Cultural Self-Awareness

Cultural Self-Awareness Assessment: Practice Examples From Psychology Training Gargi Roysircar Antioch New England Graduate School Competence in working with diverse clients is essential for all therapists. Acknowledgement of subjec- tivity is a good indicator of a key competence: therapists’ awareness of their own assumptions, values, and biases. Receiving and understanding clients’ different perspectives is a good indicator of another competence: understanding the worldviews of culturally different clients. The goals and evaluation of a curriculum for cultural self-awareness assessment are briefly described. Applications for cultural self- awareness assessment are provided, including a checklist of self-descriptions, a group activity for self-awareness development, and trainee analyses of critical incidents. Excerpts from trainees’ process notes illustrate one type of self-awareness assessment, showing trainee learning. “Therapist, know thy cultural self” is the recommended motto for trainees with regard to two developmental tasks: self- exploration about one’s own cultural heritage and understanding and valuing the differences of others. Trainees are affected per- sonally and professionally through a self-reflexive orientation in interactions with culturally different clients. That is, therapists relate better when they are introspective about their own culture- based reactions to their clients’ cultural differences. The current article examines cultural self-awareness and its relevance to trainee development in diversity competence. Diversity competence is the ability to integrate into one’s the- oretical and technical approach to assessment and intervention relevant human diversity factors that are important to the process and outcome of therapy. These diversity factors may be relevant to the therapist, the client, and/or the therapeutic relationship. Human diversity refers to group-specific factors salient for the individual. These may include sex, socioeconomic status, age, religion, race, ethnicity, regional/national origin, sexual orientation, and ability status, all or any of which may inform or shape an individual’s identity, behavior, worldview, attitudes, values, and/or beliefs. Therapists’ cultural self-awareness is a precursor for effective and culturally relevant therapy. The purpose of this article is to identify critical self-awareness characteristics that have been use- ful for developing guidelines for the self-assessment of diversity competence. I have applied these guidelines to training psychology students in human diversity. Therapists’ Awareness of Their Own Assumptions, Values, and Biases D. Sue, Arredondo, and McDavis (1992) stated in their seminal article, “A culturally skilled counselor is one who is actively engaged in the process of becoming aware of his or her own assumptions about human behavior, values, biases, pre-conceived notions, [and] personal limitations” (p. 481). Therapist self- awareness is relevant to three practitioner domains: attitudes and beliefs, knowledge, and skills. When therapists are aware of their attitudes and beliefs, they “can identify the specific cultural group(s) from which [they] derive fundamental cultural heritage and the significant beliefs and attitudes held by those cultures that are assimilated into [their] own attitudes and beliefs” (Arredondo et al., 1996, p. 51). Culturally self-aware therapists approach their knowledge critically when they can specify how their own racial and cultural heritage may “personally and professionally affect their definitions of and biases about normality/abnormality and the process of counseling” (Arredondo et al., 1996, p. 482). Culturally self-aware therapists show skills when they can openly discuss human diversity factors in therapy, including knowing when not to refer to salient cultural differences of the client. For instance, when working with women of color, therapists recognize the inherent conflict between multiculturalism and feminism, this conflict be- ing characterized by the tendency of multiculturalism to demand respect for cultural traditions and of feminism to challenge cultural traditions. Table 1 presents applications of self-awareness assess- ment that include proficiencies in attitudes and beliefs, knowledge, and skills as presented by Comas-Dı´az and Jacobsen (1991), Hays (2001), Sodowsky, Taffe, Gutkin, and Wise (1994), and D. Sue et al. (1992). Overall, the emphasis in self-awareness assessment is on the therapist’s heightened intrapersonal awareness. Self- awareness is not an end in and of itself, which could degenerate into self-absorption or guilt and anger. Rather, self-awareness is a jumping-off point to understanding the client who is culturally different from the therapist. Through self-disclosure of one’s cultural self-awareness to one’s supervisor, peer group, and client, the therapist seeks one of various levels of client–therapist interactions: from initial mutual G ARGI R OYSIRCAR received her PhD in counseling psychology and educa- tional psychology from Texas Tech University. She is professor of clinical psychology and founding director of the Multicultural Center for Research and Practice at Antioch New England Graduate School (Keene, New Hampshire). She researches the interface of acculturation and ethnic iden- tity with the mental health of immigrants and ethnic minorities, worldview differences between and within cultural groups, multicultural competencies and training in professional psychology, and multicultural assessment and instrumentation. C ORRESPONDENCE CONCERNING THIS ARTICLE should be sent to Gargi Roy- sircar, Department of Clinical Psychology, Antioch New England Graduate School, 40 Avon Street, Keene, NH 03431-3516. E-mail: g_roysircar- sodowsky@antiochne.edu Professional Psychology: Research and Practice Copyright 2004 by the American Psychological Association 2004, Vol. 35, No. 6, 658–666 0735-7028/04/$12.00 DOI: 10.1037/0735-7028.35.6.658 658 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Table 1 Guidelines for Cultural Self-Awareness Assessment Counselor’s awareness of own assumptions, values, and biases a Development of self-awareness using internal and external sources b Ethnocultural countertransference c Multicultural Counseling Inventory self-report subscales d Beliefs and attitudes Privilege Interethnic countertransference Multicultural awareness 1. Has cultural awareness and sensitivity of own heritage and respects differences 2. Understands influence of own culture on psychological experiences 3. Recognizes own limitations 4. Comfortable with cultural differences Knowledge 1. Aware of how own cultural heritage affects definition of normality 2. Acknowledges how cultural/racial discrimination affects own attitudes, beliefs, and feelings 3. Knows about variations in cultural communication styles Skills 1. Seeks out educational, consultative, and training experiences; recognizes limitations of competencies 2. Actively seeks understanding of own racial identity and seeks a nonracist identity 1. Recognizes areas in which one holds privilege 2. Privilege is contextual: It depends on cultural norms 3. The areas in which we hold privilege are those in which we are least aware 4. Psychology is a privileged profession with dominant cultural values Internal and external feedback 1. Recognizes important influences in one’s own life for the exploration of own culture 2. Personal beliefs often reflect values in therapy 3. Introspection is important, but diversity competence training is also necessary 4. Critical thinking about mainstream cultural information is essential 5. Peer relationships with diverse individuals are a valuable source of enriching diversity competence 6. Humor is invaluable for reducing conflict 1. Denial of ethnocultural differences 2. Clinical anthropologist syndrome 3. Guilt and/or pity 4. Aggression 5. Ambivalence Intraethnic countertransference 1. Overidentification 2. Us and them 3. Distancing or ambivalence 4. Cultural myopia 5. Anger 6. Survivor guilt 7. Hope and despair 1. Embraces life experiences and professional interactions of a multicultural nature 2. Enjoys multicultural interactions 3. Advocates against barriers to mental health services 4. Has an awareness and understanding of diverse racial, cultural, and ethnic minority groups 5. Is aware of legalities regarding visas, passports, green cards, and naturalization 6. Has knowledge of and tolerance for nonstandard English 7. Draws on multicultural consultation and training resources 8. Problem solves in unfamiliar settings 9. Has increasing multicultural caseload Multicultural counseling relationship 1. Comfortable with minority client’s differences 2. Confident in facing personal limitations 3. Sensitive to client mistrust 4. Understands countertransference and/or defensive reactions with minority clients 5. Sensitive to difficulties based on cognitive style 6. Strives to avoid stereotyped and biased case conceptualization 7. Understands minority client-majority group comparisons 8. Knows how differences in worldviews affect counseling a See Sue, Arredondo, and McDavis (1992). b See Hays (2001). c See Comas-Dı´az and Jacobsen (1991). d See Sodowsky, Taffe, Gutkin, and Wise (1994). 659 CULTURAL SELF-AWARENESS ASSESSSMENT This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

said, “We all tell historical stories, and by doing so we all take certain moral positions that have political consequences and are meant to further political agendas” (p. 35). Therapists’ introspec- tive processes about their moral positions and political agendas are essential before they move further in their relationships with clients or implement culturally sensitive interventions. Psychology trainees can analyze which values are embedded in which theories and explore the ways in which psychotherapy and its theoretical underpinnings have unintentionally reproduced the status quo. Such an analysis can make visible the moral and political constructions of theory and the imperatives that underlie it. Therefore, in the self-assessment of bias, therapists have to rule out (or become aware of and accept) that their social views and, by extension, their theoretical orientations do not (or do) stem from their cultural upbringing. Therapist Examination of Defensiveness Interethnic countertransference. The self-reflective process allows therapists to explore defensiveness, projections, anxieties, intellectualizations, fears, and guilt that prevent the development of a therapeutic relationship with clients culturally, ethnically, or racially different from their therapists (Comas-Dı´az & Jacobsen, 1991). If clients bring up the topic of race or respond to experi- ences of racism by blaming White society in general, therapists could internalize client concerns as attacks on them. Like their clients, they might respond nationalistically, drawing the lines of us versus them (e.g., Why are we Whites blamed for everything?). Therapists might avoid the topic of race or make universal state- ments (“women also have so little power”), thus minimizing the client’s unique experience of racism. Therapists might discover that negative reactions have occurred because of fears that clients of color have accurately analyzed certain aspects of U.S. culture. Guilt can arouse avoidance of or pity for clients’ concerns. Anger can arise when therapists feel that clients are using issues of race to gain power in the relationship. Interethnic countertransference requires self-assessment and must be worked through, so that minority clients do not feel doubly victimized. When therapists come from the same ethnic group as clients, the therapists may experience intraethnic countertransfer- ence, such as overidentification with clients’ cultural needs, and therapists may not choose interventions on the basis of a model of treatment. An assessment checklist on countertransference (Comas-Dı´az & Jacobsen, 1991) and the multicultural therapeutic relationship (Sodowsky et al., 1994) is found in Table 1. Errors in assessment. Anxiety and intellectualization might be behind a therapist’s curiosity about a client’s cultural background. Comas-Dı´az and Jacobsen (1991) labeled such a therapist a clin- ical anthropologist . An inordinate amount of time can be spent on questioning the client’s cultural background, leading to the misat- tribution of pathology to cultural differences. This is a Type I error when therapists deny the existence of true psychological problems, such as psychosis, and make attributions to culture when no such effects exist. On the other hand, some therapists may deny cultural differ- ences; that is, they may make culture and color invisible. Retaining this false assumption causes Type II errors. Malgady (1996) rec- ommends that psychologists reverse the null hypothesis of no cultural bias to specify bias and alter the practical implications of Type II errors. Such implications include missing the cultural/ racial mistrust of African Americans, the fear of loss of face in Asian Americans, and culture-bound syndromes, such as Latinas’ ataque de nervios . Thus, therapists have to question their belief that everyone is basically the same or that one can operate beyond political, historical, and cultural influences. Therapy is sidetracked in the case of both errors. Openness to Individual Differences While gaining self-efficacy in one’s ability to work with cultur- ally diverse people, the therapist is open to different ways of thinking about the individuality of a culturally different client. S. Sue (1998) described knowing how to appropriately categorize experiences as cultural, knowing when to generalize and be inclu- sive, and knowing when to individualize and be exclusive as “dynamic sizing” (p. 446) of the client. Dynamic sizing will come naturally to therapists who can analyze parts within themselves that are cultural, racial, universal, demographic, sexual, and indi- vidually distinct and that integrate to form their unique whole person. Keeping in mind the personal and situation-specific factors unique to the client falls within the therapist’s diversity compe- tence. While recognizing people as different from but equal to oneself, it is necessary for the therapist to find a common ground. The common ground, for example, could be the treatment goal, as requested by the client and agreed on by the therapist. The thera- pist’s focus on the treatment goal prevents cultural conflict. Awareness of White Racial Identity Attitudes and Privilege As stated by Parker, Moore, and Neimeyer (1998), “One as- sumption in the literature is that White therapists can better un- derstand others when they can understand their own racial identity attitudes and development” (p. 302). Effective diversity training requires that a White trainee must work through various levels of White racial identity development, such as obliviousness about race relations in the United States (called contact). In addition, McIntosh’s (2001) article on White privilege and male privilege enables many trainees to understand the “invisible package of unearned assets that [White people] can count on cashing in each day” (p. 95). Hoopes (1979) theorized that intercultural learning progresses from ethnocentrism (i.e., believing one’s culture is the best and being unaware of other cultures) to an awareness, under- standing, and eventual acceptance of other cultures and then to appreciating and selectively adopting diverse cultural perspectives. Similarly, Helms (1995) contended that if White therapists con- tinued to progress along the lines of her racial identity model, they would adopt affirmative, progressive interactions with their clients of color. Cultural Self-Assessment Tools A trainee provides a portfolio of self-assessments that explicates an individual’s efforts and progress in cultural self-awareness and knowledge. It is reasonable to assume that therapists will more likely recognize biases and question assumptions about clients when they have professional guidelines for self-monitoring, and they will also acquire knowledge about diversity characteristics of 661 CULTURAL SELF-AWARENESS ASSESSSMENT This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

their clients to be in compliance with the accreditation require- ments of the American Psychological Association (APA) and the Association for Psychology Postdoctoral and Internship Centers. Therapists incorporate criteria for self-assessment based on the APA ethical principles (e.g., Competence 2.01[b] Boundaries of Competence; Human Relations 3.01 Unfair Discrimination, 3.02 Sexual Harassment, 3.03 Other Harassment; Principle E: Respect for People’s Right and Dignity; APA, 2002). Trainees assess themselves on recent mandates, the “Profes- sional Practice Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients” (APA, 2000) and the “Guidelines on Mul- ticultural Education and Training, Research, Practice, and Orga- nizational Change for Psychologists” (APA, 2003). Guidelines for Cultural Competence in the Treatment of Ethnic Minority Popu- lations from the Council of National Psychological Associations for the Advancement of Ethnic Minority Issues (2002) is also relevant. Therapists can use these professional documents to eval- uate their diversity sensitivity both in their belief system and in their professional practice. Within the competency domain of therapists’ awareness of their own assumptions, values, and biases (Arredondo et al., 1996; D. Sue et al., 1992), there are specific statements (see also the introduction and Table 1) that therapists can refer to for guidance; for example, “Culturally skilled counselors are constantly seeking to understand themselves as racial and cultural beings and are actively seeking a nonracist identity” (D. Sue et al., 1992, p. 482). Self-assessment to identify attitudes and behaviors may include the use of journaling (Carter, 2003), process notes (Roysircar, Gard, Hubbell, & Ortega, 2005), self-reflection skills (Pedersen, 1994; also discussed in this article), and critical incidents (Brislin, 1986; also discussed in this article). Multicultural competency self-report measures for therapists have been in use since the early 1990s. Among the most widely used measures are the following: the Multicultural-Awareness-Knowledge-Skills Survey (D’Andrea, Daniels, & Heck, 1991), the Multicultural Counseling Inventory (MCI; Sodowsky et al., 1994), and the Multicultural Counseling Knowledge and Awareness Scale (Ponterotto et al., 1996). In general, these self-report measures represent the multicultural competency tripartite model of awareness, knowledge, and skills, as well as counseling relationships and worldview biases. Table 1 provides a summary of item contents of two subscales, Multicul- tural Awareness and Multicultural Counseling Relationship, of the MCI self-report measure (Sodowsky et al., 1994). Therapists may also assess their competency to work with LGB clients using Dillon and Worthington’s (2003) Lesbian, Gay, and Bisexual Affirmative Counseling Self-Efficacy Inventory. It is designed as a self-report measure to assess five affirmative therapy behaviors: application of knowledge, advocacy skills, self- awareness, relationship, and assessment skills. The person of the therapist is critical, with the use of the self as a tool at the core of diversity competence. Varied methods of self-assessment allow competency judgments to be grounded in a broad range of behaviors. These stimulate discussion, demonstrate mastery of specific concepts, integrate information from different diversity domains (culture, LGB, ageism, ability status), and can demonstrate how one training process (i.e., self-assessment in the case of this article) can effectively build competence. Self-Assessment Curriculum I use a cultural self-awareness assessment curriculum (C-SAA), which has measurable learning goals and objectives. The C-SAA model is used in culturally homogeneous settings, such as predom- inantly White institutions, as a means of increasing cultural aware- ness among trainees who have limited day-to-day diversity expe- rience. To borrow from Cushman’s (1995) metaphor of the cultural clearing, trainees engage in personal expeditions beyond their currently known worldviews. The curriculum provides guidance for holding interviews with culturally different individuals in the trainees’ local community. In these meetings, trainees exchange social communications and friendship. They are attentive to culturally empathic listening skills. The C-SAA curriculum seeks to promote a healthy sense of interpersonal agency and cultural identity in trainees through these dyadic interactions (Roysircar, 2003), followed with guided ex- ploration in session process notes of trainees’ awareness of self and others (Roysircar et al., 2005). The C-SAA curriculum provides a means with which students can begin to safely explore (a) awareness of their own cultural assumptions, values, and biases, (b) awareness of others’ cultural worldviews, and (c) relationship responses toward others who are culturally different from themselves. Clearly defined instructional goals are developed within these three areas. Structured classroom exercises (e.g., reflecting teams, individual interviews, and the writing of process notes) are designed to facilitate the actualization of these goals. The Appendix illustrates a classroom group activity in which trainees practice a self-disclosure exercise in cultural self-awareness. The C-SAA curriculum has three goals with re- spective objectives, which are observed and measured with various evaluation strategies. C-SAA Learning Goals, Objectives, and Evaluation Goal A. Trainees will expand their awareness of their own cultural values and biases. The objectives are as follows: 1. Trainees will describe in weekly process notes (Roysircar et al., 2005) their beliefs and attitudes about interviewees with dif- ferent racial, ethnic, and cultural backgrounds, sexual orientations, religions, levels of socioeconomic status, abilities, ages, and so forth. 2. Trainees can articulate their knowledge about their cultural backgrounds (including the arts, sense of beauty, history, cultural practices, and spiritual or religious traditions), gender attributions, sexual identities, families of origin and genealogies, levels of socioeconomic status, education, and attitudes toward the disabled and the elderly, and so forth. They can do this in the classroom as members of reflecting teams participating in a self-disclosure group activity (see the Appendix) and in a final case- conceptualization paper (DeFrino, 2003; Sweet & Estey, 2003; Uchison, 2003). 3. Trainees can demonstrate their interpersonal attitudes relative to interactions in diversity-related social situations through self- report instruments, such as the MCI (Sodowsky et al., 1994), as well as through measures of racial identity and consciousness, working alliance, locus of control, causal attribution, universality– diversity, prejudiced reactions and discrimination, and homopho- bia (see Roysircar et al., 2005, for findings on some of these variables). 662 ROYSIRCAR This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

centered on me and my attempt to come to terms with any issue that Mildred had already resolved in her own life. So I struggled with whether to share with her my own anxiety around the pros- pect of death. I finally decided to simply express my admiration for her having the courage to confront this issue and come to terms with it in her life. I added to her that I am still attempting to define for myself the idea of nonbeing. Mildred presents as a very intellectual person. However, I deliberately chose not to elaborate on the events that have con- fronted me: my fears of terrorism, September 11th, my daughter’s car accident, and my impending divorce. I felt that, although it was important for me to share with her to some extent to preserve the authenticity of our relationship, it would have been inappropriate to elaborate in detail on issues I am confronting in my own life. I discovered an amazing revelation in sharing with her my own discomfort with death. The proverbial elephant left the room. Again, I may not have revealed myself to someone of lesser insight than Mildred. What transpired was a wonderful conversation about key existential issues that we must all face at some point in our lives, including the prospect of nonbeing. Mildred could appreciate my hesitancy and revealed that she felt the same way at my age. My concern about revealing this part of myself to my interviewee was that she would feel compelled to avoid the subject, but fortunately this was not the case. This one issue was a critical incident in my relationship with my interviewee and proved to be something that drew us closer together. Reflection on Cultural Invisibility and Advocacy A critical incident occurred when we were talking about health care. Marie told me that many of her female-to-male transgender friends had experienced a lot of bias in health care, including mental health services. She explained that many of them had not had a gynecological appointment or sought therapy because of the bias that they had experienced from health professionals. I com- mented that as a lesbian, I did not think that was the case in such an open-minded, queer-friendly town as ours. Marie was discour- aged with my apparent ignorance about the experiences of trans- gender individuals. She said that discrimination happens every- where, even here. My difficulty was that I had a hard time believing that the same people who recognized my female partner as my spouse and had given us rights equal to those of heterosex- ual couples would not be sensitive to the issues and bias faced by trans people. I acknowledged my privilege to Marie. I acknowl- edged that lesbians who have fought prejudice long and hard also practice their own form of discrimination. I have begun to believe that if the APA’s “Professional Practice Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients” (APA, 2000) had addressed the concerns of transgender, then psychologists would have a more open and informed mind for work with transsexuals. I intend to contact APA’s Public Interest Directorate as well as the president of APA’s LGB Division regarding their exclusion of transgender people from their re- search, training, ethical principles, and public policy agenda. Connection With the Culturally Different Person’s Uniqueness Missun-Kim stated early in our meetings that because of her new location and being in a sea of White faces, when she looks in a mirror, she no longer recognizes herself. This statement hit me like a ton of bricks. This is something that I did not know— something that I never have had to experience because I grew up in a mostly White community, and I am used to not seeing others like me, a person of color. This gave me new insight into what it is like for other people of color to move from a location where every one looks like them to one where no one looks like them. While I have always felt invisible to others, Missun-Kim was becoming invisible to herself. I saw that people who are different experience an array of factors that are disconcerting, in addition to racism, prejudice, and language difficulties. I asked Missun-Kim whether she felt extreme frustration in not being able to express herself fully because she didn’t feel like herself. Missun-Kim said that she felt numb and had not expressed anger since she left Korea. As a biracial ethnic minority person, I have experienced racism first hand. However, this critical incident was a forceful reminder that to be multiculturally competent is not just to know about racism. It is important to know a minority person’s internalization of differences that could cause a narrowing of perceptual focus and detachment from one’s surroundings. Analysis of Overgeneralization of Similarities Teresa and I are similar ages, both involved in academic envi- ronments, and both from middle class families. We also look and dress similarly. Although these things seem quite superficial, I recognized a tendency in me to seek out and even possibly over- emphasize these similarities because it provided me with both the groundwork and the comfort level to build our relationship upon. I do not think identifying common ground between two individuals is generally problematic when making a connection such as this; however, I do believe it initially hindered my ability to encourage Teresa to speak about her individual experiences. This triggered me to ask if her parents were still together. “Oh yes,” she re- sponded, “my parents do not believe in divorce.” This put a completely different spin on my view of her family and the information she had given me up to that point regarding her father’s lack of responsibility, her life in two households separated by an ocean, and the childcare provided by her grandparents when she and her sister were young. Had I continued to operate on the basis of my assumptions about nuclear families, marriage, and divorce, a very important piece of Teresa’s family makeup would have been misunderstood. Self-Reflection Outcomes The expected outcome for trainees’ self-reflection was to help trainees become better informed about their cultural heritage and what it means to be a member of a race and culture. The results, as implied by the presented excerpts, were increased understanding of self and others and a greater appreciation and respect for differences. Conclusion Self-assessment of trainees on their increasing cultural self- awareness and understanding of the worldviews of the culturally 664 ROYSIRCAR This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

different might give them a sense of empowerment with regard to competent multicultural practice. Increased trainee self-efficacy is important because the practice of multicultural competencies can result in empirically verifiable delivery of effective service (e.g., Fuertes, Mueller, Chauhan, Walker, & Ladany, 2002). From the perspective of the culturally different person, the therapist is a significant representative of the dominant culture. The therapist’s openness and personalization of cultural knowledge and affirming exchanges might be critical to the culturally different person’s overall attitude toward psychological services. In conclusion, it is critical for all therapists to understand the impact of their cultural “programming” on their development of self, their perceptions of others who are different, and their preferred theoretical orientation for interventions. 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