Читать книгу Counseling the Culturally Diverse - Laura Smith L. - Страница 117

Clients of color tend to prematurely terminate counseling and therapy at a rate much higher than their White counterparts. We submit that racial microaggressions may lie at the core of the problem. For example, one study found that more than half of racial‐ and ethnic‐minority clients at a college counseling center reported experiencing a microaggression from their therapist (Owen, Tao, Imel, Wampold, & Rodolfa, 2014), and other studies report between 43% and 81% of clients experiencing at least one microaggression in therapy (Hook et al., 2016; Owen et al., 2012, 2015). The most commonly experienced microaggressions involved therapists’ subtle expression of cultural stereotypes and avoidance of or minimization of cultural issues (Hook et al., 2016). A similar study of LGBTQ clients revealed, “clients were left feeling doubtful about the effectiveness of therapy, the therapists’ abilities, and the therapists’ investment in the therapeutic process when therapists minimized their sexual reality” (Shelton & Delgado‐Romero, 2011, p. 217).

There is growing evidence to suggest that racial, gender, and sexual orientation microaggressions have a detrimental effect on the therapeutic alliance for clients of color (Owen et al., 2014), women (Owen, Tao, & Rodolfa, 2010), and LGBTQ individuals (Shelton & Delgado‐Romero, 2011, 2013). Specifically, “microaggressions can be thought of as a special case of ruptures in therapy, wherein experiences of discrimination and oppression from the larger society are recapitulated, which places the therapeutic relationship under duress and strain” (Owen et al., 2014, p. 287). Qualitative work with LGBTQ clients supports this finding, where the therapeutic alliance has been diminished by the presence of sexual orientation microaggressions: “affective consequences of sexual orientation microaggressions included clients feeling uncomfortable, confused, powerless, invisible, rejected, and forced or manipulated to comply with treatment” (Shelton & Delgado‐Romero, 2013, p. 66).

One study found that microaggressions that went unaddressed by therapists were associated with a weaker working alliance compared to situations with (a) no microaggression or (b) a resolved microaggression (Owen et al., 2015). Although studies on microaggressions in therapy suggest that they are frequent and harmful, evidence also shows that when microaggressions are acknowledged and addressed, the therapeutic alliance can be restored with positive clinical outcomes (Owen et al., 2014; Owen, Tao, & Drinane, 2019). Therefore, it is paramount that helping professionals examine their own biases and beliefs and remain aware of how they may unintentionally communicate these when working with clients who are culturally diverse.

Although therapy provides an ideal opportunity for exploring microaggressions both within the therapeutic dyad and in presenting concerns, many therapists are unsure how to approach such conversations. The multicultural orientation (MCO) framework (Owen, 2013) can be used to help therapists engage in a discourse on race, culture, racism, and microaggressions. This framework includes three pillars: (a) cultural humility, (b) cultural opportunities, and (c) cultural comfort. These pillars involve therapists being (a) aware of their own cultural values and those of others, (b) curious about others’ cultural identities and values, and (c) at ease and comfortable with discussions that involve race, racism, and culture. Studies suggest that these variables are associated with more positive therapeutic outcomes. Specifically, counselors who score higher on cultural humility (a) are less likely to microaggress and (b) have more positive therapy outcomes (Hook et al., 2016; Owen et al., 2014, 2017). Table 4.2 provides several more therapy‐specific examples of microaggressions, using the same organizing themes presented in Table 4.1. We ask that you study these themes and ask if you have ever engaged in these or similar actions. If so, how can you prevent your own personal microaggressions from impairing the therapy process?

Table 4.2 Examples of Microaggressions in Therapeutic Practice

Adapted from Sue, Bucceri et al. (2007).

Themes	Microaggression	Message
Alien in Own Land When Asian Americans and Latinx Americans are assumed to be foreign‐born	A White client does not want to work with an Asian American therapist because she “will not understand my problem”	You are not American
A White therapist tells an American‐born Latinx client that he or she should seek a Spanish‐speaking therapist
Ascription of Intelligence Assigning a degree of intelligence to a Person of Color or a woman based on race or gender	A school counselor reacts with surprise when an Asian American student says they have had trouble on the math portion of a standardized test	All Asian people are smart and good at math
A career counselor asking a Black or Latinx student, “Do you think you're ready for college?”	It is unusual for People of Color to succeed
A school counselor reacting with surprise at hearing that a female student scored high on the math portion of a standardized test	It is unusual for women to be smart and good at math
Color Blindness Statements that indicate that a White person does not want to acknowledge race	A therapist says, “I think you are being too paranoid. We should emphasize similarities, not people's differences” when a client attempts to discuss her feelings about being the only Person of Color at her job and feeling alienated and dismissed by her coworkers	Race and culture are not important variables that affect people's lives
A client of color expresses concern in discussing racial issues with her therapist; her therapist replies, “When I see you, I don't see color”	Your racial experiences are not valid
Criminality/Assumption of Criminal Status A Person of Color is presumed to be dangerous, criminal, or deviant based on their race	When a Black client shares that she was accused of stealing from work, her therapist encourages her to explore how she might have contributed to her employer's mistrust of her	You are a criminal
A therapist takes great care to ask all substance‐abuse questions in an intake with a Native American client and is suspicious of the client's nonexistent history with substances	You are deviant
Use of Sexist/Heterosexist Language Terms that exclude or degrade women and lesbian, gay, bisexual, transgender, and queer (LGBTQ) groups	During the intake session, when a female client discloses that she has been in her current relationship for 1 year, the therapist asks how long the client has known her boyfriend	Heterosexuality is the norm
When an adult female client explains she is feeling isolated at work, her male therapist asks, “Aren't there any girls you can gossip with there?”	Application of language that implies to adolescent or adult females, “your problems are trivial”
Denial of Individual Racism/Sexism/Heterosexism A statement made when a member of the power group renounces their biases	When a client of color asks his or her therapist about how race affects their working relationship, the therapist replies, “Race does not affect the way I treat you”	Your racial/ethnic experience is not important
When a client of color expresses hesitancy in discussing racial issues with his White female therapist, she replies, “I understand. As a woman, I face discrimination also”	Your racial oppression is no different than my gender oppression.
A therapist's nonverbal behavior conveys discomfort when a bisexual male client is describing a recent sexual experience with a man; when he asks her about it, she insists she has “no negative feelings toward gay people” and says it is important to keep the conversation on him	I am incapable of homonegativity, yet I am unwilling to explore this
Myth of Meritocracy Statements that assert that race or gender does not play a role in succeeding in career advancement or education	A school counselor tells a Black student that “if you work hard, you can succeed like everyone else”	People of color are lazy and need to work harder; if you don't succeed, you have only yourself to blame (blaming the victim)
When a female client visits a career counselor to share her concerns that a male coworker was chosen for a managerial position over her, despite the fact that she was better qualified and has been in the job longer, the counselor responds that “he must have been better suited for some of the job requirements”	Women are incompetent and need to work harder; if you don't succeed, you have only yourself to blame (blaming the victim)
Pathologizing Cultural Values/Communication Styles The notion that the values and communication styles of the dominant/White culture are ideal Second‐Class Citizen When a member of the power group is given preferential treatment over a target group member Traditional Gender Role Prejudicing and Stereotyping When expectations of traditional roles or stereotypes are conveyed	When a Black client is loud, emotional, and confrontational in a counseling session, the therapist diagnoses her with borderline personality disorder	Assimilate to the dominant culture
When a client of Asian or Native American descent has trouble maintaining eye contact with his therapist, she diagnoses him with a social anxiety disorder
Asking a client, “Do you really think your problem stems from racism?”	Leave your cultural baggage outside
When a male client calls and requests a session time that is currently taken by a female client, the therapist grants him the appointment without calling the female client to see if she can change times	Male clients are more valued than female clients
A client of color is not welcomed or acknowledged by a receptionist	White clients are more valued than clients of color
A therapist continually asks a middle‐aged female client about dating and “putting herself out there” despite the client not having expressed interest in exploring this area	Women should be married, and dating should be an important topic/part of your life
	A gay male client has been with his partner for 5 years; his therapist continually probes his desires to meet other men and be unfaithful	Gay men are promiscuous/cannot have monogamous relationships
A therapist raises her eyebrows when a female client mentions that she has had a one‐night stand	Women should not be sexually adventurous
Sexual Objectification When women are treated like objects at men's disposal	A male therapist puts his hands on a female client's back as she walks out of the session	Your body is not yours
A male therapist looks at his female client's breasts while she is talking	Your body/appearance is for men's enjoyment and pleasure
Assumption of Abnormality Occurs when it is implied that there is something wrong with being lesbian, gay, bisexual, transgender, and queer (LGBTQ)	When discussing his client's bisexuality, a therapist repeatedly implies that there is a “crisis of identity”	Bisexuality represents a confusion about sexual orientation
When a lesbian comes in for career counseling, the therapist continually insists that she needs to discuss her sexuality	Your sexual orientation represents pathology
The therapist of a 20‐year‐old lesbian inadvertently refers to sexuality as a “phase”	Your sexuality is something that is not stable