In Culture-Centered Counseling, Dr. Paul B. Pedersen shows how recognizing the centrality of culture can augment therapy and result in effective treatment of all clients. This approach involves recognizing cultural assumptions and acquiring knowledge and skills to get beyond them, something that may be done no matter what treatment model a therapist might use.
The video demonstrates how inclusive cultural empathy with a divergent contextual focus differs from conventional convergent and individualistic interpretations of empathy. In this session, Dr. Pedersen works with a young Latina woman named Maria who is trying to become more assertive in her interpersonal relationships. Dr. Pedersen helps Maria begin to find a way to be assertive without sacrificing the traditions she wants to preserve from her heritage.
The "culture-centered" approach to counseling and therapy assumes that cultural factors complicate counseling, but in a positive way, and that behaviors have no meaning until they are understood in the cultural context in which those behaviors have been learned and are displayed.
The goals of culture-centered therapy are
- to establish an accurate awareness of how the therapist is culturally similar and at the same time culturally different from the client;
- to gather the relevant facts, information, and meaningful knowledge to comprehend priorities in the client's cultural context; and
- to demonstrate culturally appropriate skills for helping the client change or examine culturally learned behaviors and perspectives.
This three-stage developmental sequence guides the therapist toward higher levels of multicultural competence in therapy.
Key issues in the approach include the following:
- attaining and maintaining a dynamic, holistic "balance"; health itself may be defined as having a sense of balance in life;
- multicultural awareness of culturally learned assumptions about self and others leading to accurate assessment;
- multicultural knowledge of relevant facts and information leading to meaningful comprehension;
- multicultural skills for identifying appropriate interventions through counseling and therapy;
- training counselors to "hear the voices" a client is thinking but not saying through the role-played involvement of an anticounselor and a procounselor in The Triad Training Model in role-played interviews;
- recognizing a "relational" rather than an "individuated" self, where the client's multicultural "identity" is composed of multiple simultaneous potential self-perspectives that compete for salience but remain connected in different ways;
- recognizing that each of us belongs to many different cultures at the same time according to the broadly defined perspective of multiculturalism to include ethnographic demographic, status, and affiliation variables; and
- recognizing that family relationships are central to the culture of many if not most societies, both at the nuclear–extended biological family level and as a familial metaphor in which small groups compose support groups for one another.
When Dr. Pedersen practices culture-centered therapy, he imagines a "cultural grid," with one dimension focused on "behaviors" and the other dimension focused on "cultural identities." In using the cultural grid, he first identifies a particularly important behavior of the client. Second, Dr. Pedersen finds out why the client expressed that behavior, what he or she expected to happen as a result of that behavior, and how the client explains that behavior. Third, Dr. Pedersen finds out where the client learned that behavior and which of the client's "cultural teachers," from the thousand or so culture teachers they have encountered, is most salient.
Only after completing these three tasks can the therapist attempt to interpret, understand, or suggest new behaviors that might be more effective and efficient to accomplish the client's expectations. This three-step sequence keeps therapists from imposing his or her interpretation of the client's behavior from his or her own cultural perspective.
During the session, the therapist should be
- demonstrating observation skills for exploring the client's cultural context;
- focusing skills for identifying cultural patterns, themes, and salient features;
- reflecting feelings and culturally mediated meanings from the client's perspective;
- using paraphrasing and summarizing skills to link culture with behaviors;
- using self-disclosure, feedback, structuring, exploring, and other strategies to influence behavior changes for the future, with guidance and modeling from the therapist; and
- managing conflict and confrontation skills with others and within the individual toward intentionality in matching behaviors with the cultural context.
Four behaviors that are important to the therapist are
- understanding the "problem" from the client's viewpoint
- recognizing resistance in specific rather than vague general terms
- reducing defensiveness
- developing "recovery" skills
How to Proceed
The therapist might begin by listening and observing the client in the person's cultural context and by avoiding stereotyping. This may require the use of informal as well as formal therapy methods or meeting in informal as well as formal contexts. The therapist might focus on discovering relevant culturally learned assumptions being made by the client and therapist. Paraphrasing and summarizing will help clarify important priorities in the client's cultural context, resources available to the client, and dangers or obstacles to successful therapy.
As a result of increased awareness, knowledge gaps will appear, indicating those facts and information required for therapy to succeed without forcing the client to become the therapist's "teacher." The counselor does the necessary homework to achieve a meaningful understanding of this person in his or her cultural context.
On the basis of accurate awareness and meaningful knowledge, the therapist can begin introducing appropriate therapy skills to explore the consequences of changing or not changing selected behaviors. Therapy takes on an "educational" perspective to avoid the stigma in many cultures toward pathology-centered therapies. The client becomes a consultant in the therapy process, working together with the therapist provider.
Although each test and theory is culturally biased to reflect the assumptions of the cultural context in which that test or theory originated and although there are no "culture-free" tests or theories, the therapist can nonetheless make appropriate use of these culturally biased tests or theories by compensating for the inherent bias. A wide variety of activities, scales, tests, and measures might therefore be appropriately used.
This Videotaped Session
In this session Dr. Pedersen focuses almost exclusively on increasing his awareness of the client's culturally learned assumptions and on identifying ways in which his own culturally learned assumptions might be sometimes similar and sometimes different from the client. He looks for repeated patterns in the client's behaviors and responses in different situations and how those patterns relate to the client's cultural identities. He explores the client's internal dialogue, speculating on positive and negative messages that the client may have been thinking but not saying.
He focuses on salient relationships, such as family, and resources that are important to the client. Paraphrasing and summarizing let him know whether he understands the client. Structuring, leading, and linking help put together the different patterns from the client's perspective as he moves toward a more meaningful understanding of the client's cultural context. Eventually he influences the client toward what seem to be culturally appropriate outcomes.
Successful culture-centered therapeutic outcomes will result in both the therapist and the client learning something new about each other's cultural context. Therapists will become better able to imagine the positive and negative messages that the culturally different clients are thinking but not saying, and clients will become better managers of their own internal dialogues as a mental health resource. Clients will become more articulate about their own cultural context in both its positive and its negative effect on them. Clients will be better able to appreciate the ways in which they are culturally similar and different from others and also will be prepared to make informed choices about reshaping their cultural context.
In cases of extreme pathology, the therapist may need to take control of a "troubled" client, offering a temporary, means-oriented coalition against the problem to provide a safe place for the client to nurture growth. Imagine the problem as a third presence in the therapeutic interview—almost like another "person." As the client grows to become more powerful, the therapist may back off and reduce the degree of power or control.
This relationship can be described in a heuristic force-field equation at which any point in the interview T + CL is equal to or slightly greater than P (problem). As the client's power grows, the therapist's power or degree of control will be reduced over time to provide a safe context at all times for the client to maintain a holistic force-field balance of power between the client, the therapist, and the "problem." If the client becomes weaker, the therapist will correspondingly increase his or her degree of power or control in the relationship.
- Hofstede, G. J., Pedersen, P., & Hofstede, G. (2002). Exploring culture: Exercises, stories, and synthetic cultures. Yarmouth, ME: Intercultural Press.
- Ivey, A. E., & Ivey M. (2003). Intentional interviewing and counseling: Facilitating development in a multicultural society (5th ed.). Pacific Grove, CA: Brooks/Cole.
- Ivey, A. E., Pedersen, P., & Ivey M. (2001). Intentional group counseling: A microskills approach. Pacific Grove, CA: Brooks/Cole.
- Pedersen, P. (2000). A handbook for developing multicultural awareness. Alexandria, VA: American Counseling Association.
- Ponterotto, J. G. (2001). Handbook of multicultural counseling (2nd ed.). Thousand Oaks, CA: Sage.
- Sue, D. W., Carter, R. T., Casas, J. M., Fouad, N. A., & Ivey, A. E. (1998). Multicultural counseling competencies: Individual and organizational development. Thousand Oaks, CA: Sage.
- Sue, D. W., Ivey, A. E., & Pedersen, P. B. (1996). A theory of multicultural counseling and therapy. Pacific Grove, CA: Brooks/Cole.
- Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice (3rd ed.). New York: Wiley.
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