Handbook of Multicultural Counseling Competencies E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 1266

Veröffentlichungsjahr: 2010

Beschreibung

A THOROUGH AND CONTEMPORARY EXPLORATION OF ISSUES FUNDAMENTAL TO MULTICULTURAL COMPETENCY

Handbook of Multicultural Counseling Competencies draws together an expert group of contributors who provide a wide range of viewpoints and personal experiences to explore the identification and development of specific competencies necessary to work effectively with an increasingly diverse population. Beginning with a Foreword by Derald Wing Sue, this unique handbook offers a broad, comprehensive view of multiculturalism that is inclusive and reflective. The coverage in this important book lies beyond the scope of traditionally defined multiculturalism, with discussion of historically overlooked groups that have experienced prejudice and bias because of their size, social class, age, language, disability, or sexual orientation.

This book provides readers with:

• Practical cases and examples to enhance skill development, promote critical thinking, and increase awareness
• A cross-section of diversity characteristics and best practice guidelines
• Examination of detailed, developmentally relevant competency categories
• Resources and exercises designed for practitioners at various levels of experience and expertise
• A forum for debate, discussion, and growth

Designed to help readers enhance general multicultural competency and their ability to provide services to the populations specifically described, this thought-provoking text will prove useful in facilitating ongoing dialogues about multicultural competence in all its variations.

Leseprobe

Contents

Cover

Title Page

Copyright

Foreword

Acknowledgments

Chapter 1: An Overview of Multicultural Counseling Competencies

Multiculturalism in Practice: Much Progress, Much to Be Done

What This Book Is

What This Book Is Not

Overview of Handbook

Summary

Resources

References

Chapter 2: The Competent Treatment of the Diverse Older Adult

Skills

Training and Supervision

Values and Attitudes

Summary

Resources

Web Sites/Videos on Aging

Competency Benchmark Tables

References

Chapter 3: Disability: Multiple and Intersecting Identities–developing Multicultural Competencies

Introduction

Terms and Concepts

Barriers to Competency in Issues Regarding Disability

Skills

Values and Attitudes

Summary

Resources

Competency Benchmark Tables

References

Chapter 4: Broaching Ethnicity Competently in Therapy

Knowledge

Skills

Values/Attitudes/Awareness

Supervision and Training

Conclusion

Resources

Addressing Framework

Competency Benchmark Tables

References

Chapter 5: Clinical Competencies in Working with Immigrant Communities

Definition of Terms

Theories Related to Immigrant Issues

Barriers to Competency in Working with Immigrants

Elements of Competence

Knowledge

Skills

Values/Attitudes

Supervision and Training

Conclusion

Resources

Appendix A: Experiential Exercises for Mental Health Practitioners

Appendix B: Assessment Tools

Appendix C: Films, Internet Resources, Books

Competency Benchmark Tables

References

Chapter 6: Competency with Linguistically Diverse Populations

Terminology

Elements of Competency

Knowledge

Skills

Values and Attitudes

Summary

Resources

Useful Tools and Instruments

Additional Resources

Competency Benchmark Tables

References

Chapter 7: Psychotherapy with Men: Building Practice Competencies

Getting to Know Male Clients: Two Case Examples

Definition of Terms

Knowledge about Men and Masculinities

Values and Attitudes about Men and Counseling Men

Skills for Counseling Male Clients

Final Thoughts on Psychotherapy with Men

Resources

Experiential Exercises for Professional Development

Men and Masculinities Competencies Resource Guide

Male Development and Theories of Masculinities

Constructs of Masculinities: Cultural Considerations

Assessment

Assessment Measures for Men and Masculinities

Masculine-Sensitive Psychotherapy

Men and Emotions

Psychological Help-Seeking

Men and Depression

Men, Abuse, and Trauma

Men and Loss

Men's Health

Men and Substance Abuse

Training and Supervision Issues

Men and Social Justice Issues

Training Resources: Media

Films and Books with Masculinity Themes

Web Sites and Web Resources

Competency Benchmark Tables

References

Chapter 8: Developing Multicultural Competency in Clinical Work with People of Mixed Ancestry

Definitions

Case Studies

Knowledge

Values/Attitudes

Skills

Summary

Resources

Journal Articles and Book Chapters

Books

Memoirs, Biographies, and Novels with Biracial/Multiracial Themes

News Articles

Children's Books

Movies with Biracial, Multiracial, and/or Interracial Themes

Documentaries

APA Multicultural Counseling Psychotherapy Video Series

Web Sites and Organizations

Competency Benchmark Tables

References

Chapter 9: Becoming a Racially Competent Therapist

Knowledge

Skills

Values/Attitudes/Awareness

Supervision and Training

Implications/Conclusion

Competency Benchmark Tables

References

Chapter 10: Competencies for Working with Sexual Orientation and Multiple Cultural Identities

Terminology

Historical Context of Sexual Orientation and Sexual Identity

Elements of Competency

Knowledge

Skills

Values and Attitudes

Intervention Techniques

Resources for Clinicians, Students, Trainers, and Supervisors

Summary

Resources

Self-Awareness and Self-Assessment Exercises

SO/SI Issues Seminar

Competency Benchmark Tables

References

Chapter 11: Sizeism: An Unrecognized Prejudice

Definition of Terms

Barriers to Competency in Counseling People of Size

Elements of Competency

Knowledge

Skills

Values and Attitudes

Summary

Resources

Assessment of Attitudes and Values

General Size Acceptance

Treatment from a HAES Perspective

Weight and Health

Online Resources

Sample HAES Interventions by Tenet

Self-Awareness and Self-Assessment Exercises

Size Diversity Seminar

Competency Benchmark Tables

References

Chapter 12: Developing Competency in Social Class and Classism in Counseling and Psychotherapy

Definition of Terms

The Social Class Worldview Model—Revised

Barriers to Competency in Social Class and Classism Conscious Counseling

Social Class and Classism Competency Training in Psychology

Knowledge

Skills

Values and Attitudes

Summary

Resources

Competency Benchmark Tables

References

Chapter 13: Developing Competency in Spiritual and Religious Aspects of Counseling

Definitions of Spirituality and Religion

Barriers to Competency in Spiritual/Religious Counseling

Elements of Competency

Knowledge

Skills

Values and Attitudes

Case Example

Summary

Resources for Clinicians, Students, Trainers, and Supervisors

Spiritual/Religious Competencies Resource Guide

Training Resources: Media

Spiritual/Religious Issues Seminar

Competency Benchmark Tables

References

Chapter 14: Counseling Competency with Transgender and Intersex Persons

Introduction

Transgender and Intersex 101: Defining Important Terms and Using Appropriate Language

Knowledge

Skills

Values and Attitudes

Summary

Resources

Books

Experiential Exercises

Films

Web Sites and Web Resources

Competency Benchmark Tables

References

Chapter 15: White Identity and Privilege

Definitions of Privilege and White Privilege

Developmental Models

Individual Responsibility

Knowledge

Skills

Values and Attitudes

Training

Summary

Resources

Suggested Training Activities

Resources for Exercises in White Privilege

Competency Benchmark Tables

References

Chapter 16: Counseling Competencies with Women: Understanding Gender in the Context of Multiple Dimensions of Identity

Terms and Concepts

A Brief Historical Background

Elements of Competency

Knowledge

Interventions

Skills

Values and Attitudes

Case Example

Summary

Resources

Awareness of Gender in Assessment

Texts for Teaching and Practice

Women and Depression

Domestic Violence and Partner Abuse

Eating Disorders

Video and DVD Resources from APA

Practice Guidelines

Supervision and Ethics

Journals

Organizations Specific to Women's Issues

Competency Benchmark Tables

References

Contributors' Photographs and Brief Biographies

Author Index

Subject Index

This book is printed on acid-free paper.

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Library of Congress Cataloging-in-Publication Data:

Handbook of multicultural counseling competencies / edited by Jennifer A. Erickson Cornish... [et al.]; foreword by Derald Wing Sue.

p. cm.

ISBN 978-0-470-43746-9 (cloth); 978-0-470-60917-0 (ebook); 978-0-470-60919-4 (ebook); 978-0-470-60919-4 (ebook)

1. Cross-cultural counseling. 2. Multiculturalism. 3. Minorities–Counseling. I. Cornish, Jennifer A. Erickson.

BF636.7.C76H363 2010

158 0.308–dc22

2009042696

Foreword

In my 40 years of work in the field of psychology, I have never come across a better integrated and more groundbreaking text than The Handbook of Multicultural Counseling Competencies edited by Erickson Cornish, Schreier, Nadkarni, Henderson Metzger, and Rodolfa. Simply stated, it is an outstanding piece of work destined to make a major contribution to the field by (a) broadening our understanding of multicultural identities that go beyond race/ethnicity; (b) pointing out similarities and differences that distinguish many marginalized groups; (c) offering an integrated definition of multicultural counseling competencies that incorporates developmental levels; (d) presenting “best practices” guidelines in each chapter; (e) providing readers with case vignettes to illustrate real-life situations; and (f) presenting numerous helpful exercises that allow/force readers to explore their values, biases, and assumptions about human behavior (an important cultural competency foundation). What is impressive about this book is how the editors and contributors have so smoothly combined these strengths into each chapter so that it reads with clarity, insight, and lived experience. Each chapter comes to life, is filled with nuggets of insights and truths, and provides readers with valuable suggestions for working with these populations.

Although there are now numerous published works on cultural competency, this handbook does not stick to the narrow confines of a limited population, but is philosophically grounded in the assumption that multiculturalism encompasses an umbrella that includes multiple dimensions such as age, race, ethnicity, gender, immigration, linguistic background, social class, sexual orientation, size, religion, gender identities, and multiracial identities. Reading the chapters carefully leads readers to conclude that while differences between the groups are important and oftentimes unique, sociopolitical shared similarities for many marginalized groups exist.

Sizeism, for example, is an unrecognized prejudice directed toward “overweight” and “obese” people filled with stigma and possessing damaging consequences to targets. The authors of this chapter (Abakoui & Simmons) make a strong case that they prefer the term fat as an objective statement of size and as an attempt to destigmatize the word. When one views all groups in this chapter, it is clear they share similar dynamics and processes related to stigma, prejudice, discrimination, and the detrimental consequences of marginalization. For that reason, Chapter 15, “Developing Competency with White Identity and Privilege” (Dressel, Kerr, & Steven), has special significance to each chapter as it speaks to how helping professionals need to recognize the power differentials in their relationships with marginalized groups, how traditional systems of counseling/psychotherapy may become forms of cultural oppression, and the need to work with marginalized client populations in culturally competent ways that may challenge traditional forms of helping/healing.

The editors of the Handbook have attracted a talented pool of contributors, major scholars and practitioners who are experts in their fields. They write with passion, commitment, and expertise that is immediately obvious to readers. To them, multicultural counseling competence is more than an intellectual exercise, and requires helping professionals to develop not only the knowledge base of counseling and the information related to a particular population they hope to understand, but also the attitudes, awareness, and skills needed to function in an increasingly pluralistic society. Nearly all authors emphasize the need to go beyond a cognitive understanding of groups, to exploring their own assumptions about human behavior, biases, and emotions related to the groups they hope to help. To me, this is especially important as increasing research now reveals that cultural competence may increase with training, but that unconscious biases and “nested negative” feelings toward certain marginalized groups remain unchanged unless training programs directly confront them.

Little doubt exists in my mind that The Handbook of Multicultural Counseling Competencies will become a standard and perhaps a classic in the field. It is destined to become a part of the knowledge base of counseling competence, and should be used as a major text in multicultural counseling courses and other social science disciplines. It brings together recent advances in the fields of cultural competence and multicultural populations, and is extremely relevant not only to the helping professionals but to general fields in the social sciences. Few texts on multicultural counseling present cutting-edge information in such a scholarly manner, translate cultural perspectives and methodologies in ways that have meaning to scholars and practitioners, and do such a fine job in involving readers in the real-life experiences of the populations addressed in this text.

I commend the editors and authors for producing this much-needed and valuable piece of work. You have done a great service to the profession.

—Derald Wing Sue, PhD Professor of Psychology and Education Teachers College, Columbia University

Acknowledgments

The editors would like to express our sincere gratitude to Derald Wing Sue for writing the Foreword to this volume. We could have no higher aspiration for our work than that it live up to his gracious expectations. We also want to offer our appreciation to the authors for their thoughtful contributions, to Bethany Kasdon for the countless hours she spent reviewing the chapters from a student's perspective, and to Marquita Flemming, our editor at Wiley, for her endless patience and support. Finally, the Association of Counseling Center Training Agencies (ACCTA) deserves particular thanks for multicultural leadership and for growing this book: For this reason, all royalties from the sales of the Handbook will go to support ACCTA's leadership in training psychology's newest professionals in multiculturally competent practice.

In addition, we want to thank our partners, friends, and families for their personal support to each of us: Tom Birkenholz; the Erickson Cornish family; the Henderson and Metzger families, respectively and collectively (with special thanks to Linda, Steve, Galen, and Landon, Luke, Ashley, and Elizabeth); the sugarloafers; and Maya and Michael Wilson.

Chapter 1

An Overview of Multicultural Counseling Competencies

Lynett L. Henderson Metzger, Lavita I. Nadkarni, and Jennifer A. Erickson Cornish

Introduction

The November 2008 election of the first African American U.S. President signaled for many a “dramatic change in attitudes toward race in America” (Turner, 2009). Others, however, placed significant caveats on the apparent gains made by some traditionally disenfranchised groups in this country:

Throughout this election season, where the 3 strongest candidates—a senior citizen, a woman and an African American—were “non-traditional,” we were reminded that an individual's differences are too often viewed as weakness rather than strength. We were reminded that while diversity is today a fact of life, there is still much work to be done to create a culture of inclusion where a person's age, gender, ability, race, religion or any other defining characteristic—whether physical or cultural—adds to the creativity, innovation and commitment that leads to the kind of breakthrough thinking required to solve the most seemingly intractable problems. (Crider, 2008, p. 2)

Mental health practitioners, researchers, and educators who value inclusivity and social justice likewise walk a fine line between celebrating the laudable strides made by the field in recent decades and acknowledging the enormity of the distance left to go. Much of this work lies within the arenas of race, ethnicity, and culture; much lies beyond the scope of traditionally defined “multiculturalism” and focuses on individuals whose places at the diversity table to date have been limited to folding chairs in the corner of the room. This textbook represents a small gesture of welcome toward a few of these historically overlooked groups.

Multiculturalism in Practice: Much Progress, Much to Be Done

If, as the saying goes, the journey of 1,000 miles begins with a single step, then surely the climb toward a richer definition of multicultural competence rests on the innumerable handholds placed by those with the vision, courage, and eloquence to define a paradigm—and shatter it. The seminal works of Cross, Parham, and Helms (see, e.g., Cross, Parham, & Helms, 1991; Helms, 1990), McIntosh (2008), D. W. Sue and D. Sue (1990, 2008), and so many others form the scaffolding upon which modern American multicultural discourse is built. Early (and continuing) efforts to operationalize White and non-White identity development, understand privilege and combat oppression,1 and create a shared knowledge base and minimal expectations of multicultural competencies (see, e.g., American Psychological Association [APA], 2003) provide a critical starting point for understanding what it means to be an effective and ethical practitioner in an increasingly diverse world.

Case Vignette 1.1

Mariana Prader, PhD, directs Progressive State College (PSC)'s clinical training program. The Provost has called for across-the-board budget cuts, and all program directors have been asked to submit proposals reducing expenditures by 10 percent. Dr. Prader knows next year's spreadsheet includes two big-ticket proposals from her program. One is the installation of an elevator system connecting the parking garage to the PSC Mental Health Clinic waiting area. Currently, an uncovered ramp winds from a service entrance on the far side of the building to a hallway several doors down from the waiting room entrance. The ramp is steep, ices over in winter, and (Dr. Prader thinks to herself) is a lawsuit waiting to happen. However, as no client in a wheelchair has ever utilized the Clinic, she reasons there must not be much need for disability services in the PSC community. The second item is a 5-day “SafeZone” training colloquium for all PSC personnel. Dr. Prader believes the training would be helpful in educating faculty and staff about issues facing gay, lesbian, and bisexual students, especially in light of some homophobic graffiti found on campus recently. Although she personally values diversity, Dr. Prader is aware that several faculty members have been very vocal in their opposition to the proposed colloquium; politically, the best thing for all concerned might be if the idea died a regrettable—but unavoidable—death from acute budgetitis.

Across town, Etienne Lamont, LCSW, also faces a dilemma: bran muffins, or jelly doughnuts? Eti (as his clients call him) conducts an evening parenting skills group for single fathers. Most of the men come to the two-hour group straight from work—some will return for extra hours or head to second jobs afterward—and Eti likes to offer a few snacks to tide them over. He frowns, tabulating an appropriate ratio of healthy to not-so-healthy items, and mentally runs through a quick checklist of his clients' dietary constraints. Ted and Kyle have heart conditions (bran for them). Roger has diabetes (sugar-free angelfood cake), and Vaughn has some unpronounceable gastrointestinal affliction; he probably won't eat anything, anyway. The 8 men in the group have between them 11 kids, 9 jobs, 6 functional vehicles (if you count Colin's old truck, which runs about half the time), 5 mortgages (including a pending foreclosure and an eviction notice), close to $100k in outstanding debt, and an average blood pressure of 140/90. Eti remembers taking a graduate course on “gender issues,” and his feelings of indignation over the historical and ongoing oppression of women worldwide. He pauses, checks in with himself. He still feels that anger, is still aware of his privilege and that of other men—but there is a story to be told here, too. He struggles to think of a way to speak both truths to the men in his group. Eti sighs. Men may run the world, he thinks, sticking a couple of bananas in the basket, but, man, it runs them, too.

At that exact moment, Dae-sun Yi sits at her computer and thoughtfully compares college Web sites. She is considering majoring in psychology, and would like an intellectually rigorous program with some clinical training opportunities in the community. She hopes to attend graduate school, perhaps earning a PsyD with an emphasis on working with older adults. One program, offered at a nearby school, looks pretty good. There are some interesting electives, the teachers appear to be well-respected, and the program utilizes a nationally recognized competency-based diversity training model. Dae-Sun hesitates, finger poised above the button on the mouse. Diversity—is that important?, she wonders. Is that me?

But what constitutes “effective” and “ethical” may evolve over time and with developmental level. Consider the examples discussed in Case Vignette 1.1.2

The scaffolding is there—but, as the previous vignette illustrates, it is by no means complete. Increasingly nuanced understandings of the interplay between target status and day-to-day reality are emerging from current explorations of racial microaggressions (the insidious and pervasive staccato of invalidating and disempowering messages with which persons of color are almost continually bombarded) (Sue, Capodilupo, & Holder, 2008; Sue et al., 2007), intersectional identity theory (see, e.g., Shuddhabrata Sengupta's 2006 article, “I/Me/Mine,” in which she describes multiple identities as “minefields,” and observes, “it's just that we don't know which mine (as in ‘weapon’ and as in ‘first-person possessive singular personal pronoun’) will claim which part of me,” p. 634), contemporary racism (Smith, Constantine, Graham, & Dize, 2008, for example, note that clinicians risk hitting a “developmental ceiling unless they simultaneously refine their understanding of the operations of racism within their own and their clients' conceptual worlds” [p. 337], including forms of oppression much more subtle than those encountered during the civil rights era), and myriad other issues at the forefront of social justice scholarship.

Nor are racial, ethnic, and cultural themes the only overlooked aspects of diversity. By way of example, a cursory search for the term racism appearing in publication titles over the last 20 years yields 58 results; once racism is excluded, the terms ageism, sexism, ableism, sizeism, and transphobia appear in only 19 journal titles combined over the same period of time, with sexism accounting for all but one of these.3 In decrying the 96 percent failure rate in summary judgment on employment discrimination suits based on multiple claims (cases in which the plaintiff argues that she was discriminated against based on, e.g., her age, gender, and religious affiliation), Kotkin (2009) questions whether “the realities of today's workplace” suggest that “diversity is tolerated or may even be valued up to a point,” but that “too much difference” leads to “disparate treatment” (p. 3). When the provision of psychotherapy services itself risks becoming inherently “disparate” due to a lack of clinical expertise in the core issues that impact hundreds of millions of people (or, if considered in the aggregate, every human being), the time has come for a reconsideration of what the field means by basic “cultural competence.”

Practitioners and researchers alike recognize gaps in therapists' awareness and experience in effectively meeting the needs of clients whose multicultural identities fall outside of the syllabi of most three-credit graduate “diversity” courses. Recent articles question the competency of counseling training program graduates to offer services to differently abled clients (Cornish et al., 2008; Smart & Smart, 2006) and argue that even among those with positive attitudes toward diversity in general, college “faculty members may not consider disability as an aspect of diversity” (Barnard, Stevens, Oginga Siwatu, & Lan, 2008, p. 173). Similarly, Bartoli (2007) argues that training in the areas of religion and spirituality “continues to be scarce and inadequate,” suggesting that “recent, and not so recent, graduates are left on their own to seek further training and develop relevant competencies,” a reality that renders it “dubious whether psychologists currently meet the needs of religious and spiritual clients adequately” (p. 54). In promulgating its “Guidelines for Psychological Practice with Girls and Women,” the American Psychological Association (APA, 2007) acknowledged that “many psychologists and members of the general public may believe that women's issues in psychology were dealt with and resolved in the 1970s and 1980s” (p. 949), while the needs of female clients in today's changing social and economic context remain unmet. In an increasingly pernicious double-bind, older adults chronically underutilize therapy services, while “mental health issues relevant to older individuals continue to be underrepresented in the research literature and underemphasized in psychology, medical, and other health care provider training programs” (Smith, 2007, p. 277). Popular media and the counseling and training literature are full of similar examples of a profound disconnect between the needs of the mental health field's constituent communities and the functional expertise of its providers. The Surgeon General's office, for example, has documented disparities along ethnic and racial lines in both mental health access and service delivery (U.S. Department of Health and Human Services, 2001). Leigh, Powers, Vash, and Nettles (2004) could be speaking of a broad range of categories of difference when they acknowledge that the inclusion of “disability culture” in coursework “remains incidental. Psychologists typically have minimal or no training that will prepare them to deal appropriately with people with disabilities” (p. 49). And, as Garrett et al. (2001) note,

Research has shown that persons of color tend to underutilize counseling services, terminating at a rate of greater than 50% after the first session (Priest, 1994; D. W. Sue & D. Sue, 1999). This overwhelming rate of early termination, according to Sue and Sue, has been attributed to the biased nature of services and the lack of sensitivity and understanding for the life experiences of the culturally different client (p. 148).

Without an adequate foundation upon which to build functional competencies, professionals working with the individuals and groups described in the following chapters may, too often, find themselves participating in this very lack of awareness of how best to serve the needs of those different from themselves.

What This Book Is

The list of underserved—and, too often, underacknowledged—categories of difference includes a number of dimensions explored in this Handbook: age, size, sex, and social class; spiritual/religious, racial, ethnic, and multiracial identification; immigration, linguistic, ability, and gender-identity status; sexual orientation; and White identity/privilege. This introductory text offers clinicians and clinicians-in-training an overview of these issues with an emphasis on the practical application of theory and technique to real-world case examples. In keeping with the “basic assumption” in the field of psychology that “the path toward proficiency is developmental” (Stoltenberg, 2005, p. 858), detailed, developmentally relevant competency categories will be examined, with resources and exercises geared toward students, instructors, and practitioners at various levels of experience and expertise. The topics covered in this Handbook represent a cross-section of diversity characteristics and best-practice guidelines rarely addressed in depth in textbooks of this kind. These guidelines (discussed as applicable in the following chapters) are geared toward the APA Board of Educational Affairs Council of Chairs of Training Counsels (2007) benchmarks and reflect principles shared by professional organizations throughout the mental health field (see, e.g., APA, 2007). Think of this Handbook as a multicultural “sampler” consisting of common clinical issues uncommonly included in professional training protocols.

What This Book Is Not

A seven-course meal. This Handbook does not comprehensively address any single topic, nor does it purport to provide an exhaustive overview of all (or even most) multicultural competencies. The coverage is selective and, in some ways, eclectic—by design. Excellent and detailed examinations of what might be considered foundational diversity concepts exist already in the canon of the field (see, e.g., Atkinson & Hackett, 1998; Atkinson, Morten, & Sue, 1998; Constantine & Sue, 2005, 2006; Helms & Cook, 1999; Pederson, 2001; Ponterroto, Casas, Suzuki, & Alexander, 2001; Sue, Arredondo, & McDavis, 1992; D. W. Sue & D. Sue, 1990; D. W. Sue & D. Sue, 2007;). Many of these documents provide a foundation for the comments of the authors included here. This text, however, is designed to bridge the gaps in what we don't know we don't know—helping us to examine and, in turn, reduce our multicultural blind spots in areas that we may not even recognize as diversity.

For this reason, chapter topics may be grouped (or singled out) in ways that initially seem counterintuitive. However, we believe it is well worth considering “otherness” from this broad perspective. The organizing principle behind these contributions to the conversation on multiculturalism is, “What is missing?” The authors whose work appears within these pages have each attempted to tell the stories of those about whom the “dialogue on diversity” has been largely silent. The need to understand is real—but what constitutes “competency” in this broad context, and how can the developmental needs of mental health professionals best be met?

Competency in Practice

Competency “is generally understood to mean that a professional is qualified, capable, and able to understand and do things in an appropriate and effective manner” (Rodolfa et al., 2005, p. 348), while professional competency is the “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (Epstein & Hundert, 2002, p. 277). Competencies are “complex and dynamically interactive clusters” that include “knowledge. . .skills. . .attitudes, beliefs, and values” and other important characteristics (Rubin et al., 2007, p. 453). Competency ensures that “a professional is capable (i.e., has the knowledge, skills, and values) to practice the profession safely and effectively” (Rodolfa et al., 2005, p. 349).

The “culture of competence” (Roberts, Borden, Christiansen, & Lopez, 2005, p. 356) refers to a pedagogical shift in mental health education from learning objectives to learning outcomes. The movement away from students learning to practice by accumulating hours and toward students demonstrating competent practice started within medical and nursing education (e.g., Association of American Medical Colleges, 1998). The history of the competencies movement among education and health professions (including psychology) has been well documented by Kaslow et al. (2007). As a brief summary, within psychology, the National Council of Schools and Programs in Professional Psychology (NCSPP) (Peterson, Peterson, Abrams, & Stricker, 1997) first delineated six core competencies of psychological practice, including relationship, assessment, intervention, consultation and education, and management and supervision. NCSPP subsequently expanded these ideas, which currently include relationship, assessment, intervention, diversity, research/evaluation, management/supervision, and consultation/education (see http://www.ncspp.info/model.htm). In addition to identifying competencies to be taught in a core curriculum, NCSPP “highlighted that each competency is composed of the knowledge, skills, and attitudes necessary for professional functioning” (Kaslow et al., 2007, p. 701). NCSPP recently released its Competency-Based Education for Professional Psychology handbook (Kenkel & Peterson, 2009), outlining a training model that emphasizes five components: psychological science and education, integrative pedagogy, core curriculum and the professional core competency areas, elements of practice, and social responsibility, diversity, and gender. Other training councils, including scientist-practitioner clinical psychologists (Belar & Perry, 1992), counseling psychologists (e.g., Stoltenberg et al., 2000), and clinical scientists (http://psych.arizona.edu/apcs/apcs.html) have also outlined competency-based education and training approaches. The APA Committee on Accreditation (http://www.apa.org/ed/accreditation/) and Canadian Psychological Association Accreditation Panel (http://www.cpa/ca/accreditation/) implemented competency-based approaches to accreditation of academic and internship programs beginning in the 1990s. Various organizations have developed guidelines related to competencies, including multicultural competencies (e.g., APA, 2003).

The 2002 Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, was organized by the Association of Psychology Postdoctoral and Internship Centers (APPIC), together with the APA and 33 related organizations, to move the competency movement forward. Each sponsoring organization sent a delegate; other participants were chosen based on their areas of expertise. A preconference survey resulted in consensus around eight core competency domains: scientific foundations of psychology and research; ethical, legal, public policy/advocacy, and professional issues; supervision; psychological assessment; individual and cultural diversity; intervention; consultation and interdisciplinary relationships; and professional development. A “competency cube” (Rodolfa et al., 2005) was developed at the conference that included foundational competency (reflective practice/self-assessment; scientific knowledge and methods; relationships; ethical and legal standards and policy issues; individual and cultural diversity; interdisciplinary systems), functional competency (assessment/diagnosis/conceptualization; intervention; consultation; research/evaluation; supervision/teaching; management/administration), and developmental stages (graduate education; practica/internship; postgraduate supervision; residency/fellowship; and continuing competency). Within each professional stage, specialty education was recommended via parameters of practice that differentiate specialties, including populations served.

Following the Competencies Conference in 2002, the APA Board of Educational Affairs (BEA) began to focus on the assessment of competencies, the Association of Directors of Psychology Training Centers developed an outline of competencies for graduate field placements (Hatcher & Lassiter, 2007), and a Benchmarking Conference was held by the BEA in 2007. Rubin and colleagues (2007) have described a current “national zeitgeist focusing on competencies and their assessments” (p. 453). Obviously, the competency and assessment of competency movements are beyond the scope of this Handbook. The goal of each of our chapters, however, is to help clinicians enhance not only their ability to provide services to the populations specifically described, but also their general multicultural competency. Some of the populations included in this Handbook have received considerable attention in the literature, and others little scrutiny at all. As previously discussed in this chapter, the list of topics addressed in this book is not meant to be exhaustive, but does represent many of the target groups we feel have experienced discrimination in the United States and can be treated and supported more competently by well-trained mental health professionals.

Certainly, every mental health professional cannot be expected to possess all of the knowledge, skills, attitudes, and values necessary to work optimally with each of these populations, particularly since each includes many different subpopulations, each of which is itself subject to constantly changing contexts. However, we hope this volume will give the reader a general overview of the basic aspects of competency, with many resources and references provided for further information.

D. W. Sue and D. Sue (2008) describe culturally competent counselors, in part, as being aware of their own assumptions, values, and biases; understanding the worldview of culturally diverse clients; and using appropriate intervention strategies and techniques. These criteria correspond with the attitudes/values, knowledge, and skills typically used to define competence in general.

Knowledge has been defined as “facts [and] information. . .acquired. . .through experience or education; the theoretical or practical understanding of a subject” (The New Oxford American Dictionary, 2005, p. 938). Thus knowledge of a specific diverse population will include such information as the definition of the population, including its various segments, and the history of oppression the population has experienced.

Skill has been defined as “proficiency, ability or dexterity” (Webster's, 2005, p. 1058) and “the ability to do something well; expertise” (The New Oxford American Dictionary, 2005, p. 1589). For the diverse populations in this Handbook, clinical/counseling skills are outlined relevant to functional categories, including assessment, diagnosis, case conceptualization, intervention, relationship, collaboration, referral, and supervision and training.

Attitude is “a settled way of thinking or feeling about someone or something, typically. . .that is reflected in a person's behavior” (The New Oxford American Dictionary, 2005, p. 102), while a value is “a principle, standard, or quality considered inherently worthwhile or desirable” (The American Heritage Dictionary, 1983, p. 749). One of the most difficult aspects for a mental health counselor working with diverse populations is to overcome his or her own isms, including racism, heterosexism, and ageism (Henderson Daniel, Roysircar, Abeles, & Boyd, 2004); however, those who do engage in such self-assessment craft a more reflective and likely more effective practice.

Multicultural Counseling Competency

Consistent across various definitions of multicultural competence has been the view that the competencies are not static, but ever changing. In his 2004 keynote address to the Teachers College Winter Roundtable on Cultural Psychology and Education, Parham (as cited in Hanson et al., 2006) described the process of becoming a multiculturally competent psychotherapist as a complex and lifelong journey. Implicit in this understanding is that the psychotherapist is engaging in an active process of personal and social change. Multicultural competence can be defined as the extent to which a psychotherapist is actively engaged in the process of self-awareness, obtaining knowledge, and implementing skills in working with diverse individuals (Arredondo et al., 1996; Constantine, Hage, Kindaichi, & Bryant, 2007; Sue, Arredondo, & McDavis, 1992).

The domains within this multicultural counseling competencies model can be thought of from either a fixed-goal or process perspective (Collins & Pieterse, 2007). The fixed-goal perspective implies that the eventual competency outcome is seen through demonstrable behaviors, whereas the process perspective requires internal engagement and change. Within the knowledge domain, multicultural counseling competence may consist of obtaining information about “various worldview orientations, histories of oppression endured by marginalized populations, and culture-specific values that influence the subjective and collaborative experience of marginalized populations” (Constantine et al., 2007, p. 24). Skill development and implementation, within the multicultural counseling competency, requires that the psychotherapist act in a way that “draws from an existing fund of cultural knowledge to design mental health interventions that are relevant to marginalized populations” (Constantine et al., 2007, p. 24). The process dimension or domain of self-awareness requires that the multiculturally competent counselor is “cognizant of one's attitudes, beliefs and values regarding race, ethnicity, and culture along with one's awareness of the sociopolitical relevance of cultural group membership in terms of issues of cultural privilege, discrimination, and oppression” (Constantine et al., 2007, p. 24).

History of Multicultural Counseling Competency in Mental Health

The integration of multiculturalism into graduate clinical and counseling psychology curricula, training, and research has been a 30-year endeavor. There has been widespread agreement that the United States has become increasingly diverse over the past several decades and that mental health practitioners have been, and will be, providing counseling to clients who may have different worldviews from their own. Yet, there remains some debate as to what form of service delivery is deemed to be culturally relevant and what constitutes multiculturally competent psychotherapy.

For example, various iterations of a multicultural counseling competencies model have been proposed since the early 1980s. The American Counseling Association (ACA) and the APA both supported the creation of and endorsed the multicultural counseling competencies and multicultural guidelines, respectively (see, e.g., Arredondo & Perez, 2006). Sue et al. (1982) were the first to propose a model that addressed counselor competency with respect to racial and ethnic groups. The model delineated three broad competency areas: therapist's awareness of her or his own assumptions, values, and biases; understanding the worldview of culturally different others; and developing appropriate intervention strategies and techniques. These three areas are reflected in a therapist's attitudes, knowledge, and skills. The second iteration of the multicultural counseling competencies (Sue et al., 1998) added competencies at the organizational/systemic level. These 31 multicultural counseling competencies were operationalized through the addition of 119 explanatory statements, and the introduction of a model highlighting multiple identity dimensions within a contextual framework (Arredondo et al., 1996). In 2003, the Association for Multicultural Counseling and Development, a division within ACA, produced an updated version of the multicultural counseling competencies (Roysircar, Arredondo, Fuertes, Ponterotto, & Toporek, 2003). Similarly, the APA has produced aspirational guidelines to promote competent research, assessment, and clinical practice with diverse populations. At present, there are APA practice guidelines for working with gay, lesbian, bisexual, and transgender populations, older adults, girls and women, and ethnic, linguistic, and culturally diverse populations (examined in more detail within the relevant chapters in this volume). In 2003, guidelines with respect to multicultural education, training, research, practice, and organizational change were adopted by the APA. A list of Multicultural Competency Guidelines proposed by the APA and other organizations is included below.

Multicultural Competency Guidelines

The following Web sites provide links to the core multicultural competency guidelines for most major professional organizations in the United States (please see individual chapters for additional information and topic-specific resources):

APA Ethics Code (2002)

http://www.apa.org/ethics/code/index,aspx

APA Guidelines for Psychotherapy with Older Adults (2004)

http://www.apa.org/practice/guidelines/older-adults.pdf

APA Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists (2002)

http://www.apastyle.org/manual/related/guidelines-multicultural-education.pdf

APA Guidelines for Psychotherapy with Lesbian, Gay and Bisexual Clients (2000)

http://www.apapracticecentral.org/ce/guidelines/glbt.pdf

APA Guidelines for Psychological Practice with Girls and Women (2007)

http://www.apa.org/about/division/girlsandwomen.pdf

American Counseling Association Ethics Code

http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx

National Association of Social Workers Cultural Standards (2006)

http://www.socialworkers.org/practice/standards/NASWCulturalStandardsIndicators2006.pdf

National Association of Social Workers Code of Ethics

http://www.socialworkers.org/pubs/code/code.asp

American Psychiatric Association Ethics Code

http://www.psych.org

AMCD Multicultural Counseling Competencies

http://www.counseling.org/Files/FD.ashx?guid=735d18d6-2a6e-41bf-bd4a-5f4ce48a100

As a result of widespread acceptance of the multicultural counseling competencies among professional organizations and accrediting bodies (such as the APA, The Council for Accreditation of Counseling and Related Educational Programs [CACREP], etc.), most graduate programs have incorporated at least one course in multicultural issues into their training models. Several authors have assessed the implementation of these competencies and guidelines across curricula and practica experiences, and within supervision (Smith, Constantine, Dunn, Dinehart, & Montoya, 2006; Vereen, Hill, & McNeal, 2008). Despite such attention to multicultural education, research has shown that there appear to be some gaps between beliefs and practice, and that skill development and implementation will require further efforts on the part of training institutions and psychotherapists at all levels of training (Hanson et al., 2006; Henderson Daniel, Roysircar, Abeles, & Boyd, 2004).

In addition to widespread endorsement, the multicultural counseling competencies have also received criticism, leading to a rich debate within the various fields. Weinrach and Thomas (2002) and Thomas and Weinrach (2004) have questioned the imposition of the multicultural counseling competencies on mental health professionals, and believe them to have created potential ethical concerns for practitioners. They argue that the competencies are exclusive in nature, with an undue emphasis on racial identity and who defines such, that dissimilar identity constructs are given the same weight, that the terms multicultural and diversity are used interchangeably, and that the competencies are dated based on their source material. Their arguments have received support from Vontress and Jackson (2004) and Patterson (2004), who propose a universal system of counseling, grounded in empiricism and theory, that requires respect, genuineness, empathic understanding—coupled with communication of these concepts—and structure. Yet, in their 20-year content analysis of empirical research on the multicultural counseling competencies (MCC), Worthington, Soth-McNett, and Moreno (2007) concluded that “the existing empirical MCC process/outcome research has shown consistently that counselors who possess MCCs tend to evidence improved counseling processes and outcomes with clients across racial and ethnic differences” (p. 358).

Overview of Handbook

Our goal is to describe the knowledge, skills, and attitudes/values necessary to work with diverse populations, focusing on the following areas of diversity: age, disability, ethnicity, immigration, language, men, multiracial individuals, race, sexual orientation, size, social class, spirituality/religion, transsexual/intersex/transgender identity, White identity/privilege, and women. We present the groups in alphabetical order by subject for ease of reference, although we acknowledge that members of certain groups have experienced differential levels of oppression at specific historical times.

Each chapter synthesizes the existing literature into the competencies of practical knowledge, skills, and attitudes/values necessary for clinical work with that particular target group. In addition, references and resources relevant to each population group are included. A developmental approach is utilized throughout, generally based on the June 2007 Benchmarks document (APA, Board of Educational Affairs & Council of Chairs of Training Councils, 2007). Although each chapter is written using the same general outline, each is designed to function either as a stand-alone resource or in conjunction with the remaining material for a more comprehensive examination of these issues. Each chapter is briefly summarized below.

Age and Diverse Older Adults

Given that the population of the United States is aging as well as becoming increasingly diverse, it is vital that all health-care providers receive adequate education on adult development, aging, and multiculturalism, as well as the intersection between these topics. This chapter presents the demographics of today's aging population, examines important concepts such as the sociocultural/psychological dynamics of aging, and outlines common misconceptions and ageist beliefs when treating diverse older adults. Appropriate skills needed for effective assessment and intervention with this population are described.

Disability

In this chapter, the concept of disability as a multicultural issue is examined. Various models for understanding disabilities are explored, including explanations of types of disability, historical and legal considerations, developmental concerns, multiple minority status, and current issues and skills needed to treat individuals with disabilities.

Ethnicity

Ethnicity is an often-overlooked and even more often misunderstood cornerstone of self-identification for many individuals. This chapter clarifies terms and explores issues involved in the examination of ethnic differences through the lens of personal experience as well as current research. Using a developmental approach to explore the multicultural competencies needed by practitioners at various points along the developmental continuum, this chapter describes competent psychotherapeutic work with clients from diverse ethnic backgrounds.

Immigration

Immigration imposes significant pressures on members of immigrant communities as it necessitates a psychological restructuring against the backdrop of multiple cultural contexts. Understanding immigrants' experiences and competently serving their mental health needs becomes imperative. This chapter highlights the requisite knowledge and skills needed to work with a specific group, Asian Indians, who have immigrated to the United States.

Language

The importance of training future mental health practitioners to become competent in issues of language acquisition development related to the areas of assessment and intervention is undeniable (e.g., U.S. Census data from 2000 reports that 18% of the population speaks a language other than English). This chapter focuses on self- awareness about English-language learners and knowledge related to second-language acquisition. Vignettes guide the reader to turn this knowledge into competent practice.

Men

The chapter on psychotherapy with men serves as a primer for the conceptual and clinical issues that therapists experience when treating male clients. Many training models fail to recognize how male socialization and male identities influence the process of psychotherapy. Pertinent knowledge, skills, and values/attitudes are examined, with an emphasis on the core concepts, historical and present-day realities, and clinical dynamics that inform the provision of services to male clients.

Multiracial Identities

There are a growing number of individuals who identify as multiracial or of mixed race. Individuals of racially diverse ancestry have faced a long history of oppression and marginalization in this country. Typically the identity development trajectories and self-conceptualizations of multiracial people differ in important ways from those of individuals with a single racial identification. Therefore, mental health practitioners must increase their understanding of the unique characteristics and needs of this population to provide competent services for these individuals. This chapter provides guidelines and resources to enhance professionals' awareness of their own values and attitudes, knowledge of ecological issues, and skills in developing competency in working with persons of mixed ancestry.

Race

Understanding the concept of race, the unique challenges and opportunities of racial identity formation in the face of historical and ongoing racism, and the needs of racially diverse individuals represents a core multicultural counseling competency. This chapter provides an introduction to the basic terms, identity development concepts, historical contexts, and assessment and intervention models relevant to providing competent and effective services to people of color in the United States.

Sexual Orientation

A proliferation of research and scholarly writing regarding the development of sexual orientation and identity has occurred over the past 30 years since the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. This chapter helps mental health practitioners familiarize themselves with the professional literature, educate themselves regarding gay, lesbian, and bisexual culture, examine their own beliefs and attitudes, and synthesize this information into an effective therapeutic stance to provide competent clinical treatment.

Size

Currently there is a “war on obesity” being fought in the media, in medical and mental health consulting rooms, and in our homes, with research typically focused on treatment for obesity and the stigma of being fat. This chapter outlines the importance of size as an aspect of diversity and how size-acceptance in conjunction with treatment from a health-at-every-size perspective can improve mental and physical health for our clients. This chapter provides tools to create a respectful and supportive therapeutic environment to help clients reach their therapeutic goals.

Social Class

This chapter examines the clinical and training goals necessary for mental health practitioners to integrate social class and an awareness of classism into their work. Using the Social Class Worldview model, the authors review relevant literature and provide suggestions for how best to become a competent mental health practitioner in the arenas of social class and classism.

Spirituality and Religion

The chapter on spiritual and religious aspects of counseling outlines knowledge, skills, and attitudes/values necessary to provide sensitive services to individuals who hold a range of spiritual and religious worldviews. The authors provide a summary of central elements of major world religions, a comprehensive resource guide, and training and practice suggestions to enhance practitioners' competency in religious and spiritual development.

Transsexual/Intersex/Transgender

This chapter addresses identities located along both the biologically influenced continuum of sex identity and the more socially constructed continuum of gender identity. Working with individuals who present with identities outside the traditional dichotomous framework of gender and sex can be intimidating for mental health practitioners because they are often conflated with sexual orientation as well as with each other. For each of the topics presented in this chapter, a rationale for its emphasis in mental health training, a summary of current knowledge and scholarship in the area, key definitions and terms, and recommendations for necessary skill development and self-awareness are provided.

White Identity and Privilege

The understanding of White privilege is a crucial element in becoming a culturally sensitive mental health provider. For White mental health practitioners, this understanding must go beyond a cognitive processing and encompass an affective experience of self. This chapter emphasizes the need for a lifelong commitment to an understanding of privilege and describes the knowledge, skills, and values/attitudes necessary to incorporate this understanding into competent practice.

Women

This chapter focuses on women's gender within the context of multiple identities, noting that in an increasingly global world, and one that adheres almost universally to patriarchal social structures, it is important for therapists to understand the strengths demonstrated and challenges experienced by women by virtue of being female. A selected review of the historical backdrop and the literature on the psychology of women is discussed, and practitioners are provided with an overview of the knowledge, skills, and values/attitudes necessary for competent practice when treating women.

Summary

While this book provides practical guidelines for working with 15 categories of difference not commonly addressed in training manuals of this type, many topics remain unexplored. Areas for further study include disparate treatment based on geographic location/geography of origin among individuals born in the United States (including, e.g., stereotypes and assumptions based on a person hailing from “the South,” “the West Coast,” etc.); political affiliation (expressed or assumed); level of educational attainment (as distinct from professional identity and socioeconomic status); marital status and traditional versus nontraditional family structures (cohabitation, adoption, unpartnered individuals, work-related issues, etc.); veteran status and military service experience or affiliation; educational issues (e.g., providing services to students who utilize American Sign Language or other assisted-learning modalities); and a whole host of other areas ripe for exploration. Even within the broad topics covered here, it is clear that the field would benefit from a more in-depth focus on specific permutations of human experience (the dynamics of traumatic brain injury, for example) and a greater range of coverage of these and additional categories (e.g., the challenges facing younger adults as a function of age or perceived age). This list could clearly extend indefinitely.

Notwithstanding the rich body of work yet to be done, however, we hope within these chapters to have assembled a useful, relevant, and timely exploration of issues fundamental to multicultural competency at each stage of professional development. Below we provide a selection of resources designed to serve as a general introduction to the experiential possibilities of multicultural awareness and diversity training. These resources do not focus on a particular population or set of competencies, but, rather, on the process of increasing one's recognition of the way diversity issues influence day-to-day life as well as mental health practice. Each of these activities can be modified depending on the goal, size of the group, or type of setting. These resources represent a starting point for discussing the principles and concepts presented in greater detail throughout the remainder of this book. The authors hope that these materials will prove useful in facilitating ongoing dialogues about multicultural competence in all its permutations—a dialogue in which they feel very honored to have taken some small part.

Resources

The following resources are provided as suggestions for further inquiry and as tools students, clinicians, trainees, and supervisors can utilize to help improve the quality of the services they provide.

EXERCISE 1.1: The “Name Game”

Ideal as an icebreaker or group-bonding experience, this activity involves each group participant simply writing her or his full name on a chalkboard, dry-erase surface, or large piece of paper and explaining what she or he knows about the source and meaning of each component.

As can be seen in the example below, participants do not need to have a particularly sophisticated knowledge of the linguistic derivations of their names or genealogies to generate interesting avenues for discussion and exploration of a variety of personal identities:

LynettLeeHenderson MetzgerMy father, a police officer, came across this name on a file while my mother was pregnant with me. She tells me that she does not know the type of case involved, but assures me that it was not “murder or anything really bad.”My father's middle name; growing up, it was important to me that it was the “boy spelling” for this reason.My partner and I took the same combined name: Henderson (my mother's family name, not an uncommon practice in the South; space no hyphen) Metzger (“butcher” in German; especially meaningful to preserve because many of his Jewish extended family members were killed in the Holocaust).

Variations include having group members write down the meanings of their names (without the names attached), collecting these, and having group members match meanings with names, or recall exercises in which group members are asked to remember particular names and meanings.

While generally perceived as a relatively nonthreatening way to open a discussion around sociocultural issues, this exercise should be approached thoughtfully in terms of accessibility issues (e.g., are there obstacles that make it impossible or awkward for some participants to get to the front of the room, write their names, etc.) and with the awareness that names and the act of naming are charged topics in their own right. For example, those with limited access to their own biographical information (through adoption or removal from the home, family secret-keeping, etc.), whose names are inextricably linked with oppressive or imperialistic historical realities (e.g., those with family “slave names,” descendents of immigrants who anglicized their names upon arrival to this country), and who have undergone or are in the process of undergoing identity transitions (as in divorce, emancipation, gender realignment surgery, or other significant life changes) may find this exercise particularly challenging.

Facilitators are encouraged begin with a disclaimer allowing anyone who chooses to do so to opt out of the exercise (and to structure the exercise in such a way that it is not immediately obvious who has and has not participated), to be alert to cues that participation may be distressing to some individuals, and to intervene appropriately if any aspect of the activity has the effect of perpetuating oppression, increasingly marginalization, or otherwise limiting open and productive communication. When participants do choose to discuss these types of issues, however, the experience can be an especially rich and rewarding one for all those involved.

Exercise 1.2: Sample Sociocultural Identity Wheel

In this exercise, participants are provided with (or draw) a circle with a circle inside it; the two circles are connected by lines, thus creating several smaller compartments. Participants are asked to write down one of their sociocultural identities in each segment, and perhaps to circle “two or three” that are the most salient. Those who wish to do so are then invited to share a salient identity. In the course of the discussion, attention may be directed to helpful concepts—for example, which identities typically reflect a degree of personal choice (e.g., political affiliation, social group membership) and which represent more or less immutable factors (e.g., visual racial/ethnic group status, some types of differential ability)—and questions may be raised regarding thought-provoking response patterns (e.g., “What do we make of the fact that no White participants identified race or ethnicity as a salient sociocultural identity?”). This exercise can be structured to take only a few minutes or can incorporate substantial additional material and analysis.

Figure 1.1 Sociocultural Identity Wheel

In the figure, the participant self-identifies as a sister/daughter, a dog lover, a New Yorker, a vegan, a 9/11 survivor, a psychiatric nurse, a Catholic, and a woman. She has selected “9/11 survivor,” “psychiatric nurse,” and “woman” as her three most salient identities, as indicated by the circle around each identity. Note that, in this example, participants are asked to highlight 8 sociocultural identities; however, any number could be selected.

Variations on This Theme

Asking participants to identify ways in which they are members of a “target group” (traditionally disenfranchised, marginalized, or oppressed individuals—e.g., women, persons of color, and those who are differently abled) or “non-target group” (traditionally empowered individuals—e.g., men, White people, those with high socioeconomic status) [see below for a more detailed description of these concepts]Examining the intersection between multiple identities (e.g., What does it mean to be a bisexual Latina mother?)Exploring relationships between salient life experiences and these identities (i.e., each participant might be asked to complete a Life Experiences Wheel similar to the Sociocultural Identity Wheel and comment on how, for example, socioeconomic status has impacted his or her career choice and professional development; what affirming and invalidating messages she or he has gotten based on racial and ethnic identification; to what extent gender-based violence has impacted past and present relationships, etc.)

Exercise 1.3: “Knapsack of Privileges” Exercise

Peggy McIntosh (2008) famously “unpacked” the invisible “knapsack” of White privilege (p. 239), acknowledging the unearned and largely unrecognized collection of entitlements, presumptions in their favor, and cultural cache of which White individuals in American society are the unspoken beneficiaries on a daily basis (for more information on White privilege specifically, please see Chapter 15). This concept has been expanded to include a broad range of privilege categories (e.g., heterosexual privilege; McIntosh, 2002), and can be useful in assisting those for whom this may be a new perspective in thinking through how the dual dynamics of privilege and oppression play out in everyday experiences. Along with those discussed elsewhere in this volume, identified privileges might include items such as the following:

As a White person, I do not worry that I have (or that my child has) been invited to a party or social event as the token representative of my race to demonstrate the inclusivity and open-mindedness of the host.As a White student or employee, my image is not routinely used on marketing materials, in photos, etc., as evidence of the organization's diverse enrollment or hiring practices.As a person of an accepted faith-based denomination, I can rest assured that my religion will not be associated with terrorism.As a person who is traditionally abled, I can assume I will be able to attend a class such as this (find suitable transportation; be able to gain access to the building; find a comfortable seat; and participate fully in the activities of the semester) without undue hardship.As a heterosexual woman, I do not have to worry that people will assume I am a child molester if I am around young children.As a young adult, I can expect that not being able to recall a memory does not reflect anything about my age.As a person with a culturally validated body shape, I do not have to fear that people will roll their eyes, groan, complain, or ask to move when I am assigned a seat next to them on an airplane.As a native English speaker, I can question a sales assistant, service provider, or government official about a confusing or unclear item, bill, or policy without him or her assuming that I do not understand enough to have a valid concern.As a cisgender individual, I am addressed by others using titles and pronouns that fit my concept of my own identity. I am never referred to by derogatory terms such as “s/he” or “it.”

One simple exercise involves printing a variety of these types of privileges on strips of paper, dividing participants into small discussion groups, and having each group member randomly select a privilege to read and discuss. The individual may hold the privilege (i.e., be a member of a group that benefits from the privilege) or may not hold the privilege (i.e., be a member of a group that lacks the privilege). Ideally, each discussion group will be composed of individuals from a variety of privileged/nonprivileged statuses. The specific items used in the exercise can be tailored to reflect areas of particular salience for the participants or venue. Participants may also be asked to generate ideas about ways in which they are privileged in their particular identities or settings.

Exercise 1.4: Saliency Exercises

Another way to begin talking about a broad variety of multicultural issues involves asking participants to think through various scenarios, evaluating the salient sociocultural considerations in each. There are obviously innumerable ways to present this material, from providing clinical vignettes (all vignettes, as with all clinical experiences—and, indeed, all human interactions—include diversity, power, and privilege components, some more explicitly than others) to deconstructing popular media images and themes or asking participants to bring in real-life examples of situations in which they noticed an exercise of privilege, were aware of an identity status, reacted to a power differential, observed (or perpetrated) an act of microaggression, and so forth.

One specific type of exercise involves examining the implications of our assumptions in particular circumstances. These are the ways in which our minds fill in the blanks when certain sociocultural cues are ambiguous or missing. For example, participants might be given the following instructions: