Jeffery Scott Mio. Handbook of Racial & Ethnic Minority Psychology. Editor: Guillermo Bernai. Sage Publications. 2003.
Why is it important to teach issues of multiculturalism to graduate students in the mental health field? Models of intervention were developed to be general models, so shouldn’t these models apply to diverse populations a therapist will encounter? Isn’t a good therapist simply a good therapist, and shouldn’t this good therapist do well across diverse populations? If a therapist does not know how to treat those from diverse populations, why not just keep assigning that therapist diverse clients until that therapist gets it right?
For those of us who teach multicultural courses or present multicultural material at conferences, the above questions are familiar. They seem to reveal at least three stances of students or colleagues who express them. The first stance is a naive view of the world, one that has a “people are people” orientation. Individuals who hold this position are genuine in their beliefs but minimize the complexity of people and the importance of this complexity. The second stance is an intentionally or unintentionally racist stance. Individuals who hold this position feel that general models of therapy (developed by White theorists) are superior and that the inclusion of issues of diversity is a nuisance factor that should be ignored. The third stance is an intellectually lazy stance. Individuals who hold this position may feel that there is an importance to issues of diversity, but they are too lazy to improve their skills, so they justify their stance by adopting a “people are people” orientation. All of these stances are forms of resistance to multiculturalism (Mio & Awakuni, 2000), and they represent real obstacles to overcome before issues of multiculturalism can be fully received.
History of Inclusion of a Multicultural Component to Graduate Training
As most people who are concerned about the inclusion of multiculturalism and other forms of diversity in graduate training know, the formal inclusion of such issues was mandated by the American Psychological Association (APA) in a famous conference, known as the 1973 Vail Conference (Bernai & Padilla, 1982; Korman, 1973). The Vail Conference asserted that the treatment of culturally diverse clients without knowledge about services relevant to such populations is considered unethical. Moreover, denial of such services simply because of a lack of expertise is equally unethical. Essentially, the Vail Conference stated that culturally competent therapists should be hired, and therapists should obtain training to become culturally competent themselves.
Although this mandate was disseminated in 1973 to all directors of clinical training, there were very few road maps to implement such a mandate. Although various articles and book chapters were published in the area of multiculturalism at that time, there were no textbooks or so-called “standard” articles that would constitute the core of a course dealing with multiculturalism. Thus, those who wanted to resist the mandate could do so by pointing out the dearth of material for a course of this sort.
Resistance to the inclusion of multicultural issues in graduate curricula was rendered moot with the publication of some landmark books in the late 1970s and early 1980s. These books include Pedersen, Lonner, and Draguns’s (1976) Counseling Across Cultures; Atkinson, Morten, and Sue’s (1979) Counseling American Minorities: A Cross-Cultural Perspective; Sue’s (1991b) Counseling the Culturally Different: Theory and Practice; and an ambitious series of books called the Handbook of Cross-Cultural Psychology (Triandis & Berry, 1980; Triandis & Brislin, 1980; Triandis & Draguns, 1980; Triandis & Herrón, 1981; Triandis & Lambert, 1980; Triandis & Lonner, 1980). The principal argument (resistance) against the inclusion of multicultural issues in graduate curricula having been addressed, such courses should have been flooding graduate programs across the country, right?
As has been documented elsewhere (Mio & Awakuni, 2000; Mio & Morris, 1990; Sue et al., 1998), programs across the country still resisted the inclusion of multicultural issues in graduate curricula. Sue et al. (1982) initially published a set of multicultural competencies that could be used to measure both how competent trainees were in the multicultural area and how successful programs were in training their students to be culturally competent. Although this article was one of the most cited in the literature (Ponterotto & Sabnani, 1989), support for the article was principally verbal and not behavioral (Sue et al., 1998). Those in power to change graduate curricula seemed not to be moved to change their curricula to seriously incorporate multicultural competencies.
Part of the resistance against the multicultural competency standards was that they were too vague, general, and/or abstract (Sue et al., 1998). Despite the fact that the Accreditation Handbook (American Psychological Association, 1986) states that competence in conducting therapy with diverse populations is a criterion for accreditation by the discipline (Criterion II in the Accreditation Handbook), many programs fail to meet these standards. Rickard and Clements (1993) suggested that many directors of clinical training genuinely wanted to comply with the standard, but they felt that the guidelines were unclear. Altmaier (1993) pointed out that Criterion II was no less unclear than other guidelines set forth by the Accreditation Handbook. Thus, suggestions that the multicultural guidelines were unclear were just another form of resistance to this standard. Payton (1993) stated that more clarity would not necessarily produce better therapists. Multicultural competency was aspirational, so one must strive to become more and more competent in this area and not think that reaching a certain plateau was sufficient.
In response to criticisms of needing more clarity, more specific criteria of multicultural competence were developed (Arredondo et al, 1996; D. W. Sue, 1991a, 1995; Sue, Arredondo, & McDavis, 1992). However, a new set of criticisms was then presented: These standards were too specific (Sue et al., 1998). Quite clearly, taken together, these two fundamentally opposing criticisms revealed what was underlying them: There was simply a resistance to incorporating these standards at all into graduate training, despite the fact that the lack of competence in multiculturalism is considered to be unethical as defined by our own profession.
Different Models of Multicultural Training
In a series of articles taking a retrospective perspective on the history of psychology’s scientist-practitioner model of clinical psychology (Albee, 2000; Baker & Benjamin, 2000; Belar, 2000; Benjamin & Baker, 2000; Nathan, 2000; Peterson, 2000; Routh, 2000; Strieker, 2000), most congratulated our profession for taking such an empirically based approach to the understanding of psychological phenomena. However, Albee (2000) took exception to this stance. He criticized our profession for uncritically accepting the medical model of psychological disorders. This forever placed psychology under the control of medicine/psychiatry. Instead of the medical/organic/brain-defect model, Albee contended that psychology should have taken a social learning/stress-related model:
The social model… seeks to end or to reduce poverty with all its associated stresses, as well as discrimination, exploitation, and prejudices as other major sources of stress leading to emotional problems. By aligning itself with the conservative view of causation, clinical psychology has joined the forces that perpetuate social injustice, (p. 248)
Had the profession of psychology adopted Albee’s (2000) suggested model, perhaps we would not have experienced as much resistance as we historically have experienced in attempting to include issues of multiculturalism in clinical graduate curricula. However, we did not adopt that model, and we are now encountering resistance to such inclusion.
For years, people had been fighting for the inclusion of just a single course that dealt with multicultural issues to help trainees understand that there were different perspectives to the traditional models of psychopathology, assessment, and treatment they were learning. However, as the profession evolved, and as more and more information about this area informed us of how we conceptualized the field of clinical psychology, the single-course model seemed inadequate. Thus, we have emerged from a single-course model to a cluster model to an integrative model (Barker-Hackett, 1999; D’Andrea & Daniels, 1991; Hills & Strozier, 1992; Peterson, Peterson, Abrams, & Strieker, 1997). The single-course model suggests that a single course on multicultural issues is sufficient enough to sensitize therapists in training to such issues. The cluster model suggests that because of the amount of information in the area of multiculturalism, such material can only be covered by multiple courses dealing with the topic. The integrative model is a fundamental shift in philosophy about multiculturalism. It suggests that multiculturalism is so important that it should be integrated throughout the curriculum in the graduate training program. This philosophical stance underlies Paul Pedersen’s call for multiculturalism to be considered the “fourth force” in therapy (Essandoh, 1996; Pedersen, 1990, 1991, 1999).
In general, those who are exposed to more multicultural experience with respect to formal courses and practicum experiences are more culturally competent therapists than those not having as much experience in these areas (Holcomb-McCoy & Myers, 1999; Pope-Davis, Reynolds, Dings, & Ottavi, 1994; Rogers, Hoffman, & Wade, 1998; Rogers, Ponterotto, Conoley, & Wiese, 1992). This underscores the importance of such training; those who do not receive such training do their clients a disservice. Unfortunately, commitment to this area is uneven within our discipline. Counseling psychology programs seem to take multiculturalism much more seriously than clinical psychology programs (Pope-Davis, Reynolds, Dings, & Nielson, 1995; Quintana & Bernai, 1995). For example, Pope-Davis et al. (1995) found that “counseling psychology students complete an average of 1.6 multicultural counseling courses, and clinical psychology students complete an average of 0.9, a difference of nearly a standard deviation” (p. 325). Thus, the older, more established segment of our profession would appear to be more resistant to the inclusion of multicultural issues in its curricula.
As suggested by those who have taught multicultural courses at both the undergraduate and graduate levels, students enrolled in these courses experience uncomfortable or even resistant feelings (Gloria, Rieckmann, & Rush, 2000; Golding & Kraemer, 2000; Mio & Awakum, 2000; Mio & Morris, 1990; Organista, Chun, & Marín, 2000; Ponterotto, 1988). Although there are many ways of addressing such feelings, one of the more popular models for helping individuals overcome their feelings of discomfort are activity-based interventions (Goldstein, 2000; Mio, 1989; Singelis, 1998). For example, Mio (1989) had students engaging in cross-cultural activities and writing about their experiences. These students were judged by independent raters as being more culturally sensitive than those who did not engage in such activities.
In one of the most comprehensive models of activity-based learning, Pedersen presented what he called the counselor-client-anti-counselor triad (Pedersen, 1977, 1988; Pedersen, Holwill, & Shapiro, 1978). In this exercise, students play roles of counselor, client, and anti-counselor. “Counselor” and “client” are self-explanatory. A student plays the role of a counselor, and another student plays the role of an ethnic minority client. The “anti-counselor” is a student who stands or sits to the side of the counselor and reveals either underlying or racist/culturally insensitive interpretations of the counselor’s interventions or the self-doubts that the counselor may hold. Pedersen et al. (1978) found that those who participated in the triad model were more empathie toward the simulated ethnic minority client after the training than before.
Ridley, Mendoza, and Kanitz (1994) proposed a multicultural training model they called the multicultural counseling training program development pyramid. This model contained five elements of training: training philosophy, learning objectives, instructional strategies, program designs, and evaluation. At the base of the pyramid, training philosophy provided the foundation. Here, it was proposed that the philosophy of the training program should hold multiculturalism at its core. Upon this foundation, learning objectives of multicultural training could be built. Then, instructional strategies for how to deliver multicultural training could be devised. Program designs that gave students multicultural experiences was next. Finally, such programs should have an evaluation component built in to demonstrate the effectiveness of the training program. Those who reviewed this model were in general agreement with the objectives that Ridley et al. were attempting to accomplish (Arredondo, 1994; Atkinson, 1994; Cheatham, 1994; Fukuyama, 1994).
One of the more enduring and powerful models of teaching cultural sensitivity is the racial/ethnic/minority identity model. This model was first formalized by William E. Cross (1971), who discussed the Negro-to-Black process of identity. This model formed the basis for many similar models (e.g., Atkinson et al, 1979; Parham, 1989). This model was presented primarily as a description of the processes through which “Negroes” moved through an acceptance of the White norms and preferences to an understanding of the importance of a Black identity. Atkinson et al. (1979) discussed how this process was true for all Peoples of Color, and Parham (1989) discussed how one cycles through the stages of encountering bigotry or extremely positive affirmations of one’s own ethnicity to withdrawal into one’s own ethnic group to an emergence of valuing one’s own ethnicity while appreciating ethnic differences of other groups. Cross’s general model has been adapted for biracial identity (Poston, 1990) and gay and lesbian identity (Cass, 1979; Sophie, 1985).
Although the Cross model was extremely influential among ethnic minority communities, it was not until Janet Helms (Helms, 1984, 1986, 1990, 1995; Helms & Carter, 1991) adapted the Cross model to understand how White individuals went through similar stages that this model became a general training model for all individuals. Some reported on how this White racial identity was important in the understanding gained by their graduate students in training (Corvin & Wiggins, 1989; Ponterotto, 1988). This model not only helped individuals to understand the racial/ethnic barriers placed in front of People of Color, but it also gave these students experiential involvement in multicultural issues.
As stated before, one of the most consistent voices in trying to infuse multicultural training in graduate curricula has been Derald Wing Sue. Beginning from Sue et al. (1982), Sue attempted to establish multicultural competencies that would be adopted by all training programs. Sue et al. (1998) discussed three dimensions that are important in developing multicultural competence as a therapist: (a) awareness of one’s attitudes and beliefs about issues of diversity, (b) knowledge about one’s own worldview and the worldview of those from other perspectives, and (c) specific skills in working with those from differing groups. Within each of these three dimensions, Sue et al. (1998) also specified areas of awareness, knowledge, and skills. For example, within the first dimension of awareness, culturally skilled therapists need to be aware of how their own cultural background may influence the process of therapy, be knowledgeable of communication style differences, and have the skills to seek out training in areas they have identified as being insufficient in their therapy repertoire. This competency-based model subsumed the identity development model, especially in the areas of awareness and knowledge. However, both models stand as different ways of getting students to become aware of the importance of the multicultural arena.
In one of the first articles published about teaching a multicultural course, McDavis and Parker (1977) discussed elements of the more formal awareness-knowledge-skills model proposed by Sue and his colleagues. They reported five basic goals of their course: (a) becoming aware of one’s own and others’ attitudes toward ethnic minorities, (b) learning skills to effectively treat ethnic minorities in group experiences, (c) learning about ethnic minority perceptions toward the counseling process, (d) learning skills for rapport building, and (e) learning skills to effectively treat ethnic minorities in one-to-one therapy situations. In addressing the knowledge area, the authors reported that students needed to write a term paper that contained resources in dealing with ethnic minority populations. Other articles discussed the structures of their courses as well (Mio & Morris, 1990; Parker, Moore, & Neimeyer, 1997). Parker et al. (1997), in particular, did a nice job of combining both the racial/ethnic identity model with the competency-based model.
General Issues to Cover in a Multicultural Curriculum
In this section, I will be covering all of the topic areas that should or could be covered in a graduate curriculum in multiculturalism. Although this list will not be comprehensive, it demonstrates the breadth of topics covered in courses, clusters of courses, or entire curricula on multiculturalism. Accompanying the topic areas will be some selected references that are relevant to the topic. Again, this will not be a comprehensive list but will be exemplary of articles in the area of discussion. For those interested in some relevant terms that multicultural researchers, theorists, and practitioners encounter, I refer you to a multicultural dictionary edited by myself and my colleagues (Mio, Trimble, Arredondo, Cheatham, & Sue, 1999).
What Do We Mean by “Culture”? One question with which I begin my courses on multiculturalism is on what is meant by culture (Mio & Awakuni, 2000; Mio & Morris, 1990). This typically stimulates a lively discussion by students as they grapple with this seemingly innocent question. Kluckhohn and Strodtbeck (1961) asked this question years ago and presented areas in which different cultures vary, such as if they were past, present, or future oriented or if they perceived the essence of being human to be good, evil, or a combination of the two. Vontress (1988) discussed how there was not a single culture but five cultures (universal, ecological, national, regional, and racioethnic), so a simplistic question of what culture is does not make sense.
Assimilation/Acculturation of Immigrants. Issues of assimilation/acculturation of immigrants need to be discussed. In her very influential books, McGoldrick and her colleagues (McGoldrick, Giordano, & Pearce, 1996; McGoldrick, Pearce, & Giordano, 1982) discussed important questions to keep in mind regarding ethnic minority clients. Such questions include what the immigrant history of clients or their families were, if they were living in ethnic enclaves or not, what type of religious or cultural practices they may observe, and if their families came with large groups of immigrants or if they came separately. All of these questions have implications for the degree to which they are or want to be absorbed into the larger community. Mendoza (1989) presented an empirically validated scale to measure acculturation in Mexican American adolescents and adults. This scale measured five dimensions along which such individuals could vary in acculturation, thus making the concept of acculturation multidimensional as opposed to unidimensional. This scale measured areas such as language spoken, the ethnicity of friends and coworkers, and food preferences. One important distinction a therapist must make is between an immigrant family versus a refugee family. Immigrants are those families who voluntarily came to the United States. They typically begin their acculturation process before they come to the United States by preparing for their voyage, reading about the culture to which they will be absorbed, and learning English. On the other hand, refugees are those families who are fleeing from political oppression and even the threat of death. These individuals sometimes only have days or even hours to decide to come to the United States. Thus, their acculturation process occurs almost entirely after they have arrived here, and there may still be a resistance to acculturate because of the hopes of returning to their homeland at some time in the future. Some researchers who have written about these issues are Baptiste (1993) and Gonsalves (1992).
Intelligence Testing. As Sue has repeatedly indicated (Sue, 1991a; Sue & Sue, 1990, 1999), intelligence testing has long been a political issue that often attempted to scientifically “prove” the inferiority of ethnic minorities to the White majority population. Sue and Sue (1999) wrote,
For example, de Gobineau’s (1915) The Inequality of Human Races and Darwin’s (1859) On the Origin of Species by Natural Selection were used to support the genetic intellectual superiority of Whites and the genetic inferiority of the lower races. Galton (1869) wrote explicitly that African “Negroes” were “half-witted men who made childish, stupid and simpleton-like mistakes,” while Jews were inferior physically and mentally and only designed for a parasitical existence on other nations of people. In 1916 Terman, using the Binet scales in testing Black, Mexican American, and Spanish Indian families, concluded that they were uneducable. (p. 19)
Although other, more contemporary examples have challenged the intelligence of ethnic minority populations besides Darwin, Galton, and Terman, one of the most recent and celebrated assaults on the intelligence of ethnic minorities came in the 1994 publishing of Herrnstein and Murray’s The Bell Curve. Others have refuted Herrnstein and Murray’s claims (Gould, 1996; Ryan, 1995; Samuda, 1998; Suzuki, Meller, & Ponterotto, 1996; Willie, 1995), but such debates continue to raise the question of scientific evidence of racial superiority. Before the Herrnstein and Murray book came out, another important book by Paniagua (1994) dealt with intelligence testing and other forms of assessment of ethnic minorities.
White (Majority) Privilege. One of the more emotionally evocative topics covered in multicultural courses is the issue of White privilege. Of course, the individual most quoted in this area is Peggy Mclntosh (Mclntosh, 1988, 1995; Mclntosh & Hu-Dehart, 1998). Mclntosh’s stance is that in the United States, Whites may not realize that they are privileged in this society and that many things that they accomplish or that affirm their positive images are due to this unearned privilege. This lack of awareness prevents them from fully understanding the pervasiveness of racism and how this racism prevents many individuals from succeeding—or even trying. For example, Mclntosh (1995) suggested that one of her privileges as a White woman is, “I can turn on the television or open to the front page of the paper and see people of my race widely and positively represented” (p. 79). In my own courses on multicultural issues, I discuss this privilege and challenge students to think of the last time they have seen any Asian male in a romantic situation. (Asian females are being portrayed more and more as objects of desire, but this is only for White males.) Asian males tend to either not be seen at all or are on martial arts-based programs and films. Pack-Brown (1999) underscored the importance in getting White therapists and counselors to understand their privileged status in their professional development.
Racism. One of the most important topics to cover in courses on multiculturalism is that of racism. Because this is such a well-known topic, I will not go into a long discussion here. However, as Jones (1997) and Ridley (1995) have pointed out, it is important for individuals to understand how some modern forms of racism are presented in a disguised form. As I have pointed out elsewhere (Mio & Awakuni, 2000), these more subtle forms of racism are ways of resisting the inclusion of multiculturalism into curricula. Some of the more cited references in racism are Dovidio and Gaertner (1986), Guthne (1976, 1998), Jones (1972, 1997), Ridley (1995), and Tatum (1997). Related topics are stereotyping (Casas, Ponterotto, & Sweeney, 1987; McGoldrick & Rohrbaugh, 1997; Mok, 1998), prejudice (Ponterotto & Pedersen, 1993), and affirmative action (Pratkanis & Turner, 1994).
Attribution Theory. Attribution theory has long been influential in social psychology. At least dating back to Heider (1958), social psychologists have discussed how we attribute causes of behavior to internal (dispositional) or external (situational) variables. Others who have contributed to the early formulation of attribution theory are Jones and Davis (1965), Kelley (1967, 1972, 1973), and McArthur (1972). The reason why attribution theory is important to understand is because of two important offshoots of the theory. Jones and Davis reported that there is a difference between attributions made by “actors” and “observers.” Actors are those who engage in behaviors, whereas observers are those who observe the actors’ behaviors. Actors tend to attribute behaviors to external or situational factors, whereas observers tend to attribute behaviors to internal or dispositional factors. For example, an actor who trips might attribute the trip to a crack in the sidewalk, whereas an observer may attribute the trip to the actor being clumsy. Lee Ross (1977) labeled the observer’s tendency to overemphasize dispositional factors and underemphasize situational factors as “the fundamental attribution error.” Ross believed this to be an error of attribution because of the lack of appreciation of environmental factors that may actually be the cause of the behavior. He believed this error to be common and pervasive. Thomas Pettigrew (1979) extended the fundamental attribution error to an attribution to an entire group. He labeled this “the ultimate attribution error.” For example, if one were to observe an actor stealing a loaf of bread, the observer may attribute this theft to the actor being a bad person. If the actor also happens to be a member of an ethnic minority group, the observer may attribute the theft to ethnic minorities being bad. Pettigrew asserted that this perpetuates prejudice and racism because if the actor is a member of the White majority group, observers tend not to make this attribution to the White majority but only to the disposition of the actor.
According to Claude Steele (Steele & Aronson, 1995), the ultimate attribution error interacts with stereotypes to cause members of groups on the downside of power to perform worse on tasks, thus perpetuating the stereotypes. Steele termed this stereotype threat. Steele found that when highly intelligent African Americans were placed in an extremely intellectually challenging situation, they actually performed as well if not better than their White counterparts. However, if one were to make race salient by suggesting that the test would help determine if there is a difference between African Americans and Whites, these highly intelligent African Americans performed worse than their White counterparts. Steele replicated these findings with women highly accomplished in mathematics. When these women were taking an extremely challenging mathematics examination, they performed just as well as their male counterparts unless they were led to believe that the test would be diagnostic about gender differences in mathematical ability. Steele has suggested that when making the negative stereotypes salient, the stereotypes created an added pressure on the targets of the stereotypes, and the resultant anxiety fed on itself and distracted the targets from concentrating on the task at hand.
Worldviews. An important issue in multicultural courses is that of worldview. Students need to understand how their view of the world may differ from those of others. Some of these differences may be subtle, but some may be profound. Differing perspectives of the world have been discussed by Ho (1995), Kluckhohn and Strodtbeck (1961), Merchant and Dupuy (1996), Pedersen (1977, 1988, 1997, 1999), Pedersen et al. (1978), Robin and Spires (1983), Sue and Sue (1999), Tamura and Lau (1992), Ting-Toomey (1994), and Triandis (1995). For example, Sue and Sue discussed a model of worldview that Sue presented long ago (D. W. Sue, 1978) that crossed locus of control with locus of responsibility. This resulted in a 2×2 matrix with four worldviews: internal locus of control-internal locus of responsibility (IC-IR), external locus of control-internal locus of responsibility (EC-IR), external locus of control-external locus of responsibility (EC-ER), and internal locus of control-external locus of responsibility (IC-ER). The typical Western worldview is the IC-IR perspective, in which people feel that they hold both the control and responsibility for their position in life. This contrasts with those cultures that place more control of lives to fate (external locus of control). Issues such as individualism and collectivism (Triandis, 1995) also form the basis of differing worldviews.
Emic Versus Etic Distinction. One of the distinctions made by multicultural researchers is that of emic, or culture-specific, versus etic, or generalizable, phenomena. Among the most prominent researchers in this area is Harry Triandis and his colleagues (Triandis, 1989; Triandis et al, 1986; Triandis, Bontempo, Villareal, Asai, & Lucca, 1988; Triandis et al, 1993). Elsewhere, I (Mio & Awakuni, 2000) have summarized a particularly illustrative research finding by Triandis et al. (1988) on the emic versus etic distinction:
For example, Triandis, Bontempo, Villareal, Asai, and Lucca (1988) discussed how the term “self-reliance” was interpreted differently in individualistic versus collectivistic societies. In individualistic societies, “self-reliance” meant the freedom to pursue one’s own goals and to be in competition with others. In collectivistic societies, it meant not burdening the in-group, whereas competition was unrelated. Even the word “competition” had different connotations in these two societies. In individualistic societies, “competition” meant individuals would compete with one another, whereas in collectivistic societies, it meant that different in-groups would compete, (p. 12)
Other more recent researchers who discuss the importance of the emicetic distinction are Fischer, Jome, and Atkinson (1998) and S. Sue (1999).
Individualism Versus Collectivism. Triandis and his colleagues have been one of the leading voices in examining the emicetic distinction; they have also examined the individualism-collectivism distinction (Hui & Triandis, 1996; Triandis, 1989,1995; Triandis et al, 1986; Triandis et al, 1988; Triandis et al., 1993). Individualism tends to be a Western (i.e., North American, Western European, Australian, and New Zealand) perspective, in which individual rights, needs, and freedoms tend to be placed above the needs of the society when there is a conflict between these two needs. Collectivism is associated with most of the rest of the world, in which the individual subjugates his or her rights, needs, and freedoms in deference to societal needs. This dimension can be examined apart from the etic-emic distinction studied by Triandis and his colleagues (Dien, 1999; Hofstede, 1980, 1982, 1983; Hofstede & Bond, 1984; Tamura & Lau, 1992; Ting-Toomey, 1994). For example, one of the important additions to the individualism-collectivism literature was Hofstede’s (1980) discussion of power distance in connection with the individualism-collectivism dimension. Triandis (1995) called this dimension a horizontal-vertical dimension. This resulted in a 2×2 matrix yielding four relevant quadrants: horizontal individualism, horizontal collectivism, vertical individualism, and vertical collectivism. The horizontal segment of the dimension suggests an equal status among society members, whereas the vertical segment suggests a hierarchical structure. For example, societies that emphasize horizontal individualism tend to value uniqueness among its citizens, whereas horizontal collectivistic societies value cooperativeness among its citizens. Societies that can be characterized by vertical individualism value achievement orientation, whereas vertical collectivistic societies value dutifulness.
Research/Methodological Issues. As discussed earlier, emic and etic distinctions are important research issues when investigating cultural differences. This topic is perhaps the most important one in the area of multiculturalism, for it not only relates to data collection within ethnic minority communities but also has implications for simple terms one uses in conducting therapy or even communicating with communities different from one’s own. Other areas of research/methodological importance are the following: how to conduct culturally sensitive research (Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, 2000; Merchant & Dupuy, 1996; S. Sue, 1999), therapist-client match (Atkinson, 1985; Atkinson & Schein, 1986), the measurement of multicultural competence (Coleman, 1996; Sodowsky, Taffe, Gutkin, & Wise, 1992), assessment of ethnic minority clients (Malgady, 1996; Paniagua, 1994), racial identity and the counseling process (Helms, 1990; Pope-Davis, Menefee, & Ottavi, 1993), and White researchers studying ethnic minority populations (Atkinson, 1993; Casas & San Miguel, 1993; Helms, 1993; Ivey, 1993; Mio & Iwamasa, 1993; Parham, 1993; Pedersen, 1993; Ponterotto, 1993; D. W. Sue, 1993).
Acculturative Stress and Psychopathology. Society can be the source of support or stress. To the extent that racism exists in society, society as a source of stress is a given. Some have found such a connection between acculturation into the broader society and stress, health risks, and psychopathology (Anderson, 1991; Clark, Anderson, Clark, & Williams, 1999; Smart & Smart, 1995). For example, in their review of the literature on racism and stress, Clark et al. (1999) concluded, “Despite the different sampling schemes and data quantification methodologies and the paucity of studies, the results of the research reviewed in this section were generally consistent. The perception of racism usually resulted in psychological and physiological stress responses” (p. 812). Such responses included “low birth weight and infant mortality … depression … the healing process… breast cancer survival… hearth disease … mean arterial blood pressure changes … and chronic obstructive pulmonary disease” (p. 812).
Racial Identity Development. One of the most vigorous areas of research has been in the area of racial identity development. As mentioned previously, the theory of racial identity has been so powerful that it represents one of the major theoretical models for teaching multicultural courses. As discussed earlier, Cross’s (1971) Negro-to-Black model of identity development was one of the very first formal models published in this area. Helms’s (1984) White racial identity model was the next major advancement in this area because it was one of the first models that applied ethnic minority identity development to White identity development. Throughout much of the history of models such as these, it was suggested that all individuals went through stages of awareness—the first stage involved complete unawareness of the racial oppression of the broader society; intervening stages included awareness, withdrawal, and activism; and finally, individuals developed a deep understanding of racial/ethnic differences and an integration of their identity with their own race/ethnicity and others’ race/ ethnicity. The concept of “stages” has been attacked, and more recently, Helms (1995) suggested that the term statuses should replace stages. Other resources on racial identity development issues are Burkard, Ponterotto, Reynolds, and Alfonso (1999); Corvin and Wiggins (1989); Cross (1995); Gushue (1993); Helms (1990); Neville et al. (1996); Pack-Brown (1999); Parham (1989); Parker et al. (1997); Ponterotto (1988); and Pope-Davis et al. (1993). Those studying biracial/multiracial identity development have been Kerwin and Ponterotto (1995), Poston (1990), Root (1992, 1996, 1998), and Stephan and Stephan (1989).
General Therapy Issues. As many have pointed out, multicultural issues in therapy are general therapy issues (Arredondo, 1998; Essandoh, 1996; Fischer et al, 1998; Pedersen, 1999; Rooney, Flores, & Mercier, 1998; Sue et al, 1998). As Sue and Zane (1987) discussed, simple knowledge about a culture is a distal element to conducting therapy; what is most important (proximal) in the therapy situation is the credibility of the therapist. Cultural competence adds to the credibility of the therapist, and it is here that multicultural training adds to the therapeutic environment. Thus, knowledge about cultural issues needs to be integrated within one’s presentation of self as a therapist so that the client can feel comfortable enough to allow therapy to proceed. As S. Sue (1977) long ago pointed out, ethnic minority clients tend to drop out of therapy after only one session at a much higher rate than their White majority counterparts. This dropout rate can at least in part be explained by the clients’ perceived cultural insensitivity of the therapist.
In my estimation, one of the most important general issue articles on cultural transference and countertransference in multiculturalism was written by Comas-Diaz and Jacobsen (1991). This article discusses two types of therapeutic dyads: a White therapist with an ethnic minority client and an ethnic minority therapist with an ethnic minority client. The authors discuss the types of transference feelings that an ethnic minority client may have toward either a White therapist or an ethnic minority therapist. Such reactions may include having resentment, being overly cooperative, and feeling that the ethnic minority therapist is a “sell-out.” The authors also discuss the types of countertransference feelings that a White or ethnic minority therapist may have toward an ethnic minority client. Such reactions may include being a cultural anthropologist (e.g., analyzing the client as an interesting “specimen” from a culture not yet encountered), feeling guilt, and discounting the importance of racial/ethnic issues.
Books designed for courses on multiculturalism should include general issues such as racism, worldviews, values, immigration, individualism-collectivism, and ethnic-specific chapters dealing with at least the following four racial/ethnic groups: African Americans/ Blacks, Hispanics/Latinos/Latinas, Native American Indians, and Asians. Such recent books that meet these criteria include Using Race and Culture in Counseling and Psychotherapy: Theory and Process (Helms & Cook, 1999), Counseling and Psychotherapy: A Multicultural Perspective (Ivey, Ivey, & Simek-Morgan, 1993), Ethnicity & Family Therapy (McGoldrick et al., 1996), Counseling Across Cultures (Pedersen, Draguns, Lonner, & Trimble, 1996), Handbook of Multicultural Counseling (Ponterotto, Casas, Suzuki, & Alexander, 1995), and Counseling the Culturally Different: Theory and Practice (Sue & Sue, 1999). Other supplementary books include Resistance to Multiculturalism: Issues and Interventions (Mio & Awakuni, 2000); Multiculturalism as a Fourth Force (Pedersen, 1999); Multicultural Counseling Competencies: Assessment, Education and Training, and Supervision (Pope-Davis & Coleman, 1997); and Working With Culture: Psychotherapeutic Interventions With Ethnic Minority Children and Adolescents (Vargas & Koss-Chioino, 1992).
Group-Specific Therapy Issues
Every course on multicultural/diversity issues deals with ethnic-specific groups. Groups almost always discussed are African Americans/Blacks, Hispanics/Latinos/Latinas, Native American Indians, and Asians. Some books discuss even more groups, including subdivisions within the four above categories, Middle Eastern cultures, Jewish cultures, European cultures, and Slavic cultures (McGoldrick et al., 1996). However, courses on multiculturalism/diversity are now beginning to include populations other than race/ ethnic-based ones, including issues dealing with gender, gay/lesbian/bisexual concerns, disabilities, and the elderly. Although other chapters in this volume will deal with all of these subpopulations, I will briefly mention the specific populations and resources that may be of interest to the reader.
African Americans/Blacks. Just as there was a movement in the late 1960s and early 1970s of moving from Negro to Black, so too was there a movement in the late 1980s and early 1990s of moving from Blacks to African Americans. However, the term African American leaves out those individuals in the United States who are actually from Africa, Jamaica, or Haiti, and other Blacks not born in America. All such individuals are targets of discrimination based on skin color; articles based on such forms of racism are relevant to all of these individuals, and such issues are brought into the therapy situation. Such resources dealing with racism include Anderson (1991), Clark et al. (1999), Harris (1995), and Pinderhughes (1982). Other resources having a broader scope include Greene (1996); Hines and Boyd-Franklin (1996); McNair (1992); Taylor, Chatters, Tucker, and Lewis (1990); Whaley (2000); White (1984); White and Parham (1990); and White, Parham, and Ajamu (1999).
Hispanics/Latinos/Latinas. One of the major issues when dealing with Hispanics/ Latinos/Latinas is the issue of immigration and acculturation status (Buriel, 1993; Smart & Smart, 1995). Other resources examining general issues when dealing with Hispanics/ Latinos/Latinas are Bernai and Enchautegui (1994), Bernai and Shapiro (1996), Falicov (1996), Garcia-Preto (1996), and Vega (1990). Such issues include the role of religion, language, machismo, and fatalism. Finally, a major issue with which Hispanics/Latinos/ Latinas must deal is the particular form of institutionalized racism related to the Immigration and Naturalization Service (INS) (Falicov, 1996). As has been pointed out by many, how many of us carry around proof of our citizenship or permanent residence status? However, Hispanics/Latinos/Latinas are routinely stopped by the INS and asked to produce exactly such documentation.
Native American Indians. As Trimble, Fleming, Beauvais, and Jumper-Thurman (1996) have pointed out,
Most scholars know the term American Indian is an imposed ethnic category with little relevant meaning. At best, it is a generalized gloss that was first foisted upon the Arawak, a now-extinct tribe once indigenous to islands off the southeastern coast of the United States, by a wayward Italian sailor who thought he had reached India, (pp. 178-179)
Thus, naming and self-identity are two of the major issues within Native American Indian populations. Other resources that deal with general issues involving Native American Indians are Attneave (1982); Choney, Berryhill-Paapke, and Robbins (1995); Garrett and Garrett (1994); Heinrich, Corbine, and Thomas (1990); McWhirter and Ryan (1991); and Tafoya and Del Vecchio (1996). I might add that when students first learn about the program of stealing Native American Indian children from their families and sending them to boarding schools, feelings of sadness, guilt, and anger are stirred.
Asians. Asians are an extremely diverse group of people, with each group having its own language. However, the issue of collectivism seems to cut across all Asian groups. Collectivism is evidenced in different ways across Asian communities, especially in the form of power distance, as discussed before (Dien, 1999; Hofstede, 1980). Issues such as duty, saving face, giving face, and cooperation are related to collectivism. Some of the resources that discuss Asian issues include Berg and Jaya (1993); Lee and Zane (1998); Leong, Wagner, and Kim (1995); Leung and Boehnlein (1996); Mok (1998, 1999); Okazaki (1997); Shon and Ja (1982); Tamura and Lau (1992); and Ting-Toomey (1994).
Gender Issues. Despite the fact that women are in the numerical majority in this country, the major theories of intervention were developed from a male perspective. Issues of the patriarchal structure of society have been raised by feminist theorists, and such issues have resulted in treatments that have been unfair to women. Resources that discuss such issues include Brown (1994), Comas-Diaz and Greene (1994), Enns (1993), Hays (1996), Landnne (1995), and Worell and Johnson (1997).
Gay/Lesbian/Bisexual Issues. As stated earlier, issues of identity development have been applied to gay and lesbian identity (Cass, 1979; Sophie, 1985). Although issues of identity development may occur either within or without the context of therapy, a major issue that therapists in training need to confront is their own countertransference feelings about homosexuality (Gelso, Fassinger, Gomez, & Latts, 1995; Hayes & Erkis, 2000). Other resources that discuss more general issues include Greene (1997) and Pope (1994).
Individuals With Disabilities. Perhaps the major issue related to issues of individuals with disabilities is simply the awareness of nondisabled individuals that the issue of disability is an important issue of concern. Nondisabled individuals need to be aware of issues such as physical access to facilities, assumptions of impairment beyond the disability, and the disability not necessarily being the main issue for the need for services. Some helpful resources in this area include Asch and Russo (1985); Barnartt (1996); Esten and Willmott (1993); Henwood and Pope-Davis (1994); Kemp and Mallinckrodt (1996); Leigh, Corbett, Gutman, and Morere (1996); Mackelprang and Salsgiver (1999); Raifman and Vernon (1996); Swain, Finkelstein, French, and Oliver (1993); and Yuker (1988).
Elderly Populations. A growing recognition is that America is getting older. Therapists need to know how to treat older adults (Abeles et al., 1998). Older adults have issues that are specific to them as opposed to a general model of treatment. Such issues include the wide gender disparity due to women living longer than men, generational or cohort differences, language differences among older immigrants, issues of mortality, and dementia. Some important resources in this area include Division 20 (1994); Duffy (1999); Gatz et al. (1998); Hartman-Stein (1998); Knight, Teri, Santos, and Wohlford (1995); Niederehe and Schneider (1998); Storandt and VandenBos (1994); and Zant and Knight (1996).
Addressing Resistance to Multicultural Material
As I have pointed out elsewhere (Mio & Awakuni, 2000), resistance to multiculturalism comes in many forms, both at the broader level and at the individual level. Those who have written about teaching multicultural courses (McDavis & Parker, 1977; Mio & Morris, 1990; Organista et al, 2000) have pointed out how emotionally evocative discussions of this topic are, which lead to resistance against the perceived source of such troubling thoughts. Such emotions need to be addressed. Because I have already pointed out the resistance of the broader profession, I will restrict my comments in this section to addressing resistance to two specific populations in training: White majority students and ethnic minority students.
Resistance Among White/Majority Individuals
As has been pointed out a while ago, resistance to White students’ resistance to multicultural issues can be conceptualized within the context of White identity development models (Corvin & Wiggins, 1989; Helms, 1990; Ponterotto, 1988). Kiselica (1998) noted that this resistance is in part due to the difficult and painful nature of the journey from racism to multiculturalism:
White racial identity growth also is painful because it is a provocative, personal voyage marked by the disturbing discovery that one is racist, a self-revelation that poses an intense and soul-searching conflict for the Anglo: Do I deny my racism, retreat from multicultural training, and avoid contact with the culturally different? Or do I confront this reprehensible facet of my identity, attempt to change it, and pursue multiculturalism? (p. 9)
To address these painful experiences, Kiselica (1998) suggested that the enriching aspects of this journey also be discussed:
Although confronting ethnocentrism and racism is a critical component to multicultural training, an overemphasis of these tasks can obscure what may be the most enriching aspect of cross-cultural counseling and psychotherapy: experiencing the beauty of different cultures and sensing one’s personal development toward a multicultural identity. The multicultural training literature has done little to adequately emphasize the potential for mental health professionals to discover these joys, which are inherent in multicultural counseling. Much more attention needs to be devoted in the multicultural literature and throughout the multicultural training process to this subject, for it can be a major motivator for professionals to pursue cross-cultural encounters, (p. 17)
Lark and Paul (1998), in responding to Kiselica’s (1998) article, agreed with its conclusions. They also extended it to discuss the importance of their mentor, who was a White individual strongly supportive of multicultural issues. They identified with him, saw him as a possible future self, and appreciated his multicultural perspective. Tatum (1997) would agree with this position. She discussed how White allies who come into her courses on multiculturalism to discuss their allied activities have a profound effect on White students. These students were burdened with the weight of racism and felt powerless by its enormity. However, when a White ally comes into her courses, these students suddenly see how their individual actions may make a difference, and they feel empowered by the experience.
Roades and Mio (2000) noted that although many discuss the importance of allies both in the multicultural literature and in workshops they have attended, little actual empirical evidence is collected on this important group of individuals. In their preliminary examination of their data, it appeared that allies seem to have a particularly strong sense of social justice. This not only motivated them into becoming allies, but it also helped to sustain their current efforts. Another important motivating force seems to be their connection with groups on the downside of power and their own victimization in some settings. For example, a White woman may advocate for ethnic minorities both due to her connection and friendship with ethnic minority individuals and also because of her own sense of victimization in a patriarchal society.
Still, despite efforts to make the journey of multiculturalism less painful for individuals, some White students and even professionals are resistant to this domain. Although students in training and professionals alike have criticized their graduate programs for the paucity of multicultural courses and training opportunities, there is evidence that many failed to take such courses when the opportunity presented itself (Mintz, Bartels, & Rideout, 1995), or they failed to take additional training in multiculturalism despite working with large populations of ethnic minority clients (Ramirez, Wassef, Paniagua, & Linskey, 1996). This resistance has found evidence in professional writings (Weinrach & Thomas, 1997), claiming that multicultural sensitivity amounts to little more than “political correctness” in our profession.
To address such resistance (at least in the classroom), I have advocated for a number of different techniques, exercises, and experiences (Mio, 1989; Mio & Awakuni, 2000; Mio & Morris, 1990). First, I have revealed my own resistance to multiculturalism, which was not overcome until well into my teaching years. In so doing, I hope to model for my students my vulnerability and invite them to do the same. I have also advocated for experiential involvement with ethnic minority communities as an adjunct to learning about such communities. I also use a number of videotaped television programs, educational materials, and commercially released films that deal with multicultural issues (to be discussed in the last section of this chapter). Moreover, I feel that it is important for instructors to allow for a confidential, safe environment for particularly resistant but shy students to be able to express their opinions. Therefore, I have used a “reaction paper” exercise, which requires students to turn in a weekly 1- to 2-page paper to react to any topic between papers, such as the readings, the course lectures, or the weekly news. I give every student feedback on their papers, responding to their particular concerns. Some may feel that students will still hold back from “politically incorrect” statements, but this is not the case. I have published such exchanges elsewhere (Mio & Awakuni, 2000).
Resistance Among Ethnic Minority Individuals
Although most efforts on resistance deal with the resistance to multiculturalism by White students, resistance among ethnic minorities is also an issue in multicultural courses. Such resistance is evidenced among ethnic minority students who are (a) still in denial of the importance of their ethnic minority status in this country (Atkinson et al., 1979; Cross, 1971, 1995; Parham, 1989), (b) simply tired of being the ethnic minority “educator” (Jackson, 1996; Mio & Awakuni, 2000), and (c) trying to get out of additional work (Mio & Awakuni, 2000).
The first form of ethnic minority resistance is an important one that cannot be ignored. Some ethnic minority students feel that they have never been the targets of racism, so racism must not exist. Others who have experienced racism and felt that they have overcome it have a sense that “if I overcame racism, then anyone can overcome racism.” Still others may even feel that this is a White majority country, so ethnic minorities are not deserving of equal status. Many have felt that resistance from ethnic minority students is particularly difficult to address (personal communication from the Asian American Psychological Association listserv, 1998, 1999). If we were to consider this form of resistance to be an early stage or status in the ethnic minority identity development model, we can at least be mollified in the assumption that time will address this resistance. Even though this may not feel very good to us in the short run, it should theoretically turn out positively in the long run. As an illustration, I taught an undergraduate course in multiculturalism recently. There was one ethnic minority student who completely denied that racism existed in this country, and if it did, those who blamed a hindrance in their progress were “weak” and not deserving of anything better. Although other students in the class were visibly upset by this student, they were not able to break through his resistance. In his weekly reaction papers, he continued discounting the importance of racism. However, the next term, this student e-mailed me, apologizing for his behavior. He said that he had changed jobs, and he ran into racism that hindered his progress. He said that everything we had discussed in the class was true, and he was sorry that he had so vehemently denied the truths he now discovered.
The second form of resistance from ethnic minority students—that of being the class “educator”—is being voiced more and more. Often, students have felt that whenever issues of race/ethnicity were discussed in classes, other students would turn to them and ask them what their opinion was. The tenor of these discussions is, “What do people of your ethnicity think about this?” As Mclntosh (1995) indicated, White individuals have the privilege of never being asked, “What do White people feel about this issue?” If one is White, one gets to express one’s opinion as one’s own, not as a representation of an entire people. Because ethnic minorities often feel that they are being asked to speak for their entire group, they sometimes shut down from this burden. Another reaction is anger that they have to educate otherwise bright individuals about issues of multiculturalism. They feel that they do not want to contribute to the intellectual laziness of their student colleagues because if they were truly interested in the answer to their questions, they would go out and research these answers on their own.
The third form of resistance from ethnic minority students—that of getting out of work—is disappointing for me to admit. However, the truth is that sometimes this happens. As discussed in the first section of this chapter, for years there was a fight for the inclusion of multicultural courses in graduate curricula. This fight was in part a response to some ethnic minority student complaints that courses in these curricula were not relevant to their existence or their communities. Now that multiculturalism is required in graduate training programs, some ethnic minority students feel that because of their personal experiences, they need not take such courses. As I stated elsewhere (Mio & Awakuni, 2000), I had a reputation of being a demanding instructor, and two ethnic minority students asked both the director of graduate training and me if they could be given credit for having fulfilled the multicultural requirement because they had a multicultural course at the undergraduate level from a well-respected leader in the field. Although we allowed them to receive such credit, two other ethnic minority students who had taken the same course also took my course, and they felt that they gained immeasurable knowledge from it.
In addressing these latter two forms of resistance, I would recommend that instructors particularly watch themselves when they call on ethnic minority students for their opinions. Questions should always be framed as “What do you feel?” as opposed to “What do your people feel?” Instructors should also be advocates for ethnic minority students when other students ask well-intentioned but naive questions that hint of the ethnic minority student speaking for everyone in their ethnic minority group. With respect to the resistance of trying to get out of work, I would suggest that instructors recognize that identity development is a process that takes time and maturity. Students who may have felt that they understood issues at the undergraduate level are much more mature at the graduate level, and another look at the same issues may be understood in a totally different light. Also, I know that for myself, I assign much more work at the graduate level, and I have much higher expectations for my graduate students than for my undergraduate students.
The Use of Films to Underscore Course Material
As I have stated elsewhere (Mio & Awakuni, 2000; Mio & Morris, 1990), many videotapes are available to help supplement courses in multiculturalism. Others have advocated the use of videotapes as well (Pinterits & Atkinson, 1998; Williams, 1999). Some films I have found to be of particular value include Eyes on the Prize (Hampton, 1986), The Color of Pear (Lee, 1994), Black in White America (Nunn, 1989), and A Class Divided (Peters, 1985). Other commercially released films that have also contributed to my students’ understanding of multicultural issues include Stand and Deliver, My Family/Mi Familia, and Who Killed Vincent Chin? Finally, a series of videotapes by APA Division 45 and Microtraining Associates, Inc. (2000) has been developed to demonstrate culturally competent therapy. In this series of videotapes, ethnic minority therapists discuss theoretical issues involved in culturally competent therapy and act out therapy scenarios to demonstrate these issues.
The importance of these videotaped resources as an adjunct to multicultural courses is that they provide an emotionally evocative and dramatic component to these courses. Although the troubling experience of grappling with racism is also emotionally evocative, these videotaped resources present issues in a manner that is difficult to deny or resist. They pull for discussion as opposed to pushing for withdrawal. I have typically found vigorous discussion after showing these videotapes, and the reaction paper assignments I have students do on a weekly basis are generally in response to these videotapes and ensuing class discussions.
Conclusion
Teaching courses on multiculturalism presents challenges, difficulties, and opportunities. The profession of psychology itself has put up roadblocks along the way to the inclusion of multicultural issues throughout the years. However, even though many of these barriers have been removed, those who teach multicultural issues still encounter resistance to this material both from their colleagues and from students. These resistances are embedded within a cultural context of resistance to such issues. To the extent that these issues are addressed within the larger society, the teaching of multiculturalism will encounter less and less resistance.
This chapter was written with the assumption that many of those reading it may have never taught a course in multiculturalism before. Therefore, I have included models of teaching multiculturalism along with key issues covered in a course or curriculum in multiculturalism. Thus, I have tried to be as inclusive as possible in citing the relevant literature in the field. Such topics typically covered in courses on multiculturalism include assimilation/acculturation, intelligence testing, White privilege, racism, emicetic distinctions, individualism-collectivism distinctions, research and methodological issues, racial identity, and norms, values, and other issues related to specific groups of diversity. These groups of diversity are broadening, including more than just ethnic minority populations, such as women, gays and lesbians, individuals with disabilities, and older adults. As the scope of diversity becomes larger and larger, one can truly see how this area is becoming a “fourth force” in psychology.