What are the three primary components of multicultural competence as it is applied to clinical work?

Running head: GROUP-SPECIFIC AND MULTICULTURAL APPROACES

How multicultural issues are addressed in counseling research and
practice: Group-specific and multicultural approaches

Harue Ishii

Kawagoe, Japan

Abstract

The tripartite model of multicultural counseling competency has activated organizational emphasis on improving counselor abilities to work with diverse clients. It has also generated a controversy over how multicultural issues might be addressed in multicultural counseling research and practice. This paper provides a socio-historical context in which the need for multicultural counseling competencies emerged. It also reviews the contributions and criticisms of the competencies model and discusses two different approaches to address multicultural issues in multicultural counseling research and practice.

How multicultural issues are address in counseling research and practice: Group-specific and multicultural approaches

     Since its inception, the Sue et al. (1982, 1992) tripartite model of multicultural counseling competencies has dominated both conceptual and empirical work in the multicultural counseling literature (Worthington, Soth-McNett, & Moreno, 2007). The tripartite competencies model also generated debates and criticisms. One of the major controversies is how multicultural issues are addressed in the conceptualization of multicultural counseling competencies. The purpose of this paper is to provide a socio-historical context in which the need for multicultural counseling competencies emerged and discuss two different approaches to deal with multiculturalism within the multicultural competencies model.

Movement Toward Multicultural Counseling Competencies

     While the population in the United States continues to diversify, the U.S. Department of Health and Human Services (DHHS; 1999, 2001) has continued to report disparities in mental health services for ethnic minorities. Ethnic minorities are less likely to have access to and receive mental health services, often receive a poorer quality of services, and are under-represented in mental health research (DHHS, 2001). In addition, ethnic minorities experience higher disability rates compared to European Americans (Smart & Smart, 1997). Disability and chronic illness often co-exist with mental disorders such as depression and anxiety (Bairey-Merz et al., 2002; Falvo, 2005; Penninx et al., 2001), pointing to the need for clinicians’ competency in addressing mental health concerns of minority clients with disabilities. However, many clinicians are inadequately prepared to serve ethnically diverse populations (DHHS, 2001) as well as to address disability-related issues in counseling (Kemp & Mallinckrodt, 1996; Sue & Sue, 2003). Given the consistent mental health service disparities, a lack of clinician cultural competencies poses a significant problem that needs to be addressed in the counseling field. Because of the significant role that training programs can play in enhancing the cultural competency of clinicians, DHHS (2001) recommended that training programs address the impact of culture on mental health and mental health services in order to implement culturally responsive services for minority clients.

     Over the past two decades, the counseling profession has underscored the importance of multicultural counseling training, which has become an integral part of counselor education (Ridley, Mendoza, & Kanitz, 1994). Sue and his associates’ (Sue, Arredondo, & McDavis, 1992; Sue et al., 1982) position papers that proposed a tripartite conceptualization of multicultural counseling competencies became a major force in this period when multicultural counseling gained significant attention in the field. The tripartite model (Sue et al., 1982, 1992) has three components; awareness, knowledge, and skills. The awareness component refers to counselor awareness of one’s own worldview and cultural biases. Multicultural knowledge requires counselors to be knowledgeable about various cultural factors that might influence the counseling process (e.g., clients’ culture and cultural identity). The skills component addresses counselor ability to form rapport with culturally diverse clients and to implement culturally responsive interventions. The tripartite model propelled organizational emphases to implement multicultural competencies in training programs. Professional organizations such as the American Counseling Association (2005) integrated multicultural counseling competence into the ethical standards. Further, accreditation bodies such as the Council for Accreditation of Counseling and Related Programs (2009) mandated programs to infuse multicultural issues into their curriculum in order to implement quality multicultural training across graduate programs.

     The tripartite model also stimulated research (see Worthington et al., 2007 for a review) along with the development of instruments that purport to measure the multicultural counseling competencies (e.g., LaFromboise, Coleman, & Hernandez, 1991; Ponterotto, Alexander, & Grieger, 1995; Sodowsky, Taffe, Gutkin, & Wise, 1994). While the tripartite model made much contribution to the field, it also received criticisms. In the next section, two major criticisms of the model are discussed, followed by two opposing approaches to addressing multicultural issues in relation to the competencies model.

Criticisms on the Multicultural Counseling Competencies Model

     Two major criticisms of the Sue et al. (1982, 1992) multicultural counseling competencies model are a lack of empirical support for the model and almost exclusive focus on four racial/ethnic groups in the U.S. (African Americans, Asian Americans, Latino Americans, and Native Americans). Constantine, Gloria, and Ladany (2002) evaluated the factor structure of multicultural counseling competence measures and did not find support for the theoretically proposed three factor structure. With the exception of the Cross-Cultural Counseling Inventory-Revised (CCCI-R; LaFromboise et al., 1991), other competency measures use self-report. Thus, they are affected by the influence of social desirability (Constantine & Ladany, 2000; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998) and have the tendency to measure anticipated rather than actual behaviors or competencies (Constantine & Ladany, 2000; Ladany, Inman, Constantine, & Hofheinz, 1997). A recent content analysis of multicultural counseling competency research noted a theory-research gap in the multicultural counseling literature, showing the need for more empirical evidence on the competencies model (Worthington et al., 2007). Conceptually, the model was criticized for a lack of attention to various socio-cultural factors beyond race/ethnicity, which led to debate on what cultural aspects should be included in defining multicultural counseling competencies.

Group-Specific vs. Multidimensional Approach

     The original Sue et al.’s (1982) multicultural competence model focused exclusively on racial/ethnic issues. Although the second position paper (Sue et al., 1992) attempted to define the multicultural counseling competencies more inclusively by considering other diversity factors (e.g., sexual orientation, disability, gender, religion, and socioeconomic status), the major emphasis was still on race/ethnicity. In addition, while the inclusive approach avoids becoming exclusive, there has been the argument that such an all-inclusive approach obscures the understanding of each factor as a powerful dimension of human experience (Sue & Sue, 2003).

     Helms and her associates (Helms, 1990; Helms & Richardson, 1997; Helms & Cook, 1999) argued that such all-inclusive definition is useless as a scientific construct because it lacks precise conceptualization to understand the role of race in the counseling process and its sociopolitical implications on clients’ mental health. With the emphasis on specificity, Helms and Richardson (1997) suggested that researchers and professionals address the question of “Which competencies work best for what aspects of diversity?” (p. 77). To emphasize the significance of race, Helms and her associates (Helms, 1990; Helms & Carter, 1990; Helms & Perham, 1996) developed racial identity development models for European Americans and African Americans as well as instruments to measure the racial identity statuses. Those racial identity development models generally assume that individuals begin developing with a racially unaware state, then going through racial awakening and psychological dissonance in order to move toward a fuller acceptance and awareness of racial issues. The models led to a body of research that related racial identity with various psychological constructs including defense mechanisms (Utsey & Garnat, 2002), racism (Pope-Davis & Ottavi, 1994), and self-reported multicultural counseling competencies for counselors (Constantine, 2002; Ladany et al., 1997; Neimeyer & Vinson, 2003; Ottavi, Pope-Davis, & Dings, 1994). There are other group-specific models that focus on the identity development of a specific socio-cultural group such as gays and lesbians (Cass, 1979) and feminists (McNamara & Rickard, 1989). Those group-specific models often provide rich information specific to the group and a more explicit operational definition of the construct. Therefore, group-specific models render themselves suitable for yielding instruments and large-scale quantitative research. Because of the specificity, the group-specific approach produced much research and a better understanding of the impact of each socio-cultural factor on people. However, this approach fails to consider two major issues; salience of group membership for an individual and the interaction effects of multiple socio-cultural factors.

     Pedersen (1991) emphasized individuals’ multiple identities (e.g., being a Latino gay man with a disability) and argued that all counseling relationships are essentially cross- or multi-cultural. In highlighting the complexity of multicultural counseling, he asserted that because such multiple identities within a client are affected by contextual factors, it is important for counselors to assess which identity is more salient for the client in a given context. From a social constructionist perspective, Collins (2000) described the concept of intersectionality that suggests complex and dynamic interactions between social oppression and individuals’ identity and everyday experience. According to her conceptualization, different social categories (e.g., race, social class, gender, sexuality, etc.) create different oppression systems that intersect each other and influence individuals’ social positioning in a given context. Much like a matrix, for instance, two women’s social proximity may be close in the context of experiencing sexism, yet it becomes distant in the context of dealing with mobility issues if one of the women has a spinal cord injury. In contrast to the single-dimensional approach to multiculturalism, those views attempt to theorize the impact of multiple socio-cultural factors on individuals and the interactions among different socio-cultural factors.

     Clinical value of the multi-dimensional approach to multiculturalism can be supported by the data that show a high concentration of risk factors among certain socio-cultural groups as well as high comorbidity rates in clinical populations. For example, because ethnic minorities are less likely to receive effective treatment, they bear higher rates of disability burden relative to European Americans (DHHS, 2001). Demographic variables such as having a disability, being a woman, African American, and Latino American, and having less education have been associated with an increased likelihood of living in poverty (Kruse, 1998). Focusing on wide-ranging impacts of poverty, Evans (2004) suggested that poverty does not occur in isolation and that it is the accumulation of multiple social and environmental risk factors that makes chronic poverty more detrimental to individuals’ physical and psychological wellbeing. These data point to the need for counselors to consider the interrelations among physical, psychological, and social factors that may affect clients’ presenting issues. Thus, the multi-dimensional approach can provide more realistic conceptualization in practice because it addresses the intersectionality among different socio-cultural factors and the complexity inherent in multicultural counseling. On the other hand, due to the complexity, the multi-dimensional approach is less likely to be research-friendly to quickly generate empirical data.

Conclusions

     This paper reviewed single- and multi-dimensional approaches to multiculturalism within the realm of Sue et al. (1992) multicultural counseling competencies model. The single-dimensional approach advanced research and our understanding of the impact of a specific socio-cultural factor on our clients. The multi-dimensional approach provides clinically useful conceptualizations that help us better understand the salience and intersectionality of different socio-cultural factors for a given client. Given the emphasis on a holistic approach in counseling, the author suggests that multicultural counseling research and practice utilize knowledge gained from the group-specific approach and move toward the multi-dimensional approach in addressing multicultural issues in counseling. To foster empirical endeavors researchers are encouraged to incorporate the multi-dimensional nature of socio-cultural identity and the interactional effects of different socio-cultural factors in their research. In particular, the development of instruments or assessment strategies to measure the multi-dimensional socio-cultural factors will greatly facilitate research. Similarly, counselor educators are encouraged to train students to become competent in addressing various socio-cultural issues in counseling, including ethnicity, race, gender, disability, sexual orientation, age, socioeconomic status, and religion. In addition, students should be taught about the concept of saliency and intersectionality in order to conceptualize socio-culturally diverse clients.

     Multiculturalism has been referred as a ‘fourth force’ in counseling alongside the traditional psychodynamic, cognitive-behavioral, and humanistic approaches (Ivey, Ivey, & Simek-Morgan, 1997; Pedersen, 1991). Given the data suggesting the continuing disparities in mental health services for diverse socio-cultural populations, organizational efforts to enhance multiculturalism and multicultural counseling competency need to be continued in the counseling field.

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Author Note

Harue Ishii was an Assistant Professor in the Department of Individual, Family and Community Education at the University of New Mexico at the time this manuscript was submitted. Harue Ishii is now in private practice in Japan. She is a licensed mental health counselor and national certified counselor.

Correspondence concerning this article should be addressed to Harue Ishii, Kawagoe City, Saitama Prefecture, Japan. E-mail: . Phone: (+81) 50-5532-5426.

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