang involvement.

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Cultural Issues in Counseling Today’s Military Veterans Molly K. Tschopp and Michael P. Frain

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nited States military veterans include men and women of diverse backgrounds who served in various eras of war and peacetime. There has been increased attention to the successful community reintegration and well-being of the population of military veterans, particularly the growing number of wounded warriors returning from military service. In order to inform culturally relevant mental health counseling with military veterans, this chapter includes background and statistics regarding the current population of veterans as well as issues facing veterans today.

THE VETERAN POPULATION The U.S. Bureau of Labor Statistics report on data from the 2012 Current Population Survey (CPS), defining veterans as “men and women who have previously served on active duty in the U.S. Armed Forces and who were civilians at the time these data were collected,” indicated that there are approximately 21.2 million veterans in the civilian noninstitutional U.S. population (U.S. Bureau of Labor Statistics, 2013, p. 2). Almost 10 million of these individuals are veterans from the wartime periods of World War II, the Korean War, and the Vietnam era; 5.6 million served during the Gulf War era I and Gulf War era II; and another 5.7 million served outside these wartime periods. Diversity among the veteran population has grown over time. There has been a notable increase in women veterans. Only 3% of veterans from World War II, the Korean War, and the Vietnam era were women, whereas 17% of Gulf War era II (from September 2001 on) veterans were women (U.S. Bureau of Labor Statistics, 2013). The veteran population is made up of individuals from diverse ethnic and cultural backgrounds. The U.S. Department of Veterans Affairs, National Center for Veterans Analysis and Statistics (NCVAS; 2013) reported that in 2011 minority veterans made up approximately 20% of the total veteran population, with Black (11%) and Hispanic (6%) veterans as the largest minority veteran groups. Minority veterans made up approximately 33% of the women veteran population. The NCVAS report summarized findings on the socioeconomic indicators of minority veterans as compared to nonveteran 341

minority counterparts, as well as compared to each other. The report indicated: On average, most minority Veterans appear to be better off in terms of some key socio-economic indicators (education, employment, poverty, health care coverage) than their non-Veteran minority counterparts. However, when minority Veterans are compared with each other, their results mirror those of the population in general. American Indian and Alaska Natives have the highest poverty and uninsured rates. Asians have high levels of college education. High percentages of Hispanics and Asian are employed. Without controlling for specific factors, it is difficult to determine whether minority status, Veteran status, age, sex, or something else explains the differences between groups. (p. 21)

In 1994, the U.S. Department of Veterans Affairs (VA) established a Center for Minority Veterans. The Center is involved in policies, programs, outreach, and advocacy for veterans who are minorities (U.S. Department of Veterans Affairs, 2013a).

MILITARY CULTURE While the population of veterans is quite diverse, they comprise a unique subculture influenced by a shared experience of military culture (Strom et  al., 2012). In addition, each individual will be influenced by various factors such as military duty status, roles, and exposure to combat situations during military service (U.S. Department of Veterans Affairs, National Center for PTSD, 2004). Mental health professionals should recognize the existence of military culture and consider an individual’s level of military acculturation (Danish & Antonides, 2009). Counselors strive for cultural competency in serving all clients. The Association for Multicultural Counseling and Development (AMCD) Cultural Competencies described culturally skilled counselors as those who are knowledgeable about the life experiences, background, community, and resources of the particular group with which they are working and understand how culture may affect manifestation of psychological disorder and impact help seeking (Arredondo

et  al., 1996). These competencies are important underpinnings in appreciating veterans’ lived experiences, understanding potential barriers, and harnessing strengths and assets. Military culture refers to the traditions and values reinforced in military services aimed at preparing and maintaining personnel to work as a cohesive unit in accomplishing a mission. Exum, Coll, and Weiss (2011) define military culture as comprised of the values, beliefs, traditions, norms, perceptions and behaviors that govern how members of the armed forces think, communicate, and interact with one another as well as with civilians. This notion of culture also determines how military personnel view their function in life, their status, and the role of military in American society. (p. 17)

Military values include honor, integrity, courage, commitment, loyalty, respect, devotion to duty (Exum et al., 2011), and group solidarity (Malmin, 2013). These elements are crucial in engaging military personnel for immersion in the highly regimented environment of military service. Transition to civilian culture can be challenging for those exiting the military. Civilian culture emphasizes individuality, individual achievement, personal freedom and fluid social mobility. These characteristics are in stark contrast to the military culture’s strict hierarchical social structure and emphasis on ‘the mission’, the chain of command, and group solidarity in pursuit of the mission. (Exum et  al., 2011, p. 23)

Cook (2004) highlighted the element of self-sacrifice and the awareness that one may be injured or die for service to one’s country. Mental health professionals must acknowledge the values of military culture and the sacrifices the veteran has made to uphold his or her commitment to service (Coll, Weiss, & Yarvis, 2011). Counselor cultural competencies include an awareness of how elements of counseling may conflict with the client’s cultural values (Arredondo et al., 1996). For example, veterans who are acculturated to military culture may

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view help seeking and disclosure as clashing with the values of courage and devotion to duty. Sociopolitical factors have historically influenced the attitudes toward and treatment of veterans. Veterans may be conflicted about their service, particularly when the civilian community has limited awareness or is unsupportive of military operations (Exum et al., 2011). Mental health professionals, particularly civilian professionals, should be aware of the culture of unit cohesion and the need to gain trust as an outsider. Those who have not personally been part of the culture and lifestyle of military service may not be seen as capable of understanding the experience, and this belief may be a barrier to veterans seeking access to civilian mental health resources (Danish & Antonides, 2009). Counselor advocacy competencies (Lewis, Arnold, House, & Toporek, 2002) are particularly relevant when working with veterans. By attending to social, political, and environmental issues that shape veterans’ experiences, counselors apply empowerment competencies. Advocacy-oriented counselors may also draw from community collaboration, systems advocacy, public information, and social/political advocacy competencies to engage as change agents working within their communities or larger systems to reduce stigma around mental health issues, address barriers to help seeking, and access to treatment for veterans.

ISSUES FACING VETERANS Physical and Psychological Wounds Veterans recently transitioning from military to civilian life may experience various physical and psychosocial adjustment issues. Notably, the prevalence of disability in returning military personnel is significant in considering the needs of veteran populations. Given improved equipment and medical advancements, many veterans are returning with severe injuries that would have been fatal in earlier wars. The ratio of injuries to deaths is much higher than in the past. For example, the U.S. Department of Defense reported as of August

22, 2012, the number of deaths in Operation Iraqi Freedom (OIF) as 4,422, whereas 31,926 were Wounded in Action (WIA). As of August 22, 2012, over 49,000 individuals had been WIA serving in OIF, Operation New Dawn (OND), and Operation Enduring Freedom (OEF; U.S. Department of Defense, 2012). Service-connected disabilities are assessed with a severity rating system from 0 to 100 percent. In the 2011 American Community Survey (U.S. Census Bureau, 2011), over 810,000 of the 3.5 million veterans identifying as having a serviceconnected disability reported a disability rating of 70% or higher. The U.S. Bureau of Labor Statistics (2013) report on results of the 2012 Current Population Survey indicated that approximately 14% of all veteran respondents reported a serviceconnected disability. The prevalence of serviceconnected disability was particularly high for Gulf War-era II veterans at 28% (U.S. Bureau of Labor Statistics, 2013). However, the number of veterans with service-connected disabilities is only one part of the picture, as additional wounded veterans may still be waiting to go through the formal process for a VA disability compensation application for a service-connected disability rating, did not qualify, or have chosen not to go through the formal process with the VA. The language psychological and/ or physical wounds of deployment has been used in reference to veterans in an effort to be sensitive to potential negative responses and concern over affiliation with the term disability. Literature has indicated that veterans expressed closer identification with the term wounded (e.g., Grossman, 2009; Shackelford, 2009). The U.S. Department of Veterans Affairs, U.S. Veterans Benefits Administration, reported that in 2011 the most prevalent conditions for which individuals were receiving service-connected disability compensation were tinnitus, hearing loss, and posttraumatic stress disorder (PTSD). Blast injuries from improvised explosive devices (IED) contribute to these prevalent conditions. Polytrauma is common given the nature of such precipitating events. Polytrauma care is “for Veterans and returning Service members with injuries to more

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than one physical region or organ system, one of which may be life threatening, and which results in physical, cognitive, psychological, or psychosocial impairments and functional disability” (U.S. Department of Veterans Affairs, 2013b, para. 1). The Institute of Medicine (IOM; 2013) summarized literature findings on prevalence rates for a number of conditions among service members who had served in Iraq and Afghanistan as follows: “19.5 to 22.8 percent for mild TBI (commonly known as concussion), 4 to 20 percent for PTSD, 5 to 37 percent for depression, and 4.7 to 39 percent for problematic alcohol use” (p. 2).

Traumatic Brain Injury Traumatic brain injury (TBI) is considered to be the “signature injury” of the Gulf War era II (Corrigan & Cole, 2008; Snell & Halter, 2010). The impact of TBI varies based on location and severity of the injury in its cognitive, psychosocial, and behavioral effects. The U.S. Department of Defense, Defense and Veterans Brain Injury Center (DVBIC), is responsible for reporting brain injuries of U.S. military personnel around the world. Figures reported by DVBIC (2014) “represent medical diagnoses of TBI that occurred anywhere U.S. forces are located including the continental United States since 2000” (p. 1). Between 2000 and 2013 (Q1–Q3), a total of 287,861 head injuries of all severities (penetrating, severe, moderate, mild, and not classifiable) were reported. DVBIC noted that not all of the TBIs are deployment related, as they may have been acquired during military training or from other common causes of head injury similar to those in the general population, such as vehicle accidents, recreation and sports, or falls. Of the 287,861 total cases, 82.5% were considered mild. Mild TBI can have serious outcomes such as memory loss, depression, aggression, and headaches. TBI coupled with PTSD can contribute to additional functional issues for veterans that must be carefully assessed and addressed by mental health professionals. The co-occurrence of TBI, PTSD, substance abuse, and pain is also a prevalent concern (Saxon, 2011).

Posttraumatic Stress Disorder Veterans may have experienced traumatic events during the course of their service contributing to mental health conditions such as PTSD. The fifth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 2013) revised diagnostic criteria for PTSD and includes a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition. (U.S. Department of Veterans Affairs, National Center for PTSD, 2013a, para. 2)

The U.S. Department of Veterans Affairs has established a National Center for PTSD, which serves as a resource for research and treatment. Both men and women veterans may have experienced military sexual trauma (MST), defined by the VA by U.S. Code 1720D of Title 38 as psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty for training. (As cited in U.S. Department of Veterans Affairs, National Center for PTSD, 2013b, para. 2)

MST is correlated with high lifetime rates of PTSD (Street & Stafford, 2004). MST is considered to be underreported. Issues around reporting MST are complicated by the military culture values of unit cohesion and loyalty as well as fear of revictimization and retaliation (Cater & Leach, 2011).

Suicide Veterans are committing suicide at an alarming rate. The authors of the U.S. Department of Veterans

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Affairs, Mental Health Services Suicide Prevention Program 2012 Suicide Data Report, reported that in 2010 an estimated 22 veterans died from suicide each day (Kemp & Bossarte, 2012). They noted that these findings should be interpreted with caution given the limited number of states reporting prevalence rates. The report also indicated that more than 69% of veteran suicides were among those age 50 years or older, and males accounted for more than 97% of all suicides among those identified as veterans (Kemp & Bossarte, 2012). York, Lamis, Pope, and Egede (2013) discussed the VA focus on veteran health disparities, including gender, race and ethnicity, and rural residence, in the risk for mental health disorders and suicide. VA health researchers found that more rural veterans are unemployed, disabled, or receive VA disability compensation, have a payee or fiduciary, and have a poor health related quality of life. Rural Veterans had lower rates (10–22%) of mental health disorders as compared to urban Veterans, yet burden, defined as lower quality of life scores, was higher in rural Veterans for six psychiatric disorders (depression, anxiety, post traumatic stress disorder, alcohol dependence, schizophrenia, and bipolar disorder) as compared to suburban/urban Veterans. (p. 222)

To address the mental health needs of veterans and rate of suicide, the VA is developing programming aimed at greater accessibility for all veterans, such as the Veteran’s Crisis Line and telemental health services.

COMMUNITY REINTEGRATION If I had to label the age that our nation is entering, I would call it the “age of veterans”. Many significant changes in every sector of the United States will be influenced by our returning service members and veterans. This country has never experienced an influx of military personnel comparable to the number of individuals returning from wars in Iraq and Afghanistan. (Dungy, 2009, p. 22)

While many veterans adjust well to the transition to civilian life, others may experience difficulty and

present to mental health professionals with reintegration and adjustment issues. Veterans may have experienced multiple deployments and extended time away from their support networks. Families have likely experienced role reorganization, which can present challenges for the veteran reentering the family system. Marital and parental relationships may be negatively affected by behavioral, social, and emotional changes in the veteran, such as emotional numbing (Graf, Miller, Feist, & Freeman, 2011). In addition, veterans who have experienced physical or psychological injuries may require caregiving by family members or friends, and these individuals may not feel prepared or capable of providing such care for their loved one (Schaaf et  al., 2013). Some veterans experience financial strain or lack basic resources in the civilian community. U.S. Department of Housing and Urban Development (HUD; Kravitz, 2012) reported that while veteran homelessness fell by 7.2 percent since January 2011, homelessness is still a grave concern. The author reported that on a single night in January 2012, 62,619 veterans were homeless. Women are the fastest growing subset of the homeless-veteran population in America (American Psychological Association, 2013). Mental health professionals should be aware that some veterans may be challenged in finding employment, which affects financial resources as well as career identity. For example, in 2012, male veterans ages 18 to 24 who served during Gulf War era II had an unemployment rate of 20% as compared to an unemployment rate of 16.4% for male nonveterans of the same age group (U.S. Bureau of Labor Statistics, 2013). Acquiring employment may be complicated by difficulty finding a position that translates the specific skills from the veteran’s military experience into a civilian occupation. Veterans with TBI or mental health conditions may experience additional issues with job readiness and job performance (Adler et al., 2011). Vocational rehabilitation including career counseling, rehabilitation technology, appropriate accommodations, or supported employment is available for qualifying veterans with disabilities (Boutin, 2011; Sporner, 2012; Twamley et al., 2013).

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Higher education can provide veterans with the opportunities to develop skills and knowledge to progress toward their career goals, reintegrate into civilian life, and enhance job options. Unemployment rates in 2012 for veterans with higher levels of education were lower than for those with less education (U.S. Bureau of Labor Statistics, 2013). It has been reported that the primary incentive for military enlistment across service branches is the “desire to earn educational benefits for higher education” (Smith-Osborne, 2009, p. 112). Given the number of returning military personnel and the August 2009 implementation of the Post-9/11 Veterans Educational Assistance Act of 2008, there is an influx of veterans seeking to use their new benefits in higher education (American Council on Education, 2008). However, student veterans may encounter a number of psychosocial, cultural, and financial barriers in transitioning to the academic setting (Student Veterans of America, 2009). Mental health professionals, particularly those in campus counseling centers, may be in a position to provide individual and group support for student veterans. Given the number of veterans returning with physical and psychological wounds, consideration of the needs of student veterans with such health conditions and disabilities is paramount. Grossman (2009) summarized a projection of the potential for health conditions/disability among the incoming student veteran population, estimating as high as 40% of incoming student veterans with psychiatric, physical, and cognitive issues. Most veterans returning with disabilities were likely in their physical prime before incurring injury and are not experienced with seeking academic accommodations or navigating disability supports or services (Dungy, 2009; Grossman, 2009; Kelly, Fox, Smith, & Wittenhagen, 2011). Student veterans may be unfamiliar with the ways in which accommodations may be beneficial, may be hesitant to disclose disability, or perceive the use of accommodations as “weak” (Burnett & Segoria, 2009; Shackelford, 2009). Grossman (2009) encouraged campus personnel to use veteran-specific outreach activities to encourage support service use by veterans who

may hold negative perceptions of the terms and labels around “disability.” Mental health professionals should be aware that issues of disclosure, stigma, and not identifying with the term disability may limit student veteran service utilization. Veterans with disabilities, aging veterans, and those who have not been exposed to or experienced higher education may be challenged in adjusting to the academic setting. National Survey of Student Engagement (2010) results indicate that 66% of combat-veteran respondents were first-generation college students. First-generation students tend to come from low-income backgrounds (Wurster, Rinaldi, Woods, & Liu, 2013) and may not have the same resources as continuing-generation students (Stephens, Fryberg, Markus, Johnson, & Covarrubias, 2012). There is an emphasis on making postsecondary settings more accessible and welcoming to veterans with and without disabilities (Vance & Miller, 2009) in an effort to enhance academic success and promote retention (Coll, Oh, Joyce, & Coll, 2009). Campus climate as experienced by student veterans is influenced by multiple factors, “including policies; practices; attitudes of faculty, staff, and students; and the local community itself ” (Lokken, Pfeffer, McAuley, & Strong, 2009, p. 45). Coll and colleagues (2009) suggested that student veterans can benefit from a strength-based approach focused on building supports and creating “a positive college environment in which the veteran student may achieve personal growth, dignity, self worth, academic greatness, and individual autonomy” (p. 3). In addition, student veterans, particularly those with psychological and physical wounds, may benefit from a comprehensive, collaborative, and holistic system that bridges campus and community resources and supports (Burnett & Segoria, 2009).

CONCLUSION Veterans with mental health issues may be reluctant to seek support due to stigma around ­mental illness and help seeking (Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009). Active military personnel have reported concerns about

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revealing mental health issues due to perceptions of being “weak,” mistrust of mental health professionals, and fear they would be treated differently by their unit and leaders (Kim, Britt, Klocko, Riviere, & Adler, 2011). Veterans have expressed additional concerns around internalized stigma regarding perceptions of veterans with mental illness (Mittal et al., 2013). Veterans’ social and vocational opportunities, including career development as they transition into the civilian workforce, may be impacted by stigma. In their qualitative study with treatment-seeking OEF and OIF combat veterans, Mittal and colleagues (2013) found that perceptions of stigma and self-stigma related to PTSD “discourage adequate treatment and create barriers to work, housing, and health care opportunities” (p. 86). Participants also reported concern that the public would hold them responsible for their mental

health issues given that they had volunteered for military service. The authors highlighted the importance of peer-based outreach for addressing stigma and overcoming resistance to help seeking reinforced through military culture. Not all veterans will experience mental health disorders or difficulty transitioning from active duty to civilian life. Graf and colleagues (2011) found that participants identified some positive changes in their family member veteran, such as increased maturity, appreciative attitude, and work ethic. Veterans may report a greater appreciation for life and family (Coll et  al., 2011). Mental health professionals can assist veterans in building on their strengths and serve as an important source of support in aiding veterans with the physical, psychological, and social impact of their military service and civilian community reintegration.

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34

Caution Immigration May Be Harmful to Your Mental Health J. Manuel Casas

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nquestionably, since the founding of this country, immigration has played a significant and often tumultuous part of its history (Casas & Cabrera, 2011), and issues and turmoil associated with this phenomenon have perennially emerged on the American scene. Knowing the history of immigration in this country as well as the history of this country’s social, economic, and political interactions with those countries from which many of today’s immigrants are coming is very helpful for understanding the pressing immigration issues with which the United States is presently dealing, and in particular, the recent surge of undocumented and unaccompanied children entering the country. Unfortunately, given limitations of space, attention is focused on present-day facts and events, and in particular, the traumatic impact that the immigration process can have on the mental health and well-being of the immigrant populations in the United States. To this end, in line with the Report of the APA Presidential Task Force on Immigration (APA, 2012) for which I served as one of the authors, I first provide a brief demographic overview of the immigrant population in general and subpopulations in particular; I then address selective challenges, problems, and events that impact the mental health of the population—challenges that impede well-being and healthy adjustment to living in this country; in turn, I highlight existing policies and barriers that impede the provision of mental health services to the population; subsequently, I put forth some recommendations to increase and improve the provision of such services; finally, I briefly make recommendations for the advancement of training, research, and policy of relevance to the immigrant population.

Note: Portions of this chapter are based on the Report of the American Psychological Association (APA) Presidential Task Force on Immigration (2012) on which I served as one of its authors.

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THE DEMOGRAPHICS Immigrants in General Migrating to these United States for reasons including seeking economic/educational opportunities, escaping from violence and war and seeking refuge, fleeing from environmental catastrophes, and trying to reunify with family members has resulted in the fact that the United States today has approximately 40.4 million immigrants—the largest number in its history (Passel & Cohen, 2012; U.S. Census Bureau, 2011). This number represents a 28% increase over the total in 2000. As a nation of immigrants, the United States has successfully negotiated larger proportions of newcomers in its past (14.7% in 1910 vs. 12.9% today) and is far from alone among postindustrial countries in experiencing a growth in immigration in recent decades. It is worth noting that as a result of fighting and unrest, the increase in immigrants and/or refugees from the Middle East to Europe has reached monumental proportions (Kiely, Farley, & Gore, 2015). This phenomenon is causing tremendous upheaval in Europe, and it is only a matter of time when the United States will have to decide what humanitarian actions it is willing to take with respect to these immigrants. Nearly three quarters of the foreign born are naturalized citizens or authorized noncitizens (Congressional Budget Office [CBO], 2011). One in five persons currently residing in the United States is a first- or second-generation immigrant, and nearly a quarter of children under the age of 18 have an immigrant parent (Mather, 2009). It should be noted that the population of first- and second-generation immigrant children grew by 66% between 1995 and 2012 to 18.7 million, or one quarter of all U.S. children. Given this rate of growth, it is not surprising that immigrants and second-generation individuals have become a significant part of our national tapestry.

Undocumented With respect to undocumented immigrants, during the boom economic years in the last quarter

of the last century and the coinciding period of immigrant deregulation, the undocumented immigrant population grew dramatically from less than 1 million in 1980 to a peak of nearly 12 million in 1996 (Hoefer, Rytina, & Baker, 2009). However, coinciding with the recent recession, the undocumented population declined by 1 million between 2007 and 2009 (Passel & Taylor, 2010). The current estimate of the undocumented population is 11.7 million (Passel, Cohn, & Gonzalez-Barrera, 2013). Nearly half of undocumented adults are parents of minors, making those born in the United States citizens of this country. It is worth noting that the high number of undocumented immigrants has been maintained despite record numbers of deportations, approximately 400,000 each year, stepped-up border enforcement, and the passage of draconian laws to crack down on illegal immigration in states like Alabama, Arizona, and Georgia (Passel, Cohn, & Gonzalez-Barrera, 2013). Challengingly, more recent studies also show that the downturn of immigrants that occurred for economic and enforcement reasons, especially in reference to Mexicans, has not reversed itself. In fact, more Mexican immigrants are leaving the United States than are actually trying to enter it. This is especially true of undocumented immigrants (Gonzalez-Barrera, 2015). Regardless of possible discrepancies in findings, the fact of the matter is that a significant number of immigrants live and will continue to live in this country. As with past economic downturns, an unfortunate result of the recession (i.e., unemployment) was the reemergence of the tendency to blame the immigrants, the “outsiders,” for its cause (Simon, 1985). Such an attitude served as a catalyst for transforming immigration into a divisive social and political issue (Massey & Sánchez, 2010) that made immigrants the subject of negative media coverage (Massey, 2010), victims of increased hate crimes (Leadership Conference on Civil Rights Education Fund, 2009), and targets of exclusionary political legislation (Carter, Lawrence, & Morse, 2011). Given the recent surge of undocumented children into this country, immigration has actually become

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even more socially and politically divisive across all segments of the U.S. population.

Children: Documented and Undocumented Because immigrant children represent a rapidly growing segment of this population and one that is subject to particularly traumatic experiences that have lifelong impact, attention is directed to selective and imposing characteristics associated with this group in general, and more specifically, with those that are arriving daily or are already here in this country without documentation. While such attention would be appropriate under normal circumstances, it is greatly warranted at this time when, as previously mentioned, an extremely large number of undocumented and unaccompanied children and youth have been arriving in the United States. Quite astonishingly, immigrant youth, including first and second generation and general documented and undocumented, are the fastest growing child population in the United States. Currently, 16 million children have at least one parent who is an immigrant. Today, nearly 23% of youth under the age of 18 have immigrant parents. By 2030, it is projected that this age group will have grown to 30%. As previously mentioned, the majority of these youth are U.S. citizens. Nationwide, approximately 5.5 million children have at least one undocumented parent, 4.5 million of whom were born in the United States, making them citizens of this country. These kinds of “mixed status” family situations (some family members are citizens, legal residents, or in the process of regularizing their status, while others remain undocumented) are very common, with an estimated 9 million of such combinations (Taylor, Lopez, Passel, & Motel, 2011). As might be expected, these children find themselves at different levels or stages of the acculturation process and living in varied settings, and as such, the mental health challenges that they face vary concomitantly. Given the rapidly changing events and statistics relative to undocumented children, it is

hard to provide an accurate count of this group. However, a recent estimate put the group as representing approximately 1.7 million of the population (M. M. Suárez-Orozco & Suárez, 2014). Interestingly, a significant number of these children have been living in this country most of their lives and know no other homeland. While many have been educated and socialized within the majority culture, it would be safe to say that their levels of acculturation, and concomitantly the problems they encounter, will also vary. One major problem that is unique to these children, however, is the all-consuming fear of deportation that must be dealt with on a daily basis. With regard to numbers of undocumented and unaccompanied youth, about 3 years ago, federal agents annually intercepted some 8,000 unaccompanied minors entering the United States illegally. By last year, the number had jumped to nearly 26,000. Since October, an estimated 52,000 minors (ages 5 and up), most of them unaccompanied, the majority coming from El Salvador, Guatemala, and Honduras (the poorest and most dangerous countries in the hemisphere), have crossed the border. This number is nearly double the number of young immigrants caught crossing during the same period a year earlier. According to a new study by the Pew Research Center (Krogstad, Gonzalez-Barrera, & Lopez, 2014), the number of minors age 12 and younger has grown 117% compared with 2013, while the number of girls younger than 18 caught at the U.S. border was up 77% this year through May. That compares with an 8% increase a year ago (Krogstad, Gonzalez-Barrera, & Lopez, 2014). A low projection for the rest of this year is that a total of 80,000 to 90,000 of such youngsters may attempt to cross into this country. The Border Patrol estimates that by the end of next year, 142,000 such youngsters will be apprehended. According to the United Nations High Commissioner for Refugees (UNHCR; 2014), the majority of these unaccompanied and undocumented immigrants should actually be considered refugees because they are fleeing crime and violence in their countries of origin, and if returned to their countries could very likely face death. More

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specifically, this Commission estimates that 60% of the children might be eligible for some form of humanitarian protection. Likewise, a 2012 report from the nonpartisan Vera Institute of Justice identified 40% of immigrant children as eligible for some protection under U.S. Immigration Law (Villagra, 2014). Finally, when all is said and done, the United States has entered into numerous treaties with other countries to ensure the protection and safe passage of refugees. Under these treaties, the United States may not return an individual to a country where he or she faces persecution from a government or a group the government is unable or unwilling to control. Treating these children as refugees would have a tremendous impact on the manner in which they are processed through the immigration system, and most important, decrease the trauma associated with the process. For information relative to refugees and the challenges they face, see Tummala-Narra and Deshpande, this volume, Chapter 36. Given these demographics, psychologists are, and increasingly will be, serving immigrant adults and children, documented and undocumented, presenting an array of problems across a variety of settings including schools, community centers, clinics, hospitals, and prisons. As such, they should be aware of this complex demographic transformation and consider its implications as citizens, practitioners, researchers, and faculty.

PRESENTING PROBLEMS Bearing in mind the complex interplay between person and context, I would like to reiterate that, while most immigrants adapt well to their new lives, a good number of them experience diverse mental health problems, at varied stages of their lives, that are the result of their involvement in the immigration process. Unfortunately, for varied reasons, such problems tend to go unnoticed and/or are ignored. While the sources and causes of the mental health problems faced by immigrants are quite varied, many of these problems are linked to experiences that can be categorized under the headings of trauma, discrimination, and

a­ cculturation trauma (APA, 2012). According to some researchers, some of the pervasive problems inherent in each of the categories involve negotiating loss and separation from country of origin, family members, and familiar customs and traditions, exposure to a new physical environment, and the need to navigate unfamiliar cultural contexts (Akhtar, 2010; Tummala-Narra, 2009).

Trauma-Based Presenting Problems Traumatic experiences can occur at various stages of the immigration process: premigration trauma or events that are experienced before migrating, traumatic events that are experienced during the transit to the new country, and ongoing traumatic experiences in the new country. Premigration Trauma. While accepting the fact that extreme poverty continues to serve as a major reason for immigrating, it is the “unspeakable” and uncontrolled violence (i.e., murder, rape, and kidnapping) committed by cartels, gangs, and even persons in authority positions (e.g., police persons) that is the overriding factor in forcing many individuals to leave their countries of origin (Women’s Refugee Commission, 2012). This is especially true for those individuals coming from El Salvador, Guatemala, and Honduras. To this point, in 2012, the countries of El Salvador, Guatemala, Honduras, and Mexico accounted for 41,828 homicides, at a rate of 28 per 100,000 people. If Mexico is excluded, the rate jumps to 54 per 100,000 people. In the United States, the rate is under five (Wong, 2014). While these statistics may vary somewhat from one study to another, the numbers remain high and could be used to support the belief that violence in these countries is tantamount to an undeclared civil war, and as such, it is safe to say that that violence as a catalyst for migration is and has been a longunfolding problem (Flood at the Border, 2014). Seeking to provide a more comprehensive understanding of the historical-based violence to which immigrants of all ages are subjected, C AUTI ON

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I present the following facts in order to more accurately depict these children not only as victims of the violence that is presently occurring in their country of origin but also as victims of a violence that has its roots in past and ongoing U.S. policies and practices. I do so with the hope of encouraging this country to take greater responsibility in developing the most humanitarian approaches in dealing with immigrants in general and children and families in particular. To begin with, it is worth remembering that historically the United States determined the economic destiny of Central America—poverty for the majority of people. It supported authoritarian and dictatorial governments as it saw fit. The U.S. demand for drugs (i.e., marijuana and cocaine) helps to keep the cartels that are responsible for a great deal of the violence from which these people are fleeing in business, and while drugs are being smuggled north, U.S. policy facilitates the smuggling of guns south. More than one quarter million guns are slipped across the U.S.-Mexico border each year, according to a 2013 study by the University of San Diego’s Trans-Border Institute (McDougal, Shirk, Muggah, & Patterson, 2013). Ironically, with respect to gangs, U.S. deportations of foreign-born criminals helps feed the gangs that are prompting the flow of minors north (they have their roots in U.S. cities). There is much talk about the need to secure the border; perhaps more security/control is necessary, but the control should be a two-way street. While more control may be necessary relative to undocumented persons, for the sake of the children, more security is needed to control the surge of U.S.-made guns and gangs from making their way into Guatemala, Honduras, and El Salvador. Trauma During Transit. Living situations are so bad in these designated countries that both children and adults feel they have no options but to travel thousands of miles and brave hunger, dehydration, robbery, extortion, sexual abuse, kidnapping, and murder to reach the United States (Villagra, 2014). Needless to say, experiencing

such traumatic events can greatly contribute to the development of diverse mental health problems. I will not go into detail relative to these events; instead, I direct selective attention to traumatizing events, situations, and practices that are receiving a great deal of attention as a result of the surge of children entering this country. Many of these events that I consider to take place while in transit to the immigrant’s final destination actually occur on the U.S. side of the border, if and when a child and/or an adult is caught by the Border Patrol and enters the formal immigration process. These events exemplify the varied humanitarian, systemic, legal, and economic problems that the United States has to address in its efforts to deal humanely with youth in particular. From a systemic and legal perspective, the problem is that there is a lack of policy, guidelines, procedures, and resources for efficaciously and expeditiously processing these youngsters through immigration hearings and eventually immigration court. Yet such processing is the law. As of 2008, the Department of Health and Human Services must take charge of unaccompanied and undocumented minors 72 hours after they are detained by immigration agents. However, the lack of youth housing facilities is making it next to impossible to meet this deadline (e.g., the need to transport these youth from one part of the county to another part). Furthermore, initial hearings/interviews should be held within 10 to 15 days; however, the average wait time is 111 days. Unfortunately, while waiting, the youth are often detained in less than adequate (i.e., substandard) shelters. The waiting time increases for decisions to be made if the youth enters the immigration court system. At present (February 2016), the average waiting time in immigration court is 667 days. A case takes 578 days to make its way through the immigration courts, with over 400,000 cases currently pending (Transactional Access Records Clearinghouse [TRAC] at Syracuse University, 2016) according to federal court records compiled by Syracuse University. Astonishingly, because of

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legal maneuvering, some cases have stretched as long as 5 years (Becerra, 2014). From a legal perspective, the problem is that the playing field is not level for these youth. For all intents and purposes, while in custody, most of these individuals, as well as many before them, are not being afforded access to basic due process, and worse yet, treated with basic human dignity. With respect to due process, unlike people charged with criminal offenses, those detained on immigration violations, and children in particular, do not have the right to a court-appointed attorney during the deportation proceeding, so if the detained person/child can’t afford a lawyer, he or she often faces the judge alone. Finally, from a humanitarian and economic perspective, the problem is that the immigration system (i.e., the Border Patrol) is not prepared to adequately meet the housing needs of this onslaught of youngsters. This became apparent when detention facilities on the border became unacceptably overcrowded. Forced to react to this situation, older youngsters and parents with children were taken to bus depots far from their point of entry (often in other states) and given instructions to appear in immigration court at a later date and possibly closer to their desired destinations (i.e., where family members await them). As a result of a quick and negative reaction to such procedures, emergency shelters and processing centers have been set up in states such as California, Texas, and Oklahoma. Unfortunately, these centers most often are unable to provide much needed physical and mental health services. As previously mentioned, the arrival of these youngsters is serving to fuel the socially and politically divisive anti-immigration fires that have been burning across this nation for some time. Recently, three busloads of mothers and children were stopped from reaching their designated processing center in Murrieta, California, by a group of irate citizens who feared that if allowed to get off the bus they would never leave the city. In contrast, the reaction to a convoy of migrants arriving at El Centro’s Border Patrol Station was essentially muted. In a similar vein, with the help of a few paid

staffers, an estimated 800 volunteers in McAllen, Texas, work in shifts to maintain an immigrant relief center to provide shelter and limited services to undocumented immigrants who are preparing to be bused to destinations around the United States where they will remain until their immigration cases are heard in court. Trauma in the New Country. Once they are in this country, immigrants, and the undocumented in particular, are frequently subjected to varied traumatic experiences (Capps, Castañeda, Chaudry, & Santos, 2007), substandard living conditions, lack of adequate living resources/unemployment, racial profiling, ongoing discrimination (ParraCardona, Bulock, Imig, Villarruel, & Gold, 2006), exposure to gangs (Passel & Cohn, 2009), immigration raids in the community, the arbitrary checking of family members’ documentation status (e.g., Arizona SB 1070, Secure Communities Act; Nill, 2011), forcible removal or separation from their family for an indeterminate period of time (Capps et al., 2007), discovery upon returning home that their family has been taken away, violation of their home by authorities, placement in detention camps or in child welfare, and deportation to their country of origin. Such traumatic experiences and transitions at any age and at any stage of the immigration process can produce a range of psychological problems (Capps et  al., 2007), including poor identity formation, inability to form relationships (Gonzáles, 2010), posttraumatic stress disorder, acculturation stress, intergenerational conflict (Kohatsu, Concepción, & Perez, 2010), feelings of persecution, high distrust of institutions and authority figures, fear of school, inability to concentrate, acting-out behaviors, eating disorders, loss of motivation (i.e., lowered aspirations and expectations), depression, anxiety, suicidal ideation (Desjarlais, Eisenberg, Good, & Kleinman, 1995; Duldulao, Takeuchi, & Hong, 2009; I. Lopez, Ramirez, Guarnaccia, Canino, & Bird, 2011), and difficulties in school and work performance (C. Suárez-Orozco, SuárezOrozco, & Todorova, 2008).

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Discrimination- and Racism-Based Presenting Problems Immigrants, especially those of color, are often the targets of discriminatory practices (M. H. Lopez, Morin, & Taylor, 2010) or at least the victims of microaggressions (Sue et al., 2007). Whether subtle or overt, the negative impact of discrimination on the psychological well-being of an individual is still the same (Sue et al., 2007). Both overt and aversive forms of racism and microaggressions have important implications for immigrant individuals’ sense of well-being and belonging (Dovidio & Gaertner, 2004; Sue, 2010). Specifically, experiences of racial/ ethnic discrimination have been associated with mental health problems, including depression, anxiety, substance abuse, and suicidal ideation (Alegria et al., 2004; Cheng et al., 2010; Gee, Spencer, Chen, Yip, & Takeuchi, 2007; Tran, Lee, & Burgess, 2010; Tummala-Narra, Alegŕia, & Chen, 2011; see APA 2006, Resolution on Prejudice, Stereotypes, and Discrimination). Negative and potentially hurtful stereotypes, when ascribed to immigrants, can further result in a loss of personal control, especially for young immigrants (Flores & Kaplan, 2009). Profiling contributes to a social atmosphere that produces fear and anxiety for immigrants, especially those of color, who might possibly live in fear of being spotted and deported. This is especially relevant in the context of some highly publicized laws that allow law enforcement to actively seek out perceived immigrants even when they have broken no laws or very minor laws, which under other circumstances could be overlooked or minimally punished (e.g., warnings given). In summary, the racial and political contexts of the adopted country affect immigrant adults’ and children’s (both authorized and unauthorized) sense of safety and belonging and their ability to trust the systems of care will be able to help them when they are facing mental health challenges. Research has also demonstrated a relationship between perceived discrimination and decreased

use of mental health services, as well as the use of collectivistic coping strategies (Gee et  al., 2007; Jang, Chiriboga, Kim, & Rhew, 2010; TummalaNarra, Inman, & Ettigi, 2011). Considering evidence for the role of racial discrimination in psychological distress, future research is necessary to investigate the unique ways in which discrimination is experienced by immigrants and differences across gender, generation (first vs. second vs. third), and social class. Additionally, future research can address the intersectionality of social identities (e.g., race, culture, language, immigration status, age, gender, sexual orientation, social class, religion, and ability/disability status) and its relationship to immigrants’ experience of and ability to cope with discrimination.

Acculturation-Based Problems Acculturation is a naturally occurring process that can result in either positive or negative outcomes depending on existing contextual conditions (for details, see the Report of the APA Presidential Task Force on Immigration, APA, 2012). A variety of outcomes can ensue from the process. For example, the process can shape the expression of psychological distress, including culture-bound syndromes. In other instances, immigrants’ experiences of gender roles can vary significantly between the country of origin and the new culture, at times characterized by feelings of increased freedom and less adherence to traditional roles, and at other times by feelings of increased oppression and demands. As individuals negotiate their identities in a new cultural environment and find ways to cope with immigration-related stress, they may experience increasing tensions among family members. Intergenerational conflicts are common in immigrant households, reflective of an acculturation gap between parents and children and spouses and partners (Birman, 2006). Several studies reveal that greater conflict with parents, particularly with mothers, is associated with psychological distress, such as depressive symptoms. Acculturative

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c­ onflicts are often at the root of what brings immigrant families into treatment. In some cases, second-generation children and adolescents may experience role reversal when they are in a position to translate for their parents from their language to English or to help their parents and/or grandparents navigate mainstream culture (C. Suárez-Orozco et al., 2008). Many older adult immigrants, particularly those who immigrate late in life and have limited English proficiency, experience loneliness and isolation related to difficulties in navigating a cultural context in which they may no longer be revered or sought out as respected elders by family and younger members of their communities (McCaffrey, 2008; Ponce, Hays, & Cunningham, 2006).

BARRIERS TO TREATMENT While an increasing number of immigrants are seeking mental health services for the varied psychological problems noted above, most underutilize these services. A number of barriers to culturally sensitive and appropriate mental health services for racial/ ethnic minority and immigrant populations have been well documented in the literature. Both distal and proximal barriers (Casas, Raley, & Vasquez, 2008) affect the use of mental health services by immigrants. These barriers can be broadly grou­ ped into the following categories: social-­cultural, contextual-structural, and clinical-procedural.

Social-Cultural Barriers Some important social-cultural barriers include differences in symptom expression (e.g., somatic symptoms; Alegria et  al., 2008) and conflicting views about the causes of (i.e., attributions) and ways of coping with mental health problems (Atkinson, 2004; Koss-Chioino, 2000). For some immigrants, from an existential perspective, mental health problems are part of life and should be endured and taken in stride—“tiene que aceptar lo que Dios manda, es su cruz.” From another perspective, some immigrants view self-help as the best

means of dealing with mental health problems (Donnelly et al., 2011) or may lack an understanding of how psychological problems can be treated from a Western perspective (Inman & TummalaNarra, 2010). Others may prefer alternate sources of help rooted in their cultural contexts (e.g., priests, saints, curanderos, healers, herbalists, “sobadures,” and imans (Comas-Diáz & Greene, 2013; McNeill & Cervantes, 2008). Another social-cultural barrier involves stigma, which some cultures associate with mental health problems (Brach & Fraser, 2000; Wu, Kviz, & Miller, 2009). More specifically, some cultures that maintain strong family ties see individuals with mental health problems as bringing shame to the family, destroying the family reputation, exemplifying an overall family weakness, or as retribution for family wrongs (Hong & Domokos-Cheng Ham, 2001). In some cases, individuals may believe that mental health care should be sought for more severe problems such as psychosis but not for problems thought to be less serious (e.g., anxiety, depression).

Contextual-Structural Barriers Contextual-structural barriers include lack of access to appropriate and culturally sensitive mental health services (Lazear, Pires, Isaacs, Chaulk, & Huang, 2008; Wu et al., 2009), lack of knowledge of available mental health services (Garcia & Saewyc, 2007), shortage of racial/ethnic minority mental health workers and/or persons trained to work with racial/ethnic minority persons (APA, 2009a), older persons and culturally diverse elders (APA, 2009b), lack of access to interpreters, and lack of resources (e.g., lack of child care, transportation, finances) for accessing services (Rodríguez, Valentine, Son, & Muhammad, 2009).

Clinical-Procedural Barriers Clinical-procedural barriers include lack of culturally sensitive and relevant services (Maton, Kohout, Wicherski, Leary, & Vinokurov, 2006); “clinician bias” (Maton et  al., 2006); c­ommunication

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problems related to language differences and cultural nuances (Kim et al., 2011); misdiagnosis of presenting problems (Olfson et al., 2002); failure to assess cultural, linguistic, and procedural appropriateness of tests for targeted populations (Dana, 2005; Kwan, Gong, & Younnjung, 2010; Suzuki, Ponterotto, & Meller, 2008); lack of attention to culturally embedded expressions of resilience (Tummala-Narra, 2007); and failure to use the most efficacious mental health interventions (McNeill & Cervantes, 2008; e.g., evidence-based interventions adapted for use with minority and immigrant populations). Clinicians may also use Western-based theories of development that may not be suitable when working with immigrants from collectivistic cultures (Calliess, Sieberer, Machleidt, & Ziegenbein, 2008). For example, a clinician may downplay the role of religion and spirituality in the client’s life (McNeill & Cervantes, 2008) and overemphasize autonomy and independence as therapeutic goals (Dwairy, 2008). While contextual-structural and clinical-procedural barriers can be found across varied regions of the United States, they are becoming ever more prevalent in small towns and rural communities of the South and Midwest, where a growing number of immigrants from Mexico, Central America, and South America in search of low-skilled opportunities are settling. Unfortunately, these communities particularly lack the service infrastructure that is necessary to meet the mental health needs of Latino immigrants (e.g., access to health care, immigration assistance, and services provided in their dominant language; Buki & Piedra, 2012).

INTERVENTIONS Among clinicians who work with immigrants, it is widely accepted that in order to provide the most effective mental health services to immigrants the following guiding principles should be applied: Use an ecological perspective (Bronfenbrenner & Morris, 2006) to develop and guide interventions. Integrate evidence-based practice with practicebased evidence.

Provide culturally competent treatment. Use comprehensive community-based services. Use a social justice perspective as a driving force for all services.

To make sure that we are all on the same track, I will provide a few comments relative to these principles.

Ecological Framework Clinicians working with immigrants should give serious consideration to the use of an ecological framework (Bronfenbrenner & Morris, 2006). Such a framework is based on the belief that the human experience is a result of reciprocal interactions between individuals and their environments, varying as a function of the individual, his or her contexts and culture, and time. Each context offers particular risks as well as protective factors that either detract from or enhance healthy adaptation. They need to be understood in framing the immigrant experience and considered in the development and implementation of mental health treatments. In line with the APA’s publication titled “Resilience and Recovery After War: Refugee Children and Families in the United States” (APA, 2010), the information that should be gathered to inform interventions should include effects of migration (before, during, and after), legal/documentation status, acculturation, risk and resilience, cultural and religious beliefs, age of migration/ developmental stage, race, ethnicity, gender, social class, sexual orientation, disability/ability, experiences of racism and discrimination, language and educational barriers, and access to services and resources. All of this information is critical to developing a complex understanding of the individual’s experiences of distress.

Evidence-Based Practice and Practice-Based Evidence Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise. The purpose of EBPP is

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to ­promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention (Kazdin, 2008). Evidence-based practices work from the assumption that individual characteristics and sociocultural context both play important roles in assessment and intervention (La Roche & Christopher, 2009). There has been growing discussion in the field about prioritizing evidence-based treatments (EBTs) over practice-based adaptations of these treatments or practice approaches judged appropriate by clinicians but not empirically tested in randomized clinical trials. While arguments could be made for the use of either and/or both practices, psychology’s propensity to prefer interventions that are based in research has resulted in the overwhelming tendency to give more credence and preference to the use of evidence-based practices. However, it should be noted that with the exception of a few studies, research documenting the effectiveness of EBTs with diverse communities is still in its infancy. With respect to practice-based approaches, much of the evidence available is clinic or practitioner specific and as such is much too often limited with respect to their generalizability. For those wanting more information on the use of the two approaches, I refer you to the APA Presidential Task Force on Immigration (2012).

but for immigrant groups as well. For the sake of clarity and consistency, the definition of culturally competent that I am using is the same one provided in the APA’s (2010) report on refugees: “the capacity of programs to provide services in ways that are acceptable, engaging, and effective with multicultural populations” (Birman et  al., 2005, p. 12). Culture competency is emphasized given the fact that over the past two decades numerous researchers have addressed cultural competency from a variety of perspectives and across differing contexts (APA, 2002; Marmol, 2003; Nastasi, Moore, & Varjas, 2004; Pedersen, 2003; Vera, Vila, & Alegría, 2003) and have shown that to obtain effective clinical outcomes, both clinicians and the services provided need to be culturally sensitive and competent. As noted in the APA Presidential Task Force on Immigration (2012), cultural competence involves three broad dimensions: therapists’ cultural knowledge, therapists’ attitudes and beliefs toward culturally different clients and self-understanding, and therapists’ skills and use of culturally appropriate interventions. Working from these dimensions, cultural competence in practice includes attending to actual treatment practices (i.e., theoretical orientations and interventions) and promoting and facilitating access to services.

Culturally Competent Treatment

In order to ensure positive outcomes for the client, clinicians must find ways to collaborate with the various contexts/systems that are a part of the client’s life, thereby validating and empowering the client. In line with systems of care models (Casas, Pavelski, Furlong, & Zanglis, 2001), an outcome of such collaboration is the establishment of comprehensive community-based services that provide mental health, social, legal, and educational assistance, and are located in settings where the target immigrant population is likely to be found (e.g., schools, churches, and community centers; Birman et al., 2008; Hernandez, Denton,

As noted in the APA Presidential Task Force on Immigration (2012), cultural competency should be an inherent principle that underscores all work performed by psychologists. This position is aptly presented in the APA mission statement as well as in varied documents and publications, including the APA Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change (APA, 2002). These guidelines are applicable not only for minority ethnic and racial groups

Comprehensive Community-Based Services

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& Macartney, 2007). These services offer an alternative to clinic-based services. From a contextual perspective, comprehensive community-based services are critical because they address the larger context of immigrants’ lives. For example, therapy in a clinical setting is but one component of the overall treatment model. Again, for examples of such services, please see the APA Presidential Task Force on Immigration (2012).

Social Justice Perspective The social justice perspective in psychological treatment is rooted in the belief that all people have a right to equitable treatment and a fair allocation of societal resources, including decision making (Crethar, Torres Rivera, & Nash, 2008). Psychologists committed to a social justice perspective must work toward making society better for all by challenging systemic inequalities (Corey, Corey, & Callanan, 2011). The social justice framework requires a paradigm shift in the way psychologists, counselors, and other service providers perceive the therapeutic process (Herlihy & Watson, 2007). To successfully follow a social justice perspective, clinicians must make use of the ecological framework to conceptualize all of the contributing factors associated with a presenting problem. By so doing, clinicians will have the kind of information necessary to develop and/or identify the most appropriate and potentially effective interventions. Successful implementation of such interventions with immigrants and other groups that share similar characteristics will require that clinicians be prepared to assume new and diverse helping roles. Therapeutic interventions should seek to help individuals both change themselves and take steps to change the conditions contributing to the problem they face (Homan, 2008).

CONCLUSION AND RECOMMENDATIONS When I began writing this chapter, I envisioned addressing the topic of immigration and mental

health from a comprehensive and straightforward, neatly organized perspective. In other words, I was prepared to present a tapestry of information. Little did I know that in the pursuing months (e.g., the summer of 2014) the surge of undocumented unaccompanied children would provoke so much attention and emotions as well as generate an abundance of information that would require me to change my neat tapestry into an ever-evolving quilt having no set design and being comprised of pieces of material that would be provided on a daily basis. Given this situation, I have tried to present a quilt that is comprised of information that is relevant and applicable to immigrants in general and to undocumented children in particular. Taking into consideration the issues I have addressed, I conclude this chapter by putting forth the following four recommendations that I think are quite comprehensive in nature and merit your consideration. Space permitting, I could provide many more. 1. Most training programs do not offer culturalcompetency training specific to the needs of immigrant clients (APA, 2010). Without such training, it is impossible to provide the most effective and appropriate services and interventions to these clients. Consequently, there is a great need to significantly improve and enhance education and training opportunities related to immigrant issues. 2. With respect to research, the field of psychology should make immigrant-origin populations a population considered in research agendas at every phase of development. Only by doing so will the field discover the kinds of meaningful findings needed to inform practice and policy. 3. Addressing practice, in order to improve the quality and the effectiveness of all facets of mental health services provided to immigrants, it behooves the profession to adopt and implement the guiding principles addressed in this chapter. 4. Finally, relative to advocacy and policymaking, it is of utmost importance that psychologists acquire the information and develop the skills

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needed to advocate for social justice, and in this case, the humane treatment of all persons, including immigrants. Unfortunately, this kind of information is not normally taught and/ or developed in most training programs—­ something else for which to advocate. Of high priority in this area is the need to advocate for the development and/or implementation of existing laws and policies, (e.g., the 1952 United Nations Convention Relating to the Status of Refugees, the United Nations Convention on the Rights of the Child) that protect the rights and guarantee the safety of the immigrant, and in particular, those immigrants that lack documentation. To

this end, there is a need to improve collaboration and advocacy between and among individuals, organizations, and systems that provide care to immigrant-origin adults and children.

While these recommendations, if heeded, will not eradicate the immigration challenges that this nation is facing, they can result in much more positive humane outcomes than merely taking military-focused steps to secure the border. For a more detailed list of recommendations that merit attention, I refer you to the APA Presidential Task Force on Immigration (2012).

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CHAPTER

35

Difficult Dialogues in Counselor Training and Higher Education Roger L. Worthington and Marvyn R. Arévalo Avalos

In human societies there will always be differences of views and interests. But the reality today is that we are all interdependent and have to coexist on this small planet. Therefore, the only sensible and intelligent way of resolving differences and clashes of interests, whether between individuals or nations, is through dialogue. The promotion of a culture of dialogue and nonviolence for the future of humankind is thus an important task of the international community. Tenzin Gyatso, H. H. the XIVth Dalai Lama (1997)

E

quipping the next generation of citizens to function effectively in a democratic society is one of the core values of colleges and universities (Association of American Colleges and Universities, 2007), and higher education institutions have a critical role to play in preparing students and future leaders for the new global realities they will face in the 21st century (Gurin, Dey, Hurtado, & Gurin, 2002; Hernandez-Gravelle, O’Neil, & Batten, 2012; Schoem & Hurtado, 2001). More so than ever before, people across the world are engaged in discourse across differences—through travel, through social media, and across the airwaves. Yet ideological rhetoric and conflicts of identity continue to result in polarization in local, regional, national, and international contexts. As a result, there is tremendous need for people to interact across differences in rational, healthy, productive, and civil ways (Batten & Hernandez-Gravelle, 2012; van der Zee & van Oudenhoven, 2000, 2001; van der Zee, van Oudenhoven, Ponterotto, & Fietzer, 2013). Thus, advancing democratic values, respecting freedom of inquiry, and promoting pluralism are critical features of healthy and vibrant academic communities (Ford Foundation, 2005; Worthington, 2006). Higher education institutions have an obligation to protect academic freedom from internal and external threats that have the potential to substitute divisive polemics for empirical evidence and critical thinking as the basis for inquiry, discovery, and civil discourse (O’Neil, 2008, 2012; Schaffer, 2012; Worthington, Hart, & Khairallah, 2009). Yet higher education in the United States is persistently at the 360

center of the ongoing “culture wars” that have been present in this country for many years (Ford Foundation, 2005; Hunter, 1990; B. L. R. Smith, Mayer, & Fritschler, 2008; D. G. Smith, 2009), and there is a perception that we are losing the cultural value of civility in the face of disagreements over values, perspectives, and worldviews (Landis, 2008; Leskes, 2013; Worthington, 2006). As demographic shifts become more apparent in the United States, there is greater urgency to prepare students, along with faculty and staff, to constructively engage in dialogues that deepen and enhance understanding across a multitude of identity and ideological differences (Gurin, Nagda, & Zuniga, 2013; Nash, Bradley, & Chickering, 2008). Professional psychology has advocated the use of difficult dialogues in the advancement of multiculturalism and social justice for many years (Toporek & Worthington, 2014). As a major program focus of the National Multicultural Conference and Summit (NMCS) beginning in 1999, difficult dialogues have addressed race, gender, sexual orientation, religion, disability, social class, and a host of other intersecting identities related to multicultural competencies (Bingham, Porche-Burke, James, Sue, & Vasquez, 2002; Sanchez, Kawahara, Thomas, & Worthington, 2011; Sue, Bingham, PorcheBurke, & Vasquez, 1999). In addition, D. W. Sue and colleagues (Sue, Capodilupo, & Holder, 2008; Sue and Constantine, 2007; Sue, Nadal, Capodilupo, Lin, Rivera, & Torino, 2008) have advanced a program of qualitative research regarding race talk that describes difficult dialogues as arising primarily from unplanned or implicit interactions among students and faculty that are disruptive to the usual progression of classroom activities and call attention to identities and worldviews in ways that arouse strong emotional and behavioral responses (Sue, 2013, p. 665). Their program of research is particularly valuable because it provides empirical conceptualizations of classroom dynamics for students and faculty of different racial and ethnic backgrounds that have implications for learning outcomes and the development of multicultural competencies. However, it is important to provide a brief set of distinguishing features for the material

that follows. First, although Young (2003) as well as Sue and colleagues note that these types of difficult dialogues have the potential to become promising educational opportunities, the circumstances under which they occur are generally encounters incidental to instruction that, if they are managed effectively, can produce positive outcomes. Second, whereas descriptions of the difficult dialogues associated with the NMCS conference programs provided a broad inclusiveness of multiple and intersecting identities, more recent work by Sue and colleagues focuses narrowly on race talk in particular. Thus, there is a need for a broader, more inclusive definition of difficult dialogues in higher education and counselor training (see also Dessel, 2014; Dessel & Ali, 2012; Dessel, Rogge, & Garlington, 2006; Dessel, Woodford, Routenberg, & Breijak, 2013; Dessel, Woodford, & Warren, 2011; Nagda & Maxwell, 2011; Nash et  al., 2008; Watt, 2007; Watt et al., 2009; Yablon, 2010).

DEFINING DIFFICULT DIALOGUES A simple universally accepted definition of the term difficult dialogues does not exist (HernandezGravelle, 2012a). In fact, there is a wide array of similar terms used for a variety of differing concepts of dialogue, including difficult conversations, intergroup dialogue (Gurin et al., 2013; Maxwell, Nagda, & Thompson, 2011), sustained dialogues (Parker, 2011; Parker, Nemeroff, & Kelleher, 2011), deliberative dialogues (London, 2004), civil dialogue (Leskes, 2013), and moral conversations (Nash et al., 2008), among others. Furthermore, a number of authors have offered somewhat divergent definitions of the same term difficult dialogues (e.g., Ford Foundation, 2005; Hernandez-Gravelle, 2012a; Landis, 2008; Merculieff & Roderick, 2013; Sue, 2013; Watt, 2007; Worthington et al., 2009; Young, 2003). Although a detailed list and analysis of the varying definitions associated with these terms are beyond the scope of this chapter, the common theme that unites each of these simultaneously convergent and divergent concepts is the use of dialogue in higher education

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(and other contexts) to address potentially controversial issues, conflicts, and intra- or interpersonally anxiety-provoking material. The model of difficult dialogues described in this chapter is based on work arising from the Ford Foundation (2005) Difficult Dialogues Initiative (Hernandez-Gravelle et al., 2012b). Generally, dialogue refers to efforts people make to talk with and listen to one another in open and honest ways about ideas or problems that often result in an empathic airing of differences with the potential to lead toward mutual understanding and collaborative decision making (Nash et  al., 2008). For the purpose of this chapter, difficult dialogues are purposeful, planned (often educational) interactions and discourse that occur among individuals with divergent attitudes, beliefs, values, backgrounds, perspectives, and/or worldviews about complex social and moral dilemmas or controversies. Although there is substantial evidence that engaging in meaningful interactions across differences has the potential to prompt changes in attitudes, beliefs, and assumptions (Tropp & Pettigrew, 2005), the expressed purpose of difficult dialogues is not always to change other people’s beliefs, values, or perspectives. Instead, the central intention is to create models of dialogue based on mutual respect, open-mindedness, and an informed exchange of ideas and beliefs. Whereas intense and unsettling emotional reactions occur within the context of difficult dialogues, the purpose of the dialogue is not to evoke intense emotions (or to avoid them) but to work through challenging reactions that have the potential to diminish opportunities for clarity of communication and depth of understanding across differences. Personal reference group identities such as race, ethnicity, gender, sexual orientation, disability, social class, and political ideology are often, but not always, the focus of difficult dialogues. In addition, difficult dialogues can focus on broader societal issues (e.g., human rights, civil rights, foreign policy, public health policy, legal doctrine, scientific debates, political debates) or more focal controversies related to education and professional training (e.g., the development

of multicultural competencies, conflicts between personal or religious values and professional ethics, issues of academic freedom, the changing landscape of higher education). In the broadest sense, difficult dialogues may take place in a variety of venues, including undergraduate and graduate higher education, academic and professional associations, organizational governance, civic and community affairs, business affairs, government, and media. In addition, the process and format of difficult dialogues varies considerably as a function of context (Bojer, Roehl, Knuth, & Magner, 2008; Schirch & Campt, 2007; Schoem & Hurtado, 2001). For example, as noted by Sue (2013), difficult dialogues can emerge spontaneously when interactions across differences result in microaggressions that evoke strong emotional reactions or conflict. Alternatively, it is possible to plan structured difficult dialogues to take place as (a) the pedagogical approach to an entire course, (b) a pedagogical adjunct to content delivery as part of a course, (c) public forums in campus or community contexts, (d) large town hall meetings in campus or community contexts, and (e) formal or informal group interactions at professional conferences or other structured activities. For the purposes of this chapter, we narrow our focus in the sections that follow to difficult dialogues pedagogy in higher education contexts.

THEORETICAL FRAMEWORK FOR DIFFICULT DIALOGUES We have adapted the theoretical framework provided by Gurin et al. (2013) for intergroup dialogue to aid our conceptualization. Figure 35.1 provides a critical-dialogic framework for difficult dialogues in which pedagogical practices (topical content, open inquiry, catalytic exercises, guidelines for dialogue, expert facilitation) and dialogic communication (self-reflective dialogue, engaged dialogue, critical dialogue) interact with interpersonal processes (trust, group cohesion, risk taking, acknowledgment of mistakes, forgiveness) and intrapersonal processes (self-monitoring within group dynamics,

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Figure 35.1  Adapted Critical-Dialogic Model of Difficult Dialogues Teaching and Learning Psychological Outcomes Pedagogical Practices

Interpersonal Process Educational Outcomes

Dialogic Communication

Intrapersonal Process Civic Development

Pedagogical Practices • • • •

Topical Content Open Inquiry Catalytic Exercises Guidelines for Dialogue • Expert Facilitation

• Self-Reflective Dialogue • Engaged Dialogue • Critical Dialogue

Psychological Outcomes • • • • • •

Interpersonal Process

Dialogic Communication

Cognitive Complexity Diunital Reasoning Openness to Diversity Affective Positivity Appreciating Differences Identity Development

Intrapersonal Process

• • • •

• Self-Monitoring Within Group Dynamics • Assessing Emotional Reactions • Critical Thinking

Trust Cohesion Risk Taking Acknowledge Mistakes • Forgiveness

Civic Development

Educational Outcomes • Active Learning Orientation • Academic Freedom Orientation • Pluralism Orientation

• Community Engagement • Democratic Engagement • Social Justice Activism

Source: Adapted from Gurin, Nagda, and Zuniga (2013).

assessing emotional reactions, critical thinking), which together produce psychological outcomes (cognitive complexity, openness to diversity, affective positivity, appreciation of differences, identity development), educational outcomes (active learning orientation, academic freedom orientation, pluralism orientation), and civic development (community engagement, democratic engagement, social justice activism). Some (but not all) difficult dialogues are conceptualized on the basis of intergroup contact theory (Allport, 1954), as is the

case for intergroup dialogue (Gurin et  al., 2013), in which quality interactions among members of differing identity groups help to reduce stereotypes and prejudice while increasing collaboration and intergroup harmony. Difficult dialogues differ from intergroup dialogues in that they do not involve the systematic, balanced assignment of particular identity group members as participants and facilitators (e.g., men and women, Whites, and people of color). Instead, difficult dialogues often adopt an “open space” principle that “whoever comes are the right

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people” (Bojer et al., 2008, p. 88). These distinctions arise out of necessity when (a) the topic of dialogue is not centrally focused on identity group relations or (b) balancing identity group membership within a particular dialogue is not feasible. Thus, whereas most instructors do not have the ability to select specific students based on identity group membership, it is still possible and desirable to teach from a difficult dialogues perspective (see also Ford, 2012). Pedagogical practices. “There is no single formula for prompting or managing difficult dialogues or for assessing their quality” (Hernandez-Gravelle,

2012b, p. 168). Indeed, there are a wide variety of methods designed for different purposes and formats (Bojer et al., 2008). Table 35.1 provides an overview of a process for difficult dialogues that can be adapted in different ways for a number of different purposes. However, because there are many different approaches, difficult dialogues require advanced preparation and strategic navigation (Hernandez-Gravelle, 2012b). For example, it is essential to carefully consider the purpose of the dialogue in advance of gathering participants or making decisions about a particular method (Bojer et  al., 2008)—that is,

Table 35.1  Difficult Dialogue Process Outline 1. Planning Difficult Dialogues a. Establish the Topic, Need(s), and Purpose(s) for the Dialogue: Provide a title and concise description of what the dialogue is intended to accomplish. b. Provide a Frame for the Dialogue: What are the issues of difference or conflict or controversy that will be the focus of the dialogue? Are there areas of common ground (e.g., there is agreement on a preferred outcome but not on the process for how to achieve the outcome)? What are the central questions that need to be addressed? Provide parameters that guide the focus of the dialogue (e.g., how will participants know if they are staying on track or getting off track?). Will there be multiple meetings of the same group, or will the dialogue take place within a single meeting? c. Who Will Lead the Dialogue? Will the dialogue leader be an organizer, convener, moderator, or facilitator? Will there be more than one leader, and if so, what are the respective roles of each leader? d. Identify Characteristics of the Participants: Are the participants a predefined group (e.g., students in a specific course), or will the facilitators need to select or recruit potential participants for the dialogue? What are some important or defining characteristics of (potential) participants? What is already known about the variability of perspectives, values, attitudes and beliefs between (potential) participants? Do preexisting group dynamics exist among (potential) participants that need to be taken into consideration in approaching the dialogue? Are there any important considerations about the personality characteristics or social status of specific participants that might have an impact on the dialogue? 2. Engaging in Difficult Dialogues a. Introduce the Topic Briefly: State the title and provide a brief description of what the dialogue is intended to accomplish. b. Establish the Guidelines for Dialogue: In some cases, this may involve providing the participants with a predetermined set of guidelines for dialogue, whereas in other cases it may be more suitable for the participants to generate organically a set of guidelines within which the dialogue will occur. It is also possible to use a hybrid approach in which a brief set of guidelines is used by the group as a catalyst in developing their own set of guidelines.

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c. Allow Participants to Introduce Themselves: This is particularly useful in small groups in which participants share something about themselves or their role as a stakeholder related to the topic. In larger groups that will be constrained by time (e.g., single meeting dialogues), it is sometimes necessary to carefully abbreviate (or eliminate) this step. d. Remind Participants about the Overarching Goals and Objectives: What is the dialogue intended to accomplish in general terms? Clarify any misconceptions about what can and cannot be expected by participants at the end of the dialogue. e. Begin the Dialogue: Open the dialogue by providing the frame and purpose for the dialogue, followed by an open question. f. Engaged Facilitation: This process includes a combination of active listening, communication, and observation skills. An engaged facilitator responds to a variety of group dialogue issues, such as engaging quiet or resistant participants, balancing questions related to topical content or process comments about group dynamics, and monitoring time and the flow of the dialogue. 3. Debriefing Difficult Dialogues a. Establish the Rationale for Debriefing: Allow participants to give feedback to one another and the facilitator(s) about their reactions to the dialogue and clarify. Avoid rehashing any points of conflict or disagreement; focus on process feedback. b. Focus on Strengths: Identify positive aspects of the difficult dialogue (e.g., what did the participants do to enhance communication and understanding?). c. Address Roadblocks: Identify aspects of the difficult dialogue that posed a challenge for communication and understanding across differences (e.g., unspoken group dynamics or unfamiliarity with the content), and brainstorm ways to address these issues in future dialogues. d. Facilitator Feedback: Facilitator(s) provide feedback about group process, with a focus on enhancing the quality of communication and promoting positive outcomes. Facilitators may also self-disclose information about their own intrapersonal processes (e.g., “I felt like communication improved when . . . ”).

what are the specific needs being addressed by the dialogue and what goals or objectives are to be achieved? Because there are inherent challenges to dialogues described as “difficult,” it is critical to identify the issues of difference, conflict, or controversy that may be the focus of attention. It is also important to anticipate potential areas where there might be “common ground” among participants with otherwise differing perspectives (e.g., there might be agreement on a preferred outcome but not on the process for how to achieve the outcome). Thus, in order to effectively frame the dialogue, facilitators should identify a number of central questions that need to be addressed about

the purpose, process, and expected outcomes of the dialogue. It is often useful to allow the process to be flexible and/or open-ended because beginning with a precise and rigid set of objectives has the potential to inadvertently or inappropriately narrow or constrict the dialogue in ways that stifle full exploration of the focal issues (Bojer et al., 2008; Saunders, 2011). In our work for the Ford Foundation Difficult Dialogues Initiative, one of the most frequent issues raised in faculty development programing was the tension between content delivery and opportunities for experiential learning through dialogue (Hernandez-Gravelle, 2012a).

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Conducting d ­ ifficult dialogues requires that the facilitator find an appropriate balance between the content (the material or information that is being addressed in the discourse) and process (the dynamics of group participation and engagement). Whereas theory and research about the topic are used to help inform the ways participants think about and discuss ideas, the process of interacting across differences encourages increased insights related to the content and has the potential to encourage participants to more deeply explore the literature on a particular topic (Beale & Schoem, 2001). The form and nature of the content should be based on the characteristics of the audience in terms of background knowledge of participants, preexisting perspectives, level of sophistication with the subject matter, level of complexity of the focal topic, and so on. In most cases, some type of reading or other media (e.g., scholarly works, news reports, editorials, videos, movies) will provide information on the variety of different perspectives and views about the topic. In addition, some difficult dialogues might incorporate guest speakers (e.g., keynote or panel) who provide background information as well as take a stance on the issues or questions central to the dialogue. In other cases, there may be live demonstrations (e.g., interactive theatre, debate) to provide a catalyst for more focused discussion among difficult dialogue participants (see Burgoyne, Placier, Taulbee, & Welch, 2008, for a description of interactive theatre). It is also important to note that difficult dialogues require expert facilitation and that few instructors have training for how to facilitate difficult dialogues. In fact, in addition to concerns about delivery of specific course content, “fear” is one of the most common reasons given by instructors about why they do not engage in difficult dialogues in their own classrooms (Burgoyne et  al., 2008; Hernandez-Gravelle, 2012b; Pasque, Chesler, Charbeneau, & Carlson, 2013; Young, 2003). These fears arise in part because faculty members have not received training in how to facilitate dialogue regarding issues that are controversial, and also because instructors anticipate

that such dialogues may turn out poorly and result in negative teaching evaluations. Pasque et  al. (2013) identified a number of ways faculty resist or avoid difficult dialogues about race, including denial that racial conflict exists, minimizing or trivializing the conflict, and diffusing, distracting, or diverting attention away from racial conflict. As a result, one of the best practices arising from the Ford Foundation Difficult Dialogues Initiative was faculty development designed to increase the self-efficacy to facilitate difficult dialogues in their classrooms (Hernandez-Gravelle, 2012b). Broadly, faculty development involves (a) differentiating dialogue, debate, discussion, conversation, and instruction, along with skills in (b) active listening, (c) group facilitation, (d) mediation, and (e) conflict resolution, as well as (f) opportunities for practice and rehearsal of difficult dialogues through role plays and interactive theatre. Maxwell et al. (2011) provided a comprehensive volume on the facilitation of intergroup dialogues, whereas Schirch and Campt (2007) provided a brief practical guide for planning, designing, and facilitating difficult dialogues. In addition, purposeful dialogue requires an agreement among participants about the basic principles or guidelines used to design and govern the process—and different approaches based on varying needs are guided by disparate principles (Bojer et al., 2008; Merculieff & Roderick, 2013). In a poignant essay for the Association of American Colleges and Universities, Leskes (2013) described a set of defining guidelines for “civil dialogue” that corresponds closely to our work with difficult dialogues (paraphrased as follows): •• Engage in a serious exchange of views. •• Focus on substantive issues rather than on other participants. •• Present and support positions based on scholarly data/information. •• Respectfully listen to the views and ideas of others. •• Focus on identifying the sources of common ground as well as disagreement. •• Express open-mindedness and a willingness to shift perspectives.

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•• Express an openness and willingness to compromise. •• Refrain from physical, emotional, and verbal intimidation or violence.

The value of respectful dialogue is a common unifying theme across the spectrum of different types of dialogue in which participants strive to avoid unproductive language (Dessel et al., 2006). Whereas in some dialogues political correctness may be adopted by consensus as a group guideline, alternatively, in other groups it may be eschewed as prohibitive to the goals of difficult dialogues. That is, the norm of political correctness may be purposefully suspended as one way to encourage greater transparency, developmental growth, active partnerships in learning, and acknowledgement of mistakes through forgiveness. Generally, facilitators establish agreement among participants about the guidelines for dialogue at the outset so that everyone has a common understanding of the ground rules (Merculieff & Roderick, 2013; Schirch & Campt, 2007). In that context, there is an emphasis on creating courageous spaces in which participants have the ability not only to feel “safe” but also to have a level of fortitude and trust to take significant risks, make mistakes, and respond to missteps by others with forgiveness and support for personal growth and learning. Dialogic Communication. Our model of difficult dialogues teaching and learning identifies three components of interrelated dialogic communication that form the core of difficult dialogues communication. Self-reflective dialogue involves a process of self-disclosure about views, beliefs, and values regarding the topic in a manner that takes ownership of personal perspectives while simultaneously opening the door to examining and/ or questioning underlying assumptions. Engaged dialogue involves listening to and attempting to understand the assumptions, beliefs, and values of other participants with an openness to learn and an effort to withhold criticisms and judgments. Critical dialogue involves an advanced stage of discourse that integrates content learning into the

dialogue by identifying scholarly and evidencebased perspectives, providing breadth and depth to new understandings of the complexities of human interactions across differences. That is, critical dialogue prompts participants to suspend adherence to their own assumptions, beliefs, and perspectives in order to incorporate new knowledge and understanding that arises from extant scholarly analyses as well as direct interpersonal experiences with people with differing values, beliefs, perspectives, and worldviews. In addition, critical dialogue includes efforts to identify areas of difference as well as common ground among participants with an emphasis on recognizing and understanding the complexities of the interrelationships among pluralism, power, privilege, social justice, academic freedom, and freedom of expression. In critical discourse, participants are encouraged to engage one another more deeply through interpersonal processes that involve challenges to beliefs and assumptions, and exploration of interpersonal experiences of power and privilege (Gurin et al., 2013; Maxwell et al., 2011). In that context, challenging interactions are encouraged rather than avoided with the mutual understanding that differences, disagreements, discomfort, tensions, and conflicts have the potential to serve a common purpose of enhancing individual and group learning objectives. Thus, “civility” is characterized by respect (not necessarily politeness), and “incivility” is characterized by actions that are intended to disrupt or diminish the quality of the learning atmosphere for an individual or the group. Interpersonal and Intrapersonal Processes. Interpersonal and intrapersonal processes are inextricably intertwined in the functioning of difficult dialogues. Intrapersonal processes occur as participants (and facilitators) grapple with their own emotional reactions to the dialogue, engage in critical thinking, and monitor their own behavior within the context of the group dynamics. Participants’ willingness to be engaged in authentic exchanges of views, values, and ideas across differences are closely tied to their ability to suspend

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rigid adherence to previously held beliefs, assumptions, and perspectives, along with their experience of others in the discourse. It is critical that the learning context is characterized by trust, support, encouragement, interpersonal transparency, and a willingness to take risks and acknowledge mistakes. Interpersonal courage, risk taking, and forgiveness are key features of the group dynamic necessary for an optimal learning environment. These conditions are highly dependent on the characteristics of the participants in the dialogue and the facilitation skills of the instructor, as well as attention to the stage-wise processes of group dynamics. In some dialogues, participants are specifically identified stakeholders with an investment in the subject of the dialogue based on personal identity, specific personal experiences, educational role, professional status, and/or community membership. Thus, under these circumstances, it is often important to give participants an opportunity to state explicitly their personal stake in the dialogue. Transparency regarding one’s stake in the dialogue (and more broadly the topic of discussion) provides group members with an early appreciation of where areas of difference and commonality might exist, and it cues participants to listen in ways that facilitate increased understanding. It also provides the facilitators with a sense of where differences and potential misunderstandings may arise so that they have the opportunity to employ more effective facilitation skills. In their description of motivational interviewing, Miller and Rollnick (2002) provided a useful framework for dialogic communication in an interpersonal context that can be applied to difficult dialogues characterized by “consonance” as opposed to “dissonance.” In motivational interviewing, dissonance can occur when people engaged in dialogue have different agendas or aspirations, when there is a lack of agreement about the roles in the relationship, and when there are power differentials or power struggles. When dissonance is present, there are a variety of disruptive interpersonal behaviors that may occur, including but not limited to arguing, interrupting, criticizing, labeling (or name calling), negating,

minimizing, dismissing, excusing, shaming, blaming, and veiled threats—all of which interfere with productive difficult dialogues. These characteristics are particularly problematic when overt or covert power differentials exist and are expressed by assuming a dominant or expert role or acting paternalistic. Consonance, on the other hand, is characterized by mutuality, egalitarian relationships, greater listening, empathy, a desire to learn and understand the perspectives of others, and collaborative learning (e.g., we are all on the same team even when we disagree). In the context of interpersonal consonance, participants in a difficult dialogue are less likely to argue for others to change their perspectives, values, or worldviews, while at the same time express confidence in the abilities of everyone to learn and understand differences with greater complexity. Psychological Outcomes, Educational Outcomes, and Civic Development. Difficult dialogues often result in psychological and educational learning outcomes and in the promotion of civic development (Dessel et  al., 2006; Ford, 2012; Gurin et  al., 2013; Hernandez-Gravelle, 2012b; Leskes, 2013; Parker et al., 2011; Sorensen, Nagda, Gurin, & Maxwell, 2009). Psychological outcomes may include increased cognitive complexity, diunital reasoning, greater affective positivity, openness to diversity, appreciating differences, and identity development. Educational outcomes may include an active learning orientation, academic freedom orientation, and pluralism orientation. Civic development outcomes may include increased community engagement, democratic engagement, and social justice activism. Cognitive complexity generally refers to the degree of differentiation, integration, and articulation of the basic mental structures (or personal constructs) people use to interpret and respond to the world around them, in which people with greater cognitive complexity tend to view events and objects in terms of nuances and subtle gradations rather than general categories and stereotypes. In addition, cognitive complexity involves that ability to make observations from more

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than one position or viewpoint. Citing Myers (1988), Alberta and Wood (2009) described diunital reasoning as “the skill of recognizing the reality inherent in two culturally divergent worldviews,” which “in its most robust form, . . . allows one to accept as true two mutually exclusive concepts” (p. 569). Affective positivity is represented by positive emotions and positive interactions with others, which includes but is not limited to trust, openness, excitement, engagement, and close personal friendships (Gurin et al., 2013). Multicultural personality (as described by Ponterotto, 2010; Ponterotto, Utsey, & Pedersen, 2006; van der Zee et  al., 2013) provides a useful framework for understanding psychological outcomes in which narrow personality traits are hypothesized to predict prejudice, identity development, cross-cultural contact, and multicultural counseling competencies, among other counselingrelated variables. In counselor training programs, difficult dialogues have the potential to greatly enhance the multicultural functioning of future professionals (Sue, 2013) and effectively map onto developmentally progressive multicultural personality characteristics (e.g., Ponterotto, 2010), including openness to diversity, appreciating differences, and identity development. The psychological and educational outcomes gained through participation in difficult dialogues serve as a springboard for the development of greater community engagement, democratic engagement, and social justice activism (Dessel et  al., 2006; Gurin et  al., 2013; Sorensen et  al., 2009). For example, when difficult dialogues are centered on discussion of racial identity, it can trigger participants to examine their own identity and promotes identity development, which in turn gives rise to professional growth, consciousness raising, and skills needed to address personal and institutional issues related to race (Bryan, Wilson, Lewis, & Wills, 2012; Ford, 2012; Sue, 2013). Furthermore, facilitated dialogues among identity groups of students based on gender, race, sexual orientation, and religion can lead to the development of perspective-taking and empathy skills, knowledge about social and cultural

diversity, collaborations within and across social identities, and critical self-reflection with regard to biases, power, privilege, and personal identity (Dessel & Ali, 2012; Dessel et al., 2013; Ford, 2012; Gurin et al., 2013).

DIFFICULT DIALOGUES IN ACTION In this section, we provide an example of difficult dialogues in action based on a fictitious account of events at Midwestern University (MU).1 Over the course of its history, MU had a series of incidents on campus that earned it a reputation as an institution embedded in a culture of exclusion rather than inclusion. For African Americans in the region, the historical legacy was recounted through generations with the caution that the institution was racist and unchanging. MU, like countless other institutions of higher education, was founded as a Whites-only, men-only institution, and it had a history of highly publicized court cases in which the institution and its leaders fought to prevent African American students from enrolling in the university. Student protests began to occur regularly on campus, and the Black Student Organization (BSO) repeatedly submitted complaints to the campus president, the university trustees, and state and federal authorities. Finally, the Department of Education Office of Civil Rights intervened to enforce a settlement between students and the administration to increase the diversity of the student body, increase the numbers of faculty of color, establish the MU Black Student Center, and create a new position in the central administration for a chief diversity officer. Although the settlement was viewed as a victory, within a short period of time members of the BSO were demonstrating and writing letters to the president again highlighting various ways 1. Although some of the events described are based on actual incidents, the case study described is intended solely to provide a fictitious example of difficult dialogues in teaching and learning in higher education. The characters in the story are fictional.

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conditions in the arbitrated agreement had never been met—enrollment figures that included international students under the rubric of “minority students” were used to conceal the low numbers of African American student enrollments, and the graduation rates for African American students lagged behind those for other racial and ethnic groups. A comprehensive campus climate study revealed that numerous underrepresented groups, and especially African American students, experienced high levels of marginalization and microaggressions on campus. Last year, there was a series of events during Black History Month that caused increased tensions on campus. In the first incident, cotton balls were carefully arranged in rows on tables in the student union cafeteria in the section where African American students were known to congregate, and a permanent marker was used to scrawl a note on one table that read, “Keep your cotton picking hands off our Homecoming”— which was a clear reference to a letter of complaint sent to the president by the BSO and the campus Pan-Hellenic Council demanding that the annual homecoming events on campus become more inclusive of Black fraternities and sororities (the Divine Nine). Immediately, there were complaints of harassment and the local chapter of the National Association for the Advancement of Colored People (NAACP) called on the university president to investigate the incident as a hate crime (i.e., vandalism). Only a few days later, during a peaceful demonstration held under the banner of “Black Lives Matter”—the slogan developed in response to the shooting death of Michael Brown—members of the student community took to anonymous social media to post inflammatory racist comments. The following morning, the campus awoke to news that the entry to the Black Student Center had been vandalized with graffiti containing the words, “[N-word] history month.” Within 2 days, the campus police had arrested several suspects involved in both incidents of vandalism based on photos obtained from surveillance cameras and charged them with hate crimes—which resulted in a sudden backlash

across the state, particularly among rural White citizens claiming that cotton balls and graffiti cannot be a hate crime. A town hall meeting was arranged in the law school and promoted as a “difficult dialogue” intended to help raise awareness about race, power, privilege, and the law. A panel of faculty experts was convened to speak from a variety of viewpoints on the topic, but the majority of time was set aside for participants in the audience to share their thoughts, views, and reactions to the series of events. Guidelines for dialogue were posted on a video screen with a projector to ensure that participants (panelists and audience members alike) (a) understood the purpose of the dialogue (increasing shared understanding), (b) engaged in dialogues characterized by respect (sharing airtime, avoid name calling), and (c) actively worked to produce an atmosphere in which participants could take risks, pursue learning, and forgive mistakes (courageous space). The difficult dialogue facilitator was a member of the Office of Diversity and Inclusion who was skilled in counseling, dialogue, conflict resolution, mediation, and a wide array of diversity issues. Although the university president and a number of other administrators were present, they did not have formal speaking roles. Participants from a variety of different racial and ethnic groups expressed intense emotional reactions about the events toward campus administrators, toward specific segments of the campus community, and toward each other. Members of the BSO repeated calls for action on the arbitration agreement that had not yet become realized and accused the president and other administrators of purposeful passive inaction. The president sat stiffly for much of the first hour, arms folded in front of her, and at one point stepped outside to take a phone call before reentering the room. Another senior administrator could be seen visibly shaking his head seemingly only when African American students were speaking. Several students questioned whether administrators even wanted to be in the room, expecting that they would be in trouble with the press if they did not show up. One student said,

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I know I am not allowed to call anyone any names, but I can tell you that I believe that these events, these “incidents” as you call them (pointing to one of the panelists), are “racist incidents.” They are racist incidents, and when you claim, when people claim, that they are “isolated” incidents perpetrated by “a few bad apples,” that is just plain wrong. It shows that you don’t . . . people who say those things don’t live in the same world I live in—a racist world where racist things happen everyday—to me!! Racist things happen to me everyday!! And when you say you think it is just a few bad apples it shows me that you don’t have a clue, that you are ignorant—can I say that? Because it’s true—people who don’t see the racism all around us either don’t care about my experience or they are just sticking their heads in the sand. How am I supposed to respect a university with leaders who claim to be ignorant to things that everyone else can see?

Her statement became a pivotal moment during the dialogue. Finally, the president stood and stepped to the microphone and said, You’re absolutely right. Things need to change— and that starts with me. I have been naïve, or maybe ignorant, to assume that these are isolated incidents—but based on the stories I have heard here tonight, clearly they are not. And I promise you I will try to see and understand the world, this campus, a little more clearly than I have in the past. My job will be to find ways, and I will ask other administrators to work with me on this, we are going to make things change. We are an educational institution and it’s time we all learned more about how to deal with (pointing to the title of the forum on the projection screen) race, power, privilege, and the law . . . and higher education.

The first step taken by the president was to establish a series of town hall meetings on race, power, privilege, and higher education. The first meeting was titled, “Why Is It so Difficult to Talk About Race?” She brought invited speakers to campus to talk about racial microaggressions, diversifying the student body, and racial injustice. Before long, increasing numbers of the faculty began to attend the town hall meetings, and there were calls

for topics based on faculty research as well as to promote faculty development for facilitating difficult dialogues in the classroom. Student affairs staff members were regular attendees from the beginning and also wanted new professional development opportunities to help facilitate difficult dialogues in the co-curriculum, in the residence halls, and within student government and student organizations. Race became one of several topics of discussion as the focus expanded to include a campus climate of inclusion based on sexual orientation, gender identity and expression, (dis)ability, religious pluralism, and social class. Before long, difficult dialogues were being held on topics such as climate change, campus sustainability efforts, sexual health, sexual assault, cyberbullying, the surveillance state, the prison industrial complex, wealth disparities, health disparities, and educational disparities.

SUMMARY AND CONCLUSIONS Lee Bollinger, president of Columbia University and former president of the University of Michigan, said, “Our public universities have advanced the notion that in educating college students for the world they will inhabit, it is necessary to bring people together from diverse parts of society and to educate them in that context” (Bollinger, 2007). Difficult dialogues teaching and learning helps to define what it means to bring people together from diverse parts of society and to educate them in that context. A fundamental mission of higher education is rooted in the discovery of new knowledge and the resolution of social problems—which vitally depend on critical thinking, effective communication, veracity, and collaboration among those with differing cultural and ideological perspectives. Yet as educators and as scholars, there are seemingly an overwhelming number of difficult dialogues that we face on college and university campuses every day, including wealth disparities, health disparities, educational disparities, the prison industrial complex, racial injustice, sexual violence, gun violence,

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war and international conflicts, terrorism, torture, the surveillance state, and climate change. All of these difficult dialogues take place within a broader societal context as portrayed by the “culture wars media” through cable news television outlets such as CNN and MSNBC, and Fox News. We cannot afford for the university to become a political battleground akin to the halls of government, talk radio, reality television, Internet blogs, or cable news television—yet that is exactly the way universities are sometimes perceived by the general public as well as many policymakers. When veracity and open inquiry succumb to polemics and demagoguery, the very foundation of the university is threatened. More than ever, the nation, indeed the world, is in critical need of tools and capacities for engaging with differences in a constructive, healthy, and civil manner. Higher education institutions have a major responsibility for preparing students and future leaders to foster constructive dialogues about some of society’s most contentious social issues. Difficult dialogues address the increasing polarization of our society and the need to deal more effectively with breakdowns in civil discourse by fostering the self-confidence and skills to engage in the rigorous exchange of ideas with the spirit of academic freedom and freedom of expression. Being part of a difficult dialogue means that participants are seeking to examine the limits of their own knowledge, comfort, and understanding, while simultaneously searching for a more deeply held understanding of people with different or unfamiliar perspectives. Participating

in difficult dialogues requires each person to be engaged in the group encounter with a commitment to self and others to pursue a process that involves respect, humility, patience, courage, and perseverance. At one extreme are voices that are too forceful and may overrun the complexities of other peoples, cultures, and traditions. At the other extreme are voices that are not forceful enough, sometimes by personal or cultural inclination, or in other instances because they have been intimidated into silence. Whereas some academic environments are inherently competitive, difficult dialogues pedagogy assumes a cooperative educational atmosphere in which students and faculty members are engaged in a mutually supportive learning endeavor. Nevertheless, difficult dialogues have the potential for challenging an individual’s core beliefs about themselves and the world around them, which can lead to resistance and intense emotional exchanges. One of the greatest strengths of difficult dialogues is the extent to which people are challenged to reflect on how their personal experiences and worldviews influence attitudes and beliefs about complex societal issues. Overall, difficult dialogues have the potential for increasing cognitive complexity, diminishing mistrust based on stereotypes and monocultural worldviews, fostering more productive learning environments characterized by pluralism and active learning, as well as greater civic and community engagement. Engaging in difficult dialogues advances the higher education mission of preparing future generations of citizens for a democratic and pluralistic society.

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PART

VI

Affirming Multiple Identities

A

 major objective of the Handbook is to demonstrate the continuing advancement and applicability of multicultural counseling in our diverse society. In line with this objective, Part VI reflects the perspective that it is critical for counseling professionals to think broadly about the various facets of diverse identities that may be relevant in the provision of psychological interventions. To this end, this section highlights various aspects of identity including immigration status, LGBTQ, older adults, disability, disaster survivors, and members of Middle Eastern and North African communities. In the chapter titled “Immigrants and Refugees: A Contextual Counseling Perspective,” TummalaNarra and Deshpande address various aspects of the immigrant and refugee experiences in relation to multicultural counseling. Acculturative stress and traumatic stress are associated with mental health issues. A case vignette is utilized to illustrate the complexity of working with an immigrant client followed by a discussion of various approaches to counseling these diverse groups. Reynolds’s chapter, “Addressing the Needs of LGBTQ Youth: A Counseling Perspective,” serves to increase the readers’ awareness of the experiences of LGBTQ youth who experience persistent and harmful anti-LGBTQ bullying that affects every aspect of their lives. The experiences of LGBTQ youth are examined along with approaches and strategies for combating anti-LGBTQ bullying. Counselors and psychologists serve as advocates and social change agents working toward creating environments where all youth feel welcomed and affirmed. In the chapter “Multicultural Counseling With Older Adults: Considerations for Intervention and Assessment,” Ford and Crowther emphasize the importance of adopting a multicultural social justicesensitive perspective when treating older adults. Issues and challenges that require attention and action are addressed, including increasing the awareness of how older adults have been subjected to societal biases and invalid stereotypes resulting in inequity of treatment and provision of less effective care. The authors draw attention to the importance of integrating multicultural understanding throughout the process of therapy. Cordes, Cameron, Mona, Syme, and Coble-Temple address the need for counseling psychologists to develop skills in working with the growing number of people with disabilities (PWD) who are at greater risk for poverty, discrimination, and marginalization. Exposure to microaggressions, stereotypes, and stigma are also noted. Disability status can impact all life domains including interpersonal relationships, sexuality, educational and occupational pursuits, and health care. Counselors collaborate on interdisciplinary teams in

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provision of services given the myriad of ailments that can become salient in treatment. PWD can be understood using a minority cultural experience within an ableist cultural milieu. Advocacy efforts are addressed in light of biopsychosocial factors that impact the quality of life of PWD. Culturally competent treatment for PWD includes being creative and flexible. Disability affirmative approaches and evidence-based practices are presented. The chapter titled “Disaster Survivors: Impli­ cations for Counseling” by Boyd and Gunsolley provides a general discussion of the types of disasters and the effects they have on individuals and communities. Alternative views are proposed for understanding the experience of ethnic minority and other marginalized communities in the aftermath of a disaster. Finally, the authors discuss the role of mental health professionals in providing culturally responsive disaster mental health services to marginalized communities.

Çiftçi and Shawahin review relevant theory, research, and assessment practices in relation to the mental health of Middle Eastern and North African individuals in their chapter titled “Counseling Middle Eastern Americans: Challenges and Opportunities.” The authors note that discrimination in the forms of governmental scrutiny and negative portrayal in the media are present for members of these communities in addition to the more normative cultural stressors experienced by other immigrants. Premigration trauma, identity, and cultural factors are discussed as they impact the provision of counseling services. Finally, Jackson and Mathew critique the research evidence for effectiveness of training in multicultural counselor competencies. They specifically focus on constructively addressing multicultural self-awareness and intersecting identity challenges for trainers.

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CHAPTER

36

Immigrants and Refugees A Contextual Counseling Perspective Pratyusha Tummala-Narra and Anita Deshpande

O

ver the past several decades, migration across the globe has increased, largely as a result of political conflict, war, famine, and natural disasters. While the United States is composed of Native populations and immigrants (both forced and voluntary), recent migration trends reflect the largest numbers of immigrants in the nation’s history. There are approximately 40 million immigrants in the United States today, and a majority of foreign-born individuals have legal status (e.g., naturalized citizens or authorized noncitizens; U.S. Census Bureau, 2011). The passage of the Immigration and Nationality Act in 1965 marked a change in U.S. policy toward immigration from non-European countries. Over the past two decades, in particular, immigrants in the United States have origins primarily in Asia, Latin America, the Caribbean, and Africa (U.S. Census Bureau, 2010). The American Psychological Association (APA) Report of the Task Force on Immigration (2012) has noted that one in five people living in the United States is a first-generation or second-generation immigrant, calling attention to the specific mental health needs of immigrant-origin individuals and communities. The numbers of refugees crossing international borders have steadily increased since the 1970s and multiplied more than by a dozen times by 2000 (Pumariega, Rothe, & Pumariega, 2005). By the end of 2012, there were 15.4 million refugees, with developing countries hosting approximately 80% of refugees worldwide (United Nations Refugee Agency, 2012). The United States offers political asylum to over 20,000 individuals each year and provides temporary protection for foreign nationals who may face conditions similar to those of refugees in their countries of origin and for victims of trafficking (Migration Policy Institute, 2011). A significant number of refugees have arrived in the United States since the 1970s. Over the past two decades, the largest numbers of refugees in the United States arrived from countries such as the former Soviet Union, former Yugoslavia, Vietnam, Myanmar, and Iraq. In 2009, 74,602 refugees from over 60 different countries (23 of these countries in Africa) were admitted into the United States (Immigration Policy Center, 2010; Migration Policy Institute, 2011). It has been estimated that over 40% of refugees arriving in the United States are children (APA, 2010).

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The growing numbers of immigrants and refugees globally and within the United States raise important challenges concerning research and practice for mental health professionals. In this chapter, we address various aspects of immigrant and refugee experiences and their relevance to multicultural counseling. Specifically, while recognizing that experiences of immigrants and refugees reflect both challenges and strengths, we discuss the context of migration to the United States, acculturative stress, traumatic stress, and mental health issues. We present a brief case vignette to illustrate the complexity of working with an immigrant client in psychotherapy followed by a discussion of approaches to counseling.

THE CONTEXT OF MIGRATION The experience of migration for immigrants and refugees is distinct in important ways. Immigrants are those individuals who voluntarily migrate to a country other than their birth country. Children who are immigrants typically do not have a choice in their migration and most often accompany parents and other relatives to a new country. Immigrants choose to leave their countries of origin for a variety of reasons, including the search for better educational, vocational, and economic opportunities, and family reunification. Refugees, on the other hand, involuntarily migrate to countries other than their birth countries due to social, political, and/ or religious persecution, war, political conflict, and natural disasters (APA, 2012). Refugee status is assessed on an individual basis, and children are typically eligible as dependents (Jefferys & Martin, 2008). Refugees who are allowed entry to the United States are provided with housing, health care, and vocational training by the federal government and may apply to become permanent residents after one year. Unaccompanied minors, or children who arrive without parents or caregivers, often with histories of exposure to violence and war, consist of a relatively small subgroup of refugees who may be detained by immigration officials and later placed in shelters,

foster care, residential treatment, or other types of living situations (APA, 2010). Both ­immigrants and refugees may struggle with legal status in the United States, as immigrants may enter the country without authorization or lose their authorization through overstaying their visas, and refugees may have temporary protected status and need to apply for asylum. It is important to note that denial of asylum requests are relatively high in the United States and often depend on the individual’s national origin and access to adequate legal advocacy and resources (Kanstroom, 2010). Further, immigration legislation since the terrorist attacks of September 2001 has raised growing concerns about delays in obtaining authorization status and deportation. Although immigrants and refugees have unique trajectories of migration and cultural adjustment in the United States, both groups of migrants contribute in notable ways to the social and economic fabric of contemporary American society. For example, immigrants have been instrumental to engineering and technological innovation in the United States and contribute heavily to agricultural, service, and construction industries (Schumacher-Matos, 2011). Immigrants and refugees have diverse educational and employment experiences in their countries of origin and upon migration may experience underemployment, working in positions for which they are overqualified. Migration to the United States further reflects diversity with respect to language, religion, and cultural belief systems. For example, it is estimated that there are approximately 460 languages spoken in homes, and the number of individuals practicing non-Judeo-Christian religions has risen considerably in the United States over the past two decades (APA, 2012). Several subgroups of immigrants and refugees have been found to be especially vulnerable to stress in the migration process. Women, for example, have been found to be twice as likely as men to be divorced, separated, or widowed, less likely to have college and advanced degrees, and more likely to live in poverty compared with men (Migration Policy Institute, 2011). An estimated 10.8 million

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undocumented immigrants in the United States are more likely than documented immigrants to work in low-paying jobs under dangerous conditions (APA, 2012; Yoshikawa, 2011). Other migrants who suffer traumatic events premigration, during transit, and postmigration, such as victims of trafficking, are often at a loss for structural legal, economic, and social supports in the United States after their arrival. Lesbian, gay, bisexual, and transgender (LGBT) migrants are also vulnerable to discrimination and persecution in their countries of origin and in the United States. Additionally, immigrants and refugees with disabilities may face challenges in both the country of origin and new country when negotiating different ways to access support, cultural beliefs concerning ability status, and barriers within workplace and educational settings (APA, 2012). An understanding of the context of migration for immigrants and refugees further requires the assessment of premigration and postmigration circumstances and stressors. For example, traumatic events, poverty, political instability, and discrimination based on gender, race, religion, ethnicity, social class, sexual orientation, and dis/ ability both prior to and after migration can contribute to considerable physical and psychological distress for individuals and families. Immigrants, in particular, may have also developed images of the new country while living in the country of origin. These images, sometimes promoted through access to the Internet and media, can involve feelings of hope, anxiety, fear about separation from loved ones, and ambivalence (TummalaNarra, 2013). In a poignant interview study with Latina immigrant women, Paris (2008) described the dream of a better life in the United States as a major motivator for women who walked through the desert despite illness and the lack of food and water. Indeed, the trajectories of many immigrants and refugees demonstrate tremendous resilience and hope, often in the context of negotiating loss, trauma, separation from family and friends, language barriers, concerns about financial resources and legal status, and sociocultural adjustment.

ACCULTURATIVE STRESS The term acculturation refers to how migrants adjust to the dominant culture and to potential changes in their values, beliefs, and behaviors that develop as a consequence of interacting with the new culture and its members (Farver, Xu, Bhadha, Narang, & Lieber, 2007). Researchers have conceptualized individual approaches to acculturation as involving specific strategies, such as assimilation, where one adopts the new culture without maintaining a connection with the heritage culture, and integration, where one attempts to maintain certain components of the heritage culture while also actively participating and integrating into the host culture (Berry, 2005). The process of acculturation can vary across different ethnic groups where greater perceived discrepancies between the dominant culture and the culture of origin can place an individual at increased risk for psychological distress (Akhtar, 2011; Berry, 2005). This tension is referred to as acculturative stress, the stress that inevitably emerges as one works to reconcile the disparities between one’s culture of origin and the host culture (Beckerman & Corbett, 2008). Experiencing acculturative stress contributes to poor mental health outcomes such as lower self-esteem, anxiety, depression, substance abuse, suicidal ideation, and posttraumatic stress disorder (PTSD; Dow, 2011). For immigrant and refugee populations, acculturative stress can develop from a variety of experiences, such as adjustment to a new language, learning new social norms, intergenerational cultural conflicts within the family, and experiences of discrimination (Dow, 2011; Pumariega et  al., 2005). Additionally, mourning for family (e.g., parents, children, spouses, siblings), friends, and familiar physical and cultural environments and objects is an important aspect of immigrants’ negotiation of separation, adjustment, and identity transformation (Ainslie, Tummala-Narra, Harlem, Ruth, & Barbanel, 2013; Akhtar, 2011). It is important to note that processes of mourning have been thought to be distinct for immigrants and refugees, as for the latter, the experience of exile can complicate feelings of loyalty and belonging in the country of origin and in the new country (Akhtar, 2011). I M M I G R A NT S A ND REF UG EES

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English language proficiency is a major issue that facilitates adjustment to living in the United States. For individuals seeking enrollment in school or access to gainful employment in the United States, learning English is essential. Research has indicated that learning a new language tends to be increasingly more difficult for adult immigrants than it is for children, with some never attaining host-language proficiency (APA, 2012). Given how critical language proficiency is to succeeding in one’s host country, accomplishing such a task can cause stress, especially if the language acquisition process feels particularly difficult and there is limited access to adequate support and education (Brune, Eiroa-Orosa, Fischer-Ortman, Delijaj, & Haasen, 2011). Recent studies have also demonstrated that English language and native language proficiencies and a bilingual preference among immigrants predict lower levels of acculturative stress (Lueck & Wilson, 2010), suggesting that the ability to use and interact in heritage and new language contexts may be especially important for migrant populations. The lack of opportunity to engage in one’s heritage language may be experienced, then, as another important loss in cultural adjustment. Another related aspect of the acculturation process involves one’s ability to understand the social norms of the host culture and obtain the appropriate social skills one needs in order to feel like he or she “fits in” and can effectively integrate into the new cultural environment (Ward & Kennedy, 1999). A number of factors, such as duration of residence in the host country, the extent to which one interacts and identifies with members of the host culture, general knowledge of the new culture, documentation status, access to economic resources, and language proficiency, influence individuals’ integration within the new culture. Research indicates that adult immigrants, when compared to immigrant children, are more likely to fear and resist adapting to new cultural norms in favor of maintaining traditions and behaviors connected with the heritage culture (APA, 2012). While connecting with an existing ethnic and/or religious community in the new

cultural context can help to alleviate fears about losing connection to one’s heritage culture, such communities are not always accessible, contributing to feelings of isolation from both new and old cultural contexts (Dow, 2011). Acculturative stress may also encompass challenges related to shifts in ideals and behaviors concerning gender roles and sexuality. Specifically, gender roles for men and women in the country of origin and in the new cultural context may differ significantly. For some individuals, relocating to the United States may pose opportunities for increased sexual freedom and egalitarian relationships among men and women (Morash, Bui, Zhang, & Holtfreter, 2007). For others, new expectations concerning men’s and women’s roles may be experienced as demanding and oppressive. Cultural expectations concerning gender roles can also extend to parenting. For example, some studies have found that immigrant girls are monitored more closely by parents when compared with boys during adolescence (Suárez-Orozco & Qin, 2006). For LGBT immigrants and refugees, living in the United States may offer an opportunity to openly discuss and explore one’s sexual orientation and gender identity. However, racial minority LGBT individuals may face marginalization in both mainstream and ethnic communities (APA, 2012; Tummala-Narra, 2013). Immigrants and refugees often become scapegoats for collective anxiety, particularly as the presence of immigrant and refugee communities become more visible in mainstream society (Ainslie, 2009). Anti-immigrant policy and xenophobia are prominent sources of stress for immigrants and refugees in the United States. Migrants considered racial minorities as marked by physical features such as skin color, hair texture, and eyelid shape are more likely to experience discrimination when compared with those perceived as White (APA, 2012). In this vein, for many migrants, this type of minority status may be a new experience. There is ample evidence that, in spite of the criteria used, repeated experiences of overt and aversive discrimination, microaggressions, and stereotyping (both positive and negative) have deleterious

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effects on mental health outcomes (e.g., lower selfesteem, depression, anxiety, substance use, suicidal ideation) among immigrants and refugees (SuárezOrozco, Suárez-Orozco, & Todorova, 2008; D. W. Sue, 2010; Takeuchi et  al., 2007). Further, many immigrants and refugees experience being racialized upon their arrival to the United States, as racial categories and hierarchies inherent to the American social and political context typically differ from group distinctions that are more relevant in the country of origin, such as those centered around gender and social class (Comas-Diaz, 2006). Additionally, experiences of discrimination related to gender, religion, sexual orientation, social class, and dis/ability can further compound the effects of racial and ethnic discrimination, and interfere with individuals’ negotiation of multiple aspects of identity. Immigrant and refugee parents and children cope with unique challenges in dealing with discrimination and other acculturative stress (Akhtar, 2011; Suárez-Orozco et al., 2008). Each member of a family may experience stress related to language, discrimination, and cultural value conflicts outside the home, and yet these stressful experiences may not be openly discussed among family members. Many parents are focused on securing basic needs such as food, housing, and education for the family through their work, providing financial assistance to relatives and sometimes children left behind in the country of origin, and seeking ways to maintain connection with the heritage culture for themselves and for their children. Children, on the other hand, may be invested in maintaining a strong connection to their parents and their communities, assisting parents with acculturating to a new language and cultural norms, adjusting to a new, unfamiliar educational system, and finding ways to create a sense of belonging with friends from similar and different ethnic backgrounds in their school environment. The loss of extended family connections, which may have been a major source of support in the country of origin, and traumatic experiences can exacerbate tensions that develop within the family. An important emerging variant of parentchild relationships among some immigrants and

refugees involves transnationalism. Technological changes have opened new possibilities for migrants to maintain connections with family and friends in their countries of origin. Transnational practices have been noted to provide a sense of continuity in the lives of immigrants and refugees (Satzewich & Wong, 2006). In the case of refugees, the access to technology, such as the Internet and teleconference, may become even more important when family members, including children, are dispersed to different geographic regions (Carranza, 2012).

TRAUMATIC STRESS As noted above, traumatic experiences are unfortunately prevalent among migrants, particularly refugees. For instance, prior to their entry into the host culture, refugees will have likely experienced a variety of traumatic experiences such as torture, murder, kidnapping, sexual assault, and forced starvation, enduring forced separation and the loss of family members, spending extended amounts of time under harsh living conditions within their homeland (Baker, 2011). Exposure to pre- and postmigration stressors, dangerous and prolonged journeys often across several regions and countries, and the ongoing fears of deportation place refugees at an increased risk for developing a variety of mental health problems, including PTSD, anxiety, depression, and suicidal ideation (APA, 2010; Ehntholt & Yule, 2006). In fact, refugees are 10 times more likely to be diagnosed with PTSD compared with the general population, and asylum seekers have been diagnosed with PTSD at rates of 40% to 60% (Crumlish & O’Rourke, 2010; Toar, O’Brien, & Fahey, 2009). In an effort to distinguish the experiences of survivors of torture and refugees, the term continuous traumatic stress (Higson-Smith, 2013) has recently been introduced to describe the effects of and adaptation to ongoing threats of danger in the experiences of torture survivors. In addition to collective violence, many immigrants and refugees experience interpersonal violence both within and outside of their ethnic I M M I G R A NT S A ND REF UG EES

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communities pre- and postmigration. Studies ­indicate that violence against immigrant and refugee women may be exacerbated by patriarchal family and community structures (Morash et al., 2007). Women may not seek help due to stigma associated with violence and abuse, the lack of knowledge concerning resources, concerns about practitioners not being able to understand or value their cultural beliefs, the fear of losing connection with children and other family members and friends, the fear of losing authorization status, and deportation (Tummala-Narra, 2013). It is also important to consider that both women and men may be reluctant to disclose experiences of interpersonal violence such as rape and sexual assault to others both within the family and outside of the family, as disclosure may place the individual at further risk for abuse or being blamed for the violence.

MENTAL HEALTH ISSUES A substantive number of studies indicate that foreign nativity can protect against poor mental health outcomes (Alegría et  al., 2008; Schwartz, Unger, Zamboanga, & Szapocznik, 2010). This phenomenon is referred to as the immigrant paradox. For example, research concerning experiences of immigrant Latino populations suggests that increases in the length of U.S. residency are associated with an increase in psychiatric diagnoses (Alegría et  al., 2008), and those Latinos who primarily speak Spanish and mostly socialize with other Spanish speakers experience lower drug and alcohol use (Alegría et  al., 2008). It is important to consider, however, that other studies indicate an opposite effect with foreign-born individuals, reporting increased levels of psychological symptoms when compared with U.S.-born individuals (APA, 2012). While more research is required to understand these discrepancies and the immigrant paradox itself, several issues should be considered. It is possible that first-generation or foreign-born individuals experience and express psychological distress in ways other than how it is described in Western psychiatric diagnostic systems, such as somatic symptoms; are less likely to report their symptoms;

and are less likely to seek services (Pumariega et  al., 2005). Further, some studies examining mental health outcomes across nativity caution against overgeneralizing the immigrant paradox to all ethnic groups across all psychiatric disorders. For example, Alegría and colleagues (2008), in the National Latino and Asian American Study (NLAAS), found that while the immigrant paradox was evident for Mexican participants across mood, anxiety, and substance disorders, it was only evident for other Latino participants for substance disorders. Relatedly, data from the NLAAS also indicated that patterns of mental disorders varied across the interaction between nativity and gender for Asian American participants (S. Sue, Cheng, Saad, & Chu, 2012; Takeuchi et al., 2007). While immigrants and refugees experience a wide range of mental health issues, some major concerns have been conceptualized as driven by stress related to acculturation, discrimination, and trauma (APA, 2012). Immigrant and refugee children and adolescents can experience mental health problems similar to those of adults, with particular effects on academic and social functioning. Family cohesion, parental well-being, and peer relationships have been noted as important factors in either buffering against or exacerbating psychological distress among youth (Pumariega et  al., 2005). Adults who migrate in late life may also be vulnerable to mental health problems due to linguistic barriers, lack of social support, isolation, physical limitations, and cultural value conflicts (Pumariega et al., 2005; Tummala-Narra, Sathasivam-Rueckert, & Sundaram, 2013). A clear understanding of psychological distress must encompass knowledge concerning specific cultural beliefs, explanations of mental illness, expressions of distress, culturally valued approaches to treatment, and resilience. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; American Psychiatric Association, 2013) includes a description of culture-bound syndromes, or clusters of mental health symptoms occurring within specific cultural groups, Euro-American conceptions of mental disorders may still preclude descriptions

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of mental health problems that lie outside the purview of the traditional Western conceptualization of symptomatology (Kleinman, 1997; S. Sue et al., 2012). The challenges of our existing diagnostic systems leave immigrant and refugee clients vulnerable to misdiagnosis of mental health problems and to potential misunderstandings concerning expressions of resilience. It is especially important that mental health professionals attend to risk and protective factors specific to different immigrant and refugee subgroups. Studies indicate that distinct mental health symptoms (e.g., depressive and somatic symptoms) are experienced across different subgroups of refugees and immigrants (Nicolas et al., 2007; Shoeb, Weinstein, & Mollica, 2007). Research indicates that immigrants and refugees across different ethnic groups access mental health care services at a significantly lower rate than the general population, and instead tend to seek help from informal, community-based supports, religious authorities, and traditional healers (Hochhausen, Le, & Perry, 2011; S. Sue et al., 2012). Several barriers may limit utilization of mental health care. Difficulties with communication due to language differences is one such barrier that can make accessing services next to impossible as the process relies heavily on verbal interactions (Kim et  al., 2011). Language barriers contribute to misunderstandings between therapists and clients and subsequently discourage immigrant and refugee clients from returning to treatment or accessing services at all (Kim et  al., 2011). Undocumented migrants may also fear being identified and deported, or may not access services due to frequent relocations within the United States (Yoshikawa, 2011). Limited access to culturally sensitive interventions and services, bicultural, bilingual practitioners, and interpreters are also barriers immigrant and refugee communities are likely to face (APA, 2012; Donnelly et  al., 2011). For some immigrant and refugee individuals, a lack of awareness and familiarity with mental health concepts can prevent members from these communities from seeking out the appropriate treatment when such need arises (Donnelly et al., 2011).

In addition, there may be a reluctance to seek out services for fear of discrimination and misconceptualization of presenting issues and sociocultural context by mental health practitioners. Further, stigma and shame associated with mental illness and the belief that one should seek help only in cases of severe problems, such as psychosis, can impede utilization of mental health care (APA, 2012). Relatedly, mental health problems may be attributed to an individual’s character and mental or spiritual strength rather than to stress related to external demands (Crumlish & O’Rourke, 2010; Donnelly et al., 2011).

Case Illustration We describe the following brief case illustration in order to highlight the ways in which psychological stress and help-seeking processes intersect in the context of migration. Karen is a 55-year-old heterosexual, married Korean American woman who was referred to a therapist by her primary care physician to help cope with depressed mood, poor sleep, and difficulty concentrating at work. Approximately 4 months prior to meeting with her physician, Karen’s mother, who lives in Korea, fell and fractured her hip, after which Karen became increasingly sad and anxious about her mother’s health. When Karen was in her late 20s, she moved from Korea with her husband to the United States where he pursued his education. In subsequent years, after experiencing considerable anxiety over visa status, Karen and her husband began working in a small business. Even after living in the United States for several years, Karen missed her family and friends in Korea, familiar food, and the ability to speak in Korean with others. She often found it difficult to understand the nuances of the English language, especially those related to humor. Eventually, she met and developed friendships with other Korean immigrants who lived in her neighborhood. Both Karen and her husband found these relationships especially helpful when faced with racism. For example, they were both subject to racial slurs and told to “go back home” numerous I M M I G R A NT S A ND REF UG EES

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times by people on the street or with whom they had contact in their business. Although she felt comforted by her Korean friends, she also felt pressured by them to have children, despite the fact that she and her husband had difficulty conceiving a child. Although she was content with her marriage and had accepted that she would not have children, she felt as though she had disappointed her parents in Korea and her new extended family in the United States. Additionally, Karen’s childhood experiences of witnessing her father hit her mother left her feeling guilty for having left Korea to pursue her own dreams. In counseling, Karen told her therapist that she feels like she abandoned her mother, and sometimes wishes that she and her husband could return to Korea. At the same time, her parents have asked her to remain in the United States since moving back to Korea would potentially mean that the family would have severe economic hardships. Counseling focused on Karen’s symptoms of depression through an understanding of her own conceptualization of emotional distress. For several months in counseling, she struggled with the notion of depression as something that is more or less a part of life rather than a mental illness as formulated from a Euro-American diagnostic perspective. At times, she wondered whether her therapist would judge her as “crazy.” The therapist, in these moments, would assure her that she did not perceive Karen as “crazy,” but rather as someone who has coped with stressful transitions and changes without having an opportunity to address them. In counseling, she explored how her cultural identifications had transformed in the process of living in the United States. For the first time, Karen talked about how difficult it was at times to adopt new perspectives regarding her role as a woman, wife, and daughter in a country where she never fully felt accepted. As she continued to talk more openly about her ambivalence about living in the United States as a Korean immigrant, she experienced improved mood and sleep, and began to disclose some of her conflicts to her husband and later to a couple of her closest friends. She began to break the silence around her traumatic experiences

in childhood, which were never discussed openly in her Korean American community. Karen’s case underscores the importance of pre- and postmigration stress and its cumulative effects on mental health across the lifespan. Karen faced multiple types of acculturative stress, which affected her ability to safely adjust to living in the United States. Her resilience in the face of this stress is evident in her ability to form friendships, a supportive marriage, and secure employment. It was important that counseling allow for the validation of her stress related to trauma and acculturation, her resilience, and her own conceptualization of mental health and related stigma.

APPROACHES TO COUNSELING Literature over the past two decades highlights the importance of sociocultural context in the conceptualization and implementation of assessment and intervention with immigrants and refugees (APA, 2010, 2012; Park-Taylor, Ventura, & Ng, 2010). Culturally competent approaches to counseling encompass both evidence-based practices and practice-based evidence. Specifically, evidencebased practice in psychology (EBPP) is rooted in empirical evidence for specific assessment and intervention practices, whereas practice-based evidence refers to a pool of knowledge developed in practice with immigrants and refugees that has not been systematically or empirically examined but offers valuable information concerning “practice as usual” and the modification of traditional treatment practices with immigrants and refugees (APA, 2010, 2012; Beehler, Birman, & Campbell, 2012). Assessment of psychological issues should consider culturally specific expressions and conceptualizations of distress. Psychological instruments should meet criteria for cross-cultural equivalence beyond translation into languages other than English, across multiple factors such as content, construct, and semantics, and should be modified to the characteristics of individual cultural groups (Shoeb et  al., 2007). Further, even in cases when a client is proficient in English, it may be helpful for the client to complete psychological testing or

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engage in counseling in his or her first language, and/or utilize the help of an interpreter (Grey & Young, 2008). Shoeb and colleagues (2007) noted that relying on language and constructs stemming from Western psychiatry can contribute to misdiagnosis, as evidenced in the case of PTSD when it is prioritized as an explanation of emotional distress over indigenous explanations. As immigrants and refugees typically negotiate multiple cultural identifications, it is also possible that they struggle with varying, and sometimes contradictory, explanations of mental health issues that shift over time. As such, it is important for clinicians to examine the role of their own socialization and cultural perspectives as they intersect with the client’s explanations of distress. Additionally, clinicians should consider the potential role of stigma accompanying diagnostic labels and the appropriateness of cultural-bound syndromes as descriptors of mental health (APA, 2012). Clinicians should be attuned to the fact that culturally embedded sources and expressions of resilience coexist with mental illness and psychological distress (Harvey & Tummala-Narra, 2007). Assessment should be conceptualized as a task that occurs throughout the evaluation and treatment process rather than only taking place during the initial meetings with a client. Although interventions with immigrants and refugees encompass an array of modalities, such as individual, family, and group therapies, expressive arts therapy, and school and communitybased interventions, in this chapter, we focus on counseling approaches. A wide range of theoretical orientations, such as cognitive-behavioral theory, psychoanalytic theory, humanistic-existential theory, family systems theory, feminist theory, and relational-cultural theory, have been used to conceptualize counseling with immigrants and refugees. Recommendations for counseling within each of these paradigms suggest that attention to sociocultural context is essential for conceptualization and intervention to be effective. Several evidence-based practices involving culturally adapted cognitive-behavioral therapy (CBT) for immigrants have been described in the

literature. Some examples include the Culturally Informed and Flexible Family-Based Treatment for Adolescents (Santisteban & Mena, 2009), in which family and individual CBT are combined with educational interventions to address family conflict, and Cuento Therapy, in which CBT is used to address anxiety and academic self-esteem and performance among Latino/a students (APA, 2012). A Cantonese-language CBT program that addresses depression among immigrants from Hong Kong in Canada has also been found to be more effective than “treatment as usual” (Shen, Alden, Söchting, & Tsang, 2006; S. Sue et  al., 2012). A number of studies indicate that culturally adapted treatments that address specific linguistic and cultural needs are beneficial to refugees as well. For example, Hinton, Pich, Hofmann, and Otto (2013) described CBT that integrates acceptance and mindfulness as helpful to Latino/a and Southeast Asian refugees with histories of trauma. In recent years, counseling approaches with immigrants and refugees have also been developed by psychoanalytic scholars. These approaches emphasize the influence of intrapsychic, interpersonal, social, and linguistic aspects of the migration process on individuals’ psychological life and the therapeutic process. For example, race and ethnicity are thought to be important therapeutic factors that manifest in transference and countertransference, at times shifting power dynamics between the therapist and the client (Akhtar, 2011; Suchet, 2007). The psychoanalytic perspective on migration has also focused on the influence of traumatic stress in the context of migration, and particularly, its impact on the development of cultural identifications and identity more broadly (Ainslie et al., 2013). This framework further emphasizes the importance of clinicians’ attending to processes of mourning and loss in the migration process. Feminist therapists have drawn attention to unjust social conditions as shaping the experience of immigrant and refugee women and girls. Feminist, multicultural scholars (Comas-Díaz, 2006; Espin, 2006) have challenged the decontextualized position of the client and the therapist, attended to issues of intersectionality (e.g., race and I M M I G R A NT S A ND REF UG EES

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sexual orientation, religion, and gender), and called for a strength-based approach to women’s experiences of oppression and resilience. One example of feminist therapy, known as Empowerment Feminist Therapy (Díaz-Lázaro, Verdinelli, & Cohen, 2012), integrates feminist and multicultural concepts to address clients’ experiences with oppression and assumes that personal and social identities are interdependent. Relational-cultural theorists (Ruiz, 2012) have further suggested that disconnections in interpersonal relationships experienced by immigrant women are shaped by social and political factors. While we have briefly described some existing counseling approaches with immigrants and refugees, we note that all counseling assessment and interventions should be rooted in a commitment to cultural competence. Cultural competence involves attending to the intersection of individual, interpersonal, and systems issues and includes three broad dimensions of counseling: specifically, the therapist’s cultural knowledge, the therapist’s attitudes and beliefs and self-examination, and the use of culturally appropriate interventions (Casas, Pavelski, Furlong, & Zanglis, 2001; D. W. Sue, Arredondo, & McDavis, 1992). Further, counseling immigrant and refugee clients from a perspective that values both cultural competence and social justice entails attention to a number of issues, such as an accurate understanding of the migration process and acculturation, financial stress, immigration status and legal concerns, educational concerns, language and communication issues, and access to appropriate care and support. The lack of adequate access to care, in fact, is a form of social injustice, and as such, advocacy that involves collaboration with the client’s communities of reference and other sources of help (e.g., legal, spiritual) should be considered a component of counseling practice. Access to appropriate care

can also involve ­advocating for access to interpreters and to e­ stablish solid working relationships with interpreters who are in a position to provide valuable cultural knowledge and a connection to the client’s community (Yakushko, 2010). Clinicians should convey curiosity and interest in the clients’ perspectives, worldviews, and concerns about safety, such as those concerning trauma, immigration status, and deportation, and facilitate a therapeutic context in which the client experiences a sense of safety and collaboration (Inman & Tummala-Narra, 2010). An examination of the therapist’s own cultural background, sociocultural history, and social location should inform an understanding of the therapeutic relationship and process. It is important that clinicians be able to openly discuss experiences of discrimination (e.g., racism, sexism, homophobia) with clients and help clients to effectively cope with discriminationrelated stress. Further, clinicians should attend to indigenous explanations of psychological distress, sources of resilience, and healing practices that the client may choose to utilize in conjunction with counseling. In many cases, it may be helpful to include family members, friends, and relevant members of the client’s community so that the client accesses increased supports and is better able to manage potential stigma about mental illness or about seeking help from a mental health professional. At times, connecting with family members who live in areas distant from the client both within and outside of the United States may involve the use of technology, such as e-mail, Skype, and teleconference. Finally, it is important that clinicians communicate with other professionals involved with the client’s care, teachers and guidance counselors in schools, and consult with colleagues and seek appropriate supervision on an ongoing basis in order to attend to the complex issues and dilemmas that may arise in counseling practices with immigrant and refugee clients.

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CHAPTER

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Addressing the Needs of LGBTQ Youth A Counseling Imperative Amy L. Reynolds

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ocial justice is at the core of the counseling profession. While the field has struggled at times to effectively and reliably implement multicultural or social justice guidelines (Fox, 2003; Speight & Vera, 2004), when examining the history of the counseling profession, it is clear that the underlying values are consistent with social justice and advocacy (Fouad, Gerstein, & Toporek, 2006; Goodman et al., 2004; Kiselica & Robinson, 2001). Whether you trace those roots to Clifford Beers, who single-handedly transformed the mental health field (Kiselica, 2004), or the work of Frank Parsons with impoverished boys in Boston (Fouad et al., 2006), it is difficult to avoid the link between the counseling field in the early 20th century and social justice and advocacy (Kiselica, 2004). With the growth of the multicultural counseling movement, those roots have been strengthened and expanded with increasingly more professionals emphasizing the need for social advocacy and social justice (Goodman et al., 2004; McCabe & Rubinson, 2008; Stone, 2003). The opportunities for applying a social justice approach to counseling are seemingly endless. While there may not be complete agreement on what constitutes social justice or advocacy work, “it is no longer sufficient or appropriate to simply address human and community problems through a reliance on individual-oriented interventions and solutions” (Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006, p. 55). According to Ratts, Toporek, and Lewis (2010), “the goal of social justice is to ensure that all individuals have an opportunity to achieve their academic, career, and personal/social potential in society” (p. 6). Given that lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth continue to face the negative consequences of living in a homophobic and heteronormative world (Meyer, 2013), their need for affirmative counseling and advocacy is well documented (Singh, 2010; Whitman, Horn, & Boyd, 2007). The purpose of this chapter is to increase awareness of the experiences of LGBTQ youth who continue to experience persistent and harmful anti-LGBTQ bullying that negatively affects every aspect of their lives as well as to identify strategies for effectively meeting their needs. A single chapter cannot adequately address this important and complex issue or the growing literature and research exploring the experiences of LGBTQ youth. However, what it can do is to expand our understanding of LGBTQ youth and what

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they need. The experiences of LGBTQ youth will be briefly examined, as will some of the approaches and strategies for combatting anti-LGBTQ bullying. This chapter highlights the role of counselors in schools and communities as advocates and social change agents to help create the type of schools and communities where all youth feel welcome and affirmed. It is important to briefly acknowledge some of the identity and terminology issues that arise when exploring this heterogeneous group. The language and terminology used when discussing sexual minorities is quite variable and dependent on the values, identity, and theoretical framework of those describing that broader community or possibly even identifying themselves (Fassinger & Arseneau, 2007; Singh, 2010). There is diverse terminology to describe who may be a member of this sexual minority group (e.g., lesbian, gay, bisexual, transgender, queer, pansexual). Much of the inherent challenge in differentiating variations in sexual orientation and gender identity is due to the complexity of LGBTQ identity and the tendency to view sexual minorities as a homogenous group when, in fact, their experiences and identities are quite diverse and ever changing (Fassinger & Arseneau, 2007). When working with LGBTQ individuals, it is important to remember that although common experiences of invisibility, oppression, isolation, and marginalization are faced by all or most LGBT people, these populations also encounter issues that are shared uniquely by their reference groups, as well as influences that are particular to their own individual constellation of contextual effects on identity development and enactment. (Fassinger & Arseneau, 2007, p. 43)

The complexity of understanding LGBT identity is further complicated when dealing with youth because of the developmental constraints and realities they experience (Halverson, 2010; Hollander, 2000). Since “many LGB youths first experience questions about their sexual orientation during their identity struggles in adolescence” (Chen, Androsiglio, & Ng, 2010, p. 535), the term questioning youth has been used to acknowledge how

those considering, exploring, or questioning their sexual orientation or gender identity faced unique developmental challenges. Unfortunately, there is little agreement about what the term questioning youth even means (Hollander, 2000). Often, what is mistakenly assumed is that these are actually LGBT youth who have not yet fully embraced that label. In addition to being inaccurate, such assumptions may alienate the very adolescents they are attempting to reach. What many questioning youth need is time to explore who they are rather than be expected to foreclose on a particular identity before they are ready. Appreciation of these developmental influences is further complicated by generational differences where Vaccaro (2009) found that millennial LGB youth are more likely to define their identities as fluid and multidimensional. According to Halverson (2010), “understanding the developmental mechanism for LGBTQ identity exploration is a necessary precursor to the design of environments that facilitate positive developmental paths toward healthy adulthood” (p. 636).

UNDERSTANDING THE EXPERIENCES OF LGBTQ YOUTH While a nuanced understanding of the complex identity issues facing LGBTQ youth is essential, it is even more important to grasp their daily experiences, which can be filled with prejudice, homophobic words and actions, invisibility, heterosexist policies and barriers, microaggressions, isolation, and the stress that other minority groups experience (D’Augelli, Pilkington, & Hershberger, 2002; Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012; Meyer, 2013). While there is evidence to suggest that LGBT adults report increased societal acceptance in the past decade, they continue to experience rejection, bias, discrimination, and even hate crimes (Pew Research Center, 2013). Despite gains in the acceptance of marriage equality and more positive attitudes toward LGBT individuals, it is essential that counselors working with LGBTQ youth not underestimate the ongoing threat to their

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mental health, physical safety, and emotional wellbeing. Vaccaro (2009) highlighted the power of such misperceptions in her intergenerational study of LGB millennials, generation X, and baby boomers. While “Boomers and Xers assumed Millennial youth came out early, faced little struggle in coming out, and had positive responses from families” (Vaccaro, 2009, p. 130), millennials reported experiencing ongoing homophobia and heterosexism across many settings, including home and school. Without proper understanding of the true range of experiences faced by LGBTQ youth, counselors in all settings will be poorly equipped to address their concerns and provide affirmative and effective counseling. Extensive research exists that documents both the chronic and acute experiences of discrimination, bias, prejudice, and microaggressions experienced by LGBTQ youth within their homes, their schools and colleges, in their communities, and even in their social circles. The prevalence and type of anti-LGBTQ bullying that exists is extensive and occurs in diverse settings on a continuum from name calling to social shunning to verbal harassment to cyberbullying to physical threats, all the way to physical and sexual assault (Espelage, Aragon, Birkett, & Koenig, 2008; Kosciw et al., 2012; Varjas, Meyers, Kiperman, & Howard, 2013). Nadal et al. (2011) further documented the range of microaggressions or more covert forms of discrimination experienced by LGBT individuals including the use of heterosexist terminology, assumption of sexual abnormality, disapproval of LGBT experience, and denial of heterosexism. This pervasive and often veiled homophobia and heterosexism contributes to the isolation, marginalization, and minority stress experienced by LGBTQ individuals (Meyer, 2013). To fully appreciate the problem, it is important to briefly highlight several studies that chronicle the extent of the harassment, discrimination, and violence that still occur despite more recent gains in social acceptance of LGBTQ individuals and rights. As part of the biennial survey conducted by Gay Lesbian Straight Education Network (GLSEN), Kosciw et  al. (2012) identified a wide

range of homophobic remarks, harassment, and assault still being experienced by LGBTQ youth in the schools. LGBT students report continually hearing biased remarks in school, including over 50% reporting hearing homophobic and genderphobic remarks from school staff. Many LGBTQ students do not feel safe in school due to verbal harassment, physical harassment, and physical assault. Contributing to the hostile school climate is that 36% of LGBTQ youth surveyed report that school staff do not typically respond or intervene when an incident is reported. D’Augelli et al. (2002) assessed both vicarious and direct sexual orientation victimization and also found high levels of harassment and violence: More than half (59%) experienced verbal abuse, 24% were threatened with violence, 11% had objects thrown at them, 11% had been physically attacked, 2% were threatened with weapons, 5% were sexually assaulted, and 20% had been threatened with the disclosure of their sexual orientation. (p. 156)

Their study found that the observing or being aware of the victimization of other LGBTQ youth was all that was needed to cause LGBTQ youth to fear for their safety. Such difficulties experienced by LGBTQ youth occur at every level of schooling. LGBTQ youth reported that both verbal harassment or threats and physical harassment or violence typically began around age 13, with some incidents occurring as early as 6 or 8 years old (D’Augelli et  al., 2006). Research has also shown that anti-LGBTQ bullying regularly occurs in elementary and middle school. While elementary school is not a setting where most expect anti-LGBT bullying to occur, 26% of students hear homophobic remarks (e.g., fag, lesbo) at least sometimes, and 23% report that bullying occurs when a boy acts or looks too much like a girl or a girl acts or looks too much like a boy (GLSEN, 2012). While the biennial climate survey done by GLSEN typically surveys children from ages 13 to 18, they have also examined the experiences of middle school–aged children more closely. Their results suggest that middle school students

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experience more verbal and physical harassment and physical assault than high school students around issues of both sexual orientation and gender expression (GLSEN, 2009). According to research by D’Augelli et al. (2006), while the majority of incidents were reported to occur at school, many also occurred at home and in public settings. In addition to age differences in the type and severity of anti-LGBTQ bullying experienced, other within-group differences warrant further attention. LGBTQ youth in rural areas are more likely to hear anti-LGBTQ remarks and experience more harassment and abuse than those in urban and suburban schools (Palmer, Kosciw, & Bartkiewicz, 2012). In a study by Diaz and Kosciw (2009), LGBTQ students of color often deal with multiple types of victimization focused on their sexual orientation, gender expression, and race making it difficult for them to feel safe anywhere. Attending to these within-group differences is important because LGBTQ are not a homogenous, monolithic group. Increasingly, concerns have been expressed about how anti-LGBTQ bullying is occurring in cyberspace. Due to access to the Internet and social media, especially for adolescents, harassment is pervasive and relentless. Kosciw et  al. (2012) reported that 55% of LGBTQ students faced electronic harassment through text messaging or social media. A qualitative study by Varjas et  al. (2013) found that while there was positive uses for technology by LGBTQ youth (e.g., networking, gathering resources), over 60% experienced cyberbullying due to their sexual orientation. The cumulative effect of these various forms of harassment, violence, and victimization have deleterious effects on their self-esteem, identity, relationships, academic performance, vocational goals, and mental health (Burkard, Reynolds, Wurl, & Schultz, in press; D’Augelli et  al., 2002; Meyer, 2013; Nadal et al., 2011; Schneider & Dimito, 2010). Many studies have documented how LGBTQ youth experience significant levels of distress, suicidality, and mental health disorders such as posttraumatic stress disorder (PTSD), substance abuse, and depression (D’Augelli et  al., 2006; Meyer, 2013;

Russell, Ryan, Toomey, Diaz, & Sanchez, 2011). The most common explanation for “the cause of the higher prevalence of disorders among LGB people is that stigma, prejudice, and discrimination create a stressful social environment that can lead to mental health problems” (Meyer, 2013, p. 4). Beyond increased risk for mental health concerns and problems in psychosocial adjustment, victimization also negatively affects the grades, attendance, and educational/vocational aspirations of LGBTQ individuals (Kosciw, Palmer, Kull, & Greytak, 2013; Poteat, Mereish, DiGiovanni, & Koenig, 2011; Schneider & Dimito, 2010). Kosciw et  al. (2013) report that hostile school climates cause many LGBTQ students to miss school, thus limiting their educational opportunities. Those who experience victimization typically report lower grade point averages (GPAs) and are much less likely to pursue higher education. The negative effects of anti-LGBTQ victimization may have long-term consequences because school avoidance and absenteeism “may limit their opportunities for a full education and stable future” (Darwich, Hymel, & Waterhouse, 2012, p. 381). Schneider and Dimito further noted that anti-LGBTQ discrimination influenced the colleges and careers chosen by LGBTQ individuals.

STRATEGIES TO ADDRESS THE NEEDS OF LGBTQ YOUTH In response to the extensive negative and long-term effects resulting from anti-LGBTQ victimization, there has been an increase in attention on and resources to combat anti-LGBTQ bullying in recent years (Farmer, Welfare, & Burge, 2013). Websites such as “It Gets Better” (http://www.itgetsbetter .org) and “The Trevor Project” (http://www.thet revorproject.org), and educational programming like National Coming Out Day (http://www.hrc .org/resources/entry/national-coming-out-day) or National Day of Silence (http://www.dayofsilence .org/), have filled a much-needed vacuum to help fight bullying and create safe spaces for LGBTQ youth. Such responsiveness has led to increased

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visibility for ongoing programs and the development of more resources and programs within schools and across the country to address the needs of LGBTQ youth. Knowledge of the factors that can moderate or diminish the negative effects of bullying as well as the institutional (primarily school-based) interventions that can prevent bullying and enhance the resilience of LGBTQ youth is essential for all counselors. Two of the most important factors in helping LGBTQ youth manage or cope with anti-LGBTQ bullying and minimize its negative effects are people and programs. Some studies have found that support and involvement of adults, especially family members, in the lives of LGBTQ youth can be beneficial in terms of mental health (Espelage et  al., 2008). Ryan, Russell, Huebner, Diaz, and Sanchez (2010) found that family support and acceptance are crucial to the self-esteem and general well-being of LGBTQ youth and provide buffers against depression, suicidality, and substance abuse. However, Poteat et  al. (2011) found that while general parental support had more positive effects, it often did not negate the harmful effects of homophobic victimization. Research by Doty, Willoughby, Lindahl, and Malik (2010) also found that friends provided more support for sexualityrelated concerns than family members and that LGBTQ youth report receiving the most support from friends who were also LGBTQ. It is important to note that the effects of social support from families and friends is further complicated for LGBTQ youth of color who are less likely to be out and more likely to struggle to find support (Poteat et al.). Adult support at school for LGBTQ youth becomes especially important when support at home is nonexistent (Darwich et  al., 2012). According to Espelage and colleagues (2008), “social and institutional support are essential components of maintaining well-being in sexualminority youth” (p. 213). Research has shown that support from teachers, counselors, and administrators in the school setting can help to moderate or negate the harmful effects of anti-LGBTQ bullying. Goodenow, Szalacha, and Westheimer (2006)

found that LGB youths who identified supportive school staff members were not as likely to attempt suicide or be threatened by others. Research by Kosciw et al. (2012) also has shown that LGBTQ youth who report supportive adults in their school are less likely to miss school, have higher GPAs and educational aspirations, and are more likely to feel part of the school community. Therefore, it is essential that school counselors and other personnel proactively reach out to LGBTQ youth to help counteract the negative effects of antiLGBTQ bullying. Relatedly, school climate has been shown to have an important impact on LGBTQ youth. While many studies have identified the deleterious effect of a negative and homophobic school climate (D’Augelli et al., 2002; Kosciw et al., 2013), fewer have focused on how an affirming climate can have positive or moderating effects on antiLGBTQ victimization. Research by Espelage et al. (2008) has suggested that a positive school climate can protect LGBTQ youth against mental health issues such as depression and drug use, and have a moderating effect on negative outcomes for LGBTQ youth. More specifically, programs such as Gay Straight Alliances (GSA) have been shown to contribute positively to psychosocial outcomes for LGBTQ youth. Goodenow et al. (2006), Heck, Flentje, and Cochran (2011), Kosciw et al. (2013), and others have found that schools with GSAs have reduced school victimization, lower suicide rates, increased feelings of safety, higher GPAs, stronger sense of belonging to one’s school, and more supportive school staff members and teachers. Griffin, Lee, Waugh, and Beyer (2004), in their qualitative study, identified four different roles that GSAs play in schools: (a) counseling and support for LGBT students, (b) safe space for LGBT students and friends, (c) primary vehicle for education and awareness in school, and (d) part of broader efforts to educate and raise awareness in school. Kosciw et al. (2013) also showed how an inclusive school curriculum with positive examples of LGBT people and history and comprehensive anti-LGBTQ bullying policies had positive effects on LGBTQ youth and their school experiences.

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While much has been written about the need for school-based anti-LGBTQ bullying programs and activities that will reduce harm and promote tolerance among students, teachers, and staff (e.g., Henning-Stout, James, & Macintosh, 2000; Whitman et  al., 2007), the remainder of this chapter highlights the role of counselors, both in schools and the community, in combatting the pervasive anti-LGBTQ bullying affecting the quality of life and well-being of LGBTQ youth.

THE ROLE OF COUNSELORS AS ADVOCATES FOR LGBTQ YOUTH In order to be successful in efforts to combat antiLGBTQ bullying, it is imperative that counselors and psychologists embrace a social justice and social advocacy approach so that they are able to act as change agents and advocates in families, schools, and communities. There are three critical ways for counselors and psychologists interested in advocating on behalf of LGBTQ youth to work toward achieving that goal: (a) affirmative counseling, (b) competence training, and (c) advocacy. Affirmative counseling has become the standard and model for working with LGBTQ individuals in a therapeutic setting (Bieschke, Perez, & DeBord, 2007; Burnes et  al., 2010). Although there is no definitive agreement on what constitutes affirmative therapy and “how to” models do not exist (Reynolds, 2003), it is essential that counselors move beyond unlearning their own homophobic and heterosexist attitudes and biases and learn how to provide counseling services that affirm LGBTQ individuals and provide them with the tools they need to live effectively in a heterosexist and homophobic world. Crisp and McCave (2007) suggest that such affirmative counseling can be used by any practitioners and across all modalities of therapy. More specifically, they discuss how affirmative practice is in tune with the needs of LGBTQ youth because it (1) focuses on affirming youths’ identities; (2) empowers youth;

(3) supports youth in self-identifying in whatever way they feel is appropriate; (4) supports youth in identifying homophobic forces in their lives; (5) considers problems in the context of the homophobia and discrimination that youth experience; and (6) can be used in a variety of settings (p. 405).

Given that most research exploring antiLGBTQ bullying highlights how it is not the gender and sexual orientation of these adolescents that creates difficulties but rather the victimization they experience (D’Augelli et al., 2002; Meyer, 2013), it is particularly important that affirmative practice be sensitive to context and larger societal forces negatively affecting LGBTQ youth. The role of counselors in the community and schools in advocating for LGBTQ youth has received much attention in recent years (Crisp & McCave, 2007; Stone, 2003). Jacob (2013) notes that despite increased visibility of anti-LGBTQ bullying and its most negative consequences (e.g., suicide), there are still some schools that have not adequately addressed the needs of LGBTQ youth or attempted to reduce the bullying or harassment they experience. Regardless of whether they are working in communities, with families, or within the school setting, counselors and psychologists working with LGBTQ youth have an obligation to provide affirmative counseling (Crisp & McCave, 2007). From an ethical standpoint, both Morrow (2000) and Greene (2007) have laid out the compelling ethical imperative for providing LGBTQ affirmative therapy. Jacob has further detailed some of the important ethical and legal issues related to developing schools that are safe and welcoming to LGBTQ youth. Despite increasing awareness and acceptance of LGBTQ individuals, there are ongoing concerns regarding heterosexist bias and homophobia among mental health professionals (Greene, 2007). First and foremost, affirmative counseling for LGBTQ youth relies on the assumption that as long as homophobia, transphobia, heterosexism, or

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other forms of related bias exist, counselors must take extra steps and engage in additional efforts to assure that there is no bias within the therapy process. Just as Freeman (1975) suggested in her seminal work on feminism, if one does not actively combat the societal oppression that exists, then one is supporting the status quo. That means that a null environment is never acceptable. Counselors must actively combat any external or internalized bias that exists within the client, the therapy room, and the setting where they work to assure that LGBTQ youth have a fighting chance to learn to fully accept themselves. Matthews (2007) suggests that affirmative counseling begins “before we even know the client’s sexual orientation” (p. 201), which means that counselors must ensure that they actively seek out their own biases in order to prevent them from infecting the therapeutic process. As such, competence is necessary, and counselors must learn to educate themselves. Crisp and McCave (2007) suggests that LGBTQ affirmative practice is ultimately a type of cultural competency where unique knowledge, attitudes, and skills are needed to work effectively with LGBTQ individuals. Counselors need to increase their awareness of various practice guidelines or competencies needed to work with LGBTQ individuals (e.g., American Psychological Association [APA], 2012; Harper et al., 2013). The centrality of developing the necessary awareness, knowledge, and skills to work with LGBTQ youth cannot be underestimated. Given that “adequate preparation to work with LGB clients is mandated by ethical and accreditation standards of the counseling profession” (Farmer et  al., 2013, p. 195), ensuring that all counselors and psychologists are competent is paramount. Research by Farmer et  al. (2013) has shown that there is a variability of LGB competence of counselors across different settings and different aspects of competence. They found that community counselors had higher levels of knowledge than school counselors even though they did not see more LGB clients. Their results also indicated that counselors viewed themselves as more competent in terms of their attitudes and least competent in terms of their skills. Focusing on competence training for

working with LGBTQ youth can occur both within graduate training programs and within settings where counselors and psychologists work with LGBTQ youth. While some have acknowledged the tendency of counseling or psychology training programs to reflect heterosexism (Farmer et  al., 2013; Phillips, 2000), there have been increased efforts to expand and enhance the attention to LGBT issues and competence in training programs across varied counselor and psychologist training programs (Phillips, 2000; Whitman et  al., 2007). Biaggio, Orchard, Larson, Petrino, and Mihara (2003) have suggested that more systemic and institutional issues such as institutional climate, policies of universities and programs, and accreditation bodies need to be considered when incorporating LGBT issues into training programs. Phillips (2000) highlighted the importance of using both individual and organizational strategies to create LGB affirmative training environments. According to Savage, Prout, and Chard (2004), caution should be heeded, though, just not to tag on lesbian and gay male issues to the program of studies without a thorough examination of where the program and its faculty stand on these issues and issues of diversity as a whole. (p. 208)

Studies have shown that some training efforts are meeting with success (Greytak, Kosciw, & Boesen, 2013; Rutter, Estrada, Ferguson, & Diggs, 2008; Whitman et  al., 2007), but more research is needed to understand what training efforts are most successful. The importance of LGBTQ professional development and training for school personnel is well documented (DePaul, Walsh, & Dam, 2009; Stone, 2003), and some suggest that such efforts are essential to developing more LGBTQ allies and advocates (Dillon et al., 2004). McCabe and Rubinson (2008) suggest that “specialized training in the issues and difficulties faced by LGBT youth may be necessary to enable psychologists and counselors to make positive changes” (p. 472). While individual resistance and institutional barriers to providing LGBTQ-affirming training for counselors and psychologists working in school

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and community settings exist, there is consensus within the broader counseling profession of the need for counselors to serve as advocates for LGBTQ youth and act as partners in diverse settings to combat bullying (Crisp & McCave, 2007; Farmer et  al., 2013; McCabe & Rubinson, 2008; Stone, 2003; Whitman et al., 2007). Exploring possible approaches, interventions, and strategies for addressing and preventing anti-LGBTQ bullying is essential in order to move beyond individual and institutional barriers and ensure the ability of LGBTQ youth to survive and thrive. Advocacy may very well be one of the most important ways that counselors can have a positive impact on the lives of LGBTQ youth. Being allies and advocates for LGBTQ youth can occur in a variety of forms and across a wide range of settings. In order to combat individual resistance and institutional barriers, incorporating proactive, systemic, and systematic change efforts is essential (DePaul et  al., 2009; McCabe & Rubinson, 2008; Moe, Leggett, & Perera-Diltz, 2011; Ouellett, 1996; Stone, 2003). Moe et al. (2011) emphasize the importance of relying on comprehensive prevention-oriented programs rather than piecemeal reactive efforts and suggest that “adopting a systemic-change perspective facilitates the integration of LGBTQ advocacy, anti-bullying, and suicide prevention into both the system-wide and individual services provided” (p. 8). Given that LGBTQ youth spend much of their time in the school setting, much of the discussion here focuses on promoting systemic changes in the schools; however, the suggestions made and lessons learned from school-based interventions have heuristic value for other settings like community or faith-based organizations. In order to effectively create systemic change necessary to address anti-LGBTQ bullying in schools and create an affirming environment, it is essential to rely on frameworks or models to guide one’s efforts. The social justice framework provided by the American Counseling Association (ACA) advocacy competencies (Ratts, DeKruyf, & ChenHayes, 2007; Singh, 2010) and multicultural organization development (MCOD; Ouellett, 1996) are two effective models for systemic change.

Ratts et al. (2007) made an effective case for the importance of ACA advocacy competencies in helping school counselors address the many challenges facing youth, especially those targeted by oppression and discrimination like students in poverty, students of color, and LGBTQ youth. These advocacy competencies target three levels: clients/students, schools/communities, and the public arena. Learning to discern between micro and macro change efforts is important for counselors because it enhances the range and type of interventions that can be created. For example, Singh (2010) distinguishes between acting on behalf of LGBTQ youth and working directly with them to nurture resilience and address issues of homophobia and heterosexism. Empowering LGBTQ youth to combat internalized homophobia and affirm their own identity is vital to their well-being and can be accomplished when meeting with students one-on-one or through programmatic activities like GSA. Acting on behalf of LGBTQ youth by developing training programs to enhance the LGBTQ competency of counselors and school personnel can have a powerful effect on school and community settings. Seeking out valuable local and national resources to educate others and affirm LGBTQ youth is an important way for counselors to be advocates. Singh suggests that counselors provide schoolwide advocacy by conducting school climate surveys, establishing GSAs, or developing a systems approach to training and advocacy. Working closely with community organizations is another way for counselors to help provide resources, offer interventions, and make a difference in the lives of LGBTQ youth. By evaluating the effectiveness of community organizations to adequately address the needs of LGBTQ youth and identifying local barriers, counselors can make a meaningful impact in their lives. Finally, by focusing on the public arena and providing LGBTQ education for the larger community or advocating at the political or social level (e.g., local policies or state laws), counselors can create lasting change that will impact the lives of LGBTQ youth far into the future. While offering in-depth examples of these advocacy efforts or

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competencies is not the purpose of this chapter, there are growing examples of the need for system interventions in collaboration with or on behalf of LGBTQ youth (DePaul et al., 2009; Singh, 2010). Inevitably, such social advocacy efforts lead to backlash and resistance, so it is important that counselors develop awareness of how to counteract such challenges. In his discussion of MCOD tools and strategies, Ouellett (1996) suggested that schools vary in their openness to change and that such differences need to be taken into consideration when designing change efforts. Support for the status quo, support for change at the individual level, and support for change at the systemic level are the three levels of readiness for change. By increasing awareness of where one’s institution exists on this continuum, LGBTQ allies and advocates will be better prepared to develop meaningful and effective interventions to create the change necessary to provide affirming counseling and support for LGBTQ youth. If an individual school or school district is in denial about the need for interventions on LGBTQ issues, any programs or training are likely to be narrow or reactive in nature. Efforts focused on making broad systemic changes will likely meet with resistance.

When schools are more open to a systemwide effort, there is more opportunity to create a wide range of changes, such as incorporating LGBTQ issues into relevant policies and procedures, developing proactive training for counselors, teachers, and administrators, or expanding other advocacy efforts to include LGBTQ issues. By relying on the growing social justice and social advocacy literature, counselors will be well equipped to systemically and systematically address the important concerns affecting LGBTQ youth. Providing LGBTQ-affirming counseling, enhancing the LGBTQ competency-based training in graduate programs and work settings, and developing system-oriented interventions and programs are just some of the strategies available to ensure that the concerns affecting LGBTQ youth are taken seriously. By “acting as advocates and change agents, counselors can facilitate the establishment of a supportive school climate, changing the system to productive learning environments for all students” (Stone, 2003, p. 152). Returning to our roots and core values of social justice and advocacy provides counselors with the tools and strategies necessary to affirm LGBTQ youth and create meaningful change.

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CHAPTER

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Multicultural Counseling With Older Adults Considerations for Intervention and Assessment Katy L. Ford and Martha R. Crowther

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dvances in medical care, nutrition, and other quality-of-life indicators, the consequent extension of the average life expectancy, and the large numbers of adults approaching old age in the United States and other Western societies are only a few of the factors that have been cited to predict the explosion of the older adult population in coming decades. This demographic shift may precipitate what some have referred to as a “crisis” in geriatric mental health care (Molinari, 2012). Certainly, the label of older adult denotes membership in a distinct culture, necessitating careful consideration of issues unique to this group by professionals working with them. The multicultural counselor would do well to understand the special circumstances and challenges of later life and the issues commonly targeted by older adults in mental health treatment, as well as to recognize older adulthood as a culture with which the professional should aim to interact competently. The notion of older age as a minority status warranting protection from discrimination by the American government has been turned down (Pasupathi & Lockenhoff, 2002). Nevertheless, ageism is a very real threat to equity, accessibility, and effectiveness of mental health services for older adults (Pasupathi & Lockenhoff, 2002). Ageism is characterized by the broad application of inaccurate stereotypes to older adults and results in discrimination against them. Many of the most common stereotypes regarding older age are directly related to their mental health or their participation in health services. These include such assumptions as (a) older adults are incapable of achieving real psychological change and thus would not benefit from mental health services, (b) many of the concerns or problems of adulthood (e.g., finances, parenting) lessen with age, and (c) older adults are all alike. These assumptions clearly contribute to society’s dismissal of the importance of geriatric mental health services. Mental health professionals can avoid such stereotyping by committing themselves to the achievement of cultural competency and by keeping abreast of the empirical literature regarding older age and geropsychology. Relevant themes of the extant body of geropsychology literature are highlighted in this chapter. 394

In addition to its drastic growth in numbers, the older adult population is expected to become much more diverse over the next half century (Ortman, Velkoff, & Hogan, 2014). Older age is an important factor in itself, but increasingly, researchers, policymakers, and clinicians are exploring the intersection of aging and belonging to one or more minority groups. It is evident that aging minorities face even more challenges and require an even greater degree of cultural competency on the part of the mental health professional. This chapter surveys the considerations that should be made by those professionals working with older adults for assessment and intervention. In order to work more competently with older clients, counselors and psychologists should be aware of the issues that commonly arise in work with older adults. Many of these are issues familiar to multicultural counselors from their work with other clients, but some multicultural issues may be magnified by age. Others are primarily issues of aging, likely complicated by additional layers of cultural diversity. Still other multicultural issues with older adults illustrate the larger concept of social injustice, which is at the forefront of much of multicultural counseling theory. These three categories are discussed separately, and where possible, interventions that have received considerable empirical support will be mentioned. The chapter concludes with some general suggestions for work with older adults and recommendations for further reading.

MULTICULTURAL ISSUES, EXACERBATED BY AGE Medical Health Problems. Health disparities are present across the life span, yet older adults account for a disproportionate amount of health services utilization (Center for Health Workforce Studies, 2006). On average, older adults experience a greater number of chronic medical illnesses than their younger counterparts (Federal Interagency Forum on Aging-Related Statistics, 2012), and simply as a matter of time, even the healthiest elders are

more frequently and intensely faced with their own mortality (Carstensen, Isaacowitz, & Charles, 1999). Furthermore, research has shown that physical health among aging racial/ethnic minorities is even poorer than that of their White agemates (Johnson & Smith, 2002). The multicultural counselor should be prepared to help older clients process issues of physical decline, medical illness, and approaching death. Interventions that may be of use in this regard include health literacy training and pain and illness management interventions. Health literacy is strongly linked to satisfaction with health care and with physical health outcomes (Kutner, Greenburg, Jin, & Paulsen, 2006). Unfortunately, older adults as a group have considerably lower health literacy than younger adults in the United States. The interventions targeting health literacy that have been examined in the literature vary widely and use narrow samples; this has led to a lack of strong support for any one intervention to date (Manafo & Wong, 2012). However, there is strong evidence that the education of health care professionals regarding older adults’ issues with health literacy leads to significantly better outcomes for older patients (Sadowski, 2011; Speros, 2009). Multicultural counselors can encourage their older clients to ask for more information from health care providers, or they can use their positions in multidisciplinary health care teams to promote awareness of older adults’ health literacy issues among medical professionals. Indeed, therapists’ cooperation with medical and other health professionals is an integral part of treatment for any client with chronic pain, illness, or disability (Knight & Lee, 2008). These collaborators can provide an accurate assessment of the client’s true physical capabilities, allowing for psychological treatment to center on optimizing functionality, self-efficacy, and subjective experiences of the pain or disability. Psychological treatments that have been identified as helpful in this regard include supportive therapies and cognitive-behavioral techniques aimed at correcting maladaptive thoughts about pain or illness and

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eliminating habits that contribute to the perpetuation of pain or disability (Songer, 2005).

securing transportation or accessing community resources more difficult than younger clients.

Poverty. Aging individuals often find themselves attempting to live on lower incomes than they have for most of their lives. Furthermore, older adults’ health insurance coverage is unlikely to keep pace with their medical expenses, and racial/ethnic minority elders’ rates of poverty are far higher than those among their White counterparts and younger adults of racial/ethnic minority groups (Hinrichsen, 2006). Poverty’s influence on matters of mental health care is twofold: Not only may the condition foster psychological distress but poverty also creates significant barriers to accessing mental health services. As aging may coincide with dwindling openness to utilizing mental health services, the compounding effects of age and poverty constitute a serious threat to the psychological well-being of those individuals who fall into both categories.

Religiosity. Many factors (including ones discussed above) can have both positive and negative effects on mental health status and mental health services utilization, but religiosity exemplifies this dynamic perhaps better than any other. Some research (Gray, 2001; Harris, Edlund, & Larson, 2006; Maselko, Gilman, & Buka, 2009) has found indicators of greater religiosity to be correlated with better mental health, more positive attitudes toward mental illness, and more help-seeking behavior. Other research has found the opposite. In one study, as many as 30% of mentally ill adults who sought help from religious leaders or churches had negative experiences and may have received counsel that was counterproductive to their recovery (Stanford, 2007). Because religiosity carries different significance for people of different cultures and ethnicities, it is likely to differentially affect their perceptions about mental illness. For example, Chandler (2010) recognizes African Americans’ religiosity as a natural outgrowth of their historical repression and oppression. It consequently serves as both a positive and negative coping strategy: An overreliance on religious resources or explanations for adverse life situations can lead to denial or failure to take action. Conversely, religiosity can serve as a positive coping mechanism and can provide social support and access to resources not otherwise available. Religion is a particularly salient part of life for many older adults (Benjamins & Brown, 2004; Levin & Taylor, 1997), so aging may only further compound this issue. Among older adults, religious values can play an especially important role in medical decision making (Hicken, Plowhead, & Gibson, 2010) and in the risk for suicidality (Duberstein & Heisel, 2008). Thus, as with any other clients, an assessment of older adults’ religious or spiritual values, and consideration or incorporation of those into therapy, can enhance the salience and effectiveness of treatment.

Rurality. Rural communities have similar rates of mental illness prevalence to urban or suburban areas but are more than twice as likely to be Mental Health Professional Shortage Areas (Health Resources & Services Administration, 2015). Behavioral health treatment rates are already critically low in rural areas, with particular complications for older adults. People aged 65 and older are likely to be more highly concentrated in rural areas (White House Council of Economic Advisers, 2010), and rural older adults have higher suicide rates than their urban agemates (New Freedom Commission on Health, 2004). Even when there is access to care, mental health treatment in rural areas can be complicated by difficulty maintaining confidentiality and avoiding multiple relationships due to the intimate camaraderie present in many small communities. The universal lack of resources in rural communities may also serve to exacerbate many other problems of living (e.g., poverty, health problems) among residents of these areas. In addition, factors related to geographical location of the client (urban or rural) should be considered when working with older adults, as they may find

Gender. Another multicultural consideration that becomes increasingly important with age is ­gender.

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Due to the fact that more women survive into older adulthood than men (Administration on Aging, n.d.), work with the aged necessitates a thoughtful view to women’s issues. This factor intersects with other factors; for example, older women may be more prone to financial difficulty (Federal Interagency Forum on Aging-Related Statistics, 2012; Whitbourne & Whitbourne, 2012) or to experience health problems associated with older age (American Psychological Association [APA], 2007).

ISSUES OF AGING MAGNIFIED BY LAYERS OF CULTURAL DIVERSITY Bereavement. Late life may be marked by a myriad of losses, including those of significantother persons, but also those of health, various abilities, and roles, and financial losses. Losses inevitably produce stress. Although most older adults employ healthy emotional coping strategies, a few others may find themselves especially prone to psychological distress as the losses accumulate. In order to better serve older clients, the multicultural counselor should be familiar with the bereavement process, including the differences between bereavement (the state of having lost something or someone), grief (inner, or psychological, suffering resulting from the death or loss), and mourning (outward or public display of grief; Byrne, 2010). Theories of grief and bereavement vary among psychologists and clinicians, but research suggests that grief and psychopathology are not synonymous. In fact, many people who experience a loss are able to grieve normally, without any psychological intervention (Gallagher-Thompson et  al., 2008). However, treatment may be indicated when grief is complicated (most definitions require that symptoms remain severe at least 12 months following the loss). Therapeutic techniques for complicated grief that have received empirical support include interpersonal psychotherapy, cognitivebehavioral therapy, or some combination of the two (Gallagher-Thompson et al., 2008; Neimeyer,

Holland, Currier, & Mehta, 2008; Shear, Frank, Houck, & Reynolds, 2005). The effects of gender, race/ethnicity, or any other cultural factor on bereavement can be complicated but potent, and should not be ignored. Members of any minority group are likely to have encountered more losses across the life span, and this may contribute to an accumulation of difficulty that peaks in later life (Brown & Jackson, 2004). However, some theorists have conjectured that this history of disadvantage means that, by older adulthood, minority group members have become equipped with better emotional coping. They may also value family and community to a greater degree, providing more social support for the bereaved, on one hand, and more opportunities for loss, on the other (Brown & Jackson, 2004). Caregiving and Grandparenting. Caregiving is relevant to counseling work with older adults in a variety of ways. Older adults may have roles as caregivers for their aging spouses or for adult children with disabilities. Unsurprisingly, these responsibilities may precipitate distress. Caregiving concerns are a common impetus for entry into therapy (Crowther & Austin, 2009). Caregiving concerns can include difficulty coping with the changes observed in a loved one or adjusting to the associated time and financial burdens (Blieszner, 2009). Similarly, older adults may serve as a primary source of care for grandchildren. In many such cases—besides the major adjustments related to a return to parenting in later life—the family is grieving the loss of the child’s parent(s) (Blieszner, 2009; Hayslip & Kaminski, 2005). Furthermore, caregiving and custodial grandparenting can constitute a barrier to mental health service utilization (e.g., when no child care is available). One therapeutic approach that has proven especially effective in working with caregiver clients is Acceptance and Commitment Therapy (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Márquez-González, Romero-Moreno, & Losada, 2010). Custodial grandparents may also benefit from parenting-skills training (with an emphasis on the societal changes that have occurred since

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they first served as parents), or group therapy that provides an extra layer of social support (Hayslip & Kaminski, 2005). Finally, women, African Americans, and Hispanics/Latinos are disproportionately likely to serve as custodial grandparents. Among older adults providing care for any sort of family member, racial/ethnic minority caregivers are significantly more likely to live in poverty (Pinquart & Sörensen, 2001); obviously, the cultural context of caregiving is important for professionals working with these clients. Dementia and Cognitive Decline. Most older adults will experience some small degree of cognitive decline that does not significantly interfere with daily life, but a few will suffer from more severe decline or some form of dementia. The risk for dementia increases with age; while only 5% of older adults age 71 to 79 qualify for a diagnosis of dementia, the rate for those 90 and older is nearly 40% (Plassman et al., 2007). Dementia is characterized by impairment that interferes with some aspect of an older adult’s functional capacity. Mild cognitive impairment is characterized by decline beyond what could be expected with normal aging processes but not severe enough to qualify as dementia. Distinguishing between dementia, mild cognitive impairment, and normal age-related cognitive decline is a complex and nuanced task because the causes and manifestations of impairment are extremely varied (Cosentino, Brickman, & Manly, 2011). Thus, the assessment for and treatment of dementia are best conducted by a professional with extensive training in neuropsychology. For mental health professionals working with older adults, an awareness of the signs of incipient dementia is key, as well as a knowledge of actions (such as regular exercise) that can be taken to prevent or delay cognitive decline (Stine-Morrow & Basak, 2011). Furthermore, it is important to recognize that clients experiencing any degree of cognitive decline may have difficulty emotionally processing such changes. Research has supported the efficacy of some treatments for improving memory and cognitive functioning in older adults with impairment.

Many of these involve training on specific elementary components of memory, such as association, categorization, visual imagery, attention, and rehearsal (Rebok et al., 2012). Treatments that are effective with more severely impaired clients typically focus on regaining or maintaining functionality and quality of life; techniques such as spaced retrieval training (Logan & Balota, 2008; Ozgis, Rendell, & Henry, 2008) and procedural memory learning (Loewenstein, Acevedo, Czaja, & Duara, 2004; Woods, Thorgrimsen, Spector, Royan, & Orrell, 2006) rely on impaired adults’ implicit or motor memory capabilities, which usually remain intact the longest over the course of dementia (Rebok et al., 2012). Finally, few studies have been conducted that evaluate the effectiveness of psychological treatments when used with older adults in the later stages of dementia. However, some developers of psychotherapeutic treatments have offered suggestions for adaptation of their treatments for use with moderately to severely cognitively impaired older adults (e.g., Gallagher-Thompson & Thompson, 2010). Other geropsychologists have offered more general suggestions for adjusting therapy to better suit clients with impairment. Knight and Lee (2008), for example, suggest that therapists slow their speaking speed, allow older adults more time to process the therapist’s statement before moving on, frequently check-in to ensure clients are comprehending important points of the session, minimize distractions in the therapy setting, and present any stimuli in multiple modalities (e.g., verbally and visually).

ISSUES OF SOCIAL JUSTICE Many of the concerns relevant to clinical work with senior clients discussed thus far have their roots in social injustice. However, a few issues are more clearly linked to societal influences, including the devaluation of older adults (and other groups) by Western society and resultant age discrimination. Ageism can lead to problems for older adults who wish to remain in the workplace (Bowen, Noack, & Staudinger, 2011). Age discrimination is at the

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heart of the debate over health care rationing for the very old (Moody, 2002). Furthermore, the internalization of age stereotypes can negatively impact older adults’ emotional and physical health (Hummert, 2011). Older adults may also encounter problems as the result of the accumulation of a life history of social injustices. For example, late-life poverty can be linked to life course choices made much earlier, such as the timing of childbirth or the decision to enter the workforce rather than attaining more education. However, such life choices are often dictated by social class in the first place (Moody, 2002). As social justice issues may have such an acute impact on the day-to-day lives and mental health needs of older adults, it is imperative that those working with older adults be prepared to address them. Barriers to Sexual Intimacy. The dismissal of sexuality as an important part of later life can be attributed to a combination of actual, typical agerelated physiological changes (National Institute on Aging, 2013), rates of widowhood, and societal views of older adults as simply “nonsexual” beings (Sharpe, 2004). When older adults reside in long-term care settings, others entrusted with their care may actively prevent or discourage their sexual behaviors (e.g., nursing home staff; DiNapoli, Breland, & Allen, 2013). This may also happen when concerns arise regarding older adults’ capacity to consent to sexual relationships (American Bar Association & APA, 2008). More often, however, the taboo of senior sexuality exerts influence more subtly. For example, in one study, the expression of physical intimacy by older adults was largely dependent upon sociocultural context (DeLamater & Karraker, 2009). The low ratio of female- to male-directed pharmaceutical interventions for physiological barriers to sexual intimacy also serves as an indicator of the societal emphasis on male sexuality. Nevertheless, as mentioned above, a larger number of women survive into older age than men. Professionals working with older adults should be aware of their own biases regarding late-life sexuality, and they should work to foster

a therapeutic environment in which older clients feel comfortable voicing their concerns. Intolerance of Diversity. The current cohort of older adults lived during an era when sexual minorities and racial/ethnic minorities (among other groups) were openly discriminated against. Despite concerted efforts, fair treatment for these groups has yet to be realized, and older minorities undoubtedly still suffer the effects of oppression. These effects can be situational (e.g., poverty) or psychological. Furthermore, as noted earlier, a common societal misconception about older adults is that they are all alike. Thus, diversity among the older adult population is often assumed absent, and thus overlooked. For these reasons, older adults who belong to a minority group may be in double jeopardy (Ferraro & Farmer, 1996) and suffer even more social injustices than other older adults or younger members of their minority groups.

GENERAL SUGGESTIONS FOR THERAPY As with any demographic group, the differences between individual older adults are far more significant than the characteristics that set them apart from other groups. Keeping in mind that it is the therapist’s responsibility to respond to the unique disposition of each client, however, some general suggestions can be made. The first general finding regarding psychotherapeutic interventions with older adults is that they work (Scogin & Shah, 2012). In fact, for many older adults, psychotherapy is preferable to medication for the treatment of mental illnesses, as polypharmacy is a salient problem in this population (Scogin & Shah, 2012). For many conditions, group therapy is recommended for older adults (e.g., Byrne, 2010; Coon, Keaveny, Valverde, Dadvar, & Gallagher-Thompson, 2012; Ghaed, Ayers, & Wetherell, 2012). Group treatments may engender benefits including (but not limited to) normalization of problems, information sharing, social engagement, and unique opportunities for interpersonal observations/demonstrations.

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Older adults are more prone to physical illness and disability, sensory impairment, and “microlevel cognitive decline,” including minimal slowing in basic cognitive capacities such as perceptual speed and divided attention (Knight & Lee, 2008, pp. 71–72). Thus, care should always be taken to accommodate clients’ specific deficits, both in the physical setting and in the processes of psychotherapy with older adults. When providing service to older adults, it is important to ensure that the location where therapy is delivered has a wheelchair ramp and that the rooms are big enough to fit medical equipment such as walkers or power chairs. If travel is extremely difficult for an older adult, delivery of services in the client’s residence may be preferable. With regard to sensory impairments, simple actions that can be helpful include providing large-print versions of any clinical information or session materials and speaking clearly, slowly, and with a lower pitch (older adults have difficulty hearing higher-pitched sounds; Hardin, 2012).

GENERAL SUGGESTIONS FOR ASSESSMENT Many of the suggestions for therapy also apply to the assessment of older adult clients. Notably, however, sensory deficits can play an even more vital role in assessments. Difficulty seeing or hearing stimuli can result in responses that might otherwise

signify cognitive impairment, potentially resulting in inaccurate diagnosis and treatment. In addition, it is important to select evaluation instruments that have been validated with older adult samples and provide normative data for this population. Some assessments have alternate forms and administration instructions when used with older clients (e.g., for those aged 65+, on the Wechsler Memory Scale-IV, frequently used in assessment for dementia; Wechsler, 2008).

CONCLUSIONS AND SUGGESTIONS FOR FURTHER READING In sum, work with older adults in particular requires many of the skills fundamental to multicultural counseling as a whole. The ability to assess one’s competence to work with a population or an individual is key. It is also important to cultivate a network of resources including access to the relevant literature and trusted, competent colleagues to whom clients outside the realm of one’s own professional competence may be referred. The following are excellent resources for those working with older adults, for the first time or the thousandth (Knight, 2004; Laidlaw & Knight, 2008; Mast, 2011; Pachana, Laidlaw, & Knight, 2010; Schaie & Willis, 2011; Scogin & Shah, 2012).

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CHAPTER

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Perspectives on Disability Within Integrated Health Care Colleen Clemency Cordes, Rebecca P. Cameron, Linda R. Mona, Maggie L. Syme, and Alette Coble-Temple

A

lthough scholarship about disability experiences and disability identity is not new, a focus on cultural competence when working with people with disabilities (PWD) is not yet common in counseling and clinical psychology training programs (American Psychological Association [APA], 2012). Definitions of disability have evolved and broadened over time, and may include medical, legal, social, or political factors. The legal definition, as articulated in the Americans with Disabilities Act (ADA; 1990), emphasizes a limitation of function, whereas the medical definition emphasizes a specific condition or pathology and its impact on activities of daily living. According to the ADA, disability is defined as “(A) A physical or mental impairment that substantially limits one or more of the major life activities of such individual; (B) A record of such an impairment; or (C) Being regarded as having such an impairment” (Yee & Breslin, 2010, p. 253). In contrast, the “new paradigm of disability” emphasizes interactions among a variety of factors in order to better represent the experiences of PWD (Pledger, 2003). This interactionist paradigm affords providers strategies for enhancing resiliency, empowerment, and well-being among clients with disabilities and invites creative and sophisticated research on the efficacy of currently available psychotherapeutic approaches for PWD in a variety of clinical settings (Olkin, 1999). Providers need to develop skills in working with PWD, in part because disability is an increasingly prevalent experience both globally and in the United States. The World Health Organization (WHO) estimates that worldwide, 15% (approximately 1 billion people) have a disability. This is an increase from

Authors’ Note: While the clinical training and backgrounds of individuals who treat and serve people with disabilities (PWD) vary substantially, the importance and practice of culturally competent service delivery does not; as such, throughout this chapter we refer to psychologists, physicians, counselors, and other medical professionals as “providers.”

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an estimated 10% in the 1970s, which is linked to the aging of the population and increased rates of chronic diseases (WHO, 2011). Estimates of the prevalence of severe disabilities are much lower, ranging from approximately 2% to 4% (WHO, 2011). Additionally, in the United States alone, 47.5 million people (21.8% of the population) reported that they were living with a disability as of 2011 (Reichard, Stolzle, & Fox, 2011). Disability is associated all too frequently with greater risk of poverty and marginalization, as well as with exposure to microaggressions, stereotypes, and stigma (Keller & Galgay, 2010; Olkin, 1999). With the passage of the Patient Protection and Affordable Care Act (commonly known as “Obamacare” or the ACA) in 2010, disability was identified as a health disparity demographic, as PWD are at greater risk for chronic health conditions such as cardiovascular disease, high blood pressure, and diabetes (Reichard et al., 2011; Yee & Breslin, 2010). Providers who become knowledgeable about the ways in which disability affects all life domains, including interpersonal relationships, sexuality, educational and occupational pursuits, and health care, will be better prepared to address the needs of this growing population in the varied treatment settings in which PWD present for care. Structural changes to health care delivery may play a role in empowering PWD, and integrated primary health care is an emerging model that promotes culturally competent service delivery. In this model, mental health providers work alongside a variety of health care professionals on a common treatment plan and shared medical records in order to promote the whole health of patients. While this approach has long been embraced by rehabilitation services, it is only now becoming more common in subacute clinics. This model of interprofessional collaboration and communication is likely to be of particular importance to PWD because they often see a variety of specialists in addition to their primary care doctors, thus placing them at risk for fragmented care (Lipson, Rich, Libersky, & Parchman, 2011). Although most providers report positive views of PWD (Strike, Skovholt, & Hummel, 2004),

many lack awareness of how health care policy and systems have historically been developed from a nondisabled perspective. The siloed care characteristic of the health care system has required PWD to navigate a complex and convoluted health care environment. The Patient Centered Medical Home (PCMH) movement, supported by ACA, has at its core five principles that can promote the health and well-being of PWD: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety (pcmh.ahrq .gov). This movement originated in the provision of health care services for children and youth with special health care needs and their families who needed to facilitate care between multiple specialty providers, but it has still not been comprehensively adopted within adult health care systems (Sawyer & Macnee, 2010). The ACA’s support of PCMH is rooted in efforts to improve patient-centered care and reduce costs across populations; PWD may be among the most likely to benefit from this legislation, as integrated health care has been identified as a way to address accessibility, stigmatization, and marginalization of PWD (Zolnierek, 2008). When providers collaborate consistently and plan and provide care within the context of an interdisciplinary team, the patient’s experience as a whole person rather than a collection of ailments becomes salient. This shift in conceptualization and approach sets the foundation for disability culturally competent health care, and the resulting benefits are both immediately practical and potentially transformative for the patient. This chapter explores the treatment of PWD in the context of integrated care, with the aim to better prepare providers to address the needs of PWD across settings. Accordingly, we review and discuss disability culture, clinical issues, and psychotherapeutic approaches to working with PWD in integrated care clinics.

DISABILITY AND CULTURE Within psychology and related disciplines, multicultural awareness began with recognition of the need to address race and ethnicity (Cross, 1971;

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Helms, 1995; Phinney, 1990). More recently, scholars have called for a comprehensive, multifaceted approach to diversity that includes disability and its interactions with other identities (Hays, 2009). The APA (2012) adopted the Guidelines for Assessment of and Intervention With Persons With Disabilities in 2011 with the goal to “conceptualize and implement more effective, fair, and ethical psychological assessments and interventions with persons with disabilities” (p. 1). These guidelines provide evidence-based standards for clinical work with PWD, including strategies for making the therapeutic setting disability sensitive, strengthening the therapeutic relationship, and gaining expertise through ongoing professional development. The guidelines are distributed across three broad areas of professional practice: (a) disability awareness, training, accessibility, and diversity; (b) testing and assessment; and (c) interventions. Whereas these guidelines provide an initial framework for discussing disability diversity, they lack specific directives to promote cultural competence among providers working with PWD. Increased attention to disability identity and professional competence will hopefully facilitate the incorporation of disability issues into training programs over time. An understanding of conceptualizations of disability is critical when working with PWD, as a PWD’s self-conceptualization may reflect one or more of these models, which in turn may influence treatment planning (Sue & Sue, 2003). Historically, disability has been understood from a moral framework, perhaps as evidence of, or punishment for, sin. It has been perceived as a test of character from which one can emerge as either deserving one’s “hardship” or rising above it to inspire others. Medical models tend to emphasize disabilityrelated diagnoses and opportunities for restoring function in order to minimize or eliminate the disability. More recently, emphasis has been placed on the social context of disability, in which nondisabled norms lead to inaccessible spaces, unavailable resources, and attitudinal barriers; disablement is created by a culture that fails to honor and incorporate differences. Individuals with disabilities can be understood to have a minority cultural experience

within an ableist cultural milieu (described further below), which in turn can lead to the development of cohesion, mutual support, and empowerment for individuals who identify as PWD (Olkin, 1999). This new paradigm emphasizes the interactions among biopsychosocial aspects of disability, highlighting a complex interplay among enabling and disabling factors. Similar to other cultural groups, those who identify with disability share a common set of values and ideals, serving to unify and fortify the group (Gill, 1991). Disability cultural values include, for example, an appreciation of the absurd and a willingness to accept help and assume interdependence (Gill, 1991). When disability is viewed as a cultural identity, it becomes a source of strength and brings PWD together, allowing for mutual support with shared experiences and common values. Identifying as a PWD, therefore, allows one to access membership in disability culture and to lay claim to the strengths and perspectives of the group. Yet disability is a stigmatized identity, and claiming membership in this group can be costly and may involve ambivalence. Deciding to identify as a PWD means consciously deciding to risk marginalization and loss of privilege, including having one’s voice discounted as a minority viewpoint. In addition, models of minority identity development often include a phase in which majority culture is actively rejected (Phinney, 1990) in favor of immersion into the minority culture; for a PWD, this may increase stress within family relationships and potentially jeopardize assistance (Olkin, 1999). Thus, claiming the strengths of disability culture through disability identity development may also involve psychological risk.

The ADDRESSING Model Disability as a cultural identity does not exist in isolation but rather intersects and influences other aspects of identity. When working with PWD, it is important for providers to be aware of the complex ways in which multiple cultural contexts shape their identity. Hays (1996) developed the ADDRESSING model for organizing and

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s­ystemically considering nine interconnected cultural influences. These factors include: Age and generational influences, Developmental and acquired Disability, Religion, Ethnicity, Social status, Sexual orientation, Indigenous heritage, National origin, and Gender. An appreciation of these intersecting identities is particularly critical when considering PWD’s potential for health risk; multiple minority status compounds a PWD’s likelihood of chronic mental and physical health concerns (Yee & Breslin, 2010). Providers working in integrated care settings must take caution to balance the demands of the fast-paced primary care clinic with the time-intensiveness of a comprehensive cultural assessment conducted in specialty mental health clinics. When utilizing the ADDRESSING model, for example, providers may glean relevant information from the medical record (e.g., age, ethnicity, gender, social status); however, they must be cautious and avoid assumptions, as membership in a particular demographic group does not ensure cultural identification with the target group. In the absence of a comprehensive cultural assessment and direct knowledge of whether a PWD identifies as such, it may be prudent to frame core disability cultural strengths as part of overall well-being rather than explicitly linking these values to disability culture. Providers should approach PWD with sensitivity and openness, while being alert for culture-linked strengths and vulnerabilities and the cultural variables that may influence clients’ goals and priorities for treatment. This will allow providers to tailor treatments in a way that affirms and integrates the strengths associated with multiple facets of identity. By understanding PWD through the lens of the ADDRESSING model, providers can more comprehensively understand their clients’ lived experiences and tailor evidence-based interventions to meet their needs. Case Example Illustrating the ADDRESSING Model. Gita is a 62-year-old Muslim woman who presents for an initial primary care appointment to assess chronic fatigue over the past 6 months. She presents to clinic wearing a hijab (veil that covers the head and chest). The provider enters into the primary care exam room to conduct an

initial assessment and is aware that the patient is complaining of chronic fatigue symptoms. As the provider looks at the ADDRESSING framework model on the top of her intake form, she notices Gita’s hijab and makes a note to make sure that she covers ethnicity, culture, and religion/spirituality during the assessment. Gita reports that fatigue symptoms began soon after being diagnosed with rheumatoid arthritis around 6 months ago. She discussed the ways that it is interfering with her role as a wife and mother and her concerns about the future. The provider inquires further about Gita’s symptoms and discovers that she has not been taking her immune suppressor medication as prescribed and had not yet followed up on physical therapy treatment. The provider normalized Gita’s frustrations with fatigue and her daily activities and began to ask her specific questions about her understanding of her condition. After ascertaining that Gita was not aware that fatigue could be a symptom of rheumatoid arthritis and that medication and physical therapy may help, the provider gave Gita specific written and verbal information on her condition. Then the provider specifically asked Gita if there were any cultural or religious/spiritual beliefs that might interfere with her participation in medical treatment. Gita noted that she did not believe that her Muslim faith had influenced her medical adherence efforts. She did note, however, that she felt that her cultural beliefs about her roles as a wife and mother were challenged when she received the diagnosis. She stated that she believed that she should be able to handle the condition and maintain her busy schedule without treatment. The provider empathized and gave her support, touching on the ways in which our belief systems can guide our health care choices and exploring values related to gender. The provider asked Gita to complete a values clarification exercise before her follow-up appointment in two weeks.

DISABILITY IN CONTEXT Over the past 50 years, there has been a series of movements in the United States to overcome the

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legal, structural, and attitudinal barriers associated with historical oppression of African Americans and other racial/ethnic minority groups, women, and lesbian, gay, bisexual, and transgender (LGBT) individuals. These movements have led to progress in the acceptance of individual differences, reducing the casual acceptance of “isms” that are pervasive in society and creating a platform to acknowledge and celebrate pride in identity. This movement has evolved more slowly within the disability community in comparison to other minority groups. Similar to the LGBT community, disability identity may not be a shared characteristic among family members, thus limiting opportunities for solidarity around disability identity and the accompanying natural transmission of cultural strengths and strategies for overcoming societal barriers. In fact, nondisabled family members may experience challenges and ambivalence in balancing the need to provide assistance with the need to support autonomy in a disabled loved one. Disability is the one group where any person can enter at any time without choice and may also be uniquely threatening to the nondisabled community, promoting distancing and a tendency to denigrate or idealize PWD. These factors may slow or limit the development of a thriving member/ ally community (e.g., LGBT community) in support of greater acknowledgment, inclusion, and civil rights. Like other marginalized groups, the experience of stigma for PWD is significant. Historically, negative attitudes expressed in reference to or toward PWD have implications that they are undesirable. While improved legal protections through civil rights laws are important strategies to reduce discriminatory experiences, negativity toward and aversion to disability continues to exist and to be expressed to PWD. When society operates from the unconscious belief that assumes that every person who is disabled wishes to be nondisabled and that being nondisabled is inherently superior to being disabled, these misconceptions fuel a culture of prejudice and oppression termed “ableism.” PWD experience microaggressive acts on a daily basis that may lead to internalized pain and oppression

(Weeber, 1999). The ultimate implication of these microaggressive acts is that PWD are deemed “less than” compared to nondisabled people. PWD who employ adaptive responses to disability stigma and ableist microaggressions are able to effectively navigate socialization and acculturation with the nondisabled population. Adaptive responses fall into four main categories: adaptive social behavior, rationalization of the ableist behavior, opportunities for advocacy, and the employment of either direct or humorous communication. Bell (2013) found that when PWD engaged in opportunities for self-advocacy, they experience less negative responses to disability stigma and microaggressions. PWD have also articulated that having allies and/or advocates is essential for developing resilience and maintaining healthy functioning. Keller and Galgay (2010) identified eight patterns of microaggressions that PWD encounter: denial of identity, denial of privacy, helplessness, secondary gain, spread effect, patronization, second class citizenship, and desexualization. PWD who experience microaggressions in any of these domains may feel discounted, devalued, minimized, and oppressed. Relational/attitudinal microaggressions (Coble-Temple & Bell, 2013) are verbal, nonverbal, or behavioral responses encountered by PWD when interacting with people who identify as nondisabled. The messages conveyed by the nondisabled individual, whether intentional or unintentional, are negative, hostile, or demeaning messages about disability or PWD and often manifest through what is included or omitted in communication. For example, a provider who typically asks new clients about their sexual history but does not include those questions when conducting an initial session with a PWD may hold attitudes consistent with the myth that PWD are asexual. Communication style plays a fundamental role in the experience of microaggressions for PWD. Research demonstrates that PWD are more likely to encounter subtle shifts in tone of voice (Bell, 2013). This can range from a slow, drawn-out, patronizing tone to one of a loud, exaggerated excitement. The impact of these relational microaggressions leads

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to ruptures in the relationship between able-bodied people and PWD, potentially damaging therapeutic relationships and leading to more adverse outcomes. Providers must increase their awareness of the potential for their own behavior to contribute to the dynamics of microaggressions in both personal and professional encounters with PWD. Providers who work in integrated primary care should make an effort to educate interdisciplinary team members regarding the ramifications of microaggressions for clients and family members as well as colleagues. As noted above, the fields of psychology and medicine have been slow to recognize, develop, and incorporate disability culture training for all practitioners. Under ACA, new funding initiatives in hospitals and educational institutions are aimed at enhancing disability competence through education with the ultimate goal of decreasing health care disparities for PWD (Yee & Breslin, 2010). However, these programs have not yet been developed and implemented, nor are they explicitly required. As a result, PWD may be inadvertently marginalized by providers who fail to contextualize and conceptualize the experience of the PWD (Strike et al., 2004). Culturally competent providers working in integrated care settings are in the best position to serve as advocates and educators among their professional peers in order to enhance accessible services for PWD.

RELEVANT CLINICAL CONCERNS As definitions of health have shifted from a focus on disease toward quality of life, researchers have documented the need for providers to serve in advocacy roles in order to promote whole person health care (Krahn & Campbell, 2011). In order to be effective advocates, providers should be attuned to a myriad of biopsychosocial factors that influence quality of life among PWD. PWD are at risk for mental health concerns, yet despite significantly higher rates of mood disorders and decreased quality of life, PWD access treatment services at

lower rates than their nondisabled peers (Evans et al., 2012). In the United States, primary care has become the de facto mental health system, with PWD often presenting to physicians with comorbid anxiety and depression. Given the challenges PWD frequently face in accessing services, the disability community and PWD caregivers have increasingly advocated for “one stop shopping” for service provision via interdisciplinary PCMH (Chapman & Tait, 2010). When providers work side by side in a PCMH setting, there is the potential to reduce the overreliance on psychotropic medications as the first-line intervention for behavioral concerns. Providers should be aware of inequities in access to intimate relationships. PWD, especially women with disabilities (WWD), are less likely to be partnered than their nondisabled peers and to report dissatisfaction with dating and relationship opportunities (Nosek, Howland, Rintala, Young, & Chanpong, 2001). Additionally, issues related to body image, sexual esteem, and internalized ableism that may impact PWD’s engagement in intimate relationships and encounters may also be salient for PWD presenting for treatment, especially in WWD (Clemency Cordes, Mona, Syme, Cameron, & Smith, 2013). Sexual well-being and body esteem have been shown to be stronger predictors of overall psychological well-being among PWD than among their nondisabled counterparts (Taleporos & McCabe, 2002). Providers should provide PWD with an opportunity to explore their sexuality and encourage opportunities for enhanced well-being by promoting intimacy and exploration of the sexual self. Women with disabilities who are partnered, however, face unique risks. For example, whereas WWD are just as likely to experience intimate partner violence (IPV) as their nondisabled peers, abusive relationships may take on a different dynamic for WWD in the form of withholding personal assistance, medical care, transportation, or adaptive devices (Nosek et  al., 2001). Additionally, WWD are less likely to leave the abusive partner due to significant challenges accessing existing programs aimed at decreasing violence in the home and/or due to fear of losing

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their children to their able-bodied abuser (Nosek et al., 2001). Given that women experiencing IPV commonly report for medical services related to the ramifications of their abuse, providers working within integrated health care systems should routinely ask WWD about safety to ensure that IPV is not overlooked and be sensitive to the dilemmas that a male or female PWD may face in relation to IPV. This may include utilizing adapted screening and assessment protocols that are sensitive to the unique needs of PWD, without the PWD’s partner or caregiver(s) present. Inequities with regard to employment and socioeconomic status can also be clinically significant for PWD. While the passage of ADA has led to increased access to employment opportunities, PWD are 5 times more likely to be involuntarily unemployed or underemployed than their nondisabled peers (Turner & Turner, 2004). As a result, more than 40% of PWD with activity limitations live with an income level at or below 200% of the poverty line (Altman & Bernstein, 2008). Lack of employment has been linked to increased risk of depressive symptoms among the general population; with PWD, the relationship between disability, unemployment, and depression is even more profound (Turner & Turner, 2004). Researchers have explained these findings by arguing that employment may be more closely tied to self-worth and self-esteem for PWD than their nondisabled peers (Turner & Turner, 2004). Large national studies have repeatedly highlighted increased rates of chronic health conditions among PWD compared to their nondisabled peers (Reichard et al., 2011). These disparities may be the result of a variety of factors, including difficulty accessing care, environmental factors, biological underpinnings and ramifications of disability, social circumstances that increase a PWD’s vulnerability to comorbid conditions (Vander Ploeg Booth, 2011), and/or provider bias and prejudice. In a national study of WWD, 31% noted that they had previously been denied reproductive health care by a physician solely due to their disability status (Nosek et al., 2001). Additionally, PWD are less likely to access preventative health services,

including mammography, sexually transmitted infection and cancer screenings, and dental care (Hames & Carlson, 2006; Reichard et al., 2011). Health disparities noted among PWD may, in part, be due to health behaviors such as physical inactivity, cigarette smoking, and alcohol use; these can be addressed by health care providers who are sensitive to disability-related constraints. PWD are more likely to be obese than their nondisabled peers, with the greatest risk for elevated body mass index (BMI) among individuals with mobility difficulties (Altman & Berstein, 2008). Although the relationship between disability and excess weight is well established, the causal nature of this relationship is not fully understood. A number of factors may contribute to higher rates of obesity among PWD, including limited ability to purchase and prepare healthy foods, and mobility limitations that may inhibit an individual’s ability to engage in cardiovascular exercise. Efforts to address weight concerns among PWD need to take into account the factors that are unique to disability in developing realistic and supportive weight management interventions. PWD, particularly those with severe and persistent mental illnesses, are significantly more likely to self-report tobacco use, with roughly 40% of PWD between the ages of 18 and 65 identifying as active smokers (Altman & Berstein, 2008). Given that tobacco use may contribute to the onset or exacerbation of disability, providers are encouraged to engage PWD in tobacco cessation efforts when possible. Finally, there is evidence to suggest that individuals with acquired disabilities such as traumatic brain and spinal cord injuries have higher rates of alcohol and other substance misuse as compared to nondisabled individuals (Altman & Bernstein, 2008), suggesting that providers should screen for and be prepared to treat substance misuse. Overall, providers working in integrated care must take these factors into consideration and modify interventions to be disabilityconscious, recognizing that lifestyle-related health disparities noted among this population may involve environmental, social, and structural factors unique to PWD.

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CULTURALLY COMPETENT TREATMENT

Disability Affirmative Therapy (DAT)

Mental health professionals utilize evidence-based (APA Presidential Task Force, 2006) and culturally responsive practices (Hays, 2009; Whaley & Davis, 2007). Thus, treatments should include the integration of the best available treatments with clinical expertise and a consideration of the cultural context and preferences of the client. The lack of specific training in disability (Artman & Daniels, 2010; Olkin & Pledger, 2003) makes living up to these standards more challenging. In addition, currently there are no evidence-based practices (EBPs) specific to clients with disabilities. The available treatment studies on PWD typically target a few specific disability groups and underrepresent the heterogeneity of PWD. However, there are more resources and guidelines becoming available to providers outlining how the principles of existing effective treatments can be applied to clients with disabilities. This integration requires the clinician to be creative and flexible—key disability cultural values—and to conduct therapy from a disabilityaffirmative approach (Olkin, 1999). Implicit models of disability that affect our therapeutic effectiveness with PWD need to be explored as a means of self-assessment and as the first step toward embracing disability cultural competence. Awareness of various models of disability can assist with challenging personal frameworks. In addition, being aware of disability in our interactions with clients and challenging our own ableist values will increase our effectiveness as assessment and treatment providers. For example, we might be more likely to ask questions that would lead to discussion of a hidden disability or to acknowledgment of a family member with a disability. Being available to affirm and value our clients’ identities and to advocate with them directly and/or to support their own empowerment strategies when they experience barriers is critical. As a result, PWD may experience profound benefits through increased trust in their providers, greater self-efficacy, and greater ability to effect practical change.

Disability affirmative therapy is a metatheoretical or contextual approach, similar to feminist therapy, that adopts a disability-positive orientation and poses a culturally centered framework within which the clinician can apply specific treatments for psychological concerns (see Olkin, 1999, 2007). DAT is predicated on the mental health provider working from a social model of disability (described above) and includes examining personal beliefs and values, integrating a disability-affirmative perspective into clinical work, and advocating for and empowering clients. The disability-affirmative clinician embraces the values of disability culture, acknowledges marginalization and environmental barriers, seeks information about the client’s specific disability, researches local resources, and balances empowerment of the client with the provider’s own advocacy efforts. For the provider working in integrated care settings, this may mean acknowledging that the traditional 15-minute medical visit is grounded in nondisabled assumptions, and services may need to be expanded and/ or adjusted in order to ensure that a PWD’s needs are met within the primary care milieu.

Evidence-Based Practices Established, evidence-based treatments (e.g., cognitive–behavioral therapy [CBT]) can be integrated into a disability-affirmative framework, allowing the clinician to treat individual psychological concerns while also addressing social and political factors affecting functioning (Mona et  al., 2009). Embedding these traditional techniques within a disability-affirmative framework and taking a collaborative approach to treatment planning is key to providing culturally competent care for PWD. Treatments that have been found effective for specific disability groups include CBT, behavioral techniques (e.g., relaxation training, mindfulness), motivational interviewing, life skills training, psychoeducation, and several family-focused therapies for individuals with

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developmental disabilities (Perry & Weiss, 2005). For instance, a review of studies concluded that CBT is effective for individuals with a spinal cord injury with depression, anxiety, and adjustmentrelated concerns (Mehta et  al., 2011). There is also emerging evidence supporting the use of CBT and mindfulness for mood and behavioral issues among individuals with mild to moderate intellectual disabilities (Harper, Webb, & Rayner, 2013; Hassiotis et al., 2013). Although research is growing for these select groups, many disability groups remain unrepresented in the literature. Work needs to be done to determine treatment effectiveness for specific treatment strategies among more heterogeneous groups of PWD. Many or all of the evidence-based practices described above can be adapted and delivered in an integrated primary care clinic. A flexible approach to tailoring established treatments will allow providers to accommodate PWD’s needs and preferences. For example, when approaching behavioral tasks such as increasing physical activity, the integrated care provider may take a graded-task approach, breaking down activity prescriptions into manageable steps that allow for a sense of mastery to be reached while providing opportunities to anticipate and problem solve for any challenges ahead (Mona, RomesserScehnet, Cameron, & Cardenas, 2006). Treatment approaches that promote access to care, such as telephone-based counseling, have also been found effective for individuals with acquired disabilities (Dorstyn, Mathias, & Denson, 2011). Telemental health services, along with other electronic means of communication (e.g., patient portals, secure e-mail, etc.), are increasingly commonplace in integrated clinical settings to facilitate engagement, provide services in a disability-affirmative manner, and enhance patient outcomes. The APA’s Guidelines for Assessment of and Intervention With Persons With Disabilities (2012) underscore the collaborative nature of therapy— key to a disability-affirmative approach and central to the provision of integrated care. The provider should co-construct therapy with the client, including the goals, interventions, and structure of the

sessions (e.g., length and frequency of sessions; APA, 2012), being mindful of the tendency to focus treatment on pathology and distress instead of allowing the PWD to articulate goals, which may be related to increasing well-being (e.g., selfefficacy) or supporting positive health behaviors. Interventions for PWD may also include increasing self-determination and empowering the client to advocate for her or his needs. The provider supports these efforts by also advocating for the PWD’s wishes and involving them directly in the process of securing resources and services (Gill, Kewman, & Brannon, 2003). Providers working in integrated care settings should be attuned to the power differentials inherent in medical settings, wherein medical providers are commonly seen as the expert in charge of prescribing treatment. This dynamic runs contrary to the disability-affirmative approach, and providers should be prepared to work collaboratively with physicians and other care team members to ensure that PWD are appropriately engaged in their health care and health-related decision making.

CASE ILLUSTRATION The following case illustrates the role of a culturally competent mental health provider working in an integrated primary care clinic: Robert is a 32-year-old Filipino man who seeks treatment due to concerns about his sexual health. Robert, a man who has lived as a double below-the-knee amputee for the past 10 years, discloses to his PCP that he is sexually active with both men and women. Robert has many questions about the degree to which being sexual with both genders is “normal” in addition to wanting to seek resources on support groups that focus on bisexuality and other alternative sexual practices. The PCP requests that the mental health provider intervene early in this visit. The mental health provider is introduced to Robert via warm handoff, wherein the PCP introduces the provider and describes the reason for referral in front of Robert. Once the PCP leaves the exam room, the provider asked Robert to elaborate on the questions that he had asked his

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PCP. Robert noted that he had been attracted to both genders all of his adult life but only recently began experimenting sexually with men. He stated that he was enjoying these new experiences but was concerned about how “normal” it might be to enjoy sexual experiences with both genders. The mental health provider provided empathic understanding and support and gave Robert information about the ways in which sexual orientation and sexual attraction fall on a continuum. In order to ensure provision of culturally competent services, the provider asked Robert specifically if any of his cultural, religious/spiritual beliefs, and/or gender beliefs were in conflict with his decision to be sexual with both genders. Robert talked about his Catholic upbringing and stated that although he does not currently adhere to a Catholic belief system on sexual orientation and behavior, it is “very difficult” to abandon the beliefs altogether. The provider normalized Robert’s experiences and directed him to web-based psychoeducation on perspectives on sexual orientation and behavior. He encouraged Robert to engage in a self-assessment exercise that would assist him to better define his current beliefs on sexual health. Robert requested to meet with the provider for a follow-up when he returns to see his PCP.

CONCLUSIONS Given that rates of disability continue to rise throughout the United States and worldwide, it is increasingly evident that providers must be positioned to address the whole-health needs of PWD

in a culturally competent manner. Whereas seminal legislation such as ADA and ACA have assisted in breaking down barriers to PWD’s well-being, many providers still lack the requisite knowledge, skills, and abilities to effectively work with this population. Providers are encouraged to explore their own assumptions about disability and to seek out opportunities for continued education and supervision to maximize their disability cultural competency. For instance, additional training on the medical aspects of disability can directly serve the client’s needs and enhance collaboration with medical providers who are part of the health care team. Additionally, in an evolving health care system, wherein services are increasingly provided in primary care and/or other medical systems, providers must be prepared to serve PWD outside of the traditional specialty mental health care system. Finally, providers must be attuned to their emerging role as patient advocates and facilitators of advocacy, fostering improved mental, behavioral, and physical outcomes for PWD through systematically addressing social, environmental, and legislative barriers to care. In an integrated care setting, this may include educating care team members on issues such as creating accessible offices, addressing risk factors for chronic physical and mental health concerns, and improving person-centered care. When delivered effectively, collaborative approaches to integrated behavioral and primary health care have led to increased provider knowledge and competency, improved patient access to services, and greater consumer self-efficacy among PWD (Mastal, Reardon, & English, 2007).

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CHAPTER

40

Disaster Survivors Implications for Counseling Beth Boyd and Hitomi Gunsolley

T

he devastating impact of disasters has been felt across the United States and around the world in what seems to be an ever-increasing frequency and intensity over the last decade. In 2012 alone, 357 natural disasters occurred in 120 countries worldwide, 9,655 people were killed, an estimated 124.5 million were affected by disasters, and economic damages from disasters are estimated at $157 billion (Guha-Sapir, Hoyois, & Below, 2013). Although the number of people killed and affected by disasters in 2012 fell far below the average of 2002–2011 (107,000 killed and 268 million affected), economic costs soared higher than ever before. These disasters included floods, droughts, storms, earthquakes, and wildfires. Eight out of the 10 countries with the most disaster-related deaths in 2012 are classified by the World Bank as lowermiddle income or low-income economies. In the United States, as in other developed countries, the death tolls due to disaster are smaller, but the economic costs continue to soar. In 2012, Hurricane Sandy alone caused an estimated $20 to $50 billion in damage (Ferris, Petz, & Stark, 2013). In the immediate and long-term aftermath of a disaster, the experiences of ethnic minority and other marginalized communities are often significantly different than the experience of communities who are more identified with the mainstream culture (U.S. Department of Health & Human Services [USDHHS], 2003). Marginalized communities may exist very separately from the mainstream (e.g., Native American reservations) or may be embedded within a larger population (e.g., Vietnamese community in Biloxi, Mississippi). These communities have often experienced multiple traumatic events over prolonged periods of time, have learned to function to some extent within that context, but are not immune from the disorienting effects of larger, more discrete disasters. In fact, the disaster may serve to magnify predisaster conditions, resulting in postdisaster experiences that are far different from the mainstream of society. If disaster recovery workers are unaware of these differences, services that are intended to aid in the recovery process will fall far short at best and may even add to the traumatic stress of the disaster. This chapter begins with a general discussion of types of disasters and the effects they have on individuals and communities. An alternative view is proposed for understanding the experience of ethnic minority and other marginalized communities in the aftermath of a disaster, followed by a discussion of the role of mental 411

health professionals in providing culturally responsive disaster mental health services to marginalized communities.

TYPES OF DISASTERS The United States has experienced a large number of natural, technological, and conflict-related disasters in the last two decades, exposing more people than ever before to the effects of traumatic stress. Natural disasters are those events that occur as part of the natural world. These include severe weather events (e.g., hurricane, tornado, flood, tsunami, winter weather, or extreme heat), earthquakes, volcanic eruptions, wildfires, or landslides. In the time period from 2001–2011, it is estimated that 89,843,822 people in urban areas were affected by natural disasters worldwide (however, this does not include numbers from the Japan earthquake; Provost, 2011). These types of events are generally seen by survivors as unavoidable “acts of God.” Relative to human-made events, which are often seen as avoidable, the effects of natural disasters are sometimes easier for people to accept. On the other hand, some people may see natural disasters as evidence that the world is a dangerous and unpredictable place (Yates, 1998). Human-made disasters (sometimes designated as “technological” or “conflict-related”) are categorized by the Centers for Disease Control and Prevention (2013) as due to bioterrorism, chemical emergencies, radiation emergencies, or mass casualty incidents. Bioterrorism attacks are deliberate releases of virus bacteria or other germs (spread through air, water, or food) with the intent to cause illness or death to people, plants, or animals (e.g., U.S. anthrax attacks of 2001). Chemical emergency refers to the accidental or deliberate release of a chemical that has the potential to cause harm to people’s health. Industrial accidents or the crash of a vehicle carrying hazardous chemicals are the most common examples of this kind of disaster, but it could also be the result of a deliberate act (e.g., Ghouta, Syria, chemical attack of 2013). A radiation emergency occurs when people are exposed to high levels of radiation

that may result in death or serious risks to health (e.g., Fukushima nuclear power plant meltdown in 2011). A mass casualty incident simply refers to situations where large numbers of injuries and/or deaths occur. Common examples of mass casualty disasters include transportation industry crashes (e.g., airplanes, trains, multiple vehicle car accidents), bridge or building collapses, fires, and explosions. Many disasters have both a natural and a human-made component (e.g., Japan earthquake, tsunami, and damage to the Fukushima nuclear power plant in 2011). Survivors and others affected by human-made disasters often feel that the event was preventable, feel betrayed by fellow human beings, or become focused on affixing blame for the event. When these events are followed by prolonged investigation and/or litigation, healing for survivors may become more complicated (DeWolfe, 2000).

INDIVIDUAL REACTIONS TO TRAUMATIC STRESS Because of the large number of mass casualty events that have occurred in the most recent decade, many people are now familiar with the normal and expected responses to the traumatic stress of disaster (DeWolfe, 2000; USDHHS, 2005). People exposed to traumatic events are affected in all areas of their lives and are seen as having “normal reactions to abnormal situations” (DeWolfe, 2000, p. 13). Traumatic stress affects people emotionally (e.g., denial, fear, anxiety, anger sadness, guilt), cognitively (e.g., disorientation, confusion, limited attention span, memory problems, difficulty setting priorities), behaviorally (e.g., increased or decreased activity, sleep, and appetite, difficulty communicating, changes in job or school performance, hypervigilance, increased use of substances), physiologically (e.g., increased blood pressure, respirations, and heartbeat, stomach distress, headaches, muscle aches, tremors, exaggerated startle response, fatigue, tunnel vision), and spiritually (e.g., feeling the world has turned upside down, loss of a sense of meaning, crisis of faith).

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People may experience reactions in one or any combination of these domains, but for most people who have adequate psychosocial support, these reactions will resolve without the need for specialized mental health treatment. Characteristics of a disaster that may have an impact on ability to recover include intensity of the impact, the proportion of the community that has sustained personal losses, potential for recurrence of other hazards, amount of change in survivors’ cultural lives and routine activities, and the types and extent of losses sustained by survivors (Bolin, 1985; USDHHS, 2003). Although the individual expressions of traumatic stress differ widely across cultures, some reactions are found to be fairly consistent and include •• concern for the basic survival of self and loved ones, feelings of grief over the loss of loved ones and loss of valued and meaningful possessions, and the experience of fear and anxiety about safety of self and loved ones; •• sleep disturbances, including nightmares and imagery from the traumatic event; •• concerns about relocation; and •• a need to feel one is part of the community and its recovery efforts.

COMMUNITY REACTIONS TO TRAUMATIC STRESS Disasters are not just individual events; they are also community events. Communities also experience the effects of traumatic stress following a disaster (Hobfall & deVries, 1995; Williams, Zinner, & Ellis, 1999). There may be a communal experience of shock, disbelief, grief, or anger (emotional), disorientation (cognitive), unconstructive behaviors (behavioral), and struggle to make sense of what has happened (spiritual; Boyd, Quevillon, & Engdahl, 2010). Ideally, a community can come to see itself as a stronger, more cohesive, resilient version of itself. But this depends in large part on the degree that interventions contribute to making the event manageable, whether those resources are sufficient to the need, and whether the community can successfully reframe the traumatic event

into a challenge that can be successfully overcome (Williams, Zinner, & Ellis 1999). After an in-depth analysis of the multiple definitions of resilience, the Community and Regional Resilience Institute (CARRI, 2013) developed the following definition of community resilience: “Community resilience is the capacity to anticipate risk, limit impact, and bounce back rapidly through survival, adaptability, evolution, and growth in the face of turbulent change” (p. 10). When people have to be evacuated and relocated from their homes and communities, important community ties, kinship systems, and social support systems can be seriously damaged, leaving people with inadequate support systems at the time when they need them the most (Erickson, 1976; Laborde, Brannock, & Parrish, 2011). This presents a serious threat to a community’s ability to be resilient. As quickly as possible, the reestablishment of a sense of community (even within a shelter or temporary location) can help people to regain a sense of control and stabilization within their social environment, even while acknowledging that this context may be forever changed (Milligan & McGuinness, 2009). Successfully reconnecting survivors with their community is an important source of identity, meaning, and resilience, and often depends on strong community leadership. For example, just hours after Oklahoma City was hit by an F5 tornado in May of 1999, community leaders helped affected residents to reframe the disaster by reminding them of the way the community previously came together and provided communal support following the bombing of the Murrah Federal Building in 1995 (Boyd et al., 2010). Promoting community resilience and wellness can speed the community healing process. But what will be seen as healing is inextricably linked to the historical and cultural identities of the affected people (Landau, 2007; Walsh, 2007). Just as individuals with a history of previous unresolved losses often have a more difficult time recovering from disaster, a community with a history of similar losses will struggle as well. For example, Williams, Zinner, and Ellis (1999) emphasize that for those DISA STER SURVIVORS

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who seek to provide help with healing, it is critical to understand •• the history of loss in the community, •• how those losses were perceived (both within and outside of the community), •• the overall impact of the losses within the community, •• what actions were helpful (or not helpful) to the community, •• what legacy of loss has remained in the community since the disaster, and •• how the community has grown or found meaning in the event. (p. 15)

When a community is scattered by dislocation, the resulting disruption in the foundation of home and identity leads to feelings of helplessness, isolation, and loss of sense of community and cultural identity (Laborde et al., 2011). This is reflected in the many examples of African American families relocated to historically White neighborhoods following Hurricane Katrina, resulting in the loss or disruption of family and support systems, cultural resources, and sense of place and belonging.

DISPROPORTIONATE IMPACT No one who has experienced a disaster is untouched by it, but the impact of disasters is often disproportionately harmful to ethnic minority and other marginalized communities (Marsella, Johnson, Watson, & Gryczynski, 2008). People from diverse cultures, individuals with limited proficiency in the mainstream language (e.g., English in the United States), individuals with disabilities, the homeless, the elderly, children, and those who are transportation disadvantaged often have additional risk factors that may cause them to experience disproportionate effects and which may have a negative impact on their ability to recover from a disaster (National Biodefense Science Board [NBSB], 2008). People living in rural areas, particularly those marginalized by poverty or ethnocultural status, and survivors of political repression, genocide, or displacement may also have a heightened risk of additional risk factors (Institute of Medicine,

2003). In addition to this higher risk for negative effects, these vulnerable populations are also less likely to have the available time, energy, and personal resources necessary to adequately recover from a disaster. They are more likely to have difficulty securing adequate assistance to help in the recovery process (Bolin & Bolton, 1986). Disasters, regardless of type, are detrimental to the existing protective mechanisms of social groups and tend to exacerbate preexisting tensions and problems with social injustice and inequality (Inter-Agency Standing Committee [IASC], 2007). The most economically or culturally marginalized communities are at greatest risk for disruptions in the healing process after a disaster occurs (Cox & Perry, 2011). These communities are often less prepared, have fewer resources available for help, are more likely to suffer devastating effects, and experience a much slower recovery process overall (Laborde et  al., 2011). When disaster response personnel lack adequate knowledge, awareness, or skills to respond to the specific cultural and language needs of diverse communities, further damage may be done. This was painfully clear in the aftermath of Hurricane Katrina in 2005 but is certainly not a new phenomenon. In a review of the literature on natural disasters, Fothergill, Maestas and Darlington (1999) found that racial and ethnic minority communities are more vulnerable to disaster, less likely to have received disaster education, often left out of preparation activities, have less trust in official warnings, and are disproportionately impacted (both physically and psychologically) by natural disasters. It is not surprising, then, that these communities often have greater difficulties in the recovery process due to economic factors (e.g., lower income, fewer savings, greater unemployment, less insurance), less access to communication channels and information, differences in language, and experience of discriminatory practices. The authors point out that the kind of marginalization in disaster experienced by racial and ethnic minority communities was present in every phase of disaster and cannot simply be explained by differences in economic resources and power. The evidence of cultural ignorance,

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cultural insensitivity, and racial isolation and racial bias in housing, information dissemination, and relief assistance exposed in the review of previous studies is difficult to ignore and has continued to be reported in disasters since that time (Andrulis, Siddiqui, & Purtle, 2009). One example of the kind of insensitivity and marginalization mentioned above is the way in which media attention can become a critical resource or a source of damaging information following a disaster. Media coverage of major disasters often results in millions of dollars in donations to humanitarian aid organizations for the benefit of affected people and communities. For example, one year after Hurricane Sandy’s landfall on the U.S. northeast coast, the American Red Cross reported that they had received $308 million in donations for affected people (American Red Cross, 2013). This kind of attention can be critical in providing public awareness and securing needed resources. However, ethnic minority communities seldom receive the kind of media attention that is often seen in more affluent areas. For example, six federally recognized Native American communities and several smaller unrecognized tribes along the Gulf Coast were affected by Hurricane Katrina (Indianz.com, 2005). It is estimated that 4,500 United Houma Nation people lost everything they owned, and another 5,000 to 6,000 Native people were left homeless after Hurricane Rita (which occurred 4 weeks after Hurricane Katrina). These facts were not covered in the mainstream media, were largely unknown by the general public, and tribes received little help from governmental agencies or humanitarian aid organizations. Help that was received came primarily from other tribes and Native organizations across the country. As much as media attention can be crucial to attaining needed resources, it can also have an extremely damaging impact on communities where people are misunderstood. Again, Hurricane Katrina provided numerous examples of a negative light being cast on the actions of African American survivors in New Orleans, Louisiana. For example, African American survivors were characterized as “looters” in the aftermath of Katrina while White

survivors were characterized as “finding food and supplies.” This kind of media attention has a devastating effect on the public perception of an already marginalized group. One can only speculate on the impact such perceptions have on the ability of targeted groups to adequately recover from the effects of disaster.

LONG-TERM TRAUMA For many marginalized communities, the current disaster is not the first event to stress the community resources. Some communities have had a long history of resource loss, dislocation, discrimination, isolation, and lack of access to outside support and resources. While previous experience of traumatic stress may make an individual or a community stronger and more able to survive a new event, marginalized individuals and communities are less likely to have received adequate help in the past and consequently are less likely to be thriving when a new disaster occurs. In many diverse communities, there is a greater likelihood that the long-term effects of poverty, discrimination, unemployment, and oppression have had a traumatizing effect even before the “disaster” occurs. Similarly, when a disaster continues to have an impact long after the actual event has occurred (e.g., survivors of the Japan earthquake and tsunami are still living in temporary shelters 3 years later), it is important to understand the ways in which individuals and communities continue to suffer beyond the actual occurrence of the identified disaster. Some marginalized communities experience historical trauma—the cumulative emotional and psychological wounding over the life span and across generations (Brave Heart & De Bruyn, 1998). For example, Native American people have sustained many generations of traumatic losses, including land, culture, and language, while traditional ceremonial ways of grieving and healing were outlawed until 1978. This has resulted in high levels of substance abuse, suicide, depression, anxiety, low self-esteem, anger, difficulty recognizing and expressing emotions, and difficulty recognizing unresolved historical grief (referred to as the DISA STER SURVIVORS

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historical trauma response). When a disaster occurs on top of this cumulative and intergenerational traumatic stress, the effects of the disaster are magnified and multiplied. Consequently, help to the community in the form of disaster relief services hardly scratches the surface of the wounds that need to be healed. To make the situation worse, the specific cultural lens of Western psychology leads one to “diagnose” and look for “disorders.” When helpers come from outside the community and do not understand the many ways in which the community is experiencing and expressing the historical trauma response, the community may be seen as “pathological” rather than “wounded,” or “grieving,” or suffering from inequalities. When a community has had these kinds of previous experiences with outside “helpers,” it becomes suspicious of help systems, distrustful of outsiders, and unlikely to ask for help in times of crisis. In return, those on the outside may come to blame the community for its own social problems and overlook the enormous social injustices and historical trauma that have taken place over time and across generations. The interaction of these processes is what has marginalized the community in the first place. In order to counteract these potentially damaging perspectives and actually be of help in the aftermath of disasters, disaster mental health professionals will need to completely change the way they see and understand these communities.

OPPORTUNITIES FOR HEALING Traumatic events always bring with them new opportunities for healing. However, in order to recognize these opportunities for healing and act in truly responsive ways in the face of a new disaster in an already marginalized, previously traumatized community, the community must be understood in the context of the long-term, cumulative traumatic stress it has experienced. To do this, it may be useful to selectively examine the literature on individual trauma response. There has been recognition for some time that individual survivors of repeated and prolonged childhood abuse, neglect, or other traumatic experiences do not fit neatly within our

current system of diagnosis (Courtois & Ford, 2009). The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013), diagnosis of posttraumatic stress disorder (PTSD) is not sufficient to account for or guide the treatment of people with these complex traumatic stress reactions. Hermann (1992) proposed the existence of a complex traumatic stress disorder in individual survivors of prolonged and repeated traumatic stress as a more appropriate way to understand how the experience of ongoing trauma can change the developmental trajectory of a child. Hermann (1992) noted that children who had experienced prolonged and repeated abuse as young children seemed to exhibit specific symptoms (e.g., somatization, dissociation, dysregulation of information processing, attention and emotions, relational disturbance, and selfalienation) that were (a) in addition to those seen in PTSD and (b) seldom seen in those who had experienced a single, acute traumatic event. The precipitating events were most often human made, perpetrated by someone with a dominant role over the child, and resulted in the child feeling unprotected, neglected, betrayed and/or blamed for the trauma. Further, these experiences had a significant impact on the future emotional, cognitive, physiological, behavioral, and spiritual development of the child. Hermann (2009) emphasized that complex traumatic stress reactions have two important aspects: (a) they are embedded in a larger social structure which allows the abuse or exploitation of a subordinate group and (b) they are relational and take place when the victim is under the power of the perpetrator. This understanding of cumulative childhood trauma has led to the development of specific ways of treating those who have experienced prolonged and multiple traumatic events (Courtois & Ford, 2009). For both children (Ford & Cloitre, 2009) and adults with childhood experiences of prolonged trauma (Courtois, Ford, & Cloitre, 2009), these approaches generally focus on recognizing areas of strength and resilience. Individuals are reinforced for having survived their circumstances, despite being in the relative helpless position of being a

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child. Group approaches are especially helpful, as even those who are suffering are called upon to provide support for each other, and in that process, discover that they have something important to contribute. This helps people to put words to their experience, understand that they are not alone, reach out to support those around them, and rebuild trusting relationships. It is considered empowering for people to take part in their own healing process, and the importance of developing a trusting and truly collaborative treatment relationship is emphasized. Treatment approaches generally include a three-stage approach with the following elements (Hermann, 2009): 1. establishing a sense of safety, 2. finding positive meaning in the trauma, and 3. establishing or reestablishing social connections and natural systems of support. (pp. xv–xvi)

COMPLEX TRAUMATIC STRESS AT THE COMMUNITY LEVEL It may be useful to conceptualize communities that have experienced prolonged and multiple traumatic events as experiencing a form of “complex traumatic stress.” In many ways, the repeated and ongoing exposure to traumatic stressors at the community level can alter both the structure and the functioning of that community and its ability to be resilient in the face of disaster. On a basic level, these communities have already experienced serious losses of resources and often do not have access to the resources necessary to make a successful recovery (Hobfall, 1998). But beyond that, the event of new disaster and its resulting loss of life, property, and safety will likely both trigger and multiply the experiences of previous traumatic events or processes (Vogt, King, & King, 2007). As a community reexperiences all of the traumatic stress of old and new events, it can become overwhelmed, paralyzed, and stuck in old patterns of behaving, relating, processing information, and understanding itself. For those who seek to help, it is critical to understand that this is not a discrete disaster event; it is a situation

that is overlaid on a picture where historical and/ or intergenerational trauma already exists, where social injustices and inequalities occur, and where loss of important sociocultural resources have already taken place. Most often, the community is functioning, with inadequate resources and in the face of multiple stressors, but the system is fragile and vulnerable to additional adversity. When a disaster-affected community is already showing the effects of prolonged and repeated traumatic stress, it is not enough to simply offer disaster recovery-related services. The process of healing will be similar to that of the individual who has experienced complex traumatic stress reaction. This sort of approach actually fits quite well with the basic disaster mental health principle that trauma is a process, not an event (USDHHS, 2005). However, potential helpers will need to fully embrace this concept to remember that the community is experiencing more than the effects of the current disaster. For example, simply reassuring people about fears of tornados will not be adequate because those fears actually trigger many other fears that will likely not be apparent to one who is unfamiliar with the history and reality of the community. Similar to an individual survivor, in the aftermath of a new disaster, a community that has become marginalized due to long-term cumulative trauma and the resulting social issues will also need to (a) establish a sense of safety, (b) find positive meaning in the event, and (c) establish or reestablish its social connections. While it is true that everyone needs to establish a sense of safety following a disaster, this is an opportunity for those who have been marginalized to establish a new sense of safety within the larger social system (e.g., neighboring communities, the larger community within which it resides), or with outside helpers who have previously not been trusted. This sense of safety, along with being perceived by others as resilient survivors (as opposed to being seen as passive, pathologized victims), can itself facilitate positive meaning for the event. Recognizing the current crisis as an opportunity to establish or reestablish meaningful social connections both within and between the marginalized community and the DISA STER SURVIVORS

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social structures around it can have a far-reaching impact on community resilience. In turn, this may also contribute to the overall resilience of the larger social structures to which the community belongs. This kind of healing requires mental health professionals to be knowledgeable about the effects of disaster, able to see the larger context of the community and the strengths that have sustained it, willing to act outside of their usual roles in order to promote social justice and transformative change in the community, and the skills to be truly culturally responsive. Figure 40.1 illustrates the effects of disaster on a marginalized community. Area A refers to the complex array of traumatic stressors

and the resulting effects of those stressors on the social system before the disaster occurs. In Area B, the disaster acts as a multiplier, rather than a discrete event, triggering and multiplying the effects of the previous traumatic stress. Area C shows that exposure to disaster triggers the previous experiences and adds new traumatic stressors—but also brings opportunities for transformative change. Culturally responsive disaster responders understand the community as “grieving” or “wounded” rather than “pathological” and seek to empower the community, focus on the strengths that have sustained it, and support local cultural resources to engage the natural healing process.

Figure 40.1  Effects of Disaster on Marginalized Communities Area B

Area A

Area C

Marginalized Communities MULTIPLIER Historical Trauma Response

Historical Trauma Response

Social Injustice Inequalities, Poverty, Discrimination

Social Injustice, Inequalities, Poverty, Discrimination

Loss of Resources DISASTER Vulnerable System

Loss of Resources Additional Grief and Loss, Financial Struggle, Instability of System Vulnerable System

Area D Culturally responsive services • Support local cultural resources • Recognize local knowledge • Develop collaborative relationships • Develop sense of safety • Make positive meaning of event • Re-establish social connections

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Opportunities for Systems Change Access to Resources Righting Injustice

THE ROLE OF CULTURE The kind of response discussed above will only be possible when disaster mental health providers are knowledgeable about the culture of the marginalized community and aware that, as outsiders, they may not make the correct interpretation of community reactions and behaviors. Culture frames how individuals and communities (see Area D) experience the disaster, the meaning of the event, what is considered traumatic, how traumatic stress is manifested, what is seen as help, and how the community will know it is whole again. “Help” will not be considered useful unless it is consistent with the community’s cultural understanding of what help should be, who should give it, what it should be focused on accomplishing, who should receive it first, and so on. Culture is a protective system that guides behavior, defines support, and provides the template for community recovery in times of crisis. Culture is evident in all interactions, but if we are unaware of ourselves as cultural beings, or that we approach new experiences from within our own cultural framework, we may be unable to recognize that survivors are responding from within their own cultural frameworks as well. It is crucial for helpers to remember that individuals and communities are embedded in broader social contexts that will affect every aspect of their experience of, and response to, disasters and their consequences (Hobfall, 1998). Those responding to disasters in marginalized communities must seek to understand “the importance that ethnocultural factors play in shaping the nature, meaning, and responses of people from different ethnocultural traditions to the burdens and tragedies that disasters impose upon human lives” (Marsella et al., 2008, p. 4). In order to build one’s capacity to work across cultures, attention must be given to the examination and awareness of one’s own attitudes, values, and biases in an attempt to understand the ways in which they might influence work in the context of disaster. In addition, one must seek the knowledge, skills, attitudes, policies, and structures necessary to provide support that recognizes and values the importance of culture in the lives of individuals and communities affected

by disaster (USDHHS, 2003). Work with marginalized communities, in particular, requires that helpers also have an understanding of the following: •• the importance of community to those who have been marginalized, •• the added impact of racism and discrimination, and •• the impact that social and economic inequality has on everyday life and recovery from disaster.

Providing culturally responsive disaster mental health response in marginalized communities may include stepping outside of usual roles in order to advocate for and facilitate positive social change. To this point, the destructive forces of disaster may actually create new opportunities for changing and healing the context in which survivor communities exist. Working on healing at the community level helps to ensure the cultural relevance of the work and requires that mental health professionals take a long-term perspective and keep the community at the center of the healing process by supporting local cultural resources, recognizing local knowledge, and encouraging leadership by those who understand the culture, language, and sociopolitical history of the community. Culturally responsive disaster mental health professionals understand that true community healing must come from within the community itself. This means that helpers from outside the community work to put themselves in roles where they can empower, support, partner, facilitate, and work to build local capacity. More than anything, culturally responsive mental health care must be grounded in the community’s concepts of wellness, trauma, healing, and help. The community’s natural resilience and capacity to heal itself should be recognized and supported.

INTERAGENCY STANDING COMMITTEE GUIDELINES The IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007) emphasize the importance of working with local DISA STER SURVIVORS

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cultural resources to mobilize communities following a disaster. This document provides a useful framework highlighting the essential nature of community participation, capacity building, and attention to human rights issues in disaster response. The guidelines emphasize the critical need for culturally responsive psychosocial interventions and provides action sheets with suggested activities and process indicators of success. Although the guidelines have been developed for humanitarian relief operations across the world, they provide an essential resource for working with marginalized communities in the United States as well. The IASC guidelines are particularly useful because they were developed by an international group of experts and are less bound by Western majority cultural approaches. Furthermore, they emphasize a consultative approach that respects the local knowledge of community members as well as the specialized knowledge of helpers. When disaster response comes from outside the community, it is easy for responders to misunderstand or misinterpret the behaviors they encounter. Some examples from the authors’ experiences can illustrate the need to understand reactions from a local perspective.

Example 1 A Native American community that had experienced multiple years of flooding from an overflowing river had not applied for disaster relief resources to deal with the physical and emotional impact of the flooding. Local authorities reached out to Native traditional spiritual leaders for help, and they helped to clarify that the community did not conceptualize the flooding as “disaster.” In fact, there is no word for “disaster” in the tribal language. Providing help required an understanding that the community saw the flooding as a part of the natural world. Further, the community had a relationship with the river that had a long history and a focus on maintaining a balance between the natural and unnatural worlds. Further, the flooding, which also impacted the surrounding non-Native communities, had exacerbated existing racial tensions and

the resulting social injustices. “Help” in the community meant privileging local knowledge about the impact and meaning of the flooding, working to help reinstate “balance” rather than providing “services” or “treatment,” and leveraging influence to obtain needed resources. Community leaders were supported, formal and informal helpers in the community were mobilized to provide psychosocial support, and outside helpers concentrated on building the local capacity.

Example 2 Following the earthquake and tsunami in Japan in 2011, Japanese people were often described as being compliant and orderly in their response to the disaster (CNN, 2011; Sankei Shimbun, 2011). This behavior was often characterized as “polite,” and the lack of behaviors showing panic or fighting for resources was often noted. Without knowing the Japanese cultural value on community needs over those of the individual, group harmony, and belongingness, outside helpers would not know that people acted primarily to preserve that harmony. Belongingness to the group is strongly associated with access to resources; therefore, people behaved in a manner to maintain the interpersonal harmony to ensure their access to the resources. There was, therefore, simply no need for panic, violence, or fighting for resources. While misinterpreting behaviors as polite might be seen as a “positive” misinterpretation, it is still incorrect. Helping within a community requires that perspectives and behaviors are understood within their cultural context.

DISASTER INTERVENTIONS In the aftermath of disaster, helpers must also bring specialized knowledge for providing best practices in disaster mental health and psychosocial support. Disaster Mental Health. Disaster mental health is a field of practice intended to assist disaster survivors, rescue and recovery workers, and other people affected by a disaster to develop the skills necessary

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to cope with the extreme stress that often occurs in the aftermath of a disaster. Although everyone who experiences a disaster will be affected in some way, not everyone will require formal mental health services. In fact, with adequate support, the vast majority of people can and will successfully overcome the effects of traumatic stress without the need for professional services (DeWolfe, 2000). The goal of disaster mental health intervention is to provide psychological support, information about normal reactions to disaster, and development of positive coping skills in order to prevent the negative, long-term effects of disaster, such as PTSD. Disaster mental health services differ from traditional mental health approaches because they are more practical than psychological in nature. Services are provided by professionals trained in disaster mental health response, often in nontraditional places such as shelters, food lines, churches, hospitals, morgues, and family service centers because these places are embedded in survivors’ natural communities, where they most often turn for help in times of need. If the nature of the disaster is such that survivors can remain in their homes, these services may also be provided in their homes. The assessment of one’s strengths and coping skills is the primary focus of disaster counseling, rather than past experiences or identification of pathology. Survivors are seen as capable and resilient, and in possession of a range of skills and strengths that have already led to their survival in the disaster. Counselors focus on validating the survivor’s common reactions and experiences of the disaster, helping to normalize reactions that may be quite anxiety provoking to the survivor and educating them about the possible effects on themselves, their children, their loved ones, and community. Helping survivors to reconnect to their natural support systems is also seen as critically important because these supports are the most sustainable. Psychological First Aid. The world watched as the Pentagon was attacked and the Twin Towers of the World Trade Center collapsed on September 11, 2001. Together with the hundreds of thousands of people in New York City that witnessed the

buildings fall, millions of people across the country and the world experienced the horrors of that scene and were affected by what they saw. In the aftermath, the number of affected people was far greater than the number of mental health professionals who could help. In the following years, and the advent of more large-scale disasters (e.g., Gujarat, India, earthquake, Hurricane Katrina, Indian Ocean tsunami), the Institute of Medicine (2003) and the NBSB (2008) recommended the development of a national plan for the implementation of community-based psychological first aid (PFA). Community-based PFA is a grassroots public health model for providing psychological support to the survivors of disaster. This model is provided by nonmental health professionals to family, friends, neighbors, coworkers, and students, and focuses on education regarding traumatic stress and active listening. This form of PFA also incorporates psychological support provided by primary care providers to their patients and by emergency responders to those they serve. PFA is a pragmatic nonintrusive support rather than a formal counseling intervention and focuses on providing a sense of safety, calming, self- and community efficacy, connectedness, and hope. Community-based PFA is adapted to the specific needs of each community in which it is implemented, making it a genuinely culturally responsive intervention (Jacobs & Meyer, 2006). Mental health professionals serve as (a) trainers and consultants in adapting the model to individual communities (including those with special needs and vulnerable populations), (b) supervisors of PFA networks, and (c) bridges to the higher continuum of care for those who may need a professional level of care.

CONCLUSIONS Disasters affect individuals and communities in a variety of important ways. Whether they result from natural causes or are human made, they leave a lasting impression on everyone who experiences them. A community may be particularly vulnerable because of its history of loss, access to DISA STER SURVIVORS

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resources, social injustices and inequalities, and ability to make positive meaning of traumatic events. Historical and/or intergenerational trauma and experiences of discrimination, oppression, and poverty may have contributed to marginalizing the community from the mainstream. Just as individuals who have experienced prolonged and repeated traumatic events express unique challenges to disaster that must be understood within the context of their overall history, communities can also demonstrate this complex traumatic stress reaction. New experiences of disaster serve to trigger and multiply the effects of previously encountered

traumas and create additional experiences of grief, loss, system instability, and social injustice over the top of those that existed prior to the disaster. However, disasters may also create new opportunities for healing old wounds, strengthening local cultural resources, and building local capacity for healing and wellness. Taking advantage of these opportunities will require mental health professionals to prepare themselves to be knowledgeable about the disaster environment, the complexity of the previous trauma experiences of marginalized communities, and develop the skills to be truly culturally responsive in their approach.

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CHAPTER

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Counseling Middle Eastern Americans Challenges and Opportunities Ayşe Çiftçi and Lamise Shawahin

U

nderstanding and addressing the mental health needs of Middle Eastern individuals and communities is critical given the increasing population of Middle Easterners in the United States. The risk factors (e.g., discrimination, pre-immigration stress) this population experiences for mental health concerns, cultural considerations, and the dearth of research focusing on this population are presented in this chapter. This chapter also reviews relevant theory, research, and assessment related to the mental health of Middle Eastern individuals and communities in the United States. The final section of this chapter highlights counseling implications for work with this population.

WHO ARE MIDDLE EASTERN AMERICANS? The population of Middle Eastern Americans in the United States is estimated to be 2.5 million and originate from the Levant, North Africa, Turkey, Iran, Armenia, and Afghanistan (Nasseri & Moulton, 2011). Eightytwo percent of Middle Eastern and North African Americans are U.S. citizens, with 63% born in the United States. The majority of Middle Eastern and North African Americans are Muslim and a minority adhere to Christianity, Judaism, and other religious traditions (Amer & Kayyali, 2016; Arab American Institute [AAI], 2014). Middle Easterners are culturally, linguistically, and religiously diverse and can speak Arabic, Farsi, or Turkish. Several other ethnoreligious and cultural groups fall under the category of Middle Eastern and North African including Copts, Chaldeans, Amazigh, Druze, Armenians, Yazidis, and Assyrians. Most scholars define three major periods of immigration from the Middle East and North Africa. The first wave of immigration occurred between the late 1800s and mid-1920s from the Middle East and North Africa and occurred from the Ottoman province of Syria, which included modern-day Lebanon, Palestine, and Syria (Naber, 2008). This wave ended with the passing of restrictive immigration laws that limited the number of non-European immigrants to the United States (Yakushko, 2009). The second wave of immigration occurred between the 1940s and 1960s as a result of political instability in the region (Awad, 2010). 423

Restrictive quota-based immigration policies ended with the Immigration and Naturalization Act of 1965 (Yakushko, 2009). The third wave of immigration from the Middle East and North Africa occurred between 1967 and 2003 and consisted of refugees, political asylum seekers, and those seeking economic opportunities (Awad, 2010). While current U.S. governmental racial classifications categorize Middle Easterners as White, many scholars have argued for official reclassification as a minority group (Naber, 2008). Early U.S. naturalization laws did not allow individuals who were not classified White to become citizens. Naturalization gave immigrants access to voting rights, land ownership, and the ability to travel easily between the United States and their country of origin. Acquiring U.S. citizenship was dependent on being classified as White, and early immigrants from the Middle East and North Africa pursued litigation to be afforded such classification and rights (Gualtieri, 2009). U.S. federal courts contested the race of early Middle Eastern immigrants from the late 1880s to the mid-1940s. For example, in one federal court case in 1909, a Syrian, Costa George Najour, was naturalized on the basis of being considered belonging to the White race (Gualtieri, 2009). However, in a 1914 case, another Syrian, George Dow, was deemed Asiatic and denied citizenship (Samhan, 1999). By the 1940s, immigrants from the Middle East and North Africa were deemed by the U.S. Census Bureau to be treated in the same way as other immigrants from the Mediterranean countries (e.g., Italy, Greece). Although they were officially categorized as non-European Whites, U.S. political and social discourse represented Middle Eastern and North African immigrants as bandits, savages, and terrorists (Shaheen, 2001). Scholars argue that since World War II, and particularly after 9/11, anti-Arab racism emerged in the context of continued socioeconomic and military conflicts in the Middle East (Naber, 2008). Scholars further note that these conflicts sparked policy (e.g., increased surveillance) specifically targeting Arab Americans, further increasing antiArab sentiments in the United States. For example, as Naber (2008) notes, a number of FBI policies

as early as 1972 limited the civil rights (e.g., free speech) of individuals of Arab descent and authorizing surveillance, wiretapping, and spying on this population. In response to these policies and social trends, Arab Americans sought official recognition as a minority group in the United States in the early 1990s in testimony presented before a congressional committee (AAI, 1993). A 2010 write-in campaign encouraged individuals of Middle Eastern descent to check the “other” box on the U.S. Census and indicate their ancestry. The struggle for recognition as a minority group in the United States has continued since then, and as of late April 2015, the U.S. Census Bureau announced that they are moving forward with a pilot program to determine whether a separate Middle Eastern and North African category should be added to the 2020 census (AAI, 2015). Reclassifying individuals of Middle Eastern and North African ancestry as a minority group in the United States will allow for a more accurate portrayal of the experiences of this population in the United States and allow for more resources to be targeted at research to better understand their experiences.

RESEARCH AND ASSESSMENT Limitations of the current racial classification system used to categorize Middle Eastern and North Africans has resulted in impediments in examining health outcomes for this population. Unlike some other major ethnic groups in the United States, demographic data on Middle Easterners and North Africans is not routinely collected at points of health service delivery (e.g., hospitals, mental health clinics). Most research focused on Middle Eastern and North African health outcomes and service usage in the United States largely relies on sampling from ethnic enclaves, particularly in the greater Detroit area. These samples are often not representative of the entire Middle Eastern and North African immigrant population as they often disproportionately represent low-income Middle Easterners, Arabs, and Muslims (Read, Amick, & Donato, 2005). Even prior to the attacks on the World Trade Center, literature suggested that Middle Eastern

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and North African Americans may have been at risk for mental health problems due to typical stressors related to immigration and pre-immigration trauma. For example, a 1989 health needs assessment revealed that commonly endorsed health problems by Middle Eastern and North African Americans included emotional problems and family stress (Laffrey, Meleis, Lipson, Solomon, & Omidian, 1989). In the only study to examine the levels of anxiety and depression in a sample of ArabAmerican population in the United States, Amer and Hovey (2012) noted 50% of their sample (N = 611) reported depression scores that met clinical criteria as assessed by the Center for Epidemiological Studies-Depression Scale (CES-D).They noted 25% of their sample reported moderate to severe anxiety levels on the Beck Anxiety Inventory (Amer & Hovey, 2012). Similarly, Amer, Awad, and Hovey (2014) noted 41.2% of their sample of second-­ generation Arab Americans met clinical criteria using the CES-D. Previous research examining depressive symptoms among Arab American populations yielded similar results. For example, in a study conducted by Hassouneh and Kulwicki (2007), 40% of the Arab Muslim sample (N = 30) of women met clinical criteria on the CES-D. Researchers examining mental health concerns in Middle Eastern and North African populations have speculated as to the relatively high levels of depression found among this population. Amer et al. (2014) compared their findings in a sample (N = 119) of Arab Americans with previous studies and noted second-generation Arab Americans have mean CES-D scores that are similar to Arab populations in the Middle East (i.e., United Arab Emirates, Lebanon) than with a White U.S. sample. The similarities identified between Arab American Muslim populations in the United States and abroad can potentially be explained by both populations experiencing out of the ordinary stressors that are associated with mental health difficulties. For example, Arab Americans in the United States experience ethnic discrimination (Awad, 2010; Moradi & Hasan, 2004), which may contribute to mental health difficulties. Internationally, many majority Arab countries in the Middle East have been in a state of almost constant political turmoil,

war, and instability since the mid-20th century, which also contributes to mental health difficulties including depression and posttraumatic stress disorder (PTSD; Kira, Alawneh, Aboymediene, Lewandowski, & Laddis, 2014). Below is a review of research focused on Middle Eastern and North African Americans’ mental health and experiences with discrimination, pre-immigration trauma, and cultural factors. Discrimination. In addition to normative cultural stressors experienced by immigrants to the United States, Middle Eastern and North African Americans experience governmental scrutiny, negative portrayal in the media, and discrimination (Amer, 2005). Efforts to document and disseminate statistics related to discrimination against Muslims and those of Arab or Middle Eastern descent have been made through the efforts of the American-Arab Anti-Discrimination Committee (ADC) and the Council on American-Islamic Relations (CAIR). These organizations lobby lawmakers and inform policy and media regarding the prevalence of discrimination against Arab and Muslim Americans in the United States. The ADC was founded in 1980 by the first Arab American senator, James Abourezk, in response to “stereotyping, defamation, and discrimination against Americans of Arab origin” (Ibish, 2003, p. 1). CAIR was founded in 1994 to provide a voice for Muslim Americans, defend civil liberties of Muslims, and promote an accurate understanding of Islam. Anti-Muslim rhetoric in the United States impacts Middle Eastern and North African immigrants as well as other non-Muslim groups such as Sikhs, as the identities of Middle Eastern and Muslim are often conflated by mainstream and scholarly sources alike. CAIR has issued annual reports since 1995 outlining Islamic relations in the United States. CAIR also collects data regarding hate crimes committed against Muslim and Middle Eastern and North African Americans. In a 2009 report, CAIR noted that hate crimes and discrimination against Muslim Americans appeared to be “leveling off ” (CAIR, 2009). However, in a more recent report

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CAIR (2010) noted a dramatic spike in anti-Muslim rhetoric in public, private, and media sectors as well as hate crimes directed toward Muslims or Middle Eastern and North African Americans. Examples of private sector (i.e., occurring outside of government) anti-Muslim bias included an increase in national anti-Islamic hate groups lobbying for limiting the civil rights of Muslims in the United States. Public sector (i.e., occurring within or by U.S. government) anti-Muslim bias included state legislatures publicly advocating for anti-Islamic hate groups and initiating legislation intended to limit the civil liberties of Muslims and Middle Eastern and North African Americans. From 2011 to 2012, 78 bills or amendments designed to vilify Islamic practices were introduced in the legislatures of 29 states (CAIR, 2013). An additional 37 bills were introduced and seven states passed such legislation by the middle of 2003. Media examples cited by CAIR included a perceived increase in the acceptability of hateful rhetoric toward Middle Easterners and North Africans in the media (CAIR, 2010). CAIR noted an increase in reported hate crimes toward Middle Easterners and North Africans including violent attacks, vandalism, and threats. In one case, an 18-year-old Iraqi refugee and his mother were physically assaulted while their assailants shouted racial slurs at them in Cedar Rapids, Iowa, following a softball game (CAIR, 2013). In addition to overt acts of discrimination documented by Arab and Muslim interest groups, researchers have noted Middle Eastern and North African Americans may also routinely experience microaggressions (i.e., daily, commonplace intentional or unintentional indignities directed at minority individuals; Çiftçi, Shawahin, ReidMarks, & Ellison, 2013; Nadal, Griffin, Hamit, Leon, & Rivera, 2012; Sue, Capodilupo, & Holder, 2008). Such experiences are likely to go unreported and not be accounted for in the overall statistics examining discrimination against Middle Eastern and North African individuals. Overall, Middle Eastern and North African Americans appear to be at risk for experiencing systemic and interpersonal acts of violence and discrimination that impact their psychological health and well-being.

Experiences of discrimination have an effect on the mental health and psychological well-being of Middle Eastern and North African American adults (Ghaffari & Çiftçi, 2010) as well as adolescents (Ahmed, Kia-Keating, & Tsai, 2011). The relationship between discrimination and mental health is further complicated by factors such as personal identification with Whiteness. For example, in a study conducted by Abdulrahim, James, Yamout, and Baker (2012), second-generation Arab Americans and Arab Americans who identify as ethnically White tended to experience greater negative mental effects of discrimination than first generation and Arabs who do not identify as White. Although ethnically non-White Arabs reported greater levels of discrimination, ethnically White-identified Arabs reported greater psychological distress. Notably, Arab Americans between the ages of 18 and 29 reported more discrimination than older (i.e., over 30) Arab Americans. Perceived discrimination is connected to poor health outcomes among Middle Eastern and North African Americans including PTSD symptoms and overall poor health (e.g., respiratory, digestive) in a population of Iraqi refugees (Abu-Ras & Suarez, 2009; Kira et al., 2008). AbuRas and Abu-Bader (2009) conducted qualitative interviews with Arab Americans in New York City and identified themes of fear of hate crimes, anxiety about the future, threats to their safety, loss of community, isolation, and stigmatization as themes. Experiences of discrimination therefore play a strong role in the mental health of Middle Eastern and North African populations in the United States. Premigration Trauma. Many Middle Eastern and North African refugees from the second and third waves of immigration to the United States fled their home countries due to political turmoil, war, and occupation. For example, numerous Palestinian refugees arrived in the United States both after the establishment of the state of Israel in 1948 as well as after the 1967 Arab-Israeli war, which marked further displacement of Palestinians. The 1979 Islamic Revolution in Iran resulted in many

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Iranians fleeing the new regime to the United States. The first Gulf War, Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF) marked large numbers of refugees from Iraq and Afghanistan seeking asylum in the United States. Thus, many Middle Eastern and North African immigrants experienced war-related trauma prior to their arrival in the United States. Mental health issues related to premigration trauma including major depressive disorder and PTSD symptomology have been noted in Arab immigrant women (Norris, Aroian, & Nikerson, 2011). Iraqi refugees who arrived in the United States after the Persian Gulf War exhibited more PTSD and health problems than other clients at a clinic that predominantly serves Arab Americans (Jamil et al., 2002). Exposure to war and political turmoil may exacerbate existing difficulties related to migration and discrimination factors for many Middle Eastern and North African Americans. Identity and Cultural Factors. Pressure to withdraw from community, conflicts between collectivistic and individualistic culture, and acculturative stress impacts the mental health and psychosocial adjustment of Middle Eastern and North African Americans. Such factors are important for clinicians and researchers to understand when working with this population. Many Middle Eastern and North African Americans come from collectivistic cultures that emphasize the importance of community and family. Stress factors such as perceived discrimination are positively correlated with withdrawal and isolation from one’s community (Abu-Ras & Abu-Bader, 2009). Perceived discrimination among this population causes individuals to become wary of their community members and also causes them to feel like they should disassociate from their community in order to avoid being targeted for discrimination or increased surveillance. Withdrawing from the community in this way leads to decreased social support. Lack of social support is also correlated with higher levels of PTSD and depression among Middle Eastern and North African populations (Abu-Ras & Abu-Bader, 2009).

Acculturative factors play a role in the mental health of Middle Eastern and North Africans in the United States. However, a challenge of much of the literature focusing on this population is the use of one-dimensional assessments of acculturation. For example, one study operationalized acculturation using demographic factors and language preference and found that a greater preference for English over native language was associated with decreased psychological distress (Khuwaja, Selwyn, Kapadia, McCurdy, & Khuwaja, 2007). Based on these findings, the authors concluded greater identification with U.S. culture resulted in decreased psychological distress. Identifying with mainstream culture and experiencing discrimination and marginalization may be one reason why higher mainstream cultural identification is related to depressive symptoms. Contrasting these findings, Asvat and Malcarne (2008) found that higher mainstream cultural identification was associated with more past-year depressive symptoms. Similarly, a study focused on Arab college students revealed those who adhered to more traditionalist cultural practices showed better psychosocial adjustment than those who were more acculturated to mainstream U.S. culture (Amin, 2000). Other research on Middle Eastern and North African populations in the United States examined acculturation from a multidimensional perspective. For example, Awad (2010) operationalized acculturation using both ethnic society and dominant society immersion in a study examining perceived discrimination and religious identification among Arab Americans. Muslims reported a higher degree of ethnic society immersion and less dominant society immersion than Christians in the sample of Arab Americans. Hassouneh and Kulwicki (2007) found an association between acculturative stress, discrimination, and depressive symptoms on the CES-D. Britto and Amer (2007) noted the importance of examining the intersection of Muslim faith and American culture. They examined cultural identity and found that moderate bicultural identification was associated with lower family support and greater family acculturative stress. Acculturative factors may also contribute to difficulties related to substance use

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for Middle Eastern and North African populations. For example, Arfken, Kubiak, and Farrag (2009) noted an association between acculturation to American society and polysubstance abuse in Arab American clients. Identifying with mainstream culture and experiencing discrimination and marginalization may be one reason why higher mainstream cultural identification is related to depressive symptoms. This could explain why second-generation and more acculturated Middle Eastern and North African immigrants experience more negative mental health outcomes than their first-generation and less acculturated counterparts. Using Berry’s model of acculturation strategies adapted for use with Arab Americans, Amer and Hovey (2007) examined the impact of acculturation on the mental health of second-generation Arab Americans. This study found that integration strategies of acculturation were related to increased family functioning. Similarly, Jadalla and Lee (2012) found that bicultural identification was associated with better physical health outcomes among Arab American Muslims. Studies that have examined multidimensional operationalization of acculturation in American Muslim populations have yielded more complex findings than those utilizing onedimensional assessments of acculturation.

COUNSELING IMPLICATIONS It is critical for mental health practitioners to understand how the identity and experiences of Middle Eastern and North African Americans in the United States may contribute to their presenting concerns in counseling. Further, it is important for practitioners to understand and overcome institutional and cultural barriers to help seeking among this population. Understanding and effectively utilizing the unique strengths this community possesses can be an important resource for practitioners working with Middle Eastern and North African communities. In the limited research that exists, scholars have noted a disparity between the need for services and the use of services among Middle Easterners

and North Africans in the United States (Khan, 2006). It is critical that this disparity is understood and addressed by researchers and practitioners alike. One potential factor that may be preventing Middle Easterners and North Africans from utilizing services is concern about institutional discrimination. Given the prevalence of discrimination in the United States, it is possible that experiences of discrimination, or fears that discrimination will occur when seeking services, may play a role in negative attitudes toward mental health services among Middle Eastern and North African populations (Aloud, 2004). Practitioners should assess for and address any mistrust or misinformation regarding confidentiality and concerns about government surveillance or access to health records during intake sessions or as the issue arises. Practitioners serving Middle Eastern and North African populations should be aware of both (a) cultural beliefs and customs among Middle Eastern and North African populations that may serve as a barrier to seeking services and (b) cultural factors that may facilitate help seeking and compliance with mental health care services. Misinformation about what counseling entails and culturally held beliefs about the nature of mental illness can contribute to underutilization of services. Aloud (2004) found that lower levels of knowledge about formal mental health care services were related to higher levels of negative attitudes toward mental health services among this population. Culturally held beliefs about mental illness may also decrease the likelihood of seeking services among this population. For example, some Middle Easterners and North Africans may hold the belief that mental illness is a test from God, a sign of weak faith, or an opportunity to absolve oneself from a sin. Thus, they may be more inclined to seek informal or community-based sources of help for mental illness. Abu-Ras, Gheith, and Cournos (2008) found that among Arab American Muslim populations, religious leaders play a substantial role in mental health promotion. Similarly, Padela, Killawi, Heisler, Demonner, and Fetters (2011) noted that religious leaders play a significant role in the health of Muslim Middle Easterners.

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Finally, concerns related to shaming one’s community or making one’s ethnic group “look bad” may be a factor in underutilization of mental health care services among this population. It is critical for psychologists and other mental health care providers working with Middle Eastern and North African populations to collaborate and work closely with community and religious leaders. Practitioners at university counseling centers are in a unique position to serve Middle Eastern and North African emerging adults who may be at particular risk for mental health concerns. Outreach programs targeted toward increasing service utilization among Middle Eastern and North African college students can help address underutilization of services. University counseling centers can work to develop relationships with leaders and advisers of student organizations that have large populations of Middle Eastern and North African students, such as the Arab Student Union, Muslim Student Association, or Students for Justice in Palestine. Offering to facilitate psychoeducational workshops or simply arranging for a time to present and discuss the services offered at the university counseling center can increase service utilization among Middle Eastern and North African students. University counseling centers can serve as important social justice advocates by developing an awareness of the scrutiny faced by Middle Eastern and North African student organizations, especially those doing work around the issue of Palestine, and acting as allies if issues should occur. Additionally, reaching out to Middle Eastern or North African faculty who may have a relationship with the student body may also be useful. University counseling centers can serve as advocates for this population by developing and implementing training to faculty and staff on issues faced by Middle Eastern or North African populations. Such training could enable faculty to better understand when it may be important to refer a student to counseling services. Practitioners in community settings should work to develop meaningful relationships with Middle Eastern and North African religious and community leaders. Practitioners should work to

develop mutually beneficial relationships with community leaders that will facilitate understanding on both the part of the practitioner and the leader. For example, practitioners could offer consultation and training to community and religious leaders on understanding the circumstances under which it may be beneficial for a community member to be referred to counseling services. Practitioners can benefit from a relationship with a community leader by dialoging with them to better understand issues faced by the community. Acquiring such knowledge can help a practitioner develop a better understanding and more targeted interventions. Practitioners can use this collaborative relationship to deliver psychoeducational workshops at religious or community centers based on the needs of the community. Such workshops could target issues such as (a) intergenerational communication skills, (b) addressing or clarifying misconceptions about the use of formal mental health care services, (c) encouraging community-based help seeking (e.g., from friends, family, and religious leaders), and (d) facilitating community-based prevention. Practitioners can also utilize a relationship with a trusted religious leader to address issues of community awareness and attitudes. An ongoing relationship of mutual education can help a religious or community leader address misconceptions, negative attitudes, and stigma related to mental health in a way that is culturally sensitive. Additionally, a religious or community leader can deliver sermons about mental illness that allows for culturally held beliefs and the utilization of services to coexist. One example of an existing community organization that seamlessly blends cultural and religious practices with addressing mental and physical health concerns is Muslims Understanding and Helping Special Education Needs (MUHSEN). MUHSEN was founded by Palestinian American Sheikh Omar Suleiman and a Muslim couple, Farhan and Joohi Tahir, who have a daughter with autism. MUHSEN is an organization that seeks to clarify misconceptions about disability and mental illness from a theological perspective and make religious spaces more inclusive for community members experiencing mental illness and other disabilities.

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Aboul-Enein and Aboul-Enein (2010) suggested that increased cultural competence among mental health and other practitioners can assist in increasing health care service usage among Middle Eastern and North African Americans. Cultural competence entails developing an awareness, knowledge, and skill base for working with a specific population. Practitioners working with Middle Eastern and North African populations should routinely attend lectures, conferences, and talks that focus on this population. Practitioners should be aware of and acknowledge the diversity among Middle Easterners and North Africans in the United States and take care not to conflate this identity with Muslim identity. They should continually seek updated knowledge on best practices in working with Middle Eastern and North African populations and keep up with current sociopolitical trends. Practitioners can increase their knowledge base by partnering with a community leader or scholar who has expertise in working with Middle Eastern and North African populations and consulting when ethical and appropriate. Finally, practitioners can increase their skills by interacting with individuals from Middle Eastern and North African populations in nonclinical settings in order to better understand cultural customs. Seeking additional training on family systems approaches may be useful in working with this population, as the family is critical in many Middle Eastern and North African populations. They can work to make their practice and waiting room more culturally sensitive by including magazines and reading materials relevant to Middle Eastern and North African populations and by ensuring that services can be offered in the preferred language of the client. Practitioners should be aware of and adapt their interactions with Middle Eastern and North African populations to reflect an understanding of their culture. For example, gift giving is common in Middle Eastern culture and practitioners should be sensitive and give careful thought and consideration to how to approach accepting or not accepting gifts from clients from this background. Culturally sensitive practice with Middle Eastern and North African populations may entail critical

reflection on current practices and creative interventions that may help this population feel more comfortable with counseling services. Some potential modes of service delivery to consider include expanding services to home-based care, telephone, or Internet services. Finally, mentoring and encouraging Middle Eastern and North African high school and university students to pursue mental health as a career is critical for faculty and supervisors in training programs. Middle Eastern and North African practitioners can serve as critical liaisons between the community and the profession of mental health care. Research with other underrepresented groups in the United States has indicated that patients report greater satisfaction with care and comply with treatment recommendations from practitioners from their own ethnic or racial background (LaVeist & Carrol, 2002).

Case Study: Selma Elkhair Selma is a 23-year-old Lebanese American Muslim woman who is currently enrolled full-time at a large urban university where she studies nursing and works part-time at a library on her university’s campus. She lives at home approximately 45 minutes from campus with her parents and two younger siblings. Selma self-referred to therapy due to feelings of isolation and loneliness. At the initial interview, Selma reported depressive features including a loss of interest in school and social activities, loss of energy, depressed mood most of the day, and feelings of guilt and shame related to her sexual and religious identity. She expressed difficulties falling asleep due to rumination regarding her sexual identity. She noted since she began questioning her sexual identity, two years prior to seeking treatment, she stopped praying the obligatory prayers in Islam and fasting during Ramadan. Selma admitted she often removes her headscarf when she goes out with friends or attends some of her classes without the knowledge of her parents. She presented for treatment wearing hijab, a headscarf that covers the hair, a loose-fitting shirt, and casual pants.

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During the intake interview, Selma revealed several interpersonal stressors including expectations to care for her younger siblings, pressure to not move out of her family’s home until marriage, and excessive gossip from the community. Selma noted she is expected to routinely drop off and pick up her siblings from school and other activities, which she noted is a source of stress for her. She expressed a desire to find a roommate and live outside of her family home closer to her university and work, but stated her parents become upset with her when she attempts to address the subject with them. Finally, she described several situations in which members of the Lebanese American community saw her without her headscarf and informed her parents about her behavior. Selma reported feeling attracted to women, and stated she had never been in a sexual or romantic relationship with anyone. Selma explained feeling guilty for feeling sexually attracted to women and explained she routinely sought out information about the permissibility of same-sex relationships in Islam on online forums and found that most Muslim religious leaders believe same-sex romantic relationships are a sin. She explained she does not feel comfortable seeking advice from religious leaders in the mosque her family attends due to fears of gossip. Selma explained she has slowly lost motivation to follow other tenets of the religion (e.g., prayer) she previously found comfort in. She additionally noted that her guilt about her sexual identity has been exacerbated by increased pressure from her family to find a partner and get married. Selma’s presentation is consistent with major depressive disorder, and there are numerous cultural factors for a clinician to consider when working with her. These cultural factors and clinical considerations are discussed in more detail below. Family and Community Relations. It is critical for clinicians to understand the role of family and community in the lives of MENA (Middle Eastern and North African) Americans. Many MENA families, especially recent immigrants, are immersed in their communities, and it is

common for personal family information to be known by individuals outside of the family. Family reputation is an important consideration for many MENA Americans, and often, the actions of one family member can reflect on the entire family. MENA families tend to be more communitarian as opposed to individualistic, and it is not uncommon for children to remain living with their parents until marriage. Understanding these and other cultural factors and making efforts to avoid imposing Western expectations on clients presenting with these circumstances is imperative. A clinician working with a client with similar presenting concerns as Selma might seek out resources to better understand the history and culture of the client’s country of origin and the role of family. McGoldrik, Giordano, and Garcia-Preto (2005) include several chapters on Middle Eastern families in their text Ethnicity and Family Therapy that are useful for clinicians to consider when working with this population. At the same time, it is important to understand the client as an individual and recognize that their experience may be different from that of the majority of MENA individuals. It will be important for a clinician working with Selma to assist her in engaging in problem solving and deciding what is best for her within the context of her family structure. Selma may be resistant to interventions that do not take her family into consideration. Individuals in Selma’s situation may avoid the subject of marriage by using continuing education as an excuse, feigning “pickiness” about who to marry, or even get married to a samesex partner and have a separate life on the side. Regardless of the path the client chooses to take, it is critical for the clinician to maintain an openness to both the client’s family and individual needs. Religious and Sexual Identity. Religion and lesbian, gay, or bisexual individuals are often perceived to be irreconcilable. In Islam, as with nearly every religion, there are alternative interpretations of religious texts that allow for more flexibility around the permissibility of same-sex relationships (Habib, 2009). It is c­ ommon for individuals exploring their sexual identity to reject their

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religious identity in the process. These individuals may or may not ever reconcile their religious and sexual identity. It is important for clinicians to know that resources exist for lesbian, gay, bisexual, transgende, questioning/queer (LGBTQ) Muslims, including a yearly retreat, numerous online forums, and routine publications. However, these resources may not be appropriate for every client. It is critical to encourage identity exploration with clients in Selma’s circumstances and to maintain an open attitude as the client develops a sense of self within the context of their community. In Selma’s case, she is still in the early process of personal, spiritual, and sexual identity development. It will be critical for a clinician working with Selma to encourage her exploration of her identity and also recognize that her exploration may or may not end in identifying as lesbian or bisexual. Further, it is critical for clinicians to understand that for MENA populations, “coming out” may not be the end result of sexual identity development

(Mousa, 2011). Finally, clinicians working with clients like Selma should appropriately seek consultation when needed.

CONCLUSION The changing sociopolitical and cultural context of Middle Easterners and North Africans in the United States continues to impact the mental health and well-being of this population. Counseling theories and research must take into consideration the complex history of Middle Eastern and North African Americans in order to be developed into practical interventions with this community. Although limitations associated with current research and clinical models may be a barrier to serving Middle Eastern and North African populations, connecting with community and religious leaders can serve as an important opportunity for psychologists and other mental health practitioners to meaningfully connect with this population.

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CHAPTER

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Multicultural Self-Awareness Challenges for Trainers Examining Intersecting Identities of Power and Oppression Margo A. Jackson and Jaya T. Mathew

T

oward the goal of effective counseling practice from a core foundation in social justice, this chapter critiques the research evidence for effectiveness of education and training in multicultural counselor competencies, and it focuses on constructively addressing multicultural self-awareness challenges for trainers. Key to multicultural competency training is the continual process needed (a) for recognizing, addressing, and exploring the influences of individual trainers’ own intersecting identities on their multicultural empathic understanding with clients and trainees by (b) explicitly addressing hidden biases in their intersecting social positions of privilege and power, as well as oppression and marginality. We share case examples of our own challenges and learning in the process of training counselors to develop multicultural self-awareness. In conclusion, we offer recommendations for trainers in addressing challenges and developing competencies in multicultural self-awareness with trainers. Trainers who are educators and clinical supervisors of counselors, psychologists, social workers, and other helping professionals are expected to promote the development of multicultural competencies for ethical and effective counseling practice (American Counseling Association, 2014; American Psychological Association [APA], 2010; National Association of Social Workers, 2008). Key to multicultural competencies training is the continual process needed for recognizing, addressing, and exploring the influences of individual trainers’ own intersecting identities on their multicultural empathic understanding with clients and trainees. We submit that the ongoing process to develop multicultural self-awareness must include consciously and constructively examining the intersecting influences of trainers’ as well as their trainees’ own hidden biases. Furthermore we submit that trainers and trainees need to examine their own social positions of privilege and power as well as oppression and marginality that are elicited in the contexts of training and counseling relationships in ways that are often unconscious or unintentional, yet potentially harmful or helpful. We argue that effective multicultural counseling practice requires

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trainers who, despite significant challenges, engage in this continual process of critical reflection, bravely facilitate difficult dialogues about influences of their own privileged and oppressed identities and social positions, and doggedly work toward social justice action.

MULTICULTURAL SELFAWARENESS: FOUNDATIONAL YET LIMITED IN TRAINING Multicultural self-awareness of one’s own cultural socialization attitudes, beliefs, values, and biases is the foundational component of the widely accepted tripartite model for developing multicultural competencies in counseling and psychology (APA, 2003; Arredondo et  al., 1996; Sue, Arredondo, & McDavis, 1992). Some research suggests that it is the component most predicative of actual competence (Torres-Rivera, Phan, Maddux, Wilbur, & Garrett, 2001). Foundationally, it is the multicultural self-awareness component that allows a trainer or counselor to discern how to effectively use the other two components of multicultural counseling competencies (MCC), knowledge (for understanding the worldviews and sociopolitical realities of diverse clients), and skills (for applying appropriate interventions with diverse clients). Nevertheless, there is evidence to suggest that training in multicultural counseling competencies may be limited to a predominant focus on the general knowledge component about different racial and ethnic groups (Pieterse, Evans, Risner-Butner, Collins, & Mason, 2009). Moreover, although Pieterse et  al. (2009) found some support for a renewed focus on general knowledge about social justice advocacy in multicultural course syllabi, they found limited attention to “the intersection of contextual and identity-based variables . . . specifically in relation to oppression and diversity” (p. 108). In the following discussion, we offer potential explanations for and consequences of the current limitations in multicultural counseling competencies training in the foundational MCC self-awareness component. We use this

­ iscussion to support a rationale for training methd ods to constructively address these limitations.

CONSEQUENCES OF MCC SELF-AWARENESS LIMITATIONS Significant racial and ethnic disparities persist in the United States in access to quality services in mental health care, education, employment, and other domains of psychosocial well-being (Alegría et al., 2008; Lukyanova, Balcazar, Oberoi, & SuarezBalcazar, 2014; Olneck, 2005). Ethical and effective counseling practice is needed to address these disparities. This requires that practitioners use a cultural lens for (a) recognizing the influences on individuals of their different contexts (e.g., sociopolitical, ecological, historical) and (b) intersections with their racial/ethnic and other multicultural identity group memberships (e.g., age, gender, class, sexual orientation, ability/disability status, religion; APA, 2003; Worthington & Dillon, 2011). Thus, social justice advocacy has appropriately become a renewed focus for developing multicultural competencies in counseling practice and training (Ratts, Toporek, & Lewis, 2010; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006). Nevertheless, for practitioners and trainers alike, significant resistance exists to recognizing their own positions of influence in contextual and intersecting identities that perpetuate social injustice (Hernández & McDowell, 2010; Liu, Pickett, & Ivey, 2007). For trainers and trainees, there are inherent difficulties in the process of (a) confronting one’s own privileged identities of dominant social positions that pervasively function to disadvantage, marginalize, and silence diverse others (McIntosh, 1998; Sue, 2013), and (b) examining the complex intersections with one’s own and others’ targeted identities (i.e., memberships in groups targeted for discrimination or oppression; Mattsson, 2014; Watts-Jones, 2010). We submit that these two aspects of personal and relational consciousnessraising are foundational to social justice advocacy in multiculturally competent counseling practice. Furthermore, we submit that these are key

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aspects of developing critical consciousness (Freire, 1970/2000) in the MCC self-awareness component that are largely missing or limited in MCC training to date. Contextual variables include the embedded influence of dominant sociopolitical forces on definitions of therapeutic effectiveness. The consequence of ignoring these contextual variables is that it not only limits our understanding but also results in therapeutic harm and cultural oppression to groups of color and other culturally diverse groups (Sue, 2015a). Intersectionality variables in MCC training and practice include the embedded influence of our social positions of unearned privilege and disadvantage on therapeutic effectiveness. The consequence of ignoring intersectionality variables is that it may function to reinforce our unconscious assumptions that uphold oppression and injustice (Mattsson, 2014; McIntosh, 2014). Thus, we argue that ignoring contextual and intersectional variables limits MCC self-awareness and may explain the mixed results of empirical evidence for the therapeutic effectiveness of MCC training. There is evidence supporting the effectiveness of MCC training outcomes with (mostly White, heterosexual) trainees in enhancing their racial consciousness (Chao, Wei, Good, & Flores, 2011; Yeung, Spanierman, & Landrum-Brown, 2013); raising White privilege awareness, reducing racial prejudice, and increasing support for affirmative action (Case, 2007); increasing heterosexual privilege awareness and support for same-sex marriage (Case & Stewart, 2010); reducing negative attitudes and beliefs about transsexual people (Case & Stewart, 2013); and increasing MCC knowledge but not MCC awareness in relation to racial/ ethnic identity and gender-role attitudes (Chao, 2012). In one of the few studies of MCC training outcomes with trainees of color, participants who rated their MCC coursework more highly in quality also reported higher scores in general MCC self-awareness (Mathew, 2010). However, further qualitative investigation with trainees of color revealed specific and glaring limitations in their training experiences to develop MCC self-awareness (Mathew, 2010). These limitations

included trainees of color feeling short-changed by the Eurocentric focus of the MCC curriculum and supervision, being subject to assumptions by trainers and fellow trainees that they themselves (as trainees of color) did not need MCC training, and thus being marginalized from opportunities to develop MCC self-awareness of their own biases, stereotypes, and cultural heritage in relation to their professional growth and practice (Mathew, 2010). Therefore, it seems apparent that contextual and intersectionality variables were ignored in the MCC self-awareness training for these trainees of color. Furthermore, their experience of MCC training may have, in effect, reinforced maintaining the oppressive status quo of blindness to or silencing of critical consciousness (Freire, 1970/2000). Yet the empirical literature to date has yielded mixed results regarding the effectiveness of MCC training for therapeutic outcomes with diverse clients. On the one hand, the results of a 20-year content analysis of empirical research on MCC indicated “consistently that counselors who possess MCCs tend to evidence improved counseling processes and outcomes with clients across racial and ethnic differences . . . with respect to client perceptions of counselors, client outcomes, attrition, and self-disclosure” (Worthington, Soth, & Moreno, 2007, p. 358). On the other hand, the results of some research, including a recent meta-analysis, have disputed the effectiveness of MCC training, finding insignificant associations between client ratings of therapist MCC and psychotherapy outcomes (Owen, Leach, Wampold, & Rodolfa, 2011; Tao, Owen, Pace, & Imel, 2015). Although the focus on race and ethnicity is merited in research on MCC training effectiveness for serving the needs of underserved clients, much of this research is limited in several ways, for example, by universality assumptions (Worthington et  al., 2007), therapeutic effectiveness narrowly defined by embedded dominant Eurocentric worldviews or decontextualized conceptualizations (Sue, 2015a), measurement issues (Ridley & Shaw-Ridley, 2011; Worthington & Dillon, 2011), and inattention to intersectionality (Hernández & McDowell, 2010; Liu et al., 2007). We submit that

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one reason for the mixed results to date on the effectiveness of MC training is because of critical limitations in the definition, measurement, and training methods of MCC in the self-awareness component. As a consequence, MCC training may not be as effective in facilitating positive therapeutic outcomes as is needed for incorporating culture into counseling and overcoming inequities in mental health care delivery.

REASONS FOR MCC SELF-AWARENESS LIMITATIONS Why is it so difficult for trainers and trainees to develop MCC self-awareness of contextual and intersectionality influences of their own identities of social positions in privilege and oppression? Perhaps if we better understand the underlying psychological and psychosocial mechanisms that explain these limitations, then we might use this understanding to inform more effective MCC training. In the following discussion, we focus on the pervasive cultural context that dulls and skews critical consciousness of social injustice influences, the complex and differing emotional reactions elicited in examining one’s own hidden biases in intersecting identities of unearned advantages and disadvantages, and the likely defenses elicited that limit the validity of current self-report assessments of MCC self-awareness. Dominant Cultural Context Limits Critical Consciousness. By contextual variables in MCC we mean the environments and relationships that influence or give meaning to one’s feelings, thoughts, or behavior. As the multicultural guidelines of APA (2003) note, “All individuals exist in social, political, historical, and economic contexts, and psychologists [must] understand the influence of these contexts on individuals’ behavior” (p. 377). However, our clinical understanding of individuals’ contextual influences is often blinded or skewed in relation to our positions of power and oppression. Several authors (e.g., McIntosh, 1998; Sue, 2015b) have

explained how the pervasive narrative and systems in U.S. sociopolitical and cultural contexts, by claiming equal opportunity and meritocracy as norms and denying social injustice, essentially function by contradiction to (a) limit dominant group members’ conscious awareness of unjust influences on oppressed group members and thus (b) further marginalize oppressed group members by misattributing unjust consequences to their inferiority (i.e., blaming the victim), and (c) reinforce in dominant group members an irrational sense of entitlement for their own unearned privileges from socially unjust legacies. MCC trainers and trainees who are in positions of power in relation to their trainees and clients, respectively, are likewise vulnerable to limited conscious awareness of social injustice influences and misattributions. White, male, heterosexual, middle-class, able-bodied, Judeo-Christian, and Eurocentric cultural values are dominant and pervasive underlying assumptions not only in U.S. society but also in counselor training and practice (Sue, 2015a). These normative assumptions often operate to blind trainers and trainees to contextual influences relevant to social injustice in their counseling relationships with clients as well as in their training and supervisory relationships with each other (Hernández & McDowell, 2010). In his classic book Pedagogy of the Oppressed, Paolo Freire (1970/2000) explained that social injustice is perpetuated by the dominant system of social relations that creates a culture of silence for repressing the voices of and instilling negative self-images into the people it oppresses. Thus, Freire advocated, education is needed to engage in a learning process to develop critical consciousness, defined as a conscious awareness not only to perceive, expose, and assess sociopolitical and economic contradictions but also to take action against the oppressive elements that are illuminated by that understanding. Despite the need for critical consciousness of social injustice influences in MCC self-awareness for ethical and effective counseling practice, the dominant and pervasive sociopolitical context for U.S. counselor training to date likely functions more as a culture of silence.

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Emotional Reactions to Examining One’s Own Hidden Biases in Intersecting Identities. Systemic influences that are largely silenced or unconscious manifest in interpersonal relationships. These hidden influences manifest in ways that people psychologically defend themselves against critical consciousness of their own complicity in (as dominant group members) or victimization by (as oppressed group members) social injustice. In their counseling and supervisory relationships, trainers and trainees belong to complex intersecting identities of privileged power and disempowered oppression relative to the legacies of the dominant sociopolitical context. Thus, another likely reason why developing critical consciousness in MCC self-awareness is difficult for counselors is that they may respond in unconsciously defensive ways from their intersecting social positions as dominant group members as well as oppressed group members (e.g., guilt and silencing versus anger and withdrawal, respectively). Beyond systemic influences, social injustice manifests interpersonally in pervasive, subtle, inadvertent, and everyday interactions that are biased and harmful (Mattsson, 2014). While overt forms of discrimination persist, far more common are hidden biases or covert forms of stereotyping, prejudice, and discrimination in interpersonal relations that are automatic, often unconscious, and ambiguous (e.g., implicit biases and microaggressions; Dovidio & Gaertner, 2000; Sue, 2010). None of us (including counseling trainers and trainees) is immune to the pervasive influences of these contextual and interpersonal forms of social injustice, yet our consciousness and the consequences vary by our own social positions of power in intersecting identities with group memberships of unearned advantages and disadvantages (McIntosh, 1998). Consistent with Pieterse and colleagues’ (2009) analysis of multicultural counseling training, McIntosh (2014) noted that most training programs in professional counseling and human services encourage practitioners to acquire knowledge and understanding specific to the groups they serve. However, in McIntosh’s evaluation, “Unfortunately, many clinical programs do not help practitioners

examine their own locations in the social structure or system and the associated privileges and disadvantages afforded to them by their respective social locations” (p. 173). Education for social justice transformation, in clinical training in particular, requires learning new information in ways that disrupt the hegemonic lenses of seeing (i.e., blinders of inattention and misattribution) through which we make ourselves dominant (Chapman, 2011). Furthermore, Hernández and McDowell (2010) argued that this process requires effectively acknowledging and challenging the power dynamics shaped by the interconnected social identities of trainers and trainees in clinical supervisory relationships. Thus, limited awareness and analysis of intersectionality function to stunt the development of MCC self-awareness of critical consciousness in supervisory and counseling relationships for trainers as well as trainees. Intersectionality, a concept introduced by feminists, refers to “the confluence of multiple identities in each individual, as well as social location, [including] the elevation, and subjugation associated with the identities” (Watts-Jones, 2010, p. 406). Intersectionality is central to the therapeutic process. For example, we can help expand clients’ understanding of themselves and others through intersectionality discussions to consider the complexity of both/and aspects that may exist in their lives and relationships, in contrast to making either/or assumptions limited to Black/White or good/bad. A critically reflective intersectionality lens can be used as a tool to facilitate therapeutic understanding of power and oppression dynamics in supervisory and counseling relationships (Hernández & McDowell, 2010; Mattsson, 2014; Watts-Jones, 2010). Thus, an analytical approach using an intersectionality lens is needed in counselor training for raising critical consciousness fundamental to MCC self-awareness and therapeutic effectiveness. The process of developing critical consciousness in MCC self-awareness requires difficult dialogues of reflection and exchange with others, in clinical training and supervisory relationships that (as defined by Watt, 2007) “centers on

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an awakening of potentially conflicting views or beliefs or values about social justice issues (such as racism, sexism, ableism, heterosexism/homophobia)” (p. 116). To date, although not focused explicitly on incorporating an intersectionality lens, Sue (2013) explained several reasons why engaging in some types of dialogues is so difficult. Sue explained how certain social and academic norms (to avoid, ignore, silence, or discourage indepth exploration of potentially offensive, uncomfortable, and emotionally intense topics) impede difficult dialogues about racial injustice. Reasons why White trainers and trainees struggle to engage in difficult dialogues about racial injustice include “fears of appearing racist, of realizing their racism, of acknowledging White privilege, and of taking responsibility to combat racism” (Sue, 2013, p. 663). For trainers and trainees whose identities include social positions as people of color, engaging in difficult dialogues often exposes them to microaggressions that minimize, discount, invalidate, or assail their own racial/ethnic identities (Mathew, 2010; Sue, 2013). Thus, trainers and trainees may have difficulty acknowledging their social locations of privilege as a defense against that being used to justify or delegitimize the pain of their other oppressed identities. Yet from an intersectionality lens, these are not either/or identities but rather identities of both power and oppression. Watt (2007) proposed that the intensely negative emotional reactions to difficult dialogues about participants’ dominant and marginalized identities (a) occur because the process exposes participants to uncomfortable awareness of their own roles and relationships in the dynamics of power and oppression; (b) thus elicit cognitive dissonance experiences that contradict participants’ self-concepts that are steeped in pervasive and dominant privileged identity assumptions; and as a result (c) prompt defense mechanisms against critical consciousness, defenses such as attacking, denial, minimization, rationalization, and withdrawal. In difficult dialogues exploring critical consciousness dynamics, participants with oppressed social identities (including trainers and trainees)

are often challenged to not only push back against privileged assumptions but also defend themselves against further victimization (Sue, 2015b). Consciously examining one’s own hidden biases by engaging in meaningful difficult dialogues about social injustice often elicits intense emotional reactions that are negative, including anger, hostility, fear, betrayal, remorse, shame, hopelessness, vulnerability, and defensiveness (Sue, 2015b). Eventually, however, this process may also promote positive feelings including compassion, understanding, connection, inspiration, and motivation to social justice action (Watt, 2007; Young, 2003). Clinical training requires eliciting and challenging the intense negative emotional reactions of difficult dialogues in order to develop the MCC self-awareness through which knowledge and skills can promote therapeutic effectiveness (Carter, 2005). To summarize, we have discussed several psychosocial mechanisms explaining resistances to examining contextual and intersectionality variables that reinforce social injustice and limit critical consciousness of power and oppression in MCC training. These mechanisms underlying hidden biases often operate in supervisory and counseling relationships to blind trainers, as well as their trainees, to critical consciousness in therapeutic understanding. Furthermore, these resistances may explain why self-report assessments of MCC self-awareness are inadequate. In the next section, we share brief case examples of our own intersectionality challenges and learning in the process of training counselors to develop critical consciousness in MCC self-awareness.

TWO CASE EXAMPLES OF INTERSECTIONALITY CHALLENGES IN DEVELOPING OUR OWN AND TRAINEES’ MCC SELF-AWARENESS As Watts-Jones (2010) aptly noted regarding the process of “leaving the comfort zone” to examine

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one’s own intersectionality dynamics in supervisory and counseling relationships, (a) training is the place to practice “talking about identities and relative privilege and subjugation . . . by making it routine to consider and talk about intersectionality as personal and in the room, and not simply as a theoretical construct” (p. 410), and yet (b) “It is much harder to do . . . yourself than to ask someone else to do it” (p. 409). We (coauthors of this chapter) are trainers in the position of power in relation to our trainees and clients, and we know that we are vulnerable to hidden biases in social consciousness that may limit our therapeutic effectiveness. Thus, we have regularly consulted with each other as trusted colleagues in the ongoing process of examining our own intersectionality issues and dynamics in developing MCC self-awareness. These regular consultations are lifelines that include processing together our vulnerabilities and challenges as well as progress and triumphs. One working assumption that we share is that the benefits of engaging in the process of examining our own hidden biases is that we may not only increase our awareness of automatic negative and unhelpful reactions but also develop a better understanding of potential empathic strengths, that is, name and analyze our assumptions and reactions that both hinder and facilitate our therapeutic understanding (Jackson, 2011). Another working assumption we share is that as trainers we need to name our identities with trainees and model the challenging parallel process of critical consciousness raising in MCC self-awareness. In addition to our status of power as trainers, we share privileged identities in our social positions of education (PhD in counseling psychology), socioeconomic status (middle class), U.S. citizenship, sexual orientation (heterosexual), marital status (married), and religious affiliation (Christian). We share subjugated identities as women. Among our differing marginalized identities, Dr. Mathew is a person of color (Indian American) from an immigrant family, including her partner who is Indian. Dr. Jackson is White and of European descent (English, Scottish, and Irish), privileged

identities. Her partner is Black and their adult daughters are biracial, marginalized identities as an interracial family. Case Example #1: MCC Self-Awareness Defenses Eliciting Most Difficulty for This Trainer. During difficult dialogues on privilege and oppression in a graduate clinical course taught by Dr. Mathew, some White students expressed angry denials that they had unearned privilege, claiming that as firstgeneration college students they had struggled (using oppressed social class identity to discount privileged White identity). Other students said in exasperation, “Why can’t we just all get along? We are all humans!” (denying racial injustice). Yet some of the negative comments that students made about immigrants were particularly hurtful to Dr. Mathew. Following are excerpts from personal reflections she wrote in consultation with Dr. Jackson, focused on developing together their own MCC self-awareness as trainers: I can easily slip into the frame of mind that they are insulting me, my parents, partner, or even worse, students who are undocumented that I deeply admire. I can become appalled and move away from those students who make these comments rather than leaning in to them from a place of compassion. It is hard work emotionally at times and in other moments it is ok. I think it depends on my mood, my context, my inner resources, etc. So as I write this I am struck by the fact that diversity trainers may need to have emotional hardiness or wellness. I am having an image of a shield of armor. Sometimes I have to put on this permeable shield of armor. The armor has to be tough and strong to deflect the pain yet malleable enough for me to share my story, my experiences, in a way that allows for students to connect. I have to share diversity content with a fine balance of facts, affective material, empathy, all the while maintaining boundaries to protect myself. It is indeed a labor of love to do anti-oppression work.

One student, Amy (a pseudonym), who made a particularly hurtful comment in that class rationalizing inhumane treatment of undocumented immigrants, came to talk further with Dr. Mathew

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after class about her feelings and emerging social consciousness realizations. In the class, Dr. Mathew had shared that while working as a therapist with undocumented students, she often heard stories of undocumented individuals becoming permanently disabled due to being subjected to hazardous working conditions. She gave an example of a person who had resigned himself to losing his eyesight from being exposed to chemical fumes on the job. Undocumented persons often must maintain employment in order to financially support their families, and they do not have the power to successfully negotiate for safe working conditions. Amy’s unsympathetic response in class to Dr. Mathew sharing this story was to express her belief that undocumented immigrants do have choices and that they can decide not to work in harmful conditions by returning to their countries of origin. In contrast, after class, Amy discussed with Dr. Mathew how she was coming to realize her blind spots in how she had been socialized to believe a single stereotyped narrative about immigrants. Amy (a middle-aged White woman) reflected on being a 16-year-old working in a factory and having her hours reduced due to immigrants from Mexico being hired. She remembered the manager telling her to stay away from the immigrants and implying that they could harm her. Amy disclosed that she had always viewed immigrants as stealing jobs, not paying taxes, and taking advantage of the system. She also voiced having a fear of Latino men. Dr. Mathew normalized Amy’s feelings in how they were both socialized as women to automatically fear men of color, and she affirmed her evolving critical consciousness of underlying social injustice influences. (Details of the content of this case example have been changed in order to protect the identities of clients and students.) Dr. Mathew shared the following reflections with Dr. Jackson: It was a wonderful teachable moment. I could see the light bulbs turn on, and she had new insight. I live for these moments in doing the work that we do. It made all the other students’ comments fade into the background. If even one student out of 19

has an “aha” experience, then it makes it all worth it. However, the hard part for me is walking out of those classes or trainings and feeling like “ugh, no one got it.” [Yet] I know realistically that I am “planting seeds.”

Subsequently, more work is needed to cultivate the seeds of evolving critical consciousness in Amy’s and other students’ MCC self-awareness for effective clinical practice. In this case example, Dr. Mathew and Amy committed to the next step in their regular clinical supervision meetings of processing more specifically how societal messages and blind spots about immigrants and men of color interacted to impact Amy’s practice with clients. This included the commitment to disclose when and how she may have been rejecting or minimizing with clients, then working toward how to be aware in the moment so as not to act upon the blind spots in sessions. Dr. Mathew helped Amy to develop habits in clinical practice to first acknowledge each blind spot, then process where the biases came from, followed by critically and consciously self-monitoring for when the related thoughts or feelings occur. By engaging in these steps, Amy was able to build the ability to better recognize her blind spots and suspend judgments when triggered, in essence creating a meta-awareness. In the process of creating this MCC meta-awareness, Dr. Mathew has noted that Amy and other students in clinical supervision often experience the following emotional stages: defensiveness, shame and guilt, overcompensating or “walking on egg shells,” and ultimately being able to take an appropriate level of responsibility. By fully exploring their MCC blind spots in clinical supervision, her students are thus making a commitment to not only engage in difficult consciousness raising in MCC self-awareness but also take critical actions that inform and transform their counseling practice. This case example reinforces some key points of this chapter. It is indeed an ongoing and challenging process to develop MCC self-awareness in critical consciousness of power and oppression. An intersectionality analysis can reveal how it is particularly hurtful when one of the trainer’s own

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identities is maligned in difficult dialogues. Yet note how Dr. Mathew acknowledged these hurtful feelings and her impulse to withdraw, managing as a trainer to lean in empathically by sharing a story that disrupted the dominant narrative about immigrants. In planting and cultivating this seed, she helped a resistant student to begin to develop critical consciousness about immigrants by examining her own socialization and relevant hidden biases. She further facilitated therapeutic understanding with this student by keeping oppression in focus from their shared identities as women wrongly socialized to fear men of color. Case Example #2: MCC Self-Awareness Defenses Eliciting Most Difficulty for This Trainer. In the roles of clinical and research trainer, Dr. Jackson met regularly with her research team of inspiring graduate students of color to work on data analysis of focus group narratives with community youth of color on their experiences with racial microaggressions and coping. At an initial stage of the data analysis, they were reviewing together the descriptive themes they had independently noted as well as their own memos about their reactions in order to help bracket their biases. The research team members were advanced doctoral students in counseling psychology who identified as Black Americans. They had worked closely with Dr. Jackson for several years, and they had courageously engaged in training to learn about microaggressions and process their own experiences in order to develop MCC self-awareness, critical consciousness, and therapeutic understanding in clinical and research practice. Following are excerpts from personal reflections that Dr. Jackson wrote in consultation with Dr. Mathew focused on developing together their own MCC self-awareness as trainers (used here with permission from the graduate student research team members):

About my own potential biases, this is an area of heightened sensitivity for me from my experience with and perspectives from my own biracial marriage and daughters. Certainly, I may be hypersensitive and that may influence potential hidden biases of my own in misinterpretations of the participants’ voices. Worse, I recognize that my team members cannot as freely call me out, as I am in the position of power over them. Yet the focus in our data analysis is supposed to be on empathically understanding and documenting the participants’ voices as well as noting possible influences of our own reactions. The disturbing dynamics I observed happened when our team initially reviewed together the transcribed narratives of the biracial or bicultural participants who were talking about their experiences with racial and other microaggressions. Our team members’ reactions ranged from defensively protective to judgmentally minimizing the microaggression experiences of biracial and bicultural participants. At one point, I was surprised at how far our “interpretations” went beyond the text in ways that reminded me of how White counselor trainees too often react to microaggressions by defensively rationalizing, over-interpreting, or blaming the victim for hypersensitivity, effectively discounting the victim’s experience (and their own feelings of helplessness) vs. acknowledging and affirming the real anger and pain of the victim. This hurt me to witness and experience. Plus, I’m realizing that particularly with some passages we reviewed yesterday, it seemed they also discounted my own reactions as if their reactions were more “true.” Yet our reactions for each of us are our own. The point of this stage of data analysis is to focus on capturing the participants’ voices, while noting our own reactions and keeping our interpretations as close as possible to the data (transcript narrative text of the participants). So, I spoke up to note how and where it seemed our discussion of descriptive themes had strayed far from the participants’ voices. At times, we disagreed but did refocus better going forward with comments like “I think this does (or doesn’t) describe this participant’s voice because . . . ” So, that is progress.

The challenge now, I’m seeing, is how to overcome our defensiveness about the hidden biases among all of us as research team members regarding participants’ multiracial and multicultural identities.

Yet it was not until Dr. Mathew suggested using an exercise to explore intersectionality influences with the research team that real progress was made

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in recognizing their hidden biases (Dr. Jackson’s as well as her fellow research team members’) that limited or facilitated their empathic understanding of the voices of the participants of color. Dr. Jackson and her team members each independently completed the intersectionality exercise (available on request from the authors), then they processed together their responses at that point and at later stages in the data analysis. Over the course of engaging in this process, they had many difficult dialogues examining how participants’ experiences elicited in each of them challenging emotions and thoughts from their own life experiences. Intersectionality introduced a new freedom in the process to consider different identities of power and oppression less defensively and more clearly. Dr. Jackson was amazed and inspired not only by what they learned in closely documenting the participants’ voices but also by what they learned together about limitations and strengths in their own therapeutic perspectives and voices for social justice action. As a result of this evolving critical consciousness, examples of social justice actions that this research team has taken to date include (a) conducted a professional development workshop with staff of the youth program at the urban community center that collaborated in this research-service project titled “Facilitating Difficult Dialogues on Racial Microaggression Experiences and How to Navigate Constructively with Community Youth”; (b) through presentations at professional association conferences, shared preliminary research results that give voice to participants’ experiences with racial microaggressions and coping (e.g., Jackson, Holland, Dillon, & Regis, 2013); and (c) by preparing manuscripts to submit for publication, aim to contribute to scientific understanding that informs constructive training in bias awareness and social justice advocacy (e.g., Jackson, Regis, Dillon, & Holland, in preparation 2015). We have shared two case examples of intersectionality challenges for us (co-authors) as trainers in the ongoing process of developing our own and

our trainees’ MCC self-awareness. We focused in particular on trainee defenses that elicited our own defenses from our intersecting identities of privilege and oppression. We discussed how we navigated these challenges, including helpful consultation with each other. Next, we outline some recommendations for trainers in addressing challenges and developing competencies in multicultural self-awareness with trainees.

RECOMMENDATIONS We recommend that MCC trainers cultivate relationships with trustworthy colleagues with whom they arrange regular and confidential consultations about their own hidden biases in developing critical consciousness in training and practice. These consultations are needed to focus on honestly examining each other’s own evolving MCC self-awareness issues, including the influences of their intersecting identities of power and oppression in their current training and therapeutic relationships. By resiliently engaging in this difficult process with trustworthy colleagues, MCC trainers can provide each other with constructive challenges, invaluable support, and helpful resources. Trainers must learn to tolerate their own process as well as make space to tolerate their trainees’ process. We assert that trainers can expect their trainees to constructively engage in difficult dialogues in MCC self-awareness, a process that exposes their vulnerabilities and elicits their defenses, only to the degree to which trainers themselves can do so. We highly recommend an article by WattsJones (2010) as one exemplary model for incorporating into therapeutic training and practice critical consciousness and intersectionality in MCC selfawareness. Watts-Jones described a method she uses as a therapist and supervisor for “a model of location of self ” to initiate dialogues with clients and trainees “about similarities and differences in their key identities, such as race, ethnicity, gender, class, sexual orientation, and religion, and how they may influence the therapy process” (p. 405). With this collaborative method, she self-discloses

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her identities and invites dialogue about how the intersections of the identities held by her clients or trainees may be beneficial and/or limiting for developing their therapeutic understanding together. She notes how these thoughtful dialogues invite participants to recognize and address explicit and implicit ways that this experience, including associated privilege or subjugation in the world, may function in their therapeutic relationships together. We also appreciate how Watts-Jones described the evolution of this method in her clinical practice, its grounding conceptual foundations including social justice perspectives, clinical benefits and challenges in the use of this method, and how it is “a tool in progress” (p. 418) to be further developed. In their approach to operationalizing the foundational tripartite theory for MCC development, Arredondo et  al. (1996) provided a framework for addressing contextual and intersectionality variables with a model of Personal Dimensions of Identity (PDI model). This model includes “A” Dimensions of age, culture, ethnicity, gender, language, physical disability, race, sexual orientation, and social class; “B” Dimensions of educational background, geographic location, income, marital status, religion, work experience, citizenship status, military experience, and hobbies/recreational interests; and “C” Dimensions of historical moments/eras (Arredondo et al., 1996, p. 46). We share the underlying working assumptions of Arredondo et al. in their use of this framework for examining individual differences and shared identity based on the conceptualization of A, B, and C Dimensions of Personal Identity [including these] premises: (a) That we are all multicultural individuals; (b) that we all possess a personal, political, and historical culture; (c) that we are affected by sociocultural, political, environmental, and historical events; and that (d) multiculturalism also intersects with multiple factors of individual diversity. (p. 45)

We recommend using this framework to help focus trainers and trainees on critical consciousness

of contextual and intersectionality influences in their therapeutic relationships. Furthermore, as Worthington and Dillon (2011) aptly noted, “there have been major conceptual advancements in researchers’ understanding of multiculturalism in applied psychology as a whole (e.g., microaggressions, implicit bias, stereotype threat) that require integration into the foundational theory of MCCs” (p. 14). Although more are needed, several resources provide helpful recommendations for facilitating difficult dialogues that promote MCC selfawareness and constructively address privilege and oppression in training and therapeutic relationships. For example, following are some resources we recommend. In addition to those discussed above, Carter (2005) described his pioneering work in developing a racial-cultural laboratory. Watt (2007) introduced the Privileged Identity Exploration (PIE) model. McIntosh (2014) described a clinical training activity designed to help participants recognize their own unearned privileges and disadvantages as a critical element of developing self-awareness in therapeutic practice. Hernández and McDowell (2010) advocated for a framework of clinical supervision grounded in examining intersectionality, power, and relational safety in context. Mattsson (2014) outlined a structure for using intersectionality as a tool in therapeutic practice aimed to challenge oppression and inequality. Todd, Spanierman, and Aber (2010) investigated predictors of White students’ general emotional responses to reflecting on their Whiteness, and they discussed implications of their findings for racial diversity education research and practice. Mathew (2010) investigated MCC training experiences of trainees of color, and she documented their recommendations for practices that facilitated their developing MCC self-awareness. Young (2003) offered a model for facilitating difficult classroom dialogues of emotionally charged multicultural awareness. In Sue’s (2015b) book, he offered particularly helpful recommendations in the final chapter titled “Helping People Talk About Race: Facilitation Skills for Educators and Trainers.”

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In conclusion, the process of developing critical consciousness in MCC self-awareness and therapeutic effectiveness in training and practice is a lifelong learning process. As Chapman (2011) asserted, “crucial in education for social transformation . . . is noting the ways that all of us are ‘in process’, however long we may have

been at it” (p. 26). Thus, all counselors and trainers need to remain focused on vigilance of their hidden biases to raise critical consciousness, be gentle with themselves and with others in empathically learning from mistakes and triumphs, and resiliently persist in taking action to promote social justice.

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PART

VII

Culture and Intervention

M

any of the chapters in this edition of the Handbook of Multicultural Counseling include practical examples of interventions that take into consideration cultural and sociopolitical influences in promoting access to high-quality mental health and educational services with diverse individuals and groups. The chapters highlighted in this part of the Handbook on Culture and Intervention focus on social justice applications of multicultural counseling for marginalized and underserved clients in rural and urban settings, updating information on ways to effectively integrate cultural variables in career counseling theory and practice, and promoting organizational change in institutions of higher education to increase the probability of attaining desired social justice goals. In the chapter “Underserved Rural Communities: Challenges and Opportunities for Improved Practice,” Juntunen and Quincer advocate for recognizing the culturally distinguishing features inherent in the geographic and psychosocial locations and multicultural identities of rural citizens. They note that despite significant needs for mental health care in rural communities, there is stigmatization of treatment, lack of access and availability of resources, and poor quality of services to support rural psychological health and well-being. Finally, the authors constructively address these challenges and offer recommendations for improving services in rural communities. In the chapter titled “Underserved Urban Community Interventions,” Perry, Wallace, and Pickett argue that multicultural competency requires providing treatment that goes beyond the traditional clinical, therapeutic settings and treatments. They contend that since a great number of presenting mental health problems for which individuals in underserved urban communities seek help are tied to societal conditions and contexts, interventions must deal directly with the sociopolitical contexts in which these individuals live. To this end, they propose the implementation of community-based interventions anchored within the respective communities that serve as a collaborative and strengths-based resource for individuals. To provide a comprehensive understanding of such interventions, the authors review and critique experimental and quasi-experimental studies and exemplary nonexperimental studies. Acknowledging the challenges in conducting research on such interventions, Perry and his coauthors offer recommendations to improve and expand research capabilities with community-based interventions. In the chapter titled “Career Counseling: Updates on Theory and Practice,” Kantamneni and Shada discuss how it is essential that career theory and practice address the needs of an increasingly diverse society and workforce in the United States. They present updates to dominant career counseling theories

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and critique empirical evidence for multicultural applications of such theories to practice in career counseling. The authors highlight the cultural formulation approach as a framework for career counseling and they summarize recent empirical support for this approach. Finally, in the chapter “Organizational Change in Institutions of Higher Education,” the authors, Arredondo and Abdullah, address the increasing numbers of college-going ethnic and racial minority youth. They contend that with such an increase, the time for inclusive and culturally responsive institutional leadership is

now. They identify challenges, opportunities, and relevant models that can be used to advance inclusive diversity to benefit all stakeholders. The authors underscore the benefits of working from multicultural and social justice principles that serve as the basis for administrators to lead with fairness, compassion, hope, and cultural competence. Finally, they emphasize that multiculturally trained psychologists who are prepared as agents of change are ideal candidates for assuming leadership roles that focus on organizational changes that emphasize multiculturally informed and culturally responsive practices.

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CHAPTER

43

Underserved Rural Communities Challenges and Opportunities for Improved Practice Cindy L. Juntunen and Melissa A. Quincer

T

he experience of rural citizens and the concept of rurality are often overlooked in counseling psychology’s attention to multiculturalism and inclusiveness, even though rural communities are uniquely different from the suburban and metropolitan communities that are often assumed to be the norm. Rural communities and citizens are often defined by stereotypes and regularly dismissed as part of “flyover country” (Robertson, 2004). Unfortunately, psychology has done little to combat the impact of such stereotypes through research, training, or practice emphases. Despite the recognition by the American Psychological Association (APA) that psychological services are a critical need in rural areas (APA, 2007), there is still a tendency for psychology to practice “urbancentrism” (Stamm, as cited in Benson, 2003), or attending more carefully to the problems of urban and suburban areas. This oversight has contributed to persistent health care disparities, particularly for emotional and mental health care, in rural communities relative to suburban and urban communities (Hauenstein et al., 2007). The tremendous diversity of and within rural communities increases the difficulty of fully understanding the psychological characteristics and needs of rural citizens. In addition to the complexity of rurality itself, it is important to note that other vulnerable populations, including elders and people living in poverty, are overrepresented in rural communities. It is also a culturally diverse population, although this is not consistently recognized. Racial and ethnic minorities in rural areas may live in even more isolated communities (such as American Indian reservation and tribal lands) and are often overlooked in diversity conversations, but that is also changing as rural demographics reflect more ethnic and racial diversity (Lichter, 2012). In this chapter, we briefly review the complexity of defining and identifying rural as both a geographical location and an aspect of social identity. We then discuss the ways in which rurality contributes to mental health concerns and limited resources to address those concerns. The research relevant to rural health and well-being is reviewed, followed by suggestions for new research directions. Finally, issues relevant to providing behavioral health services to rural communities are discussed, along with suggestions for increasing rural awareness through training both students and professionals. 447

“RURAL” AS A PHYSICAL AND SOCIAL LOCATION The term rural is associated with numerous stereotypes. On the positive end of the spectrum, rural may be associated with peaceful agricultural scenes, close-knit neighbors, and children riding bicycles on safe small-town streets. Negative stereotypes include isolated “hicks,” uneducated “rednecks,” and scenes of poverty reminiscent of the Dust Bowl of the 1930s. The reality of rural identity is of course much more complex than such images convey and speaks not only to the size or density of one’s home community but also to the cultural values and norms consistent with rural roots. In order to work competently with rural populations, psychologists must understand both the place and social context that influences rural populations and their emotional and behavioral health needs (Ory, Smith, & Bolin, 2011).

Definitions and Descriptors of Rural Communities The essential meaning of rural as an adjective, which is “of or relating to the country and the people who live there instead of the city” (MerriamWebster, 2014), has limited practical application when considering the breadth of variation between country and city. It is surprisingly difficult to find consistent definitions of rural communities at even the most basic level of population, as multiple taxonomies are used to classify communities as rural or urban, or metropolitan or nonmetropolitan, even across various U.S. federal offices (Hart, Larson, & Lishner, 2005). The U.S. Bureau of the Census defines rural as “all population, housing and territory not included within an urban area” (U.S. Bureau of the Census, 2012). The Census Bureau has two classifications for urban areas: Urbanized areas have populations of 50,000 or more, and urban clusters have at least 2,500 and less than 50,000 people. By this definition, a town of 3,000, for example, would not be considered rural. The U.S. Office of Management 4 4 8       C ulture and I nter v ention

and Budget (USOMB) identifies metropolitan areas as including a core urban area with a population of 50,000 or greater and further identifies micropolitan areas, which have a population of greater than 10,000 and less than 50,000 (USOMB, 2010). A town of 3,000 located outside a county with a metropolitan or micropolitan statistical area would be considered rural by this definition. A more complex approach is used by the U.S. Department of Agriculture (USDA), which has identified an urban-rural continuum that includes both population size and proximity to metropolitan areas. This approach is perhaps most informative for conceptualizing underserved rural communities as it provides the context necessary to understand access to services available in larger metro communities. The continuum codes for 2013 include nine categories, of which three are metro and six are nonmetro (USDA, 2013a). Nonmetro areas include some combination of the following elements: open countryside, towns with fewer than 2,500 people, and urban areas with populations of 2,500 to 49,999. Every county in the United States has been designated to one of these nine categories, which can have significant implications for eligibility for funds designated to support rural or urban communities. In addition, the USDA has a system for identifying Frontier and Remote (FAR) communities across the United States. There are four different FAR code levels, representing the range of need for significant travel for higher-order services such as advanced medical care (Level 1 FAR) to the need to travel significant distances in order to obtain basics such as groceries and essential health care needs (Level 4 FAR). Although the urban population is growing and the rural population is decreasing overall (U.S. Census Bureau, 2012), 35% of the total U.S. population lived in Level 4 FAR areas in 2012. In other words, more than one third of the U.S. population must travel in order to buy groceries, fill their gas tanks, and/ or access critical health care. The variation across states is significant; for example, 0% of the populations in Connecticut and Delaware live in any FAR area, while over 70% of the populations of

North Dakota and South Dakota live in Level 4 FAR areas (USDA, 2012).

Rural as a Social Location In addition to meeting certain population parameters, there are several ways in which rural has a particular meaning as a cultural identity or social location. Social location can impact access to resources as importantly as geographical location (Kennedy et al., 2012), as it includes multiple factors that contribute to health disparities such as educational resources, economic characteristics, and cultural and community norms. Citizens of rural communities are more likely to live in poverty than those in metropolitan regions, particularly in the southern region of the United States (USDA, 2013b). In 2012, 17.7% of people living in nonmetropolitan areas were poor compared to 14.5% of the metropolitan U.S. population. In addition, rural full-time workers earn 20% less than full-time metro workers (USDA, 2013b). Although there are aspects of rural life that are less expensive than metro life, such as rent, there are other costs, such as travel and the additional cost of shipping for essentials such as groceries, that make the cost of living more balanced. It is interesting to note that rural populations are not included in the Consumer Price Index measure conducted by the U.S. Department of Labor, thus reinforcing the “flyover” stereotype. Economic disparities are often accompanied by educational disparities, and that is true for rural students as well. As more people move from rural to metro areas, the rural tax base decreases and so does funding for public schools. It can be difficult for schools with limited resources to compete for qualified teachers, particularly in math, science, and advanced placement courses (Duncan, 2013). Technology and the use of distance education and educational apps have alleviated some of this shortage, but rural students are less likely to meet college readiness benchmarks. For example, graduates of rural schools continue to enroll in college at lower rates than their metro counterparts, after controlling for income variation (National Student

Clearinghouse, 2013), and rural adults are less likely to have completed a baccalaureate degree than metro adults (National Center for Education Statistics [NCES], 2007). Beyond financial and educational issues, the social location of rurality is substantially defined by family, cultural, and community norms. Rural values are generally identified as including a strong work ethic, self-reliance, and strong family and social support (Wagenfeld, 2003). In an analysis of word frequencies in books published between 1800 and 2000, Greenfield (2013) found that as populations in the United States and the United Kingdom became more urbanized, the values reflected in publications changed substantially. She concluded that rural life places a priority on social obligation, sharing with or giving to others, and social belonging. In contrast, urban environments place more emphasis on individual choice, personal possessions, and child-centered social activity. Rural values often include self-sufficiency, and there is some evidence that a longstanding attitude of independence emerging from the early settling of the U.S. western frontier continues to play an important role in the values of rural and frontier communities today (Kitayama, Conway, Pietromonaco, Park, & Plaut, 2010). As we examine more closely in the next sections, this has important implications for rural help-seeking behaviors and for working effectively with rural populations.

RURAL AND UNDERSERVED Unique Needs of Rural Populations A review of rural health concerns reveals that there are higher levels of depression, substance abuse, domestic violence, incest, child abuse, and rates of suicide in rural communities when compared to urban communities (Smalley et  al., 2010). A larger percentage of the rural population rated their mental health as “fair or poor” and a lower proportion as “excellent” when compared to metro populations, even though the utilization of mental

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health services was lower in rural communities (Hauenstein et  al., 2007; Ziller, Anderson, & Coburn, 2010). It appears that self-reported mental health issues decrease as rurality (as measured by the USDA rural-urban continuum) increases (Hauenstein et al., 2007). In addition to serious mental health concerns, practitioners in rural areas also report working with clients in difficult life circumstances. One study of practitioners serving the Appalachian region discovered high rates of comorbid substance use, with 83% of practitioners endorsing “frequent” interaction with clients with substance abuse and 92.8% stating they “frequently” worked with individuals living in impoverished settings (Hastings & Cohn, 2013).

Access and Availability There has long been recognition that further knowledge and resources are needed to adequately address the mental health needs of the rural population. In the 1970s, there was a focus on the lack of knowledge about rural health need and the high turnover rate in mental health fields in rural communities. In 1987, the American government recognized the disparity and formed the National Rural Health Advisory Committee and the National Rural Health Advisory (Smalley et  al., 2010). Even with this increased focus on rural areas, there are still areas of disparity. Rural Healthy People 2010 is an initiative focused on increasing the quality of health care available in rural areas through health promotion and disease prevention. This initiative identified 12 rural focus areas, including mental health and mental disorders, which respondents of the Rural Healthy People survey ranked fourth in priority (Bellamy, Bolin, & Gamm, 2011). A survey associated with Rural Healthy People 2020 has ranked mental health and mental disorders third in priority (Bolin & Bellamy, 2012). It is clear that although there has been a focus on health, and specifically mental health, disparities for quite some time, further effort is needed to improve access and availability in rural areas. The continuing disparity of access for rural community members has most recently been 4 5 0       C ulture and I nter v ention

r­ ecognized by the U.S. vice president, who pledged funds to support the construction and expansion of mental health services to rural communities in 2014 (Office of the Vice President, 2013). It is clear that there remains a shortage of mental health professionals in rural communities. More than half of the Mental Health Professional Shortage Areas (as designated by the U.S. Department of Health and Human Services [USDHHS]) are located in nonmetropolitan areas (USDHHS, 2013). Due to these shortage areas, individuals are often discouraged from seeking services or must travel to receive services. It is not unusual for the round-trip travel to a provider to require several hours. This causes extra financial burdens because people lose income to take time off and purchase fuel to drive to their appointment in addition to paying for the appointment (Robinson et al., 2012). Rural citizens are also less likely to have health insurance and less likely to be covered by Medicaid (National Rural Health Association, 2008).

Acceptability Additional barriers to service include attitudes toward mental health care in rural communities. The high emphasis on independence prevalent in rural culture can lead to increased stigmatization of help seeking for mental health issues and decreased ability to recognize the signs of depression and other mental health issues (Elliott & Larson, 2004). Often, rural residents are reluctant to let others know they are experiencing difficulty. Additionally, rural residents have expressed feeling that others aren’t recognizing their struggles (Robinson et al., 2012). There are some avenues to obtaining help and support that are seen as less stigmatizing, for example, through the use of a primary care physician or clergy member (Andren et al., 2013). Additionally, addressing attitudes about mental health through education (Robinson et  al., 2012) and targeting perceptions (Deen, Bridges, McGahan, & Andrews, 2012) could reduce stigma and increase the likelihood of rural individuals seeking services. There are challenges associated with confidentiality and dual relationships that accompany

seeking mental health services in rural communities. There is an increased risk of encountering a provider outside of the office in a smaller community. Additionally, cars can be recognized by other members of the community, so it may be difficult to preserve confidentiality if individuals must park in a lot only associated with a mental health practice (Hastings & Cohn, 2013). For that reason, it is recommended that practitioners have a concealed parking lot or a lot that is shared with other agencies or in an integrated care center (Smalley et al., 2010). In addition to stigma, there are several beliefs that are commonly held by rural individuals that could be barriers to seeking services. Rural communities hold strong values regarding self-reliance and independence (Doherty, 2004). For example, studies have found rural individuals to be less likely to seek mental health care because of an emphasis on controlling one’s own destiny (Bock & Campbell, 2005). Studies have found that rural adults have less positive perspectives on receiving mental health care (Hayslip, Maiden, Thomison, & Temple, 2010). Instead, rural individuals are likely to seek support from friends or family before seeking professional help (Andren et  al., 2013). Unfortunately, this combination of values and beliefs often create a culture of secrecy and shame around seeking mental health care (Jones, Cook, & Wang, 2011).

RURAL PSYCHOLOGICAL PRACTICE Workforce Issues As previously stated, there are shortages of providers in rural areas. The ratio of psychologists to population is less than half in rural communities (16:100,000) than that of nonrural communities (39:100,000) according to a study conducted for the APA (2007). Within-state variation is further illustrated by a study that examined Washington State Department of Health records of licensure of mental health professionals. Shortage areas were found in rural areas in the state. For instance, urban

areas had 3 times more psychiatrists per capita and 1.5 times more other mental health professionals. This study has been proposed as a model to explore mental health shortage areas in other states (Baldwin et al., 2006). One contributing factor to the lack of mental health providers in rural areas is difficulty retaining mental health care providers. High turnover rates in rural sites have caused researchers to explore what keeps mental health care providers from defecting to urban areas. One such qualitative study of mental health providers who had worked in rural Alaskan communities for 5 years or more identified factors impacting retention. The providers identified a love of rural living, including a slower pace of life, living in a smaller, tight-knit community, and a short commute as benefits that kept them engaged in rural practice. The long-term providers also identified reasons other providers did not last in the rural Alaskan villages. These reasons included the remote location and distance from desired urban amenities, high expense of living (specific to Alaskan locations), distance from aging parents, and lack of medical and educational services for themselves or their partner (Bischoff et al., 2013).

Rural Practice: Challenges and Benefits Many researchers have identified challenges to working in rural communities. High levels of job dissatisfaction and burnout may be due to limited social support for mental health care providers in rural settings. Stigma in the community can contribute to this lack of social support. Additionally, mental health professionals in rural communities may experience a lack of privacy. It is common to encounter clients outside the office, and clients may even be aware of where counselors live (Hastings & Cohn, 2013). Various ethical issues are also more likely to arise in rural communities: multiple relationships, competence, and boundaries. The small population of the town and limited access to other professionals and professional training contribute to these concerns (Schank & Skovholt, 2006).

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In spite of the challenges, there are also benefits to working in rural communities. Mental health professionals who want to function as generalists will find ample opportunity to do so in rural communities. There are also opportunities to work in integrated settings and loan repayment options in many states. Others have endorsed the match between their own ideals and rural values. Perhaps these benefits contribute to the satisfaction of rural mental health workers, over half of whom endorsed being “delighted” or “pleased” with their jobs in one study (Hastings & Cohn, 2013).

Provider Implications Mental health providers who find themselves working with a rural population would do well to follow the research-driven suggestions from a meta-analysis conducted by Smalley et al. (2010) focusing on rural mental health. These guidelines are designed to assist providers in offering high-quality care to their clients. •• Know the specific mental health burdens that disproportionately affect rural populations (substance abuse, suicide, etc.). •• Be aware that residents of rural areas frequently present with more severe symptoms and later into the course of a mental disorder. •• Prepare to face ethical dilemmas that frequently occur in rural areas. •• Consider ways to counteract the burden of stigma in rural areas (having an office in a remote location, with a concealed parking lot, or housed with other agencies/health care providers, etc.). •• Create and sustain close connections with schools. •• Explore ways to better connect with physicians, improve referral mechanisms, and promote the importance of mental health screening in primary care settings. •• Be open to exploring nontraditional treatment delivery modalities (telehealth, school-based, etc.). •• Be proactive in informing clients (particularly family clients) of the role of the therapist and the responsibilities of those receiving therapy. •• Be an advocate for mental health resources in their areas.

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•• Be cognizant of the particular challenges that caregivers of older adults in rural areas face and the impact this may have on their mental health. •• Prepare for operating within the limitations of specific insurers (e.g., Medicare). •• Be knowledgeable of the unique culture of rural populations and have a flexible, creative perspective. (p. 486)

RECOMMENDATIONS FOR IMPROVING SERVICES TO RURAL COMMUNITIES The list of suggestions provided by Smalley and colleagues (2010) serves as an excellent starting point for considering optimal practices and competencies necessary to meet the psychological needs of rural communities. We have identified five innovative and critical areas of practice development that are particularly relevant to rural communities: telepsychology services, integrating psychological and behavioral health into primary care settings, developing more intentional and effective school-based interventions, increasing attention to prevention and early identification, and educating first responders and nonspecialist professionals in the essentials of mental and psychological health.

Telepsychology One viable option for combating the lack of mental health services in rural areas is the use of telehealth technology, often referred to as telepsychology or telemental health in the helping professions. Telepsychology involves the use of real-time video conferencing as a means of providing therapeutic behavioral services (Nelson & Bui, 2010). This technology has been successfully applied to various rural populations. Telepsychology has been used to offer services to rural underserved families (Reese, Slone, Soares, & Sprang, 2012), rural substance users (Staton-Tindall et al., 2012), and rural veterans (Barnwell, Juretic, Hoerster, Van de Plasch, & Felker, 2012).

Providers in Alaska who make use of this technology cited access to remote populations, professional growth, and increased workload as positives of using this technology. In the future, users state there needs to be a focus on the ethics of telepsychology and applying appropriate cultural knowledge for communities of which the provider is not a member (Ford, Avey, DeRuyter, Whipple, & Rivkin, 2012). As evidenced by the recent publication of the Guidelines for the Practice of Telepsychology (APA, 2013), this service delivery model has the potential to both address some of the difficulties in serving rural areas and bring up new questions about ethical, jurisdictional, and best practice issues in the next couple of years.

Integrated Behavioral Health Care Interprofessional health care systems and comprehensive patient-centered medical homes are increasingly part of the U.S. health care reform conversation, and these movements show great promise for meeting the needs of underserved rural communities. In fact, integrated care has been identified as an “ideal” strategy for meeting rural psychological health needs (Gale & Deprez, 2003). As part of an integrated health care team, often working in a primary care clinic or practice, psychologists can confront some of the major aforementioned barriers, including accessibility and acceptability. There is some evidence that rural residents are more likely to approach physicians than mental health specialists for emotional or psychological health concerns (Deen et al., 2012; Hauenstein et al., 2007). Psychologists who are part of the integrated health team may have increased credibility through their association with a local primary care provider, and their location in a primary care setting can protect confidentiality and reduce the stigma associated with seeking a mental health specialist. In addition to providing more support to clients, integrated health care can address some of the workforce issues that limit the number of psychologists available to rural communities. Isolation

and lack of professional support can contribute to provider turnover. Being part of an integrated care team may contribute to greater job satisfaction and a sense of community for the rural provider and mitigate some of the professional factors that contribute to burnout.

School-Based Interventions The role of psychologists and psychological science in the schools has long been recognized, and the APA emphasizes this collaboration through the Center for Psychology in Schools and Education (CPSE; http://www.apa.org/ed/schools/index .aspx). Collaborating with school personnel is particularly useful for rural populations because even the smallest communities are associated with a school district. Whether children attend a school two blocks from home or are bused to a consolidated school district an hour away, school identity and personnel can be powerful forces in preventing mental health concerns and fostering healthy development (USDHHS, n.d.). There are a number of successful school-based programs that have been established and tested by psychologists (see Espelage & Poteat, 2012), but relatively few have been specifically implemented or tested in rural schools. This is an important next step to demonstrate the effectiveness of empirically supported interventions in schools. For rural providers, school districts, and citizens, this is a rich public health approach that could decrease stigma, increase mental health literacy, and improve mental health for rural communities.

Prevention and Early Intervention Collaborating with primary care providers, school professionals, and other nonmental health specialists also provides numerous opportunities for primary prevention and early intervention in mental health concerns. As noted previously, rural communities have lower ratings of overall health and mental health. One of the factors contributing to

      4 5 3

Underserved Rural Communities

higher levels of illness is the lack of identification of early indicators of mental health concerns. As an example of this concern, one of the authors grew up in a small town that was a 2-hour drive from the nearest mental health professional. A childhood friend was diagnosed with bipolar disorder in her mid-30s. In hindsight, and based on knowledge gained from an extensive education in psychology, the author could see that the symptoms had been present since middle school. Instead of being appropriately diagnosed during adolescence or young adulthood, this friend went through several years of substance abuse, multiple treatments for substance abuse, and highly conflicted relationships. She was finally referred to a psychologist after her spouse took her to an emergency room during a rapid-cycle episode in which manic and depressive states were occurring repeatedly over the course of a single day. The pain of this single family is not uncommon in rural areas, where lack of knowledge about mental health and lack of resources to treat it are common. Although there may not be a psychologist or mental health specialist in every community, prevention and education efforts can be implemented through schools, public health nurses, county offices, local police forces, and county agents of the USDA, to name a few common rural institutions. As mental health literacy increases in rural communities through local agencies or through media outlets, it is increasingly likely that nonspecialist professionals, family members, and neighbors will be able to recognize early signs of mental health concern and have enough knowledge to help individuals seek appropriate assistance.

Educating First Responders and Nonspecialist Professionals Mental illness in rural communities is most likely to initially be encountered by first responders or professionals who have no or limited training in mental health issues. For example, clergy are commonly sought for counseling in rural communities, but most clergy report feeling unprepared 4 5 4       C ulture and I nter v ention

to deal effectively with mental health concerns (Hall & Gjesfjeld, 2013). Similarly, physicians may be sought out for mental health concerns, but they frequently do not recognize the mental health issues. For example, in a meta-analysis of 118 studies that assessed diagnosis of depression by primary care physicians, slightly less than 50% of cases were correctly identified, and fewer were accurately recorded in patient charts (Mitchell, Vaze, & Rao, 2009). Such recognition becomes even less likely when you consider the likelihood that first responders to rural emergencies, many of whom are volunteer firefighters or emergency medical technicians, will have even less preparation. In recognition of these needs, psychologists can be instrumental in helping nonspecialists recognize mental health symptoms and crises. The Western Interstate Commission for Higher Education (WICHE), which includes 14 states that have a high proportion of rural communities, recommends Mental Health First Aid (MHFA; Kitchener, Jorm, & Kelly, 2009) training. The MHFA program is designed to help laypeople identify and respond effectively to individuals with a mental health crisis or experiencing symptoms consistent with early mental health concerns. MHFA has been implemented in numerous rural communities in Australia and is increasingly available in the United States. Psychologists who are trained to train others with MHFA can make a substantial impact on rural mental health through this consultation and outreach programming.

CONCLUSION Approximately 60 million people live in rural communities in the United States, representing just under 20% of the population (U.S. Bureau of the Census, 2012). That 20% is spread across more than 70% of the land mass of the United States, sometimes in extremely isolated communities with population densities of less than six people per square mile (frontier counties). Given the complexity of rural communities and the issues faced by the significant number

of rural citizens, it is essential for psychology to dedicate more intellectual and training energy to meeting the needs of chronically underserved rural populations. The barriers to providing culturally competent services to rural communities are significant, but the resources to break down these barriers are numerous. Technology, collaboration with other professionals, and outreach and education designed to increase mental health literacy can all be utilized to enhance psychological services for rural populations.

Perhaps most important, effective change is contingent upon training psychologists to recognize that rurality is an important cultural construct. We cannot allow the profession to continue to practice urbancentrism and fly over rural communities as if they have no unique or distinguishing features of their own. Culturally competent providers must also recognize the culture inherent in the geographic and social locations of rural citizens and be open to both the challenges and opportunities to supporting rural psychological health and well-being.

      4 5 5

Underserved Rural Communities

CHAPTER

44

Underserved Urban Community Interventions Justin C. Perry, Eric W. Wallace, and Lela L. Pickett

I

n their seminal document operationalizing multicultural counseling competencies and standards, Sue, Arredondo, and McDavis (1992) proposed that culturally skilled counselors “should be cognizant of sociopolitical contexts in conducting evaluations and improving interventions” (p. 483). As one of the last skills they listed, it remains one of the most important yet least implemented competencies, that is, depending on how “interventions” are defined. If defined beyond the traditional model of providing treatment in consulting-room settings such as college counseling centers, hospitals, and mental health agencies, then the counseling profession has a lot more work left to do in fulfilling Sue et al.’s call to action. More than 20 years later, the design, implementation, evaluation, and dissemination of community-based interventions is still a role counseling scientist-practitioners rarely adopt in their normal work activities (Adams, 2007; D’Andrea & Heckman, 2008; Vera, 2007). As prevention scholars have long argued, trying to “treat away” mental and physical illnesses is not a viable approach. Instead, solutions that possess the greatest potential of mitigating these widespread problems are those anchored within communities themselves; in doing so, they work toward eliminating the stigma of seeking out mental health treatment through the provision of strength-based, collaborative, interprofessional services that are made accessible to the general population, regardless of ability to pay. Bond and Hauf (2007) took this premise further by proposing that community-based collaboration should be a best practice guideline for any prevention initiative to take hold and mature. Through these partnerships, community interventions become owned by stakeholders through mutual respect, the sharing of power, and the engagement of parties invested in the process. The emphasis on the involvement of community members in prevention research is nearly synonymous with standards of cultural sensitivity or competence, as they inevitably require that the design, delivery, content, and ongoing evaluation and refinement of any intervention must be responsive to the cultural values, beliefs, practices, and norms of the community it seeks to benefit (Reese & Vera, 2007). In response to growing national concerns such as concentrated poverty, housing and economic segregation, violence, homelessness, health disparities, the achievement gap, and school dropout rates, 456

the American Psychological Association (APA) created a Task Force on Urban Psychology (TFUP; 2005) designed to raise awareness of why an urban psychology is needed. Given that about 80% of the U.S. population live in urban areas and that half of the world’s population reside in cities, rising to 75% by 2020 (APA, 2005), the income inequalities, loss of jobs, crowding, crime, physical decay, unstable housing, and social disorder that plague many urban environments affect all taxpayers and public citizens. In their report, the APA Task Force endorsed an ecological perspective focusing on (a) the resilience of urban families; (b) interdisciplinary, multilevel, multimethod research; (c) the inclusion of urban policy studies, urban education, prevention and health promotion, advocacy, consultation and technical support, and outreach as coursework; and (d) formation of interdisciplinary conferences and seminars. These recommendations converge around the need for community intervention research. Against this backdrop of challenges residents of urban communities must commonly face, we discuss a meta-analysis of community-based programs. This discussion will set the stage for the main part of the chapter, where we examine studies published over the past 5 years based on experimental or quasi-experimental designs. Drawing from this assessment of trends and limitations, we also incorporate several nonexperimental studies that elucidate the processes, challenges, and opportunities involved with undertaking this type of research. We conclude with thoughts on how multicultural counseling researchers can become more involved with the nontraditional line of research we advocate, including recommendations for moving forward.

CLARIFYING OUR TERMS According to the U.S. Census Bureau (2010), urban areas are classified as representing “densely developed territory, and encompass residential, commercial, and other non-residential urban land uses” (p. 1); consisting of census tracts or blocks that meet population density requirements of at least 1,000

people per square mile. Furthermore, urbanized areas consist of 50,000 or more inhabitants, whereas urban clusters consist of at least 2,500 people but less than 50,000. While technically useful, government delineations of what it means to live in an urban environment do not necessarily answer the question of what it means to live in an underserviced neighborhood. Instead of relying on indicators like socioeconomic status (SES), racial and ethnic concentration, or residential stability, Creasey and Jarvis (2013) contended that employment rates, health care, and the school systems are important factors to consider as well, in which “underserviced populations live in communities that have difficult access to good health care, jobs and schools” (p. 3). The combination of these social and economic forces typically gives rise to the sources of adversity that policy analysts are familiar with when analyzing the problems of urban blight and decay. In addition to clarifying the above terms, it is important to understand the terms large cities or big cities existing in centralized, metropolitan areas, where much of the community-based research is conducted. Generally speaking, large cities can be defined as a territory inside an urbanized area and a principal city with a population of at least 250,000 inhabitants or more; as such, large cities are not synonymous with urban areas or inner-city areas. They are also a unit of classification that policy analysts in economics, health care, and education typically use to examine trends between urban and nonurban populations, often with regard to certain “gaps.”

PARAMETERS OF OUR REVIEW Urban populations are often placed at greater risk for experiencing a multitude of psychological and/ or behavioral problems (e.g., anxiety, externalizing disorders, trauma) and to receive less help for such difficulties than the general population (APA, 2005; Farahmand et  al., 2012). These statistics do not include all of the other problems that are typically related to their origins and aggravation, including infectious diseases (e.g., HIV/AIDS) and various health problems (e.g., asthma, diabetes,

U N D E R S E R V E D URBA N COM M UNI T Y I NTERVENTI ONS

      4 5 7

hypertension). In this chapter, we focus on community interventions targeting mental health (e.g., depression, self-esteem) and/or behavioral/health risk (e.g., social skills, hyperactivity, alcohol/drug use, HIV/AIDS, teenage pregnancy) outcomes that use counseling activities or related practices. Hence, we do not address vocational (career) interventions commonly implemented in schools, after-school programs, and job training and employment programs. This chapter cannot accommodate the literature pertaining to this subject nor does it address the literature on educational (academic) interventions (Kenny, 2013; Perry & Wallace, 2015; Perry, Wallace, & Barto, 2013). The interventions examined entail a wide range of psychosocial or psychoeducational services. These services may be delivered in multiple formats or modalities (e.g., workshops, coaching, mobile devices, consultation groups) across a host of settings (e.g., schools, homes, community centers, parks, nonprofit agencies). We limited our review to studies published within the past 5 years at the time of our literature review (2008 to 2013), while further narrowing them down to journal articles. The same timeframe and format restriction was applied to our review of exemplary nonexperimental studies.

Comments on Recent Meta-Analyses While concerning only children and adolescents, two recent meta-analyses by Farahmand and colleagues (2011, 2012) are informative, as both focused on low-income urban youth, a population that is commonly served in community-based counseling interventions that aim to reach a large number of people in universal (primary) or secondary (indicated, targeted) prevention programs. In this chapter, many of the interventions we discuss focus on youth and are based in school or schoollinked settings. This is not surprising given that schools and settings/agencies connected to schools function as centralized hubs for program delivery and the coordination of such efforts. 4 5 8       C u lture and I ntervention

Departing from prior meta-analyses that looked at the general population, the first meta-analysis by Farahmand, Grant, Polo, Duffy, and Dubois (2011) made a unique contribution. The authors examined mental health and behavioral interventions based in the school environment. Compared to the metaanalytic findings obtained from a broader population of youth (Rones & Hoagwood, 2000), the authors classified only about half as many studies in their meta-analysis of low-income urban youth as “effective,” with roughly twice as many classified as “ineffective.” Farahmand et al. (2011) found a very small overall effect size of .08 at post-test and .06 at follow-up. Collectively, these findings are not very compelling in terms of practical impact or effect size. Building on this meta-analysis, Farahmand et  al. (2012) examined a broader range of interventions by extending their scope to programs delivered outside of the school setting, once again among low-income urban youth. For study inclusion, they focused on “community-based mental health and behavioral programs for school-aged youth” published between 1975 and 2010 (p. 197). Meta-analyses of the 33 studies revealed an overall effect size of .25 at post-test. The mean effect size for the six studies that also reported follow-up outcomes was very small (.05). These negligible findings indicated that even small gains that were made virtually disappeared. Based on moderator analyses, there were no differences as a function of universal versus selected programs, the problem (e.g., externalizing, alcohol use, socioemotional), single-component versus multi-component programs, program length, dosage, type of change agent, manualized/nonmanualized, or gender of the participants. Perhaps more provocative than the effect sizes was how they were interpreted. According to Farahmand et al. (2012), interventions targeting the “environment” (i.e., the family) “as opposed to the school or neighborhood” may be more effective and feasible because “families may be more amenable to change than schools, given the large difference in size and complexity between the two systems” (p. 209). This kind of conclusion is wrought with a number of confounds. For example, the studies

they reviewed did not test for the comparative impact of school or neighborhood interventions against family interventions. And given that the overall effect size was .25, with an even smaller one at follow-up, it is hard to support the notion that families are “amenable to change” when there was such a small impact in the first place. A more appropriate concern would be how to improve or innovate the interventions reviewed, while further studying their impact within the context of providing other services. To summarize our discussion of this timely and important set of meta-analyses, much more empirical work should be devoted to improving existing practices. To that end, improved community interventions should possess the capacities to be replicated to varying degrees of adaptation. To the extent that these efforts fail to show interventions yielding effect sizes that can break above the small effect size range, efforts should be made toward fostering partnerships with stakeholders who share the same investment but look at them from different points of view, especially if the ultimate goal is to ensure program sustainability (Bond & Hauf, 2007).

Urban Community Interventions: A 5-Year Review and Synthesis According to our review criteria, seven studies in relevant community settings based on experimental or quasi-experimental designs were identified, published between 2008 and 2013. In Table 44.1, each study is summarized with respect to main activities, sample characteristics, research/evaluation design, quantitative outcomes, and effect sizes. We did not include every aspect about each dimension, such as additional analyses and results (e.g., moderation) or other aspects of the sample (e.g., additional races/ ethnicities). The effect sizes are presented in the order in which the outcomes are listed. The type of effect size is provided in parentheses for the effect sizes reported as statistically significant, although one study (Mendelson et  al., 2010) did not report type of effect size. One study compared

two versions of the same program (O’Connor, Rodriguez, Capella, Morris, & McClowry, 2012). In Table 44.2, each of the studies is summarized with respect to its settings, personnel, community partners/collaborators, supervision/ training, fidelity of implementation, dosage, and sustainability. As we can see, much of the information was missing, not reported, or simply not measured by the researchers. This is particularly evident for the fidelity measures, dosage, and sustainability. In contrast to Table 44.1, the information presented here is concerned with process-oriented features of the programs. As we can see, these interventions cut across a wide range of purposes and urban populations and traverse multiple settings. Four studies occurred in schools, and two evaluated the same child temperament program with different methods (Gould, Dariotis, Mendelson, & Greenberg, 2012; Mendelson et al., 2010). One of the school-based studies evaluated a youth action research program in five urban high schools (Ozer & Douglas, 2013). Another study targeted couples to assist them with coping and parenting while improving their mental health and financial anxieties (Wadsworth et  al., 2010). Two studies shared a health risk focus, one which targeted lowincome women of color screened as being at high risk for HIV infection (Jones & Lacroix, 2012) and the other one recruiting low-income adults of color diagnosed with type 2 diabetes (Spencer et al., 2013). Before turning to different issues of consideration in the sections below, it is important to note that we do not discuss in detail the flaws in study design (e.g., power, selection bias, group equivalency) or problems with methodology (e.g., measures, covariates, fidelity assessment).

REPORTING AND INTERPRETING EFFECT SIZES By simply looking at the data in Table 44.1, it may not be immediately clear how to interpret the ­practical value, worth, or meaning of the ­ interventions. Ideally, researchers should frame the effect sizes

U N D E R S E R V E D URBA N COM M UNI T Y I NTERVENTI ONS

      4 5 9

4 6 0       •• •• •• •• ••

.83 .70 .51 .64 (ES metric not reported) •• Nine remaining outcomes NS

•• 2.94 for Impulsive Action subscale •• (t-value) •• All remaining outcomes NS for moderator effect •• -.30 average effect size •• (Cohen’s d) •• -6.1 to -6.4 average effect size (logtransformed) •• Outc. 3 NS

•• Involuntary Response to Peer Stress •• Rumination •• Intrusive Thoughts •• Emotional Arousal •• Nine outcomes measured other forms of involuntary response, depressive symptoms, positive/ negative affect, and relations with peers and school •• Same as Study 1 described above •• Used low, medium, and high levels of baseline depressive symptoms as a moderator

•• Diabetes-Related Distress as a Screener for •• Depression •• Problem Areas in Diabetes Related Distress •• Severity of Depressive Symptoms

•• Experimental •• Pilot RCT, with two schools randomized and two schools as wait-list control group

•• Same as Study 1 described above •• Different use of method w/ multilevel modeling and moderators •• Experimental •• Randomized 6-month delayed control group

•• 97 4th and 5th grade students •• Mean age of 9.7 •• 60.8% female •• 83.5% African American

•• Same as Study 1 described above

•• 164 adults with type 2 diabetes •• 43% Latino/a, 57% African American •• 71% female •• Mean age 53 •• Low-income

•• Mindfulness program during school hours on a weekly basis (four days per week for 12 weeks; 45 minutes per session) •• Yoga-based physical activity •• Breathing techniques •• Guided mindfulness practices

•• Same as Study 1 described above

•• Diabetes education classes (English and Spanish; 11 2-hr. group sessions on a biweekly basis) •• Home visits (2x month; each 1 hr.) for selfmanagement goals, communication skills, and referrals •• Clinic visit with primary care provider •• Telephone contact biweekly

School-Based Mindfulness (no formal program name reported)

School-Based Mindfulness (no formal program name reported)

Community Health Worker (no formal program name reported)

2. Gould, Dariotis, Mendelson, and Greenberg (2012)

3. Spencer et al. (2013)

1. Mendelson et al. (2010)

Effect Sizes

Measured Outcomes

Design

Sample

Interventions/Activities

Program

Study

Table 44.1  Community-Based Interventions in Underserved Urban Settings Using Experimental or Quasi-Experimental Designs

      4 61

•• No test of Outc. 1 – 4 on mean differences •• -.19 for Outc. 1 predicting disruptive behavior at T5 •• (β) •• R2 of .21

•• •• •• •• •• ••

•• Parenting efficacy •• Child disruptive behavior •• Child temperament •• Parental depression

•• General Sociopolitical Skills •• Motivation to Influence School or Community •• Participatory Behavior •• Perceived Control •• Self-Esteem

•• Quasiexperimental •• Eleven schools in total •• Six hosted collaborative version •• Five hosted parallel version •• Individual growth modeling and mediational analyses

•• Experimental •• Randomized within-school cluster design (at least two classes at each school randomized to treatment or control group) •• 178 in treatment •• 223 in control

•• 202 children in K–2 and parents •• 82 K–2 teachers w/96% female •• 85% free or reduced lunch •• 56% children were male •• 85% parents were female •• Mean age of children 6.07

•• 401 youth •• 35% Asian, 31% Latino, 14% African American •• 65% female •• Mean age 16.3 •• Five high schools in large urban area in CA (35% to 57% free or reduced lunch)

•• 10 sessions each for parents and teachers focusing on topics such as recognizing child temperament, reframing child temperament, caregiver responses, gaining control, fostering social competencies, etc. •• Each session lasts 2 hours •• In “Parallel” version, parent and teacher sessions held separately •• In “Collaborative” version, half of parent and teacher sessions held jointly •• Six week introductory Peer Resources curriculum focusing on team building, communication, and social justice principles •• Peer mentoring and peer education for one or two semesters •• Experimental condition received training to conduct research on a topic of concern (e.g., transition to 9th grade, stress, cyberbullying, sexual health, school bathrooms, interethnic friendships), w/each project lasting at least one semester

INSIGHTS Into Children’s Temperament

“Youth-led” or “youthdriven” participatory research programs (YPAR)

4. O’Conner, Rodriguez, Cappella, Morris, and McClowry (2012)

5. Ozer and Douglas (2013)

(Continued)

-.08 at F1 -.10 at F1 -.15 at F2 -.12 at F2 (B coefficient) Outcomes 1 -4 at other follow-up time points NS •• Outcome 5 NS

Effect Sizes

Measured Outcomes

Design

Sample

Interventions/Activities

Program

Study

4 6 2       •• Experimental •• Control condition of 12-HIV health promotion messages

•• 238 women •• Prior engagement in high or very high sexual risk •• Mean age 22 •• 88.2% African American •• 61.8% unemployed •• Low income

•• Series of on-demand, mobile 12-episode soap opera series streamed to smartphones on a weekly basis for 12 weeks •• Each episode 15–20 minutes •• Episode series features four women and their male partners, communicating principles of reducing HIV risk through archetypical characters and high-risk situations

Love, Sex, and Choices

7. Jones and Lacroix (2012)

•• Survey ratings evaluating experience of watching the videos on smartphone

••

••

••

••

••

•• Not applicable

.08 Outc. 2 NS .06 Outc. 4 NS Outc. 5 NS .06 Outc. 7 NS Outc. 8 NS Outc. 9 NS (partial η2)

•• •• •• •• •• •• •• •• •• •• •• •• •• ••

•• Experimental •• Men-only group (n = 39) •• Women-only group (n = 47) •• Couple’s Group (n = 45) •• Control Group (n = 42)

•• 173 low-income couples with children •• 32.8% Caucasian, 27.9% African American, 23.5% Hispanic •• Mean income of $23,219, w/ 53% at or below poverty •• Mean age 31 to 33.9 by gender

•• Workshops with 14 hours of content conducted either three Saturdays (6 hrs. each) or five weeknights (3.5 hrs. each) •• Main components of curriculum: (1) relationship education; (2) stress and coping skill training; (3) child-centered parent training

Fatherhood, Relationship, and Marriage Education (FRAME)

6. Wadsworth, Santiago, Einhorn, Etter, Rienks, and Markman (2011)

Financial Worries Coping Efficacy Problem Solving Primary Control Coping Secondary Control Coping Disengagement Coping Involuntary Engagement Involuntary Disengagement Depression

Effect Sizes

Measured Outcomes

Design

Sample

Interventions/Activities

Program

Study

Table 44.1  (Continued)

      4 6 3

•• Community leaders, parents, and teachers; details not reported.

(Continued)

•• Not reported •• Mean sessions attended were 9 for teachers, 7 for parents, 8 for children •• Percentages of attendance at all, 9, or 8 sessions was also reported •• Model scripts •• Checklists •• Documentation of each session •• Ongoing supervision/ training •• Videotaped sessions •• 92% of components completed

•• Facilitators were trained in each program version •• Enrolled in graduate-level course on temperament theory, parenting practices, behavior management strategies, and sociocultural issues •• Training using script manuals and drama therapy techniques

•• INSIGHTS developer •• Facilitators

•• Classrooms in large urban school district

4.

•• Not reported •• Not measured or analyzed

•• Not measured or analyzed

•• Community Health Center •• REACH Detroit

•• Community Health Workers •• Health Care Providers

•• Patient Homes •• Health Centers/ Facilities

3.

•• Same as above

•• Not reported

•• Community Health Workers received 80 hrs. of training; supervision not reported •• Health Care Providers received training in cultural competence, but frequency not reported; supervision not reported

•• Same as above

•• Same as above

•• Same as above

•• Same as above

2.

•• Not measured or analyzed

•• Not measured or analyzed

Sustainability

•• Same as above

•• Supervisor involved •• Indicates research assistants were trained; details not reported

•• Baltimore-based Holistic Life Foundation (HLF)

•• Supervisor •• Graduate assistants •• Researchers •• Instructors

•• Four Baltimore City public elementary schools

1.

Dosage

Fidelity Measures

•• Same as above

Supervision/Training

Partners/Collaborators

Personnel

Settings

Study

Table 44.2  Additional Characteristics of Studies Listed in Table 44.1

4 6 4       •• Not reported •• Tracking of video usage via Helix Session log •• Tracking technical performance of video through calls, texts, and/ or e-mails to research team •• Indicates research assistants were trained; details not reported

•• Filmmaker •• Professional actors

•• Research assistants •• Project director •• Information technology specialists

•• Public housing units, STD clinics, community centers, storefront, food pantries for screening •• Mobile platforms for the intervention

7.

•• Reports 7 waves of intervention; will be 10 in total

•• Not measured or analyzed

•• Audio-recorded sessions •• Checklists for leader adherence •• Satisfaction, utility, and leader ratings

•• Indicates providers were highly trained; details not reported

•• Not reported

•• Community service providers •• Clinical Ψ grad students •• Postdoctoral fellows

•• University •• Community college •• Housing authority community center

6.

Sustainability •• Not reported

•• Not measured or analyzed

•• Not reported

•• Not reported beyond participating schools

•• Researchers •• Certified classroom teachers •• Supervisor

•• Five high schools in large urban area in CA

5.

Dosage •• Not measured or analyzed

Fidelity Measures

Supervision/Training

Partners/Collaborators

Personnel

Settings

Study

Table 44.2  (Continued)

in such a way that stakeholders can readily judge their importance within a policy-based perspective of understanding the benefits relative to the costs of delivering a program and its long-term consequences. Putting the effect sizes into their proper contexts, with all relevant caveats, requires more than stating if they fall in a small, medium, or large range. Oftentimes, consumers of such knowledge may need to carefully render their own judgments. Based on the effect size of .83 for reducing involuntary stress reactions, Mendelson et al. (2010) concluded that “mindfulness-based practices were effective in enhancing self-regulatory capacities in reducing activation and persistent or worrying thoughts for the youth” (p. 991). Aside from not reporting type of effect size as well as the underpowered nature of the design, one cannot tell how valuable a reduction such change represents. Similarly, in Spencer et  al. (2013), the mean difference in the index of diabetes-related emotional distress was not explained with respect to a clinical rubric. At 6 months, it was not clear how a mean of 19.0 for the intervention group was a favorable result in contrast to the delayed control group, which had a mean of 24.2 after 6 months. Overall, the studies in Table 44.1 illustrate common challenges when trying to interpret and make practical sense of the effect sizes, out of which some of the findings may not be reported in a clear manner and many of which are not benchmarked according to how they compare to the benefits of other interventions. They also reflect the difficulties in evaluating the impact of interventions after they have been delivered, though some of the programs were in the stages of pilot implementation. With the exception of Ozer and Douglas (2013), follow-up evaluations were not conducted or had not yet been undertaken; the gains made at posttest for Ozer and Douglas had essentially dissipated.

ALIGNMENT OF OUTCOMES WITH THE INTERVENTION In addition to judging the importance of effect sizes, which can be interpreted according to arbitrary or

unclear standards, another typical challenge underlying intervention research is how to conceptually align the activities/components with the outcomes of change thought to be affected by the intervention. To be brief, researchers often use “logic models” to conceptualize how the different resources and parts of their interventions result from each other (e.g., inputs → activities → outputs → outcomes → impact); relatedly, a “theory of change” can be used to provide a rationale for why an intervention produces change in the outcomes it targets. Among the studies in Table 44.1, however, none of them provided a logic model. Given that many of the targeted outcomes were not significantly changed, one plausible explanation may reside in the lack of clear alignment between the activities and the outcomes that were measured. The outcome of depression is useful to consider with respect to alignment, which was measured among children, parents/couples, and adults in four studies in Table 44.1, none of which led to significant change. According to Spencer et al. (2013), “Although the intervention was not targeted at reducing mental illness, there is reason to believe that the intervention could produce better mental health outcomes” (p. 138). Beyond this statement, however, they did not provide a clear rationale governing this hypothesis. Indeed, it is not clear how diabetes education classes, biweekly telephone contact, and/or home visits would lead to lower depression. The same issue is demonstrated in Wadsworth et  al.’s (2011) Fatherhood, Relationship, and Marriage Education (FRAME) intervention, where only three out of nine outcomes significantly changed. In this study, FRAME was guided by a Family Stress Model that emphasizes (by virtue of its name) stress as a core origin of family disruption/dysfunction based on economic hardship, which in turn interferes with their relationships and the parent-child relationship, leading to negative outcomes for children. The activities that flow from the principles of the theory, however, were not explained in terms of how or why they can reduce depression by providing workshops designed to improve couples’ coping skills. The same issue with alignment was

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noted by Gould et al. (2012). In Ozer and Douglas (2013), the “developmental benefits” of youth-led or youth-driven participatory research programs (YPAR) were not explained in terms of how they related to this personality variable.

FIDELITY OF IMPLEMENTATION The assessment of an intervention, especially one that is immersed in the community, should use multiple measures of fidelity gathered from multiple sources. Also referred to as adherence or integrity, fidelity is concerned with the extent to which an intervention is delivered as intended. This often overlooked issue of methodology and evaluation overlaps with quality programming and feasibility/ usability. By quality programming, we refer to the extent to which an intervention is implemented in such a way that it is experienced as engaging, satisfying, relevant, and/or useful. The quality depends on the skills and dispositions the providers possess, including their cultural competence. By feasibility and usability, we refer to the extent to which an intervention is able to be executed without practical, technical, or financial barriers (e.g., transportation, equipment, recruitment, costs), including how it can be adopted by others in an efficient, flexible, and cost-effective manner. As previously noted, many of the studies in Table 44.2 did not create, use, or analyze any measures of fidelity implementation. In our view, this stands as a major limitation in terms of gaining a better empirical understanding of the results and how to continuously improve upon them. By measuring fidelity using systematic methods, one can have greater confidence in how the intervention was actually carried out rather than based on mere assumption. Rarely, if ever, do community interventions get implemented with 100% fidelity, provided that the measures are sensitive and comprehensive enough. With this kind of information, researchers can determine the extent to which failing to meet metrics of fidelity, or deviating from fidelity, can negatively or positively influence the impact of a program; such information can further provide rich sources 4 6 6       C u lture and I ntervention

of data for making modifications to an intervention. In this respect, fidelity is naturally tied to what some scholars and stakeholders refer to as a formative evaluation, or determining how well the benchmarks and performance indicators are being met, thus serving to make iterative corrections to a program. In one of the two studies from Table 44.2 that did employ fidelity measures, O’Connor et  al. (2012) is a good example with respect to the methods used for multiple purposes; however, they did not adequately describe their methods. The scripts that facilitators followed were not clearly described, nor were the checklists and documentations of each session. The videotaped sessions were also not clearly reported in terms of what was evaluated (e.g., 10-minute segments, the entire session), the frequency and means by which they were selected (e.g., every session, two random sessions), and the interreliability, internal consistency, and validity of the procedures used to evaluate the sessions. Without this basic information, the observation that 92% of the components were “adequately completed” should be interpreted with caution. Based on a formative evaluation, Jones and Lacroix (2012) illustrate how fidelity measures can be used in the early stages of program design before moving to a formal efficacy trial. After pilot testing and tailoring the content of the soap operas, they developed a survey in collaboration with the in-house technology team to improve the experience of watching the videos; this “tool” was first pilot tested with a group of nursing students and four women from public housing who carried the smartphones for a week. One of the questions, for example, was rated on a Likert response scale (“I would like to continue to watch the videos that you send on the cell phone”). Other questions asked, for instance, about the size of the screen, the battery life of the phone, mobile connection, or error messages. Survey data indicated that 96.5% enjoyed watching the videos on their cell phones and 99.1% found them to be accessible, but out of the 161 phones distributed at the start of the study, 47 were damaged or not repaired, 56 were stolen, and three were lost. When presented in such concrete detail,

this kind of formative evaluation can provide useful results for other practitioners who wish to consider implementing such a program. Finally, it is important to note that none of the studies we reviewed in Table 44.2 measured cultural competence as an independent variable designed to measure program quality, repeating the observation made by D’Andrea and Heckman (2008) about the field in general. It is possible that researchers did not believe that cultural competency was relevant, though Spencer et  al. (2013) did report that the health care providers received training in cultural competence. We concur with Cartwright, Daniels, and Zhang (2008) that relying on self-report measures of multicultural competence alone may lead to inaccurate (that is, inflated) conclusions due to pressures of social desirability as well as the overestimation of abilities. Thus, it is important to triangulate data (e.g., field notes, interviews, focus groups) to reach a more accurate evaluation of cultural competence.

MEASUREMENT AND ANALYSIS OF DOSAGE Similar to other categories in Table 44.2, information reported on measuring dosage of the community interventions was largely absent, either because the researchers did not measure it or failed to report such data. One of the two studies (O’Connor et al., 2012) recorded number of sessions attended in the INSIGHTS program, reporting the means and percentages of attendance for children, teachers, and parents. The other study (Jones & LaCroix, 2012) recorded frequency of video usage through the mobile platform. Without such data, one will have a less sophisticated understanding of allocating resources, or how to select different modes and options for program delivery. When coming across various meta-analyses in the literature that conclude that dosage is not a significant moderator of program impact, such findings should obviously not be taken as meaning that, say, receiving three sessions of an intervention will be just as effective as 20 sessions. Three

sessions may be enough dosage for a subgroup or to change one outcome, but it will more than likely not be sufficient for every individual who can benefit from the program. In the end, reaching a decision on “how much is enough” in an intervention should be evaluated in light of its costs and long-lasting impact. Over time, even a seemingly inexpensive intervention may result in a greater payoff if its benefits are shown to last and can positively affect other facets of well-being. In these situations, such programs may be justified from the perspective of making long-term investments that curb much greater societal costs associated with health care expenditures (physical and mental), public assistance programs, school drop out, or special education services.

COLLABORATION AND PARTNERSHIPS IN THE COMMUNITY For many community interventions in high-need urban areas, establishing and maintaining collaborative relationships with stakeholders and partners is essential for success and their longevity. What is not so obvious are the scientific principles underlying these processes. In a way, the behavior that occurs between individuals, groups, and organizations is more an art than a science, as community-based research requires researchers to get outside the traditional roles of neutrality. In other words, the relationship building does not conveniently follow a set of laws or patterns of behavior that can dictate real-life decision making and practices. Qualitative designs and methods are commonly used to capture, disseminate, and make meaning out of the complex web of relationships and ecological forces that constrain or facilitate an intervention. As many scholars across the social-psychological and educational disciplines have noted, social action (participatory action) research is appropriate when the underlying goal is to embed the project within the lived experiences or voiced concerns of a community, such that the project becomes naturally owned by the members of that

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community. This can be a powerful approach for researchers who intend to make a difference in a community but who are initially viewed as outsiders. In Table 44.2, a variety of partners and collaborators participated, including foundations, community health centers, community leaders, parents, teachers, filmmakers and actors, and K–12 schools. Yet the level of detail about their involvement or contributions was limited in its scope and depth. Moreover, no qualitative data was analyzed with respect to the processes of collaboration and various stages of program design and delivery. Without this information, other users and policymakers cannot fully anticipate and appreciate the salient issues when adopting these interventions, especially if they are delivered to a different population in different settings. Based on a mixed methods case study, Miller, Forney, Hubbard, and Camacho (2012) provided a vivid account of implementing an HIV prevention program, the Mpowerment project, to Black gay and bisexual men in Detroit during the fourth and fifth years after its initial adoption from being originally based on evidence obtained among White counterparts in Eugene, Oregon, and Santa Barbara, California. Factors shaping how the program evolved and operated were the basis of an “implementation study.” From 2008 to 2009, the research team observed 112 hours of activities through field notes and conducted 12 interviews of men occupying leadership roles in the program; the interviews were designed to document the program’s history and rationale for making changes. Furthermore, they also examined records to help advise Mpowerment on how to improve its methods of documenting activities and attendance, totaling to a review of 480 artifacts. Miller et  al. performed “relational content analysis” on textual data to investigate the reasons why changes were made. As Miller et al. summarized, Mpowerment Detroit members perceived a fundamental mismatch between the regional and cultural context of the original program and the context of their ongoing community-based replication effort. Members reported that these contextual

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mismatches became more acute in their impact over time and ultimately drive significant reinvention. (p. 204)

Among the mismatches were socioeconomic differences and racial differences with respect to Black men’s well-being. After the men rejected certain aspects of the model (e.g., formal, scripted nature of group discussions), the program included youth leadership and mentoring activities emphasizing the family, church, school, and fraternity. An important implementation issue that Miller et  al. (2012) addressed at the end was the extent to which the intervention’s elements/ activities were preserved versus reinvented. In short, did they end up delivering the same intervention in the same manner with fidelity? Based on what they described as rather deep, pervasive modifications to make the program culturally relevant, the answer is clearly not. The tension between making cultural adaptions to programs like these as opposed to testing (replicating) the impact of an intervention is an ongoing debate within the field of multicultural counseling. In an entirely different study that sought to adapt the Parent-Child Interaction Therapy (PCIT) model (a dyadic parent training program) to a preschool setting so that teachers can also benefit from its use of PRIDE skills (Praise, Reflect, Imitate, Describe, Enthusiasm), Gershenson, Lyon, and Budd (2010) created a Teacher-Child Interaction Training (TCIT) program consisting of group workshops and in-class practice sessions for 12 teachers. Led by a clinical psychologist and two clinical psychology graduate students, they engaged with “community experts” and consultants to gain perspective on how to most appropriately plan the program and bring it into the culture of the identified preschool while garnering teachers’ support for training. Describing the outcomes of adapting elements of the PCIT model to suit the TCIT model, Gershenson et  al. provided a narrative account. Even in a purely descriptive work of scholarship, other providers of the TCIT can understand its origins and rationale, and will

have a guide for making their own adaptations (for another account in an urban school, see Cappella, Jackson, Bilal, Hamre, & Soule, 2011).

CONCLUSION AND RECOMMENDATIONS FOR MOVING FORWARD When considering the studies we have reviewed, one fact we cannot overlook is the lack of representation by scholars in multicultural counseling. More specifically, not a single study was published or conducted by an academic in a counseling psychology or counselor educator department/program. In fact, the closest specialization represented was clinical psychology. All studies were published in community psychology, school psychology, or nonpsychological disciplines. Had our review included career and educational interventions, we suspect that we would have essentially arrived at the same conclusion. So what does this say about researchers who identify themselves with the world of multicultural counseling? To explain this rather striking contradiction between what is aspired toward in the field (at least in theory) and what is actually being produced, it could be that many of our colleagues are actively designing, implementing, and evaluating such interventions with partners in urban communities but are simply not publishing their work in journal outlets. Unfortunately, we suspect that the more realistic explanation points toward the reality that the work is just not happening in our field, or is not occurring among a critical mass of researchers that is needed to transform community-based research into a normal activity that we do or think about habitually. Of course, there may be good reasons, including lack of alignment with licensure requirements, lack of interest among the faculty or students, lack of access to underserved urban communities in the area, and no clear connection between the curriculum and the sort of work advocated here. Undertaking these projects also comes with professional risks in academia, such as sacrificing time that could

be used to publish basic research, not getting a grant funded, not getting rewarded for community service, or not knowing how it will all turn out with partners one seeks to engage. Taking an academic exercise and then attempting the real work of trying to hammer it out with the brass tacks of program design, training and supervision, program implementation, budget management, program evaluation, and motivating project staff are skills that most researchers in our field were not formally trained in as graduate students. Despite all of these obstacles, we believe that now is the time to seize the opportunities. Without question, problems in mental health within urban neighborhoods can accommodate our expertise; stakeholders will benefit from our contributions. While this call to action is not new, we now are in a position to draw from research that rests on methods and innovations in design and practice that were not available even a decade ago. The good news (or bad news, depending on how one looks at it) is that there remains a lot more room for improvement concerning “what works” in urban settings. The key is merging our theories and research with those existing in other disciplines while seeking to collaborate with people delivering other services in other settings. In an era of interdisciplinary research, we cannot be complacent with what we already know and do best. Through the adaptation of constructs and approaches to cultural competence to meet the purposes of interventions that are inherently psychosocial in nature, we believe that real inroads can be made in this sorely needed area of research in multicultural counseling. The question then becomes, “What realistic, ambitious steps can be undertaken to make this vision happen within the near future (i.e., next 5 years)?” While certainly not an exhaustive list, the three recommendations we identify below can provide a useful starting point for the field. Recommendation 1: Convene a special national conference meeting focusing on the work we advocate here, sponsored by a counseling organization/ institute/professional program such as Division 17 (APA), National Multicultural Conference and

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Summit (NMCS), Institute for the Study and Promotion of Race and Culture at Boston College (ISPRC), or the Annual Winter Roundtable at Teachers College, Columbia University.

At this meeting, the goal would be to hold a productive and practical exchange of ideas about how to engage in urban communities through various research using real-life examples of community-based interventions, as opposed to basic research studies or theoretical presentations, while building a broad coalition of researchers, policymakers, and practitioners for carrying out future work. Attendees would not just be counselors; in fact, a solid majority of people would be professionals and stakeholders outside of the field. Of course, this recommendation begs the question, “Would such an idea have a wide range of appeal to our colleagues?” It’s hard to say, especially if operating under the assumption that the large majority of academics in our field do not perform urban community interventions. But perhaps this kind of focus is really the only way that such recognition, and therefore any systematic impetus, could occur in multicultural counseling. It’s unlikely that recommending new courses or providing generic advice about how to create more internships/ practicums in urban communities would hold any substantial amount of traction in the absence of such an event to steer these initiatives and provide it with a national platform. Recommendation 2: Dedicate a special issue in a widely disseminated counseling journal that focuses on the work we advocate here, such as the Journal of Multicultural Counseling and Development, Journal of Counseling and Development, or The Counseling Psychologist.

While not as ideal as the first recommendation, this step would at least reach a large audience of counseling scientist-practitioners so that general awareness could be raised about what people in counseling—as well as those outside of the field— are doing with respect to community-based intervention research in urban settings. This special issue would likely entail a handful of counseling 4 7 0       C u lture and I ntervention

academics who are actually engaged in this kind of work, combined with a variety of constituents and practitioners in urban communities who directly benefit from such work and have mutually collaborated with such academics. Although this hypothetical issue would probably not galvanize a broad coalition, it might be capable of setting into motion the dialogue that needs to occur in counseling programs all over the country, including programs that have no focus or interest in urban community interventions. This could help stimulate conversations that might inspire new people in the field, especially graduate students, who might not have otherwise been exposed to such ideas and practices within their own program. Recommendation 3: Incorporate sustainability into community-based intervention research.

The third and final recommendation pertains to the research process in general. In this chapter, our discussion of community interventions would be insufficient without commenting on the issue of sustainability. Among the challenges to conducting the research we advocate, this is perhaps the biggest one of all, yet the least understood in terms of how to overcome. When asking a colleague of ours what he would do once his federal grant expired in order to keep the intervention going, his response captures the inherent dilemma one must face when justifying the large investments and sacrifice put into these massive projects: “I will apply for another grant.” Ironically, that choice of strategy seems to defeat the purpose of sponsoring interventions so that they can be designed, pilot tested, improved, implemented, and eventually brought up to scale at an affordable cost, or to the point where it becomes “business as usual” and thereby is absorbed into the normal operating budget of an entity. This point of tension brings us to the following question: How does one ensure that an intervention can survive once the seed monies are gone, or after the original personnel decide to no longer conduct or manage the project and move on? Based on a study of a behavioral consultation intervention for after-school staff in low-income

urban communities, Lyon, Frazier, Mehta, Atkins, and Weisbach (2011) observed how sustainability should ideally be a priority during the initial stages of design and implementation in such a way that its integration throughout the course of the intervention becomes “routinized” as a standard practice by the end of its original timetable. Low levels of organizational support and buy-in, lack of perceived congruence between a program and the recipients, and/or low levels of motivation among personnel are all barriers to routinization. Planning for staff turnover/attrition while forecasting how much consultation and support will be required from the outside party (e.g., academic researchers) is even harder to predict or control. The uncertainties governing such planning often require the original team of implementers to figure out ways in which to continue to fund essential elements of an intervention through a variety of revenue streams.

The process of creating sustainability may even help promote other processes and ingredients of change, such as relationship building and making innovations to a program. From this perspective, we recommend that a section of results in future studies should be devoted to describing and analyzing how such reciprocal influences occur, or why they did not occur. In closing, we would like to acknowledge that a lot of ground has been covered within a short span of pages. By no means did we get to fully address each aspect, but we hope it will provide a stimulus for those who want to engage in community-based interventions or who are presently engaged in such work. In moving this work from a small proportion of academics to a sizable network of collaborators/ partners, the end result would, we believe, not just be good for the profession but for the communities that will ultimately benefit from our collective efforts.

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Career Counseling Updates on Theory and Practice Neeta Kantamneni and Nichole Shada

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mericans spend typically a third of our waking hours in paid work (Leong, Hartung, & Pearce, 2013), which allows us access to both basic and higher-level needs. At a minimum, employment allows us to finance basic needs such as shelter, food, and clothing (Blustein, 2006). At the other end of the continuum, work allows us to relate to others, contribute to society, and cultivate a sense of identity and meaning in life (Blustein, 2006; Leong et al., 2013). The vital role that work plays in our lives is universal for most human beings. With a few exceptions, regardless of gender, race/ethnicity, sexual orientation, social class, religiosity, ability status, and age, most individuals have sought employment at some point in their lives. As Leong and colleagues (2013) so eloquently state, “The universality and centrality of work in human life extends across cultures and contexts as work provides people with a source of livelihood and potentially serves as an instrument for self-construction and social contribution” (p. 451). Vocational psychology’s origins are rooted within a social justice perspective; the field emerged in the early 1900s with a strong emphasis in providing career assistance to individuals most in need, often those who were poor (Hartung & Blustein, 2002). Early vocational psychologists (e.g., Holland and Super) developed career and vocational theories to specifically help young European immigrants find gainful employment. More recent theorists (e.g., Lent, Brown, Hackett, and Blustein) have argued that career and work choices are not made in isolation but instead, context (e.g., family, school, and cultural environments) and sociopolitical forces (e.g., available opportunity structures) influence these choices. These recent perspectives (e.g., social cognitive career theory, career construction, and the psychology of working) have infused a social justice framework in understanding work choices and career development by arguing that vocational psychologists need to explore and understand contextual and sociopolitical forces that impact how career and work decisions are made. Ideally, all individuals would have the same access to opportunity structures that allow them to find meaningful employment that matches their interests, personalities, and values; utilize their strengths; and provide an opportunity to implement their self-concept through work. However, what constitutes

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meaningful employment may differ dramatically based on our worldviews, cultural values, and access to opportunities and resources. Our social class background may affect the types of learning experiences and resources that are available to us. Our cultural values may define how we construct meaning through our work. Our acculturation levels may determine what types of work we envision are available to us. Our environment may govern the role models to which we are exposed. Even though work is universal across human life, the unique cultural and environmental factors each individual experiences within his or her life shapes the context in which career decisions are made. These contextual factors may be particularly important for individuals from diverse cultural backgrounds, who may not experience the career development process as linearly as vocational psychologists have often theorized. Individuals from diverse cultural backgrounds may experience obstacles that hinder or change their career trajectories, and they may not view career choice as an individual decision but rather one that places greater importance on factors other than interests and personality. It is anticipated that the United States will continue to become increasingly diverse over the next half a century. For example, the Hispanic and Asian American populations in the United States are expected to more than double between 2012 and 2060, and the African American population is expected to grow by 50% (U.S. Census Bureau, 2012). As we move toward greater diversity in our society, it is essential that our career theories and practices address the needs of an increasingly diverse workforce. Several prominent vocational psychologists (e.g., Fouad & Kantamneni, 2008; Leong, 2010; Worthington, Flores, & Navarro, 2005) have long argued for the need to integrate culturally appropriate and sensitive theoretical frameworks, counseling practices, and assessment strategies within the career counseling process in order to better serve individuals from varied backgrounds. In this chapter, we discuss cultural considerations in career counseling theories and practices. The purpose of this chapter is twofold. First, we

review the extant literature and research on the cultural applicability and validity of select v­ ocational theories: Holland’s theory, Super’s life-span, lifespace theory, career construction theory, social cognitive career theory, and the psychology of working perspective. Due to space constraints, we focus on these theoretical frameworks because they have received the most attention within vocational psychology research over the past decade. It is beyond the scope of this chapter to provide a thorough review of each of these vocational theories. Instead, we focus on providing a brief overview of each framework and highlight some of the formative multicultural research on each theory with a particular focus on culturally relevant factors such as ethnic identity, acculturation, and family influences. Second, we discuss a prominent career counseling model, the cultural formulation model, which identifies sensitive ways to discuss culture and context within the career counseling process. This model was chosen because it provides a comprehensive framework for identifying and working with cultural factors within the career counseling process. We end the chapter with implications for researchers and practitioners alike.

CULTURAL CONSIDERATIONS OF CAREER THEORIES Holland’s Theory Stemming from Frank Parson’s tripartite model, Holland’s (1997) theory is the most recognized and researched person-environment fit theory (Betz, 2008). Initially proposed in 1959, Holland’s theory is based on the notion that career choice is an expression of personality. Individuals’ cultural background and personal factors combine to create distinct personality types, which, in turn, are implemented in their career choices. Additionally, work environments are characterized by personality types; Holland’s theory asserts that by understanding an individual’s personality type, career counselors and vocational psychologists can “match” people to work environments that best suit their personalities. Personality

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types and work environments are described in six different types (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional [RIASEC]), and a match between personality and work environment is theorized to be related to job satisfaction and tenure (Holland, 1997). Numerous studies have investigated the crosscultural validity of Holland’s theory with diverse racial/ethnic groups. Much of this line of research has focused on examining two primary areas: (a) whether Holland’s calculus hypothesis fits the structure of interests across racial/ethnic groups and (b) whether cultural factors are related to vocational interests and key Holland tenets. Holland’s calculus hypothesis asserts that vocational interests are organized in an equidistant RIASEC ordering around a hexagon, such that interest types that are closer to one another on the hexagon are more similar to each other, and interest types that are farther apart are more dissimilar. A long line of research has examined Holland’s calculus hypothesis with a variety of assessment tools (i.e., Strong Interest Inventory, Unisex Edition of the ACT Interest Inventory [UNIACT], Self-Directed Search) and with diverse populations. Several methodologically rigorous studies have found similar RIASEC interest structures for major racial/ethnic groups with a variety of interest assessments (e.g., Armstrong, Hubert, & Rounds, 2003; Day & Rounds, 1998; Gupta, Tracey, & Gore, 2008; Kantamneni, 2014; Kantamneni & Fouad, 2011; Rounds & Tracey, 1996) suggesting that, for the most part, a circular RIASEC structure of interests accurately describes vocational interests regardless of racial/ethnic background. For example, Gupta et al. (2008) found no differences in fit across five ethnic groups for the UNIACT, and Kantamneni and Fouad (2011) found support for most racial/ethnic groups on the 2005 Strong Interest Inventory. However, a few studies have found noteworthy exceptions; for example, recent research has found that African American females (Kantamneni & Fouad, 2011), Latino males (Flores, Spanierman, Armstrong, & Velez, 2006; Kantamneni & Fouad, 2011) and South Asian American males (Kantamneni & Fouad, 2013) did not possess a circular RIASEC ordering on the 2005 4 74       C ulture an d I n t erv ention

Strong Interest Inventory. These findings suggest that the perceived structure of vocational interests may not be best represented by Holland’s calculus hypothesis for certain populations. A second line of multicultural research with Holland’s theory has focused on examining whether cultural factors are related to vocational interests and key Holland tenets. A small amount of research has examined whether key Holland tenets are relevant and applicable for diverse racial/ ethnic groups. In an investigation of adult workers in India, Leong, Austin, Sekaran, and Komarraju (1998) found that congruence, differentiation, and consistency were not predictive of job satisfaction, suggesting that perhaps these fundamental Holland constructs may not be as relevant or meaningful for Indian workers. Additionally, a meta-analysis conducted by Tsabari, Tziner, and Meir (2005) examined whether culture moderated the relationship between congruence (a match between personality and work environment) and job satisfaction, and found a stronger relationship between congruence and satisfaction for individuals from individualistic societies than those from collectivist societies. Research is also emerging on how specific cultural factors are related to Holland tenets and vocational interests. Two separate investigations (i.e., Gupta & Tracey, 2005; Kantamneni & Fouad, 2013) have examined how cultural variables predict congruence for South Asian American college students; both studies found that cultural factors (i.e., Asian values, collectivistic orientation, and dharma) did not predict congruence. Conversely, Tang, Fouad, and Smith (1999) found that acculturation influenced the relationship between interests and career choice; family expectations were more predictive of career choices than interests for Asian Americans who were less assimilated to U.S. culture. Kantamneni and Fouad (2013) also found that acculturation predicted realistic interests, and individualistic and collectivistic values predicted social interests, for South Asian Americans. Combined, these studies provide an initial understanding that some cultural factors, specifically acculturation and family expectations,

may be related to vocational interests. However, the research in this area is extremely limited, and more research is needed with a broader range of racial/ ethnic groups. In sum, multicultural research has found support for some of Holland’s tenets (i.e., calculus hypotheses), whereas limited support has been found for others (i.e., congruence). Holland’s theory has been critiqued for largely ignoring barriers and limited opportunities faced by individuals, particularly those who may experience systematic discrimination and oppression within our society (Fouad & Kantamneni, 2013). Moreover, Holland’s theory does not explicitly address the role of culture in developing vocational identities. Considering the limited research that has been conducted examining the relationship between cultural factors and key Holland tenets has found mixed results, it is imperative that continued research examine how cultural factors may play a role in the development, expression, and measurement of vocational interests.

Super’s Life-Span, Life-Space Theory Super’s developmental theory is an influential framework within vocational psychology and revolutionized the field since its introduction in 1953 (Betz, 2008). Super’s life-span, life-space theory conceptualizes career or vocational development as a process that occurs across various life stages and culminates in a vocational self-concept (Juntunen & Even, 2012). Super theorized that individuals move through five stages (life space): growth, exploration, career maturity, establishment, and disengagement, with major developmental tasks corresponding to each of the stages (Juntunen & Even, 2012). While the developmental stages appear to follow a linear pattern, Super recognized that individuals may return to earlier stages of development if they make a career change or transition (Hartung, 2013). Additionally, Super’s early work cited that career maturity (an individual’s ability to make academic/career choices)

was required for ­individuals to progress successfully though life stages of vocational development (Hartung, 2013). Super later replaced career maturity with career adaptability, which reflects an individual’s readiness and resources to cope with vocational development and work transitions (Hartung, 2013; Savickas, 2013). Moreover, according to Super’s theory, individuals hold nine major life roles throughout their life span that interact with their career development: child, student, leisurite, citizen, worker, spouse, homemaker, parent, and annuitant (Hartung, 2013). Career development is influenced by an individual’s role salience (the relative importance placed on various life roles) and personal values (Juntunen & Even, 2012). Role salience may be influenced by a number of contextual factors such as cultural values, economic stressors, gender, family expectations, and social class (Hartung, 2013). Empirical evidence exists supporting the developmental tasks of Super’s theory (Juntunen & Even, 2012). Research suggests that the development of career maturity begins in childhood and continues in adolescence (Hartung, Porfeli, & Vondracek, 2005) and is positively related to commitment to work (Nevill & Super, 1988). Planfulness and future orientation also promote academic success and career maturity (Lewis, Savickas, & Jones, 1996). Although much of the early research investigating key constructs in Super’s theory was conducted with White upper-middle-class men, research on Super’s theory was extended to women and people of color by the 1980s (Fouad & Kantamneni, 2013; Juntunen & Even, 2012). According to Fouad and Arbona (1994), more recent research has demonstrated some cross-cultural validity of Super’s theory. For example, Super and Šverko (1995) conducted the Multinational Work Importance Study, which demonstrated the cross-cultural validity of constructs of Super’s theory (work values and life-role salience) across 12 nations (Hartung, 2013). Results suggested that developmental stages, gender, and culture influence life-role salience and work values (Niles & Goodnough, 1996). A study by Westbrook, Buck, Wynne, and Sanford (1994) examined differences in career maturity C A REER COUNSELI NG

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as measured by students’ perceived self-ratings of scholastic ability (e.g., numerical ability, scholastic aptitude, abstract reasoning). The study found ethnic and gender differences among students’ self-ratings, suggesting that contextual factors (e.g., ethnicity and gender) may be related to career maturity (Westbrook et al., 1994). Bullington and Arbona (2001) explored the extent to which the vocational development of Mexican American adolescents followed the developmental tasks outlined by Super’s theory. They found that students engaged in developmentally appropriate tasks. However, they also found that family and ethnic factors influenced components of the career development process, such as planning, knowledge, and occupational preferences. Additionally, Hammond, Betz, Multon, and Irvin (2010) examined the work values of African American college students using Super’s Work Values Inventory-Revised. Results suggested that the Work Values Inventory-Revised was a reliable and valid measure of work value dimensions for African Americans and value scores consistently correlated with ethnic identity achievement (Hammond et al., 2010). Research has also examined the applicability of Super’s theory with underrepresented populations. For example, House (2004) examined the career barriers experienced by lesbian women at various stages of vocational development as defined by Super’s theory. The study found that lesbian women experience a wide variety of barriers during each level of vocational development, particularly during the establishment and maintenance stages (House, 2004). Additionally, Kenny and Bledsoe (2005) explored the relational factors influencing the career adaptability of a diverse sample of urban high school students. The study found that support from family, teachers, and close friends as well as peer beliefs about school influenced the career adaptability of participants (Kenny & Bledsoe, 2005). Combined, these studies suggest that vocational psychologists and career counselors should consider cultural variables such as racial and ethnic background, cultural values, social class, gender, familial influences, and sexual orientation when utilizing Super’s theory to conceptualize the 4 76       C ult ure an d I n t erv ention

vocational development of clients from diverse backgrounds. Super’s life-span, life-space theory has been critiqued for theorizing that vocational development occurs in a linear manner since many individuals do not experience career development in such a linear fashion (Juntunen & Even, 2012). Vondracek and Porfeli (2002) suggested that a linear pattern of vocational development fails to take environmental and contextual factors into account. In his later work, Super recognized that some individuals do not progress through their careers in a linear manner but engage in a process called “recycling” where they return to a previous stage in the career development process as part of a new career path (Juntunen & Even, 2012; Super, 1994). Super’s theory has also been criticized for its insufficient consideration of cultural factors (Hartung, 2013). In later work expanding the theory, Super, Savickas, and Super (1996) identified that racial and ethnic background influence an individual’s self-concept and inform vocational decisions (Fouad & Kantamneni, 2013). Expansions of the theory have also recognized that contextual factors like cultural values, social class, and gender can impact career development (Hartung, 2013). The theory’s acknowledgment of the impact of cultural factors on self-concept, life roles, and vocational development appears to increase the theory’s utility with diverse clients. However, additional research is needed to examine the effectiveness of Super’s theory with individuals from various cultural backgrounds.

Career Construction Theory Mark Savickas introduced career construction theory in 2005 (Juntunen & Even, 2012). The theory expands on ideas originally proposed by Super and was designed for use with diverse populations (Savickas, 2013). The theory proposes that individuals “build careers through personal constructivism and social constructionism” (Savickas, 2013, p. 147). Career construction theory emphasizes three major components: vocational personality, career adaptability, and life themes. An individual’s vocational personality is a reflection

of his or her needs, interests, abilities, and values. Understanding an individual’s vocational personality can help determine which careers may be a good fit for that person (Savickas, 2011b). Career adaptability reflects an individual’s readiness and resources to cope with vocational development and work transitions (Hartung, 2013; Savickas, 2013) and ability to adapt to an unstable labor force and workplace environment (Juntunen & Even, 2012). In career construction theory, life themes emerge as the individual tells the story of his or her personal experiences (Savickas, 2011a). Life themes help an individual make meaning of work and inform career decisions. Emerging multicultural research examining career construction theory suggests that racial/ethnic background can influence an individual’s career expectations and career adaptability. A recent study by Blustein and colleagues (2010) utilized a career construction framework to examine the influence of race and ethnicity on high school students’ narratives about the connection between school, work, and societal expectations of success. Findings of the study revealed that most of the students saw a connection between school and work, believed that society had low expectations for their future due to their racial and ethnic background, and had trouble predicting their future success due to their background (Blustein et al., 2010). Guan and colleagues (2013) examined the career adaptability of Chinese university graduates during the job search process and found that career adaptability was positively correlated with self-efficacy, employment status, and person-environment fit for individuals who secured employment, and that gender, age, educational level, major, and family background (family socioeconomic status [SES] and parent education) moderated levels of career concern. Finally, two studies have investigated the efficacy of a constructivist career course on career development. GrierReed, Skaar, and Conkel-Ziebell (2009) found that a constructivist course decreased dysfunctional career thoughts and increased career decision selfefficacy in a career course with a diverse sample of college students (45% students of color), and GrierReed and Skaar (2010) found that a similar course

was effective in increasing empowerment but not in decreasing career indecision for a sample of college students in which the majority were students of color. As a whole, the results of these studies lend support to the major tenets of career construction theory and suggest that developing and implementing interventions based on this framework can be helpful with students of color. Career construction theory appears to be a culturally sensitive theoretical foundation for work with clients from diverse backgrounds. It was initially developed for use with diverse populations (Savickas, 2013) and directly argues that the self is shaped by culture and social context. However, the theory has mainly been applied in practice settings, and additional research is needed to provide further evidence for its major tenets (Juntunen & Even, 2012).

Social Cognitive Career Theory Social cognitive career theory (SCCT) formally emerged in the 1990s (Lent, Brown, & Hackett, 1994) and has been an influential vocational theory since its introduction, stimulating extensive research with diverse populations over the past three decades. Betz and Hackett (1981) were the first to extend social cognitive theory to vocational development as a framework for understanding women’s career and work decisions (Lent, 2013). Since this extension and the initial introduction of social cognitive career theory, a primary focus of SCCT has been to understand the vocational development of individuals from a wide range of backgrounds (Lent, Brown, & Hackett, 1994, 2000). As Lent and Sheu (2009) eloquently stated, “[SCCT] intended to incorporate cultural and other contextual factors that pervade the career development process but that have not always been the explicit focus of earlier career theories” (p. 691). Hence, a primary purpose of SCCT was to provide a framework to explore how contextual factors influence career development for individuals from diverse backgrounds. Due to this focus, SCCT has stimulated extensive research examining the career development process of individuals from culturally C A REER COUNSELI NG

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diverse backgrounds. According to SCCT, person inputs and background contextual affordances create learning experiences for individuals. These learning experiences influence self-efficacy and outcome expectations, which in turn influence interests, goals, and actions. A strength of SCCT lays in its focus on both individual and contextual factors. In order to fully understand vocational development, SCCT argues that contextual, cultural, and environmental factors need to be explored. For the past 30 years, a growing amount of research has examined the social cognitive career model with diverse cultural populations, with much of the research examining gender and race/ ethnicity. This body of research has enhanced our knowledge on how individuals from underrepresented groups, particularly women and individuals from minority racial/ethnic backgrounds, make career decisions. This is perhaps the strongest contribution that SCCT has made in vocational psychology. By emphasizing culture and context directly within the model, SCCT has provided a framework to guide multicultural vocational research, which in turn has resulted in a mounting literature base on the vocational development of racial/ethnic minorities. Since Betz and Hackett’s (1981) seminal research on women’s career development, research utilizing a social cognitive career framework has found that women and men develop self-efficacy in traditional tasks and career fields. For example, Betz and Hackett found that college women reported stronger self-efficacy in traditionally female occupations, which in turn was linked to interests and goals in traditional fields. However, the development of self-efficacy beliefs in traditional career fields may be due to access to learning experiences that enable the development of such beliefs, suggesting that environmental experiences may expand or constrain traditional and nontraditional career pursuits (Lent, 2013). Research has also investigated whether vocational decision making can be explained using social cognitive career models for African American (e.g., Gainor & Lent, 1998), Latino(a) (e.g., Flores, Navarro, & DeWitz, 2008; Flores & O’Brien, 4 7 8       C ult ure an d I n t erv ention

2002), and Asian American (e.g., Tang et al., 1999) student populations, and a few studies have specifically examined the role of cultural factors (e.g., ethnic identity and acculturation) in the social cognitive career models. For example, Gainor and Lent (1998) found support for SCCT in explaining math interests and intentions of Black college students. Lent, Lopez, Lopez, and Sheu (2008) tested the SCCT model for White and Black college students and found that satisfaction fully mediated the relationship between interest and persistence in engineering for White and Black female and male college students. Byars-Winston, Estrada, Howard, Davis, and Zalapa (2010) found that the social cognitive career model explained the development of interests and goals in biological science and engineering majors for African Americans, Latino(a)s, Southeast Asians, and Native American undergraduate students. As a whole, these studies provide support that SCCT can help understand how students of color make career decisions, specifically in math and science fields. Research has also examined the relationship between specific cultural variables and social cognitive variables. For example, Kelly, Gunsalus, and Gunsalus (2009) examined the relationship between ethnic identity and social cognitive outcomes for Korean American college students and found that ethnic identity indirectly predicted goal intentions through outcome expectations. Gushue and Whitson (2006) found that career decision self-efficacy mediated the relationships between egalitarian gender role attitudes, ethnic identity, and gender traditionality in career goals. This study highlights the importance of considering gender role attitudes and ethnic identity when exploring career goals for Black and Latina girls. Additionally, Byars-Winston and her colleagues (2010) found that other-group orientation predicted science, technology, engineering, and math (STEM) self-efficacy, suggesting that comfort interacting with others outside of their ethnic groups was related to feeling more confident in STEM pursuits. Research related to acculturation and familial influences has also found interesting results.

Flores and her colleagues (2008) found that Anglooriented acculturation was positively related to educational goal expectations and educational aspirations. However, Mexican-oriented acculturation, college self-efficacy, and outcome expectations were not related to aspirations or expectations. Additionally, Flores and O’Brien (2002) examined the social cognitive career model with Mexican American adolescent women and found partial support for the SCCT model with this population. Nontraditional career self-efficacy, parental support, barriers, acculturation, and feminist attitudes predicted career choice prestige; acculturation, feminist attitudes, and nontraditional career selfefficacy also predicted career choice traditionality. However, the path between nontraditional career interests and goals was not supported. Tang et al. (1999) found similar results in a study examining the vocational development of Asian American college students in which interests also did not predict traditionality of career choices once self-efficacy, acculturation, and family involvement were taken into account. Together, these findings suggest that factors other than interests (e.g., acculturation and familial influences) may play a stronger role in the career goals of individuals from diverse cultural backgrounds. Vocational psychologists have also argued that social cognitive career theory can be a useful framework in working with client populations who may experience marginalization within society, such as persons with disabilities (Szymanski, Enright, Hershenson, & Ettinger, 2003), gay and lesbian workers (Fisher, Gushue, & Cerrone, 2011; Morrow, Gore, & Campbell, 1996), and individuals from diverse social class backgrounds (Thompson & Dahling, 2012). In sum, this line of research has produced invaluable knowledge on whether the larger SCCT model fits for various populations who have historically been underrepresented in vocational literature, whether specific cultural variables predict social cognitive career constructs, and whether these constructs predict specific types of interests and goals (e.g., math and science). For the most part, evidence has supported the use of SCCT with diverse racial ethnic groups, and research has

provided beginning support that some contextual factors (i.e., acculturation) are related to selfefficacy, outcome expectations, and interests and goals. Considering the vast amount of culturally salient research that has surfaced since SCCT was formally introduced to vocational psychology, it is evident that this model lends itself well to understanding the vocational development of individuals from diverse and underrepresented backgrounds.

The Psychology of Working Perspective The psychology of working perspective was first introduced by David Blustein in 2006 in response to the need for vocational psychology to understand career-related experiences of individuals who have been largely overlooked due to forms of social oppression (e.g., social class, racism; Blustein, Kenna, Gill, & DeVoy, 2008). A primary emphasis of the psychology of working perspective is to specifically recognize cultural and sociopolitical factors that may influence work decisions as well as to explore how work-related decisions are made for individuals who may choose work based on survival-related needs (e.g., food, shelter). The psychology of working perspective posits that work can fulfill three major human needs: survival and power, social connectedness, and self-determination (Juntunen & Even, 2012). First, while some individuals have the opportunity to work in jobs or careers that provide personal fulfillment, the reality for many individuals is that the purpose of work is to meet basic survival needs (e.g., food, water, shelter; Blustein et  al., 2008). Work also allows for humans to access economic, social, or psychological power, which helps individuals acquire material and social resources (Blustein et al., 2008). Second, work provides an avenue for connection and relatedness with others (Blustein, 2006). Individuals who have supportive work relationships are generally more successful at overcoming work-related challenges and stressors (Blustein et al., 2008). Third, work has the potential to allow us to implement self-determination in our lives. C A REER COUNSELI NG

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Work satisfaction can be increased if an individual’s work activities can become more intrinsically motivated. Workers who have opportunities for autonomy, relatedness, and competence are more likely to find increased meaning and satisfaction in work (Blustein et al., 2008; Ryan & Deci, 2000). The psychology of working perspective is a promising framework for understanding the influence of contextual (e.g., race/ethnicity, social class, sexual orientation) and cultural (e.g., cultural values, worldview) factors on career experiences. Although the psychology of working framework is relatively new, research has investigated some of its core assumptions. For example, a qualitative study by Chaves and colleagues (2004) utilized a psychology of working perspective to examine the meaning of work for poor and working-class urban adolescents. They found that economically disadvantaged students generally defined work in terms of external outcomes (e.g., money) as opposed to representations of self-concept or personal work interests. A qualitative study by Blustein and colleagues (2002) examined the impact of social class on the school-to-work transitions of young working-class adults and found that participants who grew up in families with higher levels of SES expressed greater interest in work as a source of personal satisfaction, self-concept crystallization, access to external resources, and levels of career adaptability compared to participants who grew up in lower SES households (Blustein et al., 2002). Additionally, research by Guerrero and Singh (2013) examined the job preferences of Mexican American women with low educational attainment and found that participants valued the opportunity for survival, power acquisition, social connection, self-determination, and autonomy as well as the chance to help others, use one’s existing abilities, and learn. The results of these studies appear to support the major tenets of the psychology of working perspective with the populations investigated. The psychology of working framework recognizes that cultural, economic, and sociopolitical factors should be considered during psychological and vocational counseling with clients (Blustein et al., 2008). The approach calls for more attention 4 8 0       C ult ure an d I n t erv ention

to social inequalities related to work (Betz, 2008) and encourages vocational psychologists and career counselors to consider cultural and economic factors such as social class, race, cultural values, worldview, and immigration status when working with clients. This framework lends itself well to working with clients from diverse, underrepresented, and marginalized backgrounds, many of whom may experience barriers that restrict opportunities and choice in their career development. Moreover, the psychology of working perspective has the potential to inform public policy issues including workplace diversity, harassment policies, work oppression, and unemployment policies (Juntunen & Even, 2012) and offers promising new directions for research and practice. However, additional research is needed to examine the use of this perspective with clients from diverse populations. Since this perspective is relatively new, forthcoming research has the potential to provide cultural validity to the tenets central to the psychology of working perspective.

CULTURALLY SENSITIVE CAREER COUNSELING: THE CULTURAL FORMULATION APPROACH In the previous section, we briefly reviewed multicultural considerations and research related to several vocational theories. Each of these theories provided us with a framework to understand the work and career development process for individuals from diverse backgrounds. In this next section, we examine culturally sensitive career counseling practice by discussing the cultural formulation approach initially set forth by Leong, Hardin, and Gupta (2007) and expanded upon in a special issue of the Journal of Career Development (Leong, 2010). This issue provided an in-depth overview of the approach and discussed how it can be used with African Americans, Latinos/Latinas, Asian Americans, Native American, and international students. The cultural formulation approach

was chosen because it provides a comprehensive framework for integrating cultural factors into career counseling. As Leong (2010) argues, since an individual’s cultural identity can play a critical role in vocational development, it is essential to include cultural factors in career assessment and counseling.

Cultural Formulation Approach Leong and his colleagues (2007) initially proposed the cultural formulation approach to introduce a framework that can guide career counseling and assessment with diverse populations. The cultural formulation approach outlines five culture-centric dimensions that are essential to career counseling and assessment: (a) cultural identity, (b) cultural conception of career problems, (c) cultural context and psychosocial environment, (d) cultural dynamics of the therapeutic relationship, and (e) overall cultural assessment (Leong, 2010). Several core principles guided the development of the cultural formulation model for career counseling and assessment. First, this model operates on the premise that all individuals have multiple selves (e.g., private, public, collective); one’s cultural background influences the type of self that is most accessible to an individual. Second, these multiple conceptions of the self influence how people construct meaning from their vocational choices (Leong, 2010). Third, Leong et  al. (2007) argued that not only does culture directly shape multiple conceptions of the self, cultural context also indirectly shapes the opportunities available to individuals through their environment. Members of minority groups may experience limited opportunities due to systematic oppression present within society that creates barriers that directly and indirectly affect vocational development (Leong, 2010). Leong, Hardin, and Gupta (2010) argued that cultural contexts have extensive and widespread implications for how individuals can implement one’s self-concept in the world of work. Finally, cultural factors (e.g., cultural values) can influence the therapeutic relationship

between counselors and clients (Leong et al., 2010). In order to work effectively with clients from diverse backgrounds, it is important to remember that a variety of cultural factors may affect how clients present in session as well as how the counselors understand and respond to client issues. The first dimension of the cultural formulation approach is the cultural identity of the individual (Leong et al., 2007, 2010). This dimension includes the extent to which clients identify with their cultural background and the culture in which they reside. Leong (2010) argued that we can begin to understand individuals’ cultural identities by examining how acculturation levels and ethnic identity intersect with other cultural aspects of one’s identity (e.g., sexual orientation, religion, social class). The second dimension of the model is the cultural conception of career concerns. This dimension includes understanding how clients understand the roots of their career concerns and how these concerns are related to cultural contexts. In order to provide culturally sensitive career counseling, Leong (2010) asserted that counselors need to account for cultural factors and move beyond traditional notions of career counseling that advocate for people to make individualistic career choices that implement their self-concepts. The third dimension of the cultural formulation approach is related to understanding the self in relation to its cultural contexts and includes a consideration of how culture influences the perception of supports and stressors in the environment (Leong et  al., 2010). In other words, this dimension advocates for career counselors to consider the cultural environment in which vocational concerns develop and surface. The fourth dimension, cultural dynamics of the therapeutic relationship, places an emphasis on understanding how cultural similarities and differences affect the working alliance, which in turn affects counseling, assessment, and treatment (Leong, 2010). And finally, the fifth dimension of the model focuses on an overall cultural assessment that integrates “all of the cultural information into an integrated formulation . . . and seeks to provide a culturally appropriate career counseling plan for the client” (Leong et al., 2010, p. 477). C A REER COUNSELI NG

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Leading vocational psychologists have found the cultural formulation approach to be applicable when working with a diverse range of clients, including African Americans (Byars-Winston, 2010), Latinos/as (Flores, Ramos, & Kanagui, 2010), Asian Americans (Leong et al., 2010), and Native Americans (Juntunen & Cline, 2010). For example, Byars-Winston (2010) recommended that vocational psychologists and career counselors utilize the cultural formulation model to design interventions that facilitate both vocational and racial-ethnic identity development for African American clients. Flores and her colleagues (2010) argued that this approach encourages vocational psychologists and career counselors to integrate cultural and contextual considerations into career counseling and assessment with Latino/a clients. Additionally, utilizing a cultural formulation approach allows for counselors to consider how aspects of the Latino culture (e.g., family expectations and responsibilities, gender norms, immigration status, acculturation, and language barriers) can influence vocational development and career decision making (Flores et  al., 2010). Moreover, Juntunen and Cline (2010) contended that the cultural formulation model encourages vocational psychologists and career counselors to consider cultural (e.g., collectivism, present-orientation, respect for elders, humility) and social (e.g., history of oppression) contexts during career counseling with Native Americans. In sum, the cultural formulation approach provides a framework for culturally sensitive career counseling and assessment. Heppner and Fu (2010) noted that the cultural formulation approach can be broadly applied to work with clients from various diverse backgrounds beyond race and ethnicity. This approach has the potential to encourage vocational psychologists and career counselors alike to integrate elements of a client’s multidimensional cultural identity into career counseling and assessment. However, vocational psychologists have also argued that there is still a paucity of research that fully examines the role of culture in career and work choices. For example, Juntunen and Cline (2010) contended that limited 4 8 2       C ult ure an d I n t erv ention

research has examined the vocational development concerns of Native Americans and that additional research is needed. Byars-Winston (2010) provided a similar critique, stating that additional research is needed to examine the effects of the cultural identity of African Americans on career variables (e.g., career aspirations) and career outcomes (e.g., career entry). Likewise, vocational psychologists have not fully discussed how the cultural formulation model can be used to address the vocational development and career counseling process for individuals who may differ in sexual orientation, social class, religion, age, ability status, and other dimensions of identity. Hence, the model could be expanded to discuss these contextual factors in a more comprehensive manner.

CONCLUSION Culture and career/work development are intricately interwoven concepts; we cannot fully understand the career decisions that people make without understanding the cultural milieu related to vocational development. Despite many of the early vocational theories’ foundation in helping young immigrants from Western Europe find gainful employment in the United States (Gysbers, Heppner, & Johnston, 2003), vocational theories have only begun to specifically examine how cultural background affects vocational development for individuals who may not experience career development in a traditional way. Vocational psychologists (i.e., Fouad & Kantamneni, 2008; Worthington et al., 2005) have argued that our race/ ethnicity, gender, social class, sexual orientation, ability status, age, and religion/spirituality play a role in vocational development. In order to effectively and sensitively explore career and vocational choices with clients from diverse backgrounds, it is imperative that career counselors fully explore these cultural influences with clients. Many of the core vocational theories have now been updated to reflect the important role that these factors play in career development. We are also seeing new, emerging vocational theories such as the social cognitive career theory,

the psychology of working perspective, and the relational/cultural paradigm (see Schultheiss, 2007) that directly examine how group- and societal-level contextual factors influence the career development process. Although not previously discussed in this chapter, Schultheiss (2007) formally introduced the relational/cultural paradigm and argued that although the paradigm itself is not a new theoretical framework per se, it can be used as a metatheory alongside existing frameworks (Juntunen & Even, 2012). The relational/cultural paradigm provides vocational psychologists a useful framework to integrate a relational and contextual perspective when understanding clients’ vocational development. These emerging perspectives continue vocational psychology’s tradition of infusing social justice into understanding how work and career choices are made for individuals from diverse and underrepresented backgrounds, many of whom may have differential access to opportunity structures that promote vocational development. These perspectives also provide a framework for advancing our knowledge of how sociopolitical and contextual factors directly influence work choices and move us toward understanding vocational development in an inclusive manner that accounts for cultural, contextual, and societal factors. In order to provide culturally sensitive career counseling to clients from diverse cultural backgrounds, it is critical to acknowledge that all clients possess a unique cultural background that affects their vocational development. It is the job of culturally sensitive psychologists and counselors to examine the multiple intersections of cultural identity in order to gain a full understanding of how culture, context, and environment play a role in career and work decisions. This includes, but is not limited to, exploring gender and gender role socialization, acculturation levels, racial/ethnic identity, immigration status, sexual orientation, social class background, ability status, age, religiosity and spirituality, perceptions of discrimination and oppression, barriers and supports, role models, cultural values, family influences, and opportunity structures available to our clients. It

is essential for us to create safe environments so that clients can fully explore their cultural identities in relation to their vocational development. Similarly, we need to be aware that all clients may not view the career development process in the same manner, and we encourage counselors and psychologists to begin work with clients by first understanding how individuals construct meaning from making career decisions and how they envision the career development process to transpire. We also need to expand our focus beyond individual clients to consider how systems and structures (e.g., the education system, workforce, and government systems) influence the lives and career outcomes of individuals and must assume a social justice agenda to work to improve these systems (Blustein, McWhirter, & Perry, 2005). Several current vocational theories (e.g., social cognitive career theory, psychology of working perspective) provide the necessary framework to integrate a social justice approach into vocational research and practice. At an individual level, career and work counseling can act as a mechanism for social change by helping individuals from marginalized backgrounds access meaningful work and the economic resources often associated with work. On a larger scale, vocational psychologists can enact social change by advocating for greater opportunity structures for individuals from marginalized backgrounds through social policy and the development of interventions. Research examining culture and context in vocational development has flourished over the past several decades and for the most part has found that cultural factors are important in how career decisions are made. Culturally sensitive career counseling may be informed by this research as well as any of the vocational theories described in this chapter. However, it is imperative that career counselors explicitly integrate culture, context, and environment in their conceptualization of client concerns regardless of which theoretical perspective or approach is used. Additionally, further research is needed to provide a more comprehensive understanding of how these cultural factors affect vocational development, particularly C A REER COUNSELI NG

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for certain subgroups. For example, although a unified body of research is emerging on the career development of some groups in some areas (e.g., Latino/as, women, math and science intentions), less vocational research has investigated the career development of other racial/ethnic groups

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(e.g., Middle-Eastern Americans, LGBT students and adults, immigrants). We are excited to see future growth and advancement in gaining knowledge in this area as well as the increased expansion of our current vocational theories to more fully include culture-salient factors.

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Organizational Change in Institutions of Higher Education Patricia Arredondo and Lubnaa Badriyyah Abdullah

THE OPPORTUNITY FOR PSYCHOLOGISTS AS ACADEMIC LEADERS “We are already deep in the new century, a century that is fundamentally different from the one we assume we live in. Things somehow don’t fit” (quoted in Reingold, 1990, p. 6). This quote is attributed to Peter Drucker, preeminent management guru, commenting on the way business organizations were changing and suggesting that the mind-set and practices of organizational leaders must also change as a result. The quote is quite apropos for higher education institutions across the nation because higher education is in the midst of major transformation and even revolution. To any higher education administrator, this should not be news. Some of the reasons that underlie this transformation that is greatly challenging higher education as it has existed over the years include but are not limited to the following: globalization, changing technology and innovation, ever-increasing financial operating challenges, cost and value of a college degree to students, time to degree, and relative to the focus of this chapter, changing racial/ethnic student demographics. For the sake of emphasis, we again note that as we approach the third decade of the 21st century there are certainties relative to higher education—it is in flux. News sources report stories about the closure of institutions (particularly for-profit schools like Corinthian); drops in enrollment for schools previously very secure in their annual admissions; institutions that are in financial deficit because of enrollment loss, decreasing state funding and unmet fundraising goals; and waiting lists for admission into community colleges, particularly in the southwest states and California, where many first-generation Latinas/os reside. While there are multiple forces affecting the sustainability of higher education institutions, change, uncertainty, and survival may most often describe the types of situations faced by educational leaders and communities. Although long-range planning, particularly driven by enrollment, is a primary approach to sustaining institutions of higher education and is central to an institution’s budget planning, these

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plans seem to be disrupted by external forces and changes. For example, economic downturns and personal setbacks (e.g., 2008 recession); concerns about the overall value of higher education and its affordability; demographic changes reflected in the pool of potential students to include a greater number of students from diverse cultural, racial, ethnic, and economic backgrounds; changes in institutional reputation; and limited access to specific institutions can all potentially affect longrange planning. One concern that merits specific attention is the increased demand for institutional accountability. More specifically, the federal government is making accountability a priority, requiring reports about the number of underrepresented racial ethnic minority students, the overall graduation rates, institutional debt, and the default on student loans. Suffice it to say that these forces are engendering unpredictability, and for academic administrators, a need to remain focused and calm while managing institutional, social, economic, and demographic changes as those noted above. With respect to demographic changes, six of the American Psychological Association’s (APA) Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2003) articulate the need for psychologists to acknowledge and address these changes: “Psychologists are encouraged to use organizational change processes to support culturally informed organizational (policy) development and practices” (p. 60). Additionally, guidelines one and two are critical for the successful functioning of an academic administrative leader. These two foundational guidelines address the individual’s self-knowledge as well as the individual’s knowledge of others’ upbringing and life experiences. Guidelines one and two also address “blind spots” that are bound to exist in multicultural contexts and relationships. To this end, introspection to recognize how cultural heritage and the biases that ensue from one’s upbringing and other socialization experiences is recommended for more culturally responsive and effective leadership. Suffice it to say that because all institutions are diverse along many dimensions of identity (i.e., age, 4 8 6       C u lt u r e a n d I n t e r v e ntion

socioeconomic status, race, and sexual orientation), administrators have to be well prepared to engage with many “others.” As will be made evident in this chapter, the student transformation, in particular, provides opportunities for administrators, especially those well trained in multicultural psychology and education, to prepare their respective institutions to effectively and successfully deal with this transformation. In particular, this chapter addresses the opportunities for psychologists, especially those in higher education leadership roles, to apply models of change and growth at individual, institutional, and community levels that are responsive to the changes that are taking place in society as a whole and in higher education in particular. More specifically, the objectives of this chapter are to discuss the changing landscape of higher education, especially the increase in the number of college-going ethnic and racial minority youth; identify the challenges and opportunities to introduce models that advance inclusive diversity that benefit all stakeholders; and to underscore the benefits of working from multicultural and social justice principles that serve as the basis for leading with fairness, compassion, hope, and cultural competence. Transformation in higher education is underway, and psychologists prepared as agents of change who are also in leadership roles can enact changes through the use of multiculturally informed and culturally responsive practices. The time for inclusive and culturally responsive leadership is now.

THE MULTICULTURAL CONTEXT Legal Footnotes The Civil Rights Act of 1964 was a major legislation aimed to “equalize” access to housing, employment, and education/higher education, particularly in the South. Scenes from the integration of the University of Arkansas and Alabama are shared by documentaries and are stark reminders that legislating diversity still engenders resistance. The goodwill and leadership of academic administrators to address gender, ethnic, and racial inequalities is required.

For many years, quotas was often the term used to describe hires as a result of affirmative action policy. Students of color and women were seen from a deficit perspective, as though they did not have a right to attend a university. It could be said that organizational change in higher education, influenced by policies for inclusion based on ethnicity, gender, and racial identity, has been going on for 50 years. Though this may seem like a long time, there are still many institutions that are working on the goal to increase diversity among their student body and faculty. Organizationally, the focus must not be limited to increasing numbers, but more important, it has to be a part of more comprehensive efforts to develop and implement policies and practices that result in the institutionalization of diversity. In the mid-1990s, corporate organizations spoke about the business case for diversity (Arredondo, 1996; Thomas, 1991). When initiatives would launch, the rationale generally fell into categories including legal compliance, the moral thing to do, and diversity as a priority. Selfinterest and the “business case for diversity” were often articulated as the corporate rationale. For these organizations, the business case was tied to measurable outcomes—more sales in ethnic U.S. markets, greater market share against competitors for particular products, and building brand loyalty through ethnic marketing. Universities generally began their plans for diversity through the Equal Employment Opportunity (EEO)/Affirmative Action lens and/ or legal rulings. Noteworthy is the Regents of the University of California v. Bakke case (1978) from the University of California-Davis Medical School. Allan Bakke won his discrimination suit for entrance to the school contending he was denied admission based on his race in two consecutive attempts. The Supreme Court found that racial quotas employed by the university violated the Equal Protection Clause of the Fourteenth Amendment. The University of Texas used the term critical mass to support their consideration of admitting underrepresented students to their undergraduate program (Fisher v. University of Texas, 2013). Here again, the plaintiff argued that

race was used in the admissions process, thereby violating the Equal Protection Clause as in the Bakke case. However, in 2013, the U.S. Court of Appeals for the Fifth Circuit found in favor of the University of Texas, stating that when other means to achieve demographic diversity cannot be met, universities may consider race as part of a holistic admissions process. Another high-profile suit at the University of Michigan found its way to the Supreme Court (Grutter v. Bollinger, 2003). The Supreme Court found that the U.S. Constitution does not prohibit the use of race in admissions decisions aimed to further an interest in obtaining a more diverse student body. The court contended that affirmative action should not be allowed permanent status and that a color-blind approach should be implemented in belief that race-based policies for admission should be limited and eventually deemed unnecessary. It appears that race-related policies are not acceptable in higher education even when these policies would contribute to fairness and inclusion of historically underrepresented individuals. Most often, these lawsuits involve public versus private institutions.

CHANGING DEMOGRAPHICS OF HISTORICALLY UNDERREPRESENTED STUDENTS Although national data on racial and ethnic groups show that non-Latino/Hispanic Caucasians are the largest racial and cultural group in the United States, this group is also growing at the slowest rate (U.S. Census Bureau, 2010). Conversely, individuals assigned or designated ethnic, racial, biracial, multiracial, and multiethnic/multiple heritage “minorities” are becoming an increasingly larger percentage of the U.S. population, and as a result, are predicted to systematically account for a higher percentage of the U.S. workforce and college-going population. By 2050, the U.S. population projections indicate that Caucasians will account for 47%, Hispanics for 29%, African Americans for 13%, and Asians for 9% of the total population (Passel & Cohn,

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2008). More recent statistics indicate that by 2060, Caucasians will account for 43%, Hispanics for 31%, African Americans for 15%, Asians for 8.2%, and individuals of two or more races for 6.4% of the total population (Ortman, 2012). The lack of preciseness in reporting beyond the four demographic groups, and now individuals with mixed heritage, often leaves room for error. For example, American Indians currently account for approximately 0.9% of the U.S. population (Norris, Vines, & Hoeffel, 2012), and of course, the Census does not report on other visible cultural groups including those of Middle Eastern–East Asian ancestry. Naturally, as noted above, institutions of higher education are already experiencing a demographic shift, with students, in particular, bringing more cultural diversity to the classroom, residence halls, sports teams, and social encounters. Depending on the type of institution (i.e., public, private, professional school, community college, research, etc.) and the geographic setting, the student body may reflect more or less cultural diversity. This same trend is likely not descriptive of faculty, staff, and academic administrators. Even in Historically Black Colleges and Universities (HBCU), Hispanic-Serving Institutions (HSI), and Tribal Colleges, a higher percentage of Caucasian faculty is commonplace. For academic administrators as well, this is a fact that requires dialogue, not denial or oversight.

INSTITUTIONAL APPROACHES TO ADDRESS DIVERSITY The previous sections provide a brief context and rationale why psychologists are ideally suited to take the opportunities to assume positions as academic leaders within diversifying institutions, a major reason for this being the fact that psychologists have the skills needed to facilitate institutional change, and in particular, assessment and human development skills that enable administrators to educate others to know, understand, and appreciate diverse individuals, groups, and 4 8 8       C u lt u r e a n d I n t e r v e ntion

communities from a holistic and developmental perspective. This section reflects the premise that institutional sustainability will be best accomplished through a variety of diversity-focused developmental approaches. One of the authors (Arredondo) has had extensive consulting and teaching experiences working with organizational diversity change agents across diverse institutional settings. Although she found that there were many parallel experiences that could be gleaned from the corporate world’s interest and focus on diversity, higher education institutions were more hesitant and reluctant to “get on board” with issues of diversity. Examples shared herein come from some of her experiences as an experienced and well-established organizational diversity change consultant. There are multiple pathways to advance diversity in higher education. Some are part of a cohesive plan and others are more random and assumed by a champion for a particular interest (i.e., a mentorship program for first-generation students). Some examples of institutional behaviors to demonstrate commitment to diversity include establishing diversity committees to guide institutional plans, climate studies or assessments, hiring goals (particularly of faculty), community advisory groups, enrollment plans for a more diverse student body, sociocultural programming, diversity requirements across the curriculum, requiring diversity training in some form for academic leaders, faculty and staff, and employing a chief diversity officer. A diversity plan or institutional initiative is generally grounded in the university’s mission statement. Of course, it is the behavior behind the mission statement that diversity advocates will monitor. An institutional diversity plan with benchmarks and measurable objectives rather than disparate activities can move the needle on specific goals, particularly if there is accountability (APA, 2003; Arredondo, 1996). Here again, a psychologist, as an academic leader, appreciates the importance of monitoring and documenting change. In higher education, some institutions have used a diversity scorecard to monitor changes for

different criteria such as access, retention, institutional receptivity, organizational climate, and so forth (Hubbard, 2004). Generally, outcomes are often underreported or ambiguous because diversity plans have not been comprehensive and measurable. However, The Intercultural Campus: Transcending Culture and Power in American Higher Education (Tanaka, 2003) is one example of research that included several undergraduate institutions that assessed their performance relative to diversity on several levels. In particular, leaders at Del Rey University used surveys and focus groups to “track change in campus racial climate and sensitivity toward diversity” (Tanaka, 2003, p. 132). An Intercultural Committee was formed and led by the director of the Office of Institutional Research. The committee, comprised of a researcher from the School of Education, a researcher from the psychology department, the director of research in the campus intercultural project, and an undergraduate student research assistant, assumed the task of supervising the development and application of assessment protocols. In addition, it supervised consultants who provided technical and analytical assistance for the interpretation of the results of the assessment. Finally, an Oversight Committee was formed to oversee budget decisions and coordinate the work of all other branches of the intercultural committee (Tanaka, 2003). Over the years, diversity-related activities and initiatives have been developed and implemented across the country in private, public, and professional schools. Concomitantly, publications relative to topics and issues regarding diversity have increased over the years. However, those that focus on diversity, and in particular, its advancement within higher education, are still lacking. For instance, unlike the business sector that reports on best places to work for African Americans and so forth, Diversity is the only publication that reports on institutions that are doing well in terms of diversity. The Chronicle of Higher Education publishes “Diversity in Academe” annually. This is primarily a demographic report, however, rather than one that provides exemplary examples of how higher education institutions are advancing inclusive diversity.

THE TURN TOWARD DIVERSITY The term diversity within the context of higher education has become somewhat synonymous with terms such as multicultural that are readily used to define today’s learners, instructors, and environments. However, a study by Berrey (2011) on the shift in multiculturalism at the University of Michigan–Ann Arbor demonstrates how over the years university leaders continue to describe their campus community and their institution’s mission and values in terms of diversity. For example, the Regents of the University of Michigan (2014) mission statement includes the following diversity clause: The University of Michigan Student Life is committed to student learning and the development of the whole student in a diverse and multicultural campus community. Student Life seeks to engender a diverse community that is accessible, safe and inclusive. We value a community that appreciates and learns from our similarities and differences. We pledge our commitment to support the success of all community members. We will continue meeting the needs of students of color to invest in their educational success. Student Life’s commitment to diversity and to a diverse campus community continues. (para. 1)

In addition, other institutions, such as The Chicago School of Professional Psychology (2014), have also opted to describe their mission and values in terms of diversity with the following “Commitment to Diversity” statement: The Chicago School of Professional Psychology is committed to being the school of choice by building an environment of mutual respect and inclusion where all individuals will be valued for who they are and what they can contribute, and in turn, are expected to be participatory members of an active learning community that promotes cultural awareness, competence, and understanding of diversity. (para. 1)

During the orientation sessions at The Chicago School of Professional Psychology, all new students

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take the school’s Diversity Oath. The same practice takes place at commencement, signifying in a very public way the institution’s commitment. The statement reads: As a member of The Chicago School Community, I hereby affirm to actively participate in this learning community by embracing its commitment to understand and respect individual and cultural differences. As such, I will seek to gain knowledge of human difference that I may increase my understanding of self and others. And, I will seek to build an environment of mutual respect and inclusion where all are valued. (para. 2)

Each organization or educational institution may feel the push to accept diversity and adopt multiculturalism for different reasons: responses to legal mandates, the increasing inclusionary zeitgeist, and pressures from peer institutions and professionals. In fact, 63% of colleges and universities have already established or anticipate establishing a diversity education course in their undergraduate curricula (Berrey, 2011). Of course, this is only one diversity-related practice. Others may include goals for hiring more diverse faculty and staff, and creating institutional guidelines to “reward” or recognize behaviors that affirm diversity. In these examples, it is administrative leaders who model and hold others accountable for advancing practices that become institutionalized. Additionally, the diversity scorecard previously mentioned may also be used to account for actions initiated and their effects on the institution’s objectives. Administrators may adopt a diversity target to signal their compliance with ethnic and racebased affirmative action laws. As a result, programs geared toward serving students of color, other ethnic minority groups, and Caucasian students become justified and supported by the law. However, this is not popularly used as a rationale because of the widespread realization that diversity serves the institution’s positive goals of inclusion. Under state and national legal structures, the term multiculturalism outlines race and inclusion in a more complex view than binary Black-White racial or ethnic terms. By doing so, multiculturalism can 4 9 0       C u lt u r e a n d I n t e r v e ntion

be extended to encourage diversity in terms of other factors such as culture, gender, language, or disability, military or veteran status, sexual orientation and transgender identity, disability status, or age (protected statuses). Diversity and multiculturalism on the institutional or organizational level also provide a “selling point” or advantage for the institution, which works to attract more Caucasian and ethnically diverse students and also reposition diversity in terms that are compatible outside organizational and professional pressures. As a result, a supportive organizational environment for underrepresented groups is established within the infrastructure of the organization and signals that prejudice and discrimination toward any and all individuals and groups is unacceptable. Under this approach, race-conscious language for talking about differences can be established and used throughout the institution (Berrey, 2011). However, this does not eliminate racism, stereotyping, or discriminatory behaviors. Addressing climate issues at both micro and macro levels of the organization must remain a priority. For example, student satisfaction and employee satisfaction surveys are good sources for feedback about individuals’ experiences. Although the existence of multicultural and diversity programs within an institution may suggest change, it generally does not “prescribe” or hold expectations for institutional outcomes. Unfortunately, there are some cases where universities may promote their value for diversity and multiculturalism; however, measures of accountability are not in place. Thus, the expressed desires for institutional change fall short. Therefore, with the push for diversity among institutions and organizations of higher education, there is also an enormous amount of trust required of administrators to value inclusion and to follow through. An administrative team that follows through on statements about valuing diversity will engender trust. Followthrough is not always easy because other priorities often “jump on the table,” but academic leaders are responsible to ensure the mission and goals are put into practice and that commitments made to multicultural groups are honored. Sometimes these

commitments are funding related, as with scholarships for first-generation students, or promised inclusion of underrepresented groups on essential committees within the organization.

UNPACKING BARRIERS TO DIVERSITY CHANGE WORK IN HIGHER EDUCATION Thus far, the discussion has focused on the context for organizational change through a focus on diversity led by the academic administration of a university or college. It has also been stated that the philosophical premises and rationale for advancing diversity initiatives that sustain must be mission congruent and approached with a long-term lens. The ensuing discussion acknowledges that the pathway to change will also come with resistance from different forces in the organization. Though disappointing when this occurs, administrative leaders cannot be surprised. Rather, they must anticipate such resistance and be prepared to address it. More specifically, “Diversity awareness training is a popular type of diversity training initiative. It is often met with confusion, disorder, approval, reverence, bewilderment, and even hostility” (Cavaleros, van Vuuren, & Visser, 2002, p. 51). At an institutional and organizational level, multiculturalism and diversity awareness may be met with staunch resistance. Resistance toward diversity change work in higher education can occur on the employee and student levels. It is largely the responsibility of educators and administrators to not only prepare students to function effectively in a multicultural, global context but also to encourage them to actively address social inequities and promote social transformation (Bierema, 2010). Race-conscious admissions policies, in accordance with Supreme Court rulings, have been implemented as a means of providing educational benefits to diverse student populations, particularly students of color. This type of diversity rationale, commonly known as structural diversity, is based on the premise that the increased

representation of students of color on college campuses will lead to more frequent interaction among students of different racial and ethnic groups, which results in student learning and retention (Bowman, 2012). Structural diversity at institutions of higher education has increased over the last 20 years (Elliott et al., 2013), though the mere presence of diversity among the faculty, staff, and students does not always indicate that transformation to a truly multicultural organization has occurred. Two noteworthy examples are HBCU and HSI. Though Black and Latino students predominantly attend these institutions respectively, the makeup of faculty, in particular, does not reflect the student demographic.

The Role of Structural Diversity Studies on the impact of structural diversity at universities and colleges indicate that structural diversity may notably shape postcollege behaviors, attitudes, and intergroup relations, particularly race relations. However, although structural diversity is positively correlated with White students having close interracial friendships, among Black and Hispanic students, structural diversity lacks significant effects, and findings indicate that structural diversity may actually perpetuate homogeneity among groups and is less effective in increasing between-group inclusion for underrepresented students (Bowman, 2012). In predominantly White institutions (PWI), the ethnic and racial minority student is often visibly of color. When this is not the case (Latina/o students who appear to be visibly White), other characteristics and behaviors may serve to single them out. Although, for reasons noted above, these students are often sought out to join PWI, they fail to become a critical mass. Thus, campus isolation and marginalization are often commonplace. Academic leaders are reminded to read Beverly Tatum’s (one of our multicultural pioneers, this volume, Chapter 15) classic book, “Why Are All the Black Kids Sitting Together in the Cafeteria?”: And Other Conversations About Race (2003).

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Top-down measures to implement institutional and organizational change in higher education (i.e., hiring goals and implementing curriculum changes) can be effective, although legislating change does not necessarily lead to institutionalization of desired outcomes. It has often been noted that stakeholders have to be involved in change processes to shape and “own” the desirable outcomes. At colleges and universities, leaders in academic and student affairs must identify opportunities to enhance student interactions with other diverse students in educationally purposeful ways inside and outside of the classroom. One approach often taken is the facilitation of “difficult dialogues” on diversity and multiculturalism within the college so as to develop a sense of shared responsibility for diversity discourse among the students and staff. Therefore, at the institutional level, facilitated dialogues about multiculturalism may encourage students from different backgrounds to communicate issues of social injustice in a safe and supportive environment. By creating opportunities for interaction as well as communication among staff and students at the college/university, gaps in misunderstanding among diverse groups can be highlighted and the support and institutional policies that can narrow this gap are identified (Elliott et al., 2013).

Diversity Curriculum In a study on the impact of an undergraduate diversity course, it was found that 80.7% of students reported greatly altered views about multicultural issues, and 63% reported increased general awareness of diversity issues following the completion of the class (Bierema, 2010). Piland, Hess, and Piland (2000) reported that students actually desire courses enriched with multicultural values, particularly women and ethnic and racial minority groups, while White males need the learning experiences most. By infusing concepts, examples, and practices for diversity and inclusion into the learning experience, individuals of all backgrounds are given the opportunity to develop their understanding of self and others. In addition, as the visible diversity 4 9 2       C u lt u r e a n d I n t e r v e ntion

at the university/college increases, institutions may address the needs of other underrepresented populations and encourage dialogues on sexual orientation, xenophobia, and religious intolerance in addition to race and ethnicity. As previously mentioned, these educational awareness programs are needed in PWI and HBCU, and HSI as well. As a way to address institutional barriers to diversity-related change in higher education, administrators and educators can take proactive measures that work to reduce apprehensiveness and fear among students to engage in diversity discourses. The first step that administrators can take toward institutional diversity change is to outline certain necessary competencies for educators who teach diversity curriculum in higher education. These competencies align with Multicultural Guidelines one and two (APA, 2003) that address recognizing one’s own experiences with privilege and oppression, developing the ability to facilitate diversity dialogues, and viewing diversity education as a developmental process. Disability, age, class, culture, gender, race, religion, sexual orientation, and many other identity factors affect privilege in life. As diversity educators, it is important to understand how one’s own privileges inform one’s worldview and personal perspectives that may result in the promotion of biases and assumptions about students’ capacity to learn and be successful. It is of equal importance to understand how bias may impact the way we teach and relate to students (Multicultural Guidelines one and two). Reflection on one’s personal experiences with oppression and asymmetrical power relations may help educators to facilitate conversations among students about how the establishments of power and privilege affect relationships among diverse individuals and groups. The impact of such selfawareness and self-reflection among the staff will likely add to the quality of the classroom experience for the student and encourage students to consider their own experiences in context. Moreover, accrediting bodies from the Council on Accreditation to regional accreditors, such as the Higher Learning Commission, have ­expectations

of organizations regarding diversity in the curriculum that are tied to student learning outcomes (Higher Learning Commission, 2014). In addition, funders, including the federal government and private foundations, often specify expectations for evidence of diversity plans and the inclusion of diverse voices within the institution and community advisory boards as well. Thus, administrators are required to plan for and be responsive to accreditation guidelines.

LEARNING AND DEVELOPMENTAL MODELS TO PROMOTE INCLUSION FOR DIVERSITY Adopting sensitivity toward multiculturalism occurs through a developmental process, and there are determinants in any organization, including universities and colleges, that can dictate how quickly or slowly an institution moves toward change. Ethnocentrism is one such determinant or barrier. Ethnocentrism involves evaluating and judging another culture solely by the standards of one’s own culture, while ethnorelativism involves being comfortable with diverse customs, as well as the capacity for adaptability to change (Bennett, 1993). Bennett’s (1993) Model of Developing Intercultural Sensitivity identifies six developmental stages toward understanding diversity that move individuals, and potentially organizations and institutions, from ethnocentrism to ethnorelativism: 1. Denial of difference 2. Defense against difference 3. Minimization of difference 4. Acceptance of difference 5. Adaptation of difference 6. Integration of difference

These developmental stages suggest that diversity-related education is a process that adult learners and educators experience across the

lifetime. These stages, when considered at the organizational level, may also help administrators to identify how, where, and why institutional-type resistance against diversity change occurs. For example, institutional resistance against diversity may occur because educators believe we are in a postracial society. If this premise is in place, there will likely be inattention to racism, microaggressions, and other forms of institutional bias and discriminatory behavior. Some administrators may view that racial/ethnic groups experience varying degrees of social capital (stage 1). Those who are more openly threatened by cultural difference may seek to defend against differences (stage 2) aggressively by establishing strong in-group, outgroup beliefs that favor one’s own culture as “the best,” at the expense of devaluing other cultures. Conversely, administrators who wish to minimize the differences between students in an attempt to encourage homogeneity or “equity” at the school (stage 3) may also encourage resistance against diversity change. Ultimately, the goal is to get administrators, educators, and students each on the same page when it comes to understanding diversity and to establish a learning structure that enhances the acceptance and integration of all of our differences (stages 4 and 5). Although Bennett’s model may be best understood and applied on an individual rather than macro level, it is helpful in informing those administrative teams whose leaders may be making some of the major administrative decisions that affect the rest of the staff and students. Moreover, applying Bennett’s model at the individual and administrator level should have a trickle-down effect on the rest of the staff and student body, where the end result is widespread intercultural sensitivity at the macro level. Resistance can occur on an individual level for administrators and students both, and can impact or delay institutional ethnocultural change. Active resistance to diversity-related change might include subtle and more obvious efforts to discriminate against or socially isolate individuals that represent, or wish to implement, ethnocultural diversification. Inaction, another form of resistance, is a passive approach to opposing change, which may

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involve silence regarding discriminatory behaviors or avoiding issues/people associated with diversity (Stevens, Plaut, & Sanchez-Burks, 2008). Inaction may assume the form of administrators making minimal or basic policy changes and considering the new policy sufficient enough to create an environment that caters to diversity. Active resistance can be much more difficult to combat as there may be deep-rooted beliefs and practices at play that prevent others from welcoming diversity change. Whether resistance is active or passive, each type involves a set of attitudes and beliefs that contribute to the reason why resistance occurs. Below is a list of the common types of attitudes associated with resistance to organizational diversity change, as well as a few ways to combat these attitudes and resistance. These attitudes may be toward diversity in general or toward ethnocultural diversification in higher education specifically. 1. “Initiatives to diversity on a campus are unfair and violate academic freedom.” 2. “Advantaging or allowing accommodations for persons from ethnic minority groups is unfair. Decisions should be based on qualification, ability, and merit.” 3. “It is not the responsibility of the school to account for the specific needs of individuals. Everyone is responsible for their own welfare.” 4. “I do not see color. I view individuals on their own merits, so the differences between people are not that important to consider or accommodate for.” 5. “Tiyanna, our provost, is Black and a woman, we are already diverse! Besides, racism is over, we have a Black president.” 6. “Diversification is too expensive. It will be a hassle to change the curriculum or hire new staff. Instead, let’s just promote tolerance and keep the demographic and school values the same.” 7. “The primary beneficiaries of diversification are Black people and Hispanics.” 8. “Mandating ethnocultural diversity is illegal. Besides, not being more diverse has no real consequences.”

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Many of these attitudes may be the result of being ill-informed on how change through ethnic and racial diversity in higher education takes place, as well as the organizational ramifications that result. The best way to counter these types of resistant attitudes is to educate and provide examples to staff, faculty, and students alike on the benefits of diversity in higher education. These benefits for the individual and organization must be clearly articulated. It may be helpful to explain to critics that diversity in higher education fosters an environment that welcomes the input from individuals from diverse groups, thereby broadening and adding complexity to the learning environment. Individuals who may be most resistant may need to be invited to become involved in intergroup dialogues, which may reduce boundaries or fears associated with diversity changes. Encourage selfexamination; it may influence one to consider the impact of discrimination on one’s self as a means of understanding how diversification may be necessary and helpful to address comparable discrimination within academia (Nagayama Hall, Martinez, Tuan, McMahon, & Chain, 2011). It is the responsibility of administrators to take positions and to take actions. They are the role models others look to for affirmation.

IMPLICATION OF INSTITUTIONAL DIVERSITY: THREE DIVERSITY CHANGE APPROACHES In contrast to a problem-focused approach that many institutions of higher education may take toward a diversity agenda, viewing diversity as an opportunity rather than a threat fosters an environment for increased organizational understanding and change. Ultimately, individuals of all identity backgrounds look toward the organization’s policies regarding diversity when deciding whether or not to join the institution. Diverse Issues in Higher Education, as one example, publishes an annual report on promising places to work in student affairs, and other such reports. An organization’s openness and their policies in

support of diversity and inclusion may impact the way individuals identify themselves within the organization, and their identity and/or connections with the organization as a whole. Diversity best practices will not only invite people in but also provide the basis for an internal climate that truly fosters diversity and inclusion that will likely attract and retain more individuals from diverse backgrounds. Leveraging diversity has several important implications for individual and organizational performance. Organizations can lead, advance, and cultivate diversity in a variety of ways. Of these, three approaches are discussed: the color-blind approach, the multicultural approach, and the “AIM” approach toward diversity. A review of the above-mentioned paradigms may better inform an institution of which tactics are best to promote diversity and positive self-regard within its own domain (Stevens et al., 2008).

The Color-Blind Approach The basic premise of the color-blind approach to diversity is to ignore, or better yet minimize and disregard, cultural group identities so that group members identify with the overarching organizational identity. This philosophy, in practice, is reached by emphasizing a superordinate goal or identity that is believed to increase an individual’s organizational identity and decrease the salience of individual differences. Although there are some positive aspects to this approach in that this approach is grounded in the ideals of meritocracy and equality, it also has significant and barring fundamental limitations. On the one hand, employees are discouraged under this approach from acting and thinking in unique ways associated with their cultural or identity affiliations. This fact discourages people of visibly diverse backgrounds to fully utilize the viewpoints of their distinctive group memberships. On the other hand, this approach stresses individual accomplishments and qualifications over diversity to preserve the preference for unity and egalitarianism. Given this fact, it is likely that some individuals will identify highly with an organization that implements color blindness,

while those of underrepresented backgrounds and other ethnic or culture minority status may feel excluded. Ethnic and racial minority group members, in particular, may distrust a color-blind approach because they are perceived as being exclusive of their group. Within organizations that are not very diverse, feelings of isolation felt by racial and ethnic minorities may be exacerbated, as they may perceive the organization as ignoring or devaluing their differences. The feeling of marginalization or exclusion because of the color-blind approach likely affects how individuals will attach to, and identify with, an organization. In fact, glossing over differences may contribute to dissatisfaction, perceived racial bias, and ultimately serve as motivation for some to leave the organization. Although the color-blind approach may appeal to those not categorized as “minorities” and is the dominant model used for diversity in mainstream American culture, this approach may alienate visible ethnic and racial minorities and allow a culture of racism to develop (Stevens et al., 2008).

The Multicultural Approach This approach emphasizes the benefits of diversity and explicitly recognizes people’s differences as a source of strength. Under the multicultural approach, diverse backgrounds are recognized and group identities such a race, ethnicity, gender, sexual orientation, and religious affiliation are acknowledged and brought into the organization visibly. Under this approach, there usually is an explicit and visible focus on diversity as an institutional priority composed of diverse initiatives. Embedded in these initiatives may be outreach and recruitment plans for underrepresented individuals, usually visible ethnic and racial minorities who often happen to be first-generation students. Another initiative may consist of recruitment plans to increase faculty, staff, and students, including activities that celebrate diversity (e.g., presentations by faculty and guests). A range of programming can go on under the multicultural approach, including mentoring programs, multicultural potlucks, and “diversity days” where

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individuals’ backgrounds are celebrated. At times, it may be necessary to incorporate some aspect of diversity training (e.g., workshops) designed to educate and/or increase a sense of awareness among the faculty and staff. If done well, multicultural or diversity-orientated workshops can diminish bias and increase cultural consciousness. Ethnic and racial minority groups may favor a multicultural approach to diversity because it recognizes difference, unlike the color-blind app­ roach, which stresses sameness. Multicultural diversity initiatives may run the risk of failing, however, if they are positioned as only for ethnic and racial minorities. If the diversity of White individuals or those with another identity are overlooked, as often happens with diversity initiatives, these individuals will likely feel isolated and be nonsupportive of diversity change initiatives. According to the literature, nonethnic or racial minorities are likely to have lowered motivation to identify and affiliate with an organization that supports a multicultural approach to diversity (Stevens et al., 2008).

The AIM Approach The AIM approach, or all-inclusive multiculturalism approach, is somewhat of a synthesis of the color-blind and multicultural approaches. With the AIM approach, acknowledgment of differences, and the acknowledgment of how differences have important consequences for individuals, is the focus. This approach works to explicitly endorse all groups, regardless of their identity status. The AIM model attempts to enhance positive intergroup relationships as well as increase organization satisfaction and performance. By focusing on the self-affirmation needs of all students and individuals, an environment that fosters identity and allows everyone to flourish is created. The philosophy of the AIM approach is to create a truly inclusive institutional climate beyond surface-level displays of appreciation for diversity by encouraging individuals to integrate diversity into their daily lives outside the organizational context. Doing so places more responsibility on administrative staff and instructors to demonstrate 4 9 6       C u lt u r e a n d I n t e r v e ntion

and inspire open communication among students and staff. This approach affords individuals the opportunity to build mutually supportive relationships with diverse others. Moreover, the AIM approach encourages the perspective of diversity and multiculturalism as a learning process. Actively learning about one’s self in relation to others, as well as recognizing the diversity that all individuals have to offer, encourages one to adopt diversity as a personal principle of integrity. This way, authentic relationships among individuals can thrive and the prejudice and stereotyping typically associated with diversity will likely diminish. To implement the AIM approach, a few key components are suggested (Stevens et al., 2008). 1. Communication and language: An environment that is inclusive, where everyone, regardless of their identity, feels as though they belong, begins with communicating changes to group members, as well as the general public, so as to articulate the organization’s identity, viewpoints, and commitment. a. Word choices in diversity mission statements should communicate inclusionary terms that reflect all stakeholders in the organization. Avoid language that appears exclusive. b. Potentially avoid using the word diverse, as it often is associated with ethnic and racial minorities only. c. Explicitly communicate that all organizational members are included within the term diversity. 2. Implement changes at the structural level. a. Foster inclusion and involvement in diversity initiatives or colloquia. b. Ensure that units in charge of the institutional diversity agenda reflect the inclusion and diversity that the institution states it promotes. c. Resource groups should be composed of minority and nonethnic and racial minority individuals. (pp. 125–126)

The AIM approach may present administrators, educators, and students with a myriad of benefits,

most of which will be experienced on the personal level. The following list comprises several proposed benefits of AIM: •• Allows institutions of higher education to realize the benefits of “true” diversity at the group/ organizational level. •• Decreases resistance and conflicts by allowing nonethnic and racial minorities to feel included in diversity discourse, while also fostering the needs of minorities to feel included and respected. •• Increases retention as a result of higher organizational trust and satisfaction by both minority and nonethnic and racial minority groups. •• Allows individuals to flourish and reach their fullest potential. •• Group members feel more free and able to engage and challenge each other, while also being supportive and respectful at the same time. •• Positive intergroup relations are fostered, which results in heightened engagement and overall institution performance.

CONCLUSION The demographic diversity of students is rapidly changing at all levels of higher education, from community colleges to professional schools. It can be expected, then, that institutions of higher education will endeavor to adopt cultural competence models, multicultural values, and worldviews into all domains of the educational environment. Affirmative action policies may facilitate the transition for some colleges to be more inclusive of people coming from diverse backgrounds. However, these policies do not always guarantee that an institution will truly adopt multiculturalism within their ideals. As the literature indicates, institutions that are proactive with comprehensive diversity initiatives are generally more successful (Kreitz, 2008). Sometimes, resistance to diversity-related changes in higher education occurs because institutional barriers bar the school from easily making changes. For example, structural diversity and other top-down measures assume that the mere presence of more diverse students at the school

will result in homogeneity among students and an improvement in campus climate. Although studies show that White students benefit from this type of diversity-change measure, it is less likely that students of color do. Instead, it is more beneficial for institutions to take an active stance toward diversity change by incorporating diversity classes, facilitating dialogue across groups, developing mentorship networks, and providing a safe atmosphere where students can explore and learn about themselves and diverse others. Moreover, institutions can make use of Bennett’s (1993) model of the development of intercultural sensitivity to understand diversity education as a process that adult learners and educators may likely experience across their lives. After all, everyone has the opportunity to become a leader and advocate for diversity in the 21st century. When dealing with resistance toward diversity change in higher education, institutions need to assume that resistors are either active or passive. Active resistors take a much more proactive stand against change and may discriminate against or socially isolate others. They challenge and file civil suits particularly around admissions policies. Passive resistors may generally be much easier to influence and may resign to inaction or silence about the discrimination others face. This stance of passivity is potentially harmful to others and contributes to a hostile environment. Of the types of resistors (active or passive), it can generally be assumed that they share certain similar attitudes toward diversity, multiculturalism, or change in general that prevents them from willingly engaging in change efforts. In terms of implementing diversity change at the institutional level, research suggests that colorblind approaches that tend to ignore, or better yet overlook, cultural group identities so that group members identify with the overarching organizational identity are perceived as mutually exclusive to underrepresented groups and ethnic and racial minorities. In addition, a color-blind approach to diversity change may foster an environment of racism and segregation. The multicultural approach emphasizes the benefits of diversity and explicitly

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recognizes differences between people as a source of strength. Although diverse backgrounds are recognized and group identities such a race, ethnicity, gender, and religious affiliation are retained and acknowledged, underrepresented and White persons may feel the term multicultural does not apply to them. The most sensitive approach, therefore, is the AIM approach. The AIM approach recognizes others’ differences and acknowledges how differences have important consequences for individuals. Under AIM, the diversity of all people is acknowledged and celebrated. To conclude, we emphasize the importance of practicing self-reflection for educators and administrators who wish to implement diversity-oriented changes. It is recommended that educators understand their own biases and how they may impact the way they teach about diversity and how they create classrooms for inclusion. In addition, there are other measures administrators have to consider.

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For example, institutional mission statements and websites need to convey that the term diversity is all-inclusive and does not simply refer to ethnic and racial minorities. How a student identifies with the diversity stance of an institution can give insight into how successful, and ultimately satisfied, the student will be with his or her learning experience. Keep this in mind, and when it seems as though diversity change initiatives are failing, remember that diversity in higher education adds complexity and richness to the learning experience as a whole, and keep working hard until the desired consensus is reached. To this end, educators, researchers, and organizational/institutional leaders are encouraged to gain competency on ethnic and culturally diverse groups (APA, 2003) so as to better incorporate diversity lenses within the organization and to implement organizational change congruent with the changing demographics of the United States.

Epilogue The Handbook of Multicultural Counseling, Past, Present, and Future Joseph G. Ponterotto

I

feel delighted and honored to write this Epilogue to the fourth edition of the Handbook of Multicultural Counseling (Casas, Suzuki, Alexander, & Jackson, 2016). Let me begin by dedicating this Epilogue to my good friend Jesus Manuel Casas—my mentor and my role model for courage, vision, and voice for change in counseling and psychology. As I reflect on our 35 years of friendship and professional collaboration, I smile broadly and feel warmth and deep satisfaction in my heart. My work with Manny has been my greatest professional joy. For 20 of these 35 years we worked together, on and off, on the first three editions of this Handbook. Because my professional life has taken a different path in recent years (including a small private practice and writing for the general public) and my multicultural research and writing has slowed down, the invitation to write this closing chapter and connect with this new edition of the Handbook was deeply meaningful. In closing out this masterful new edition of the Handbook, I thought it would be fruitful to first review the history of the Handbook. The first edition of the Handbook was published in 1995, and we started working on the book in 1993. The idea for a comprehensive handbook summarizing recent developments in the field and pointing to directions for future work originated in my discussions with Manny Casas. Though at present, handbooks on different topics are plentiful—in fact, one can find a comprehensive handbook on almost any topic in counseling, education,

or p ­sychology—back in 1993, such handbooks were rare. We initially modeled our vision of the handbook on two highly respected handbooks in psychology that were available at the time: the Handbook of Counseling Psychology (Brown & Lent, 1992) and the Handbook of Psychotherapy and Behavior Change (Garfield & Bergin, 1978). As Manny and I reflected on our cultural identities intersecting with the mission of the Handbook, we thought it important to expand the cultural lens of the editing team. As Mexican American and Italian American males, we believed it important to broaden the editing team across race/ethnicity and gender. In consulting with colleagues and in our own knowledge of visionary scholars in the field, Manny and I asked Lisa Suzuki and Charlene Alexander to join the editing team. They said yes, and we were delighted and excited to begin work on the first edition of the Handbook. At the time we began working on the Handbook in 1993, there were three textbooks dominating training in multicultural counseling: Counseling the Culturally Different (Sue & Sue, 1981), Counseling American Minorities (Atkinson, Morten, & Sue, 1979), and Counseling Across Cultures (Pedersen, Draguns, Lonner, & Trimble, 1976). I think it is appropriate to acknowledge the great impact these three works and their respective editors and contributing authors had in highlighting the importance of multicultural competence integration in training. The authors or editors of these collective works were Donald R. Atkinson, George Morten,

499

Derald Wing Sue, David Sue, Paul B. Pedersen, Juris G. Draguns, Walter J. Lonner, and Joseph E. Trimble. Let this fourth edition of the Handbook of Multicultural Counseling also honor these multicultural pioneers. While these landmark textbooks were primarily geared toward the master’s level multicultural class and the practitioner, we decided that the Handbooks of Multicultural Counseling would also include advanced topics, thus targeting doctoral students, including those working on their dissertations, as well as master clinicians and seasoned scholars working on cutting-edge multicultural research.

STRUCTURE OF THE HANDBOOKS The contents and structure of the Handbooks have reflected the research, theory, and practice trends reflective in the time period. Some constants across the four editions of the Handbook have been ethics, research methods and reviews, theoretical updates, assessment and testing, and clinical practice. In the second edition, we added the Life Story section to bring the personal and professional lives of pioneering multicultural scholars closer to our readers. These life story sections are my favorite part of the Handbooks, as through the writing of these courageous pioneers in the field, they become personal role models for us. As I read through the pioneers featured in this fourth edition of the Handbook, I was again riveted to and personally impacted by their stories—their courage, perseverance, determination, vision, dedication to others, and their humbleness. After reading this set of life stories, memories of all the life stories across the previous editions flashed through my mind. I provide Table 1 for the reader, which lists in alphabetical order all the pioneers honored thus far in the Handbooks of Multicultural Counseling. I suggest after reading this edition’s life stories that the reader go back and read others from previous editions. I suggest as well that you begin to write your own life story, even if you are a first-year graduate student in counseling or any field of psychology

or education. As highlighted by the editors of this book, among you are the multicultural pioneers of the next generations.

CONTENTS OF THE HANDBOOKS Over the course of four editions of the Handbook of Multicultural Counseling, our contributing authors have addressed critical and emerging topics. I thought it of value to content analyze the major topical areas of our coverage. Table 2 organizes the collective group of 178 chapters into 21 major content categories. I used a simple card sort procedure to organize the content analysis. More specifically, I wrote each chapter title in each edition on a separate index card and then used a card sort procedure to cluster the 178 index cards into common categories. This procedure was not a formal process with multiple sorters and an interrater reliability check, and readers should know that the clustering of content coverage reflects my organizing research lens based on my familiarity with all 178 chapters (see Table 2). The largest cluster of chapters is the multicultural life stories of our field’s pioneers and visionary leaders. This cluster includes 36 individual life stories and three integrating life story chapters (39/178 = 21.9% of all chapters). The second largest cluster (10.7%) of chapters focused on racial/ethnic identity development theories and research. Many groups were covered in this cluster, both minority and majority groups, with an emphasis on minority identity development models and the great heterogeneity existing within these groups. Another emphasis across the four editions of the Handbook was applied counseling and assessment strategies and approaches across a wide variety of groups and developmental cohorts (10.1%). Consistent with the evolving professional identity of both the counseling and counseling psychology professions, the next significant cluster of chapters clustered in the areas of career development and practice, and social justice and organizational change (both at 5.1%). General multicultural

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assessment models and the assessment of acculturation and worldview (4.5%) and rigorous quantitative, qualitative, and mixed method approaches to multicultural research (3.9%) were also well covered in the Handbooks. Comprehensive coverage of multicultural training, supervision, and the teaching process (3.4%), and issues of racism, bias, and the psychotherapy of liberation (3.4%) was also evident in the collective set of Handbooks. The remaining clusters of chapter coverage in the Handbooks can be viewed in Table 2. As can be gleaned from Table 2, the content coverage across the four editions of the Handbook has been both broad and deep. I believe that along with the multiple editions of Counseling the Culturally Diverse (Sue & Sue, 1981), Counseling Across Cultures (Pedersen et  al., 1976), and Counseling American Minorities (Atkinson et  al., 1979), the Handbook of Multicultural Counseling (Casas et al., 2016) has imprinted the construct of multicultural awareness and competence on the soul of the counseling and psychology professions.

WHERE DO WE GO FROM HERE? PROGRESS AND CONTINUING CHALLENGES In the last half-century, the counseling and psychology professions have achieved great gains regarding understanding culture in counseling and enhancing the quality of psychological services to all our human groups. Part of this progress is due to the 36 pioneers listed in Table 1 who impacted individual, institutional, and organization change through their fierce advocacy and sheer competence and brilliance. Their courage formed the foundation for the current and future generations of counseling professionals, as their work and efforts at times came up against strong walls of resistance resulting in their careers, tenures, and promotions being threatened. This is particularly the case for our pioneers in Table 1 who started writing and speaking publicly on multicultural topics in the 1960s and early 1970s when multicultural issues were not mainstream in counseling and psychology and were, in fact,

judged by many in our field to be tangential and nonessential to the scholarly and applied mission of counseling and psychology. Naturally, there are other multicultural pioneers in addition to our 36 profiled who have contributed significantly to the multicultural surge of the last half-century, and their life story invitations await future editions of the Handbook. In acknowledging the hundreds of authors who contributed to the Handbooks of Multicultural Counseling and the classic multiedition texts by Sue and Sue (1981), Pedersen et al. (1976), and Atkinson et al. (1979), we note major advances in the field of multicultural counseling. The publication of this fourth edition of the Handbook of Multicultural Counseling in 2016 marks the 40th anniversary of the inaugural edition of Pedersen et al.’s (1976) Counseling Across Cultures, perhaps the first landmark multigroup, comprehensive multicultural counseling textbook. In that time, the profession has made marked gains in the areas of multicultural training, as now multicultural competence is infused in accreditation criteria for the American Psychological Association (APA), the Masters in Psychology and Counseling Accreditation Council (MPCAC), and the Council for the Accreditation of Counseling and Related Education Programs (CACREP), as well as in licensing criteria for all 50 U.S. states. Just a sampling of the significant gains regarding the counseling and related professions’ multicultural competence since Pedersen et al.’s (1976) landmark work reside in the development and validation of comprehensive multicultural theories; refined culturally anchored assessment and intervention practices; the expansion of bilingual training programs and service centers; the integration of qualitative and mixed methods research into the preexisting dominant quantitative perspective on counseling research; the incorporation of culturally indigenous counseling models and approaches into the traditional western version of “healing practices”; the centrality of institutional and organizational social justice initiatives to combat overt and covert prejudice in all its forms and expanding the traditional one-on-one and Epi log ue

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small-group counseling models to complex systems; greater attention to religious and spiritual issues in counseling; the complexity and importance of working across multiple identities inclusive of race, ethnicity, sexual orientation, gender, social class, and religion; and advocating for more attention to deeply ingrained White racism toward African American men. These are just a few of the topics to which this edition of the Handbook and other books cited earlier address with insight, depth, and great candor. Despite our 40 years of marked gains in increasing our cultural awareness and improving the quality of service and research to the broad quilt of cultures that is North America, there remain great challenges that will be addressed by you—the readers of this fourth edition Handbook. Some of these challenges are reflected in current events that took place during the time I and other contributors were working on our chapters for this Handbook. Interestingly, all the editions of the Handbook of Multicultural Counseling have been informed by the current racial, ethnic, and political events in society, nationally and internationally. The present and subsequent editions also reflect what is currently going on outside the “ivory tower” and “counseling clinic.” In the short time I was reading this latest Handbook edition and working on this brief epilogue, a number of current events were deeply impacting the psychology of our society (known as psychohistory). Among these were the tragedy of multiple Black men losing their life to police bullets and physical violence; the race-based massacre of African American church attendees in Charleston, South Carolina; and the ethical and human rights reappraisal of the APA based on a few in its leadership accused of being complicit in supporting the Department of Defense’s (DoD) and Central Intelligence Agency’s (CIA) “enhanced” interrogation policies. Some current events were poignant and heartwarming, and were driven in part by the influence of counselors and psychologists conducting their research and informing the public and the politique. Among these were the U.S. Supreme Court’s

decision on the constitutional right of same-sex marriage and the support in many quarters of Caitlin Jenner’s (and other transgender individuals speaking publicly) transgender process. Finally, other current events may not yet have a valence of negative or positive but pique the curiosity of multicultural researchers. Chief among these current events is the apparent polling popularity (in July and August 2015) of presidential candidate Donald J. Trump and the many criticisms of democratic front-runner Hillary Clinton and current president Barack Obama. What is the role of race and gender in the public’s perception of presidential candidates and figures? Similarly, the raising of the U.S. flag marking the opening of the U.S. Embassy in Havana, Cuba, on August 14, 2015, has also resulted in polarizing reactions among the U.S. public. These current and emerging events spawn ideas for future multicultural counseling research and subsequent editions of this Handbook. Let us explore a few of them: 1. Addressing the ingrained nature of -isms. As we acknowledge continuing oppression and violence toward minority groups, particularly African American men but also women, religious minorities, sexual orientation minorities, and others, counseling researchers can focus their research on the mechanisms of unconscious, deeply ingrained hate based on these perceived differences. Innovative quantitative (e.g., neuroscience and fMRI research) and qualitative approaches must be used to get at the deep core of fear and hate that results in prejudice and isms in their many forms. Applied research on effective ways to counter the ingrained hate must be tested and intervention models implemented beginning with parent training and elementary education. 2. The fluidity of gender. Much of North American society still operates from dichotomies, including that of gender. The male-female categorical model needs to be revised to capture the continuum that is gender, and counseling researchers can be at the forefront in the research and applied implications of gender studies. Greater awareness

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of transgender issues is important, as is continuing research and theory on sexual orientation and gender roles. 3. Multicultural counselors as political psychologists. The discussion above about the public’s current reaction (2015–2016) to Donald J. Trump, Hillary Clinton, and Barack Obama likely taps deep-seated race and gender biases, and multicultural political psychology can serve as a marked contribution to the public’s awareness of these issues as they explore their own values and biases and make informed judgments in the polling booth. 4. Multicultural ethics. Many in our field, and in the public, have had strong reactions to the Hoffman Report and its allegation that select members of the APA were complicit with members of the DoD and CIA to position and word APA’s ethical guidelines so that they didn’t contradict DoD interrogation policies and procedures. (It is important for mental health professionals and students to read the full 542-page Hoffman Report [http://www.apa.org/independent-review/ APA-FINAL-Report-7.2.15.pdf] as well as various reaction papers by those discussed in the report when forming their own judgment.) As I read the Hoffman report and reactions, in addition to general ethical and moral issues, I wondered what role prisoner race and religion had in the interrogationintensity decisions. Would waterboarding “interrogation” methods have been used on FBI suspects Timothy McVeigh or Edward Snowden? Further, what role did race and religion have on the tragedy of torture at Abu Ghraib prison in Iraq? Though ethics (particularly) and military psychology have been addressed in the Handbooks of Multicultural Counseling (refer back to Table 2 again), perhaps future editions of the book can devote entire subsections to these critical issues. 5. Interdisciplinary multicultural perspectives. In regard to the major textbooks in multicultural counseling, perhaps the Handbook of Multicultural Counseling has been at the forefront in addressing interdisciplinary contexts for the work of counselors. Nonetheless, given the complexity of the

issues described above and in this new edition of the Handbook, it appears that increased interdisciplinary collaboration is needed to address the myriad of complex topics counseling researchers, practitioners, teachers, and supervisors work with day to day. Perhaps future editions of the Handbook can engage scholars and practitioners in such fields as law, ethics, sociology, economics, political science, neuroscience, evolutionary psychology, psychobiography, anthropology, and media studies among many others to partner with counselors and psychologists in writing chapters to balance depth and breadth of coverage. 6. Promoting multilingual development and training. The world is no longer a collection of specific linguistic groups interacting among their own. Multilingualism, like multiculturalism, is now the emerging trend and the core of future communication patterns. The Handbook going forward can devote more attention to bilingualism in practice and training. It appears to me that every counseling program in North America should be a bilingual program with bilingual classes, practicums, internship, supervision, and research reporting. That a majority of master’sand doctoral-level counselors and counseling psychologists only speak and work in English appears untenable to me for the health and viability of the profession going forward. The above constitute but a few of the emerging research and applied areas that this and subsequent Handbook editions have already addressed or will address. The multicultural counseling field (which is the counseling field) is a vibrant, exciting, critical, and dynamic discipline of study, and I both invite and challenge readers to forge ahead in leading the profession and engaging your own pioneer journey. Manny Casas, Lisa Suzuki, Charlene Alexander, Margo Jackson, and their group of distinguished contributing authors have coalesced a masterpiece of literature in this fourth edition of the Handbook of Multicultural Counseling. This Handbook will be read by thousands of readers worldwide, and many will affirm Epi log ue

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and empower their identity as professional counselors through the wisdom passed on in the life stories and through the scholarship and applied strategies embedded throughout the many chapters. My deepest thanks and admiration for the editors, the pioneers in this edition, and the many visionary contributing chapter authors.

REFERENCES Atkinson, D. R., Morten, G., & Sue, D. W. (1979). Counseling American minorities: A cross-cultural perspective. Dubuque, IA: William C Brown. (Now in its sixth edition.) Brown, S. D., & Lent, R. W. (Eds.). (1992). Handbook of counseling psychology (2nd ed.). New York, NY: Wiley. (Now in its fourth edition.)

Casas, J. M., Suzuki, L. A., Alexander, C. M., & Jackson, M. A. (Eds.). (2016). Handbook of multicultural counseling (4th ed.). Thousand Oaks, CA: Sage. (Previous editions in 1995, 2001, 2009.) Garfield, S. L., & Bergin, A. (Eds.). (1978). Handbook of psychotherapy and behavior change: An empirical analysis (2nd ed.). New York, NY: Wiley. (Now in its sixth edition.) Pedersen, P. B., Draguns, J. G., Lonner, W. J., & Trimble, J. E. (Eds). (1976). Counseling across cultures. Honolulu: University of Hawaii Press. (Now in its sixth edition.) Sue, D. W., & Sue, D. (1981). Counseling the culturally different: Theory and practice. New York, NY: Wiley. (Now in its sixth edition and named changed to Counseling the Culturally Diverse: Theory and Practice.)

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Table 1  Pioneers Honored in the Handbook of Multicultural Counseling (arranged alphabetically) Pioneer

Edition

Chapter

Patricia Arredondo

3rd

5

Martha E. Banks

4th

5

Carolyn G. Barcus

3rd

2

Guillermo Bernal

4th

6

Rosie Phillips Bingham

3rd

3

Robert T. Carter

4th

7

J. Manuel Casas

2nd

8

Fanny M. Cheung

4th

8

Lillian Comas-Díaz

4th

9

William E. Cross Jr.

2nd

4

Eduardo Duran

3rd

1

Michelle Fine

3rd

12

Nadya A. Fouad

2nd

6

Mary A. Fukuyama

3rd

8

Beverly A. Greene

4th

10

Janet E. Helms

2nd

3

Bertha Garrett Holliday

4th

11

Allen E. Ivey

3rd

11

Teresa D. LaFromboise

2nd

2

Anthony Marsella

4th

12

Susan L. Morrow

3rd

9

Rhoda Olkin

3rd

10

Amado M. Padilla

3rd

6

Thomas Parham

4th

13

Paul Bodholdt Pedersen

2nd

9

Amy L. Reynolds

2nd

10

Maria P. P. Root

2nd

11

Daya Singh Sandhu

2nd

12

(Continued)

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Table 1  (Continued) Pioneer

Edition

Chapter

Derald Wing Sue

2nd

5

Richard M. Suinn

3rd

7

Lisa Suzuki

4th

14

Beverly Daniel Tatum

4th

15

Joseph E. Trimble

2nd

1

Melba J. T. Vasquez

2nd

7

Joseph L. White

3rd

4

Diane Willis

4th

16

Note: The first edition of the Handbook (1995) did not include Pioneer Life Stories.

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Table 2  T  opical Content of the First Four Editions of the Handbook of Multicultural Counseling Inclusive of 178 Content Chapters Topical Focus

# of Chapters

% of all Chapters

Multicultural Pioneer Life Stories and Integrations

39

21.5

Identities

19

10.7

  Native American/Hawaiian

(3)

  White Americans

(3)

 Nigrescence/Black/Afro-Caribbean

(3)

  Biracial and Multiracial

(3)

 Hispanic/Latino

(2)

  Asian American

(2)

  Sexual Orientation

(2)

  General Discussion

(1)

Counseling and Assessment Across Various Groups

18

 Families

(4)

  Immigrants and Refugees

(4)

  Older Adults

(2)

 Children

(1)

 Adolescents

(1)

 Adults

(1)

  African American Men

(1)

  Military Veterans

(1)

  Persons With Disabilities

(1)

  Group Approaches

(1)

  Social Class and Disenfranchised

(1)

10.1

Career Theory and Practice

9

 5.1

Social Justice and Organizational Change

9

 5.1

General Assessment, Acculturation, and Worldview

8

 4.5

Research Methods: Quantitative, Qualitative, and Mixed Methods

7

 3.9

Training, Supervision, and Teaching

6

 3.4

(Continued)

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Table 2  (Continued) Topical Focus

# of Chapters

% of all Chapters

Racism, Bias, and Psychology of Liberation

6

 3.4

Spirituality and Religion

5

 2.8

Multicultural Counseling Competencies

5

 2.8

The College Campus: Predominantly White and Historically Black

5

 2.8

Integrative Empirical Research Reviews

5

 2.8

Ethical Issues

4

 2.3

Indigenous Healing Approaches and Models

4

 2.3

School Counseling

4

 2.3

Historical Perspectives

3

 1.7

International Issues

2

 1.1

Positive Psychology

2

 1.1

Community Interventions

2

 1.1

Other Topics

3

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 Trauma

(1)

  Disaster Relief

(1)

  Culture and Technology

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References

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Kennedy, S. (1993, March 29). Stuart W. Cook, 79, psychologist who revealed effects of racism. The New York Times. Retrieved from http://www.nytimes. com/1993/03/29/obituaries/stuart-w-cook79-psychologist-who-revealed-effects-of-racism .html. Morse, G., & Blume, A., (2013, September). Does the APA ethics code work for us? Communique. Retrieved from http://www.apa.org/pi/oema/ resources/communique/2013/09/code-ethics.aspx Straits, K., Bird, D., Tsinajinnie, E., Espinoza, J., Good­ kind, J., Spencer, O., . . . Guiding principles workgroup (2012). Guiding principles for engaging in research with Native American Communities, Version 1. Albuquerque: University of New Mexico Center for Rural and Community Behavioral Health & Albuquerque Area Southwest Tribal Epidemiology Center. Retrieved from http://hsc.unm.edu/vision 2020/common/do cs/Guiding_Pr inciples_ Research_Native_Communities2012.pdf Sue, D. W., Bernier, Y., Durran, A., Feinberg, L., Pedersen, P. B., Smith, E. J., & Vasquez-Nuttal, E. (1982). Position paper: Cross-cultural counseling competencies. The Counseling Psychologist, 10, 45–52.

CHAPTER 4 Arredondo, P., & D’Andrea, M. (1997, October). Develo­ ping a comprehensive multicultural and diversity agenda for ACA. Counseling Today, 40(4), 43. Bush, George W. (2001, November 15). Remarks with President Vladimir Putin of Russia and a question-and-answer session with Crawford High School students in Crawford. Retrieved from The American Presidency Project website, http://www .presidency.ucsb.edu/ws/index.php?pid=73461&st =backward&st1=afghanistan D’Andrea, M. (2006). Expanding our thinking of White racism. In M. Constantine & D. W. Sue (Eds.), Addressing racism: Facilitating cultural competence in mental health and educational settings (pp. 78–93). New York, NY: Wiley. D’Andrea, M. (2014, March). The evolution and devolution of the multicultural counseling movement: Lessons for the supporters of social justice c­ ounseling and advocacy movement. Presentation made at

the annual meeting of the American Counseling Association in Honolulu, HI. D’Andrea, M., & Arredondo, P. (1997, January). ACA leaders work together to address multicultural and diversity issues in the profession. Counseling Today, 39(7), 22–23. D’Andrea, M., & Daniels, J. (1996). What is multicultural group counseling? Identifying its potential benefits, barriers, and future challenges. Counseling and Human Development, 28(6), 1–16. D’Andrea, M., & Daniels, J. (2005, July). A socially responsible approach to counseling, mental health care. Counseling Today, 48(1), 36–38. D’Andrea, M., & Daniels, J. (2010). Promoting multiculturalism, democracy, and social justice in organizational settings: A case study. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), The handbook of multicultural counseling (3rd ed.). Thousand Oaks, CA: Sage. D’Andrea, M., & Daniels, J. (2015, March). Neuroscience and social justice counseling. Presentation made at the annual meeting of the American Counseling Association in Orlando, FL. D’Andrea, M., Daniels, J., Arredondo, P., Bradford Ivey, M. B., Ivey, A. E., Locke, D., . . . Sue, D. W. (2001). Fostering organizational changes to realize the revolutionary potential of the multicultural movement: An updated case study. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), The handbook of multicultural counseling (2nd ed., pp. 222–253). Thousand Oaks, CA: Sage. Daniels, J., Parham, T., & D’Andrea, M. (2011, March). Therapeutic benefits and challenges of social justice activism: Voices of creativity, courage, resistance, and resilience. Presentation made at the annual meeting of the American Counseling Association in New Orleans, LA. Davis, A. Y. (2012). The meaning of freedom: And other difficult dialogues. Boston, MA: Open Media Publishers. Douglass, F. (1857). If there is no struggle, there is no progress. Retrieved from http:/www.blackpast. org/1857-frederick-douglass-if-there-is-no-strug gle-there-is-no-progress Giroux, H. A. (2014). Neoliberalism’s war on democracy. Boston, MA: Haymarket Books.

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Ivey, A. E., D’Andrea, M., & Ivey, M. B. (2012). Theories of counseling and psychotherapy: A multicultural perspective (7th ed.). Thousand Oaks, CA: Sage. Lewis, J., Lewis, M., Daniels, J., & D’Andrea, M. (2011). Community counseling: A social justice perspective (3rd ed.). Pacific Grove, CA: Brooks/Cole. Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (Eds.). (2001). The handbook of multicultural counseling (2nd ed.). Thousand Oaks, CA: Sage. Prilleltensky, I. (1989). Psychology and the status quo. American Psychologist, 44(5), 795–802. Sue, D. W., Arredondo, P., & McDavis, R. J. (1991). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477–486. Sue, D. W., Ivey, A. E., & Pedersen, P. B. (Eds.). (1996). A theory of multicultural counseling and therapy. Pacific Grove, CA: Brooks/Cole. Sue D. W., & Sue, D. (2015). Counseling the culturally diverse: Theory and practice (7th ed.). New York, NY: Wiley. Weinrach, S. G., & Thomas, K. R. (2004). The AMCD Multicultural Counseling Competencies: A critically flawed initiative. Journal of Mental Health Counseling, 26(1), 81–93. West, C. (1993). Race matters. Boston, MA: First Vintage Books. Wrenn, G. C. (1962). The culturally encapsulated counselor. Harvard Educational Review, 32(4), 444–449.

CHAPTER 5 Ackerman, R. J., & Banks, M. E. (2007). Caregiving. In V. Muhlbauer & J. C. Chrisler (Eds.), Women over 50: Psychological perspectives (pp. 147–163). New York, NY: Springer. Banks, M. E. (2003). Disability in the family: A life span perspective. Cultural Diversity and Ethnic Minority Psychology, 9(4), 367–384. doi:10.1037/1099-9809. 9.4.367 Banks, M. E. (2010). 2009 Division 35 presidential address: Feminist psychology and women with disabilities: An emerging alliance. Psychology of Women Quarterly, 34, 431–442. doi: 10.1111/j.14716402.2010.01593.x

Banks, M. E. (2012a). Multiple minority identities and mental health: Social and research implications of diversity within and between groups. In R. Nettles & R. Balter (Eds.), Multiple minority identities: Applications for practice, research, and training (pp. 35–58). New York, NY: Springer. Banks, M. E. (2012b). Nearly bionic, and still going. In E. Cole & M. Gergen (Eds.), Retiring, but not shy: Feminist psychologists create their post-careers (pp. 252–265). Chagrin Falls, OH: Taos Institute Publications. Banks, M. E. (2013). Women of Color with disabilities. In L. Comas-Díaz & B. Greene (Eds.), Psychological health of Women of Color: Intersections, challenges, and opportunities (pp. 219–231). Westport, CT: Praeger. Banks, M. E., & Kaschak, E. (Eds.). (2003). Women with visible and invisible disabilities: Multiple intersections, multiple issues, multiple therapies. New York, NY: Haworth Press. Banks, M. E., & Lee, S. (in press). Womanism and spirituality/theology. In T. Bryant-Davis & L. ComasDíaz (Eds.), Womanism and mujerismo psychology. Washington, DC: APA. Feldman, S. I., & Tegart, G. (2003). Keep moving: Conceptions of illness and disability of middleaged African-American women with arthritis. In M. E. Banks & E. Kaschak (Eds.), Women with visible and invisible disabilities: Multiple intersections, multiple issues, multiple therapies (pp. 127–143). New York, NY: Haworth Press. Lee, S. (2010, Fall). Church bridges the gap by reducing physical barriers. East Ohio Joining Hands, 11(1), 15. Marshall, C. A., Kendall, E., Banks, M. E., & Gover, R. M. S. (Eds.). (2009). Disability: Insights from across fields and around the world. Volumes I, II, and III. Westport, CT: Praeger. United Methodist Church. (2013). The Book of Discipline of the United Methodist Church 2012 [Kindle Edition]. Available from Amazon.com. World Council of Churches. (2003). A Church of all and for all: An interim statement. Retrieved from http:// www.oikoumene.org/en/resources/documents/ wcc-commissions/faith-and-order-commission/ ix-other-study-processes/a-church-of-all-and-forall-an-interim-statement

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CHAPTER 6 Allen, E. (Editor & Translator). (2002). José Martí: Selected writings. New York, NY: Penguin Books. Bernal, G. (1985). A history of psychology in Cuba. Journal of Community Psychology, 13(2), 222–235. Bernal, G., Jacobson, L. I., & López, G. N. (1975). Do the effects of behaviour modification programs endure? Behaviour Research & Therapy, 13, 61–64. Jacobson, L. I., Bernal, G., & López, G. N. (1973). Effects of behavioral training on the functioning of a profoundly retarded microcephalic teenager with cerebral palsy and without language or verbal comprehension: A case study. Behaviour Research & Therapy, 11, 143–145. Louro Bernal, I., & Bernal, G. (2013). The development of psychology in Cuba in the work of Dr. Alfonso Bernal del Riesgo [in Spanish]. Revista Interamericana de Psicología, 47(2), 177–184. Perez-Firmat, G. (1995). Next year in Cuba: A Cubano’s coming-of-age in America. New York, NY: Anchor. Vornholt, J. (1996). Star Trek: First contact. New York, NY: Aladdin.

CHAPTER 7 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Carlson, E. B. (1997). Trauma assessments: Clinician’s guide. New York, NY: Gilford Press. Carter, R. T. (1991). Cultural values: A review of empirical research and implications for counseling. Journal of Counseling and Development, 70, 164–173. Carter, R. T. (1995). The influence of race and racial identity in the psychotherapy process: Toward a racially inclusive model. New York, NY: Wiley. Carter, R. T. (2004). Disaster response to communities of color: Cultural responsive intervention. Technical Report, Connecticut Department of Mental Health and Addiction (DMHAS). Retrieved from http:// www.dmhas.state.ct.us/ Carter, R. T. (Ed.). (2005a). Handbook of racial-cultural psychology and counseling: Theory and research (Vol. 1). Hoboken, NJ: Wiley.

Carter, R. T. (Ed.). (2005b). Handbook of racial-cultural psychology and counseling: Training and practice (Vol. 2). Hoboken, NJ: Wiley. Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and assessing racebased traumatic stress. The Counseling Psychologist, 35(1), 13–105. Carter R. T., & Forsyth J. M. (2009). A guide to the forensic assessment of race-based traumatic stress reactions. Journal of the American Academy of Psychiatry and the Law, 37, 28–40. Carter, R. T., & Helms, J. E. (2002, February). Racial harassment: The identified trauma. Symposium conducted at Teachers College, Winter Roundtable on Cross-Cultural Psychology and Education, New York, NY. Carter, R. T., Johnson, V., Muchow, C., Lyons, J., Forquer, E., & Galgay, C. (in press). The development of classes of racism measures for frequency and stress reactions: Relationships to race-based traumatic symptoms. Traumatology. Carter, R. T., & Mazzula, S. (2011, August). Initial development of the Race-based Traumatic Stress Scale. Paper presented at the 119th Annual Convention of the American Psychological Association, Washington, DC. Carter, R. T., Mazzula, S., Victoria, R., Vazquez, R., Hall, S., Smith, S., . . . Williams, B. (2013). The development of the race-based traumatic stress symptom scale. Psychological Trauma: Theory, Policy, Research, and Practice, 5(1), 1–9. Carter, R.T., & Muchow, C. (2016). Construct validity of the race-based traumatic stress symptom scale and test of measurement equivalence. Manuscript submitted for publication. Carter, R. T., Pieterse, A., & Muchow, C. (2016). Construct validity and measurement equivalence of the RBTSSS with Black Americans. Manuscript submitted for publication. Carter, R. T., & Qureshi, A. (1995). A typology of philosophical assumptions in multicultural counseling and training. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), The handbook of multicultural counseling (pp. 239–262). Newbury Park, CA: Sage. Carter, R. T., & Sant-Barket, S. M. (2015). Assessment of the impact of racial discrimination and r­ acism:

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How to use the Race-Based Traumatic Stress Symptom Scale in practice. Traumatology, 21(1), 32–39. Carter, R. T., & Scheuermann, T. D. (2012). Legal and policy standards for addressing workplace racism: Employer liability and shared responsibility for race-based traumatic stress. University of Maryland Law Journal of Race, Religion, Gender and Class, 12(1), 1–100. Duckitt, J. H. (1992). Psychology and prejudice: A historical analysis and integrative framework. American Psychologist, 47(10), 1182–1193. Guthrie, R. V. (2004). Even the rat was white: A historical view of psychology (2nd ed.). Upper Saddle River, NJ: Pearson Education. Helms, J. E. (1990). Black and white racial identity: Theory, research and practice. Westport, CT: Greenwood. Helms, J. E. (2001). Update of Helms’s White and People of Color racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 181–198). Thousand Oaks, CA: Sage. Helms, J. E., & Cook, D. (1999). Using race and culture in counseling and psychotherapy. Needham, MA: Allyn and Bacon. Sue, D. W., Carter, R. T., Casas, J. M., Fouad, N. A., Ivey, A. E., LaFromboise, T., . . . Vazquez-Natall, E. (1998). Multicultural counseling competencies: Individual, professional and organizational development. Thousand Oaks, CA: Sage. Thompson, C. E., & Carter, R. T. (Eds.). (1997). Racial identity development theory: Applications to individual, group and organizations. Hillsdale, NJ: Erlbaum.

CHAPTER 8 Cheung, F. M. (1989). The Women’s Center: A community approach to feminism in Hong Kong. American Journal of Community Psychology, 17(1), 99–107. Cheung, F. M. (1998). Cross-cultural psychopathology. In A. S. Bellack & M. Hersen (Eds.), Comprehensive clinical psychology, Volume 10: Sociocultural and individual differences (pp. 35–51). Oxford, England: Pergamon.

Cheung, F. M. (2009). The cultural perspective of personality assessment. In J. N. Butcher (Ed.), Oxford handbook of personality assessment (pp. 44–56). New York, NY: Oxford University Press. Cheung, F. M. (2010). Sex discrimination in education: Contexts in implementing equal opportunities in Hong Kong. Ethics & Behavior, 20, 277–287. Cheung, F. M. (2012). Mainstreaming culture in psychology. American Psychologist, 67(8), 721–730. Cheung, F. M., Cheung, S. F., Zhang, J. X., Leung, K., Leong, F. T. L., & Yeh, K. H. (2008). Relevance of openness as a personality dimension in Chinese culture. Journal of Cross-cultural Psychology, 39, 81–108. Cheung, F. M., Fan, W. Q., & Cheung, S. F. (2013). From Chinese to cross-cultural personality assessment: A combined emic-etic approach to study personality in culture. In M. Gelfand, Y. Y. Hong, & C. Y. Chiu (Eds.), Advances in psychology and culture series, Volume III (pp. 117–178). Oxford, England: Oxford University Press. Cheung, F. M., & Halpern, D. F. (2010). Women at the top: Powerful leaders define success as work + family in a culture of gender. American Psychologist, 65, 182–193. Cheung, F. M., Leung, K., Fan, R., Song, W. Z., Zhang, J. X., & Zhang, J. P. (1996). Development of the Chinese Personality Assessment Inventory (CPAI). Journal of Cross-cultural Psychology, 27, 181–199. Cheung, F. M., Leung, K., Zhang, J. X., Sun, H. F., Gan, Y. Q., Song, W. Z., & Xie, D. (2001). Indigenous Chinese personality construct: Is the Five Factor Model complete? Journal of Cross-Cultural Psychology, 32, 407–433. Cheung, F. M., Song, W. Z., & Butcher, J. N. (1991). An infrequency scale for the Chinese MMPI. Psychological Assessment, 3, 648–653. Cheung, F. M., van de Vijver, F., & Leong, F. T. L. (2011). Toward a new approach to the study of personality in culture. American Psychologist, 66(10), 593–603. Cheung, F. M., Zhang, J. X., & Song, W. Z. (2003). Manual of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Chinese edition. Hong Kong: The Chinese University Press. International Test Commission (2010). International Test Commission guidelines for translating and

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CHAPTER 9 Alegría, M., & Woo, W. (2009). Conceptual issues in Latino mental health. In F. A. Villarruel, G. Carlo, J. M. Grau, M. Azmitia, N. Cabrera, & T. J. Chahin (Eds.), Handbook of U. S. Latino psychology: Developmental and community-based perspectives (pp. 15–30). Thousand Oaks, CA: Sage. Allione, T. (2008). Feeding your demons: Ancient wisdom for resolving inner conflict. New York, NY: Little, Brown. Castillo, R. J. (1994). Spirit possession in South Asia, dissociation or hysteria? Culture, Medicine and Psychiatry, 18, 1–21. Comas-Díaz, L. (1981). Puerto Rican espiritismo and psychotherapy. American Journal of Orthopsychiatry, 51(4), 636–645. Comas-Díaz, L. (2005). Becoming a multicultural psychotherapist: The confluence of culture, ethnicity and gender. In Session, 61(2), 973–981. Comas-Díaz, L. (2006). Latino healing: The integration of ethnic psychology into psychotherapy. Psychotherapy: Theory, Research, Practice and Training, 43(4), 436–453. Comas-Díaz, L. (2009). Changing psychology: History and legacy of the Society for the Psychological Study of Ethnic Minority Issues. Cultural Diversity and Ethnic Minority Psychology, 15(4), 400–408.

Comas-Díaz, L. (2010). On being a Latina healer: Voice, consciousness, and identity. Psychotherapy: Theory, Research, Practice and Training, 47(20), 162–168. Comas-Díaz, L. (2011). Transcultural woman: Healing in a strange land. In L. Comas-Díaz & M. B. Weiner (Eds.), Women psychotherapists: Journeys in healing (pp. 81–95). New York, NY: Jason Aronson. Comas-Díaz, L. (2012). Multicultural care: A clinician’s guide to cultural competence. Washington, DC: APA. Comas-Díaz, L. (2013a). Duende: Evocation, quest, and soul. In M. Hoyt (Ed.), Therapist stories of inspiration, passion, and renewal: What’s love got to do with it (pp. 50–57). New York, NY: Routledge. Comas-Díaz, L. (2013b). Comadres: The healing power of a female bond. Women & Therapy, 36(1–2), 62–75. De Rios, M. D. (1997). Magical realism: A cultural intervention for traumatized Hispanic children. Cultural Diversity and Mental Health, 3(3), 159–170. D’Haen, T. (1995). Magical realism and postmodernism: Decentering privileged centers. In L. Parkinson Zamora & W. B. Faris (Eds.), Magical realism: Theory, history, community (pp. 191–208). Durham, NC: Duke University Press. Fanon, F. (1967). Black skin, white masks. New York, NY: Grove Press. Faris, W. B. (2004). Ordinary enchantments: Magical realism and the remystification of narrative. Nashville, TN: Vanderbilt University Press. Flores, A. (1955). Magical realism in Spanish American fiction. Hispania, 38(2), 187–192. Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Seabury Press. García Lorca, F. (1933). Teoría y juego del duende [Theory and play of the duende] (A. S. Kline, Trans.). Retrieved from http://www.poetryintranslation.com/PITBR/Spanish/LorcaDuende.htm In Spanish: http://homepage.mac.com/eeskenazi/ duende.htm Harwood, A. (1977). Rx: Spiritualists as needed: A study of a Puerto Rican community mental health resource. New York, NY: Wiley.

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Koss-Chioino, J. D. (1992). Women as healers, women as patients: Mental health care and traditional healing in Puerto Rico. Boulder, CO: Westview Press. Lewis-Fernandez, R. (1994). Culture and dissociation: A comparison of ataques de nervios among Puerto Ricans and possession syndrome in India. In D. Spiegel (Ed.), Dissociation: Culture, mind, and body. (pp. 123–167). Washington, DC: American Psychiatric Press. Norat, G. (2005). Latina grandmothers: Spiritual bridges to ancestral lands. Journal of the Association for Research on Mothering, 7(2), 98–111. Nunez Molina, M. (2001). Community healing among Puerto Ricans: Espiritismo as a therapy for the soul. In M. Fernandez Olmo & I. Paravisini (Eds.), Healing cultures: Art and religion as curative practices in the Caribbean and its diaspora. New York, NY: Palgrave. Parkinson Zamora, L. (1995). Magical romance/magical realism: Ghosts in U.S. and Latin American fiction. In L. P. Zamora & W. B. Faris (Eds.), Magical realism: Theory, history, community (pp. 497–550). Durham, NC: Duke University Press. Pole, N., Best, S. R., Metzler, T., & Marmar, C. R. (2005). Why are Hispanics at greater risk for PTSD? Cultural Diversity and Ethnic Minority Psychology, 11(2), 144–161. Rivera, E. T. (2005). Espiritismo: The flywheel of the Puerto Rican spiritual tradition. Interamerican Journal of Psychology, 39(2), 295–300. Rivera Ramos, E. (2001). The legal construction of identity: The judicial and social legacy of American colonialism in Puerto Rico. Washington, DC: APA. Rowland, S. (2002). Jung: A feminist revision. Cambridge, England: Polity Press. Tedlock, B. (2005). The woman in the shaman’s body: Reclaiming the feminine in religion and medicine. New York, NY: Bantam Books.

CHAPTER 10 Goldstein, R. (1989). Go the way your blood beats: An interview with James Baldwin by Richard Goldstein June 26, 1984 (Village Voice). In Q. Troupe (Ed.), James Baldwin: The Legacy (pp. 173–189). New York, NY: Simon & Schuster/Touchstone.

Sondheim, S. (1964). Everybody says don’t. On Anyone Can Whistle [Vinyl record]. New York, NY: Columbia Records.

CHAPTER 11 American Psychological Association Delegation to the WCAR. (2004). Final report of the APA delegation to the UN World Conference Against Racism, Racial Discrimination, Xenophobia and Other Related Intolerance. Washington, DC: APA. Retrieved from http://www.apa.org/pi/OEM/programs/rac ism/un-conference-apa.aspx Bryant-Davis, T., Okorodudu, C., & Holliday, B. (2004). Combating racism: The role of psychologists and the United Nations. In J. L. Chin (Ed.), The psychology of
prejudice and discrimination, Vol. 1: Racism in America (pp. 223–235). Westport, CT: Praeger. Davis, A., and Dollard, J. (1964/1940). Children of bondage: The personality development of Negro youth in the urban south. New York, NY: Harper and Row. (Original work published by the American Council on Education, 1940) Davis, A., Gardner, B. G., & Gardner, M.R. (1941). Deep South: A social anthropological study of caste and class. Chicago, IL: University of Chicago Press. Erikson, E. (1963). Childhood and society. New York, NY: Norton. Erikson, E. (1968). Identity: Youth and crisis. New York, NY: Norton. Holliday, B. G. (1985). Developmental imperatives of social ecologies: Lessons learned from black children. In H. P. McAdoo (Ed.), Black children (pp. 53–69). Beverly Hills, CA: Sage. Holliday, B. G. (1986). African-American families and social change: 1940 to 1980. Family Perspective Journal, 20(4), 289–305. (An earlier version of this paper was presented to staff of the American Association for the Advancement of Science, April 1986, Washington, D.C.) Holliday, B. G. (1989). Trailblazers in black adolescent research. In R. L. Jones (Ed.), Black adolescents (pp. 39–58). Berkeley, CA: Cobb & Henry. Holliday, B. G. (1999). The American Council on Education’s studies on Negro youth development:

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An historical note with lessons on research, context, and social policy. In R. L. Jones (Ed.), African American children, youth and parenting (pp. 3–30). Hampton, VA: Cobb & Henry. Holliday, B. G., & Figueroa-Garcia, A. (Eds.). (1994–2010). Communique [semi-annual newsjournal of the APA Office of Ethnic Minority Affairs]. Washington, DC: APA. Retrieved from http://www.apa.org/pi/oema/ resources/communique/index.aspx Holliday, B.G., & Holmes, A. L. (2003). A tale of challenge and change: A history and chronology of ethnic minorities in U.S. psychology. In G. Vernal, J. E. Trimble, A. K. Burle, & F. D. L. Long (Eds.), Handbook of ethnic and racial minority psychology (pp. 15–64). Thousand Oaks: CA: Sage. Retrieved from http://www.apa.org/pi/oema/resources/talechallenge-change.pdf Holliday, B. G., Preston, S. M., Bourne, D., & Wynn, S. (2011). Final report: Developing minority biomedical research talent in psychology: A collaborative and systemic approach for strengthening institutional capacity for recruitment, retention, training and research (The APA/NIGMS Project, NIH grant T36-GM08640). Washington, DC: APA. Retrieved from http://www.apa.org/pi/oema/programs/recruitment/minority-research.aspx Howard, J. H. (1972). Toward a social psychology of colonialism. In R. L. Jones (Ed.), Black psychology. New York, NY: Harper & Row. Lewin, K. (1935). Psycho-sociological problems of a minority group. Character and Personality, 3, 176–187. Lewin, K. (1951). Field theory in social science. New York, NY: Harper & Row. Lewin, K. (1954). Behavior and development as a function of the total situation. In Leonard Carmichael (Ed.), Manual of child psychology (2nd ed.). New York, NY: John Wiley.

CHAPTER 12 Marsella, A. J. (1998). Toward a global-community psychology. Meeting the needs of a changing world. American Psychologist, 58, 1282–1291. Marsella, A. J. (2013). All psychologies are indigenous psychologies: Reflections on psychology in a global era. International Psychology, 24, 5–7.

CHAPTER 13 Cross, W. E., Parham, T. A., & Helms, J. E. (1992a). Nigrescence revisited: Theory and research. In R. L. Jones (Ed.), Advances in black psychology. Richmond, CA: Cobb & Henry. Cross, W. E., Parham, T. A., & Helms, J. E. (1992b). The stages of Black identity development. In R. L. Jones (Ed.), Black psychology (3rd ed.). Richmond, CA: Cobb & Henry. Gallardo, M., Yeh, C., Trimble, J., & Parham, T. A. (Eds.). (2012). Culturally adaptive counseling skills: Demonstrations of evidence based practices. Thousand Oaks, CA: Sage. Gaye, Marvin. (1971). What’s going on [Vinyl record]. Detroit, MI: Tamla Records. Impressions. (1965). People get ready [Vinyl record]. Chicago, IL: ABC-Paramount. King, M. L., Jr. (1962, July 19). Address to the National Press Club. Retrieved from http://www.theking center.org/archive/document/mlk-addressnational-press-club King, M. L., Jr. (1963). Strength to love. New York, NY: Pocket Books. King, M. L., Jr. (1968, February 4). The drum major instinct. Retrieved from http://kingencyclopedia. stanford.edu/encyclopedia/documentsentry/doc_ the_drum_major_instinct/ Parham, T. A. (1989). Cycles of Psychological Nigres­ cence. The Counseling Psychologist, 17(2), 187–226. Parham, T. A. (1993). Psychological storms: The African American struggle for identity. Chicago, IL: African American Images. Parham, T. A. (2002). Counseling African descent people: Raising the bar of practitioner competence. Thousand Oaks, CA: Sage. Parham, T. A., Ajamu, A., & White, J. (2011). The psychology of Blacks: Centering our perspectives in the African consciousness (4th ed.). Upper Saddle River, NJ: Prentice Hall. Parham, T. A., & Helms, J. E. (1981). Influences of black students’ racial identity attitudes on preferences for counselor’s race. Journal of Counseling Psychology, 28(3), 250–257. Parham, T. A., & Helms, J. E. (1985a). The relation of racial identity attitudes to self-actualization

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Index

AACD. See American Association for Counseling and Development AAMA. See African American Acculturation Scale AAMAS. See Asian American Multidimensional Acculturation Scale Aaron, G. A., 319, 322 ABBT. See Acceptance based behavioral therapies Abdul-Adil, J., 27 Abdulrahim, S., 426 Abe-Kim, J. S., 318 Abelmann, N., 317 Aber, M. S., 443 Abernethy, A. D., 282 Ableism, 405 Abner, E. L., 246 Aboul-Enein, B. H., 430 Aboul-Enein, F. H., 430 Aboumediene, S., 425 Abraido-Lanza, A. F., 287 Abreau, J. M., 267 Abu-Bader, S. H., 426–427 Abu-Ras, W., 426–428 Abu-Ras, W. M., 426 Acceptance and Commitment Therapy, 397 Acceptance based behavioral therapies, 182 Accountability, of ethical committees and training programs, 40–41 Acculturation Anglo-oriented, 479 assessments of, 266–267 career choice affected by, 474 cross-cultural counseling and, 300 definition of, 377 description of, 120–121 educational goals and, 479 gangs and, 336, 339 gender roles and, 378 by immigrants, 354–355 Mexican-oriented, 479 Acculturative stress, 288, 377–379 Acevedo, A., 398 Ackerman, R. J., 56 Action-oriented spirituality, 285 Adachi, P. J. C., 329–330

Adams, E. M., 456 Adams, T., 283 Adams, T. E., 240–241 ADC. See American-Arab Anti-Discrimination Committee ADDRESSING model, 403–404 Ad Hoc Committee on Equality of Opportunity in Psychology, 8 Ad Hoc Committee on Ethnic and Cultural Diversity, 11 Adler, A. B., 347 Adler, D. A., 345 Advocacy American Counseling Association competencies for, 392 for American Indians, 159 competencies in, 29 for LGBTQ youth, 390–393 life story about, 57–59 psychologist training in, 321–322 for social equity, 229 social justice, 117, 170 Affective positivity, 369 Affirmative Action, 487 Affirmative counseling, for LGBTQ youth, 390 Affleck, D. C., 307 Affordable Care Act, 402, 406 African American Acculturation Scale, 266–267 African Americans. See also Blacks; People of color action-oriented spirituality in, 285 Afrocentricity of, 252, 254–255 bias toward, 250 category-based bias effects on, 255–257 discrimination against, 251–252 explicit attitudes toward, 253 feature-based bias effects on, 257–258 homicide rates among, 330 individuating features of, 251 LGBTQ, 291–292 liberation theology in, 291 life story narratives of, 96–117, 125–137, 146–154 religiosity of, 396 social cognitive career models for, 478 spirituality among, 283, 285, 287–288 stereotyping of, 250–251 within-group variations in, 251–252 African mysticism, 285

616

Afrocentricity, 252, 254–255 Age differences, 123 Age discrimination, 398–399 Ageism, 394, 398 Ægisdóttir, S., 298–300, 302 Agresti, A. A., 267 Aguilera, A., 309–310 Agustin, E. O., 266 Ahluwalia, M., 265 Ahluwalia, M. K., 24, 193 Ahmed, S. R., 426 Ai, A. L., 283 AIM approach to diversity, 495–496, 498 Ainslie, R. C., 377–378, 383 Ajamu, A., 127, 134 Akhtar, S., 351, 377, 379, 383 Aklin, W. M., 260 Alarcon, R., 291 Alaska Native people mental health research with, 205 storytelling by, 210 Alawneh, A. W. N., 425 Albano, A. M., 178 Albee, G., 223 Alberta, A. J., 369 Albrecht, T. L., 252 Alcántara, C., 260 Aldarondo, E., 18, 24 Alden, L. E., 383 Alegría, M., 89, 179, 354–355, 357, 380, 434 Alexander, C. M., 43, 46, 189, 219, 315, 499 Alexander, J. F., 339 Alexander, M., 333 Ali, A., 25 Ali, N., 361, 369 Allen, A., 235 Allen, E., 62 Allen, I. E., 183 Allen, K., 327 Allen, R. S., 399 Alleyne, V. L., 287 All-inclusive multiculturalism approach to diversity, 495–496, 498 Allione, T., 94, 290 Allport, G., 33 Allport, G. W., 250, 273, 363 Aloud, N., 428 Altman, B., 407 Altrichter, H., 195 Altruism, 226 Alvarez, A. N., 193 Amanti, C., 194 AMCD. See Association for Multicultural Counseling and Development Amer, M. M., 423, 425, 427–428 American-Arab Anti-Discrimination Committee, 425 American Association for Counseling and Development, 38 American Civil Liberties Union, 79, 109, 168

American Counseling Association Code of Ethics, 32 demonstrations at conferences of, 45 description of, 31 ethical standards, 37–39 social justice endorsement by, 216 American Educational Research Association, 150 American Indian Institute, 162 American Indian pediatric psychologist, 155–165 American Indians. See also Native Americans advocacy for, 159 American Psychological Association activities for, 163–164 child abuse in, 160–162 Council of, 204 Early Head Start for, 162–163 Great Turtle Island story, 199, 201–203 Head Start for, 162–163 mental health needs of, 159–160 mental health research with, 205 multicultural work for, 159–164 spirituality among, 283 storytelling by, 210 American Middle East/North African Psychological Network, 37 American Personnel and Guidance Association, 37–38 American Psychiatric Association, 14 American Psychological Association action taking by, 15–16 Ad Hoc Committee on Equality of Opportunity in Psychology, 8 American Indian activities, 163–164 Board of Ethnic Minority Affairs, 10–11 Board of Social and Ethical Responsibility in Psychology, 9 Code of Ethical Principles, 12, 32 Commission on Ethnic Minority Recruitment, Retention, and Training, 12 Committee on Ethnic Minority Affairs, 12 Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, 12 Council of Representatives, 9, 13–15, 41 Department of Defense and, 14–15 directorates of, 10 diversity issues in, 7–15 Division 17, 11, 13 Division 45, 10 Division on Maturity and Old Age, 8 Division 12 Task Force on Promotion and Dissemination of Psychological Procedures, 178 early beginnings of, 7–10 Ethical Standards, 33–37 Ethics Code, 31–32 ethnic minority concerns addressed by, 7–15 from 1980 to 1991, 10–11 from 1992 to 1999, 11–13 from 2000 to 2013, 13–15 Guidelines and Principles in Professional Psychology, 12 Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists, 13–14

I ndex

      617

guiding principles of, 6–7 historical description of, 7–15 Hoffman Report, 15 Minority Fellowship Program, 9 multicultural accomplishments of, 7–8 multicultural conferences, 10 multicultural guidelines of, 229 multiculturalism as described by, 215 multicultural psychology affected by, 4 National Conference on the Psychological Aspects of Aging, 8 Office of Ethnic Minority Affairs, 10 in pre-1980s, 7–10 Presidential Task Force on Evidence-Based Practice, 178 racial concerns addressed by, 7–15 reports published by, 14 social issues and, 6 Task Force on Psychological Ethics and National Security, 15 torture condemnation by, 14–15 American Psychologist, 119, 141, 271 Amick, B., 424 Amin, A. H., 427 Amodio, D. M., 253 Ampuero, M., 235 Amundson, D., 330 Amundson, N., 295, 298 Analytic autoethnography, 241–242 Ancestral wisdom, 90–91, 94–95 Ancient Ones, 198–199, 202, 213 Ancis, J. R., 218 Andayani, S., 262 Andermann, L., 318 Anderson, C. A., 329 Anderson, L., 241–242 Anderson, N. H., 252 Anderson, N. J., 450 Andersson, G., 245 Andren, K., 450–451 Andrews, A., 450 Andrews, R., 246 Androsiglio, R., 386 Andrulis, D., 415 Angel, R., 260 Anthony K., 314 Anticolonial counseling definition of, 188 interventions, 188–189 Antonides, B. J., 342–343 Anyon, J., 191 Appeal, H., 283 Appio, L. M., 231 Apps, 245–246, 310 Arab Americans. See Middle Eastern Americans Aragon, S. R., 387, 389 Arbona, C., 475–476 Archambault-Stephens, A., 201 Arciniega, M., 218 Ardelt, M., 272 Arfaniarromo, A., 335 Arfken, C. L., 428

Argyle, M., 261 Armour, M., 20 Armstrong, K., 256 Armstrong, P. I., 474 Arnold, M. S., 29, 279, 343 Aroian, K. J., 427 Arora, A. K., 190 Arredondo, M. T., 311 Arredondo, P., 13, 28, 45, 216, 218, 224, 295, 299, 322, 342, 384, 434, 443, 456, 487–488 Arseneau, J. R., 386 Artiles, A. J., 325 Artman, L. K., 408 Arts-based approaches, 246–248 ASASH. See A Short Acculturation Scale for Hispanics Ashburn-Nardo, L., 252 A Short Acculturation Scale for Hispanics, 266 Asian American(s) religious diversity among, 283–284 social cognitive career models for, 478 spirituality among, 283–284 Asian American Multidimensional Acculturation Scale, 267 Asian American Psychological Association, 9, 37 Assessments acculturation, 266–267 cultural competence in, 268 culturally based, 265–266 culturally sensitive, 482 ethnic identity, 265–266 minority stress, 268 multicultural positive psychology, 276–277 older adults, 400 psychological. See Psychological assessments racial identity, 266 racism, 268 spirituality, 267–268, 292 Assimilation, 60–70, 140 Assimilation Blues: Black Families in White Communities, 147, 150 Association for Multicultural Counseling and Development, 13, 45, 135, 342 Association of Black Psychologists, 9, 37 Association of Psychologists Por La Raza, 9 Asvat, Y., 427 Aten, J. D., 219 Atkins, M., 194 Atkins, M. S., 471 Atkinson, D. R., 219, 355, 499, 501 Atkinson, R., 51 Attribute-based linear models of judgment, 252 Austin, A., 397 Austin, J. T., 474 Austin, S., 14–15 Authentic generosity, 230 Autobiography, 241 Autoethnography, 240–242 Aversive-hostile racism, 79 Avey, J., 453 Avoidant racism, 79

618       H a n d b o o k o f M u lti c u ltur a l Counseling

Awad, G. H., 274, 423–425, 427 Ayeli, 289 Ayers, C. R., 399 Ayers, R., 194 Ayers, W., 194 Azrael, D., 331 Bacigalupe, G., 281 Backhaus, A., 309 Badiee, M., 321 Baez, A., 292 Bakan, D., 233 Baker, B. C., 349 Baker, D. C., 312 Baker, J. A., 327 Baker, M., 379 Baker, M. J., 181 Baker, P., 285 Baker, T. B., 317 Baker, W., 426 Balcazar, F. E., 434 Baldwin, L., 451 Ball, J., 189 Balota, D. A., 398 Banaji, M. R., 18, 253 Bang, M., 246 Banks, K. H., 280 Banks, M. E., 55–57, 59, 167 Baños, R. M., 309 Bansod, A., 310 Banyard, V., 233 Barak, A., 245, 309 Baranowski, K., 235 Barbanel, L., 377 Bard, D., 197 Barden, J., 251 Bardick, A. D., 314 Bargh, J. A., 255 Barley, D. E., 308 Barlow, D. H., 181, 185 Barnett, J. E., 319 Barnwell, S., 452 Barrera, A., 316, 319, 321 Barrera, M., 186 Barry, A., 315 Barry, D. T., 265 Bartkiewicz, M. J., 219, 386–388 Barto, L., 458 Basak, C., 398 Batista, C., 186, 288 Batten, G. S., 360, 362 Batts, V., 253 Baucom, D. H., 181 Bauman, R., 240 Baumeister, R. F., 227–228 Bazron, B., 329 Beale, R. L., 366 Bear, G., 326 Beauvais, F., 265

Becerra, H., 353 Beck, A. T., 203 Beck, C., 267 Becker, A. B., 321 Beckerman, N. L., 377 Becquart, E., 250 Beehler, S., 382 Behavior ethnocultural determinants of, 118–119, 124 racial determinants of, 118–119, 124 Behavioral observations, 261–262 Belar, C. D., 302, 304 Belitz, J., 336 Bell, A., 405 Bell, K., 405 Bellamy, G. R., 450 Belle, D., 229 Below, R., 411 BEMA. See Board of Ethnic Minority Affairs Bemak, F., 234 Benda, B. B., 339 Benedikovičová, J., 272 Benjamins, M., 396 Bennet Johnson, S., 181–182 Bennett, M. J., 493, 497 Benson, E., 447 Benzmiller, H., 14–15 Benzmiller, H. L., 33, 36, 42 Bereavement, 397 Berganza, C. E., 304 Berg-Cross, L., 261 Bergin, A., 499 Berkel, L. A., 300 Berman, M., 178 Bernal, G., 64–65, 168, 181, 184–185, 278, 300 Bernal, G. E., 245 Bernal, M., 12 Bernier, J. E., 11, 13 Bernier, Y., 32 Bernstein, A., 407 Bernstein, J. S., 204 Berrey, E. C., 489–490 Berry, J. W., 300, 316, 377 Berry, K., 241 Betancourt, H., 178–179 Betz, N. E., 11, 475–478, 480 Beuscher, L., 267 Beutler, L. E., 181 Beyer, C., 389 Bhadha, B. R., 377 Bhowmik, 231 Biaggio, M., 391 Bias category-based. See Category-based bias explicit racial, 252 feature-based. See Feature-based bias higher education affected by, 492 implicit racial, 252 Bibeau, D., 321

I ndex

      619

Bickman, L., 11 Bicultural Acculturation Scale for Hispanics, 266 Bicultural Ethnic Identity: American Indian Adolescents, 265 Bicultural Ethnic Identity Scale, 265 Bidell, M., 12 Bierema, L. L., 492 Bies, R. J., 20 Bieschke, K. J., 390 Biever, J. L., 27 BigFoot, D. S., 161, 197–198, 201, 206–208, 211 Biklen, D., 191 Bilal, C., 469 Bingham, R. P., 315, 361 Bioterrorism attacks, 412 Bird, D., 37 Bird, H., 353 Bird, S. L., 195 Birkett, M., 387, 389 Birmaher, B., 178 Birman, D., 354, 357, 382 Bischoff, R. J., 451 Bjorck, J. P., 283 Black, A. R., 288, 290 Black liberation theology, 291 Blacks. See also African Americans life story narrative of, 96–107 qualitative study of, 148 Blair, I. V., 250–251, 253, 256–257 Blalock, K., 256 Blasé, S. L., 306 Bledsoe, M., 476 Blieszner, R., 397 Blizinsky, K. D., 307 Blood, N., 203 Bluemel, J., 274 Blume, A., 33 Blumstein, A., 331 Blustein, D. L., 281, 472, 477, 479–480, 483 Board of Ethnic Minority Affairs, 10–11 Board of Social and Ethical Responsibility in Psychology, 9 Boat, T., 329 Bobrowski, L., 333 Bochner, A. P., 241–242 Bock, S., 451 Bodenhausen, G. V., 250 Bodily expressions, 262 Boesen, M. J., 219, 386–387, 391 Bohan, J. S., 291 Bohner, G., 255 Bojer, M. M., 362, 364–365 Bolin, J., 450 Bolin, J. N., 448 Bolin, R., 413–414 Bolling, P., 14 Bollinger, L. C., 371 Bolton, P., 414 Bond, F. W., 397 Bond, L. A., 456, 459 Bondü, R., 324

Boniel-Nissim, M., 245, 309 Bonner, B. L., 197–198 Border Protection, Anti-terrorism, and Illegal Immigration Control Act of 2005, 23 Borgen, F. H., 264 Born, G., 315 Borrero, N. E., 189–191, 194 Borum, R., 326 Bossarte, R., 345 Botella, C., 309 Bottorff, J. L., 247 Bouffard, S., 326 Boutin, D. L., 346 Bowen, C. E., 398 Bowen, G., 327 Bowen, R., 235 Bowers, C., 246 Bowling, B., 219 Bowman, N. A., 491 Bowman, P. J., 274 Boyd, B., 413 Boyd, C. J., 385, 390 Boyd-Franklin, N., 282 Boyle, E., Jr., 252 Brach, C., 355 Bradley, D. L., 361 Braga, A. A., 331 Braginsky, D. D., 18 Brah, A., 189 Brannock, K., 413–414 Brannon, R. W., 409 Bratini, L., 229–231 Brave Heart, M. Y. H., 284, 415 Brédart, S., 250 Breijak, D. P., 361 Breitbart, W., 267 Breland, G. L., 399 Brenner, J., 245 Breslin, M. L., 401–402, 404, 406 Brewer, D. D., 339 Brewer, M. B., 250–251, 254 Brewster, A., 327 Brickman, A. M., 398 Bridges, A. J., 450 Brief Implicit Association Test, 253 Bright, M. M., 292 Britt, T. W., 347 Brittan-Powell, C. S., 193 Britto, P. R., 427 Broaching behavior, 256 Brock, S. E., 331 Brockenbrough, K. K., 327 Bronfenbrenner, U., 335, 338, 356 Bronstein, L. R., 321 Brooks, D., 138, 144 Brooks, J. E., 274 Brown, C., 222, 396 Brown, E., 250, 328, 397 Brown, L. G., 260

6 2 0       H a n d b o o k o f M u lti c u ltur a l Counseling

Brown, R., 255, 325 Brown, S. D., 477 Brown, W., 333 Brown-Anderson, F., 267 Brown v. Board of Education, 6, 33, 109, 146 Brown v. Entertainment Merchants Association, 330 Bruce, B. K., 318 Brune, M., 378 Bryan, M. L., 369 Bryant, R. M., 309 Bryk, A. S., 328 BSERP. See Board of Social and Ethical Responsibility in Psychology Bu, H., 283 Buchtel, E., 180 Buck, J. N., 262, 264 Buck, R. R., 475–476 Buckler, R. E., 267 Budd, K. S., 468 Buddhists, 283 Bufka, L. F., 312 Bui, H., 378 Bui, T., 452 Buia, T. C., 246 Buka, S., 396 Buki, L. P., 320, 356 Bullard, R. D., 234 Bullington, R. L., 476 Bullis, J. R., 184 Bullock, H. E., 24–25, 235 Bullock, M., 295, 304 Bullying of LGBTQ youth, 387–392 of youth, 325 Bulock, L. A., 353 Burge, P. L., 388, 391 Burgess, D. J., 354 Burgoyne, S., 366 Burkard, A. W., 218, 388 Burnes, T. R., 218, 390 Burnett, S. E., 346 Burnier, D., 242 Burrelli, J., 299 Burris, L. J., 198 Burris, M., 246 Burrows, L., 255 Bush, George W., 49 Bush, N. E., 310 Bushman, B. J., 330 Butcher, J. N., 84, 262–263 Butler, J., III, 287 Butler, R., 321 Buttaro, L., 189 Butz, D. A., 254 Byars-Winston, A., 478, 482 Byrd-Olmstead, J., 316, 321 Byrne, G. J., 397, 399 Cabiya, J., 263 Cabral, R. R., 183–184, 255

Cabrera, A. P., 348 Cabrera, M. F., 311 Cabrera, N. L., 272, 274 CAIP. See Cultural Assessment Interview Protocol CAIR. See Council on American-Islamic Relations Calabrese, R. L., 335, 338 Caldwell, L. D., 287 Calhoun, K. S., 181 Callanan, P., 358 Calliess, I. T., 356 Camacho, L. M., 468 Camacho-Gonsalves, T., 183 Camangian, P., 194–195 Camara, W. J., 262 Cameron, R. P., 406, 409 Campbell, A., 335–336 Campbell, B. W., 479 Campbell, C. D., 451 Campbell, R., 382 Campbell, V. A., 406 Campt, D., 362, 366–367 Canal District United Methodist Women’s Social Action, 58 Canino, G., 353 Cannon-Bowers, J., 246 Cao, Z., 179 Capodilupo, C. M., 327, 361, 426 Cappella, E., 459, 461, 469 Capps, R. M., 353 Cardenas, V., 409 Cardona, B., 309 Career construction theory, 476–477 Career counseling culturally sensitive, 480–482 overview of, 472–473 Career development, 482 Career theories career construction theory, 476–477 Holland’s, 473–475 psychology of working perspective, 479–480 social cognitive career theory, 477–479 summary of, 482–483 Super’s life-span, life space theory, 475–476 Caregiving, 56, 397–398 Care receiving, 56–57 Carhill, A., 301 Caribbean Alliance of National Psychological Associations, 70 Carless, D., 240 Carlo, G., 288 Carlson, C., 366 Carlson, E. B., 78 Carlson, T., 407 Carlyle, K. E., 246 Carney, C. G., 216, 223 Carpenter-Song, E., 320 Carranza, M. E., 379 CARRI. See Community and Regional Resilience Institute Carroll, J. S., 252 Carroll, T., 430

I ndex

      6 21

Carstensen, I. L., 395 Cartels, 351–352 Carter, A., 349 Carter, D., 14–15 Carter, D. J., 33, 36, 42 Carter, J. H., 292 Carter, R., 215 Carter, R. T., 72–73, 75, 77, 79–80, 188, 266, 268, 315, 443 Cartledge, G., 325 Cartwright, B. Y., 467 Casali, S., 183 Casas, J. M., 11, 43, 46, 189, 219, 295, 315, 348, 355, 357, 384, 499 Case, K. A., 435 Cashwell, C. S., 293 Castañeda, R. M., 353 Castillo, R. J., 89 Castle, P. H., 224 Castleden, H., 246–247 Castro, F. G., 12, 186 Catalano, R. F., 339 Catanese, K. R., 227–228 Category-based bias description of, 250–251 measurement of, 252–255 negative consequences of, in counseling, 255–257 Cater, J. K., 344 Cater, N., 204 Catholics, 284 Cavaleros, C., 491 Cavanagh, K., 308–309 CCSI. See Collectivistic Coping Styles Inventory CEMA. See Committee on Ethnic Minority Affairs CEMRRAT. See Commission on Ethnic Minority Recruitment, Retention, and Training Center for Minority Veterans, 342 Center for Psychology in Schools and Education, 453 Center on Child Abuse and Neglect, 161 CEOP. See Committee on Equality of Opportunity in Psychology Cerrone, M. T., 479 Certified lay speaker, 59 Cervantes, J. M., 289, 293, 355–356 Cesario, J., 251 CFI. See Cultural Formulation Interview Chaffin, M., 197 Chain, J., 494 Chambers, D. A., 229–230 Chambless, D. L., 181–182 Chandler, D., 396 Chang, E. C., 273–274, 276, 278, 280 Chang, J., 186, 278 Chang, T., 189 Chang, V., 310 Changing contexts, 62–64 Chanpong, G. F., 406–407 Chao, R. C., 435 Chapleau, K. M., 251 Chapman, C., 437, 444 Chapman, T., 406 Charbeneau, J., 366

Chard, K. M., 391 Charitable efforts, 226 Charity, philanthropy, 18–19 Charles, S. T., 395 Charmaz, K., 242 Chaskin, R. J., 332, 340 Chatterji, P., 179 Chatters, L. M., 283 Chaudry, A., 353 Chaulk, P., 355 Chaves, A. P., 281, 480 Chávez, J. M., 26 Chavez-Korell, S., 219 Chavira, J. A., 289 Chavous, T. M., 266 Chemical emergency, 412 Chen, C., 179, 354 Chen, E. C., 13, 219, 386 Chen, J., 354 Chen, M., 255 Cheng, C. M., 255 Cheng, J. K., 354 Cheng, J. K. Y., 380 Chen-Hayes, S. F., 392 Chesler, M. A., 366 Cheung, F. M., 82–87, 262–263 Cheung, S. F., 84–85 Chiao, J. Y., 307 Chicago Democratic Convention, 112 Chicago School of Professional Psychology, The, 489–490 Chickering, A. W., 361 Children abuse of, 160–162, 416 as immigrants, 350–351, 376, 379 maltreatment of, 324 Chinen, R. T., 261 Chinese Personality Assessment Inventory, 84–85, 263 Chinese somatization, 85 Ching, A. M., 193 Ching, A. M. L., 194 Chiriboga, D. A., 354 Cho, B., 295 Cho, Y., 308 Choi, I., 85, 273 Choi, J., 21 Choudry, A., 188 Chow, C., 183 Christensen, H., 245 Christie, D. J., 302 Christopher, J. C., 274, 280–281, 317 Christopher, M. S., 181–183, 185, 317, 357 Chronicle of Higher Education, 489 Chu, J., 380 Chu, J. P., 316, 319, 321 Chung, C. C., 234 Chung, R. H. G., 267 Church, 57–58 Ciarocco, N. J., 227 Ciftci, A., 426

6 2 2       H a n d b o o k o f M u lti c u ltur a l Counseling

Circle, 200–201, 203 Civil Rights Act of 1964, 486 Civil Rights Era, 108–117 Civil rights movement, 32 Clark, C. M., 335 Clark, E. M., 287 Clark, J. L., 202 Clarke, G., 310 Classism, 227 Clauss-Ehlers, C. S., 272 Clemency Cordes, C., 406 Client-therapist relationships, feature-based bias effects on, 257 Client worldview, 29 Cline, K., 482 Clinical interview, 259–260 Clinical Psychologist, The, 163 Clinical training, strengths-based approach to, 280 Cloitre, M., 416 CNPAAEMI. See Council of National Psychological Associations for the Advancement of Ethnic Minority Interests Coates, R. B., 21 Coates, R. D., 239 Coble-Temple, A., 405 Coburn, A. F., 450 Cochran, B. N., 389 Co-created practices, 230 Co-created therapeutic practices, 230 Code of Ethical Principles description of, 32 revision of, 12 Codrington, J., 29 Coffey, A., 240 Cognitive-behavior interventions, evidence-based, 203 Cognitive-behavior therapy description of, 182 for immigrants and refugees, 383 with indigenous populations, 206 for people with disabilities, 408–409 promotion of, 206 trauma-focused, 197, 203, 207–209 Cognitive complexity, 368–369 Cognitive decline, 398 Cohen, A. K., 335–336 Cohen, B. B., 384 Cohen, D. M., 326 Cohen, J., 203, 207 Cohen, J. A., 197 Cohen, L. M., 317 Cohn, A. M., 245 Cohn, D., 6, 307, 349, 353, 487 Cohn, T. J., 450–452 Cole, T. B., 344 Cole-Lewis, H., 309 Coleman, A. E., 283 Coleman, H., 183 Coleman, H. L. K., 12 Coll, J. E., 342–343, 346 Coll, L. C., 346 Collective unconsciousness, 282

Collectivistic coping, 189 Collectivistic Coping Styles Inventory, 277–278 Collectivistic cultures description of, 189 facial expressions in, 262 Collectivistic values, 474 Collins, N. M., 26–27, 216, 434 Colonial commonsense, 243 Colonialism, 189, 296 Colonization, 243 Color-blind approach to diversity, 494, 497 Comas-Díaz, L., 88–94, 282–283, 285, 287, 289, 291–292, 355, 379, 383 Commission on Ethnic Minority Recruitment, Retention, and Training, 12, 115 Commission on the Interrelations of the American Jewish Congress, 33 Committee on Equality of Opportunity in Psychology, 8–9 Committee on Ethical Standards for Psychology, 33 Committee on Ethnic Minority Affairs, 10, 12 Committee on International Relations in Psychology, 297 Committee on Women, 9 Communication barriers to, 300 dialogic, 367 e-mail, 309–310, 314 immigrant difficulties with, 381 with people with disabilities, 405–406 texting, 309–310, 314 youth violence prevention through, 326–327 Community military veteran’s reintegration into, 345–346 rural, 396 traumatic stress effects on, 413–414 wellness in, 413 youth violence in, 324 Community and Regional Resilience Institute, 413 Community based participatory action research, 321 Community based participatory research, 247 Community-based psychological first aid, 421 Community-based services, for immigrants, 357–358 Community mental health, 321 Community organizing, 29 Community praxis, 230–231 Community psychology, 321 Community resilience, 413 Competence cultural. See Cultural competence in technology-mediated mental health services, 311–312 Complex traumatic stress disorder in communities, 417–418 in disaster survivors, 416 Complicated grief, 397 Compton, S. N., 178 Concepción, W. R., 353 Conde-Frazier, E., 291 Confidentiality, 312 Confirmatory factor analyses, 79 Conkel-Ziebell, J. L., 477

I ndex

      6 2 3

Connectedness, 198 Consciousness raising, 26 Consoli, A. J., 219 Consonance, 368 Constantine, M. G., 218–219, 272, 274–275, 277–278, 287, 361 Consumer Price Index, 449 Continuous traumatic stress, 379 Contractor, L. F. M., 319 Conway, L., 449 Cook, B., 179 Cook, D., 72 Cook, E. T., 339 Cook, M., 261 Cook, M. L., 342 Cook, P. J., 331 Cook, S., 33 Cook, T. M., 451 Coon, D. W., 399 Cooper, L. A., 255 Coping in gang-involved youth, 337 multicultural positive psychology research in, 276 religiosity as method of, 396 Corbett, L., 377 Corcoran, K., 337 Cordero, D., 288 Corey, G., 358 Corey, M. S., 358 Cork, D., 331 Corneille, O., 250 Cornell, D., 324, 327, 329 Cornell, D. G., 326–327 Cornes, J. M., 272, 281 Cornish, M. A., 189 Correll, J., 254 Corrigan, J. D., 344 Cosentino, S. A., 398 Costantino, G., 263–264 Council for Accreditation of Counseling and Related Educational Programs, 216 Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, 12, 14 Council on American-Islamic Relations, 425 Counseling Persons of African Descent, 134 Counseling Psychologist, The, 11, 75–76, 297 Counseling psychologists description of, 225–226 education and, 231–234 intentions of, 226 practice diversification by, 232 psychopolitical validity, 229–230 Counseling psychology, social justice in, 18 Counselors culturally relevant skills of, 29 self-awareness of beliefs and attitudes by, 28 Counselor training description of, 301–302 difficult dialogues in. See Difficult dialogues in LGBTQ youth counseling, 391–392

Courage, 136–137 Cournos, F., 428 Courtois, C. A., 416 Coutasse, A., 313 Coutinho, M., 325 Covarrubias, R., 346 Cowie, H., 325 Cox, R. S., 414 CPAI. See Chinese Personality Assessment Inventory Cragun, C. L., 292 Craig, D. C., 33, 36, 42 Craig, W., 325 Crandall, C. S., 252 Creswell, J. W., 321 Crethar, H., 226, 358 Crisp, C., 390–392 Critical consciousness description of, 26–27 development of, 29, 435 dominant cultural context effects on, 436 in multicultural counseling competencies, 436–437, 440, 444 Critical dialogue, 367 Critical discourse, 367 Critical pedagogy, 27 Crits-Christoph, P., 181–182 Croizet, J., 255 Cross, T. L., 198, 329 Cross, W. E., 135 Cross, W. E. Jr., 147–148, 402 Cross-cultural counseling, 71–72, 299–300 Cross-cultural Personality Assessment Inventory, 85 Cross-cultural research, 301 Crow, G., 240 Crowther, M., 397 Crumlish, N., 379, 381 Cruz, C. M., 206 Cruz, I., 191 Cruz, M. R., 317 Csikszentmihalyi, M., 271–273 Cubic, B., 318 Cuijpers, P., 245 Cultural adaptations, 185–186, 207 Cultural assessment, 481 Cultural Assessment Interview Protocol, 261 Cultural assumptions, 182 Cultural biases, 41 Cultural competence in assessments, 268 dimensions of, 357 in immigrant interventions, 357 in mental health, 180 in Middle Eastern Americans, 430 in positive psychology, 272 training in, 322 Cultural conception of career concerns, 481 Cultural constructs cultural groups and, 272–273 justice as, 21 in restorative justice interventions, 21

6 2 4       H a n d b o o k o f M u lti c u ltur a l Counseling

Cultural contexts, 481 Cultural differences assumptions about, 72 interventions affected by, 186 in psychology, 72 Cultural dynamics of therapeutic relationships, 481 Cultural encapsulation, 44 Cultural evidence-based psychotherapies advantages of, 186 characteristics of, 184–185 cultural match in, 185 definition of, 184 disadvantages of, 186 evidence for, 184–185 recommendations for advancing, 187 Cultural formulation approach, 480–482 Cultural Formulation Interview, 260–261 Cultural genogram, 292–293 Cultural groups constructs used differently by, 272–273 definition of, 179 Cultural identity, 481 Culturally Adaptive Counseling Skills: Demonstrations of Evidence Based Practices, 134 Culturally based trauma-informed approach to gangs, 338–339 Culturally competent treatment description of, 180 for immigrants, 357 for people with disabilities, 408–409 Culturally Informed and Flexible Family-Based Treatment for Adolescents, 383 Culturally sensitive counseling, 256 Culturally sensitive treatments, 321 Cultural match in cultural evidence-based psychotherapies, 185 definition of, 180 measurement of, 186 Cultural oppression, 284 Cultural relevance, 81–87 Cultural self-awareness, 21–24 Cultural socialization, 81 Cultural variability in bodily expressions, 262 in clinical interview, 260 in eye contact, 261 in facial expressions, 262 in verbal expression, 262 Culture behavioral observations and, 261–262 clinical interview affected by, 260 collectivistic, 189 coping affected by, 276 disability and, 402–403, 406 disaster reactions affected by, 419 gangs as, 336–337 importance of, in psychology, 316 intelligence testing affected by, 141 military, 342–343 restorative justice and, 21

retributive justice and, 21 social norms of, 378 Cumba-Aviles, E., 278 Cumulative childhood trauma, 416 Cunningham, W. E., 355 Curanderismo, 285, 289 Currie, C., 325 Currier, J. M., 397 Curry, D. G., 333 Cushman, P., 179, 185 Czaja, S. J., 398 Dadvar, S., 399 Dahling, J. J., 479 Dahlstrom, W. G., 262 D’Alessio, S., 331 Daley, C. M., 318 Dallmayr, F., 296 Dalton, J. H., 19 Dam, U. C., 391 D’Amico, M., 241 Dana, R. H., 262, 356 D’Andrea, M., 43–48, 219, 456, 467 D’Angelo, E., 180, 186, 288 Daniels, J., 43, 45–47, 219, 467 Daniels, J. A., 326, 408 Danish, S. J., 318, 342–343 Danzinger, K., 3, 295 Dariotis, J. K., 459–460 Darlington, J. D., 414 Darwich, L., 388–389 Darwin, C., 5 Dasgupta, N., 252 DAT. See Disability affirmative therapy Databases, 297–298 Data collection, 245 D’Augelli, A. R., 386–389 David, E. J. R., 189, 317 Davidov, B. J., 273 Davidson, K. W., 178 Davies, A. N., 267 Davies, P. G., 250–251, 254, 325 Davis, A. Y., 48–49 Davis, D., 478 Davis, D. E., 319 Davis, K., 231 Davis, K. E., 245, 408 Davis, T., 180 Day, S. X., 271, 474 Day-Vines, N. L., 256 Dean, J., 261 De Arrellano, M., 207 Deblinger, E., 197, 203, 207 DeBord, K. A., 390 De Bruyn, L. M., 415 Deci, E. L., 480 Decker, S. H., 333 Decolonization theory, 243–245 Deen, T. L., 450, 453

I ndex

      6 2 5

DeFanti, E., 292 Deficit models, 273 De Houwer, J., 253, 255 Dei, G. S., 189 De Jong, P., 272 DeKruyf, L., 392 Dela Cruz, F. A., 266 DeLamater, J., 399 Delambo, D. A., 256 Delamont, S., 241 Delaney, R., 334 de la Rosa, M., 288 De Las Cuevas, C., 311 DeLeon, P. H., 319 Delijaj, B., 378 Delinquency, life course theory of, 327 Delphin, M. E., 322 Delpit, L., 195, 328 DeMaso, D. R., 320 Dementia, 398 Demeyer, T. A., 204 Demonner, S., 428 Demonstrations, 45 Dennis, K., 329 Denson, L., 409 Denton, N. A., 357 Denzin, N. K., 239, 242–243 DePalma, R., 327 Department of Defense, 14–15 Department of Mental Health and Addiction Services, 78 DePaul, J., 391–393 DePaulo, B. M., 261 Deprez, R. D., 453 Deprivation models, 273 De Rios, M. D., 94 Derksen, D. J., 330 DeRoche, K. K., 195 DeRuyter, J., 453 Deryck, F., 324 Desai, R., 319 De Shazer, S., 272 Desjarlais, R., 353 Deslich, S., 313 Dessel, A. B., 361, 367–369 Devine, P. G., 253 Devolution description of, 44 in multicultural counseling movement, 46–50 DeVoy, J. E., 479 deVries, M. W., 413 DeWall, C. N., 227 DeWitz, S., 478 DeWolfe, D. J., 412, 421 Dey, E. L., 360 D’Haen, T., 89 Diagnosis, 260–261 Dialect, 121 Dialogic communication, 367 Diaz, E., 388

Diaz, R., 389 Diaz, R. M., 388 Díaz-Lázaro, C. M., 384 Dickerson, D. L., 204 Diekema, D., 317 Diem, J., 239–241 Diener, E., 276 Difficult dialogues critical-dialogic framework for, 362–363 defining of, 361–362 dialogic communication, 367 educational outcomes of, 368–369 example of, 369–371 expert facilitation of, 366 faculty resistance to, 366 guidelines for, 366–367 intergroup contact theory of, 363 interpersonal and intrapersonal processes, 367–368 in multicultural counseling competency development, 437 negative emotional reactions to, 438 outline for, 364–365 overview of, 360–361 participation in, 372 pedagogical practices, 364–367 psychological outcomes of, 368–369 racial identity as focus of, 369 respectful dialogue, 367 summary of, 371–372 theoretical framework for, 362–369 venues for, 362 Diggs, G. A., 391 DiGiovanni, C. D., 388 Dillon, F., 288 Dillon, F. R., 391, 434–435, 443 Dillon, G. L., 442 Dillon, G. L., Jr., 442 Dimito, A., 388 DiNapoli, E. A., 399 Dinehart, J. M., 218 Disability. See also People with disabilities ADDRESSING model for, 403–404 context of, 404–406 as cultural identity, 403, 406 culture and, 402–403 definition of, 401 implicit models of, 408 life story of, 53–59 medical models of, 403 prevalence of, 401–402 risks associated with, 402 social context of, 403 stigma experienced by, 405 Disability affirmative therapy, 408 Disability Discrimination Ordinance, 86 Disaster mental health, 419–421 Disaster response, 304 Disasters cultural influences on reactions to, 419 disproportionate impact of, 414–415

6 2 6       H a n d b o o k o f M u lti c u ltur a l Counseling

ethnic minority communities affected by, 411, 414–415 healing opportunities after, 416–417 human-made, 412 Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial Support in Emergency Settings for, 419–420 interventions after, 420–421 long-term trauma caused by, 415–416 marginalized communities affected by, 418–419 media coverage of, 415 natural, 412 prevalence of, 411 psychological first aid for, 421 sense of safety after, 417 summary of, 421–422 traumatic stress caused by, 412–414 types of, 412 Discrimination against African Americans, 251–252 age-based, 398–399 Code of Ethical Principles and, 12 definition of, 250 description of, 6 against immigrants, 354 individuating features in, 251–252 life story of, 61 against Middle Eastern Americans, 425–426 psychological distress caused by, 354 racial, 78 social categorization in, 250–251 Disengagement, 262 Dissonance, 368 Distributive justice, 19–20 Diunital reasoning, 369 Diverse Issues in Higher Education, 493 Diversity AIM approach to, 495–496, 498 barriers to, 491–492 changes in, 497 color-blind approach to, 494, 497 defining of, 72 in higher education, 488–491, 494–497 institutional approaches to, 488–489 learning and developmental models for promoting inclusion for, 493–494 multicultural approach to, 494–495, 497 multiculturalism and, 490 resistance to, 493–494, 497 structural, 491–492, 497 validity of, 124 Diversity, 489 Diversity Initiative of the Committee of State Leaders, 14 Division 17, 11, 13 Division 37, 161, 163–164 Division 45, 10, 169 Division on Maturity and Old Age, 8 Divorce, 120 Dixon, W. A., 277

Doescher, M. P., 256 Doherty, G. W., 451 Dombrowksi, R. D., 246 Domenech-Rodríguez, M., 184–185, 300 Domenech-Rodríguez, M. M., 245 Domestic Workers United, 228 Domokos-Cheng Ham, M., 355 Donato, K. M., 424 Dong, N. J., 284 Donnelly, T. T., 355, 381 Dorstyn, D., 309, 409 Dostaler, S., 325 Doty, N. D., 389 Doucet, J., 229 Douglas, K., 241 Douglas, L., 459, 461, 465 Douglass, F., 46 Dovidio, J. F., 252–253, 262, 354, 437 Dow, H. D., 377–378 Downey, C. A., 273–274, 276, 278, 280 Doyle, A. B., 182 Doyle, W., 326 Draghi-Lorenz, R., 308 Draguns, J. G., 260, 499 Drake, R. E., 320 Dream interpretation, 94 Dreese, M., 33 Dressel, J. L., 219 Dressler, W. W., 252 Driessen, E., 178, 182 Drug cartels, 351–352 Druss, B. G., 179 Drysdale, D. A., 326 DSM-5, 260–261 Duan, C., 219, 222 Duara, R., 398 Duberstein, P. R., 396 Dubois, D. L., 458 Duckitt, J. H., 72 Duffy, S. N., 458 Duggan, M., 245 Duldulao, A. A., 353 Dulles Conference, 10 Duncan, A., 449 Dungy, G. J., 345 Dunn, M. A., 255 Dunn, T. W., 218 Dunton, B. C., 252 Duran, A., 11, 13 Duran, B., 320 Duran, E., 284, 320 Durlak, J. A., 328 Durran, A., 32 Dwairy, M., 356 Dwyer, K., 326–327 Dwyer, T. F., 307 Dyadic relationships, 188 Dymnicki, A. B., 328 Dynamic sizing, 260

I ndex

      6 2 7

EAEIS. See East Asian Ethnic Identity Scale Early Head Start, 162 Early socialization, 96–97 East Asian Ethnic Identity Scale, 265 East Ohio Conference Commission on Religion and Race, 58 Ebbinghaus, H., 3 Eberhardt, J. L., 250–252, 325 EBPP. See Evidence-based practice in psychology Echevarria, S. E., 287 Ecological field theory, 112 Ecological framework, for immigrant interventions, 356 Edlund, M. J., 396 Education, 27, 97 difficult dialogues in. See Difficult dialogues game-changing transformations of, 231–234 integrated, 110 Edwards, K. J., 267 Edwards, L. M., 271–273, 278 Edwards, T. A., 260 EEO. See Equal Employment Opportunity EFPA. See European Federation of Psychologists’ Association Egede, L. E., 345 Egley, A., 333 Ehntholt, K. A., 379 Eiroa-Orosa, F. J., 378 Eisenberg, L., 353 Ekman, P., 262 Elderhood, 116 Elechi, O. O., 21 Elias, M. J., 19 Eliot, M., 327 Elliott, B. A., 450 Elliott, C. M., II, 491–492 Elliott, M., 267 Ellis, C., 240–242 Ellis, J., 308 Ellis, M. V., 218 Ellis, R. R., 413 Ellison, C. G., 267 Ellison, C. W., 267 Ellison, Z., 426 El Salvador, 351 E-mail, 309–310, 314 EMDR. See Eye Movement Desensitization and Reprocessing Emic, 85, 87 Emmons, L., 316, 319, 321 Emmons, R. A., 267 Emotional Freedom Techniques, 94 Emotional safety, 325 Emotions, 262 Empathy, 168 Empirically supported treatments cognitive-behavior therapy, 182 description of, 177–178 Empirically validated treatments, 317 Empowerment, 20, 115 Empowerment Feminist Therapy, 384 “End-to-end encryption,” 312 Eng, E., 247 Engdahl, R., 413

Engel, R. S., 326 Engelbrecht, L., 318 English, M., 410 English language proficiency, 378 Enns, C. Z., 18 Enright, M. S., 479 Equal Employment Opportunity, 487 Equal Opportunities Commission, 86–87 Equal Opportunity and Affirmative Action, 160–161 Erdberg, P., 263 Erdoes, R., 204 Erickson, K. T., 413 Eriksson, H., 246 Eron, L., 329 Eshleman, A., 252 Espelage, D. L., 325, 327–328, 387, 389, 453 Espin, O. M., 383 Espinoza, J., 37 Espinoza, M., 189 Espiritismo, 90, 285, 289 Esquivel, G. B., 264 Estacio, E. V., 29 Estrada, D., 391 Estrada, Y., 478 Ethical codes, 39 Ethical guidelines accountability issues, 40–41 recommendations for, 40–42 research and, 41–42 Ethical standards American Counseling Association, 37–39 American Psychological Association, 33–37 historical perspective on, 32–33 overview of, 31 review of, 33–37 Ethics Code, 31–32 Ethnic differences, 121–122 Ethnic diversity, 217 Ethnic identity assessment of, 265–266 definition of, 265 by Latinos, 288 Ethnicity definition of, 179 intelligence test differences based on, 264 Ethnic match benefits of, 184 definition of, 180 in universal evidence-based psychotherapies, 181 Ethnic minorities cultural adaptations for, 185–186 evidence-based psychotherapy benefits for, 182 mental health disparities in, 179 religious diversity in, 283 “Ethnic Minorities: Issues and Concerns for Psychology, Now and in the Future,” 12 Ethnic minority communities disaster effects on, 411, 414–415 vulnerability of, 414

6 2 8       H a n d b o o k o f M u lti c u ltur a l Counseling

Ethnic minority groups demographic changes for, 487–488 growth of, 6 Ethnic Minority Issues Committee, 66 Ethnic minority psychological associations establishment of, 9 history of, 8 Ethnocentric biases, 119, 122 Ethnocentricity, 41 Ethnocentrism, 493 Ethnocultural groups, technology-based approaches and, 245–246 Ethnography autoethnography, 240–242 definition of, 241 innovative approaches in, 240–242 performance, 240 Ethnorelativism, 493 Etic, 85, 87 Ettigi, S., 354 Ettinger, J. M., 479 Eurocentric values, 37 European Americans category-based bias effects on, 255–257 feature-based bias effects on, 257–258 individuating features of, 251–252 European Federation of Psychologists’ Association, 297 EuroPsy, 297 Evans, A. C., 329 Evans, E., 406 Evans, K., 245 Evans, S. A., 216, 434 Even, C. E., 475–477, 479–480, 483 Evidence-based cognitive-behavior interventions, 203 Evidence-based practice in psychology definition of, 178 immigrant interventions based on, 356–357, 382 Evidence-based psychotherapies categories of, 180 cultural. See Cultural evidence-based psychotherapies definition of, 178 ethnic minority benefits, 182 history of, 177–178 racial and ethnic minority, 183–184, 186 studies of, 179–180 summary of, 186 universal. See Universal evidence-based psychotherapies Evidence-based treatments criticism of, 245 description of, 198, 203 development of, 206–212 enhancement of, 206–212 with indigenous peoples, 205–206 Evil eye, 285, 287 Evocative autoethnography, 241–242 Evolutionary theory, 5 Excellence, 136 Exceptionalism, 123 Exclusion harm caused by, 227 social exclusion theory, 227

Exner, J., 263 Exner, J. E., 263 Experimental psychology, 4 Explicit racial bias, 252 Exum, H. A., 342–343 Eyberg, S. M., 197 Eye contact, 261–262 Eye Movement Desensitization and Reprocessing, 94 Eysenck, H. J., 177 Fabelo, T., 326 Facial expressions, 262 Fahey, T., 379 Falender, C. A., 218 Fallman, J. L., 251, 257 False generosity of the oppressor, 226 Families, youth violence in, 324 Fan, R., 85 Fan, W. Q., 85 Fan, X., 327 Fanon, F., 91 Farahmand, F. K., 457–458 Farchione, T. J., 184 Faris, W. B., 89 Farley, R., 349 Farmer, L. B., 388, 391–392 Farmer, M. M., 399 Farrag, M., 428 Farrington, D. R., 339 Farsimadan, F., 308 Farver, J. M., 377 Fassinger, R. E., 386 Fast Food Forward, 228 Fazio, R. H., 252–253 Feature-based bias description of, 251–252 measurement of, 252–255 negative consequences of, in multicultural counseling, 257–258 Feeding Your Demons, 94, 290 Feeling thermometers, 253 Fein, R. A., 326 Fein, S., 255 Feinberg, L., 11, 13, 32 Feist, A., 345 Feisthamel, K. P., 219 Feldman, S. I., 54 Felker, B. L., 452 Feminism, 86, 169, 391 Feminist therapy, 383–384 Ferguson, C. J., 330 Ferguson, L. K., 391 Fernandez, C. A., 192 Fernández-Liria, A., 24 Fernandez-Rios, L., 272, 281 Ferraro, K. F., 399 Ferris, E., 411 Fetters, M. D., 428 Fettes, D. L., 319, 322

I ndex

      6 2 9

Fidelity, 466–467 Field, L. D., 219 Fietzer, A. W., 360 File, T., 308 Filipino Americans, 283 Fine, M., 28–29, 193, 247 Finison, L. J., 6 First Person Shooter Task, 254 Fiscella, K., 256 Fischer, A. R., 265 Fischer, J. D., 267 Fischer-Ortman, J., 378 Fisher, C., 36 Fisher, C. B., 12 Fisher, L. D., 479 Fisher v. University of Texas, 487 Fiske, S. T., 250 Fitchett, G., 267 Five Factor Model, 85 Flanagan, C. A., 327 Flanagan, R., 263–264 Fleming, C. M., 265 Fleming, W., 267 Flentje, A., 389 Flewelling, R. L., 318 Flores, A., 89 Flores, L., 354 Flores, L. Y., 277, 300, 435, 473–474, 478–479, 482 Flores, M. P., 274 Flynn, J. R., 141 Fogel-Grinvald, H., 325 Folk healing, 94 Fong, C., 255 Ford, J. D., 416 Ford, K. A., 364, 368–369 Ford, T., 453 Ford Foundation Difficult Dialogues Initiative, 365 Foreign students, 299 Forgiveness, 273 Forneris, T., 318 Forney, J. C., 468 Forsyth, J. M., 79 Fothergill, A. E., 414 Fouad, N. A., 18, 24, 226, 301, 385, 434, 473–475, 482 Foucault, M., 18 Fouche, C., 321 Fournet, M., 255 Fowers, B. J., 273 Fox, D. R., 385 Fox, E. L., 346 Fox, M., 28–29 Fox, M. H., 402 FPST. See First person shooter task Frank, E., 397 Frank, J., 293 Franks, P., 256 Fraser, I., 355

Frazier, S. L., 471 Freeman, J., 391 Freeman, M., 239 Freeman, S., 345 Freire, P., 26, 91–92, 193, 226–227, 230, 233–234, 435–436 Friar, J. T., 262 Friedlander, M. L., 11, 292 Friesen, W. V., 262 Frijda, N. H., 262 Fritschler, A. L., 361 Fryberg, S. A., 346 Fu, C., 482 Fuchs, C., 182 Fuentes, M., 180 Fuertes, J. N., 13, 309 Fugita, S. S., 261 Fu-Kiau, K. K. B., 288 Funderburk, B. W., 198, 211 Fung, K., 318 Furlong, M. J., 325, 331, 357, 384 Furnham, A., 234 Gabaccia, D. R., 301 Gabbard, G. O., 313 Gaertner, S. L., 252–253, 256, 354, 437 Gainor, K. A., 478 Gale, J. A., 453 Galgay, C. E., 402, 405 Galietta, M., 267 Gall, T. L., 292 Gallagher-Thompson, D., 397, 399 Gallardo, M., 134 Gallardo, M. E., 185, 189, 193, 300 Gallo, A. M., 240 Galton, F., 5 Gamba, R. J., 266 Gamm, L. D., 450 Gan, Y. Q., 85 Gandy, O. H., 256 Gangs acculturation adjustment difficulties and, 336, 339 culturally based trauma-informed approach to, 338–339 cultural values of, 336–337 definition of, 333 history of, 332 interventions for, 339 joining, 335 label as, 333–334 loyalty in, 336–337 power in, 336 as reactive contraculture, 335–336 respect in, 337 sense of belonging associated with, 336 statistics regarding, 333 system-induced traumatization and retraumatization leading to involvement in, 334–335 trauma experienced by youth in, 337–338 youth of color in, 333–334

6 3 0       H a n d b o o k o f M u lti c u ltur a l Counseling

Gangure D. P., 308 Gannon, L., 18 Garcia, C. M., 355 Garcia, M., 26, 37 García, S. N., 24 García Lorca, F., 90 Garcia-Palacios, A., 309 Garcia-Preto, N., 431 Gardner, J., 18 Garfield, S. L., 499 Garibaldi, M. L., 325 Garland, A. F., 329 Garlington, S. B., 361 Garofalo, R., 246 Garrett, J. T., 283, 289 Garrett, M. T., 283, 289, 434 Garrido, M., 263 Garriott, L. J., 247 Garvin, T., 246–247 Garvin, T. D., 315–316 Gauthier, J., 303 Gawronski, B., 253, 255 Gaye, Marvin, 129 Gay Lesbian Straight Education Network, 387 Gay Straight Alliances, 389, 392 Gee, G. C., 316, 354 Geertz, C., 241–242 Geist, M. R., 195 Gelso, C. J., 11 Gender bereavement affected by, 397 fluidity of, 502–503 of older adults, 396–397 Gender differences, 123 Gender equality, 86 Gender roles, 378 Generosity, 226–227 authentic, 230 Genogram cultural, 292–293 spiritual, 292 Genogram journey, 64–65 Georgas, J., 264 George, L. K., 267 Gergen, K., 243 Gergen, K. J., 239, 316 Geroski, A. M., 189 Gershenson, R. A., 468 Gerstein, L., 41 Gerstein, L. H., 18, 24, 295, 298–300, 302, 385, 434 Ghaed, S. G., 399 Ghaffari, A., 426 Ghafoori, B., 263 Gheith, A., 428 Ghosh, R., 191 Giardina, M. D., 239 Gibson, B. E., 247 Gibson, W., 396 Gielen, U. P., 298, 302

Gilbert, N., 240 Gill, C. J., 403 Gill, N., 479 Gillespie, R. E., 219 Gilman, S. E., 396 Giordano, J., 431 Girard, P., 312 Giroux, H. A., 47, 49 Gjesfjeld, C. D., 454 GLADP. See Latin American Guide for Psychiatric Diagnosis Glanz, K., 321 Glass, G. V., 177 Global-community psychology, 120 Glosoff, H. L., 39 GLSEN. See Gay Lesbian Straight Education Network Goff, P., 252 Goff, P. A., 250, 325 Gokani, R., 18, 28 Gold, S. J., 353 Goldblum, P., 316, 319, 321 Goldstein, M. B., 347 Goldstein, R., 96, 98 Gone, J. P., 179, 198, 206, 243–244, 260, 317, 320–321 Gong, Y., 356 Gonzáles, R. G., 353 Gonzalez, B., 318 Gonzalez, H. M., 182 Gonzalez, J., 203, 206 González, N., 194 González, R., 27, 252 Gonzalez-Barrera, A., 349–350 Good, B., 353 Good, G. E., 435 Good, M., 329 Goodall, H. L., 241 Goodenough, W., 38 Goodenow, C., 389 Goodkind, J., 37 Goodman, L. A., 18, 233, 385 Goodnough, G. E., 475 Gordon, H. S., 256 Gore, D., 349 Gore, P. A., 474, 479 Gorman, J. M., 181 Gottlieb, M., 314 Gould, L. F., 459–460, 466 Gover, R. M. S., 55 Govorun, O., 255 Graf, N. M., 345, 347 Graglia, P., 195 Graham, J. R., 262 Grandparenting, 397–398 Granello, D., 256 Grant, K. E., 458 Grant, S., 327 Gratzer, B., 246 Gray, A. J., 396 Gray, M., 271–272 Gray, S. A., 250

I ndex

      6 31

Great Spirit, 283, 285 Great Turtle Island, 199, 201–203 Green, C. E., 188, 268 Green, M., 267 Greenberg, J., 20 Greenberg, M. T., 339, 459–460 Greenburg, E., 395 Greene, B., 256–257, 291, 355, 390 Greenfield, P. M., 449 Greenleaf, A. T., 309 Greenwald, A. G., 252–254 Gregory, A., 325, 327 Gregory, W. H., 290 Grey, N., 383 Greytak, E. A., 219, 386–388, 391 Grief, 397, 415 Grieger, I., 261 Grier-Reed, T. L., 477 Griffin, K. E., 426 Griffin, P., 389 Griffith, D. M., 27 Griffiths, K. M., 245 Griner, D., 184, 218, 245 Grossman, D. C., 331 Grossman, P. D., 343, 346 Groth-Marnat, G., 263 Group-oriented interventions, 189 Groves, C., 245 Grutter v. Bollinger, 487 Grych, J. H., 328 Gryczynski, J., 414, 419 GSAs. See Gay Straight Alliances Guadagno, R. E., 308 Gualtieri, S., 424 Guan, Y., 477 Guarnaccia, P., 353 Guarnaccia, P. J., 260 Guarnizo, L. E., 301 Guatemala, 351 Guerrero, L., 480 Guha-Sapir, D., 411 Guided imagery, 288 Guidelines and Principles in Professional Psychology, 12 Guidelines for Assessment of and Intervention With Persons With Disabilities, 403, 409 Guidelines for Multicultural Competence, 299 Guidelines for the Practice of Telepsychology, 311, 453 Guidelines on Mental Health and Psychosocial Support in Emergency Settings, 419 Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists, 13–14 Guillermo, T., 192 Gulerce, A., 316 Guleree, A., 243 Guns, 330–331 Gunsalus, A. C., 478 Gunsalus, R., 478 Guo, A., 14–15

Guo, A. X., 33, 36, 42 Gupta, A., 480–481 Gupta, S., 474 Gurin, G., 360 Gurin, P., 360–363, 367–369 Gurwitch, R., 198, 211 Gushue, G. V., 478–479 Gutheil, T. G., 313 Guthrie, R. V., 6, 8, 72 Gutierrez, K., 189 Gysbers, N. C., 482 Haasen, C., 378 Habib, S., 431 Hacker, K., 193 Hackett, G., 477–478 Hage, S. M., 292 Hagiwara, N., 251–252, 254, 257 Hagman, B. T., 245 Halbert, C. H., 256 Hales, R. E., 321 Hall, G. C. N., 183, 185, 263, 288, 316, 321 Hall, R. E., 257 Hall, S., 79, 454 Hall, T. W., 267 Halpern, D. F., 86 Halter, M. J., 344 Halverson, E. R., 386 Hamby, S., 328 Hamer, L., 18, 20–21 Hames, A., 407 Hamit, S., 426 Hammer, A. I., 264 Hamming, B. J., 331 Hammond, M. S., 476 Hamre, B. K., 469 Han, K., 263 Handbook of Racial-Cultural Psychology and Counseling: Theory and Research (Vol. 1), 77 Hanna, F. J., 309 Hansen, J. C., 264 Hardee, B. B., 253 Hardin, E., 480–481 Hardin, S. R., 400 Hardy, J., 281 Hardy, K. V., 292 Harel-Fisch, Y., 325 Hare-Mustin, R. T., 26 Harlem, A., 377 Harmon, L. W., 264 Harper, A., 391 Harper, F. D., 189 Harper, K. W., 290 Harper, S., 409 Harrell, S. P., 283 Harris, K. M., 396 Hart, J., 360 Hart, L., 448 Hart, M. A., 244

6 3 2       H a n d b o o k o f M u lti c u ltur a l Counseling

Hartung, P. J., 472, 475, 477 Harvard Educational Review, 150 Harvey, M. R., 383 Harwood, A., 90 Hasan, H. A., 337 Hasan, N., 301 Hasan, N. T., 425 Hassiotis, A., 409 Hassouneh, D. M., 425, 427 Hastings, S. L., 450–452 Hauenstein, E. J., 447, 450 Hauf, A. M. C., 456, 459 Haug, I. E., 293 Hawkins, J. D., 339 Hawxhurst, D., 243 Hayes, R. L., 300 Hayes, S. C., 397 Hays, P. A., 203, 206, 215, 274 Hays, R. D., 355 Hayslip, B., 397–398, 451 Hays P. A., 403, 408 Head Start, 162–163 Healing after disasters, 416–417 spirituality and, 287–288 Health definition of, 317 interdisciplinarity in, 317–321 Health disparities description of, 320 in older adults, 395 in people with disabilities, 407 Health literacy, 395 Health professional shortage areas, 313 Heath, A. E., 217 Heavy Head, R., 203 Hebl, M., 262 Heck, N. C., 389 Heckman, E. F., 456, 467 Heckmann, R. C., 267 Hedges, M., 224 Hedman, E., 245 Heine, S., 180 Heinowitz, A. E., 320 Heisel, M. J., 396 Heisler, M., 428 Helms, J. E., 11, 18, 72, 80, 135, 188, 266, 268, 403 Helping game-changing conceptions of, 226–229 storytelling for, 198–203 Hemenway, D., 330–331 Hen, L., 245, 309 Hendrick, C., 318 Hendrick, S. S., 318 Henggeler, S. W., 339 Henning-Stout, M., 390 Henrichson, C., 334 Henry, J. D., 398 Henry, P. J., 253

Henry, R. G., 24 Henze, K., 188 Hepburn, L. M., 330 Heppner, M. J., 224, 280, 482 Heppner, P. P., 276–278, 280, 295, 298–300 Herlihy, B., 358 Herman, J., 337–338 Herman, K. C., 256, 327 Hermann, J. L., 416–417 Hernandez, D., 292 Hernandez, D. J., 357 Hernández, P., 434–437 Hernandez-Gravelle, H., 360–362, 364–366, 368 Hernandez-Wolfe, P., 26 Herringshaw, A. J., 280 Hershberger, S. L., 386–388 Hershenson, D. B., 479 Hess, S., 492 Hetland, J., 325 Hicken, B. L., 396 Hickinbottom, S., 281, 317 Hierholzer, R. W., 263 Higher education barriers to diversity change work in, 491–492 bias effects on, 492 costs of, 49 difficult dialogues in. See Difficult dialogues diversity curriculum in, 492–493 diversity in, 488–491, 494–497 institutional change in, 492 mission of, 371 organizational change in, 492 Higher education institutions demographic shifts in, 488 structural diversity in, 491–492 sustainability of, 485 Higher Learning Commission, 492 Higson-Smith, C., 379 Hill, C. E., 11 Hill, C. L., 260–261 Hill, J., 19, 244 Hill, P. C., 273–274 Hillery, J. M., 261 Hills, H. I., 12 Hilty, D., 311–312 Hinrichsen, G. A., 396 Hinton, D., 180 Hinton, D. E., 184, 383 Hirsch, J. K., 280 Hispanics. See also Latinos homicide rates among, 331 religious diversity among, 284 Historical grief, 415 Historical trauma, 317 Historical trauma response, 416 HITECH requirements, 312 Hoagwood, K., 458 Hobbs, N., 33 Hobfall, S. E., 413, 417, 419

I ndex

      6 3 3

Hochhausen, L., 381 Hodge, D. R., 283, 292–293 Hodson, G., 253 Hoefer, M., 349 Hoeffel, E. M., 488 Hoerster, K. D., 452 Hoffman, D., 14–15 Hoffman, D. H., 33, 36, 42 Hoffman, H. G., 254 Hoffman, R., 317 Hoffman Report, 15, 39, 42 Hofmann, S. G., 383 Hogan, H., 395 Hohenshil, T., 295, 298 Holder, A. M. B., 264, 361, 426 Holland, J., 264 Holland, J. L., 473–474 Holland, J. M., 397 Holland, Y. J., 442 Hollander, G., 386 Holland’s career theory, 473–475 Holleran, L. K., 336 Holliday, B. G., 5–6 Hollis, J. W., 12 Hollon, S., 178, 182 Hollon, S. D., 203 Holm, E., 246 Holman Jones, S., 241 Holmes, A. L., 5–6 Holt, C. L., 287 Holtfreter, K., 378 Holtz, C. A., 280 Homan, M., 358 Homelessness, 25, 29 Homicides, 324, 330–331 Honduras, 351 Hong, G. K., 355 Hong, J. J., 185, 288 Hong, J. S., 327 Hong, S., 353 Honoring Children Series description of, 197–204 healing, 204–205 Making Relatives, 211 Mending the Circle, 207–209 Respectful Ways, 211–212 wellness, 204–205 Hood, K. K., 197 Hook, J. N., 319 Hooponopono, 290 Hooten, W. M., 318 Hopson, A., 292 Horn, S. S., 385, 390 Horowitz, M., 319 Horowitz, R., 336 Hostile racism, 79 Hothershall, D., 5 Houck, P. R., 397 House, C. C., 476

House, R., 29, 279, 343 House-Tree-Person, 262, 264 Houston, T. R., 282 Hovey, J. D., 425, 428 Howard, A., 252, 387–388 Howard, C., 478 Howard, J. M., 308 Howe, K., 274, 280–281 Howell, J. C., 332–333 Howland, C., 406–407 Hoyois, P., 411 HR4437, 23 HTP. See House-Tree-Person Huai, N., 325 Huang, J., 186 Huang, L., 186, 355 Huang, Y.-P., 277 Huart, J., 250 Hubbard, E. E., 489 Hubbard, P., 468 Hubert, L., 474 Huebner, D., 389 Huesmann, L., 329 Huey, S. J., Jr., 245 Hughes, C., 4 Humanism, 272 Human-made disasters, 412 Hummel, T. J., 402 Hummert, M. L., 399 Hunt, M., 3 Hunter, J. D., 361 Hunter-Reel, D., 245 Huntley, D. K., 260 Hur, J., 263 Hurley, E., 41 Hurley, E. J., 302 Hurricane Katrina, 78, 414–415 Hurricane Sandy, 415 Hurtado, S., 360, 362 Hutcheson, H., 318 Hutchison, A., 41 Huu-ay-aht First Nation, 246–247 Huygens, I., 243 Huynh, V. W., 325 Hwang, K. K., 321 Hwang, W. C., 181 Hyler, S. E., 308 Hymel, S., 388–389 Ialongo, N., 326 IAT. See Implicit Association Test Ibish, H., 425 I Ching, 284 Ikeda, R. M., 331 Imel, Z. E., 435 Imig, D. R., 353 Immersion-Emmersion stage, 147 Immigrant paradox, 380 Immigrants. See also Refugees

6 3 4       H a n d b o o k o f M u lti c u ltur a l Counseling

acculturation problems for, 354–355 acculturative stress in, 377–379 barriers to treatment of, 355–356, 381 children, 350–351, 376, 379 clinical-procedural barriers in, 355–356 cognitive-behavior therapy for, 383 community-based services for, 357–358 contextual-structural barriers in, 355 counseling approaches for, 382–384 culturally competent treatment of, 357 demographics of, 349–351 description of, 348 discrimination against, 354, 379 ecological framework for, 356 English language proficiency in, 378 evidence-based practice in psychology for, 356–357, 382 interpersonal violence against, 379–380 interventions for, 356–358 language barriers in, 381 lesbian, gay, bisexual, and transgender, 377–378 mental health issues for, 380–382 migration of, 376–377 mourning by, 377 negative media coverage of, 349 psychological distress in, 380, 384 racism against, 354 as refugees, 350–351 scapegoating of, 378 social-cultural barriers in, 355 social justice perspective in interventions for, 358 stereotyping of, 354 transit-related trauma by, 352–353 transnationalism in, 379 trauma-based presenting problems in, 351–353 traumatic stress in, 379–380 undocumented, 349–351, 376–377 women as, 376, 383–384 Immigration context for, 376–377 poverty as reason for, 351 reasons for, 349, 351, 376 recommendations for dealing with, 358–359 statistics regarding, 375 violence as reason for, 351 Implicit Association Test, 253 Implicit measures, 249 Implicit racial bias, 252–253 Inclusion, 228 Income inequity, 25 Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture report, 36 Index of Race-Related Stress-Brief Version, 268 Indian Country Child Trauma Center, 207 Indian Health Service, 197 Indigenous peoples cognitive-behavior therapies with, 206 decolonization, 242–245 evidence-based treatments used with, 205–206 innovative approaches for studying of, 242–245

Indigenous stories description of, 212 Honoring Children Series. See Honoring Children Series introduction of, 198 Indigenous theory, 243 Individualism, 185 Individualistic cultures, 262 Individualistic values, 262 Influence of Race and Racial Identity in Psychotherapy: Toward a Racially Inclusive Model, The, 75 Injustice, 28 Inman, A., 195 Inman, A. G., 218–219, 354–355, 384 Inner numbness, 228 Innovative approaches arts-based, 246–248 decolonization theory, 243–245 definition of, 240 ethnographic, 240–242 indigenous, 242–245 participant-employed photography, 246–247 performance as, 248 technology-based, 245–246 Insel, T., 306 Institute of Psychology, 83–84 Institutional competence, 28–29 Integrated behavioral healthcare, 453 Integrated education, 110 Integration, 151–152 Intellectual humility, 138 Intelligence Testing and Minority Students: Foundations, Performance Factors and Assessment Issues, 141 Intelligence tests, 264 Interactional justice, 20 Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial Support in Emergency Settings, 419–420 Interamerican Society of Psychology, 297 Intercultural Campus: Transcending Culture and Power in American Higher Education, The, 489 Intercultural sensitivity, 497 Intercultural Values Inventory, 75 Interdisciplinarity approaches to, 315–316 challenges to engaging, 316 definition of, 315–316 distinct foci on, 316–317 examples of, 316 in health, 317–321 Interdisciplinary Group on Preventing School and Community Violence, 323 Interdisciplinary health work challenges to, 319–321 collaborations in, 318–319 overview of, 317–318 social justice aspects of, 319–320 training issues in, 318 Interdisciplinary multicultural perspectives, 503 Interdisciplinary work, 315–316 Intergroup contact theory, 363

I ndex

      6 3 5

Internal-External Ethnic Identity Measure, 265–266 International Association for Counselling, 296 International Association of Applied Psychology, 303 International Association of Cross-Cultural Psychology, 296, 303 International associations, 296 International Classification of Functioning, Disability and Health, 304 International counseling and psychology cross-cultural research, 301–302 databases, 297–298 definition of, 295–296 forums, 296–298 history of, 294–295 recommendations for, 304–305 International engagement cultural contexts and, 304 description of, 295 examples of, 303–304 foreign students, 299 issues related to, 298–300 recommendations for, 304–305 student and scholar exchange, 298–299 Universal Declaration of Ethical Principles for Psychologists, 302–303 Internationalism, 295–296 Internationalization, 296 International pluralism, 296 International Society for Traumatic Stress Studies, 296 International Union of Psychological Science, 296, 303 Internet connectivity, 307–308 Interpersonal and intrapersonal processes, in difficult dialogues, 367–368 Interpersonal justice, 20 Interpersonal violence, 379–380 Intersectionality, 437–442 Interventions after disasters, 420–421 anticolonial counseling, 188–189 cultural influences on, 185–186 for gangs, 339 immigrants, 356–358 for rural communities, 453–454 social justice perspective in, 358 urban community. See Urban community interventions Interview, clinical, 259–260 Intimate partner violence, 406 Intuitive empathy, 94 IRRS-B. See Index of Race-Related Stress-Brief Version Irvin, T., 476 Isaacowitz, D., 395 Isaacs, M., 329, 355 Islamic Revolution, 426 Israel, B. A., 321 Israel, T., 18, 24, 434 Ito, T. A., 254 Iturbide, M. I., 288 IUPsyS, 297, 303

Ivey, A. E., 26–27, 44, 48–49, 434 Ivey, M. B., 44 Jach, E. A., 29 Jackson, D. R., 469 Jackson, J. R., 252 Jackson, J. S., 283, 397 Jackson, M., 252 Jackson, M. A., 264, 439, 442, 499 Jackson, M. C., 325 Jackson, M. L., 218 Jacob, S., 390 Jacobs, D. H., 309 Jacobs, G., 304 Jacobs, G. A., 421 Jacobson, L. I., 64–65 Jadalla, A., 428 Jahns, R-G., 310 Jalel, B., 184 James, S., 361, 390 James, S. A., 426 Jamil, H., 427 Jang, Y., 354 Japanese Americans, 283 Jarjoura, R., 325 Jefferson, S. O., 245 Jeffery, B., 247 Jefferys, K. J., 376 Jeglic, E. L., 280 Jenkins, C., 250 Jenkins, M., 18, 20–21 Jernigan, M. M., 188 Jimerson, S. R., 325 Jin, Y., 395 John, D. A., 292 Johnson, B., 252 Johnson, C., 252, 317 Johnson, C. S., 346 Johnson, D. C., 347 Johnson, E. J., 252 Johnson, J., 328, 395 Johnson, J. L., 414, 419 Johnson, N., 329 Johnson, N. J., 252 Johnson, R. M., 331 Johnson, S., 251 Johnson, V., 307 Johnston, J. A., 482 Johnstone, B. I., 287 Jones, A. R., 451 Jones, B. J., 475 Jones, J. M., 24 Jones, M., 242 Jones, R., 459, 462, 466–467 Jones, S., 326 Jones, S. H., 240–241 Jorge, M. R., 304 Jorm, A. F., 245, 454 Josselson, R., 239

6 3 6       H a n d b o o k o f M u lti c u ltur a l Counseling

Jost, J. T., 18 Journal for Social Action in Counseling and Psychology, 24, 28 Journal of Career Development, 480 Journal of Clinical Child Psychology, 158 Journal of Counseling Psychology, 76 Joyce, C., 346 Juang, L., 193 Judd, C. M., 250–252, 254, 257 Judgment, attribute-based linear models of, 252 Jun, H., 220, 222 Juntunen, C. L., 475–477, 479–480, 482–483 Juretic, M. A., 452 Jurisdiction, 312–313 Justice as cultural construct, 21 definition of, 19 distributive, 19–20 interactional, 20 interpersonal, 20 procedural, 19–20 restorative, 20–21 retributive, 20–21 social. See Social justice structural, 19–20 Justice for Filipino American Veterans, 22 Kaemmer, B., 262 Kahle, E. R., 280 Kahn, K. B., 216, 223, 254 Kalodner, C. R., 326 Kaminski, P. L., 397–398 Kanagui, M., 482 Kanagui-Munoz, M., 276 Kane, R., 309 Kanitz, B. E., 216, 218 Kanstroom, D., 376 Kantamneni, N., 473–475, 482 Kapadia, A., 427 Kaplan, A., 354 Kaplan, R. M., 178 Karabenick, S. A., 300 Karlsen, S., 316 Karpinski, A., 253 Karraker, A., 399 Kasa-Hendrickson, C., 191 Kaschak, E., 55 Kashy, D. A., 251 Kaslow, F., 314 Katz, Y. J., 327 Kawahara, D., 361 Kawakami, K., 252 Kayyali, R. A., 423 Kazdin, A. E., 306, 321, 329, 357 Keaveny, M., 399 Keeles, O., 246 Kellam, S. G., 326 Kelleher, C., 361 Keller, J. F., 267 Keller, R. M., 402, 405

Kelly, B. C., 346 Kelly, C. M., 454 Kelly, J. F., 256–257 Kelly, K. R., 478 Kelly, P. A., 256 Kelly, U. A., 320 Kemmis, S., 195 Kemp, J., 325, 345 Kempf, A., 189 Kendall, E., 55 Kendall, P. C., 178 Kendziora, K., 325, 328 Kenna, A. C., 479 Kennedy, A., 378 Kennedy, A. C., 449 Kennedy, D. M., 331 Kennedy, K. D., 242 Kennedy, P. S., 288 Kennedy, S., 33 Kenny, M. E., 458, 476 Kerl, S. B., 218 Kershaw, T., 309 Ketterer, H. L., 263 Kewman, D. G., 409 Khairallah, T., 360 Khan, Z., 428 Khuankaew, O., 320 Khuwaja, A., 427 Khuwaja, S. A., 427 Kia-Keating, M., 426 Kiefe, C. I., 252 Kieling, C., 329 Kiely, E., 349 Killawi, A., 428 Kim, A. B., 194 Kim, B. S., 188, 219 Kim, B. S. K., 218 Kim, G., 354, 356, 381 Kim, H. S., 262 Kim, J. M., 280 Kim, P. Y., 347 Kim, R. S. K., 267 Kim, U. E., 316 King, D. W., 417 King, I. A., 417 King, L. A., 271 King, M. L. K. Jr., 30, 126, 137 King, T., 198 Kinscherff, R., 329 Kious, W. J., 199 Kiperman, S., 387–388 Kira, I. A., 425–426 Kirk, M. D., 288 Kirmayer, L. J., 260 Kiselica, M., 385 Kiselica, M. S., 24, 385 Kiskotagan, L., 247 Kitayama, S., 272, 449 Kitchener, B. A., 454

I ndex

      6 3 7

Kivel, P., 19 Klein, J. T., 315–316 Klein, M. W., 333, 340 Klein, N. C., 339 Kleinman, A., 85, 321, 353 Kleinman, A. M., 381 Kliewer, C., 191 Klocko, R. P., 347 Klonoff, E. A., 251, 257, 266, 268 Kloos, B., 19 Knaevelsrud, C., 245 Knight, B., 400 Knight, B. G., 395, 400 Knuth, M., 362 Kocet, M. M., 39 Koenig, B. W., 387–389 Koenig, H. G., 267 Koerner, S., 285 Kohatsu, E. L., 353 Kohler, J., 258 Kohn, L., 181 Kohn-Wood, L., 143, 239–241, 246 Kohout, J. L., 355 Kolmes, K., 314 Komarraju, M., 474 Kooyman, L., 318 Kopala, M., 143 Korean Americans, 283 Korman, M., 9 Kosciw, J. G., 219, 386–389, 391 Koss-Chioino, J., 293 Koss-Chioino, J. D., 90, 355 Kouznetsova, N., 262 Kovach, M., 191 Kozol, J., 234 Krahn, G., 406 Krause, N., 267 Kravitz, J., 345 Kreitz, P. A., 497 Krogstad, J. M., 350 Kruger, D., 318 Krupp, D., 262 Kubiak, S. P., 428 Kubokawa, A., 280 Kuhn, E., 314 Kulkarni, M., 179 Kull, R. M., 388 Kulwicki, A., 425, 427 Kusche, C. C., 339 Kutner, M., 395 Kviz, F. J., 355 Kwan, K. K., 356 Kwan, K. L. K., 263, 265–266 Kwong, A. K., 189 Laborde, D. J., 413–414 Lacroix, L. J., 459, 462, 466–467 Ladany, N., 193, 218–219 Laddis, A., 425

Laffrey, S. C., 425 LaFrance, M., 261 LaFromboise, T., 181, 206 LaFromboise, T. D., 18, 206 Lahman, M. K. E., 195, 248 Laidlaw, K., 400 Lamanna, J. D., 318 Lambert, M. J., 308 Lame Deer, J. F., 204 Lamis, D. A., 345 Landau, J., 413 Landis, K., 361 Landolt, P., 301 Landrine, H., 251, 257, 266, 268 Landrum-Brown, J., 435 Lang, S., 244 Language, in psychological assessment, 262 Lapointe, J. M., 327 La Roche, M., 27, 180, 182, 184–186, 288, 317 La Roche, M. J., 181–183, 357 LaRowe, S. D., 246 Larson, D. B., 267, 287 Larson, E. H., 448 Larson, J., 391 Larson, J. T., 450 Larson, S. L., 396 Larson, S. S., 287 Laszloffy, T., 292 Latifi, S., 14–15 Latifi, S. Y., 33, 36, 42 Latin American Guide for Psychiatric Diagnosis, 304 Lating, J. M., 319, 322 Latinos. See also Hispanics ethnic identity by, 288 liberation theology in, 291 lived spirituality in, 285 religious diversity among, 284 social cognitive career models for, 478 syncretism by, 287 Latta, R. E., 18 Lau, A., 181 Lau, A. S., 186, 245 Laub, J. H., 327 LaVeist, T. A., 430 Lawrence, M., 349 Lawson, W., 320 Layous, K. L., 273 Lazarus, R. S., 272 Lazear, K. J., 355 Le, C. N., 284 Le, H., 381 Leach, J., 344 Leach, M. M., 435 Leadership, 135 League of United Latin American Citizens, 22 Leap, J., 339 Leary, G. E., 355 Ledbetter, M. F., 267 Lee, C., 389

6 3 8       H a n d b o o k o f M u lti c u ltur a l Counseling

Lee, D.-G., 277 Lee, E., 186 Lee, H., 273 Lee, J., 182, 428 Lee, L. O., 395, 400 Lee, M. A., 24 Lee, R. M., 354 Lee, S., 58–59 Lee, S. J., 189 Lees, K. E., 25 Leff, S., 183 Legacy, 137 Leggett, E. S., 392 Leidner, B., 302 Lenert, L., 310 Lent, 281 Lent, R. W., 477–478 Lentin, A., 215 Leon, J., 426 Leonard, A. D., 246 Leong, F., 297, 301 Leong, F. L., 473 Leong, F. T. L., 85, 87, 295, 472, 474, 480–481 Leskes, A., 361, 366, 368 Lesser, I. M., 260 Leung, K., 85 Leung, S.-M. A., 298–300 Levin, J. S., 396 Levy, R., 183 Lew, L., 260 Lew, S., 267 Lewandowski, L., 425 Lewis, A. A., 369 Lewis, B. L., 20–21 Lewis, D. M., 475 Lewis, J., 47 Lewis, J. A., 29, 226, 279, 318, 320, 343, 385, 434 Lewis, M., 47 Lewis, R., 327 Lewis, Y., 318 Lewis-Fernandez, R., 89, 321 Lexical decision task, 253 LGBTQ people African Americans, 291–292 exclusion of, 227 historical oppression of, 405 immigrants, 377–378 leadership development among, 228 minorities, 378 LGBTQ youth advocacy for, 390–393 affirmative counseling for, 390–391 bullying of, 387–392 competence training for counselors dealing with, 391–392 counselors as advocates for, 390–393 empowerment of, 392 experiences of, 386–388 harassment of, 387–388 homophobic victimization of, 387, 389, 392

overview of, 385–386 school climate effects on, 389, 393 strategies to address the needs of, 388–390 violence against, 387 Li, L. C., 260–261 Liang, B., 18 Liang, C. T., 193 Libby, D. J., 319 Liberation, 284 multicultural spirituality and, 285–286, 291–292 Liberation psychologists, 291 Liberation psychology, 26 Liberation theology, 291–292 Libersky, J., 402 Lichter, D. T., 447 Lichter, L. S., 330 Lichter, S. R., 330 Lickel, B., 302 Lieber, E., 377 Liefooghe, A. P. D., 325 Life-span, life space theory, 475–476 Life span development, 112 Life stories African Americans, 96–117, 125–137, 146–154 American Indian pediatric psychologist, 155–165 assimilation, 60–70 cultural relevance in psychology, 81–87 definition of, 51 disability, 53–59 it takes a village, 96–107 magical realism, 88–90 multicultural pioneers, 125–165 multicultural psychology, 118–124 research on race, 71–80 warrior-healer, 125–137 Lillis, J., 397 Lin, A. I., 327, 361 Lin, H., 300 Lincoln, K. D., 283 Lincoln, Y. S., 243 Lindahl, K. M., 389 Lindefors, N., 245 Lipson, D., 402 Lipson, J. G., 425 Lishner, D. M., 448 Literacy, 97 Little, T., 327 Little, V., 317 Littlefield, D., 318 Liu, K., 252 Liu, M. W., 12 Liu, W. M., 20, 28, 346, 434 Lived spirituality, 285 Livingston, R. W., 251, 254 Ljtósson, B., 245 Lo, H. T., 318 Lock, A., 243, 316 Lockenhoff, C. E., 394 Loeber, R., 339

I ndex

      6 3 9

Loewenstein, D. A., 398 Logan, J. M., 398 Lokken, J. M., 346 London, S., 361 Lonner, W. J., 499, 501 Loper, A. B., 327 Lopez, A. M., 313 Lopez, A. M., Jr., 478 Lopez, C. R. V., 33, 36, 42 Lopez, E., 247 Lopez, F. G., 478 López, G. N., 64–65 Lopez, I., 353 Lopez, M. H., 350, 354 Lopez, S. J., 271–273, 281 Lopez, S. R., 178–179 Losada, A., 397 Lott, B., 24–25 Louro Bernal, I., 65 Low, B., 317 Low, S., 327–328 Lowe, S., 186 Lowman, R., 295–296 Luavasa, M., 189 Luborsky, L., 177 Lucas, M., 300 Lucio, E., 263 Ludwig, J., 331 Lueck, K., 378 Lukyanova, V. V., 434 Luoma, J. B., 397 Lustig, K., 182, 185–186 Luthar, S., 193 Luxton, D. D., 310 Lykes, B., 291 Lynn, R., 141 Lyon, A. R., 468, 471 Lyons, H. Z., 218 Lyubomirsky, S., 273 Ma, D. S., 254 Ma, P.-W., 189 Ma, P. W. W., 189 Macartney, S. C., 358 Machleidt, W., 356 Macintosh, S., 390 Mackenzie, S., 316 Macnee, S., 402 Macrae, C. N., 250 Macrae, N. C., 250 Maddox, K. B., 250 Maddux, C., 434 Maddux, W. W., 251 Maercker, A., 245 Maestas, E. G., 414 Maestas, M. L., 263 Magaletta, P. R., 309, 319 Magical realism, 88–90, 93–94, 169, 285 Magner, C., 362

Maher, E. J., 197 Maiden, R. J., 451 Major, B., 262 Malcarne, V. L., 427 Maldonado-Perez, Z., 291 Malgady, R., 263–264 Malgady, R. G., 263 Malik, N. M., 389 Malley, J. C., 347 Malmin, M., 342 Manafo, E., 395 Manber, R., 310 Mance, J., 318 Manese, J. E., 256 Manly, J. J., 398 Mannarino, A., 203, 207 Mannarino, A. P., 197 Manson, S. M., 205, 265 Mao, S., 235 MAP. See Multicultural Assessment Procedure Maramba, G. G., 183 Marán, B. V., 266 Maranzani, B, 139 Marecek, J., 26 Marginalization, 63 Marginalized communities, 418–419 Marginalized groups, 227 Margullis, C., 260 Marín, G., 266 Markham, C. M., 246 Markides, K. S., 284 Marks, D. F., 29 Marks, S., 311–312 Markus, H. R., 346 Marmol, L., 357 Márquez-González, M., 397 Marsella, A., 414, 419 Marsella, A. J., 3–4, 85, 118–124 Marshall, C. A., 55 Marshall, D. S., 218 Martell-Otero, L. I., 291 Martin, D. C., 376 Martinez, C. R., 186 Martinez, C. R., Jr., 494 Martinez, J., 318 Martinez, M. J., 280 Martin–Zimmerman case, 249–258 Maselko, J., 396 Maslow, A., 271 Mason, L. B., 216, 434 Mass casualty incident, 412 Massey, D. S., 349 Mast, B. T., 400 Mastal, M. F., 410 Masuda, A., 397 Mather, M., 349 Mathew, J. T., 435, 438 Mathias, J., 409 Maton, K. I., 355

6 4 0       H a n d b o o k o f M u lti c u ltur a l Counseling

Matsumoto, D., 262 Matthews, C. R., 391 Mattis, J. S., 193 Mattsson, T., 435, 437, 443 Matusov, E., 327 Maxson, C. L., 333, 340 Maxwell, K. E., 361, 366, 368 Mayer, J. D., 361 Mayer, L. S., 326 Mayer, M. J., 325 Mayfield-Johnson, S., 287 Mayo, C., 261 Mays, V. M., 18 Mazzula, S., 79 McAuley, J., 346 MCC. See Multicultural counseling competencies McCabe, M., 406 McCabe, P. C., 385, 391–392 McCaffrey, R., 355 McCann, R. A., 310 McCave, E. L., 390–392 McClellan, M. J., 309 McClowry, S., 459, 461 McConahay, J. B., 253 McCoubrie, R. C., 267 McCoy, S. K., 262 McCreary, M. L, 216 McCurdy, S., 427 McCurry, S., 181 McDade, T. W., 252 McDavis, R. J., 13, 28, 45, 216, 295, 299, 322, 384, 434, 456 McDonald, J. D., 203, 206 McDonald, M., 272 McDougal, T., 352 McDowell, T., 26, 434–437 McElroy, E., 198 McFall, M. S., 317 McGahan, T. C., 450 McGhee, D. E., 252–253 McGoldrick, M., 431 McGuinness, T. M., 413 McGuire, T., 179 McIntosh, P., 434–436, 443 McIntyre, A., 27 McKenzie, K., 27 McKitrick, D. S., 260 McLeroy, K. R., 321 McMahon, T. R., 494 McNeil, K. A., 316 McNeill, B., 355–356 MCOD. See Multicultural organization development McRae, M. B., 287, 315 McTaggart, R., 195 McWhirter, E., 483 Media disaster coverage by, 415 violence portrayed in, 329–330 Medicine Wheel, 201 Mehl-Medrona, L., 288

Mehrabian, A., 262 Mehta, S., 409 Mehta, T., 397, 471 MEIM. See Multigroup Ethnic Identity Measure Meir, E. I., 474 Meise, U., 311 Meleis, A. I., 425 Meller, P., 141 Meller, P. J., 356 Mena, M. P., 383 Mendelberg, T., 325 Mendelson, T., 459–460, 465 Mendoza, D. W., 216, 218 Meng, X. L., 179 Mental disorders, 329 Mental health, 205 community, 321 cultural competence matches for, 180 disaster, 419–421 disparities in, in ethnic minorities, 179 of military veterans, 346–347 oppression and, 229 poverty effects on, 396 in rural communities, 449–454 stigma associated with, 355 Western notions of, 321 Mental Health: Culture, Race, and Ethnicity, 179 Mental health care, in rural communities, 396 Mental health care providers in integrated care settings, 409 public policy work by, 321 Mental health needs of American Indians, 159–160 of youth, 328–329 Mental health services, technology-mediated access issues, 307–308 boundaries in, 313–314 codes, 311–313 competence issues, 311–312 confidentiality, 312 efficacy of, 308–309 e-mail, 309–310 ethical complexities, 310–311 guidelines, 311–313 jurisdiction issues, 312–313 law, 311–313 legal complexities, 310–311 mHealth apps, 310 overview of, 306–307 social media, 313–314 standards, 311–313 telehealth, 307 texting, 309–310 Mental illness, 205 Mental wellness, 205 Mentoring, 92–93, 129–132, 136, 430 Merculieff, I., 361, 367 Mereish, E. H., 388 Merikangas, K. R., 328

I ndex

      6 41

Mertens, D. M., 239 Merz Nagel, D., 314 Meta-analysis, 177, 317 METCO, 152 Mexico, 351 Meyer, D. L., 421 Meyer, I. H., 386–388, 390 Meyer, O., 308 Meyer, O. L., 185, 288 Meyers, F. J., 321 Meyers, J., 387–388 Meyers, N., 337 Mezzich, J., 304 Mezzich, J. E., 304 mHealth apps, 310 Mickelson, R. A., 191 Microaggressions, 405 Middle Eastern Americans acculturative factors in, 427 case study of, 430–432 community relations in, 431 counseling of, 428–432 cultural competence in, 430 demographics of, 423–424 discrimination against, 425–426 family relations in, 431 governmental scrutiny of, 425 immigration of, 423–424 mainstream culture in, 427–428 mental health problems in, 425, 427 mentoring of, 430 post-traumatic stress disorder in, 426–427 premigration trauma in, 426–427 psychological well-being of, 426 racial classification of, 424 racism against, 424 research and assessment of, 424–428 sexual identity in, 431–432 Migration. See also Immigrants; Immigration; Refugees description of, 376–377 psychoanalytic perspective of, 383 Mihara, R., 391 Mild cognitive impairment, 398 Military culture, 342–343 Military sexual trauma, 344 Military values, 342 Military veterans community reintegration for, 345–346 counselor cultural competencies for, 341–342 definition of, 341 disabilities in, 343, 346 employment of, 345 homelessness in, 345 issues faced by, 343–345 mental health issues for, 346–347 physical wounds in, 343–344 polytrauma in, 343–344 population of, 341–342

post-traumatic stress disorder in, 344, 347 psychological wounds in, 343–344 self-sacrifice by, 341 sexual trauma in, 344 sociopolitical factors that affect, 342 suicide among, 344–345 traumatic brain injury in, 344 unemployment rates in, 346 vocational rehabilitation for, 345–346 Miller, A. M., 355 Miller, E., 345 Miller, G., 267 Miller, G. E., 317 Miller, J., 230 Miller, J. B., 151 Miller, L., 287 Miller, M., 331 Miller, M. L., 292 Miller, R. L., 468 Miller, S. D., 272 Miller, T., 319 Miller, T. W., 319 Miller, W. K., 346 Miller, W. R., 368 Miller Analogies Test, 82 Milligan, G., 413 Millings, A., 308–309 Milne, A. B., 250 Mimms, T., 282 Mindfulness, 94, 409 Mindfulness and acceptance-based behavioral therapies, 185 Miniconvention on Racism, 115–116 Ministry, 151 Minkler, M., 316 Minnesota Multiphasic Personality Inventory-2, 82–83, 169, 244, 263 Minority Fellowship Program, 9 Minority stress assessments, 268 Minority Student Group, 64 Miranda, J., 179, 181 Mishkind, M. C., 310 Misra, G., 243, 316 Mitchell, A. J., 454 Mitchell, J., 245 Mitchell, R. J., 316 Mittal, D., 347 MMPI-2. See Minnesota Multiphasic Personality Inventory-2 Moane, G., 21, 26, 320 Mobile-based technology, 245–246 Model Cities Program, 113 Model of Developing Intercultural Sensitivity, 493 Model of Optimal Human Functioning for People of Color, 274–275 Modern racism scale, 253 Modzeleski, W., 326, 331 Moe, J. L., 392 Mohatt, G., 206

6 4 2       H a n d b o o k o f M u lti c u ltur a l Counseling

Moise-Titus, J., 329 Molinari, V., 394 Moll, L. C., 194 Mollica, R., 381 Mona, L. R., 406, 408–409 Monahan, C., 246 Moncrief, A. M., 320 Montgomery, K. N., 189 Montiel, C. J., 302 Montoya, J. A., 218 Moody, H., 399 Moon, K., 263 Moore, B., 18, 20–21 Moore, J. L., III, 277–278 Moore, M., 204 Moore, R. B., 357 Moradi, B., 217, 265, 425 Moran, J. R., 265 Moran, T. A., 288 Morash, M., 378, 380 Morawski, J. G., 6 Moreno, M. V., 435 Morgan, R. D., 309, 319 Morin, R., 354 Morishima, J. K., 260 Morita therapy, 290 Morlock, L., 327 Morrell, H., 317 Morris, J., 459, 461 Morris, M. E., 310 Morris, P. A., 356 Morris, S. V. C., 21 Morrow, S., 243 Morrow, S. L., 301, 390, 479 Morse, A., 349 Morse, G., 33 Morten, G., 499, 501 Mortensen, L., 245 Moskowitz, D., 255 Moskowitz, G. B., 250 Motel, S., 350 Motivational interviewing, 368 Moulton, L. H., 423 Mourning, 397 Mousa, K. E. H., 432 Moxley, D. P., 247 Muchow, C., 79–80 Muggah, R, 352 Muhammad, M., 355 MUHSEN. See Muslims Understanding and Helping Special Education Needs Multicultural, defined, 72 Multicultural approach to diversity, 494–495, 497 Multicultural Assessment Procedure, 261 Multicultural competence components of, 21 institutional level of, 29 insufficiency of, among trainers and supervisors, 220 position paper on, 13

training for, 218, 220 tripartite model of, 217–218 Multicultural competency training description of, 433 multicultural self-awareness in, 433 Multicultural counseling category-based bias in, negative consequences of, 255–257 competence model in, 216 cross-cultural counseling versus, 299 definition of, 222 evidence-supported best instructional practices in, 223 feature-based bias in, negative consequences of, 257–258 future research areas for, 502–503 growth-focused approach, 223 legal considerations, 486–487 skill training in, 223–224 social justice in, 223 student-centered approach, 223 student expectations, 223 Sue’s three-dimensional illustration of, 216 supervisor training in, 223 teaching of, 223–224 training in. See Multicultural training Multicultural counseling competencies contextual variables in, 436 critical consciousness in, 436–437, 440, 444 description of, 433 difficult dialogues needed for development of, 437 intersectionality challenges in developing self-awareness in, 438–442 intersectionality variables in, 435 knowledge, 434 recommendations, 442–444 skills, 434 training, 435 Multicultural counseling movement advocates of, 47–48 devolution of, 46–50 evolution of, 44–46, 50 organizational changes in, 47 overview of, 43 pioneers in, 44–45 principles, assumptions, and actions of, 44–46 punitive actions effect on, 48 revolutionary character of, 44–46 summary of, 50 training programs affected by, 44 Multicultural ethics, 503 Multicultural identity, 222 Multiculturalism advocacy around, 40 American Psychological Association description of, 215 in American Psychological Association ethical standards, 35–36 as context, 222–223 deep structures of, lack of understanding of, 219–220 definition of, 490 diversity and, 490

I ndex

      6 4 3

positive psychology and, 280 sensitivity toward, 493 Multicultural organization development, 392–393 Multicultural personality, 369 Multicultural perspective, 87 Multicultural pioneers accomplishments of, 166–173 life stories of, 125–165 Multicultural positive psychology advancements in, 274–278 assessments, 276–277 challenges for, 281 Constantine and Sue’s Model, 274–275 in coping, 276 cultural-specific assessment measures, 277–278 current status of, 280–281 future directions for, 280–281 research in, 276 research opportunities in, 281 theory of, 274–275 Wong’s framework, 275–276 Multicultural psychology definition of, 3 focus of, 4 forces impacting, 5–7, 15 hallmarks of, 274 highlights of, 7–8 history of, 3–4 individual-level variables in, 274 interdisciplinarity in. See Interdisciplinarity life story narrative about, 118–124 movements that affected, 4 positive psychology and, connection between, 273–274 scientific racism effects on, 5–6 social justice effects on, 6–7, 278–280 strengths perspective in, 273 Multicultural self-awareness defenses, 439–441 description of, 433 foundational nature of, 434 intersectionality challenges in developing, 438–442 limitations in, 433–438 in multicultural competency training, 433 recommendations, 442–444 Multicultural spirituality beliefs fostered by, 285 characteristics of, 285 core assumptions of, 286 curanderismo, 285, 289 empowerment aspect of, 285–286 espiritismo, 285, 289 Feeding Your Demons, 290 healing and, 287–288 Hooponopono, 290 liberation aspect of, 285–286, 291–292 Morita therapy, 290 Naikan therapy, 290–291 Ntu psychotherapy, 290 origins of, 284–285

overview of, 282–283 psychologists and, 292–293 psychotherapies based on, 288–291 Santeria, 285, 289–290 summary of, 293 syncretism, 285–287 therapies based on, 288–291 Tibetan Bon, 290 wellness and, 287–288 Multicultural supervision centrality of, 223 conducting of, 221 critical analysis of, 219–221 current state of, 219–221 description of, 218–219 integration of, 223 narrow understanding of, 221 underemphasis on, 221 Multicultural training centrality of, 223 competencies targeted in, 217 conducting of, 221 Council for Accreditation of Counseling and Related Educational Programs, 216 course content of, 217 critical analysis of, 219–221 current state of, 219–221 delivery of, 216–217 effectiveness of, 218 ethnic diversity as focus of, 217 focus of, 222 future challenges for, 221–224 goals of, 220–221 growth of, 12 inclusiveness levels, 215 instructional methods used in, 217–218 instructors, 217–218 integration of, 223 multicultural competence promotion by, 217–218 process goals of, 221 programs for, 437 racial diversity as focus of, 217 reasons for, 220 social justice inclusion in, 215–216 theoretical framework of, 216 training versus, 221 Multigroup Ethnic Identity Measure, 265 Multilingual development and training, 503 Multinational Work Importance Study, 475 Multon, K. D., 476 Muñoz, R. F., 309–310 Muran, J. C., 188 Murphy, C. M., 287, 308 Murray, C., 327 Murray, H. A., 262–263 Murray, K. M., 327 Murray-García, J., 304 Muscanell, N. L., 308 Muslims, 423, 425–426. See also Middle Eastern Americans

6 4 4       H a n d b o o k o f M u lti c u ltur a l Counseling

Muslims Understanding and Helping Special Education Needs, 429 Mustanski, B., 246 Myers, R. A., 11 Myrick, H., 246 Mysticism, 285 NAACP. See National Association for the Advancement of Colored People Naber, N., 423–424 Nadal, K. L., 189, 361, 387–388, 426 Nagata, D. K., 143 Nagata, D. N., 240 Nagayama Hall, G. C., 494 Nagda, B. A., 361, 368 Nagda, B. R., 361, 363 Naikan therapy, 290–291 Narang, S., 377 Narrative techniques, 272 Nash, R. J., 361–362 Nash, S., 358 Nasseri, K., 423 Nastasi, B. K., 357 Nathan, J. S., 262 National Association for the Advancement of Colored People, 370 National Board for Certified Counselors, 297 National Center for Veterans Analysis and Statistics, 341 National Child Traumatic Stress Network, 207 National Conference on Graduate Education in Psychology, 11 National Conference on the Psychological Aspects of Aging, 8 National Institute for Multicultural Counseling, 43, 45–46 National Latina/o Psychological Association, 37 National Latino and Asian American Study, 380 National Multicultural Conference and Summit, 13, 361 Nation of Islam, 291 Native Americans. See also American Indians historical trauma suffered by, 415 Medicine Wheel, 201 Natural disasters, 412 Nature of Prejudice, 33 Navarro, R. L., 473, 478 Nazroo, J. Y., 316 NBCC. See National Board for Certified Counselors Neckerman, H. J., 339 Neff, D., 194 Negros, 97–98, 108–109 Neimeyer, G. J., 217 Neimeyer, R. A., 397 Nelson, A., 179 Nelson, C. J., 267 Nelson, E., 452 Nelson, P. D., 302, 304 Nelson, S., 253 Nemeroff, T., 361 Nepomuceno, C. A., 256 Nesbitt, T. S., 321

Neuberg, S. L., 250 Neuhauser, L., 316 Nevill, D. D., 475 Neville, H. A., 224, 274, 276 Newcomb, T. M., 183 Newell, W. H., 316 Ng, V., 382, 386 NGOs. See Nongovernmental organizations “Niche of resistance,” 21 Nickerson, A. B., 325, 331 Nickerson, D. M., 427 Nicolas, G., 268, 381 Niehardt, J. G., 200 Niles, S., 295, 298 Niles, S. G., 475 Nill, A., 353 Nilsson, J. E., 300 Nisbett, R. E, 85 Nkomo, S. M., 189 NLAAS. See National Latino and Asian American Study NMCS. See National Multicultural Conference and Summit Noack, M. G., 398 Noboa, J., 335, 338 Noguera, P., 325 Nongovernmental organizations, 298 Norasakkunkit, V., 272 Norat, G., 90 Norcross, J. C., 178, 224, 308 Nordin, C., 246 Norenzayan, A., 85 Norris, A. E., 427 Norris, T., 488 Norsworthy, K. L., 298–300, 320 North African Americans, 427 Nosek, B. A., 18, 253 Nosek, M. A., 406–407 Nota, L., 277 Novotny, C. M., 183 Ntu psychotherapy, 290 Nunez Molina, M., 90 Nuss, C. K., 228 Oades-Sese, G. V., 264 Oakes, M. A., 254 “Obamacare.” See Patient Protection and Affordable Care Act Oberoi, A. K., 434 Obesity, in people with disabilities, 407 O’Brien, K. K., 379 O’Brien, K. M., 224, 478–479 O’Callaghan, J., 272 Ockene, J. K., 178 O’Connell, M. E., 329 O’Connor, E., 459, 461, 466 OEMA. See Office of Ethnic Minority Affairs Oetting, E. R., 265 Office of Ethnic Minority Affairs, 10, 93, 114–115, 169 Oh, H., 346 Okazaki, S., 260, 317

I ndex

      6 4 5

Okoro, C. A., 331 Okubo, Y., 193–194 Olafsson, R. F., 325 Older adults age discrimination against, 398–399 assessment of, 400 bereavement in, 397 caregiving by, 397–398 cognitive decline in, 398 deficits of, 400 dementia in, 398 diversity intolerance by, 399 gender of, 396–397 grandparenting by, 397–398 group therapy for, 399 health disparities in, 395 health literacy of, 395 issues that affect, 395–397 medical health problems in, 395 minority, 399 population growth of, 394–395 poverty in, 396, 399 psychological treatments for, 395 psychotherapeutic interventions for, 399–400 religiosity of, 396 rurality of, 396 sexual intimacy barriers for, 399 social justice issues for, 398–399 stereotypes about, 394 women as, 397, 399 Olfson, M., 356 Olitzky, S. L., 264 Olkin, R., 401–403, 408 Olneck, N., 434 Olson, M. A., 253 Omidian, P. A., 425 O’Neil, R. M., 360, 362 Onoue, M. A., 265 Operation Enduring Freedom, 427 Operation Iraqi Freedom, 343, 427 Oppression, 70 marginalized groups affected by, 227 mental health and, 229 social exclusion theory of, 227 Orchard, S., 391 Orleans, C. T., 178 Orliffe, J. L., 247 O’Rourke, K., 379, 381 Orrell, M., 398 Orsillo, L., 182 Ortiz, M. Z., 287 Ortman, J. M., 395, 488 Ory, M. G., 448 Osher, D., 325–328 Osher, T. W., 328–329 Oswald, D., 325 Otero, A., 304 Otero-Sabogal, R., 266 O’Toole, M. E., 326

Ottaway, A., 280 Otten, S., 250 Otto, M. W., 383 Ouellett, M. L., 392–393 Overstreet, S., 334 Owen, J., 435 Ozer, E. J., 277, 459, 461, 465 Ozgis, S., 398 Pace, B. T., 435 Pace, T., 244 Pachana, N., 400 Pacific Islanders religious diversity among, 283–284 spirituality among, 283–284 Padela, A. I., 428 Padilla, A. M., 272, 300 Padilla, G. V., 266 Pain, H., 240 Palestinian refugees, 426 Palinkas, L. A., 319, 322 Palmer, N. A., 219, 386–388 Paloutzian, R. F., 267 Panday, J., 303 Pannu, R. K., 193 Parchman, M., 402 Parent-Child Interaction Therapy, 468 Parham, T., 45, 289, 293 Parham, T. A., 126–127, 134–135, 191, 300 Paris, D., 189, 194 Paris, R., 377 Park, B., 252, 254 Park, H., 449 Park, Y. S., 295 Parker, E. A., 321 Parker, P., 361 Parker, P. N., 361 Parker, V., 316 Parkinson Zamora, L., 89–90 Park-Taylor, J., 322, 382 Parra-Cardona, J. R., 353 Parrish, T., 413–414 Parsons, B. V., 339 Participant-employed photography, 246–247 Participatory action research, 230, 244 community based, 321 Pasque, P. A., 366 Passel, J. C., 6 Passel, J. S., 307, 349–350, 353, 487 Pasupathi, M., 394 Patient Centered Medical Home, 402, 406 Patient Protection and Affordable Care Act, 402, 406 Patrick, A. R., 309 Patrick, R., 258 Patterson, J. H., 352 Patterson, T., 314 Patton, M. J., 11 Paul, M. E., 246 Paulsen, C., 395

6 4 6       H a n d b o o k o f M u lti c u ltur a l Counseling

Pavelski, R., 357, 384 Payne, A., 255 Payne, B. K., 252, 254 Payton, G., 292 PCIT. See Parent-Child Interaction Therapy Pearce, M., 472 Pearson, G., 332 Pedagogy of the Oppressed, 436 Pedersen, P., 82, 256, 273, 297, 301 Pedersen, P. B., 32, 48–49, 217, 221, 256, 357, 369, 499, 501 Pedersen, P. L., 11, 13 Pedrotti, J. P., 273, 278 Pedrotti, J. T., 272–274, 278, 280–281 Pedroza, R., 285 Peng, K., 85 Penk, W. E., 319 Penner, L. A., 252, 255 People of color. See also African Americans post-traumatic stress disorder in, 78 religious diversity among, 283–284 soul wounds in, 284–285 spiritual connectedness among, 283–284 spirituality assessments in, 292 syncretism in, 284–287 People with disabilities ADDRESSING model for, 403–404 case illustration of, 409–410 chronic health problems in, 407 clinical concerns for, 406–407 cognitive-behavioral therapy for, 408–409 communication with, 405–406 culturally competent treatment for, 408–409 definition of, 401 disability affirmative therapy for, 408 evidence-based practices for, 408–409 health disparities in, 407 ideals of, 403 intimate partner violence in, 406–407 Microaggressions experienced by, 405 obesity in, 407 Patient Centered Medical Home, 402, 406 prevalence of, 401–402 provider’s role in care of, 409 psychological well-being of, 406 quality of life in, 406 self-conceptualization of, 403 stigma experienced by, 405 summary of, 410 telephone-based counseling of, 409 tobacco use by, 407 unemployment of, 407 values of, 403 women, 406 Perera-Diltz, D., 392 Perez, J. E., 310 Perez, L. M., 318 Perez, P., 353 Perez, R. M., 390

Perez, W., 300 Perez-Firmat, G., 67 Peréz-Gualdrón, L., 188, 194 Pérez-Sales, P., 24 Perez-Stable, E. J., 266 Performance, as innovative approach, 248 Performance ethnography, 240 Perkins, S., 235 Perrett, D. I., 250 Perry, A., 409 Perry, D. F., 381 Perry, J. C., 458, 483 Perry, K. E., 414 Personal Dimensions of Identity model, 443 Personal Information Protection and Electronic Documents Act, 310 Personality tests, 263–264 Personality types, 473–474 Person-in-Culture-Interview, 261 Peruche, B. M., 254 Petaia, L. S., 190 Petersen, C. H., 277 Peterson, C., 272 Petrino, K., 391 Pettigrew, T. F., 362 Petty, R. E., 251 Petz, D., 411 Pfeffer, D. S., 346 Pfund, R. A., 308 Phan, L. T., 434 Phelps, E. A., 255 Philanthropy, 18–19 Phillips, 290 Phillips, C., 219 Phillips, C. M., 330 Phillips, J., 391 Phinney, J., 300 Phinney, J. S., 265, 403 Phoenix, A., 189 Photovoice, 246–247 Phung, A. H., 263 Piacentini, J., 178 Pich, V., 383 PICI. See Person-in-Culture-Interview Pickett, T., Jr., 434 Pickren, W. E., 6, 295 Piedra, L. M., 356 Pieterse, A., 79–80, 434, 437 Pieterse, A. L., 216–217 Pietromonaco, P. R., 449 Pietrzak, R. H., 347 Piland, A., 492 Piland, W. E., 492 Pilkington, N. W., 386–388 Pilver, C. E., 319 Pinheiro, P. S., 324 Pinquart, M., 398 Pinzon, C., 287 Pipher, M., 320

I ndex

      6 4 7

Pires, S., 355 Pitner, R. O., 29 Pituc, S. T., 189, 192–194 PL. See Psychologists League Placier, P., 366 Plant, E. A., 254 Plassman, B. L., 398 Plaut, V. C., 449, 494 Pledger, C., 401, 408 Plowhead, A., 396 Podolski, C., 329 Poirier, J., 325 Polanin, J., 328 Pole, N., 89, 179 Pollio, D. E., 308 Polo, A. J., 245, 458 Polytrauma, 343–344 Pomeroy, C., 321 Ponce, N. A., 355 Ponterotto, J., 301 Ponterotto, J. G., 11, 13, 43, 46, 141, 189, 218–220, 259, 262, 315, 356, 360, 369 Poortinga, Y. H., 303 Pope, C. A., 345 Pope, K. S., 181–182 Pope-Davis, D. B., 12 Porché-Burke, L., 315, 361 Porfeli, E., 476 Porfeli, E. J., 475 Portes, A., 300–301 Positionality case stories of, 22–24 description of, 21–22 Positive psychology advancements in, 274–278, 281 challenges for, 281 criticisms of, 272 culturally-embedded, 272–273 cultural-specific assessment measures used in, 277–278 current status of, 280–281 future directions for, 280–281 growth of, 271 history of, 271–272 multicultural. See Multicultural positive psychology multicultural psychology and, connection between, 273–274 “newness” of, 271–272 research opportunities in, 281 social justice-oriented, 278–280 training classes in, 280 Post, B. C., 189 Post-traumatic stress disorder, 77–78, 207, 287–288 in gang-involved youth, 337 in Middle Eastern Americans, 426–427 in military veterans, 344, 347 in refugees, 379, 383 stigma associated with, 347 Poteat, V., 453 Poteat, V. P., 388–389 Poudrier, J., 247

Poulos, Christopher N., 241 Poverty description of, 25–26, 122 migration because of, 351 in older adults, 396, 399 in rural communities, 449 Powell, K., 248 Power, 26–27 Prause, J., 324 Prejudice definition of, 250 individuating features in, 251–252 social categorization in, 250–251 President’s New Freedom Commission, 179 Prest, L. A., 267 Pretorius, T. B., 277 Priester, P. E., 217–218, 224 Prilleltensky, I., 43–44, 229–230, 246, 317–318, 320 Prince, M., 307 Privilege, 26–27, 29 Privileged Identity Exploration model, 443 Problem Solving Inventory, 277–278 Procedural justice, 19–20 Prochaska, J. O., 308 Professional organizations, 135 Professional values, 39 Project Homeless Connect, 25–26 Project Making Medicine clinical training program, 197, 207 Prophetic Christianity, 291 Protestants, 284 Proudfoot, J., 246 Prout, H. T., 391 Provost, C., 412 PSI. See Problem Solving Inventory Psychic numbing, 337 Psychological assessments. See also Assessments behavioral observations, 261–262 bodily expressions, 262 clinical interview, 259–260 cultural validity of, 260 diagnosis, 260–261 eye contact, 261–262 facial expressions, 262 genograms used in, 293 language, 262 multicultural considerations in, 260–261 overview of, 259 speech, 262 summary of, 268 Psychological distress, 380, 384 Psychological Ethics and National Security, 39 Psychological first aid, for disasters, 421 Psychological harm, 77 Psychological measures House-Tree-Person, 262, 264 intelligence tests, 264 Minnesota Multiphasic Personality Inventory-2, 82–83, 169, 244, 263 overview of, 262

6 4 8       H a n d b o o k o f M u lti c u ltur a l Counseling

personality tests, 263–264 Rorschach, 263–264 Strong Interest Inventory, 264 Tell-Me-A-Story, 263 Thematic Apperception Test, 262–263 vocational interests, 264 Wechsler scales, 262, 264 Psychological Storms: The African American Struggle for Identity, 134 Psychological testing, 140–141 Psychological Treatment of Ethnic Minority Populations, 14 Psychological well-being, 267 Psychologists as academic leaders, 485–486 advocacy training for, 321–322 interdisciplinary social justice training for, 321–322 liberation, 291 multicultural spirituality and, 292–293 private conduct of, 32 self-healing by, 293 spirituality/religiosity self-assessments by, 293 Psychologists League, 6 Psychology “acultural” nature of, 4 cultural difference movement in, 72 culture in, 316 experimental, 4 global-community, 120 liberation, 26 origin of term, 3 positive. See Positive psychology scholars involved in, 4 scientific bases of, 91 Psychology of Blacks: Centering Our Perspectives in the African Consciousness, 134 Psychology of working perspective, 479–480 Psychopolitical validity, 229–230 Psychotherapy community praxis activities versus, 230 evidence-based. See Evidence-based psychotherapies magical realism in, 93–94 multicultural spirituality, 288–291 Ntu, 290 for older adults, 399 Publishing, 136 Puchala, C., 288 Puente, A. E., 262 Puerto Rico, 64–65, 67–70, 89–92 Pumariega, A. J., 375, 377, 380 Pumariega, J. B., 375, 377 Purdie, V. J., 250, 325 Purdie-Vaughns, V. J., 251 Purtle, J., 415 PWD. See People with disabilities Pyle, C. M., 267 Qin, B., 378 Qualitative Strategies in Ethnocultural Research, 143 Quamma, J. P., 339 Quero, S., 309

Questioning youth, 386 Quevillon, R. P., 413 Qui, X., 327 Quimby, E., 320 Quintana, S., 187 Quinton, W. J., 262 Quizon, C. A., 193 Quotas, 487 Qureshi, A., 72 Race. See also specific race definition of, 178–179 intelligence test differences based on, 264 research on, 71–80 traumatic stress research based on, 77–80 Race-Based Traumatic Stress Symptom Scale, 79–80, 268 Race-Related Events Scale, 268 Rachal, J. R., 287 Racial and ethnic minority evidence-based psychotherapies, 183–184, 186 Racial bias description of, 122 explicit, 252 implicit, 252–253 Racial classifications, 179 Racial-Cultural Counseling Lab, 76 Racial-cultural researcher, 71–72 Racial differences deficit models of, 273 deprivation models of, 273 description of, 121–122 Racial discrimination, 78 Racial diversity, 217 Racial encounters, 77 Racial groups demographic changes for, 487–488 growth of, 6 mental health services underutilization by, 179 Racial identity assessment of, 266 definition of, 266 description of, 99 development of, case study of, 147–148 difficult dialogues on, 369 Racial Identity Theory and Measures, 80 Racial oppression, 72 Racial profiling, 326 Racial socialization, 99 Racism assessment of, 268 aversive-hostile, 79 avoidant, 79 hostile, 79 against immigrants, 354 life story of, 96 scientific, 5–6 self-exploration in, 76 vagueness associated with, 78

I ndex

      6 4 9

Radiation emergency, 412 Radical empathy, 293 Raffaelli, M., 288 Raley, J. D., 355 Ramage, M. T., 264 Ramirez, R., 353 Ramniceanu, J., 290 Ramos, K., 482 Randall-David, E., 247 Randazzo, M. R., 329 Rao, M. A., 327 Rao, S., 454 Ratts, M. J., 220, 279, 318 316, 320, 385, 392, 434 Rausch, M. K., 325 Rawls, J., 239 Rayner, K., 409 RBTSSS. See Race-Based Traumatic Stress Symptom Scale Read, J. N. G., 424 Realistic, Investigative, Artistic, Social, Enterprising, and Conventional assessment, 264, 474 Reardon, E., 410 Rebok, G. W., 326, 398 Reddy, M., 326 Redington, R. M., 225 Reed, G. M., 304 Rees, C., 309 Reese, L. E., 456 Reese, R. J., 309, 452 Reference groups, 71–72 Refugees. See also Immigrants acculturative stress in, 377–379 cognitive-behavior therapy for, 383 counseling approaches for, 382–384 description of, 350–351 discrimination against, 379 English language proficiency in, 378 interpersonal violence against, 379–380 mental health issues for, 380–382 migration of, 376–377 mourning by, 377 Palestinian, 426 post-traumatic stress disorder in, 379, 383 psychological distress in, 380, 384 scapegoating of, 378 statistics regarding, 375 transnationalism in, 379 traumatic stress in, 379–380 women as, 376, 383–384 Regents of the University of California v. Bakke, 487 Reger, G. M., 310 Regional organizations, 296–297 Regis, A. K., 442 Reich, J. A., 316–317 Reich, S. M., 316–317 Reichard, A., 402, 407 Reid-Marks, L., 426 Reiki, 287 Reingold, E., 485 Reinke, W. M., 327

Reis, B. F., 260 Reiser, R., 319, 322 Relational/cultural paradigm, 483 Relational-cultural therapy, 230 Relaxation, 210 Religion. See also Spirituality description of, 57–59 diversity of, among people of color, 283–284 Religiosity, of older adults, 396 Religious differences, 122–123 REMEBPs. See Racial and ethnic minority evidence-based psychotherapies Rendell, P. G., 398 RES. See Race-Related Events Scale Research, 134–135 cross-cultural, 301–302 ethical guidelines encouragement of, 41–42 on race, 71–80 in racial oppression, 72 Research training, strengths-based approach to, 280 Resnick, M., 327 Restorative justice, 20–21 Retributive justice, 20–21 Revised-Multidimensional Inventory of Black Identity, 266 Reyes, G., 304 Reyes-Ortiz, C. A., 284 Reynolds, A., 217, 221 Reynolds, A. L., 217, 220, 388 Reynolds, C. F., 397 Reynolds, D. K., 290 Reza, A., 331 Reza, J. V., 28–29 Rhew, S., 354 Rhoten, D., 316 RIASEC assessment. See Realistic, Investigative, Artistic, Social, Enterprising, and Conventional assessment Rich, E., 402 Richards, C. S., 317 Richards, G., 6 Richardson, D., 316 Richeson, J. A., 252, 262 Ridgeway, C. L., 317 Ridley, C. R., 216, 218, 260–261, 435 Rikard-Figueroa, K., 267 Rinaldi, A. P., 346 Rintala, D. H., 406–407 Ripski, M. B., 325, 327 Risen, J., 15 Risner-Butner, A., 216, 434 Ritchie, P., 303 Ritzler, B., 263 Rivera, D. P., 327, 361, 426 Rivera, E. T., 90 Rivera, L. M., 266 Rivera Ramos, E., 90 Riviere, L. A., 347 Rivkin, I., 453 R-MIBI. See Revised-Multidimensional Inventory of Black Identity

6 5 0       H a n d b o o k o f M u lti c u ltur a l Counseling

Robbins, R., 244 Robers, S., 325, 331 Roberto, A. J., 246 Roberts, J. V., 20 Roberts, L., 309 Robertson, D., 447 Robinson, C. C., 318 Robinson, M., 24, 385 Robinson, N., 247 Robinson, W., 450 Robinson-Zañartu, C., 243 Robitschek, C., 281 Rochlen, A. B., 311 Roderick, L., 361, 367 Rodgers, A., 309 Rodolfa, E., 435 Rodriguez, E., 459, 461 Rodriguez, K. H., 265 Rodriguez, K. L., 195, 248 Rodríguez, M., 284, 355 Rodríguez, M. M. D., 219 Rodriguez-Quintana, N., 278 Roehl, H., 362 Roehlke, H., 219 Roemer, L., 182 Rogers, J., 320 Rogge, M. E., 361 Rogler, L. H., 263 Rollnick, S., 368 Rome, J. D., 318 Romero, L., 231 Romero-Moreno, R., 397 Romesser-Scehnet, J. M., 409 Romi, S., 327 Romo, H. D., 242 Rones, M., 458 Roosevelt, F. D., 139 Rorschach, H., 262–264 Rorschach Comprehensive System, 263–264 Rosenberg, E., 320 Rosen D., 224 Rosenfeld, B., 267 Rosenthal, D. A., 256 Rosenzweig, L., 231 Rothe, E., 375, 377 Rottinghaus, P. R., 271 Rounds, J., 474 Routenberg, R., 361 Rowe, M., 322 Rowland, S., 92 Rowley, S. A. J., 266 Royan, L., 398 Roysircar, G., 18, 24, 274, 434 Rubinson, F., 385, 391–392 Rucker-Sobczak, L., 185 Ruffin, B., 288 Ruiz, E., 384 Rumbaut, R., 300

Rural definition of, 448 as social location, 449 stereotypes associated with, 448 Rural communities barriers to service in, 450–451 definition of, 447 descriptors of, 447–448 disaster effects on people living in, 414 early interventions in, 453–454 education disparities in, 449 first responders for, 454 integrated behavioral healthcare for, 453 mental health in, 449–454 mental health provider shortages for, 451–452 nonspecialist professionals in, 454 overview of, 447 population statistics, 454 poverty in, 449 psychological practice for, 451–452 school-based interventions in, 453 as social location, 449 telepsychology for, 452–453 unique needs of, 449–450 values in, 449 Rurality, 396, 447 Russell, G. M., 291 Russell, J. A., 262 Russell, J. C., 25 Russell, K. Y., 257 Russell, S. T., 388–389 Russon, J. M., 320 Ruth, R., 377 Rutherford, A., 295 Rutter, P. A., 391 Ruzek, J., 318 Ryan, C., 388–389 Ryan, R. M., 480 Rytina, N., 349 Saad, C., 380 Saavedra, J., 304 Sabogal, F., 266 Sadler, M. S., 250 Sadowski, C. A., 395 Saewyc, E. M., 355 Safety emotional, 325 in schools, 325 Safran, M. A., 307 SAI. See Spirituality Assessment Inventory Sakamoto, I., 29 Saklofske, D. H., 264 Saleeby, D., 272 Salloum, I., 304 Salvatore, J., 252 Sam, D. L., 300 Samhan, H. H., 424 Sammons, C. C., 218, 224

I ndex

      6 51

Sampson, R. J., 327 Sanchez, F. J., 361 Sanchez, J., 388–389 Sanchez, M., 288 Sánchez, R. M., 349 Sanchez-Burks, J., 494 Sandage, S. J., 273–274 Sanderson, W. C., 181–182 Sanford, E., 475–476 San Francisco State University, 25 Sanger, D. D., 21 Saniotis, A., 309 Sankei Shimbun, 420 Sanna, L. J., 280 Sant-Barket, S. M., 79 Santeria, 285, 289–290 Santisteban, D. A., 245, 383 Santos, R., 353 Sathasivam-Rueckert, N., 380 Satzewich, V., 379 Saunders, H., 365 Saunders, S. M., 292 Savage, T. A., 391 Saver, B. G., 256 Savickas, M. L., 475–477 Sawyer, S. M., 402 Saxon, A. J., 344 SBCM. See Strength-Based Counseling Model SCCT. See Social cognitive career theory Schaaf, K., 345 Schaaf, K. W., 318 Schaffer, F. P., 360 Schaie, K. W., 400 Schank, J. A., 451 Schauer, E. J., 21 Schechner, R., 240 Schedule of Racist Events, 268 Scheithauer, H., 324 Schellinger, K. B., 328 Scheuermann, T. D., 79 Schingaro, N., 242 Schirch, L., 362, 366–367 Schlemmer, E., 318 Schmidt, M., 231 Schmidt, S., 197, 201, 207 Schneider, B., 328 Schneider, M. S., 388 Schoem, D., 362, 366 Scholarship description of, 134–135 game-changing transformations of, 231–234 School(s) emotional safety in, 325 environment of, youth violence and, 327 Gay Straight Alliances in, 389 homicides in, 331 LGBTQ youth affected by, 389, 393 safety of, 325

youth violence in, 324–325 zero-tolerance discipline in, 326–327 Schore, A. N., 308 Schorr, L. B., 232–233 Schotland, M., 277 Schultheiss, D. E. P., 483 Schultz, J., 388 Schulz, A. J., 321 Schulz, E., 287 Schumacher-Matos, E., 376 Schwartz, J. L. K., 252–253 Schwartz, R. C., 219 Schwartz, S. J., 380 Science-oriented programs, 298 Scientific racism multicultural psychology affected by, 5–6 origins of, 5 tenets of, 5 Scogin, F. E., 399 Scott, E. L., 267 Sears, D. O., 253 Segerstrom, S. C., 317 Segoria, J., 346 Sekaran, U., 474 Self-healing, 293 Self-reflective dialogue, 367 Seligman, M. E. P., 271–273 Sellers, R. M., 266 Selwyn, B. J., 427 Semistructured clinical interview, 260 Senate Democratic Policy Committee, 114 Sequential Priming Task, 253 Serrano-García, I., 18 Serwacki, M, 331 Setton, D., 199 Seven Sacred Directions, 201 Seventh Direction, 202 Sex Discrimination Ordinance, 86 Sexual identity, in Middle Eastern Americans, 431–432 Sexual intimacy barriers, for older adults, 399 Sexual orientation, 99 Sexual trauma, 344 Shackelford, A. L., 343, 346 Shah, A. E., 399–400 Shaheen, J., 424 Shaker, L., 256 Shallcross, L., 216–217, 219–220 Shamanism, 289 Shamanistic healing, 94 Shapira, N., 309 Shapira, N. A., 245 Sharf, B. F., 256 Sharkey, J. D., 331 Sharpe, T. H., 399 Shaw, J., 321 Shawahin, L., 426 Shaw-Ridley, M., 435 Shea, J. M., 247 Shea, M., 189

6 5 2       H a n d b o o k o f M u lti c u ltur a l Counseling

Shear, K., 397 Shear, M. K., 181 Sheely-Moore, A. I., 318 Shegog, R., 246 Sheldon, R., 333 Shelton, J., 252 Shelton, J. N., 262 Shelton, N., 266 Shen, E. K., 383 Sherman, D. K., 262 Sherrill, J. T., 178 Sherwood, J., 243 Sheu, H., 478 Sheu, H. B., 477 Shin, S., 255 Shin, S.-M., 183 Shinshu Buddhism, 290 Shirai, Y., 285 Shirk, D. A., 352 Shoeb, M., 381–383 Shoham, V., 181–182 Shore, J., 312 Shore, J. H., 311–312 Short, E. L., 315 Shulman, H., 18, 317, 320 Siddiqui, N., 415 Sieberer, M., 356 Siegel, D. J., 308 Siegel, M., 292 Silbereisen, R., 303 Silovsky, J., 197, 207 Silovsky, J. F., 198 Silver, H., 227 Silver, R. C., 324 Simon, R. J., 349 Simoni, J., 243 Simoni, J. M., 274, 287 Simons, A. B., 326 Simons, R., 4 Simpson, L. R., 191 Singer, B., 177 Singh, A. A., 385–386, 392–393 Singh, S., 480 Single-category Implicit Association Test, 253 Sipes, J. L., 198–199, 201, 204 SI. See Strong Interest Inventory Siu, T. W. Y., 194 Skaar, N. R., 477 Skiba, R., 325 Skiba, R. J., 325 Skovholt, T. M., 402, 451 Slavery, 100 Sloan, T., 28 Slone, N. C., 309–310, 452 Smalley, K., 449, 452 Smart phones, 308 Smedley, B., 179 Smith, B. L. R., 361 Smith, C. A., 240

Smith, D., 191 Smith, D. G., 361 Smith, E. J., 11, 13, 32, 278–279 Smith, G. H., 188, 190 Smith, J. M., 346 Smith, K., 406 Smith, L., 225, 227–231, 233–235, 243 Smith, L. A., 267 Smith, L. C., 189 Smith, L. T., 188–190, 233, 243 Smith, M., 448 Smith, M. A., 266 Smith, M. B., 6 Smith, M. L., 177 Smith, M. P., 327 Smith, N., 395 Smith, P. K., 325 Smith, P. L., 474 Smith, S., 79 Smith, T., 183–184 Smith, T. B., 184–185, 218, 245, 255 Smith, T. J., 24 Smith-Osborne, A., 346 Smoking cessation research, 317–318 Smyth, K. F., 232–233 Snell, F. I., 344 Snow, P. C., 21 Snow, S., 241 Snowden, Lonnie R., 18 Snyder, C. R., 272, 281 Soares, N., 452 Sobhanian, F., 309 Söchting, I., 383 Social and emotional learning, 328 Social change, 19 Social class, 242 Social cognitive career theory, 477–479 Social-ecological child development, 114 Social equity, 229 Social exclusion/inclusion, 227 Social exclusion theory, 227 Social justice advocacy for, 117, 170, 434 altruism and, 226 challenges for, 28 client worldview and, 29 in counseling, 223, 279, 385 definitions of, 17–18, 239 empowerment in, 115 examples of, 24–27 factors that affect, 15 goal of, 6, 385 in immigrant interventions, 358 injustice and, 28 in interdisciplinary health work, 319–320 in multicultural counseling, 223 multicultural psychology affected by, 6–7, 278–280 in multicultural training, 215–216 in older adults, 398–399

I ndex

      6 5 3

positionality and, 21–22 positive psychology oriented toward, 278–280 psychologist training in, 321–322 recommendations for, 28–29 skills in, 24–27 spirituality and, 150–151 unattainability of, 28 vocational psychology and, 472 in vocational research and practice, 483 Social location and context, 141–143 Social media, 313–314 Social norms, 378 Social processes, 70 Social service, 18–19 Social victimization, 325 Social work, 272 Society for Research in Child Development, 114, 273 Society for the Psychological Study of Social Issues, 6 Society of Indian Psychologists, 9, 37 Society of Pediatric Psychology, 158 Socioeconomic status, 27, 302 Sodowsky, G. R., 265 Sola, A. B., 260 Solomon, M., 308, 425 Solution-focused therapy, 272 Somatization, 260 Somervell, P., 265 Son, J. B., 355 Sondheim, S., 107 Song, M., 335 Song, W. Z., 84–85 Songer, D., 396 Sonn, C. C., 317 Sorensen, N., 368–369 Sörensen, S., 398 Soth, A. M., 435 Soto, G. L., 287 Souchek, J., 256 Soule, C., 469 Soul wounds, 284 Southwest Direction, 202 Southwick, S. M., 347 Soygüt, G., 304 Spanierman, L. B., 435, 443, 474 Sparks, E., 18 Spector, A., 398 Speech, in psychological assessment, 262 Speight, S. L., 18, 216, 218, 223–224, 320, 385 Spelman College, 153–154 Spence, J., 206 Spencer, M., 246–247, 354 Spencer, M. S., 459–460, 465, 467 Spencer, O., 37 Spencer, S. J., 255 Spergel, I. A., 333, 335 Speros, C., 395 Speyer, C., 311 Spickard, P., 257

Spielmans, G., 178 Spier, E., 325 Spiritual genogram, 292 Spirituality action-oriented, 285 in African Americans, 283, 285, 287–288 in American Indians, 283 in Asian Americans, 283–284 assessment of, 267–268, 292 definition of, 267 description of, 57–59, 150–151, 282 healing and, 287–288 lived, 285 in Pacific Islanders, 283–284 psychological well-being and, 267 psychotherapist’s sensitivity during assessment of, 292 syncretism, 284–287 wellness and, 287–288 Spirituality Assessment Inventory, 267–268 Spiritual journaling, 293 Spiritual Well-Being Scale, 267 Sporner, M. L., 346 Sprague, J., 326 Sprang, R., 452 Spry, T., 240 SPSSI. See Society for the Psychological Study of Social Issues SPT. See Sequential priming task SRE. See Schedule of Racist Events Srinivasan, S., 192 Sriram, N. N., 253 Srivastava, K., 280 Stafford, J., 344 Stalans, L. J., 20 Stanford, M. S., 396 Stark, C., 411 Staton-Tindall, M., 452 Staudinger, U. M., 398 Stec, B., 313 Steckler, A., 321 Steinman, R. B., 253 S.T.E.P. Act. See Street Terrorism Enforcement and Prevention Act Stepanova, E. V., 251, 254 Stephens, N. M., 346 Stereotype Implicit Association Test, 253 Stereotypes description of, 122–123 of older adults, 394 of “rural,” 448 Stereotyping of African Americans, 250–251 definition of, 250 of immigrants, 354 individuating features in, 251–252 social categorization in, 250–251 Stevens, F. G., 494–496 Stevens, M. J., 298, 302

6 5 4       H a n d b o o k o f M u lti c u ltur a l Counseling

Steward, R., 220 Stewart, B., 435 Stewart, B. D., 255 Stewart, M. O., 203 Stewart, S., 243–244 Stine-Morrow, E. A. L., 398 Stith, A., 179 Stiver, I., 230 Stolzenberg, L., 331 Stolzle, H., 402 Stone, C. B., 385, 390–393 Storlie, C. A., 29 Storytelling Honoring Children Series. See Honoring Children Series teaching and helping uses of, 198–203 Well-Being Circle, 208–209 Stoudt, B. G., 28–29 Stout, M. D., 327 Strain, J. D., 219 Straits, K., 37 Strasburger, V. C., 330 Street, A., 344 Street, R. L., Jr., 256 Street gangs acculturation adjustment difficulties and, 336, 339 culturally based trauma-informed approach to, 338–339 cultural values of, 336–337 definition of, 333 history of, 332 interventions for, 339 joining, 335 label as, 333–334 loyalty in, 336–337 power in, 336 as reactive contraculture, 335–336 respect in, 337 sense of belonging associated with, 336 statistics regarding, 333 system-induced traumatization and retraumatization leading to involvement in, 334–335 trauma experienced by youth in, 337–338 youth of color in, 333–334 Street Terrorism Enforcement and Prevention Act, 333 Streng, J., 247 Strength-Based Counseling Model, 278–280 Stress acculturative, 288, 377–379 traumatic, 379–380 Strike, D. L., 402 Strom, T. Q., 342 Strong, C., 346 Strong Interest Inventory, 264 Strozier, L. L., 12 Strube, M. J., 251, 254 Structural diversity, 491–492, 497 Structural equation modeling, 79 Structural inequalities, 18–19 Structural injustice, 20

Structural justice, 19–20 Structured clinical interview, 260 Struggles, contextualizing of, 136 Strunk, D., 203 Stuart, G. L., 181 Stubbings, D., 309 Stucke, T. S., 227 Student and scholar exchange, 298–299 Studying Psychology in the United States, 301 Suárez, C. S., 350 Suarez, Z. E., 426 Suarez-Balcazar, Y., 434 Suárez-Orozco, C., 263, 301, 353, 355, 378–379 Suárez-Orozco, M., 263, 353, 355, 379 Suárez-Orozco, M. M., 350 Subich, L. M., 264 Substance abuse, 329 Substance Abuse Mental Health Services Administration, 206–207, 338 Suchet, M., 383 Suda, J., 191 Sue, D., 216, 260–262, 273, 283, 290, 300, 307, 309, 329, 403, 499, 501 Sue, D. W., 11, 13, 18, 28, 32, 43–44, 47–49, 192, 216, 218–219, 235, 262, 272–275, 283, 290, 295, 299–300, 307, 309, 315, 322, 327, 329, 354, 361–362, 369, 379, 384, 403, 426, 434–436, 438, 443, 456, 499, 501 Sue, S., 26–27, 179, 182–184, 186, 260–261, 273, 278, 318, 380–381, 383 Suicide, by military veterans, 344–345 Suinn, R. M., 267 Sule, D. D., 338 Sulzenbacher, H., 311 Sun, H. F., 85 Sundaram, S., 380 Super, C. M., 476 Super, D. E., 475–476 Supernatural, 285 Super’s life-span, life space theory, 475–476 Suvak, M. K., 308 Suzuki, L. A., 43, 46, 141, 143–144, 189, 193, 219, 240, 259, 262, 265, 287, 315, 356, 499 Suzuki, T., 14 Sverko, B., 475 Swahn, M. H., 331 Swartz, L., 319 SWBS. See Spiritual Well-Being Scale Swearer, S. M., 325 Sweet, E., 252 Symbolic racism scale, 253 Symbolic violence, 228 Syme, M. L., 406 Syncretism description of, 88, 92–94, 169 in people of color, 284–287 System-induced trauma, 334–335 Syvertsen, A. K., 327 Szalacha, L., 389

I ndex

      6 5 5

Szapocznik, J., 380 Szasz, T., 18 Szymanski, E. M., 479 Taft, C. T., 308 Taiko performance, 248 Tailor, C. B., 310 Tait, F., 406 Takeuchi, D., 179 Takeuchi, D. T., 318, 353–354, 379–380 Takeuchi, S., 262 Taleporos, G., 406 Talleyrand, R. M., 234 Tan, S.-Y., 284 Tanaka, G. K., 489 Tanaka-Matsumi, J., 260 Tang, M., 474, 478–479 Tao, K. W., 435 Tashiro, T., 245 Task Force on Communications with Minority Constituencies, 10 Task Force on Psychological Ethics and National Security, 15 Task Force on Urban Psychology, 457 Task Group on Professional Training and Minority Groups, 9 TAT. See Thematic Apperception Test Tatum, B. D., 153, 172–173, 491 Taulbee, M., 366 Tawa, J., 27 Taylor, C., 240 Taylor, G., 187 Taylor, P., 349–350, 354 Taylor, R. D., 328 Taylor, R. J., 283, 396 Taylor, R. R., 321 Taylor, S. E., 250 TBI. See Traumatic brain injury TCIT. See Teacher-Child Interaction Training Teacher-Child Interaction Training, 468 Technology-based approaches, 245–246 Technology-mediated mental health services access issues, 307–308 boundaries in, 313–314 codes, 311–313 competence issues, 311–312 confidentiality, 312 efficacy of, 308–309 e-mail, 309–310 ethical complexities, 310–311 guidelines, 311–313 jurisdiction issues, 312–313 law, 311–313 legal complexities, 310–311 mHealth apps, 310 overview of, 306–307 social media, 313–314 standards, 311–313 telehealth, 307 texting, 309–310

Tedlock, B., 94 Teehee, M., 37 Tegart, G., 54 Tejeda, C., 189 Telehealth, 307 Telemental health services, 312, 409, 452–453 Telephone-based counseling, 409 Telepsychiatry, 307 Telepsychology, 311, 452–453 Teletherapy, 308–309, 311 Tellegen, A., 262 Tell-Me-A-Story, 263 TEMAS. See Tell-Me-A-Story Temple, J. R., 451 Tenzin Gyatso, H. H. the XIVth Dalai Lama, 360 Tervalon, M., 304 Texting, 309–310, 314 TFUP. See Task Force on Urban Psychology Thematic Apperception Test, 262–263 Therapeutic spaces, 41 Thomas, E., 19 Thomas, K. R., 45 Thomas, L. R., 361 Thomas, R., 247 Thomas, R. R., Jr., 487 Thomison, N. L., 451 Thompkins, D. E., 335, 339 Thompson, A. R., 325 Thompson, C. E., 188 Thompson, L. W., 398 Thompson, M. C., 361 Thompson, M. N., 479 Thompson-Brenner, H., 183 Thorgrimsen, L., 398 Threat assessments, 327 Thurston, A., 310 Tibetan Bon, 290 Tice, D. M., 227 Tiernan, K. A., 185 Tilling, R. L., 199 Tillmann, Lisa M., 241 Timpka, T., 246 Tito, P., 189–190 Titus, P., 267 Toar, M., 379 Todd, N. R., 443 Todorova, I., 353, 355, 379 Todorova, T., 263 Tokenism, 317 Tomblin, S., 313 Tomes, H., 6 Toomey, R. B., 388 Toporek, R. L., 12, 18, 20, 24, 26, 28–29, 216, 226, 279, 318, 320, 343, 361, 385, 434 Torino, G. C., 327, 361 Torres-Rivera, E., 358, 434 Tortolero, S. R., 246 Torture, 14–15

6 5 6       H a n d b o o k o f M u lti c u ltur a l Counseling

Tovar-Blank, Z. G., 216 Toward a New Psychology of Women, 151 Townsend, C. O., 318 Tracey, T. J., 474 Tracey, T. J. G., 474 Tracy, S., 333 Training programs, 44 Tran, A. G. T. T., 354 Transactions, 226 Transdisciplinarity, 316 Transformative paradigm, 239 Transformed practices, 230 Transnationalism, 379 Trauma in immigrants, 351–353 system-induced, 334–335 Trauma-focused cognitive-behavior therapy, 197, 203, 207–209 Traumatic brain injury, 344 Traumatic stress. See also Post-traumatic stress disorder behavioral effects of, 412–=413 cognitive effects of, 412–413 community reactions to, 413–414 continuous, 379 disasters as cause of, 412–414 emotional effects of, 412–413 in immigrants, 379–380 physiological effects of, 412 race-based research, 77–80 spiritual effects of, 412–413 Travers, M., 240 Trawalter, S., 252 Treat, T. A., 181 Triad Model, 256 Trimble, J., 206 Trimble, J. E., 206, 300, 499, 501 Trockel, M., 310 Tropp, L. R., 302, 362 Trotter, R. T., 289 Troyano, N., 187 Trudeau, K. J., 178 Truman, J., 325, 331 Tsabari, O., 474 Tsai, K. H., 426 Tsai, W., 280 Tsang, P., 383 Tsinajinnie, E., 37 Tuan, M., 494 Tuck, E., 244 Tummala-Narra, P., 257, 351, 354–356, 377–378, 380, 383–384 Turgesen, J. N., 318 Turner, J. B., 407 Turner, R. J., 407 Turner, S. M., 260 Turner-Essel, L., 302 Turney, H. M., 339 Twamley, E. W., 346 Twenge, J. M., 227–228 Tziner, A., 474

Uchida, Y., 272 UD. See Universal Declaration of Ethical Principles for Psychologists UEBPs. See Universal evidence-based psychotherapies Umbreit, M., 20 Umbreit, M. S., 21 UN Conference on Racism, 115 Underrepresented students, 487–488 Undocumented immigrants, 349–351, 376–377 Unger, J. B., 380 UNHCR. See United Nations High Commissioner for Refugees UNIACT. See Unisex Edition of the ACT Interest Inventory Unisex Edition of the ACT Interest Inventory, 474 United Nations High Commissioner for Refugees, 350–351 United States demographic changes in, 16 diversity in, 473 Universal Declaration of Ethical Principles for Psychologists, 296, 302–303 Universal evidence-based psychotherapies advantages of, 181–183 characteristics of, 180–181 criticism of, 182 cultural assumptions and, 182 cultural match in, 181 disadvantages of, 181–183 ethnic match in, 181 evidence regarding, 181 goal of, 182 historical context of, 181–182 identification of, 181 University of California, San Francisco, 65 University of California, Santa Barbara, 148–149 University of Chicago, 111 University of Michigan, 489 University of Oklahoma Health Sciences Center, 157 Urban community interventions community collaboration and partnerships, 467–469 effect sizes, 459–465 fidelity of implementation, 466–467 meta-analyses, 458–459 outcomes with, 465–466 overview of, 456–457 recommendations, 469–471 review parameters, 457–459 terminology associated with, 457 Urbanized areas, 457 Urland, G. R., 254 U.S. Department of Health and Human Services, 450 U.S. Office of Management and Budget, 448 USDHHS. See U.S. Department of Health and Human Services Using Qualitative Methods in Psychology, 142 Usitalo, 178 USOMB. See U.S. Office of Management and Budget “Us versus them” representations, 256 Utsey, S. O., 268, 369

I ndex

      6 5 7

Vaccaro, A., 387 Vail Conference, 9, 11, 32 Valdez, D., 336 Valencia, R. R., 141 Valentine, J. M., 355 Valverde, I. R., 399 Vance, M. L., 346 Van de Plasch, R., 452 Vander Ploeg Booth, K., 407 Van der Zee, K. I., 360, 369 van de Vijver, F., 85, 87 van de Vijver, F. J. R., 264 Van Dorn, R., 329 Vang, H. C., 273–274 Van Oudenhoven, J. P., 360 Van Tran, T., 267 van Vuuren, L. J., 491 Varas-Díaz, N., 18 Varjas, K., 387–388 Varjas, K. M., 357 Vasquez, E., 6, 11, 13, 287 Vasquez, M., 315 Vasquez, M. J. T., 6, 355, 361 Vasquez, M. T., 24 Vasquez-Nuttal, E., 32 Vaughn, S. R., 216 Vaze, A., 454 Vazquez, M., 361 Vazquez, R., 79 Vedder, P., 300 Velez, A. D., 474 Velkoff, V. A., 395 Ventura, A. B., 382 Vera, E. M., 18, 216, 223, 320, 385, 456 Vera, M., 357 Verbal expression, 262 Verdinelli, S., 384 Verduin, M. L., 246 Veterans. See Military veterans Victoria, R., 79 Videoconferencing, 311, 452 Vietnamese Americans, 283 Vigil, J. D., 334–338, 340 Vigil, P., 267 Viglucci Lopez, C., 14–15 Vila, D., 357 Villagra, H., 351–352 Villarruel, F. A., 353 Vines, P. L., 488 Vinokurov, A., 355 Violence by drug cartels, 351–352 gun, 331 immigration from, 351 interpersonal, 379–380 intimate partner, 406 against LGBTQ youth, 387 media, 329–330 youth. See Youth violence

Visser, D., 491 Visser, P. L., 280 Vocational interests assessment, 264 Vocational psychology, 472 Vocational rehabilitation, for military veterans, 345–346 Vogt, D. S., 417 Volavka, J., 329 Volet, S., 300 “Volkerpsychologie,” 4 Vondracek, F. W., 475–476 Vontress, C. E., 218 Vornholt, J., 60 Vosler-Hunter, W. L., 267 Vossekuil, B., 326 Voting Rights Act of 1965, 6 Vriniotis, M., 331 Vryan, K. D., 242 Wade, N. G., 189 Wade, W. A., 181 Wadsworth, M. E., 462, 465 Waehler, C., 302 Waelde, L. C., 268 Wagenfeld, M. O., 449 Wagner, B., 245 Wagner, N., 260 Wakin, D. J., 284 Wales-North, M., 27 Walker, T. D., 216 Walkup, J. T., 178 Wallace, E. W., 458 Wallbott, H. G., 262 Waller, M. A., 336 Walling, S., 308 Walsh, F., 413 Walsh, M. E., 391 Walsh, R. G., 18, 28 Walsh-Bowers, R., 267 Walters, K., 243 Walters, K. L., 274 Wampold, B., 182–183, 435 Wampold, B. E., 11 Wandersman, A., 19 Wang, C., 246 Wang, J., 451 Wang, K. T., 280 Wang, L.-F., 277 Wang, M. Q., 287 Wang, S., 321 Wang, Y.-W., 277 Wantz, R. A., 12 Ward, C., 378 Warger, C., 326 Warner, K. E., 329 Warren, J. M., 310 Warren, N., 361 Washington, A., 337 Washington, O. G., 247 Wasik, B. H., 261, 302, 304

6 5 8       H a n d b o o k o f M u lti c u ltur a l Counseling

Waterhouse, T., 388–389 Watkins, D. C., 245 Watkins, M., 18, 24, 317, 320 Watlington, C. G., 287 Watson, M. F., 320 Watson, N., 317 Watson, P., 414, 419 Watson, Z. E., 358 Watt, S. K., 288, 361, 437–438, 443 Watts, R. J., 27 Watts, S., 246, 310 Watts-Jones, D., 434, 437–438, 442–443 Waugh, J., 389 Weapons Identification Task, 254 Webb, T., 409 Wechsler, D., 262, 400 Wechsler scales, 262, 264 Wedding, D., 298 Weeber, J., 405 Wei, M., 276–277, 435 Weinrach, S. G., 45 Weinstein, H., 381 Weinstein, R. S., 325 Weintraub, S. R., 18 Weisbach, J., 471 Weisburd, D. L., 331 Weiss, E. L., 342–343 Weiss, J., 409 Weiss, L. G., 264 Weissberg, R. P., 328 Weisz, J. R., 329 Welch, S., 366 Welfare, L. E., 388, 391 Well-Being Circle, 208–209 Wellness community, 413 spirituality and, 287–288 “Wellness in Your Hand,” 246 Wells, K., 179 Wells, R. S., 319, 322 Welsh, K. L., 331 Wendt, G., 243 West, C., 19, 47–48, 126 West, L., 185 Westbrook, B. W., 475–476 Westen, D., 183 Western Interstate Commission for Higher Education, 454 Westheimer, K., 389 Weszkalnys, G., 315 Wetherell, J. L., 399 Wexley, K. N., 261 Whaley, A. L., 245, 408 “What It Takes” program, 232 Whealin, J. M., 318 Wheaton, J. E., 256 Whipple, J. L., 453 Whitbeck, L. B., 207 Whitbourne, S. B., 397 Whitbourne, S. K., 397

White, J., 127, 134 White, J. L., 126 White Crow, J., 201 White privilege, 27 White Racial Identity Attitude Scale, 266 White Racial Identity Scale, 75 Whiting, J. B., 320 Whitley, R., 320 Whitman, J. S., 385, 390, 392 Whitson, M. L., 478 “Why Are All the Black Kids Sitting Together in the Cafeteria? and Other Conversations About Race, 152 WICHE. See Western Interstate Commission for Higher Education Wicherski, M., 355 Wiger, D. E., 260 Wilbur, M. P., 434 Wiles, R., 240 Wilkins, E. J., 320 Williams, B., 79, 287 Williams, C. J., 252 Williams, D. R., 267, 292 Williams, M. B., 413 Williams, M. J., 252, 325 Williams, T. R., 283 Williams, W. R., 235 Williams-Nickelson, C., 301 Willis, D. J., 155–165 Willis, S. L., 400 Willment, J. H., 314 Willoughby, B. L. B., 389 Willoughby, T., 329–330 Wills, L. E., 369 Wills, M., 301 Wilson, B. S., 369 Wilson, J. P., 288 Wilson, M., 257, 378 Winn, M. T., 189 Wisdom, 272 WIT. See Weapons identification task Wittenbrink, B., 252, 254 Wittenhagen, L. A., 346 Wittson, C. L., 307 Witty, T. E., 277 Wolfe, C. T., 255 Women career development in, 478 as grandparents, 398 as immigrants, 376, 383–384 as older adults, 397, 399 Women with disabilities description of, 406 intimate partner violence against, 406–407 Wong, D., 256 Wong, J., 316, 319, 321 Wong, L., 379 Wong, P. T. P., 275, 281 Wong, S., 395 Wong, T. K., 351

I ndex

      6 5 9

Woo, W., 89 Wood, A. H., 369 Woodford, M. R., 361 Woodrich, L. E., 185 Woods, B., 398 Woods, S. W., 181 Woods, T. S., 346 Woods-Giscombé, C. L., 288, 290 Woodson, S. J., 281 Woody, S. R., 181 Woolf, S. H., 245 Work development, 482 Work-play balance, 164 World Council for Psychotherapy, 296 World Council of Churches, 58 World Health Organization Psychiatric Research Center, 119 Worthington, E. L., Jr., 292 Worthington, R. L., 26, 360–361, 434–435, 443, 473, 482 Wrenn, C. G., 215 Wrenn, G. C., 44 WRIAS. See White Racial Identity Attitude Scale Writing, 136 Wu, J. T., 256 Wu, K., 190, 194 Wu, M. C., 355 Wundt, W. M., 4 Wurl, A., 388 Wurster, K. G., 346 WWD. See Women with disabilities Wyche, K. F., 235 Wynne, D., 475–476 X, Malcolm, 128, 171 Xenitidou, M., 240 Xenophobia, 378 Xie, D., 85 Xu, Y., 377 Yablon, Y. B., 361 Yablonsky, G. S., 251 Yakushko, O., 301, 315, 384, 424 Yamout, R., 426 Yang, K., 244 Yang, S., 272 Yankelovich, D., 232 Yarborough, B., 310 Yarvis, J. S., 342 Yates, S., 412 Yee, N., 245 Yee, S., 401–402, 404, 406 Yeh, C. E., 300 Yeh, C. J., 188–195 Yeh, K. H., 85 Yellowlees, P., 311–312 Yeung, J. G., 435 Yip, T., 354 Yoga, 287

Yonan, J., 314 York, J. A., 345 Yoshikawa, H., 321, 377, 381 Young, A., 260 Young, G., 361, 366, 438, 443 Young, H. M., 321 Young, I. M., 19–20, 191 Young, J. S., 293 Young, K., 383 Young, M. E., 406–407 Younggren, J. N., 12 Younis, M., 283 Younnjung, M., 356 Youssef-Morgan, C. M., 281 Youth in gangs. See Gangs immigrant, 350 LGBTQ. See LGBTQ youth media violence exposure in, 329–330 mental health needs of, 328–329 undocumented, 350 Youth of color criminalization of, 333–334 in gangs, 333–334 Youth violence behaviors suggestive of, 326–327 bullying, 325 communication as prevention method for, 326–327 in community, 324 connection and support effects, 327–328 in family, 324 guns, 330–331 homicides, 324, 330–331 identification methods, 326 overview of, 323–325 prevention of, 325–328 problem-solving approach to, 327 racial profiling and, 326 in school, 324–325 school environment and, 327 substance abuse as risk factor for, 329 threat assessments, 327 universal interventions, 328 zero-tolerance discipline and, 326 Yu, E. A., 280 Yule, W., 379 Zack, J. S., 311 Zagursky, F., 319, 322 Zalapa, J., 478 Zamboanga, B. L., 380 Zane, N., 183–184, 186, 308 Zane, N. W. S., 185, 288 Zanglis, I., 357, 384 Zaretsky, A., 318 Zavala, M., 243–244 Zerhouni, E. A., 245 Zero-tolerance discipline, 326–327

6 6 0       H a n d b o o k o f M u lti c u ltur a l Counseling

Zhang, J., 331 Zhang, J. P., 85 Zhang, J. X., 84–85 Zhang, S., 467 Zhang, Y., 378 Ziegenbein, M., 356

Ziller, E. C., 450 Zimmerman, R. S., 246 Zinner, E. S., 413 Zolnierek, C. D., 402 Zuber-Skerritt, O., 195 Zuniga, X., 361, 363

I ndex

      6 61

Contributors List

Lubnaa Badriyyah Abdullah Doctoral Student The Chicago School of Professional Psychology Chicago, IL [email protected] Patricia Arredondo Consultant The Arredondo Advisory Group Chicago, IL [email protected]

Oklahoma City, OK [email protected] Noah E. Borrero Associate Professor Teacher Education Department, School of Education University of San Francisco San Francisco, CA [email protected]

Marvyn R. Arévalo Avalos Doctoral Student Department of Counseling and Psychology Arizona State University Tempe, Arizona marvyn.aré[email protected]

Beth Boyd Director, Clinical Psychology Program Professor, Disaster Mental Health Institute University of South Dakota Vermillion, SD [email protected]

Martha E. Banks Research Neuropsychologist Research and Development Division ABackans DCP, Inc. Akron, OH [email protected]

Merry Bullock Senior Director Office of International Affairs American Psychological Association Washington, DC [email protected]

Guillermo Bernal Director, Institute for Psychological Research Professor of Psychology, University of Puerto Rico San Juan, PR [email protected]

Rebecca P. Cameron Professor Department of Psychology  California State University, Sacramento Sacramento, CA [email protected]

Dolores Subia BigFoot Assistant Professor, University of Oklahoma Health Sciences Center Department of Pediatrics, Indian Country Child Trauma Center

Robert T. Carter Professor  Teachers College Columbia University  662

New York, NY [email protected] Fanny M. Cheung Vice President, Research, and Choh-Ming Li Professor Department of Psychology The Chinese University of Hong Kong Shatin, Hong Kong [email protected] Michael S. Christopher Associate Professor Graduate School of Psychology Pacific University Hillsboro, OR [email protected] Ayşe Çiftçi Associate Professor Department of Educational Studies Purdue University West Layfayette, IN [email protected] Colleen Clemency Cordes Director and Clinical Associate Professor Doctor of Behavioral Health Program College of Health Solutions Arizona State University Phoenix, AZ [email protected] Alette Coble-Temple Professor Department of Psychology John F. Kennedy University Pleasant Hill, CA [email protected] Lillian Comas-Díaz Clinical Professor Department of Psychiatry and Behavioral Sciences George Washington University Washington, DC [email protected]

Andrés J. Consoli Associate Professor Department of Counseling, Clinical, and School Psychology Gevirtz Graduate School of Education University of California, Santa Barbara Santa Barbara, CA [email protected] Melissa L. Morgan Consoli Associate Professor Department of Counseling, Clinical, and School Psychology Gevirtz Graduate School of Education University of California, Santa Barbara Santa Barbara, CA [email protected] Dewey G. Cornell Professor Curry School of Education University of Virginia Charlottesville, VA [email protected] Martha R. Crowther Professor and Director of Clinical Psychology Department of Psychology University of Alabama Tuscaloosa, AL [email protected] Cynthia de las Fuentes Independent Practice  Anderson House at Heritage Square Austin, TX [email protected] Michael D’Andrea Professor College of Education University of Hawaii Honolulu, HI [email protected]

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Contri butors Li s t

Anita Deshpande Doctoral Candidate Counseling Psychology Boston College Chestnut Hill, MA [email protected] Changming Duan Professor and Program Director Doctoral Program in Counseling Psychology Department of Educational Psychology University of Kansas Lawrence, KS [email protected] Martha Ramos Duffer Licensed Psychologist Independent Practice  Anderson House at Heritage Square Austin, TX [email protected] Lisa M. Edwards Associate Professor Counselor Education and Counseling Psychology Marquette University Milwaukee, WI [email protected] Dorothy L. Espelage Edward William Gutgsell and Jane Marr Gutgsell Endowed Professor Hardie Professor of Education Department of Educational Psychology University of Illinois at Urbana-Champaign Champaign, IL [email protected] Joey Nuñez Estrada Jr. Assistant Professor College of Education Department of Counseling and School Psychology San Diego State University San Diego, CA [email protected]

Lisa Y. Flores Professor and Program Director in Counseling Psychology Department of Educational, School, and Counseling Psychology University of Missouri Columbia, MO [email protected] Katy L. Ford Doctoral Candidate Clinical Psychology University of Alabama Tuscaloosa, AL [email protected] Michael P. Frain Professor Department of Counselor Education Florida Atlantic University Boca Raton, FL [email protected] Beverly A. Greene Professor Department of Psychology College of Liberal Arts and Sciences St. John’s University Jamaica, NY [email protected] Hitomi Gunsolley Psychology Associate Sex Offender Treatment Program Oshkosh Correctional Institution Oshkosh, WI [email protected] Nao Hagiwara Assistant Professor Department of Psychology Virginia Commonwealth University Richmond, VA [email protected]

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Robert A. Hernandez Senior Lecturer School of Social Welfare University of Southern California Los Angeles, CA [email protected]

Steven Kim Adjunct Lecturer, University of Southern California Founder, Project Kinship Santa Ana, CA [email protected] 

Bertha Garrett Holliday Independent Consultant Diversity Assessment, Planning, Implementation, and Evaluation Washington, DC [email protected]

Laura Kohn-Wood Associate Professor and Chair Department of Educational and Psychological Studies School of Education and Human Development University of Miami Coral Gables, FL [email protected]

Shane R. Jimerson Professor and Chair Department of Counseling, Clinical, and School Psychology University of California, Santa Barbara Santa Barbara, CA [email protected] Cindy L. Juntunen Chester Fritz Distinguished Professor and Training Co-Director Doctoral Program in Counseling Psychology College of Education and Human Development University of North Dakota Grand Forks, ND [email protected] Neeta Kantamneni Assistant Professor Department of Educational Psychology University of Nebraska–Lincoln Lincoln, NE [email protected] Jackie H. J. Kim Doctoral Candidate University of Michigan Ann Arbor, MI [email protected]

Martin La Roche Assistant Professor and Director of Training Martha Eliot Health Center Harvard Medical School Boston Children’s Hospital Cambridge, MA [email protected] Elsa Lee Doctoral Candidate Department of Psychology New York University New York, NY [email protected] Jaya T. Mathew Licensed Psychologist Wellness 360 Dallas, TX [email protected] Charlotte M. McCloskey Staff Psychologist Mental Health Clinic Kansas City VA Medical Center Kansas City, MO [email protected]

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Contri butors Li s t

Ahjane D. Macquoid Doctoral Student University of Miami School of Education and Human Development Coral Gables, FL [email protected] Anthony J. Marsella Professor Emeritus Department of Psychology University of Hawaii at Manoa Honolulu, Hawaii [email protected] Matthew J. Mayer Associate Professor Graduate School of Education Rutgers University New Brunswick, NJ [email protected] Amy Mitchell Doctoral Candidate Counseling Psychology Ball State University Muncie, IN [email protected] Linda R. Mona Clinical Psychologist Spinal Cord Injury/Disorder Service VA Long Beach Healthcare System Long Beach, CA [email protected] Donna K. Nagata Professor Department of Psychology University of Michigan Ann Arbor, MI [email protected] Pratyusha Tummala Narra Associate Professor Counseling Psychology Boston College

Chestnut Hill, MA [email protected] Amanda B. Nickerson Professor, Counseling, School, and Educational Psychology Director. Alberti Center for Bullying Abuse Prevention University at Buffalo, the State University of New York Buffalo, NY [email protected] David Osher Vice President and Institute Fellow American Institutes for Research  Washington, DC [email protected] Thomas A. Parham Vice Chancellor University of California, Irvine Irvine, CA [email protected] Jennifer Teramoto Pedrotti Professor Psychology and Child Development California Polytechnic State University San Luis Obispo, CA [email protected] Justin C. Perry Chair and Associate Professor, College of Education and Human Services Director, Center for Urban Education Department of Counseling, Administration, Supervision, and Adult Learning Cleveland State University Cleveland, OH [email protected] Lela L. Pickett Doctoral Student Department of Psychology

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Cleveland State University Lakewood, OH [email protected] Joseph G. Ponterotto Professor Graduate School of Education Division of Psychological and Educational Services Fordham University New York, NY [email protected] Melissa A. Quincer Doctoral Student, Counseling Psychology College of Education and Human Development University of North Dakota Grand Forks, ND [email protected] Amy L. Reynolds Associate Professor Counseling, School, and Educational Psychology University of Buffalo Buffalo, NY [email protected] Bryan O. Rojas-Arauz Doctoral Student Counseling Psychology University of Oregon Eugene, Oregon [email protected] William Sapigao Counselor Skyline College San Bruno, CA [email protected] Nichole Shada Doctoral Student Counseling Psychology University of Nebraska–Lincoln Lincoln, NE [email protected]

Lamise Shawahin Psychology Intern Clement J. Zablocki VA Medical Center Milwaukee, WI [email protected] Ellen L. Short Associate Professor School of Education, Department of Counseling and School Psychology Long Island University, Brooklyn Campus Brooklyn, NY [email protected] Alexandra Smith Licensed Professional Counselor  Lawrence, KS [email protected] Darrick Smith Assistant Professor Department of Leadership Studies School of Education University of San Francisco San Francisco, CA [email protected] Laura Smith Associate Professor Department of Counseling and Clinical Psychology Teachers College Columbia University New York, NY [email protected] Elena V. Stepanova Assistant Professor Department of Psychology University of Southern Mississippi Hattiesburg, MS [email protected] Maggie L. Syme Assistant Professor Department of Gerontology

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Contri butors Li s t

Kansas State University Manhattan, KS [email protected]

Santa Clara University Santa Clara, CA [email protected] 

Beverly Daniel Tatum President Emerita Spelman College Atlanta, GA [email protected]

Lindsey M. West Assistant Professor and Clinical Psychologist Department of Psychiatry and Health Behavior The Medical College of Georgia Augusta University Augusta, GA [email protected]

Rebecca L. Toporek Professor and Coordinator Career Counseling Specialization Department of Counseling San Francisco State University San Francisco, CA [email protected] Molly K. Tschopp Associate Professor and Director Rehabilitation Counseling Program Counseling Psychology and Guidance Services Ball State University Muncie, IN [email protected] Melba J. T. Vasquez Independent Practice Anderson House at Heritage Square Austin, TX [email protected] Eric W. Wallace Doctoral Student College of Education and Human Services Department of Counseling, Administration, Supervision, and Adult Learning Cleveland State University Cleveland, OH [email protected] Sherry C. Wang Assistant Professor Department of Counseling Psychology

Diane J. Willis Professor Emeritus Pediatrics University of Oklahoma Norman, OK [email protected] Roger L. Worthington Professor and Chair Counseling Higher Education and Special Education University of Maryland College Park, MD [email protected] Oksana Yakushko Program Chair and Professor Clinical Psychology Department Pacifica Graduate Institute Carpinteria, CA [email protected] Christine J. Yeh Professor Department of Counseling Psychology School of Education University of San Francisco San Francisco, CA [email protected]

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About the Editors

J. Manuel Casas is professor emeritus in the Department of Counseling, Clinical, and School Psychology at the University of California, Santa Barbara. He has published extensively on sociocultural, psychological, and contextual factors that negatively affect ethnic/racial populations including immigrants. He counteracts the negativity of these factors by directing attention to resiliency factors that can help these populations lead sound and healthy lives. His work has been widely cited both within and outside of the United States. Dr. Casas can be reached at [email protected]. Lisa A. Suzuki is an associate professor in the Department of Applied Psychology at New York University. She is co-editor with Joseph Ponterotto of the Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications now in its third edition. She is also co-editor of Qualitative Strategies for Ethnocultural Research with Donna K. Nagata and Laura Kohn-Wood. Her main research interests have been in the areas of multicultural assessment and qualitative research methods. Dr. Suzuki can be reached at [email protected]. Charlene M. Alexander is the Associate Provost for Diversity and Professor of Counseling Psychology at Ball State University where she is responsible for implementing strategic initiatives to support the diversity efforts of the university. Her research interests are in the areas of multicultural counseling, school counseling, and the impact of immersive learning experiences on counseling students’ multicultural competency development. Dr. Alexander can be reached at [email protected]. Margo A. Jackson is Professor of Counseling Psychology and Contemporary Learning and Interdisciplinary Research of the Graduate School of Education at Fordham University, Lincoln Center. Her research, teaching, and service focus on methods to assess and constructively address hidden biases and strengths of counselors, educators, and other leaders; career development across the life span; and training and supervision in multicultural counseling and psychology. Dr. Jackson can be reached at [email protected].

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