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Introduction to Clinical Psychology: Professional Issues


Michael's birth name is Miguel. Michael's parents are Nicaraguan immigrants ... Michael's older brother 'caught' him and another boy holding hands in his room ... – PowerPoint PPT presentation

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Title: Introduction to Clinical Psychology: Professional Issues

Introduction to Clinical Psychology
Professional Issues EthicsDiversity
Multicultural Competencies
  • Tamara D. Warner, Ph.D.
  • Research Assistant Professor
  • University of Florida, Department of Pediatrics
  • November 16, 2007

  • "There is very little difference between one
    person and another, but what little there is, is
    very important.
  • William James
  •  Don't judge any man until you have walked two
    moons in his moccasins.
  • Roman/Indian proverb
  • Dedicated to the memory of Jenny Sivinski

Learning Objectives
  • Provide overview of basic assumptions behind the
    movement towards multicultural competencies in
    clinical psychology
  • Provide some definitions and a conceptual
    framework to think about cultural issues as they
    relate to clinical psychology
  • Have lecturer and students draw upon their own
    personal experiences to increase self-knowledge
    as related to the development of multicultural

Clinical Vignette
  • Michael, a bright 13-year-old, was referred to an
    outpatient clinic due to symptoms of anxiety and
    acting-out behavior in school. He had been
    cutting classes, talking back to his teachers,
    displaying an attitude problem, experiencing
    difficulties with his peers and appearing overly
    worried and anxious at home. Michael made good
    eye contact during his first evaluative session.

Does it matter if ?
  • Michaels birth name is Miguel.
  • Michaels parents are Nicaraguan immigrants and
    migrant farm workers.
  • This is Michaels 3rd school in 2 years.

Does it matter if .?
  • Michael is African-American.
  • Michaels mother died of cancer 6 months ago.
  • Michael was placed in a foster home with
    European-American parents.
  • Michaels foster parents are Catholic, but
    Michael was raised in a traditional Black Baptist

Does it matter if .?
  • Michael is wearing a Christian cross around his
    neck. A star of David is attached to the back of
    his jacket.
  • Michaels parents recently went through a bitter
    divorce including a protracted custody battle.
  • Michael mother is Christian and of Irish-American
  • Michaels father is Jewish American.

Does it matter if .?
  • Michael recently discovered that he is attracted
    to other boys.
  • Michaels older brother caught him and another
    boy holding hands in his room and has threatened
    to tell their father.

  • Basic
  • Assumptions

Basic Assumptions
  • U.S. population is become increasingly diverse.
  • Globalization (economic, cultural) will continue
    to increase cross-cultural exchanges.
  • The field of psychology does not (and will not in
    the foreseeable future) reflect the diversity of
    those we serve.
  • Developing competencies regarding assessment,
    treatment and research with diverse populations
    is not just important, but essential.

Browning of America
  • Increasing ethnic diversity in the United States
  • By 2050, if not sooner, no group will constitute
    more than 50 percent of the population.
  • Ethnic minorities constitute a growing share of
    the population heterogeneity within all ethnic
    groups is growing.
  • Changes in the U.S. population stem largely from
  • 38 of Hispanics and 61 of Asians in the U.S.
    are immigrants.
  • Explosive growth of Hispanics in U.S. increased
    by more than 28 million during past 30 years,
    expected to grow by 55 million in next 20 years

Rand Corp Population Matters Policy Brief RB-5050
(2001) http//
Psychologists are not diverse
  • Minorities are under-represented at all levels of
    the psychology pipeline with under-representation
    increasing as you move up the pipeline.
  • At the rate the profession is currently going, we
    will never have enough ethnic minority
    psychologists to meet the need of all of
    Americas children.
  • ALL psychologists (and other mental health
    professionals) must be trained to work with
    multicultural populations.
  • Maton, K.I., Kohout, J. L., Wicherski, M., Leary,
    G. E., Vinokurov, A. (2006). Minority students
    of color and the psychology graduate pipeline
    Disquieting and encouraging trends, 1989-2003.
    American Psychologist, 61(2), 117-131.

Why important?
  • Failing to address issues related to diversity
  • Impedes the effectiveness of psychologists as
    health service providers
  • We cannot assume that the phenomenology of
    different disorders is the same in all groups.
  • Hinders the progress of psychological science
  • 90 of psychological science is based on samples
    that reflect 5 of the worlds diversity (Sue,
  • Huge generalizability problem!

Its Who We Are
  • Ethical Principles
  • (A) Beneficence and Nonmaleficence
  • Psychologists strive to benefit those with whom
    they work and take care to do no harm.
  • (C) Integrity
  • Psychologists seek to promote accuracy, honesty,
    and truthfulness in the science, teaching and
    practice of psychology.

Its Who We Are
  • Ethical Principles
  • (D) Justice
  • Psychologists recognize that fairness and
    justice entitle all persons to access to and
    benefit from the contributions of psychology and
    to equal quality in the processes, procedures,
    and services being conducted by psychologists.

Its Who We Are
  • (E) Respect for People's Rights and Dignity
  • Psychologists respect the dignity and worth of
    all people Psychologists are aware of and
    respect cultural, individual, and role
    differences, including those based on age,
    gender, gender identity, race, ethnicity,
    culture, national origin, religion, sexual
    orientation, disability, language, and
    socioeconomic status and consider these factors
    when working with members of such groups.
    Psychologists try to eliminate the effect on
    their work of biases based on those factors, and
    they do not knowingly participate in or condone
    activities of others based upon such prejudices.

Basic Assumptions Summary
  • It is important.
  • All psychologists need to learn multicultural
  • It affects our effectiveness as health service
  • Its a matter of scientific integrity.
  • Its part of our core ethical values as

  • Some
  • Definitions

(No Transcript)
Some definitions
  • Culture - system of shared beliefs, values,
    customs, behaviors, and artifacts that the
    members of society use to cope with their world
    and with one another, and that are transmitted
    from generation to generation through learning
    (anthropologist Franz Boaz)
  • Race - physical characteristics, such as skin
    color, facial features, and hair type, common to
    a population. Social construction not a
    biological/genetic reality.
  • Ethnicity - characterization of a group by its
    common nationality, culture, or language.
  • Multiculturalism broad term encompassing race,
    ethnicity, language, sexual orientation, gender,
    age disability, class status, education,
    religious/spiritual orientation and other
    cultural dimensions

Culture ? ethnicity
  • An identifiable integrated pattern of human
    behavior that includes
  • customs, beliefs, values, behaviors,
  • Observed in ethnic, religious social groups
  • Affected by age (generation), gender, education
    and socioeconomic status other factors
  • Reflects ones level of acculturation

Within group heterogeneity
  • Who are Hispanics in the U.S.?
  • Mexico, Puerto Rica, Cuba, El Salvador, Colombia,
    Guatemala, Nicaragua, Ecuador, Peru, Honduras and
    other Central and South American countries
  • Who are Asians in the U.S.?
  • China, the Philippines, Japan, India, Korea,
    Vietnam, Laos, Cambodia, Thailand, (Hmong)

Culture is multi-faceted
Religion birth death rituals afterlife?
marriage gender roles holidays
Ethnicity name language/dialect
birthplace/migratory status food
preferences traditions art, literature, music age
gender roles
Socialization name language generation gender educ
ation socioeconomic status geographic region
Culture is Invisible
  • Individuals are generally blind to their own
    culture. Culture is like skin. You are not aware
    of it until certain experiences (texture,
    temperature) bring it into your conscious
  • What seems normative or obvious to you is
    probably part of your culture. It may not be
    obvious to individuals who do not share your
  • Traveling outside the United States
  • Privacy and personal distance

Names as a Cultural Phenomenon
  • Names
  • Tyler, Connor, Jackson, Mason, Logan, Christian,
    Jordan, Madison

Whats in a Name?
  • Black or African-American names
  • Invented or creatively-spelled variants of more
    traditional names.
  • Created using fashionable syllables
  • prefixes La- or De-
  • suffixes -ique or isha
  • Also, punctuation marks like apostrophes and
  • DeAndre, DeJuan, DeShawn, Keyshawn, Latonya,
    LaShonda, Lashawn, TKevah, YaSheema
  • Ebony, Precious, Unique are examples of
    vocabulary names commonly used by black
  • Imani and Malik are examples of African/Muslim
    names used by black Americans.
  • Andre, Darius, Darryl, Maurice and Tyrone are
    more commonly used by black Americans.
  • http//

Multicultural Misunderstanding?
  • A white and a black co-worker decide to get their
    toddlers together for a playgroup. Afterwards .

Poor Sarah. Why were her Mama give her such a
common name? There are 4 Sarahs in our preschool
class alone!
Taquarious? Why would she give her child such
an usual name? Its going to make life harder
for him.
The extent to which an individual has adopted the
values, beliefs and behaviors of the dominant
culture Considered on a continuum
Bicultural blended code-switchers
Acculturated Assimilated
Where are you on this continuum? Where is the
person you are communicating with?
Culture is difficult to pin down
  • It will not always be easy to evaluate the role
    that cultural variables play in assessment
    because members of culturally and linguistically
    diverse groups differ in how firmly their adhere
    to their groups cultural traditions and
    practices. Greater diversity exists within any
    group, especially between recent immigrants and
    those who have had more opportunity to become
    acculturated into their new society. Even among
    those who are acculturated, differences exist in
    patterns of acculturation. (Sattler, p. 636)

Minority Status
  • Specific stressors associated with being a
    minority (ethnic, sexual orientation, disability)
  • Double consciousness W.E.B. duBois The Souls
    of Black Folk (1903)
  • Born with a veil, and gifted with second-sight
    in this American world
  • A sense of always looking at ones self through
    the eyes of others, of measuring ones soul by
    the tape of a world that looks on in amused
    contempt and pity. One ever feels his
    two-ness,an American, a Negro two souls, two
    thoughts, two unreconciled strivings two warring
    ideals in one dark body
  • Often, it has to do with the fact that your
    experiences contradict the fundamental
    assumptions of the larger culture
  • Ethnicity It doesnt matter where you come
  • Sexual orientation When you get married one
  • Disability Everyone has equal opportunity.

Identity Development
  • All people go through a process of developing a
    sense of racial or ethnic identity (also true for
    gender, GLBT and other aspects)
  • At different stages in the developmental process,
    we assign different degrees of important to the
    concept or race/ethnicity
  • Different models for minority/ethnic identity
    than majority/White identity

Ethnic (Minority) Identity Development
  • Sue and Sue (1990)
  • Stage 1 Conformity - preference for dominant
    cultural values, self-deprecating of own
  • Stage 2 Dissonance questioning and challenging
    beliefs of the conformity stage
  • Stage 3 Resistance and Immersion rejection of
    dominant society and endorsement of minority
  • Stage 4 Introspection less rigid resistance of
    dominant society view
  • Stage 5 Integrative Awareness appreciation of
    unique aspects of both the minority and dominant

White (Majority) Racial Identity Development
  • Helms (1984)
  • Stage 1 Contact oblivious to racism, minimal
    experiences with minorities, color-blind
  • Stage 2 Disintegration become conflicted over
    unresolved racial more dilemmas, increasingly
    conscious of own Whiteness
  • Stage 3 Reintegration regression to a tendency
    to idealize own group and dominant ideology, more
    conscious belief in White racial superiority,
    blame minorities for their own problems

White (Majority) Racial Identity Development
  • Helms (1984)
  • Stage 4 Pseudo-Independence attempt to
    understand differences and reach out to
    minorities who are similar to self, more
    intellectual than experiential or affective
    approach to race
  • Stage 5 Immersion/Emersion search for more
    personal understanding of racism White
    privilege, increased willingness to truly
    confront ones biases become more active in
    combating racism
  • Stage 6 Autonomy increasing awareness, less
    guilt, acceptance of ones own role in
    perpetuating racism, knowledgeable about cultural
    differences, no longer fearful, strive to develop
    nonracist white identity

Unearned Privileges
  • Peggy McIntosh (1988) White Privilege Unpacking
    the Invisible Knapsack
  • Shift from racism, sexism, heterosexism, able-ism
    to understanding of unearned privileges, which
    most of us are completely oblivious to
  • "I was taught to see racism only in individual
    acts of meanness, not in invisible systems
    conferring dominance on my group
  • White privilege -- an invisible package of
    unearned assets that I can count on cashing in
    each day, but about which I was "meant" to remain
    oblivious. White privilege is like an invisible
    weightless knapsack of special provisions, maps,
    passports, codebooks, visas, clothes, tools, and
    blank checks.

Examples of White Privilege
  • I can if I wish arrange to be in the company of
    people of my race most of the time.
  • I can avoid spending time with people whom I was
    trained to mistrust and who have learned to
    mistrust my kind or me.
  • If I should need to move, I can be pretty sure of
    renting or purchasing housing in an area which I
    can afford and in which I would want to live.
  • I can be pretty sure that my neighbors in such a
    location will be neutral or pleasant to me.
  • I can go shopping alone most of the time, pretty
    well assured that I will not be followed or
  • I can turn on the television or open to the front
    page of the paper and see people of my race
    widely represented not as criminals.
  • When I am told about our national heritage or
    about "civilization," I am shown that people of
    my color made it what it is.
  • I can be sure that my children will be given
    curricular materials that testify to the
    existence of their race.

More Examples
  • I can go into a supermarket and find the staple
    foods which fit with my cultural traditions, into
    a hairdresser's shop and find someone who can cut
    my hair.
  • Whether I use checks, credit cards or cash, I can
    count on my skin color not to work against the
    appearance of financial reliability.
  • I can be pretty sure that my children's teachers
    and employers will tolerate them if they fit
    school and workplace norms my chief worries
    about them do not concern others' attitudes
    toward their race.
  • I can talk with my mouth full and not have people
    put this down to my color.
  • I can swear, or dress in second hand clothes, or
    not answer letters, without having people
    attribute these choices to the bad morals, the
    poverty or the illiteracy of my race.
  • I can speak in public to a powerful male group
    without putting my race on trial.

More Examples
  • I can do well in a challenging situation without
    being called a credit to my race.
  • I am never asked to speak for all the people of
    my racial group.
  • I can remain oblivious of the language and
    customs of persons of color who constitute the
    world's majority without feeling in my culture
    any penalty for such oblivion.
  • I can be pretty sure that if I ask to talk to the
    "person in charge," I will be facing a person of
    my race.
  • If a traffic cop pulls me over or if the IRS
    audits my tax return, I can be sure I haven't
    been singled out because of my race.
  • I can easily buy posters, post-cards, picture
    books, greeting cards, dolls, toys and children's
    magazines featuring people of my race.
  • If my day, week or year is going badly, I need
    not ask of each negative episode or situation
    whether it had racial overtones.
  • I can be sure that if I need legal or medical
    help, my race will not work against me.
  • I can expect figurative language and imagery in
    all of the arts to testify to experiences of my

Definitions Summary
  • Diversity has many dimensions
  • Culture (vs. race/ethnicity)
  • Acculturation
  • Minority status
  • Identity development


Commitment to Cultural Awareness
  • All people are multicultural beings all
    interactions are cross-cultural. (APA
    Guidelines, p. 382)
  • Guideline 1 Psychologists are encouraged to
    recognize that, as cultural beings, they may hold
    attitudes and beliefs that can detrimentally
    influence their perceptions of and interactions
    with individuals who are ethnically and racially
    different from themselves.
  • First multicultural competence

My Personal Experiences
  • B.A., Harvard University, 1992
  • M.A., University of Michigan, 1996
  • M.S., University of Florida, 1999
  • Ph.D., University of Florida, 2003
  • African American
  • Christian woman and mother originally from rural
    Appalachia, working class background, mostly
    heterosexual, first generation college, divorced
    remarried (first husband was Jewish)

Growing Up
  • Charleston, WV (4 minority in the entire state)
  • Both of my parents attended segregated schools
  • Blacks on TV
  • I was the only African American child in my class
    (with the exception of 1st 3rd grades)
  • Grew up in mixed race neighborhood
  • One Asian (mixed race) and one Latino family in
    my neighborhood
  • No religious diversity to speak of

The Story of Billy Boy
Racial/Ethnic Socialization
  • I am no Nigger-o.
  • Traveling cross-country
  • Light skin and good hair (yellow towels)
  • Piano lessons and Presbyterian Church
  • Barbie Dolls and Baby Christie
  • Toni Morrisons The Bluest Eye, A Girl Like Me
  • Junior High wake-up call
  • By graduation proud to be Black?
  • You want to major in what?
  • Multicultural wedding celebration
  • Womens studies and homophobia
  • Traveling to Black countries

Majority At Last
Self Awareness Exercise
  • Take out a sheet of paper and with your
    non-dominant hand, write out answers to the
    following 3 questions
  • What is your racial/ethnic background?
  • What is a strength that you have drawn upon
    coming from your racial/ethnic background?
  • What has been a challenge or weakness coming from
    your racial/ethnic background?
  • Think of a specific incident that helped to
    socialize you into your racial/ethnic background.

Self Awareness Exercise 2
  • Think of a time when you were the only one or
    when you were singled out or excluded from an
    event. You may be the only one in your family to
    have done something, or the only American
    traveling abroad, the only one not invited to a
    party, or the only representative of your
    religious tradition.

Self-Awareness Exercise 3
  • List 3 different privileges that you enjoy as a
    result of your racial/ethnic background, gender,
    education, socioeconomic status, appearance and
    able-body status. How can these privileges
    help/harm you ability to function effectively as
    a psychologist (assessment, treatment, research)?

Self-Awareness Challenge(s)
  • Disability status
  • As psychologists in health care settings, we must
    increase our empathetic understanding of living
    with a disability
  • Mobility-impaired, hemiplegia, blind, deaf,
  • Some random ideas
  • Spend one full weekday day in a wheelchair
  • Bathing, toileting
  • Travel, mobility
  • Communicating with other 3 feel lower to the
  • Spend one full weekday not using your
    non-dominant arm
  • Go to University Avenue Gale Lemerand Drive and
    get directions to the Reitz Union without using
  • Paint a prominent port-wine stain on the side of
    face neck

Self-Awareness Challenges
  • Attend any ethnic group gathering of group that
    is NOT designed to be a cultural presentation
  • For one month, learn about the news affecting a
    specific ethnic group -- read print publications,
    TV/radio news programs or email
  • Attend a religious service of a different ethnic
    group in a language other than your own
  • Gainesville Chinese Christian Church
  • Korean Baptist Church of Gainesville
  • Iglesia Evangelica Bautista
  • Jehovahs Witness (Spanish) Archer Road

Developing Multicultural Competencies
  • Self-awareness is the first step towards
    development multicultural competencies
  • Individuals and groups are often blind to their
    own culture and how it affects behavior and
    interactions with others
  • You need to be aware of how your own cultural and
    religious background (beliefs, values, and
    biases) differ from others and how it may affect
    your functioning as a psychologist
  • The next step is learning about other groups
    (both information and experience)
  • You need to be aware of how the beliefs and
    behaviors of others differ from your own
  • Find willing partners and allies to assist with
    your education.
  • The third step is practice with consultation,
    as needed.

Developing Multicultural Competencies
  • Dont make too many assumptions.
  • Use the suggestions re psychotherapy in Cardemil
    Battle, 2003
  • Dont be afraid to ask.
  • Dont be afraid to make mistakes. Its the only
    way we really learn.

  • "There is very little difference between one
    person and another, but what little there is, is
    very important.
  • William James
  • Don't judge any man until you have walked two
    moons in his moccasins.
  • Roman/Indian proverb

Discussion Fundamental Tension
  • Some authors have argued that, philosophically,
    multiculturalism is fundamentally untenable.
    Multiculturalism holds that all aspects of human
    diversity should be (at least) tolerated and/or
    accepted. This involves a kind of moral
    relativism, which is at odds with the core belief
    systems of some religious traditions.
  • For example, some fundamentalist Christians
    believe that, according to the Bible,
    homosexuality is a sin. Psychologists who are
    fundamentalist Christians would argue that they
    cannot and should not accept homosexuality or
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