Positive Multiculturalism as Aspirational Ethical Practice: Therapeutic Applications Molly Haas Cowan, PsyD Jeanne M. Slattery, PhD John A. “Jay” Mills, PhD, ABPP Ground Rules (Ervin, 2014) 1. Be respectful/mindful of others 2. Self-reflect and become aware of your personal reactions 3. Know your limits and boundaries, disclosing only what is okay for you 4. Sit with tough emotions • How do you know when you are feeling defensive? • It’s not the emotional response but what you do with it that matters. Ground Rules (Ervin, 2014) 5. Listen to others' perspectives and ideas even when you disagree 6. Be open to giving and receiving corrective feedback 7. Don't shut others down—and be aware when you feel shut down 8. Remember: • You have the right to “screw up” in an attempt to understand yourself, your reactions, and the larger world • You have the right to "let it be" We promise to… (Ervin, 2014) • Challenge you • Encourage critical thinking • Push buttons and play “devil's advocate” to encourage multicultural competence • Provide a safe place to do these things Our overriding assumptions: • We've all internalized “isms.” To work effectively in this field we need to explore, deconstruct, and challenge our personal “isms” • There are many ways to learn about “isms” Our Goals 1. Use General Ethical Principles and guild-specific Code of Ethics to guide a multicultural practice; 2. Describe a positive multicultural approach, as well as reasons for paying attention to multicultural issues; 3. Recognize barriers to developing multicultural competency; and 4. Identify strategies for teaching and supervising therapy trainees to apply accepted professional principles in determining how multiculturalism is a part of practice and/or an impediment to optimal practice. Good Practice Ethical Practice Positive Multiculturalism Aspirational principles of ethics code (APA, 2010) • • • • • Beneficence and nonmaleficence Fidelity and responsibility Integrity Justice Respect for people's rights and dignity Guidelines on multicultural education, training, research, practice, and organizational change (APA, 2002) Guideline #1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves. Guideline #2: Psychologists are encouraged to recognize the importance of multicultural sensitivity/responsiveness, knowledge, and understanding about ethnically and racially different individuals. Guideline #5: Psychologists strive to apply culturally-appropriate skills in clinical and other applied psychological practices. Today the nation is no longer divided along [racial] lines, yet the Voting Rights Act continues to treat it as if it were. –John Roberts (6/2013) www.nydailynews.c om Perceived racism (Norton & Sommers, 2011) Blacks continue to indicate drastically poorer outcomes for Black than White Americans: "from employment to police treatment, loan rates to education," yet… Perhaps this reflects perception as a zero sum game (Norton & Sommers, 2011) Seeing multicultural ideas can be difficult Some definitions: Role of culture Race/ethnicity/gender/class/religion/sexual orientation, etc. influence: • preferences, values, habits, goals, etc. • how we are seen • how we see others • experiences of oppression and privilege Some definitions: Multiple identities (Slattery & Park, 2011) What do we see as racism? (Sommers & Norton, 2006) 1. Discomfort/unfamiliarity (e.g., is uncomfortable around Blacks; doesn't socialize regularly with Blacks) 2. Overt racism (e.g., discourages kids from playing with Blacks; thinks Blacks are not suited for certain professions) 3. Denial of problem (e.g., thinks slavery was so long ago it is unimportant to talk about; doesn't speak up or act when someone else is racist) • People of Color are more likely to identify subtle forms of bias as racism • White observers often respond to allegations of subtle bias with skepticism or questions about ulterior motives Microaggressions (Sue et al., 2007) • Using racist epithets and offensive language, making racist jokes • Making unwarranted assumptions about a person’s behavior or background because of skin color • Silencing racial minorities by dominating work or classroom discussions or frequently interrupting them • Treating a person as a representative of an entire group solely because of skin color • Dismissing claims of racism • Giving subtle preference to people who share your racial background or skin color Barriers to acknowledging racism? • Attitudes are the result of personal experience • Perceive self as an expert • Expect a favorable outcome from status quo • Attitudes are repeatedly expressed • Stand to win—or lose—something due to the issue Barriers to change? • • • • • Anger/discomfort Shame about making mistakes May need to acknowledge/give up privilege Lack of knowledge and self-assessed expertise Questions about what should be addressed (and how) White racial identity (Slattery & Park, 2011) 1. 2. 3. 4. 5. Contact Disintegration Reintegration Pseudo-independence Independence What would you do? Problem with self-reports (Banaji & Greenwald, 2013) 1. White lies • How are you? • Do I look fat in these? 2. Gray lies • Can you spare a dollar? • Is Ms. X at home? 3. Colorless lies • How may cigarettes do you smoke a day? 4. Red lies • I love you. 4. Blue lies • Did you go to church this week? www.financefox.ca Implicit Association Test Shoot or no shoot? (Watt & Sherbourne, in progress) Reactions to taking Implicit Attitude Test (Casad, Flores, & Didway, 2012) Accurate Inaccurate After taking IAT 33% 46% Unsure 21% Why? (Casad et al., 2012) Reasons given for IAT's invalidity Structure of test is problematic In-group preference Explicit and implicit attitude incongruence Measures cultural stereotypes Measures associations, not prejudice Measures snap judgments 25% 15% 13% 8% 6% 6% Reactions to taking Implicit Attitude Test (Casad et al., 2012) Accurate Inaccurate After taking IAT After lecture/ reading Unsure 33% 46% 21% 45% 33% 22% What happens when we are colorblind? (Plaut, Thomas, & Goren, 2009) Whites' color blindness Whites' multiculturalis m Whites' color blindness Minorities' psychological engagement Minorities' Minorities' psychological perception of engagement bias -.66 *** .57* -.70 ** -- -.54* .54* -- -- -.76*** * p < .05, ** p < .01, *** p < .001 What changes are desirable? Knowledge Attitude Self-reflection Behavior What changes? (Pope, 1993; Reynolds, 1997) • First-order changes (assimilation) • Increased awareness, knowledge, skills • Second-order change (accommodation) • Cognitive restructuring • Worldview and paradigm shifts Stages of change (Prochaska, 1999) • • • • Precontemplation Contemplation Action Maintenance Ethical acculturation model (Handelsman, Gottlieb, & Knapp, 2005) Personal Ethics High Low Professional High Assimilation Integration Ethics Low Marginalization Separation Our modification Personal Commitment to Multicultural Competence High Low Professional High Assimilation Integration Commitment Low Marginalization Separation Recommendations from our experience • Start where you are • Foster sensitivity to signs of own biases • Engage in empathy-inducing activities • Exploration of aesthetic traditions from other countries • Direct engagement in perspective-broadening activities • Contact with situations causing cognitive dissonance • Perform psychosocial histories of clients (seeing beyond symptoms) Goals for effective therapists-incontext • Acknowledge that all helping occurs in a context • Attend to one’s own context, assumptions, and biases on ongoing basis • Recognize that different people may draw different conclusions under “similar” circumstances due to different cultures/contexts • Remain attentive to attitudes and actions related to therapist’s ongoing multicultural development • Consider how multiculturalism modifies/enhances theoretical and practical dimensions of therapy • Read professional literature with an eye to multicultural issues • Read the news, stay current with cultural issues to be able to perceive culture-influenced issues readily Questions to consider with client • What is the client’s unique cultural perspective about the world and self? • How does culture/context influence the symptoms or problems? • How does culture factor in the client’s decision to seek treatment? • How might this client might perceive therapist as a result of multicultural factors? • • What opportunities? What barriers? • How does culture influence the therapeutic alliance? • What parts of the client’s unique cultural perspective pose difficulties for the therapist? Multiculturally-informed issues for treatment • Identify and explore microaggressions, oppression, and privilege • Assist clients in understanding implications of their worldview • Promote consideration of costs and benefits of culture-related choices • Empower clients in making conscious choices that are valid from their own context and culture The Color of Fear Resnick: And so you thought that your children, all five of your children, somehow because of what you saw as your defective mothering, were not on the path of righteousness and were stumbling. [Hmm] And did you feel then that it was good for them or bad for them, if you in fact threw them into the sea—or in a bathtub—in a very real sense? What were you trying to accomplish then when you did take your children’s lives? Andrea Yates Yates: Maybe in their innocent years … God would take them up. Resnick: It would be their innocent years and God would take them up? Is that what you said? Yates: Be with him. Uh huh. Resnick: God would take them up to be with Him in heaven? Is that what you mean? [Uh huh.] All right. And if you had not taken their lives, what did you think would happen to them? Yates: Guess they would have continued stumbling. Resnick: And where would they end up? www.nytimes.com Lia Lee and her mother Henry Louis Gates Jr. news.harvard.edu References American Psychological Association. (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Retrieved from http://www.apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx American Psychological Association. (2010).Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/index.aspx?item=3 Banaji, M. R., & Greenwald, A. G. (2013). Blindspot: Hidden biases of good people. New York, NY: Delacorte. Casad, B. J., Flores, A. J., & Didway, J. D. (2012). Using the Implicit Attitude Test as an unconsciousness raising tool in psychology. Teaching of Psychology, 40, 118-123. Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36, 59–65. References (cont.) Norton, M. I, & Sommers, S. R. (2011). Whites see racism as a zero-sum game that they are losing. Perspectives on Psychological Science, 6(3), 215–218. Plaut, V. C., Thomas, K. M., & Goren, M. J. (2009). Is multiculturalism or color blindness better for minorities? Psychological Science, 20(4), 444-446. Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.). The heart and soul of change: What works in therapy (pp. 227–255). Washington, DC: American Psychological Association. Slattery, J. M., & Park, C. L. (2011). Empathic counseling: Meaning, context, ethics, and skill. Pacific Grove, CA: Brooks/Cole. Sommers, S. R., & Norton, M. I. (2006). Lay theories about white racists: What constitutes racism (and what doesn't). Group Processes and Intergroup Relations, 9, 117-138. Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62, 271-286. Watt, J., & Sherburne, C. L. (2011). Implicit attitudes as viewed through a shoot-no shoot simulation. (Unpublished manuscript).