CONTENTS Cover Title Page Copyright Preface About the Authors Section One: The Multiple Dimensions of Multicultural Counseling and Therapy Part I: The Affective and Conceptual Dimensions of Multicultural Counseling and Therapy Chapter 1: Obstacles to Cultural Competence Reactions to Reading Counseling the Culturally Diverse Emotional Self-Revelations and Fears: Majority Group Members Emotional Invalidation versus Affirmation: For Marginalized Group Members Recognizing and Understanding Resistance to Multicultural Training Cultural Competence and Emotions Summary References Chapter 2: The Superordinate Nature of Multicultural Counseling and Therapy Culture-Universal (Etic) versus Culture-Specific (Emic) Formulations The Nature of Multicultural Counseling Competence A Tripartite Framework for Understanding the Multiple Dimensions of Identity Individual and Universal Biases in Psychology and Mental Health The Impact of Group Identities on Counseling and Psychotherapy What Is Multicultural Counseling/Therapy? What Is Cultural Competence? Cultural Humility and Cultural Competence Social Justice and Cultural Competence Summary References Chapter 3: Obstacles to Cultural Competence Counselors from Marginalized Groups Working with Majority and Other Marginalized Group Clients The Politics of Interethnic and Interracial Bias and Discrimination The Historical and Political Relationships between Groups of Color Differences between Racial/Ethnic Groups Counselors of Color and Dyadic Combinations Summary References Part II: The Impact and Social Justice Implications of Counseling and Psychotherapy Chapter 4: The Political and Social Justice Implications of Counseling and Psychotherapy Impact of Political Oppression The Education and Training of Counseling/Mental Health Professionals Definitions of Mental Health Counseling and Mental Health Literature The Need to Treat Social Problems—Social Justice Counseling The Foci of Counseling Interventions: Individual, Professional, Organizational, and Societal Social Justice Counseling Summary 2 References Chapter 5: The Impact of Systemic Oppression The Rest of the Story Effects of Historical and Current Oppression Counselor Credibility and Attractiveness Formation of Individual and Systemic Worldviews Formation of Worldviews Summary References Chapter 6: Microaggressions in Counseling and Psychotherapy Contemporary Forms of Oppression Evolution of the “Isms”: Microaggressions The Dynamics and Dilemmas of Microaggressions Counseling Implications Summary References Part III: The Practice Dimensions of Multicultural Counseling/Therapy Chapter 7: Barriers to Multicultural Counseling and Therapy Identifying Multicultural Counseling Issues Generic Characteristics of Counseling/Therapy Culture-Bound Values Class-Bound Values Language Barriers Patterns of “American” Cultural Assumptions and Multicultural Family Counseling/Therapy Overgeneralizing and Stereotyping Summary References Chapter 8: Communication Styles and Its Impact on Counseling and Psychotherapy Communication Styles Sociopolitical Facets of Nonverbal Communication Counseling and Therapy as Communication Style Summary References Chapter 9: Multicultural Evidence-Based Practice Evidence-Based Practice (EBP) and Multiculturalism Evidence-Based Practice (EBP) and Diversity Issues in Counseling Summary References Chapter 10: Non-Western Indigenous Methods of Healing Legitimacy of Cultural Syndromes: Nightmare Deaths and the Hmong Sudden Death Phenomenon The Principles of Indigenous Healing Dangers and Benefits of Spirituality Summary References Part IV: Racial/Cultural Identity Development in Multicultural Counseling and Therapy Chapter 11: Racial/Cultural Identity Development in People of Color Racial Awakening 3 Racial/Cultural Identity Development Models A Racial/Cultural Identity Development Model Counseling Implications of the R/CID Model Value of R/CID Framework Summary References Chapter 12: White Racial Identity Development Understanding the Dynamics of Whiteness Models of White Racial Identity Development The Process of White Racial Identity Development: A Descriptive Model Developing a Nonracist and Antiracist White Identity Summary References Section Two: Multicultural Counseling and Specific Populations Part V: Understanding Specific Populations Chapter 13: Culturally Competent Assessment Therapist Variables Affecting Diagnosis Cultural Competence and Preventing Diagnostic Errors Contextual and Collaborative Assessment Infusing Cultural Competence into Standard Clinical Assessments Summary References Part VI: Counseling Marginalized Racial/Ethnic Group Populations Chapter 14: Counseling African Americans Characteristics and Strengths Specific Challenges Summary References Chapter 15: Counseling American Indians/Native Americans* and Alaska Natives Characteristics and Strengths Specific Challenges Summary References Chapter 16: Counseling Asian Americans and Pacific Islanders Characteristics and Strengths Specific Challenges Summary References Chapter 17: Counseling Latinas/os Characteristics and Strengths Specific Challenges Summary References Chapter 18: Counseling Multiracial Individuals Characteristics and Strengths Specific Challenges Summary References Part VII: Counseling and Special Circumstances Involving Ethnic Populations 4 Chapter 19: Counseling Arab Americans and Muslim Americans Characteristics and Strengths Specific Challenges Summary References Chapter 20: Counseling Immigrants and Refugees Characteristics and Strengths Specific Challenges Summary References Chapter 21: Counseling Jewish Americans Characteristics and Strengths Specific Challenges Summary References Part VIII: Counseling and Special Circumstances Involving Other Multicultural Populations Chapter 22: Counseling Individuals with Disabilities Characteristics and Strengths Specific Challenges Summary References Chapter 23: Counseling LGBT Individuals Characteristics and Strengths Specific Challenges Summary References Chapter 24: Counseling Older Adults Characteristics and Strengths Specific Challenges Summary References Chapter 25: Counseling Individuals Living in Poverty Characteristics and Strengths Specific Challenges Summary References Chapter 26: Counseling Women Characteristics and Strengths Specific Challenges Summary References Glossary Index End User License Agreement List of Tables Table 3.1 Table 6.1 5 Table 6.2 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 8.1 Table 9.1 Table 9.2 Table 9.3 Table 10.1 Table 11.1 Table 12.1 Table 22.1 List of Illustrations Figure 2.1 Figure 4.1 Figure 5.1 Figure 9.1 Figure 14.1 6 Seventh Edition Counseling the Culturally Diverse Theory and Practice Derald Wing Sue | David Sue 7 Copyright © 2016 by John Wiley & Sons, Inc. 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If this book refers to media such as a CD or DVD that is not included in the version you purchased, you may download this material at http://booksupport.wiley.com. For more information about Wiley products, visit www.wiley.com. Library of Congress Cataloging-in-Publication Data: Sue, Derald Wing. Counseling the culturally diverse : theory and practice / Derald Wing Sue, David Sue. – 7th edition. pages cm Includes bibliographical references and index. ISBN 978-1-119-08430-3 (cloth) – ISBN 978-1-119-08437-2 (pdf) – ISBN 978-1-119-08433-4 (epub) 1. Cross-cultural counseling. I. Sue, David. II. Title. BF637.C6S85 2016 158.3–dc23 2015018013 8 PREFACE Since its publication in 1981, Counseling the Culturally Diverse: Theory and Practice (CCD) has become a classic in the field, used in the overwhelming majority of graduate training programs in counseling, counselor education, and clinical psychology, and now forms part of the multicultural knowledge base of licensing and certification exams. It continues to lead the field in the theory, research, and practice of multicultural counseling/therapy and upholds the highest standards of scholarship; it is the most frequently cited text in multicultural psychology and ethnic minority mental health. Over many decades, feedback from reviewers and readers indicate the success of CCD is related to its (a) integrated conceptual framework, (b) up-to-date coverage of research in the field, (c) ability to actively address clinical applications through translating research/concepts to practice, (d) use of numerous examples, vignettes, and case studies that add life and meaning to the material, (e) ability to involve readers in personal self-reflection and exploration, (f) engaging writing style, and (g) passionate style of communication—hard hitting, intense and challenging. The 13 chapters on specific populations continue to be hailed as among the best thumbnail sketches of how multicultural counseling relates to the various marginalized groups in our society. Adopters have consistently praised the culture-universal and culture-specific balance of the book. The seventh edition of CCD does not change the basic formula which has made and continues to make it a success in the academic and clinical markets. Changes to CCD In the seventh edition, major changes were made as a result of reviewing three dozen texts on multicultural counseling, general multicultural mental health care, multicultural assessment, multicultural competencies, multicultural supervision, and multicultural consultation. Content coverage, general orientation, philosophical approach, writing style, and pedagogy were analyzed in addition to a 2014 survey conducted by the publisher sent to over 1,300 instructors who each received a copy of the 2013 edition of CCD. The survey asked what were the unique challenges to teaching the course, what type of materials would prove helpful to instructors, and what areas needed additional coverage. Based upon a review of competing texts, analysis of the survey, and feedback from past adopters, several findings informed the revision process. Comprehensiveness When compared to other texts in the field, CCD explores and covers nearly all major multicultural counseling topics in the profession. Indeed, reviewers believed it the most comprehensive of the texts published, and noted that it leads in coverage of microaggressions in counseling, interracial/interethnic counseling, social justice approaches to counseling, the implications of indigenous healing, the sociopolitical nature of counseling, racial identity development, and the cultural use of evidence-based practice. In the reviews, two important observations were made: (a) many competing texts lacked specific coverage of these topics and/or covered these areas superficially, and (b) many competitors relied heavily upon the content of CCD, adapting it for their books. This latter observation is certainly flattering, as it indicates that CCD continues to be the flagship leader in the field of multicultural counseling by continuing to break new ground in the profession and presenting original cutting-edge research. Streamlined and Up-to-Date Coverage In the survey of instructors, there was a notable absence of requests to cover additional topics. We surmise that instructors were satisfied by the comprehensiveness of topical coverage in CCD, a conclusion also supported in our review of competing books. Rather than suggesting additional topics, ironically, some adopters noted that CCD explores too much material and that it was difficult to cover everything in a single course. Among those who provided this feedback, there were suggestions that CCD be shortened. They did not recommend eliminating topics, but rather condensing, summarizing, and streamlining, or eliminating certain subtopics. We have tried our best 9 to do so without violating the integrity of the content. Note that many of the chapters have been retitled because of changes. Despite our intent to shorten major sections of the text, new advances and important changes in multicultural counseling suggest additional areas that need to be addressed. These include expanded coverage of internalized racism, cultural humility, expansion of microaggression coverage to other marginalized groups, social justice/advocacy skills, recent research and thinking on evidence-based practice, and new approaches to work with specific populations. It goes without saying that the most up-to-date research findings and scholarly works have been integrated into all topics. We have also studied carefully the multicultural guidelines proposed by the American Psychological Association and the 2016 Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2015) to make sure the content conforms to them. Additionally, the American Counseling Association's Multicultural Counseling Competencies Revision Committee has presented a draft proposal of new and integrated Multicultural and Social Justice Counseling Competencies (MSJCC) (2015) which is incorporated into the conceptual framework of the text. Thus the text not only represents the most comprehensive coverage of the field, but the most current work of scholars in multicultural counseling and mental health practice. Emotive Nature of Content One of the greatest concerns of instructors is the strong emotive reactions of students to the material: grief, anger, depression, and guilt in working through the content. This has been a perennial issue for students and instructors since the first edition was published in 1981. We have been aware from the beginning that CCD is very likely to elicit strong emotions among readers because the content of the book challenges racial, gender, and sexual orientation realities, and traditional therapeutic beliefs. On the one hand, CCD can be said to accomplish one of its major goals by indicating that cultural competence is more than an intellectual exercise, and that it must include dealing with strong and powerful nested and hidden emotions and biases on the part of the helper. On the other hand, these powerful feelings can become so intense in students (arousing defensiveness, guilt, and anxiety) that they prevent self-exploration (a necessary component of cultural competence in the helping professions). To aid students in their journey to cultural competence, we have completely rewritten Chapter 1, formerly titled “The Multicultural Journey to Cultural Competence: Personal Narratives.” The original intent of this chapter was to present personal narratives of the emotive reactions of a White psychologist in contrast to psychologists of color to the content of CCD. It was used to illustrate differences in racial realities of three individuals and to anticipate the emotive reactions of readers and their meanings. Feedback throughout the years indicates that it has been relatively successful in allowing students to link their own emotive reactions with that of the storyteller. But more seemed needed. The one downside to these long narratives was a reliance on students and instructors to distill multicultural lessons from the life stories on their own. Although these lessons seemed obvious to the authors, it was apparently not so obvious for students. The revision of Chapter 1, now titled “Obstacles to Cultural Competence: Understanding Resistance to Multicultural Training,” eliminates the longer narratives in favor of a dozen or more one-paragraph personal statements from a variety of students and people that will illustrate differences in racial realities and emotive reactions that have implications for the students' personal lives, their development as racial/cultural beings, their cultural competence, and their roles as multicultural counselors. Using shorter statements or vignettes will allow us to comment more in depth and help students make sense of their feelings and deconstruct their meanings, and will help them digest the contents of the forthcoming chapters. Within-Chapter Changes/Additions We strengthen each chapter by an increased focus on pedagogy, providing instructors with material to facilitate experiential activities and discussion and to help students digest the material. We open every chapter with broad Chapter Objectives, followed by more specific and oftentimes controversial Reflection and Discussion Questions interspersed throughout. Further, every single chapter opens with a clinical vignette, longer narrative, or situational example that previews the major concepts and issues discussed in the chapter. Many of these are new and serve to anchor the multicultural issues to follow. They add life and meaning to the chapter concepts and research. 10