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Strategies for Building Multicultural Competence in Mental Health and Educational Settings

John Wiley & Sons

Chapter One

People of color, including those of multiracial and multiethnic heritage, represent an increasing proportion of the U.S. population (Jones & Smith, 2001; U.S. Census Bureau, 2003). According to the 2000 U.S. Census (U.S. Census Bureau, 2003), approximately 40% of the nation's population consists of people of color (Jones & Smith, 2001). The landscape of racial and ethnic diversity across the United States indicates particularly high cultural diversity in coastal and border states, especially California, Texas, Arizona, New Mexico, Washington, Florida, New York, and Louisiana, and a general growth in cultural diversity in the midwestern, northwestern, and southern regions of the United States (U.S. Census Bureau, 2003). These demographic statistics underscore the need for professional psychologists to have a vested interest in addressing cultural diversity issues as practitioners, educators, researchers, and policymakers. Thus, it behooves psychologists and the larger field of psychology to reflect on potential monocultural biases to foster cultural relevance in research, practice, education, and training (Sue, 2001).

Recently, the American Psychological Association (APA) as a professional organization has responded to the increased diversification of the United States, in part, with explicit statements endorsing the importance of cultural competence for psychologists. Specifically, the "Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists" (APA, 2003), herein referred to as the APA Multicultural Guidelines, is a compilation of six prescriptive statements that reflect the evolution of the psychology profession with regard to recognizing that cultural competence is necessary in meeting the varied needs of individuals belonging to diverse cultural groups or historically marginalized groups. These multicultural competencies reflect a response to several APA divisions' calls for recognition and integration of multicultural initiatives within the larger psychological community, as well as the exponentially growing representation of people of color in the United States (Sue, Bingham, Porche-Burke, & Vasquez, 1999). As a living document, this set of competencies was designed to be expanded alongside future empirical and conceptual psychological contributions and as broader social movements influence public interests.

RELEVANT BACKGROUND

The APA Multicultural Guidelines (APA, 2003) were published with the goal of affecting current and future psychological practice, training, education, and research and had been preceded by nearly 40 years of attention to multicultural issues in certain subfields of applied psychology. Social movements such as the Civil Rights Movement in the 1950s and 1960s represented forums for political action and subsequent public policy initiatives that addressed explicit differential access to human rights and power based on race and ethnicity. In the social context of change, structural and functional changes occurred within the psychology profession that affected the development of organizational bodies focused on cultural diversity issues. Specifically, momentum from the sociopolitical activism in the late 1960s created an atmosphere in which leading African American psychologists mobilized to increase representation of Black people in psychology and in leadership roles in professional psychological organizations, eliminate racially biased research from professional journals, and establish training programs in which cultural issues were included (Robinson & Morris, 2000). This kind of activism marked the beginning of the Association of Black Psychologists (ABP); other subgroups of psychologists of color, such as the Asian American Psychological Association (AAPA), were formed in the early 1970s.

Greater visibility of psychologists of color in the profession facilitated the development and disbursement of research related to people of color The APA Guidelines: Initial Development and Summary 5 (APA, 2003). For example, in 1971, the National Institute of Mental Health (NIMH) established an Office of Minority Research; NIMH reorganized 15 years later to support research that included populations of color in all research. With financial and instrumental support from NIMH, organizations such as ABPsi and AAPA were able to support and publish research pertinent to populations of color. Additionally, interfacing with NIMH gave psychologists of color the opportunity to represent and increase visibility for multicultural issues within the profession.

Significant contributions to the multicultural psychology literature emerged from several counseling psychologists' commitment to enhancing mental health professionals' competence in working with clients of color (Constantine, 2002; Robinson & Morris, 2000). Sue and his colleagues' seminal work and development of a tripartite model of multicultural counseling competence (i.e., Sue et al., 1982) has laid the foundation for much of the existing literature on multicultural counseling (Constantine & Ladany, 2001). Sue and his colleagues defined the tripartite model in terms of counselors' (1) recognizing their personal attitudes and values around race and ethnicity, (2) developing their knowledge of diverse cultural worldviews and experiences, and (3) identifying effective skills in working with clients of color.

Ten years later, under the leadership of Dr. Thomas Parham, members of the Professional Standards Committee of the Association for Multicultural Counseling and Development (i.e., Sue, Arredondo, & McDavis, 1992) expanded the tripartite model to include three desired characteristics of multiculturally competent counselors: awareness of personal assumptions, values, and biases; understanding the worldviews of culturally diverse clients; and developing abilities to use and create culturally appropriate intervention strategies. The three counselor characteristics were crossed with the three dimensions of competence from the first iteration of the tripartite model to yield nine competency areas in which 31 total statements were offered. Arredondo and her colleagues (1996) produced a supplement to Sue et al.'s competencies that served to formally define constructs and competencies that had been hard to implement in the previous version.

The third major revision of the multicultural competencies (Sue et al., 1998) reflected major empirical and theoretical emphases in the literature, namely, research in racial and ethnic identity models (see Helms & Cook, 1999), and expanded the range of professional helping roles, such as social change agent and advocate (Atkinson, Thompson, & Grant, 1993). This was evident in the inclusion of three new competencies under the skills dimension, two of which speak to racial and cultural identity models and the third to adopting helping roles other than those of counselor or psychotherapist. Further, characteristics of multiculturally-competent organizations were described and operationalized (Sue et al., 1998). Eleven operationalization statements concerning multiculturally inclusive organizations stressed commitment to diversity in all levels of personnel (including formal and informal mentorship), mission statements, and action plans. These competencies promoted the inclusion of diversity agendas in all facets of organizational management such that culture was now regarded as central rather than peripheral in multicultural organizational settings. The third iteration of the tripartite model of multicultural counseling competence also underscored the role of psychologists in addressing the effects of interpersonal and institutional racism from mesocosmic levels, including therapy and the classroom, to systemic levels that include the field of psychology itself (Sue et al., 1998).

FOUNDATIONAL PRINCIPLES OF THE MULTICULTURAL GUIDELINES

The APA Multicultural Guidelines are grounded in six principles that "articulate respect and inclusiveness for the national heritage of all groups, recognition of cultural contexts as defining forces for individuals' and groups' lived experiences, and the role of external forces such as historical, economic, and socio-political events" (APA, 2003, p. 382). In their philosophical underpinnings, the principles of the APA Multicultural Guidelines encourage psychologists to see themselves as potential leaders of social justice in teaching, research, and clinical capacities and as active advocates of multiculturalism against the deleterious effects of racism, discrimination, and oppression. The principles are designed to influence the planning and actualization of education, research, practice, and organizational change informed by multiculturalism. Although all of the principles encourage psychologists to reflect on their own professional stances, Principles 5 and 6 specifically address organizational and social change roles that psychologists may engage to benefit clients, students, trainees, and the broader society.

Principle 1: Ethical conduct of psychologists is enhanced by knowledge of differences in beliefs and practices that emerge from socialization through racial and ethnic group affiliation and membership and how those beliefs and practices will necessarily affect the education, training, research, and practice of psychology.

In accordance with ethical principles related to respecting all individuals (APA, 1992: Principle D; APA, 2002: Principle E) and social responsibility (APA, 1992: Principle F; APA, 2002: Principle D), it is clear that greater The APA Guidelines: Initial Development and Summary 7 knowledge of cultural differences will guide psychologists' understanding of their roles as teachers, trainers, researchers, and practitioners, such that their behavior in these capacities would reflect multicultural sensitivity. In particular, psychologists who engage social justice work that derives from knowledge of contextual influences on a group of marginalized individuals may exhibit appreciation and respect for others' broader social and cultural conditions.

Principle 2: Understanding and recognizing the interface between individuals' socialization experiences based on ethnic and racial heritage can enhance the quality of education, training, practice, and research in the field of psychology.

Psychologists should be aware of how their own cultural identities might affect interpersonal dynamics in practice, teaching, training, and research contexts. Additionally, psychologists' understanding of collective experiences based in race and ethnicity may contribute to greater sensitivity to intra- and intercultural group dynamics.

Principle 3: Recognition of the ways in which the intersection of racial and ethnic group membership with other dimensions of identity (e.g., gender, age, sexual orientation, disability, religion/spiritual orientation, educational attainment/experiences, and socioeconomic status) enhances the understanding and treatment of all people.

An appreciation of how cultural identities interface, in addition to recognition of within-group differences along varied dimensions of identity, can inform research, treatment, and organizational interventions for given cultural groups. The integration of various dimensions of identity may lead to richer understandings of individuals' experiences and contribute to complex and innovative research in psychology.

Principle 4: Knowledge of historically derived approaches that have viewed cultural differences as deficits and have not valued certain social identities helps psychologists to understand the underrepresentation of ethnic minorities in the profession and affirms and values the role of ethnicity and race in developing personal identity.

Historical knowledge of the institutional uses of psychology to promote oppressive systems, such as academic segregation, institutionalization in mental illness facilities, slavery, and immigration restrictions, may lead psychologists to reflect on the systemic implications of research, treatment, conceptualization, and education models. Additionally, recognizing that traditional models of psychology and psychotherapy were derived in specific social contexts that may not have validated the humanity of people of color can allow psychologists to adopt or create novel approaches to psychology that may better suit clients' concerns.

Principle 5: Psychologists are uniquely able to promote racial equity and social justice. This is aided by their awareness of their impact on others and the influence of their personal and professional roles in society.

Sensitivity to racism, oppression, and mechanisms of social injustice related to race and ethnicity affords psychologists opportunities to address inequality at individual, group, and political levels. For example, at the individual level, psychologists may work with clients in naming certain experiences as discriminatory and finding personal advocacy resources. Psychologists may be able to address injustices at the group level through encouraging collegial faculty members to recruit prospective graduate students of color into majority-White graduate programs. At the political level, psychologists may develop research programs that address psychological and academic benefits of affirmative action and use this research to promote public policy and law.

Principle 6: Psychologists' knowledge about the roles of organizations, including employers and professional psychological associations, are potential sources of behavioral practices that encourage discourse, education and training, institutional change, and research and policy development that reflect rather than neglect cultural differences. Psychologists recognize that organizations can be gatekeepers or agents of the status quo, rather than leaders in a changing society with respect to multiculturalism.

Psychologists may be able to utilize their connections to organizations, specifically professional psychological associations, to promote multicultural initiatives and contribute to ongoing pushes for integrating multiculturalism. For example, groups of psychologists may become involved as consultants with secondary school educational boards to increase retention, graduation, and college enrollment rates of students of color. Further, psychologists may be involved in psychological organizations, such as the Society for the Psychological Study of Ethnic Minority Issues (APA, Division 45), to develop professional strategies that explicitly target enrollment, retention, and graduation rates of students of color at secondary and postsecondary educational levels.

THE MULTICULTURAL GUIDELINES

Guideline 1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves.

The APA Multicultural Guidelines state that interactions between any two people are multicultural in that individuals' cultural perspectives shape perceptions of life experiences (Arredondo et al., 1996; Sue & Sue, 2003). Knowledge of cultural influences on worldview orientations may inform psychologists' understanding of how their norms and values may contrast with those of clients, trainees, and research participants. Additionally, primary awareness of personal race-based stereotypes may allow psychologists the opportunity to reflect on the origin and reinforcement of these stereotypes on social and psychological levels, addressing how, when, and to whom stereotypes are conjured; this may be a critical step in developing cultural sensitivity. Psychologists are not immune from tendencies to differentiate in-groups from out-groups; however, it is when power is distributed unequally, favoring psychologists, that psychology may be a medium for exploitation, insult, and ignorance. Mental health professionals may de-emphasize racial and ethnic group membership through the adoption of color-blind approaches or the focus on universal aspects of human behavior over racial or ethnic differences. Values endorsing assimilation with the White majority group may be masked by a color-blind approach, though psychologists may be unaware of pernicious effects of color blindness, including maintaining a harmful status quo and ignoring potentially salient race-related factors (Ridley, 1995). Once aware of attitudes and values related to race, ethnicity, and culture, psychologists may process and reduce their biases through various strategies, including building a "we" conceptualization of human interaction from an "us versus them" conceptualization (Gaertner & Dovidio, 2000) or increasing contact with people of color to foster connection and empathy.

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Excerpted from Strategies for Building Multicultural Competence in Mental Health and Educational Settings by Madonna G. Constantine Derald Wing Sue Excerpted by permission.
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