Culturally Adaptive Counseling Skills: Demonstrations of Evidence-Based Practices

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Edited by: Miguel E. Gallardo, Christine J. Yeh, Joseph E. Trimble & Thomas A. Parham

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  • Chapters
  • Front Matter
  • Back Matter
  • Subject Index
  • Part I: African-Centered Applications of the SISM

    Part II: Socioculturally Specific Therapeutic Skills for Latinas/os: Expanding Our Evidence-Based Practice Perspectives

    Part III: Culturally Adapted Counseling Skills for Asian Americans and Pacific Islanders

    Part IV: North American Indian and Alaska Native Communities: Moving Beyond the Surface Level

    Part V: Middle Eastern Americans: Challenging Misperceptions and Widening the Lens

    Part VI: Where Do We Go from Here? Education, Training, Practice, and Research Implications

  • Dedication

    To my siblings, Janet, John and Joanie: Thank you for leading the way and for being teachers in my life's journey.

    —M. E. G.

    For Skye, Lark, and Tai who inspire me always.

    —C. J. Y

    I wish to dedicate this book to all of those who made a positive difference in the lives of those in need.

    —J. E. T.

    This book is dedicated to my teachers, mzees, and colleagues in the discipline of African psychology. The struggle for the mental liberation of our people continues, and perhaps this work will enable professionals to serve our people in more culturally appropriate and sensitive ways.

    —T. A. P.

    Copyright

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    Acknowledgments

    Miguel E. Gallardo: I want to acknowledge Dr. Thomas Parham for his tireless work in advocating for, educating, and empowering ethnocultural communities. It is his previous work that laid the foundation for this book. Thank you for always gently pushing, while never wavering.

    I also want to acknowledge the National Latina/o Psychological Association for being the womb that nurtures, supports, and guides Latina/o psychologists nationally. I hope this book represents a small segment of the expansive work that represents who we are and what we do.

    Christine J. Yeh: I wish to thank my coauthors for giving me the privilege of this incredible journey together. I thank my parents, George and Lillian Yeh for all their sacrifice and support. I also thank the Samoan Community Development Center and the Asian American Psychological Association for supporting me professionally and personally.

    Joseph E. Trimble: I wish to acknowledge the thoughtful consideration and generous assistance provided us by our acquisition editor at Sage, Kassie Graves; the invaluable constructive comments and advice provided us by the many anonymous reviewers of our prospectus and chapters; our copy editors; our mentors and advisors who carefully guided us on our paths toward maturity, character, wisdom, and truthfulness; and the enlightenment provided us by our ancestors and the creator. Thank you, also, to my lovely spouse, Molly Ellen, for her love, steadfast encouragement, unfading support, and careful scrutiny of my writing and to our lovely daughters, Gen, Lee, and Casey, for their compassionate encouragement and love.

    Thomas A. Parham: In all things, I give honor to the Creator and ancestors. I thank my wife Davida and daughters Tonya and Kenya for their unwavering support and encouragement. I also wish to thank Dorothy Clegern, who helped to produce final drafts of several chapters. Finally, I thank my coauthors, both for the honor and privilege of collaborating with you and for trusting that this was a project that merited a broader audience than a single journal (even TCP) could provide and a broader vision than that journal could appreciate.

    We would also like to acknowledge the following reviewers for their helpful suggestions: Norma Day-Vines, Virginia Tech; Kimberly Desmond, Indiana University of Pennsylvania; and Jose Torres, University of Wisconsin-Milwaukee.

    Foreword

    Upon reading this book, Culturally Adaptive Counseling Skills: Demonstrations of Evidence-Based Practices, edited by four of this country's leading multicultural psychologists, Drs. Gallardo, Yeh, Parham, and Trimble, and with contributions from other outstanding psychologists, the first thought that came to mind was that during the last 25 years, the specialization of multicultural counseling psychology has come a long way in establishing itself as a legitimate field of study. This is especially evident in the increased quantity, quality, and utility of research and publication works that essentially serve as the core of the specialization. With this thought in mind, I decided to take advantage of having been invited to write this Foreword to identify and address three overriding concerns or issues that I believe gave and continue to give impetus to increasing the quantity and, more important, improving the quality of such works.

    The first concern addressed the preeminent, and now widely accepted, need to take culture into consideration across all aspects of counseling psychology: research, training, and practice. The second concern addressed the need to ensure that the inclusion of culture in the work of counseling psychologists is not a random event; it is theory driven and research supported. Finally, the third concern focused on the lack of frameworks/models that could be used to direct and guide counseling psychologists on how to appropriately and effectively include and use culture in the context of their work. From the onset, I would like to say that I believe that this book exemplifies the state of the art with respect to the manner by which these three enduring concerns should be addressed by multicultural counseling psychologists.

    This first concern essentially gave impetus to the development of the multicultural counseling movement, by recognizing the failure of counseling psychology to acknowledge, accept, and address the pivotal role that culture plays in the life of an individual as a whole and, more specifically, in all aspects associated with the counseling process. The basis for this concern was rooted in the emerging belief that the psychological needs of individuals, especially those from ethnic, racial, and cultural minority groups (i.e., African Americans, Asian Americans, American Indians, and Latinas/os), could not be effectively met unless their culture and the socioecological context in which they exist were given specific and serious consideration. At the time, the failure to address culture was even more disconcerting given the fact that the ethnic, racial, and cultural makeup of the United States was, and for that matter is, rapidly changing. Recent census reports project that the ethnic, racial, and cultural groups, taken as an aggregate, will comprise a very significant segment of the U.S. population by the year 2050, if not sooner (U.S. Census Bureau, 2004). Given the increase in the size of these groups to date, it is safe to say that at present the majority of counselors/therapists find themselves working with an ever-growing number of individuals from diverse ethnic, racial, and cultural backgrounds.

    Recognizing and accepting the pivotal role that culture plays in the sociocultural development and makeup of the individual, counseling psychologists, of whom a significant number were racial/ethnic minority persons, began an initial wave of research and publication endeavors that would eventually serve as the foundation for what is now recognized and accepted as the multicultural counseling specialization within the broader field of counseling psychology. The successful outcome of such endeavors is aptly exemplified in the dramatic increase in research and publication that has occurred in the last 25 years.

    Providing a sense of the focus of early endeavors, Ponterotto and Casas (1991) reported the results of a six-year (1983–1988) content analysis of articles published in four major counseling journals. This analysis identified 183 conceptual and empirical articles that focused on racial/ethnic minority populations. The analysis found that the myriad topics addressed in the articles could be placed into five broad categories: client variables, counselor variables, counseling process variables, assessment, and professional issues and development. Demonstrating a growing professional need to develop a more in-depth and comprehensive understanding of the sociocultural characteristics of the racial/ethnic minority client, the largest number of articles fell under the category of client variables. It should be noted that these categories, with the exception of professional issues and development, were similar to those that were identified as applicable for use in a comparable review that included a more extensive selection of counseling-related journals and that covered the five-year period between 1980 and 1984 (Ponterotto, 1988). I would dare to predict that if a similar content analysis were conducted today, the validity and utility of these categories would be supported. In fact, in reviewing the chapters that comprise this book, it quickly becomes apparent that these categories serve to organize the content contained therein.

    In addition to journal articles, the last 25 years witnessed a very impressive increase in the publication of chapters and books (e.g., handbooks) that focus directly on the cultural and socioecological factors that must be considered when working with persons from diverse racial and ethnic backgrounds (see Ponterotto, Casas, Suzuki, & Alexander, 2010). With the increase in publications, another concern soon surfaced. This concern was composed of criticism directed at the quality (e.g., the methodological soundness) and utility of the research and publications. Wanting to find empirical evidence that might substantiate or refute the bases of the criticisms, Ponterotto and Casas (1991) conducted the content analysis noted above and concluded that a good number of the criticisms were valid (e.g., disregard for within-group or intra-cultural differences, the use of easily available college student participants, reliance on culturally encapsulated instruments). More recent evidence in support of these criticisms is available (see Prieto, McNeill, Walls, & Gomez, 2001). It bears noting that in recent years, the overall quality and utility of the articles has greatly improved. More specifically, today's publications, as evident in this book, demonstrate an increased academic sophistication and methodological ability for addressing and dealing with the complex and central role that culture and socioecological factors play in the lives of all human beings.

    The second concern, the need to ensure that the inclusion of culture in the work of counseling psychologists is not an arbitrary and random event but one that is theory driven and research supported, was initially put forth by multicultural specialists who expressed a deep concern for the lack of theoretically substantiated frameworks to guide and give meaning to their multicultural work (Casas, Vasquez, & Ruiz de Esparza, 2002; Sue, Ivey, & Pedersen, 1996). Lacking such frameworks, these psychologists felt that they were forced to rely on theories and frameworks that solely reflected a Eurocentric perspective and, for all intents and purposes, were found to fall short of meeting the counseling needs of a good number of persons from culturally different groups. Short of developing “new” theories and frameworks, initial efforts were made to adapt the existing theories for use with diverse cultural groups by inserting cultural content, assumed to be of relevance to all and/or to specific cultural groups, throughout the entire Eurocentric-based counseling process. Most frequently, the rhyme or reason for such inclusion was not adequately explained.

    Recognizing the fact that without a driving comprehensive theory (i.e., a metatheory), such random and poorly understood inclusion of culture into existing theories and frameworks fell short and would continue to fall short of meeting the counseling needs of diverse cultural groups, a few dedicated counseling psychologists took it upon themselves to develop such a metatheory or paradigm (Sue et al., 1996). While first hesitant to undertake such a development, these psychologists eventually concluded that the multicultural counseling field had matured to the point where the development of such a theory would be beneficial not only for theory building but also for research, training, and practice. Such a theory would be applicable across cultures. That is to say, the guiding principles of the theory would have universal applicability, while the content that gives life to the principles would be culture specific. The metatheory that resulted from their efforts is aptly named “A Theory of Multicultural Counseling and Therapy.” In a nutshell, the proposed metatheory sought to provide an organizational framework that would enable psychologists to outline the theoretical, philosophical, ethical, political, and professional underpinnings of the many counseling/helping approaches. Furthermore, such a theory would be culture centered (Pedersen & Ivey, 1993). That is to say, the role of culture in a person's life would be perceived as central and not marginal, fundamental and not merely exotic (Sue et al., 1996).

    The implications of accepting and using this metatheory across research, practice, and training were critically examined by leading multicultural counseling psychologists. These psychologists concluded that the theory was conceptually sound and had the potential to stimulate further theory development. More important, these psychologists shared the consensus that being composed of definable and substantive constructs, the theory could easily be used to guide and structure the work of multicultural psychologists. The use of this theory is very easily identified throughout this edited book.

    Closely tied to the concern regarding the lack of theory was the third concern, regarding the lack of frameworks that could serve as blueprints on why, when, and how culture might be incorporated into any multicultural-focused work. Early on, Casas and Vasquez (1989) proposed such a framework. While a step in the right direction, their framework was rather broad in its presentation and basically failed to provide the specificity and “hands on” direction that, given the state of development of the multicultural field at that time, was still needed. A more specific and detailed framework/model that actually serves as the basic guiding structure for presenting the content of this book was proposed by Parham (2002). This model is titled the Skills Identification Model. While originally developed to identify specific cultural knowledge and skills that are essential to accurately understand and effectively work with African American communities, it is also applicable, as clearly exemplified in this book, for use with Asian, Latina/o, Native American, and Middle Eastern communities. The use of this skills-focused model has been widely accepted by multicultural psychologists. Its use, within the context of the metatheory described above, greatly helps to give the content of this book unity and direction, while also increasing its pragmatic and applied value.

    Yes, the field of multicultural counseling psychology has come a long way in establishing itself as a legitimate, vital, and fruitful field of study. This is due to the efforts of multicultural psychologists who recognized the need to address and overcome concerns and challenges, such as the three that are the focus of this Foreword. The successful outcome of these efforts is exemplified in this book, whose major objective is to clearly demonstrate how to appropriately and effectively address and use culture with all individuals across all counseling endeavors—research, training, and practice. From my reading, I would expect that the structure and content of this book will set the mark for the kinds of publications that are still greatly needed to continue to move the field of multicultural counseling psychology into the future.

    J. ManuelCasas, PhD Professor Emeritus, Counseling, Clinical & School Psychology University of California, Santa Barbara
    References
    Casas, J. M., & Vasquez, M. J. T. (1989). Counseling the Hispanic client: A theoretical and applied perspective. In P. B.Pedersen, J. G.Draguns, W. J.Lonner, & J. E.Trimble (Eds.), Counseling across cultures (
    3rd ed.
    , pp. 153–175). Honolulu: University of Hawaii Press.
    Casas, J. M., & Vasquez, M. J. T., & Ruiz de Esparza, C. A. (2002). Counseling the Latino/a: A guiding framework for a diverse population. In P. B.Pedersen, J. G.Draguns, W. J.Lonner, & J. E.Trimble (Eds.), Counseling across cultures (
    5th ed.
    , pp. 133–159). Thousand Oaks, CA: Sage.
    Parham, T. A. (2002). Counseling models for African Americans: The what and how of counseling. In T. A.Parham (Ed.), Counseling persons of African descent: Raising the bar of practitioner competence (pp. 100–118). Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/9781452229119
    Pedersen, P. B., & Ivey, A. E. (1993). Culture-centered counseling and interviewing skills. Westport, CT: Greenwood/Praeger.
    Ponterotto, J. G. (1988). Racial/ethnic minority research in the Journal of Counseling Psychology: A content analysis and methodological critique. Journal of Counseling Psychology, 35, 410–418. http://dx.doi.org/10.1037/0022-0167.35.4.410
    Ponterotto, J. G., & Casas, J. M. (1991). Handbook of racial/ethnic minority counseling research. Springfield, IL: Charles C. Thomas.
    Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (2010). Handbook of multicultural counseling (
    3rd ed.
    ). Thousand Oaks, CA: Sage.
    Prieto, L. R., McNeill, B. W., Walls, R. G., & Gomez, S. P. (2001). Chicanas/os and mental health services: An overview of utilization, counselor preference, and assessment issues. Counseling Psychologist, 29, 18–54. http://dx.doi.org/10.1177/0011000001291002
    Sue, D. W., Ivey, A. E., & Pedersen, P. B. (1996). A theory of multicultural counseling and therapy. Pacific Grove, CA: Brooks Cole.
    U.S. Census Bureau. (2004). U.S. interim projections by age, sex, race, and Hispanic origin. Retrieved January 11, 2011, from http://www.Census.gov/ipc/www/usinterimproj
  • Afterword: On Sending a Wolf of Color Out into a Socially Unjust World

    Janet E.Helms

    If the reader has come this far in the journey to discover how Parham's (2002) Skills Identification Model may be adapted to fit the needs of clients other than, or in addition to, African Americans of otherwise unspecified ethnicity, then you will have discovered that absorbing the knowledge and skills that the authors offer will require many readings. I feel a bit like an ungrateful guest who, having just sated herself on a gourmet meal, expresses her gratitude by criticizing the chef. So, I begin by highlighting some aspects of the book that the reader has already recognized herself or himself. Time constraints do not permit me to address the merits of each of the chapters in the detail that they deserve. Perhaps the authors will forgive me for this inadequacy.

    Nevertheless, I think there are some ingredients missing from this excellent presentation of applications of multicultural theory to the counseling and psychotherapy process, which, if added, might help to protect or buffer the well-intentioned culturally responsive therapist, researcher, and future therapists from the fate that befell the maligned wolf in the tale of the Wolf and Red Riding Hood with which Gallardo, Parham, Trimble, and Yeh began Chapter 1. These include (a) the invisibility of white culture, (b) racism and ethnoviolence as tapestries in the United States that are often mistaken for cultural psychopathology, (c) social interaction theory as a model for understanding the dynamics of the helping process at multiple levels, and (d) the nature of our ethical responsibilities to students trained to be culturally responsive therapists.

    In this afterword, I briefly discuss each of these four themes and explain why I believe they deserve serious attention. I often refer to the fable in my examples because I think it was a charming way to introduce Chapter 1 and it is an easy way to make the invisible visible. However, in my culture, it is considered disrespectful to address a learned individual by a single name without a title. So, henceforth, the “maligned wolf” is Mr. Wolf in my examples.

    Brief Highlights

    Each chapter's authors want the reader to understand and incorporate into the reader's practice deep cultural knowledge of the specific ethnic group(s) whose cultural dynamics the authors discuss. Even therapists already engaged in the process of becoming culturally responsive therapists will learn something that they did not know about the culture or historical contexts of the specific ethnocultural groups that are represented, as well as how to be more responsive generally. Each chapter also presents one or more conceptual models and additions to the SISM to make it more responsive to clients' cultural needs. Interestingly, many of these embellishments seem to be focused on the assessment process. That is, how can we learn what we do not know about our clients? This assessment focus is important because it reminds us that not only do the theories we use require cultural refinement, so, too, do the standard assessment procedures that are routinely used for diagnostic purposes as if they are culture free. The chapter authors provide examples of the types of questions that should be asked to acquire information necessary to intervene appropriately. In the future, it would be useful to have available a model for integrating the various assessment recommendations across groups with respect to specific standard measures and procedures. Perhaps Yeh, Gallardo, Parham, and Trimble's integration of ecological models may serve as a framework for integrating cultural dynamics into the assessment process.

    Another major contribution of the book is the inclusion of case materials along with descriptions of the relevant aspects of the clients' cultural origins that might have affected the presenting problem as well as the helpers' roles in resolving it. The case materials are excellent examples of the art of doing therapy as described by a person with in-depth knowledge of the focal ethnocultural group, even though some of the therapists and clients were from different cultural backgrounds. Sometimes the helper-client cultural mismatches were preferred by the client, which raises interesting questions about how best to manage culture-specific transference and countertransference issues in the helping process when the historical and cultural backgrounds of the client's and helper's communities may be additional parties in the helping relationship.

    Nevertheless, the knowledge and skills demonstrated in the case materials may be quite intimidating if they are interpreted as meaning that such sophisticated knowledge and skills are required for providing beneficial mental health services to clients from every ethnic group in the United States, which, of course, is beyond the capacity of any person. Instead, I prefer to interpret the chapters as providing would-be culturally responsive therapists with a flexible frame for knowledge and skill development, regardless of the helpers' and clients' specific ethnocultural origins.

    Missing Ingredients
    Invisibility of White Culture

    As I read each chapter, I wondered who the intended audience was. I figured that it must be people who do not have to routinely exist in cultural environments different from their own because the authors continually implicitly contrasted the cultural dimensions of their ethnocultural group with some other culture, although virtually none of them called it by name. Then, as I reached the end of the book, my wonderment was resolved. Virtually none of the authors or chapters discussed white American cultures, either at the level of specific ethnic groups (e.g., Irish, Italians, Greeks) or society (e.g., white cultural patterns). Consequently, the reader is left with the impression that culture is only manifested by people of color or recent immigrant groups and that, if cultural impasses occur, it is because of problems within the client's home culture or because the therapist misunderstands the client's culture.

    However, every person, including therapists, is the recipient of some cultural socialization. Such socialization is what enables us to survive within our cultural units, whatever they may be; it is not necessarily pathological. Impasses occur when members of different cultures must interact and one cultural group has the power to define normality for the other(s). In the United States, white culture is synonymous with “American culture” (Torkelson & Hartmann, 2010). Yet white culture is invisible in the psychological literature, even though it is the norm for U.S. American society. In my quick search for empirical studies on white or American culture in the psychological literature, I located only five, and these were typically comparisons of some aspect of the culture of African Americans, Latina/o Americans, Asian American/Pacific Islander Americans, or Native Americans (ALANA) or related immigrant groups to a white sample. The implicit message is that either white people do not have describable culture, or it does not matter so long as others conform to it.

    With the exception of the chapters on Indigenous people, most of the foregoing chapters dealt with immigrants to the United States who were transitioning in some manner from their cultures of origin to the dominant American culture, sometimes over many generations, while at the same time trying to hold onto those aspects of culture that defined their personhood and enabled their cultural units to survive. Many impasses occur because the rules of the culture into which the client and/or therapist have moved are unspoken and unacknowledged, but are enforceable through law, ethical codes, and U.S. American traditions nevertheless (Helms & Cook, 1999, pp. 316–318). Thus, what is needed is a cultural framework for allowing everyone to recognize white cultural values and/or patterns so that impasses can be anticipated, diagnosed, or recognized as they occur. The model should be taught to therapists in training as well as their clients. A conceptual model of white culture that I still find useful is Katz's (1985) sociopolitical description of its basic components. Although Katz's model should be studied empirically on white samples, Helms and Cook describe some of its possible applications to the counseling process. It might be comparably useful for helping people generally to understand how to engage in unfamiliar cultural contexts.

    For example, Mr. Wolf entered a helping relationship without recognizing the alleged value of cultural dimensions such as “aesthetics” and “history” in U.S. American society. Aesthetics refers to the belief that the people (or entities) should exhibit European physical characteristics and cultural practices; history refers to the belief that the only worthwhile knowledge is derived from the experiences of European immigrants in the United States. Little Red Riding Hood, her grandmother, and the woodsman conformed to these values, but Mr. Wolf did not. Thus, he was immediately in the middle of a cultural impasse as soon as Little Red Riding Hood spoke to him, but so was she. Perhaps if Mr. Wolf had known what cultural patterns he was encountering in advance, he might have employed some of the intriguing compensatory strategies described in the previous chapters, including enhancing understanding of the two cultures by engaging the surrounding communities in difficult dialogues and the treatment process (Chapter 3, this volume). Mr. Wolf should not have had the complete responsibility for re-educating Little Red Riding Hood and her grandmother.

    Racism and Ethnoviolence as Sources of Pathology

    Insofar as I can tell, the authors did not actually define ethnocultural. I inferred that they intended their focus to be specific ethnic group cultures (i.e., ethnicity) rather than racial groups as socially defined (i.e., sociorace) or ethnic group classifications, which often are used as substitutes for racial groups. Some of the chapter authors subsumed “race” under “ethnocultural.” Admittedly, there is considerable controversy (Helms & Talleyrand, 1997; Phinney, 1996) about whether “ethnicity” should subsume “race.” One problem with conflating the two concepts is that doing so obscures the negative effects of ethnoviolence and racism on mental health and contributes to misperceptions of cultures rather than abusive social systems as problematic (Helms, Nicolas, & Green, 2011).

    From my perspective, the interventions that follow from impasses attributable to race, or more accurately racial socialization, are quite different from the impasses attributable to cultural socialization. As the authors demonstrate throughout this book, culture has behavioral and psychological implications for individuals' levels of functioning, even when the rules of the culture are invisible. Race has no behavioral or psychological meaning (Helms, Jernigan, & Mascher, 2005). In the United States, individuals are treated or mistreated according to their perceived racial categories, whether or not such categories are consistent with how they conceptualize themselves. People also are mistreated because of their cultural practices or presumed practices, but this type of abuse may be difficult to recognize because race may be more salient in people's perceptions of others. Mistreating people because of their perceived race is racism and/or race-related emotional abuse; mistreating them because of presumed cultural practices is ethnoviolence or culture-related emotional abuse (Brubaker & Laitin, 1998). Racism and ethnoviolence are both types of inter-group relations that are imposed by members of more powerful out-groups. Helms et al. (2011) discuss a variety of issues associated with racism or ethnoviolence as catalysts for posttraumatic stress disorder (PTSD) with greater complexity than I can indulge in here. Also, Sue and associates (2007) provide a taxonomy of microaggressions (i.e., seemingly small, usually psychological assaults with potentially serious emotional consequences). Knowledge of their framework might be serviceable whether one is considering PTSD or less severe stress-related mental health issues associated with racism or ethnoviolence.

    However, my main point is that we do clients, trainees, and ourselves a great disservice if we do not provide them with the skills to cope with threats to their self-integrity based on physical appearance (racism) or presumed common in-group cultural practices (ethnoviolence). Little Red Riding Hood engaged in microaggressions against Mr. Wolf not because of their cultural mismatches. She did not take time to know him well enough to understand his cultural values (e.g., respeto). Instead she reacted to him on the basis of his physical appearance and whatever stereotypes she had learned to associate with “big ears” and “big teeth.”

    Social Interaction Theory

    In their introductory chapter, Gallardo, Parham, Trimble, and Yeh acknowledge disparities in power as a major contributing factor in the manifestation of cultural impasses and advocate empowerment as a goal for training programs and practitioners working with members of inappropriately served ethnocultural communities. Parham's (2002) Skills Identification Model, as outlined in Chapter 1, is a process model in that it pertains to four principles of facilitative helping relationships (positive relationships, shared worldviews, shared expectations, and participatory interventions or rituals) and five domains of cultures (nature of reality, value orientations, relationship to Divine force, systems of knowledge, and human interaction). The SISM provides six specific actions or themes (e.g., client connecting, culturally responsive assessment) by which these aspects may be integrated into culturally responsive therapeutic relationships. Each of the culturally responsive process dimensions are assumed to be universal or etic, in that they are expected to be appropriate for all groups, but emic or universal, in that it is noted that they must be adapted to the cultural dimensions of specific groups. Most of the chapters illustrate how such adaptations may occur.

    However, the model and cultural adaptations of it do not appear to include a framework for diagnosing power dynamics in the therapy, training, or societal relationships. That is, helping clients, for example, develop “awareness of surrounding environmental circumstances that contribute to the establishment of behaviors and feelings of oppression” (Chapter 1) is a necessary condition for fostering empowerment. The capacity to diagnose the power dynamics in interactions at the person and system levels is a necessary skill because it allows the experiencing person to make wise decisions about how best to intervene and/or resist disempowering interactions.

    The social interaction model (Helms & Cook, 1999) is useful for this purpose because it recognizes that any interaction, including therapy, involves expressions of power or lack thereof by each party or entity (e.g., pairs of individuals, groups, coalitions) involved in the interaction. Helms and colleagues have illustrated how the model may be used to understand the effects of power dynamics in therapy interactions (Helms & Cook, 1999), assessment (Helms et al., 2011), and therapy supervision (Jernigan, Green, Helms, Gualdron-Murhib, & Henze, 2010). Without going into great detail, interactions may be classified as parallel, regressive, and progressive. Each type has different implications for attitudes, values, behaviors, and emotions.

    In parallel interactions or events, participants share power; no one's perspective is more valued than another's perspective. Maintaining harmony is a primary goal of such interactions. When culture is the underlying dynamic of the potential power differential, parallel therapy interactions are often supportive if both parties share a common manner of communicating from shared cultural perspectives, but they are not necessarily healing or empowering. Regressive interactions occur when the person or coalition with the most power in the interaction has the least understanding of or respect for the other person or group's cultural socialization. Such relationships are potentially harmful for all parties involved. For the least powerful, they contribute to psychological and perhaps physical withdrawal from the situation(s); for the most powerful, they contribute to entrenchment in culturally encapsulated worldviews. Although ostensibly in the more powerful role of counselor or educator, Mr. Wolf was actually in regressive interactions with Little Red Riding Hood, her grandmother, the woodsman, and seemingly the surrounding community. Although clients and trainees will probably not literally leap out a window when they experience regressive interactions, underutilization of services and premature termination may be an analogous form of withdrawing from potentially harmful experiences.

    In progressive interactions, the person with greatest power (e.g., perhaps the therapist) has developed the skills and knowledge to help the persons understand and value the qualities of their own culture as well as the culture with which the persons are in conflict. The book Culturally Adaptive Counseling Skills: Demonstrations of Evidence-Based Practices is designed to promote progressive relationships with respect to culture and thereby empower helpers as well as those they seek to help.

    Ethical Obligations for Changing Systems

    The implications of teaching people to deliver culturally responsive interventions are contained throughout the chapters. Toporek (Chapter 17, this volume) proffers some specific training resources and strategies for engaging in progressive interactions with therapists-in-training during the training process. Nevertheless, every year around December through January, I am reminded of the resistance to change by an ethical dilemma that I think was not discussed in the foregoing chapters. Those of us who participate in the education of culturally responsive therapists perhaps recognize my timeframe as the period during which doctoral students in psychology participate in interviews to determine whether they will be selected for a predoctoral internship, a requirement that they must successfully complete in order to receive their doctoral degree.

    Each year, candidates return with horror stories about their experiences at sites where the messages of the value and necessity of delivering culturally responsive services, such as those that permeate this book, apparently have not been received. Internship candidates are placed in multiple regressive interactions, where their potential benefactors barrage them with criticisms of who they are as people (“I'm afraid of you because you're so well dressed” or “Do you expect me to expose my clients to an Asian therapist?”) as well as for their culturally responsive skills (“We don't do that ‘cultural stuff’ here; hopefully it's just a stage you're going through” or “Can you do real therapy?”). The parallels with Mr. Wolf's experiences are perhaps obvious. One might argue that candidates should not seek to match culturally unresponsive sites. But given that there are more potential interns than there are accredited sites, and even sites that advertise themselves as culturally responsive do not practice any SISM principles or guidelines or offer equivalent culturally responsive climates, such an argument is essentially nonsensical.

    In effect, culturally responsive educators, supervisors, and mentors send our mentees off into systems in which they are often the only person who values what we have taught them. We expect them to change systems and advocate for client empowerment once they get into the system. However, often the only way to get into the required systems is to hide the skills and knowledge that we have taught them and they have taught us. Models exist for advocating for clients and teaching them to advocate for themselves in oppressive systems, but they do not exist for educators and supervisors. Ethical concerns for culturally responsive educators are (a) What do we do about ensuring the availability of internship placements for candidates who practice what we teach? (b) Should we be sending our mentees into potentially damaging environments? and (c) How might we best advocate for culturally responsive and socially just training environments once trainees enter the helping professions? Failure to attend to such systemic disempowerment issues means that the helpers we intend to train to be culturally responsive may eventually succumb to the pressures of the more powerful racially and culturally unjust systems, as did Mr. Wolf.

    References
    Brubaker, R., & Laitin, D. D. (1998). Ethnic and nationalist violence. Annual Review of Sociology, 24, 423–452. http://dx.doi.org/10.1146/annurev.soc.24.1.423
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    Helms, J. E., Jernigan, M. M., & Mascher, J. (2005). The meaning of race in psychology and how to change it. American Psychologist, 60, 27–36. http://dx.doi.org/10.1037/0003-066X.60.1.27
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    About the Editors

    Miguel E. Gallardo, Psy.D., is an associate professor of psychology at Pepperdine University's Graduate School of Education and Psychology, where he teaches courses on multicultural and social justice, intimate partner violence, and professional practice issues. He is a licensed psychologist and maintains an independent/consultation practice where he conducts therapy with adolescents and adults. Dr. Gallardo's areas of scholarship and research interests include understanding the psychotherapy process when working with ethnocultural communities, particularly the Latina/o community, and understanding the processes by which individuals develop cultural awareness and responsiveness. Dr. Gallardo has published refereed journal articles and book chapters in the areas of multicultural psychology, Latina/o psychology, ethics, and evidence-based practices. He is co-editor of the book Intersections of Multiple Identities: A Casebook of Evidence-Based Practices with Diverse Populations, published in 2009. Dr. Gallardo is a past president of the California Psychological Association. He is one of the founders and served as the first president of the California Latino Psychological Association and continues to be active in psychological organizations at the state and national levels. Dr. Gallardo is currently serving a two-year governor-appointed position on the California Board of Psychology. He is the recipient of several awards for his dedication and commitment to the field of psychology locally, statewide, and nationally. Dr. Gallardo is a Fellow of the American Psychological Association.

    Christine J. Yeh, Ph.D. is professor and chair, Department of Counseling Psychology at the University of San Francisco. She was previously associate professor in counseling psychology at Teachers College, Columbia University. Her research has focused on ethnic identity, cultural adjustment, mental health, and coping of Asian Americans, Pacific Islanders, and Native Hawaiians. She is author of more than 70 articles, chapters, and other publications. Dr. Yeh has also received 22 grants from federal and local agencies, foundations, and universities, including a five-year National Institute of Mental Health grant for Asian immigrant mental health. She is the recipient of several awards, including Distinguished Fellow, Early Career, and the Okura Community Leadership Award from the Asian American Psychological Association; Outstanding Research Award from the American Educational Research Association (Division E) and the American Counseling Association; the Community Service Award (Division 17, SERD, American Psychological Association); and five Outstanding Teaching Awards (Teachers College, Columbia University).

    Joseph E. Trimble, Ph.D., is a distinguished professor in the Center for Cross-Cultural Research, Department of Psychology, at Western Washington University; also he is a President's Professor at the Center for Alaska Native Health Research at the University of Alaska, Fairbanks. Through out his long career, he has focused his efforts on promoting psychological and sociocultural mental health research with indigenous populations, especially American Indians and Alaska Natives. He is the editor or author of 18 books and more than 100 journal articles and chapters and the recipient of 20 fellow ships, awards, and honors, including the Excellence in Teaching Award and the Paul J. Olscamp Outstanding Faculty Research Award at Western Washington University; the Distinguished Psychologist Award from the Washington State Psychological Association; the Peace and Social Justice Award from the American Psychological Association's Division on Peace Psychology; the Distinguished Elder Award from the National Multicultural Conference and Summit; the Henry Tomes Award for Distinguished Contributions to the Advancement of Ethnic Minority Psychology by the Council of National Psychological Associations for the Advancement of Ethnic Minority Interests and APA's Society for the Psychological Study of Ethnic Minority Issues; and the International Lifetime Achievement Award for Multicultural and Diversity Counseling from the Ontario Institute for Studies in Education, University of Toronto.

    Thomas A. Parham, Ph.D., is interim vice chancellor for student affairs and an adjunct faculty member at the University of California, Irvine. Dr. Parham is a past president of the National Association of Black Psychologists. For more than 30 years, Dr. Parham has focused his research efforts in the area of psychological nigrescence and has authored numerous articles in the area. Writing in the areas of African American psychology, identity development, and multicultural counseling remains his primary focus. Among the dozens of honors and awards he has received are election to Fellow status of Division 17 (Counseling Psychology) and 45 (Ethnic Minority Issues) of the American Psychological Association in 1994; the Samuel H. Johnson Award for Exemplary Service and Scholarship from the Association for Multicultural Counseling and Development in 1995; his election to the title of Distinguished Psychologist by the Association of Black Psychologists (ABPsi's highest honor) in 1998; the APA Dalmus Taylor Award for Leadership, Scholarship, and Advising in 1999; the Association of Black Psychologists Certification and Proficiency in African Centered/Black Psychology, Board Certified Fellow and Board Certified Diplomate, July 2007; the American Psychological Association Division 17 Society of Counseling Psychology Award for Lifetime Achievement in Mentoring, August 2007; and the Janet E. Helms Award for Mentoring and Scholarship in 2010.

    About the Contributors

    I. David Acevedo-Polakovich, Ph.D., is a faculty member at Central Michigan University, where he is assistant professor in the clinical psychology doctoral program and director of the Center for Community-Academic Initiatives for Development. His research and professional work focus on developing effective health and human services for historically underserved youth and families, with a particular emphasis on prevention and applied development programs targeted at adolescents. He is also actively involved in scholarship examining the development of successful community-academic initiatives and approaches to the development of practice-based evidence. More information on Dr. Acevedo-Polakovich and his work is available at http://www.cmich.edu/chsbs/x23916.xml.

    Noha Alshugairi, M.S., MFTI, was born in Cairo, Egypt, and raised in Jeddah, Saudi Arabia. In 1984 she immigrated to the United States, where she has resided ever since. She received her B.A. in zoology from Rutgers University in 1986 and her M.S. in counseling from California State University, Fullerton in 2007. She is currently a licensed marriage and family therapist in private practice in Newport Beach, California. She co-hosts “Family Connection,” an Internet Radio show, on http://www.onelegacyradio.com. As a Certified Positive Discipline Associate, she conducts parenting classes and frequently lectures on issues related to women and family. Her interests include divorce in the American Muslim community, parent and child relationships, and the intertwining of faith and culture in the American Muslim community.

    Metra Azar-Salem, M.S., MFT Intern, was born in Kabul, Afghanistan, in 1978 after the country had just been invaded by the USSR and her family was on the verge of migration. After 9/11 she worked closely with new Afghan immigrant families, which inspired her to apply for her master's in marriage and family therapy (MFT). She completed her master's and is currently in the last phase of her dissertation.

    She currently works at an Islamic school in Irvine, California, where she provides culturally sensitive therapeutic services to adults, children, and couples as well as parent education classes and groups. In 2008, she was awarded the Minority Fellowship by the American Association for Marriage and Family Therapy, which entailed a three-year training program under Dr. Kenneth Hardy as well as a full scholarship for her doctoral studies. She has been married for 13 years and has three boys of her own.

    J. Manuel Casas, Ph.D., received his doctorate from Stanford University in counseling psychology. He is a Professor Emeritus in the Department of Counseling, Clinical, and School Psychology at the University of California, Santa Barbara. He has over 135 publications. He is the co-author of the Handbook of Racial/Ethnic Minority Counseling Research (Charles C Thomas, 1991) and is one of the editors of the three editions of the Handbook of Multicultural Counseling (Sage, 1995, 2001, 2010). His most recent endeavors have focused on Latina/o families, especially those who are immigrants, who are at risk for experiencing educational and psychosocial problems and trauma. His work in this area gives attention to resiliency factors that can help Latina/o families avoid or overcome such problems.

    Angela M. Enno is a doctoral student in the Combined Clinical, Counseling and School Psychology Ph.D. Program at Utah State University. Ms. Enno has published in the areas of ethnic identity and community context, training for cultural competence, and interventions for treating anxiety spectrum disorders. Her future goals include working with American Indian communities in clinical settings and conducting community-based research and mentoring American Indian and other diverse students in psychology.

    Anderson J. Franklin, Ph.D., is the Honorable David S. Nelson Professor of Psychology and Education in the Department of Counseling, Developmental and Educational Psychology at Boston College, Lynch School of Education, and Professor Emeritus of Psychology at The Graduate Center, The City University of New York. He directs the Nelson Chair Roundtable for Networking Community Based Programs and the Boston College Collaborative Extended Learning Project, strengthening ties between schools, families, and community partners. He was awarded an honorary doctorate of humane letters from Lewis and Clark College in Oregon and the 2010 Outstanding Alumnus Award from the University of Oregon College of Education, as well as the American Psychological Association's Presidential Citation for outstanding service as Distinguished Elder/Senior Psychologist at the 2009 National Multicultural Conference and Summit. He is the author of From Brotherhood to Man hood: How Black Men Rescue Their Relationships and Dreams From the Invisibility Syndrome.

    Cheryl Gering, M.A., is currently a doctoral student in clinical psychology at Central Michigan University with interests in child clinical psychology and pediatric neuropsychology. Her professional experiences have focused on evidence-based assessment and treatment of children with disruptive beha vior problems and/or a history of child maltreatment. Her research examines (1) cognitive and situational factors impacting parents' strategy use when interacting with their children and (2) predictors of social adjustment among typically developing children and children with neurodevelopmental conditions. Ms. Gering also has an active interest in the neuropsychological assessment and treatment of children and young adults with acquired or congenital brain dysfunction.

    Cheryl Tawede Grills, Ph.D., is a clinical psychologist with an emphasis in community psychology. She is professor of psychology at Loyola Marymount University and associate dean in the College of Liberal Arts. Dr. Grills is also president-elect of the National Association of Black Psychologists and founder and director of Imoyase Community Support Services, a nonprofit program evaluation and consulting organization serving community-based organizations and foundations around the country. Among the honors and awards she has received is her election in 2004 to the title of Distinguished Psychologist by the Association of Black Psychologists. Her research interests and publications include African-centered models of treatment engagement with African Americans, substance abuse prevention and treatment, community psychology, community mental health, prevention, and the provision of action research and program evaluation services. She has also studied under traditional medical practitioners in Ghana, Nigeria, and Senegal and is a registered member of the Ghana National Association of Traditional Healers.

    Jeff E. Harris, Ph.D., is an associate professor of psychology at Texas Woman's University. His Ph.D. in counseling psychology was awarded by The Ohio State University in 1990. Dr. Harris worked for several years at university counseling centers in Illinois and Hawaii. American Board of Professional Psychology certification as a specialist in counseling psychology was awarded in 2004. Dr. Harris is the author of Integrative Multitheoretical Psychotherapy (2008, Houghton-Mifflin) and coauthor of Workshops: Designing and Facilitating Experiential Learning (1999, Sage). As the originator of multitheoretical psychotherapy (MTP), Dr. Harris has trained psychotherapists at regional and national conferences and has been featured in five training videos. His current research focuses on applying MTP to depression and testing the effectiveness of key strategies training. Dr. Harris lives in Denton, Texas, with his wife and daughter. He enjoys biking, hiking, skiing, and reading about world religions.

    Janet E. Helms, Ph.D., is the Augustus Long Professor in the Department of Counseling, Developmental, and Educational Psychology and director of the Institute for the Study and Promotion of Race and Culture at Boston College. Dr. Helms serves on the editorial boards of the Journal of Psychological Assessment and the Journal of Counseling Psychology and is on the Counsel of Research Elders of the Journal of Cultural Diversity and Ethnic Minority Psychology. She has written more than 60 empirical and theoretical articles and four books on the topics of racial identity and cultural influences on assessment and counseling practice. Her books include A Race Is a Nice Thing to Have (Microtraining Associates) and (with Donelda Cook) Using Race and Culture in Counseling and Psychotherapy: Theory and Process (Allyn & Bacon). Dr. Helms' work has been acknowledged with awards from national psychological associations and universities throughout the nation.

    Arpana Inman, Ph.D., received her doctorate in counseling psychology from Temple University and is currently an associate professor in counseling psychology at Lehigh University. Her areas of research include Asian American coping and mental health, international counseling and psychology, multicultural competencies in supervision and training, and South Asian diasporic identity. She has presented nationally and internationally in these areas. She is also involved with the South Asian community at a national level and is a cofounder of the South Asian Psychological Networking Association, which runs a Web site and Listserv for South Asian concerns. She currently serves on the editorial boards of the Asian American Journal of Psychology, Psychotherapy Research, and Psychotherapy: Theory, Research, Training, and Practice.

    Jeff King, Ph.D., is an associate professor and director of the Center for Cross-Cultural Research at Western Washington University's Department of Psychology, in Bellingham, Washington. He is a licensed clinical psychologist and has worked primarily with American Indian populations for the past 20 years. He is currently president of the First Nations Behavioral Health Association and active board member of the National Multi-Ethnic Behavioral Health Alliance. Both organizations work toward a reduction in the disparities in behavioral health for Native Americans and other ethnic minority populations. Dr. King is a tribally enrolled member of the Muscogee (Creek) Nation of Oklahoma.

    Susana Ortiz Salgado, Ph.D., is the current president of the California Latino Psychological Association and is a licensed psychologist and coordinator for the Psychological Disabilities Program at Santa Ana College. Dr. Salgado has a strong passion for integrating multiculturalism and social justice into every aspect of her professional and personal life. She is a firm believer in integrating advocacy in her role as a psychologist and has a strong commitment to working toward social justice and serving disenfranchised communities. Her current focus is destigmatizing mental health concerns and access to mental health services within Latina/o communities. Dr. Salgado's clinical and research interests lie within an array of multicultural and gender-related areas. Her interests include gender socialization within Latina/o families, Latina/o mental health, and career development of Latina/o students.

    Kao Chiu Saechao, M.S.W., is a registered associate social worker with the California Board of Behavioral Sciences. He is the program lead for the Family and Children Division of the Mental Health Department at Asian Americans for Community Involvement in San Jose. Kao earned his master's in social work at San Jose State University and was recognized as the Outstanding MSW Field Student of 2008. He received his bachelor's in social welfare and double minors in education and ethnic studies from the University of California, Berkeley in 2005, played for the Cal Men's Volleyball team, and volunteered as a mentor and tutor to underrepresented youths in the community. Currently he is pursuing his clinical licensure and is involved with the Asian and Pacific Islander Social Work Council to promote social work as a profession. Kao's interests include community mental health, intergenerational conflicts in Southeast Asian family systems, and the transcultural practice of clinical social work.

    Maryam Sayyedi, Ph.D., is the founder and clinical director of Omid Multicultural Institute for Development in Irvine, California. She is a licensed clinical child psychologist and an adjunct faculty member in the Department of Counseling at California State University, Fullerton. She obtained her Ph.D. in clinical psychology from Washington State University with concentrations in child development and neuropsychology. Dr. Sayyedi is bilingual and fluent in Farsi, and she has devoted her practice and research to addressing the mental health needs of Middle Eastern American adolescents, children, and their families.

    Gayle Skawennio Morse, Ph.D., has conducted research for nearly a decade on examining the effects of polychlorinated biphenyls and other toxic chemicals on mental health. Currently she is looking at the neurological effects of toxic chemicals as well as cross-cultural studies of psychological measures and human health. In her role as the co-director of the American Indian Support Program, she is responsible for mentoring American Indian students and coordinating the Retreat and Convention of American Indian Psychologists. The unique design of the Retreat incorporates traditional views into the world of research and allows Native students to meet and interact with elders and leaders in the field of psychology. She is an enrolled member of the Mohawk Tribe and draws from the tribe the principles of respect, trust, and empowerment that have guided her both professionally and personally.

    Nita Tewari, Ph.D., received her doctorate in counseling psychology from Southern Illinois University. She has served in positions of research psychologist at California State University, Long Beach; clinical researcher at the University of California, Irvine (UCI) Department of Psychiatry and Human Behavior; and most recently was a staff psychologist in the Counseling Center and adjunct faculty member in the School of Social Sciences and Asian American Studies at UCI. Dr. Tewari has provided clinical and consulting services to diverse populations since 1993 and has several publications in the areas of Indian American, South Asian, and Asian American mental health. Her most recent book, Asian American Psychology: Current Perspectives, was published in 2009. She also cofounded the South Asian Psychological Networking Association in 2002 and served as vice president of the Asian American Psychological Association (2008–2009). She is currently a consultant in the area of multicultural and Asian American psychology.

    Rebecca L. Toporek, Ph.D., is an associate professor in the Department of Counseling at San Francisco State University. She has written extensively on multicultural training, social justice advocacy, systemic interventions in discrimination, community engagement, and career and college counseling. She is committed to bringing others' work to the forefront, for example, as a coeditor of the Handbook for Social Justice in Counseling Psychology, ACA Advocacy Competencies: A Social Justice Framework for Counselors, Handbook of Multicultural Competencies, and, currently, the Journal for Social Action in Counseling and Psychology. She is involved in community partnerships in San Francisco and New Orleans focused on career and workplace issues integrating multicultural and social justice perspectives.

    Jorge Wong, Ph.D., is the director of Behavioral Health Services at Asian Americans for Community Involvement in San Jose, California. He advocates for the advancement of cultural diversity in clinical practice, social justice, public service, and leadership development. He serves in local and statewide organizations, including the Mental Health, Alcohol and Drugs Contractors associations of Santa Clara County; San Jose's Independent Police Auditor; California Psychological Association; California Psychology Internship Council; Consumer and Family Leadership Committee of the Mental Health Services Oversight and Accountability Commission; Mental Health Loan Assumption Program; Office of Problem Gambling; and Kaiser Permanente's Research Project on Genes, Environment, and Health. He is clinical faculty at the Pacific Graduate School of Psychology at Palo Alto University, certified in healthcare compliance and ethics, and practices in community mental health and forensic settings. He enjoys volleyball, dragon boating, mud runs, and marathons with his interns and trainees.


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