It once may have been a skill set reserved for specialists, but multicultural counseling has quickly become an everyday part of most counselors’ workloads. In a nation whose immigrant population is booming, many counselors find themselves working with people and cultures they had little to no contact with before. At the same time, within businesses, government and other organizations, concern about multicultural issues has become institutionalized, creating a need for well-trained professionals.

Thoughtful traditional counseling practices often serve counselors well in these instances, and experts in cross-cultural counseling stress concepts familiar to the entire profession: building trust and rapport, gathering information, exploring emotions, finding the right pace, noticing resistance, being aware of the process.

“Our culture-world is made of mosaics of similarities and differences,” says Ruth Chao, an assistant professor at Tennessee State University. She has also served as the principal investigator for the Multicultural Families and Adolescents Study. “We all smile, treat each other with respect and cherish sincerity. For example, ask your clients from another culture how they greet one another, how people are positioned by social status or other questions about emotional issues, and their answers will probably make you nod in agreement. They will respect you as a counselor, and your work will be effective, though your client may be limited by shyness, language and conventions.”

While skillful traditional counseling should serve all cultures, the reality is that it doesn’t, says Timothy Grothaus, an assistant professor at Old Dominion University in Norfolk, Va. “It is my hope that one day, multicultural alertness or counseling competence would be sufficiently infused in our training, our theories, our notions of best practice, etc., that it would seem somewhat quaint to make a special point of it,” he says. “We’re making progress but, by empirical indicators, have a ways to go yet.”

His colleague, Karen Dunlap-Joachim, a professor of counseling at Old Dominion, where a pocket of instructors specializes in and stresses multicultural counseling, suggests that multicultural counseling must be separately addressed. “I would love to think that all counselors would be sensitive to cultural issues in counseling all clients,” says Dunlap-Joachim, an American Counseling Association member, “but I don’t believe that all counselors are even aware of how much they are invested in their own culture or that they have a cultural link that affects their work. If one does not draw direct attention to the examination of culture — your client’s and your own — as a separate and important entity to be explored and understood from the client’s level of acculturation, I do not believe we can best serve any client, but especially clients whose cultural beliefs and expectations may be so very different from the clinician’s.”

Looking back

In 1992, the need to address multicultural issues in counseling was clear, and a key paper was published in ACA’s Journal of Counseling & Development that proposed development of 31 competencies. In the article (“Multicultural counseling competencies and standards: A call to the profession”), Derald Wing Sue, Patricia Arredondo and Roderick McDavis, described three dimensions of culturally conscious counseling:

• Becoming aware of one’s own assumptions about human behavior, values, biases, preconceived notions, personal limitations and other negative approaches
• Actively attempting to understand the worldview of one’s own culturally different clients without negative judgments
• Developing and practicing appropr- iate, relevant and sensitive intervention strategies and skills in working with culturally different clients

Within each of those dimensions, the paper developed beliefs, attitudes, knowledge and skills and recommended culturally skilled counselors understand the limitations of generic counseling, which could clash with the cultural values of minority groups. In addition, the authors warned against bias in assessment instruments and barriers in mental health services. They also recommended counselors have a “knowledge of minority family structures, hierarchies, values and beliefs” and an awareness of community characteristics and resources. Other recommendations included using verbal and nonverbal responses accurately and consulting with traditional healers and religious/spiritual leaders. The paper also suggested using translators with the appropriate background or referring clients to effective bilingual counselors when necessary.

In 1996, the Association for Multicultural Counseling and Development, a division of ACA, approved the 31 competencies suggested for specialists in the field. The ACA Governing Council endorsed the multicultural counseling competencies in 2002.

More recently, Garrett McAuliffe has authored a new book, Culturally Alert Counseling: A Comprehensive Introduction (available in June from Sage Publications). McAuliffe, a professor of counseling at Old Dominion, serves on the Editorial Board for the Journal of Counseling & Development. He also presented at the ACA Convention in Detroit on “Keys to a Culturally Alert Practice.” He says all counselors need to make their practices accessible to people of all cultures, deal directly with cultural issues and tailor their counseling to the specific needs of the client. Initially, he says, counselors should make sure their surroundings are “inclusive and welcoming” to all potential clients. This might include using images or artifacts from other cultures to decorate the office or ensuring that the waiting room contains reading material written in various languages. The counselor should indicate a knowledge of or interest in the client’s culture, McAuliffe says, and speaking even a bit of the appropriate language can play a significant role in helping the client feel more at ease. Counselors also need to train staff to work with a variety of cultures and be sensitive to each, he says.

“You have many ways to learn about cultures,” Chao adds. “Make friends with people from (clients’) cultures, ask questions in the introduction session, go to cultural fairs, read up on cultures and expose yourself to these cultures. Your clients will be impressed with your eagerness and would be happy to talk with you, for nothing attracts more than eager enthusiasm.”

Small talk and self-disclosure work well, particularly if the clinician offers personal “safe facts,” McAuliffe says. He says counselors can also ask questions that  gather information without making the client feel uneasy. For instance: “On a scale of 1 to 5, what is your comfort level with regard to addressing the issue of culture?” or “How do you feel about working with me since I am not of your race?”

McAuliffe also suggests some standard counseling procedures with a slight variation. “Share your ideas on the nature of counseling and check out the client’s response,” he says. “Do culturally informed consent.” Bring up cultural differences in sessions and “explicitly consider gender, ethnicity, religion and other factors in the client’s world,” he says. People from significantly different cultures often have a longer “feeling-out period,” but McAuliffe recommends acknowledging the “elephant in the room” early in the process.

Distinct issues

McAuliffe says it is also appropriate to engage the client on issues that are distinct to them, asking questions such as:

• What role did your culture play in your choices?
• Help me understand what you are going through as a person of this race.
• How do you think people perceive you as a result of your ethnicity?
• What would you like me to know about your experiences in your culture? What about the experiences someone like you faces in this culture?

McAuliffe also suggests being deliberate in using knowledge gained about the client’s culture. “When there are significant cultural differences, the client needs to know that the counselor can understand them and wants to,” he says.

He recommends a more reserved, less personal approach than one might normally use initially, with sensitivity to the topics of sexuality, gender or even career aspirations, which may be an issue with family in some cultures. Some may care little about career issues, while in others, they may be of primary importance. “Recognize that in some cultures, achievement and its attendant family honor are often more important than emotional exploration and self-fulfillment, but praising oneself is not valued,” he says.

The counselor may want to include the client’s perceptions of family or even ancestors in the discussion, he says. Have the client talk about how those people might react to an issue, he suggests, especially when working with clients from cultures that give priority to the family or group over the individual.

In such “collectivist” cultures, fact- and meaning-oriented counseling is more important than knowing and expressing feelings, McAuliffe explains. These clients may be more comfortable with a less direct and more formally polite approach, he says. In addition, family should perhaps be included in the counseling sessions, particularly when the client is making a nontraditional choice and a compromise is necessary, he says.

Certain topics may not be acceptable to some cultures. For instance, he says, sexuality is not a topic that should be discussed with members of many South Asian, East Asian or Middle Eastern cultures. Gender roles are somewhat taboo for Middle Eastern cultures. At the same time, he says, discussions about sexual behavior for men — even relations with other men — is not extremely restricted in Latino cultures, where it is viewed as the result of an overwhelming urge.

McAuliffe recommends solution-focused counseling in many cases, particularly where the group is primary to the client’s culture. Chao recommends cognitive behavioral therapy combined with “a sensitivity to cultural differences.” If clients are struggling with cultural rules that are limiting or unwanted, McAuliffe says counselors can carefully help them separate themselves from their “cultural story” by using narrative counseling approaches.

At the same time, McAuliffe notes that a strict “particularistic” approach that uses specific culturally based methods may not allow for a client’s enculturation, acculturation or the convergence of cultural identities. “Culture is always present in clients’ lives, but it may not be central to their concerns at any one time,” he says. “Instead, individual personality, situational and universal human condition issues may be more prominent.”

But a universalistic stance also may be inadequate, he says. Always applying person-centered theory or having the client search for his/her own solutions, for instance, may be misconstrued as indifference or even incompetence, he says, while egalitarianism may be misidentified as a lack of respect or a violation of decorum.

McAuliffe suggests that counselors apply traditional Western methods that also use some culturally specific strategies — varying structure and directness, emotionality and the use of silence and pause times, for example. “Counselors must remind themselves of the limits of generalizations,” he says. “Individuals within groups vary greatly in their levels of acculturation, enculturation and cultural identity as well as other characteristics.”

Jim Paterson is a contributing writer to Counseling Today and a high school counselor living in Olney, Md. Contact him at mypat@radix.net.

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