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Cross-cultural Issues
Chapter Nine
from A Counselor's Guide to Learning to Live Without Violence
published by Volcano Press.
http://www.volcanopress.com/
Source: Daniel Jay Sonkin, Ph.D. Readings, software,
and books for the general public as well as professionals on domestic violence
and childhood abuse. The author provides assessment tools to help individuals
and families recognize violence within thier households. This site is updated
frequently.
http://www.daniel-sonkin.com/
Until recently, most of the written material examining the
cross-cultural/ethnic issues relating to domestic violence has been found in
training manuals and curricula developed by battered women's programs. Mental
health professionals have not conducted systematic research or developed
clinical interventions speciÞc to populations of color. As a result, many of
the programs and interventions developed for male batterers in this country have
been conceived from the Eurocentric point of view, not thoroughly taking into
account the unique perspective of the man of color. Learning to Live without
Violence may be criticized in this way as well, even though it was written
with the idea of appealing to the broadest cross-section of male batterers. Yet,
as was discussed earlier, the population of male batterers is not a homogeneous
one - in fact, there is considerable research indicating that there may be many
different types of batterers. Although some may argue that male violence against
women supersedes culture, researchers are now Þnding that ethnicity and culture
are critically important when considering community response systems and
treatment interventions for victims and offenders. Therefore, a consideration of
the cross-cultural counseling theories is necessary in order for counselors to
begin to integrate ethnicity/culture into violence treatment theory and
approaches.
Compared to general domestic violence literature, research and clinical
materials on domestic violence in families of color is minuscule. A literature
search on this topic with psychological abstracts found over Þfteen hundred
citations on the topic of domestic violence, whereas there were only Þfteen
citations on the topic of domestic violence and ethnicity. Most of these
articles were published in the last four years; many of them focus on the rates
of occurrence, etiology (causes), and suggestions for community and individual
interventions.
Studies with Latin (Torres, 1991; Diaz, 1989; Parilla, Bakeman, and Norris,
1994; Rodriguez, 1986; Rouse, 1988), Asian (Ho, 1990; Frye and D'Avanzo, 1994;
Song, 1986), Native American (Black Bear, 1988; DeBruyn, Hymbaugh, and Valdez,
1988; Gotowiec and Beiser, 1993-94; Larose, 1989) and African-American
(Brice-Baker, 1994; Campbell, Campbell, King, Parker, and Ryan, 1994; Finn,
1986; Hampton, 1987; Lockhart and White, 1989; Lockhart, 1987; Marsh, 1993;
Uzzell and Peebles-Wilkins, 1989) families indicate that although rates of
occurrence may not differ between people of color and majority culture
individuals, women and men of color face unique challenges that must be taken
into consideration when formulating treatment, criminal justice, and social
service responses.
One difference in particular is the history and continual experience of
oppression and racism that people of color encounter on a daily basis. These
experiences, together with the belief that the various protective systems set up
to provide services (e.g., police, social services, or the courts) will not act
in a protective fashion, may serve to ultimately prevent a battered woman from
seeking help from others. In addition, discrimination in employment and economic
inequality create tremendous barriers for battered women of color to escape
their violent partners. Evidence exists that people of color may experience
extreme stress in the daily task of navigating between their own and the
majority culture (Anderson, 1991; Gaines and Reed, 1995). The results of this
stress, added to the reality of experiencing racism, dealing with difÞculties
inherent in day-to-day living, and being a victim of violence, can tax an
individual's coping resources to their maximum abilities (Koss, Goodman,
Fitzgerald, Russo, Keita, and Browne, 1994).
There are several problems that arise when addressing the issue of ethnic
minorities and domestic violence. First, there exists the danger of
overgeneralizing specific ethnic groups by saying all "African-American men
do this," or all "Asian-American men do that." Doing so
perpetuates stereotypes that contribute to prejudice and racism. Second, when we
discuss the history of racial injustice experienced by many people of color in
this country, it may begin to sound as though oppression is the reason for
domestic violence. Although the effects of racism may play an important role in
a man's life, it does not mean that racism is the only cause of domestic
violence. Saying so only promotes the myth that men of color are dangerous,
because all men of color have experienced racism to one degree or another. It is
well known that the vast majority of persons belonging to ethnic minorities in
the United States are law-abiding citizens. All people of color have to contend
with the effects of racism on a daily basis, and yet the majority of these
individuals do not beat their wives or commit other crimes. However, one cannot
underplay the effects that racism may have on a particular individual.
Differences exist between individuals as to how they experience and are affected
by various social stressors. As a white male, I may be criticized for attempting
to address this issue because, as a member of a majority culture, I benefit from
white privilege and therefore know little of what it is like to be a victim of
racism. Because I am white, I enjoy the privilege of being a member of a
majority culture in many ways. However, because I am also Jewish, I have
experienced antisemitism and therefore can also understand, to some degree, the
experience of racism from the other side of the fence.
How can we Þnd ways of addressing the unique needs of ethnic minorities
seeking services for domestic violence? Perhaps it would be useful to look into
the general literature relating to psychotherapy services for minorities.
Treatment Services for Ethnic Minorities
There have been two decades of research into the adequacy of psychotherapy
services for ethnic minorities, and yet many service providers are as perplexed
as ever as to how to increase the effectiveness of these services. In the early
1980s, the Special Populations Task Force of the President's Commission on
Mental Health indicated that ethnic minorities are underserved or
inappropriately served by the mental health system. This fact has only somewhat
changed in the past ten years. One study in the Seattle area found that some
populations were overrepresented, whereas others were underrepresented. However,
regardless of the utilization rates, all ethnic minority clients have a higher
dropout rate than whites. Ethnic minorities had a fifty percent dropout rate, as
opposed to a thirty percent dropout rate for whites.
How can this problem be explained? Many ethnic minorities either avoid
services or drop out because of the lack of bilingual services. In addition,
most mental health intervention theories are based on the white majority culture
and, therefore, ethnic- or culture-speciÞc behaviors are either framed as
pathological or not understood as potentially helpful in solving interpersonal
problems. Likewise, in addition to this ignorance, many therapists hold racist
attitudes to which clients are acutely sensitive. Most importantly, therapists
today - most of whom are still of the majority culture - have difÞculty
providing culturally responsive forms of interventions. Most majority-culture
therapists are not familiar with the cultural backgrounds and lifestyles of the
various ethnic minority groups they serve. Consequently, they are unable to
devise culturally sensitive forms of treatment. Ethnic minorities often Þnd
mental health services strange, foreign, or unhelpful. For example, Latinos
value linearity, role-structured rather than egalitarian relationships, and a
present-time orientation. African-American cultural traditions include group
identiÞcation, extended family kinship networks, spirituality, and a þexible
concept of time. When the counselor fails to recognize these differences, it
becomes an impediment to effective treatment. These traditions, along with the
client's reactions to a history of racial oppression, must be understood by
counselors in order to truly understand the ethnic minority's experience of life
in the majority culture that white therapists take for granted.
The President's Commission recommended that, in the best of all possible
worlds, services would be delivered by, or there would always be the option of,
professionals who share the same value system, beliefs, and class experience of
the client being served. However, this scenario is far from attainable at this
time. In order to move toward this possibility, graduate training programs would
need to expand their outreach efforts so as to better represent the diversity of
ethnic groups in the larger culture.
Similarly, programs also need to better train students on how to address the
needs of ethnic minorities by developing sensitivity to other cultures and
altering traditional psychotherapy techniques accordingly. However, knowledge is
not enough to provide culturally sensitive psychotherapy services, because
cultural knowledge and "techniques" can often be applied in
inappropriate ways.
Another way of teaching cultural sensitivity is by helping majority-culture
therapists to become aware of their own ethnic identity. Also a historical
knowledge of minority cultures and the prejudice and racism they have
encountered is necessary to understand the cultural context that many clients
have to continually struggle with on a daily basis. However, most importantly,
new paradigms of cross-cultural counseling need to be developed so that
therapists can reformulate how they approach psychotherapy with ethnic
minorities.
Stanley Sue, a psychologist at UCLA, describes two basic processes that are
important to consider when working with ethnic minorities - credibility and
giving (Sue and Nolan, 1987). Obviously these are not the only elements
necessary for effective cross-cultural counseling, but they are important and
worth considering in working with minority-culture male batterers.
"Credibility" refers to the client's perception of the therapist as
an effective and trustworthy helper. Therapeutic success is increased when the
client believes in the process, in that the methods being employed are credible.
Credibility may be divided into two components: ascribed and achieved status.
Ascribed status is the position or role in which the therapist is placed by
the client before the counseling even begins. These elements may include the
client's perception of counseling and the counselor's age, sex, race, and
experience. Minority clients may enter into counseling with the expectation that
the experience is not going to be helpful. They may view therapy as another
majority culture institution that is racist and oppressive. This notion may be
particularly reinforced if the counselor is white. These factors all contribute
to the low ascribed status the mental health profession has with ethnic
minorities.
Achieved status refers more directly to the therapist's skills and knowledge.
Through the actions of the therapist, clients may come to have faith, trust, conÞdence,
or hope that the outcome will be positive. The achieved status is likely to be
directly related to the counselor's experience, but equally important, the
increase in status is likely to occur when the therapist intervenes in a
culturally consistent manner.
By analyzing the credibility we may begin to understand how we can better
respond to the therapeutic needs of minority-culture clients. Credibility helps
us to understand why ethnic-minority clients may either underutilize the
treatment opportunity or prematurely drop out. When the ascribed status is low,
clients are likely to avoid counseling altogether. When the ascribed status is
somewhat higher but the achieved status is low, a client may enter therapy but
prematurely terminate because the counselor may not be addressing the client's
cultural needs. This process does not mean that the therapist should support or
match clients' beliefs that are ultimately interfering with problem resolution;
however, incongruities in cultural beliefs and therapeutic orientation can lead
to decreased achieved status and premature termination of treatment. By focusing
on credibility rather than just techniques and information, therapists will use
culture-speciÞc techniques when necessary and not use culture-speciÞc
approaches for the clients who would not beneÞt from them.
Clients often wonder how talking about problems can bring about a change in
their life situation. "Giving" is the client's perception that
something was received from the therapeutic encounter. The client has received a
"gift" from the therapist. Typically, therapists attempt to raise the
clients' expectation that they will receive something for their efforts. For
many clients, this expectation is sufÞcient to set aside their immediate needs
in favor of something they may receive in the future. For ethnic minorities,
because of the high drop-out rate, it is critically important that counselors
not simply raise their client's expectations but help them to feel that they are
receiving a direct beneÞt from the session. Typically, the Þrst few sessions
of counseling are focused on the therapist-collected information. For the ethnic
minority, where there may be a great deal of skepticism about unfamiliar methods
of treatment or institutions that have historically been used to oppress people,
it is important to help the client attain some type of meaningful gain right
from the onset of counseling. These gifts may include behavioral interventions,
providing structure or clarity during a crisis, and normalizing certain thoughts
and feelings within a cultural context. In some cases, it may be appropriate to
give a client an actual gift, such as a book.
Obviously these are not new ideas, but they can be very helpful in beginning
to structure counseling interventions that can provide culturally relevant
services to ethnic minorities. Historically, psychology has placed a great deal
of emphasis on gaining knowledge of ethnic minorities without much focus on how
to apply that knowledge to the actual counseling process. In order to
effectively counsel ethnic minorities, we must learn about our own ethnic
identity and the culture of others, and at the same time develop new ways of
clinically applying that knowledge.
Racism and Violence in Society
All ethnic minority groups in the United States have at one time or another
been victim to institutionalized oppression by the government - from the Native
Americans' Trail of Tears and the slavery of the African-Americans, to the
internment of Japanese-Americans during World War II, to recent legislation in
California aimed at prohibiting medical, educational, and Þnancial aid to
illegal Latin immigrants. The United States was founded on the hope that the
country would be a homogeneous group of white, Protestant Europeans. Yet
ironically, throughout history other social forces have brought other ethnic
groups to this country, making it one of the most heterogeneous populations in
the world. Still today, prejudice and racism are rampant across the country,
ultimately contributing to the economic and emotional suffering of millions of
people.
This history of oppression of others has exacted a high price to the majority
culture. Anger, distrust, and bitterness towards whites and the institutions
which they represent have contributed to many social ills, such as crime, urban
decay, and violence. The Mexican-American child, who is denied adequate
education because of the lack of Þnancial resources of the parent, has a
greater chance of dropping out of school and stealing the white man's BMW. The
learning-disabled African-American child, who was prematurely born because of
inadequate medical services to his mother, will ultimately cost all Americans
more in taxes if he doesn't receive specialized education and instead is labeled
stupid. In addition to the social losses, many individuals experience personal
pain resulting from racism, such as not being able to pursue certain friendships
because of social pressures against intermingling.
Prejudice is deÞned as prejudging another or forming an opinion of an
individual or group of individuals based on limited information. All of us have
prejudices based on the various cultural stereotypes to which we have been
exposed during our lifetime. Racism may be deÞned as prejudice plus power. It
is a system of advantage based on race (Tatum, 1992). It is virtually impossible
to live in contemporary society and not be exposed to some aspect of personal,
cultural, or institutionalized racism. Therefore, all people will internalize,
to one degree or another, some negative attitudes or beliefs about people of
color. In order to break the cycle of prejudice and racism we all need to take
responsibility for reeducating ourselves, identifying negative attitudes, and
changing behaviors.
A white therapist may say, "I am not a part of the institutionalization
of racism in the country. I don't have power to promote racist policies. Why
would a person of color distrust me?" First of all, psychology for many
years contributed to myths and the misunderstanding of minorities by promoting
research that promulgated the belief that they were inferior to whites. Second,
psychotherapeutic principles were developed on the basis of experience with
white, middle-class individuals and therefore reþect that bias. Many ethnic
minorities Þnd traditional mental health interventions to be peculiar and in
some cases disrespectful of their values and traditions. Lastly, licensed mental
health providers do have power to affect people's lives. They have the power to
report different forms of abuse, power to hospitalize, power to refuse
treatment, power to affect insurance reimbursement, power to help or not help,
to name but a few. When seen from this point of view, the perspective of the
ethnic minority, one can understand how historical and contemporary social
treatment of ethnic minorities can have an effect on an individual's attitude
towards mental health services.
Although many Americans, both white and ethnic minorities, today suffer
economic or emotional problems, the person of color has the added burden of
dealing with prejudice and racism on a daily basis. Mothers and fathers, in
addition to struggling to survive, need to teach their children the realities of
racism in society while not overwhelming them to the point that they give up
before they begin. Many people, mostly white, believe that prejudice and racism
are not a problem today, many years after the civil rights movement. What has
changed somewhat is the blatant racism of the years of slavery. However, this
blatant hatred of people of color has in many ways gone underground and
therefore has taken on more subtle forms. Centuries of ignorance and hatred are
not easily changed overnight. If you are uncertain if this is the reality, just
ask a person of color, of any class, if a racism problem in America still
exists.
What is the relationship between prejudice, racism, and domestic violence?
Sociologists are trying to answer this question by examining the effects of
racism on the development of children. Studies indicate that overt and subtle
forms of racism can exact a high toll on the self-esteem of children. We know
that low self-esteem has been correlated with a variety of problems including
alcohol and drug abuse and violence. We also know that low self-esteem can
interfere with an individual's performance in academic or employment activities.
It is well known, too, that poverty also exacerbates whatever psychological
problems an individual experiences, in that it compounds the stressors one must
overcome in order to succeed. Studies indicate, fairly consistently, that a
history of childhood abuse may lead to a problem with violence as an adolescent
or adult. Many adults who grew up in violent homes suffer from low self-esteem.
Racism in all its overt and subtle manifestations will have some degree of
psychological impact on an individual and therefore will only worsen whatever
emotional toll is taken on the child who witnesses or is victim of violence
during childhood.
Cross-Cultural Counseling with Male Batterers
First it is important to recognize that, to one degree or another, every
person of color entering into a batterer treatment program has experienced
prejudice and racism. Do not be afraid of communicating to the client that you
recognize the extent to which race and racism may play a signiÞcant role in his
life and that he doesn't have to protect you from his experiences and feelings
about it. This issue may become most critical with the court-mandated client. He
may feel that the system has treated him more harshly than his white male
counterpart. He may feel that he is being victimized by white culture and the
courts. Although there is doubtless some truth to the client's observation, the
counselor must combine sensitivity to his feelings with helping him take
responsibility for his problem with violence. One of the advantages of group
counseling is that clients can see that men of all ethnic backgrounds are
experiencing the problem of domestic violence and are being held accountable by
the criminal justice system.
Therapists should not assume that social class protects an individual from
the effects of societal racism. Just as poverty compounds the psychological
effects of racism, middle- and upper-class status can also complicate how one
deals with racism. Many middle- and upper-class men of color may feel guilt for
"making it" and leaving others behind. He may also use much of his
hard-earned money supporting other family members. Many highly educated
African-American males confront invisible barriers at work and school. They may
be confronted with hostility if they are the Þrst person of color in a
particular occupation or status within a company.
If we were to utilize Sue's theory of credibility and giving in understanding
the cross-cultural counseling of male batterers, it could help us understand why
some men of color may have difÞculty with the various treatment programs
developed by domestic violence advocates and clinicians.
For the most part, men in general do not hold counseling services in high
esteem, therefore the ascribed status will be low. Men of color, for the reasons
described earlier, may view counseling in even less favorable ways. This
expectation could be somewhat mitigated if the counselor is of the same ethnic
group or older in age. But a white counselor will need to pay particular
attention to achieved status as a way to facilitate the minority client's
connection with the counseling process. Even for the court-mandated client,
resistance to change, acting out, or uncooperative behaviors could develop if
the counselor is not sensitive to the cultural issues. Additionally, if one of
the goals of counseling male batterers is raising self-esteem, then it would
follow that addressing cultural contributors to low self-esteem would be
important in minimizing the psychological stress that can in turn raise the risk
for domestic violence.
Another way for counselors to work towards increasing achieved status is to
learn speciÞc cultural characteristics, integrating this knowledge into the
counseling approach. Counselors should not be afraid to directly ask clients
about their cultural values, but they should not use this technique as a
replacement for learning about the speciÞc ethnic groups. For example: with
Native Americans, counselors may allow longer silences or pose questions that
guide and advance rather than highly directive ones; with African-Americans,
counselors might need to recognize the value of extended family kinship and the
stressing of nonverbal communication skills; with Asian-Americans, counselors
may need to appreciate their strong family values of privacy and nondisclosure,
hierarchical family roles, and the connection between emotional and physical
problems; with Hispanic Americans, the counselor may need to recognize the
strong patriarchal family patterns, incorporation of spiritual practices, and
the value of personalismo (personal greeting, handshaking, the use
of Þrst names and small talk) for developing rapport. It is beyond the scope of
this chapter to give the reader a comprehensive understanding of all the
cultural values in all the various ethnic groups, so a section on cross-cultural
issues is included in the reading list at the end of this book. Certainly,
counselors should become familiar with the body of literature on cross-cultural
counseling.
If we were to redesign the Learning to Live without Violence Program, or any
other approach, for ethnic minority groups we might need to reconceptualize the
problem, change the means for problem resolution, and possibly change the goals
of treatment. Obviously, the main goal of domestic violence treatment must be
the safety of all family members; therefore, the abuser must stop his
destructive behavior. If we maintain this goal, we can see how it can become
possible to develop another approach to treatment of male batterers. For Native
Americans the problem may be conceived as a spiritual illness, and therefore the
client may need to visit a medicine person or another spiritual leader in the
tribe. One part of the treatment plan may include a "vision quest" or
a series of "sweats" or "chants." An Asian-American client's
violence may be attributed to an imbalance in energy forces within the boy and
therefore he might need to receive herbal or acupuncture treatments. Or, an
elder relative may be brought into treatment to help motivate the client to deal
with his problem with violence. A Hispanic or African-American man may beneÞt
from family therapy and advocacy services that address important social needs
which may be strongly contributing to stress and conþict at home.
Lastly, the best way to develop treatment approaches speciÞc to ethnic
populations is to offer counseling services for individual groups led by
professionals who identify with the same cultural and class background. Because
the vast majority of clinicians who have written about treatment of male
batterers are of majority-culture ethnicity, the most commonly used treatment
interventions and program philosophies represent a Eurocentric point of view.
Though it has been very difÞcult in the past for a man of color to Þnd a
homogeneous group, this is changing today in that more programs are developing
services for speciÞc ethnic populations. Volcano Press has received many
requests for a translation of Learning to Live without Violence into
Spanish. At the time of this writing, this project is already underway. As more
and more programs offer services speciÞcally for men of color, a culturally
relevant treatment paradigm is likely to evolve over time. This was how many of
the interventions in Learning to Live without Violence were developed.
This approach evolved over years of reÞnement by ethnically heterogeneous
groups of men. The structure more or less grew out of the program, rather than
being devised and then simply imposed on the men.
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Black Bear, Tillie (1988). Native American clients. In: Anne L. Horton and
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