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"Building a Sane Society and Transforming Psychology and Mental Health-Care"
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The cultural context of psychology: Questions and answers for accurate research and appropriate practice Paul Pedersen, University of Alabama-Birmingham, Robert Carter, Columbia University & Joseph Ponterotto, Fordham University
January, 1996
* submitted to the journal Cultural Diversity and Mental Health
An accurate psychological assessment, meaningful psychological interpretation and appropriate psychological intervention requires that behaviors be understood in their cultural context where those behaviors were learned. As psychologists become more aware of the complex and dynamic cultural contexts in which our behaviors are learned we become aware of the many "unanswered questions" about the cultural context of psychology. In August, 1995 Robert Carter from Columbia Teachers College, Jim Nageotte from SAGE Press, Paul Pedersen from Syracuse University and Joe Ponterotto from Fordham University organized a two day conference focusing on psychology in the context of cultures. The forum was intended to raise questions and discuss answers about research gaps, appropriate theory and competent practice at Lubin House, a Syracuse University Conference Center at 11 East 61st St, New York, N.Y..
1. Rationale:
Most conferences focus on lengthy presentations by a small group to the relatively passive audience of listeners. There is usually little or no time for questions and discussions of issues after the presentations. Recognizing the considerable expertise in the audience that is underutilized, this conference was designed as a conference without formal presentations. The plan was to move directly to the discussion of previously identified stimulus questions so that the audience could actively participate. In the process of identifying priority questions for discussion the conference organizers hoped to (1) identify topics for dissertations on culture and mental health issues, (2) identify networks of resources for collaborative research and publication on the cultural context of psychology, (3) to mobilize the synergy of the group working together generating answers to difficult questions, (4) to produce a document recording ideas from the discussion for dissemination to other interested colleagues in the field, and (5) to experiment with an innovative conference designed to focus on discussion rather than presentations. The facilitators were invited to identify questions based on their extensive publications and visibility as leaders in the field of multicultural counseling. There are, of course, many other professionals who are also well known in the field but who were unavailable to participate. In addition four doctoral students from Syracuse University Dept of Counseling & Human Services, were recruited to take notes during the discussion session. These students were Beverly Brunell, Esther Lopez-Bernstein, Thomas Matthews and Christopher Weiss. The notes were taken on lap-top computers and the documents were eventually merged into a 120 page single space document from the discussions. The conference was organized as a "think tank" with twenty seven conversation groups focusing on a different set of pressing questions about the latest research, current and emerging theory and insights from across the country on theory and practice. There were no formal presentations. Each session was led by a facilitator who had identified from three to five difficult and "unanswered questions" about the cultural context of psychology which were then discussed by the whole group. The emphasis was on small group discussion with full audience participation throughout. This brief article will attempt to highlight selected issues raised in the discussion groups at the conference. The discussion will organize the questions and answers into three groups; those emphasizing awareness of cultural assumptions, those emphasizing knowledge about particular cultures and those emphasizing the skills needed to provide accurate and appropriate direct service to clients in their cultural contexts.
2. Questions about cultural awareness:
Most of the questions about cultural awareness related to underlying assumptions about culture, defining culture-related terms and identifying "starting points" for accurately interpreting psychological data in its cultural context. Farah Ibrahim from the University of Connecticut-Storrs asked what variables are defined as culture and why those variables are so controversial. * Are we watering down the definition of culture until it becomes meaningless? * Is culture more "personal" and less abstract than other constructs? * Is there an implicit assumption that in the USA there is only one culture? * Do we need an operational definition and more terms to define it? * Is culture also a process where people from different groups have different narratives? * Is culture a conversation about sharing power? * s gender also anchored in a cultural context? * How does culture mediate gender? Don Locke from the University of North Carolina-Asheville asked why we need so many "umbrella" terms to define racial and ethnic groups and "who speaks for multiculturalism?" * Can only "insider" group members speak for the group in a narrow rather than a broad focus? * How can we organize the confusion of terminology about multiculturalism and the wide range of emotions attached to these terms. * Do the political aspects of culture further increase the controversy in culture-related language? * Can we agree on "what is culture?" * Is clearly defined terminology essential to a meaningful discussion. Frederick Leong from Ohio State University attacked the underlying assumptions of a linear, positivistic, and empirical approach to epistemology. These assumptions have led to a simplistic perspective and a unidimensional model of human behavior rather than the complementarity of multiple different perspectives. * How do we integrate culture-general (etic) with culture-specific (emic) models and theories in cross-cultural counseling? * How can a multicultural perspective help psychology become more multidimensional? * Is part of the problem in psychology the tendency to look at one variable independently from others while ignoring the complex cultural context? * Does each individual function at all three levels, universal, individual and group simultaneously? * Does complex adaptive systems theory suggest a means of identifying complex and dynamic cultural patterns through chaos theory and complexity theory where many interactive variables are combined? Janet Helms from the University of Maryland and Robert Carter from Teachers College, Columbia University focused on the definition of terms and the importance of "race". * Has the dominant White culture invented terms like ethnicity because they are uncomfortable with "race" issues? * * Do factors of guilt and shame complicate "racial" issues, especially for the dominant culture? * How can people who have such different cultural values and access to power even communicate about race issues? * Is race a pseudo-biological term that has sociopolitical meaning? * Can we start by developing scales to assess race or racism and by being more active in organizations? Robert Carter from Teachers College, Columbia University focused on how race issues influence therapy. * Do we all operate within a culture using language to communicate meaning across geographical boundaries? * Is race different from the other cultural categories as a more permanent characteristic that was used to construct society? * Does race evoke emotion and therefore tends to be "untouchable?" * Is race a real part of both the client's and the counselor's perspective? * Does race influence human development and personality through perception. * Does race function like gender in making a difference? * Can we get anywhere if we do not agree that we all have a "race"? * Is most psychological research about race...the "white" race? Grace Powless Age from Cornell University asked what competencies are necessary when working with American Indians. * How does one integrate traditional and contemporary healing practices? * How does one integrate traditional and contemporary healing practices in respect to the historical tension between traditional and contemporary healing practices? * How is power and control defined in the American Indian worldview? * Do the words normal, healthy, healing and wellness have the same meaning in the American Indian context as elsewhere? * How do indigenous self-determination and termination play a role in the identity and understanding of American Indians in their communities? * How does one address the urban versus rural reservation and generational differences among American Indian communities? * Is the American Indian identity more than a race? * Has the romanticization of American Indian identity contributed to the confusion? * Given the history and training of traditional clinical psychology programs, is there a need to consider a "high-context" worldview and a history of colonial ("Whitening processes") exploitation, appropriation, and extermination as part of the context? Timothy Thomason from Northern Arizona University asked what we need to know to provide culturally appropriate assessment and intervention services to American Indians. * Do we need more participatory action model approaches on treatment programs? * Do we need better criteria of effectiveness in alcohol treatment programs? * Do we need better translations of indigenous traditional Indian healing? * Do we need to redefine "mental health" in the American Indian more holistic context? * Do we need better indigenous assessment measures?. * Do we need a more appropriate theory regarding culturally appropriate psychological services for American Indians? * Do we need psychotherapeutic methodologies that incorporate storytelling, talking circles, sweat-lodge/vision quest perspectives? * Do we need a more spiritual emphasis regarding healing processes? Paul Pedersen from the University of Alabama at Birmingham asked questions about the generic application of multiculturalism to all psychological interventions. * Can we find "common ground" between dominant culture and minority member colleagues and clients? * How can we identify the changing salience of broadly defined cultural variables in an interview? * Can we compensate for cultural bias in the theory and practice of counseling without throwing out theories, tests and traditional psychological procedures? * Is there an alternative to relativism and absolutism in describing guidelines for ethical behavior in multicultural settings? * Is cultural encapsulation getting better or getting worse in fields of applied psychology? * How can we demonstrate the positive value of making all theories of counseling more "culture-centered?" * How can we get textbooks, tests and professional guidelines to make their underlying assumptions explicit rather than implicit? If behavior is learned and displayed in a cultural context then how can that behavior be assessed accurately, interpreted meaningfully, and changed appropriately without regard for that cultural context?
3. Questions about cultural knowledge:
Some of the discussions emphasized the need for specific facts and information about the cultural context as a necessary step in giving appropriate care. The emphasis on meaningful knowledge presumed accurate assumptions about the cultural context in the first place. Harold Cheatham from Pennsylvania State University asked about the danger of doing "too much" for the client and moving "too far" outside the traditional counseling model. * As the counselor works to make sense of the client's issues within the context of multiculturalism, when does the counselor begin to do too much for the client? * How will or does the counselor determine when this boundary has been reached/crossed? * Are there guidelines for the practice of the counselor extending himself or herself beyond the psychological counseling walls, or is this a decision the counselor must make? * After years of struggle, how do you envision the end product of equality among culture, gender and lifestyle? * What would it look, sound, and feel like to live in that environment? * How would members of the society at large interact with one another (socially , in business, in education, in government, as neighbors)? * To what images do we strive? * How do/can we train counselors to assess the extent to which their own backgrounds affect their working relationships? It is fairly well established that various ethnic groups have different orientations to factors and values such as family, community, time, age, and so on. Counselors need to be aware of these differences across groups, but do they also need to be aware of within-group differences (e.g. within-group distribution and variability of time orientation)? * How do we prepare counselors to assess and work within the individual client's within-group differences? Oliva Espin from San Diego State University asked about women's roles when a group migrates to an unfamiliar society. * Are behaviors necessarily modified, requiring migrants to become more rigid and "traditionalizing" the roles and behavior, especially of women and girls to protect their culture? * Do many conflicts of migrant groups relate to male-female relationships? * Does the provider want to be respectful of the migrant's culture but not condone violence or the denial of opportunities for women in the host society? * Is cultural sensitivity a way of condoning injustices? * Should culture be preserved at the expense of women who "carry culture on their backs"? * Is the acculturation/adaptation process different for women and men? * Can an immigrant/refugee woman preserve cultural identity while acculturating/adapting to U.S. society? * Is narrative research, which allows women to tell their stories useful? * Why do so many of us come from immigrant families where, once the immigrants have "blended," the stories of pain are forgotten? * Do migrants become scapegoats of social problems in the stereotype? * Do providers need more sensitive training to provide for migrants in an equitable way? Lillian Comas-Diaz from Transcultural Mental Health Institute, Washington D.C. asked questions about how cross-cultural practice might influence general psychological practice. * The issues of managed care are complicated by cultural issues such as choice of care-giver, uninformed providers, advocacy of client's identity and involvement of paraprofessionals. *Good clinical care requires political involvement. Providers can not provide quality care if they can not communicate accurately and meaningfully with their clients. * Providers of psychological services need to become more politically involved and historically aware beyond protecting the status quo. * More training of therapists in culturally different perspectives from a practical as well as a theoretical perspective is essential. * Changes in accreditation processes are important to sanction cultural issues as important. * Culture specific and cultural general approaches are both necessary. * DSM-IV's attention to cultural issues needs define clinical skills in a cultural context rather than put culture in a clinical context. Oliva Espin from San Diego State University asked about women's roles when a group migrates to an unfamiliar society. * Behaviors are necessarily modified requiring the migrants to "rigidify" and "traditionalize" the roles and behavior of especially women and girls to protect their culture. * Many conflicts of migrant groups relate to male-female relationships. * The provider wants to be respectful of the migrant's culture but not condone violence or the denial of opportunities for women in the host society. * Cultural sensitivity can become a way of condoning injustices. * Should culture be preserved at the expense of women who "carry culture on their backs!" * The acculturation/adaptation process is different for women than for men. * Can an immigrant/refugee woman preserve cultural identity while acculturating/adapting to the U.S. society? * Narrative research allowing women to tell their stories is useful. * Many of us come from immigrant families and can more easily identify with the migrants, but once the migrants have "blended" the stories of pain are forgotten. * Migrants become scapegoats of social problems in the stereotype. * Providers need more sensitive training to provide for migrants in an equitable way. Nadya Fouad from The University of Wisconsin-Milwaukee asked questions about how gender differences or sexual preference differences influenced career choices, making dominant culture heterosexual males the criterion group for everyone else. * We need new norms that are sensitive to different cultural contexts. * We need to re-evaluate traditional career development theories regarding their cultural sensitivity. * Realistic choices need to be defined for minority group persons that look at satisfaction as well as satisfactoriness in a balanced perspective. * How does vocational choice affect identity issues in multicultural contexts? * Traditional vocational concepts such as "vocational maturity" and "stage/ladder focus on career development need to be redefined according to the cultural context and gender. * The criteria of success needs to be re-examined for majority and minority cultural contexts. * The role of family needs to be re-integrated into each cultural context as a complex and dynamic variable. * Power differences and issues of helplessness become especially important in career counseling across cultures. Anderson Franklin from City University of New York asked questions about psychological invisibility and social marginalization especially among African-American men. * Invisibility means being in a place where you are not acknowledged, not recognized, have no sense of gratification and are unsure if it is legitimate or valid to be present in that place. * Churches and cultural groups serve an important function in validating identity. * Issues of culture and race become more salient because of social marginalization and dissonance occurs when "the best theory going" just doesn't fit. * Social marginalization has to do with the social indicators are represented by statistical measures of social inequities. * By recognizing and valuing the importance of identity the clinician can reduce the effect of marginalization, helping the client struggle against invisibility and become more empowered. * The Black male is particularly vulnerable to marginalization without creating a Black male stereotype. * The system determines visibility but perpetuates invisibility to protect itself. Jane Fried from Northeastern University asked how we can energize a dialogue between counseling and the other social sciences. * Self-reflective anthro/ethnographer roles have developed from notions of cultural "common sense" to social and individual change. * There are newly emerging "transdisciplines" of cultural psychology and self-reflexive anthropology that are having an influence on multicultural counseling. * The importance of environment is critical to the cultural context. * We need to consider which "world" we are empowering the culturally different client to function in. * Science has been used as a means of colonializaing and new applications of "elevated science" have emerged. * We need to target our changes selectively to make progress within each cultural context. * The rules are still to a large degree controlled by a narrowly defined typically White male group of insiders. * Anthropology trains providers to ask the right questions and develop a more dynamic and holistic model for assessment. * The tendency is for the dominant culture to only make changes that benefit itself. Barbara Okun from Northeastern University asked questions about conflicting loyalties across class and gender differences. * Training sometimes strengthens an inflexible perspective and prevents change such as by minimalizing culture. * Change agents can include both insiders and outsiders with the threat most often coming from "inside" rather than outside the group. * The threat is more real to those inside the group who can lose power or tenure and have more to risk. * "Old boy" networks tend to enforce insider rules and "protect" against outsider intervention. * Culturally sensitive insiders have a task/role to mentor for constructive change. * Simplistic solutions to complex problems are used to create a false unity within the group. * The real problems of taking on the system by insiders can not be minimalized. * Factors of age and gender mediate questions of loyalty for others within the group and protecting the status quo. * A critical mass within the group is needed to generate energy for constructive change in a proactive rather than reactive effort. * Training is needed to address issues of backlash and polarization on issues of acculturation.
4. Questions about cultural skill:
A third category of discussion groups focused on skill-based direct service interventions or applications of culturally accurate awareness and culturally grounded knowledge. The questions and ideas brought out in discussion were action oriented. Patricia Arredondo from Empowerment Workshops, Boston, Massachusetts focused on questions of organizational and business management practices. * What language would best relate to the organizational setting and which multicultural models could be applied to business environments? * It is important to broaden the discussion from solely clinical to the more inclusive organizational context. * Diversity in organizations requires that we emphasize relationship factors as they relate to empowerment and ultimately to the "bottom line." * Organizations resist putting personal issues ahead of bottom-line factors and the dominant culture in organizations is especially resistant to change by minority groups. * In the top-down model change starts at the top and works its way down. * Change is uncomfortable because it disrupts the hierarchy at the personal and organizational level. * Coalitions can be formed to facilitate constructive change and help systems adapt. * The "culture of organizations" is about fluidity and adaptation to chaos. * Diversity issues are still not considered a high priority in organizations and are met with "quick-fix" strategies. * There is little incentive for organizational leaders to participate in diversity training even when they are themselves minority group members. Richard Brislin from the East West Center, Honolulu, Hawaii, focused on questions of multicultural training. * Classroom activities that simulate intercultural experiences tend to work best for training. * Groups that are more culturally diverse are easier to teach than homogenous and particularly dominant culture groups. * We can learn our cultural patterns from persons of other cultures who see us differently than we see ourselves. * Working together to accomplish a task or going "somewhere where you're different" also are effective training approaches. * Often minority persons, who experience the consequences of "being different" more than dominant culture persons resent the "obligation" to teach or train those dominant culture peers and feel this can become another example of their "being used." * Good training needs to provide a safe environment where people can take risks. * It is frustrating for the instructor to meet the widely divergent training needs of students. * Good training is based on clearly defined goals, investment of emotional energy, favorable conditions for cultural contact, based on careful homework and scientific methods and a focus on both content and process. Ann Kathleen Burlew from the University of Cincinnati focused on questions of getting published in the multicultural area. * Mainstream journals are more valuable for promotion tenure review even though they will be less receptive to culture-based articles. * Traditional research methods are more highly regarded even though they may be less appropriate. * The authors most qualified to write about culture are often overwhelmed by their own practical involvement. * The most recognized assessment measures are typically not validated with minority populations. * More emphasis on mentoring is needed to recruit new authors, special issues of mainstream journals, more emphasis needs to be placed on "whiteness" as well as "blackness" factors. * There needs to be a higher level of commitment to multiculturalism by mainstream journals and the dominant culture. * The polarization of quantitative vs. qualitative methodology and research vs. practice applications needs to be reconciled. * Practice-based criterion groups need to be developed to advise researchers writing for publication. * The quality of multicultural publications will be enhanced when there is an effective network linking people dong culturally responsive research with people publishing culturally responsive research. J. Manuel Casas from the University of California, Santa Barbara raised questions on the implementation o a Multi-Agency Integrated System of Care (MISC) designed to provide comprehensive and integrated child-centered, family-focused, autonomy-building, community-based, rationally managed and culturally competent services. * To accomplish this goal we need to identify the most effective methodologies for assessment, define effectiveness in working with culturally distinct groups, identify appropriate skills, develop more culturally appropriate instruments and generate racial/ethnic criteria for each target population. * Each cultural context is significantly and uniquely different. * We need to get beyond statistical significance to achieve actual significance in our research. * There is a stigma attached to many service agencies and "collaboration" with those agencies as a client. * The best place to start is with direct involvement through immersion in the community and permanent rather than temporary involvement of the care-takers with the population. * Outsider providers may know the needs of a community without being able to adequately and appropriately meet those needs. * The political consequences often overshadow humanitarian consequences of services in minority communities. Michael D'Andrea from the University of Hawaii asked questions about competencies for working with culturally diverse client populations. * Why are those competencies not more prominent in accreditation rules and why are multicultural competencies not more strongly advocated by the APA and other professional counselor organizations. * The American Counseling Association is considering including multicultural competencies in their guidelines for certification and accreditation and is currently undergoing a three year sensitivity training program for the governing board. * We need to identify indigenous helping frameworks as alternatives to traditional counseling approaches. * We need to distinguish between personal and cultural dimensions of identity as we develop competencies. * Competencies need not just to be evaluated but activated toward culture-sensitive change. * Minorities are "expected" to have more cultural competence than dominant culture counselors according to the stereotype. * How important is "comfort" as an outcome measure of competence? * How do we address colleagues unwilling to become competent? * Conformity to the status quo inhibits new competencies with the focus often on the provider rather than the consumer. James Jackson from the University of Michigan asked questions about multicultural research paradigms. * We need to examine "natural" linkages among cross-ethnic and cross-national approaches to research. * We need to untangle biological, structural and social factors to distinguish the "universal" processes from those that are culturally bounded. * What are the differences and similarities among descriptive comparative, comparative outcome and comparative process research? * Are ethnic differences merely the result of exposure to a different context? * We need to step outside the US domestic scene to understand how ethnic groups in other countries define themselves. * Each country defines dominant and subordinate groups differently. * Psychology claims to consider social variables but has tended to disregard many contextual factors and focus on the "dominant" groups in the U.S. and elsewhere. * The basis of subjugation is economic more than morality. * Neuroticism and pathology in the dominant group has been functional and being a bigot results in higher levels of stress. * We need to disentangle adaptive behaviors from those that are culturally determined. * The sending-receiving model of research can complement other approaches. * Complexity and context are the crucial bases for cross-cultural research. Sunkyo Kwon from Humboldt University, Berlin, Germany raised questions about bridging information gaps through the internet. * Many non-U.S. based scholars do research---however valuable--- that never reaches a larger audience because of the limits of conventional approaches of dissemination. * Colleagues currently working on culture-related problems work in unnecessary isolation around the world. * There are uncountable numbers of datasets around the world that have never been fully analyzed or examined comparatively. * Where and how does the accumulated body of scientific knowledge about cross-cultural psychology become established? * Problems of reconciling diversity, merging information, synthesis, dissemination and the research-practice gap inhibit coordination of valuable information. * The lag in disseminating or publishing information leads to isolation. * Computers introduce email, usenet, file transfer protocols, worldwide web and other facilities to reduce the lag time of information dissemination. * The irony is those most proficient with technology seem to be the least productive in producing research. * Colleagues from more industrialized countries benefit most from computer technology and it can lead to domination by an elite upperclass. * We need new skills to manage information overload. Joseph Ponterotto from Fordham University asked questions based on trends for the future. * The subfields of psychology---often working in isolation--- have focused increased attention to multiculturalism and diversity. * An interdisciplinary knowledge base would assist both research and practice. * What are the future trends in counseling, clinical, social work, family psychology and other subfields of psychology and how can psychologists from these different disciplines work together? * We need to know ourselves first and to listen carefully focusing more on self-awareness as a professional competency. * We need to know the historical, political, spiritual context before intervening. * We need to get beyond stereotyping but not depend on the client to teach us. * The field of Counseling has taken leadership in promoting multiculturalism and interdisciplinary connections among the subfields of psychology. * Change needs to accommodate emotional as well as intellectual data about culture requiring that we create a "safe place" to exchange ideas. * Whites need to become more actively involved, perhaps as part of multicultural teams for research, teaching and training.
5. Conclusion:
The Lubin House conference attempted to (1) bring together colleagues interested in the cultural context of psychology to exchange ideas, (2) identify some of the research gaps regarding the cultural context of psychology, (3) generate connections between networks of colleagues for future collaboration, (4) try on the model of a conference without presentations but almost entirely discussion-focused, (5) stimulate dissertation research and publications on new ideas about multiculturalism and (6) to provide opportunities for support and sharing among colleagues working on multicultural issues. The meeting accomplished other serendipitous goals beyond the intended agenda in a shared feeling of "good will" and solidarity. Participants who attended the APA meetings immediately following this conference volunteered positive examples of insights or connections made through this meeting. The intangible outcomes may ultimately become the most important through a ripple effect in the profession, even though those outcomes may never be explicitly connected to this conference. Although the conference was not evaluated in any formal sense the feedback from participants has been uniformly positive and anecdotal data suggests that the conference had valuable meaning to most if not all participants. A continuing theme of the conference emphasized the importance of activism and the dangers of passivity regarding the cultural context of psychology. We need to model more active and less passive alternatives in our psychological applications to cultural contexts. The traditionally passive model of one presenter reading a paper to hundreds of highly trained passively listening colleagues is not an efficient way to disseminate understanding. It is not just the content of the services we provide but also the process by which we provide that content which is in need of change.
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