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Canadian Journal of Counselling / Revue canadienne de counseling I 2001, Vol. 35:1 (^49)
Changing the Face of Multicultural Counselling with
Principles of Change
Roshni Daya
University of Calgary
A B S T R A C T
Discussion in multicultural counselling has focused on whether the culture specific (ernie) or universal position (etic) is more useful. More recently a common factors ap- proach has been introduced. This article provides a critical analysis of each of these positions and introduces the principles of change approach as a way of unifying multicultural counselling and moving the conversation to a more applied level. Direc- tions for future research are provided.
R E S U M E
Jusqu'à présent, les discussions dans le domaine du counseling multiculturel ont eu pour objet de déterminer quelle approche était la plus utile : une approche particulière à la culture (émique) ou une position universelle (étique). Plus récemment, une approche centrée sur les facteurs communs est apparue. Cet article fournit une analyse critique de chacune de ces approches et en présente une nouvelle axée sur des principes d'évolution, comme moyen d'unifier le counseling multiculturel et de diriger les discussions vers un niveau plus appliqué. Des recommandations pour des recherches futures sont également incluses.
During the past two decades a dialogue about diversity-sensitive counselling has occurred within the counselling profession. The current status of this dia- logue represents a postmodern clash of values (Thomas & Weinrach, 1998). Two popular positions are the culture specific position (ernie) and the universal posi- tion (etic). This paper will begin with a discussion of different definitions of culture that lie at the root of multicultural or diversity-sensitive counselling. A critical analysis of the two predominant approaches — the ernie approach and the etic approach — will be provided, as well as a discussion of the premises upon which each are based. This will be followed by a discussion of the more recent common facrors approach to multicultural counselling. The second part of the paper will focus on how the profession can move beyond the basic debate and into culturally responsive professional practice. The multicultural movement has highlighted the need for counsellors to be prepared for professional practice with clients from cultural backgrounds differ- ent from their own (Arthur, 1998). Both the Canadian Psychological Association (CPA) (1996) and the American Psychological Association (APA) (1993) have recognized the importance of this issue. These associations have recently set guidelines for non-discriminatory practice and standards of training for working with individuals from culturally diverse populations, emphasizing issues perti- nent to therapeutic conduct with culturally diverse populations.
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These steps have been taken in response to research findings that suggest high rates of attrition and low use of mental health services by diverse groups (Sue & McKinney, 1975). Other research has found that only a limited number of doc- toral level APA psychologists indicate feeling highly competent in providing ser- vices to individuals from various ethnic and divetse groups (Allison, Crawford, Echmendia, Robinson, & Knapp, 1994). In addition to involvement by APA and CPA, there has been unprecedented growth in the number of professionals writing about diversity and competency with diverse groups. Research and literature has addressed and articulated profes- sional standards for multicultural counselling competencies (Arredondo et al.,
- and training models (Reynolds, 1995).
D E F I N I T I O N S O F C U L T U R E It has been assertively stated that the field is "moving toward a generic theory of multicultural counselling as a 'fourth force' position, complementary to the other three forces of psychodynamic, behavioural, and humanistic explanations of human behaviour" (Pedersen, 1991, p.7). This view of multicultutal counsel- ling as a fourth force has been shared and endorsed by many researchers (Ibrahim, 1991; Ivey, Ivey, & Semek-Morgan, 1993). Despite this bold position, multicultural counselling is fraught with theoretical ambiguities and tensions. Central to the disarray within the field is the dispute over the meaning of culture. The term culture' has been defined both broadly (inclusive definition) and nar- rowly (exclusive definition).
Inclusive Definition
When broadly defined, culture is a frame of reference from which we encoun- ter ourselves, our lives, and the world around us (Draguns, 1996; Pedersen, 1985). This definition of culture includes values norms, beliefs, attitudes, behaviouts, and traditions that link the individuals of the groups to one another (Leighton, 1982). It may also include demographic variables, status variables, affiliation, and ethnographic variables. When culture is defined broadly, all counselling is multicultural to some extent (Pedersen, 1991).
Exclusionary Definition
A narrow definition of culture limits the variables to ethnicity or nationality (Pedersen, 1991). From this perspective an individual is culturally diverse only if he/she is of different ethnicity or nationality than the majority group. The pro- ponents of an exclusionary definition fear is that if a broad definition of culture is employed the effects of racism against the minority group member will be over- looked (Essandoh, 1996).
Internalized Culture
The resolution to this debate may be found by changing the focus of attention from external culture to the internalized culture of the client. Ho (1995) argued
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Patterson (1996) stressed that the recent emphasis on techniques has dis- tracted the profession from the idea that counsellor competence rests in the per- sonal qualities of the counsellor. The dichotomy of technique versus counsellor qualities set up in Patterson's (1996) position is a false one. The development of these counsellor qualities need not exclude one's skillful ability to apply appro- priate and effective counselling interventions. The application of techniques be- comes dangerous when it is done in a blanket format in the absence of developing the relationship and assessing the appropriateness of the intervention to the specific client, with a unique cultural composition, experiencing a particu- lar distress, in the moment (Paul, 1967).
Pedersen (1996) stressed that saying that all counselling is multicultural is not the same as advocating a single universal system of counselling. From his per- spective, emphasizing the generic dimension of multiculturalism in all counsel- ling teminds the therapist that all behaviout is culturally learned and that it is imporrant to pay attention to the client's cultural context. This approach empha- sizes that the counsellor has a cultural perspective just as the client does. When culture is defined narrowly and only culatte specific techniques ate employed there is the fear that the counsellor will view the client as the only one in the therapeutic encounter who comes from a cultural context. In that case, it be- comes easy for the therapist to encourage the client to shed that cultural context and become like everyone else. Instead, Pedersen's (1991) position that multicultural counselling is a generic approach to counselling encourages coun- sellors to be aware of themselves and their clients as cultural beings placed in the context of larger culrures. With this belief in mind the counsellor becomes able to see clients' cultural milieu changing from moment to moment. The counsellot learns to appreciate the complexity of the individual in constant struggle to bal- ance the ever-changing salience of each aspect of self.
The Ernie Position Supporters of the ernie position espouse that to provide effective mental health service to the culturally diverse client, the therapist must have knowledge specific to that client's culture. When counsellors have conceptualized all of the characteristics of a variety of cultural, racial, and ethnic groups, they will be skill- ful and effective counsellors (Speight et al., 1991). The ernie position is founded upon recommendations of investigators for improving the relationship between therapists and ethnic minority clients. Rec- ommendations typically suggest that therapists improve their knowledge of various cultures and the specific techniques based on this knowledge (Sue &i Zane, 1987). Inherent to these tecommendations is the assumption that cultur- ally diverse clients receive an inferior quality of care because counsellors are unfa- miliar with the cultural backgrounds of their ethnically diverse clients. Lack of knowledge of clients' cultural background means that therapists are unable to devise culturally appropriate tteatment (Sue & Zane, 1987).
Principles of Change (^) 53
Another premise of the ernie position is the belief that most prominent theo- ries of counselling (e.g., behavioural, client-centred, psychodynamic) start from Euro-North American cultural frameworks. These theories reflect the values, mores, customs, philosophies, and language of the culture from which they have originated (Nwachuku & Ivey, 1991). Often the theory is adapted for use with culturally diverse clients. Such an adaptation is ineffective because the values implicit to the theory are often antagonistic to the values and experiences of members of the culturally different group (Sue, Ivey, & Pedersen, 1996). Adapt- ing the theory does not remove or negate the effect of the implicit values repre- sented by the theory. Sue et al. (1996) provide an example. They report that most Western theories emphasize individualism and the development of a separate sense of self. The majority of societies and cultures in the world have a more collective notion of identity. These cultures do not define the psychosocial unit of operation as the individual but instead focus on groups as the most significant unit of operation. Thus, with clients coming from collective cultures it may be more helpful to focus on relationships or the family unit than on the internal intrapsychic di- mension that is most often emphasized in Western frameworks. Instead of adapting existing Euro-North American based theories, the culture-specific approach asserts that counselling theory would be enriched if theorizing began from the point of view of the host culture (Nwachuku & Ivey, 1991). Attempts to do this have been made by Nwachuku and Ivey (1991), who have developed a step model for generating a culture specific theory. In sum, the ernie approach to multicultural counselling emphasizes that theory and techniques best serve the culturally diverse client when they are developed from a culture specific framework, which holds that ethnicity and nationality are the most significant dimensions of culture. The development of these theories can be done through the use of indigenous systems of healing. The emerging com- mon factors perspective of multicultural counselling has taken a different ap- proach to informing therapeutic practice with culturally diverse clients.
T H E C O M M O N F A C T O R S P E R S P E C T I V E Common factors theorists propose that the curative properties of any psycho- therapy lie not in its theoretically unique components, but in the components common to all psychotherapies (Garfield, 1992). This idea was first introduced to counselling in the 1930s (Rosenzweig, 1936), but has only recently received attention in the multicultural counselling literature (Fischer, Jome, & Atkinson, 1998; Sue & Zane, 1987). Frank (1961) is considered the 'father' of the common factors approach. He emphasized the importance of considering factors that are universal, relevant, and common to all psychological and spiritual healing en- counters. The underlying premise of universal healing elements makes the com- mon factors paradigm particularly suitable for multicultural counselling
Sue and Zane ( 1987) were among the first to move in this direction with their assertion that therapist credibility and giving (the client's belief that something has been received from the encounter) in the therapeutic relationship are crucial
Principies of Change (^55)
Fischer et al. (1998) asserted that the four common factors above are the most relevant to multicultural counselling because these factors are transcultural in nature. They believed that none of the above factors exclusively reflect a Euro- North American value system. As multicultural counselling becomes relevant to the professional practice of most counsellors and psychologists, the research and literature in this area contin- ues to grow exponentially. It is common for writers to assert their commitment to either the etic or the ernie position. Unfortunately, this kind of rivalry has masked more important issues and has impacted the credibility of the movement (Weinrach & Thomas, 1996). The common factors approach proposed by Fischer et al. (1998) is a first step to moving beyond the divisive debate to a more fruitful and unifying road for multicultural counselling scholars and practitioners.
A review of the multicultural counselling literature might lead some psychologists to the conclusion that they must choose between two camps, one that says that techniques or rituals associated with their theorerical approach can be applied across all cultures and one that says that psychologists must apply only those techniques from the client's indigineous culture. Instead of choosing between these etic and ernie approaches, we suggest that counsellors can use a common factors approach as a guiding framework for counselling, especially with cul- turally different clients (p. 566).
C O M M O N C R I T I C I S M S The common factors position has been criticized for being overly general and ambiguous in the differentiation of factors. This results in abstract ideas that have little practical value (Sue et al., 1996). An examination of the common factors articulated by Fischer et al., (1998) substantiates the validity of this criti- cism. Though this approach meets its goal of providing an organizational frame- work for the multicultural counselling literature, it gives little direction to therapists who want to know what they can do to alleviate the suffering of the culturally diverse client. The criticism of applicability is also relevant to etic and ernie approaches. The etic approach stresses the multicultural nature of all counselling relationships, but says little about what to do within that relationship. The ernie approach stresses the importance of understanding the client's ethnic background and us- ing techniques derived from that knowledge. This approach has been criticized on the basis that culture specific knowledge and techniques seem to have no relationship to general therapeutic techniques and processes. Sue and Zane (1987) state that "the major problem with approaches emphasizing either cul- tural knowledge or culture specific techniques is that neither is linked to particu- lar processes that result in effective therapy" (p.39) (emphasis added). The emphasis here is on the need to link theory and techniques to psychological pro- cesses so that they can be appropriately utilized in the therapeutic encounter. What is needed is a way for therapists to move beyond the basic debate and into culturally responsive professional practice.
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C U L T U R A L L Y R E S P O N S I V E P R O F E S S I O N A L P R A C T I C E Culturally responsive professional practice can be approached through an ex- amination of the guidelines and professional standards for multicultural compe- tencies. The American Counselling Association (1995), the American Psychological Association (1993), and the Canadian Psychological Association (1996) stated that professionals appreciate that the innate worth of human be- ings is not enhanced or reduced by their culture, nationality, ethnicity, colour, race, status, and/or any other preference of personal characteristic, condition, or status. The question becomes, "What are the criteria used to determine whether competent and responsible professional service is being provided to the cultur- ally diverse client?" To answer this question the Professional Standards and Cer- tification Committee of the Association for Multicultural Counseling and Development was charged with the task of providing guidelines of competence. Sue, Arredondo, and McDavis, (1992) were instrumental in developing the Multicultural Counselling Competencies into the domains of awareness, knowl- edge, and skills. Each of these domains have been described in detail by Arredondo et al., (1996) and Sue et al., (1998).
Guidelines for the Development of Competencies Sue et al., (1998) suggested four principles for guiding the development of one's competencies in these areas. First, the individual must learn from and expe- rience as many cultural sources as possible. Second, the individual must spend time with healthy people of that culture. It is easy for professional practitioners to develop distorted pictures of cultural characteristic because so many of them most often have with people in distress. Third, the individual must learn through real life encounters. Last, the individual must constantly be aware of the manifes- tations of bias in the surrounding context. This outline provides some guidance for counsellors in the process of develop- ing their awareness and knowledge base with respect to multicultural issues. Little is said about the development of skills in this area. Though awareness and knowledge are important components of multicultural counselling competen- cies, these components alone do not facilitate the development of the skills nec- essary to provide culturally responsive treatment. It has been suggested that the combination of awareness, knowledge, and skill is necessary and sufficient for successful multicultural counselling (Pope-Davis & Dings, 1995). It is asserted here that though necessary, these three dimensions are not sufficient for success- ful counselling. The principles of change model may provide the missing link.
P R I N C I P L E S O F C H A N G E — A N A P P L I E D M O D E L The rationale for proposing an approach that is based on common principles of change stems from the position that the processes of change are universal. That is, regardless of the cultural identity and worldview of the client and thera-
5H (^) Roshni Daya
Daya (1999) has abstracted and articulated the core processes of change found in Buddhist psychology. These are having a flexible sense of self, living in the here and now, experiencing, transmuting emotions into wisdom, developing a sense of compassion, openness, and achieving awareness of the interdependency of all systems. If the Eastern and Western change processes are universal, it is important that the therapeutic environment provide the client with the opportunity to experi- ence them. In order to do this each therapist must have an undetstanding of each of these processes and a broad repertoire of skills that would enable affecting them. The skills of the therapist are most crucial at the implementation level. It is necessary for the therapist be able to assess which change processes to implement with any given client and in what manner to do this so that the client will benefit from the experience. Information about the values, beliefs, biases, internalized cultural identity, and worldview of the client is most relevant at this juncture. The therapist will combine that knowledge with an understanding of theoretical beliefs, awareness of personal values and assumprions, and an in-depth under- standing of the change processes to implement an intervention strategy that is appropriate for rhe client in this context. The multicultural counsellor is placed in the position of straddling an interesting fence, employing universal principles of change flexibly and adaptively to the content of the client's individual cultural context (Steenbarger & Pels, 1997). The principles of change paradigm provides a way for the therapist to employ the awareness, knowledge, and skill requirements outlined by the Multicultural Counselling Competencies. Awareness of one's own values and beliefs is helpful in determining one's theoretical approach. Knowledge of theory, the various principles of change, and the client's broad cultural background is necessary. The skill is for the therapist to use awareness and knowledge to implement a concrete intervention so that therapy is meaningful for the client. Developing this skill will ensure that the client receives responsive treatment that considers the indi- vidual as holding and residing within a cultural context. Before this paradigm can be of use in the multicultural counselling context research needs to be per- formed. The next section will outline future directions for research in this area.
D I R E C T I O N S F O R R E S E A R C H
The importance of mechanisms of change has received increased attention during the past decade (Grencavage & Norcross, 1990; Orlinsky, Graive, & Parks, 1994). Most of the work that has been done in this area has focused on identifying which mechanisms of change are consistent across Western schools of psychotherapy and using the findings to develop models of psychotherapy based on the common principles of change (Prochaska & DiClemente, 1992). Though the principles of change have begun to be tested for their presence across differ-
Principles of Change (^59)
ent theories, they have not been tested for their presence in therapy with clients from different cultural backgrounds. In this context it may be most helpful to employ a narrow definition of culture. Thus, research could begin with analyzing therapy sessions with clients of various ethnic groups to determine whether or not the principles of change that have been articulated in the literature also effect change with diverse clients. If so, the next step would be to create interventions that would employ the principles of change in a way that is most appropriate to the cultural context of specific diverse clients. It is also important that researchers and practitioners move beyond Western paradigms to determine the universality of change processes that are found in Eastern systems. A principles of change paradigm promises to be a respectful way of bringing Eastern and Western ideas of growth and health into the therapeutic context. For example, assume that the first step of the proposed research finds that the process of ventilation of feelings is a universal change mechanism. The next step of research would be to determine how to best implement ventilation of feelings in the therapeutic context with clients from various cultural backgrounds. When therapy is approached in this manner, responding to the needs and unique char- acteristics of each client is emphasized as opposed to implementing a prescribed treatment plan. This is truly client responsive professional practice with culture being seen as an integral part of the client. The proposed research builds upon research in the common factors area and in the psychotherapy process area. In order for multicultural counselling to move ahead and attain increased presence in the field of psychotherapy it is important to build upon relevant and ongoing research in the field. This will help the field move further, faster and with more credibility. The aim of the proposed research would be to find a way for all people to benefit from something that may be common to human functioning.
C O N C L U S I O N The ability to provide competent services to the diverse client is a reality for practicing professionals in Canada. The field of multicultural counselling has been instrumental in bringing issues of diversity to the attention of the counsel- ling profession. Unfortunately, debates about the definition of culture, and cul- ture-specific versus universal approaches have prevented proponents from moving forward in a unified manner. Agreement on a focal point is crucial so that multicultural counselling can become a powerful paradigm within the field of psychotherapy. The principles of change approach holds that promise as it builds upon change processes that may be universal to humans, while respecting the unique cultural manifestations of those change processes. The time is ripe for empirical investigation of the universality of change processes as well as ways to employ them in the therapeutic context with the diverse client. Research in this area could do more than unify multicultural counselling — it could bring the importance of responsive therapy to the attention of the whole profession.
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About the Author Roshni Daya is a Ph.D. Candidate at the University of Calgary. Her dissertation research is in the area of multicultural counselling. Specifically she is bridging Eastern psychology (Buddhist psy- chology) with Western psychotherapy through uncovering universal change mechanisms.
Address correspondence to Roshni Daya, University of Calgary, Department of Educational Psy- chology, 2500 University Drive, Calgary, Alberta T 2 N 1N4. e-mail: rdaya@ucalgary.ca
